	Addendum A.- OPPS APCs for CY 2018																																																																																																																																																																																																										
  APC 	Group Title	SI	Relative Weight	Payment Rate 	National Unadjusted Copayment 	Minimum Unadjusted Copayment 																																																																																																																																																																																																					
0701	Sr89 strontium	K		"$1,408.057"	.	$281.62																																																																																																																																																																																																					
0726	Dexrazoxane HCl injection	K		$185.892	.	$37.18																																																																																																																																																																																																					
0731	Sargramostim injection	K		$37.702	.	$7.55																																																																																																																																																																																																					
0736	Amphotericin b liposome inj	K		$21.515	.	$4.31																																																																																																																																																																																																					
0738	Rasburicase	K		$263.063	.	$52.62																																																																																																																																																																																																					
0751	Mechlorethamine hcl inj	K		$292.478	.	$58.50																																																																																																																																																																																																					
0752	Dactinomycin injection	K		"$1,404.012"	.	$280.81																																																																																																																																																																																																					
0759	"Naltrexone, depot form"	K		$3.262	.	$0.66																																																																																																																																																																																																					
0800	Leuprolide acetate	K		"$1,087.909"	.	$217.59																																																																																																																																																																																																					
0802	Etoposide oral	K		$74.182	.	$14.84																																																																																																																																																																																																					
0807	Aldesleukin injection	K		"$3,598.382"	.	$719.68																																																																																																																																																																																																					
0809	Bcg live intravesical vac	K		$131.252	.	$26.26																																																																																																																																																																																																					
0810	Goserelin acetate implant	K		$351.525	.	$70.31																																																																																																																																																																																																					
0812	Carmustine injection	K		"$3,863.469"	.	$772.70																																																																																																																																																																																																					
0820	Daunorubicin injection	K		$37.860	.	$7.58																																																																																																																																																																																																					
0823	Docetaxel injection	K		$1.891	.	$0.38																																																																																																																																																																																																					
0825	Nelarabine injection	K		$151.658	.	$30.34																																																																																																																																																																																																					
0832	Idarubicin hcl injection	K		$39.474	.	$7.90																																																																																																																																																																																																					
0836	Interferon alfa-2b inj	K		$31.706	.	$6.35																																																																																																																																																																																																					
0838	Interferon gamma 1-b inj	K		"$6,308.134"	.	"$1,261.63"																																																																																																																																																																																																					
0840	Inj melphalan hydrochl	K		"$1,369.461"	.	$273.90																																																																																																																																																																																																					
0843	Pegaspargase injection	K		"$13,907.578"	.	"$2,781.52"																																																																																																																																																																																																					
0844	Pentostatin injection	K		"$2,001.257"	.	$400.26																																																																																																																																																																																																					
0849	Rituximab injection	K		$848.408	.	$169.69																																																																																																																																																																																																					
0850	Streptozocin injection	K		$322.729	.	$64.55																																																																																																																																																																																																					
0851	Thiotepa injection	K		$828.897	.	$165.78																																																																																																																																																																																																					
0856	Porfimer sodium injection	K		"$21,219.568"	.	"$4,243.92"																																																																																																																																																																																																					
0858	Inj cladribine	K		$20.662	.	$4.14																																																																																																																																																																																																					
0864	Mitoxantrone hydrochl	K		$38.980	.	$7.80																																																																																																																																																																																																					
0868	Oral aprepitant	K		$7.661	.	$1.54																																																																																																																																																																																																					
0873	Hyalgan supartz visco-3 dose	K		$87.643	.	$17.53																																																																																																																																																																																																					
0874	Synvisc or synvisc-one	K		$12.272	.	$2.46																																																																																																																																																																																																					
0875	Euflexxa inj per dose	K		$155.230	.	$31.05																																																																																																																																																																																																					
0877	Orthovisc inj per dose	K		$149.482	.	$29.90																																																																																																																																																																																																					
0887	Azathioprine parenteral	K		$238.081	.	$47.62																																																																																																																																																																																																					
0890	Lymphocyte immune globulin	K		"$1,817.043"	.	$363.41																																																																																																																																																																																																					
0901	Alpha 1 proteinase inhibitor	K		$4.937	.	$0.99																																																																																																																																																																																																					
0902	"Injection,onabotulinumtoxinA"	K		$6.031	.	$1.21																																																																																																																																																																																																					
0903	Cytomegalovirus imm IV /vial	K		"$1,128.705"	.	$225.75																																																																																																																																																																																																					
0910	Interferon beta-1b / .25 MG	K		$380.395	.	$76.08																																																																																																																																																																																																					
0925	Factor viii	K		$1.018	.	$0.21																																																																																																																																																																																																					
0927	Factor viii recombinant	K		$1.244	.	$0.25																																																																																																																																																																																																					
0928	Factor ix complex	K		$1.386	.	$0.28																																																																																																																																																																																																					
0929	Anti-inhibitor	K		$1.937	.	$0.39																																																																																																																																																																																																					
0931	Factor IX non-recombinant	K		$1.142	.	$0.23																																																																																																																																																																																																					
0932	Factor ix recombinant nos	K		$1.503	.	$0.31																																																																																																																																																																																																					
0943	Octagam injection	K		$36.618	.	$7.33																																																																																																																																																																																																					
0944	Gammagard liquid injection	K		$39.783	.	$7.96																																																																																																																																																																																																					
0946	Hepagam b im injection	K		$61.120	.	$12.23																																																																																																																																																																																																					
0947	Flebogamma injection	K		$29.836	.	$5.97																																																																																																																																																																																																					
0948	Gamunex-C/Gammaked	K		$38.944	.	$7.79																																																																																																																																																																																																					
0961	"Albumin (human),5%, 50ml"	K		$11.799	.	$2.36																																																																																																																																																																																																					
0963	"Albumin (human), 5%, 250 ml"	K		$54.720	.	$10.95																																																																																																																																																																																																					
0964	"Albumin (human), 25%, 20 ml"	K		$22.488	.	$4.50																																																																																																																																																																																																					
0965	"Albumin (human), 25%, 50ml"	K		$53.438	.	$10.69																																																																																																																																																																																																					
1015	Injection glatiramer acetate	K		$214.441	.	$42.89																																																																																																																																																																																																					
1052	"Injection, voriconazole"	K		$2.697	.	$0.54																																																																																																																																																																																																					
1064	"I131 iodide cap, rx"	K		$40.698	.	$8.14																																																																																																																																																																																																					
1083	Adalimumab injection	K		"$1,176.929"	.	$235.39																																																																																																																																																																																																					
1138	"Hepagam b intravenous, inj"	K		$61.120	.	$12.23																																																																																																																																																																																																					
1139	Protein c concentrate	K		$15.129	.	$3.03																																																																																																																																																																																																					
1142	Supprelin LA implant	K		"$29,003.674"	.	"$5,800.74"																																																																																																																																																																																																					
1150	"I131 iodide sol, rx"	K		$12.560	.	$2.52																																																																																																																																																																																																					
1166	Cytarabine liposome inj	K		$641.670	.	$128.34																																																																																																																																																																																																					
1168	"Inj, temsirolimus"	K		$70.508	.	$14.11																																																																																																																																																																																																					
1178	Busulfan injection	K		$34.725	.	$6.95																																																																																																																																																																																																					
1203	Verteporfin injection	K		$10.761	.	$2.16																																																																																																																																																																																																					
1207	"Octreotide injection, depot"	K		$183.640	.	$36.73																																																																																																																																																																																																					
1213	Antihemophilic viii/vwf comp	K		$0.981	.	$0.20																																																																																																																																																																																																					
1214	Inj IVIG privigen 500 mg	K		$38.506	.	$7.71																																																																																																																																																																																																					
1232	Mitomycin injection	K		$133.654	.	$26.74																																																																																																																																																																																																					
1235	Valrubicin injection	K		"$1,198.557"	.	$239.72																																																																																																																																																																																																					
1236	Levoleucovorin injection	K		$0.532	.	$0.11																																																																																																																																																																																																					
1237	Inj iron dextran	K		$13.043	.	$2.61																																																																																																																																																																																																					
1238	Topotecan oral	K		$103.628	.	$20.73																																																																																																																																																																																																					
1253	Triamcinolone A inj PRS-free	K		$3.884	.	$0.78																																																																																																																																																																																																					
1263	Antithrombin iii injection	K		$3.745	.	$0.75																																																																																																																																																																																																					
1268	Xyntha inj	K		$1.251	.	$0.26																																																																																																																																																																																																					
1274	Edetate calcium disodium inj	K 		"$5,594.422"	.	"$1,118.89"																																																																																																																																																																																																					
1280	Corticotropin injection	K		"$3,771.358"	.	$754.28																																																																																																																																																																																																					
1281	Bevacizumab injection	K		$1.879	.	$0.38																																																																																																																																																																																																					
1289	AbobotulinumtoxinA	K		$8.261	.	$1.66																																																																																																																																																																																																					
1291	Rilonacept injection	K		$24.091	.	$4.82																																																																																																																																																																																																					
1295	Sm 153 lexidronam	K		"$13,307.035"	.	"$2,661.41"																																																																																																																																																																																																					
1296	Degarelix injection	K		$3.635	.	$0.73																																																																																																																																																																																																					
1297	"Ferumoxytol, non-esrd"	K		$0.908	.	$0.19																																																																																																																																																																																																					
1311	Canakinumab injection	K		$106.118	.	$21.23																																																																																																																																																																																																					
1312	Hizentra injection	K		$9.813	.	$1.97																																																																																																																																																																																																					
1327	Imiglucerase injection	K		$41.689	.	$8.34																																																																																																																																																																																																					
1340	"Collagenase, clost hist inj"	K		$41.833	.	$8.37																																																																																																																																																																																																					
1341	Amobarbital 125 MG inj	K		$194.258	.	$38.86																																																																																																																																																																																																					
1352	Wilate injection	K		$1.035	.	$0.21																																																																																																																																																																																																					
1353	Belimumab injection	K		$42.808	.	$8.57																																																																																																																																																																																																					
1408	Cyclophosphamide 100 MG inj	K		$42.059	.	$8.42																																																																																																																																																																																																					
1413	Lumizyme injection	K		$159.734	.	$31.95																																																																																																																																																																																																					
1415	Glassia injection	K		$4.569	.	$0.92																																																																																																																																																																																																					
1416	Factor xiii anti-hem factor	K		$8.211	.	$1.65																																																																																																																																																																																																					
1417	Gel-one	K		$510.570	.	$102.12																																																																																																																																																																																																					
1420	Aflibercept injection	K		$974.587	.	$194.92																																																																																																																																																																																																					
1421	Imported lipodox inj	K		$508.429	.	$101.69																																																																																																																																																																																																					
1426	Eribulin mesylate injection	K		$109.163	.	$21.84																																																																																																																																																																																																					
1431	Centruroides immune f(ab)	K		"$4,459.017"	.	$891.81																																																																																																																																																																																																					
1433	Calcitonin salmon injection	K		"$2,287.942"	.	$457.59																																																																																																																																																																																																					
1440	Inj desmopressin acetate	K		$12.752	.	$2.56																																																																																																																																																																																																					
1442	Non-HEU TC-99M add-on/dose	K		$10.000	.	$2.00																																																																																																																																																																																																					
1443	Icatibant injection	K		$335.339	.	$67.07																																																																																																																																																																																																					
1446	Visualization adjunct	K		$4.040	.	$0.81																																																																																																																																																																																																					
1458	Phentolaine mesylate inj	K		$358.276	.	$71.66																																																																																																																																																																																																					
1466	"Inj, vincristine sul lip 1mg"	K		"$2,701.777"	.	$540.36																																																																																																																																																																																																					
1467	Factor ix recombinan rixubis	K		$1.271	.	$0.26																																																																																																																																																																																																					
1468	Inj Aripiprazole Ext Rel 1mg	K		$4.886	.	$0.98																																																																																																																																																																																																					
1469	Inj filgrastim excl biosimil	K		$1.007	.	$0.21																																																																																																																																																																																																					
1471	"Injection, Pertuzumab, 1 mg"	K		$11.156	.	$2.24																																																																																																																																																																																																					
1472	Inj beta interferon im 1 mcg	K		$50.112	.	$10.03																																																																																																																																																																																																					
1474	Certolizumab pegol inj 1mg	K		$7.467	.	$1.50																																																																																																																																																																																																					
1475	Golimumab for iv use 1mg	K		$24.736	.	$4.95																																																																																																																																																																																																					
1476	Obinutuzumab inj	K		$58.944	.	$11.79																																																																																																																																																																																																					
1478	"	Human fibrinogen conc inj"	K		$1.159	.	$0.24																																																																																																																																																																																																					
1480	"Elosulfase alfa, injection"	K		$230.957	.	$46.20																																																																																																																																																																																																					
1482	"	Darbepoetin alfa, esrd use"	K		$3.954	.	$0.80																																																																																																																																																																																																					
1484	"	Pentazocine injection"	K		$71.465	.	$14.30																																																																																																																																																																																																					
1485	"	Ferumoxytol, esrd use"	K		$0.908	.	$0.19																																																																																																																																																																																																					
1486	Factor ix fc fusion recomb	K		$2.987	.	$0.60																																																																																																																																																																																																					
1488	"Injection, ramucirumab"	K		$56.534	.	$11.31																																																																																																																																																																																																					
1489	"Injection, vedolizumab"	K		$18.590	.	$3.72																																																																																																																																																																																																					
1490	Inj pembrolizumab	K		$47.965	.	$9.60																																																																																																																																																																																																					
1491	New Technology  - Level 1A ($0-$10)	S		$5.00	.	$1.00																																																																																																																																																																																																					
1492	New Technology  - Level 1B ($11-$20)	S		$15.50	.	$3.10																																																																																																																																																																																																					
1493	New Technology  - Level 1C ($21-$30)	S		$25.50	.	$5.10																																																																																																																																																																																																					
1494	New Technology  - Level 1D ($31-$40)	S		$35.50	.	$7.10																																																																																																																																																																																																					
1495	New Technology  - Level 1E ($41-$50)	S		$45.50	.	$9.10																																																																																																																																																																																																					
1496	New Technology  - Level 1A ($0-$10)	T		$5.00	.	$1.00																																																																																																																																																																																																					
1497	New Technology  - Level 1B ($11-$20)	T		$15.50	.	$3.10																																																																																																																																																																																																					
1498	New Technology  - Level 1C ($21-$30)	T		$25.50	.	$5.10																																																																																																																																																																																																					
1499	New Technology  - Level 1D ($31-$40)	T		$35.50	.	$7.10																																																																																																																																																																																																					
1500	New Technology  - Level 1E ($41-$50)	T		$45.50	.	$9.10																																																																																																																																																																																																					
1502	New Technology - Level 2 ($51 - $100)	S		$75.50	.	$15.10																																																																																																																																																																																																					
1503	New Technology - Level 3 ($101 - $200)	S		$150.50	.	$30.10																																																																																																																																																																																																					
1504	New Technology - Level 4 ($201 - $300)	S		$250.50	.	$50.10																																																																																																																																																																																																					
1505	New Technology - Level 5 ($301 - $400)	S		$350.50	.	$70.10																																																																																																																																																																																																					
1506	New Technology - Level 6 ($401 - $500)	S		$450.50	.	$90.10																																																																																																																																																																																																					
1507	New Technology - Level 7 ($501 - $600)	S		$550.50	.	$110.10																																																																																																																																																																																																					
1508	New Technology - Level 8 ($601 - $700)	S		$650.50	.	$130.10																																																																																																																																																																																																					
1509	New Technology - Level 9 ($701 - $800)	S		$750.50	.	$150.10																																																																																																																																																																																																					
1510	New Technology - Level 10 ($801 - $900)	S		$850.50	.	$170.10																																																																																																																																																																																																					
1511	New Technology - Level 11 ($901 - $1000)	S		$950.50	.	$190.10																																																																																																																																																																																																					
1512	New Technology - Level 12 ($1001 - $1100)	S		"$1,050.50"	.	$210.10																																																																																																																																																																																																					
1513	New Technology - Level 13 ($1101 - $1200)	S		"$1,150.50"	.	$230.10																																																																																																																																																																																																					
1514	New Technology - Level 14 ($1201- $1300)	S		"$1,250.50"	.	$250.10																																																																																																																																																																																																					
1515	New Technology - Level 15 ($1301 - $1400)	S		"$1,350.50"	.	$270.10																																																																																																																																																																																																					
1516	New Technology - Level 16  ($1401 - $1500)	S		"$1,450.50"	.	$290.10																																																																																																																																																																																																					
1517	New Technology - Level 17 ($1501-$1600)	S		"$1,550.50"	.	$310.10																																																																																																																																																																																																					
1518	New Technology - Level 18 ($1601-$1700)	S		"$1,650.50"	.	$330.10																																																																																																																																																																																																					
1519	New Technology - Level 19 ($1701-$1800)	S		"$1,750.50"	.	$350.10																																																																																																																																																																																																					
1520	New Technology - Level 20 ($1801-$1900)	S		"$1,850.50"	.	$370.10																																																																																																																																																																																																					
1521	New Technology - Level 21 ($1901-$2000)	S		"$1,950.50"	.	$390.10																																																																																																																																																																																																					
1522	New Technology - Level 22 ($2001-$2500)	S		"$2,250.50"	.	$450.10																																																																																																																																																																																																					
1523	New Technology - Level 23 ($2501-$3000)	S		"$2,750.50"	.	$550.10																																																																																																																																																																																																					
1524	New Technology - Level 24 ($3001-$3500)	S		"$3,250.50"	.	$650.10																																																																																																																																																																																																					
1525	New Technology - Level 25 ($3501-$4000)	S		"$3,750.50"	.	$750.10																																																																																																																																																																																																					
1526	New Technology - Level 26 ($4001-$4500)	S		"$4,250.50"	.	$850.10																																																																																																																																																																																																					
1527	New Technology - Level 27 ($4501-$5000)	S		"$4,750.50"	.	$950.10																																																																																																																																																																																																					
1528	New Technology - Level 28 ($5001-$5500)	S		"$5,250.50"	.	"$1,050.10"																																																																																																																																																																																																					
1529	New Technology - Level 29 ($5501-$6000)	S		"$5,750.50"	.	"$1,150.10"																																																																																																																																																																																																					
1530	New Technology - Level 30 ($6001-$6500)	S		"$6,250.50"	.	"$1,250.10"																																																																																																																																																																																																					
1531	New Technology - Level 31 ($6501-$7000)	S		"$6,750.50"	.	"$1,350.10"																																																																																																																																																																																																					
1532	New Technology - Level 32 ($7001-$7500)	S		"$7,250.50"	.	"$1,450.10"																																																																																																																																																																																																					
1533	New Technology - Level 33 ($7501-$8000)	S		"$7,750.50"	.	"$1,550.10"																																																																																																																																																																																																					
1534	New Technology - Level 34 ($8001-$8500)	S		"$8,250.50"	.	"$1,650.10"																																																																																																																																																																																																					
1535	New Technology - Level 35 ($8501-$9000)	S		"$8,750.50"	.	"$1,750.10"																																																																																																																																																																																																					
1536	New Technology - Level 36 ($9001-$9500)	S		"$9,250.50"	.	"$1,850.10"																																																																																																																																																																																																					
1537	New Technology - Level 37 ($9501-$10000)	S		"$9,750.50"	.	"$1,950.10"																																																																																																																																																																																																					
1539	New Technology - Level 2 ($51 - $100)	T		$75.50	.	$15.10																																																																																																																																																																																																					
1540	New Technology - Level 3 ($101 - $200)	T		$150.50	.	$30.10																																																																																																																																																																																																					
1541	New Technology - Level 4 ($201 - $300)	T		$250.50	.	$50.10																																																																																																																																																																																																					
1542	New Technology - Level 5 ($301 - $400)	T		$350.50	.	$70.10																																																																																																																																																																																																					
1543	New Technology - Level 6 ($401 - $500)	T		$450.50	.	$90.10																																																																																																																																																																																																					
1544	New Technology - Level 7 ($501 - $600)	T		$550.50	.	$110.10																																																																																																																																																																																																					
1545	New Technology - Level 8 ($601 - $700)	T		$650.50	.	$130.10																																																																																																																																																																																																					
1546	New Technology - Level 9 ($701 - $800)	T		$750.50	.	$150.10																																																																																																																																																																																																					
1547	New Technology - Level 10 ($801 - $900)	T		$850.50	.	$170.10																																																																																																																																																																																																					
1548	New Technology - Level 11 ($901 - $1000)	T		$950.50	.	$190.10																																																																																																																																																																																																					
1549	New Technology - Level 12 ($1001 - $1100)	T		"$1,050.50"	.	$210.10																																																																																																																																																																																																					
1550	New Technology - Level 13 ($1101 - $1200)	T		"$1,150.50"	.	$230.10																																																																																																																																																																																																					
1551	New Technology - Level 14 ($1201- $1300)	T		"$1,250.50"	.	$250.10																																																																																																																																																																																																					
1552	New Technology - Level 15 ($1301 - $1400)	T		"$1,350.50"	.	$270.10																																																																																																																																																																																																					
1553	New Technology - Level 16 ($1401 - $1500)	T		"$1,450.50"	.	$290.10																																																																																																																																																																																																					
1554	New Technology - Level 17 ($1501-$1600)	T		"$1,550.50"	.	$310.10																																																																																																																																																																																																					
1555	New Technology - Level 18 ($1601-$1700)	T		"$1,650.50"	.	$330.10																																																																																																																																																																																																					
1556	New Technology - Level 19 ($1701-$1800)	T		"$1,750.50"	.	$350.10																																																																																																																																																																																																					
1557	New Technology - Level 20 ($1801-$1900)	T		"$1,850.50"	.	$370.10																																																																																																																																																																																																					
1558	New Technology - Level 21 ($1901-$2000)	T		"$1,950.50"	.	$390.10																																																																																																																																																																																																					
1559	New Technology - Level 22 ($2001-$2500)	T		"$2,250.50"	.	$450.10																																																																																																																																																																																																					
1560	New Technology - Level 23 ($2501-$3000)	T		"$2,750.50"	.	$550.10																																																																																																																																																																																																					
1561	New Technology - Level 24 ($3001-$3500)	T		"$3,250.50"	.	$650.10																																																																																																																																																																																																					
1562	New Technology - Level 25 ($3501-$4000)	T		"$3,750.50"	.	$750.10																																																																																																																																																																																																					
1563	New Technology - Level 26 ($4001-$4500)	T		"$4,250.50"	.	$850.10																																																																																																																																																																																																					
1564	New Technology - Level 27 ($4501-$5000)	T		"$4,750.50"	.	$950.10																																																																																																																																																																																																					
1565	New Technology - Level 28 ($5001-$5500)	T		"$5,250.50"	.	"$1,050.10"																																																																																																																																																																																																					
1566	New Technology - Level 29 ($5501-$6000)	T		"$5,750.50"	.	"$1,150.10"																																																																																																																																																																																																					
1567	New Technology - Level 30 ($6001-$6500)	T		"$6,250.50"	.	"$1,250.10"																																																																																																																																																																																																					
1568	New Technology - Level 31 ($6501-$7000)	T		"$6,750.50"	.	"$1,350.10"																																																																																																																																																																																																					
1569	New Technology - Level 32 ($7001-$7500)	T		"$7,250.50"	.	"$1,450.10"																																																																																																																																																																																																					
1570	New Technology - Level 33 ($7501-$8000)	T		"$7,750.50"	.	"$1,550.10"																																																																																																																																																																																																					
1571	New Technology - Level 34 ($8001-$8500)	T		"$8,250.50"	.	"$1,650.10"																																																																																																																																																																																																					
1572	New Technology - Level 35 ($8501-$9000)	T		"$8,750.50"	.	"$1,750.10"																																																																																																																																																																																																					
1573	New Technology - Level 36 ($9001-$9500)	T		"$9,250.50"	.	"$1,850.10"																																																																																																																																																																																																					
1574	New Technology - Level 37 ($9501-$10000)	T		"$9,750.50"	.	"$1,950.10"																																																																																																																																																																																																					
1575	"New Technology - Level 38 ($10,001-$15,000)"	S		"$12,500.50"	.	"$2,500.10"																																																																																																																																																																																																					
1576	"New Technology - Level 39 ($15,001-$20,000)"	S		"$17,500.50"	.	"$3,500.10"																																																																																																																																																																																																					
1577	"New Technology - Level 40 ($20,001-$25,000)"	S		"$22,500.50"	.	"$4,500.10"																																																																																																																																																																																																					
1578	"New Technology - Level 41 ($25,001-$30,000)"	S		"$27,500.50"	.	"$5,500.10"																																																																																																																																																																																																					
1579	"New Technology - Level 42 ($30,001-$40,000)"	S		"$35,000.50"	.	"$7,000.10"																																																																																																																																																																																																					
1580	"New Technology - Level 43 ($40,001-$50,000)"	S		"$45,000.50"	.	"$9,000.10"																																																																																																																																																																																																					
1581	"New Technology - Level 44 ($50,001-$60,000)"	S		"$55,000.50"	.	"$11,000.10"																																																																																																																																																																																																					
1582	"New Technology - Level 45 ($60,001-$70,000)"	S		"$65,000.50"	.	"$13,000.10"																																																																																																																																																																																																					
1583	"New Technology - Level 46 ($70,001-$80,000)"	S		"$75,000.50"	.	"$15,000.10"																																																																																																																																																																																																					
1584	"New Technology - Level 47 ($80,001-$90,000)"	S		"$85,000.50"	.	"$17,000.10"																																																																																																																																																																																																					
1585	"New Technology - Level 48 ($90,001-$100,000)"	S		"$95,000.50"	.	"$19,000.10"																																																																																																																																																																																																					
1589	"New Technology - Level 38 ($10,001-$15,000)"	T		"$12,500.50"	.	"$2,500.10"																																																																																																																																																																																																					
1590	"New Technology - Level 39 ($15,001-$20,000)"	T		"$17,500.50"	.	"$3,500.10"																																																																																																																																																																																																					
1591	"New Technology - Level 40 ($20,001-$25,000)"	T		"$22,500.50"	.	"$4,500.10"																																																																																																																																																																																																					
1592	"New Technology - Level 41 ($25,001-$30,000)"	T		"$27,500.50"	.	"$5,500.10"																																																																																																																																																																																																					
1593	"New Technology - Level 42 ($30,001-$40,000)"	T		"$35,000.50"	.	"$7,000.10"																																																																																																																																																																																																					
1594	"New Technology - Level 43 ($40,001-$50,000)"	T		"$45,000.50"	.	"$9,000.10"																																																																																																																																																																																																					
1595	"New Technology - Level 44 ($50,001-$60,000)"	T		"$55,000.50"	.	"$11,000.10"																																																																																																																																																																																																					
1596	"New Technology - Level 45 ($60,001-$70,000)"	T		"$65,000.50"	.	"$13,000.10"																																																																																																																																																																																																					
1597	"New Technology - Level 46 ($70,001-$80,000)"	T		"$75,000.50"	.	"$15,000.10"																																																																																																																																																																																																					
1598	"New Technology - Level 47 ($80,001-$90,000)"	T		"$85,000.50"	.	"$17,000.10"																																																																																																																																																																																																					
1599	"New Technology - Level 48 ($90,001-$100,000)"	T		"$95,000.50"	.	"$19,000.10"																																																																																																																																																																																																					
1607	Eptifibatide injection	K		$21.736	.	$4.35																																																																																																																																																																																																					
1608	Etanercept injection	K		$588.565	.	$117.72																																																																																																																																																																																																					
1609	"Rho(D) immune globulin h, sd"	K		$23.796	.	$4.76																																																																																																																																																																																																					
1613	Trastuzumab injection	K		$97.803	.	$19.57																																																																																																																																																																																																					
1630	"Hep b ig, im"	K		$124.273	.	$24.86																																																																																																																																																																																																					
1631	Baclofen intrathecal trial	K		$70.337	.	$14.07																																																																																																																																																																																																					
1643	"Y90 ibritumomab, rx"	K		"$48,204.342"	.	"$9,640.87"																																																																																																																																																																																																					
1656	Factor viii fc fusion recomb	K		$2.023	.	$0.41																																																																																																																																																																																																					
1658	"Injection, belinostat, 10mg"	K		$35.206	.	$7.05																																																																																																																																																																																																					
1660	"Injection, oritavancin"	K		$23.364	.	$4.68																																																																																																																																																																																																					
1662	Inj tedizolid phosphate	K		$1.326	.	$0.27																																																																																																																																																																																																					
1669	Erythro lactobionate /500 mg	K		$64.899	.	$12.98																																																																																																																																																																																																					
1670	Tetanus immune globulin inj	K		$557.454	.	$111.50																																																																																																																																																																																																					
1675	P32 Na phosphate	K		$56.640	.	$11.33																																																																																																																																																																																																					
1683	Basiliximab	K		"$3,440.367"	.	$688.08																																																																																																																																																																																																					
1684	Corticorelin ovine triflutal	K		$8.614	.	$1.73																																																																																																																																																																																																					
1685	"Darbepoetin alfa, non-esrd"	K		$3.954	.	$0.80																																																																																																																																																																																																					
1686	"Epoetin alfa, non-esrd"	K		$12.942	.	$2.59																																																																																																																																																																																																					
1687	Digoxin immune fab (ovine)	K		"$3,267.026"	.	$653.41																																																																																																																																																																																																					
1688	Ethanolamine oleate	K		$443.682	.	$88.74																																																																																																																																																																																																					
1689	Fomepizole	K		$7.206	.	$1.45																																																																																																																																																																																																					
1690	Hemin	K		$24.000	.	$4.80																																																																																																																																																																																																					
1694	Ziconotide injection	K		$7.419	.	$1.49																																																																																																																																																																																																					
1695	Nesiritide injection	K		$73.299	.	$14.66																																																																																																																																																																																																					
1696	Palifermin injection	K		$19.204	.	$3.85																																																																																																																																																																																																					
1697	Pegaptanib sodium injection	K		$729.472	.	$145.90																																																																																																																																																																																																					
1700	Inj secretin synthetic human	K		$34.781	.	$6.96																																																																																																																																																																																																					
1701	Treprostinil injection	K		$61.237	.	$12.25																																																																																																																																																																																																					
1704	"Humate-P, inj"	K		$1.088	.	$0.22																																																																																																																																																																																																					
1705	Factor viia	K		$2.001	.	$0.41																																																																																																																																																																																																					
1709	Azacitidine injection	K		$1.657	.	$0.34																																																																																																																																																																																																					
1710	Clofarabine injection	K		$149.956	.	$30.00																																																																																																																																																																																																					
1711	Vantas implant	K		"$3,284.123"	.	$656.83																																																																																																																																																																																																					
1712	Paclitaxel protein bound	K		$10.777	.	$2.16																																																																																																																																																																																																					
1739	"Pegademase bovine, 25 iu"	K		$352.273	.	$70.46																																																																																																																																																																																																					
1743	Nandrolone decanoate 50 mg	K		$133.360	.	$26.68																																																																																																																																																																																																					
1745	Radium ra223 dichloride ther	K		$131.072	.	$26.22																																																																																																																																																																																																					
1746	Factor xiii recomb a-subunit	K		$15.133	.	$3.03																																																																																																																																																																																																					
1747	Monovisc inj per dose	K		$856.785	.	$171.36																																																																																																																																																																																																					
1748	Inj tbo filgrastim 1 microg	K		$0.627	.	$0.13																																																																																																																																																																																																					
1761	"Rolapitant, oral, 1mg"	K		$2.300	.	$0.46																																																																																																																																																																																																					
1809	"Injection, alemtuzumab"	K		"$1,778.597"	.	$355.72																																																																																																																																																																																																					
1822	Inj filgrastim gcsf biosimil	G		$0.715	.	$0.15																																																																																																																																																																																																					
1823	"Injection, dalbavancin"	K		$14.400	.	$2.88																																																																																																																																																																																																					
1824	"	Ceftaroline fosamil inj"	K		$2.625	.	$0.53																																																																																																																																																																																																					
1825	Ceftazidime and avibactam	K		$76.921	.	$15.39																																																																																																																																																																																																					
1826	Hyqvia 100mg immuneglobulin	K		$13.136	.	$2.63																																																																																																																																																																																																					
1827	Factor viii recomb obizur	K		$5.297	.	$1.06																																																																																																																																																																																																					
1828	Carbidopa levodopa ent 100ml	K		$2.138	.	$0.43																																																																																																																																																																																																					
1829	"	Penicillin g benzathine inj"	K		$11.921	.	$2.39																																																																																																																																																																																																					
1832	Dimethyl sulfoxide 50% 50 ml	K		$554.155	.	$110.84																																																																																																																																																																																																					
1844	Factor viii pegylated recomb	G		$1.872	.	$0.38																																																																																																																																																																																																					
1845	Tacrol envarsus ex rel oral	G		$1.235	.	$0.25																																																																																																																																																																																																					
1846	Factor viii nuwiq recomb 1iu	G		$1.521	.	$0.31																																																																																																																																																																																																					
1847	"Inj., infliximab biosimilar"	G		$78.724	.	$15.75																																																																																																																																																																																																					
1848	Artiss fibrin sealant	K		$111.352	.	$22.28																																																																																																																																																																																																					
1849	Foscarnet sodium injection	K		$75.172	.	$15.04																																																																																																																																																																																																					
1850	Gamma globulin 1 cc inj	K		$31.764	.	$6.36																																																																																																																																																																																																					
1851	Gamma globulin > 10 cc inj	K		$317.637	.	$63.53																																																																																																																																																																																																					
1852	Interferon beta-1a inj	K		$482.210	.	$96.45																																																																																																																																																																																																					
1853	Minocycline hydrochloride	K		$1.549	.	$0.31																																																																																																																																																																																																					
1854	Pentobarbital sodium inj	K		$52.401	.	$10.49																																																																																																																																																																																																					
1856	Factor viii recomb novoeight	K		$1.294	.	$0.26																																																																																																																																																																																																					
1857	"Inj, factor x, (human), 1iu"	K		$6.834	.	$1.37																																																																																																																																																																																																					
1858	Leuprolide acetate injeciton	K		$25.972	.	$5.20																																																																																																																																																																																																					
1859	Argatroban nonesrd use 1mg	K		$1.292	.	$0.26																																																																																																																																																																																																					
1860	Monoclonal antibodies	K		$231.220	.	$46.25																																																																																																																																																																																																					
1861	"Inj., bendeka 1 mg"	G		$23.765	.	$4.76																																																																																																																																																																																																					
1862	Gelsyn-3 injection 0.1 mg	G		$2.177	.	$0.44																																																																																																																																																																																																					
1863	Inj diclofenac sodium 0.5mg	K		$0.191	.	$0.04																																																																																																																																																																																																					
1901	"New Technology - Level 49 ($100,001-$115,000)"	S		"$107,500.50"	.	"$21,500.10"																																																																																																																																																																																																					
1902	"New Technology - Level 49 ($100,001-$115,000)"	T		"$107,500.50"	.	"$21,500.10"																																																																																																																																																																																																					
1903	"New Technology - Level 50 ($115,001-$130,000)"	S		"$122,500.50"	.	"$24,500.10"																																																																																																																																																																																																					
1904	"New Technology - Level 50 ($115,001-$130,000)"	T		"$122,500.50"	.	"$24,500.10"																																																																																																																																																																																																					
1905	"New Technology - Level 51 ($130,001-$145,000)"	S		"$137,500.50"	.	"$27,500.10"																																																																																																																																																																																																					
1906	"New Technology - Level 51 ($130,001-$145,000)"	T		"$137,500.50"	.	"$27,500.10"																																																																																																																																																																																																					
1907	"New Technology - Level 52 ($145,001-$160,000)"	S		"$152,500.50"	.	"$30,500.10"																																																																																																																																																																																																					
1908	"New Technology - Level 52 ($145,001-$160,000)"	T		"$152,500.50"	.	"$30,500.10"																																																																																																																																																																																																					
2616	"Brachytx, non-str,Yttrium-90"	U	212.5799	"$16,716.43"	.	"$3,343.29"																																																																																																																																																																																																					
2632	Iodine I-125 sodium iodide	U	0.3389	$26.65	.	$5.33																																																																																																																																																																																																					
2634	"Brachytx, non-str, HA, I-125"	U	1.4962	$117.66	.	$23.54																																																																																																																																																																																																					
2635	"Brachytx, non-str, HA, P-103"	U	0.3299	$25.94	.	$5.19																																																																																																																																																																																																					
2636	"Brachy linear, non-str,P-103"	U	0.3444	$27.08	.	$5.42																																																																																																																																																																																																					
2638	"Brachytx, stranded, I-125"	U	0.4417	$34.73	.	$6.95																																																																																																																																																																																																					
2639	"Brachytx, non-stranded,I-125"	U	0.4408	$34.66	.	$6.94																																																																																																																																																																																																					
2640	"Brachytx, stranded, P-103"	U	1.0010	$78.71	.	$15.75																																																																																																																																																																																																					
2641	"Brachytx, non-stranded,P-103"	U	0.8173	$64.27	.	$12.86																																																																																																																																																																																																					
2642	"Brachytx, stranded, C-131"	U	1.1177	$87.89	.	$17.58																																																																																																																																																																																																					
2643	"Brachytx, non-stranded,C-131"	U	1.1115	$87.40	.	$17.48																																																																																																																																																																																																					
2644	Brachytx cesium-131 chloride	U	1.3363	$105.08	.	$21.02																																																																																																																																																																																																					
2645	"Brachytx, non-str, Gold-198"	U	1.5590	$122.59	.	$24.52																																																																																																																																																																																																					
2646	"Brachytx, non-str, HDR Ir-192"	U	3.7460	$294.57	.	$58.92																																																																																																																																																																																																					
2647	"Brachytx, NS, Non-HDRIr-192"	U	0.2436	$19.16	.	$3.84																																																																																																																																																																																																					
2648	"Brachytx planar, p-103"	U		$4.69	.	$0.94																																																																																																																																																																																																					
2698	"Brachytx, stranded, NOS"	U	0.4417	$34.73	.	$6.95																																																																																																																																																																																																					
2699	"Brachytx, non-stranded, NOS"	U	0.2436	$19.16	.	$3.84																																																																																																																																																																																																					
2731	"Immune globulin, powder"	K		$34.282	.	$6.86																																																																																																																																																																																																					
2770	Quinupristin/dalfopristin	K		$428.618	.	$85.73																																																																																																																																																																																																					
4001	Echo guidance radiotherapy	S		$23.76	.	$4.75																																																																																																																																																																																																					
4002	Stereoscopic x-ray guidance 	S		$57.59	.	$11.52																																																																																																																																																																																																					
4003	"Radiation treatment delivery, MeV <= 5; simple "	S		$202.30	.	$40.46																																																																																																																																																																																																					
4004	"Radiation treatment delivery, 6-10 MeV; simple "	S		$150.10	.	$30.02																																																																																																																																																																																																					
4005	"Radiation treatment delivery, 11-19 MeV; simple "	S		$149.74	.	$29.95																																																																																																																																																																																																					
4006	"Radiation treatment delivery, MeV>=20; simple "	S		$150.10	.	$30.02																																																																																																																																																																																																					
4007	"Radiation treatment delivery, MeV<=5; intermediate"	S		$303.81	.	$60.76																																																																																																																																																																																																					
4008	"Radiation treatment delivery, 6-10 MeV; intermediate "	S		$207.70	.	$41.54																																																																																																																																																																																																					
4009	"Radiation treatment delivery, 11-19 MeV; intermediate"	S		$206.98	.	$41.40																																																																																																																																																																																																					
4010	"Radiation treatment delivery, MeV >=20; intermediate"	S		$205.54	.	$41.11																																																																																																																																																																																																					
4011	"Radiation treatment delivery, MeV<=5; complex"	S		$288.69	.	$57.74																																																																																																																																																																																																					
4012	"Radiation treatment delivery, 6-10 MeV; complex"	S		$274.65	.	$54.93																																																																																																																																																																																																					
4013	"Radiation treatment delivery, 11-19 MeV; complex"	S		$274.65	.	$54.93																																																																																																																																																																																																					
4014	"Radiation treatment delivery, MeV >=20; complex"	S		$275.01	.	$55.00																																																																																																																																																																																																					
5012	Clinic Visits and Related Services	V	1.4457	$113.68	.	$22.74																																																																																																																																																																																																					
5021	Level 1 Type A ED Visits	V	0.8731	$68.66	.	$13.74																																																																																																																																																																																																					
5022	Level 2 Type A ED Visits	V	1.5851	$124.65	.	$24.93																																																																																																																																																																																																					
5023	Level 3 Type A ED Visits	V	2.7862	$219.10	.	$43.82																																																																																																																																																																																																					
5024	Level 4 Type A ED Visits	V	4.5208	$355.50	.	$71.10																																																																																																																																																																																																					
5025	Level 5 Type A ED Visits	V	6.6230	$520.81	.	$104.17																																																																																																																																																																																																					
5031	Level 1 Type B ED Visits	V	1.3033	$102.49	.	$20.50																																																																																																																																																																																																					
5032	Level 2 Type B ED Visits	V	1.1548	$90.81	.	$18.17																																																																																																																																																																																																					
5033	Level 3 Type B ED Visits	V	2.0048	$157.65	.	$31.53																																																																																																																																																																																																					
5034	Level 4 Type B ED Visits	V	2.6578	$209.00	.	$41.80																																																																																																																																																																																																					
5035	Level 5 Type B ED Visits	V	3.6352	$285.86	.	$57.18																																																																																																																																																																																																					
5041	Critical Care	S	9.3288	$733.58	.	$146.72																																																																																																																																																																																																					
5045	Trauma Response with Critical Care	S	12.1764	$957.50	.	$191.50																																																																																																																																																																																																					
5051	Level 1 Skin Procedures	T	2.1483	$168.93	.	$33.79																																																																																																																																																																																																					
5052	Level 2 Skin Procedures	T	3.9521	$310.78	.	$62.16																																																																																																																																																																																																					
5053	Level 3 Skin Procedures	T	6.2080	$488.17	.	$97.64																																																																																																																																																																																																					
5054	Level 4 Skin Procedures	T	19.9440	"$1,568.32"	.	$313.67																																																																																																																																																																																																					
5055	Level 5 Skin Procedures	T	34.4664	"$2,710.30"	.	$542.06																																																																																																																																																																																																					
5061	Hyperbaric Oxygen	S	1.4518	$114.16	.	$22.84																																																																																																																																																																																																					
5071	Level 1 Excision/ Biopsy/ Incision and Drainage	T	7.2843	$572.81	.	$114.57																																																																																																																																																																																																					
5072	Level 2 Excision/ Biopsy/ Incision and Drainage	J1	17.1415	"$1,347.94"	.	$269.59																																																																																																																																																																																																					
5073	Level 3 Excision/ Biopsy/ Incision and Drainage	J1	29.5628	"$2,324.70"	.	$464.94																																																																																																																																																																																																					
5091	Level 1 Breast/Lymphatic Surgery and Related Procedures	J1	34.6871	"$2,727.65"	.	$545.53																																																																																																																																																																																																					
5092	Level 2 Breast/Lymphatic Surgery and Related Procedures	J1	61.1875	"$4,811.54"	.	$962.31																																																																																																																																																																																																					
5093	Level 3 Breast/Lymphatic Surgery and Related Procedures	J1	93.9419	"$7,387.22"	.	"$1,477.45"																																																																																																																																																																																																					
5094	Level 4 Breast/Lymphatic Surgery and Related Procedures	J1	144.8161	"$11,387.76"	.	"$2,277.56"																																																																																																																																																																																																					
5101	Level 1 Strapping and Cast Application	T	1.7220	$135.41	.	$27.09																																																																																																																																																																																																					
5102	Level 2 Strapping and Cast Application	T	3.0172	$237.26	.	$47.46																																																																																																																																																																																																					
5111	Level 1 Musculoskeletal Procedures	T	2.7327	$214.89	.	$42.98																																																																																																																																																																																																					
5112	Level 2 Musculoskeletal Procedures	J1	17.1657	"$1,349.84"	.	$269.97																																																																																																																																																																																																					
5113	Level 3 Musculoskeletal Procedures	J1	33.6365	"$2,645.04"	.	$529.01																																																																																																																																																																																																					
5114	Level 4 Musculoskeletal Procedures	J1	71.2909	"$5,606.03"	.	"$1,121.21"																																																																																																																																																																																																					
5115	Level 5 Musculoskeletal Procedures	J1	128.7225	"$10,122.22"	.	"$2,024.45"																																																																																																																																																																																																					
5116	Level 6 Musculoskeletal Procedures	J1	195.4568	"$15,369.94"	.	"$3,073.99"																																																																																																																																																																																																					
5151	Level 1 Airway Endoscopy	T	1.9974	$157.07	.	$31.42																																																																																																																																																																																																					
5152	Level 2 Airway Endoscopy	T	4.7744	$375.44	.	$75.09																																																																																																																																																																																																					
5153	Level 3 Airway Endoscopy	J1	16.8321	"$1,323.61"	.	$264.73																																																																																																																																																																																																					
5154	Level 4 Airway Endoscopy	J1	33.2722	"$2,616.39"	.	$523.28																																																																																																																																																																																																					
5155	Level 5 Airway Endoscopy	J1	61.8525	"$4,863.83"	.	$972.77																																																																																																																																																																																																					
5161	Level 1 ENT Procedures	T	2.2697	$178.48	.	$35.70																																																																																																																																																																																																					
5162	Level 2 ENT Procedures	T	5.8477	$459.84	.	$91.97																																																																																																																																																																																																					
5163	Level 3 ENT Procedures	T	14.4730	"$1,138.10"	.	$227.62																																																																																																																																																																																																					
5164	Level 4 ENT Procedures	J1	27.9630	"$2,198.90"	.	$439.78																																																																																																																																																																																																					
5165	Level 5 ENT Procedures	J1	55.1718	"$4,338.49"	.	$867.70																																																																																																																																																																																																					
5166	Cochlear Implant Procedure	J1	414.5394	"$32,597.72"	"$7,835.75"	"$6,519.55"																																																																																																																																																																																																					
5181	Level 1 Vascular Procedures	T	7.7894	$612.53	.	$122.51																																																																																																																																																																																																					
5182	Level 2 Vascular Procedures	T	12.4994	$982.90	.	$196.58																																																																																																																																																																																																					
5183	Level 3 Vascular Procedures	T	31.6976	"$2,492.57"	.	$498.52																																																																																																																																																																																																					
5184	Level 4 Vascular Procedures	T	54.2330	"$4,264.67"	.	$852.94																																																																																																																																																																																																					
5191	Level 1 Endovascular Procedures	J1	35.7776	"$2,813.41"	$865.56	$562.69																																																																																																																																																																																																					
5192	Level 2 Endovascular Procedures	J1	64.6607	"$5,084.66"	.	"$1,016.94"																																																																																																																																																																																																					
5193	Level 3 Endovascular Procedures	J1	133.6503	"$10,509.72"	.	"$2,101.95"																																																																																																																																																																																																					
5194	Level 4 Endovascular Procedures	J1	203.7145	"$16,019.29"	.	"$3,203.86"																																																																																																																																																																																																					
5200	Implantation Wireless PA Pressure Monitor	J1	414.9030	"$32,626.31"	"$9,081.23"	"$6,525.27"																																																																																																																																																																																																					
5211	Level 1 Electrophysiologic Procedures	J1	11.5621	$909.20	.	$181.84																																																																																																																																																																																																					
5212	Level 2 Electrophysiologic Procedures	J1	67.5765	"$5,313.95"	.	"$1,062.79"																																																																																																																																																																																																					
5213	Level 3 Electrophysiologic Procedures	J1	235.4500	"$18,514.85"	.	"$3,702.97"																																																																																																																																																																																																					
5221	Level1 Pacemaker and Similar Procedures	T	36.4686	"$2,867.74"	.	$573.55																																																																																																																																																																																																					
5222	Level 2 Pacemaker and Similar Procedures	J1	93.7291	"$7,370.48"	.	"$1,474.10"																																																																																																																																																																																																					
5223	Level 3 Pacemaker and Similar Procedures	J1	123.9549	"$9,747.32"	.	"$1,949.47"																																																																																																																																																																																																					
5224	Level 4 Pacemaker and Similar Procedures	J1	223.6167	"$17,584.32"	.	"$3,516.87"																																																																																																																																																																																																					
5231	Level 1 ICD and Similar Procedures	J1	281.1561	"$22,108.99"	.	"$4,421.80"																																																																																																																																																																																																					
5232	Level 2 ICD and Similar Procedures	J1	393.7127	"$30,959.99"	.	"$6,192.00"																																																																																																																																																																																																					
5241	Level 1 Blood Product Exchange and Related Services	S	4.7694	$375.05	.	$75.01																																																																																																																																																																																																					
5242	Level 2 Blood Product Exchange and Related Services	S	15.5356	"$1,221.66"	.	$244.34																																																																																																																																																																																																					
5243	Level 3 Blood Product Exchange and Related Services	S	47.0503	"$3,699.85"	.	$739.97																																																																																																																																																																																																					
5244	Level 4 Blood Product Exchange and Related Services	J1	387.1167	"$30,441.31"	.	"$6,088.27"																																																																																																																																																																																																					
5301	Level 1 Upper GI Procedures	T	9.4542	$743.44	.	$148.69																																																																																																																																																																																																					
5302	Level 2 Upper GI Procedures 	J1	18.1506	"$1,427.29"	.	$285.46																																																																																																																																																																																																					
5303	Level 3 Upper GI Procedures	J1	34.8855	"$2,743.26"	.	$548.66																																																																																																																																																																																																					
5311	Level 1 Lower GI Procedures 	T	9.0281	$709.93	.	$141.99																																																																																																																																																																																																					
5312	Level 2 Lower GI Procedures 	T	11.9071	$936.33	.	$187.27																																																																																																																																																																																																					
5313	Level 3 Lower GI Procedures 	J1	29.4454	"$2,315.47"	.	$463.10																																																																																																																																																																																																					
5331	Complex GI Procedures	J1	54.5974	"$4,293.32"	.	$858.67																																																																																																																																																																																																					
5341	Abdominal/Peritoneal/Biliary and Related Procedures	J1	37.0182	"$2,910.96"	.	$582.20																																																																																																																																																																																																					
5361	Level 1 Laparoscopy and Related Services	J1	57.0778	"$4,488.37"	.	$897.68																																																																																																																																																																																																					
5362	Level 2 Laparoscopy and Related Services	J1	96.5829	"$7,594.89"	"$1,526.22"	"$1,518.98"																																																																																																																																																																																																					
5371	Level 1 Urology and Related Services	T	2.9187	$229.51	.	$45.91																																																																																																																																																																																																					
5372	Level 2 Urology and Related Services	T	7.1921	$565.56	.	$113.12																																																																																																																																																																																																					
5373	Level 3 Urology and Related Services	J1	21.5622	"$1,695.57"	.	$339.12																																																																																																																																																																																																					
5374	Level 4 Urology and Related Services	J1	34.2919	"$2,696.58"	.	$539.32																																																																																																																																																																																																					
5375	Level 5 Urology and Related Services	J1	47.1256	"$3,705.77"	.	$741.16																																																																																																																																																																																																					
5376	Level 6 Urology and Related Services	J1	96.5936	"$7,595.73"	.	"$1,519.15"																																																																																																																																																																																																					
5377	Level 7 Urology and Related Services	J1	199.6126	"$15,696.74"	.	"$3,139.35"																																																																																																																																																																																																					
5401	Dialysis	S	7.6045	$597.99	.	$119.60																																																																																																																																																																																																					
5411	Level 1 Gynecologic Procedures	T	2.0435	$160.69	.	$32.14																																																																																																																																																																																																					
5412	Level 2 Gynecologic Procedures	T	3.4123	$268.33	.	$53.67																																																																																																																																																																																																					
5413	Level 3 Gynecologic Procedures	T	7.3193	$575.56	.	$115.12																																																																																																																																																																																																					
5414	Level 4 Gynecologic Procedures	J1	28.9004	"$2,272.61"	.	$454.53																																																																																																																																																																																																					
5415	Level 5 Gynecologic Procedures	J1	52.2855	"$4,111.52"	$902.82	$822.31																																																																																																																																																																																																					
5416	Level 6 Gynecologic Procedures	J1	79.9497	"$6,286.92"	"$1,405.70"	"$1,257.39"																																																																																																																																																																																																					
5431	Level 1 Nerve Procedures	J1	20.4791	"$1,610.39"	.	$322.08																																																																																																																																																																																																					
5432	Level 2 Nerve Procedures	J1	58.8442	"$4,627.27"	.	$925.46																																																																																																																																																																																																					
5441	Level 1 Nerve Injections	T	3.1116	$244.68	.	$48.94																																																																																																																																																																																																					
5442	Level 2 Nerve Injections	T	6.9096	$543.34	.	$108.67																																																																																																																																																																																																					
5443	Level 3 Nerve Injections	T	8.5474	$672.13	.	$134.43																																																																																																																																																																																																					
5461	Level 1 Neurostimulator and Related Procedures	T	36.6139	"$2,879.17"	.	$575.84																																																																																																																																																																																																					
5462	Level 2 Neurostimulator and Related Procedures	J1	77.0028	"$6,055.19"	.	"$1,211.04"																																																																																																																																																																																																					
5463	Level 3 Neurostimulator and Related Procedures	J1	233.5777	"$18,367.62"	.	"$3,673.53"																																																																																																																																																																																																					
5464	Level 4 Neurostimulator and Related Procedures	J1	354.6704	"$27,889.86"	.	"$5,577.98"																																																																																																																																																																																																					
5471	Implantation of Drug Infusion Device	J1	209.0602	"$16,439.66"	.	"$3,287.94"																																																																																																																																																																																																					
5481	Laser Eye Procedures	T	6.2051	$487.94	$101.51	$97.59																																																																																																																																																																																																					
5491	Level 1 Intraocular Procedures	J1	24.4284	"$1,920.95"	.	$384.19																																																																																																																																																																																																					
5492	Level 2 Intraocular Procedures	J1	45.9141	"$3,610.50"	.	$722.10																																																																																																																																																																																																					
5493	Level 3 Intraocular Procedures	J1	116.8224	"$9,186.45"	.	"$1,837.29"																																																																																																																																																																																																					
5494	Level 4 Intraocular Procedures	J1	121.2136	"$9,531.75"	.	"$1,906.35"																																																																																																																																																																																																					
5495	Level 5 Intraocular Procedures	J1	223.3083	"$17,560.07"	.	"$3,512.02"																																																																																																																																																																																																					
5501	"Level 1 Extraocular, Repair, and Plastic Eye Procedures"	T	3.4036	$267.65	.	$53.53																																																																																																																																																																																																					
5502	"Level 2 Extraocular, Repair, and Plastic Eye Procedures"	T	10.2792	$808.32	.	$161.67																																																																																																																																																																																																					
5503	"Level 3 Extraocular, Repair, and Plastic Eye Procedures"	J1	23.0330	"$1,811.22"	.	$362.25																																																																																																																																																																																																					
5504	"Level 4 Extraocular, Repair, and Plastic Eye Procedures"	J1	37.5320	"$2,951.37"	.	$590.28																																																																																																																																																																																																					
5521	Level 1 Imaging without Contrast	S	0.7899	$62.11	.	$12.43																																																																																																																																																																																																					
5522	Level 2 Imaging without Contrast	S	1.5100	$118.74	.	$23.75																																																																																																																																																																																																					
5523	Level 3 Imaging without Contrast	S	3.1184	$245.22	.	$49.05																																																																																																																																																																																																					
5524	Level 4 Imaging without Contrast	S	6.1888	$486.66	.	$97.34																																																																																																																																																																																																					
5571	Level 1 Imaging with Contrast	S	3.2138	$252.72	.	$50.55																																																																																																																																																																																																					
5572	Level 2 Imaging with Contrast	S	5.8032	$456.34	$111.70	$91.27																																																																																																																																																																																																					
5573	Level 3 Imaging with Contrast	S	8.6707	$681.83	.	$136.37																																																																																																																																																																																																					
5591	Level 1 Nuclear Medicine and Related Services 	S	4.4435	$349.42	.	$69.89																																																																																																																																																																																																					
5592	Level 2 Nuclear Medicine and Related Services	S	5.7614	$453.05	.	$90.61																																																																																																																																																																																																					
5593	Level 3 Nuclear Medicine and Related Services 	S	15.2932	"$1,202.60"	.	$240.52																																																																																																																																																																																																					
5594	Level 4 Nuclear Medicine and Related Services	S	17.5126	"$1,377.12"	.	$275.43																																																																																																																																																																																																					
5611	Level 1 Therapeutic Radiation Treatment Preparation	S	1.5940	$125.35	$32.44	$25.07																																																																																																																																																																																																					
5612	Level 2 Therapeutic Radiation Treatment Preparation	S	4.1084	$323.07	.	$64.62																																																																																																																																																																																																					
5613	Level 3 Therapeutic Radiation Treatment Preparation	S	15.0898	"$1,186.60"	.	$237.32																																																																																																																																																																																																					
5621	Level 1 Radiation Therapy	S	1.5861	$124.72	.	$24.95																																																																																																																																																																																																					
5622	Level 2 Radiation Therapy	S	2.7954	$219.82	.	$43.97																																																																																																																																																																																																					
5623	Level 3 Radiation Therapy	S	6.6417	$522.28	.	$104.46																																																																																																																																																																																																					
5624	Level 4 Radiation Therapy	S	9.0806	$714.06	.	$142.82																																																																																																																																																																																																					
5625	Level 5 Radiation Therapy	S	13.3964	"$1,053.44"	.	$210.69																																																																																																																																																																																																					
5626	Level 6 Radiation Therapy	S 	21.3274	"$1,677.10"	.	$335.42																																																																																																																																																																																																					
5627	Level 7 Radiation Therapy	J1	96.2048	"$7,565.16"	.	"$1,513.04"																																																																																																																																																																																																					
5661	Therapeutic Nuclear Medicine	S	3.0325	$238.46	.	$47.70																																																																																																																																																																																																					
5671	Level 1 Pathology	S	0.5684	$44.70	.	$8.94																																																																																																																																																																																																					
5672	Level 2 Pathology	S	1.6426	$129.17	.	$25.84																																																																																																																																																																																																					
5673	Level 3 Pathology	S	2.7395	$215.42	.	$43.09																																																																																																																																																																																																					
5674	Level 4 Pathology	S	6.8788	$540.92	.	$108.19																																																																																																																																																																																																					
5691	Level 1 Drug Administration	S	0.4709	$37.03	.	$7.41																																																																																																																																																																																																					
5692	Level 2 Drug Administration	S	0.7401	$58.20	.	$11.64																																																																																																																																																																																																					
5693	Level 3 Drug Administration	S	2.4299	$191.08	.	$38.22																																																																																																																																																																																																					
5694	Level 4 Drug Administration	S	3.7838	$297.54	.	$59.51																																																																																																																																																																																																					
5721	Level1 Diagnostic Tests and Related Services	S	1.7334	$136.31	.	$27.27																																																																																																																																																																																																					
5722	Level 2 Diagnostic Tests and Related Services	S	3.1641	$248.81	.	$49.77																																																																																																																																																																																																					
5723	Level 3 Diagnostic Tests and Related Services	S	5.6508	$444.36	.	$88.88																																																																																																																																																																																																					
5724	Level 4 Diagnostic Tests and Related Services	S	11.4822	$902.91	.	$180.59																																																																																																																																																																																																					
5731	Level 1 Minor Procedures	S	0.2222	$17.47	.	$3.50																																																																																																																																																																																																					
5732	Level 2 Minor Procedures	S	0.4044	$31.80	.	$6.36																																																																																																																																																																																																					
5733	Level 3 Minor Procedures	S	0.7116	$55.96	.	$11.20																																																																																																																																																																																																					
5734	Level 4 Minor Procedures	S	1.3357	$105.03	.	$21.01																																																																																																																																																																																																					
5735	Level 5 Minor Procedures	S	4.1964	$329.99	.	$66.00																																																																																																																																																																																																					
5741	Level 1 Electronic Analysis of Devices	S	0.4798	$37.73	.	$7.55																																																																																																																																																																																																					
5742	Level 2 Electronic Analysis of Devices	S	1.4646	$115.17	.	$23.04																																																																																																																																																																																																					
5743	Level 3 Electronic Analysis of Devices	S	3.3302	$261.87	.	$52.38																																																																																																																																																																																																					
5771	Cardiac Rehabilitation	S	1.4834	$116.65	.	$23.33																																																																																																																																																																																																					
5781	Resuscitation and Cardioversion	S	6.5190	$512.63	.	$102.53																																																																																																																																																																																																					
5791	Pulmonary Treatment	S	2.3699	$186.36	.	$37.28																																																																																																																																																																																																					
5801	Ventilation Initiation and Management	S	5.8583	$460.67	.	$92.14																																																																																																																																																																																																					
5811	Manipulation Therapy	S	0.3412	$26.83	.	$5.37																																																																																																																																																																																																					
5821	Level 1 Health and Behavior Services	S	0.3867	$30.41	.	$6.09																																																																																																																																																																																																					
5822	Level 2 Health and Behavior Services	S	0.9148	$71.94	.	$14.39																																																																																																																																																																																																					
5823	Level 3 Health and Behavior Services	S	1.5761	$123.94	.	$24.79																																																																																																																																																																																																					
5853	Partial Hospitalization (3 or more services) for CMHCs	P	1.8223	$143.30	.	$28.66																																																																																																																																																																																																					
5863	Partial Hospitalization (3 or more services) for Hospital-based PHPs	P	2.6478	$208.21	.	$41.65																																																																																																																																																																																																					
5871	Dental Procedures	S	9.8222	$772.38	.	$154.48																																																																																																																																																																																																					
5881	Ancillary Outpatient Services When Patient Dies	J1	90.0005	"$7,077.28"	.	"$1,415.46"																																																																																																																																																																																																					
7000	Amifostine	K		$959.810	.	$191.97																																																																																																																																																																																																					
7011	Oprelvekin injection	K		$467.216	.	$93.45																																																																																																																																																																																																					
7034	"	Somatropin injection"	K		$81.590	.	$16.32																																																																																																																																																																																																					
7035	Teniposide	K		"$2,645.707"	.	$529.15																																																																																																																																																																																																					
7041	Tirofiban HCl	K		$9.191	.	$1.84																																																																																																																																																																																																					
7043	Infliximab not biosimil 10mg	K		$87.149	.	$17.43																																																																																																																																																																																																					
7046	Doxorubicin inj 10mg	K		$374.931	.	$74.99																																																																																																																																																																																																					
7048	Alteplase recombinant	K		$83.991	.	$16.80																																																																																																																																																																																																					
7308	Aminolevulinic acid hcl top	K		$367.809	.	$73.57																																																																																																																																																																																																					
8004	Ultrasound Composite	S	3.8133	$299.86	.	$59.98																																																																																																																																																																																																					
8005	CT and CTA without Contrast Composite	S	3.4948	$274.82	.	$54.97																																																																																																																																																																																																					
8006	CT and CTA with Contrast Composite	S	6.3687	$500.81	.	$100.17																																																																																																																																																																																																					
8007	MRI and MRA without Contrast Composite	S	7.0722	$556.13	.	$111.23																																																																																																																																																																																																					
8008	MRI and MRA with Contrast Composite	S	11.0865	$871.80	.	$174.36																																																																																																																																																																																																					
8010	Mental Health Services Composite	S	2.6478	$208.21	.	$41.65																																																																																																																																																																																																					
8011	Comprehensive Observation Services	J2	29.8802	"$2,349.66"	.	$469.94																																																																																																																																																																																																					
9002	Tenecteplase injection	K		$111.696	.	$22.34																																																																																																																																																																																																					
9003	Palivizumab	K		$176.350	.	$35.27																																																																																																																																																																																																					
9005	Reteplase injection	K		"$2,301.910"	.	$460.39																																																																																																																																																																																																					
9006	Tacrolimus injection	K		$188.317	.	$37.67																																																																																																																																																																																																					
9012	Arsenic trioxide injection	K		$71.337	.	$14.27																																																																																																																																																																																																					
9014	"Injection, cerliponase alfa"	G		$95.400	.	$19.08																																																																																																																																																																																																					
9015	"C-1 esterase, haegarda"	G		$9.964	.	$2.00																																																																																																																																																																																																					
9016	"Inj, triptorelin ext rel"	G		"$2,826.667"	.	$565.34																																																																																																																																																																																																					
9018	"Inj, rimabotulinumtoxinB"	K		$11.978	.	$2.40																																																																																																																																																																																																					
9019	Caspofungin acetate	K		$12.461	.	$2.50																																																																																																																																																																																																					
9024	Amphotericin b lipid complex	K		$13.859	.	$2.78																																																																																																																																																																																																					
9028	Inj. inotuzumab ozogamicin	G		"$2,202.444"	.	$440.49																																																																																																																																																																																																					
9029	"Injection, guselkumab"	G		$102.650	.	$20.53																																																																																																																																																																																																					
9031	"Inj, etelcalcetide, 0.1 mg"	K		$3.466	.	$0.70																																																																																																																																																																																																					
9032	Baclofen 10 MG injection	K		$164.619	.	$32.93																																																																																																																																																																																																					
9033	Cidofovir injection	K		$477.545	.	$95.51																																																																																																																																																																																																					
9034	"Inj cuvitru, 100 mg"	K		$13.184	.	$2.64																																																																																																																																																																																																					
9038	Inj estrogen conjugate	K		$304.606	.	$60.93																																																																																																																																																																																																					
9042	Glucagon hydrochloride	K		$205.553	.	$41.12																																																																																																																																																																																																					
9043	"Inj, afstyla, 1 i.u."	G		$1.407	.	$0.29																																																																																																																																																																																																					
9044	Ibutilide fumarate injection	K		$169.137	.	$33.83																																																																																																																																																																																																					
9052	Fluciciovine F-18	G		$389.550	$0.00	$0.00																																																																																																																																																																																																					
9056	Gallium Ga-68	G		$66.741	$0.00	$0.00																																																																																																																																																																																																					
9058	Buprenorphine implant 74.2mg	G		"$1,261.308"	.	$252.27																																																																																																																																																																																																					
9059	Vonvendi inj 1 iu vwf:rco	G		$2.265	.	$0.46																																																																																																																																																																																																					
9064	Aripiprazole injection	K		$0.757	.	$0.16																																																																																																																																																																																																					
9065	Argatroban esrd dialysis 1mg	K		$1.292	.	$0.26																																																																																																																																																																																																					
9066	Inj dihydroergotamine mesylt	K		$105.618	.	$21.13																																																																																																																																																																																																					
9071	Capsaicin 8% patch	K		$3.150	.	$0.63																																																																																																																																																																																																					
9072	Fosphenytoin inj pe	K		$4.974	.	$1.00																																																																																																																																																																																																					
9074	"Makena, 10 mg"	K		$2.707	.	$0.55																																																																																																																																																																																																					
9075	"Inj, kovaltry, 1 i.u."	K		$1.240	.	$0.25																																																																																																																																																																																																					
9076	Dimecaprol injection	K		$52.694	.	$10.54																																																																																																																																																																																																					
9077	Epoetin beta non esrd	K		$1.628	.	$0.33																																																																																																																																																																																																					
9078	Testosterone undecanoate 1mg	K		$1.287	.	$0.26																																																																																																																																																																																																					
9079	"Genvisc 850, inj, 1mg"	K		$7.420	.	$1.49																																																																																																																																																																																																					
9080	Fludarabine phosphate inj	K		$104.887	.	$20.98																																																																																																																																																																																																					
9081	Tisagenlecleucel car-pos t	K		"$503,500.000"	.	"$100,700.00"																																																																																																																																																																																																					
9104	Antithymocyte globuln rabbit	K		$710.345	.	$142.07																																																																																																																																																																																																					
9108	Thyrotropin injection	K		"$1,579.688"	.	$315.94																																																																																																																																																																																																					
9119	"Injection, pegfilgrastim 6mg"	K		"$4,320.732"	.	$864.15																																																																																																																																																																																																					
9120	"Injection, Fulvestrant"	K		$96.767	.	$19.36																																																																																																																																																																																																					
9122	Triptorelin pamoate	K		$391.110	.	$78.23																																																																																																																																																																																																					
9124	Daptomycin injection	K		$0.618	.	$0.13																																																																																																																																																																																																					
9125	"Risperidone, long acting"	K		$8.625	.	$1.73																																																																																																																																																																																																					
9126	Natalizumab injection	K		$19.415	.	$3.89																																																																																																																																																																																																					
9130	"Inj, Imm Glob Bivigam, 500mg"	K		$38.310	.	$7.67																																																																																																																																																																																																					
9131	"Inj, Ado-trastuzumab Emt 1mg"	K		$29.814	.	$5.97																																																																																																																																																																																																					
9132	"Kcentra, per i.u."	K		$1.857	.	$0.38																																																																																																																																																																																																					
9133	"Rabies ig, im/sc"	K		$314.271	.	$62.86																																																																																																																																																																																																					
9134	"Rabies ig, heat treated"	K		$317.428	.	$63.49																																																																																																																																																																																																					
9135	"Varicella-zoster ig, im"	K		"$1,304.837"	.	$260.97																																																																																																																																																																																																					
9139	"Rabies vaccine, im"	K		$269.123	.	$53.83																																																																																																																																																																																																					
9140	"Rabies vaccine, id"	K		$141.020	.	$28.21																																																																																																																																																																																																					
9171	Factor ix idelvion inj	G		$4.143	.	$0.83																																																																																																																																																																																																					
9207	Bortezomib injection	K		$46.873	.	$9.38																																																																																																																																																																																																					
9208	Agalsidase beta injection	K		$171.065	.	$34.22																																																																																																																																																																																																					
9209	Laronidase injection	K		$30.612	.	$6.13																																																																																																																																																																																																					
9210	Palonosetron hcl	K		$20.899	.	$4.18																																																																																																																																																																																																					
9213	Pemetrexed injection	K		$64.978	.	$13.00																																																																																																																																																																																																					
9214	Bevacizumab injection	K		$75.177	.	$15.04																																																																																																																																																																																																					
9215	Cetuximab injection	K		$57.619	.	$11.53																																																																																																																																																																																																					
9217	Leuprolide acetate suspnsion	K		$209.709	.	$41.95																																																																																																																																																																																																					
9224	Galsulfase injection	K		$380.500	.	$76.10																																																																																																																																																																																																					
9225	Fluocinolone acetonide implt	K		"$20,114.347"	.	"$4,022.87"																																																																																																																																																																																																					
9228	Tigecycline injection	K		$2.986	.	$0.60																																																																																																																																																																																																					
9229	Ibandronate sodium injection	K		$82.872	.	$16.58																																																																																																																																																																																																					
9230	Abatacept injection	K		$49.589	.	$9.92																																																																																																																																																																																																					
9231	Decitabine injection	K		$17.703	.	$3.55																																																																																																																																																																																																					
9232	Idursulfase injection	K		$542.859	.	$108.58																																																																																																																																																																																																					
9233	Ranibizumab injection	K		$378.353	.	$75.68																																																																																																																																																																																																					
9234	Alglucosidase alfa injection	K		$206.700	.	$41.34																																																																																																																																																																																																					
9235	Panitumumab injection	K		$110.278	.	$22.06																																																																																																																																																																																																					
9236	Eculizumab injection	K		$226.628	.	$45.33																																																																																																																																																																																																					
9237	"Inj, lanreotide acetate"	K		$55.984	.	$11.20																																																																																																																																																																																																					
9240	"Injection, ixabepilone"	K		$74.096	.	$14.82																																																																																																																																																																																																					
9242	"Injection, fosaprepitant"	K		$2.025	.	$0.41																																																																																																																																																																																																					
9243	"Inj., treanda 1 mg"	K		$29.189	.	$5.84																																																																																																																																																																																																					
9245	Romiplostim injection	K		$66.857	.	$13.38																																																																																																																																																																																																					
9251	C1 esterase inhibitor inj	K		$57.210	.	$11.45																																																																																																																																																																																																					
9252	Plerixafor injection	K		$314.438	.	$62.89																																																																																																																																																																																																					
9253	Temozolomide injection	K		$9.699	.	$1.94																																																																																																																																																																																																					
9255	Paliperidone palmitate inj	K		$10.015	.	$2.01																																																																																																																																																																																																					
9256	Dexamethasone intra implant	K		$200.738	.	$40.15																																																																																																																																																																																																					
9258	Telavancin injection	K		$5.115	.	$1.03																																																																																																																																																																																																					
9259	Pralatrexate injection	K		$247.970	.	$49.60																																																																																																																																																																																																					
9260	Ofatumumab injection	K		$54.907	.	$10.99																																																																																																																																																																																																					
9261	"Ustekinumab sub cu inj, 1 mg"	K		$187.258	.	$37.46																																																																																																																																																																																																					
9263	Ecallantide injection	K		$441.288	.	$88.26																																																																																																																																																																																																					
9264	Tocilizumab injection	K		$4.370	.	$0.88																																																																																																																																																																																																					
9265	Romidepsin injection	K		$328.832	.	$65.77																																																																																																																																																																																																					
9269	"C-1 esterase, berinert"	K		$48.973	.	$9.80																																																																																																																																																																																																					
9270	Gammaplex IVIG	K		$41.079	.	$8.22																																																																																																																																																																																																					
9271	Velaglucerase alfa	K		$342.348	.	$68.47																																																																																																																																																																																																					
9272	"Inj, denosumab"	K		$17.332	.	$3.47																																																																																																																																																																																																					
9273	Sipuleucel-T auto CD54+	K		"$40,440.171"	.	"$8,088.04"																																																																																																																																																																																																					
9274	Crotalidae Poly Immune Fab	K		"$2,870.724"	.	$574.15																																																																																																																																																																																																					
9276	Cabazitaxel injection	K		$159.095	.	$31.82																																																																																																																																																																																																					
9278	Incobotulinumtoxin A	K		$5.082	.	$1.02																																																																																																																																																																																																					
9281	"Injection, pegloticase"	K		"$2,006.661"	.	$401.34																																																																																																																																																																																																					
9284	Ipilimumab injection	K		$146.780	.	$29.36																																																																																																																																																																																																					
9286	Belatacept injection	K		$3.935	.	$0.79																																																																																																																																																																																																					
9287	Brentuximab vedotin inj	K		$139.386	.	$27.88																																																																																																																																																																																																					
9289	Erwinaze injection	K		$402.743	.	$80.55																																																																																																																																																																																																					
9293	"Injection, glucarpidase "	K		$298.602	.	$59.73																																																																																																																																																																																																					
9294	"Inj, taliglucerase alfa 10 u"	K		$40.369	.	$8.08																																																																																																																																																																																																					
9295	"Injection, Carfilzomib, 1 mg"	K		$33.161	.	$6.64																																																																																																																																																																																																					
9296	"Inj, ziv-aflibercept, 1mg"	K		$8.153	.	$1.64																																																																																																																																																																																																					
9297	"Inj, Omacetaxine Mep, 0.01mg"	K		$2.852	.	$0.58																																																																																																																																																																																																					
9298	"Inj, Ocriplasmin, 0.125 mg"	K		"$1,046.750"	.	$209.35																																																																																																																																																																																																					
9300	Omalizumab injection	K		$34.932	.	$6.99																																																																																																																																																																																																					
9301	"Aminolevulinic acid, 10% gel"	G		$1.431	.	$0.29																																																																																																																																																																																																					
9302	"Inj, daunorubicin-cytarabine"	G		$186.705	.	$37.35																																																																																																																																																																																																					
9441	Inj ferric carboxymaltos 1mg	K		$1.062	.	$0.22																																																																																																																																																																																																					
9445	"Injection, ruconest"	K		$27.987	.	$5.60																																																																																																																																																																																																					
9448	Netupitant palonosetron oral	K		$458.473	.	$91.70																																																																																																																																																																																																					
9449	"Injection, blinatumomab"	K		$103.429	.	$20.69																																																																																																																																																																																																					
9450	Fluocinol acet intravit imp	K		$490.801	.	$98.17																																																																																																																																																																																																					
9451	"Injection, peramivir"	K		$1.611	.	$0.33																																																																																																																																																																																																					
9452	Inj ceftolozane tazobactam	K		$4.964	.	$1.00																																																																																																																																																																																																					
9453	"Injection, nivolumab"	K		$26.804	.	$5.37																																																																																																																																																																																																					
9454	"Inj, pasireotide long acting"	K		$267.201	.	$53.45																																																																																																																																																																																																					
9455	"Injection, siltuximab"	K		$92.775	.	$18.56																																																																																																																																																																																																					
9456	"Injection, isavuconazonium"	K		$0.687	.	$0.14																																																																																																																																																																																																					
9458	Florbetaben f18 diagnostic	G		"$2,968.000"	$0.00	$0.00																																																																																																																																																																																																					
9459	Flutemetamol f18 diagnostic	G		"$3,498.000"	$0.00	$0.00																																																																																																																																																																																																					
9460	"Injection, cangrelor"	G		$15.174	.	$3.04																																																																																																																																																																																																					
9461	"Choline c-11, diagnostic, per study dose up to 20 millicuries"	G		"$5,700.000"	$0.00	$0.00																																																																																																																																																																																																					
9470	Aripiprazole lauroxil 1mg	G		$2.458	.	$0.50																																																																																																																																																																																																					
9471	Hymovis injection 1 mg	G		$19.257	.	$3.86																																																																																																																																																																																																					
9472	Inj talimogene laherparepvec	G		$47.210	.	$9.45																																																																																																																																																																																																					
9473	"Injection, mepolizumab, 1mg"	G		$27.773	.	$5.56																																																																																																																																																																																																					
9474	Inj irinotecan liposome 1 mg	G		$41.132	.	$8.23																																																																																																																																																																																																					
9475	"Injection, necitumumab, 1 mg"	G		$5.289	.	$1.06																																																																																																																																																																																																					
9476	"Injection, daratumumab 10 mg"	G		$49.148	.	$9.83																																																																																																																																																																																																					
9477	"Injection, elotuzumab, 1mg"	G		$6.262	.	$1.26																																																																																																																																																																																																					
9478	Inj sebelipase alfa 1 mg	G		$530.000	.	$106.00																																																																																																																																																																																																					
9479	"Instill, ciprofloxacin otic"	G		$29.958	.	$6.00																																																																																																																																																																																																					
9480	Injection trabectedin 0.1mg	G		$289.167	.	$57.84																																																																																																																																																																																																					
9481	"Injection, reslizumab"	G		$8.847	.	$1.77																																																																																																																																																																																																					
9482	Sotalol hydrochloride IV	G		$9.985	.	$2.00																																																																																																																																																																																																					
9483	"Inj, atezolizumab,10 mg"	G		$75.643	.	$15.13																																																																																																																																																																																																					
9484	"Inj, eteplirsen, 10 mg"	G		$169.600	.	$33.92																																																																																																																																																																																																					
9485	"Inj, olaratumab, 10 mg"	G		$49.950	.	$9.99																																																																																																																																																																																																					
9486	"Inj, granisetron, xr, 0.1 mg"	G		$4.883	.	$0.98																																																																																																																																																																																																					
9487	"Ustekinumab, iv inject,1 mg"	G		$12.882	.	$2.58																																																																																																																																																																																																					
9488	Conivaptan hcl	G		$30.517	.	$6.11																																																																																																																																																																																																					
9489	"Inj, nusinersen, 0.1mg"	G		"$1,103.792"	.	$220.76																																																																																																																																																																																																					
9490	"Inj, bezlotoxumab, 10 mg"	G		$40.233	.	$8.05																																																																																																																																																																																																					
9491	"Injection, avelumab, 10 mg"	G		$79.439	.	$15.89																																																																																																																																																																																																					
9492	"Injection, durvalumab"	G		$73.751	.	$14.76																																																																																																																																																																																																					
9493	"Injection, edaravone"	G		$19.186	.	$3.84																																																																																																																																																																																																					
9494	"Injection, ocrelizumab"	G		$57.417	.	$11.49																																																																																																																																																																																																					
9495	Gemtuzumab ozogamicin inj	G		$193.156	.	$38.64																																																																																																																																																																																																					
9497	"Loxapine, inhalation powder"	K		$153.700	.	$30.74																																																																																																																																																																																																					
9500	"Platelets, irradiated"	R	2.2780	$179.13	.	$35.83																																																																																																																																																																																																					
9501	Platelet pheres leukoreduced	R	6.0654	$476.96	.	$95.40																																																																																																																																																																																																					
9502	Platelet pheresis irradiated	R	7.0504	$554.42	.	$110.89																																																																																																																																																																																																					
9503	Fr frz plasma donor retested	R	0.6149	$48.35	.	$9.67																																																																																																																																																																																																					
9504	RBC deglycerolized	R	5.3513	$420.80	.	$84.16																																																																																																																																																																																																					
9505	RBC irradiated	R	2.7185	$213.77	.	$42.76																																																																																																																																																																																																					
9507	"Platelets, pheresis"	R	5.3559	$421.17	.	$84.24																																																																																																																																																																																																					
9508	Plasma 1 donor frz w/in 8 hr	R	0.9208	$72.41	.	$14.49																																																																																																																																																																																																					
9509	"Frozen plasma, pooled, sd"	R	0.7703	$60.57	.	$12.12																																																																																																																																																																																																					
9510	Whole blood for transfusion	R	1.9954	$156.91	.	$31.39																																																																																																																																																																																																					
9511	Cryoprecipitate each unit	R	0.5596	$44.00	.	$8.80																																																																																																																																																																																																					
9512	RBC leukocytes reduced	R	2.3368	$183.76	.	$36.76																																																																																																																																																																																																					
9513	"Plasma, frz between 8-24hour"	R	0.9440	$74.23	.	$14.85																																																																																																																																																																																																					
9514	"Plasma protein fract,5%,50ml"	R	0.1957	$15.39	.	$3.08																																																																																																																																																																																																					
9515	"Platelets, each unit"	R	1.4617	$114.94	.	$22.99																																																																																																																																																																																																					
9516	Plaelet rich plasma unit	R	1.5705	$123.50	.	$24.70																																																																																																																																																																																																					
9517	Red blood cells unit	R	1.8157	$142.78	.	$28.56																																																																																																																																																																																																					
9518	Washed red blood cells unit	R	4.8865	$384.25	.	$76.85																																																																																																																																																																																																					
9519	"Plasmaprotein fract,5%,250ml"	R	0.5964	$46.90	.	$9.38																																																																																																																																																																																																					
9520	Blood split unit	R	1.3056	$102.67	.	$20.54																																																																																																																																																																																																					
9521	Platelets leukoreduced irrad	R	2.1318	$167.64	.	$33.53																																																																																																																																																																																																					
9522	RBC leukoreduced irradiated	R	3.3086	$260.18	.	$52.04																																																																																																																																																																																																					
9523	Cryoprecipitatereducedplasma	R	1.3420	$105.53	.	$21.11																																																																																																																																																																																																					
9524	"Blood, l/r, cmv-neg"	R	2.4500	$192.66	.	$38.54																																																																																																																																																																																																					
9525	"Platelets, hla-m, l/r, unit"	R	9.7826	$769.26	.	$153.86																																																																																																																																																																																																					
9526	Platelets leukocytes reduced	R	1.4840	$116.70	.	$23.34																																																																																																																																																																																																					
9527	"Blood, l/r, froz/degly/wash"	R	3.6050	$283.48	.	$56.70																																																																																																																																																																																																					
9528	"Plt, aph/pher, l/r, cmv-neg"	R	4.3228	$339.93	.	$67.99																																																																																																																																																																																																					
9529	"Blood, l/r, irradiated"	R	1.9741	$155.24	.	$31.05																																																																																																																																																																																																					
9530	Plate pheres leukoredu irrad	R	7.9431	$624.61	.	$124.93																																																																																																																																																																																																					
9531	"Plt, pher, l/r cmv-neg, irr"	R	6.8645	$539.80	.	$107.96																																																																																																																																																																																																					
9532	"RBC, frz/deg/wsh, l/r, irrad"	R	3.5827	$281.73	.	$56.35																																																																																																																																																																																																					
9533	"RBC, l/r, cmv-neg, irrad"	R	3.0270	$238.03	.	$47.61																																																																																																																																																																																																					
9534	Pathogen reduced plasma pool	R	0.9440	$74.23	.	$14.85																																																																																																																																																																																																					
9535	Pathogen reduced plasma sing	R	0.9208	$72.41	.	$14.49																																																																																																																																																																																																					
9536	"Platelets, pathogen reduced"	R	7.9431	$624.61	.	$124.93																																																																																																																																																																																																					
