	Addendum A.-Proposed OPPS APCs for CY 2018																																																																																																																																																																																																																																		
APC  	Group Title	SI	Relative Weight 	Payment Rate 	National Unadjusted Copayment 	Minimum Unadjusted Copayment 																																																																																																																																																																																																																													
0701	Sr89 strontium	K		"$1,275.107"	.	$255.03																																																																																																																																																																																																																													
0726	Dexrazoxane HCl injection	K		$206.330	.	$41.27																																																																																																																																																																																																																													
0731	Sargramostim injection	K		$37.085	.	$7.42																																																																																																																																																																																																																													
0736	Amphotericin b liposome inj	K		$19.533	.	$3.91																																																																																																																																																																																																																													
0738	Rasburicase	K		$259.153	.	$51.84																																																																																																																																																																																																																													
0751	Mechlorethamine hcl inj	K		$265.888	.	$53.18																																																																																																																																																																																																																													
0752	Dactinomycin injection	K		"$1,276.378"	.	$255.28																																																																																																																																																																																																																													
0759	"Naltrexone, depot form"	K		$3.248	.	$0.65																																																																																																																																																																																																																													
0800	Leuprolide acetate	K		"$1,024.549"	.	$204.91																																																																																																																																																																																																																													
0802	Etoposide oral	K		$74.254	.	$14.86																																																																																																																																																																																																																													
0807	Aldesleukin injection	K		"$3,067.640"	.	$613.53																																																																																																																																																																																																																													
0809	Bcg live intravesical vac	K		$128.383	.	$25.68																																																																																																																																																																																																																													
0810	Goserelin acetate implant	K		$349.915	.	$69.99																																																																																																																																																																																																																													
0812	Carmustine injection	K		"$3,846.964"	.	$769.40																																																																																																																																																																																																																													
0820	Daunorubicin injection	K		$39.242	.	$7.85																																																																																																																																																																																																																													
0823	Docetaxel injection	K		$1.888	.	$0.38																																																																																																																																																																																																																													
0825	Nelarabine injection	K		$152.029	.	$30.41																																																																																																																																																																																																																													
0832	Idarubicin hcl injection	K		$41.537	.	$8.31																																																																																																																																																																																																																													
0836	Interferon alfa-2b inj	K		$28.522	.	$5.71																																																																																																																																																																																																																													
0838	Interferon gamma 1-b inj	K		"$6,308.134"	.	"$1,261.63"																																																																																																																																																																																																																													
0840	Inj melphalan hydrochl	K		"$1,804.125"	.	$360.83																																																																																																																																																																																																																													
0843	Pegaspargase injection	K		"$13,912.195"	.	"$2,782.44"																																																																																																																																																																																																																													
0844	Pentostatin injection	K		"$1,883.124"	.	$376.63																																																																																																																																																																																																																													
0849	Rituximab injection	K		$818.308	.	$163.67																																																																																																																																																																																																																													
0850	Streptozocin injection	K		$320.212	.	$64.05																																																																																																																																																																																																																													
0851	Thiotepa injection	K		$872.144	.	$174.43																																																																																																																																																																																																																													
0856	Porfimer sodium injection	K		"$21,219.568"	.	"$4,243.92"																																																																																																																																																																																																																													
0858	Inj cladribine	K		$20.032	.	$4.01																																																																																																																																																																																																																													
0864	Mitoxantrone hydrochl	K		$32.849	.	$6.57																																																																																																																																																																																																																													
0868	Oral aprepitant	K		$11.783	.	$2.36																																																																																																																																																																																																																													
0873	Hyalgan/supartz inj per dose	K		$87.159	.	$17.44																																																																																																																																																																																																																													
0874	Synvisc or synvisc-one	K		$12.539	.	$2.51																																																																																																																																																																																																																													
0875	Euflexxa inj per dose	K		$153.837	.	$30.77																																																																																																																																																																																																																													
0877	Orthovisc inj per dose	K		$153.554	.	$30.72																																																																																																																																																																																																																													
0887	Azathioprine parenteral	K		$250.448	.	$50.09																																																																																																																																																																																																																													
0890	Lymphocyte immune globulin	K		"$1,478.800"	.	$295.76																																																																																																																																																																																																																													
0901	Alpha 1 proteinase inhibitor	K		$4.817	.	$0.97																																																																																																																																																																																																																													
0902	"Injection,onabotulinumtoxinA"	K		$5.941	.	$1.19																																																																																																																																																																																																																													
0903	Cytomegalovirus imm IV /vial	K		"$1,127.740"	.	$225.55																																																																																																																																																																																																																													
0910	Interferon beta-1b / .25 MG	K		$376.299	.	$75.26																																																																																																																																																																																																																													
0925	Factor viii	K		$1.012	.	$0.21																																																																																																																																																																																																																													
0927	Factor viii recombinant	K		$1.199	.	$0.24																																																																																																																																																																																																																													
0928	Factor ix complex	K		$1.339	.	$0.27																																																																																																																																																																																																																													
0929	Anti-inhibitor	K		$1.932	.	$0.39																																																																																																																																																																																																																													
0931	Factor IX non-recombinant	K		$1.157	.	$0.24																																																																																																																																																																																																																													
0932	Factor ix recombinant nos	K		$1.506	.	$0.31																																																																																																																																																																																																																													
0943	Octagam injection	K		$36.087	.	$7.22																																																																																																																																																																																																																													
0944	Gammagard liquid injection	K		$40.431	.	$8.09																																																																																																																																																																																																																													
0946	Hepagam b im injection	K		$58.645	.	$11.73																																																																																																																																																																																																																													
0947	Flebogamma injection	K		$30.175	.	$6.04																																																																																																																																																																																																																													
0948	Gamunex-C/Gammaked	K		$33.930	.	$6.79																																																																																																																																																																																																																													
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		$197.901	.	$39.59																																																																																																																																																																																																																													
1052	"Injection, voriconazole"	K		$3.643	.	$0.73																																																																																																																																																																																																																													
1064	"I131 iodide cap, rx"	K		$40.698	.	$8.14																																																																																																																																																																																																																													
1083	Adalimumab injection	K		"$1,176.926"	.	$235.39																																																																																																																																																																																																																													
1138	"Hepagam b intravenous, inj"	K		$58.645	.	$11.73																																																																																																																																																																																																																													
1139	Protein c concentrate	K		$15.197	.	$3.04																																																																																																																																																																																																																													
1142	Supprelin LA implant	K		"$27,736.926"	.	"$5,547.39"																																																																																																																																																																																																																													
1150	"I131 iodide sol, rx"	K		$12.560	.	$2.52																																																																																																																																																																																																																													
1166	Cytarabine liposome inj	K		$593.988	.	$118.80																																																																																																																																																																																																																													
1168	"Inj, temsirolimus"	K		$67.302	.	$13.47																																																																																																																																																																																																																													
1178	Busulfan injection	K		$36.501	.	$7.31																																																																																																																																																																																																																													
1203	Verteporfin injection	K		$10.758	.	$2.16																																																																																																																																																																																																																													
1207	"Octreotide injection, depot"	K		$175.550	.	$35.11																																																																																																																																																																																																																													
1213	Antihemophilic viii/vwf comp	K		$0.986	.	$0.20																																																																																																																																																																																																																													
1214	Inj IVIG privigen 500 mg	K		$38.867	.	$7.78																																																																																																																																																																																																																													
1232	Mitomycin injection	K		$115.681	.	$23.14																																																																																																																																																																																																																													
1235	Valrubicin injection	K		"$1,158.108"	.	$231.63																																																																																																																																																																																																																													
1236	Levoleucovorin injection	K		$0.707	.	$0.15																																																																																																																																																																																																																													
1237	Inj iron dextran	K		$12.455	.	$2.50																																																																																																																																																																																																																													
1238	Topotecan oral	K		$103.786	.	$20.76																																																																																																																																																																																																																													
1253	Triamcinolone A inj PRS-free	K		$3.738	.	$0.75																																																																																																																																																																																																																													
1263	Antithrombin iii injection	K		$3.222	.	$0.65																																																																																																																																																																																																																													
1268	Xyntha inj	K		$1.222	.	$0.25																																																																																																																																																																																																																													
1274	Edetate calcium disodium inj	K 		"$5,594.422"	.	"$1,118.89"																																																																																																																																																																																																																													
1280	Corticotropin injection	K		"$3,537.092"	.	$707.42																																																																																																																																																																																																																													
1281	Bevacizumab injection	K		$1.840	.	$0.37																																																																																																																																																																																																																													
1289	AbobotulinumtoxinA	K		$7.965	.	$1.60																																																																																																																																																																																																																													
1291	Rilonacept injection	K		$24.091	.	$4.82																																																																																																																																																																																																																													
1295	Sm 153 lexidronam	K		"$12,055.906"	.	"$2,411.19"																																																																																																																																																																																																																													
1296	Degarelix injection	K		$3.634	.	$0.73																																																																																																																																																																																																																													
1297	"Ferumoxytol, non-esrd"	K		$0.892	.	$0.18																																																																																																																																																																																																																													
1311	Canakinumab injection	K		$92.506	.	$18.51																																																																																																																																																																																																																													
1312	Hizentra injection	K		$9.826	.	$1.97																																																																																																																																																																																																																													
1327	Imiglucerase injection	K		$41.798	.	$8.36																																																																																																																																																																																																																													
1340	"Collagenase, clost hist inj"	K		$40.692	.	$8.14																																																																																																																																																																																																																													
1341	Amobarbital 125 MG inj	K		$194.258	.	$38.86																																																																																																																																																																																																																													
1352	Wilate injection	K		$1.010	.	$0.21																																																																																																																																																																																																																													
1353	Belimumab injection	K		$42.581	.	$8.52																																																																																																																																																																																																																													
1408	Cyclophosphamide 100 MG inj	K		$42.306	.	$8.47																																																																																																																																																																																																																													
1413	Lumizyme injection	K		$159.736	.	$31.95																																																																																																																																																																																																																													
1415	Glassia injection	K		$4.357	.	$0.88																																																																																																																																																																																																																													
1416	Factor xiii anti-hem factor	K		$8.192	.	$1.64																																																																																																																																																																																																																													
1417	Gel-one	K		$543.610	.	$108.73																																																																																																																																																																																																																													
1420	Aflibercept injection	K		$980.144	.	$196.03																																																																																																																																																																																																																													
1421	Imported lipodox inj	K		$508.429	.	$101.69																																																																																																																																																																																																																													
1426	Eribulin mesylate injection	K		$108.310	.	$21.67																																																																																																																																																																																																																													
1431	Centruroides immune f(ab)	K		"$4,246.689"	.	$849.34																																																																																																																																																																																																																													
1433	Calcitonin salmon injection	K		"$2,267.891"	.	$453.58																																																																																																																																																																																																																													
1440	Inj desmopressin acetate	K		$13.154	.	$2.64																																																																																																																																																																																																																													
1442	Non-HEU TC-99M add-on/dose	K		$10.000	.	$2.00																																																																																																																																																																																																																													
1443	Icatibant injection	K		$325.607	.	$65.13																																																																																																																																																																																																																													
1458	Phentolaine mesylate inj	K		$334.922	.	$66.99																																																																																																																																																																																																																													
1466	"Inj, vincristine sul lip 1mg"	K		"$2,600.362"	.	$520.08																																																																																																																																																																																																																													
1467	Factor ix recombinan rixubis	K		$1.250	.	$0.25																																																																																																																																																																																																																													
1468	Inj Aripiprazole Ext Rel 1mg	K		$4.584	.	$0.92																																																																																																																																																																																																																													
1469	Inj filgrastim excl biosimil	K		$1.009	.	$0.21																																																																																																																																																																																																																													
1471	"Injection, Pertuzumab, 1 mg"	K		$10.882	.	$2.18																																																																																																																																																																																																																													
1472	Inj beta interferon im 1 mcg	K		$46.206	.	$9.25																																																																																																																																																																																																																													
1474	Certolizumab pegol inj 1mg	K		$7.344	.	$1.47																																																																																																																																																																																																																													
1475	Golimumab for iv use 1mg	K		$24.990	.	$5.00																																																																																																																																																																																																																													
1476	Obinutuzumab inj	K		$57.361	.	$11.48																																																																																																																																																																																																																													
1478	"	Human fibrinogen conc inj"	K		$1.151	.	$0.24																																																																																																																																																																																																																													
1480	"Elosulfase alfa, injection"	K		$224.372	.	$44.88																																																																																																																																																																																																																													
1482	"	Darbepoetin alfa, esrd use"	K		$3.854	.	$0.78																																																																																																																																																																																																																													
1484	"	Pentazocine injection"	K		$136.714	.	$27.35																																																																																																																																																																																																																													
1485	"	Ferumoxytol, esrd use"	K		$0.892	.	$0.18																																																																																																																																																																																																																													
1486	Factor ix fc fusion recomb	K		$2.926	.	$0.59																																																																																																																																																																																																																													
1488	"Injection, ramucirumab"	K		$56.271	.	$11.26																																																																																																																																																																																																																													
1489	"Injection, vedolizumab"	K		$18.127	.	$3.63																																																																																																																																																																																																																													
1490	Inj pembrolizumab	K		$47.300	.	$9.46																																																																																																																																																																																																																													
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		$23.608	.	$4.73																																																																																																																																																																																																																													
1608	Etanercept injection	K		$437.584	.	$87.52																																																																																																																																																																																																																													
1609	"Rho(D) immune globulin h, sd"	K		$22.699	.	$4.54																																																																																																																																																																																																																													
1613	Trastuzumab injection	K		$94.494	.	$18.90																																																																																																																																																																																																																													
1630	"Hep b ig, im"	K		$111.956	.	$22.40																																																																																																																																																																																																																													
1631	Baclofen intrathecal trial	K		$76.836	.	$15.37																																																																																																																																																																																																																													
1643	"Y90 ibritumomab, rx"	K		"$47,111.897"	.	"$9,422.38"																																																																																																																																																																																																																													
1656	Factor viii fc fusion recomb	K		$1.977	.	$0.40																																																																																																																																																																																																																													
1658	"Injection, belinostat, 10mg"	K		$34.392	.	$6.88																																																																																																																																																																																																																													
1660	"Injection, oritavancin"	K		$24.562	.	$4.92																																																																																																																																																																																																																													
1662	Inj tedizolid phosphate	K		$1.270	.	$0.26																																																																																																																																																																																																																													
1669	Erythro lactobionate /500 mg	K		$59.443	.	$11.89																																																																																																																																																																																																																													
1670	Tetanus immune globulin inj	K		$365.149	.	$73.03																																																																																																																																																																																																																													
1675	P32 Na phosphate	K		$56.640	.	$11.33																																																																																																																																																																																																																													
1683	Basiliximab	K		"$3,357.342"	.	$671.47																																																																																																																																																																																																																													
1684	Corticorelin ovine triflutal	K		$8.121	.	$1.63																																																																																																																																																																																																																													
1685	"Darbepoetin alfa, non-esrd"	K		$3.854	.	$0.78																																																																																																																																																																																																																													
1686	"Epoetin alfa, non-esrd"	K		$13.618	.	$2.73																																																																																																																																																																																																																													
1687	Digoxin immune fab (ovine)	K		"$3,267.538"	.	$653.51																																																																																																																																																																																																																													
1688	Ethanolamine oleate	K		$422.372	.	$84.48																																																																																																																																																																																																																													
1689	Fomepizole	K		$7.778	.	$1.56																																																																																																																																																																																																																													
1690	Hemin	K		$22.858	.	$4.58																																																																																																																																																																																																																													
1694	Ziconotide injection	K		$7.328	.	$1.47																																																																																																																																																																																																																													
1695	Nesiritide injection	K		$73.181	.	$14.64																																																																																																																																																																																																																													
1696	Palifermin injection	K		$17.679	.	$3.54																																																																																																																																																																																																																													
1697	Pegaptanib sodium injection	K		"$1,054.700"	.	$210.94																																																																																																																																																																																																																													
1700	Inj secretin synthetic human	K		$34.781	.	$6.96																																																																																																																																																																																																																													
1701	Treprostinil injection	K		$61.237	.	$12.25																																																																																																																																																																																																																													
1704	"Humate-P, inj"	K		$1.086	.	$0.22																																																																																																																																																																																																																													
1705	Factor viia	K		$1.925	.	$0.39																																																																																																																																																																																																																													
1709	Azacitidine injection	K		$2.112	.	$0.43																																																																																																																																																																																																																													
1710	Clofarabine injection	K		$152.368	.	$30.48																																																																																																																																																																																																																													
1711	Vantas implant	K		"$3,128.806"	.	$625.77																																																																																																																																																																																																																													
1712	Paclitaxel protein bound	K		$10.447	.	$2.09																																																																																																																																																																																																																													
1739	"Pegademase bovine, 25 iu"	K		$345.228	.	$69.05																																																																																																																																																																																																																													
1743	Nandrolone decanoate 50 mg	K		$133.360	.	$26.68																																																																																																																																																																																																																													
1745	Radium ra223 dichloride ther	K		$128.745	.	$25.75																																																																																																																																																																																																																													
1746	Factor xiii recomb a-subunit	K		$14.742	.	$2.95																																																																																																																																																																																																																													
1747	Monovisc inj per dose	K		$895.154	.	$179.04																																																																																																																																																																																																																													
1748	Inj tbo filgrastim 1 microg	K		$0.665	.	$0.14																																																																																																																																																																																																																													
1761	"Rolapitant, oral, 1mg"	K		$2.148	.	$0.43																																																																																																																																																																																																																													
1809	"Injection, alemtuzumab"	K		"$1,753.020"	.	$350.61																																																																																																																																																																																																																													
1822	Inj filgrastim gcsf biosimil	G		$0.755	.	$0.16																																																																																																																																																																																																																													
1823	"Injection, dalbavancin"	K		$14.728	.	$2.95																																																																																																																																																																																																																													
1824	"	Ceftaroline fosamil inj"	K		$2.465	.	$0.50																																																																																																																																																																																																																													
1825	Ceftazidime and avibactam	K		$77.131	.	$15.43																																																																																																																																																																																																																													
1826	Hyqvia 100mg immuneglobulin	K		$12.956	.	$2.60																																																																																																																																																																																																																													
1827	Factor viii recomb obizur	K		$3.964	.	$0.80																																																																																																																																																																																																																													
1828	Carbidopa levodopa ent 100ml	K		$2.244	.	$0.45																																																																																																																																																																																																																													
1829	"	Penicillin g benzathine inj"	K		$10.746	.	$2.15																																																																																																																																																																																																																													
1832	Dimethyl sulfoxide 50% 50 ml	K		$533.721	.	$106.75																																																																																																																																																																																																																													
1844	Factor viii pegylated recomb	G		$1.710	.	$0.35																																																																																																																																																																																																																													
1845	Tacrol envarsus ex rel oral	G		$1.231	.	$0.25																																																																																																																																																																																																																													
1846	Factor viii nuwiq recomb 1iu	G		$1.630	.	$0.33																																																																																																																																																																																																																													
1847	"Inj., infliximab biosimilar"	G		$100.306	.	$20.07																																																																																																																																																																																																																													
1848	Artiss fibrin sealant	K		$111.683	.	$22.34																																																																																																																																																																																																																													
1849	Foscarnet sodium injection	K		$75.172	.	$15.04																																																																																																																																																																																																																													
1850	Gamma globulin 1 cc inj	K		$35.738	.	$7.15																																																																																																																																																																																																																													
1851	Gamma globulin > 10 cc inj	K		$357.381	.	$71.48																																																																																																																																																																																																																													
1852	Interferon beta-1a inj	K		$482.210	.	$96.45																																																																																																																																																																																																																													
1853	Minocycline hydrochloride	K		$1.505	.	$0.31																																																																																																																																																																																																																													
1854	Pentobarbital sodium inj	K		$47.343	.	$9.47																																																																																																																																																																																																																													
1856	Factor viii recomb novoeight	K		$1.287	.	$0.26																																																																																																																																																																																																																													
1857	"Inj, factor x, (human), 1iu"	K		$6.516	.	$1.31																																																																																																																																																																																																																													
1859	Argatroban nonesrd use 1mg	K		$1.619	.	$0.33																																																																																																																																																																																																																													
1860	Monoclonal antibodies	K		$231.220	.	$46.25																																																																																																																																																																																																																													
1861	"Inj., bendeka 1 mg"	G		$23.457	.	$4.70																																																																																																																																																																																																																													
1862	Gel-syn injection 0.1 mg	G		$2.177	.	$0.44																																																																																																																																																																																																																													
1863	Inj diclofenac sodium 0.5mg	K		$0.164	.	$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	216.2687	"$16,540.88"	.	"$3,308.18"																																																																																																																																																																																																																													
2632	Iodine I-125 sodium iodide	U	0.3410	$26.08	.	$5.22																																																																																																																																																																																																																													
2634	"Brachytx, non-str, HA, I-125"	U	1.5006	$114.77	.	$22.96																																																																																																																																																																																																																													
2635	"Brachytx, non-str, HA, P-103"	U	0.3336	$25.51	.	$5.11																																																																																																																																																																																																																													
2636	"Brachy linear, non-str,P-103"	U	0.3864	$29.55	.	$5.91																																																																																																																																																																																																																													
2638	"Brachytx, stranded, I-125"	U	0.4810	$36.79	.	$7.36																																																																																																																																																																																																																													
2639	"Brachytx, non-stranded,I-125"	U	0.4545	$34.76	.	$6.96																																																																																																																																																																																																																													
2640	"Brachytx, stranded, P-103"	U	0.9872	$75.50	.	$15.10																																																																																																																																																																																																																													
2641	"Brachytx, non-stranded,P-103"	U	0.8710	$66.62	.	$13.33																																																																																																																																																																																																																													
2642	"Brachytx, stranded, C-131"	U	1.1167	$85.41	.	$17.09																																																																																																																																																																																																																													
2643	"Brachytx, non-stranded,C-131"	U	1.1014	$84.24	.	$16.85																																																																																																																																																																																																																													
2644	Brachytx cesium-131 chloride	U	1.3202	$100.97	.	$20.20																																																																																																																																																																																																																													
2645	"Brachytx, non-str, Gold-198"	U	1.6098	$123.12	.	$24.63																																																																																																																																																																																																																													
2646	"Brachytx, non-str, HDR Ir-192"	U	3.7356	$285.71	.	$57.15																																																																																																																																																																																																																													
2647	"Brachytx, NS, Non-HDRIr-192"	U	0.2613	$19.99	.	$4.00																																																																																																																																																																																																																													
2698	"Brachytx, stranded, NOS"	U	0.4810	$36.79	.	$7.36																																																																																																																																																																																																																													
2699	"Brachytx, non-stranded, NOS"	U	0.2613	$19.99	.	$4.00																																																																																																																																																																																																																													
2731	"Immune globulin, powder"	K		$32.638	.	$6.53																																																																																																																																																																																																																													
2770	Quinupristin/dalfopristin	K		$436.772	.	$87.36																																																																																																																																																																																																																													
4001	Echo guidance radiotherapy	S		$23.03	.	$4.61																																																																																																																																																																																																																													
4002	Stereoscopic x-ray guidance 	S		$56.50	.	$11.30																																																																																																																																																																																																																													
4003	"Radiation treatment delivery, MeV <= 5; simple "	S		$200.47	.	$40.09																																																																																																																																																																																																																													
4004	"Radiation treatment delivery, 6-10 MeV; simple "	S		$147.56	.	$29.51																																																																																																																																																																																																																													
4005	"Radiation treatment delivery, 11-19 MeV; simple "	S		$147.20	.	$29.44																																																																																																																																																																																																																													
4006	"Radiation treatment delivery, MeV>=20; simple "	S		$147.56	.	$29.51																																																																																																																																																																																																																													
4007	"Radiation treatment delivery, MeV<=5; intermediate"	S		$301.96	.	$60.39																																																																																																																																																																																																																													
4008	"Radiation treatment delivery, 6-10 MeV; intermediate "	S		$204.42	.	$40.88																																																																																																																																																																																																																													
4009	"Radiation treatment delivery, 11-19 MeV; intermediate"	S		$203.71	.	$40.74																																																																																																																																																																																																																													
4010	"Radiation treatment delivery, MeV >=20; intermediate"	S		$202.27	.	$40.45																																																																																																																																																																																																																													
4011	"Radiation treatment delivery, MeV<=5; complex"	S		$285.04	.	$57.01																																																																																																																																																																																																																													
4012	"Radiation treatment delivery, 6-10 MeV; complex"	S		$269.93	.	$53.99																																																																																																																																																																																																																													
4013	"Radiation treatment delivery, 11-19 MeV; complex"	S		$270.29	.	$54.06																																																																																																																																																																																																																													
4014	"Radiation treatment delivery, MeV >=20; complex"	S		$270.65	.	$54.13																																																																																																																																																																																																																													
5012	Clinic Visits and Related Services	V	1.4328	$109.58	.	$21.92																																																																																																																																																																																																																													
5021	Level 1 Type A ED Visits	V	0.8792	$67.24	.	$13.45																																																																																																																																																																																																																													
5022	Level 2 Type A ED Visits	V	1.5913	$121.71	.	$24.35																																																																																																																																																																																																																													
5023	Level 3 Type A ED Visits	V	2.7981	$214.01	.	$42.81																																																																																																																																																																																																																													
5024	Level 4 Type A ED Visits	V	4.5291	$346.40	.	$69.28																																																																																																																																																																																																																													
5025	Level 5 Type A ED Visits	V	6.6139	$505.85	.	$101.17																																																																																																																																																																																																																													
5031	Level 1 Type B ED Visits	V	1.3268	$101.48	.	$20.30																																																																																																																																																																																																																													
5032	Level 2 Type B ED Visits	V	1.1696	$89.45	.	$17.89																																																																																																																																																																																																																													
5033	Level 3 Type B ED Visits	V	2.0213	$154.60	.	$30.92																																																																																																																																																																																																																													
5034	Level 4 Type B ED Visits	V	2.6050	$199.24	.	$39.85																																																																																																																																																																																																																													
5035	Level 5 Type B ED Visits	V	3.6042	$275.66	.	$55.14																																																																																																																																																																																																																													
5041	Critical Care	S	9.3555	$715.54	.	$143.11																																																																																																																																																																																																																													
5045	Trauma Response with Critical Care	S	12.1681	$930.65	.	$186.13																																																																																																																																																																																																																													
5051	Level 1 Skin Procedures	T	2.1546	$164.79	.	$32.96																																																																																																																																																																																																																													
5052	Level 2 Skin Procedures	T	4.0190	$307.39	.	$61.48																																																																																																																																																																																																																													
5053	Level 3 Skin Procedures	T	6.1297	$468.82	.	$93.77																																																																																																																																																																																																																													
5054	Level 4 Skin Procedures	T	19.8886	"$1,521.14"	.	$304.23																																																																																																																																																																																																																													
5055	Level 5 Skin Procedures	T	33.5328	"$2,564.69"	.	$512.94																																																																																																																																																																																																																													
5061	Hyperbaric Oxygen	S	1.4632	$111.91	.	$22.39																																																																																																																																																																																																																													
5071	Level 1 Excision/ Biopsy/ Incision and Drainage	T	7.2217	$552.34	.	$110.47																																																																																																																																																																																																																													
5072	Level 2 Excision/ Biopsy/ Incision and Drainage	J1	16.5858	"$1,268.53"	.	$253.71																																																																																																																																																																																																																													
5073	Level 3 Excision/ Biopsy/ Incision and Drainage	J1	29.0583	"$2,222.47"	.	$444.50																																																																																																																																																																																																																													
5091	Level 1 Breast/Lymphatic Surgery and Related Procedures	J1	34.3661	"$2,628.42"	.	$525.69																																																																																																																																																																																																																													
5092	Level 2 Breast/Lymphatic Surgery and Related Procedures	J1	60.3596	"$4,616.48"	.	$923.30																																																																																																																																																																																																																													
5093	Level 3 Breast/Lymphatic Surgery and Related Procedures	J1	91.8336	"$7,023.71"	.	"$1,404.75"																																																																																																																																																																																																																													
5094	Level 4 Breast/Lymphatic Surgery and Related Procedures	J1	136.0714	"$10,407.15"	.	"$2,081.43"																																																																																																																																																																																																																													
5101	Level 1 Strapping and Cast Application	T	1.7149	$131.16	.	$26.24																																																																																																																																																																																																																													
5102	Level 2 Strapping and Cast Application	T	3.0689	$234.72	.	$46.95																																																																																																																																																																																																																													
5111	Level 1 Musculoskeletal Procedures	T	2.7924	$213.57	.	$42.72																																																																																																																																																																																																																													
5112	Level 2 Musculoskeletal Procedures	J1	16.4859	"$1,260.89"	.	$252.18																																																																																																																																																																																																																													
5113	Level 3 Musculoskeletal Procedures	J1	32.6955	"$2,500.65"	.	$500.13																																																																																																																																																																																																																													
5114	Level 4 Musculoskeletal Procedures	J1	70.4108	"$5,385.23"	.	"$1,077.05"																																																																																																																																																																																																																													
5115	Level 5 Musculoskeletal Procedures	J1	129.6065	"$9,912.69"	.	"$1,982.54"																																																																																																																																																																																																																													
5116	Level 6 Musculoskeletal Procedures	J1	198.4094	"$15,174.95"	.	"$3,034.99"																																																																																																																																																																																																																													
5151	Level 1 Airway Endoscopy	T	1.9712	$150.76	.	$30.16																																																																																																																																																																																																																													
5152	Level 2 Airway Endoscopy	T	4.6437	$355.16	.	$71.04																																																																																																																																																																																																																													
5153	Level 3 Airway Endoscopy	J1	16.5216	"$1,263.62"	.	$252.73																																																																																																																																																																																																																													
5154	Level 4 Airway Endoscopy	J1	32.3758	"$2,476.20"	.	$495.24																																																																																																																																																																																																																													
5155	Level 5 Airway Endoscopy	J1	60.5218	"$4,628.89"	.	$925.78																																																																																																																																																																																																																													
5161	Level 1 ENT Procedures	T	2.4889	$190.36	.	$38.08																																																																																																																																																																																																																													
5162	Level 2 ENT Procedures	T	5.9355	$453.96	.	$90.80																																																																																																																																																																																																																													
5163	Level 3 ENT Procedures	T	14.4241	"$1,103.20"	.	$220.64																																																																																																																																																																																																																													
5164	Level 4 ENT Procedures	J1	27.6624	"$2,115.70"	.	$423.14																																																																																																																																																																																																																													
5165	Level 5 ENT Procedures	J1	53.4884	"$4,090.95"	.	$818.19																																																																																																																																																																																																																													
5166	Cochlear Implant Procedure	J1	417.9354	"$31,964.95"	"$7,835.75"	"$6,392.99"																																																																																																																																																																																																																													
5181	Level 1 Vascular Procedures	T	7.6630	$586.09	.	$117.22																																																																																																																																																																																																																													
5182	Level 2 Vascular Procedures	T	12.3600	$945.33	.	$189.07																																																																																																																																																																																																																													
5183	Level 3 Vascular Procedures	T	31.5066	"$2,409.72"	.	$481.95																																																																																																																																																																																																																													
5184	Level 4 Vascular Procedures	T	53.4007	"$4,084.25"	.	$816.85																																																																																																																																																																																																																													
5191	Level 1 Endovascular Procedures	J1	37.1951	"$2,844.79"	$871.76	$568.96																																																																																																																																																																																																																													
5192	Level 2 Endovascular Procedures	J1	65.3656	"$4,999.36"	.	$999.88																																																																																																																																																																																																																													
5193	Level 3 Endovascular Procedures	J1	133.5989	"$10,218.04"	.	"$2,043.61"																																																																																																																																																																																																																													
5194	Level 4 Endovascular Procedures	J1	203.6133	"$15,572.96"	.	"$3,114.60"																																																																																																																																																																																																																													
5200	Implantation Wireless PA Pressure Monitor	J1	425.6711	"$32,556.60"	"$9,081.23"	"$6,511.32"																																																																																																																																																																																																																													
5211	Level 1 Electrophysiologic Procedures	J1	11.3373	$867.11	.	$173.43																																																																																																																																																																																																																													
5212	Level 2 Electrophysiologic Procedures	J1	67.2824	"$5,145.96"	.	"$1,029.20"																																																																																																																																																																																																																													
5213	Level 3 Electrophysiologic Procedures	J1	233.6145	"$17,867.54"	.	"$3,573.51"																																																																																																																																																																																																																													
5221	Level1 Pacemaker and Similar Procedures	T	34.3896	"$2,630.22"	.	$526.05																																																																																																																																																																																																																													
5222	Level 2 Pacemaker and Similar Procedures	J1	93.9371	"$7,184.59"	.	"$1,436.92"																																																																																																																																																																																																																													
5223	Level 3 Pacemaker and Similar Procedures	J1	123.9975	"$9,483.70"	.	"$1,896.74"																																																																																																																																																																																																																													
5224	Level 4 Pacemaker and Similar Procedures	J1	222.7640	"$17,037.66"	.	"$3,407.54"																																																																																																																																																																																																																													
5231	Level 1 ICD and Similar Procedures	J1	285.7050	"$21,851.58"	.	"$4,370.32"																																																																																																																																																																																																																													
5232	Level 2 ICD and Similar Procedures	J1	399.5516	"$30,558.91"	.	"$6,111.79"																																																																																																																																																																																																																													
5241	Level 1 Blood Product Exchange and Related Services	S	4.7964	$366.84	.	$73.37																																																																																																																																																																																																																													
5242	Level 2 Blood Product Exchange and Related Services	S	15.6035	"$1,193.40"	.	$238.68																																																																																																																																																																																																																													
5243	Level 3 Blood Product Exchange and Related Services	S	41.0024	"$3,135.99"	.	$627.20																																																																																																																																																																																																																													
5244	Level 4 Blood Product Exchange and Related Services	J1	340.5946	"$26,049.70"	.	"$5,209.94"																																																																																																																																																																																																																													
5301	Level 1 Upper GI Procedures	T	9.3916	$718.30	.	$143.66																																																																																																																																																																																																																													
5302	Level 2 Upper GI Procedures 	J1	17.9783	"$1,375.03"	.	$275.01																																																																																																																																																																																																																													
5303	Level 3 Upper GI Procedures	J1	34.3989	"$2,630.93"	.	$526.19																																																																																																																																																																																																																													
5311	Level 1 Lower GI Procedures 	T	9.0264	$690.37	.	$138.08																																																																																																																																																																																																																													
5312	Level 2 Lower GI Procedures 	T	11.8594	$907.04	.	$181.41																																																																																																																																																																																																																													
5313	Level 3 Lower GI Procedures 	J1	29.2304	"$2,235.63"	.	$447.13																																																																																																																																																																																																																													
5331	Complex GI Procedures	J1	53.8587	"$4,119.27"	.	$823.86																																																																																																																																																																																																																													
5341	Abdominal/Peritoneal/Biliary and Related Procedures	J1	36.4560	"$2,788.26"	.	$557.66																																																																																																																																																																																																																													
5361	Level 1 Laparoscopy and Related Services	J1	56.7532	"$4,340.65"	.	$868.13																																																																																																																																																																																																																													
5362	Level 2 Laparoscopy and Related Services	J1	94.3155	"$7,213.53"	"$1,526.22"	"$1,442.71"																																																																																																																																																																																																																													
5371	Level 1 Urology and Related Services	T	2.9104	$222.60	.	$44.52																																																																																																																																																																																																																													
5372	Level 2 Urology and Related Services	T	7.1555	$547.27	.	$109.46																																																																																																																																																																																																																													
5373	Level 3 Urology and Related Services	J1	21.4515	"$1,640.68"	.	$328.14																																																																																																																																																																																																																													
5374	Level 4 Urology and Related Services	J1	34.1200	"$2,609.60"	.	$521.92																																																																																																																																																																																																																													
5375	Level 5 Urology and Related Services	J1	47.0385	"$3,597.65"	.	$719.53																																																																																																																																																																																																																													
5376	Level 6 Urology and Related Services	J1	97.3825	"$7,448.11"	.	"$1,489.63"																																																																																																																																																																																																																													
5377	Level 7 Urology and Related Services	J1	199.0093	"$15,220.83"	.	"$3,044.17"																																																																																																																																																																																																																													
5401	Dialysis	S	7.5533	$577.70	.	$115.54																																																																																																																																																																																																																													
5411	Level 1 Gynecologic Procedures	T	2.0159	$154.18	.	$30.84																																																																																																																																																																																																																													
5412	Level 2 Gynecologic Procedures	T	3.6317	$277.76	.	$55.56																																																																																																																																																																																																																													
5413	Level 3 Gynecologic Procedures	T	8.8930	$680.16	.	$136.04																																																																																																																																																																																																																													
5414	Level 4 Gynecologic Procedures	J1	28.6203	"$2,188.97"	.	$437.80																																																																																																																																																																																																																													
5415	Level 5 Gynecologic Procedures	J1	51.3414	"$3,926.74"	$902.82	$785.35																																																																																																																																																																																																																													
5416	Level 6 Gynecologic Procedures	J1	78.2379	"$5,983.87"	"$1,405.70"	"$1,196.78"																																																																																																																																																																																																																													
5431	Level 1 Nerve Procedures	J1	20.9349	"$1,601.16"	.	$320.24																																																																																																																																																																																																																													
5432	Level 2 Nerve Procedures	J1	58.9083	"$4,505.48"	.	$901.10																																																																																																																																																																																																																													
5441	Level 1 Nerve Injections	T	3.1764	$242.94	.	$48.59																																																																																																																																																																																																																													
5442	Level 2 Nerve Injections	T	6.9049	$528.11	.	$105.63																																																																																																																																																																																																																													
5443	Level 3 Nerve Injections	T	8.6037	$658.04	.	$131.61																																																																																																																																																																																																																													
5461	Level 1 Neurostimulator and Related Procedures	T	38.1785	"$2,920.01"	.	$584.01																																																																																																																																																																																																																													
5462	Level 2 Neurostimulator and Related Procedures	J1	78.2340	"$5,983.57"	.	"$1,196.72"																																																																																																																																																																																																																													
5463	Level 3 Neurostimulator and Related Procedures	J1	234.9579	"$17,970.29"	.	"$3,594.06"																																																																																																																																																																																																																													
5464	Level 4 Neurostimulator and Related Procedures	J1	354.6497	"$27,124.67"	.	"$5,424.94"																																																																																																																																																																																																																													
5471	Implantation of Drug Infusion Device	J1	208.4909	"$15,946.01"	.	"$3,189.21"																																																																																																																																																																																																																													
5481	Laser Eye Procedures	T	6.1893	$473.38	$101.51	$94.68																																																																																																																																																																																																																													
5491	Level 1 Intraocular Procedures	J1	24.4268	"$1,868.23"	.	$373.65																																																																																																																																																																																																																													
5492	Level 2 Intraocular Procedures	J1	45.6993	"$3,495.22"	.	$699.05																																																																																																																																																																																																																													
5493	Level 3 Intraocular Procedures	J1	127.2185	"$9,730.05"	.	"$1,946.01"																																																																																																																																																																																																																													
5494	Level 4 Intraocular Procedures	J1	114.8315	"$8,782.66"	.	"$1,756.54"																																																																																																																																																																																																																													
5495	Level 5 Intraocular Procedures	J1	221.7930	"$16,963.39"	.	"$3,392.68"																																																																																																																																																																																																																													
5501	"Level 1 Extraocular, Repair, and Plastic Eye Procedures"	T	3.4281	$262.19	.	$52.44																																																																																																																																																																																																																													
5502	"Level 2 Extraocular, Repair, and Plastic Eye Procedures"	T	10.3564	$792.09	.	$158.42																																																																																																																																																																																																																													
5503	"Level 3 Extraocular, Repair, and Plastic Eye Procedures"	J1	22.6388	"$1,731.48"	.	$346.30																																																																																																																																																																																																																													
5504	"Level 4 Extraocular, Repair, and Plastic Eye Procedures"	J1	36.8383	"$2,817.50"	.	$563.50																																																																																																																																																																																																																													
5521	Level 1 Imaging without Contrast	S	0.7736	$59.17	.	$11.84																																																																																																																																																																																																																													
5522	Level 2 Imaging without Contrast	S	1.2622	$96.54	.	$19.31																																																																																																																																																																																																																													
5523	Level 3 Imaging without Contrast	S	1.9569	$149.67	.	$29.94																																																																																																																																																																																																																													
5524	Level 4 Imaging without Contrast	S	3.4526	$264.07	.	$52.82																																																																																																																																																																																																																													
5525	Level 5 Imaging without Contrast	S	6.1841	$472.98	.	$94.60																																																																																																																																																																																																																													
5571	Level 1 Imaging with Contrast	S	2.9726	$227.35	.	$45.47																																																																																																																																																																																																																													
5572	Level 2 Imaging with Contrast	S	4.4342	$339.14	.	$67.83																																																																																																																																																																																																																													
5573	Level 3 Imaging with Contrast	S	6.3768	$487.72	.	$97.55																																																																																																																																																																																																																													
5591	Level 1 Nuclear Medicine and Related Services 	S	4.4096	$337.26	.	$67.46																																																																																																																																																																																																																													
5592	Level 2 Nuclear Medicine and Related Services	S	5.7471	$439.56	.	$87.92																																																																																																																																																																																																																													
5593	Level 3 Nuclear Medicine and Related Services 	S	15.2099	"$1,163.30"	.	$232.66																																																																																																																																																																																																																													
5594	Level 4 Nuclear Medicine and Related Services	S	17.3855	"$1,329.70"	.	$265.94																																																																																																																																																																																																																													
5611	Level 1 Therapeutic Radiation Treatment Preparation	S	1.5999	$122.37	$32.44	$24.48																																																																																																																																																																																																																													
5612	Level 2 Therapeutic Radiation Treatment Preparation	S	4.1252	$315.51	.	$63.11																																																																																																																																																																																																																													
5613	Level 3 Therapeutic Radiation Treatment Preparation	S	15.1509	"$1,158.79"	.	$231.76																																																																																																																																																																																																																													
5621	Level 1 Radiation Therapy	S	1.6271	$124.45	.	$24.89																																																																																																																																																																																																																													
5622	Level 2 Radiation Therapy	S	2.7958	$213.83	.	$42.77																																																																																																																																																																																																																													
5623	Level 3 Radiation Therapy	S	6.6900	$511.67	.	$102.34																																																																																																																																																																																																																													
5624	Level 4 Radiation Therapy	S	9.0795	$694.43	.	$138.89																																																																																																																																																																																																																													
5625	Level 5 Radiation Therapy	S	12.3135	$941.77	.	$188.36																																																																																																																																																																																																																													
5626	Level 6 Radiation Therapy	S 	21.3850	"$1,635.59"	.	$327.12																																																																																																																																																																																																																													
5627	Level 7 Radiation Therapy	J1	95.9065	"$7,335.22"	.	"$1,467.05"																																																																																																																																																																																																																													
5661	Therapeutic Nuclear Medicine	S	3.0125	$230.41	.	$46.09																																																																																																																																																																																																																													
5671	Level 1 Pathology	S	0.5544	$42.40	.	$8.48																																																																																																																																																																																																																													
5672	Level 2 Pathology	S	1.5064	$115.21	.	$23.05																																																																																																																																																																																																																													
5673	Level 3 Pathology	S	2.5412	$194.36	.	$38.88																																																																																																																																																																																																																													
5674	Level 4 Pathology	S	6.2453	$477.66	.	$95.54																																																																																																																																																																																																																													
5691	Level 1 Drug Administration	S	0.4672	$35.73	.	$7.15																																																																																																																																																																																																																													
5692	Level 2 Drug Administration	S	0.7353	$56.24	.	$11.25																																																																																																																																																																																																																													
5693	Level 3 Drug Administration	S	2.4078	$184.16	.	$36.84																																																																																																																																																																																																																													
5694	Level 4 Drug Administration	S	3.7475	$286.62	.	$57.33																																																																																																																																																																																																																													
5721	Level1 Diagnostic Tests and Related Services	S	1.6943	$129.59	.	$25.92																																																																																																																																																																																																																													
5722	Level 2 Diagnostic Tests and Related Services	S	3.1669	$242.21	.	$48.45																																																																																																																																																																																																																													
5723	Level 3 Diagnostic Tests and Related Services	S	5.6077	$428.89	.	$85.78																																																																																																																																																																																																																													
5724	Level 4 Diagnostic Tests and Related Services	S	11.4754	$877.67	.	$175.54																																																																																																																																																																																																																													
5731	Level 1 Minor Procedures	S	0.1851	$14.16	.	$2.84																																																																																																																																																																																																																													
5732	Level 2 Minor Procedures	S	0.3877	$29.65	.	$5.93																																																																																																																																																																																																																													
5733	Level 3 Minor Procedures	S	0.6958	$53.22	.	$10.65																																																																																																																																																																																																																													
5734	Level 4 Minor Procedures	S	1.2326	$94.27	.	$18.86																																																																																																																																																																																																																													
5735	Level 5 Minor Procedures	S	3.4675	$265.20	.	$53.04																																																																																																																																																																																																																													
5741	Level 1 Electronic Analysis of Devices	S	0.4798	$36.70	.	$7.34																																																																																																																																																																																																																													
5742	Level 2 Electronic Analysis of Devices	S	1.4607	$111.72	.	$22.35																																																																																																																																																																																																																													
5743	Level 3 Electronic Analysis of Devices	S	3.3191	$253.85	.	$50.77																																																																																																																																																																																																																													
5771	Cardiac Rehabilitation	S	1.4867	$113.71	.	$22.75																																																																																																																																																																																																																													
5781	Resuscitation and Cardioversion	S	6.5261	$499.14	.	$99.83																																																																																																																																																																																																																													
5791	Pulmonary Treatment	S	2.3048	$176.28	.	$35.26																																																																																																																																																																																																																													
5801	Ventilation Initiation and Management	S	5.7120	$436.87	.	$87.38																																																																																																																																																																																																																													
5811	Manipulation Therapy	S	0.3446	$26.36	.	$5.28																																																																																																																																																																																																																													
5821	Level 1 Health and Behavior Services	S	0.3487	$26.67	.	$5.34																																																																																																																																																																																																																													
5822	Level 2 Health and Behavior Services	S	0.9011	$68.92	.	$13.79																																																																																																																																																																																																																													
5823	Level 3 Health and Behavior Services	S	1.6098	$123.12	.	$24.63																																																																																																																																																																																																																													
5853	Partial Hospitalization (3 or more services) for CMHCs	P	1.6192	$123.84	.	$24.77																																																																																																																																																																																																																													
5863	Partial Hospitalization (3 or more services) for Hospital-based PHPs	P	2.6851	$205.36	.	$41.08																																																																																																																																																																																																																													
5871	Dental Procedures	S	11.3451	$867.71	.	$173.55																																																																																																																																																																																																																													
5881	Ancillary Outpatient Services When Patient Dies	J1	92.6405	"$7,085.42"	.	"$1,417.09"																																																																																																																																																																																																																													
7000	Amifostine	K		$519.005	.	$103.81																																																																																																																																																																																																																													
7011	Oprelvekin injection	K		$467.216	.	$93.45																																																																																																																																																																																																																													
7034	"	Somatropin injection"	K		$81.590	.	$16.32																																																																																																																																																																																																																													
7035	Teniposide	K		"$2,592.792"	.	$518.56																																																																																																																																																																																																																													
7041	Tirofiban HCl	K		$9.811	.	$1.97																																																																																																																																																																																																																													
7043	Infliximab not biosimil 10mg	K		$85.591	.	$17.12																																																																																																																																																																																																																													
7046	Doxorubicin inj 10mg	K		$408.154	.	$81.64																																																																																																																																																																																																																													
7048	Alteplase recombinant	K		$81.351	.	$16.28																																																																																																																																																																																																																													
7308	Aminolevulinic acid hcl top	K		$367.809	.	$73.57																																																																																																																																																																																																																													
8004	Ultrasound Composite	S	3.8038	$290.93	.	$58.19																																																																																																																																																																																																																													
8005	CT and CTA without Contrast Composite	S	3.5245	$269.56	.	$53.92																																																																																																																																																																																																																													
8006	CT and CTA with Contrast Composite	S	6.3234	$483.63	.	$96.73																																																																																																																																																																																																																													
8007	MRI and MRA without Contrast Composite	S	7.1765	$548.88	.	$109.78																																																																																																																																																																																																																													
8008	MRI and MRA with Contrast Composite	S	11.1601	$853.56	.	$170.72																																																																																																																																																																																																																													
8010	Mental Health Services Composite	S	2.6851	$205.36	.	$41.08																																																																																																																																																																																																																													
8011	Comprehensive Observation Services	J2	29.9325	"$2,289.33"	.	$457.87																																																																																																																																																																																																																													
9002	Tenecteplase injection	K		$102.418	.	$20.49																																																																																																																																																																																																																													
9003	Palivizumab	K		$176.350	.	$35.27																																																																																																																																																																																																																													
9005	Reteplase injection	K		"$2,301.910"	.	$460.39																																																																																																																																																																																																																													
9006	Tacrolimus injection	K		$170.847	.	$34.17																																																																																																																																																																																																																													
9012	Arsenic trioxide injection	K		$64.925	.	$12.99																																																																																																																																																																																																																													
9018	"Inj, rimabotulinumtoxinB"	K		$11.747	.	$2.35																																																																																																																																																																																																																													
9024	Amphotericin b lipid complex	K		$13.182	.	$2.64																																																																																																																																																																																																																													
9032	Baclofen 10 MG injection	K		$168.687	.	$33.74																																																																																																																																																																																																																													
9033	Cidofovir injection	K		$522.116	.	$104.43																																																																																																																																																																																																																													
9038	Inj estrogen conjugate	K		$278.389	.	$55.68																																																																																																																																																																																																																													
9042	Glucagon hydrochloride	K		$200.817	.	$40.17																																																																																																																																																																																																																													
9043	Afstyla Factor VIII recomb	G		$1.417	.	$0.29																																																																																																																																																																																																																													
9044	Ibutilide fumarate injection	K		$192.500	.	$38.50																																																																																																																																																																																																																													
9052	Fluciciovine F-18	G		$389.550	.	$0.00																																																																																																																																																																																																																													
9056	Gallium Ga-68	G		$66.741	.	$0.00																																																																																																																																																																																																																													
9058	Buprenorphine implant 74.2mg	G		"$1,260.592"	.	$252.12																																																																																																																																																																																																																													
9059	Vonvendi inj 1 iu vwf:rco	G		$2.268	.	$0.46																																																																																																																																																																																																																													
9063	Rh ig minidose im	K		$284.600	.	$56.92																																																																																																																																																																																																																													
9064	Aripiprazole injection	K		$0.820	.	$0.17																																																																																																																																																																																																																													
9065	Argatroban esrd dialysis 1mg	K		$23.230	.	$4.65																																																																																																																																																																																																																													
9066	Inj dihydroergotamine mesylt	K		$161.554	.	$32.32																																																																																																																																																																																																																													
9067	Etidronate disodium inj	K		$1.420	.	$0.29																																																																																																																																																																																																																													
9068	Mecasermin injection	K		$210.150	.	$42.03																																																																																																																																																																																																																													
9069	Phenobarbital sodium inj	K		$38.367	.	$7.68																																																																																																																																																																																																																													
9070	Aurothioglucose injeciton	K		$23.070	.	$4.62																																																																																																																																																																																																																													
9071	Capsaicin 8% patch	K		$2.978	.	$0.60																																																																																																																																																																																																																													
9072	Fosphenytoin inj pe	K		$6.915	.	$1.39																																																																																																																																																																																																																													
9073	Radiesse injection	K		$137.260	.	$27.46																																																																																																																																																																																																																													
9074	"Inj, Makena"	K		$2.720	.	$0.55																																																																																																																																																																																																																													
9104	Antithymocyte globuln rabbit	K		$687.769	.	$137.56																																																																																																																																																																																																																													
9108	Thyrotropin injection	K		"$1,566.931"	.	$313.39																																																																																																																																																																																																																													
9119	"Injection, pegfilgrastim 6mg"	K		"$4,191.344"	.	$838.27																																																																																																																																																																																																																													
9120	"Injection, Fulvestrant"	K		$96.243	.	$19.25																																																																																																																																																																																																																													
9122	Triptorelin pamoate	K		$365.440	.	$73.09																																																																																																																																																																																																																													
9124	Daptomycin injection	K		$0.675	.	$0.14																																																																																																																																																																																																																													
9125	"Risperidone, long acting"	K		$8.170	.	$1.64																																																																																																																																																																																																																													
9126	Natalizumab injection	K		$18.797	.	$3.76																																																																																																																																																																																																																													
9130	"Inj, Imm Glob Bivigam, 500mg"	K		$38.310	.	$7.67																																																																																																																																																																																																																													
9131	"Inj, Ado-trastuzumab Emt 1mg"	K		$29.524	.	$5.91																																																																																																																																																																																																																													
9132	"Kcentra, per i.u."	K		$1.846	.	$0.37																																																																																																																																																																																																																													
9133	"Rabies ig, im/sc"	K		$296.706	.	$59.35																																																																																																																																																																																																																													
9134	"Rabies ig, heat treated"	K		$296.338	.	$59.27																																																																																																																																																																																																																													
9135	"Varicella-zoster ig, im"	K		"$1,230.978"	.	$246.20																																																																																																																																																																																																																													
9139	"Rabies vaccine, im"	K		$269.910	.	$53.99																																																																																																																																																																																																																													
9140	"Rabies vaccine, id"	K		$141.020	.	$28.21																																																																																																																																																																																																																													
9171	Factor ix idelvion inj	G		$4.150	.	$0.83																																																																																																																																																																																																																													
9207	Bortezomib injection	K		$46.247	.	$9.25																																																																																																																																																																																																																													
9208	Agalsidase beta injection	K		$166.058	.	$33.22																																																																																																																																																																																																																													
9209	Laronidase injection	K		$30.611	.	$6.13																																																																																																																																																																																																																													
9210	Palonosetron hcl	K		$22.627	.	$4.53																																																																																																																																																																																																																													
9213	Pemetrexed injection	K		$64.041	.	$12.81																																																																																																																																																																																																																													
9214	Bevacizumab injection	K		$73.604	.	$14.73																																																																																																																																																																																																																													
9215	Cetuximab injection	K		$56.385	.	$11.28																																																																																																																																																																																																																													
9217	Leuprolide acetate suspnsion	K		$216.008	.	$43.21																																																																																																																																																																																																																													
9224	Galsulfase injection	K		$369.418	.	$73.89																																																																																																																																																																																																																													
9225	Fluocinolone acetonide implt	K		"$20,110.392"	.	"$4,022.08"																																																																																																																																																																																																																													
9228	Tigecycline injection	K		$3.178	.	$0.64																																																																																																																																																																																																																													
9229	Ibandronate sodium injection	K		$78.291	.	$15.66																																																																																																																																																																																																																													
9230	Abatacept injection	K		$46.857	.	$9.38																																																																																																																																																																																																																													
9231	Decitabine injection	K		$17.958	.	$3.60																																																																																																																																																																																																																													
9232	Idursulfase injection	K		$522.012	.	$104.41																																																																																																																																																																																																																													
9233	Ranibizumab injection	K		$375.205	.	$75.05																																																																																																																																																																																																																													
9234	Alglucosidase alfa injection	K		$206.700	.	$41.34																																																																																																																																																																																																																													
9235	Panitumumab injection	K		$107.713	.	$21.55																																																																																																																																																																																																																													
9236	Eculizumab injection	K		$226.628	.	$45.33																																																																																																																																																																																																																													
9237	"Inj, lanreotide acetate"	K		$54.011	.	$10.81																																																																																																																																																																																																																													
9240	"Injection, ixabepilone"	K		$75.364	.	$15.08																																																																																																																																																																																																																													
9242	"Injection, fosaprepitant"	K		$1.940	.	$0.39																																																																																																																																																																																																																													
9243	"Inj., treanda 1 mg"	K		$27.969	.	$5.60																																																																																																																																																																																																																													
9245	Romiplostim injection	K		$65.031	.	$13.01																																																																																																																																																																																																																													
9251	C1 esterase inhibitor inj	K		$55.530	.	$11.11																																																																																																																																																																																																																													
9252	Plerixafor injection	K		$312.098	.	$62.42																																																																																																																																																																																																																													
9253	Temozolomide injection	K		$8.947	.	$1.79																																																																																																																																																																																																																													
9255	Paliperidone palmitate inj	K		$9.504	.	$1.91																																																																																																																																																																																																																													
9256	Dexamethasone intra implant	K		$200.781	.	$40.16																																																																																																																																																																																																																													
9258	Telavancin injection	K		$5.005	.	$1.01																																																																																																																																																																																																																													
9259	Pralatrexate injection	K		$238.679	.	$47.74																																																																																																																																																																																																																													
9260	Ofatumumab injection	K		$53.387	.	$10.68																																																																																																																																																																																																																													
9261	"Ustekinumab sub cu inj, 1 mg"	K		$174.204	.	$34.85																																																																																																																																																																																																																													
9263	Ecallantide injection	K		$421.623	.	$84.33																																																																																																																																																																																																																													
9264	Tocilizumab injection	K		$4.219	.	$0.85																																																																																																																																																																																																																													
9265	Romidepsin injection	K		$317.577	.	$63.52																																																																																																																																																																																																																													
9269	"C-1 esterase, berinert"	K		$48.695	.	$9.74																																																																																																																																																																																																																													
9270	Gammaplex IVIG	K		$41.616	.	$8.33																																																																																																																																																																																																																													
9271	Velaglucerase alfa	K		$342.695	.	$68.54																																																																																																																																																																																																																													
9272	"Inj, denosumab"	K		$16.629	.	$3.33																																																																																																																																																																																																																													
9273	Sipuleucel-T auto CD54+	K		"$39,919.006"	.	"$7,983.81"																																																																																																																																																																																																																													
9274	Crotalidae Poly Immune Fab	K		"$2,869.924"	.	$573.99																																																																																																																																																																																																																													
9276	Cabazitaxel injection	K		$156.664	.	$31.34																																																																																																																																																																																																																													
9278	Incobotulinumtoxin A	K		$4.932	.	$0.99																																																																																																																																																																																																																													
9281	"Injection, pegloticase"	K		"$1,821.528"	.	$364.31																																																																																																																																																																																																																													
9284	Ipilimumab injection	K		$144.659	.	$28.94																																																																																																																																																																																																																													
9286	Belatacept injection	K		$3.826	.	$0.77																																																																																																																																																																																																																													
9287	Brentuximab vedotin inj	K		$134.154	.	$26.84																																																																																																																																																																																																																													
9289	Erwinaze injection	K		$402.743	.	$80.55																																																																																																																																																																																																																													
9293	"Injection, glucarpidase "	K		$284.215	.	$56.85																																																																																																																																																																																																																													
9294	"Inj, Taliglucerace Alfa 10 u"	K		$40.400	.	$8.08																																																																																																																																																																																																																													
9295	"Injection, Carfilzomib, 1 mg"	K		$32.204	.	$6.45																																																																																																																																																																																																																													
9296	"Inj, ziv-aflibercept, 1mg"	K		$8.122	.	$1.63																																																																																																																																																																																																																													
9297	"Inj, Omacetaxine Mep, 0.01mg"	K		$2.717	.	$0.55																																																																																																																																																																																																																													
9298	"Inj, Ocriplasmin, 0.125 mg"	K		"$1,046.750"	.	$209.35																																																																																																																																																																																																																													
9300	Omalizumab injection	K		$33.609	.	$6.73																																																																																																																																																																																																																													
9441	Inj ferric carboxymaltos 1mg	K		$1.057	.	$0.22																																																																																																																																																																																																																													
9445	"Injection, ruconest"	K		$27.938	.	$5.59																																																																																																																																																																																																																													
9448	Netupitant palonosetron oral	K		$444.910	.	$88.99																																																																																																																																																																																																																													
9449	"Injection, blinatumomab"	K		$98.832	.	$19.77																																																																																																																																																																																																																													
9450	Fluocinol acet intravit imp	K		$490.947	.	$98.19																																																																																																																																																																																																																													
9451	"Injection, peramivir"	K		$1.620	.	$0.33																																																																																																																																																																																																																													
9452	Inj ceftolozane tazobactam	K		$4.740	.	$0.95																																																																																																																																																																																																																													
9453	"Injection, nivolumab"	K		$26.428	.	$5.29																																																																																																																																																																																																																													
9454	"Inj, pasireotide long acting"	K		$260.757	.	$52.16																																																																																																																																																																																																																													
9455	"Injection, siltuximab"	K		$90.023	.	$18.01																																																																																																																																																																																																																													
9456	"Injection, isavuconazonium"	K		$0.634	.	$0.13																																																																																																																																																																																																																													
9458	Florbetaben f18 diagnostic	G		"$2,968.000"	.	$0.00																																																																																																																																																																																																																													
9459	Flutemetamol f18 diagnostic	G		"$3,498.000"	.	$0.00																																																																																																																																																																																																																													
9460	"Injection, cangrelor"	G		$15.366	.	$3.08																																																																																																																																																																																																																													
9461	"Choline c-11, diagnostic, per study dose up to 20 millicuries"	G		"$5,700.000"	.	$0.00																																																																																																																																																																																																																													
9470	Aripiprazole lauroxil 1mg	G		$2.386	.	$0.48																																																																																																																																																																																																																													
9471	Hymovis injection 1 mg	G		$16.763	.	$3.36																																																																																																																																																																																																																													
9472	Inj talimogene laherparepvec	G		$46.042	.	$9.21																																																																																																																																																																																																																													
9473	"Injection, mepolizumab, 1mg"	G		$26.654	.	$5.34																																																																																																																																																																																																																													
9474	Inj irinotecan liposome 1 mg	G		$39.482	.	$7.90																																																																																																																																																																																																																													
9475	"Injection, necitumumab, 1 mg"	G		$5.253	.	$1.06																																																																																																																																																																																																																													
9476	"Injection, daratumumab 10 mg"	G		$48.105	.	$9.63																																																																																																																																																																																																																													
9477	"Injection, elotuzumab, 1mg"	G		$6.210	.	$1.25																																																																																																																																																																																																																													
9478	Inj sebelipase alfa 1 mg	G		$530.000	.	$106.00																																																																																																																																																																																																																													
9479	"Instill, ciprofloxacin otic"	G		$29.949	.	$5.99																																																																																																																																																																																																																													
9480	Injection trabectedin 0.1mg	G		$283.444	.	$56.69																																																																																																																																																																																																																													
9481	"Injection, reslizumab"	G		$8.846	.	$1.77																																																																																																																																																																																																																													
9482	Sotalol hydrochloride IV	G		$9.985	.	$2.00																																																																																																																																																																																																																													
9483	"Injection, atezolizumab"	G		$75.621	.	$15.13																																																																																																																																																																																																																													
9484	"Injection, eteplirsen"	G		$169.600	.	$33.92																																																																																																																																																																																																																													
9485	"Injection, olaratumab"	G		$50.032	.	$10.01																																																																																																																																																																																																																													
9486	"Inj, granisetron ext"	G		$5.187	.	$1.04																																																																																																																																																																																																																													
9487	"Ustekinumab IV Inj, 1 mg"	G		$12.781	.	$2.56																																																																																																																																																																																																																													
9488	Conivaptan HCL	G		$29.927	.	$5.99																																																																																																																																																																																																																													
9489	"Injection, nusinersen"	G		"$1,104.167"	.	$220.84																																																																																																																																																																																																																													
9490	"Injection, bezlotoxumab"	G		$40.280	.	$8.06																																																																																																																																																																																																																													
9497	"Loxapine, inhalation powder"	K		$150.043	.	$30.01																																																																																																																																																																																																																													
9500	"Platelets, irradiated"	R	2.2026	$168.46	.	$33.70																																																																																																																																																																																																																													
9501	Platelet pheres leukoreduced	R	6.2921	$481.24	.	$96.25																																																																																																																																																																																																																													
9502	Platelet pheresis irradiated	R	7.0765	$541.23	.	$108.25																																																																																																																																																																																																																													
9503	Fr frz plasma donor retested	R	0.7388	$56.51	.	$11.31																																																																																																																																																																																																																													
9504	RBC deglycerolized	R	5.3948	$412.61	.	$82.53																																																																																																																																																																																																																													
9505	RBC irradiated	R	2.8127	$215.12	.	$43.03																																																																																																																																																																																																																													
9507	"Platelets, pheresis"	R	5.6991	$435.88	.	$87.18																																																																																																																																																																																																																													
9508	Plasma 1 donor frz w/in 8 hr	R	0.9409	$71.96	.	$14.40																																																																																																																																																																																																																													
9509	"Frozen plasma, pooled, sd"	R	0.7951	$60.81	.	$12.17																																																																																																																																																																																																																													
9510	Whole blood for transfusion	R	1.5610	$119.39	.	$23.88																																																																																																																																																																																																																													
9511	Cryoprecipitate each unit	R	0.5006	$38.29	.	$7.66																																																																																																																																																																																																																													
9512	RBC leukocytes reduced	R	2.4088	$184.23	.	$36.85																																																																																																																																																																																																																													
9513	"Plasma, frz between 8-24hour"	R	0.9871	$75.50	.	$15.10																																																																																																																																																																																																																													
9514	"Plasma protein fract,5%,50ml"	R	0.1974	$15.10	.	$3.02																																																																																																																																																																																																																													
9515	"Platelets, each unit"	R	1.4850	$113.58	.	$22.72																																																																																																																																																																																																																													
9516	Plaelet rich plasma unit	R	1.5758	$120.52	.	$24.11																																																																																																																																																																																																																													
9517	Red blood cells unit	R	1.8732	$143.27	.	$28.66																																																																																																																																																																																																																													
9518	Washed red blood cells unit	R	4.8113	$367.98	.	$73.60																																																																																																																																																																																																																													
9519	"Plasmaprotein fract,5%,250ml"	R	0.6193	$47.37	.	$9.48																																																																																																																																																																																																																													
9520	Blood split unit	R	1.2812	$97.99	.	$19.60																																																																																																																																																																																																																													
9521	Platelets leukoreduced irrad	R	2.1726	$166.17	.	$33.24																																																																																																																																																																																																																													
9522	RBC leukoreduced irradiated	R	3.3980	$259.89	.	$51.98																																																																																																																																																																																																																													
9523	Cryoprecipitatereducedplasma	R	1.3291	$101.65	.	$20.33																																																																																																																																																																																																																													
9524	"Blood, l/r, cmv-neg"	R	2.4797	$189.65	.	$37.93																																																																																																																																																																																																																													
9525	"Platelets, hla-m, l/r, unit"	R	9.8198	$751.05	.	$150.21																																																																																																																																																																																																																													
9526	Platelets leukocytes reduced	R	1.5580	$119.16	.	$23.84																																																																																																																																																																																																																													
9527	"Blood, l/r, froz/degly/wash"	R	3.2166	$246.02	.	$49.21																																																																																																																																																																																																																													
9528	"Plt, aph/pher, l/r, cmv-neg"	R	4.3013	$328.98	.	$65.80																																																																																																																																																																																																																													
9529	"Blood, l/r, irradiated"	R	1.8914	$144.66	.	$28.94																																																																																																																																																																																																																													
9530	Plate pheres leukoredu irrad	R	8.2052	$627.56	.	$125.52																																																																																																																																																																																																																													
9531	"Plt, pher, l/r cmv-neg, irr"	R	7.7098	$589.67	.	$117.94																																																																																																																																																																																																																													
9532	"RBC, frz/deg/wsh, l/r, irrad"	R	3.6296	$277.60	.	$55.52																																																																																																																																																																																																																													
9533	"RBC, l/r, cmv-neg, irrad"	R	3.2840	$251.17	.	$50.24																																																																																																																																																																																																																													
9534	Pathogen reduced plasma pool	R	0.7756	$59.32	.	$11.87																																																																																																																																																																																																																													
9535	Pathogen reduced plasma sing	R	1.5878	$121.44	.	$24.29																																																																																																																																																																																																																													
9536	Platelets pheresis path reduc	R	8.2052	$627.56	.	$125.52																																																																																																																																																																																																																													
