	Addendum A.-Final OPPS APCs for CY 2019																																																																																																																																																																																																																																																									
APC  	Group Title	SI	Relative Weight 	Payment Rate 	National Unadjusted Copayment 	Minimum Unadjusted Copayment 	"Note: Actual copayments would be lower due to the cap on copayments at the Inpatient Deductible of $1,364.00"																																																																																																																																																																																																																																																			
0701	Sr89 strontium	K		"$1,502.356"	.	$300.48																																																																																																																																																																																																																																																				
0726	Dexrazoxane HCl injection	K		$229.926	.	$45.99																																																																																																																																																																																																																																																				
0731	Sargramostim injection	K		$37.606	.	$7.53																																																																																																																																																																																																																																																				
0736	Amphotericin b liposome inj	K		$48.067	.	$9.62																																																																																																																																																																																																																																																				
0738	Rasburicase	K		$278.147	.	$55.63																																																																																																																																																																																																																																																				
0751	Mechlorethamine hcl inj	K		$321.723	.	$64.35																																																																																																																																																																																																																																																				
0752	Dactinomycin injection	K		"$1,427.666"	.	$285.54																																																																																																																																																																																																																																																				
0759	"Naltrexone, depot form"	K		$3.255	.	$0.66																																																																																																																																																																																																																																																				
0800	Leuprolide acetate	K		"$1,193.665"	.	$238.74																																																																																																																																																																																																																																																				
0802	Etoposide oral	K		$75.560	.	$15.12																																																																																																																																																																																																																																																				
0807	Aldesleukin injection	K		"$4,138.145"	.	$827.63																																																																																																																																																																																																																																																				
0809	Bcg live intravesical vac	K		$140.618	.	$28.13																																																																																																																																																																																																																																																				
0810	Goserelin acetate implant	K		$509.022	.	$101.81																																																																																																																																																																																																																																																				
0812	Carmustine injection	K		"$4,051.503"	.	$810.31																																																																																																																																																																																																																																																				
0820	Daunorubicin injection	K		$50.659	.	$10.14																																																																																																																																																																																																																																																				
0823	Docetaxel injection	K		$1.509	.	$0.31																																																																																																																																																																																																																																																				
0825	Nelarabine injection	K		$152.214	.	$30.45																																																																																																																																																																																																																																																				
0836	Interferon alfa-2b inj	K		$34.146	.	$6.83																																																																																																																																																																																																																																																				
0840	Inj melphalan hydrochl	K		$814.804	.	$162.97																																																																																																																																																																																																																																																				
0843	Pegaspargase injection	K		"$15,028.710"	.	"$3,005.75"	#																																																																																																																																																																																																																																																			
0844	Pentostatin injection	K		"$2,096.286"	.	$419.26																																																																																																																																																																																																																																																				
0850	Streptozocin injection	K		$348.706	.	$69.75																																																																																																																																																																																																																																																				
0851	Thiotepa injection	K		$741.578	.	$148.32																																																																																																																																																																																																																																																				
0856	Porfimer sodium injection	K		"$21,219.568"	.	"$4,243.92"	#																																																																																																																																																																																																																																																			
0858	Inj cladribine	K		$22.641	.	$4.53																																																																																																																																																																																																																																																				
0864	Mitoxantrone hydrochl	K		$27.359	.	$5.48																																																																																																																																																																																																																																																				
0873	Hyalgan supartz visco-3 dose	K		$85.304	.	$17.07																																																																																																																																																																																																																																																				
0874	Synvisc or synvisc-one	K		$11.826	.	$2.37																																																																																																																																																																																																																																																				
0875	Euflexxa inj per dose	K		$141.471	.	$28.30																																																																																																																																																																																																																																																				
0877	Orthovisc inj per dose	K		$147.787	.	$29.56																																																																																																																																																																																																																																																				
0887	Azathioprine parenteral	K		$229.356	.	$45.88																																																																																																																																																																																																																																																				
0890	Lymphocyte immune globulin	K		"$2,081.222"	.	$416.25																																																																																																																																																																																																																																																				
0901	Alpha 1 proteinase inhibitor	K		$4.460	.	$0.90																																																																																																																																																																																																																																																				
0902	"Injection,onabotulinumtoxinA"	K		$6.138	.	$1.23																																																																																																																																																																																																																																																				
0903	Cytomegalovirus imm IV /vial	K		"$1,129.154"	.	$225.84																																																																																																																																																																																																																																																				
0910	Interferon beta-1b / .25 MG	K		$379.627	.	$75.93																																																																																																																																																																																																																																																				
0925	Factor viii	K		$1.070	.	$0.22																																																																																																																																																																																																																																																				
0927	Factor viii recombinant	K		$1.326	.	$0.27																																																																																																																																																																																																																																																				
0928	Factor ix complex	K		$1.415	.	$0.29																																																																																																																																																																																																																																																				
0929	Anti-inhibitor	K		$2.082	.	$0.42																																																																																																																																																																																																																																																				
0931	Factor IX non-recombinant	K		$1.119	.	$0.23																																																																																																																																																																																																																																																				
0932	Factor ix recombinant nos	K		$1.505	.	$0.31																																																																																																																																																																																																																																																				
0943	Octagam injection	K		$36.720	.	$7.35																																																																																																																																																																																																																																																				
0944	Gammagard liquid injection	K		$43.140	.	$8.63																																																																																																																																																																																																																																																				
0946	Hepagam b im injection	K		$64.218	.	$12.85																																																																																																																																																																																																																																																				
0947	Flebogamma injection	K		$35.067	.	$7.02																																																																																																																																																																																																																																																				
0948	Gamunex-C/Gammaked	K		$39.492	.	$7.90																																																																																																																																																																																																																																																				
0961	"Albumin (human),5%, 50ml"	K		$10.490	.	$2.10																																																																																																																																																																																																																																																				
0963	"Albumin (human), 5%, 250 ml"	K		$52.450	.	$10.49																																																																																																																																																																																																																																																				
0964	"Albumin (human), 25%, 20 ml"	K		$20.980	.	$4.20																																																																																																																																																																																																																																																				
0965	"Albumin (human), 25%, 50ml"	K		$52.450	.	$10.49																																																																																																																																																																																																																																																				
1015	Injection glatiramer acetate	K		$201.168	.	$40.24																																																																																																																																																																																																																																																				
1064	"I131 iodide cap, rx"	K		$20.760	.	$4.16																																																																																																																																																																																																																																																				
1083	Adalimumab injection	K		"$1,291.088"	.	$258.22																																																																																																																																																																																																																																																				
1138	"Hepagam b intravenous, inj"	K		$64.218	.	$12.85																																																																																																																																																																																																																																																				
1139	Protein c concentrate	K		$15.151	.	$3.04																																																																																																																																																																																																																																																				
1142	Supprelin LA implant	K		"$31,835.045"	.	"$6,367.01"	#																																																																																																																																																																																																																																																			
1150	"I131 iodide sol, rx"	K		$13.570	.	$2.72																																																																																																																																																																																																																																																				
1166	Cytarabine liposome inj	K		$628.368	.	$125.68																																																																																																																																																																																																																																																				
1168	"Inj, temsirolimus"	K		$73.753	.	$14.76																																																																																																																																																																																																																																																				
1178	Busulfan injection	K		$10.373	.	$2.08																																																																																																																																																																																																																																																				
1203	Verteporfin injection	K		$10.949	.	$2.19																																																																																																																																																																																																																																																				
1207	"Octreotide injection, depot"	K		$198.510	.	$39.71																																																																																																																																																																																																																																																				
1213	Antihemophilic viii/vwf comp	K		$0.992	.	$0.20																																																																																																																																																																																																																																																				
1214	Inj IVIG privigen 500 mg	K		$39.633	.	$7.93																																																																																																																																																																																																																																																				
1232	Mitomycin injection	K		$134.247	.	$26.85																																																																																																																																																																																																																																																				
1235	Valrubicin injection	K		"$1,328.667"	.	$265.74																																																																																																																																																																																																																																																				
1236	Levoleucovorin injection	K		$0.236	.	$0.05																																																																																																																																																																																																																																																				
1237	Inj iron dextran	K		$14.056	.	$2.82																																																																																																																																																																																																																																																				
1253	Triamcinolone A inj PRS-free	K		$3.857	.	$0.78																																																																																																																																																																																																																																																				
1263	Antithrombin iii injection	K		$3.493	.	$0.70																																																																																																																																																																																																																																																				
1268	Xyntha inj	K		$1.222	.	$0.25																																																																																																																																																																																																																																																				
1274	Edetate calcium disodium inj	K 		"$5,594.422"	.	"$1,118.89"																																																																																																																																																																																																																																																				
1281	Bevacizumab injection	K		$1.981	.	$0.40																																																																																																																																																																																																																																																				
1289	AbobotulinumtoxinA	K		$8.423	.	$1.69																																																																																																																																																																																																																																																				
1295	Sm 153 lexidronam	K		"$14,658.426"	.	"$2,931.69"	#																																																																																																																																																																																																																																																			
1296	Degarelix injection	K		$3.716	.	$0.75																																																																																																																																																																																																																																																				
1297	"Ferumoxytol, non-esrd"	K		$0.980	.	$0.20																																																																																																																																																																																																																																																				
1311	Canakinumab injection	K		$111.002	.	$22.21																																																																																																																																																																																																																																																				
1312	Hizentra injection	K		$9.860	.	$1.98																																																																																																																																																																																																																																																				
1327	Imiglucerase injection	K		$41.451	.	$8.30																																																																																																																																																																																																																																																				
1340	"Collagenase, clost hist inj"	K		$45.050	.	$9.01																																																																																																																																																																																																																																																				
1341	Amobarbital 125 MG inj	K		$56.620	.	$11.33																																																																																																																																																																																																																																																				
1352	Wilate injection	K		$1.009	.	$0.21																																																																																																																																																																																																																																																				
1353	Belimumab injection	K		$44.160	.	$8.84																																																																																																																																																																																																																																																				
1408	Cyclophosphamide 100 MG inj	K		$41.612	.	$8.33																																																																																																																																																																																																																																																				
1413	Lumizyme injection	K		$163.830	.	$32.77																																																																																																																																																																																																																																																				
1415	Glassia injection	K		$4.653	.	$0.94																																																																																																																																																																																																																																																				
1416	Factor xiii anti-hem factor	K		$8.228	.	$1.65																																																																																																																																																																																																																																																				
1417	Gel-one	K		$537.361	.	$107.48																																																																																																																																																																																																																																																				
1420	Aflibercept injection	K		$967.327	.	$193.47																																																																																																																																																																																																																																																				
1421	Imported lipodox inj	K		$470.400	.	$94.08																																																																																																																																																																																																																																																				
1426	Eribulin mesylate injection	K		$114.337	.	$22.87																																																																																																																																																																																																																																																				
1431	Centruroides immune f(ab)	K		"$4,592.800"	.	$918.56																																																																																																																																																																																																																																																				
1433	Calcitonin salmon injection	K		"$2,629.525"	.	$525.91																																																																																																																																																																																																																																																				
1440	Inj desmopressin acetate	K		$12.604	.	$2.53																																																																																																																																																																																																																																																				
1442	Non-HEU TC-99M add-on/dose	K		$10.000	.	$2.00																																																																																																																																																																																																																																																				
1443	Icatibant injection	K		$359.004	.	$71.81																																																																																																																																																																																																																																																				
1446	Visualization adjunct	K		$3.859	.	$0.78																																																																																																																																																																																																																																																				
1458	Phentolaine mesylate inj	K		$392.842	.	$78.57																																																																																																																																																																																																																																																				
1466	"Inj, vincristine sul lip 1mg"	K		"$2,916.624"	.	$583.33																																																																																																																																																																																																																																																				
1467	Factor ix recombinan rixubis	K		$1.304	.	$0.27																																																																																																																																																																																																																																																				
1468	Inj Aripiprazole Ext Rel 1mg	K		$5.238	.	$1.05																																																																																																																																																																																																																																																				
1469	Inj filgrastim excl biosimil	K		$1.016	.	$0.21																																																																																																																																																																																																																																																				
1471	"Injection, Pertuzumab, 1 mg"	K		$11.865	.	$2.38																																																																																																																																																																																																																																																				
1472	Inj beta interferon im 1 mcg	K		$54.113	.	$10.83																																																																																																																																																																																																																																																				
1474	Certolizumab pegol inj 1mg	K		$8.135	.	$1.63																																																																																																																																																																																																																																																				
1475	Golimumab for iv use 1mg	K		$24.005	.	$4.81																																																																																																																																																																																																																																																				
1476	Obinutuzumab inj	K		$62.633	.	$12.53																																																																																																																																																																																																																																																				
1478	Inj human fibrinogen con nos	K		$1.164	.	$0.24																																																																																																																																																																																																																																																				
1480	"Elosulfase alfa, injection"	K		$236.628	.	$47.33																																																																																																																																																																																																																																																				
1482	"	Darbepoetin alfa, esrd use"	K		$3.773	.	$0.76																																																																																																																																																																																																																																																				
1485	"	Ferumoxytol, esrd use"	K		$0.980	.	$0.20																																																																																																																																																																																																																																																				
1486	Factor ix fc fusion recomb	K		$2.985	.	$0.60																																																																																																																																																																																																																																																				
1488	"Injection, ramucirumab"	K		$57.676	.	$11.54																																																																																																																																																																																																																																																				
1489	"Injection, vedolizumab"	K		$19.581	.	$3.92																																																																																																																																																																																																																																																				
1490	Inj pembrolizumab	K		$49.351	.	$9.88																																																																																																																																																																																																																																																				
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		$16.281	.	$3.26																																																																																																																																																																																																																																																				
1608	Etanercept injection	K		$645.540	.	$129.11																																																																																																																																																																																																																																																				
1609	"Rho(D) immune globulin h, sd"	K		$27.018	.	$5.41																																																																																																																																																																																																																																																				
1613	Trastuzumab injection	K		$104.123	.	$20.83																																																																																																																																																																																																																																																				
1630	"Hep b ig, im"	K		$112.334	.	$22.47																																																																																																																																																																																																																																																				
1643	"Y90 ibritumomab, rx"	K		"$46,661.640"	.	"$9,332.33"	#																																																																																																																																																																																																																																																			
1656	Factor viii fc fusion recomb	K		$2.012	.	$0.41																																																																																																																																																																																																																																																				
1658	"Injection, belinostat, 10mg"	K		$37.740	.	$7.55																																																																																																																																																																																																																																																				
1660	"Injection, oritavancin"	K		$23.081	.	$4.62																																																																																																																																																																																																																																																				
1662	Inj tedizolid phosphate	K		$1.426	.	$0.29																																																																																																																																																																																																																																																				
1669	Erythro lactobionate /500 mg	K		$78.867	.	$15.78																																																																																																																																																																																																																																																				
1670	Tetanus immune globulin inj	K		$255.699	.	$51.14																																																																																																																																																																																																																																																				
1675	P32 Na phosphate	K		$730.030	.	$146.01																																																																																																																																																																																																																																																				
1683	Basiliximab	K		"$3,686.128"	.	$737.23																																																																																																																																																																																																																																																				
1684	Corticorelin ovine triflutal	K		$8.593	.	$1.72																																																																																																																																																																																																																																																				
1685	"Darbepoetin alfa, non-esrd"	K		$3.773	.	$0.76																																																																																																																																																																																																																																																				
1686	"Epoetin alfa, non-esrd"	K		$12.271	.	$2.46																																																																																																																																																																																																																																																				
1687	Digoxin immune fab (ovine)	K		"$3,688.292"	.	$737.66																																																																																																																																																																																																																																																				
1688	Ethanolamine oleate	K		$444.099	.	$88.82																																																																																																																																																																																																																																																				
1689	Fomepizole	K		$7.407	.	$1.49																																																																																																																																																																																																																																																				
1690	Hemin	K		$23.028	.	$4.61																																																																																																																																																																																																																																																				
1694	Ziconotide injection	K		$7.587	.	$1.52																																																																																																																																																																																																																																																				
1695	Nesiritide injection	K		$73.338	.	$14.67																																																																																																																																																																																																																																																				
1696	Palifermin injection	K		$20.290	.	$4.06																																																																																																																																																																																																																																																				
1700	Inj secretin synthetic human	K		$34.781	.	$6.96																																																																																																																																																																																																																																																				
1701	Treprostinil injection	K		$66.136	.	$13.23																																																																																																																																																																																																																																																				
1704	"Humate-P, inj"	K		$1.123	.	$0.23																																																																																																																																																																																																																																																				
1705	Factor viia	K		$2.062	.	$0.42																																																																																																																																																																																																																																																				
1709	Azacitidine injection	K		$1.470	.	$0.30																																																																																																																																																																																																																																																				
1710	Clofarabine injection	K		$111.285	.	$22.26																																																																																																																																																																																																																																																				
1711	Vantas implant	K		"$3,610.321"	.	$722.07																																																																																																																																																																																																																																																				
1712	Paclitaxel protein bound	K		$11.600	.	$2.32																																																																																																																																																																																																																																																				
1739	"Pegademase bovine, 25 iu"	K		$367.961	.	$73.60																																																																																																																																																																																																																																																				
1743	Nandrolone decanoate 50 mg	K		$21.690	.	$4.34																																																																																																																																																																																																																																																				
1745	Radium ra223 dichloride ther	K		$136.610	.	$27.33																																																																																																																																																																																																																																																				
1746	Factor xiii recomb a-subunit	K		$14.909	.	$2.99																																																																																																																																																																																																																																																				
1747	Monovisc inj per dose	K		$779.346	.	$155.87																																																																																																																																																																																																																																																				
1748	Inj tbo filgrastim 1 microg	K		$0.579	.	$0.12																																																																																																																																																																																																																																																				
1761	"Rolapitant, oral, 1mg"	K		$2.212	.	$0.45																																																																																																																																																																																																																																																				
1809	"Injection, alemtuzumab"	K		"$1,842.129"	.	$368.43																																																																																																																																																																																																																																																				
1822	"Injection, zarxio"	K		$0.640	.	$0.13																																																																																																																																																																																																																																																				
1823	"Injection, dalbavancin"	K		$14.350	.	$2.87																																																																																																																																																																																																																																																				
1824	"	Ceftaroline fosamil inj"	K		$2.892	.	$0.58																																																																																																																																																																																																																																																				
1825	Ceftazidime and avibactam	K		$84.252	.	$16.86																																																																																																																																																																																																																																																				
1826	Hyqvia 100mg immuneglobulin	K		$14.125	.	$2.83																																																																																																																																																																																																																																																				
1827	Factor viii recomb obizur	K		$2.848	.	$0.57																																																																																																																																																																																																																																																				
1829	"	Penicillin g benzathine inj"	K		$13.902	.	$2.79																																																																																																																																																																																																																																																				
1832	Dimethyl sulfoxide 50% 50 ml	K		$535.987	.	$107.20																																																																																																																																																																																																																																																				
1844	Factor viii pegylated recomb	K		$1.717	.	$0.35																																																																																																																																																																																																																																																				
1846	Factor viii nuwiq recomb 1iu	K		$1.416	.	$0.29																																																																																																																																																																																																																																																				
1847	"Injection, inflectra"	G		$61.363	.	$12.28																																																																																																																																																																																																																																																				
1848	Artiss fibrin sealant	K		$175.118	.	$35.03																																																																																																																																																																																																																																																				
1849	Foscarnet sodium injection	K		$82.268	.	$16.46																																																																																																																																																																																																																																																				
1850	Gamma globulin 1 cc inj	K		$38.048	.	$7.61																																																																																																																																																																																																																																																				
1851	Gamma globulin > 10 cc inj	K		$380.480	.	$76.10																																																																																																																																																																																																																																																				
1852	Interferon beta-1a inj	K		"$2,785.970"	.	$557.20																																																																																																																																																																																																																																																				
1853	Minocycline hydrochloride	K		$1.571	.	$0.32																																																																																																																																																																																																																																																				
1854	Pentobarbital sodium inj	K		$47.076	.	$9.42																																																																																																																																																																																																																																																				
1856	Factor viii recomb novoeight	K		$1.340	.	$0.27																																																																																																																																																																																																																																																				
1857	"Inj, factor x, (human), 1iu"	K		$7.169	.	$1.44																																																																																																																																																																																																																																																				
1859	Argatroban nonesrd use 1mg	K		$1.228	.	$0.25																																																																																																																																																																																																																																																				
1861	"Inj., bendeka 1 mg"	G		$23.840	.	$4.77																																																																																																																																																																																																																																																				
1862	Gelsyn-3 injection 0.1 mg	G		$2.177	.	$0.44																																																																																																																																																																																																																																																				
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	209.1569	"$16,625.88"	.	"$3,325.18"	#																																																																																																																																																																																																																																																			
2632	Iodine I-125 sodium iodide	U	0.4764	$37.87	.	$7.58																																																																																																																																																																																																																																																				
2634	"Brachytx, non-str, HA, I-125"	U	1.7435	$138.59	.	$27.72																																																																																																																																																																																																																																																				
2635	"Brachytx, non-str, HA, P-103"	U	0.3412	$27.12	.	$5.43																																																																																																																																																																																																																																																				
2636	"Brachy linear, non-str,P-103"	U	0.6206	$49.33	.	$9.87																																																																																																																																																																																																																																																				
2638	"Brachytx, stranded, I-125"	U	0.4579	$36.40	.	$7.28																																																																																																																																																																																																																																																				
2639	"Brachytx, non-stranded,I-125"	U	0.4404	$35.01	.	$7.01																																																																																																																																																																																																																																																				
2640	"Brachytx, stranded, P-103"	U	0.9394	$74.67	.	$14.94																																																																																																																																																																																																																																																				
2641	"Brachytx, non-stranded,P-103"	U	0.7564	$60.13	.	$12.03																																																																																																																																																																																																																																																				
2642	"Brachytx, stranded, C-131"	U	1.0056	$79.94	.	$15.99																																																																																																																																																																																																																																																				
2643	"Brachytx, non-stranded,C-131"	U	0.9858	$78.36	.	$15.68																																																																																																																																																																																																																																																				
2645	"Brachytx, non-str, Gold-198"	U	1.0855	$86.29	.	$17.26																																																																																																																																																																																																																																																				
2646	"Brachytx, non-str, HDR Ir-192"	U	3.6581	$290.78	.	$58.16																																																																																																																																																																																																																																																				
2647	"Brachytx, NS, Non-HDRIr-192"	U	1.0683	$84.92	.	$16.99																																																																																																																																																																																																																																																				
2648	"Brachytx planar, p-103"	U	0.0590	$4.69	.	$0.94																																																																																																																																																																																																																																																				
2698	"Brachytx, stranded, NOS"	U	0.4579	$36.40	.	$7.28																																																																																																																																																																																																																																																				
2699	"Brachytx, non-stranded, NOS"	U	0.3412	$27.12	.	$5.43																																																																																																																																																																																																																																																				
2731	"Immune globulin, powder"	K		$37.945	.	$7.59																																																																																																																																																																																																																																																				
2770	Quinupristin/dalfopristin	K		$418.374	.	$83.68																																																																																																																																																																																																																																																				
2993	"Gen, neuro, trans sen/stim"	H			.	.																																																																																																																																																																																																																																																				
4001	Echo guidance radiotherapy	S		$51.90	.	$10.38																																																																																																																																																																																																																																																				
4002	Stereoscopic x-ray guidance 	S		$56.22	.	$11.25																																																																																																																																																																																																																																																				
4003	"Radiation treatment delivery, MeV <= 5; simple "	S		$199.30	.	$39.86																																																																																																																																																																																																																																																				
4004	"Radiation treatment delivery, 6-10 MeV; simple "	S		$145.96	.	$29.20																																																																																																																																																																																																																																																				
4005	"Radiation treatment delivery, 11-19 MeV; simple "	S		$145.96	.	$29.20																																																																																																																																																																																																																																																				
4006	"Radiation treatment delivery, MeV>=20; simple "	S		$145.60	.	$29.12																																																																																																																																																																																																																																																				
4007	"Radiation treatment delivery, MeV<=5; intermediate"	S		$276.06	.	$55.22																																																																																																																																																																																																																																																				
4008	"Radiation treatment delivery, 6-10 MeV; intermediate "	S		$201.46	.	$40.30																																																																																																																																																																																																																																																				
4009	"Radiation treatment delivery, 11-19 MeV; intermediate"	S		$200.38	.	$40.08																																																																																																																																																																																																																																																				
4010	"Radiation treatment delivery, MeV >=20; intermediate"	S		$200.38	.	$40.08																																																																																																																																																																																																																																																				
4011	"Radiation treatment delivery, MeV<=5; complex"	S		$272.46	.	$54.50																																																																																																																																																																																																																																																				
4012	"Radiation treatment delivery, 6-10 MeV; complex"	S		$267.05	.	$53.41																																																																																																																																																																																																																																																				
4013	"Radiation treatment delivery, 11-19 MeV; complex"	S		$267.41	.	$53.49																																																																																																																																																																																																																																																				
4014	"Radiation treatment delivery, MeV >=20; complex"	S		$267.41	.	$53.49																																																																																																																																																																																																																																																				
4015	Radiation tx delivery imrt	S		$362.55	.	$72.51																																																																																																																																																																																																																																																				
4016	Delivery comp imrt	S		$361.47	.	$72.30																																																																																																																																																																																																																																																				
5012	Clinic Visits and Related Services	V	1.4574	$115.85	.	$23.17																																																																																																																																																																																																																																																				
5021	Level 1 Type A ED Visits	V	0.8772	$69.73	.	$13.95																																																																																																																																																																																																																																																				
5022	Level 2 Type A ED Visits	V	1.6098	$127.96	.	$25.60																																																																																																																																																																																																																																																				
5023	Level 3 Type A ED Visits	V	2.8053	$222.99	.	$44.60																																																																																																																																																																																																																																																				
5024	Level 4 Type A ED Visits	V	4.5335	$360.37	.	$72.08																																																																																																																																																																																																																																																				
5025	Level 5 Type A ED Visits	V	6.6084	$525.30	.	$105.06																																																																																																																																																																																																																																																				
5031	Level 1 Type B ED Visits	V	0.9792	$77.84	.	$15.57																																																																																																																																																																																																																																																				
5032	Level 2 Type B ED Visits	V	1.1680	$92.84	.	$18.57																																																																																																																																																																																																																																																				
5033	Level 3 Type B ED Visits	V	2.0589	$163.66	.	$32.74																																																																																																																																																																																																																																																				
5034	Level 4 Type B ED Visits	V	2.7224	$216.40	.	$43.28																																																																																																																																																																																																																																																				
5035	Level 5 Type B ED Visits	V	4.0417	$321.27	.	$64.26																																																																																																																																																																																																																																																				
5041	Critical Care	S	9.3096	$740.02	.	$148.01																																																																																																																																																																																																																																																				
5045	Trauma Response with Critical Care	S	11.8927	$945.35	.	$189.07																																																																																																																																																																																																																																																				
5051	Level 1 Skin Procedures	T	2.2198	$176.45	.	$35.29																																																																																																																																																																																																																																																				
5052	Level 2 Skin Procedures	T	3.9512	$314.08	.	$62.82																																																																																																																																																																																																																																																				
5053	Level 3 Skin Procedures	T	6.0749	$482.89	.	$96.58																																																																																																																																																																																																																																																				
5054	Level 4 Skin Procedures	T	19.4862	"$1,548.96"	.	$309.80																																																																																																																																																																																																																																																				
5055	Level 5 Skin Procedures	T	34.7985	"$2,766.13"	.	$553.23																																																																																																																																																																																																																																																				
5061	Hyperbaric Oxygen	S	1.4392	$114.40	.	$22.88																																																																																																																																																																																																																																																				
5071	Level 1 Excision/ Biopsy/ Incision and Drainage	T	7.2882	$579.34	.	$115.87																																																																																																																																																																																																																																																				
5072	Level 2 Excision/ Biopsy/ Incision and Drainage	J1	17.3041	"$1,375.50"	.	$275.10																																																																																																																																																																																																																																																				
5073	Level 3 Excision/ Biopsy/ Incision and Drainage	J1	29.9194	"$2,378.29"	.	$475.66																																																																																																																																																																																																																																																				
5091	Level 1 Breast/Lymphatic Surgery and Related Procedures	J1	35.4260	"$2,816.01"	.	$563.21																																																																																																																																																																																																																																																				
5092	Level 2 Breast/Lymphatic Surgery and Related Procedures	J1	61.8343	"$4,915.21"	.	$983.05																																																																																																																																																																																																																																																				
5093	Level 3 Breast/Lymphatic Surgery and Related Procedures	J1	93.7078	"$7,448.83"	.	"$1,489.77"	#																																																																																																																																																																																																																																																			
5094	Level 4 Breast/Lymphatic Surgery and Related Procedures	J1	152.5618	"$12,127.14"	.	"$2,425.43"	#																																																																																																																																																																																																																																																			
5101	Level 1 Strapping and Cast Application	T	1.6936	$134.62	.	$26.93																																																																																																																																																																																																																																																				
5102	Level 2 Strapping and Cast Application	T	2.9636	$235.58	.	$47.12																																																																																																																																																																																																																																																				
5111	Level 1 Musculoskeletal Procedures	T	2.8317	$225.09	.	$45.02																																																																																																																																																																																																																																																				
5112	Level 2 Musculoskeletal Procedures	J1	16.5221	"$1,313.34"	.	$262.67																																																																																																																																																																																																																																																				
5113	Level 3 Musculoskeletal Procedures	J1	33.0022	"$2,623.34"	.	$524.67																																																																																																																																																																																																																																																				
5114	Level 4 Musculoskeletal Procedures	J1	71.7020	"$5,699.59"	.	"$1,139.92"																																																																																																																																																																																																																																																				
5115	Level 5 Musculoskeletal Procedures	J1	134.7827	"$10,713.88"	.	"$2,142.78"	#																																																																																																																																																																																																																																																			
5116	Level 6 Musculoskeletal Procedures	J1	193.7660	"$15,402.46"	.	"$3,080.50"	#																																																																																																																																																																																																																																																			
5151	Level 1 Airway Endoscopy	T	2.0628	$163.97	.	$32.80																																																																																																																																																																																																																																																				
5152	Level 2 Airway Endoscopy	T	4.8623	$386.50	.	$77.30																																																																																																																																																																																																																																																				
5153	Level 3 Airway Endoscopy	J1	17.2260	"$1,369.29"	.	$273.86																																																																																																																																																																																																																																																				
5154	Level 4 Airway Endoscopy	J1	34.4781	"$2,740.66"	.	$548.14																																																																																																																																																																																																																																																				
5155	Level 5 Airway Endoscopy	J1	64.7574	"$5,147.57"	.	"$1,029.52"																																																																																																																																																																																																																																																				
5161	Level 1 ENT Procedures	T	2.5933	$206.14	.	$41.23																																																																																																																																																																																																																																																				
5162	Level 2 ENT Procedures	T	6.1282	$487.13	.	$97.43																																																																																																																																																																																																																																																				
5163	Level 3 ENT Procedures	J1	16.0913	"$1,279.10"	.	$255.82																																																																																																																																																																																																																																																				
5164	Level 4 ENT Procedures	J1	28.0698	"$2,231.27"	.	$446.26																																																																																																																																																																																																																																																				
5165	Level 5 ENT Procedures	J1	55.6577	"$4,424.23"	.	$884.85																																																																																																																																																																																																																																																				
5166	Cochlear Implant Procedure	J1	402.1609	"$31,967.77"	"$7,683.79"	"$6,393.56"	#																																																																																																																																																																																																																																																			
5181	Level 1 Vascular Procedures	T	7.7999	$620.01	.	$124.01																																																																																																																																																																																																																																																				
5182	Level 2 Vascular Procedures	T	13.7581	"$1,093.63"	.	$218.73																																																																																																																																																																																																																																																				
5183	Level 3 Vascular Procedures	J1	33.2309	"$2,641.52"	.	$528.31																																																																																																																																																																																																																																																				
5184	Level 4 Vascular Procedures	J1	55.0575	"$4,376.52"	.	$875.31																																																																																																																																																																																																																																																				
5191	Level 1 Endovascular Procedures	J1	35.3555	"$2,810.41"	$864.64	$562.09																																																																																																																																																																																																																																																				
5192	Level 2 Endovascular Procedures	J1	58.8568	"$4,678.53"	.	$935.71																																																																																																																																																																																																																																																				
5193	Level 3 Endovascular Procedures	J1	121.6384	"$9,669.04"	.	"$1,933.81"	#																																																																																																																																																																																																																																																			
5194	Level 4 Endovascular Procedures	J1	193.1626	"$15,354.50"	.	"$3,070.90"	#																																																																																																																																																																																																																																																			
5200	Implantation Wireless PA Pressure Monitor	J1	369.1122	"$29,340.73"	.	"$5,868.15"	#																																																																																																																																																																																																																																																			
5211	Level 1 Electrophysiologic Procedures	J1	11.5653	$919.33	.	$183.87																																																																																																																																																																																																																																																				
5212	Level 2 Electrophysiologic Procedures	J1	64.1262	"$5,097.39"	.	"$1,019.48"																																																																																																																																																																																																																																																				
5213	Level 3 Electrophysiologic Procedures	J1	241.7127	"$19,213.74"	.	"$3,842.75"	#																																																																																																																																																																																																																																																			
5221	Level1 Pacemaker and Similar Procedures	T	39.3827	"$3,130.53"	.	$626.11																																																																																																																																																																																																																																																				
5222	Level 2 Pacemaker and Similar Procedures	J1	93.1452	"$7,404.11"	.	"$1,480.83"	#																																																																																																																																																																																																																																																			
5223	Level 3 Pacemaker and Similar Procedures	J1	124.2840	"$9,879.34"	.	"$1,975.87"	#																																																																																																																																																																																																																																																			
5224	Level 4 Pacemaker and Similar Procedures	J1	222.4055	"$17,679.01"	.	"$3,535.81"	#																																																																																																																																																																																																																																																			
5231	Level 1 ICD and Similar Procedures	J1	276.7199	"$21,996.46"	.	"$4,399.30"	#																																																																																																																																																																																																																																																			
5232	Level 2 ICD and Similar Procedures	J1	385.6633	"$30,656.38"	.	"$6,131.28"	#																																																																																																																																																																																																																																																			
5241	Level 1 Blood Product Exchange and Related Services	S	4.8169	$382.90	.	$76.58																																																																																																																																																																																																																																																				
5242	Level 2 Blood Product Exchange and Related Services	S	15.6875	"$1,247.00"	.	$249.40																																																																																																																																																																																																																																																				
5243	Level 3 Blood Product Exchange and Related Services	S	49.3458	"$3,922.50"	.	$784.50																																																																																																																																																																																																																																																				
5244	Level 4 Blood Product Exchange and Related Services	J1	476.6985	"$37,892.76"	.	"$7,578.56"	#																																																																																																																																																																																																																																																			
5301	Level 1 Upper GI Procedures	T	9.5805	$761.55	.	$152.31																																																																																																																																																																																																																																																				
5302	Level 2 Upper GI Procedures 	J1	18.6608	"$1,483.35"	.	$296.67																																																																																																																																																																																																																																																				
5303	Level 3 Upper GI Procedures	J1	35.5351	"$2,824.69"	.	$564.94																																																																																																																																																																																																																																																				
5311	Level 1 Lower GI Procedures 	T	9.3709	$744.89	.	$148.98																																																																																																																																																																																																																																																				
5312	Level 2 Lower GI Procedures 	T	12.3260	$979.79	.	$195.96																																																																																																																																																																																																																																																				
5313	Level 3 Lower GI Procedures 	J1	29.3695	"$2,334.58"	.	$466.92																																																																																																																																																																																																																																																				
5331	Complex GI Procedures	J1	56.5614	"$4,496.07"	.	$899.22																																																																																																																																																																																																																																																				
5341	Abdominal/Peritoneal/Biliary and Related Procedures	J1	37.0779	"$2,947.32"	.	$589.47																																																																																																																																																																																																																																																				
5361	Level 1 Laparoscopy and Related Services	J1	57.8167	"$4,595.85"	.	$919.17																																																																																																																																																																																																																																																				
5362	Level 2 Laparoscopy and Related Services	J1	97.3913	"$7,741.63"	.	"$1,548.33"	#																																																																																																																																																																																																																																																			
5371	Level 1 Urology and Related Services	T	2.9113	$231.42	.	$46.29																																																																																																																																																																																																																																																				
5372	Level 2 Urology and Related Services	T	7.0732	$562.25	.	$112.45																																																																																																																																																																																																																																																				
5373	Level 3 Urology and Related Services	J1	21.8864	"$1,739.75"	.	$347.95																																																																																																																																																																																																																																																				
5374	Level 4 Urology and Related Services	J1	36.8205	"$2,926.86"	.	$585.38																																																																																																																																																																																																																																																				
5375	Level 5 Urology and Related Services	J1	50.5792	"$4,020.54"	.	$804.11																																																																																																																																																																																																																																																				
5376	Level 6 Urology and Related Services	J1	96.2454	"$7,650.55"	.	"$1,530.11"	#																																																																																																																																																																																																																																																			
5377	Level 7 Urology and Related Services	J1	205.3032	"$16,319.55"	.	"$3,263.91"	#																																																																																																																																																																																																																																																			
5401	Dialysis	S	7.6957	$611.73	.	$122.35																																																																																																																																																																																																																																																				
5411	Level 1 Gynecologic Procedures	T	2.0874	$165.93	.	$33.19																																																																																																																																																																																																																																																				
5412	Level 2 Gynecologic Procedures	T	3.4344	$273.00	.	$54.60																																																																																																																																																																																																																																																				
5413	Level 3 Gynecologic Procedures	T	7.0203	$558.04	.	$111.61																																																																																																																																																																																																																																																				
5414	Level 4 Gynecologic Procedures	J1	29.7052	"$2,361.27"	.	$472.26																																																																																																																																																																																																																																																				
5415	Level 5 Gynecologic Procedures	J1	51.9037	"$4,125.83"	$902.82	$825.17																																																																																																																																																																																																																																																				
5416	Level 6 Gynecologic Procedures	J1	79.8139	"$6,344.41"	"$1,405.70"	"$1,268.89"	#																																																																																																																																																																																																																																																			
5431	Level 1 Nerve Procedures	J1	20.5243	"$1,631.48"	.	$326.30																																																																																																																																																																																																																																																				
5432	Level 2 Nerve Procedures	J1	57.4420	"$4,566.06"	.	$913.22																																																																																																																																																																																																																																																				
5441	Level 1 Nerve Injections	T	3.1133	$247.48	.	$49.50																																																																																																																																																																																																																																																				
5442	Level 2 Nerve Injections	T	7.5332	$598.81	.	$119.77																																																																																																																																																																																																																																																				
5443	Level 3 Nerve Injections	T	9.6218	$764.84	.	$152.97																																																																																																																																																																																																																																																				
5461	Level 1 Neurostimulator and Related Procedures	T	36.2285	"$2,879.80"	.	$575.96																																																																																																																																																																																																																																																				
5462	Level 2 Neurostimulator and Related Procedures	J1	75.2237	"$5,979.53"	.	"$1,195.91"																																																																																																																																																																																																																																																				
5463	Level 3 Neurostimulator and Related Procedures	J1	235.3398	"$18,707.16"	.	"$3,741.44"	#																																																																																																																																																																																																																																																			
5464	Level 4 Neurostimulator and Related Procedures	J1	348.4444	"$27,697.85"	.	"$5,539.57"	#																																																																																																																																																																																																																																																			
5471	Implantation of Drug Infusion Device	J1	202.1310	"$16,067.39"	.	"$3,213.48"	#																																																																																																																																																																																																																																																			
5481	Laser Eye Procedures	T	6.2420	$496.18	$101.51	$99.24																																																																																																																																																																																																																																																				
5491	Level 1 Intraocular Procedures	J1	24.1182	"$1,917.16"	.	$383.44																																																																																																																																																																																																																																																				
5492	Level 2 Intraocular Procedures	J1	45.7952	"$3,640.26"	.	$728.06																																																																																																																																																																																																																																																				
5493	Level 3 Intraocular Procedures	J1	123.7426	"$9,836.30"	.	"$1,967.26"	#																																																																																																																																																																																																																																																			
5494	Level 4 Intraocular Procedures	J1	204.2297	"$16,234.22"	.	"$3,246.85"	#																																																																																																																																																																																																																																																			
5501	"Level 1 Extraocular, Repair, and Plastic Eye Procedures"	T	3.5667	$283.52	.	$56.71																																																																																																																																																																																																																																																				
5502	"Level 2 Extraocular, Repair, and Plastic Eye Procedures"	T	10.1559	$807.29	.	$161.46																																																																																																																																																																																																																																																				
5503	"Level 3 Extraocular, Repair, and Plastic Eye Procedures"	J1	22.8039	"$1,812.68"	.	$362.54																																																																																																																																																																																																																																																				
5504	"Level 4 Extraocular, Repair, and Plastic Eye Procedures"	J1	37.4295	"$2,975.27"	.	$595.06																																																																																																																																																																																																																																																				
5521	Level 1 Imaging without Contrast	S	0.7838	$62.30	.	$12.46																																																																																																																																																																																																																																																				
5522	Level 2 Imaging without Contrast	S	1.4154	$112.51	.	$22.51																																																																																																																																																																																																																																																				
5523	Level 3 Imaging without Contrast	S	2.9005	$230.56	.	$46.12																																																																																																																																																																																																																																																				
5524	Level 4 Imaging without Contrast	S	6.2585	$497.49	.	$99.50																																																																																																																																																																																																																																																				
5571	Level 1 Imaging with Contrast	S	2.5379	$201.74	.	$40.35																																																																																																																																																																																																																																																				
5572	Level 2 Imaging with Contrast	S	4.8545	$385.88	.	$77.18																																																																																																																																																																																																																																																				
5573	Level 3 Imaging with Contrast	S	8.7024	$691.75	.	$138.35																																																																																																																																																																																																																																																				
5591	Level 1 Nuclear Medicine and Related Services 	S	4.4470	$353.49	.	$70.70																																																																																																																																																																																																																																																				
5592	Level 2 Nuclear Medicine and Related Services	S	5.7305	$455.52	.	$91.11																																																																																																																																																																																																																																																				
5593	Level 3 Nuclear Medicine and Related Services 	S	15.4659	"$1,229.38"	.	$245.88																																																																																																																																																																																																																																																				
5594	Level 4 Nuclear Medicine and Related Services	S	17.3046	"$1,375.54"	.	$275.11																																																																																																																																																																																																																																																				
5611	Level 1 Therapeutic Radiation Treatment Preparation	S	1.5571	$123.77	$32.03	$24.76																																																																																																																																																																																																																																																				
5612	Level 2 Therapeutic Radiation Treatment Preparation	S	4.0485	$321.82	.	$64.37																																																																																																																																																																																																																																																				
5613	Level 3 Therapeutic Radiation Treatment Preparation	S	14.9946	"$1,191.92"	.	$238.39																																																																																																																																																																																																																																																				
5621	Level 1 Radiation Therapy	S	1.4718	$116.99	.	$23.40																																																																																																																																																																																																																																																				
5622	Level 2 Radiation Therapy	S	2.8237	$224.46	.	$44.90																																																																																																																																																																																																																																																				
5623	Level 3 Radiation Therapy	S	6.5398	$519.85	.	$103.97																																																																																																																																																																																																																																																				
5624	Level 4 Radiation Therapy	S	8.8655	$704.72	.	$140.95																																																																																																																																																																																																																																																				
5625	Level 5 Radiation Therapy	S	13.5736	"$1,078.97"	.	$215.80																																																																																																																																																																																																																																																				
5626	Level 6 Radiation Therapy	S 	21.2677	"$1,690.57"	.	$338.12																																																																																																																																																																																																																																																				
5627	Level 7 Radiation Therapy	J1	96.1661	"$7,644.24"	.	"$1,528.85"	#																																																																																																																																																																																																																																																			
5661	Therapeutic Nuclear Medicine	S	2.9046	$230.89	.	$46.18																																																																																																																																																																																																																																																				
5671	Level 1 Pathology	S	0.6414	$50.98	.	$10.20																																																																																																																																																																																																																																																				
5672	Level 2 Pathology	S	1.8207	$144.73	.	$28.95																																																																																																																																																																																																																																																				
5673	Level 3 Pathology	S	3.4498	$274.22	.	$54.85																																																																																																																																																																																																																																																				
5674	Level 4 Pathology	S	7.0212	$558.12	.	$111.63																																																																																																																																																																																																																																																				
5691	Level 1 Drug Administration	S	0.4766	$37.88	.	$7.58																																																																																																																																																																																																																																																				
5692	Level 2 Drug Administration	S	0.7517	$59.75	.	$11.95																																																																																																																																																																																																																																																				
5693	Level 3 Drug Administration	S	2.3547	$187.18	.	$37.44																																																																																																																																																																																																																																																				
5694	Level 4 Drug Administration	S	3.6279	$288.38	.	$57.68																																																																																																																																																																																																																																																				
5721	Level1 Diagnostic Tests and Related Services	S	1.7103	$135.95	.	$27.19																																																																																																																																																																																																																																																				
5722	Level 2 Diagnostic Tests and Related Services	S	3.1741	$252.31	.	$50.47																																																																																																																																																																																																																																																				
5723	Level 3 Diagnostic Tests and Related Services	S	5.7274	$455.27	.	$91.06																																																																																																																																																																																																																																																				
5724	Level 4 Diagnostic Tests and Related Services	S	11.4831	$912.79	.	$182.56																																																																																																																																																																																																																																																				
5731	Level 1 Minor Procedures	S	0.2160	$17.17	.	$3.44																																																																																																																																																																																																																																																				
5732	Level 2 Minor Procedures	S	0.4041	$32.12	.	$6.43																																																																																																																																																																																																																																																				
5733	Level 3 Minor Procedures	S	0.7032	$55.90	.	$11.18																																																																																																																																																																																																																																																				
5734	Level 4 Minor Procedures	S	1.3396	$106.48	.	$21.30																																																																																																																																																																																																																																																				
5735	Level 5 Minor Procedures	S	4.3799	$348.16	.	$69.64																																																																																																																																																																																																																																																				
5741	Level 1 Electronic Analysis of Devices	S	0.4675	$37.16	.	$7.44																																																																																																																																																																																																																																																				
5742	Level 2 Electronic Analysis of Devices	S	1.4787	$117.54	.	$23.51																																																																																																																																																																																																																																																				
5743	Level 3 Electronic Analysis of Devices	S	3.5276	$280.41	.	$56.09																																																																																																																																																																																																																																																				
5771	Cardiac Rehabilitation	S	1.4863	$118.15	.	$23.63																																																																																																																																																																																																																																																				
5781	Resuscitation and Cardioversion	S	6.6234	$526.49	.	$105.30																																																																																																																																																																																																																																																				
5791	Pulmonary Treatment	S	2.4104	$191.60	.	$38.32																																																																																																																																																																																																																																																				
5801	Ventilation Initiation and Management	S	6.4155	$509.97	.	$102.00																																																																																																																																																																																																																																																				
5811	Manipulation Therapy	S	0.3117	$24.78	.	$4.96																																																																																																																																																																																																																																																				
5821	Level 1 Health and Behavior Services	S	0.4199	$33.38	.	$6.68																																																																																																																																																																																																																																																				
5822	Level 2 Health and Behavior Services	S	0.9610	$76.39	.	$15.28																																																																																																																																																																																																																																																				
5823	Level 3 Health and Behavior Services	S	1.6046	$127.55	.	$25.51																																																																																																																																																																																																																																																				
5853	Partial Hospitalization (3 or more services) for CMHCs	P	1.5169	$120.58	.	$24.12																																																																																																																																																																																																																																																				
5863	Partial Hospitalization (3 or more services) for Hospital-based PHPs	P	2.7784	$220.86	.	$44.18																																																																																																																																																																																																																																																				
5871	Dental Procedures	S	11.3119	$899.18	.	$179.84																																																																																																																																																																																																																																																				
5881	Ancillary Outpatient Services When Patient Dies	J1	84.5470	"$6,720.64"	.	"$1,344.13"																																																																																																																																																																																																																																																				
7000	Amifostine	K		$973.411	.	$194.69																																																																																																																																																																																																																																																				
7011	Oprelvekin injection	K		$426.915	.	$85.39																																																																																																																																																																																																																																																				
7035	Teniposide	K		"$2,575.153"	.	$515.04																																																																																																																																																																																																																																																				
7041	Tirofiban HCl	K		$8.259	.	$1.66																																																																																																																																																																																																																																																				
7043	Infliximab not biosimil 10mg	K		$78.833	.	$15.77																																																																																																																																																																																																																																																				
7046	Doxorubicin inj 10mg	K		$383.566	.	$76.72																																																																																																																																																																																																																																																				
7048	Alteplase recombinant	K		$87.777	.	$17.56																																																																																																																																																																																																																																																				
7308	Aminolevulinic acid hcl top	K		$404.591	.	$80.92																																																																																																																																																																																																																																																				
8004	Ultrasound Composite	S	3.7693	$299.62	.	$59.93																																																																																																																																																																																																																																																				
8005	CT and CTA without Contrast Composite	S	3.3331	$264.95	.	$52.99																																																																																																																																																																																																																																																				
8006	CT and CTA with Contrast Composite	S	6.0482	$480.77	.	$96.16																																																																																																																																																																																																																																																				
8007	MRI and MRA without Contrast Composite	S	6.8464	$544.22	.	$108.85																																																																																																																																																																																																																																																				
8008	MRI and MRA with Contrast Composite	S	10.7636	$855.60	.	$171.12																																																																																																																																																																																																																																																				
8010	Mental Health Services Composite	S	2.7784	$220.86	.	$44.18																																																																																																																																																																																																																																																				
8011	Comprehensive Observation Services	J2	30.0264	"$2,386.80"	.	$477.36																																																																																																																																																																																																																																																				
9002	Tenecteplase injection	K		$121.756	.	$24.36																																																																																																																																																																																																																																																				
9003	Palivizumab	K		"$1,205.050"	.	$241.01																																																																																																																																																																																																																																																				
9005	Reteplase injection	K		$504.980	.	$101.00																																																																																																																																																																																																																																																				
9006	Tacrolimus injection	K		$205.624	.	$41.13																																																																																																																																																																																																																																																				
9012	Arsenic trioxide injection	K		$77.034	.	$15.41																																																																																																																																																																																																																																																				
9014	"Inj., cerliponase alfa 1 mg"	G		$95.400	.	$19.08																																																																																																																																																																																																																																																				
9015	"Inj., haegarda 10 units"	G		$9.667	.	$1.94																																																																																																																																																																																																																																																				
9016	"Inj., triptorelin xr 3.75 mg"	G		"$2,826.667"	.	$565.34																																																																																																																																																																																																																																																				
9018	"Inj, rimabotulinumtoxinB"	K		$12.031	.	$2.41																																																																																																																																																																																																																																																				
9019	Caspofungin acetate	K		$12.639	.	$2.53																																																																																																																																																																																																																																																				
9024	Amphotericin b lipid complex	K		$17.723	.	$3.55																																																																																																																																																																																																																																																				
9028	Inj inotuzumab ozogam 0.1 mg	G		"$2,202.444"	.	$440.49																																																																																																																																																																																																																																																				
9029	"Inj., guselkumab, 1 mg"	G		$101.865	.	$20.38																																																																																																																																																																																																																																																				
9030	"Inj., copanlisib, 1 mg"	G		$77.902	.	$15.59																																																																																																																																																																																																																																																				
9031	"Inj, etelcalcetide, 0.1 mg"	K		$2.983	.	$0.60																																																																																																																																																																																																																																																				
9032	Baclofen 10 MG injection	K		$176.022	.	$35.21																																																																																																																																																																																																																																																				
9033	Cidofovir injection	K		$478.071	.	$95.62																																																																																																																																																																																																																																																				
9034	"Inj cuvitru, 100 mg"	K		$13.397	.	$2.68																																																																																																																																																																																																																																																				
9035	Axicabtagene ciloleucel car+ 	G		"$395,380.000"	.	"$79,076.00"	#																																																																																																																																																																																																																																																			
9036	"Injection, renflexis"	G		$64.382	.	$12.88																																																																																																																																																																																																																																																				
9038	Inj estrogen conjugate	K		$308.631	.	$61.73																																																																																																																																																																																																																																																				
9042	Glucagon hydrochloride	K		$214.385	.	$42.88																																																																																																																																																																																																																																																				
9043	"Inj, afstyla, 1 i.u."	G		$1.360	.	$0.28																																																																																																																																																																																																																																																				
9044	Ibutilide fumarate injection	K		$240.758	.	$48.16																																																																																																																																																																																																																																																				
9052	Fluciciovine F-18	G		$389.550	.	$0.00																																																																																																																																																																																																																																																				
9056	Gallium Ga-68	G		$66.741	.	$0.00																																																																																																																																																																																																																																																				
9058	Buprenorphine implant 74.2mg	G		"$1,260.234"	.	$252.05																																																																																																																																																																																																																																																				
9059	Vonvendi inj 1 iu vwf:rco	G		$2.015	.	$0.41																																																																																																																																																																																																																																																				
9065	Argatroban esrd dialysis 1mg	K		$1.228	.	$0.25																																																																																																																																																																																																																																																				
9067	Lutetium lu 177 dotatat ther	G		$251.750	.	$50.35																																																																																																																																																																																																																																																				
9070	Inj luxturna 1 billion vec g	G		"$2,963.289"	.	$592.66																																																																																																																																																																																																																																																				
9071	Capsaicin 8% patch	K		$3.159	.	$0.64																																																																																																																																																																																																																																																				
9073	Buprenorph xr 100 mg or less	G		"$1,674.800"	.	$334.96																																																																																																																																																																																																																																																				
9074	"Makena, 10 mg"	K		$27.928	.	$5.59																																																																																																																																																																																																																																																				
9075	"Inj, kovaltry, 1 i.u."	K		$1.264	.	$0.26																																																																																																																																																																																																																																																				
9078	Testosterone undecanoate 1mg	K		$1.363	.	$0.28																																																																																																																																																																																																																																																				
9079	"Genvisc 850, inj, 1mg"	K		$10.600	.	$2.12																																																																																																																																																																																																																																																				
9083	"Inj, phenylephrine ketorolac"	G		$473.244	.	$0.00																																																																																																																																																																																																																																																				
9084	Florbetapir f18	G		"$3,023.162"	.	$0.00																																																																																																																																																																																																																																																				
9085	Inj sulf hexa lipid microsph	G		$21.246	.	$0.00																																																																																																																																																																																																																																																				
9086	Hepa vacc ped/adol 3 dose	K		$28.693	.	$5.74																																																																																																																																																																																																																																																				
9087	"Inj, clevidipine butyrate"	K		$2.789	.	$0.56																																																																																																																																																																																																																																																				
9088	Peng benzathine/procaine inj	K		$11.098	.	$2.22																																																																																																																																																																																																																																																				
9089	Oral fludarabine phosphate	K		$81.420	.	$16.29																																																																																																																																																																																																																																																				
9090	Melphalan oral 2 mg	K		$12.000	.	$2.40																																																																																																																																																																																																																																																				
9091	Daunorubicin citrate inj	K		$243.800	.	$48.76																																																																																																																																																																																																																																																				
9092	Interferon alfa-2a inj	K		$169.330	.	$33.87																																																																																																																																																																																																																																																				
9093	Plicamycin (mithramycin) inj	K		$6.120	.	$1.23																																																																																																																																																																																																																																																				
9094	Radiesse injection	K		$473.900	.	$94.78																																																																																																																																																																																																																																																				
9095	"Inj, sculptra, 0.5mg"	K		$3.280	.	$0.66																																																																																																																																																																																																																																																				
9096	Inj retacrit esrd on dialysi	G		$1.169	.	$0.24																																																																																																																																																																																																																																																				
9097	Inj retacrit non-esrd use	G		$11.692	.	$2.34																																																																																																																																																																																																																																																				
9098	Chorionic gonadotropin/1000u	K		$23.950	.	$4.79																																																																																																																																																																																																																																																				
9099	"Inj fosnetupitant, palonoset"	G		$540.600	.	$108.12																																																																																																																																																																																																																																																				
9104	Antithymocyte globuln rabbit	K		$751.250	.	$150.25																																																																																																																																																																																																																																																				
9108	Thyrotropin injection	K		"$1,624.454"	.	$324.90																																																																																																																																																																																																																																																				
9119	"Injection, pegfilgrastim 6mg"	K		"$4,687.714"		$937.54																																																																																																																																																																																																																																																				
9120	"Injection, Fulvestrant"	K		$97.936	.	$19.59																																																																																																																																																																																																																																																				
9122	Triptorelin pamoate	K		$267.382	.	$53.48																																																																																																																																																																																																																																																				
9124	Daptomycin injection	K		$0.323	.	$0.07																																																																																																																																																																																																																																																				
9125	"Risperidone, long acting"	K		$9.409	.	$1.89																																																																																																																																																																																																																																																				
9126	Natalizumab injection	K		$19.828	.	$3.97																																																																																																																																																																																																																																																				
9130	"Inj, Imm Glob Bivigam, 500mg"	K		$70.516	.	$14.11																																																																																																																																																																																																																																																				
9131	"Inj, Ado-trastuzumab Emt 1mg"	K		$30.778	.	$6.16																																																																																																																																																																																																																																																				
9132	"Kcentra, per i.u."	K		$1.931	.	$0.39																																																																																																																																																																																																																																																				
9133	"Rabies ig, im/sc"	K		$334.987	.	$67.00																																																																																																																																																																																																																																																				
9134	"Rabies ig, heat treated"	K		$324.947	.	$64.99																																																																																																																																																																																																																																																				
9135	"Varicella-zoster ig, im"	K		"$1,491.374"	.	$298.28																																																																																																																																																																																																																																																				
9139	"Rabies vaccine, im"	K		$291.435	.	$58.29																																																																																																																																																																																																																																																				
9140	"Rabies vaccine, id"	K		$130.010	.	$26.01																																																																																																																																																																																																																																																				
9171	Factor ix idelvion inj	K		$4.280	.	$0.86																																																																																																																																																																																																																																																				
9172	"Injection, dexamethasone 9%"	G		$1.107	.	$0.23																																																																																																																																																																																																																																																				
9173	"Injection, fulphila"	K		$368.792	.	$73.76																																																																																																																																																																																																																																																				
9174	"Inj, durolane 1 mg"	G		"$1,033.500"	.	$206.70																																																																																																																																																																																																																																																				
9175	Puraply 1 sq cm	G		$71.198	.	$0.00																																																																																																																																																																																																																																																				
9176	Puraply am 1 sq cm	G		$68.960	.	$0.00																																																																																																																																																																																																																																																				
9177	Antithrombin recombinant	K		$103.350	.	$20.67																																																																																																																																																																																																																																																				
9179	"Injection, Aristada Initio"	G		$2.936	.	$0.59																																																																																																																																																																																																																																																				
9180	"Injection, patisiran"	G		$3.339	.	$0.67																																																																																																																																																																																																																																																				
9181	"Injection, risperidone"	G		$10.070	.	$2.01																																																																																																																																																																																																																																																				
9182	Inj mogamulizumab-kpkc	G		$200.870	.	$40.18																																																																																																																																																																																																																																																				
9183	"Injection, plazomicin"	G		$0.329	.	$0.07																																																																																																																																																																																																																																																				
9184	"Iodine i-131 iobenguane, dx"	G		$320.120	.	$0.00																																																																																																																																																																																																																																																				
9185	"Iodine i-131 iobenguane, tx"	G		$320.120	.	$64.03																																																																																																																																																																																																																																																				
9186	"Inj., rituximab, 10 mg"	K		$91.985	.	$18.40																																																																																																																																																																																																																																																				
9187	"Injection, burosumab-twza 1m"	K		$360.400	.	$72.08																																																																																																																																																																																																																																																				
9188	Inj crotalidae im f(ab')2 eq	K		"$1,256.600"	.	$251.32																																																																																																																																																																																																																																																				
9189	"Inj., ibalizumab-uiyk, 10 mg"	K		$60.155	.	$12.04																																																																																																																																																																																																																																																				
9190	"Inj., vestronidase alfa-vjbk"	K		$219.682	.	$43.94																																																																																																																																																																																																																																																				
9191	"Inj., fibryga, 1 mg"	K		$1.061	.	$0.22																																																																																																																																																																																																																																																				
9192	"Inj, bortezomib, nos, 0.1 mg"	K		$38.061	.	$7.62																																																																																																																																																																																																																																																				
9193	Nivestym	K		$0.774	.	$0.16																																																																																																																																																																																																																																																				
9194	Tisagenlecleucel car-pos t	G		"$489,764.125"		"$97,952.83"	#																																																																																																																																																																																																																																																			
9207	"Inj., velcade 0.1 mg"	K		$45.554	.	$9.12																																																																																																																																																																																																																																																				
9208	Agalsidase beta injection	K		$175.621	.	$35.13																																																																																																																																																																																																																																																				
9209	Laronidase injection	K		$30.784	.	$6.16																																																																																																																																																																																																																																																				
9210	Palonosetron hcl	K		$17.141	.	$3.43																																																																																																																																																																																																																																																				
9213	Pemetrexed injection	K		$68.217	.	$13.65																																																																																																																																																																																																																																																				
9214	Bevacizumab injection	K		$79.252	.	$15.86																																																																																																																																																																																																																																																				
9215	Cetuximab injection	K		$60.633	.	$12.13																																																																																																																																																																																																																																																				
9217	Leuprolide acetate suspnsion	K		$228.414	.	$45.69																																																																																																																																																																																																																																																				
9224	Galsulfase injection	K		$389.951	.	$78.00																																																																																																																																																																																																																																																				
9225	Fluocinolone acetonide implt	K		"$20,130.500"	.	"$4,026.10"	#																																																																																																																																																																																																																																																			
9228	Tigecycline injection	K		$2.059	.	$0.42																																																																																																																																																																																																																																																				
9229	Ibandronate sodium injection	K		$56.238	.	$11.25																																																																																																																																																																																																																																																				
9230	Abatacept injection	K		$52.929	.	$10.59																																																																																																																																																																																																																																																				
9231	Decitabine injection	K		$14.065	.	$2.82																																																																																																																																																																																																																																																				
9232	Idursulfase injection	K		$536.557	.	$107.32																																																																																																																																																																																																																																																				
9233	Ranibizumab injection	K		$373.364	.	$74.68																																																																																																																																																																																																																																																				
9234	Alglucosidase alfa injection	K		$141.140	.	$28.23																																																																																																																																																																																																																																																				
9235	Panitumumab injection	K		$114.375	.	$22.88																																																																																																																																																																																																																																																				
9236	Eculizumab injection	K		$230.479	.	$46.10																																																																																																																																																																																																																																																				
9237	"Inj, lanreotide acetate"	K		$58.843	.	$11.77																																																																																																																																																																																																																																																				
9239	Buprenorphine xr over 100 mg	G		"$1,674.800"	.	$334.96																																																																																																																																																																																																																																																				
9240	"Injection, ixabepilone"	K		$70.988	.	$14.20																																																																																																																																																																																																																																																				
9242	"Injection, fosaprepitant"	K		$2.188	.	$0.44																																																																																																																																																																																																																																																				
9243	"Inj., treanda 1 mg"	K		$30.576	.	$6.12																																																																																																																																																																																																																																																				
9245	Romiplostim injection	K		$71.399	.	$14.28																																																																																																																																																																																																																																																				
9251	C1 esterase inhibitor inj	K		$54.258	.	$10.86																																																																																																																																																																																																																																																				
9252	Plerixafor injection	K		$330.412	.	$66.09																																																																																																																																																																																																																																																				
9253	Temozolomide injection	K		$10.553	.	$2.12																																																																																																																																																																																																																																																				
9255	Paliperidone palmitate inj	K		$10.939	.	$2.19																																																																																																																																																																																																																																																				
9256	Dexamethasone intra implant	K		$200.167	.	$40.04																																																																																																																																																																																																																																																				
9257	"Inj., emicizumab-kxwh 0.5 mg"	G		$48.860	.	$9.78																																																																																																																																																																																																																																																				
9258	Telavancin injection	K		$5.468	.	$1.10																																																																																																																																																																																																																																																				
9259	Pralatrexate injection	K		$271.611	.	$54.33																																																																																																																																																																																																																																																				
9260	Ofatumumab injection	K		$58.549	.	$11.71																																																																																																																																																																																																																																																				
9261	"Ustekinumab sub cu inj, 1 mg"	K		$191.028	.	$38.21																																																																																																																																																																																																																																																				
9263	Ecallantide injection	K		$477.960	.	$95.60																																																																																																																																																																																																																																																				
9264	Tocilizumab injection	K		$4.734	.	$0.95																																																																																																																																																																																																																																																				
9265	Romidepsin injection	K		$322.580	.	$64.52																																																																																																																																																																																																																																																				
9269	"C-1 esterase, berinert"	K		$48.943	.	$9.79																																																																																																																																																																																																																																																				
9270	Gammaplex IVIG	K		$52.063	.	$10.42																																																																																																																																																																																																																																																				
9271	Velaglucerase alfa	K		$345.394	.	$69.08																																																																																																																																																																																																																																																				
9272	"Inj, denosumab"	K		$18.580	.	$3.72																																																																																																																																																																																																																																																				
9273	Sipuleucel-T auto CD54+	K		"$43,419.425"	.	"$8,683.89"	#																																																																																																																																																																																																																																																			
9274	Crotalidae Poly Immune Fab	K		"$3,250.521"	.	$650.11																																																																																																																																																																																																																																																				
9276	Cabazitaxel injection	K		$167.990	.	$33.60																																																																																																																																																																																																																																																				
9278	Incobotulinumtoxin A	K		$5.084	.	$1.02																																																																																																																																																																																																																																																				
9281	"Injection, pegloticase"	K		"$2,334.590"	.	$466.92																																																																																																																																																																																																																																																				
9284	Ipilimumab injection	K		$150.872	.	$30.18																																																																																																																																																																																																																																																				
9286	Belatacept injection	K		$3.807	.	$0.77																																																																																																																																																																																																																																																				
9287	Brentuximab vedotin inj	K		$150.484	.	$30.10																																																																																																																																																																																																																																																				
9289	Erwinaze injection	K		$414.825	.	$82.97																																																																																																																																																																																																																																																				
9293	"Injection, glucarpidase "	K		$313.310	.	$62.67																																																																																																																																																																																																																																																				
9294	"Inj, taliglucerase alfa 10 u"	K		$40.386	.	$8.08																																																																																																																																																																																																																																																				
9295	"Injection, Carfilzomib, 1 mg"	K		$36.317	.	$7.27																																																																																																																																																																																																																																																				
9296	"Inj, ziv-aflibercept, 1mg"	K		$8.321	.	$1.67																																																																																																																																																																																																																																																				
9297	"Inj, Omacetaxine Mep, 0.01mg"	K		$2.976	.	$0.60																																																																																																																																																																																																																																																				
9298	"Inj, Ocriplasmin, 0.125 mg"	K		$836.337	.	$167.27																																																																																																																																																																																																																																																				
9300	Omalizumab injection	K		$37.065	.	$7.42																																																																																																																																																																																																																																																				
9301	"Aminolevulinic acid, 10% gel"	G		$1.384	.	$0.28																																																																																																																																																																																																																																																				
9302	"Inj daunorubicin, cytarabine"	G		$186.704	.	$37.35																																																																																																																																																																																																																																																				
9441	Inj ferric carboxymaltos 1mg	K		$1.060	.	$0.22																																																																																																																																																																																																																																																				
9445	"Injection, ruconest"	K		$27.651	.	$5.54																																																																																																																																																																																																																																																				
9448	"Oral netupitant, palonosetro"	K		$301.941	.	$60.39																																																																																																																																																																																																																																																				
9449	"Injection, blinatumomab"	K		$110.366	.	$22.08																																																																																																																																																																																																																																																				
9450	Fluocinol acet intravit imp	K		$490.329	.	$98.07																																																																																																																																																																																																																																																				
9451	"Injection, peramivir"	K		$1.622	.	$0.33																																																																																																																																																																																																																																																				
9452	Inj ceftolozane tazobactam	K		$5.458	.	$1.10																																																																																																																																																																																																																																																				
9453	"Injection, nivolumab"	K		$27.541	.	$5.51																																																																																																																																																																																																																																																				
9454	"Inj, pasireotide long acting"	K		$289.623	.	$57.93																																																																																																																																																																																																																																																				
9455	"Injection, siltuximab"	K		$95.351	.	$19.08																																																																																																																																																																																																																																																				
9456	"Injection, isavuconazonium"	K		$0.848	.	$0.17																																																																																																																																																																																																																																																				
9460	"Injection, cangrelor"	K		$15.457	.	$3.10																																																																																																																																																																																																																																																				
9462	"Injection, delafloxacin"	G		$0.459	.	$0.10																																																																																																																																																																																																																																																				
9463	"Inj., aprepitant, 1 mg"	G		$2.104	.	$0.43																																																																																																																																																																																																																																																				
9464	"Inj., rolapitant, 0.5 mg"	G		$0.939	.	$0.19																																																																																																																																																																																																																																																				
9466	"Inj., benralizumab, 1 mg"	G		$167.471	.	$33.50																																																																																																																																																																																																																																																				
9467	"Inj rituximab, hyaluronidase"	G		$45.722	.	$9.15																																																																																																																																																																																																																																																				
9468	Factor ix recomb gly rebinyn	G		$3.883	.	$0.78																																																																																																																																																																																																																																																				
9469	Inj triamcinolone ace xr 1mg	G		$18.881	.	$3.78																																																																																																																																																																																																																																																				
9470	Aripiprazole lauroxil 1mg	K		$2.439	.	$0.49																																																																																																																																																																																																																																																				
9471	Hymovis injection 1 mg	K		$19.257	.	$3.86																																																																																																																																																																																																																																																				
9472	Inj talimogene laherparepvec	K		$49.994	.	$10.00																																																																																																																																																																																																																																																				
9473	"Injection, mepolizumab, 1mg"	K		$29.584	.	$5.92																																																																																																																																																																																																																																																				
9474	Inj irinotecan liposome 1 mg	K		$45.531	.	$9.11																																																																																																																																																																																																																																																				
9475	"Injection, necitumumab, 1 mg"	K		$5.572	.	$1.12																																																																																																																																																																																																																																																				
9476	"Injection, daratumumab 10 mg"	K		$52.407	.	$10.49																																																																																																																																																																																																																																																				
9477	"Injection, elotuzumab, 1mg"	K		$6.415	.	$1.29																																																																																																																																																																																																																																																				
9478	Inj sebelipase alfa 1 mg	K		$541.130	.	$108.23																																																																																																																																																																																																																																																				
9479	"Instill, ciprofloxacin otic"	K		$29.976	.	$6.00																																																																																																																																																																																																																																																				
9480	Injection trabectedin 0.1mg	K		$300.674	.	$60.14																																																																																																																																																																																																																																																				
9481	"Injection, reslizumab"	K		$9.297	.	$1.86																																																																																																																																																																																																																																																				
9482	Sotalol hydrochloride IV	K		$9.985	.	$2.00																																																																																																																																																																																																																																																				
9483	"Inj, atezolizumab,10 mg"	K		$76.912	.	$15.39																																																																																																																																																																																																																																																				
9484	"Inj, eteplirsen, 10 mg"	G		$168.121	.	$33.63																																																																																																																																																																																																																																																				
9485	"Inj, olaratumab, 10 mg"	G		$51.039	.	$10.21																																																																																																																																																																																																																																																				
9486	"Inj, granisetron, xr, 0.1 mg"	G		$3.576	.	$0.72																																																																																																																																																																																																																																																				
9487	"Ustekinumab, iv inject,1 mg"	G		$12.280	.	$2.46																																																																																																																																																																																																																																																				
9488	Conivaptan hcl	G		$31.097	.	$6.22																																																																																																																																																																																																																																																				
9489	"Inj, nusinersen, 0.1mg"	G		"$1,101.873"	.	$220.38																																																																																																																																																																																																																																																				
9490	"Inj, bezlotoxumab, 10 mg"	G		$40.162	.	$8.04																																																																																																																																																																																																																																																				
9491	"Injection, avelumab, 10 mg"	G		$81.820	.	$16.37																																																																																																																																																																																																																																																				
9492	"Inj., durvalumab, 10 mg"	G		$73.971	.	$14.80																																																																																																																																																																																																																																																				
9493	"Injection, edaravone, 1 mg"	G		$19.179	.	$3.84																																																																																																																																																																																																																																																				
9494	"Injection, ocrelizumab"	G		$57.344	.	$11.47																																																																																																																																																																																																																																																				
9495	Gemtuzumab ozogamicin inj	G		$193.156	.	$38.64																																																																																																																																																																																																																																																				
9497	Loxapine for inhalation 1 mg	K		$150.801	.	$30.17																																																																																																																																																																																																																																																				
9500	"Platelets, irradiated"	R	2.1626	$171.91	.	$34.39																																																																																																																																																																																																																																																				
9501	Platelet pheres leukoreduced	R	6.1177	$486.30	.	$97.26																																																																																																																																																																																																																																																				
9502	Platelet pheresis irradiated	R	6.9557	$552.91	.	$110.59																																																																																																																																																																																																																																																				
9503	Fr frz plasma donor retested	R	0.7901	$62.81	.	$12.57																																																																																																																																																																																																																																																				
9504	RBC deglycerolized	R	4.1658	$331.14	.	$66.23																																																																																																																																																																																																																																																				
9505	RBC irradiated	R	2.7847	$221.36	.	$44.28																																																																																																																																																																																																																																																				
9507	"Platelets, pheresis"	R	4.2405	$337.08	.	$67.42																																																																																																																																																																																																																																																				
9508	Plasma 1 donor frz w/in 8 hr	R	0.8998	$71.53	.	$14.31																																																																																																																																																																																																																																																				
9509	"Frozen plasma, pooled, sd"	R	0.9556	$75.96	.	$15.20																																																																																																																																																																																																																																																				
9510	Whole blood for transfusion	R	1.3987	$111.18	.	$22.24																																																																																																																																																																																																																																																				
9511	Cryoprecipitate each unit	R	0.6214	$49.40	.	$9.88																																																																																																																																																																																																																																																				
9512	RBC leukocytes reduced	R	2.3246	$184.78	.	$36.96																																																																																																																																																																																																																																																				
9513	"Plasma, frz between 8-24hour"	R	0.9644	$76.66	.	$15.34																																																																																																																																																																																																																																																				
9514	"Plasma protein fract,5%,50ml"	R	0.3390	$26.95	.	$5.39																																																																																																																																																																																																																																																				
9515	"Platelets, each unit"	R	1.3582	$107.96	.	$21.60																																																																																																																																																																																																																																																				
9516	Plaelet rich plasma unit	R	1.5754	$125.23	.	$25.05																																																																																																																																																																																																																																																				
9517	Red blood cells unit	R	1.7627	$140.12	.	$28.03																																																																																																																																																																																																																																																				
9518	Washed red blood cells unit	R	4.4777	$355.93	.	$71.19																																																																																																																																																																																																																																																				
9519	"Plasmaprotein fract,5%,250ml"	R	0.9684	$76.98	.	$15.40																																																																																																																																																																																																																																																				
9520	Blood split unit	R	1.5859	$126.06	.	$25.22																																																																																																																																																																																																																																																				
9521	Platelets leukoreduced irrad	R	2.1026	$167.14	.	$33.43																																																																																																																																																																																																																																																				
9522	RBC leukoreduced irradiated	R	3.2153	$255.58	.	$51.12																																																																																																																																																																																																																																																				
9523	Cryoprecipitatereducedplasma	R	1.1162	$88.73	.	$17.75																																																																																																																																																																																																																																																				
9524	"Blood, l/r, cmv-neg"	R	2.2134	$175.94	.	$35.19																																																																																																																																																																																																																																																				
9525	"Platelets, hla-m, l/r, unit"	R	10.6281	$844.83	.	$168.97																																																																																																																																																																																																																																																				
9526	Platelets leukocytes reduced	R	1.7186	$136.61	.	$27.33																																																																																																																																																																																																																																																				
9527	"Blood, l/r, froz/degly/wash"	R	3.7535	$298.37	.	$59.68																																																																																																																																																																																																																																																				
9528	"Plt, aph/pher, l/r, cmv-neg"	R	5.5990	$445.06	.	$89.02																																																																																																																																																																																																																																																				
9529	"Blood, l/r, irradiated"	R	2.8365	$225.47	.	$45.10																																																																																																																																																																																																																																																				
9530	Plate pheres leukoredu irrad	R	7.8618	$624.93	.	$124.99																																																																																																																																																																																																																																																				
9531	"Plt, pher, l/r cmv-neg, irr"	R	6.1934	$492.31	.	$98.47																																																																																																																																																																																																																																																				
9532	"RBC, frz/deg/wsh, l/r, irrad"	R	2.8244	$224.51	.	$44.91																																																																																																																																																																																																																																																				
9533	"RBC, l/r, cmv-neg, irrad"	R	2.8845	$229.29	.	$45.86																																																																																																																																																																																																																																																				
9534	Pathogen reduced plasma pool	R	0.5212	$41.43	.	$8.29																																																																																																																																																																																																																																																				
9535	Pathogen reduced plasma sing	R	0.9856	$78.35	.	$15.67																																																																																																																																																																																																																																																				
9536	Platelets pheresis path redu	R	7.8618	$624.93	.	$124.99																																																																																																																																																																																																																																																				
