	Addendum A.-Proposed 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 $1,340.00"																																																																																																																																																																																																																		
0701	Sr89 strontium	K		"$1,518.711"	.	$303.75																																																																																																																																																																																																																			
0726	Dexrazoxane HCl injection	K		$243.126	.	$48.63																																																																																																																																																																																																																			
0731	Sargramostim injection	K		$37.479	.	$7.50																																																																																																																																																																																																																			
0736	Amphotericin b liposome inj	K		$48.067	.	$9.62																																																																																																																																																																																																																			
0738	Rasburicase	K		$271.291	.	$54.26																																																																																																																																																																																																																			
0751	Mechlorethamine hcl inj	K		$292.478	.	$58.50																																																																																																																																																																																																																			
0752	Dactinomycin injection	K		"$1,580.573"	.	$316.12																																																																																																																																																																																																																			
0759	"Naltrexone, depot form"	K		$3.262	.	$0.66																																																																																																																																																																																																																			
0800	Leuprolide acetate	K		"$1,089.218"	.	$217.85																																																																																																																																																																																																																			
0802	Etoposide oral	K		$74.663	.	$14.94																																																																																																																																																																																																																			
0807	Aldesleukin injection	K		"$4,138.145"	.	$827.63																																																																																																																																																																																																																			
0809	Bcg live intravesical vac	K		$137.666	.	$27.54																																																																																																																																																																																																																			
0810	Goserelin acetate implant	K		$397.590	.	$79.52																																																																																																																																																																																																																			
0812	Carmustine injection	K		"$3,854.588"	.	$770.92																																																																																																																																																																																																																			
0820	Daunorubicin injection	K		$41.579	.	$8.32																																																																																																																																																																																																																			
0823	Docetaxel injection	K		$1.657	.	$0.34																																																																																																																																																																																																																			
0825	Nelarabine injection	K		$151.904	.	$30.38																																																																																																																																																																																																																			
0836	Interferon alfa-2b inj	K		$31.086	.	$6.22																																																																																																																																																																																																																			
0840	Inj melphalan hydrochl	K		"$1,117.993"	.	$223.60																																																																																																																																																																																																																			
0843	Pegaspargase injection	K		"$14,977.047"	.	"$2,995.41"	#																																																																																																																																																																																																																		
0844	Pentostatin injection	K		"$2,066.028"	.	$413.21																																																																																																																																																																																																																			
0849	Rituximab injection	K		$883.683	.	$176.74																																																																																																																																																																																																																			
0850	Streptozocin injection	K		$342.792	.	$68.56																																																																																																																																																																																																																			
0851	Thiotepa injection	K		$741.003	.	$148.20																																																																																																																																																																																																																			
0856	Porfimer sodium injection	K		"$21,219.568"	.	"$4,243.92"	#																																																																																																																																																																																																																		
0858	Inj cladribine	K		$22.622	.	$4.53																																																																																																																																																																																																																			
0864	Mitoxantrone hydrochl	K		$32.137	.	$6.43																																																																																																																																																																																																																			
0873	Hyalgan supartz visco-3 dose	K		$88.646	.	$17.73																																																																																																																																																																																																																			
0874	Synvisc or synvisc-one	K		$12.079	.	$2.42																																																																																																																																																																																																																			
0875	Euflexxa inj per dose	K		$149.916	.	$29.99																																																																																																																																																																																																																			
0877	Orthovisc inj per dose	K		$149.403	.	$29.88																																																																																																																																																																																																																			
0887	Azathioprine parenteral	K		$222.858	.	$44.58																																																																																																																																																																																																																			
0890	Lymphocyte immune globulin	K		"$1,937.636"	.	$387.53																																																																																																																																																																																																																			
0901	Alpha 1 proteinase inhibitor	K		$4.446	.	$0.89																																																																																																																																																																																																																			
0902	"Injection,onabotulinumtoxinA"	K		$6.147	.	$1.23																																																																																																																																																																																																																			
0903	Cytomegalovirus imm IV /vial	K		"$1,129.124"	.	$225.83																																																																																																																																																																																																																			
0910	Interferon beta-1b / .25 MG	K		$364.988	.	$73.00																																																																																																																																																																																																																			
0925	Factor viii	K		$1.039	.	$0.21																																																																																																																																																																																																																			
0927	Factor viii recombinant	K		$1.279	.	$0.26																																																																																																																																																																																																																			
0928	Factor ix complex	K		$1.401	.	$0.28																																																																																																																																																																																																																			
0929	Anti-inhibitor	K		$1.988	.	$0.40																																																																																																																																																																																																																			
0931	Factor IX non-recombinant	K		$1.128	.	$0.23																																																																																																																																																																																																																			
0932	Factor ix recombinant nos	K		$1.497	.	$0.30																																																																																																																																																																																																																			
0943	Octagam injection	K		$41.407	.	$8.29																																																																																																																																																																																																																			
0944	Gammagard liquid injection	K		$39.689	.	$7.94																																																																																																																																																																																																																			
0946	Hepagam b im injection	K		$62.213	.	$12.45																																																																																																																																																																																																																			
0947	Flebogamma injection	K		$35.146	.	$7.03																																																																																																																																																																																																																			
0948	Gamunex-C/Gammaked	K		$39.145	.	$7.83																																																																																																																																																																																																																			
0961	"Albumin (human),5%, 50ml"	K		$11.799	.	$2.36																																																																																																																																																																																																																			
0963	"Albumin (human), 5%, 250 ml"	K		$54.720	.	$10.95																																																																																																																																																																																																																			
0964	"Albumin (human), 25%, 20 ml"	K		$22.488	.	$4.50																																																																																																																																																																																																																			
0965	"Albumin (human), 25%, 50ml"	K		$53.438	.	$10.69																																																																																																																																																																																																																			
1015	Injection glatiramer acetate	K		$209.294	.	$41.86																																																																																																																																																																																																																			
1052	"Injection, voriconazole"	K		$2.097	.	$0.42																																																																																																																																																																																																																			
1064	"I131 iodide cap, rx"	K		$19.980	.	$4.00																																																																																																																																																																																																																			
1083	Adalimumab injection	K		"$1,291.088"	.	$258.22																																																																																																																																																																																																																			
1138	"Hepagam b intravenous, inj"	K		$62.213	.	$12.45																																																																																																																																																																																																																			
1139	Protein c concentrate	K		$15.198	.	$3.04																																																																																																																																																																																																																			
1142	Supprelin LA implant	K		"$30,323.337"	.	"$6,064.67"	#																																																																																																																																																																																																																		
1150	"I131 iodide sol, rx"	K		$11.880	.	$2.38																																																																																																																																																																																																																			
1166	Cytarabine liposome inj	K		$628.368	.	$125.68																																																																																																																																																																																																																			
1168	"Inj, temsirolimus"	K		$71.688	.	$14.34																																																																																																																																																																																																																			
1178	Busulfan injection	K		$27.949	.	$5.59																																																																																																																																																																																																																			
1203	Verteporfin injection	K		$10.862	.	$2.18																																																																																																																																																																																																																			
1207	"Octreotide injection, depot"	K		$190.678	.	$38.14																																																																																																																																																																																																																			
1213	Antihemophilic viii/vwf comp	K		$0.991	.	$0.20																																																																																																																																																																																																																			
1214	Inj IVIG privigen 500 mg	K		$39.652	.	$7.93																																																																																																																																																																																																																			
1232	Mitomycin injection	K		$140.081	.	$28.02																																																																																																																																																																																																																			
1235	Valrubicin injection	K		"$1,247.187"	.	$249.44																																																																																																																																																																																																																			
1236	Levoleucovorin injection	K		$0.357	.	$0.08																																																																																																																																																																																																																			
1237	Inj iron dextran	K		$13.031	.	$2.61																																																																																																																																																																																																																			
1263	Antithrombin iii injection	K		$3.593	.	$0.72																																																																																																																																																																																																																			
1268	Xyntha inj	K		$1.253	.	$0.25																																																																																																																																																																																																																			
1274	Edetate calcium disodium inj	K 		"$5,594.422"	.	"$1,118.89"																																																																																																																																																																																																																			
1281	Bevacizumab injection	K		$1.929	.	$0.39																																																																																																																																																																																																																			
1289	AbobotulinumtoxinA	K		$8.228	.	$1.65																																																																																																																																																																																																																			
1295	Sm 153 lexidronam	K		"$13,366.335"	.	"$2,673.27"	#																																																																																																																																																																																																																		
1296	Degarelix injection	K		$3.694	.	$0.74																																																																																																																																																																																																																			
1297	"Ferumoxytol, non-esrd"	K		$0.947	.	$0.19																																																																																																																																																																																																																			
1311	Canakinumab injection	K		$108.701	.	$21.74																																																																																																																																																																																																																			
1312	Hizentra injection	K		$9.833	.	$1.97																																																																																																																																																																																																																			
1327	Imiglucerase injection	K		$41.578	.	$8.32																																																																																																																																																																																																																			
1340	"Collagenase, clost hist inj"	K		$43.579	.	$8.72																																																																																																																																																																																																																			
1341	Amobarbital 125 MG inj	K		$234.020	.	$46.81																																																																																																																																																																																																																			
1352	Wilate injection	K		$1.041	.	$0.21																																																																																																																																																																																																																			
1353	Belimumab injection	K		$43.524	.	$8.71																																																																																																																																																																																																																			
1408	Cyclophosphamide 100 MG inj	K		$41.869	.	$8.38																																																																																																																																																																																																																			
1413	Lumizyme injection	K		$160.637	.	$32.13																																																																																																																																																																																																																			
1415	Glassia injection	K		$4.643	.	$0.93																																																																																																																																																																																																																			
1416	Factor xiii anti-hem factor	K		$8.217	.	$1.65																																																																																																																																																																																																																			
1417	Gel-one	K		$527.870	.	$105.58																																																																																																																																																																																																																			
1420	Aflibercept injection	K		$968.794	.	$193.76																																																																																																																																																																																																																			
1426	Eribulin mesylate injection	K		$111.284	.	$22.26																																																																																																																																																																																																																			
1431	Centruroides immune f(ab)	K		"$4,459.017"	.	$891.81																																																																																																																																																																																																																			
1433	Calcitonin salmon injection	K		"$2,461.058"	.	$492.22																																																																																																																																																																																																																			
1440	Inj desmopressin acetate	K		$13.020	.	$2.61																																																																																																																																																																																																																			
1443	Icatibant injection	K		$355.277	.	$71.06																																																																																																																																																																																																																			
1446	Visualization adjunct	K		$4.959	.	$1.00																																																																																																																																																																																																																			
1458	Phentolaine mesylate inj	K		$378.442	.	$75.69																																																																																																																																																																																																																			
1466	"Inj, vincristine sul lip 1mg"	K		"$2,807.145"	.	$561.43																																																																																																																																																																																																																			
1467	Factor ix recombinan rixubis	K		$1.312	.	$0.27																																																																																																																																																																																																																			
1468	Inj Aripiprazole Ext Rel 1mg	K		$5.013	.	$1.01																																																																																																																																																																																																																			
1469	Inj filgrastim excl biosimil	K		$1.019	.	$0.21																																																																																																																																																																																																																			
1471	"Injection, Pertuzumab, 1 mg"	K		$11.505	.	$2.31																																																																																																																																																																																																																			
1472	Inj beta interferon im 1 mcg	K		$50.171	.	$10.04																																																																																																																																																																																																																			
1474	Certolizumab pegol inj 1mg	K		$7.737	.	$1.55																																																																																																																																																																																																																			
1475	Golimumab for iv use 1mg	K		$24.037	.	$4.81																																																																																																																																																																																																																			
1476	Obinutuzumab inj	K		$60.841	.	$12.17																																																																																																																																																																																																																			
1478	"	Human fibrinogen conc inj"	K		$1.166	.	$0.24																																																																																																																																																																																																																			
1480	"Elosulfase alfa, injection"	K		$231.127	.	$46.23																																																																																																																																																																																																																			
1482	"	Darbepoetin alfa, esrd use"	K		$3.779	.	$0.76																																																																																																																																																																																																																			
1485	"	Ferumoxytol, esrd use"	K		$0.947	.	$0.19																																																																																																																																																																																																																			
1486	Factor ix fc fusion recomb	K		$3.027	.	$0.61																																																																																																																																																																																																																			
1488	"Injection, ramucirumab"	K		$56.927	.	$11.39																																																																																																																																																																																																																			
1489	"Injection, vedolizumab"	K		$19.130	.	$3.83																																																																																																																																																																																																																			
1490	Inj pembrolizumab	K		$48.705	.	$9.75																																																																																																																																																																																																																			
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		$19.507	.	$3.91																																																																																																																																																																																																																			
1608	Etanercept injection	K		$645.540	.	$129.11																																																																																																																																																																																																																			
1609	"Rho(D) immune globulin h, sd"	K		$24.306	.	$4.87																																																																																																																																																																																																																			
1613	Trastuzumab injection	K		$101.047	.	$20.21																																																																																																																																																																																																																			
1630	"Hep b ig, im"	K		$113.513	.	$22.71																																																																																																																																																																																																																			
1643	"Y90 ibritumomab, rx"	K		"$48,387.792"	.	"$9,677.56"	#																																																																																																																																																																																																																		
1656	Factor viii fc fusion recomb	K		$2.049	.	$0.41																																																																																																																																																																																																																			
1658	"Injection, belinostat, 10mg"	K		$36.270	.	$7.26																																																																																																																																																																																																																			
1660	"Injection, oritavancin"	K		$23.487	.	$4.70																																																																																																																																																																																																																			
1662	Inj tedizolid phosphate	K		$1.381	.	$0.28																																																																																																																																																																																																																			
1669	Erythro lactobionate /500 mg	K		$72.356	.	$14.48																																																																																																																																																																																																																			
1670	Tetanus immune globulin inj	K		$451.509	.	$90.31																																																																																																																																																																																																																			
1675	P32 Na phosphate	K		$256.000	.	$51.20																																																																																																																																																																																																																			
1683	Basiliximab	K		"$3,550.393"	.	$710.08																																																																																																																																																																																																																			
1684	Corticorelin ovine triflutal	K		$8.605	.	$1.73																																																																																																																																																																																																																			
1685	"Darbepoetin alfa, non-esrd"	K		$3.779	.	$0.76																																																																																																																																																																																																																			
1686	"Epoetin alfa, non-esrd"	K		$13.000	.	$2.60																																																																																																																																																																																																																			
1687	Digoxin immune fab (ovine)	K		"$3,513.187"	.	$702.64																																																																																																																																																																																																																			
1688	Ethanolamine oleate	K		$444.099	.	$88.82																																																																																																																																																																																																																			
1689	Fomepizole	K		$7.312	.	$1.47																																																																																																																																																																																																																			
1690	Hemin	K		$22.358	.	$4.48																																																																																																																																																																																																																			
1694	Ziconotide injection	K		$7.438	.	$1.49																																																																																																																																																																																																																			
1695	Nesiritide injection	K		$73.318	.	$14.67																																																																																																																																																																																																																			
1696	Palifermin injection	K		$19.094	.	$3.82																																																																																																																																																																																																																			
1700	Inj secretin synthetic human	K		$34.781	.	$6.96																																																																																																																																																																																																																			
1701	Treprostinil injection	K		$61.237	.	$12.25																																																																																																																																																																																																																			
1704	"Humate-P, inj"	K		$1.126	.	$0.23																																																																																																																																																																																																																			
1705	Factor viia	K		$2.061	.	$0.42																																																																																																																																																																																																																			
1709	Azacitidine injection	K		$1.439	.	$0.29																																																																																																																																																																																																																			
1710	Clofarabine injection	K		$129.564	.	$25.92																																																																																																																																																																																																																			
1711	Vantas implant	K		"$3,465.845"	.	$693.17																																																																																																																																																																																																																			
1712	Paclitaxel protein bound	K		$11.115	.	$2.23																																																																																																																																																																																																																			
1739	"Pegademase bovine, 25 iu"	K		$358.987	.	$71.80																																																																																																																																																																																																																			
1743	Nandrolone decanoate 50 mg	K		$72.580	.	$14.52																																																																																																																																																																																																																			
1745	Radium ra223 dichloride ther	K		$134.249	.	$26.85																																																																																																																																																																																																																			
1746	Factor xiii recomb a-subunit	K		$15.018	.	$3.01																																																																																																																																																																																																																			
1747	Monovisc inj per dose	K		$812.553	.	$162.51																																																																																																																																																																																																																			
1748	Inj tbo filgrastim 1 microg	K		$0.605	.	$0.13																																																																																																																																																																																																																			
1761	"Rolapitant, oral, 1mg"	K		$2.268	.	$0.46																																																																																																																																																																																																																			
1809	"Injection, alemtuzumab"	K		"$1,817.560"	.	$363.52																																																																																																																																																																																																																			
1822	Inj filgrastim gcsf biosimil	K		$0.681	.	$0.14																																																																																																																																																																																																																			
1823	"Injection, dalbavancin"	K		$14.734	.	$2.95																																																																																																																																																																																																																			
1824	"	Ceftaroline fosamil inj"	K		$2.618	.	$0.53																																																																																																																																																																																																																			
1825	Ceftazidime and avibactam	K		$77.079	.	$15.42																																																																																																																																																																																																																			
1826	Hyqvia 100mg immuneglobulin	K		$13.859	.	$2.78																																																																																																																																																																																																																			
1827	Factor viii recomb obizur	K		$4.047	.	$0.81																																																																																																																																																																																																																			
1829	"	Penicillin g benzathine inj"	K		$12.838	.	$2.57																																																																																																																																																																																																																			
1832	Dimethyl sulfoxide 50% 50 ml	K		$549.337	.	$109.87																																																																																																																																																																																																																			
1844	Factor viii pegylated recomb	K		$1.797	.	$0.36																																																																																																																																																																																																																			
1846	Factor viii nuwiq recomb 1iu	K		$1.621	.	$0.33																																																																																																																																																																																																																			
1847	"Injection, inflectra"	G		$69.712	.	$13.95																																																																																																																																																																																																																			
1848	Artiss fibrin sealant	K		$113.208	.	$22.65																																																																																																																																																																																																																			
1849	Foscarnet sodium injection	K		$82.268	.	$16.46																																																																																																																																																																																																																			
1850	Gamma globulin 1 cc inj	K		$38.793	.	$7.76																																																																																																																																																																																																																			
1851	Gamma globulin > 10 cc inj	K		$387.926	.	$77.59																																																																																																																																																																																																																			
1852	Interferon beta-1a inj	K		$604.400	.	$120.88																																																																																																																																																																																																																			
1853	Minocycline hydrochloride	K		$1.587	.	$0.32																																																																																																																																																																																																																			
1854	Pentobarbital sodium inj	K		$52.018	.	$10.41																																																																																																																																																																																																																			
1856	Factor viii recomb novoeight	K		$1.307	.	$0.27																																																																																																																																																																																																																			
1857	"Inj, factor x, (human), 1iu"	K		$6.840	.	$1.37																																																																																																																																																																																																																			
1859	Argatroban nonesrd use 1mg	K		$1.238	.	$0.25																																																																																																																																																																																																																			
1861	"Inj., bendeka 1 mg"	G		$23.752	.	$4.75																																																																																																																																																																																																																			
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	209.5601	"$16,669.67"	.	"$3,333.94"	#																																																																																																																																																																																																																		
2632	Iodine I-125 sodium iodide	U	0.4600	$36.59	.	$7.32																																																																																																																																																																																																																			
2634	"Brachytx, non-str, HA, I-125"	U	1.7584	$139.87	.	$27.98																																																																																																																																																																																																																			
2635	"Brachytx, non-str, HA, P-103"	U	0.3155	$25.10	.	$5.02																																																																																																																																																																																																																			
2636	"Brachy linear, non-str,P-103"	U	0.6390	$50.83	.	$10.17																																																																																																																																																																																																																			
2638	"Brachytx, stranded, I-125"	U	0.4513	$35.90	.	$7.18																																																																																																																																																																																																																			
2639	"Brachytx, non-stranded,I-125"	U	0.4408	$35.06	.	$7.02																																																																																																																																																																																																																			
2640	"Brachytx, stranded, P-103"	U	0.9539	$75.88	.	$15.18																																																																																																																																																																																																																			
2641	"Brachytx, non-stranded,P-103"	U	0.7578	$60.28	.	$12.06																																																																																																																																																																																																																			
2642	"Brachytx, stranded, C-131"	U	0.9972	$79.32	.	$15.87																																																																																																																																																																																																																			
2643	"Brachytx, non-stranded,C-131"	U	0.9956	$79.20	.	$15.84																																																																																																																																																																																																																			
2645	"Brachytx, non-str, Gold-198"	U	1.0823	$86.09	.	$17.22																																																																																																																																																																																																																			
2646	"Brachytx, non-str, HDR Ir-192"	U	3.6444	$289.90	.	$57.98																																																																																																																																																																																																																			
2647	"Brachytx, NS, Non-HDRIr-192"	U	0.3027	$24.08	.	$4.82																																																																																																																																																																																																																			
2648	"Brachytx planar, p-103"	U	0.0590	$4.69	.	$0.94																																																																																																																																																																																																																			
2698	"Brachytx, stranded, NOS"	U	0.4513	$35.90	.	$7.18																																																																																																																																																																																																																			
2699	"Brachytx, non-stranded, NOS"	U	0.3155	$25.10	.	$5.02																																																																																																																																																																																																																			
2731	"Immune globulin, powder"	K		$35.530	.	$7.11																																																																																																																																																																																																																			
2770	Quinupristin/dalfopristin	K		$419.199	.	$83.84																																																																																																																																																																																																																			
4001	Echo guidance radiotherapy	S		$51.19	.	$10.24																																																																																																																																																																																																																			
4002	Stereoscopic x-ray guidance 	S		$55.87	.	$11.17																																																																																																																																																																																																																			
4003	"Radiation treatment delivery, MeV <= 5; simple "	S		$192.13	.	$38.43																																																																																																																																																																																																																			
4004	"Radiation treatment delivery, 6-10 MeV; simple "	S		$145.27	.	$29.05																																																																																																																																																																																																																			
4005	"Radiation treatment delivery, 11-19 MeV; simple "	S		$145.27	.	$29.05																																																																																																																																																																																																																			
4006	"Radiation treatment delivery, MeV>=20; simple "	S		$144.91	.	$28.98																																																																																																																																																																																																																			
4007	"Radiation treatment delivery, MeV<=5; intermediate"	S		$266.38	.	$53.28																																																																																																																																																																																																																			
4008	"Radiation treatment delivery, 6-10 MeV; intermediate "	S		$200.42	.	$40.08																																																																																																																																																																																																																			
4009	"Radiation treatment delivery, 11-19 MeV; intermediate"	S		$199.34	.	$39.87																																																																																																																																																																																																																			
4010	"Radiation treatment delivery, MeV >=20; intermediate"	S		$199.34	.	$39.87																																																																																																																																																																																																																			
4011	"Radiation treatment delivery, MeV<=5; complex"	S		$269.27	.	$53.85																																																																																																																																																																																																																			
4012	"Radiation treatment delivery, 6-10 MeV; complex"	S		$266.02	.	$53.20																																																																																																																																																																																																																			
4013	"Radiation treatment delivery, 11-19 MeV; complex"	S		$266.38	.	$53.28																																																																																																																																																																																																																			
4014	"Radiation treatment delivery, MeV >=20; complex"	S		$266.38	.	$53.28																																																																																																																																																																																																																			
4015	Radiation tx delivery imrt	S		$360.10	.	$72.02																																																																																																																																																																																																																			
4016	Delivery comp imrt	S		$359.38	.	$71.88																																																																																																																																																																																																																			
5012	Clinic Visits and Related Services	V	1.4553	$115.76	.	$23.16																																																																																																																																																																																																																			
5021	Level 1 Type A ED Visits	V	0.8783	$69.87	.	$13.98																																																																																																																																																																																																																			
5022	Level 2 Type A ED Visits	V	1.6117	$128.20	.	$25.64																																																																																																																																																																																																																			
5023	Level 3 Type A ED Visits	V	2.8284	$224.99	.	$45.00																																																																																																																																																																																																																			
5024	Level 4 Type A ED Visits	V	4.5781	$364.17	.	$72.84																																																																																																																																																																																																																			
5025	Level 5 Type A ED Visits	V	6.6644	$530.13	.	$106.03																																																																																																																																																																																																																			
5031	Level 1 Type B ED Visits	V	1.0378	$82.55	.	$16.51																																																																																																																																																																																																																			
5032	Level 2 Type B ED Visits	V	1.1792	$93.80	.	$18.76																																																																																																																																																																																																																			
5033	Level 3 Type B ED Visits	V	2.0642	$164.20	.	$32.84																																																																																																																																																																																																																			
5034	Level 4 Type B ED Visits	V	2.8049	$223.12	.	$44.63																																																																																																																																																																																																																			
5035	Level 5 Type B ED Visits	V	4.1239	$328.04	.	$65.61																																																																																																																																																																																																																			
5041	Critical Care	S	9.4855	$754.53	.	$150.91																																																																																																																																																																																																																			
5045	Trauma Response with Critical Care	S	11.7499	$934.66	.	$186.94																																																																																																																																																																																																																			
5051	Level 1 Skin Procedures	T	2.2048	$175.38	.	$35.08																																																																																																																																																																																																																			
5052	Level 2 Skin Procedures	T	3.9814	$316.70	.	$63.34																																																																																																																																																																																																																			
5053	Level 3 Skin Procedures	T	6.0738	$483.15	.	$96.63																																																																																																																																																																																																																			
5054	Level 4 Skin Procedures	T	19.6695	"$1,564.63"	.	$312.93																																																																																																																																																																																																																			
5055	Level 5 Skin Procedures	T	34.7022	"$2,760.42"	.	$552.09																																																																																																																																																																																																																			
5061	Hyperbaric Oxygen	S	1.4493	$115.29	.	$23.06																																																																																																																																																																																																																			
5071	Level 1 Excision/ Biopsy/ Incision and Drainage	T	7.3164	$581.99	.	$116.40																																																																																																																																																																																																																			
5072	Level 2 Excision/ Biopsy/ Incision and Drainage	J1	17.2268	"$1,370.32"	.	$274.07																																																																																																																																																																																																																			
5073	Level 3 Excision/ Biopsy/ Incision and Drainage	J1	29.8681	"$2,375.89"	.	$475.18																																																																																																																																																																																																																			
5091	Level 1 Breast/Lymphatic Surgery and Related Procedures	J1	35.3351	"$2,810.77"	.	$562.16																																																																																																																																																																																																																			
5092	Level 2 Breast/Lymphatic Surgery and Related Procedures	J1	62.3478	"$4,959.52"	.	$991.91																																																																																																																																																																																																																			
5093	Level 3 Breast/Lymphatic Surgery and Related Procedures	J1	93.4287	"$7,431.88"	.	"$1,486.38"	#																																																																																																																																																																																																																		
5094	Level 4 Breast/Lymphatic Surgery and Related Procedures	J1	152.1007	"$12,099.00"	.	"$2,419.80"	#																																																																																																																																																																																																																		
5101	Level 1 Strapping and Cast Application	T	1.7237	$137.11	.	$27.43																																																																																																																																																																																																																			
5102	Level 2 Strapping and Cast Application	T	3.0638	$243.71	.	$48.75																																																																																																																																																																																																																			
5111	Level 1 Musculoskeletal Procedures	T	2.8319	$225.27	.	$45.06																																																																																																																																																																																																																			
5112	Level 2 Musculoskeletal Procedures	J1	16.6149	"$1,321.65"	.	$264.33																																																																																																																																																																																																																			
5113	Level 3 Musculoskeletal Procedures	J1	32.9981	"$2,624.87"	.	$524.98																																																																																																																																																																																																																			
5114	Level 4 Musculoskeletal Procedures	J1	71.8055	"$5,711.84"	.	"$1,142.37"																																																																																																																																																																																																																			
5115	Level 5 Musculoskeletal Procedures	J1	134.9980	"$10,738.55"	.	"$2,147.71"	#																																																																																																																																																																																																																		
5116	Level 6 Musculoskeletal Procedures	J1	194.8634	"$15,500.60"	.	"$3,100.12"	#																																																																																																																																																																																																																		
5151	Level 1 Airway Endoscopy	T	2.0071	$159.66	.	$31.94																																																																																																																																																																																																																			
5152	Level 2 Airway Endoscopy	T	4.7799	$380.22	.	$76.05																																																																																																																																																																																																																			
5153	Level 3 Airway Endoscopy	J1	17.2414	"$1,371.48"	.	$274.30																																																																																																																																																																																																																			
5154	Level 4 Airway Endoscopy	J1	34.6730	"$2,758.10"	.	$551.62																																																																																																																																																																																																																			
5155	Level 5 Airway Endoscopy	J1	64.6155	"$5,139.90"	.	"$1,027.98"																																																																																																																																																																																																																			
5161	Level 1 ENT Procedures	T	2.5762	$204.93	.	$40.99																																																																																																																																																																																																																			
5162	Level 2 ENT Procedures	T	6.0637	$482.34	.	$96.47																																																																																																																																																																																																																			
5163	Level 3 ENT Procedures	J1	16.0779	"$1,278.93"	.	$255.79																																																																																																																																																																																																																			
5164	Level 4 ENT Procedures	J1	28.1759	"$2,241.28"	.	$448.26																																																																																																																																																																																																																			
5165	Level 5 ENT Procedures	J1	55.8697	"$4,444.21"	.	$888.85																																																																																																																																																																																																																			
5166	Cochlear Implant Procedure	J1	400.2986	"$31,842.15"	"$7,653.60"	"$6,368.43"	#																																																																																																																																																																																																																		
5181	Level 1 Vascular Procedures	T	7.8225	$622.25	.	$124.45																																																																																																																																																																																																																			
5182	Level 2 Vascular Procedures	T	13.8901	"$1,104.90"	.	$220.98																																																																																																																																																																																																																			
5183	Level 3 Vascular Procedures	J1	33.2865	"$2,647.81"	.	$529.57																																																																																																																																																																																																																			
5184	Level 4 Vascular Procedures	J1	55.0784	"$4,381.27"	.	$876.26																																																																																																																																																																																																																			
5191	Level 1 Endovascular Procedures	J1	35.5755	"$2,829.89"	$865.62	$565.98																																																																																																																																																																																																																			
5192	Level 2 Endovascular Procedures	J1	59.7840	"$4,755.58"	.	$951.12																																																																																																																																																																																																																			
5193	Level 3 Endovascular Procedures	J1	122.7627	"$9,765.28"	.	"$1,953.06"	#																																																																																																																																																																																																																		
5194	Level 4 Endovascular Procedures	J1	194.9034	"$15,503.79"	.	"$3,100.76"	#																																																																																																																																																																																																																		
5200	Implantation Wireless PA Pressure Monitor	J1	367.6967	"$29,248.80"	.	"$5,849.76"	#																																																																																																																																																																																																																		
5211	Level 1 Electrophysiologic Procedures	J1	11.6008	$922.80	.	$184.56																																																																																																																																																																																																																			
5212	Level 2 Electrophysiologic Procedures	J1	69.4388	"$5,523.58"	.	"$1,104.72"																																																																																																																																																																																																																			
5213	Level 3 Electrophysiologic Procedures	J1	241.1947	"$19,186.07"	.	"$3,837.22"	#																																																																																																																																																																																																																		
5221	Level1 Pacemaker and Similar Procedures	T	40.5527	"$3,225.81"	.	$645.17																																																																																																																																																																																																																			
5222	Level 2 Pacemaker and Similar Procedures	J1	93.7071	"$7,454.02"	.	"$1,490.81"	#																																																																																																																																																																																																																		
5223	Level 3 Pacemaker and Similar Procedures	J1	124.9880	"$9,942.30"	.	"$1,988.46"	#																																																																																																																																																																																																																		
5224	Level 4 Pacemaker and Similar Procedures	J1	224.5129	"$17,859.10"	.	"$3,571.82"	#																																																																																																																																																																																																																		
5231	Level 1 ICD and Similar Procedures	J1	279.6107	"$22,241.91"	.	"$4,448.39"	#																																																																																																																																																																																																																		
5232	Level 2 ICD and Similar Procedures	J1	387.9779	"$30,862.09"	.	"$6,172.42"	#																																																																																																																																																																																																																		
5241	Level 1 Blood Product Exchange and Related Services	S	4.8197	$383.39	.	$76.68																																																																																																																																																																																																																			
5242	Level 2 Blood Product Exchange and Related Services	S	15.3744	"$1,222.97"	.	$244.60																																																																																																																																																																																																																			
5243	Level 3 Blood Product Exchange and Related Services	S	49.1820	"$3,912.23"	.	$782.45																																																																																																																																																																																																																			
5244	Level 4 Blood Product Exchange and Related Services	J1	322.4029	"$25,645.86"	.	"$5,129.18"	#																																																																																																																																																																																																																		
5301	Level 1 Upper GI Procedures	T	9.6034	$763.91	.	$152.79																																																																																																																																																																																																																			
5302	Level 2 Upper GI Procedures 	J1	18.5789	"$1,477.88"	.	$295.58																																																																																																																																																																																																																			
5303	Level 3 Upper GI Procedures	J1	35.3714	"$2,813.65"	.	$562.73																																																																																																																																																																																																																			
5311	Level 1 Lower GI Procedures 	T	9.3436	$743.25	.	$148.65																																																																																																																																																																																																																			
5312	Level 2 Lower GI Procedures 	T	12.3005	$978.46	.	$195.70																																																																																																																																																																																																																			
5313	Level 3 Lower GI Procedures 	J1	29.4170	"$2,340.00"	.	$468.00																																																																																																																																																																																																																			
5331	Complex GI Procedures	J1	56.2235	"$4,472.35"	.	$894.47																																																																																																																																																																																																																			
5341	Abdominal/Peritoneal/Biliary and Related Procedures	J1	37.1183	"$2,952.61"	.	$590.53																																																																																																																																																																																																																			
5361	Level 1 Laparoscopy and Related Services	J1	57.8463	"$4,601.44"	.	$920.29																																																																																																																																																																																																																			
5362	Level 2 Laparoscopy and Related Services	J1	97.4476	"$7,751.57"	.	"$1,550.32"	#																																																																																																																																																																																																																		
5371	Level 1 Urology and Related Services	T	2.8862	$229.59	.	$45.92																																																																																																																																																																																																																			
5372	Level 2 Urology and Related Services	T	7.0802	$563.20	.	$112.64																																																																																																																																																																																																																			
5373	Level 3 Urology and Related Services	J1	21.7650	"$1,731.32"	.	$346.27																																																																																																																																																																																																																			
5374	Level 4 Urology and Related Services	J1	34.6402	"$2,755.49"	.	$551.10																																																																																																																																																																																																																			
5375	Level 5 Urology and Related Services	J1	47.4709	"$3,776.12"	.	$755.23																																																																																																																																																																																																																			
5376	Level 6 Urology and Related Services	J1	96.1662	"$7,649.64"	.	"$1,529.93"	#																																																																																																																																																																																																																		
5377	Level 7 Urology and Related Services	J1	204.2025	"$16,243.49"	.	"$3,248.70"	#																																																																																																																																																																																																																		
5401	Dialysis	S	7.6332	$607.19	.	$121.44																																																																																																																																																																																																																			
5411	Level 1 Gynecologic Procedures	T	2.0673	$164.45	.	$32.89																																																																																																																																																																																																																			
5412	Level 2 Gynecologic Procedures	T	3.4232	$272.30	.	$54.46																																																																																																																																																																																																																			
5413	Level 3 Gynecologic Procedures	T	7.0439	$560.31	.	$112.07																																																																																																																																																																																																																			
5414	Level 4 Gynecologic Procedures	J1	29.7466	"$2,366.22"	.	$473.25																																																																																																																																																																																																																			
5415	Level 5 Gynecologic Procedures	J1	52.0014	"$4,136.50"	$902.82	$827.30																																																																																																																																																																																																																			
5416	Level 6 Gynecologic Procedures	J1	79.7104	"$6,340.64"	"$1,405.70"	"$1,268.13"	#																																																																																																																																																																																																																		
5431	Level 1 Nerve Procedures	J1	20.6618	"$1,643.56"	.	$328.72																																																																																																																																																																																																																			
5432	Level 2 Nerve Procedures	J1	57.9928	"$4,613.10"	.	$922.62																																																																																																																																																																																																																			
5441	Level 1 Nerve Injections	T	3.1263	$248.68	.	$49.74																																																																																																																																																																																																																			
5442	Level 2 Nerve Injections	T	7.6556	$608.97	.	$121.80																																																																																																																																																																																																																			
5443	Level 3 Nerve Injections	T	9.7087	$772.29	.	$154.46																																																																																																																																																																																																																			
5461	Level 1 Neurostimulator and Related Procedures	T	37.1129	"$2,952.18"	.	$590.44																																																																																																																																																																																																																			
5462	Level 2 Neurostimulator and Related Procedures	J1	76.9755	"$6,123.09"	.	"$1,224.62"																																																																																																																																																																																																																			
5463	Level 3 Neurostimulator and Related Procedures	J1	235.3140	"$18,718.29"	.	"$3,743.66"	#																																																																																																																																																																																																																		
5464	Level 4 Neurostimulator and Related Procedures	J1	347.7496	"$27,662.09"	.	"$5,532.42"	#																																																																																																																																																																																																																		
5471	Implantation of Drug Infusion Device	J1	204.6357	"$16,277.95"	.	"$3,255.59"	#																																																																																																																																																																																																																		
5481	Laser Eye Procedures	T	6.2232	$495.03	$101.51	$99.01																																																																																																																																																																																																																			
5491	Level 1 Intraocular Procedures	J1	24.2127	"$1,926.02"	.	$385.21																																																																																																																																																																																																																			
5492	Level 2 Intraocular Procedures	J1	45.8013	"$3,643.31"	.	$728.67																																																																																																																																																																																																																			
5493	Level 3 Intraocular Procedures	J1	121.2418	"$9,644.30"	.	"$1,928.86"	#																																																																																																																																																																																																																		
5494	Level 4 Intraocular Procedures	J1	140.3371	"$11,163.25"	.	"$2,232.65"	#																																																																																																																																																																																																																		
5501	"Level 1 Extraocular, Repair, and Plastic Eye Procedures"	T	3.4429	$273.87	.	$54.78																																																																																																																																																																																																																			
5502	"Level 2 Extraocular, Repair, and Plastic Eye Procedures"	T	10.1516	$807.52	.	$161.51																																																																																																																																																																																																																			
5503	"Level 3 Extraocular, Repair, and Plastic Eye Procedures"	J1	23.0115	"$1,830.47"	.	$366.10																																																																																																																																																																																																																			
5504	"Level 4 Extraocular, Repair, and Plastic Eye Procedures"	J1	37.7206	"$3,000.52"	.	$600.11																																																																																																																																																																																																																			
5521	Level 1 Imaging without Contrast	S	0.7902	$62.86	.	$12.58																																																																																																																																																																																																																			
5522	Level 2 Imaging without Contrast	S	1.4306	$113.80	.	$22.76																																																																																																																																																																																																																			
5523	Level 3 Imaging without Contrast	S	2.9139	$231.79	.	$46.36																																																																																																																																																																																																																			
5524	Level 4 Imaging without Contrast	S	6.2063	$493.69	.	$98.74																																																																																																																																																																																																																			
5571	Level 1 Imaging with Contrast	S	2.5546	$203.21	.	$40.65																																																																																																																																																																																																																			
5572	Level 2 Imaging with Contrast	S	4.8865	$388.70	.	$77.74																																																																																																																																																																																																																			
5573	Level 3 Imaging with Contrast	S	8.6291	$686.41	.	$137.29																																																																																																																																																																																																																			
5591	Level 1 Nuclear Medicine and Related Services 	S	4.4582	$354.63	.	$70.93																																																																																																																																																																																																																			
5592	Level 2 Nuclear Medicine and Related Services	S	5.7297	$455.77	.	$91.16																																																																																																																																																																																																																			
5593	Level 3 Nuclear Medicine and Related Services 	S	15.4324	"$1,227.59"	.	$245.52																																																																																																																																																																																																																			
5594	Level 4 Nuclear Medicine and Related Services	S	17.4246	"$1,386.06"	.	$277.22																																																																																																																																																																																																																			
5611	Level 1 Therapeutic Radiation Treatment Preparation	S	1.5800	$125.68	$32.44	$25.14																																																																																																																																																																																																																			
5612	Level 2 Therapeutic Radiation Treatment Preparation	S	4.1131	$327.18	.	$65.44																																																																																																																																																																																																																			
5613	Level 3 Therapeutic Radiation Treatment Preparation	S	15.1875	"$1,208.10"	.	$241.62																																																																																																																																																																																																																			
5621	Level 1 Radiation Therapy	S	1.6065	$127.79	.	$25.56																																																																																																																																																																																																																			
5622	Level 2 Radiation Therapy	S	2.8533	$226.97	.	$45.40																																																																																																																																																																																																																			
5623	Level 3 Radiation Therapy	S	6.6682	$530.43	.	$106.09																																																																																																																																																																																																																			
5624	Level 4 Radiation Therapy	S	8.9879	$714.95	.	$142.99																																																																																																																																																																																																																			
5625	Level 5 Radiation Therapy	S	13.5906	"$1,081.08"	.	$216.22																																																																																																																																																																																																																			
5626	Level 6 Radiation Therapy	S 	21.4056	"$1,702.73"	.	$340.55																																																																																																																																																																																																																			
5627	Level 7 Radiation Therapy	J1	97.8627	"$7,784.59"	.	"$1,556.92"	#																																																																																																																																																																																																																		
5661	Therapeutic Nuclear Medicine	S	2.9527	$234.88	.	$46.98																																																																																																																																																																																																																			
5671	Level 1 Pathology	S	0.6463	$51.41	.	$10.29																																																																																																																																																																																																																			
5672	Level 2 Pathology	S	1.8185	$144.65	.	$28.93																																																																																																																																																																																																																			
5673	Level 3 Pathology	S	3.4160	$271.73	.	$54.35																																																																																																																																																																																																																			
5674	Level 4 Pathology	S	6.6963	$532.66	.	$106.54																																																																																																																																																																																																																			
5691	Level 1 Drug Administration	S	0.4763	$37.89	.	$7.58																																																																																																																																																																																																																			
5692	Level 2 Drug Administration	S	0.7537	$59.95	.	$11.99																																																																																																																																																																																																																			
5693	Level 3 Drug Administration	S	2.3618	$187.87	.	$37.58																																																																																																																																																																																																																			
5694	Level 4 Drug Administration	S	3.6594	$291.09	.	$58.22																																																																																																																																																																																																																			
5721	Level1 Diagnostic Tests and Related Services	S	1.7413	$138.51	.	$27.71																																																																																																																																																																																																																			
5722	Level 2 Diagnostic Tests and Related Services	S	3.1557	$251.02	.	$50.21																																																																																																																																																																																																																			
5723	Level 3 Diagnostic Tests and Related Services	S	5.7468	$457.13	.	$91.43																																																																																																																																																																																																																			
5724	Level 4 Diagnostic Tests and Related Services	S	11.5381	$917.81	.	$183.57																																																																																																																																																																																																																			
5731	Level 1 Minor Procedures	S	0.2142	$17.04	.	$3.41																																																																																																																																																																																																																			
5732	Level 2 Minor Procedures	S	0.4135	$32.89	.	$6.58																																																																																																																																																																																																																			
5733	Level 3 Minor Procedures	S	0.7116	$56.60	.	$11.32																																																																																																																																																																																																																			
5734	Level 4 Minor Procedures	S	1.3447	$106.97	.	$21.40																																																																																																																																																																																																																			
5735	Level 5 Minor Procedures	S	4.3915	$349.33	.	$69.87																																																																																																																																																																																																																			
5741	Level 1 Electronic Analysis of Devices	S	0.4637	$36.89	.	$7.38																																																																																																																																																																																																																			
5742	Level 2 Electronic Analysis of Devices	S	1.4508	$115.41	.	$23.09																																																																																																																																																																																																																			
5743	Level 3 Electronic Analysis of Devices	S	3.5207	$280.06	.	$56.02																																																																																																																																																																																																																			
5771	Cardiac Rehabilitation	S	1.4933	$118.79	.	$23.76																																																																																																																																																																																																																			
5781	Resuscitation and Cardioversion	S	6.6059	$525.47	.	$105.10																																																																																																																																																																																																																			
5791	Pulmonary Treatment	S	2.3941	$190.44	.	$38.09																																																																																																																																																																																																																			
5801	Ventilation Initiation and Management	S	6.6510	$529.06	.	$105.82																																																																																																																																																																																																																			
5811	Manipulation Therapy	S	0.3330	$26.49	.	$5.30																																																																																																																																																																																																																			
5821	Level 1 Health and Behavior Services	S	0.4181	$33.26	.	$6.66																																																																																																																																																																																																																			
5822	Level 2 Health and Behavior Services	S	0.9179	$73.02	.	$14.61																																																																																																																																																																																																																			
5823	Level 3 Health and Behavior Services	S	1.5813	$125.79	.	$25.16																																																																																																																																																																																																																			
5853	Partial Hospitalization (3 or more services) for CMHCs	P	1.4752	$117.35	.	$23.47																																																																																																																																																																																																																			
5863	Partial Hospitalization (3 or more services) for Hospital-based PHPs	P	2.7223	$216.55	.	$43.31																																																																																																																																																																																																																			
5871	Dental Procedures	S	11.4401	$910.01	.	$182.01																																																																																																																																																																																																																			
5881	Ancillary Outpatient Services When Patient Dies	J1	82.0837	"$6,529.43"	.	"$1,305.89"																																																																																																																																																																																																																			
7000	Amifostine	K		$948.179	.	$189.64																																																																																																																																																																																																																			
7011	Oprelvekin injection	K		$467.216	.	$93.45																																																																																																																																																																																																																			
7035	Teniposide	K		"$2,540.258"	.	$508.06																																																																																																																																																																																																																			
7041	Tirofiban HCl	K		$8.794	.	$1.76																																																																																																																																																																																																																			
7043	Infliximab not biosimil 10mg	K		$83.287	.	$16.66																																																																																																																																																																																																																			
7046	Doxorubicin inj 10mg	K		$376.164	.	$75.24																																																																																																																																																																																																																			
7048	Alteplase recombinant	K		$84.577	.	$16.92																																																																																																																																																																																																																			
7308	Aminolevulinic acid hcl top	K		$404.591	.	$80.92																																																																																																																																																																																																																			
8004	Ultrasound Composite	S	3.7972	$302.05	.	$60.41																																																																																																																																																																																																																			
8005	CT and CTA without Contrast Composite	S	3.3754	$268.50	.	$53.70																																																																																																																																																																																																																			
8006	CT and CTA with Contrast Composite	S	6.1478	$489.03	.	$97.81																																																																																																																																																																																																																			
8007	MRI and MRA without Contrast Composite	S	6.8668	$546.23	.	$109.25																																																																																																																																																																																																																			
8008	MRI and MRA with Contrast Composite	S	10.8225	$860.89	.	$172.18																																																																																																																																																																																																																			
8010	Mental Health Services Composite	S	2.7223	$216.55	.	$43.31																																																																																																																																																																																																																			
8011	Comprehensive Observation Services	J2	29.9173	"$2,379.80"	.	$475.96																																																																																																																																																																																																																			
9002	Tenecteplase injection	K		$111.626	.	$22.33																																																																																																																																																																																																																			
9003	Palivizumab	K		"$1,514.170"	.	$302.84																																																																																																																																																																																																																			
9005	Reteplase injection	K		"$2,301.910"	.	$460.39																																																																																																																																																																																																																			
9006	Tacrolimus injection	K		$192.807	.	$38.57																																																																																																																																																																																																																			
9012	Arsenic trioxide injection	K		$71.815	.	$14.37																																																																																																																																																																																																																			
9014	"Injection, cerliponase alfa"	G		$95.400	.	$19.08																																																																																																																																																																																																																			
9015	"C-1 esterase, haegarda"	G		$9.667	.	$1.94																																																																																																																																																																																																																			
9016	"Inj, triptorelin ext rel"	G		"$2,826.667"	.	$565.34																																																																																																																																																																																																																			
9018	"Inj, rimabotulinumtoxinB"	K		$11.989	.	$2.40																																																																																																																																																																																																																			
9019	Caspofungin acetate	K		$15.512	.	$3.11																																																																																																																																																																																																																			
9024	Amphotericin b lipid complex	K		$17.352	.	$3.47																																																																																																																																																																																																																			
9028	Inj. inotuzumab ozogamicin	G		"$2,202.444"	.	$440.49																																																																																																																																																																																																																			
9029	"Injection, guselkumab"	G		$99.661	.	$19.94																																																																																																																																																																																																																			
9030	Inj copanlisib	G		$71.579	.	$14.32																																																																																																																																																																																																																			
9031	"Inj, etelcalcetide, 0.1 mg"	K		$3.466	.	$0.70																																																																																																																																																																																																																			
9032	Baclofen 10 MG injection	K		$178.376	.	$35.68																																																																																																																																																																																																																			
9033	Cidofovir injection	K		$493.461	.	$98.70																																																																																																																																																																																																																			
9034	"Inj cuvitru, 100 mg"	K		$13.525	.	$2.71																																																																																																																																																																																																																			
9035	Axicabtagene ciloleucel car+ 	G		"$395,380.000"	.	"$79,076.00"	#																																																																																																																																																																																																																		
9036	"Injection, renflexis"	G		$70.378	.	$14.08																																																																																																																																																																																																																			
9038	Inj estrogen conjugate	K		$301.601	.	$60.32																																																																																																																																																																																																																			
9042	Glucagon hydrochloride	K		$211.733	.	$42.35																																																																																																																																																																																																																			
9043	"Inj, afstyla, 1 i.u."	G		$1.396	.	$0.28																																																																																																																																																																																																																			
9044	Ibutilide fumarate injection	K		$321.297	.	$64.26																																																																																																																																																																																																																			
9052	Fluciciovine F-18	G		$389.550	.	$0.00																																																																																																																																																																																																																			
9056	Gallium Ga-68	G		$66.741	.	$0.00																																																																																																																																																																																																																			
9058	Buprenorphine implant 74.2mg	G		"$1,229.979"	.	$246.00																																																																																																																																																																																																																			
9059	Vonvendi inj 1 iu vwf:rco	G		$2.268	.	$0.46																																																																																																																																																																																																																			
9065	Argatroban esrd dialysis 1mg	K		$1.238	.	$0.25																																																																																																																																																																																																																			
9067	"Lutetium Lu 177 dotatate, tx"	G		$251.750	.	$50.35																																																																																																																																																																																																																			
9070	Voretigene neparvovec-rzyl	G		"$3,003.333"	.	$600.67																																																																																																																																																																																																																			
9071	Capsaicin 8% patch	K		$3.151	.	$0.63																																																																																																																																																																																																																			
9073	Buprenorph xr 100 mg or less	G		"$1,674.800"	.	$334.96																																																																																																																																																																																																																			
9074	"Makena, 10 mg"	K		$27.326	.	$5.47																																																																																																																																																																																																																			
9075	"Inj, kovaltry, 1 i.u."	K		$1.240	.	$0.25																																																																																																																																																																																																																			
9078	Testosterone undecanoate 1mg	K		$1.338	.	$0.27																																																																																																																																																																																																																			
9079	"Genvisc 850, inj, 1mg"	K		$6.442	.	$1.29																																																																																																																																																																																																																			
9081	Tisagenlecleucel car-pos t	G		"$500,838.643"	.	"$100,167.73"	#																																																																																																																																																																																																																		
9082	Puraply or puraply am	G		$104.740	.	$0.00																																																																																																																																																																																																																			
9083	"Inj, phenylephrine ketorolac"	G		$447.550	.	$0.00																																																																																																																																																																																																																			
9084	Florbetapir f18	G		"$1,541.130"	.	$0.00																																																																																																																																																																																																																			
9085	Inj sulf hexa lipid microsph	G		$23.630	.	$0.00																																																																																																																																																																																																																			
9086	Hepa vacc ped/adol 3 dose	K		$73.770	.	$14.76																																																																																																																																																																																																																			
9087	"Inj, clevidipine butyrate"	K		$6.030	.	$1.21																																																																																																																																																																																																																			
9088	Peng benzathine/procaine inj	K		$7.330	.	$1.47																																																																																																																																																																																																																			
9089	Oral fludarabine phosphate	K		$81.420	.	$16.29																																																																																																																																																																																																																			
9090	Melphalan oral 2 mg	K		$6.560	.	$1.32																																																																																																																																																																																																																			
9091	Daunorubicin citrate inj	K		$47.740	.	$9.55																																																																																																																																																																																																																			
9092	Interferon alfa-2a inj	K		$180.950	.	$36.19																																																																																																																																																																																																																			
9093	Plicamycin (mithramycin) inj	K		$7.270	.	$1.46																																																																																																																																																																																																																			
9094	Radiesse injection	K		$478.090	.	$95.62																																																																																																																																																																																																																			
9095	"Inj, sculptra, 0.5mg"	K		$3.390	.	$0.68																																																																																																																																																																																																																			
9096	Inj Retacrit esrd on dialysi	K		$1.169	.	$0.24																																																																																																																																																																																																																			
9097	Inj Retacrit non-esrd use	K		$11.692	.	$2.34																																																																																																																																																																																																																			
9098	Chorionic gonadotropin/1000u	K		$17.040	.	$3.41																																																																																																																																																																																																																			
9104	Antithymocyte globuln rabbit	K		$713.842	.	$142.77																																																																																																																																																																																																																			
9108	Thyrotropin injection	K		"$1,598.001"	.	$319.60																																																																																																																																																																																																																			
9119	"Injection, pegfilgrastim 6mg"	K		"$4,500.880"	.	$900.18																																																																																																																																																																																																																			
9120	"Injection, Fulvestrant"	K		$96.875	.	$19.38																																																																																																																																																																																																																			
9122	Triptorelin pamoate	K		$252.734	.	$50.55																																																																																																																																																																																																																			
9124	Daptomycin injection	K		$0.421	.	$0.09																																																																																																																																																																																																																			
9125	"Risperidone, long acting"	K		$8.978	.	$1.80																																																																																																																																																																																																																			
9126	Natalizumab injection	K		$19.358	.	$3.88																																																																																																																																																																																																																			
9130	"Inj, Imm Glob Bivigam, 500mg"	K		$70.516	.	$14.11																																																																																																																																																																																																																			
9131	"Inj, Ado-trastuzumab Emt 1mg"	K		$30.310	.	$6.07																																																																																																																																																																																																																			
9132	"Kcentra, per i.u."	K		$1.935	.	$0.39																																																																																																																																																																																																																			
9133	"Rabies ig, im/sc"	K		$315.082	.	$63.02																																																																																																																																																																																																																			
9134	"Rabies ig, heat treated"	K		$346.298	.	$69.26																																																																																																																																																																																																																			
9135	"Varicella-zoster ig, im"	K		"$1,357.026"	.	$271.41																																																																																																																																																																																																																			
9139	"Rabies vaccine, im"	K		$287.289	.	$57.46																																																																																																																																																																																																																			
9140	"Rabies vaccine, id"	K		$196.540	.	$39.31																																																																																																																																																																																																																			
9171	Factor ix idelvion inj	K		$4.237	.	$0.85																																																																																																																																																																																																																			
9207	Bortezomib injection	K		$46.663	.	$9.34																																																																																																																																																																																																																			
9208	Agalsidase beta injection	K		$172.189	.	$34.44																																																																																																																																																																																																																			
9209	Laronidase injection	K		$30.611	.	$6.13																																																																																																																																																																																																																			
9210	Palonosetron hcl	K		$20.022	.	$4.01																																																																																																																																																																																																																			
9213	Pemetrexed injection	K		$66.167	.	$13.24																																																																																																																																																																																																																			
9214	Bevacizumab injection	K		$77.171	.	$15.44																																																																																																																																																																																																																			
9215	Cetuximab injection	K		$59.169	.	$11.84																																																																																																																																																																																																																			
9217	Leuprolide acetate suspnsion	K		$209.297	.	$41.86																																																																																																																																																																																																																			
9224	Galsulfase injection	K		$380.905	.	$76.19																																																																																																																																																																																																																			
9225	Fluocinolone acetonide implt	K		"$20,166.500"	.	"$4,033.30"	#																																																																																																																																																																																																																		
9228	Tigecycline injection	K		$2.625	.	$0.53																																																																																																																																																																																																																			
9229	Ibandronate sodium injection	K		$74.238	.	$14.85																																																																																																																																																																																																																			
9230	Abatacept injection	K		$50.164	.	$10.04																																																																																																																																																																																																																			
9231	Decitabine injection	K		$16.420	.	$3.29																																																																																																																																																																																																																			
9232	Idursulfase injection	K		$542.884	.	$108.58																																																																																																																																																																																																																			
9233	Ranibizumab injection	K		$372.926	.	$74.59																																																																																																																																																																																																																			
9234	Alglucosidase alfa injection	K		$159.630	.	$31.93																																																																																																																																																																																																																			
9235	Panitumumab injection	K		$111.938	.	$22.39																																																																																																																																																																																																																			
9236	Eculizumab injection	K		$230.479	.	$46.10																																																																																																																																																																																																																			
9237	"Inj, lanreotide acetate"	K		$56.864	.	$11.38																																																																																																																																																																																																																			
9239	Buprenorphine xr over 100 mg	G		"$1,674.800"	.	$334.96																																																																																																																																																																																																																			
9240	"Injection, ixabepilone"	K		$72.112	.	$14.43																																																																																																																																																																																																																			
9242	"Injection, fosaprepitant"	K		$2.098	.	$0.42																																																																																																																																																																																																																			
9243	"Inj., treanda 1 mg"	K		$30.209	.	$6.05																																																																																																																																																																																																																			
9245	Romiplostim injection	K		$68.502	.	$13.70																																																																																																																																																																																																																			
9251	C1 esterase inhibitor inj	K		$56.072	.	$11.22																																																																																																																																																																																																																			
9252	Plerixafor injection	K		$314.438	.	$62.89																																																																																																																																																																																																																			
9253	Temozolomide injection	K		$9.483	.	$1.90																																																																																																																																																																																																																			
9255	Paliperidone palmitate inj	K		$10.382	.	$2.08																																																																																																																																																																																																																			
9256	Dexamethasone intra implant	K		$200.357	.	$40.08																																																																																																																																																																																																																			
9257	"Inj. emicizumab-kxwh, 0.5 mg"	G		$49.476	.	$9.90																																																																																																																																																																																																																			
9258	Telavancin injection	K		$5.392	.	$1.08																																																																																																																																																																																																																			
9259	Pralatrexate injection	K		$262.320	.	$52.47																																																																																																																																																																																																																			
9260	Ofatumumab injection	K		$56.588	.	$11.32																																																																																																																																																																																																																			
9261	"Ustekinumab sub cu inj, 1 mg"	K		$184.943	.	$36.99																																																																																																																																																																																																																			
9263	Ecallantide injection	K		$457.083	.	$91.42																																																																																																																																																																																																																			
9264	Tocilizumab injection	K		$4.539	.	$0.91																																																																																																																																																																																																																			
9265	Romidepsin injection	K		$337.022	.	$67.41																																																																																																																																																																																																																			
9269	"C-1 esterase, berinert"	K		$48.917	.	$9.79																																																																																																																																																																																																																			
9270	Gammaplex IVIG	K		$39.093	.	$7.82																																																																																																																																																																																																																			
9271	Velaglucerase alfa	K		$345.094	.	$69.02																																																																																																																																																																																																																			
9272	"Inj, denosumab"	K		$17.937	.	$3.59																																																																																																																																																																																																																			
9273	Sipuleucel-T auto CD54+	K		"$41,827.196"	.	"$8,365.44"	#																																																																																																																																																																																																																		
9274	Crotalidae Poly Immune Fab	K		"$3,086.275"	.	$617.26																																																																																																																																																																																																																			
9276	Cabazitaxel injection	K		$163.856	.	$32.78																																																																																																																																																																																																																			
9278	Incobotulinumtoxin A	K		$5.079	.	$1.02																																																																																																																																																																																																																			
9281	"Injection, pegloticase"	K		"$2,090.024"	.	$418.01																																																																																																																																																																																																																			
9284	Ipilimumab injection	K		$148.782	.	$29.76																																																																																																																																																																																																																			
9286	Belatacept injection	K		$3.886	.	$0.78																																																																																																																																																																																																																			
9287	Brentuximab vedotin inj	K		$144.837	.	$28.97																																																																																																																																																																																																																			
9289	Erwinaze injection	K		$409.061	.	$81.82																																																																																																																																																																																																																			
9294	"Inj, taliglucerase alfa 10 u"	K		$40.371	.	$8.08																																																																																																																																																																																																																			
9295	"Injection, Carfilzomib, 1 mg"	K		$34.109	.	$6.83																																																																																																																																																																																																																			
9296	"Inj, ziv-aflibercept, 1mg"	K		$8.124	.	$1.63																																																																																																																																																																																																																			
9297	"Inj, Omacetaxine Mep, 0.01mg"	K		$2.843	.	$0.57																																																																																																																																																																																																																			
9298	"Inj, Ocriplasmin, 0.125 mg"	K		"$1,046.927"	.	$209.39																																																																																																																																																																																																																			
9300	Omalizumab injection	K		$36.376	.	$7.28																																																																																																																																																																																																																			
9301	"Aminolevulinic acid, 10% gel"	G		$1.385	.	$0.28																																																																																																																																																																																																																			
9302	"Inj, daunorubicin-cytarabine"	G		$186.705	.	$37.35																																																																																																																																																																																																																			
9441	Inj ferric carboxymaltos 1mg	K		$1.052	.	$0.21																																																																																																																																																																																																																			
9445	"Injection, ruconest"	K		$27.848	.	$5.57																																																																																																																																																																																																																			
9448	Netupitant palonosetron oral	K		$366.823	.	$73.37																																																																																																																																																																																																																			
9449	"Injection, blinatumomab"	K		$107.468	.	$21.50																																																																																																																																																																																																																			
9450	Fluocinol acet intravit imp	K		$490.277	.	$98.06																																																																																																																																																																																																																			
9451	"Injection, peramivir"	K		$1.678	.	$0.34																																																																																																																																																																																																																			
9452	Inj ceftolozane tazobactam	K		$5.196	.	$1.04																																																																																																																																																																																																																			
9453	"Injection, nivolumab"	K		$27.152	.	$5.43																																																																																																																																																																																																																			
9454	"Inj, pasireotide long acting"	K		$265.761	.	$53.16																																																																																																																																																																																																																			
9455	"Injection, siltuximab"	K		$93.344	.	$18.67																																																																																																																																																																																																																			
9456	"Injection, isavuconazonium"	K		$0.720	.	$0.15																																																																																																																																																																																																																			
9460	"Injection, cangrelor"	K		$15.050	.	$3.01																																																																																																																																																																																																																			
9462	"Injection, delafloxacin"	G		$0.468	.	$0.10																																																																																																																																																																																																																			
9463	"Injection, aprepitant"	G		$2.405	.	$0.49																																																																																																																																																																																																																			
9464	"Injection, rolapitant"	G		$0.939	.	$0.19																																																																																																																																																																																																																			
9465	"Injection, Durolane"	G		"$1,033.500"	.	$206.70																																																																																																																																																																																																																			
9466	"Injection, benralizumab"	G		$167.908	.	$33.59																																																																																																																																																																																																																			
9467	Inj rituximab hyaluronidase	G		$45.721	.	$9.15																																																																																																																																																																																																																			
9468	"Inj, factor ix, Rebinyn"	G		$4.455	.	$0.90																																																																																																																																																																																																																			
9469	"Inj., triamcinolone ext rel"	G		$18.881	.	$3.78																																																																																																																																																																																																																			
9470	Aripiprazole lauroxil 1mg	K		$2.425	.	$0.49																																																																																																																																																																																																																			
9471	Hymovis injection 1 mg	K		$19.257	.	$3.86																																																																																																																																																																																																																			
9472	Inj talimogene laherparepvec	K		$48.597	.	$9.72																																																																																																																																																																																																																			
9473	"Injection, mepolizumab, 1mg"	K		$28.848	.	$5.77																																																																																																																																																																																																																			
9474	Inj irinotecan liposome 1 mg	K		$42.594	.	$8.52																																																																																																																																																																																																																			
9475	"Injection, necitumumab, 1 mg"	K		$5.363	.	$1.08																																																																																																																																																																																																																			
9476	"Injection, daratumumab 10 mg"	K		$50.394	.	$10.08																																																																																																																																																																																																																			
9477	"Injection, elotuzumab, 1mg"	K		$6.347	.	$1.27																																																																																																																																																																																																																			
9478	Inj sebelipase alfa 1 mg	K		$530.000	.	$106.00																																																																																																																																																																																																																			
9479	"Instill, ciprofloxacin otic"	K		$29.976	.	$6.00																																																																																																																																																																																																																			
9480	Injection trabectedin 0.1mg	K		$295.127	.	$59.03																																																																																																																																																																																																																			
9481	"Injection, reslizumab"	K		$9.108	.	$1.83																																																																																																																																																																																																																			
9482	Sotalol hydrochloride IV	K		$9.985	.	$2.00																																																																																																																																																																																																																			
9483	"Inj, atezolizumab,10 mg"	K		$75.971	.	$15.20																																																																																																																																																																																																																			
9484	"Inj, eteplirsen, 10 mg"	G		$168.365	.	$33.68																																																																																																																																																																																																																			
9485	"Inj, olaratumab, 10 mg"	G		$50.032	.	$10.01																																																																																																																																																																																																																			
9486	"Inj, granisetron, xr, 0.1 mg"	G		$4.344	.	$0.87																																																																																																																																																																																																																			
9487	"Ustekinumab, iv inject,1 mg"	G		$12.803	.	$2.56																																																																																																																																																																																																																			
9488	Conivaptan hcl	G		$30.931	.	$6.19																																																																																																																																																																																																																			
9489	"Inj, nusinersen, 0.1mg"	G		"$1,103.109"	.	$220.63																																																																																																																																																																																																																			
9490	"Inj, bezlotoxumab, 10 mg"	G		$40.136	.	$8.03																																																																																																																																																																																																																			
9491	"Injection, avelumab, 10 mg"	G		$80.627	.	$16.13																																																																																																																																																																																																																			
9492	"Injection, durvalumab"	G		$73.595	.	$14.72																																																																																																																																																																																																																			
9493	"Injection, edaravone"	G		$19.186	.	$3.84																																																																																																																																																																																																																			
9494	"Injection, ocrelizumab"	G		$57.164	.	$11.44																																																																																																																																																																																																																			
9495	Gemtuzumab ozogamicin inj	G		$193.156	.	$38.64																																																																																																																																																																																																																			
9497	"Loxapine, inhalation powder"	K		$146.726	.	$29.35																																																																																																																																																																																																																			
9500	"Platelets, irradiated"	R	2.2650	$180.17	.	$36.04																																																																																																																																																																																																																			
9501	Platelet pheres leukoreduced	R	6.0609	$482.12	.	$96.43																																																																																																																																																																																																																			
9502	Platelet pheresis irradiated	R	6.8885	$547.95	.	$109.59																																																																																																																																																																																																																			
9503	Fr frz plasma donor retested	R	0.7885	$62.72	.	$12.55																																																																																																																																																																																																																			
9504	RBC deglycerolized	R	3.8580	$306.89	.	$61.38																																																																																																																																																																																																																			
9505	RBC irradiated	R	2.8467	$226.44	.	$45.29																																																																																																																																																																																																																			
9507	"Platelets, pheresis"	R	4.3035	$342.33	.	$68.47																																																																																																																																																																																																																			
9508	Plasma 1 donor frz w/in 8 hr	R	0.9180	$73.02	.	$14.61																																																																																																																																																																																																																			
9509	"Frozen plasma, pooled, sd"	R	1.0247	$81.51	.	$16.31																																																																																																																																																																																																																			
9510	Whole blood for transfusion	R	1.5537	$123.59	.	$24.72																																																																																																																																																																																																																			
9511	Cryoprecipitate each unit	R	0.5572	$44.32	.	$8.87																																																																																																																																																																																																																			
9512	RBC leukocytes reduced	R	2.3074	$183.54	.	$36.71																																																																																																																																																																																																																			
9513	"Plasma, frz between 8-24hour"	R	0.9564	$76.08	.	$15.22																																																																																																																																																																																																																			
9514	"Plasma protein fract,5%,50ml"	R	1.9844	$157.85	.	$31.57																																																																																																																																																																																																																			
9515	"Platelets, each unit"	R	1.4637	$116.43	.	$23.29																																																																																																																																																																																																																			
9516	Plaelet rich plasma unit	R	1.6550	$131.65	.	$26.33																																																																																																																																																																																																																			
9517	Red blood cells unit	R	1.8210	$144.85	.	$28.97																																																																																																																																																																																																																			
9518	Washed red blood cells unit	R	4.3164	$343.35	.	$68.67																																																																																																																																																																																																																			
9519	"Plasmaprotein fract,5%,250ml"	R	0.7294	$58.02	.	$11.61																																																																																																																																																																																																																			
9520	Blood split unit	R	1.5825	$125.88	.	$25.18																																																																																																																																																																																																																			
9521	Platelets leukoreduced irrad	R	2.0764	$165.17	.	$33.04																																																																																																																																																																																																																			
9522	RBC leukoreduced irradiated	R	3.2485	$258.41	.	$51.69																																																																																																																																																																																																																			
9523	Cryoprecipitatereducedplasma	R	1.1226	$89.30	.	$17.86																																																																																																																																																																																																																			
9524	"Blood, l/r, cmv-neg"	R	2.2809	$181.44	.	$36.29																																																																																																																																																																																																																			
9525	"Platelets, hla-m, l/r, unit"	R	10.4082	$827.93	.	$165.59																																																																																																																																																																																																																			
9526	Platelets leukocytes reduced	R	1.5809	$125.75	.	$25.15																																																																																																																																																																																																																			
9527	"Blood, l/r, froz/degly/wash"	R	4.0546	$322.53	.	$64.51																																																																																																																																																																																																																			
9528	"Plt, aph/pher, l/r, cmv-neg"	R	5.3674	$426.96	.	$85.40																																																																																																																																																																																																																			
9529	"Blood, l/r, irradiated"	R	2.7466	$218.48	.	$43.70																																																																																																																																																																																																																			
9530	Plate pheres leukoredu irrad	R	7.8378	$623.47	.	$124.70																																																																																																																																																																																																																			
9531	"Plt, pher, l/r cmv-neg, irr"	R	6.1891	$492.32	.	$98.47																																																																																																																																																																																																																			
9532	"RBC, frz/deg/wsh, l/r, irrad"	R	2.9688	$236.16	.	$47.24																																																																																																																																																																																																																			
9533	"RBC, l/r, cmv-neg, irrad"	R	2.8728	$228.52	.	$45.71																																																																																																																																																																																																																			
9534	Pathogen reduced plasma pool	R	0.5613	$44.65	.	$8.93																																																																																																																																																																																																																			
9535	Pathogen reduced plasma sing	R	0.8886	$70.68	.	$14.14																																																																																																																																																																																																																			
9536	"Platelets, pathogen reduced"	R	5.6028	$445.68	.	$89.14																																																																																																																																																																																																																			
