	Addendum A.-Proposed OPPS APCs for CY 2020																																																																																																																																																																																																																																							
APC 	Group Title	SI	Relative Weight 	Payment Rate	National Unadjusted Copayment 	Minimum Unadjusted Copayment 	"Note: Actual copayments would be lower due to the cap on copayments at the Inpatient Deductible of $1,364.00"																																																																																																																																																																																																																																	
0701	Sr89 strontium	K		"$2,045.702"	.	$409.14																																																																																																																																																																																																																																		
0726	Dexrazoxane HCl injection	K		$211.494	.	$42.30																																																																																																																																																																																																																																		
0731	Sargramostim injection	K		$39.672	.	$7.94																																																																																																																																																																																																																																		
0736	Amphotericin b liposome inj	K		$23.917	.	$4.79																																																																																																																																																																																																																																		
0738	Rasburicase	K		$279.162	.	$55.84																																																																																																																																																																																																																																		
0751	Mechlorethamine hcl inj	K		$321.723	.	$64.35																																																																																																																																																																																																																																		
0752	Dactinomycin injection	K		"$1,253.860"	.	$250.78																																																																																																																																																																																																																																		
0759	"Naltrexone, depot form"	K		$3.234	.	$0.65																																																																																																																																																																																																																																		
0800	Leuprolide acetate	K		"$1,190.199"	.	$238.04																																																																																																																																																																																																																																		
0802	Etoposide oral	K		$75.860	.	$15.18																																																																																																																																																																																																																																		
0807	Aldesleukin injection	K		"$4,138.145"	.	$827.63																																																																																																																																																																																																																																		
0810	Goserelin acetate implant	K		$488.275	.	$97.66																																																																																																																																																																																																																																		
0812	Carmustine injection	K		"$3,883.225"	.	$776.65																																																																																																																																																																																																																																		
0820	Daunorubicin injection	K		$47.235	.	$9.45																																																																																																																																																																																																																																		
0823	Docetaxel injection	K		$1.155	.	$0.24																																																																																																																																																																																																																																		
0825	Nelarabine injection	K		$152.170	.	$30.44																																																																																																																																																																																																																																		
0836	Interferon alfa-2b inj	K		$33.585	.	$6.72																																																																																																																																																																																																																																		
0840	Inj melphalan hydrochl	K		$697.406	.	$139.49																																																																																																																																																																																																																																		
0843	Pegaspargase injection	K		"$15,701.929"	.	"$3,140.39"	#																																																																																																																																																																																																																																	
0844	Pentostatin injection	K		"$1,984.759"	.	$396.96																																																																																																																																																																																																																																		
0850	Streptozocin injection	K		$344.846	.	$68.97																																																																																																																																																																																																																																		
0851	Thiotepa injection	K		$553.437	.	$110.69																																																																																																																																																																																																																																		
0856	Porfimer sodium injection	K		"$21,219.568"	.	"$4,243.92"	#																																																																																																																																																																																																																																	
0858	Inj cladribine	K		$22.168	.	$4.44																																																																																																																																																																																																																																		
0864	Mitoxantrone hydrochl	K		$32.791	.	$6.56																																																																																																																																																																																																																																		
0874	Synvisc or synvisc-one	K		$11.324	.	$2.27																																																																																																																																																																																																																																		
0875	Euflexxa inj per dose	K		$145.295	.	$29.06																																																																																																																																																																																																																																		
0877	Orthovisc inj per dose	K		$506.680	.	$101.34																																																																																																																																																																																																																																		
0887	Azathioprine parenteral	K		$239.329	.	$47.87																																																																																																																																																																																																																																		
0890	Lymphocyte immune globulin	K		"$2,071.798"	.	$414.36																																																																																																																																																																																																																																		
0901	Alpha 1 proteinase inhibitor	K		$4.563	.	$0.92																																																																																																																																																																																																																																		
0902	"Injection,onabotulinumtoxinA"	K		$6.119	.	$1.23																																																																																																																																																																																																																																		
0903	Cytomegalovirus imm IV /vial	K		"$1,129.154"	.	$225.83																																																																																																																																																																																																																																		
0910	Interferon beta-1b / .25 MG	K		$373.169	.	$74.64																																																																																																																																																																																																																																		
0925	Factor viii	K		$1.036	.	$0.21																																																																																																																																																																																																																																		
0927	Factor viii recombinant	K		$1.283	.	$0.26																																																																																																																																																																																																																																		
0928	Factor ix complex	K		$1.436	.	$0.29																																																																																																																																																																																																																																		
0929	Anti-inhibitor	K		$1.924	.	$0.39																																																																																																																																																																																																																																		
0931	Factor IX non-recombinant	K		$1.145	.	$0.23																																																																																																																																																																																																																																		
0932	Factor ix recombinant nos	K		$1.500	.	$0.30																																																																																																																																																																																																																																		
0943	Octagam injection	K		$32.469	.	$6.50																																																																																																																																																																																																																																		
0944	Gammagard liquid injection	K		$42.154	.	$8.43																																																																																																																																																																																																																																		
0946	Hepagam b im injection	K		$64.610	.	$12.93																																																																																																																																																																																																																																		
0947	Flebogamma injection	K		$36.425	.	$7.29																																																																																																																																																																																																																																		
0948	Gamunex-C/Gammaked	K		$38.748	.	$7.75																																																																																																																																																																																																																																		
0961	"Albumin (human),5%, 50ml"	K		$10.490	.	$2.10																																																																																																																																																																																																																																		
0963	"Albumin (human), 5%, 250 ml"	K		$52.450	.	$10.49																																																																																																																																																																																																																																		
0964	"Albumin (human), 25%, 20 ml"	K		$20.980	.	$4.20																																																																																																																																																																																																																																		
0965	"Albumin (human), 25%, 50ml"	K		$52.450	.	$10.49																																																																																																																																																																																																																																		
1015	Injection glatiramer acetate	K		$187.346	.	$37.47																																																																																																																																																																																																																																		
1064	"I131 iodide cap, rx"	K		$20.760	.	$4.16																																																																																																																																																																																																																																		
1083	Adalimumab injection	K		"$1,371.134"	.	$274.23																																																																																																																																																																																																																																		
1138	"Hepagam b intravenous, inj"	K		$64.610	.	$12.93																																																																																																																																																																																																																																		
1139	Protein c concentrate	K		$15.124	.	$3.03																																																																																																																																																																																																																																		
1142	Supprelin LA implant	K		"$34,970.232"	.	"$6,994.05"	#																																																																																																																																																																																																																																	
1150	"I131 iodide sol, rx"	K		$13.570	.	$2.72																																																																																																																																																																																																																																		
1166	Cytarabine liposome inj	K		$628.368	.	$125.68																																																																																																																																																																																																																																		
1168	"Inj, temsirolimus"	K		$62.131	.	$12.43																																																																																																																																																																																																																																		
1178	Busulfan injection	K		$6.821	.	$1.37																																																																																																																																																																																																																																		
1203	Verteporfin injection	K		$10.960	.	$2.20																																																																																																																																																																																																																																		
1207	"Octreotide injection, depot"	K		$197.909	.	$39.59																																																																																																																																																																																																																																		
1213	Antihemophilic viii/vwf comp	K		$1.031	.	$0.21																																																																																																																																																																																																																																		
1214	Inj IVIG privigen 500 mg	K		$40.718	.	$8.15																																																																																																																																																																																																																																		
1232	Mitomycin injection	K		$115.915	.	$23.19																																																																																																																																																																																																																																		
1235	Valrubicin injection	K		"$1,380.061"	.	$276.02																																																																																																																																																																																																																																		
1236	Levoleucovorin injection	K		$0.225	.	$0.05																																																																																																																																																																																																																																		
1237	Inj iron dextran	K		$13.643	.	$2.73																																																																																																																																																																																																																																		
1263	Antithrombin iii injection	K		$3.404	.	$0.68																																																																																																																																																																																																																																		
1268	Xyntha inj	K		$1.243	.	$0.25																																																																																																																																																																																																																																		
1274	Edetate calcium disodium inj	K 		"$5,594.422"	.	"$1,118.89"																																																																																																																																																																																																																																		
1281	Bevacizumab injection	K		$2.030	.	$0.41																																																																																																																																																																																																																																		
1289	AbobotulinumtoxinA	K		$8.407	.	$1.69																																																																																																																																																																																																																																		
1295	Sm 153 lexidronam	K		"$14,648.673"	.	"$2,929.74"	#																																																																																																																																																																																																																																	
1296	Degarelix injection	K		$3.824	.	$0.77																																																																																																																																																																																																																																		
1297	"Ferumoxytol, non-esrd"	K		$0.969	.	$0.20																																																																																																																																																																																																																																		
1311	Canakinumab injection	K		$111.015	.	$22.21																																																																																																																																																																																																																																		
1312	Hizentra injection	K		$10.194	.	$2.04																																																																																																																																																																																																																																		
1327	Imiglucerase injection	K		$42.098	.	$8.42																																																																																																																																																																																																																																		
1340	"Collagenase, clost hist inj"	K		$46.955	.	$9.40																																																																																																																																																																																																																																		
1341	Amobarbital 125 MG inj	K		$56.620	.	$11.33																																																																																																																																																																																																																																		
1352	Wilate injection	K		$0.982	.	$0.20																																																																																																																																																																																																																																		
1353	Belimumab injection	K		$44.162	.	$8.84																																																																																																																																																																																																																																		
1408	Cyclophosphamide 100 MG inj	K		$37.454	.	$7.49																																																																																																																																																																																																																																		
1413	Lumizyme injection	K		$166.208	.	$33.25																																																																																																																																																																																																																																		
1415	Glassia injection	K		$4.717	.	$0.95																																																																																																																																																																																																																																		
1416	Factor xiii anti-hem factor	K		$8.472	.	$1.70																																																																																																																																																																																																																																		
1417	Gel-one	K		"$1,057.880"	.	$211.58																																																																																																																																																																																																																																		
1420	Aflibercept injection	K		$960.197	.	$192.04																																																																																																																																																																																																																																		
1421	Imported lipodox inj	K		$470.400	.	$94.08																																																																																																																																																																																																																																		
1426	Eribulin mesylate injection	K		$114.839	.	$22.97																																																																																																																																																																																																																																		
1431	Centruroides immune f(ab)	K		"$4,592.800"	.	$918.56																																																																																																																																																																																																																																		
1433	Calcitonin salmon injection	K		"$2,657.542"	.	$531.51																																																																																																																																																																																																																																		
1440	Inj desmopressin acetate	K		$12.352	.	$2.47																																																																																																																																																																																																																																		
1442	Non-HEU TC-99M add-on/dose	K		$10.000	.	$2.00																																																																																																																																																																																																																																		
1443	Icatibant injection	K		$350.381	.	$70.08																																																																																																																																																																																																																																		
1446	Visualization adjunct	K		$4.540	.	$0.91																																																																																																																																																																																																																																		
1458	Phentolaine mesylate inj	K		$387.124	.	$77.43																																																																																																																																																																																																																																		
1466	"Inj, vincristine sul lip 1mg"	K		"$3,030.373"	.	$606.08																																																																																																																																																																																																																																		
1467	Factor ix recombinan rixubis	K		$1.332	.	$0.27																																																																																																																																																																																																																																		
1468	Inj Aripiprazole Ext Rel 1mg	K		$5.453	.	$1.09																																																																																																																																																																																																																																		
1469	Inj filgrastim excl biosimil	K		$0.996	.	$0.20																																																																																																																																																																																																																																		
1471	"Injection, Pertuzumab, 1 mg"	K		$12.204	.	$2.44																																																																																																																																																																																																																																		
1472	Inj beta interferon im 1 mcg	K		$53.402	.	$10.68																																																																																																																																																																																																																																		
1474	Certolizumab pegol inj 1mg	K		$7.872	.	$1.58																																																																																																																																																																																																																																		
1475	Golimumab for iv use 1mg	K		$22.342	.	$4.47																																																																																																																																																																																																																																		
1476	Obinutuzumab inj	K		$63.912	.	$12.79																																																																																																																																																																																																																																		
1478	Inj human fibrinogen con nos	K		$1.197	.	$0.24																																																																																																																																																																																																																																		
1480	"Elosulfase alfa, injection"	K		$236.834	.	$47.37																																																																																																																																																																																																																																		
1482	"	Darbepoetin alfa, esrd use"	K		$3.967	.	$0.80																																																																																																																																																																																																																																		
1485	"	Ferumoxytol, esrd use"	K		$0.969	.	$0.20																																																																																																																																																																																																																																		
1486	Factor ix fc fusion recomb	K		$3.004	.	$0.60																																																																																																																																																																																																																																		
1488	"Injection, ramucirumab"	K		$57.680	.	$11.54																																																																																																																																																																																																																																		
1489	"Injection, vedolizumab"	K		$19.743	.	$3.95																																																																																																																																																																																																																																		
1490	Inj pembrolizumab	K		$49.204	.	$9.84																																																																																																																																																																																																																																		
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		$14.109	.	$2.83																																																																																																																																																																																																																																		
1608	Etanercept injection	K		$685.563	.	$137.12																																																																																																																																																																																																																																		
1609	"Rho(D) immune globulin h, sd"	K		$28.612	.	$5.73																																																																																																																																																																																																																																		
1613	Trastuzumab injection	K		$107.022	.	$21.41																																																																																																																																																																																																																																		
1630	"Hep b ig, im"	K		$125.369	.	$25.08																																																																																																																																																																																																																																		
1643	"Y90 ibritumomab, rx"	K		"$49,931.700"	.	"$9,986.34"	#																																																																																																																																																																																																																																	
1656	Factor viii fc fusion recomb	K		$2.015	.	$0.41																																																																																																																																																																																																																																		
1658	"Injection, belinostat, 10mg"	K		$38.886	.	$7.78																																																																																																																																																																																																																																		
1660	"Injection, oritavancin"	K		$23.906	.	$4.79																																																																																																																																																																																																																																		
1662	Inj tedizolid phosphate	K		$1.423	.	$0.29																																																																																																																																																																																																																																		
1670	Tetanus immune globulin inj	K		$408.430	.	$81.69																																																																																																																																																																																																																																		
1675	P32 Na phosphate	K		$730.030	.	$146.01																																																																																																																																																																																																																																		
1683	Basiliximab	K		"$3,687.169"	.	$737.44																																																																																																																																																																																																																																		
1684	Corticorelin ovine triflutal	K		$9.057	.	$1.82																																																																																																																																																																																																																																		
1685	"Darbepoetin alfa, non-esrd"	K		$3.967	.	$0.80																																																																																																																																																																																																																																		
1686	"Epoetin alfa, non-esrd"	K		$11.734	.	$2.35																																																																																																																																																																																																																																		
1687	Digoxin immune fab (ovine)	K		"$3,779.988"	.	$756.00																																																																																																																																																																																																																																		
1688	Ethanolamine oleate	K		$444.099	.	$88.82																																																																																																																																																																																																																																		
1689	Fomepizole	K		$6.336	.	$1.27																																																																																																																																																																																																																																		
1690	Hemin	K		$23.028	.	$4.61																																																																																																																																																																																																																																		
1694	Ziconotide injection	K		$7.720	.	$1.55																																																																																																																																																																																																																																		
1695	Nesiritide injection	K		$74.801	.	$14.96																																																																																																																																																																																																																																		
1696	Palifermin injection	K		$20.220	.	$4.05																																																																																																																																																																																																																																		
1700	Inj secretin synthetic human	K		$34.781	.	$6.96																																																																																																																																																																																																																																		
1701	Treprostinil injection	K		$66.117	.	$13.23																																																																																																																																																																																																																																		
1704	"Humate-P, inj"	K		$1.159	.	$0.24																																																																																																																																																																																																																																		
1705	Factor viia	K		$2.071	.	$0.42																																																																																																																																																																																																																																		
1709	Azacitidine injection	K		$1.353	.	$0.27																																																																																																																																																																																																																																		
1710	Clofarabine injection	K		$66.187	.	$13.24																																																																																																																																																																																																																																		
1711	Vantas implant	K		"$3,868.149"	.	$773.63																																																																																																																																																																																																																																		
1712	Paclitaxel protein bound	K		$11.851	.	$2.37																																																																																																																																																																																																																																		
1739	"Pegademase bovine, 25 iu"	K		$367.961	.	$73.60																																																																																																																																																																																																																																		
1745	Radium ra223 dichloride ther	K		$136.455	.	$27.30																																																																																																																																																																																																																																		
1746	Factor xiii recomb a-subunit	K		$14.720	.	$2.95																																																																																																																																																																																																																																		
1747	Monovisc inj per dose	K		"$1,511.147"	.	$302.23																																																																																																																																																																																																																																		
1748	Inj tbo filgrastim 1 microg	K		$0.567	.	$0.12																																																																																																																																																																																																																																		
1761	"Rolapitant, oral, 1mg"	K		$1.751	.	$0.35																																																																																																																																																																																																																																		
1809	"Injection, alemtuzumab"	K		"$1,873.162"	.	$374.64																																																																																																																																																																																																																																		
1822	"Injection, zarxio"	K		$0.636	.	$0.13																																																																																																																																																																																																																																		
1823	"Injection, dalbavancin"	K		$14.499	.	$2.90																																																																																																																																																																																																																																		
1824	"	Ceftaroline fosamil inj"	K		$2.917	.	$0.59																																																																																																																																																																																																																																		
1825	Ceftazidime and avibactam	K		$84.163	.	$16.84																																																																																																																																																																																																																																		
1826	Hyqvia 100mg immuneglobulin	K		$14.109	.	$2.83																																																																																																																																																																																																																																		
1827	Factor viii recomb obizur	K		$3.207	.	$0.65																																																																																																																																																																																																																																		
1829	"	Penicillin g benzathine inj"	K		$13.870	.	$2.78																																																																																																																																																																																																																																		
1832	Dimethyl sulfoxide 50% 50 ml	K		$550.533	.	$110.11																																																																																																																																																																																																																																		
1844	Factor viii pegylated recomb	K		$1.626	.	$0.33																																																																																																																																																																																																																																		
1846	Factor viii nuwiq recomb 1iu	K		$1.245	.	$0.25																																																																																																																																																																																																																																		
1847	"Injection, inflectra"	G		$54.338	.	$10.87																																																																																																																																																																																																																																		
1848	Artiss fibrin sealant	K		$156.842	.	$31.37																																																																																																																																																																																																																																		
1849	Foscarnet sodium injection	K		$82.268	.	$16.46																																																																																																																																																																																																																																		
1850	Gamma globulin 1 cc inj	K		$39.206	.	$7.85																																																																																																																																																																																																																																		
1851	Gamma globulin > 10 cc inj	K		$392.061	.	$78.42																																																																																																																																																																																																																																		
1852	Interferon beta-1a inj	K		"$2,785.970"	.	$557.20																																																																																																																																																																																																																																		
1853	Minocycline hydrochloride	K		$1.649	.	$0.33																																																																																																																																																																																																																																		
1854	Pentobarbital sodium inj	K		$44.398	.	$8.88																																																																																																																																																																																																																																		
1856	Factor viii recomb novoeight	K		$1.299	.	$0.26																																																																																																																																																																																																																																		
1857	"Inj, factor x, (human), 1iu"	K		$7.174	.	$1.44																																																																																																																																																																																																																																		
1859	Argatroban nonesrd use 1mg	K		$0.920	.	$0.19																																																																																																																																																																																																																																		
1861	"Inj., bendeka 1 mg"	K		$23.981	.	$4.80																																																																																																																																																																																																																																		
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	216.1554	"$17,594.62"	.	"$3,518.93"	#																																																																																																																																																																																																																																	
2632	Iodine I-125 sodium iodide	U	0.5358	$43.61	.	$8.73																																																																																																																																																																																																																																		
2634	"Brachytx, non-str, HA, I-125"	U	1.9695	$160.31	.	$32.07																																																																																																																																																																																																																																		
2635	"Brachytx, non-str, HA, P-103"	U	0.6834	$55.63	.	$11.13																																																																																																																																																																																																																																		
2636	"Brachy linear, non-str,P-103"	U	0.4706	$38.31	.	$7.67																																																																																																																																																																																																																																		
2638	"Brachytx, stranded, I-125"	U	0.4418	$35.96	.	$7.20																																																																																																																																																																																																																																		
2639	"Brachytx, non-stranded,I-125"	U	0.4478	$36.45	.	$7.29																																																																																																																																																																																																																																		
2640	"Brachytx, stranded, P-103"	U	1.0200	$83.03	.	$16.61																																																																																																																																																																																																																																		
2641	"Brachytx, non-stranded,P-103"	U	0.8548	$69.58	.	$13.92																																																																																																																																																																																																																																		
2642	"Brachytx, stranded, C-131"	U	0.8267	$67.29	.	$13.46																																																																																																																																																																																																																																		
2643	"Brachytx, non-stranded,C-131"	U	1.1170	$90.92	.	$18.19																																																																																																																																																																																																																																		
2645	"Brachytx, non-str, Gold-198"	U	1.4278	$116.22	.	$23.25																																																																																																																																																																																																																																		
2646	"Brachytx, non-str, HDR Ir-192"	U	3.9761	$323.65	.	$64.73																																																																																																																																																																																																																																		
2647	"Brachytx, NS, Non-HDRIr-192"	U	1.0070	$81.97	.	$16.40																																																																																																																																																																																																																																		
2648	"Brachytx planar, p-103"	U	0.0128	$1.04	.	$0.21																																																																																																																																																																																																																																		
2698	"Brachytx, stranded, NOS"	U	0.4418	$35.96	.	$7.20																																																																																																																																																																																																																																		
2699	"Brachytx, non-stranded, NOS"	U	0.4478	$36.45	.	$7.29																																																																																																																																																																																																																																		
2731	"Immune globulin, powder"	K		$59.808	.	$11.97																																																																																																																																																																																																																																		
2770	Quinupristin/dalfopristin	K		$417.001	.	$83.40																																																																																																																																																																																																																																		
2993	"Gen, neuro, trans sen/stim"	H			.	.																																																																																																																																																																																																																																		
4001	Echo guidance radiotherapy	S		$86.25		$17.25																																																																																																																																																																																																																																		
4002	Stereoscopic x-ray guidance 	S		$55.58		$11.12																																																																																																																																																																																																																																		
4003	"Radiation treatment delivery, MeV <= 5; simple "	S		$189.11		$37.82																																																																																																																																																																																																																																		
4004	"Radiation treatment delivery, 6-10 MeV; simple "	S		$142.91		$28.58																																																																																																																																																																																																																																		
4005	"Radiation treatment delivery, 11-19 MeV; simple "	S		$142.91		$28.58																																																																																																																																																																																																																																		
4006	"Radiation treatment delivery, MeV>=20; simple "	S		$143.28		$28.66																																																																																																																																																																																																																																		
4007	"Radiation treatment delivery, MeV<=5; intermediate"	S		$268.51		$53.70																																																																																																																																																																																																																																		
4008	"Radiation treatment delivery, 6-10 MeV; intermediate "	S		$197.41		$39.48																																																																																																																																																																																																																																		
4009	"Radiation treatment delivery, 11-19 MeV; intermediate"	S		$195.97		$39.19																																																																																																																																																																																																																																		
4010	"Radiation treatment delivery, MeV >=20; intermediate"	S		$195.97		$39.19																																																																																																																																																																																																																																		
4011	"Radiation treatment delivery, MeV<=5; complex"	S		$265.26		$53.05																																																																																																																																																																																																																																		
4012	"Radiation treatment delivery, 6-10 MeV; complex"	S		$262.01		$52.40																																																																																																																																																																																																																																		
4013	"Radiation treatment delivery, 11-19 MeV; complex"	S		$262.37		$52.47																																																																																																																																																																																																																																		
4014	"Radiation treatment delivery, MeV >=20; complex"	S		$262.37		$52.47																																																																																																																																																																																																																																		
4015	Radiation tx delivery imrt	S		$368.11		$73.62																																																																																																																																																																																																																																		
4016	Delivery comp imrt	S		$367.03		$73.41																																																																																																																																																																																																																																		
5012	Clinic Visits and Related Services	V	1.4400	$117.21	.	$23.45																																																																																																																																																																																																																																		
5021	Level 1 Type A ED Visits	V	0.8703	$70.84	.	$14.17																																																																																																																																																																																																																																		
5022	Level 2 Type A ED Visits	V	1.6003	$130.26	.	$26.06																																																																																																																																																																																																																																		
5023	Level 3 Type A ED Visits	V	2.8015	$228.04	.	$45.61																																																																																																																																																																																																																																		
5024	Level 4 Type A ED Visits	V	4.4029	$358.39	.	$71.68																																																																																																																																																																																																																																		
5025	Level 5 Type A ED Visits	V	6.3184	$514.31	.	$102.87																																																																																																																																																																																																																																		
5031	Level 1 Type B ED Visits	V	0.8207	$66.80	.	$13.36																																																																																																																																																																																																																																		
5032	Level 2 Type B ED Visits	V	1.1379	$92.62	.	$18.53																																																																																																																																																																																																																																		
5033	Level 3 Type B ED Visits	V	2.0343	$165.59	.	$33.12																																																																																																																																																																																																																																		
5034	Level 4 Type B ED Visits	V	2.6474	$215.49	.	$43.10																																																																																																																																																																																																																																		
5035	Level 5 Type B ED Visits	V	3.9620	$322.50	.	$64.50																																																																																																																																																																																																																																		
5041	Critical Care	S	8.3658	$680.96	.	$136.20																																																																																																																																																																																																																																		
5045	Trauma Response with Critical Care	S	10.8364	$882.06	.	$176.42																																																																																																																																																																																																																																		
5051	Level 1 Skin Procedures	T	2.1561	$175.50	.	$35.10																																																																																																																																																																																																																																		
5052	Level 2 Skin Procedures	T	3.9865	$324.49	.	$64.90																																																																																																																																																																																																																																		
5053	Level 3 Skin Procedures	T	6.2287	$507.00	.	$101.40																																																																																																																																																																																																																																		
5054	Level 4 Skin Procedures	T	20.2164	"$1,645.57"	.	$329.12																																																																																																																																																																																																																																		
5055	Level 5 Skin Procedures	T	37.1648	"$3,025.14"	.	$605.03																																																																																																																																																																																																																																		
5061	Hyperbaric Oxygen	S	1.4365	$116.93	.	$23.39																																																																																																																																																																																																																																		
5071	Level 1 Excision/ Biopsy/ Incision and Drainage	T	7.5800	$617.00	.	$123.40																																																																																																																																																																																																																																		
5072	Level 2 Excision/ Biopsy/ Incision and Drainage	J1	17.9004	"$1,457.06"	.	$291.42																																																																																																																																																																																																																																		
5073	Level 3 Excision/ Biopsy/ Incision and Drainage	J1	31.4698	"$2,561.58"	.	$512.32																																																																																																																																																																																																																																		
5091	Level 1 Breast/Lymphatic Surgery and Related Procedures	J1	37.6910	"$3,067.97"	.	$613.60																																																																																																																																																																																																																																		
5092	Level 2 Breast/Lymphatic Surgery and Related Procedures	J1	65.1396	"$5,302.23"	.	"$1,060.45"																																																																																																																																																																																																																																		
5093	Level 3 Breast/Lymphatic Surgery and Related Procedures	J1	100.4047	"$8,172.74"	.	"$1,634.55"	#																																																																																																																																																																																																																																	
5094	Level 4 Breast/Lymphatic Surgery and Related Procedures	J1	171.6336	"$13,970.63"	.	"$2,794.13"	#																																																																																																																																																																																																																																	
5101	Level 1 Strapping and Cast Application	T	1.6530	$134.55	.	$26.91																																																																																																																																																																																																																																		
5102	Level 2 Strapping and Cast Application	T	2.8296	$230.32	.	$46.07																																																																																																																																																																																																																																		
5111	Level 1 Musculoskeletal Procedures	T	2.7246	$221.78	.	$44.36																																																																																																																																																																																																																																		
5112	Level 2 Musculoskeletal Procedures	J1	16.9430	"$1,379.13"	.	$275.83																																																																																																																																																																																																																																		
5113	Level 3 Musculoskeletal Procedures	J1	34.1771	"$2,781.95"	.	$556.39																																																																																																																																																																																																																																		
5114	Level 4 Musculoskeletal Procedures	J1	74.3056	"$6,048.33"	.	"$1,209.67"																																																																																																																																																																																																																																		
5115	Level 5 Musculoskeletal Procedures	J1	146.9354	"$11,960.25"	.	"$2,392.05"	#																																																																																																																																																																																																																																	
5116	Level 6 Musculoskeletal Procedures	J1	198.2681	"$16,138.63"	.	"$3,227.73"	#																																																																																																																																																																																																																																	
5151	Level 1 Airway Endoscopy	T	2.0199	$164.42	.	$32.89																																																																																																																																																																																																																																		
5152	Level 2 Airway Endoscopy	T	4.7948	$390.29	.	$78.06																																																																																																																																																																																																																																		
5153	Level 3 Airway Endoscopy	J1	17.9349	"$1,459.86"	.	$291.98																																																																																																																																																																																																																																		
5154	Level 4 Airway Endoscopy	J1	36.6296	"$2,981.58"	.	$596.32																																																																																																																																																																																																																																		
5155	Level 5 Airway Endoscopy	J1	67.7249	"$5,512.67"	.	"$1,102.54"																																																																																																																																																																																																																																		
5161	Level 1 ENT Procedures	T	2.5402	$206.77	.	$41.36																																																																																																																																																																																																																																		
5162	Level 2 ENT Procedures	T	5.4425	$443.01	.	$88.61																																																																																																																																																																																																																																		
5163	Level 3 ENT Procedures	J1	16.8870	"$1,374.57"	.	$274.92																																																																																																																																																																																																																																		
5164	Level 4 ENT Procedures	J1	32.4148	"$2,638.50"	.	$527.70																																																																																																																																																																																																																																		
5165	Level 5 ENT Procedures	J1	60.3528	"$4,912.60"	.	$982.52																																																																																																																																																																																																																																		
5166	Cochlear Implant Procedure	J1	414.3685	"$33,728.77"	"$7,683.79"	"$6,745.76"	#																																																																																																																																																																																																																																	
5181	Level 1 Vascular Procedures	T	7.8905	$642.27	.	$128.46																																																																																																																																																																																																																																		
5182	Level 2 Vascular Procedures	J1	19.9689	"$1,625.43"	.	$325.09																																																																																																																																																																																																																																		
5183	Level 3 Vascular Procedures	J1	34.4979	"$2,808.06"	.	$561.62																																																																																																																																																																																																																																		
5184	Level 4 Vascular Procedures	J1	57.1445	"$4,651.45"	.	$930.29																																																																																																																																																																																																																																		
5191	Level 1 Endovascular Procedures	J1	35.6193	"$2,899.34"	$864.64	$579.87																																																																																																																																																																																																																																		
5192	Level 2 Endovascular Procedures	J1	61.3873	"$4,996.80"	.	$999.36																																																																																																																																																																																																																																		
5193	Level 3 Endovascular Procedures	J1	123.0159	"$10,013.25"	.	"$2,002.65"	#																																																																																																																																																																																																																																	
5194	Level 4 Endovascular Procedures	J1	197.1760	"$16,049.73"	.	"$3,209.95"	#																																																																																																																																																																																																																																	
5200	Implantation Wireless PA Pressure Monitor	J1	357.1305	"$29,069.71"	.	"$5,813.95"	#																																																																																																																																																																																																																																	
5211	Level 1 Electrophysiologic Procedures	J1	12.4875	"$1,016.46"	.	$203.30																																																																																																																																																																																																																																		
5212	Level 2 Electrophysiologic Procedures	J1	73.5175	"$5,984.18"	.	"$1,196.84"																																																																																																																																																																																																																																		
5213	Level 3 Electrophysiologic Procedures	J1	254.1809	"$20,689.82"	.	"$4,137.97"	#																																																																																																																																																																																																																																	
5221	Level1 Pacemaker and Similar Procedures	T	41.0115	"$3,338.25"	.	$667.65																																																																																																																																																																																																																																		
5222	Level 2 Pacemaker and Similar Procedures	J1	95.8185	"$7,799.43"	.	"$1,559.89"	#																																																																																																																																																																																																																																	
5223	Level 3 Pacemaker and Similar Procedures	J1	127.4761	"$10,376.30"	.	"$2,075.26"	#																																																																																																																																																																																																																																	
5224	Level 4 Pacemaker and Similar Procedures	J1	227.1989	"$18,493.54"	.	"$3,698.71"	#																																																																																																																																																																																																																																	
5231	Level 1 ICD and Similar Procedures	J1	284.4648	"$23,154.87"	.	"$4,630.98"	#																																																																																																																																																																																																																																	
5232	Level 2 ICD and Similar Procedures	J1	401.6053	"$32,689.87"	.	"$6,537.98"	#																																																																																																																																																																																																																																	
5241	Level 1 Blood Product Exchange and Related Services	S	4.8239	$392.66	.	$78.54																																																																																																																																																																																																																																		
5242	Level 2 Blood Product Exchange and Related Services	S	16.1860	"$1,317.51"	.	$263.51																																																																																																																																																																																																																																		
5243	Level 3 Blood Product Exchange and Related Services	S	47.0755	"$3,831.85"	.	$766.37																																																																																																																																																																																																																																		
5244	Level 4 Blood Product Exchange and Related Services	J1	507.0967	"$41,276.66"	.	"$8,255.34"	#																																																																																																																																																																																																																																	
5301	Level 1 Upper GI Procedures	T	9.7959	$797.37	.	$159.48																																																																																																																																																																																																																																		
5302	Level 2 Upper GI Procedures 	J1	19.3054	"$1,571.42"	.	$314.29																																																																																																																																																																																																																																		
5303	Level 3 Upper GI Procedures	J1	37.1375	"$3,022.92"	.	$604.59																																																																																																																																																																																																																																		
5311	Level 1 Lower GI Procedures 	T	9.5403	$776.56	.	$155.32																																																																																																																																																																																																																																		
5312	Level 2 Lower GI Procedures 	T	12.5811	"$1,024.08"	.	$204.82																																																																																																																																																																																																																																		
5313	Level 3 Lower GI Procedures 	J1	30.8641	"$2,512.28"	.	$502.46																																																																																																																																																																																																																																		
5331	Complex GI Procedures	J1	58.9762	"$4,800.54"	.	$960.11																																																																																																																																																																																																																																		
5341	Abdominal/Peritoneal/Biliary and Related Procedures	J1	38.6755	"$3,148.11"	.	$629.63																																																																																																																																																																																																																																		
5361	Level 1 Laparoscopy and Related Services	J1	60.2965	"$4,908.01"	.	$981.61																																																																																																																																																																																																																																		
5362	Level 2 Laparoscopy and Related Services	J1	104.7115	"$8,523.31"	.	"$1,704.67"	#																																																																																																																																																																																																																																	
5371	Level 1 Urology and Related Services	T	2.8956	$235.70	.	$47.14																																																																																																																																																																																																																																		
5372	Level 2 Urology and Related Services	T	6.8695	$559.16	.	$111.84																																																																																																																																																																																																																																		
5373	Level 3 Urology and Related Services	J1	22.0886	"$1,797.97"	.	$359.60																																																																																																																																																																																																																																		
5374	Level 4 Urology and Related Services	J1	37.5833	"$3,059.21"	.	$611.85																																																																																																																																																																																																																																		
5375	Level 5 Urology and Related Services	J1	52.6556	"$4,286.06"	.	$857.22																																																																																																																																																																																																																																		
5376	Level 6 Urology and Related Services	J1	100.6573	"$8,193.30"	.	"$1,638.66"	#																																																																																																																																																																																																																																	
5377	Level 7 Urology and Related Services	J1	214.5745	"$17,465.94"	.	"$3,493.19"	#																																																																																																																																																																																																																																	
5401	Dialysis	S	8.1112	$660.24	.	$132.05																																																																																																																																																																																																																																		
5411	Level 1 Gynecologic Procedures	T	2.0582	$167.53	.	$33.51																																																																																																																																																																																																																																		
5412	Level 2 Gynecologic Procedures	T	3.4098	$277.55	.	$55.51																																																																																																																																																																																																																																		
5413	Level 3 Gynecologic Procedures	T	7.9337	$645.79	.	$129.16																																																																																																																																																																																																																																		
5414	Level 4 Gynecologic Procedures	J1	31.5069	"$2,564.60"	.	$512.92																																																																																																																																																																																																																																		
5415	Level 5 Gynecologic Procedures	J1	54.3803	"$4,426.45"	$902.82	$885.29																																																																																																																																																																																																																																		
5416	Level 6 Gynecologic Procedures	J1	83.1181	"$6,765.65"	"$1,405.70"	"$1,353.13"																																																																																																																																																																																																																																		
5431	Level 1 Nerve Procedures	J1	21.4656	"$1,747.26"	.	$349.46																																																																																																																																																																																																																																		
5432	Level 2 Nerve Procedures	J1	69.4480	"$5,652.93"	.	"$1,130.59"																																																																																																																																																																																																																																		
5441	Level 1 Nerve Injections	T	3.2733	$266.44	.	$53.29																																																																																																																																																																																																																																		
5442	Level 2 Nerve Injections	T	7.7077	$627.39	.	$125.48																																																																																																																																																																																																																																		
5443	Level 3 Nerve Injections	T	9.9336	$808.58	.	$161.72																																																																																																																																																																																																																																		
5461	Level 1 Neurostimulator and Related Procedures	J1	40.1721	"$3,269.93"	.	$653.99																																																																																																																																																																																																																																		
5462	Level 2 Neurostimulator and Related Procedures	J1	77.7417	"$6,328.02"	.	"$1,265.61"																																																																																																																																																																																																																																		
5463	Level 3 Neurostimulator and Related Procedures	J1	237.9766	"$19,370.82"	.	"$3,874.17"	#																																																																																																																																																																																																																																	
5464	Level 4 Neurostimulator and Related Procedures	J1	356.5934	"$29,025.99"	.	"$5,805.20"	#																																																																																																																																																																																																																																	
5471	Implantation of Drug Infusion Device	J1	200.5841	"$16,327.14"	.	"$3,265.43"	#																																																																																																																																																																																																																																	
5481	Laser Eye Procedures	T	6.4011	$521.04	.	$104.21																																																																																																																																																																																																																																		
5491	Level 1 Intraocular Procedures	J1	25.2266	"$2,053.39"	.	$410.68																																																																																																																																																																																																																																		
5492	Level 2 Intraocular Procedures	J1	47.5093	"$3,867.16"	.	$773.44																																																																																																																																																																																																																																		
5493	Level 3 Intraocular Procedures	J1	77.2747	"$6,290.01"	.	"$1,258.01"																																																																																																																																																																																																																																		
5494	Level 4 Intraocular Procedures	J1	154.6812	"$12,590.74"	.	"$2,518.15"	#																																																																																																																																																																																																																																	
5495	Level 5 Intraocular Procedures	J1	242.5114	"$19,739.94"	.	"$3,947.99"	#																																																																																																																																																																																																																																	
5501	"Level 1 Extraocular, Repair, and Plastic Eye Procedures"	T	3.5476	$288.77	.	$57.76																																																																																																																																																																																																																																		
5502	"Level 2 Extraocular, Repair, and Plastic Eye Procedures"	T	10.3533	$842.74	.	$168.55																																																																																																																																																																																																																																		
5503	"Level 3 Extraocular, Repair, and Plastic Eye Procedures"	J1	23.9957	"$1,953.20"	.	$390.64																																																																																																																																																																																																																																		
5504	"Level 4 Extraocular, Repair, and Plastic Eye Procedures"	J1	38.7215	"$3,151.85"	.	$630.37																																																																																																																																																																																																																																		
5521	Level 1 Imaging without Contrast	S	0.9986	$81.28	.	$16.26																																																																																																																																																																																																																																		
5522	Level 2 Imaging without Contrast	S	1.3641	$111.04	.	$22.21																																																																																																																																																																																																																																		
5523	Level 3 Imaging without Contrast	S	2.8413	$231.28	.	$46.26																																																																																																																																																																																																																																		
5524	Level 4 Imaging without Contrast	S	5.8287	$474.44	.	$94.89																																																																																																																																																																																																																																		
5571	Level 1 Imaging with Contrast	S	2.2103	$179.91	.	$35.99																																																																																																																																																																																																																																		
5572	Level 2 Imaging with Contrast	S	4.5880	$373.45	.	$74.69																																																																																																																																																																																																																																		
5573	Level 3 Imaging with Contrast	S	8.3904	$682.96	.	$136.60																																																																																																																																																																																																																																		
5591	Level 1 Nuclear Medicine and Related Services 	S	4.5786	$372.69	.	$74.54																																																																																																																																																																																																																																		
5592	Level 2 Nuclear Medicine and Related Services	S	5.9262	$482.38	.	$96.48																																																																																																																																																																																																																																		
5593	Level 3 Nuclear Medicine and Related Services 	S	15.8890	"$1,293.33"	.	$258.67																																																																																																																																																																																																																																		
5594	Level 4 Nuclear Medicine and Related Services	S	18.0122	"$1,466.16"	.	$293.24																																																																																																																																																																																																																																		
5611	Level 1 Therapeutic Radiation Treatment Preparation	S	1.5781	$128.45	$32.03	$25.69																																																																																																																																																																																																																																		
5612	Level 2 Therapeutic Radiation Treatment Preparation	S	4.1672	$339.20	.	$67.84																																																																																																																																																																																																																																		
5613	Level 3 Therapeutic Radiation Treatment Preparation	S	15.4895	"$1,260.81"	.	$252.17																																																																																																																																																																																																																																		
5621	Level 1 Radiation Therapy	S	1.5219	$123.88	.	$24.78																																																																																																																																																																																																																																		
5622	Level 2 Radiation Therapy	S	2.9424	$239.51	.	$47.91																																																																																																																																																																																																																																		
5623	Level 3 Radiation Therapy	S	6.7218	$547.14	.	$109.43																																																																																																																																																																																																																																		
5624	Level 4 Radiation Therapy	S	9.2655	$754.19	.	$150.84																																																																																																																																																																																																																																		
5625	Level 5 Radiation Therapy	S	14.7745	"$1,202.61"	.	$240.53																																																																																																																																																																																																																																		
5626	Level 6 Radiation Therapy	S 	22.0010	"$1,790.84"	.	$358.17																																																																																																																																																																																																																																		
5627	Level 7 Radiation Therapy	J1	98.7376	"$8,037.04"	.	"$1,607.41"	#																																																																																																																																																																																																																																	
5661	Therapeutic Nuclear Medicine	S	2.9507	$240.18	.	$48.04																																																																																																																																																																																																																																		
5671	Level 1 Pathology	S	0.6209	$50.54	.	$10.11																																																																																																																																																																																																																																		
5672	Level 2 Pathology	S	1.8259	$148.62	.	$29.73																																																																																																																																																																																																																																		
5673	Level 3 Pathology	S	3.6418	$296.44	.	$59.29																																																																																																																																																																																																																																		
5674	Level 4 Pathology	S	7.7563	$631.35	.	$126.27																																																																																																																																																																																																																																		
5691	Level 1 Drug Administration	S	0.4728	$38.48	.	$7.70																																																																																																																																																																																																																																		
5692	Level 2 Drug Administration	S	0.7475	$60.85	.	$12.17																																																																																																																																																																																																																																		
5693	Level 3 Drug Administration	S	2.2811	$185.68	.	$37.14																																																																																																																																																																																																																																		
5694	Level 4 Drug Administration	S	3.8642	$314.54	.	$62.91																																																																																																																																																																																																																																		
5721	Level1 Diagnostic Tests and Related Services	S	1.7240	$140.33	.	$28.07																																																																																																																																																																																																																																		
5722	Level 2 Diagnostic Tests and Related Services	S	3.1524	$256.60	.	$51.32																																																																																																																																																																																																																																		
5723	Level 3 Diagnostic Tests and Related Services	S	5.9786	$486.65	.	$97.33																																																																																																																																																																																																																																		
5724	Level 4 Diagnostic Tests and Related Services	S	11.3106	$920.66	.	$184.14																																																																																																																																																																																																																																		
5731	Level 1 Minor Procedures	S	0.2896	$23.57	.	$4.72																																																																																																																																																																																																																																		
5732	Level 2 Minor Procedures	S	0.4218	$34.33	.	$6.87																																																																																																																																																																																																																																		
5733	Level 3 Minor Procedures	S	0.6864	$55.87	.	$11.18																																																																																																																																																																																																																																		
5734	Level 4 Minor Procedures	S	1.3512	$109.98	.	$22.00																																																																																																																																																																																																																																		
5735	Level 5 Minor Procedures	S	4.4503	$362.25	.	$72.45																																																																																																																																																																																																																																		
5741	Level 1 Electronic Analysis of Devices	S	0.4522	$36.81	.	$7.37																																																																																																																																																																																																																																		
5742	Level 2 Electronic Analysis of Devices	S	1.3964	$113.66	.	$22.74																																																																																																																																																																																																																																		
5743	Level 3 Electronic Analysis of Devices	S	3.3329	$271.29	.	$54.26																																																																																																																																																																																																																																		
5771	Cardiac Rehabilitation	S	1.3588	$110.60	.	$22.12																																																																																																																																																																																																																																		
5781	Resuscitation and Cardioversion	S	6.6692	$542.86	.	$108.58																																																																																																																																																																																																																																		
5791	Pulmonary Treatment	S	2.2545	$183.51	.	$36.71																																																																																																																																																																																																																																		
5801	Ventilation Initiation and Management	S	5.8543	$476.53	.	$95.31																																																																																																																																																																																																																																		
5811	Manipulation Therapy	S	0.3391	$27.60	.	$5.52																																																																																																																																																																																																																																		
5821	Level 1 Health and Behavior Services	S	0.3512	$28.59	.	$5.72																																																																																																																																																																																																																																		
5822	Level 2 Health and Behavior Services	S	0.9958	$81.06	.	$16.22																																																																																																																																																																																																																																		
5823	Level 3 Health and Behavior Services	S	1.6004	$130.27	.	$26.06																																																																																																																																																																																																																																		
5853	Partial Hospitalization (3 or more services) for CMHCs	P	1.5306	$124.59	.	$24.92																																																																																																																																																																																																																																		
5863	Partial Hospitalization (3 or more services) for Hospital-based PHPs	P	2.8035	$228.20	.	$45.64																																																																																																																																																																																																																																		
5871	Dental Procedures	S	12.3078	"$1,001.83"	.	$200.37																																																																																																																																																																																																																																		
5881	Ancillary Outpatient Services When Patient Dies	J1	76.8986	"$6,259.39"	.	"$1,251.88"																																																																																																																																																																																																																																		
7000	Amifostine	K		$990.389	.	$198.08																																																																																																																																																																																																																																		
7011	Oprelvekin injection	K		$163.980	.	$32.80																																																																																																																																																																																																																																		
7035	Teniposide	K		"$2,645.707"	.	$529.15																																																																																																																																																																																																																																		
7041	Tirofiban HCl	K		$10.978	.	$2.20																																																																																																																																																																																																																																		
7043	Infliximab not biosimil 10mg	K		$71.826	.	$14.37																																																																																																																																																																																																																																		
7046	Doxorubicin inj 10mg	K		$361.360	.	$72.28																																																																																																																																																																																																																																		
7048	Alteplase recombinant	K		$87.682	.	$17.54																																																																																																																																																																																																																																		
7308	Aminolevulinic acid hcl top	K		$396.078	.	$79.22																																																																																																																																																																																																																																		
8004	Ultrasound Composite	S	3.8146	$310.50	.	$62.10																																																																																																																																																																																																																																		
8005	CT and CTA without Contrast Composite	S	2.8483	$231.85	.	$46.37																																																																																																																																																																																																																																		
8006	CT and CTA with Contrast Composite	S	5.4852	$446.48	.	$89.30																																																																																																																																																																																																																																		
8007	MRI and MRA without Contrast Composite	S	6.5418	$532.49	.	$106.50																																																																																																																																																																																																																																		
8008	MRI and MRA with Contrast Composite	S	10.4174	$847.96	.	$169.60																																																																																																																																																																																																																																		
8010	Mental Health Services Composite	S	2.8035	$228.20	.	$45.64																																																																																																																																																																																																																																		
8011	Comprehensive Observation Services	J2	27.3505	"$2,226.28"	.	$445.26																																																																																																																																																																																																																																		
9002	Tenecteplase injection	K		$121.777	.	$24.36																																																																																																																																																																																																																																		
9003	Palivizumab	K		"$1,205.050"	.	$241.01																																																																																																																																																																																																																																		
9006	Tacrolimus injection	K		$205.996	.	$41.20																																																																																																																																																																																																																																		
9012	Arsenic trioxide injection	K		$63.011	.	$12.61																																																																																																																																																																																																																																		
9014	"Inj., cerliponase alfa 1 mg"	G		$93.751	.	$18.75																																																																																																																																																																																																																																		
9015	"Inj., haegarda 10 units"	G		$9.667	.	$1.94																																																																																																																																																																																																																																		
9016	"Inj., triptorelin xr 3.75 mg"	G		"$2,896.970"	.	$579.40																																																																																																																																																																																																																																		
9018	"Inj, rimabotulinumtoxinB"	K		$11.973	.	$2.40																																																																																																																																																																																																																																		
9024	Amphotericin b lipid complex	K		$6.164	.	$1.24																																																																																																																																																																																																																																		
9028	Inj inotuzumab ozogam 0.1 mg	G		"$2,199.140"	.	$439.83																																																																																																																																																																																																																																		
9029	"Inj., guselkumab, 1 mg"	G		$95.318	.	$19.07																																																																																																																																																																																																																																		
9030	"Inj., copanlisib, 1 mg"	G		$77.699	.	$15.54																																																																																																																																																																																																																																		
9031	"Inj, etelcalcetide, 0.1 mg"	K		$2.825	.	$0.57																																																																																																																																																																																																																																		
9032	Baclofen 10 MG injection	K		$174.189	.	$34.84																																																																																																																																																																																																																																		
9033	Cidofovir injection	K		$579.906	.	$115.99																																																																																																																																																																																																																																		
9034	"Inj cuvitru, 100 mg"	K		$13.169	.	$2.64																																																																																																																																																																																																																																		
9035	Axicabtagene ciloleucel car+ 	G		"$395,380.000"	.	"$79,076.00"	#																																																																																																																																																																																																																																	
9036	"Injection, renflexis"	G		$59.266	.	$11.86																																																																																																																																																																																																																																		
9038	Inj estrogen conjugate	K		$309.209	.	$61.85																																																																																																																																																																																																																																		
9042	Glucagon hydrochloride	K		$207.127	.	$41.43																																																																																																																																																																																																																																		
9043	"Inj, afstyla, 1 i.u."	K		$1.356	.	$0.28																																																																																																																																																																																																																																		
9044	Ibutilide fumarate injection	K		$131.540	.	$26.31																																																																																																																																																																																																																																		
9058	Buprenorphine implant 74.2mg	K		"$1,263.188"	.	$252.64																																																																																																																																																																																																																																		
9059	Vonvendi inj 1 iu vwf:rco	K		$1.929	.	$0.39																																																																																																																																																																																																																																		
9067	Lutetium lu 177 dotatat ther	G		$251.750	.	$50.35																																																																																																																																																																																																																																		
9070	Inj luxturna 1 billion vec g	G		"$2,915.000"	.	$583.00																																																																																																																																																																																																																																		
9071	Capsaicin 8% patch	K		$3.144	.	$0.63																																																																																																																																																																																																																																		
9073	Buprenorph xr 100 mg or less	G		"$1,674.800"	.	$334.96																																																																																																																																																																																																																																		
9074	"Makena, 10 mg"	K		$22.198	.	$4.44																																																																																																																																																																																																																																		
9078	Testosterone undecanoate 1mg	K		$1.416	.	$0.29																																																																																																																																																																																																																																		
9079	"Genvisc 850, inj, 1mg"	K		$7.195	.	$1.44																																																																																																																																																																																																																																		
9083	"Inj, phenylephrine ketorolac"	G		$437.395	.	$0.00																																																																																																																																																																																																																																		
9084	Florbetapir f18	G		"$3,029.067"	.	$0.00																																																																																																																																																																																																																																		
9085	Inj sulf hexa lipid microsph	G		$19.971	.	$0.00																																																																																																																																																																																																																																		
9088	Peng benzathine/procaine inj	K		$11.013	.	$2.21																																																																																																																																																																																																																																		
9092	Interferon alfa-2a inj	K		$169.330	.	$33.87																																																																																																																																																																																																																																		
9094	Radiesse injection	K		$473.900	.	$94.78																																																																																																																																																																																																																																		
9095	"Inj, sculptra, 0.5mg"	K		$3.280	.	$0.66																																																																																																																																																																																																																																		
9096	Inj retacrit esrd on dialysi	G		$1.136	.	$0.23																																																																																																																																																																																																																																		
9097	Inj retacrit non-esrd use	G		$11.361	.	$2.28																																																																																																																																																																																																																																		
9099	"Inj fosnetupitant, palonoset"	G		$528.697	.	$105.74																																																																																																																																																																																																																																		
9104	Antithymocyte globuln rabbit	K		$739.751	.	$147.95																																																																																																																																																																																																																																		
9108	Thyrotropin injection	K		"$1,652.120"	.	$330.43																																																																																																																																																																																																																																		
9119	"Injection, pegfilgrastim 6mg"	K		"$4,655.476"	.	$931.10																																																																																																																																																																																																																																		
9120	"Injection, Fulvestrant"	K		$97.541	.	$19.51																																																																																																																																																																																																																																		
9122	Triptorelin pamoate	K		$240.681	.	$48.14																																																																																																																																																																																																																																		
9124	Daptomycin injection	K		$0.367	.	$0.08																																																																																																																																																																																																																																		
9125	"Risperidone, long acting"	K		$9.391	.	$1.88																																																																																																																																																																																																																																		
9126	Natalizumab injection	K		$19.694	.	$3.94																																																																																																																																																																																																																																		
9131	"Inj, Ado-trastuzumab Emt 1mg"	K		$31.208	.	$6.25																																																																																																																																																																																																																																		
9132	"Kcentra, per i.u."	K		$1.933	.	$0.39																																																																																																																																																																																																																																		
9133	"Rabies ig, im/sc"	K		$312.463	.	$62.50																																																																																																																																																																																																																																		
9134	"Rabies ig, heat treated"	K		$279.236	.	$55.85																																																																																																																																																																																																																																		
9135	"Varicella-zoster ig, im"	K		"$1,565.939"	.	$313.19																																																																																																																																																																																																																																		
9139	"Rabies vaccine, im"	K		$283.755	.	$56.76																																																																																																																																																																																																																																		
9140	"Rabies vaccine, id"	K		$130.010	.	$26.01																																																																																																																																																																																																																																		
9171	Factor ix idelvion inj	K		$4.297	.	$0.86																																																																																																																																																																																																																																		
9172	"Injection, dexamethasone 9%"	G		$1.107	.	$0.23																																																																																																																																																																																																																																		
9173	"Injection, fulphila"	G		$350.123	.	$70.03																																																																																																																																																																																																																																		
9174	"Inj, durolane 1 mg"	G		$17.225	.	$3.45																																																																																																																																																																																																																																		
9175	Puraply 1 sq cm	G		$53.136	.	$0.00																																																																																																																																																																																																																																		
9176	Puraply am 1 sq cm	G		$81.989	.	$0.00																																																																																																																																																																																																																																		
9177	Antithrombin recombinant	K		$103.350	.	$20.67																																																																																																																																																																																																																																		
9178	"Inj., meropenem, vaborbactam"	K		$1.676	.	$0.34																																																																																																																																																																																																																																		
9179	"Injection, Aristada Initio"	G		$2.710	.	$0.55																																																																																																																																																																																																																																		
9180	"Injection, patisiran"	G		$98.401	.	$19.68																																																																																																																																																																																																																																		
9181	"Injection, risperidone"	G		$9.785	.	$1.96																																																																																																																																																																																																																																		
9182	Inj mogamulizumab-kpkc	G		$200.870	.	$40.18																																																																																																																																																																																																																																		
9183	"Injection, plazomicin"	G		$3.159	.	$0.64																																																																																																																																																																																																																																		
9184	"Iodine i-131 iobenguane, dx"	G		$320.120	.	$0.00																																																																																																																																																																																																																																		
9185	"Iodine i-131 iobenguane, tx"	G		$320.120	.	$64.03																																																																																																																																																																																																																																		
9186	"Inj., rituximab, 10 mg"	K		$95.200	.	$19.04																																																																																																																																																																																																																																		
9187	"Injection, burosumab-twza 1m"	K		$353.284	.	$70.66																																																																																																																																																																																																																																		
9188	Inj crotalidae im f(ab')2 eq	K		"$1,256.600"	.	$251.32																																																																																																																																																																																																																																		
9189	"Inj., ibalizumab-uiyk, 10 mg"	K		$58.471	.	$11.70																																																																																																																																																																																																																																		
9190	"Inj., vestronidase alfa-vjbk"	K		$218.528	.	$43.71																																																																																																																																																																																																																																		
9191	"Inj., fibryga, 1 mg"	K		$1.272	.	$0.26																																																																																																																																																																																																																																		
9192	"Inj, bortezomib, nos, 0.1 mg"	K		$31.056	.	$6.22																																																																																																																																																																																																																																		
9193	Nivestym	G		$0.733	.	$0.15																																																																																																																																																																																																																																		
9194	Tisagenlecleucel car-pos t	G		"$449,128.309"	.	"$89,825.67"	#																																																																																																																																																																																																																																	
9195	"Injection, udenyca 0.5 mg"	G		$358.354	.	$71.67																																																																																																																																																																																																																																		
9196	"Inj, trivisc 1 mg"	K		$6.992	.	$1.40																																																																																																																																																																																																																																		
9197	"Injection, fremanezumab-vfrm"	G		$2.648	.	$0.53																																																																																																																																																																																																																																		
9198	"Inj, coagulation factor Xa"	G		$291.500	.	$58.30																																																																																																																																																																																																																																		
9199	"Injection, caplacizumab-yhdp"	G		$683.545	.	$136.71																																																																																																																																																																																																																																		
9207	"Inj., velcade 0.1 mg"	K		$44.460	.	$8.90																																																																																																																																																																																																																																		
9208	Agalsidase beta injection	K		$178.196	.	$35.64																																																																																																																																																																																																																																		
9209	Laronidase injection	K		$31.221	.	$6.25																																																																																																																																																																																																																																		
9213	Pemetrexed injection	K		$68.342	.	$13.67																																																																																																																																																																																																																																		
9214	Bevacizumab injection	K		$81.219	.	$16.25																																																																																																																																																																																																																																		
9215	Cetuximab injection	K		$60.734	.	$12.15																																																																																																																																																																																																																																		
9217	Leuprolide acetate suspnsion	K		$224.295	.	$44.86																																																																																																																																																																																																																																		
9224	Galsulfase injection	K		$390.309	.	$78.07																																																																																																																																																																																																																																		
9225	Fluocinolone acetonide implt	K		"$20,131.152"	.	"$4,026.23"	#																																																																																																																																																																																																																																	
9228	Tigecycline injection	K		$1.779	.	$0.36																																																																																																																																																																																																																																		
9229	Ibandronate sodium injection	K		$44.451	.	$8.89																																																																																																																																																																																																																																		
9230	Abatacept injection	K		$52.490	.	$10.50																																																																																																																																																																																																																																		
9231	Decitabine injection	K		$8.754	.	$1.75																																																																																																																																																																																																																																		
9232	Idursulfase injection	K		$542.980	.	$108.60																																																																																																																																																																																																																																		
9233	Ranibizumab injection	K		$364.147	.	$72.83																																																																																																																																																																																																																																		
9234	Alglucosidase alfa injection	K		$141.140	.	$28.23																																																																																																																																																																																																																																		
9235	Panitumumab injection	K		$115.033	.	$23.01																																																																																																																																																																																																																																		
9236	Eculizumab injection	K		$230.479	.	$46.10																																																																																																																																																																																																																																		
9237	"Inj, lanreotide acetate"	K		$58.736	.	$11.75																																																																																																																																																																																																																																		
9239	Buprenorphine xr over 100 mg	G		"$1,674.800"	.	$334.96																																																																																																																																																																																																																																		
9240	"Injection, ixabepilone"	K		$84.242	.	$16.85																																																																																																																																																																																																																																		
9242	"Injection, fosaprepitant"	K		$2.052	.	$0.41																																																																																																																																																																																																																																		
9243	"Inj., treanda 1 mg"	K		$29.950	.	$5.99																																																																																																																																																																																																																																		
9245	Romiplostim injection	K		$71.749	.	$14.35																																																																																																																																																																																																																																		
9251	C1 esterase inhibitor inj	K		$54.966	.	$11.00																																																																																																																																																																																																																																		
9252	Plerixafor injection	K		$330.524	.	$66.11																																																																																																																																																																																																																																		
9253	Temozolomide injection	K		$10.404	.	$2.08																																																																																																																																																																																																																																		
9255	Paliperidone palmitate inj	K		$10.870	.	$2.18																																																																																																																																																																																																																																		
9256	Dexamethasone intra implant	K		$200.147	.	$40.03																																																																																																																																																																																																																																		
9257	"Inj., emicizumab-kxwh 0.5 mg"	G		$48.080	.	$9.62																																																																																																																																																																																																																																		
9258	Telavancin injection	K		$5.982	.	$1.20																																																																																																																																																																																																																																		
9259	Pralatrexate injection	K		$281.457	.	$56.30																																																																																																																																																																																																																																		
9260	Ofatumumab injection	K		$58.419	.	$11.69																																																																																																																																																																																																																																		
9261	"Ustekinumab sub cu inj, 1 mg"	K		$180.319	.	$36.07																																																																																																																																																																																																																																		
9263	Ecallantide injection	K		$480.203	.	$96.04																																																																																																																																																																																																																																		
9264	Tocilizumab injection	K		$4.929	.	$0.99																																																																																																																																																																																																																																		
9265	Romidepsin injection	K		$313.700	.	$62.74																																																																																																																																																																																																																																		
9269	"C-1 esterase, berinert"	K		$48.944	.	$9.79																																																																																																																																																																																																																																		
9270	Gammaplex IVIG	K		$44.201	.	$8.84																																																																																																																																																																																																																																		
9271	Velaglucerase alfa	K		$345.506	.	$69.11																																																																																																																																																																																																																																		
9272	"Inj, denosumab"	K		$18.690	.	$3.74																																																																																																																																																																																																																																		
9273	Sipuleucel-T auto CD54+	K		"$45,027.551"	.	"$9,005.51"	#																																																																																																																																																																																																																																	
9274	Crotalidae Poly Immune Fab	K		"$3,322.069"	.	$664.42																																																																																																																																																																																																																																		
9276	Cabazitaxel injection	K		$168.825	.	$33.77																																																																																																																																																																																																																																		
9278	Incobotulinumtoxin A	K		$5.086	.	$1.02																																																																																																																																																																																																																																		
9281	"Injection, pegloticase"	K		"$2,403.302"	.	$480.66																																																																																																																																																																																																																																		
9284	Ipilimumab injection	K		$150.937	.	$30.19																																																																																																																																																																																																																																		
9286	Belatacept injection	K		$3.777	.	$0.76																																																																																																																																																																																																																																		
9287	Brentuximab vedotin inj	K		$156.373	.	$31.28																																																																																																																																																																																																																																		
9289	Erwinaze injection	K		$414.824	.	$82.97																																																																																																																																																																																																																																		
9294	"Inj, taliglucerase alfa 10 u"	K		$40.364	.	$8.08																																																																																																																																																																																																																																		
9295	"Injection, Carfilzomib, 1 mg"	K		$36.356	.	$7.28																																																																																																																																																																																																																																		
9296	"Inj, ziv-aflibercept, 1mg"	K		$8.223	.	$1.65																																																																																																																																																																																																																																		
9297	"Inj, Omacetaxine Mep, 0.01mg"	K		$2.975	.	$0.60																																																																																																																																																																																																																																		
9298	"Inj, Ocriplasmin, 0.125 mg"	K		"$1,042.281"	.	$208.46																																																																																																																																																																																																																																		
9299	Inj. jivi 1 iu	G		$2.031	.	$0.41																																																																																																																																																																																																																																		
9300	Omalizumab injection	K		$37.015	.	$7.41																																																																																																																																																																																																																																		
9301	"Aminolevulinic acid, 10% gel"	G		$1.441	.	$0.29																																																																																																																																																																																																																																		
9302	"Inj daunorubicin, cytarabine"	G		$192.306	.	$38.47																																																																																																																																																																																																																																		
9303	"Injection, levoleucovorin"	G		$4.120	.	$0.83																																																																																																																																																																																																																																		
9304	"Injection, cemiplimab-rwlc"	G		$27.472	.	$5.50																																																																																																																																																																																																																																		
9305	Moxetumomab pasudotox-tdfk	G		$21.458	.	$4.30																																																																																																																																																																																																																																		
9306	"Inj., tildrakizumab, 1 mg"	G		$135.866	.	$27.18																																																																																																																																																																																																																																		
9307	Cocaine hcl nasal solution	G		$1.623	.	$0.33																																																																																																																																																																																																																																		
9308	Dexamethasone ophth insert	G		$138.749	.	$27.75																																																																																																																																																																																																																																		
9309	"Injection, tagraxofusp-erzs"	G		$251.629	.	$50.33																																																																																																																																																																																																																																		
9310	"Injection, emapalumab-lzsg"	G		$784.515	.	$156.91																																																																																																																																																																																																																																		
9311	"Injection, omadacycline"	G		$3.554	.	$0.71																																																																																																																																																																																																																																		
9312	"Injection, ravulizumab-cwv"	G		$219.871	.	$43.98																																																																																																																																																																																																																																		
9313	Inj. belrapzo/bendamustine	G		$23.492	.	$4.70																																																																																																																																																																																																																																		
9314	"Inj. herceptin hylecta, 10mg"	K		$80.258	.	$16.06																																																																																																																																																																																																																																		
9315	"	Diphtheria antitoxin"	K		"$2,916.630"	.	$583.33																																																																																																																																																																																																																																		
9316	Corticotropin injection	K		"$3,977.620"	.	$795.53																																																																																																																																																																																																																																		
9317	Doripenem injection	K		$0.885	.	$0.18																																																																																																																																																																																																																																		
9318	Inj hydroxyprogst capoat nos	K		$7.990	.	$1.60																																																																																																																																																																																																																																		
9319	Somatropin injection	K		$89.310	.	$17.87																																																																																																																																																																																																																																		
9320	Carbidopa levodopa ent 100ml	K		$212.175	.	$42.44																																																																																																																																																																																																																																		
9321	Fosphenytoin inj pe	K		$2.266	.	$0.46																																																																																																																																																																																																																																		
9322	Bcg live intravesical 1mg	K		$2.821	.	$0.57																																																																																																																																																																																																																																		
9441	Inj ferric carboxymaltos 1mg	K		$1.072	.	$0.22																																																																																																																																																																																																																																		
9445	"Injection, ruconest"	K		$27.342	.	$5.47																																																																																																																																																																																																																																		
9448	"Oral netupitant, palonosetro"	K		$259.813	.	$51.97																																																																																																																																																																																																																																		
9449	"Injection, blinatumomab"	K		$110.305	.	$22.07																																																																																																																																																																																																																																		
9450	Fluocinol acet intravit imp	K		$490.813	.	$98.17																																																																																																																																																																																																																																		
9451	"Injection, peramivir"	K		$1.678	.	$0.34																																																																																																																																																																																																																																		
9452	Inj ceftolozane tazobactam	K		$5.412	.	$1.09																																																																																																																																																																																																																																		
9453	"Injection, nivolumab"	K		$27.464	.	$5.50																																																																																																																																																																																																																																		
9454	"Inj, pasireotide long acting"	K		$304.730	.	$60.95																																																																																																																																																																																																																																		
9455	"Injection, siltuximab"	K		$95.628	.	$19.13																																																																																																																																																																																																																																		
9456	"Injection, isavuconazonium"	K		$0.734	.	$0.15																																																																																																																																																																																																																																		
9460	"Injection, cangrelor"	K		$15.408	.	$3.09																																																																																																																																																																																																																																		
9462	"Injection, delafloxacin"	G		$0.468	.	$0.10																																																																																																																																																																																																																																		
9463	"Inj., aprepitant, 1 mg"	G		$2.230	.	$0.45																																																																																																																																																																																																																																		
9464	"Inj., rolapitant, 0.5 mg"	G		$0.939	.	$0.19																																																																																																																																																																																																																																		
9466	"Inj., benralizumab, 1 mg"	G		$166.880	.	$33.38																																																																																																																																																																																																																																		
9467	"Inj rituximab, hyaluronidase"	G		$45.284	.	$9.06																																																																																																																																																																																																																																		
9468	Factor ix recomb gly rebinyn	G		$3.690	.	$0.74																																																																																																																																																																																																																																		
9469	Inj triamcinolone ace xr 1mg	G		$18.881	.	$3.78																																																																																																																																																																																																																																		
9470	Aripiprazole lauroxil 1mg	K		$2.580	.	$0.52																																																																																																																																																																																																																																		
9471	Hymovis injection 1 mg	K		$19.257	.	$3.86																																																																																																																																																																																																																																		
9472	Inj talimogene laherparepvec	K		$49.899	.	$9.98																																																																																																																																																																																																																																		
9473	"Injection, mepolizumab, 1mg"	K		$29.413	.	$5.89																																																																																																																																																																																																																																		
9474	Inj irinotecan liposome 1 mg	K		$45.745	.	$9.15																																																																																																																																																																																																																																		
9475	"Injection, necitumumab, 1 mg"	K		$5.631	.	$1.13																																																																																																																																																																																																																																		
9476	"Injection, daratumumab 10 mg"	K		$52.286	.	$10.46																																																																																																																																																																																																																																		
9477	"Injection, elotuzumab, 1mg"	K		$6.396	.	$1.28																																																																																																																																																																																																																																		
9478	Inj sebelipase alfa 1 mg	K		$541.130	.	$108.23																																																																																																																																																																																																																																		
9479	"Instill, ciprofloxacin otic"	K		$29.964	.	$6.00																																																																																																																																																																																																																																		
9480	Injection trabectedin 0.1mg	K		$300.651	.	$60.13																																																																																																																																																																																																																																		
9481	"Injection, reslizumab"	K		$9.464	.	$1.90																																																																																																																																																																																																																																		
9482	Sotalol hydrochloride IV	K		$9.985	.	$2.00																																																																																																																																																																																																																																		
9483	"Inj, atezolizumab,10 mg"	K		$77.459	.	$15.50																																																																																																																																																																																																																																		
9484	"Inj, eteplirsen, 10 mg"	G		$167.940	.	$33.59																																																																																																																																																																																																																																		
9485	"Inj, olaratumab, 10 mg"	G		$51.085	.	$10.22																																																																																																																																																																																																																																		
9486	"Inj, granisetron, xr, 0.1 mg"	G		$2.804	.	$0.56																																																																																																																																																																																																																																		
9487	"Ustekinumab, iv inject,1 mg"	G		$12.024	.	$2.41																																																																																																																																																																																																																																		
9488	Conivaptan hcl	G		$32.320	.	$6.47																																																																																																																																																																																																																																		
9489	"Inj, nusinersen, 0.1mg"	G		"$1,101.518"	.	$220.31																																																																																																																																																																																																																																		
9490	"Inj, bezlotoxumab, 10 mg"	G		$40.004	.	$8.00																																																																																																																																																																																																																																		
9491	"Injection, avelumab, 10 mg"	G		$81.742	.	$16.35																																																																																																																																																																																																																																		
9492	"Inj., durvalumab, 10 mg"	G		$73.778	.	$14.76																																																																																																																																																																																																																																		
9493	"Injection, edaravone, 1 mg"	G		$19.522	.	$3.91																																																																																																																																																																																																																																		
9494	"Injection, ocrelizumab"	G		$57.406	.	$11.49																																																																																																																																																																																																																																		
9495	Gemtuzumab ozogamicin inj	G		$192.963	.	$38.60																																																																																																																																																																																																																																		
9500	"Platelets, irradiated"	R	2.2452	$182.75	.	$36.55																																																																																																																																																																																																																																		
9501	Platelet pheres leukoreduced	R	6.3333	$515.52	.	$103.11																																																																																																																																																																																																																																		
9502	Platelet pheresis irradiated	R	9.3017	$757.14	.	$151.43																																																																																																																																																																																																																																		
9503	Fr frz plasma donor retested	R	0.6309	$51.35	.	$10.27																																																																																																																																																																																																																																		
9504	RBC deglycerolized	R	4.2191	$343.43	.	$68.69																																																																																																																																																																																																																																		
9505	RBC irradiated	R	2.9654	$241.38	.	$48.28																																																																																																																																																																																																																																		
9507	"Platelets, pheresis"	R	3.9934	$325.05	.	$65.01																																																																																																																																																																																																																																		
9508	Plasma 1 donor frz w/in 8 hr	R	1.0871	$88.49	.	$17.70																																																																																																																																																																																																																																		
9509	"Frozen plasma, pooled, sd"	R	1.0358	$84.31	.	$16.87																																																																																																																																																																																																																																		
9510	Whole blood for transfusion	R	1.4309	$116.47	.	$23.30																																																																																																																																																																																																																																		
9511	Cryoprecipitate each unit	R	0.6258	$50.94	.	$10.19																																																																																																																																																																																																																																		
9512	RBC leukocytes reduced	R	2.3901	$194.55	.	$38.91																																																																																																																																																																																																																																		
9513	"Plasma, frz between 8-24hour"	R	0.9671	$78.72	.	$15.75																																																																																																																																																																																																																																		
9514	"Plasma protein fract,5%,50ml"	R	0.2267	$18.45	.	$3.69																																																																																																																																																																																																																																		
9515	"Platelets, each unit"	R	1.4147	$115.15	.	$23.03																																																																																																																																																																																																																																		
9516	Plaelet rich plasma unit	R	1.6631	$135.37	.	$27.08																																																																																																																																																																																																																																		
9517	Red blood cells unit	R	1.7689	$143.98	.	$28.80																																																																																																																																																																																																																																		
9518	Washed red blood cells unit	R	4.6410	$377.77	.	$75.56																																																																																																																																																																																																																																		
9519	"Plasmaprotein fract,5%,250ml"	R	1.3133	$106.90	.	$21.38																																																																																																																																																																																																																																		
9520	Blood split unit	R	1.7636	$143.55	.	$28.71																																																																																																																																																																																																																																		
9521	Platelets leukoreduced irrad	R	2.6796	$218.11	.	$43.63																																																																																																																																																																																																																																		
9522	RBC leukoreduced irradiated	R	3.3454	$272.31	.	$54.47																																																																																																																																																																																																																																		
9523	Cryoprecipitatereducedplasma	R	1.2218	$99.45	.	$19.89																																																																																																																																																																																																																																		
9524	"Blood, l/r, cmv-neg"	R	2.3393	$190.41	.	$38.09																																																																																																																																																																																																																																		
9525	"Platelets, hla-m, l/r, unit"	R	10.4698	$852.22	.	$170.45																																																																																																																																																																																																																																		
9526	Platelets leukocytes reduced	R	1.7091	$139.12	.	$27.83																																																																																																																																																																																																																																		
9527	"Blood, l/r, froz/degly/wash"	R	4.1220	$335.52	.	$67.11																																																																																																																																																																																																																																		
9528	"Plt, aph/pher, l/r, cmv-neg"	R	6.3065	$513.34	.	$102.67																																																																																																																																																																																																																																		
9529	"Blood, l/r, irradiated"	R	2.6431	$215.14	.	$43.03																																																																																																																																																																																																																																		
9530	Plate pheres leukoredu irrad	R	8.1026	$659.54	.	$131.91																																																																																																																																																																																																																																		
9531	"Plt, pher, l/r cmv-neg, irr"	R	6.4313	$523.49	.	$104.70																																																																																																																																																																																																																																		
9532	"RBC, frz/deg/wsh, l/r, irrad"	R	3.3543	$273.03	.	$54.61																																																																																																																																																																																																																																		
9533	"RBC, l/r, cmv-neg, irrad"	R	3.0852	$251.13	.	$50.23																																																																																																																																																																																																																																		
9534	Pathogen reduced plasma pool	R	0.3730	$30.36	.	$6.08																																																																																																																																																																																																																																		
9535	Pathogen reduced plasma sing	R	1.2203	$99.33	.	$19.87																																																																																																																																																																																																																																		
9536	Platelets pheresis path redu	R	7.3819	$600.87	.	$120.18																																																																																																																																																																																																																																		
