	Addendum A.-Final OPPS APCs for CY 2014																																																																																																																																																																																										
APC	Group Title	SI	Relative Weight 	Payment Rate 	National Unadjusted Copayment 	Minimum Unadjusted Copayment 	* Indicates a Change 																																																																																																																																																																																				
0001	Level I Photochemotherapy	S	0.5238	$38.07	.	$7.62																																																																																																																																																																																					
0004	Level I Needle Biopsy/ Aspiration Except Bone Marrow	T	5.6589	$411.24	.	$82.25																																																																																																																																																																																					
0005	Level II Needle Biopsy/Aspiration Except Bone Marrow	T	9.6609	$702.08	.	$140.42																																																																																																																																																																																					
0006	Level I Incision & Drainage	T	2.1970	$159.66	.	$31.94																																																																																																																																																																																					
0007	Level II Incision & Drainage	T	11.6214	$844.55	.	$168.91																																																																																																																																																																																					
0008	Level III Incision and Drainage	T	21.5968	"$1,569.48"	.	$313.90																																																																																																																																																																																					
0012	Level I Debridement & Destruction	T	0.8370	$60.83	.	$12.17																																																																																																																																																																																					
0013	Level II Debridement & Destruction	T	1.1522	$83.73	.	$16.75																																																																																																																																																																																					
0015	Level III Debridement & Destruction	T	2.0281	$147.39	.	$29.48																																																																																																																																																																																					
0016	Level IV Debridement & Destruction	T	3.7815	$274.81	.	$54.97																																																																																																																																																																																					
0017	Level V Debridement & Destruction	T	20.7931	"$1,511.08"	.	$302.22																																																																																																																																																																																					
0019	Level I Excision/ Biopsy	T	4.3867	$318.79	.	$63.76																																																																																																																																																																																					
0020	Level II Excision/ Biopsy	T	8.8192	$640.91	.	$128.19																																																																																																																																																																																					
0021	Level III Excision/ Biopsy	T	15.7741	"$1,146.34"	.	$229.27																																																																																																																																																																																					
0022	Level IV Excision/ Biopsy	T	23.8955	"$1,736.53"	$350.78	$347.31																																																																																																																																																																																					
0028	Level I Breast and Skin Surgery	T	27.1667	"$1,974.26"	.	$394.86																																																																																																																																																																																					
0029	Level II Breast and Skin Surgery	T	36.5419	"$2,655.57"	$581.52	$531.12																																																																																																																																																																																					
0030	Level III Breast and Skin Surgery	T	49.3559	"$3,586.79"	$747.07	$717.36																																																																																																																																																																																					
0031	Level I Health and Behavior Services	S	0.3292	$23.92	.	$4.79																																																																																																																																																																																					
0034	Mental Health Services Composite	S	2.9398	$213.64	.	$42.73																																																																																																																																																																																					
0035	Vascular Puncture and Minor Diagnostic Procedures	X	0.3042	$22.11	.	$4.43																																																																																																																																																																																					
0037	Level IV Needle Biopsy/Aspiration Except Bone Marrow	T	16.8325	"$1,223.25"	.	$244.65																																																																																																																																																																																					
0039	Level I Implantation of Neurostimulator Generator	S	237.1326	"$17,232.90"	.	"$3,446.58"																																																																																																																																																																																					
0040	Level I Implantation/Revision/Replacement of Neurostimulator Electrodes 	S	63.6628	"$4,626.50"	.	$925.30																																																																																																																																																																																					
0041	Level I Arthroscopy	T	29.6630	"$2,155.67"	.	$431.14																																																																																																																																																																																					
0042	Level II Arthroscopy	T	58.6059	"$4,259.01"	.	$851.81																																																																																																																																																																																					
0045	Bone/Joint Manipulation Under Anesthesia	T	15.8858	"$1,154.45"	$257.70	$230.89																																																																																																																																																																																					
0047	Arthroplasty without Prosthesis	T	42.9663	"$3,122.45"	.	$624.49																																																																																																																																																																																					
0048	Level I Arthroplasty or Implantation with Prosthesis	T	63.8333	"$4,638.89"	.	$927.78																																																																																																																																																																																					
0049	Level I Musculoskeletal Procedures Except Hand and Foot	T	22.5544	"$1,639.07"	.	$327.82																																																																																																																																																																																					
0050	Level II Musculoskeletal Procedures Except Hand and Foot	T	35.4456	"$2,575.90"	.	$515.18																																																																																																																																																																																					
0051	Level III Musculoskeletal Procedures Except Hand and Foot	T	52.0371	"$3,781.64"	.	$756.33																																																																																																																																																																																					
0052	Level IV Musculoskeletal Procedures Except Hand and Foot	T	89.5388	"$6,506.96"	.	"$1,301.40"																																																																																																																																																																																					
0053	Level I Hand Musculoskeletal Procedures	T	17.2090	"$1,250.61"	.	$250.13																																																																																																																																																																																					
0054	Level II Hand Musculoskeletal Procedures	T	30.6686	"$2,228.75"	.	$445.75																																																																																																																																																																																					
0055	Level I Foot Musculoskeletal Procedures	T	23.1692	"$1,683.75"	$353.37	$336.75																																																																																																																																																																																					
0056	Level II Foot Musculoskeletal Procedures	T	67.0037	"$4,869.29"	.	$973.86																																																																																																																																																																																					
0057	Bunion Procedures	T	35.9716	"$2,614.13"	.	$522.83																																																																																																																																																																																					
0058	Level I Cast Application	S	1.3789	$100.21	.	$20.05																																																																																																																																																																																					
0059	Level I Strapping	S	0.7685	$55.85	.	$11.17																																																																																																																																																																																					
0060	Manipulation Therapy	S	0.2422	$17.60	.	$3.52																																																																																																																																																																																					
0061	Level II Implantation/Revision/Replacement of Neurostimulator Electrodes 	S	102.1644	"$7,424.49"	.	"$1,484.90"																																																																																																																																																																																					
0062	Level I Treatment Fracture/Dislocation	T	27.6887	"$2,012.19"	.	$402.44																																																																																																																																																																																					
0063	Level II Treatment Fracture/Dislocation	T	56.7594	"$4,124.82"	.	$824.97																																																																																																																																																																																					
0064	Level III Treatment Fracture/Dislocation	T	74.0813	"$5,383.64"	.	"$1,076.73"																																																																																																																																																																																					
0065	"IORT, MRgFUS, and MEG"	S	17.1769	"$1,248.28"	.	$249.66																																																																																																																																																																																					
0066	Level I Stereotactic Radiosurgery	S	26.4380	"$1,921.30"	.	$384.26																																																																																																																																																																																					
0067	Level II Stereotactic Radiosurgery	S	49.4227	"$3,591.65"	.	$718.33																																																																																																																																																																																					
0069	Thoracoscopy	T	36.3292	"$2,640.12"	$591.64	$528.03																																																																																																																																																																																					
0070	Thoracentesis/Lavage Procedures	T	6.6765	$485.19	.	$97.04																																																																																																																																																																																					
0071	Level I Endoscopy Upper Airway	T	2.0698	$150.42	.	$30.09																																																																																																																																																																																					
0072	Level II Endoscopy Upper Airway	T	5.0854	$369.57	.	$73.92																																																																																																																																																																																					
0073	Level III Endoscopy Upper Airway	T	16.7369	"$1,216.30"	.	$243.26																																																																																																																																																																																					
0074	Level IV Endoscopy Upper Airway	T	25.8756	"$1,880.43"	.	$376.09																																																																																																																																																																																					
0075	Level V Endoscopy Upper Airway	T	41.9936	"$3,051.76"	.	$610.36																																																																																																																																																																																					
0076	Level I Endoscopy Lower Airway	T	13.0947	$951.62	.	$190.33																																																																																																																																																																																					
0077	Level I Pulmonary Treatment	S	0.5415	$39.35	.	$7.87																																																																																																																																																																																					
0078	Level III Pulmonary Treatment	S	1.8631	$135.40	.	$27.08																																																																																																																																																																																					
0079	Ventilation Initiation and Management	S	4.8053	$349.21	.	$69.85																																																																																																																																																																																					
0080	Diagnostic Cardiac Catheterization	T	35.5980	"$2,586.98"	$795.89	$517.40																																																																																																																																																																																					
0082	Coronary or Non-Coronary Atherectomy	T	121.6791	"$8,842.66"	.	"$1,768.54"																																																																																																																																																																																					
0083	"Coronary Angioplasty, Valvuloplasty, and Level I Endovascular Revascularization of the Lower Extremity "	T	60.6892	"$4,410.41"	.	$882.09																																																																																																																																																																																					
0084	Level I Electrophysiologic Procedures	S	10.3795	$754.30	.	$150.86																																																																																																																																																																																					
0085	Level II Electrophysiologic Procedures	T	58.2446	"$4,232.75"	.	$846.55																																																																																																																																																																																					
0088	Thrombectomy	T	45.0181	"$3,271.56"	$655.22	$654.32																																																																																																																																																																																					
0089	Insertion/Replacement of Permanent Pacemaker and Electrodes	T	120.9586	"$8,790.30"	.	"$1,758.06"																																																																																																																																																																																					
0090	Level I Insertion/Replacement of Permanent Pacemaker 	T	101.1821	"$7,353.11"	"$1,593.50"	"$1,470.63"																																																																																																																																																																																					
0093	Vascular Reconstruction/Fistula Repair 	T	39.1718	"$2,846.69"	.	$569.34																																																																																																																																																																																					
0094	Level I Resuscitation and Cardioversion	S	2.1968	$159.65	$43.48	$31.93																																																																																																																																																																																					
0095	Cardiac Rehabilitation	S	1.4213	$103.29	.	$20.66																																																																																																																																																																																					
0096	Level II Noninvasive Physiologic Studies	S	1.8035	$131.06	$36.86	$26.22																																																																																																																																																																																					
0097	Level I Noninvasive Physiologic Studies	S	0.9657	$70.18	.	$14.04																																																																																																																																																																																					
0099	Electrocardiograms/Cardiography	S	0.3732	$27.12	.	$5.43																																																																																																																																																																																					
0100	Cardiac Stress Tests	X	3.3604	$244.21	.	$48.85																																																																																																																																																																																					
0101	Tilt Table Evaluation	S	4.4677	$324.68	$100.24	$64.94																																																																																																																																																																																					
0102	Level II Pulmonary Treatment	S	1.0759	$78.19	.	$15.64																																																																																																																																																																																					
0103	Miscellaneous Vascular Procedures	T	20.9727	"$1,524.13"	.	$304.83																																																																																																																																																																																					
0104	Transcatheter Placement of Intracoronary Stents	T	87.5681	"$6,363.75"	.	"$1,272.75"																																																																																																																																																																																					
0105	"Repair/Revision/Removal of Pacemakers, AICDs, or Vascular Devices"	T	31.8926	"$2,317.70"	.	$463.54																																																																																																																																																																																					
0106	"Insertion/Replacement/Repair of Pacemaker Generator, Leads, and/or Electrodes"	T	63.3253	"$4,601.98"	.	$920.40																																																																																																																																																																																					
0107	Level I Implantation of Cardioverter-Defibrillators (ICDs)	T	344.2616	"$25,018.18"	.	"$5,003.64"																																																																																																																																																																																					
0108	Level II Implantation of Cardioverter-Defibrillators (ICDs)	T	442.3292	"$32,144.95"	.	"$6,428.99"																																																																																																																																																																																					
0110	Transfusion	S	3.9241	$285.17	.	$57.04																																																																																																																																																																																					
0111	Blood Product Exchange	S	14.9351	"$1,085.36"	.	$217.08																																																																																																																																																																																					
0112	Apheresis and Stem Cell Procedures	S	42.1852	"$3,065.68"	.	$613.14																																																																																																																																																																																					
0113	Excision Lymphatic System	T	27.8917	"$2,026.95"	.	$405.39																																																																																																																																																																																					
0114	Thyroid/Lymphadenectomy Procedures	T	54.6762	"$3,973.43"	.	$794.69																																																																																																																																																																																					
0115	Cannula/Access Device Procedures	T	39.1123	"$2,842.37"	.	$568.48																																																																																																																																																																																					
0121	Level I Tube or Catheter Changes or Repositioning	T	6.4191	$466.49	.	$93.30																																																																																																																																																																																					
0126	Level I Urinary and Anal Procedures	T	1.0909	$79.28	.	$15.86																																																																																																																																																																																					
0129	Level I Closed Treatment Fracture	T	1.4885	$108.17	.	$21.64																																																																																																																																																																																					
0130	Level I Laparoscopy	T	40.3317	"$2,930.99"	$659.53	$586.20																																																																																																																																																																																					
0131	Level II Laparoscopy	T	50.2049	"$3,648.49"	"$1,001.89"	$729.70																																																																																																																																																																																					
0132	Level III Laparoscopy	T	73.8306	"$5,365.42"	"$1,236.99"	"$1,073.09"																																																																																																																																																																																					
0138	Level II Closed Treatment Fracture 	T	2.3869	$173.46	.	$34.70																																																																																																																																																																																					
0139	Level III Closed Treatment Fracture 	T	6.1774	$448.92	.	$89.79																																																																																																																																																																																					
0141	Level I Upper GI Procedures	T	9.2260	$670.47	$138.69	$134.10																																																																																																																																																																																					
0142	Level I Small Intestine Endoscopy	T	11.5200	$837.18	.	$167.44																																																																																																																																																																																					
0143	Lower GI Endoscopy	T	10.1393	$736.84	$186.06	$147.37																																																																																																																																																																																					
0146	Level I Sigmoidoscopy and Anoscopy	T	6.3436	$461.00	.	$92.20																																																																																																																																																																																					
0147	Level II Sigmoidoscopy and Anoscopy	T	10.7242	$779.35	.	$155.87																																																																																																																																																																																					
0148	Level I Anal/Rectal Procedures	T	6.5068	$472.86	.	$94.58																																																																																																																																																																																					
0149	Level III Anal/Rectal Procedures	T	26.2718	"$1,909.22"	.	$381.85																																																																																																																																																																																					
0150	Level IV Anal/Rectal Procedures	T	34.4192	"$2,501.31"	.	$500.27																																																																																																																																																																																					
0151	Endoscopic Retrograde Cholangio-Pancreatography (ERCP)	T	26.6085	"$1,933.69"	.	$386.74																																																																																																																																																																																					
0152	Level I Percutaneous Abdominal and Biliary Procedures	T	24.6087	"$1,788.36"	.	$357.68																																																																																																																																																																																					
0153	Peritoneal and Abdominal Procedures	T	25.2695	"$1,836.39"	.	$367.28																																																																																																																																																																																					
0154	Hernia/Hydrocele Procedures	T	35.7723	"$2,599.64"	.	$519.93																																																																																																																																																																																					
0155	Level II Anal/Rectal Procedures	T	19.5389	"$1,419.93"	.	$283.99																																																																																																																																																																																					
0156	Level III Urinary and Anal Procedures	T	5.7679	$419.16	.	$83.84																																																																																																																																																																																					
0157	Colorectal Cancer Screening: Barium Enema	S	3.9900	$289.96	.	$58.00																																																																																																																																																																																					
0158	Colorectal Cancer Screening: Colonoscopy	T	8.8993	$646.73	$0.00	$0.00																																																																																																																																																																																					
0159	Colorectal Cancer Screening: Flexible Sigmoidoscopy	S	6.3454	$461.13	$0.00	$0.00																																																																																																																																																																																					
0160	Level I Cystourethroscopy and other Genitourinary Procedures	T	7.4170	$539.01	.	$107.81																																																																																																																																																																																					
0161	Level II Cystourethroscopy and other Genitourinary Procedures	T	16.5786	"$1,204.80"	.	$240.96																																																																																																																																																																																					
0162	Level III Cystourethroscopy and other Genitourinary Procedures	T	27.6217	"$2,007.32"	.	$401.47																																																																																																																																																																																					
0163	Level IV Cystourethroscopy and other Genitourinary Procedures	T	39.9743	"$2,905.01"	.	$581.01																																																																																																																																																																																					
0164	Level II Urinary and Anal Procedures	T	2.9049	$211.10	.	$42.22																																																																																																																																																																																					
0165	Level IV Urinary and Anal Procedures	T	19.5262	"$1,419.01"	.	$283.81																																																																																																																																																																																					
0166	Level I Urethral Procedures	T	21.0424	"$1,529.19"	.	$305.84																																																																																																																																																																																					
0168	Level II Urethral Procedures	T	34.8886	"$2,535.42"	.	$507.09																																																																																																																																																																																					
0169	Lithotripsy	T	41.1594	"$2,991.14"	$979.42	$598.23																																																																																																																																																																																					
0170	Dialysis	S	8.3974	$610.26	.	$122.06																																																																																																																																																																																					
0172	Level I Partial Hospitalization (3 services) for CMHCs	P	1.3628	$99.04	.	$19.81																																																																																																																																																																																					
0173	Level II Partial Hospitalization (4 or more services) for CMHCs	P	1.5374	$111.73	.	$22.35																																																																																																																																																																																					
0174	Level IV Laparoscopy	T	118.2491	"$8,593.40"	"$1,911.61"	"$1,718.68"																																																																																																																																																																																					
0175	Level I Partial Hospitalization (3 services) for Hospital-based PHPs	P	2.6166	$190.15	.	$38.03																																																																																																																																																																																					
0176	Level II Partial Hospitalization (4 or more services) for Hospital-based PHPs	P	2.9398	$213.64	.	$42.73																																																																																																																																																																																					
0177	Level I Echocardiogram with Contrast	S	6.8881	$500.57	$129.40	$100.12																																																																																																																																																																																					
0178	Level II Echocardiogram with Contrast	S	9.0028	$654.25	$172.48	$130.85																																																																																																																																																																																					
0181	Level II Male Genital Procedures	T	29.9333	"$2,175.31"	.	$435.07																																																																																																																																																																																					
0183	Level I Male Genital Procedures	T	23.8784	"$1,735.29"	.	$347.06																																																																																																																																																																																					
0184	Prostate Biopsy	T	14.6135	"$1,061.99"	.	$212.40																																																																																																																																																																																					
0188	Level II Female Reproductive Proc	T	1.7430	$126.67	.	$25.34																																																																																																																																																																																					
0189	Level III Female Reproductive Proc	T	2.6066	$189.43	.	$37.89																																																																																																																																																																																					
0190	Level I Hysteroscopy	T	24.2648	"$1,763.37"	$424.28	$352.68																																																																																																																																																																																					
0191	Level I Female Reproductive Proc	T	0.1421	$10.33	.	$2.07																																																																																																																																																																																					
0192	Level IV Female Reproductive Proc	T	5.0798	$369.16	.	$73.84																																																																																																																																																																																					
0193	Level V Female Reproductive Proc	T	18.9234	"$1,375.20"	.	$275.04																																																																																																																																																																																					
0195	Level VI Female Reproductive Procedures	T	34.7118	"$2,522.58"	.	$504.52																																																																																																																																																																																					
0202	Level VII Female Reproductive Procedures	T	49.1097	"$3,568.90"	$981.50	$713.78																																																																																																																																																																																					
0203	Level IV Nerve Injections	T	21.2609	"$1,545.07"	.	$309.02																																																																																																																																																																																					
0204	Level I Nerve Injections	T	2.7825	$202.21	.	$40.45																																																																																																																																																																																					
0205	Level III Male Genital Procedures	T	48.8969	"$3,553.44"	.	$710.69																																																																																																																																																																																					
0206	Level II Nerve Injections	T	4.8710	$353.99	.	$70.80																																																																																																																																																																																					
0207	Level III Nerve Injections	T	9.2183	$669.91	.	$133.99																																																																																																																																																																																					
0208	Laminotomies and Laminectomies	T	55.0874	"$4,003.31"	.	$800.67																																																																																																																																																																																					
0209	"Level II Extended EEG, Sleep, and Cardiovascular Studies"	S	6.0562	$440.12	$136.62	$88.03																																																																																																																																																																																					
0213	"Level I Extended EEG, Sleep, and Cardiovascular Studies"	S	2.4989	$181.60	$53.58	$36.32																																																																																																																																																																																					
0215	Level I Nerve and Muscle Services	S	0.6921	$50.30	.	$10.06																																																																																																																																																																																					
0216	Level III Nerve and Muscle Services	S	2.9831	$216.79	.	$43.36																																																																																																																																																																																					
0218	Level II Nerve and Muscle Services	S	1.7579	$127.75	.	$25.55																																																																																																																																																																																					
0219	Vascular Ligation 	T	29.4349	"$2,139.09"	.	$427.82																																																																																																																																																																																					
0220	Level I Nerve Procedures	T	19.0430	"$1,383.89"	.	$276.78																																																																																																																																																																																					
0221	Level II Nerve Procedures	T	39.4068	"$2,863.77"	.	$572.76																																																																																																																																																																																					
0224	Implantation of Catheter/Reservoir/Shunt	T	47.0009	"$3,415.65"	.	$683.13																																																																																																																																																																																					
0227	Implantation of Drug Infusion Device	T	201.5875	"$14,649.77"	.	"$2,929.96"																																																																																																																																																																																					
0229	Level II Endovascular Revascularization of the Lower Extremity 	T	125.4912	"$9,119.70"	.	"$1,823.94"																																																																																																																																																																																					
0230	Level I Eye Tests & Treatments	S	0.7093	$51.55	.	$10.31																																																																																																																																																																																					
0231	Level III Eye Tests & Treatments	S	2.5031	$181.91	.	$36.39																																																																																																																																																																																					
0232	Level I Anterior Segment Eye Procedures	T	2.3720	$172.38	.	$34.48																																																																																																																																																																																					
0233	Level III Anterior Segment Eye Procedures	T	16.4184	"$1,193.16"	.	$238.64																																																																																																																																																																																					
0234	Level IV Anterior Segment Eye Procedures	T	24.0664	"$1,748.95"	.	$349.79																																																																																																																																																																																					
0235	Level I Posterior Segment Eye Procedures	T	5.9113	$429.59	.	$85.92																																																																																																																																																																																					
0237	Level II Posterior Segment Eye Procedures	T	23.5977	"$1,714.89"	.	$342.98																																																																																																																																																																																					
0238	Level I Repair and Plastic Eye Procedures	T	3.5139	$255.36	.	$51.08																																																																																																																																																																																					
0239	Level II Repair and Plastic Eye Procedures	T	8.8578	$643.71	.	$128.75																																																																																																																																																																																					
0240	Level III Repair and Plastic Eye Procedures	T	19.9516	"$1,449.92"	$294.00	$289.99																																																																																																																																																																																					
0241	Level IV Repair and Plastic Eye Procedures	T	27.3406	"$1,986.90"	.	$397.38																																																																																																																																																																																					
0242	Level V Repair and Plastic Eye Procedures	T	42.9732	"$3,122.95"	.	$624.59																																																																																																																																																																																					
0243	Strabismus/Muscle Procedures	T	26.7931	"$1,947.11"	$412.25	$389.43																																																																																																																																																																																					
0244	Corneal and Amniotic Membrane Transplant	T	44.4209	"$3,228.16"	$794.86	$645.64																																																																																																																																																																																					
0246	Cataract Procedures with IOL Insert	T	24.3011	"$1,766.01"	$490.32	$353.21																																																																																																																																																																																					
0247	Laser Eye Procedures	T	5.8928	$428.24	$102.26	$85.65																																																																																																																																																																																					
0249	Cataract Procedures without IOL Insert	T	29.6448	"$2,154.35"	$499.26	$430.87																																																																																																																																																																																					
0250	Level I ENT Procedures	T	1.1575	$84.12	$24.11	$16.83																																																																																																																																																																																					
0251	Level II ENT Procedures	T	3.5927	$261.09	.	$52.22																																																																																																																																																																																					
0252	Level III ENT Procedures	T	7.5014	$545.14	.	$109.03																																																																																																																																																																																					
0253	Level IV ENT Procedures	T	16.7579	"$1,217.83"	.	$243.57																																																																																																																																																																																					
0254	Level V ENT Procedures	T	25.5846	"$1,859.28"	.	$371.86																																																																																																																																																																																					
0255	Level II Anterior Segment Eye Procedures	T	10.2636	$745.88	.	$149.18																																																																																																																																																																																					
0256	Level VI ENT Procedures	T	49.0518	"$3,564.69"	.	$712.94																																																																																																																																																																																					
0259	Level VII ENT Procedures	T	423.2920	"$30,761.48"	"$7,921.74"	"$6,152.30"																																																																																																																																																																																					
0260	Level I Plain Film Except Teeth	X	0.7891	$57.35	.	$11.47																																																																																																																																																																																					
0261	Level II Plain Film Except Teeth Including Bone Density Measurement	X	1.2507	$90.89	.	$18.18																																																																																																																																																																																					
0262	Plain Film of Teeth	X	0.5866	$42.63	.	$8.53																																																																																																																																																																																					
0263	Level I Miscellaneous Radiology Procedures	X	4.3746	$317.91	.	$63.59																																																																																																																																																																																					
0265	Level I Diagnostic and Screening Ultrasound	S	1.2391	$90.05	$22.26	$18.01																																																																																																																																																																																					
0266	Level II Diagnostic and Screening Ultrasound	S	1.8517	$134.57	$37.23	$26.92																																																																																																																																																																																					
0267	Level III Diagnostic and Screening Ultrasound	S	2.6261	$190.84	$59.55	$38.17																																																																																																																																																																																					
0269	Level II Echocardiogram Without Contrast 	S	5.8794	$427.27	.	$85.46																																																																																																																																																																																					
0270	Level III Echocardiogram Without Contrast 	S	8.1793	$594.41	$128.73	$118.89																																																																																																																																																																																					
0272	Fluoroscopy	X	2.1559	$156.67	.	$31.34																																																																																																																																																																																					
0274	Myelography	S	8.2207	$597.41	.	$119.49																																																																																																																																																																																					
0275	Arthrography	S	4.6693	$339.33	$68.90	$67.87																																																																																																																																																																																					
0276	Level I Digestive Radiology	S	1.4014	$101.84	$32.84	$20.37																																																																																																																																																																																					
0277	Level II Digestive Radiology	S	2.0810	$151.23	$46.51	$30.25																																																																																																																																																																																					
0278	Diagnostic Urography	S	3.5447	$257.60	$58.44	$51.52																																																																																																																																																																																					
0279	Level II Angiography and Venography	S	35.4530	"$2,576.44"	.	$515.29																																																																																																																																																																																					
0280	Level III Angiography and Venography	S	62.1095	"$4,513.62"	.	$902.73																																																																																																																																																																																					
0282	Miscellaneous Computed Axial Tomography	S	1.0948	$79.56	$26.51	$15.92																																																																																																																																																																																					
0283	Computed Tomography with Contrast	S	3.4263	$249.00	$79.99	$49.80																																																																																																																																																																																					
0284	Magnetic Resonance Imaging and Magnetic Resonance Angiography with Contrast	S	5.8687	$426.49	$137.54	$85.30																																																																																																																																																																																					
0288	Bone Density:Axial Skeleton	S	1.2407	$90.16	$0.00	$0.00																																																																																																																																																																																					
0293	Level VI Anterior Segment Eye Procedures	T	105.9269	"$7,697.92"	.	"$1,539.59"																																																																																																																																																																																					
0299	Hyperthermia and Radiation Treatment Procedures	S	5.6861	$413.22	.	$82.65																																																																																																																																																																																					
0300	Level I Radiation Therapy	S	1.4346	$104.26	.	$20.86																																																																																																																																																																																					
0301	Level II Radiation Therapy	S	2.6458	$192.28	.	$38.46																																																																																																																																																																																					
0303	Treatment Device Construction	X	2.9377	$213.49	$66.95	$42.70																																																																																																																																																																																					
0304	Level I Therapeutic Radiation Treatment Preparation	X	1.5776	$114.65	$34.63	$22.93																																																																																																																																																																																					
0305	Level II Therapeutic Radiation Treatment Preparation	X	4.2846	$311.37	$88.78	$62.28																																																																																																																																																																																					
0308	Positron Emission Tomography (PET) imaging	S	18.0344	"$1,310.60"	.	$262.12																																																																																																																																																																																					
0310	Level III Therapeutic Radiation Treatment Preparation	X	14.2612	"$1,036.39"	$325.27	$207.28																																																																																																																																																																																					
0312	Radioelement Applications	S	4.9715	$361.29	.	$72.26																																																																																																																																																																																					
0313	Brachytherapy	S	10.0974	$733.80	$259.86	$146.76																																																																																																																																																																																					
0315	Level II Implantation of Neurostimulator Generator 	S	317.7731	"$23,093.21"	.	"$4,618.65"																																																																																																																																																																																					
0317	Level II Miscellaneous Radiology Procedures	X	10.1647	$738.69	.	$147.74																																																																																																																																																																																					
0318	Implantation of Neurostimulator Pulse Generator and Electrode 	S	380.1966	"$27,629.65"	"$9,121.76"	"$5,525.93"																																																																																																																																																																																					
0319	Level III Endovascular Revascularization of the Lower Extremity	T	213.4246	"$15,509.99"	"$5,559.48"	"$3,102.00"																																																																																																																																																																																					
0320	Electroconvulsive Therapy	S	5.9928	$435.51	.	$87.11																																																																																																																																																																																					
0322	Brief Individual Psychotherapy	S	1.1613	$84.39	.	$16.88																																																																																																																																																																																					
0323	Extended Individual Psychotherapy	S	1.5807	$114.87	.	$22.98																																																																																																																																																																																					
0324	Family Psychotherapy	S	1.7784	$129.24	.	$25.85																																																																																																																																																																																					
0325	Group Psychotherapy	S	0.9541	$69.34	.	$13.87																																																																																																																																																																																					
0326	Level I Skin Repair	T	2.7388	$199.03	.	$39.81																																																																																																																																																																																					
0327	Level II Skin Repair	T	5.6337	$409.41	.	$81.89																																																																																																																																																																																					
0328	Level III Skin Repair	T	18.8682	"$1,371.19"	.	$274.24																																																																																																																																																																																					
0329	Level IV Skin Repair	T	31.1050	"$2,260.46"	.	$452.10																																																																																																																																																																																					
0330	Dental Procedures	S	6.2552	$454.58	.	$90.92																																																																																																																																																																																					
0331	Combined Abdomen and Pelvis CT without Contrast 	S	3.3271	$241.79	$93.48	$48.36																																																																																																																																																																																					
0332	Computed Tomography without Contrast	S	1.7403	$126.47	$48.90	$25.30																																																																																																																																																																																					
0333	Computed Tomography without Contrast followed by Contrast	S	3.8584	$280.40	$97.38	$56.08																																																																																																																																																																																					
0334	Combined Abdomen and Pelvis CT with Contrast 	S	5.3683	$390.13	$125.73	$78.03																																																																																																																																																																																					
0336	Magnetic Resonance Imaging and Magnetic Resonance Angiography without Contrast	S	4.0563	$294.78	$116.16	$58.96																																																																																																																																																																																					
0337	Magnetic Resonance Imaging and Magnetic Resonance Angiography without Contrast followed by Contrast	S	6.7828	$492.92	$177.30	$98.59																																																																																																																																																																																					
0340	Level I Minor Procedures	X	0.7353	$53.44	.	$10.69																																																																																																																																																																																					
0341	Skin Tests	X	0.1720	$12.50	.	$2.50																																																																																																																																																																																					
0342	Level I Pathology	X	0.2730	$19.84	.	$3.97																																																																																																																																																																																					
0343	Level III Pathology	X	0.8458	$61.47	.	$12.30																																																																																																																																																																																					
0344	Level IV Pathology	X	2.4724	$179.67	.	$35.94																																																																																																																																																																																					
0345	Level I Transfusion Laboratory Procedures	X	0.1668	$12.12	.	$2.43																																																																																																																																																																																					
0346	Level II Transfusion Laboratory Procedures	X	0.4344	$31.57	.	$6.32																																																																																																																																																																																					
0347	Level III Transfusion Laboratory Procedures	X	0.8319	$60.46	.	$12.10																																																																																																																																																																																					
0351	Level VII Anterior Segment Eye Procedures	T	213.9921	"$15,551.23"	"$3,226.34"	"$3,110.25"																																																																																																																																																																																					
0360	Level I Alimentary Tests	X	1.9973	$145.15	$33.59	$29.03																																																																																																																																																																																					
0361	Level II Alimentary Tests	X	4.4489	$323.31	$83.23	$64.67																																																																																																																																																																																					
0363	Level I Otorhinolaryngologic Function Tests	X	1.0239	$74.41	$16.12	$14.89																																																																																																																																																																																					
0364	Level I Audiometry	X	0.4530	$32.92	.	$6.59																																																																																																																																																																																					
0365	Level II Audiometry	X	1.0561	$76.75	.	$15.35																																																																																																																																																																																					
0366	Level III Audiometry	X	1.6185	$117.62	.	$23.53																																																																																																																																																																																					
0367	Level I Pulmonary Test	X	0.7895	$57.37	$11.97	$11.48																																																																																																																																																																																					
0368	Level II Pulmonary Tests	X	1.2211	$88.74	$20.93	$17.75																																																																																																																																																																																					
0369	Level III Pulmonary Tests	X	3.3536	$243.71	.	$48.75																																																																																																																																																																																					
0370	Multiple Allergy Tests	X	0.5687	$41.33	.	$8.27																																																																																																																																																																																					
0373	Level I Neuropsychological Testing	X	1.5077	$109.57	.	$21.92																																																																																																																																																																																					
0375	Ancillary Outpatient Services When Patient Expires	S	95.1306	"$6,913.33"	.	"$1,382.67"																																																																																																																																																																																					
0377	Level II Cardiac Imaging	S	15.8743	"$1,153.62"	.	$230.73																																																																																																																																																																																					
0378	Level II Pulmonary Imaging	S	5.9289	$430.87	$126.64	$86.18																																																																																																																																																																																					
0381	Single Allergy Tests	X	0.4810	$34.96	.	$7.00																																																																																																																																																																																					
0382	Level II Neuropsychological Testing	X	2.8102	$204.22	.	$40.85																																																																																																																																																																																					
0383	Cardiac Computed Tomographic Imaging	S	3.0549	$222.01	.	$44.41																																																																																																																																																																																					
0384	GI Procedures with Stents	T	32.6316	"$2,371.40"	.	$474.28																																																																																																																																																																																					
0385	Level I Prosthetic Urological Procedures	S	114.1752	"$8,297.34"	.	"$1,659.47"																																																																																																																																																																																					
0386	Level II Prosthetic Urological Procedures	S	186.0767	"$13,522.57"	.	"$2,704.52"																																																																																																																																																																																					
0387	Level II Hysteroscopy	T	38.7710	"$2,817.57"	$654.35	$563.52																																																																																																																																																																																					
0388	Discography	S	37.9928	"$2,761.01"	.	$552.21																																																																																																																																																																																					
0389	Level I Non-imaging Nuclear Medicine	S	1.9318	$140.39	.	$28.08																																																																																																																																																																																					
0390	Level I Endocrine Imaging	S	2.5236	$183.40	$47.69	$36.68																																																																																																																																																																																					
0391	Level II Endocrine Imaging	S	3.9484	$286.94	$65.46	$57.39																																																																																																																																																																																					
0392	Level II Non-imaging Nuclear Medicine	S	3.5423	$257.43	.	$51.49																																																																																																																																																																																					
0393	Hematologic Processing & Studies	S	7.7877	$565.95	.	$113.19																																																																																																																																																																																					
0394	Hepatobiliary Imaging	S	5.1267	$372.57	$90.78	$74.52																																																																																																																																																																																					
0395	GI Tract Imaging	S	4.4553	$323.78	$87.01	$64.76																																																																																																																																																																																					
0396	Bone Imaging	S	4.4576	$323.94	$94.20	$64.79																																																																																																																																																																																					
0398	Level I Cardiac Imaging	S	5.2717	$383.10	$93.33	$76.62																																																																																																																																																																																					
0400	Hematopoietic Imaging	S	4.7658	$346.34	$90.90	$69.27																																																																																																																																																																																					
0401	Level I Pulmonary Imaging	S	4.2109	$306.01	$71.16	$61.21																																																																																																																																																																																					
0402	Level II Nervous System Imaging	S	7.3368	$533.18	.	$106.64																																																																																																																																																																																					
0403	Level I Nervous System Imaging	S	2.2385	$162.68	$44.61	$32.54																																																																																																																																																																																					
0404	Renal and Genitourinary Studies	S	5.7384	$417.02	.	$83.41																																																																																																																																																																																					
0406	Level I Tumor/Infection Imaging	S	5.2671	$382.77	$85.06	$76.56																																																																																																																																																																																					
0407	Level I Radionuclide Therapy	S	3.5200	$255.81	$78.13	$51.17																																																																																																																																																																																					
0408	Level III Tumor/Infection Imaging	S	15.9266	"$1,157.42"	.	$231.49																																																																																																																																																																																					
0412	Level III Radiation Therapy	S	7.0241	$510.46	.	$102.10																																																																																																																																																																																					
0413	Level II Radionuclide Therapy	S	4.9081	$356.68	.	$71.34																																																																																																																																																																																					
0414	Level II Tumor/Infection Imaging	S	9.0402	$656.97	.	$131.40																																																																																																																																																																																					
0415	Level II Endoscopy Lower Airway	T	27.5263	"$2,000.39"	.	$400.08																																																																																																																																																																																					
0419	Level II Upper GI Procedures 	T	13.9400	"$1,013.05"	$207.70	$202.61																																																																																																																																																																																					
0420	Level II Minor Procedures	X	1.3520	$98.25	.	$19.65																																																																																																																																																																																					
0422	Level III Upper GI Procedures	T	27.0909	"$1,968.75"	.	$393.75																																																																																																																																																																																					
0423	Level II Percutaneous Abdominal and Biliary Procedures	T	56.5030	"$4,106.19"	.	$821.24																																																																																																																																																																																					
0424	Level II Small Intestine Endoscopy 	T	16.9672	"$1,233.04"	.	$246.61																																																																																																																																																																																					
0425	Level II Arthroplasty or Implantation with Prosthesis	T	133.9177	"$9,732.07"	.	"$1,946.42"																																																																																																																																																																																					
0426	Level II Strapping and Cast Application	S	1.9032	$138.31	.	$27.67																																																																																																																																																																																					
0427	Level II Tube or Catheter Changes or Repositioning	T	17.9738	"$1,306.19"	.	$261.24																																																																																																																																																																																					
0428	Level III Sigmoidoscopy and Anoscopy	T	22.8029	"$1,657.13"	.	$331.43																																																																																																																																																																																					
0429	Level V Cystourethroscopy and other Genitourinary Procedures	T	45.4686	"$3,304.29"	.	$660.86																																																																																																																																																																																					
0431	Level IV Closed Treatment Fracture	T	17.2302	"$1,252.15"	.	$250.43																																																																																																																																																																																					
0432	Level II Health and Behavior Services	S	0.6759	$49.12	.	$9.83																																																																																																																																																																																					
0433	Level II Pathology	X	0.5027	$36.53	.	$7.31																																																																																																																																																																																					
0434	Cardiac Defect Repair	T	175.9639	"$12,787.65"	.	"$2,557.53"																																																																																																																																																																																					
0435	"Level III Extended EEG, Sleep, and Cardiovascular Studies"	S	11.8685	$862.51	$267.73	$172.51																																																																																																																																																																																					
0436	Level I Drug Administration	S	0.4059	$29.50	.	$5.90																																																																																																																																																																																					
0437	Level II Drug Administration	S	0.6024	$43.78	.	$8.76																																																																																																																																																																																					
0438	Level III Drug Administration	S	1.4572	$105.90	.	$21.18																																																																																																																																																																																					
0439	Level IV Drug Administration	S	2.3693	$172.18	.	$34.44																																																																																																																																																																																					
0440	Level V Drug Administration	S	4.1217	$299.53	.	$59.91																																																																																																																																																																																					
0442	Dosimetric Drug Administration	S	25.0763	"$1,822.34"	.	$364.47																																																																																																																																																																																					
0609	Level 1 Type A Emergency Visits	V	0.7658	$55.65	$12.04	$11.13																																																																																																																																																																																					
0613	Level 2 Type A Emergency Visits	V	1.3886	$100.91	$20.80	$20.19																																																																																																																																																																																					
0614	Level 3 Type A Emergency Visits	V	2.2904	$166.45	$33.60	$33.29																																																																																																																																																																																					
0615	Level 4 Type A Emergency Visits	V	4.0416	$293.71	.	$58.75																																																																																																																																																																																					
0616	Level 5 Type A Emergency Visits	V	6.2738	$455.93	.	$91.19																																																																																																																																																																																					
0617	Critical Care	S	8.7371	$634.94	.	$126.99																																																																																																																																																																																					
0618	Trauma Response with Critical Care	S	13.2308	$961.51	.	$192.31																																																																																																																																																																																					
0621	Level I Vascular Access Procedures	T	11.6924	$849.71	.	$169.95																																																																																																																																																																																					
0622	Level II Vascular Access Procedures	T	26.4748	"$1,923.98"	.	$384.80																																																																																																																																																																																					
0623	Level III Vascular Access Procedures	T	32.2881	"$2,346.44"	.	$469.29																																																																																																																																																																																					
0624	Phlebotomy and Minor Vascular Access Device Procedures	X	1.1143	$80.98	.	$16.20																																																																																																																																																																																					
0626	Level 1 Type B Emergency Visits	V	0.7145	$51.92	.	$10.39																																																																																																																																																																																					
0627	Level 2 Type B Emergency Visits	V	0.8486	$61.67	.	$12.34																																																																																																																																																																																					
0628	Level 3 Type B Emergency Visits	V	1.2620	$91.71	.	$18.35																																																																																																																																																																																					
0629	Level 4 Type B Emergency Visits	V	2.2467	$163.27	.	$32.66																																																																																																																																																																																					
0630	Level 5 Type B Emergency Visits	V	4.2992	$312.43	.	$62.49																																																																																																																																																																																					
0631	Level 1 Examinations & Related Services 	V	1.0401	$75.59	.	$15.12																																																																																																																																																																																					
0632	Level 2 Examinations & Related Services 	V	1.3283	$96.53	.	$19.31																																																																																																																																																																																					
0633	Level 3 Examinations & Related Services 	V	4.5113	$327.85	.	$65.57																																																																																																																																																																																					
0634	Hospital Clinic Visits	V	1.2732	$92.53	.	$18.51																																																																																																																																																																																					
0648	Level IV Breast and Skin Surgery	T	66.6929	"$4,846.71"	.	$969.35																																																																																																																																																																																					
0651	Complex Interstitial Radiation Source Application	S	13.7315	$997.90	.	$199.58																																																																																																																																																																																					
0652	Insertion of Intraperitoneal and Pleural Catheters	T	33.2571	"$2,416.86"	.	$483.38																																																																																																																																																																																					
0653	Vascular Reconstruction/Fistula Repair with Device	T	42.4215	"$3,082.86"	.	$616.58																																																																																																																																																																																					
0654	Level II Insertion/Replacement of Permanent Pacemaker 	T	115.4162	"$8,387.53"	.	"$1,677.51"																																																																																																																																																																																					
0655	Insertion/Replacement/Conversion of a Permanent Dual Chamber Pacemaker or Pacing Electrode	T	145.7012	"$10,588.40"	.	"$2,117.68"																																																																																																																																																																																					
0656	Transcatheter Placement of Intracoronary Drug-Eluting Stents	T	106.1485	"$7,714.02"	.	"$1,542.81"																																																																																																																																																																																					
0659	Hyperbaric Oxygen	S	1.5264	$110.93	.	$22.19																																																																																																																																																																																					
0660	Level II Otorhinolaryngologic Function Tests	X	1.9041	$138.37	.	$27.68																																																																																																																																																																																					
0661	Level V Pathology	X	3.8286	$278.23	.	$55.65																																																																																																																																																																																					
0662	CT Angiography	S	4.0175	$291.96	$98.43	$58.40																																																																																																																																																																																					
0664	Level I Proton Beam Radiation Therapy	S	12.0042	$872.37	.	$174.48																																																																																																																																																																																					
0665	Bone Density:AppendicularSkeleton	S	0.7047	$51.21	$0.00	$0.00																																																																																																																																																																																					
0667	Level II Proton Beam Radiation Therapy	S	16.5851	"$1,205.27"	.	$241.06																																																																																																																																																																																					
0668	Level I Angiography and Venography	T	11.3792	$826.95	.	$165.39																																																																																																																																																																																					
0672	Level III Posterior Segment Eye Procedures	T	42.1116	"$3,060.33"	.	$612.07																																																																																																																																																																																					
0673	Level V Anterior Segment Eye Procedures	T	41.7956	"$3,037.37"	$635.64	$607.48																																																																																																																																																																																					
0674	Prostate Cryoablation	T	112.8868	"$8,203.71"	.	"$1,640.75"																																																																																																																																																																																					
0676	Thrombolysis and Other Device Revisions 	T	2.5286	$183.76	.	$36.76																																																																																																																																																																																					
0678	External Counterpulsation	T	1.4936	$108.54	.	$21.71																																																																																																																																																																																					
0679	Level II Resuscitation and Cardioversion	S	6.0743	$441.43	$95.30	$88.29																																																																																																																																																																																					
0680	Insertion of Patient Activated Event Recorders	S	85.6249	"$6,222.53"	.	"$1,244.51"																																																																																																																																																																																					
0683	Level II Photochemotherapy	S	2.9575	$214.93	.	$42.99																																																																																																																																																																																					
0685	Level III Needle Biopsy/Aspiration Except Bone Marrow	T	10.4271	$757.76	.	$151.56																																																																																																																																																																																					
0687	Revision/Removal of Neurostimulator Electrodes	T	23.5410	"$1,710.77"	$389.48	$342.16																																																																																																																																																																																					
0688	Revision/Removal of Neurostimulator Pulse Generator Receiver	T	30.5781	"$2,222.17"	$657.64	$444.44																																																																																																																																																																																					
0690	Level I Electronic Analysis of Devices	S	0.4974	$36.15	.	$7.23																																																																																																																																																																																					
0691	Level III Electronic Analysis of Devices	S	3.7962	$275.88	.	$55.18																																																																																																																																																																																					
0692	Level II Electronic Analysis of Devices	S	1.5938	$115.82	.	$23.17																																																																																																																																																																																					
0694	Mohs Surgery	T	6.0024	$436.21	$88.07	$87.25																																																																																																																																																																																					
0697	Level I Echocardiogram Without Contrast 	S	3.4494	$250.67	.	$50.14																																																																																																																																																																																					
0698	Level II Eye Tests & Treatments	S	1.0663	$77.49	.	$15.50																																																																																																																																																																																					
0699	Level IV Eye Tests & Treatments	T	16.4654	"$1,196.57"	.	$239.32																																																																																																																																																																																					
0701	Sr89 strontium	K		"$1,130.06"	.	$226.02	*																																																																																																																																																																																				
0726	Dexrazoxane HCl injection	K		$144.86	.	$28.98	*																																																																																																																																																																																				
0731	Sargramostim injection	K		$30.13	.	$6.03	*																																																																																																																																																																																				
0736	Amphotericin b liposome inj	K		$16.83	.	$3.37	*																																																																																																																																																																																				
0738	Rasburicase	K		$218.75	.	$43.75	*																																																																																																																																																																																				
0747	Chlorothiazide sodium inj	K		$122.65	.	$24.53	*																																																																																																																																																																																				
0751	Mechlorethamine hcl inj	K		$189.63	.	$37.93	*																																																																																																																																																																																				
0752	Dactinomycin injection	K		$807.19	.	$161.44	*																																																																																																																																																																																				
0759	"Naltrexone, depot form"	K		$2.88	.	$0.58	*																																																																																																																																																																																				
0800	Leuprolide acetate	K		$829.72	.	$165.95	*																																																																																																																																																																																				
0802	Etoposide oral	K		$57.09	.	$11.42	*																																																																																																																																																																																				
0807	Aldesleukin injection	K		"$2,110.63"	.	$422.13	*																																																																																																																																																																																				
0809	Bcg live intravesical vac	K		$121.96	.	$24.40	*																																																																																																																																																																																				
0810	Goserelin acetate implant	K		$225.02	.	$45.01	*																																																																																																																																																																																				
0812	Carmustine injection	K		"$1,861.12"	.	$372.23	*																																																																																																																																																																																				
0814	"Asparaginase, NOS"	K		$64.56	.	$12.91																																																																																																																																																																																					
0820	Daunorubicin injection	K		$22.56	.	$4.52	*																																																																																																																																																																																				
0821	Daunorubicin citrate inj	K		$239.10	.	$47.82	*																																																																																																																																																																																				
0823	Docetaxel injection	K		$4.66	.	$0.94	*																																																																																																																																																																																				
0825	Nelarabine injection	K		$138.87	.	$27.78	*																																																																																																																																																																																				
0827	Floxuridine injection	K		$55.65	.	$11.13	*																																																																																																																																																																																				
0831	Ifosfamide injection	K		$33.41	.	$6.69	*																																																																																																																																																																																				
0832	Idarubicin hcl injection	K		$49.11	.	$9.83	*																																																																																																																																																																																				
0835	Cosyntropin injection NOS	K		$101.68	.	$20.34																																																																																																																																																																																					
0836	Interferon alfa-2b inj	K		$21.17	.	$4.24	*																																																																																																																																																																																				
0838	Interferon gamma 1-b inj	K		"$3,168.87"	.	$633.78	*																																																																																																																																																																																				
0840	Inj melphalan hydrochl	K		"$1,226.63"	.	$245.33	*																																																																																																																																																																																				
0842	Fludarabine phosphate inj	K		$70.98	.	$14.20	*																																																																																																																																																																																				
0843	Pegaspargase injection	K		"$6,220.80"	.	"$1,244.16"	*																																																																																																																																																																																				
0844	Pentostatin injection	K		"$1,483.27"	.	$296.66	*																																																																																																																																																																																				
0849	Rituximab injection	K		$708.68	.	$141.74	*																																																																																																																																																																																				
0850	Streptozocin injection	K		$335.28	.	$67.06	*																																																																																																																																																																																				
0851	Thiotepa injection	K		$630.70	.	$126.14																																																																																																																																																																																					
0856	Porfimer sodium injection	K		"$20,002.20"	.	"$4,000.44"	*																																																																																																																																																																																				
0858	Inj cladribine	K		$21.21	.	$4.25	*																																																																																																																																																																																				
0861	Leuprolide acetate injeciton	K		$7.18	.	$1.44	*																																																																																																																																																																																				
0864	Mitoxantrone hydrochl	K		$32.34	.	$6.47	*																																																																																																																																																																																				
0868	Oral aprepitant	K		$7.68	.	$1.54	*																																																																																																																																																																																				
0873	Hyalgan/supartz inj per dose	K		$90.81	.	$18.17	*																																																																																																																																																																																				
0874	Synvisc or synvisc-one	K		$12.50	.	$2.50	*																																																																																																																																																																																				
0875	Euflexxa inj per dose	K		$160.42	.	$32.09	*																																																																																																																																																																																				
0877	Orthovisc inj per dose	K		$186.89	.	$37.38	*																																																																																																																																																																																				
0887	Azathioprine parenteral	K		$217.30	.	$43.46																																																																																																																																																																																					
0890	Lymphocyte immune globulin	K		$852.69	.	$170.54	*																																																																																																																																																																																				
0901	Alpha 1 proteinase inhibitor	K		$4.11	.	$0.83	*																																																																																																																																																																																				
0902	"Injection,onabotulinumtoxinA"	K		$5.56	.	$1.12	*																																																																																																																																																																																				
0903	Cytomegalovirus imm IV /vial	K		"$1,013.87"	.	$202.78																																																																																																																																																																																					
0910	Interferon beta-1b / .25 MG	K		$353.28	.	$70.66	*																																																																																																																																																																																				
0913	Ganciclovir long act implant	K		"$16,960.00"	.	"$3,392.00"																																																																																																																																																																																					
0925	Factor viii	K		$0.93	.	$0.19																																																																																																																																																																																					
0927	Factor viii recombinant	K		$1.14	.	$0.23																																																																																																																																																																																					
0928	Factor ix complex	K		$1.12	.	$0.22																																																																																																																																																																																					
0929	Anti-inhibitor	K		$1.70	.	$0.34																																																																																																																																																																																					
0931	Factor IX non-recombinant	K		$1.01	.	$0.20																																																																																																																																																																																					
0932	Factor IX recombinant	K		$1.35	.	$0.27	*																																																																																																																																																																																				
0933	Gamma globulin > 10 CC inj	K		$287.67	.	$57.54	*																																																																																																																																																																																				
0934	"Capecitabine, oral"	K		$28.63	.	$5.73	*																																																																																																																																																																																				
0943	Octagam injection	K		$36.92	.	$7.39	*																																																																																																																																																																																				
0944	Gammagard liquid injection	K		$39.36	.	$7.88	*																																																																																																																																																																																				
0945	Rhophylac injection	K		$4.80	.	$0.96	*																																																																																																																																																																																				
0946	Hepagam b im injection	K		$53.70	.	$10.74	*																																																																																																																																																																																				
0947	Flebogamma injection	K		$37.76	.	$7.56	*																																																																																																																																																																																				
0948	Gamunex-C/Gammaked	K		$40.02	.	$8.01	*																																																																																																																																																																																				
0949	"Frozen plasma, pooled, sd"	R	0.9852	$71.60	.	$14.32																																																																																																																																																																																					
0950	Whole blood for transfusion	R	2.6922	$195.65	.	$39.13																																																																																																																																																																																					
0952	Cryoprecipitate each unit	R	0.9017	$65.53	.	$13.11																																																																																																																																																																																					
0954	RBC leukocytes reduced	R	2.6243	$190.71	.	$38.15																																																																																																																																																																																					
0955	"Plasma, frz between 8-24hour"	R	0.9578	$69.61	.	$13.93																																																																																																																																																																																					
0956	"Plasma protein fract,5%,50ml"	R	0.2308	$16.77	.	$3.36																																																																																																																																																																																					
0957	"Platelets, each unit"	R	1.6189	$117.65	.	$23.53																																																																																																																																																																																					
0958	Plaelet rich plasma unit	R	2.2834	$165.94	.	$33.19																																																																																																																																																																																					
0959	Red blood cells unit	R	2.0846	$151.49	.	$30.30																																																																																																																																																																																					
0960	Washed red blood cells unit	R	3.9824	$289.41	.	$57.89																																																																																																																																																																																					
0961	"Albumin (human),5%, 50ml"	K		$20.94	.	$4.19																																																																																																																																																																																					
0963	"Albumin (human), 5%, 250 ml"	K		$68.22	.	$13.64																																																																																																																																																																																					
0964	"Albumin (human), 25%, 20 ml"	K		$34.13	.	$6.83																																																																																																																																																																																					
0965	"Albumin (human), 25%, 50ml"	K		$69.57	.	$13.91																																																																																																																																																																																					
0966	"Plasmaprotein fract,5%,250ml"	R	0.5095	$37.03	.	$7.41																																																																																																																																																																																					
0967	Blood split unit	R	1.3989	$101.66	.	$20.34																																																																																																																																																																																					
0968	Platelets leukoreduced irrad	R	2.2131	$160.83	.	$32.17																																																																																																																																																																																					
0969	RBC leukoreduced irradiated	R	3.8311	$278.41	.	$55.69																																																																																																																																																																																					
1009	Cryoprecipitatereducedplasma	R	1.1834	$86.00	.	$17.20																																																																																																																																																																																					
1010	"Blood, l/r, cmv-neg"	R	2.3364	$169.79	.	$33.96																																																																																																																																																																																					
1011	"Platelets, hla-m, l/r, unit"	R	10.7576	$781.78	.	$156.36																																																																																																																																																																																					
1013	Platelets leukocytes reduced	R	1.6274	$118.27	.	$23.66																																																																																																																																																																																					
1015	Injection glatiramer acetate	K		$176.31	.	$35.27	*																																																																																																																																																																																				
1016	"Blood, l/r, froz/degly/wash"	R	3.1210	$226.81	.	$45.37																																																																																																																																																																																					
1017	"Plt, aph/pher, l/r, cmv-neg"	R	5.9522	$432.56	.	$86.52																																																																																																																																																																																					
1018	"Blood, l/r, irradiated"	R	2.2752	$165.34	.	$33.07																																																																																																																																																																																					
1019	Plate pheres leukoredu irrad	R	9.2150	$669.67	.	$133.94																																																																																																																																																																																					
1020	"Plt, pher, l/r cmv-neg, irr"	R	9.6381	$700.42	.	$140.09																																																																																																																																																																																					
1021	"RBC, frz/deg/wsh, l/r, irrad"	R	5.9800	$434.58	.	$86.92																																																																																																																																																																																					
1022	"RBC, l/r, cmv-neg, irrad"	R	3.9952	$290.34	.	$58.07																																																																																																																																																																																					
1023	Pralidoxime chloride inj	K		$89.16	.	$17.84	*																																																																																																																																																																																				
1052	"Injection, voriconazole"	K		$3.97	.	$0.80	*																																																																																																																																																																																				
1064	"I131 iodide cap, rx"	K		$18.52	.	$3.71																																																																																																																																																																																					
1083	Adalimumab injection	K		$570.94	.	$114.19	*																																																																																																																																																																																				
1086	Temozolomide	K		$5.39	.	$1.08	*																																																																																																																																																																																				
1138	"Hepagam b intravenous, inj"	K		$53.70	.	$10.74	*																																																																																																																																																																																				
1139	Protein c concentrate	K		$14.52	.	$2.91	*																																																																																																																																																																																				
1142	Supprelin LA implant	K		"$18,317.24"	.	"$3,663.45"	*																																																																																																																																																																																				
1150	"I131 iodide sol, rx"	K		$10.80	.	$2.16																																																																																																																																																																																					
1166	Cytarabine liposome inj	K		$561.39	.	$112.28	*																																																																																																																																																																																				
1168	"Inj, temsirolimus"	K		$58.83	.	$11.77	*																																																																																																																																																																																				
1178	Busulfan injection	K		$28.94	.	$5.79																																																																																																																																																																																					
1203	Verteporfin injection	K		$10.79	.	$2.16	*																																																																																																																																																																																				
1207	"Octreotide injection, depot"	K		$141.87	.	$28.38	*																																																																																																																																																																																				
1213	Antihemophilic viii/vwf comp	K		$0.94	.	$0.19	*																																																																																																																																																																																				
1214	Inj IVIG privigen 500 mg	K		$37.03	.	$7.41	*																																																																																																																																																																																				
1232	Mitomycin injection	K		$20.88	.	$4.18	*																																																																																																																																																																																				
1235	Valrubicin injection	K		"$1,085.29"	.	$217.06	*																																																																																																																																																																																				
1236	Levoleucovorin injection	K		$1.77	.	$0.36	*																																																																																																																																																																																				
1237	Inj iron dextran	K		$12.16	.	$2.44	*																																																																																																																																																																																				
1238	Topotecan oral	K		$94.74	.	$18.95	*																																																																																																																																																																																				
1253	Triamcinolone A inj PRS-free	K		$3.73	.	$0.75	*																																																																																																																																																																																				
1263	Antithrombin iii injection	K		$3.27	.	$0.66	*																																																																																																																																																																																				
1268	Xyntha inj	K		$1.17	.	$0.24	*																																																																																																																																																																																				
1272	Acetylcysteine injection	K 		$2.19	.	$0.44	*																																																																																																																																																																																				
1274	Edetate calcium disodium inj	K 		"$3,477.51"	.	$695.51	*																																																																																																																																																																																				
1280	Corticotropin injection	K		"$3,324.92"	.	$664.99	*																																																																																																																																																																																				
1281	Bevacizumab injection	K		$1.67	.	$0.34	*																																																																																																																																																																																				
1289	AbobotulinumtoxinA	K		$7.43	.	$1.49	*																																																																																																																																																																																				
1291	Rilonacept injection	K		$24.09	.	$4.82																																																																																																																																																																																					
1295	Sm 153 lexidronam	K		"$8,442.67"	.	"$1,688.54"	*																																																																																																																																																																																				
1296	Degarelix injection	K		$3.55	.	$0.71	*																																																																																																																																																																																				
1297	"Ferumoxytol, non-esrd"	K		$0.74	.	$0.15	*																																																																																																																																																																																				
1311	Canakinumab injection	K		$90.96	.	$18.20	*																																																																																																																																																																																				
1312	Hizentra injection	K		$7.94	.	$1.59	*																																																																																																																																																																																				
1327	Imiglucerase injection	K		$42.01	.	$8.40																																																																																																																																																																																					
1331	Olanzapine long-acting inj	K		$2.75	.	$0.55																																																																																																																																																																																					
1332	Antithrombin recombinant	K		$103.35	.	$20.67																																																																																																																																																																																					
1338	"Methyl aminolevulinate, top"	K		$83.69	.	$16.74																																																																																																																																																																																					
1340	"Collagenase, clost hist inj"	K		$38.26	.	$7.66	*																																																																																																																																																																																				
1341	Amobarbital 125 MG inj	K		$194.26	.	$38.85																																																																																																																																																																																					
1343	Ganciclovir sodium injection	K		$72.11	.	$14.43	*																																																																																																																																																																																				
1350	Topotecan injection	K		$1.83	.	$0.37	*																																																																																																																																																																																				
1352	Wilate injection	K		$0.95	.	$0.19	*																																																																																																																																																																																				
1353	Belimumab injection	K		$39.48	.	$7.90	*																																																																																																																																																																																				
1354	Hydroxyprogesterone caproate	K		$2.66	.	$0.54	*																																																																																																																																																																																				
1356	Zoledronic Acid 1mg	K		$47.48	.	$9.50	*																																																																																																																																																																																				
1361	Enfuvirtide injection	K		$0.55	.	$0.11																																																																																																																																																																																					
1408	Cyclophosphamide 100 MG inj	K		$63.16	.	$12.64	*																																																																																																																																																																																				
1413	Lumizyme injection	K		$153.64	.	$30.73																																																																																																																																																																																					
1415	Glassia injection	K		$3.98	.	$0.80	*																																																																																																																																																																																				
1416	Factor XIII anti-hem factor	K		$6.74	.	$1.35																																																																																																																																																																																					
1417	Gel-one	K		$562.08	.	$112.42	*																																																																																																																																																																																				
1419	Dermacell	G		$80.58		$0.00	*																																																																																																																																																																																				
1420	Aflibercept injection	G		$980.50	.	$196.10																																																																																																																																																																																					
1421	Imported lipodox inj	K		$508.43	.	$101.69	*																																																																																																																																																																																				
1422	Anthrax vaccine sc or im	K		$94.05	.	$18.81																																																																																																																																																																																					
1424	Nabilone oral	K		$28.42	.	$5.68																																																																																																																																																																																					
1426	Eribulin mesylate injection	K		$99.01	.	$19.81	*																																																																																																																																																																																				
1431	Centruroides immune f(ab)	G		"$3,635.80"	.	$727.16																																																																																																																																																																																					
1433	Calcitonin salmon injection	K		$69.29	.	$13.86	*																																																																																																																																																																																				
1439	"Aprotonin, 10,000 kiu"	K		$3.42	.	$0.68																																																																																																																																																																																					
1440	Inj desmopressin acetate	K		$5.08	.	$1.02	*																																																																																																																																																																																				
1442	Non-HEU TC-99M add-on/dose	K		$10.00	.	$2.00																																																																																																																																																																																					
1443	Icatibant injection	K		$276.90	.	$55.38	*																																																																																																																																																																																				
1445	Methylnaltrexone injection	K		$0.48	.	$0.10	*																																																																																																																																																																																				
1448	Opthalmic mitomycin	G		$368.88	.	$73.78	*																																																																																																																																																																																				
1449	Talymed	G		$13.78		$0.00																																																																																																																																																																																					
1454	Mumps vaccine sc	K		$162.34	.	$32.47																																																																																																																																																																																					
1455	Foscarnet sodium injection	K		$13.32	.	$2.66																																																																																																																																																																																					
1456	Pentobarbital sodium inj	K		$35.82	.	$7.17	*																																																																																																																																																																																				
1457	Totazoline hcl injection	K		$40.01	.	$8.01																																																																																																																																																																																					
1458	Phentolaine mesylate inj	K		$113.40	.	$22.68	*																																																																																																																																																																																				
1459	Urea injection	K		$122.40	.	$24.48																																																																																																																																																																																					
1460	Interferon alfa-2a inj	K		$53.66	.	$10.74																																																																																																																																																																																					
1463	Tc99 Tilmanocept diag 0.5mci	G		$240.00		$0.00																																																																																																																																																																																					
1464	Factor VIII (porcine)	K		$0.20	.	$0.04																																																																																																																																																																																					
1465	Tacrolimus ex rel oral 0.1mg	G		$0.40		$0.08																																																																																																																																																																																					
1466	"Inj, vincristine sul lip 1mg"	G		"$2,148.20"		$429.64	*																																																																																																																																																																																				
1467	Factor IX recombinant	G		$1.22		$0.24																																																																																																																																																																																					
1468	Inj Aripiprazole Ext Rel 1mg	K		$3.87	.	$0.77																																																																																																																																																																																					
1469	"Inj, Filgrastim G-CSF 1mcg"	K		$0.99	.	$0.20	*																																																																																																																																																																																				
1471	"Injection, Pertuzumab, 1 mg"	G		$10.22	.	$2.04																																																																																																																																																																																					
1472	Inj beta interferon im 1 mcg	K		$36.37	.	$7.28	*																																																																																																																																																																																				
1473	Interferon alfa-n3 inj	K		$31.80	.	$6.36																																																																																																																																																																																					
1474	Certolizumab pegol inj 1mg	K		$6.56	.	$1.32	*																																																																																																																																																																																				
1475	Golimumab for iv use 1mg	K		$24.16	.	$4.84	*																																																																																																																																																																																				
1476	"Injection, obinutuzumab"	G		$54.27		$10.86	*																																																																																																																																																																																				
1477	"	Inj, tbo-filgrastim, 5 mcg"	G		$3.99		$0.80	*																																																																																																																																																																																				
1478	"	Human fibrinogen conc inj"	K		$0.97		$0.20	*																																																																																																																																																																																				
1479	"	Theraskin"	G		$32.42		$0.00	*																																																																																																																																																																																				
1480	"Injection, elosulfase alfa"	G		$222.13		$44.43	*																																																																																																																																																																																				
1481	Factor XIII A-subunit recomb	G		$134.95		$26.99	*																																																																																																																																																																																				
1486	Factor ix (Alprolix)	G		$3.02		$0.61	*																																																																																																																																																																																				
1487	Inj testosterone undecanoate	G		$1.15		$0.23	*																																																																																																																																																																																				
1488	"Injection, ramucirumab"	G		$54.06		$10.82	*																																																																																																																																																																																				
1489	"Injection, vedolizumab"	G		$17.03		$3.41	*																																																																																																																																																																																				
1491	New Technology  - Level IA ($0-$10)	S		$5.00	.	$1.00																																																																																																																																																																																					
1492	New Technology  - Level IB ($10-$20)	S		$15.00	.	$3.00																																																																																																																																																																																					
1493	New Technology  - Level IC ($20-$30)	S		$25.00	.	$5.00																																																																																																																																																																																					
1494	New Technology  - Level ID ($30-$40)	S		$35.00	.	$7.00																																																																																																																																																																																					
1495	New Technology  - Level IE ($40-$50)	S		$45.00	.	$9.00																																																																																																																																																																																					
1496	New Technology  - Level IA ($0-$10)	T		$5.00	.	$1.00																																																																																																																																																																																					
1497	New Technology  - Level IB($10-$20)	T		$15.00	.	$3.00																																																																																																																																																																																					
1498	New Technology  - Level IC ($20-$30)	T		$25.00	.	$5.00																																																																																																																																																																																					
1499	New Technology  - Level ID($30-$40)	T		$35.00	.	$7.00																																																																																																																																																																																					
1500	New Technology  - Level IE ($40-$50)	T		$45.00	.	$9.00																																																																																																																																																																																					
1502	New Technology - Level II   ($50 - $100)	S		$75.00	.	$15.00																																																																																																																																																																																					
1503	New Technology - Level III   ($100 - $200)	S		$150.00	.	$30.00																																																																																																																																																																																					
1504	New Technology - Level IV  ($200 - $300)	S		$250.00	.	$50.00																																																																																																																																																																																					
1505	New Technology - Level V   ($300 - $400)	S		$350.00	.	$70.00																																																																																																																																																																																					
1506	New Technology - Level VI  ($400 - $500)	S		$450.00	.	$90.00																																																																																																																																																																																					
1507	New Technology - Level VII  ($500 - $600)	S		$550.00	.	$110.00																																																																																																																																																																																					
1508	New Technology - Level VIII ($600 - $700)	S		$650.00	.	$130.00																																																																																																																																																																																					
1509	New Technology - Level IX   ($700 - $800)	S		$750.00	.	$150.00																																																																																																																																																																																					
1510	New Technology - Level X    ($800 - $900)	S		$850.00	.	$170.00																																																																																																																																																																																					
1511	New Technology - Level XI   ($900 - $1000)	S		$950.00	.	$190.00																																																																																																																																																																																					
1512	New Technology - Level XII  ($1000 - $1100)	S		"$1,050.00"	.	$210.00																																																																																																																																																																																					
1513	New Technology - Level XIII  ($1100 - $1200)	S		"$1,150.00"	.	$230.00																																																																																																																																																																																					
1514	New Technology - Level XIV ($1200- $1300)	S		"$1,250.00"	.	$250.00																																																																																																																																																																																					
1515	New Technology - Level XV ($1300 - $1400)	S		"$1,350.00"	.	$270.00																																																																																																																																																																																					
1516	New Technology - Level XVI  ($1400 - $1500)	S		"$1,450.00"	.	$290.00																																																																																																																																																																																					
1517	New Technology - Level XVII ($1500-$1600)	S		"$1,550.00"	.	$310.00																																																																																																																																																																																					
1518	New Technology - Level XVIII ($1600-$1700)	S		"$1,650.00"	.	$330.00																																																																																																																																																																																					
1519	New Technology - Level IXX ($1700-$1800)	S		"$1,750.00"	.	$350.00																																																																																																																																																																																					
1520	New Technology - Level XX ($1800-$1900)	S		"$1,850.00"	.	$370.00																																																																																																																																																																																					
1521	New Technology - Level XXI ($1900-$2000)	S		"$1,950.00"	.	$390.00																																																																																																																																																																																					
1522	New Technology - Level XXII ($2000-$2500)	S		"$2,250.00"	.	$450.00																																																																																																																																																																																					
1523	New Technology - Level XXIII ($2500-$3000)	S		"$2,750.00"	.	$550.00																																																																																																																																																																																					
1524	New Technology - Level XXIV ($3000-$3500)	S		"$3,250.00"	.	$650.00																																																																																																																																																																																					
1525	New Technology - Level XXV ($3500-$4000)	S		"$3,750.00"	.	$750.00																																																																																																																																																																																					
1526	New Technology - Level XXVI ($4000-$4500)	S		"$4,250.00"	.	$850.00																																																																																																																																																																																					
1527	New Technology - Level XXVII ($4500-$5000)	S		"$4,750.00"	.	$950.00																																																																																																																																																																																					
1528	New Technology - Level XXVIII ($5000-$5500)	S		"$5,250.00"	.	"$1,050.00"																																																																																																																																																																																					
1529	New Technology - Level XXIX ($5500-$6000)	S		"$5,750.00"	.	"$1,150.00"																																																																																																																																																																																					
1530	New Technology - Level XXX ($6000-$6500)	S		"$6,250.00"	.	"$1,250.00"																																																																																																																																																																																					
1531	New Technology - Level XXXI ($6500-$7000)	S		"$6,750.00"	.	"$1,350.00"																																																																																																																																																																																					
1532	New Technology - Level XXXII ($7000-$7500)	S		"$7,250.00"	.	"$1,450.00"																																																																																																																																																																																					
1533	New Technology - Level XXXIII ($7500-$8000)	S		"$7,750.00"	.	"$1,550.00"																																																																																																																																																																																					
1534	New Technology - Level XXXIV ($8000-$8500)	S		"$8,250.00"	.	"$1,650.00"																																																																																																																																																																																					
1535	New Technology - Level XXXV ($8500-$9000)	S		"$8,750.00"	.	"$1,750.00"																																																																																																																																																																																					
1536	New Technology - Level XXXVI ($9000-$9500)	S		"$9,250.00"	.	"$1,850.00"																																																																																																																																																																																					
1537	New Technology - Level XXXVII ($9500-$10000)	S		"$9,750.00"	.	"$1,950.00"																																																																																																																																																																																					
1539	New Technology - Level II   ($50 - $100)	T		$75.00	.	$15.00																																																																																																																																																																																					
1540	New Technology - Level III   ($100 - $200)	T		$150.00	.	$30.00																																																																																																																																																																																					
1541	New Technology - Level IV  ($200 - $300)	T		$250.00	.	$50.00																																																																																																																																																																																					
1542	New Technology - Level V   ($300 - $400)	T		$350.00	.	$70.00																																																																																																																																																																																					
1543	New Technology - Level VI  ($400 - $500)	T		$450.00	.	$90.00																																																																																																																																																																																					
1544	New Technology - Level VII  ($500 - $600)	T		$550.00	.	$110.00																																																																																																																																																																																					
1545	New Technology - Level VIII ($600 - $700)	T		$650.00	.	$130.00																																																																																																																																																																																					
1546	New Technology - Level IX   ($700 - $800)	T		$750.00	.	$150.00																																																																																																																																																																																					
1547	New Technology - Level X    ($800 - $900)	T		$850.00	.	$170.00																																																																																																																																																																																					
1548	New Technology - Level XI   ($900 - $1000)	T		$950.00	.	$190.00																																																																																																																																																																																					
1549	New Technology - Level XII  ($1000 - $1100)	T		"$1,050.00"	.	$210.00																																																																																																																																																																																					
1550	New Technology - Level XIII  ($1100 - $1200)	T		"$1,150.00"	.	$230.00																																																																																																																																																																																					
1551	New Technology - Level XIV ($1200- $1300)	T		"$1,250.00"	.	$250.00																																																																																																																																																																																					
1552	New Technology - Level XV ($1300 - $1400)	T		"$1,350.00"	.	$270.00																																																																																																																																																																																					
1553	New Technology - Level XVI  ($1400 - $1500)	T		"$1,450.00"	.	$290.00																																																																																																																																																																																					
1554	New Technology - Level XVII ($1500-$1600)	T		"$1,550.00"	.	$310.00																																																																																																																																																																																					
1555	New Technology - Level XVIII ($1600-$1700)	T		"$1,650.00"	.	$330.00																																																																																																																																																																																					
1556	New Technology - Level XIX ($1700-$1800)	T		"$1,750.00"	.	$350.00																																																																																																																																																																																					
1557	New Technology - Level XX ($1800-$1900)	T		"$1,850.00"	.	$370.00																																																																																																																																																																																					
1558	New Technology - Level XXI ($1900-$2000)	T		"$1,950.00"	.	$390.00																																																																																																																																																																																					
1559	New Technology - Level XXII ($2000-$2500)	T		"$2,250.00"	.	$450.00																																																																																																																																																																																					
1560	New Technology - Level XXIII ($2500-$3000)	T		"$2,750.00"	.	$550.00																																																																																																																																																																																					
1561	New Technology - Level XXIV ($3000-$3500)	T		"$3,250.00"	.	$650.00																																																																																																																																																																																					
1562	New Technology - Level XXV ($3500-$4000)	T		"$3,750.00"	.	$750.00																																																																																																																																																																																					
1563	New Technology - Level XXVI ($4000-$4500)	T		"$4,250.00"	.	$850.00																																																																																																																																																																																					
1564	New Technology - Level XXVII ($4500-$5000)	T		"$4,750.00"	.	$950.00																																																																																																																																																																																					
1565	New Technology - Level XXVIII ($5000-$5500)	T		"$5,250.00"	.	"$1,050.00"																																																																																																																																																																																					
1566	New Technology - Level XXIX ($5500-$6000)	T		"$5,750.00"	.	"$1,150.00"																																																																																																																																																																																					
1567	New Technology - Level XXX ($6000-$6500)	T		"$6,250.00"	.	"$1,250.00"																																																																																																																																																																																					
1568	New Technology - Level XXXI ($6500-$7000)	T		"$6,750.00"	.	"$1,350.00"																																																																																																																																																																																					
1569	New Technology - Level XXXII ($7000-$7500)	T		"$7,250.00"	.	"$1,450.00"																																																																																																																																																																																					
1570	New Technology - Level XXXIII ($7500-$8000)	T		"$7,750.00"	.	"$1,550.00"																																																																																																																																																																																					
1571	New Technology - Level XXXIV ($8000-$8500)	T		"$8,250.00"	.	"$1,650.00"																																																																																																																																																																																					
1572	New Technology - Level XXXV ($8500-$9000)	T		"$8,750.00"	.	"$1,750.00"																																																																																																																																																																																					
1573	New Technology - Level XXXVI ($9000-$9500)	T		"$9,250.00"	.	"$1,850.00"																																																																																																																																																																																					
1574	New Technology - Level XXXVII ($9500-$10000)	T		"$9,750.00"	.	"$1,950.00"																																																																																																																																																																																					
1605	Abciximab injection	K		$739.17	.	$147.84	*																																																																																																																																																																																				
1607	Eptifibatide injection	K		$27.29	.	$5.46	*																																																																																																																																																																																				
1608	Etanercept injection	K		$285.27	.	$57.06	*																																																																																																																																																																																				
1609	"Rho(D) immune globulin h, sd"	K		$18.85	.	$3.77	*																																																																																																																																																																																				
1612	"Daclizumab, parenteral"	K		$526.34	.	$105.27																																																																																																																																																																																					
1613	Trastuzumab injection	K		$82.49	.	$16.50	*																																																																																																																																																																																				
1630	"Hep b ig, im"	K		$117.38	.	$23.48	*																																																																																																																																																																																				
1631	Baclofen intrathecal trial	K		$76.29	.	$15.26	*																																																																																																																																																																																				
1633	Alefacept	K		$41.64	.	$8.33																																																																																																																																																																																					
1643	"Y90 ibritumomab, rx"	K		"$44,161.14"	.	"$8,832.23"	*																																																																																																																																																																																				
1670	Tetanus immune globulin inj	K		$326.32	.	$65.27	*																																																																																																																																																																																				
1675	P32 Na phosphate	K		$223.07	.	$44.62																																																																																																																																																																																					
1676	P32 chromic phosphate	K		$316.07	.	$63.22																																																																																																																																																																																					
1683	Basiliximab	K		"$2,716.18"	.	$543.24	*																																																																																																																																																																																				
1684	Corticorelin ovine triflutal	K		$7.72	.	$1.55	*																																																																																																																																																																																				
1685	"Darbepoetin alfa, non-esrd"	K		$3.77	.	$0.76	*																																																																																																																																																																																				
1686	"Epoetin alfa, non-esrd"	K		$11.65	.	$2.33	*																																																																																																																																																																																				
1687	Digoxin immune fab (ovine)	K		"$2,051.63"	.	$410.33	*																																																																																																																																																																																				
1688	Ethanolamine oleate	K		$311.06	.	$62.22	*																																																																																																																																																																																				
1689	Fomepizole	K		$6.44	.	$1.29	*																																																																																																																																																																																				
1690	Hemin	K		$20.73	.	$4.15	*																																																																																																																																																																																				
1693	Lepirudin	K		$256.73	.	$51.35																																																																																																																																																																																					
1694	Ziconotide injection	K		$6.87	.	$1.37																																																																																																																																																																																					
1695	Nesiritide injection	K		$66.66	.	$13.34	*																																																																																																																																																																																				
1696	Palifermin injection	K		$14.85	.	$2.97	*																																																																																																																																																																																				
1697	Pegaptanib sodium injection	K		"$1,034.02"	.	$206.81	*																																																																																																																																																																																				
1700	Inj secretin synthetic human	K		$34.78	.	$6.96	*																																																																																																																																																																																				
1701	Treprostinil injection	K		$61.24	.	$12.25																																																																																																																																																																																					
1704	"Humate-P, inj"	K		$0.95	.	$0.19																																																																																																																																																																																					
1705	Factor viia	K		$1.73	.	$0.35	*																																																																																																																																																																																				
1709	Azacitidine injection	K		$4.08	.	$0.82	*																																																																																																																																																																																				
1710	Clofarabine injection	K		$134.10	.	$26.82	*																																																																																																																																																																																				
1711	Vantas implant	K		"$3,001.59"	.	$600.32	*																																																																																																																																																																																				
1712	Paclitaxel protein bound	K		$9.70	.	$1.94	*																																																																																																																																																																																				
1716	"Brachytx, non-str, Gold-198"	U	0.6372	$46.31	.	$9.27																																																																																																																																																																																					
1717	"Brachytx, non-str, HDR Ir-192"	U	3.8288	$278.25	.	$55.65																																																																																																																																																																																					
1719	"Brachytx, NS, Non-HDRIr-192"	U	0.4615	$33.54	.	$6.71																																																																																																																																																																																					
1738	Oxaliplatin	K		$0.57	.	$0.12	*																																																																																																																																																																																				
1739	"Pegademase bovine, 25 iu"	K		$281.40	.	$56.28	*																																																																																																																																																																																				
1741	"Urofollitropin, 75 iu"	K		$63.11	.	$12.63	*																																																																																																																																																																																				
1841	Retinal prosth int/ext comp 	H			.	.																																																																																																																																																																																					
2616	"Brachytx, non-str,Yttrium-90"	U	231.5765	"$16,829.13"	.	"$3,365.83"																																																																																																																																																																																					
2632	Iodine I-125 sodium iodide	U	0.2610	$18.97	.	$3.80																																																																																																																																																																																					
2634	"Brachytx, non-str, HA, I-125"	U	1.0200	$74.13	.	$14.83																																																																																																																																																																																					
2635	"Brachytx, non-str, HA, P-103"	U	0.3669	$26.66	.	$5.34																																																																																																																																																																																					
2636	"Brachy linear, non-str,P-103"	U	0.5551	$40.34	.	$8.07																																																																																																																																																																																					
2638	"Brachytx, stranded, I-125"	U	0.6663	$48.42	.	$9.69																																																																																																																																																																																					
2639	"Brachytx, non-stranded,I-125"	U	0.5575	$40.51	.	$8.11																																																																																																																																																																																					
2640	"Brachytx, stranded, P-103"	U	0.9885	$71.84	.	$14.37																																																																																																																																																																																					
2641	"Brachytx, non-stranded,P-103"	U	0.9461	$68.75	.	$13.75																																																																																																																																																																																					
2642	"Brachytx, stranded, C-131"	U	1.9129	$139.01	.	$27.81																																																																																																																																																																																					
2643	"Brachytx, non-stranded,C-131"	U	0.8672	$63.02	.	$12.61																																																																																																																																																																																					
2644	Brachytx cesium-131 chloride	U	0.2610	$18.97		$3.80																																																																																																																																																																																					
2698	"Brachytx, stranded, NOS"	U	0.6663	$48.42	.	$9.69																																																																																																																																																																																					
2699	"Brachytx, non-stranded, NOS"	U	0.3669	$26.66	.	$5.34																																																																																																																																																																																					
2731	"Immune globulin, powder"	K		$26.75	.	$5.35	*																																																																																																																																																																																				
2770	Quinupristin/dalfopristin	K		$245.22	.	$49.05	*																																																																																																																																																																																				
3041	Bivalirudin	K		$3.42	.	$0.69	*																																																																																																																																																																																				
3043	Gamma globulin 1 CC inj	K		$28.77	.	$5.76	*																																																																																																																																																																																				
7000	Amifostine	K		$310.72	.	$62.15	*																																																																																																																																																																																				
7011	Oprelvekin injection	K		$321.88	.	$64.38	*																																																																																																																																																																																				
7035	Teniposide	K		$830.00	.	$166.00																																																																																																																																																																																					
7038	Monoclonal antibodies	K		$6.62	.	$1.32																																																																																																																																																																																					
7041	Tirofiban HCl	K		$9.17	.	$1.84	*																																																																																																																																																																																				
7042	"Capecitabine, oral"	K		$8.67	.	$1.74	*																																																																																																																																																																																				
7043	Infliximab injection	K		$74.34	.	$14.87	*																																																																																																																																																																																				
7046	Doxorubicin inj 10mg	K		$490.49	.	$98.10	*																																																																																																																																																																																				
7048	Alteplase recombinant	K		$64.30	.	$12.86	*																																																																																																																																																																																				
7308	Aminolevulinic acid hcl top	K		$242.30	.	$48.46	*																																																																																																																																																																																				
8000	Cardiac Electrophysiologic Evaluation and Ablation Composite	T	180.4692	"$13,115.06"	.	"$2,623.02"																																																																																																																																																																																					
8001	LDR Prostate Brachytherapy Composite	T	52.9040	"$3,844.64"	.	$768.93																																																																																																																																																																																					
8004	Ultrasound Composite	S	3.9297	$285.58	.	$57.12																																																																																																																																																																																					
8005	CT and CTA without Contrast Composite	S	4.2148	$306.30	.	$61.26																																																																																																																																																																																					
8006	CT and CTA with Contrast Composite	S	7.5446	$548.28	.	$109.66																																																																																																																																																																																					
8007	MRI and MRA without Contrast Composite	S	8.5494	$621.30	.	$124.26																																																																																																																																																																																					
8008	MRI and MRA with Contrast Composite	S	12.7618	$927.43	.	$185.49																																																																																																																																																																																					
8009	Extended Assessment & Management Composite	V	16.4976	"$1,198.91"	.	$239.79																																																																																																																																																																																					
9001	Linezolid injection	K		$45.66	.	$9.14	*																																																																																																																																																																																				
9002	Tenecteplase injection	K		$86.21	.	$17.25	*																																																																																																																																																																																				
9003	Palivizumab	K		"$1,308.40"	.	$261.68																																																																																																																																																																																					
9005	Reteplase injection	K		"$2,301.91"	.	$460.39																																																																																																																																																																																					
9006	Tacrolimus injection	K		$141.10	.	$28.22	*																																																																																																																																																																																				
9012	Arsenic trioxide injection	K		$53.58	.	$10.72	*																																																																																																																																																																																				
9018	"Inj, rimabotulinumtoxinB"	K		$11.30	.	$2.26																																																																																																																																																																																					
9019	Caspofungin acetate	K		$11.84	.	$2.37	*																																																																																																																																																																																				
9024	Amphotericin b lipid complex	K		$10.41	.	$2.09	*																																																																																																																																																																																				
9032	Baclofen 10 MG injection	K		$162.80	.	$32.56	*																																																																																																																																																																																				
9033	Cidofovir injection	K		$588.10	.	$117.62	*																																																																																																																																																																																				
9038	Inj estrogen conjugate	K		$180.14	.	$36.03	*																																																																																																																																																																																				
9042	Glucagon hydrochloride	K		$146.07	.	$29.22	*																																																																																																																																																																																				
9044	Ibutilide fumarate injection	K		$112.30	.	$22.46	*																																																																																																																																																																																				
9104	Antithymocyte globuln rabbit	K		$594.74	.	$118.95	*																																																																																																																																																																																				
9108	Thyrotropin injection	K		"$1,430.43"	.	$286.09	*																																																																																																																																																																																				
9110	Alemtuzumab injection	K		$582.30	.	$116.46																																																																																																																																																																																					
9119	"Injection, pegfilgrastim 6mg"	K		"$3,403.54"	.	$680.71	*																																																																																																																																																																																				
9120	"Injection, Fulvestrant"	K		$91.27	.	$18.26	*																																																																																																																																																																																				
9121	"Injection, argatroban"	K		$15.70	.	$3.14	*																																																																																																																																																																																				
9122	Triptorelin pamoate	K		$170.77	.	$34.16	*																																																																																																																																																																																				
9124	Daptomycin injection	K		$0.67	.	$0.13																																																																																																																																																																																					
9125	"Risperidone, long acting"	K		$6.16	.	$1.24	*																																																																																																																																																																																				
9126	Natalizumab injection	K		$14.91	.	$2.99	*																																																																																																																																																																																				
9130	"Inj, Imm Glob Bivigam, 500mg"	G		$36.21	.	$7.25	*																																																																																																																																																																																				
9131	"Inj, Ado-trastuzumab Emt 1mg"	G		$29.14	.	$5.83																																																																																																																																																																																					
9132	"Kcentra, per i.u."	G		$1.54	.	$0.31																																																																																																																																																																																					
9133	"Rabies ig, im/sc"	K		$247.57	.	$49.52	*																																																																																																																																																																																				
9134	"Rabies ig, heat treated"	K		$237.82	.	$47.57	*																																																																																																																																																																																				
9135	"Varicella-zoster ig, im"	K		$675.22	.	$135.04																																																																																																																																																																																					
9137	"Bcg vaccine, percut"	K		$121.96	.	$24.40	*																																																																																																																																																																																				
9139	"Rabies vaccine, im"	K		$223.78	.	$44.76	*																																																																																																																																																																																				
9140	"Rabies vaccine, id"	K		$158.42	.	$31.69																																																																																																																																																																																					
9143	"Meningococcal vaccine, sc"	K		$106.49	.	$21.30																																																																																																																																																																																					
9144	"Encephalitis vaccine, sc"	K		$104.13	.	$20.83																																																																																																																																																																																					
9145	"Meningococcal vaccine, im"	K		$100.46	.	$20.10	*																																																																																																																																																																																				
9207	Bortezomib injection	K		$46.08	.	$9.22																																																																																																																																																																																					
9208	Agalsidase beta injection	K		$152.35	.	$30.47	*																																																																																																																																																																																				
9209	Laronidase injection	K		$29.45	.	$5.89	*																																																																																																																																																																																				
9210	Palonosetron hcl	K		$20.01	.	$4.01	*																																																																																																																																																																																				
9213	Pemetrexed injection	K		$60.27	.	$12.06	*																																																																																																																																																																																				
9214	Bevacizumab injection	K		$66.65	.	$13.33	*																																																																																																																																																																																				
9215	Cetuximab injection	K		$53.29	.	$10.66	*																																																																																																																																																																																				
9217	Leuprolide acetate suspnsion	K		$229.26	.	$45.86	*																																																																																																																																																																																				
9224	Galsulfase injection	K		$359.12	.	$71.83	*																																																																																																																																																																																				
9225	Fluocinolone acetonide implt	K		"$19,641.05"	.	"$3,928.21"	*																																																																																																																																																																																				
9227	Micafungin sodium injection	K		$0.98	.	$0.20	*																																																																																																																																																																																				
9228	Tigecycline injection	K		$2.00	.	$0.40	*																																																																																																																																																																																				
9229	Ibandronate sodium injection	K		$151.80	.	$30.36	*																																																																																																																																																																																				
9230	Abatacept injection	K		$32.25	.	$6.45	*																																																																																																																																																																																				
9231	Decitabine injection	K		$28.25	.	$5.65	*																																																																																																																																																																																				
9232	Idursulfase injection	K		$483.05	.	$96.61	*																																																																																																																																																																																				
9233	Ranibizumab injection	K		$396.43	.	$79.29	*																																																																																																																																																																																				
9234	Alglucosidase alfa injection	K		$206.63	.	$41.33																																																																																																																																																																																					
9235	Panitumumab injection	K		$94.79	.	$18.96	*																																																																																																																																																																																				
9236	Eculizumab injection	K		$206.14	.	$41.23																																																																																																																																																																																					
9237	"Inj, lanreotide acetate"	K		$41.40	.	$8.28	*																																																																																																																																																																																				
9240	"Injection, ixabepilone"	K		$70.21	.	$14.05	*																																																																																																																																																																																				
9242	"Injection, fosaprepitant"	K		$1.73	.	$0.35	*																																																																																																																																																																																				
9243	Bendamustine injection	K		$22.21	.	$4.45	*																																																																																																																																																																																				
9245	Romiplostim injection	K		$53.63	.	$10.73	*																																																																																																																																																																																				
9250	Artiss fibrin sealant	K		$132.98	.	$26.60	*																																																																																																																																																																																				
9251	C1 esterase inhibitor inj	K		$51.86	.	$10.38	*																																																																																																																																																																																				
9252	Plerixafor injection	K		$301.20	.	$60.24	*																																																																																																																																																																																				
9253	Temozolomide injection	K		$5.68	.	$1.14	*																																																																																																																																																																																				
9255	Paliperidone palmitate inj	K		$7.91	.	$1.59	*																																																																																																																																																																																				
9256	Dexamethasone intra implant	K		$201.31	.	$40.27	*																																																																																																																																																																																				
9258	Telavancin injection	K		$4.52	.	$0.91	*																																																																																																																																																																																				
9259	Pralatrexate injection	K		$197.12	.	$39.43	*																																																																																																																																																																																				
9260	Ofatumumab injection	K		$47.76	.	$9.56	*																																																																																																																																																																																				
9261	Ustekinumab injection	K		$162.29	.	$32.46	*																																																																																																																																																																																				
9263	Ecallantide injection	K		$375.64	.	$75.13	*																																																																																																																																																																																				
9264	Tocilizumab injection	K		$3.68	.	$0.74	*																																																																																																																																																																																				
9265	Romidepsin injection	K		$270.64	.	$54.13	*																																																																																																																																																																																				
9268	Capsaicin 8% patch	K		$26.50	.	$5.30	*																																																																																																																																																																																				
9269	"C-1 esterase, berinert"	K		$37.64	.	$7.53	*																																																																																																																																																																																				
9270	Gammaplex IVIG	K		$35.84	.	$7.17	*																																																																																																																																																																																				
9271	Velaglucerase alfa	K		$353.35	.	$70.67	*																																																																																																																																																																																				
9272	"Inj, denosumab"	K		$14.45	.	$2.89	*																																																																																																																																																																																				
9273	Sipuleucel-T auto CD54+	K		"$34,916.42"	.	"$6,983.29"	*																																																																																																																																																																																				
9274	Crotalidae Poly Immune Fab	K		"$2,493.12"	.	$498.63	*																																																																																																																																																																																				
9276	Cabazitaxel injection	K		$142.42	.	$28.49	*																																																																																																																																																																																				
9278	Incobotulinumtoxin A	K		$4.48	.	$0.90																																																																																																																																																																																					
9281	"Injection, pegloticase"	K		$856.64	.	$171.33	*																																																																																																																																																																																				
9284	Ipilimumab injection	K		$133.61	.	$26.73	*																																																																																																																																																																																				
9286	Belatacept injection	K		$3.81	.	$0.77	*																																																																																																																																																																																				
9287	Brentuximab vedotin inj	K		$110.82	.	$22.17	*																																																																																																																																																																																				
9289	Erwinaze injection	G		$354.76	.	$70.95																																																																																																																																																																																					
9290	"Inj, bupivacaine liposome"	G		$1.15		$0.00	*																																																																																																																																																																																				
9293	"Injection, glucarpidase "	G		$257.94	.	$51.59	*																																																																																																																																																																																				
9294	"Inj, Taliglucerace Alfa 10 u"	G		$31.94	.	$6.39	*																																																																																																																																																																																				
9295	"Injection, Carfilzomib, 1 mg"	G		$29.81	.	$5.97	*																																																																																																																																																																																				
9296	"Inj, ziv-aflibercept, 1mg"	G		$8.12	.	$1.63	*																																																																																																																																																																																				
9297	"Inj, Omacetaxine Mep, 0.01mg"	G		$2.48	.	$0.50																																																																																																																																																																																					
9298	"Inj, Ocriplasmin, 0.125 mg"	G		"$1,046.75"	.	$209.35																																																																																																																																																																																					
9300	Omalizumab injection	K		$27.85	.	$5.57	*																																																																																																																																																																																				
9366	Epifix	G		$219.52		$0.00	*																																																																																																																																																																																				
9368	Grafix core	G		$118.03		$0.00	*																																																																																																																																																																																				
9369	Grafix prime	G		$115.18		$0.00	*																																																																																																																																																																																				
9441	Inj Ferric Carboxymaltos 1mg	G		$1.05		$0.21	*																																																																																																																																																																																				
9497	"Loxapine, inhalation powder"	G		$153.70		$30.74																																																																																																																																																																																					
9500	"Platelets, irradiated"	R	2.3175	$168.42	.	$33.69																																																																																																																																																																																					
9501	Platelet pheres leukoreduced	R	6.8758	$499.68	.	$99.94																																																																																																																																																																																					
9502	Platelet pheresis irradiated	R	8.0385	$584.17	.	$116.84																																																																																																																																																																																					
9503	Fr frz plasma donor retested	R	0.8398	$61.03	.	$12.21																																																																																																																																																																																					
9504	RBC deglycerolized	R	5.2269	$379.85	.	$75.97																																																																																																																																																																																					
9505	RBC irradiated	R	3.0182	$219.34	.	$43.87																																																																																																																																																																																					
9506	"Granulocytes, pheresis unit"	R	25.9683	"$1,887.17"	.	$377.44																																																																																																																																																																																					
9507	"Platelets, pheresis"	R	5.5347	$402.22	.	$80.45																																																																																																																																																																																					
9508	Plasma 1 donor frz w/in 8 hr	R	1.0893	$79.16	.	$15.84																																																																																																																																																																																					
