	Addendum A.-Proposed OPPS APCs for CY 2012																																																																																																																																																																																																																								
APC	Group Title	   SI	Relative Weight 	Payment Rate 	National Unadjusted Copayment 	Minimum Unadjusted Copayment 																																																																																																																																																																																																																			
0001	Level I Photochemotherapy	S	0.5025	$34.88	.	$6.98																																																																																																																																																																																																																			
0002	Fine Needle Biopsy/Aspiration	T	1.7462	$121.22	.	$24.25																																																																																																																																																																																																																			
0003	Bone Marrow Biopsy/Aspiration	T	3.9075	$271.26	.	$54.26																																																																																																																																																																																																																			
0004	Level I Needle Biopsy/ Aspiration Except Bone Marrow	T	4.5956	$319.03	.	$63.81																																																																																																																																																																																																																			
0005	Level II Needle Biopsy/Aspiration Except Bone Marrow	T	8.1415	$565.18	.	$113.04																																																																																																																																																																																																																			
0006	Level I Incision & Drainage	T	1.4481	$100.53	.	$20.11																																																																																																																																																																																																																			
0007	Level II Incision & Drainage	T	13.4779	$935.64	.	$187.13																																																																																																																																																																																																																			
0008	Level III Incision and Drainage	T	20.5401	"$1,425.89"	.	$285.18																																																																																																																																																																																																																			
0012	Level I Debridement & Destruction	T	0.4047	$28.09	.	$5.62																																																																																																																																																																																																																			
0013	Level II Debridement & Destruction	T	0.9786	$67.93	.	$13.59																																																																																																																																																																																																																			
0015	Level III Debridement & Destruction	T	1.4936	$103.69	.	$20.74																																																																																																																																																																																																																			
0016	Level IV Debridement & Destruction	T	2.8248	$196.10	.	$39.22																																																																																																																																																																																																																			
0017	Level V Debridement & Destruction	T	22.0631	"$1,531.62"	.	$306.33																																																																																																																																																																																																																			
0019	Level I Excision/ Biopsy	T	4.8763	$338.51	.	$67.71																																																																																																																																																																																																																			
0020	Level II Excision/ Biopsy	T	8.6164	$598.15	.	$119.63																																																																																																																																																																																																																			
0021	Level III Excision/ Biopsy	T	17.1909	"$1,193.39"	.	$238.68																																																																																																																																																																																																																			
0022	Level IV Excision/ Biopsy	T	23.4169	"$1,625.60"	$350.05	$325.12																																																																																																																																																																																																																			
0028	Level I Breast Surgery	T	25.8383	"$1,793.69"	.	$358.74																																																																																																																																																																																																																			
0029	Level II Breast Surgery	T	33.8417	"$2,349.29"	$581.52	$469.86																																																																																																																																																																																																																			
0030	Level III Breast Surgery	T	45.0972	"$3,130.65"	$747.07	$626.13																																																																																																																																																																																																																			
0031	Smoking Cessation Services	X	0.2941	$20.42	.	$4.09																																																																																																																																																																																																																			
0034	Mental Health Services Composite	S	2.6400	$183.27	.	$36.66																																																																																																																																																																																																																			
0035	Vascular Puncture and Minor Diagnostic Procedures	X	0.2717	$18.86	.	$3.78																																																																																																																																																																																																																			
0037	Level IV Needle Biopsy/Aspiration Except Bone Marrow	T	15.3594	"$1,066.25"	$225.55	$213.25																																																																																																																																																																																																																			
0039	Level I Implantation of Neurostimulator Generator	S	209.6958	"$14,557.08"	.	"$2,911.42"																																																																																																																																																																																																																			
0040	Level I Implantation/Revision/Replacement of Neurostimulator Electrodes 	S	62.7889	"$4,358.81"	.	$871.77																																																																																																																																																																																																																			
0041	Level I Arthroscopy	T	29.4235	"$2,042.58"	.	$408.52																																																																																																																																																																																																																			
0042	Level II Arthroscopy	T	48.4545	"$3,363.71"	$804.74	$672.75																																																																																																																																																																																																																			
0045	Bone/Joint Manipulation Under Anesthesia	T	15.5166	"$1,077.16"	$268.44	$215.44																																																																																																																																																																																																																			
0047	Arthroplasty without Prosthesis	T	41.2971	"$2,866.84"	.	$573.37																																																																																																																																																																																																																			
0048	Level I Arthroplasty or Implantation with Prosthesis	T	60.0335	"$4,167.53"	.	$833.51																																																																																																																																																																																																																			
0049	Level I Musculoskeletal Procedures Except Hand and Foot	T	22.1674	"$1,538.86"	.	$307.78																																																																																																																																																																																																																			
0050	Level II Musculoskeletal Procedures Except Hand and Foot	T	32.4101	"$2,249.91"	.	$449.99																																																																																																																																																																																																																			
0051	Level III Musculoskeletal Procedures Except Hand and Foot	T	47.1841	"$3,275.52"	.	$655.11																																																																																																																																																																																																																			
0052	Level IV Musculoskeletal Procedures Except Hand and Foot	T	87.5671	"$6,078.91"	.	"$1,215.79"																																																																																																																																																																																																																			
0053	Level I Hand Musculoskeletal Procedures	T	17.4096	"$1,208.57"	$253.49	$241.72																																																																																																																																																																																																																			
0054	Level II Hand Musculoskeletal Procedures	T	29.0181	"$2,014.44"	.	$402.89																																																																																																																																																																																																																			
0055	Level I Foot Musculoskeletal Procedures	T	22.1739	"$1,539.31"	$351.47	$307.87																																																																																																																																																																																																																			
0056	Level II Foot Musculoskeletal Procedures	T	57.2099	"$3,971.51"	.	$794.31																																																																																																																																																																																																																			
0057	Bunion Procedures	T	32.5456	"$2,259.32"	$469.58	$451.87																																																																																																																																																																																																																			
0058	Level I Strapping and Cast Application	S	1.1378	$78.99	.	$15.80																																																																																																																																																																																																																			
0060	Manipulation Therapy	S	0.3234	$22.45	.	$4.49																																																																																																																																																																																																																			
0061	Level II Implantation/Revision/Replacement of Neurostimulator Electrodes 	S	86.9786	"$6,038.05"	.	"$1,207.61"																																																																																																																																																																																																																			
0062	Level I Treatment Fracture/Dislocation	T	26.2376	"$1,821.41"	$371.33	$364.29																																																																																																																																																																																																																			
0063	Level II Treatment Fracture/Dislocation	T	49.4864	"$3,435.35"	.	$687.07																																																																																																																																																																																																																			
0064	Level III Treatment Fracture/Dislocation	T	67.0623	"$4,655.46"	.	$931.10																																																																																																																																																																																																																			
0065	"Level I Stereotactic Radiosurgery, MRgFUS, and MEG"	S	12.4513	$864.37	.	$172.88																																																																																																																																																																																																																			
0066	"Level II Stereotactic Radiosurgery, MRgFUS, and MEG"	S	35.2457	"$2,446.76"	.	$489.36																																																																																																																																																																																																																			
0067	"Level III Stereotactic Radiosurgery, MRgFUS, and MEG"	S	46.8279	"$3,250.79"	.	$650.16																																																																																																																																																																																																																			
0069	Thoracoscopy	T	34.9007	"$2,422.81"	$591.64	$484.57																																																																																																																																																																																																																			
0070	Thoracentesis/Lavage Procedures	T	5.5572	$385.78	.	$77.16																																																																																																																																																																																																																			
0071	Level I Endoscopy Upper Airway	T	1.0521	$73.04	.	$14.61																																																																																																																																																																																																																			
0072	Level II Endoscopy Upper Airway	T	1.9475	$135.20	.	$27.04																																																																																																																																																																																																																			
0073	Level III Endoscopy Upper Airway	T	4.5122	$313.24	$67.83	$62.65																																																																																																																																																																																																																			
0074	Level IV Endoscopy Upper Airway	T	21.3691	"$1,483.44"	.	$296.69																																																																																																																																																																																																																			
0075	Level V Endoscopy Upper Airway	T	30.2222	"$2,098.03"	$438.93	$419.61																																																																																																																																																																																																																			
0076	Level I Endoscopy Lower Airway	T	10.4123	$722.82	$189.71	$144.57																																																																																																																																																																																																																			
0077	Level I Pulmonary Treatment	S	0.4224	$29.32	$7.74	$5.87																																																																																																																																																																																																																			
0078	Level III Pulmonary Treatment	S	1.4008	$97.24	.	$19.45																																																																																																																																																																																																																			
0079	Ventilation Initiation and Management	S	3.0221	$209.79	.	$41.96																																																																																																																																																																																																																			
0080	Diagnostic Cardiac Catheterization	T	39.2392	"$2,723.99"	$838.04	$544.80																																																																																																																																																																																																																			
0082	Coronary or Non-Coronary Atherectomy	T	104.8857	"$7,281.17"	.	"$1,456.24"																																																																																																																																																																																																																			
0083	Level I Endovascular Revascularization of the Lower Extremity 	T	65.1118	"$4,520.06"	.	$904.02																																																																																																																																																																																																																			
0084	Level I Electrophysiologic Procedures	S	9.6404	$669.24	.	$133.85																																																																																																																																																																																																																			
0085	Level II Electrophysiologic Procedures	T	52.8540	"$3,669.12"	.	$733.83																																																																																																																																																																																																																			
0086	Level III Electrophysiologic Procedures	T	133.7624	"$9,285.79"	.	"$1,857.16"																																																																																																																																																																																																																			
0088	Thrombectomy	T	41.2260	"$2,861.91"	$652.56	$572.39																																																																																																																																																																																																																			
0089	Insertion/Replacement of Permanent Pacemaker and Electrodes	T	110.9465	"$7,701.91"	"$1,620.86"	"$1,540.39"																																																																																																																																																																																																																			
0090	Insertion/Replacement of Pacemaker Pulse Generator	T	93.4566	"$6,487.76"	"$1,570.21"	"$1,297.56"																																																																																																																																																																																																																			
0091	Level II Vascular Ligation	T	43.6864	"$3,032.71"	.	$606.55																																																																																																																																																																																																																			
0092	Level I Vascular Ligation	T	26.9181	"$1,868.65"	.	$373.73																																																																																																																																																																																																																			
0093	Vascular Reconstruction/Fistula Repair without Device	T	30.7767	"$2,136.52"	.	$427.31																																																																																																																																																																																																																			
0094	Level I Resuscitation and Cardioversion	S	2.2773	$158.09	$44.32	$31.62																																																																																																																																																																																																																			
0095	Cardiac Rehabilitation	S	0.9648	$66.98	$13.49	$13.40																																																																																																																																																																																																																			
0096	Level II Noninvasive Physiologic Studies	S	1.5324	$106.38	$36.83	$21.28																																																																																																																																																																																																																			
0097	Level I Noninvasive Physiologic Studies	S	0.9478	$65.80	$23.63	$13.16																																																																																																																																																																																																																			
0099	Electrocardiograms/Cardiography	S	0.3895	$27.04	.	$5.41																																																																																																																																																																																																																			
0100	Cardiac Stress Tests	X	2.5348	$175.97	$40.87	$35.20																																																																																																																																																																																																																			
0101	Tilt Table Evaluation	S	4.2610	$295.80	$100.24	$59.16																																																																																																																																																																																																																			
0102	Level II Pulmonary Treatment	S	0.5308	$36.85	.	$7.37																																																																																																																																																																																																																			
0103	Miscellaneous Vascular Procedures	T	16.7686	"$1,164.08"	.	$232.82																																																																																																																																																																																																																			
0104	Transcatheter Placement of Intracoronary Stents	T	79.9047	"$5,546.98"	.	"$1,109.40"																																																																																																																																																																																																																			
0105	"Repair/Revision/Removal of Pacemakers, AICDs, or Vascular Devices"	T	23.2424	"$1,613.49"	.	$322.70																																																																																																																																																																																																																			
0106	Insertion/Replacement of Pacemaker Leads and/or Electrodes	T	48.5765	"$3,372.18"	.	$674.44																																																																																																																																																																																																																			
0107	Insertion of Cardioverter-Defibrillator	T	329.3230	"$22,861.60"	.	"$4,572.32"																																																																																																																																																																																																																			
0108	"Insertion/Replacement/Repair of AICD Leads, Generator, and Pacing Electrodes "	T	379.7887	"$26,364.93"	.	"$5,272.99"																																																																																																																																																																																																																			
0110	Transfusion	S	3.3671	$233.74	.	$46.75																																																																																																																																																																																																																			
0111	Blood Product Exchange	S	11.7368	$814.77	$189.47	$162.96																																																																																																																																																																																																																			
0112	Apheresis and Stem Cell Procedures	S	32.6016	"$2,263.20"	.	$452.64																																																																																																																																																																																																																			
0113	Excision Lymphatic System	T	25.4874	"$1,769.34"	.	$353.87																																																																																																																																																																																																																			
0114	Thyroid/Lymphadenectomy Procedures	T	51.2321	"$3,556.53"	.	$711.31																																																																																																																																																																																																																			
0115	Cannula/Access Device Procedures	T	36.8791	"$2,560.15"	.	$512.03																																																																																																																																																																																																																			
0121	Level I Tube or Catheter Changes or Repositioning	T	6.3178	$438.58	.	$87.72																																																																																																																																																																																																																			
0126	Level I Urinary and Anal Procedures	T	1.1699	$81.21	.	$16.25																																																																																																																																																																																																																			
0127	"Level IV Stereotactic Radiosurgery, MRgFUS, and MEG"	S	106.1294	"$7,367.50"	.	"$1,473.50"																																																																																																																																																																																																																			
0128	Echocardiogram with Contrast	S	8.1207	$563.74	$166.16	$112.75																																																																																																																																																																																																																			
0129	Level I Closed Treatment Fracture Finger/Toe/Trunk	T	1.6063	$111.51	.	$22.31																																																																																																																																																																																																																			
0130	Level I Laparoscopy	T	39.0865	"$2,713.38"	$659.53	$542.68																																																																																																																																																																																																																			
0131	Level II Laparoscopy	T	47.7164	"$3,312.47"	"$1,001.89"	$662.50																																																																																																																																																																																																																			
0132	Level III Laparoscopy	T	71.0451	"$4,931.95"	"$1,236.99"	$986.39																																																																																																																																																																																																																			
0133	Level I Skin Repair	T	1.2139	$84.27	$23.56	$16.86																																																																																																																																																																																																																			
0134	Level II Skin Repair	T	3.2846	$228.02	.	$45.61																																																																																																																																																																																																																			
0135	Level III Skin Repair	T	5.1973	$360.80	.	$72.16																																																																																																																																																																																																																			
0136	Level IV Skin Repair	T	17.2745	"$1,199.20"	.	$239.84																																																																																																																																																																																																																			
0137	Level V Skin Repair	T	21.8041	"$1,513.64"	.	$302.73																																																																																																																																																																																																																			
0138	Level II Closed Treatment Fracture Finger/Toe/Trunk	T	4.9874	$346.23	.	$69.25																																																																																																																																																																																																																			
0139	Level III Closed Treatment Fracture Finger/Toe/Trunk	T	18.6922	"$1,297.61"	.	$259.53																																																																																																																																																																																																																			
0140	Esophageal Dilation without Endoscopy	T	6.5430	$454.22	.	$90.85																																																																																																																																																																																																																			
0141	Level I Upper GI Procedures	T	8.3787	$581.65	$136.33	$116.33																																																																																																																																																																																																																			
0142	Level I Small Intestine Endoscopy	T	10.1643	$705.61	$152.78	$141.13																																																																																																																																																																																																																			
0143	Lower GI Endoscopy	T	9.3183	$646.88	$186.06	$129.38																																																																																																																																																																																																																			
0146	Level I Sigmoidoscopy and Anoscopy	T	6.3038	$437.61	.	$87.53																																																																																																																																																																																																																			
0147	Level II Sigmoidoscopy and Anoscopy	T	11.0219	$765.14	.	$153.03																																																																																																																																																																																																																			
0148	Level I Anal/Rectal Procedures	T	6.1052	$423.82	.	$84.77																																																																																																																																																																																																																			
0149	Level III Anal/Rectal Procedures	T	24.4472	"$1,697.12"	.	$339.43																																																																																																																																																																																																																			
0150	Level IV Anal/Rectal Procedures	T	32.9730	"$2,288.99"	.	$457.80																																																																																																																																																																																																																			
0151	Endoscopic Retrograde Cholangio-Pancreatography (ERCP)	T	24.4009	"$1,693.91"	.	$338.79																																																																																																																																																																																																																			
0152	Level I Percutaneous Abdominal and Biliary Procedures	T	31.2779	"$2,171.31"	.	$434.27																																																																																																																																																																																																																			
0153	Peritoneal and Abdominal Procedures	T	26.6476	"$1,849.88"	$375.24	$369.98																																																																																																																																																																																																																			
0154	Hernia/Hydrocele Procedures	T	32.9744	"$2,289.08"	$464.85	$457.82																																																																																																																																																																																																																			
0155	Level II Anal/Rectal Procedures	T	16.0235	"$1,112.35"	.	$222.47																																																																																																																																																																																																																			
0156	Level III Urinary and Anal Procedures	T	3.1976	$221.98	.	$44.40																																																																																																																																																																																																																			
0157	Colorectal Cancer Screening: Barium Enema	S	2.2553	$156.56	.	$31.32																																																																																																																																																																																																																			
0158	Colorectal Cancer Screening: Colonoscopy	T	8.3174	$577.39	.	$0.00																																																																																																																																																																																																																			
0159	Colorectal Cancer Screening: Flexible Sigmoidoscopy	S	5.4345	$377.26	.	$0.00																																																																																																																																																																																																																			
0160	Level I Cystourethroscopy and other Genitourinary Procedures	T	7.3594	$510.89	.	$102.18																																																																																																																																																																																																																			
0161	Level II Cystourethroscopy and other Genitourinary Procedures	T	17.6738	"$1,226.92"	.	$245.39																																																																																																																																																																																																																			
0162	Level III Cystourethroscopy and other Genitourinary Procedures	T	26.2690	"$1,823.59"	.	$364.72																																																																																																																																																																																																																			
0163	Level IV Cystourethroscopy and other Genitourinary Procedures	T	36.9605	"$2,565.80"	.	$513.16																																																																																																																																																																																																																			
0164	Level II Urinary and Anal Procedures	T	2.0973	$145.59	.	$29.12																																																																																																																																																																																																																			
0165	Level IV Urinary and Anal Procedures	T	20.1960	"$1,402.01"	.	$280.41																																																																																																																																																																																																																			
0166	Level I Urethral Procedures	T	20.7987	"$1,443.85"	.	$288.77																																																																																																																																																																																																																			
0168	Level II Urethral Procedures	T	32.1043	"$2,228.68"	.	$445.74																																																																																																																																																																																																																			
0169	Lithotripsy	T	51.4038	"$3,568.45"	$997.74	$713.69																																																																																																																																																																																																																			
0170	Dialysis	S	5.9462	$412.79	.	$82.56																																																																																																																																																																																																																			
0172	Level I Partial Hospitalization (3 services) for CMHCs	P	1.3595	$94.38	.	$18.88																																																																																																																																																																																																																			
0173	Level II Partial Hospitalization (4 or more services) for CMHCs	P	1.5798	$109.67	.	$21.94																																																																																																																																																																																																																			
0174	Level IV Laparoscopy	T	107.5115	"$7,463.45"	"$1,962.55"	"$1,492.69"																																																																																																																																																																																																																			
0175	Level I Partial Hospitalization (3 services) for Hospital-based PHPs	P	2.2572	$156.69	.	$31.34																																																																																																																																																																																																																			
0176	Level II Partial Hospitalization (4 or more services) for Hospital-based PHPs	P	2.6400	$183.27	.	$36.66																																																																																																																																																																																																																			
0181	Level II Male Genital Procedures	T	34.3803	"$2,386.68"	$598.48	$477.34																																																																																																																																																																																																																			
0183	Level I Male Genital Procedures	T	23.7235	"$1,646.89"	.	$329.38																																																																																																																																																																																																																			
0184	Prostate Biopsy	T	14.2476	$989.07	.	$197.82																																																																																																																																																																																																																			
0188	Level II Female Reproductive Proc	T	1.6099	$111.76	.	$22.36																																																																																																																																																																																																																			
0189	Level III Female Reproductive Proc	T	3.6121	$250.75	.	$50.15																																																																																																																																																																																																																			
0190	Level I Hysteroscopy	T	23.1868	"$1,609.63"	$424.28	$321.93																																																																																																																																																																																																																			
0191	Level I Female Reproductive Proc	T	0.1274	$8.84	$1.85	$1.77																																																																																																																																																																																																																			
0192	Level IV Female Reproductive Proc	T	7.0332	$488.24	.	$97.65																																																																																																																																																																																																																			
0193	Level V Female Reproductive Proc	T	20.7771	"$1,442.35"	.	$288.47																																																																																																																																																																																																																			
0195	Level VI Female Reproductive Procedures	T	35.9320	"$2,494.40"	.	$498.88																																																																																																																																																																																																																			
0202	Level VII Female Reproductive Procedures	T	45.5816	"$3,164.27"	$981.50	$632.86																																																																																																																																																																																																																			
0203	Level IV Nerve Injections	T	12.9066	$895.98	.	$179.20																																																																																																																																																																																																																			
0204	Level I Nerve Injections	T	2.7693	$192.24	$40.13	$38.45																																																																																																																																																																																																																			
0206	Level II Nerve Injections	T	3.9371	$273.31	.	$54.67																																																																																																																																																																																																																			
0207	Level III Nerve Injections	T	7.5480	$523.98	.	$104.80																																																																																																																																																																																																																			
0208	Laminotomies and Laminectomies	T	51.1173	"$3,548.56"	.	$709.72																																																																																																																																																																																																																			
0209	"Level II Extended EEG, Sleep, and Cardiovascular Studies"	S	11.3894	$790.65	$268.73	$158.13																																																																																																																																																																																																																			
0213	"Level I Extended EEG, Sleep, and Cardiovascular Studies"	S	2.3958	$166.32	$53.48	$33.27																																																																																																																																																																																																																			
0215	Level I Nerve and Muscle Tests	S	0.6352	$44.10	.	$8.82																																																																																																																																																																																																																			
0216	Level III Nerve and Muscle Tests	S	2.6231	$182.10	.	$36.42																																																																																																																																																																																																																			
0218	Level II Nerve and Muscle Tests	S	1.1945	$82.92	.	$16.59																																																																																																																																																																																																																			
0220	Level I Nerve Procedures	T	19.0626	"$1,323.33"	.	$264.67																																																																																																																																																																																																																			
0221	Level II Nerve Procedures	T	37.4067	"$2,596.77"	.	$519.36																																																																																																																																																																																																																			
0224	Implantation of Catheter/Reservoir/Shunt	T	42.5188	"$2,951.66"	.	$590.34																																																																																																																																																																																																																			
0227	Implantation of Drug Infusion Device	T	190.0513	"$13,193.36"	.	"$2,638.68"																																																																																																																																																																																																																			
0229	Level II Endovascular Revascularization of the Lower Extremity 	T	114.2626	"$7,932.11"	.	"$1,586.43"																																																																																																																																																																																																																			
0230	Level I Eye Tests & Treatments	S	0.6929	$48.10	.	$9.62																																																																																																																																																																																																																			
0231	Level III Eye Tests & Treatments	S	2.3088	$160.28	.	$32.06																																																																																																																																																																																																																			
0232	Level I Anterior Segment Eye Procedures	T	2.9435	$204.34	$42.27	$40.87																																																																																																																																																																																																																			
0233	Level III Anterior Segment Eye Procedures	T	16.8777	"$1,171.65"	.	$234.33																																																																																																																																																																																																																			
0234	Level IV Anterior Segment Eye Procedures	T	25.2649	"$1,753.89"	$511.31	$350.78																																																																																																																																																																																																																			
0235	Level I Posterior Segment Eye Procedures	T	4.9132	$341.07	.	$68.22																																																																																																																																																																																																																			
0237	Level II Posterior Segment Eye Procedures	T	22.7865	"$1,581.84"	.	$316.37																																																																																																																																																																																																																			
0238	Level I Repair and Plastic Eye Procedures	T	3.3278	$231.02	.	$46.21																																																																																																																																																																																																																			
0239	Level II Repair and Plastic Eye Procedures	T	8.3090	$576.81	.	$115.37																																																																																																																																																																																																																			
0240	Level III Repair and Plastic Eye Procedures	T	20.3065	"$1,409.68"	$296.20	$281.94																																																																																																																																																																																																																			
0241	Level IV Repair and Plastic Eye Procedures	T	27.0493	"$1,877.76"	$383.45	$375.56																																																																																																																																																																																																																			
0242	Level V Repair and Plastic Eye Procedures	T	40.9376	"$2,841.89"	$597.36	$568.38																																																																																																																																																																																																																			
0243	Strabismus/Muscle Procedures	T	25.2851	"$1,755.29"	$415.27	$351.06																																																																																																																																																																																																																			
0244	Corneal and Amniotic Membrane Transplant	T	38.4709	"$2,670.65"	$800.09	$534.13																																																																																																																																																																																																																			
0245	Level I Cataract Procedures without IOL Insert	T	15.2776	"$1,060.57"	.	$212.12																																																																																																																																																																																																																			
0246	Cataract Procedures with IOL Insert	T	24.0158	"$1,667.18"	$488.94	$333.44																																																																																																																																																																																																																			
0247	Laser Eye Procedures	T	5.5801	$387.37	$104.31	$77.48																																																																																																																																																																																																																			
0249	Level II Cataract Procedures without IOL Insert	T	30.7811	"$2,136.82"	$516.99	$427.37																																																																																																																																																																																																																			
0250	Level I ENT Procedures	T	1.0875	$75.49	$24.28	$15.10																																																																																																																																																																																																																			
0251	Level II ENT Procedures	T	3.3531	$232.77	.	$46.56																																																																																																																																																																																																																			
0252	Level III ENT Procedures	T	8.0353	$557.81	.	$111.57																																																																																																																																																																																																																			
0253	Level IV ENT Procedures	T	16.9180	"$1,174.45"	$277.61	$234.89																																																																																																																																																																																																																			
0254	Level V ENT Procedures	T	25.1379	"$1,745.07"	.	$349.02																																																																																																																																																																																																																			
0255	Level II Anterior Segment Eye Procedures	T	7.8512	$545.03	$124.97	$109.01																																																																																																																																																																																																																			
0256	Level VI ENT Procedures	T	45.1286	"$3,132.83"	.	$626.57																																																																																																																																																																																																																			
0259	Level VII ENT Procedures	T	395.1320	"$27,430.06"	"$7,545.06"	"$5,486.02"																																																																																																																																																																																																																			
0260	Level I Plain Film Except Teeth	X	0.6418	$44.55	.	$8.91																																																																																																																																																																																																																			
0261	Level II Plain Film Except Teeth Including Bone Density Measurement	X	1.0831	$75.19	.	$15.04																																																																																																																																																																																																																			
0262	Plain Film of Teeth	X	0.4650	$32.28	.	$6.46																																																																																																																																																																																																																			
0263	Level I Miscellaneous Radiology Procedures	X	3.3928	$235.53	.	$47.11																																																																																																																																																																																																																			
0265	Level I Diagnostic and Screening Ultrasound	S	0.8995	$62.44	$22.26	$12.49																																																																																																																																																																																																																			
0266	Level II Diagnostic and Screening Ultrasound	S	1.3711	$95.18	$36.80	$19.04																																																																																																																																																																																																																			
0267	Level III Diagnostic and Screening Ultrasound	S	2.1881	$151.90	$59.41	$30.38																																																																																																																																																																																																																			
0269	Level II Echocardiogram Without Contrast 	S	5.5306	$383.93	.	$76.79																																																																																																																																																																																																																			
0270	Level III Echocardiogram Without Contrast 	S	8.1675	$566.99	$133.61	$113.40																																																																																																																																																																																																																			
0272	Fluoroscopy	X	1.2481	$86.64	$30.47	$17.33																																																																																																																																																																																																																			
0274	Myelography	S	6.9677	$483.70	.	$96.74																																																																																																																																																																																																																			
0275	Arthrography	S	3.9868	$276.76	$68.90	$55.36																																																																																																																																																																																																																			
0276	Level I Digestive Radiology	S	1.2290	$85.32	$33.87	$17.07																																																																																																																																																																																																																			
0277	Level II Digestive Radiology	S	2.0083	$139.42	$52.93	$27.89																																																																																																																																																																																																																			
0278	Diagnostic Urography	S	2.5896	$179.77	$58.44	$35.96																																																																																																																																																																																																																			
0279	Level II Angiography and Venography	S	29.6734	"$2,059.93"	.	$411.99																																																																																																																																																																																																																			
0280	Level III Angiography and Venography	S	49.6711	"$3,448.17"	.	$689.64																																																																																																																																																																																																																			
0282	Miscellaneous Computed Axial Tomography	S	1.5453	$107.27	$35.74	$21.46																																																																																																																																																																																																																			
0283	Computed Tomography with Contrast	S	4.2806	$297.16	$95.77	$59.44																																																																																																																																																																																																																			
0284	Magnetic Resonance Imaging and Magnetic Resonance Angiography with Contrast	S	6.1872	$429.52	$144.34	$85.91																																																																																																																																																																																																																			
0288	Bone Density:Axial Skeleton	S	1.0215	$70.91	.	$0.00																																																																																																																																																																																																																			
0293	Level VI Anterior Segment Eye Procedures	T	117.7956	"$8,177.37"	.	"$1,635.48"																																																																																																																																																																																																																			
0299	Hyperthermia and Radiation Treatment Procedures	S	5.6094	$389.40	.	$77.88																																																																																																																																																																																																																			
0300	Level I Radiation Therapy	S	1.3628	$94.61	.	$18.93																																																																																																																																																																																																																			
0301	Level II Radiation Therapy	S	2.3680	$164.39	.	$32.88																																																																																																																																																																																																																			
0303	Treatment Device Construction	X	2.7910	$193.75	$64.95	$38.75																																																																																																																																																																																																																			
0304	Level I Therapeutic Radiation Treatment Preparation	X	1.4946	$103.76	$34.39	$20.76																																																																																																																																																																																																																			
0305	Level II Therapeutic Radiation Treatment Preparation	X	3.7009	$256.92	$86.44	$51.39																																																																																																																																																																																																																			
0307	Myocardial Positron Emission Tomography (PET) imaging	S	13.2711	$921.28	.	$184.26																																																																																																																																																																																																																			
0308	Non-Myocardial Positron Emission Tomography (PET) imaging	S	14.6171	"$1,014.72"	.	$202.95																																																																																																																																																																																																																			
0310	Level III Therapeutic Radiation Treatment Preparation	X	13.2460	$919.54	$322.74	$183.91																																																																																																																																																																																																																			
0312	Radioelement Applications	S	4.7014	$326.37	.	$65.28																																																																																																																																																																																																																			
0313	Brachytherapy	S	9.8659	$684.89	$258.98	$136.98																																																																																																																																																																																																																			
0315	Level II Implantation of Neurostimulator Generator 	S	284.8462	"$19,774.02"	.	"$3,954.81"																																																																																																																																																																																																																			
0317	Level II Miscellaneous Radiology Procedures	X	6.2675	$435.09	.	$87.02																																																																																																																																																																																																																			
0318	Implantation of Cranial Neurostimulator Pulse Generator and Electrode 	S	337.4240	"$23,423.97"	"$9,121.76"	"$4,684.80"																																																																																																																																																																																																																			
0319	Level III Endovascular Revascularization of the Lower Extremity	T	202.3898	"$14,049.90"	"$5,559.48"	"$2,809.98"																																																																																																																																																																																																																			
0320	Electroconvulsive Therapy	S	5.9679	$414.29	.	$82.86																																																																																																																																																																																																																			
0322	Brief Individual Psychotherapy	S	1.0957	$76.06	.	$15.22																																																																																																																																																																																																																			
0323	Extended Individual Psychotherapy	S	1.5885	$110.27	.	$22.06																																																																																																																																																																																																																			
0324	Family Psychotherapy	S	1.8739	$130.09	.	$26.02																																																																																																																																																																																																																			
0325	Group Psychotherapy	S	0.7798	$54.13	$11.54	$10.83																																																																																																																																																																																																																			
0330	Dental Procedures	S	9.5583	$663.54	.	$132.71																																																																																																																																																																																																																			
0331	Combined Abdomen and Pelvis CT without Contrast 	S	5.8040	$402.91	$155.78	$80.59																																																																																																																																																																																																																			
0332	Computed Tomography without Contrast	S	2.7424	$190.38	$73.61	$38.08																																																																																																																																																																																																																			
0333	Computed Tomography without Contrast followed by Contrast	S	4.7716	$331.24	$115.09	$66.25																																																																																																																																																																																																																			
0334	Combined Abdomen and Pelvis CT with Contrast 	S	8.2338	$571.59	$184.21	$114.32																																																																																																																																																																																																																			
0336	Magnetic Resonance Imaging and Magnetic Resonance Angiography without Contrast	S	4.8219	$334.74	$131.90	$66.95																																																																																																																																																																																																																			
0337	Magnetic Resonance Imaging and Magnetic Resonance Angiography without Contrast followed by Contrast	S	7.6393	$530.32	$196.43	$106.07																																																																																																																																																																																																																			
0340	Minor Ancillary Procedures	X	0.6739	$46.78	.	$9.36																																																																																																																																																																																																																			
0341	Skin Tests	X	0.0776	$5.39	$2.02	$1.08																																																																																																																																																																																																																			
0342	Level I Pathology	X	0.1639	$11.38	.	$2.28																																																																																																																																																																																																																			
0343	Level III Pathology	X	0.5225	$36.27	$10.78	$7.26																																																																																																																																																																																																																			
0344	Level IV Pathology	X	0.8204	$56.95	$15.56	$11.39																																																																																																																																																																																																																			
0345	Level I Transfusion Laboratory Procedures	X	0.2109	$14.64	.	$2.93																																																																																																																																																																																																																			
0346	Level II Transfusion Laboratory Procedures	X	0.3580	$24.85	.	$4.97																																																																																																																																																																																																																			
0347	Level III Transfusion Laboratory Procedures	X	0.6541	$45.41	.	$9.09																																																																																																																																																																																																																			
0350	Administration of flu and PPV vaccine	S	0.3780	$26.24	.	$0.00																																																																																																																																																																																																																			
0360	Level I Alimentary Tests	X	1.7147	$119.03	$33.57	$23.81																																																																																																																																																																																																																			
0361	Level II Alimentary Tests	X	4.1026	$284.80	$83.23	$56.96																																																																																																																																																																																																																			
0363	Level I Otorhinolaryngologic Function Tests	X	0.9462	$65.69	$17.10	$13.14																																																																																																																																																																																																																			
0364	Level I Audiometry	X	0.4896	$33.99	$7.06	$6.80																																																																																																																																																																																																																			
0365	Level II Audiometry	X	1.2340	$85.66	$18.14	$17.14																																																																																																																																																																																																																			
0366	Level III Audiometry	X	1.6976	$117.85	$23.61	$23.57																																																																																																																																																																																																																			
0367	Level I Pulmonary Test	X	0.7369	$51.16	$13.76	$10.24																																																																																																																																																																																																																			
0368	Level II Pulmonary Tests	X	0.8927	$61.97	$20.93	$12.40																																																																																																																																																																																																																			
0369	Level III Pulmonary Tests	X	2.6420	$183.41	$37.27	$36.69																																																																																																																																																																																																																			
0370	Allergy Tests	X	1.3506	$93.76	.	$18.76																																																																																																																																																																																																																			
0373	Level I Neuropsychological Testing	X	1.3767	$95.57	.	$19.12																																																																																																																																																																																																																			
0375	Ancillary Outpatient Services When Patient Expires	S	79.4058	"$5,512.35"	.	"$1,102.47"																																																																																																																																																																																																																			
0377	Level II Cardiac Imaging	S	9.7483	$676.73	.	$135.35																																																																																																																																																																																																																			
0378	Level II Pulmonary Imaging	S	4.5059	$312.80	$120.71	$62.56																																																																																																																																																																																																																			
0381	Single Allergy Tests	X	0.4731	$32.84	.	$6.57																																																																																																																																																																																																																			
0382	Level II Neuropsychological Testing	X	2.6658	$185.06	.	$37.02																																																																																																																																																																																																																			
0383	Cardiac Computed Tomographic Imaging	S	3.7294	$258.89	.	$51.78																																																																																																																																																																																																																			
0384	GI Procedures with Stents	T	29.0233	"$2,014.80"	.	$402.96																																																																																																																																																																																																																			
0385	Level I Prosthetic Urological Procedures	S	103.8680	"$7,210.52"	.	"$1,442.11"																																																																																																																																																																																																																			
0386	Level II Prosthetic Urological Procedures	S	168.5335	"$11,699.60"	.	"$2,339.92"																																																																																																																																																																																																																			
0387	Level II Hysteroscopy	T	37.9124	"$2,631.88"	$650.74	$526.38																																																																																																																																																																																																																			
0388	Discography	S	23.0551	"$1,600.49"	.	$320.10																																																																																																																																																																																																																			
0389	Level I Non-imaging Nuclear Medicine	S	1.5133	$105.05	$26.88	$21.01																																																																																																																																																																																																																			
0390	Level I Endocrine Imaging	S	1.8660	$129.54	$46.52	$25.91																																																																																																																																																																																																																			
0391	Level II Endocrine Imaging	S	3.1750	$220.41	$65.46	$44.09																																																																																																																																																																																																																			
0392	Level II Non-imaging Nuclear Medicine	S	2.5360	$176.05	$42.39	$35.21																																																																																																																																																																																																																			
0393	Hematologic Processing & Studies	S	6.3038	$437.61	.	$87.53																																																																																																																																																																																																																			
0394	Hepatobiliary Imaging	S	4.1587	$288.70	$90.78	$57.74																																																																																																																																																																																																																			
0395	GI Tract Imaging	S	3.4576	$240.03	$87.01	$48.01																																																																																																																																																																																																																			
0396	Bone Imaging	S	3.5140	$243.94	$93.91	$48.79																																																																																																																																																																																																																			
0397	Vascular Imaging	S	2.4220	$168.14	$38.85	$33.63																																																																																																																																																																																																																			
0398	Level I Cardiac Imaging	S	4.2252	$293.31	$93.33	$58.67																																																																																																																																																																																																																			
0400	Hematopoietic Imaging	S	3.7132	$257.77	$91.24	$51.56																																																																																																																																																																																																																			
0401	Level I Pulmonary Imaging	S	2.8425	$197.33	$71.16	$39.47																																																																																																																																																																																																																			
0402	Level II Nervous System Imaging	S	8.7081	$604.52	.	$120.91																																																																																																																																																																																																																			
0403	Level I Nervous System Imaging	S	3.3656	$233.64	$70.43	$46.73																																																																																																																																																																																																																			
0404	Renal and Genitourinary Studies	S	4.5715	$317.35	$81.14	$63.47																																																																																																																																																																																																																			
0406	Level I Tumor/Infection Imaging	S	4.0374	$280.28	$85.03	$56.06																																																																																																																																																																																																																			
0407	Level I Radionuclide Therapy	S	3.2808	$227.75	$78.13	$45.55																																																																																																																																																																																																																			
0408	Level III Tumor/Infection Imaging	S	13.7263	$952.88	.	$190.58																																																																																																																																																																																																																			
0409	Red Blood Cell Tests	X	0.1103	$7.66	$2.16	$1.54																																																																																																																																																																																																																			
0412	IMRT Treatment Delivery	S	6.4422	$447.22	.	$89.45																																																																																																																																																																																																																			
0413	Level II Radionuclide Therapy	S	4.0894	$283.89	.	$56.78																																																																																																																																																																																																																			
0414	Level II Tumor/Infection Imaging	S	6.9811	$484.63	.	$96.93																																																																																																																																																																																																																			
0415	Level II Endoscopy Lower Airway	T	29.1250	"$2,021.86"	$459.92	$404.38																																																																																																																																																																																																																			
0419	Level II Upper GI Procedures 	T	12.5693	$872.56	$204.51	$174.52																																																																																																																																																																																																																			
0422	Level III Upper GI Procedures	T	25.4890	"$1,769.45"	.	$353.89																																																																																																																																																																																																																			
0423	Level II Percutaneous Abdominal and Biliary Procedures	T	57.1703	"$3,968.76"	.	$793.76																																																																																																																																																																																																																			
0424	Level II Small Intestine Endoscopy 	T	15.8412	"$1,099.70"	$239.49	$219.94																																																																																																																																																																																																																			
0425	Level II Arthroplasty or Implantation with Prosthesis	T	130.4476	"$9,055.67"	.	"$1,811.14"																																																																																																																																																																																																																			
0426	Level II Strapping and Cast Application	S	2.7059	$187.84	.	$37.57																																																																																																																																																																																																																			
0427	Level II Tube or Catheter Changes or Repositioning	T	16.2153	"$1,125.67"	.	$225.14																																																																																																																																																																																																																			
0428	Level III Sigmoidoscopy and Anoscopy	T	23.9719	"$1,664.13"	.	$332.83																																																																																																																																																																																																																			
0429	Level V Cystourethroscopy and other Genitourinary Procedures	T	45.8647	"$3,183.93"	.	$636.79																																																																																																																																																																																																																			
0432	Health and Behavior Services	S	0.4940	$34.29	.	$6.86																																																																																																																																																																																																																			
0433	Level II Pathology	X	0.2464	$17.11	$5.17	$3.43																																																																																																																																																																																																																			
0434	Cardiac Defect Repair	T	166.2005	"$11,537.64"	.	"$2,307.53"																																																																																																																																																																																																																			
0436	Level I Drug Administration	S	0.3780	$26.24	.	$5.25																																																																																																																																																																																																																			
0437	Level II Drug Administration	S	0.5280	$36.65	.	$7.33																																																																																																																																																																																																																			
0438	Level III Drug Administration	S	1.0547	$73.22	.	$14.65																																																																																																																																																																																																																			
0439	Level IV Drug Administration	S	1.9117	$132.71	.	$26.55																																																																																																																																																																																																																			
0440	Level V Drug Administration	S	3.0395	$211.00	.	$42.20																																																																																																																																																																																																																			
0442	Dosimetric Drug Administration	S	22.9208	"$1,591.16"	.	$318.24																																																																																																																																																																																																																			
0604	Level 1 Hospital Clinic Visits	V	0.6941	$48.18	.	$9.64																																																																																																																																																																																																																			
0605	Level 2 Hospital Clinic Visits	V	1.0430	$72.41	.	$14.49																																																																																																																																																																																																																			
0606	Level 3 Hospital Clinic Visits	V	1.4647	$101.68	.	$20.34																																																																																																																																																																																																																			
0607	Level 4 Hospital Clinic Visits	V	1.9242	$133.58	.	$26.72																																																																																																																																																																																																																			
0608	Level 5 Hospital Clinic Visits	V	2.4718	$171.59	.	$34.32																																																																																																																																																																																																																			
0609	Level 1 Type A Emergency Visits	V	0.7290	$50.61	$12.12	$10.13																																																																																																																																																																																																																			
0613	Level 2 Type A Emergency Visits	V	1.2424	$86.25	$20.73	$17.25																																																																																																																																																																																																																			
0614	Level 3 Type A Emergency Visits	V	1.9769	$137.24	$33.86	$27.45																																																																																																																																																																																																																			
0615	Level 4 Type A Emergency Visits	V	3.1815	$220.86	$48.11	$44.18																																																																																																																																																																																																																			
0616	Level 5 Type A Emergency Visits	V	4.7283	$328.24	$72.57	$65.65																																																																																																																																																																																																																			
0617	Critical Care	S	6.8172	$473.25	$104.95	$94.65																																																																																																																																																																																																																			
0618	Trauma Response with Critical Care	S	11.6401	$808.06	.	$161.62																																																																																																																																																																																																																			
0621	Level I Vascular Access Procedures	T	11.1622	$774.88	.	$154.98																																																																																																																																																																																																																			
0622	Level II Vascular Access Procedures	T	25.1290	"$1,744.46"	.	$348.90																																																																																																																																																																																																																			
0623	Level III Vascular Access Procedures	T	30.2967	"$2,103.20"	.	$420.64																																																																																																																																																																																																																			
0624	Phlebotomy and Minor Vascular Access Device Procedures	X	0.6235	$43.28	$12.56	$8.66																																																																																																																																																																																																																			
0626	Level 1 Type B Emergency Visits	V	0.5673	$39.38	.	$7.88																																																																																																																																																																																																																			
0627	Level 2 Type B Emergency Visits	V	0.8183	$56.81	.	$11.37																																																																																																																																																																																																																			
0628	Level 3 Type B Emergency Visits	V	1.3027	$90.43	.	$18.09																																																																																																																																																																																																																			
0629	Level 4 Type B Emergency Visits	V	1.9652	$136.42	.	$27.29																																																																																																																																																																																																																			
0630	Level 5 Type B Emergency Visits	V	3.7640	$261.30	.	$52.26																																																																																																																																																																																																																			
0648	Level IV Breast Surgery	T	61.6690	"$4,281.06"	.	$856.22																																																																																																																																																																																																																			
0651	Complex Interstitial Radiation Source Application	S	12.4760	$866.08	.	$173.22																																																																																																																																																																																																																			
0652	Insertion of Intraperitoneal and Pleural Catheters	T	30.6257	"$2,126.04"	.	$425.21																																																																																																																																																																																																																			
0653	Vascular Reconstruction/Fistula Repair with Device	T	43.1404	"$2,994.81"	.	$598.97																																																																																																																																																																																																																			
0654	Insertion/Replacement of a Permanent Dual Chamber Pacemaker	T	100.4629	"$6,974.13"	.	"$1,394.83"																																																																																																																																																																																																																			
0655	Insertion/Replacement/Conversion of a Permanent Dual Chamber Pacemaker or Pacing Electrode	T	136.0608	"$9,445.34"	.	"$1,889.07"																																																																																																																																																																																																																			
0656	Transcatheter Placement of Intracoronary Drug-Eluting Stents	T	104.4584	"$7,251.50"	.	"$1,450.30"																																																																																																																																																																																																																			
0659	Hyperbaric Oxygen	S	1.4834	$102.98	.	$20.60																																																																																																																																																																																																																			
0660	Level II Otorhinolaryngologic Function Tests	X	1.8827	$130.70	$27.10	$26.14																																																																																																																																																																																																																			
0661	Level V Pathology	X	2.3755	$164.91	.	$32.99																																																																																																																																																																																																																			
0662	CT Angiography	S	4.8432	$336.21	$113.59	$67.25																																																																																																																																																																																																																			
0664	Level I Proton Beam Radiation Therapy	S	14.2952	$992.37	.	$198.48																																																																																																																																																																																																																			
0665	Bone Density:AppendicularSkeleton	S	0.4570	$31.72	.	$0.00																																																																																																																																																																																																																			
0667	Level II Proton Beam Radiation Therapy	S	18.7001	"$1,298.16"	.	$259.64																																																																																																																																																																																																																			
0668	Level I Angiography and Venography	S	9.4312	$654.71	.	$130.95																																																																																																																																																																																																																			
0672	Level III Posterior Segment Eye Procedures	T	41.3248	"$2,868.77"	.	$573.76																																																																																																																																																																																																																			
0673	Level V Anterior Segment Eye Procedures	T	41.7832	"$2,900.59"	$632.65	$580.12																																																																																																																																																																																																																			
0674	Prostate Cryoablation	T	111.0864	"$7,711.62"	.	"$1,542.33"																																																																																																																																																																																																																			
0676	Thrombolysis and Other Device Revisions 	T	2.3410	$162.51	.	$32.51																																																																																																																																																																																																																			
0678	External Counterpulsation	T	1.3160	$91.36	.	$18.28																																																																																																																																																																																																																			
0679	Level II Resuscitation and Cardioversion	S	5.3123	$368.78	$94.48	$73.76																																																																																																																																																																																																																			
0680	Insertion of Patient Activated Event Recorders	S	78.4050	"$5,442.88"	.	"$1,088.58"																																																																																																																																																																																																																			
0683	Level II Photochemotherapy	S	2.9704	$206.21	.	$41.25																																																																																																																																																																																																																			
0685	Level III Needle Biopsy/Aspiration Except Bone Marrow	T	9.7281	$675.32	.	$135.07																																																																																																																																																																																																																			
0687	Revision/Removal of Neurostimulator Electrodes	T	20.7466	"$1,440.23"	$382.52	$288.05																																																																																																																																																																																																																			
0688	Revision/Removal of Neurostimulator Pulse Generator Receiver	T	31.3873	"$2,178.91"	$768.94	$435.79																																																																																																																																																																																																																			
0690	Level I Electronic Analysis of Devices	S	0.5148	$35.74	$8.67	$7.15																																																																																																																																																																																																																			
0691	Level III Electronic Analysis of Devices	S	2.4153	$167.67	.	$33.54																																																																																																																																																																																																																			
0692	Level II Electronic Analysis of Devices	S	1.6659	$115.65	.	$23.13																																																																																																																																																																																																																			
0694	Mohs Surgery	T	5.3689	$372.71	$91.69	$74.55																																																																																																																																																																																																																			
0697	Level I Echocardiogram Without Contrast 	S	3.1535	$218.92	.	$43.79																																																																																																																																																																																																																			
0698	Level II Eye Tests & Treatments	S	1.4030	$97.40	.	$19.48																																																																																																																																																																																																																			
0699	Level IV Eye Tests & Treatments	T	15.6140	"$1,083.92"	.	$216.79																																																																																																																																																																																																																			
0701	Sr89 strontium	K		$641.83	.	$128.37																																																																																																																																																																																																																			
0726	Dexrazoxane HCl injection	K		$274.42	.	$54.89																																																																																																																																																																																																																			
0728	Filgrastim 300 mcg injection	K		$238.72	.	$47.75																																																																																																																																																																																																																			
0731	Sargramostim injection	K		$23.62	.	$4.73																																																																																																																																																																																																																			
0735	Ampho b cholesteryl sulfate	K		$13.74	.	$2.75																																																																																																																																																																																																																			
0736	Amphotericin b liposome inj	K		$14.77	.	$2.96																																																																																																																																																																																																																			
0738	Rasburicase	K		$183.08	.	$36.62																																																																																																																																																																																																																			
0747	Chlorothiazide sodium inj	K		$272.64	.	$54.53																																																																																																																																																																																																																			
0751	Mechlorethamine hcl inj	K		$154.88	.	$30.98																																																																																																																																																																																																																			
0752	Dactinomycin injection	K		$529.42	.	$105.89																																																																																																																																																																																																																			
0759	"Naltrexone, depot form"	K		$2.77	.	$0.56																																																																																																																																																																																																																			
0800	Leuprolide acetate	K		$547.54	.	$109.51																																																																																																																																																																																																																			
0802	Etoposide oral	K		$34.34	.	$6.87																																																																																																																																																																																																																			
0807	Aldesleukin injection	K		$915.45	.	$183.09																																																																																																																																																																																																																			
0809	Bcg live intravesical vac	K		$114.38	.	$22.88																																																																																																																																																																																																																			
0810	Goserelin acetate implant	K		$195.16	.	$39.04																																																																																																																																																																																																																			
0812	Carmustine injection	K		$172.56	.	$34.52																																																																																																																																																																																																																			
0814	Asparaginase injection	K		$62.07	.	$12.42																																																																																																																																																																																																																			
0820	Daunorubicin injection	K		$13.16	.	$2.64																																																																																																																																																																																																																			
0821	Daunorubicin citrate inj	K		$56.58	.	$11.32																																																																																																																																																																																																																			
0823	Docetaxel injection	K		$20.84	.	$4.17																																																																																																																																																																																																																			
0825	Nelarabine injection	K		$110.19	.	$22.04																																																																																																																																																																																																																			
0827	Floxuridine injection	K		$36.60	.	$7.32																																																																																																																																																																																																																			
0828	Gemcitabine hcl injection	K		$111.40	.	$22.28																																																																																																																																																																																																																			
0831	Ifosfomide injection	K		$31.21	.	$6.25																																																																																																																																																																																																																			
0832	Idarubicin hcl injection	K		$46.43	.	$9.29																																																																																																																																																																																																																			
0835	Cosyntropin injection NOS	K		$99.76	.	$19.96																																																																																																																																																																																																																			
0836	Interferon alfa-2b inj	K		$16.19	.	$3.24																																																																																																																																																																																																																			
0838	Interferon gamma 1-b inj	K		$549.62	.	$109.93																																																																																																																																																																																																																			
0840	Inj melphalan hydrochl	K		"$1,272.01"	.	$254.41																																																																																																																																																																																																																			
0843	Pegaspargase injection	K		"$2,675.40"	.	$535.08																																																																																																																																																																																																																			
0844	Pentostatin injection	K		"$1,068.16"	.	$213.64																																																																																																																																																																																																																			
0849	Rituximab injection	K		$599.16	.	$119.84																																																																																																																																																																																																																			
0850	Streptozocin injection	K		$264.81	.	$52.97																																																																																																																																																																																																																			
0851	Thiotepa injection	K		$106.54	.	$21.31																																																																																																																																																																																																																			
0856	Porfimer sodium injection	K		"$3,017.82"	.	$603.57																																																																																																																																																																																																																			
0858	Inj cladribine	K		$23.59	.	$4.72																																																																																																																																																																																																																			
0861	Leuprolide acetate injeciton	K		$4.88	.	$0.98																																																																																																																																																																																																																			
0864	Mitoxantrone hydrochl	K		$33.95	.	$6.79																																																																																																																																																																																																																			
0865	Interferon alfa-n3 inj	K		$20.87	.	$4.18																																																																																																																																																																																																																			
0868	Oral aprepitant	K		$5.90	.	$1.18																																																																																																																																																																																																																			
0873	Hyalgan/supartz inj per dose	K		$88.80	.	$17.76																																																																																																																																																																																																																			
0874	Synvisc or synvisc-one	K		$11.81	.	$2.37																																																																																																																																																																																																																			
0875	Euflexxa inj per dose	K		$147.16	.	$29.44																																																																																																																																																																																																																			
0877	Orthovisc inj per dose	K		$167.00	.	$33.40																																																																																																																																																																																																																			
0884	Rho d immune globulin inj	K		$82.16	.	$16.44																																																																																																																																																																																																																			
0887	Azathioprine parenteral	K		$104.77	.	$20.96																																																																																																																																																																																																																			
0890	Lymphocyte immune globulin	K		$542.36	.	$108.48																																																																																																																																																																																																																			
0900	Alglucerase injection	K		$41.19	.	$8.24																																																																																																																																																																																																																			
0901	Alpha 1 proteinase inhibitor	K		$3.79	.	$0.76																																																																																																																																																																																																																			
0902	"Injection,onabotulinumtoxinA"	K		$5.38	.	$1.08																																																																																																																																																																																																																			
0903	Cytomegalovirus imm IV /vial	K		$922.07	.	$184.42																																																																																																																																																																																																																			
0910	Interferon beta-1b / .25 MG	K		$197.14	.	$39.43																																																																																																																																																																																																																			
0913	Ganciclovir long act implant	K		"$16,640.00"	.	"$3,328.00"																																																																																																																																																																																																																			
0917	Adenosine injection	K		$89.99	.	$18.00																																																																																																																																																																																																																			
0925	Factor viii	K		$0.87	.	$0.18																																																																																																																																																																																																																			
0927	Factor viii recombinant	K		$1.09	.	$0.22																																																																																																																																																																																																																			
0928	Factor ix complex	K		$0.85	.	$0.17																																																																																																																																																																																																																			
0929	Anti-inhibitor	K		$1.57	.	$0.32																																																																																																																																																																																																																			
0931	Factor IX non-recombinant	K		$0.88	.	$0.18																																																																																																																																																																																																																			
0932	Factor IX recombinant	K		$1.13	.	$0.23																																																																																																																																																																																																																			
0933	Gamma globulin > 10 CC inj	K		$179.06	.	$35.82																																																																																																																																																																																																																			
0934	"Capecitabine, oral"	K		$22.48	.	$4.50																																																																																																																																																																																																																			
0943	Octagam injection	K		$55.80	.	$11.16																																																																																																																																																																																																																			
0944	Gammagard liquid injection	K		$37.67	.	$7.54																																																																																																																																																																																																																			
0945	Rhophylac injection	K		$5.09	.	$1.02																																																																																																																																																																																																																			
0946	Hepagam b im injection	K		$57.07	.	$11.42																																																																																																																																																																																																																			
0947	Flebogamma injection	K		$35.04	.	$7.01																																																																																																																																																																																																																			
0948	Gamunex injection	K		$36.91	.	$7.39																																																																																																																																																																																																																			
0949	"Frozen plasma, pooled, sd"	R	1.0221	$70.95	.	$14.19																																																																																																																																																																																																																			
0950	Whole blood for transfusion	R	2.7926	$193.86	.	$38.78																																																																																																																																																																																																																			
0951	Reclast injection	K		$218.47	.	$43.70																																																																																																																																																																																																																			
0952	Cryoprecipitate each unit	R	1.0975	$76.19	.	$15.24																																																																																																																																																																																																																			
0954	RBC leukocytes reduced	R	2.8046	$194.70	.	$38.94																																																																																																																																																																																																																			
0955	"Plasma, frz between 8-24hour"	R	1.0092	$70.06	.	$14.02																																																																																																																																																																																																																			
0956	"Plasma protein fract,5%,50ml"	R	0.2513	$17.45	.	$3.49																																																																																																																																																																																																																			
0957	"Platelets, each unit"	R	1.2522	$86.93	.	$17.39																																																																																																																																																																																																																			
0958	Plaelet rich plasma unit	R	1.9703	$136.78	.	$27.36																																																																																																																																																																																																																			
0959	Red blood cells unit	R	2.1382	$148.43	.	$29.69																																																																																																																																																																																																																			
0960	Washed red blood cells unit	R	4.0969	$284.41	.	$56.89																																																																																																																																																																																																																			
0961	"Albumin (human),5%, 50ml"	K		$20.37	.	$4.08																																																																																																																																																																																																																			
0963	"Albumin (human), 5%, 250 ml"	K		$67.07	.	$13.42																																																																																																																																																																																																																			
0964	"Albumin (human), 25%, 20 ml"	K		$29.16	.	$5.84																																																																																																																																																																																																																			
0965	"Albumin (human), 25%, 50ml"	K		$70.39	.	$14.08																																																																																																																																																																																																																			
0966	"Plasmaprotein fract,5%,250ml"	R	1.2214	$84.79	.	$16.96																																																																																																																																																																																																																			
0967	Blood split unit	R	2.2455	$155.88	.	$31.18																																																																																																																																																																																																																			
0968	Platelets leukoreduced irrad	R	2.0418	$141.74	.	$28.35																																																																																																																																																																																																																			
0969	RBC leukoreduced irradiated	R	3.7077	$257.39	.	$51.48																																																																																																																																																																																																																			
1009	Cryoprecipitatereducedplasma	R	1.1839	$82.19	.	$16.44																																																																																																																																																																																																																			
1010	"Blood, l/r, cmv-neg"	R	2.7475	$190.73	.	$38.15																																																																																																																																																																																																																			
1011	"Platelets, hla-m, l/r, unit"	R	11.4189	$792.70	.	$158.54																																																																																																																																																																																																																			
1013	Platelets leukocytes reduced	R	1.7459	$121.20	.	$24.24																																																																																																																																																																																																																			
1015	Injection glatiramer acetate	K		$95.57	.	$19.12																																																																																																																																																																																																																			
1016	"Blood, l/r, froz/degly/wash"	R	1.8650	$129.47	.	$25.90																																																																																																																																																																																																																			
1017	"Plt, aph/pher, l/r, cmv-neg"	R	5.7123	$396.55	.	$79.31																																																																																																																																																																																																																			
1018	"Blood, l/r, irradiated"	R	2.1603	$149.97	.	$30.00																																																																																																																																																																																																																			
1019	Plate pheres leukoredu irrad	R	9.9046	$687.58	.	$137.52																																																																																																																																																																																																																			
1020	"Plt, pher, l/r cmv-neg, irr"	R	8.6696	$601.84	.	$120.37																																																																																																																																																																																																																			
1021	"RBC, frz/deg/wsh, l/r, irrad"	R	6.2606	$434.61	.	$86.93																																																																																																																																																																																																																			
1022	"RBC, l/r, cmv-neg, irrad"	R	4.0635	$282.09	.	$56.42																																																																																																																																																																																																																			
1023	Pralidoxime chloride inj	K		$88.57	.	$17.72																																																																																																																																																																																																																			
1052	"Injection, voriconazole"	K		$6.02	.	$1.21																																																																																																																																																																																																																			
1064	"I131 iodide cap, rx"	K		$17.58	.	$3.52																																																																																																																																																																																																																			
1083	Adalimumab injection	K		$394.16	.	$78.84																																																																																																																																																																																																																			
1084	Denileukin diftitox inj	K		"$1,559.54"	.	$311.91																																																																																																																																																																																																																			
1086	Temozolomide	K		$9.31	.	$1.87																																																																																																																																																																																																																			
1138	"Hepagam b intravenous, inj"	K		$57.07	.	$11.42																																																																																																																																																																																																																			
1139	Protein c concentrate	K		$12.50	.	$2.50																																																																																																																																																																																																																			
1142	Supprelin LA implant	K		"$15,184.53"	.	"$3,036.91"																																																																																																																																																																																																																			
1150	"I131 iodide sol, rx"	K		$13.26	.	$2.66																																																																																																																																																																																																																			
1166	Cytarabine liposome inj	K		$479.02	.	$95.81																																																																																																																																																																																																																			
1167	"Inj, epirubicin hcl"	K		$1.87	.	$0.38																																																																																																																																																																																																																			
1168	"Inj, temsirolimus"	K		$49.87	.	$9.98																																																																																																																																																																																																																			
1178	Busulfan injection	K		$16.29	.	$3.26																																																																																																																																																																																																																			
1203	Verteporfin injection	K		$9.55	.	$1.91																																																																																																																																																																																																																			
1207	"Octreotide injection, depot"	K		$113.48	.	$22.70																																																																																																																																																																																																																			
1213	Antihemophilic viii/vwf comp	K		$0.90	.	$0.18																																																																																																																																																																																																																			
1214	Inj IVIG privigen 500 mg	K		$34.45	.	$6.89																																																																																																																																																																																																																			
1221	Dimethyl sulfoxide 50%	K		$82.68	.	$16.54																																																																																																																																																																																																																			
1222	Pentastarch 10% solution	K		$158.76	.	$31.76																																																																																																																																																																																																																			
1226	Inj streptokinase /250000 IU	K		$47.57	.	$9.52																																																																																																																																																																																																																			
1232	Mitomycin 5 MG inj	K		$20.36	.	$4.08																																																																																																																																																																																																																			
1235	Valrubicin injection	K		$946.64	.	$189.33																																																																																																																																																																																																																			
1236	Levoleucovorin injection	K		$1.78	.	$0.36																																																																																																																																																																																																																			
1237	Inj iron dextran	K		$11.59	.	$2.32																																																																																																																																																																																																																			
1238	Topotecan oral	K		$76.40	.	$15.28																																																																																																																																																																																																																			
1239	Rotavirus vacc 2 dose oral	K		$100.56	.	$20.12																																																																																																																																																																																																																			
1240	Apligraf skin sub	K		$34.06	.	$6.82																																																																																																																																																																																																																			
1241	Oasis wound matrix skin sub	K		$4.68	.	$0.94																																																																																																																																																																																																																			
1243	Integra BMWD skin sub	K		$15.45	.	$3.09																																																																																																																																																																																																																			
1244	Integra DRT skin sub	K		$10.95	.	$2.19																																																																																																																																																																																																																			
1245	Dermagraft skin sub	K		$39.39	.	$7.88																																																																																																																																																																																																																			
1246	Graftjacket skin sub	K		$92.79	.	$18.56																																																																																																																																																																																																																			
1247	Integra matrix skin sub	K		$20.95	.	$4.19																																																																																																																																																																																																																			
1248	Primatrix skin sub	K		$31.67	.	$6.34																																																																																																																																																																																																																			
1249	Cymetra allograft	K		$334.07	.	$66.82																																																																																																																																																																																																																			
1250	Graftjacket express allograf	K		$334.07	.	$66.82																																																																																																																																																																																																																			
1251	Integra flowable wound matri	K		$972.75	.	$194.55																																																																																																																																																																																																																			
1252	Gammagraft skin sub	K		$7.17	.	$1.44																																																																																																																																																																																																																			
1253	Triamcinolone A inj PRS-free	K		$3.17	.	$0.64																																																																																																																																																																																																																			
1263	Antithrombin iii injection	K		$2.48	.	$0.50																																																																																																																																																																																																																			
1268	Xyntha inj	K		$1.05	.	$0.21																																																																																																																																																																																																																			
1270	Alloderm skin sub	K		$31.11	.	$6.23																																																																																																																																																																																																																			
1272	Acetylcysteine injection	K 		$2.67	.	$0.54																																																																																																																																																																																																																			
1274	Edetate calcium disodium inj	K 		$192.07	.	$38.42																																																																																																																																																																																																																			
1275	"Vivaglobin, inj"	K 		$7.11	.	$1.43																																																																																																																																																																																																																			
1279	Factor VIII (porcine)	K		$1.17	.	$0.24																																																																																																																																																																																																																			
1280	Corticotropin injection	K		"$2,395.22"	.	$479.05																																																																																																																																																																																																																			
1281	Bevacizumab injection	K		$1.47	.	$0.30																																																																																																																																																																																																																			
1287	Alloskin skin sub	K		$6.07	.	$1.22																																																																																																																																																																																																																			
1289	AbobotulinumtoxinA	K		$7.41	.	$1.49																																																																																																																																																																																																																			
1290	Human fibrinogen conc inj	K		$71.52	.	$14.31																																																																																																																																																																																																																			
1291	Rilonacept injection	K		$23.63	.	$4.73																																																																																																																																																																																																																			
1295	Sm 153 lexidronam	K		"$7,555.71"	.	"$1,511.15"																																																																																																																																																																																																																			
1296	Degarelix injection	K		$2.79	.	$0.56																																																																																																																																																																																																																			
1297	"Ferumoxytol, non-esrd"	K		$0.69	.	$0.14																																																																																																																																																																																																																			
1304	Perphenazine injeciton	K		$30.91	.	$6.19																																																																																																																																																																																																																			
1306	Urea injection	K		$82.18	.	$16.44																																																																																																																																																																																																																			
1307	Oral busulfan	K		$3.59	.	$0.72																																																																																																																																																																																																																			
1308	Mecasermin injection	K		$20.18	.	$4.04																																																																																																																																																																																																																			
1311	Canakinumab injection	K		$87.45	.	$17.49																																																																																																																																																																																																																			
1312	Hizentra injection	K		$7.15	.	$1.43																																																																																																																																																																																																																			
1327	Imiglucerase injection	K		$41.19	.	$8.24																																																																																																																																																																																																																			
1331	Olanzapine long-acting inj	K		$2.70	.	$0.54																																																																																																																																																																																																																			
1332	Antithrombin recombinant	K		$101.40	.	$20.28																																																																																																																																																																																																																			
1338	"Methyl aminolevulinate, top"	K		$68.27	.	$13.66																																																																																																																																																																																																																			
1339	Oral fludarabine phosphate	G		$79.44	.	$15.89																																																																																																																																																																																																																			
1340	"Collagenase, clost hist inj"	G		$37.51	.	$7.51																																																																																																																																																																																																																			
1341	Amobarbital 125 MG inj	K		$23.38	.	$4.68																																																																																																																																																																																																																			
1342	Matristem micromatrix	K		$3.13	.	$0.63																																																																																																																																																																																																																			
1343	Ganciclovir sodium injection	K		$62.51	.	$12.51																																																																																																																																																																																																																			
1344	Gonadorelin hydroch/ 100 mcg	K		$94.82	.	$18.97																																																																																																																																																																																																																			
1345	Theraskin	K		$20.32	.	$4.07																																																																																																																																																																																																																			
1349	Anidulafungin injection	K		$1.29	.	$0.26																																																																																																																																																																																																																			
1350	Topotecan injection	K		$19.30	.	$3.86																																																																																																																																																																																																																			
1351	Matristem wound matrix	K		$6.04	.	$1.21																																																																																																																																																																																																																			
1355	Itraconazole injection	K		$359.59	.	$71.92																																																																																																																																																																																																																			
1356	Inj desmopressin acetate	K		$3.93	.	$0.79																																																																																																																																																																																																																			
1357	Inj protirelin per 250 mcg	K		$27.03	.	$5.41																																																																																																																																																																																																																			
1358	Phentolaine mesylate inj	K		$56.35	.	$11.27																																																																																																																																																																																																																			
1359	Foscarnet sodium injection	K		$13.06	.	$2.62																																																																																																																																																																																																																			
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		$515.32	.	$103.07																																																																																																																																																																																																																			
1607	Eptifibatide injection	K		$20.31	.	$4.07																																																																																																																																																																																																																			
1608	Etanercept injection	K		$203.01	.	$40.61																																																																																																																																																																																																																			
1609	"Rho(D) immune globulin h, sd"	K		$18.83	.	$3.77																																																																																																																																																																																																																			
1612	"Daclizumab, parenteral"	K		$516.41	.	$103.29																																																																																																																																																																																																																			
1613	Trastuzumab injection	K		$69.06	.	$13.82																																																																																																																																																																																																																			
1630	"Hep b ig, im"	K		$112.16	.	$22.44																																																																																																																																																																																																																			
1631	Baclofen intrathecal trial	K		$72.18	.	$14.44																																																																																																																																																																																																																			
1633	Alefacept	K		$35.86	.	$7.18																																																																																																																																																																																																																			
1643	"Y90 ibritumomab, rx"	K		"$32,078.39"	.	"$6,415.68"																																																																																																																																																																																																																			
1645	"I131 tositumomab, rx"	K		"$29,460.02"	.	"$5,892.01"																																																																																																																																																																																																																			
1670	Tetanus immune globulin inj	K		$222.97	.	$44.60																																																																																																																																																																																																																			
1675	P32 Na phosphate	K		$162.87	.	$32.58																																																																																																																																																																																																																			
1676	P32 chromic phosphate	K		$154.15	.	$30.83																																																																																																																																																																																																																			
1683	Basiliximab	K		"$2,027.27"	.	$405.46																																																																																																																																																																																																																			
1684	Corticorelin ovine triflutal	K		$5.06	.	$1.02																																																																																																																																																																																																																			
1685	"Darbepoetin alfa, non-esrd"	K		$2.98	.	$0.60																																																																																																																																																																																																																			
1686	"Epoetin alfa, non-esrd"	K		$9.57	.	$1.92																																																																																																																																																																																																																			
1687	Digoxin immune fab (ovine)	K		$583.90	.	$116.78																																																																																																																																																																																																																			
1688	Ethanolamine oleate	K		$147.14	.	$29.43																																																																																																																																																																																																																			
1689	Fomepizole	K		$6.76	.	$1.36																																																																																																																																																																																																																			
1690	Hemin	K		$8.33	.	$1.67																																																																																																																																																																																																																			
1693	Lepirudin	K		$299.56	.	$59.92																																																																																																																																																																																																																			
1694	Ziconotide injection	K		$6.48	.	$1.30																																																																																																																																																																																																																			
1695	Nesiritide injection	K		$43.93	.	$8.79																																																																																																																																																																																																																			
1696	Palifermin injection	K		$11.15	.	$2.23																																																																																																																																																																																																																			
1697	Pegaptanib sodium injection	K		"$1,002.20"	.	$200.44																																																																																																																																																																																																																			
1700	Inj secretin synthetic human	K		$26.97	.	$5.40																																																																																																																																																																																																																			
1701	Treprostinil injection	K		$60.08	.	$12.02																																																																																																																																																																																																																			
1704	"Humate-P, inj"	K		$0.87	.	$0.18																																																																																																																																																																																																																			
1705	Factor viia	K		$1.50	.	$0.30																																																																																																																																																																																																																			
1709	Azacitidine injection	K		$5.16	.	$1.04																																																																																																																																																																																																																			
1710	Clofarabine injection	K		$114.37	.	$22.88																																																																																																																																																																																																																			
1711	Vantas implant	K		"$3,223.57"	.	$644.72																																																																																																																																																																																																																			
1712	Paclitaxel protein bound	K		$9.21	.	$1.85																																																																																																																																																																																																																			
1716	"Brachytx, non-str, Gold-198"	U	1.0120	$70.25	.	$14.05																																																																																																																																																																																																																			
1717	"Brachytx, non-str, HDR Ir-192"	U	3.1681	$219.93	.	$43.99																																																																																																																																																																																																																			
1719	"Brachytx, NS, Non-HDRIr-192"	U	0.4486	$31.14	.	$6.23																																																																																																																																																																																																																			
1738	Oxaliplatin	K		$8.36	.	$1.68																																																																																																																																																																																																																			
1739	"Pegademase bovine, 25 iu"	K		$242.67	.	$48.54																																																																																																																																																																																																																			
1741	"Urofollitropin, 75 iu"	K		$63.60	.	$12.72																																																																																																																																																																																																																			
1749	"Endo, colon, retro imaging"	H			.	.																																																																																																																																																																																																																			
2210	Methyldopate hcl injection	K		$39.24	.	$7.85																																																																																																																																																																																																																			
2616	"Brachytx, non-str,Yttrium-90"	U	232.3017	"$16,126.38"	.	"$3,225.28"																																																																																																																																																																																																																			
2632	Iodine I-125 sodium iodide	U	0.2868	$19.91	.	$3.99																																																																																																																																																																																																																			
2634	"Brachytx, non-str, HA, I-125"	U	0.7908	$54.90	.	$10.98																																																																																																																																																																																																																			
2635	"Brachytx, non-str, HA, P-103"	U	0.3438	$23.87	.	$4.78																																																																																																																																																																																																																			
2636	"Brachy linear, non-str,P-103"	U	0.5112	$35.49	.	$7.10																																																																																																																																																																																																																			
2638	"Brachytx, stranded, I-125"	U	0.6225	$43.21	.	$8.65																																																																																																																																																																																																																			
2639	"Brachytx, non-stranded,I-125"	U	0.4992	$34.65	.	$6.93																																																																																																																																																																																																																			
2640	"Brachytx, stranded, P-103"	U	1.0610	$73.65	.	$14.73																																																																																																																																																																																																																			
2641	"Brachytx, non-stranded,P-103"	U	0.9263	$64.30	.	$12.86																																																																																																																																																																																																																			
2642	"Brachytx, stranded, C-131"	U	1.6922	$117.47	.	$23.50																																																																																																																																																																																																																			
2643	"Brachytx, non-stranded,C-131"	U	1.0735	$74.52	.	$14.91																																																																																																																																																																																																																			
2698	"Brachytx, stranded, NOS"	U	0.6225	$43.21	.	$8.65																																																																																																																																																																																																																			
2699	"Brachytx, non-stranded, NOS"	U	0.3438	$23.87	.	$4.78																																																																																																																																																																																																																			
2731	"Immune globulin, powder"	K		$30.62	.	$6.13																																																																																																																																																																																																																			
2770	Quinupristin/dalfopristin	K		$157.23	.	$31.45																																																																																																																																																																																																																			
3041	Bivalirudin	K		$2.54	.	$0.51																																																																																																																																																																																																																			
3043	Gamma globulin 1 CC inj	K		$17.91	.	$3.59																																																																																																																																																																																																																			
3050	Sermorelin acetate injection	K		$1.76	.	$0.36																																																																																																																																																																																																																			
7000	Amifostine	K		$314.05	.	$62.81																																																																																																																																																																																																																			
7011	Oprelvekin injection	K		$240.88	.	$48.18																																																																																																																																																																																																																			
7034	Somatropin injection	K		$56.09	.	$11.22																																																																																																																																																																																																																			
7035	Teniposide	K		$316.52	.	$63.31																																																																																																																																																																																																																			
7036	"Urokinase 250,000 IU inj"	K		$449.09	.	$89.82																																																																																																																																																																																																																			
7038	Monoclonal antibodies	K		"$1,112.14"	.	$222.43																																																																																																																																																																																																																			
7041	Tirofiban HCl	K		$8.83	.	$1.77																																																																																																																																																																																																																			
7042	"Capecitabine, oral"	K		$6.81	.	$1.37																																																																																																																																																																																																																			
7043	Infliximab injection	K		$58.90	.	$11.78																																																																																																																																																																																																																			
7046	Doxorubicin hcl liposome inj	K		$504.27	.	$100.86																																																																																																																																																																																																																			
7048	Alteplase recombinant	K		$39.22	.	$7.85																																																																																																																																																																																																																			
7049	Filgrastim 480 mcg injection	K		$376.20	.	$75.24																																																																																																																																																																																																																			
7051	Leuprolide acetate implant	K		"$4,728.88"	.	$945.78																																																																																																																																																																																																																			
7308	Aminolevulinic acid hcl top	K		$138.70	.	$27.74																																																																																																																																																																																																																			
8000	Cardiac Electrophysiologic Evaluation and Ablation Composite	T	161.2626	"$11,194.85"	.	"$2,238.97"																																																																																																																																																																																																																			
8001	LDR Prostate Brachytherapy Composite	T	46.7758	"$3,247.18"	.	$649.44																																																																																																																																																																																																																			
8002	Level I Extended Assessment & Management Composite	V	5.4881	$380.98	.	$76.20																																																																																																																																																																																																																			
8003	Level II Extended Assessment & Management Composite	V	10.2164	$709.22	.	$141.85																																																																																																																																																																																																																			
8004	Ultrasound Composite	S	2.7443	$190.51	.	$38.11																																																																																																																																																																																																																			
8005	CT and CTA without Contrast Composite	S	6.1891	$429.65	.	$85.93																																																																																																																																																																																																																			
8006	CT and CTA with Contrast Composite	S	10.3444	$718.11	.	$143.63																																																																																																																																																																																																																			
8007	MRI and MRA without Contrast Composite	S	9.9875	$693.33	.	$138.67																																																																																																																																																																																																																			
8008	MRI and MRA with Contrast Composite	S	14.3459	$995.89	.	$199.18																																																																																																																																																																																																																			
8009	Cardiac Resynchronization Therapy with Defibrillator Composite	T	379.7887	"$26,364.93"	.	"$5,272.99"																																																																																																																																																																																																																			
9001	Linezolid injection	K		$33.99	.	$6.80																																																																																																																																																																																																																			
9002	Tenecteplase injection	K		$51.95	.	$10.39																																																																																																																																																																																																																			
9004	Gemtuzumab ozogamicin inj	K		"$2,637.02"	.	$527.41																																																																																																																																																																																																																			
9005	Reteplase injection	K		"$1,332.35"	.	$266.47																																																																																																																																																																																																																			
9006	Tacrolimus injection	K		$136.85	.	$27.37																																																																																																																																																																																																																			
9012	Arsenic trioxide injection	K		$40.13	.	$8.03																																																																																																																																																																																																																			
9018	"Inj, rimabotulinumtoxinB"	K		$10.33	.	$2.07																																																																																																																																																																																																																			
9019	Caspofungin acetate	K		$12.13	.	$2.43																																																																																																																																																																																																																			
9022	IM inj interferon beta 1-a	K		$220.75	.	$44.15																																																																																																																																																																																																																			
9023	Rho d immune globulin	K		$24.81	.	$4.97																																																																																																																																																																																																																			
9024	Amphotericin b lipid complex	K		$8.76	.	$1.76																																																																																																																																																																																																																			
9032	Baclofen 10 MG injection	K		$200.54	.	$40.11																																																																																																																																																																																																																			
9033	Cidofovir injection	K		$740.09	.	$148.02																																																																																																																																																																																																																			
9038	Inj estrogen conjugate	K		$94.03	.	$18.81																																																																																																																																																																																																																			
9042	Glucagon hydrochloride	K		$95.59	.	$19.12																																																																																																																																																																																																																			
9044	Ibutilide fumarate injection	K		$129.32	.	$25.87																																																																																																																																																																																																																			
9104	Antithymocyte globuln rabbit	K		$387.17	.	$77.44																																																																																																																																																																																																																			
9108	Thyrotropin injection	K		"$1,034.03"	.	$206.81																																																																																																																																																																																																																			
9110	Alemtuzumab injection	K		$577.60	.	$115.52																																																																																																																																																																																																																			
9115	Zoledronic acid	K		$219.00	.	$43.80																																																																																																																																																																																																																			
9119	"Injection, pegfilgrastim 6mg"	K		"$2,527.87"	.	$505.58																																																																																																																																																																																																																			
9120	"Injection, Fulvestrant"	K		$81.81	.	$16.37																																																																																																																																																																																																																			
9121	"Injection, argatroban"	K		$18.71	.	$3.75																																																																																																																																																																																																																			
9122	Triptorelin pamoate	K		$193.59	.	$38.72																																																																																																																																																																																																																			
9124	Daptomycin injection	K		$0.45	.	$0.09																																																																																																																																																																																																																			
9125	"Risperidone, long acting"	K		$4.93	.	$0.99																																																																																																																																																																																																																			
9126	Natalizumab injection	K		$9.88	.	$1.98																																																																																																																																																																																																																			
9133	"Rabies ig, im/sc"	K		$159.86	.	$31.98																																																																																																																																																																																																																			
9134	"Rabies ig, heat treated"	K		$154.18	.	$30.84																																																																																																																																																																																																																			
9135	"Varicella-zoster ig, im"	K		$129.48	.	$25.90																																																																																																																																																																																																																			
9137	"Bcg vaccine, percut"	K		$112.46	.	$22.50																																																																																																																																																																																																																			
9139	"Rabies vaccine, im"	K		$190.82	.	$38.17																																																																																																																																																																																																																			
9140	"Rabies vaccine, id"	K		$107.83	.	$21.57																																																																																																																																																																																																																			
9143	"Meningococcal vaccine, sc"	K		$104.49	.	$20.90																																																																																																																																																																																																																			
9144	"Encephalitis vaccine, sc"	K		$100.16	.	$20.04																																																																																																																																																																																																																			
9145	"Meningococcal vaccine, im"	K		$83.39	.	$16.68																																																																																																																																																																																																																			
9207	Bortezomib injection	K		$39.60	.	$7.92																																																																																																																																																																																																																			
9208	Agalsidase beta injection	K		$133.65	.	$26.73																																																																																																																																																																																																																			
9209	Laronidase injection	K		$25.08	.	$5.02																																																																																																																																																																																																																			
9210	Palonosetron hcl	K		$18.51	.	$3.71																																																																																																																																																																																																																			
9213	Pemetrexed injection	K		$51.37	.	$10.28																																																																																																																																																																																																																			
9214	Bevacizumab injection	K		$58.72	.	$11.75																																																																																																																																																																																																																			
9215	Cetuximab injection	K		$49.52	.	$9.91																																																																																																																																																																																																																			
9217	Leuprolide acetate suspnsion	K		$210.96	.	$42.20																																																																																																																																																																																																																			
9224	Galsulfase injection	K		$338.26	.	$67.66																																																																																																																																																																																																																			
9225	Fluocinolone acetonide implt	K		"$18,980.00"	.	"$3,796.00"																																																																																																																																																																																																																			
9227	Micafungin sodium injection	K		$1.02	.	$0.21																																																																																																																																																																																																																			
9228	Tigecycline injection	K		$1.22	.	$0.25																																																																																																																																																																																																																			
9229	Ibandronate sodium injection	K		$144.36	.	$28.88																																																																																																																																																																																																																			
9230	Abatacept injection	K		$20.26	.	$4.06																																																																																																																																																																																																																			
9231	Decitabine injection	K		$30.71	.	$6.15																																																																																																																																																																																																																			
9232	Idursulfase injection	K		$446.45	.	$89.29																																																																																																																																																																																																																			
9233	Ranibizumab injection	K		$398.10	.	$79.62																																																																																																																																																																																																																			
9234	Alglucosidase alfa injection	K		$155.84	.	$31.17																																																																																																																																																																																																																			
9235	Panitumumab injection	K		$85.62	.	$17.13																																																																																																																																																																																																																			
9236	Eculizumab injection	K		$183.71	.	$36.75																																																																																																																																																																																																																			
9237	"Inj, lanreotide acetate"	K		$29.92	.	$5.99																																																																																																																																																																																																																			
9240	"Injection, ixabepilone"	K		$62.53	.	$12.51																																																																																																																																																																																																																			
9242	"Injection, fosaprepitant"	K		$1.71	.	$0.35																																																																																																																																																																																																																			
9243	Bendamustine injection	K		$18.15	.	$3.63																																																																																																																																																																																																																			
9244	Regadenoson injection	K		$51.36	.	$10.28																																																																																																																																																																																																																			
9245	Romiplostim injection	K		$44.84	.	$8.97																																																																																																																																																																																																																			
9248	"Inj, clevidipine butyrate"	K		$6.03	.	$1.21																																																																																																																																																																																																																			
9249	Certolizumab pegol inj	K		$3.99	.	$0.80																																																																																																																																																																																																																			
9250	Artiss fibrin sealant	K		$121.80	.	$24.36																																																																																																																																																																																																																			
9251	C1 esterase inhibitor inj	K		$43.78	.	$8.76																																																																																																																																																																																																																			
9252	Plerixafor injection	K		$278.36	.	$55.68																																																																																																																																																																																																																			
9253	Temozolomide injection	K		$4.86	.	$0.98																																																																																																																																																																																																																			
9254	"Injection, lacosamide"	K		$0.15	.	$0.03																																																																																																																																																																																																																			
9255	Paliperidone palmitate inj	K		$6.45	.	$1.29																																																																																																																																																																																																																			
9256	Dexamethasone intra implant	K		$194.17	.	$38.84																																																																																																																																																																																																																			
9258	Telavancin injection	G		$1.96	.	$0.40																																																																																																																																																																																																																			
9259	Pralatrexate injection	G		$165.63	.	$33.13																																																																																																																																																																																																																			
9260	Ofatumumab injection	G		$45.41	.	$9.09																																																																																																																																																																																																																			
9261	Ustekinumab injection	G		$112.30	.	$22.46																																																																																																																																																																																																																			
9263	Ecallantide injection	G		$275.28	.	$55.06																																																																																																																																																																																																																			
9264	Tocilizumab injection	G		$3.47	.	$0.70																																																																																																																																																																																																																			
9265	Romidepsin injection	G		$219.30	.	$43.86																																																																																																																																																																																																																			
9267	Wilate injection	G		$70.14	.	$14.03																																																																																																																																																																																																																			
9268	Capsaicin 8% patch	G		$25.55	.	$5.11																																																																																																																																																																																																																			
9269	"C-1 esterase, berinert"	G		$27.53	.	$5.51																																																																																																																																																																																																																			
9270	Gammaplex IVIG	G		$37.29	.	$7.46																																																																																																																																																																																																																			
9271	Velaglucerase alfa	G		$349.88	.	$69.98																																																																																																																																																																																																																			
9272	"Inj, denosumab"	G		$14.52	.	$2.91																																																																																																																																																																																																																			
9273	"Sipuleucel-T, per infusion"	G		"$32,860.00"	.	"$6,572.00"																																																																																																																																																																																																																			
9274	Crotalidae Poly Immune Fab	G		"$2,111.36"	.	$422.28																																																																																																																																																																																																																			
9275	Hexaminolevulinate HCl	G		$636.00	.	$0.00																																																																																																																																																																																																																			
9276	Cabazitaxel injection	G		$135.05	.	$27.01																																																																																																																																																																																																																			
9277	"Lumizyme, 1 mg"	G		$14.83	.	$2.97																																																																																																																																																																																																																			
9278	Incobotulinumtoxin A	G		$5.57	.	$1.12																																																																																																																																																																																																																			
9279	"Injection, ibuprofen"	G		$1.39	.	$0.28																																																																																																																																																																																																																			
9280	"Injection, eribulin mesylate"	G		$901.00	.	$180.20																																																																																																																																																																																																																			
9281	"Injection, pegloticase "	G		$304.75	.	$60.95																																																																																																																																																																																																																			
9282	"Injection, ceftaroline fosamil "	G		$0.72	.	$0.15																																																																																																																																																																																																																			
9300	Omalizumab injection	K		$20.64	.	$4.13																																																																																																																																																																																																																			
9358	"SurgiMend, fetal"	K		$11.09	.	$2.22																																																																																																																																																																																																																			
9360	"SurgiMend, neonatal"	K		$11.59	.	$2.32																																																																																																																																																																																																																			
9363	Integra Meshed Bil Wound Mat	K		$19.17	.	$3.84																																																																																																																																																																																																																			
9367	Endoform Dermal Template	G		$4.35	.	$0.87																																																																																																																																																																																																																			
9500	"Platelets, irradiated"	R	2.1768	$151.11	.	$30.23																																																																																																																																																																																																																			
9501	Platelet pheres leukoreduced	R	7.5524	$524.29	.	$104.86																																																																																																																																																																																																																			
9502	Platelet pheresis irradiated	R	7.5964	$527.34	.	$105.47																																																																																																																																																																																																																			
9503	Fr frz plasma donor retested	R	1.2624	$87.64	.	$17.53																																																																																																																																																																																																																			
9504	RBC deglycerolized	R	3.4728	$241.08	.	$48.22																																																																																																																																																																																																																			
9505	RBC irradiated	R	3.3729	$234.15	.	$46.83																																																																																																																																																																																																																			
9506	"Granulocytes, pheresis unit"	R	22.1451	"$1,537.31"	.	$307.47																																																																																																																																																																																																																			
9507	"Platelets, pheresis"	R	6.0636	$420.94	.	$84.19																																																																																																																																																																																																																			
9508	Plasma 1 donor frz w/in 8 hr	R	1.0927	$75.86	.	$15.18																																																																																																																																																																																																																			
