	Addendum A.-Final OPPS APCs for CY 2013					
APC	Group Title	SI	Relative Weight 	Payment Rate 	National Unadjusted Copayment 	Minimum Unadjusted Copayment 
0001	Level I Photochemotherapy	S	0.5210	$37.15	.	$7.43
0002	Fine Needle Biopsy/Aspiration	T	1.7194	$122.62	.	$24.53
0003	Bone Marrow Biopsy/Aspiration	T	3.7917	$270.40	.	$54.08
0004	Level I Needle Biopsy/ Aspiration Except Bone Marrow	T	4.8451	$345.52	.	$69.11
0005	Level II Needle Biopsy/Aspiration Except Bone Marrow	T	8.7675	$625.24	.	$125.05
0006	Level I Incision & Drainage	T	1.7592	$125.45	.	$25.09
0007	Level II Incision & Drainage	T	10.1746	$725.58	.	$145.12
0008	Level III Incision and Drainage	T	18.4976	"$1,319.12"	.	$263.83
0012	Level I Debridement & Destruction	T	0.3982	$28.40	.	$5.68
0013	Level II Debridement & Destruction	T	1.0032	$71.54	.	$14.31
0015	Level III Debridement & Destruction	T	1.4998	$106.96	.	$21.40
0016	Level IV Debridement & Destruction	T	2.9399	$209.65	.	$41.93
0017	Level V Debridement & Destruction	T	19.8814	"$1,417.80"	.	$283.56
0019	Level I Excision/ Biopsy	T	4.7170	$336.38	.	$67.28
0020	Level II Excision/ Biopsy	T	8.1838	$583.61	.	$116.73
0021	Level III Excision/ Biopsy	T	15.7299	"$1,121.75"	.	$224.35
0022	Level IV Excision/ Biopsy	T	23.2928	"$1,661.08"	$350.78	$332.22
0028	Level I Breast Surgery	T	26.1210	"$1,862.77"	.	$372.56
0029	Level II Breast Surgery	T	34.4816	"$2,458.99"	$581.52	$491.80
0030	Level III Breast Surgery	T	45.3768	"$3,235.96"	$747.07	$647.20
0031	Level I Health and Behavior Services	S	0.3135	$22.36	.	$4.48
0034	Mental Health Services Composite	S	3.2008	$228.26	.	$45.66
0035	Vascular Puncture and Minor Diagnostic Procedures	X	0.3286	$23.43	.	$4.69
0037	Level IV Needle Biopsy/Aspiration Except Bone Marrow	T	15.6849	"$1,118.54"	$227.35	$223.71
0039	Level I Implantation of Neurostimulator Generator	S	229.8982	"$16,394.73"	.	"$3,278.95"
0040	Level I Implantation/Revision/Replacement of Neurostimulator Electrodes 	S	61.6966	"$4,399.77"	.	$879.96
0041	Level I Arthroscopy	T	29.6106	"$2,111.62"	.	$422.33
0042	Level II Arthroscopy	T	54.4111	"$3,880.22"	$782.23	$776.05
0045	Bone/Joint Manipulation Under Anesthesia	T	14.5706	"$1,039.07"	$257.70	$207.82
0047	Arthroplasty without Prosthesis	T	40.2172	"$2,868.01"	.	$573.61
0048	Level I Arthroplasty or Implantation with Prosthesis	T	62.4025	"$4,450.11"	.	$890.03
0049	Level I Musculoskeletal Procedures Except Hand and Foot	T	21.8096	"$1,555.31"	.	$311.07
0050	Level II Musculoskeletal Procedures Except Hand and Foot	T	32.3471	"$2,306.77"	.	$461.36
0051	Level III Musculoskeletal Procedures Except Hand and Foot	T	48.2042	"$3,437.59"	.	$687.52
0052	Level IV Musculoskeletal Procedures Except Hand and Foot	T	82.2078	"$5,862.48"	.	"$1,172.50"
0053	Level I Hand Musculoskeletal Procedures	T	16.6230	"$1,185.44"	$249.64	$237.09
0054	Level II Hand Musculoskeletal Procedures	T	28.9725	"$2,066.12"	.	$413.23
0055	Level I Foot Musculoskeletal Procedures	T	22.2111	"$1,583.94"	$353.37	$316.79
0056	Level II Foot Musculoskeletal Procedures	T	60.6876	"$4,327.81"	.	$865.57
0057	Bunion Procedures	T	34.4317	"$2,455.43"	.	$491.09
0058	Level I Cast Application	S	1.3257	$94.54	.	$18.91
0059	Level I Strapping	S	0.7563	$53.93	.	$10.79
0060	Manipulation Therapy	S	0.2738	$19.53	.	$3.91
0061	Level II Implantation/Revision/Replacement of Neurostimulator Electrodes 	S	95.2427	"$6,792.04"	.	"$1,358.41"
0062	Level I Treatment Fracture/Dislocation	T	26.7671	"$1,908.84"	.	$381.77
0063	Level II Treatment Fracture/Dislocation	T	52.7806	"$3,763.94"	.	$752.79
0064	Level III Treatment Fracture/Dislocation	T	70.6785	"$5,040.30"	.	"$1,008.06"
0065	"Level I Stereotactic Radiosurgery, MRgFUS, and MEG"	S	13.7177	$978.25	.	$195.65
0066	"Level II Stereotactic Radiosurgery, MRgFUS, and MEG"	S	33.0205	"$2,354.79"	.	$470.96
0067	"Level III Stereotactic Radiosurgery, MRgFUS, and MEG"	S	46.2838	"$3,300.64"	.	$660.13
0069	Thoracoscopy	T	35.9647	"$2,564.75"	$591.64	$512.95
0070	Thoracentesis/Lavage Procedures	T	5.7828	$412.39	.	$82.48
0071	Level I Endoscopy Upper Airway	T	1.0839	$77.30	.	$15.46
0072	Level II Endoscopy Upper Airway	T	2.0036	$142.88	.	$28.58
0073	Level III Endoscopy Upper Airway	T	4.7291	$337.25	$67.83	$67.45
0074	Level IV Endoscopy Upper Airway	T	18.9594	"$1,352.05"	.	$270.41
0075	Level V Endoscopy Upper Airway	T	28.4215	"$2,026.82"	.	$405.37
0076	Level I Endoscopy Lower Airway	T	10.7117	$763.88	$189.82	$152.78
0077	Level I Pulmonary Treatment	S	0.4920	$35.09	$7.74	$7.02
0078	Level III Pulmonary Treatment	S	1.4155	$100.94	.	$20.19
0079	Ventilation Initiation and Management	S	3.4693	$247.41	.	$49.49
0080	Diagnostic Cardiac Catheterization	T	37.1534	"$2,649.52"	$815.13	$529.91
0082	Coronary or Non-Coronary Atherectomy	T	107.5706	"$7,671.18"	.	"$1,534.24"
0083	"Coronary Angioplasty, Valvuloplasty, and Level I Endovascular Revascularization of the Lower Extremity "	T	56.4140	"$4,023.05"	.	$804.61
0084	Level I Electrophysiologic Procedures	S	9.8911	$705.36	.	$141.08
0085	Level II Electrophysiologic Procedures	T	55.0013	"$3,922.31"	.	$784.47
0088	Thrombectomy	T	43.4735	"$3,100.23"	$655.22	$620.05
0089	Insertion/Replacement of Permanent Pacemaker and Electrodes	T	115.4087	"$8,230.14"	.	"$1,646.03"
0090	Level I Insertion/Replacement of Permanent Pacemaker 	T	92.7231	"$6,612.36"	"$1,593.50"	"$1,322.48"
0091	Level II Vascular Ligation	T	42.4137	"$3,024.65"	.	$604.93
0092	Level I Vascular Ligation	T	27.4658	"$1,958.67"	.	$391.74
0093	Vascular Reconstruction/Fistula Repair without Device	T	30.1384	"$2,149.26"	.	$429.86
0094	Level I Resuscitation and Cardioversion	S	2.2552	$160.83	$43.80	$32.17
0095	Cardiac Rehabilitation	S	1.1206	$79.91	.	$15.99
0096	Level II Noninvasive Physiologic Studies	S	1.5230	$108.61	$36.86	$21.73
0097	Level I Noninvasive Physiologic Studies	S	0.9328	$66.52	.	$13.31
0099	Electrocardiograms/Cardiography	S	0.3740	$26.67	.	$5.34
0100	Cardiac Stress Tests	X	2.4795	$176.82	$41.07	$35.37
0101	Tilt Table Evaluation	S	4.2562	$303.52	$100.24	$60.71
0102	Level II Pulmonary Treatment	S	0.5512	$39.31	.	$7.87
0103	Miscellaneous Vascular Procedures	T	16.2173	"$1,156.50"	.	$231.30
0104	Transcatheter Placement of Intracoronary Stents	T	85.6848	"$6,110.44"	.	"$1,222.09"
0105	"Repair/Revision/Removal of Pacemakers, AICDs, or Vascular Devices"	T	23.6020	"$1,683.13"	.	$336.63
0106	Insertion/Replacement of Pacemaker Leads and/or Electrodes	T	52.8101	"$3,766.05"	.	$753.21
0107	Level I Implantation of Cardioverter-Defibrillators (ICDs)	T	315.6793	"$22,512.04"	.	"$4,502.41"
0108	Level II Implantation of Cardioverter-Defibrillators (ICDs)	T	430.2162	"$30,680.01"	.	"$6,136.01"
0110	Transfusion	S	3.6520	$260.44	.	$52.09
0111	Blood Product Exchange	S	13.3306	$950.65	.	$190.13
0112	Apheresis and Stem Cell Procedures	S	40.5074	"$2,888.70"	.	$577.74
0113	Excision Lymphatic System	T	25.5213	"$1,820.00"	.	$364.00
0114	Thyroid/Lymphadenectomy Procedures	T	51.4794	"$3,671.15"	.	$734.23
0115	Cannula/Access Device Procedures	T	37.5770	"$2,679.73"	.	$535.95
0121	Level I Tube or Catheter Changes or Repositioning	T	6.1648	$439.63	.	$87.93
0126	Level I Urinary and Anal Procedures	T	1.1497	$81.99	.	$16.40
0127	"Level IV Stereotactic Radiosurgery, MRgFUS, and MEG"	S	110.9266	"$7,910.51"	.	"$1,582.11"
0129	Level I Closed Treatment Fracture	T	1.8741	$133.65	.	$26.73
0130	Level I Laparoscopy	T	38.2829	"$2,730.07"	$659.53	$546.02
0131	Level II Laparoscopy	T	48.8992	"$3,487.15"	"$1,001.89"	$697.43
0132	Level III Laparoscopy	T	71.8156	"$5,121.39"	"$1,236.99"	"$1,024.28"
0133	Level I Skin Repair	T	1.2024	$85.75	$23.38	$17.15
0134	Level II Skin Repair	T	3.5264	$251.48	.	$50.30
0135	Level III Skin Repair	T	5.5162	$393.38	.	$78.68
0136	Level IV Skin Repair	T	15.5878	"$1,111.61"	.	$222.33
0137	Level V Skin Repair	T	21.1752	"$1,510.07"	.	$302.02
0138	Level II Closed Treatment Fracture 	T	5.5931	$398.86	.	$79.78
0139	Level III Closed Treatment Fracture 	T	11.7147	$835.41	.	$167.09
0140	Esophageal Dilation without Endoscopy	T	6.7737	$483.05	.	$96.61
0141	Level I Upper GI Procedures	T	8.7424	$623.45	$138.69	$124.69
0142	Level I Small Intestine Endoscopy	T	10.5266	$750.68	$152.78	$150.14
0143	Lower GI Endoscopy	T	9.6941	$691.32	$186.06	$138.27
0146	Level I Sigmoidoscopy and Anoscopy	T	5.8940	$420.32	.	$84.07
0147	Level II Sigmoidoscopy and Anoscopy	T	10.0341	$715.56	.	$143.12
0148	Level I Anal/Rectal Procedures	T	6.1609	$439.35	.	$87.87
0149	Level III Anal/Rectal Procedures	T	25.6535	"$1,829.43"	.	$365.89
0150	Level IV Anal/Rectal Procedures	T	33.1772	"$2,365.97"	.	$473.20
0151	Endoscopic Retrograde Cholangio-Pancreatography (ERCP)	T	24.2214	"$1,727.30"	.	$345.46
0152	Level I Percutaneous Abdominal and Biliary Procedures	T	28.4347	"$2,027.76"	.	$405.56
0153	Peritoneal and Abdominal Procedures	T	25.9781	"$1,852.58"	.	$370.52
0154	Hernia/Hydrocele Procedures	T	34.0627	"$2,429.11"	.	$485.83
0155	Level II Anal/Rectal Procedures	T	17.9329	"$1,278.85"	.	$255.77
0156	Level III Urinary and Anal Procedures	T	3.2577	$232.32	.	$46.47
0157	Colorectal Cancer Screening: Barium Enema	S	2.5831	$184.21	.	$36.85
0158	Colorectal Cancer Screening: Colonoscopy	T	8.5787	$611.77	$0.00	$0.00
0159	Colorectal Cancer Screening: Flexible Sigmoidoscopy	S	5.8206	$415.08	$0.00	$0.00
0160	Level I Cystourethroscopy and other Genitourinary Procedures	T	7.1482	$509.76	.	$101.96
0161	Level II Cystourethroscopy and other Genitourinary Procedures	T	15.8635	"$1,131.27"	.	$226.26
0162	Level III Cystourethroscopy and other Genitourinary Procedures	T	26.7673	"$1,908.86"	.	$381.78
0163	Level IV Cystourethroscopy and other Genitourinary Procedures	T	38.3814	"$2,737.09"	.	$547.42
0164	Level II Urinary and Anal Procedures	T	2.1419	$152.75	.	$30.55
0165	Level IV Urinary and Anal Procedures	T	19.7656	"$1,409.54"	.	$281.91
0166	Level I Urethral Procedures	T	21.5966	"$1,540.12"	.	$308.03
0168	Level II Urethral Procedures	T	33.2789	"$2,373.22"	.	$474.65
0169	Lithotripsy	T	39.8005	"$2,838.29"	$979.42	$567.66
0170	Dialysis	S	6.9597	$496.32	.	$99.27
0172	Level I Partial Hospitalization (3 services) for CMHCs	P	1.1913	$84.96	.	$17.00
0173	Level II Partial Hospitalization (4 or more services) for CMHCs	P	1.5378	$109.67	.	$21.94
0174	Level IV Laparoscopy	T	127.3348	"$9,080.63"	"$2,020.00"	"$1,816.13"
0175	Level I Partial Hospitalization (3 services) for Hospital-based PHPs	P	2.5340	$180.71	.	$36.15
0176	Level II Partial Hospitalization (4 or more services) for Hospital-based PHPs	P	3.2008	$228.26	.	$45.66
0177	Level I Echocardiogram with Contrast	S	6.0848	$433.93	$129.40	$86.79
0178	Level II Echocardiogram with Contrast	S	8.1101	$578.36	$172.48	$115.68
0181	Level II Male Genital Procedures	T	38.9199	"$2,775.49"	$607.88	$555.10
0183	Level I Male Genital Procedures	T	23.7942	"$1,696.84"	.	$339.37
0184	Prostate Biopsy	T	13.5630	$967.22	.	$193.45
0188	Level II Female Reproductive Proc	T	1.6625	$118.56	.	$23.72
0189	Level III Female Reproductive Proc	T	3.2826	$234.09	.	$46.82
0190	Level I Hysteroscopy	T	23.5870	"$1,682.06"	$424.28	$336.42
0191	Level I Female Reproductive Proc	T	0.1157	$8.25	$1.73	$1.65
0192	Level IV Female Reproductive Proc	T	6.9849	$498.11	.	$99.63
0193	Level V Female Reproductive Proc	T	20.3967	"$1,454.55"	.	$290.91
0195	Level VI Female Reproductive Procedures	T	37.0120	"$2,639.44"	.	$527.89
0202	Level VII Female Reproductive Procedures	T	47.7547	"$3,405.53"	$981.50	$681.11
0203	Level IV Nerve Injections	T	12.0130	$856.68	.	$171.34
0204	Level I Nerve Injections	T	2.5607	$182.61	.	$36.53
0206	Level II Nerve Injections	T	4.0910	$291.74	.	$58.35
0207	Level III Nerve Injections	T	7.9333	$565.75	.	$113.15
0208	Laminotomies and Laminectomies	T	52.7056	"$3,758.59"	.	$751.72
0209	"Level II Extended EEG, Sleep, and Cardiovascular Studies"	S	11.3041	$806.13	$268.73	$161.23
0213	"Level I Extended EEG, Sleep, and Cardiovascular Studies"	S	2.4204	$172.61	$53.58	$34.53
0215	Level I Nerve and Muscle Services	S	0.6045	$43.11	.	$8.63
0216	Level III Nerve and Muscle Services	S	2.5805	$184.02	.	$36.81
0218	Level II Nerve and Muscle Services	S	1.1195	$79.83	.	$15.97
0220	Level I Nerve Procedures	T	18.8566	"$1,344.72"	.	$268.95
0221	Level II Nerve Procedures	T	34.7984	"$2,481.58"	.	$496.32
0224	Implantation of Catheter/Reservoir/Shunt	T	45.5890	"$3,251.09"	.	$650.22
0227	Implantation of Drug Infusion Device	T	197.8775	"$14,111.24"	.	"$2,822.25"
0229	Level II Endovascular Revascularization of the Lower Extremity 	T	121.3919	"$8,656.82"	.	"$1,731.37"
0230	Level I Eye Tests & Treatments	S	0.6788	$48.41	.	$9.69
0231	Level III Eye Tests & Treatments	S	2.0317	$144.89	.	$28.98
0232	Level I Anterior Segment Eye Procedures	T	2.0304	$144.79	$30.45	$28.96
0233	Level III Anterior Segment Eye Procedures	T	15.8380	"$1,129.46"	.	$225.90
0234	Level IV Anterior Segment Eye Procedures	T	23.5107	"$1,676.62"	$347.84	$335.33
0235	Level I Posterior Segment Eye Procedures	T	5.8389	$416.39	.	$83.28
0237	Level II Posterior Segment Eye Procedures	T	20.2224	"$1,442.12"	.	$288.43
0238	Level I Repair and Plastic Eye Procedures	T	3.2499	$231.76	.	$46.36
0239	Level II Repair and Plastic Eye Procedures	T	8.6336	$615.69	.	$123.14
0240	Level III Repair and Plastic Eye Procedures	T	19.1819	"$1,367.92"	$294.00	$273.59
0241	Level IV Repair and Plastic Eye Procedures	T	26.7000	"$1,904.06"	$382.94	$380.82
0242	Level V Repair and Plastic Eye Procedures	T	39.7223	"$2,832.72"	$597.36	$566.55
0243	Strabismus/Muscle Procedures	T	25.2082	"$1,797.67"	$412.25	$359.54
0244	Corneal and Amniotic Membrane Transplant	T	41.6106	"$2,967.38"	$794.86	$593.48
0246	Cataract Procedures with IOL Insert	T	24.2659	"$1,730.47"	$490.32	$346.10
0247	Laser Eye Procedures	T	5.7604	$410.79	$102.26	$82.16
0249	Cataract Procedures without IOL Insert	T	29.3838	"$2,095.45"	$499.26	$419.09
0250	Level I ENT Procedures	T	1.0950	$78.09	$24.11	$15.62
0251	Level II ENT Procedures	T	3.2225	$229.81	.	$45.97
0252	Level III ENT Procedures	T	6.9913	$498.57	$99.78	$99.72
0253	Level IV ENT Procedures	T	16.0895	"$1,147.39"	.	$229.48
0254	Level V ENT Procedures	T	25.2377	"$1,799.78"	.	$359.96
0255	Level II Anterior Segment Eye Procedures	T	9.2948	$662.84	.	$132.57
0256	Level VI ENT Procedures	T	45.9788	"$3,278.89"	.	$655.78
0259	Level VII ENT Procedures	T	425.2643	"$30,326.87"	"$7,921.74"	"$6,065.38"
0260	Level I Plain Film Except Teeth	X	0.6443	$45.95	.	$9.19
0261	Level II Plain Film Except Teeth Including Bone Density Measurement	X	0.9933	$70.84	.	$14.17
0262	Plain Film of Teeth	X	0.5031	$35.88	.	$7.18
0263	Level I Miscellaneous Radiology Procedures	X	3.5823	$255.46	.	$51.10
0265	Level I Diagnostic and Screening Ultrasound	S	0.9054	$64.57	$22.26	$12.92
0266	Level II Diagnostic and Screening Ultrasound	S	1.3928	$99.32	$37.23	$19.87
0267	Level III Diagnostic and Screening Ultrasound	S	2.1699	$154.74	$59.55	$30.95
0269	Level II Echocardiogram Without Contrast 	S	5.4757	$390.49	.	$78.10
0270	Level III Echocardiogram Without Contrast 	S	7.8339	$558.66	$128.73	$111.74
0272	Fluoroscopy	X	1.6023	$114.26	$30.47	$22.86
0274	Myelography	S	7.1179	$507.60	.	$101.52
0275	Arthrography	S	4.1881	$298.67	$68.90	$59.74
0276	Level I Digestive Radiology	S	1.1600	$82.72	$32.84	$16.55
0277	Level II Digestive Radiology	S	1.7222	$122.82	$46.51	$24.57
0278	Diagnostic Urography	S	2.9385	$209.55	$58.44	$41.91
0279	Level II Angiography and Venography	S	31.1279	"$2,219.82"	.	$443.97
0280	Level III Angiography and Venography	S	50.9080	"$3,630.40"	.	$726.08
0282	Miscellaneous Computed Axial Tomography	S	1.3864	$98.87	$32.94	$19.78
0283	Computed Tomography with Contrast	S	4.1669	$297.15	$95.46	$59.43
0284	Magnetic Resonance Imaging and Magnetic Resonance Angiography with Contrast	S	6.3741	$454.56	$146.59	$90.92
0288	Bone Density:Axial Skeleton	S	1.0359	$73.87	$0.00	$0.00
0293	Level VI Anterior Segment Eye Procedures	T	123.3630	"$8,797.39"	.	"$1,759.48"
0299	Hyperthermia and Radiation Treatment Procedures	S	5.5027	$392.41	.	$78.49
0300	Level I Radiation Therapy	S	1.3392	$95.50	.	$19.10
0301	Level II Radiation Therapy	S	2.5173	$179.52	.	$35.91
0303	Treatment Device Construction	X	2.8292	$201.76	$66.95	$40.36
0304	Level I Therapeutic Radiation Treatment Preparation	X	1.5387	$109.73	$34.63	$21.95
0305	Level II Therapeutic Radiation Treatment Preparation	X	4.0804	$290.99	$88.78	$58.20
0308	Positron Emission Tomography (PET) imaging	S	14.8096	"$1,056.12"	.	$211.23
0310	Level III Therapeutic Radiation Treatment Preparation	X	13.8052	$984.49	$325.27	$196.90
0312	Radioelement Applications	S	5.7609	$410.83	.	$82.17
0313	Brachytherapy	S	9.6431	$687.68	$259.86	$137.54
0315	Level II Implantation of Neurostimulator Generator 	S	288.8990	"$20,602.25"	.	"$4,120.45"
0317	Level II Miscellaneous Radiology Procedures	X	4.5159	$322.04	.	$64.41
0318	Implantation of Neurostimulator Pulse Generator and Electrode 	S	359.7987	"$25,658.32"	"$9,121.76"	"$5,131.67"
0319	Level III Endovascular Revascularization of the Lower Extremity	T	204.6785	"$14,596.24"	"$5,559.48"	"$2,919.25"
0320	Electroconvulsive Therapy	S	6.1511	$438.65	.	$87.73
0322	Brief Individual Psychotherapy	S	1.1619	$82.86	.	$16.58
0323	Extended Individual Psychotherapy	S	1.5448	$110.16	.	$22.04
0324	Family Psychotherapy	S	1.7979	$128.21	.	$25.65
0325	Group Psychotherapy	S	0.8506	$60.66	.	$12.14
0330	Dental Procedures	S	7.5832	$540.78	.	$108.16
0331	Combined Abdomen and Pelvis CT without Contrast 	S	4.2917	$306.05	$118.33	$61.21
0332	Computed Tomography without Contrast	S	2.4340	$173.58	$67.11	$34.72
0333	Computed Tomography without Contrast followed by Contrast	S	4.6182	$329.34	$114.38	$65.87
0334	Combined Abdomen and Pelvis CT with Contrast 	S	6.7671	$482.58	$155.52	$96.52
0336	Magnetic Resonance Imaging and Magnetic Resonance Angiography without Contrast	S	4.7466	$338.49	$133.38	$67.70
0337	Magnetic Resonance Imaging and Magnetic Resonance Angiography without Contrast followed by Contrast	S	7.7051	$549.47	$197.64	$109.90
0340	Minor Ancillary Procedures	X	0.6961	$49.64	.	$9.93
0341	Skin Tests	X	0.0957	$6.82	$2.09	$1.37
0342	Level I Pathology	X	0.1782	$12.71	.	$2.55
0343	Level III Pathology	X	0.5342	$38.10	$10.84	$7.62
0344	Level IV Pathology	X	0.8477	$60.45	$15.56	$12.09
0345	Level I Transfusion Laboratory Procedures	X	0.2519	$17.96	.	$3.60
0346	Level II Transfusion Laboratory Procedures	X	0.3504	$24.99	.	$5.00
0347	Level III Transfusion Laboratory Procedures	X	0.4810	$34.30	.	$6.86
0350	Administration of flu and PPV vaccine	S	0.3788	$27.01	$0.00	$0.00
0360	Level I Alimentary Tests	X	1.9249	$137.27	$33.59	$27.46
0361	Level II Alimentary Tests	X	4.2433	$302.60	$83.23	$60.52
0363	Level I Otorhinolaryngologic Function Tests	X	0.9156	$65.29	$16.12	$13.06
0364	Level I Audiometry	X	0.5032	$35.88	.	$7.18
0365	Level II Audiometry	X	1.2424	$88.60	$18.04	$17.72
0366	Level III Audiometry	X	1.6401	$116.96	$23.43	$23.40
0367	Level I Pulmonary Test	X	0.6318	$45.06	$11.97	$9.02
0368	Level II Pulmonary Tests	X	0.8816	$62.87	$20.93	$12.58
0369	Level III Pulmonary Tests	X	2.5221	$179.86	$36.55	$35.98
0370	Multiple Allergy Tests	X	1.3347	$95.18	.	$19.04
0373	Level I Neuropsychological Testing	X	1.2128	$86.49	.	$17.30
0375	Ancillary Outpatient Services When Patient Expires	S	92.7277	"$6,612.69"	.	"$1,322.54"
0377	Level II Cardiac Imaging	S	9.5309	$679.68	.	$135.94
0378	Level II Pulmonary Imaging	S	4.7173	$336.40	$126.64	$67.28
0381	Single Allergy Tests	X	0.3478	$24.80	.	$4.96
0382	Level II Neuropsychological Testing	X	2.4863	$177.31	.	$35.47
0383	Cardiac Computed Tomographic Imaging	S	3.7468	$267.20	.	$53.44
0384	GI Procedures with Stents	T	29.6863	"$2,117.02"	.	$423.41
0385	Level I Prosthetic Urological Procedures	S	107.0677	"$7,635.32"	.	"$1,527.07"
0386	Level II Prosthetic Urological Procedures	S	175.4934	"$12,514.96"	.	"$2,503.00"
0387	Level II Hysteroscopy	T	37.5259	"$2,676.08"	$654.35	$535.22
0388	Discography	S	24.2728	"$1,730.97"	.	$346.20
0389	Level I Non-imaging Nuclear Medicine	S	1.5990	$114.03	$26.88	$22.81
0390	Level I Endocrine Imaging	S	2.1040	$150.04	$47.69	$30.01
0391	Level II Endocrine Imaging	S	3.2664	$232.94	$65.46	$46.59
0392	Level II Non-imaging Nuclear Medicine	S	2.7567	$196.59	.	$39.32
0393	Hematologic Processing & Studies	S	6.1109	$435.79	.	$87.16
0394	Hepatobiliary Imaging	S	4.4086	$314.39	$90.78	$62.88
0395	GI Tract Imaging	S	3.6004	$256.76	$87.01	$51.36
0396	Bone Imaging	S	3.6694	$261.68	$94.20	$52.34
0397	Vascular Imaging	S	4.6411	$330.97	.	$66.20
0398	Level I Cardiac Imaging	S	4.3329	$308.99	$93.33	$61.80
0400	Hematopoietic Imaging	S	3.9257	$279.95	$90.90	$55.99
0401	Level I Pulmonary Imaging	S	3.0984	$220.96	$71.16	$44.20
0402	Level II Nervous System Imaging	S	6.4272	$458.34	.	$91.67
0403	Level I Nervous System Imaging	S	3.7033	$264.09	$72.42	$52.82
0404	Renal and Genitourinary Studies	S	4.6683	$332.91	$81.55	$66.59
0406	Level I Tumor/Infection Imaging	S	4.2080	$300.09	$85.06	$60.02
0407	Level I Radionuclide Therapy	S	3.3193	$236.71	$78.13	$47.35
0408	Level III Tumor/Infection Imaging	S	13.4001	$955.60	.	$191.12
0409	Red Blood Cell Tests	X	0.1356	$9.67	$2.17	$1.94
0412	Level III Radiation Therapy	S	6.7828	$483.70	.	$96.74
0413	Level II Radionuclide Therapy	S	4.2209	$301.01	.	$60.21
0414	Level II Tumor/Infection Imaging	S	7.0469	$502.54	.	$100.51
0415	Level II Endoscopy Lower Airway	T	22.0465	"$1,572.20"	$357.09	$314.44
0419	Level II Upper GI Procedures 	T	12.9960	$926.78	$207.70	$185.36
0422	Level III Upper GI Procedures	T	26.1852	"$1,867.35"	.	$373.47
0423	Level II Percutaneous Abdominal and Biliary Procedures	T	56.7444	"$4,046.61"	.	$809.33
0424	Level II Small Intestine Endoscopy 	T	15.5387	"$1,108.11"	$240.83	$221.63
0425	Level II Arthroplasty or Implantation with Prosthesis	T	134.6442	"$9,601.88"	.	"$1,920.38"
0426	Level II Strapping and Cast Application	S	2.6522	$189.14	.	$37.83
0427	Level II Tube or Catheter Changes or Repositioning	T	16.8497	"$1,201.60"	.	$240.32
0428	Level III Sigmoidoscopy and Anoscopy	T	21.4711	"$1,531.17"	.	$306.24
0429	Level V Cystourethroscopy and other Genitourinary Procedures	T	45.7285	"$3,261.04"	.	$652.21
0432	Level II Health and Behavior Services	S	0.6290	$44.86	.	$8.98
0433	Level II Pathology	X	0.3285	$23.43	$5.17	$4.69
0434	Cardiac Defect Repair	T	167.9170	"$11,974.67"	.	"$2,394.94"
0436	Level I Drug Administration	S	0.3788	$27.01	.	$5.41
0437	Level II Drug Administration	S	0.5487	$39.13	.	$7.83
0438	Level III Drug Administration	S	1.0473	$74.69	.	$14.94
0439	Level IV Drug Administration	S	2.0507	$146.24	.	$29.25
0440	Level V Drug Administration	S	3.2322	$230.50	.	$46.10
0442	Dosimetric Drug Administration	S	27.5195	"$1,962.50"	.	$392.50
0604	Level 1 Hospital Clinic Visits	V	0.7960	$56.77	.	$11.36
0605	Level 2 Hospital Clinic Visits	V	1.0332	$73.68	.	$14.74
0606	Level 3 Hospital Clinic Visits	V	1.3596	$96.96	.	$19.40
0607	Level 4 Hospital Clinic Visits	V	1.8017	$128.48	.	$25.70
0608	Level 5 Hospital Clinic Visits	V	2.4650	$175.79	.	$35.16
0609	Level 1 Type A Emergency Visits	V	0.7266	$51.82	$12.04	$10.37
0613	Level 2 Type A Emergency Visits	V	1.2923	$92.16	$20.80	$18.44
0614	Level 3 Type A Emergency Visits	V	2.0103	$143.36	$33.60	$28.68
0615	Level 4 Type A Emergency Visits	V	3.2164	$229.37	$47.70	$45.88
0616	Level 5 Type A Emergency Visits	V	4.8338	$344.71	$71.54	$68.95
0617	Critical Care	S	7.5142	$535.86	.	$107.18
0618	Trauma Response with Critical Care	S	12.8233	$914.47	.	$182.90
0621	Level I Vascular Access Procedures	T	11.0230	$786.08	.	$157.22
0622	Level II Vascular Access Procedures	T	24.5972	"$1,754.10"	.	$350.82
0623	Level III Vascular Access Procedures	T	31.2425	"$2,228.00"	.	$445.60
0624	Phlebotomy and Minor Vascular Access Device Procedures	X	0.6889	$49.13	$12.39	$9.83
0626	Level 1 Type B Emergency Visits	V	0.9504	$67.78	.	$13.56
0627	Level 2 Type B Emergency Visits	V	0.7589	$54.12	.	$10.83
0628	Level 3 Type B Emergency Visits	V	1.2605	$89.89	.	$17.98
0629	Level 4 Type B Emergency Visits	V	1.9113	$136.30	.	$27.26
0630	Level 5 Type B Emergency Visits	V	2.9070	$207.31	.	$41.47
0648	Level IV Breast Surgery	T	63.9715	"$4,562.00"	.	$912.40
0651	Complex Interstitial Radiation Source Application	S	12.2772	$875.52	.	$175.11
0652	Insertion of Intraperitoneal and Pleural Catheters	T	31.6784	"$2,259.08"	.	$451.82
0653	Vascular Reconstruction/Fistula Repair with Device	T	37.4589	"$2,671.31"	.	$534.27
0654	Level II Insertion/Replacement of Permanent Pacemaker 	T	108.1809	"$7,714.70"	.	"$1,542.94"
0655	Insertion/Replacement/Conversion of a Permanent Dual Chamber Pacemaker or Pacing Electrode	T	142.8432	"$10,186.58"	.	"$2,037.32"
0656	Transcatheter Placement of Intracoronary Drug-Eluting Stents	T	108.8606	"$7,763.18"	.	"$1,552.64"
0659	Hyperbaric Oxygen	S	1.5109	$107.75	.	$21.55
0660	Level II Otorhinolaryngologic Function Tests	X	1.8519	$132.06	$27.10	$26.42
0661	Level V Pathology	X	2.2023	$157.05	.	$31.41
0662	CT Angiography	S	4.7570	$339.24	$114.37	$67.85
0664	Level I Proton Beam Radiation Therapy	S	15.9383	"$1,136.61"	.	$227.33
0665	Bone Density:AppendicularSkeleton	S	0.4941	$35.24	$0.00	$0.00
0667	Level II Proton Beam Radiation Therapy	S	9.5685	$682.36	.	$136.48
0668	Level I Angiography and Venography	T	10.0404	$716.01	.	$143.21
0672	Level III Posterior Segment Eye Procedures	T	40.8587	"$2,913.76"	.	$582.76
0673	Level V Anterior Segment Eye Procedures	T	41.7586	"$2,977.93"	$635.64	$595.59
0674	Prostate Cryoablation	T	109.7287	"$7,825.08"	.	"$1,565.02"
0676	Thrombolysis and Other Device Revisions 	T	2.4212	$172.66	.	$34.54
0678	External Counterpulsation	T	1.3951	$99.49	.	$19.90
0679	Level II Resuscitation and Cardioversion	S	5.6047	$399.69	$95.30	$79.94
0680	Insertion of Patient Activated Event Recorders	S	82.6392	"$5,893.25"	.	"$1,178.65"
0683	Level II Photochemotherapy	S	2.4161	$172.30	.	$34.46
0685	Level III Needle Biopsy/Aspiration Except Bone Marrow	T	10.0060	$713.56	.	$142.72
0687	Revision/Removal of Neurostimulator Electrodes	T	21.1894	"$1,511.08"	$389.48	$302.22
0688	Revision/Removal of Neurostimulator Pulse Generator Receiver	T	36.4346	"$2,598.26"	$768.94	$519.66
0690	Level I Electronic Analysis of Devices	S	0.4761	$33.95	.	$6.79
0691	Level III Electronic Analysis of Devices	S	2.6879	$191.68	.	$38.34
0692	Level II Electronic Analysis of Devices	S	1.5631	$111.47	.	$22.30
0694	Mohs Surgery	T	5.1585	$367.87	$88.07	$73.58
0697	Level I Echocardiogram Without Contrast 	S	2.9820	$212.66	.	$42.54
0698	Level II Eye Tests & Treatments	S	1.0386	$74.07	.	$14.82
0699	Level IV Eye Tests & Treatments	T	15.8683	"$1,131.62"	.	$226.33
0701	Sr89 strontium	K		"$1,071.86"	.	$214.38
0726	Dexrazoxane HCl injection	K		$159.00	.	$31.80
0728	Filgrastim 300 mcg injection	K		$268.91	.	$53.79
0731	Sargramostim injection	K		$31.59	.	$6.32
0735	Ampho b cholesteryl sulfate	K		$14.84	.	$2.97
0736	Amphotericin b liposome inj	K		$14.83	.	$2.97
0738	Rasburicase	K		$204.73	.	$40.95
0747	Chlorothiazide sodium inj	K		$259.14	.	$51.83
0751	Mechlorethamine hcl inj	K		$157.86	.	$31.58
0752	Dactinomycin injection	K		$578.93	.	$115.79
0759	"Naltrexone, depot form"	K		$2.85	.	$0.57
0800	Leuprolide acetate	K		$663.95	.	$132.79
0802	Etoposide oral	K		$52.17	.	$10.44
0807	Aldesleukin injection	K		"$1,246.98"	.	$249.40
0809	Bcg live intravesical vac	K		$116.81	.	$23.37
0810	Goserelin acetate implant	K		$166.01	.	$33.21
0812	Carmustine injection	K		$175.76	.	$35.16
0814	"Asparaginase, NOS"	K		$63.21	.	$12.65
0820	Daunorubicin injection	K		$19.19	.	$3.84
0821	Daunorubicin citrate inj	K		$243.80	.	$48.76
0823	Docetaxel injection	K		$6.69	.	$1.34
0825	Nelarabine injection	K		$122.65	.	$24.53
0827	Floxuridine injection	K		$52.39	.	$10.48
0828	Gemcitabine hcl injection	K		$12.25	.	$2.45
0831	Ifosfamide injection	K		$30.49	.	$6.10
0832	Idarubicin hcl injection	K		$100.00	.	$20.00
0835	Cosyntropin injection NOS	K		$101.68	.	$20.34
0836	Interferon alfa-2b inj	K		$19.06	.	$3.82
0838	Interferon gamma 1-b inj	K		"$2,517.90"	.	$503.58
0840	Inj melphalan hydrochl	K		"$1,312.54"	.	$262.51
0842	Fludarabine phosphate inj	K		$84.88	.	$16.98
0843	Pegaspargase injection	K		"$5,890.00"	.	"$1,178.00"
0844	Pentostatin injection	K		$946.92	.	$189.39
0849	Rituximab injection	K		$659.72	.	$131.95
0850	Streptozocin injection	K		$274.16	.	$54.84
0851	Thiotepa injection	K		$175.30	.	$35.06
0856	Porfimer sodium injection	K		"$19,325.78"	.	"$3,865.16"
0858	Inj cladribine	K		$28.24	.	$5.65
0861	Leuprolide acetate injeciton	K		$5.98	.	$1.20
0864	Mitoxantrone hydrochl	K		$36.22	.	$7.25
0868	Oral aprepitant	K		$6.29	.	$1.26
0873	Hyalgan/supartz inj per dose	K		$92.25	.	$18.45
0874	Synvisc or synvisc-one	K		$12.22	.	$2.45
0875	Euflexxa inj per dose	K		$151.09	.	$30.22
0877	Orthovisc inj per dose	K		$169.91	.	$33.99
0884	Rho d immune globulin inj	K		$83.77	.	$16.76
0887	Azathioprine parenteral	K		$144.62	.	$28.93
0890	Lymphocyte immune globulin	K		$646.10	.	$129.22
0900	Alglucerase injection	K		$41.99	.	$8.40
0901	Alpha 1 proteinase inhibitor	K		$3.97	.	$0.80
0902	"Injection,onabotulinumtoxinA"	K		$5.47	.	$1.10
0903	Cytomegalovirus imm IV /vial	K		"$1,013.87"	.	$202.78
0910	Interferon beta-1b / .25 MG	K		$243.35	.	$48.67
0913	Ganciclovir long act implant	K		"$16,960.00"	.	"$3,392.00"
0917	Adenosine injection	K		$109.40	.	$21.88
0925	Factor viii	K		$0.90	.	$0.18
0927	Factor viii recombinant	K		$1.11	.	$0.23
0928	Factor ix complex	K		$1.03	.	$0.21
0929	Anti-inhibitor	K		$1.63	.	$0.33
0931	Factor IX non-recombinant	K		$0.94	.	$0.19
0932	Factor IX recombinant	K		$1.24	.	$0.25
0933	Gamma globulin > 10 CC inj	K		$233.37	.	$46.68
0934	"Capecitabine, oral"	K		$27.55	.	$5.51
0943	Octagam injection	K		$33.21	.	$6.65
0944	Gammagard liquid injection	K		$37.62	.	$7.53
0945	Rhophylac injection	K		$5.19	.	$1.04
0946	Hepagam b im injection	K		$52.14	.	$10.43
0947	Flebogamma injection	G		$34.43	.	$6.89
0948	Gamunex-C/Gammaked	K		$38.28	.	$7.66
0949	"Frozen plasma, pooled, sd"	R	1.0129	$72.23	.	$14.45
0950	Whole blood for transfusion	R	2.3815	$169.83	.	$33.97
0951	Reclast injection	K		$224.75	.	$44.95
0952	Cryoprecipitate each unit	R	1.1028	$78.64	.	$15.73
0954	RBC leukocytes reduced	R	2.7097	$193.24	.	$38.65
0955	"Plasma, frz between 8-24hour"	R	1.0591	$75.53	.	$15.11
0956	"Plasma protein fract,5%,50ml"	R	0.2848	$20.31	.	$4.07
0957	"Platelets, each unit"	R	1.2846	$91.61	.	$18.33
0958	Plaelet rich plasma unit	R	2.4626	$175.62	.	$35.13
0959	Red blood cells unit	R	2.1285	$151.79	.	$30.36
0960	Washed red blood cells unit	R	4.1562	$296.39	.	$59.28
0961	"Albumin (human),5%, 50ml"	K		$22.63	.	$4.53
0963	"Albumin (human), 5%, 250 ml"	K		$60.67	.	$12.14
0964	"Albumin (human), 25%, 20 ml"	K		$30.24	.	$6.05
0965	"Albumin (human), 25%, 50ml"	K		$69.20	.	$13.84
0966	"Plasmaprotein fract,5%,250ml"	R	0.6613	$47.16	.	$9.44
0967	Blood split unit	R	1.9121	$136.36	.	$27.28
0968	Platelets leukoreduced irrad	R	2.1939	$156.45	.	$31.29
0969	RBC leukoreduced irradiated	R	3.8309	$273.19	.	$54.64
1009	Cryoprecipitatereducedplasma	R	0.9531	$67.97	.	$13.60
1010	"Blood, l/r, cmv-neg"	R	2.5982	$185.29	.	$37.06
1011	"Platelets, hla-m, l/r, unit"	R	10.8739	$775.45	.	$155.09
1013	Platelets leukocytes reduced	R	1.6595	$118.34	.	$23.67
1015	Injection glatiramer acetate	K		$129.42	.	$25.89
1016	"Blood, l/r, froz/degly/wash"	R	1.7169	$122.44	.	$24.49
1017	"Plt, aph/pher, l/r, cmv-neg"	R	4.7192	$336.54	.	$67.31
1018	"Blood, l/r, irradiated"	R	2.4667	$175.91	.	$35.19
1019	Plate pheres leukoredu irrad	R	9.4536	$674.16	.	$134.84
1020	"Plt, pher, l/r cmv-neg, irr"	R	9.2615	$660.47	.	$132.10
1021	"RBC, frz/deg/wsh, l/r, irrad"	R	5.1700	$368.69	.	$73.74
1022	"RBC, l/r, cmv-neg, irrad"	R	4.0183	$286.56	.	$57.32
1023	Pralidoxime chloride inj	K		$88.60	.	$17.72
1052	"Injection, voriconazole"	K		$6.63	.	$1.33
1064	"I131 iodide cap, rx"	K		$40.70	.	$8.14
1083	Adalimumab injection	K		$456.38	.	$91.28
1084	Denileukin diftitox inj	K		"$1,646.18"	.	$329.24
1086	Temozolomide	K		$10.67	.	$2.14
1138	"Hepagam b intravenous, inj"	K		$52.14	.	$10.43
1139	Protein c concentrate	K		$13.59	.	$2.72
1142	Supprelin LA implant	K		"$16,172.58"	.	"$3,234.52"
1150	"I131 iodide sol, rx"	K		$11.23	.	$2.25
1166	Cytarabine liposome inj	K		$523.87	.	$104.78
1167	"Inj, epirubicin hcl"	K		$1.61	.	$0.33
1168	"Inj, temsirolimus"	K		$53.51	.	$10.71
1178	Busulfan injection	K		$21.90	.	$4.38
1203	Verteporfin injection	K		$10.16	.	$2.04
1207	"Octreotide injection, depot"	K		$127.00	.	$25.40
1213	Antihemophilic viii/vwf comp	K		$0.93	.	$0.19
1214	Inj IVIG privigen 500 mg	K		$35.14	.	$7.03
1221	Dimethyl sulfoxide 50%	K		$87.15	.	$17.43
1232	Mitomycin injection	K		$22.90	.	$4.58
1235	Valrubicin injection	K		"$1,006.27"	.	$201.26
1236	Levoleucovorin injection	K		$1.91	.	$0.39
1237	Inj iron dextran	K		$12.00	.	$2.40
1238	Topotecan oral	K		$83.93	.	$16.79
1239	Rotavirus vacc 2 dose oral	K		$108.65	.	$21.73
1240	Apligraf skin sub	K		$38.06	.	$7.62
1241	Oasis wound matrix skin sub	K		$7.78	.	$1.56
1242	Oasis burn matrix skin sub	K		$7.78	.	$1.56
1243	Integra BMWD skin sub	K		$20.97	.	$4.20
1244	Integra DRT 	K		$11.40	.	$2.28
1245	Dermagraft skin sub	K		$42.57	.	$8.52
1246	Graftjacket skin sub	K		$98.39	.	$19.68
1247	Integra matrix skin sub	K		$25.17	.	$5.04
1248	Primatrix skin sub	K		$37.76	.	$7.56
1249	Cymetra allograft	K		$442.20	.	$88.44
1250	Graftjacket express allograf	K		$442.20	.	$88.44
1251	Integra flowable wound matri	K		"$1,176.14"	.	$235.23
1252	Gammagraft skin sub	K		$6.87	.	$1.38
1253	Triamcinolone A inj PRS-free	K		$3.57	.	$0.72
1263	Antithrombin iii injection	K		$3.04	.	$0.61
1268	Xyntha inj	K		$1.10	.	$0.22
1270	Alloderm skin sub	K		$32.21	.	$6.45
1272	Acetylcysteine injection	K		$3.04	.	$0.61
1274	Edetate calcium disodium inj	K		$201.40	.	$40.28
1275	"Vivaglobin, inj"	K		$12.72	.	$2.55
1280	Corticotropin injection	K		"$2,948.92"	.	$589.79
1281	Bevacizumab injection	K		$1.56	.	$0.32
1287	Alloskin skin sub	K		$10.19	.	$2.04
1289	AbobotulinumtoxinA	K		$6.95	.	$1.39
1291	Rilonacept injection	K		$24.09	.	$4.82
1295	Sm 153 lexidronam	K		"$7,919.26"	.	"$1,583.86"
1296	Degarelix injection	K		$2.99	.	$0.60
1297	"Ferumoxytol, non-esrd"	K		$0.64	.	$0.13
1307	Oral busulfan	K		$5.31	.	$1.07
1311	Canakinumab injection	G		$89.41	.	$17.89
1312	Hizentra injection	K		$7.29	.	$1.46
1327	Imiglucerase injection	K		$41.74	.	$8.35
1331	Olanzapine long-acting inj	K		$2.75	.	$0.55
1332	Antithrombin recombinant	K		$103.35	.	$20.67
1338	"Methyl aminolevulinate, top"	K		$75.95	.	$15.19
1339	Oral fludarabine phosphate	K		$81.77	.	$16.36
1340	"Collagenase, clost hist inj"	K		$37.51	.	$7.51
1341	Amobarbital 125 MG inj	K		$152.43	.	$30.49
1342	Matristem micromatrix	K		$2.87	.	$0.58
1343	Ganciclovir sodium injection	K		$73.04	.	$14.61
1344	Gonadorelin hydroch/ 100 mcg	K		$6.06	.	$1.22
1345	Theraskin	K		$22.29	.	$4.46
1347	Oxacillin sodium injeciton	K		$2.38	.	$0.48
1349	Anidulafungin injection	K		$1.25	.	$0.25
1350	Topotecan injection	K		$3.13	.	$0.63
1351	Matristem wound matrix	K		$4.40	.	$0.88
1352	Wilate injection	K		$0.88	.	$0.18
1353	Belimumab injection	G		$38.32	.	$7.67
1354	Hydroxyprogesterone caproate	K		$2.70	.	$0.54
1355	Itraconazole injection	K		$88.27	.	$17.66
1357	Inj protirelin per 250 mcg	K		$29.74	.	$5.95
1361	Enfuvirtide injection	K		$0.53	.	$0.11
1408	Cyclophosphamide 100 MG inj	K		$23.48	.	$4.70
1413	Lumizyme injection	K		$153.61	.	$30.73
1414	Human fibrinogen conc inj	K		$0.91	.	$0.19
1415	Glassia injection	K		$3.92	.	$0.79
1416	Factor XIII anti-hem factor	G		$6.41	.	$1.29
1417	Gel-one	K		$614.91	.	$122.99
1419	Dermacell	K		$86.61	.	$17.33
1420	Aflibercept injection	G		$980.50	.	$196.10
1421	Imported lipodox inj	K		$498.27	.	$99.66
1422	Anthrax vaccine sc or im	K		$112.86	.	$22.58
1423	Minocycline hydrochloride	K		$0.58	.	$0.12
1424	Nabilone oral	K		$25.78	.	$5.16
1426	Eribulin mesylate injection	G		$92.81	.	$18.57
1427	Alloskin	K		$13.37	.	$2.68
1428	Arthroflex	K		$134.24	.	$26.85
1429	Flexhd/Allopatchhd/matrixhd	K		$46.69	.	$9.34
1430	Unite biomatrix	K		$31.26	.	$6.26
1431	Centruroides immune f(ab)	G		"$3,635.80"	.	$727.16
1432	Arbutamine hcl injection	K		$86.37	.	$17.28
1433	Calcitonin salmon injection	K		$62.74	.	$12.55
1434	Testosterone enanthate inj	K		$33.36	.	$6.68
1435	Injection estrone per 1 MG	K		$1.54	.	$0.31
1437	Gatifloxacin injection	K		$86.33	.	$17.27
1438	Diazoxide injection	K		$88.27	.	$17.66
1439	"Aprotonin, 10,000 kiu"	K		$2.65	.	$0.53
1440	Inj desmopressin acetate	K		$6.12	.	$1.23
1441	Intraocular Fomivirsen na	K		$85.00	.	$17.00
1442	Non-HEU TC-99M add-on/dose	K		$10.00	.	$2.00
1443	Icatibant injection	K		$235.05	.	$47.01
1444	Oral everolimus	K		$6.18	.	$1.24
1445	Methylnaltrexone injection	K		$0.37	.	$0.08
1446	Visualization adjunct	K		$1.77	.	$0.36
1447	Interferon alfacon-1 inj	K		$17.06	.	$3.42
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		$575.03	.	$115.01
1607	Eptifibatide injection	K		$24.64	.	$4.93
1608	Etanercept injection	K		$231.10	.	$46.22
1609	"Rho(D) immune globulin h, sd"	K		$18.43	.	$3.69
1612	"Daclizumab, parenteral"	K		$526.34	.	$105.27
1613	Trastuzumab injection	K		$76.40	.	$15.28
1630	"Hep b ig, im"	K		$97.15	.	$19.43
1631	Baclofen intrathecal trial	K		$76.47	.	$15.30
1633	Alefacept	K		$41.64	.	$8.33
1643	"Y90 ibritumomab, rx"	K		"$38,058.06"	.	"$7,611.62"
1645	"I131 tositumomab, rx"	K		"$30,188.56"	.	"$6,037.72"
1670	Tetanus immune globulin inj	K		$276.27	.	$55.26
1675	P32 Na phosphate	K		$170.10	.	$34.02
1676	P32 chromic phosphate	K		$114.95	.	$22.99
1683	Basiliximab	K		"$2,324.18"	.	$464.84
1684	Corticorelin ovine triflutal	K		$5.82	.	$1.17
1685	"Darbepoetin alfa, non-esrd"	K		$3.32	.	$0.67
1686	"Epoetin alfa, non-esrd"	K		$9.87	.	$1.98
1687	Digoxin immune fab (ovine)	K		$899.63	.	$179.93
1688	Ethanolamine oleate	K		$299.94	.	$59.99
1689	Fomepizole	K		$6.51	.	$1.31
1690	Hemin	K		$13.26	.	$2.66
1693	Lepirudin	K		$551.76	.	$110.36
1694	Ziconotide injection	K		$6.61	.	$1.33
1695	Nesiritide injection	K		$51.81	.	$10.37
1696	Palifermin injection	K		$12.12	.	$2.43
1697	Pegaptanib sodium injection	K		"$1,029.95"	.	$205.99
1700	Inj secretin synthetic human	K		$27.49	.	$5.50
1701	Treprostinil injection	K		$61.24	.	$12.25
1704	"Humate-P, inj"	K		$0.90	.	$0.18
1705	Factor viia	K		$1.61	.	$0.33
1709	Azacitidine injection	K		$5.52	.	$1.11
1710	Clofarabine injection	K		$125.76	.	$25.16
1711	Vantas implant	K		"$3,016.50"	.	$603.30
1712	Paclitaxel protein bound	K		$9.59	.	$1.92
1716	"Brachytx, non-str, Gold-198"	U	1.5340	$109.39	.	$21.88
1717	"Brachytx, non-str, HDR Ir-192"	U	3.4927	$249.07	.	$49.82
1719	"Brachytx, NS, Non-HDRIr-192"	U	0.5205	$37.12	.	$7.43
1738	Oxaliplatin	K		$9.25	.	$1.85
1739	"Pegademase bovine, 25 iu"	K		$265.48	.	$53.10
1741	"Urofollitropin, 75 iu"	K		$66.69	.	$13.34
1830	Power bone marrow bx needle	H			.	.
1840	Telescopic intraocular lens	H			.	.
1886	"Catheter, ablation"	H			.	.
2210	Methyldopate hcl injection	K		$42.40	.	$8.48
2616	"Brachytx, non-str,Yttrium-90"	U	219.7241	"$15,669.18"	.	"$3,133.84"
2632	Iodine I-125 sodium iodide	U	0.2949	$21.03	.	$4.21
2634	"Brachytx, non-str, HA, I-125"	U	0.9229	$65.81	.	$13.17
2635	"Brachytx, non-str, HA, P-103"	U	0.4285	$30.56	.	$6.12
2636	"Brachy linear, non-str,P-103"	U	0.4994	$35.61	.	$7.13
2638	"Brachytx, stranded, I-125"	U	0.6548	$46.70	.	$9.34
2639	"Brachytx, non-stranded,I-125"	U	0.5005	$35.69	.	$7.14
2640	"Brachytx, stranded, P-103"	U	1.0578	$75.43	.	$15.09
2641	"Brachytx, non-stranded,P-103"	U	0.8481	$60.48	.	$12.10
2642	"Brachytx, stranded, C-131"	U	1.5461	$110.26	.	$22.06
2643	"Brachytx, non-stranded,C-131"	U	0.9259	$66.03	.	$13.21
2698	"Brachytx, stranded, NOS"	U	0.6548	$46.70	.	$9.34
2699	"Brachytx, non-stranded, NOS"	U	0.4285	$30.56	.	$6.12
2731	"Immune globulin, powder"	K		$32.21	.	$6.45
2770	Quinupristin/dalfopristin	K		$175.05	.	$35.01
3041	Bivalirudin	K		$2.98	.	$0.60
3043	Gamma globulin 1 CC inj	K		$23.34	.	$4.67
3050	Sermorelin acetate injection	K		$1.80	.	$0.36
7000	Amifostine	K		$310.18	.	$62.04
7011	Oprelvekin injection	K		$244.00	.	$48.80
7034	Somatropin injection	K		$66.98	.	$13.40
7035	Teniposide	K		$321.83	.	$64.37
7036	"Urokinase 250,000 IU inj"	K		$457.73	.	$91.55
7038	Monoclonal antibodies	K		"$1,156.08"	.	$231.22
7041	Tirofiban HCl	K		$8.69	.	$1.74
7042	"Capecitabine, oral"	K		$8.28	.	$1.66
7043	Infliximab injection	K		$65.18	.	$13.04
7046	Doxil injection	K		$532.03	.	$106.41
7048	Alteplase recombinant	K		$49.22	.	$9.85
7049	Filgrastim 480 mcg injection	K		$426.87	.	$85.38
7051	Leuprolide acetate implant	K		"$4,819.82"	.	$963.97
7308	Aminolevulinic acid hcl top	K		$161.18	.	$32.24
8000	Cardiac Electrophysiologic Evaluation and Ablation Composite	T	156.2930	"$11,145.72"	"$4,458.28"	"$2,229.15"
8001	LDR Prostate Brachytherapy Composite	T	45.6392	"$3,254.67"	.	$650.94
8002	Level I Extended Assessment & Management Composite	V	6.1710	$440.07	.	$88.02
8003	Level II Extended Assessment & Management Composite	V	11.1967	$798.47	.	$159.70
8004	Ultrasound Composite	S	2.7570	$196.61	.	$39.33
8005	CT and CTA without Contrast Composite	S	5.6130	$400.28	.	$80.06
8006	CT and CTA with Contrast Composite	S	9.5649	$682.10	.	$136.42
8007	MRI and MRA without Contrast Composite	S	9.9120	$706.85	.	$141.37
8008	MRI and MRA with Contrast Composite	S	14.5688	"$1,038.94"	.	$207.79
9001	Linezolid injection	K		$39.32	.	$7.87
9002	Tenecteplase injection	K		$66.50	.	$13.30
9003	Palivizumab	K		"$1,240.19"	.	$248.04
9004	Gemtuzumab ozogamicin inj	K		"$2,742.59"	.	$548.52
9005	Reteplase injection	K		"$2,301.90"	.	$460.38
9006	Tacrolimus injection	K		$139.36	.	$27.88
9012	Arsenic trioxide injection	K		$44.99	.	$9.00
9018	"Inj, rimabotulinumtoxinB"	K		$10.89	.	$2.18
9019	Caspofungin acetate	K		$12.85	.	$2.57
9022	IM inj interferon beta 1-a	K		$287.09	.	$57.42
9023	Rho d immune globulin	K		$25.86	.	$5.18
9024	Amphotericin b lipid complex	K		$10.99	.	$2.20
9032	Baclofen 10 MG injection	K		$179.99	.	$36.00
9033	Cidofovir injection	K		$757.02	.	$151.41
9038	Inj estrogen conjugate	K		$125.45	.	$25.09
9042	Glucagon hydrochloride	K		$111.23	.	$22.25
9044	Ibutilide fumarate injection	K		$139.24	.	$27.85
9104	Antithymocyte globuln rabbit	K		$465.73	.	$93.15
9108	Thyrotropin injection	K		"$1,053.79"	.	$210.76
9110	Alemtuzumab injection	K		$587.78	.	$117.56
9115	Zoledronic acid	K		$224.10	.	$44.82
9119	"Injection, pegfilgrastim 6mg"	K		"$2,838.89"	.	$567.78
9120	"Injection, Fulvestrant"	K		$87.04	.	$17.41
9121	"Injection, argatroban"	K		$18.30	.	$3.66
9122	Triptorelin pamoate	K		$160.30	.	$32.06
9124	Daptomycin injection	K		$0.54	.	$0.11
9125	"Risperidone, long acting"	K		$5.45	.	$1.09
9126	Natalizumab injection	K		$11.59	.	$2.32
9133	"Rabies ig, im/sc"	K		$207.35	.	$41.47
9134	"Rabies ig, heat treated"	K		$194.67	.	$38.94
9135	"Varicella-zoster ig, im"	K		$79.88	.	$15.98
9137	"Bcg vaccine, percut"	K		$116.14	.	$23.23
9139	"Rabies vaccine, im"	K		$208.73	.	$41.75
9140	"Rabies vaccine, id"	K		$155.64	.	$31.13
9143	"Meningococcal vaccine, sc"	K		$106.49	.	$21.30
9144	"Encephalitis vaccine, sc"	K		$102.08	.	$20.42
9145	"Meningococcal vaccine, im"	K		$94.13	.	$18.83
9207	Bortezomib injection	K		$43.47	.	$8.70
9208	Agalsidase beta injection	K		$140.30	.	$28.06
9209	Laronidase injection	K		$26.67	.	$5.34
9210	Palonosetron hcl	K		$19.02	.	$3.81
9213	Pemetrexed injection	K		$56.51	.	$11.31
9214	Bevacizumab injection	K		$62.32	.	$12.47
9215	Cetuximab injection	K		$51.09	.	$10.22
9217	Leuprolide acetate suspnsion	K		$217.02	.	$43.41
9224	Galsulfase injection	K		$354.35	.	$70.87
9225	Fluocinolone acetonide implt	K		"$19,345.00"	.	"$3,869.00"
9227	Micafungin sodium injection	K		$0.94	.	$0.19
9228	Tigecycline injection	K		$1.46	.	$0.30
9229	Ibandronate sodium injection	K		$151.64	.	$30.33
9230	Abatacept injection	K		$22.19	.	$4.44
9231	Decitabine injection	K		$33.40	.	$6.68
9232	Idursulfase injection	K		$455.03	.	$91.01
9233	Ranibizumab injection	K		$398.31	.	$79.67
9234	Alglucosidase alfa injection	K		$204.42	.	$40.89
9235	Panitumumab injection	K		$89.02	.	$17.81
9236	Eculizumab injection	K		$195.46	.	$39.10
9237	"Inj, lanreotide acetate"	K		$33.82	.	$6.77
9240	"Injection, ixabepilone"	K		$66.49	.	$13.30
9242	"Injection, fosaprepitant"	K		$1.72	.	$0.35
9243	Bendamustine injection	K		$20.61	.	$4.13
9244	Regadenoson injection	K		$53.67	.	$10.74
9245	Romiplostim injection	K		$48.18	.	$9.64
9248	"Inj, clevidipine butyrate"	K		$2.96	.	$0.60
9249	Certolizumab pegol inj	K		$4.91	.	$0.99
9250	Artiss fibrin sealant	K		$66.43	.	$13.29
9251	C1 esterase inhibitor inj	K		$45.70	.	$9.14
9252	Plerixafor injection	K		$287.45	.	$57.49
9253	Temozolomide injection	K		$4.82	.	$0.97
9255	Paliperidone palmitate inj	K		$7.02	.	$1.41
9256	Dexamethasone intra implant	K		$195.76	.	$39.16
9258	Telavancin injection	K		$2.65	.	$0.53
9259	Pralatrexate injection	K		$173.94	.	$34.79
9260	Ofatumumab injection	K		$45.44	.	$9.09
9261	Ustekinumab injection	K		$130.53	.	$26.11
9263	Ecallantide injection	K		$318.22	.	$63.65
9264	Tocilizumab injection	K		$3.57	.	$0.72
9265	Romidepsin injection	K		$233.16	.	$46.64
9268	Capsaicin 8% patch	K		$25.55	.	$5.11
9269	"C-1 esterase, berinert"	K		$30.23	.	$6.05
9270	Gammaplex IVIG	K		$37.25	.	$7.45
9271	Velaglucerase alfa	K		$349.31	.	$69.87
9272	"Inj, denosumab"	K		$14.32	.	$2.87
9273	Sipuleucel-T auto CD54+	K		"$32,696.25"	.	"$6,539.25"
9274	Crotalidae Poly Immune Fab	K		"$2,216.80"	.	$443.36
9276	Cabazitaxel injection	K		$136.07	.	$27.22
9278	Incobotulinumtoxin A	K		$4.46	.	$0.90
9281	"Injection, pegloticase"	G		$320.77	.	$64.16
9282	"Inj, ceftaroline fosamil"	G		$0.78	.	$0.16
9283	"Injection, acetaminophen"	G		$0.11	.	$0.03
9284	Ipilimumab injection	G		$125.16	.	$25.04
9285	"Patch, lidocaine/tetracaine"	G		$13.28	$0.00	$0.00
9286	Belatacept injection	G		$3.80	.	$0.76
9287	Brentuximab vedotin inj	G		$95.40	.	$19.08
9289	Erwinaze injection	G		$334.32	.	$66.87
9290	"Inj, bupivacaine liposome"	G		$1.14	$0.00	$0.00
9292	"Injection, pertuzumab"	G		$102.86	.	$20.58
9293	"Injection, glucarpidase "	G		$233.73	.	$46.75
9294	"Inj, taliglucerase alfa"	G		$31.54	.	$6.31
9295	"Injection, carfilzomib"	G		$29.29	.	$5.86
9296	"Injection, ziv-aflibercept"	G		$16.96	.	$3.40
9300	Omalizumab injection	K		$23.53	.	$4.71
9358	"SurgiMend, fetal"	K		$12.03	.	$2.41
9360	"SurgiMend, neonatal"	K		$11.80	.	$2.36
9363	Integra Meshed Bil Wound Mat	K		$24.15	.	$4.83
9365	Oasis tri-layer wound matrix	G		$10.36	.	$2.08
9366	Epifix	G		$129.38	.	$25.88
9367	Endoform Dermal Template	K		$4.35	.	$0.87
9368	Grafix core	G		$137.47	.	$27.50
9369	Grafix prime	G		$109.40	.	$21.88
9406	Iodine I-123 ioflupane	G		"$1,974.93"	$0.00	$0.00
9500	"Platelets, irradiated"	R	1.8822	$134.23	.	$26.85
9501	Platelet pheres leukoreduced	R	7.1694	$511.27	.	$102.26
9502	Platelet pheresis irradiated	R	9.4761	$675.77	.	$135.16
9503	Fr frz plasma donor retested	R	0.7967	$56.82	.	$11.37
9504	RBC deglycerolized	R	6.7273	$479.74	.	$95.95
9505	RBC irradiated	R	2.8319	$201.95	.	$40.39
9506	"Granulocytes, pheresis unit"	R	22.6900	"$1,618.09"	.	$323.62
9507	"Platelets, pheresis"	R	6.0577	$431.99	.	$86.40
9508	Plasma 1 donor frz w/in 8 hr	R	1.1037	$78.71	.	$15.75
