	Addendum A.-Proposed OPPS APCs for CY 2013					
APC	Group Title	SI	Relative Weight 	Payment Rate 	National Unadjusted Copayment 	Minimum Unadjusted Copayment 
0001	Level I Photochemotherapy	S	0.5254	$37.59	.	$7.52
0002	Fine Needle Biopsy/Aspiration	T	1.6907	$120.95	.	$24.19
0003	Bone Marrow Biopsy/Aspiration	T	3.7979	$271.69	.	$54.34
0004	Level I Needle Biopsy/ Aspiration Except Bone Marrow	T	4.8296	$345.50	.	$69.10
0005	Level II Needle Biopsy/Aspiration Except Bone Marrow	T	8.7706	$627.42	.	$125.49
0006	Level I Incision & Drainage	T	1.7480	$125.05	.	$25.01
0007	Level II Incision & Drainage	T	10.3129	$737.75	.	$147.55
0008	Level III Incision and Drainage	T	18.1848	"$1,300.89"	.	$260.18
0012	Level I Debridement & Destruction	T	0.3984	$28.50	.	$5.70
0013	Level II Debridement & Destruction	T	0.9990	$71.47	.	$14.30
0015	Level III Debridement & Destruction	T	1.4931	$106.81	.	$21.37
0016	Level IV Debridement & Destruction	T	2.9250	$209.25	.	$41.85
0017	Level V Debridement & Destruction	T	19.9851	"$1,429.67"	.	$285.94
0019	Level I Excision/ Biopsy	T	4.7176	$337.48	.	$67.50
0020	Level II Excision/ Biopsy	T	8.2121	$587.47	.	$117.50
0021	Level III Excision/ Biopsy	T	15.7492	"$1,126.65"	.	$225.33
0022	Level IV Excision/ Biopsy	T	23.2461	"$1,662.96"	$350.78	$332.60
0028	Level I Breast Surgery	T	26.0408	"$1,862.88"	.	$372.58
0029	Level II Breast Surgery	T	34.1948	"$2,446.19"	$581.52	$489.24
0030	Level III Breast Surgery	T	45.4542	"$3,251.66"	$747.07	$650.34
0031	Level I Health and Behavior Services	S	0.3106	$22.22	.	$4.45
0034	Mental Health Services Composite	S	3.1730	$226.99	.	$45.40
0035	Vascular Puncture and Minor Diagnostic Procedures	X	0.3234	$23.14	.	$4.63
0037	Level IV Needle Biopsy/Aspiration Except Bone Marrow	T	15.6800	"$1,121.70"	$227.35	$224.34
0039	Level I Implantation of Neurostimulator Generator	S	233.1243	"$16,677.01"	.	"$3,335.41"
0040	Level I Implantation/Revision/Replacement of Neurostimulator Electrodes 	S	62.4195	"$4,465.30"	.	$893.06
0041	Level I Arthroscopy	T	29.6655	"$2,122.18"	.	$424.44
0042	Level II Arthroscopy	T	53.8580	"$3,852.84"	$776.71	$770.57
0045	Bone/Joint Manipulation Under Anesthesia	T	14.5624	"$1,041.75"	$258.36	$208.35
0047	Arthroplasty without Prosthesis	T	40.5562	"$2,901.27"	.	$580.26
0048	Level I Arthroplasty or Implantation with Prosthesis	T	62.0282	"$4,437.31"	.	$887.47
0049	Level I Musculoskeletal Procedures Except Hand and Foot	T	21.8975	"$1,566.48"	.	$313.30
0050	Level II Musculoskeletal Procedures Except Hand and Foot	T	32.1975	"$2,303.31"	.	$460.67
0051	Level III Musculoskeletal Procedures Except Hand and Foot	T	48.2459	"$3,451.37"	.	$690.28
0052	Level IV Musculoskeletal Procedures Except Hand and Foot	T	82.4593	"$5,898.89"	.	"$1,179.78"
0053	Level I Hand Musculoskeletal Procedures	T	16.5837	"$1,186.35"	$249.84	$237.27
0054	Level II Hand Musculoskeletal Procedures	T	28.8522	"$2,064.00"	.	$412.80
0055	Level I Foot Musculoskeletal Procedures	T	22.1850	"$1,587.05"	$353.37	$317.41
0056	Level II Foot Musculoskeletal Procedures	T	60.5037	"$4,328.25"	.	$865.65
0057	Bunion Procedures	T	34.3979	"$2,460.72"	.	$492.15
0058	Level I Cast Application	S	1.3212	$94.51	.	$18.91
0059	Level I Strapping	S	0.7545	$53.97	.	$10.80
0060	Manipulation Therapy	S	0.2735	$19.57	.	$3.92
0061	Level II Implantation/Revision/Replacement of Neurostimulator Electrodes 	S	96.8296	"$6,926.90"	.	"$1,385.38"
0062	Level I Treatment Fracture/Dislocation	T	26.7317	"$1,912.31"	.	$382.47
0063	Level II Treatment Fracture/Dislocation	T	52.5982	"$3,762.72"	.	$752.55
0064	Level III Treatment Fracture/Dislocation	T	70.5556	"$5,047.34"	.	"$1,009.47"
0065	"Level I Stereotactic Radiosurgery, MRgFUS, and MEG"	S	13.5157	$966.87	.	$193.38
0066	"Level II Stereotactic Radiosurgery, MRgFUS, and MEG"	S	33.0062	"$2,361.16"	.	$472.24
0067	"Level III Stereotactic Radiosurgery, MRgFUS, and MEG"	S	46.0493	"$3,294.23"	.	$658.85
0069	Thoracoscopy	T	35.8288	"$2,563.08"	$591.64	$512.62
0070	Thoracentesis/Lavage Procedures	T	5.7616	$412.17	.	$82.44
0071	Level I Endoscopy Upper Airway	T	1.0784	$77.15	.	$15.43
0072	Level II Endoscopy Upper Airway	T	1.9995	$143.04	.	$28.61
0073	Level III Endoscopy Upper Airway	T	4.7396	$339.06	$67.83	$67.82
0074	Level IV Endoscopy Upper Airway	T	18.9778	"$1,357.61"	.	$271.53
0075	Level V Endoscopy Upper Airway	T	28.5087	"$2,039.43"	.	$407.89
0076	Level I Endoscopy Lower Airway	T	10.6786	$763.92	$189.82	$152.79
0077	Level I Pulmonary Treatment	S	0.4909	$35.12	$7.74	$7.03
0078	Level III Pulmonary Treatment	S	1.4148	$101.21	.	$20.25
0079	Ventilation Initiation and Management	S	3.6238	$259.24	.	$51.85
0080	Diagnostic Cardiac Catheterization	T	36.9974	"$2,646.68"	$814.26	$529.34
0082	Coronary or Non-Coronary Atherectomy	T	105.2367	"$7,528.32"	.	"$1,505.67"
0083	"Coronary Angioplasty, Valvuloplasty, and Level I Endovascular Revascularization of the Lower Extremity "	T	56.7154	"$4,057.25"	.	$811.45
0084	Level I Electrophysiologic Procedures	S	9.4704	$677.48	.	$135.50
0085	Level II Electrophysiologic Procedures	T	54.9610	"$3,931.75"	.	$786.35
0086	Level III Electrophysiologic Procedures	T	114.6545	"$8,202.04"	.	"$1,640.41"
0088	Thrombectomy	T	43.3335	"$3,099.95"	$655.22	$619.99
0089	Insertion/Replacement of Permanent Pacemaker and Electrodes	T	115.6854	"$8,275.79"	.	"$1,655.16"
0090	Level I Insertion/Replacement of Permanent Pacemaker 	T	93.1522	"$6,663.83"	"$1,593.50"	"$1,332.77"
0091	Level II Vascular Ligation	T	42.3205	"$3,027.48"	.	$605.50
0092	Level I Vascular Ligation	T	27.4197	"$1,961.52"	.	$392.31
0093	Vascular Reconstruction/Fistula Repair without Device	T	31.4543	"$2,250.15"	.	$450.03
0094	Level I Resuscitation and Cardioversion	S	2.2476	$160.79	$43.80	$32.16
0095	Cardiac Rehabilitation	S	1.1192	$80.06	.	$16.02
0096	Level II Noninvasive Physiologic Studies	S	1.5192	$108.68	$36.86	$21.74
0097	Level I Noninvasive Physiologic Studies	S	0.9381	$67.11	.	$13.43
0099	Electrocardiograms/Cardiography	S	0.3734	$26.71	.	$5.35
0100	Cardiac Stress Tests	X	2.4849	$177.76	$41.29	$35.56
0101	Tilt Table Evaluation	S	4.2461	$303.75	$100.24	$60.75
0102	Level II Pulmonary Treatment	S	0.5533	$39.58	.	$7.92
0103	Miscellaneous Vascular Procedures	T	16.3036	"$1,166.31"	.	$233.27
0104	Transcatheter Placement of Intracoronary Stents	T	84.6536	"$6,055.86"	.	"$1,211.18"
0105	"Repair/Revision/Removal of Pacemakers, AICDs, or Vascular Devices"	T	24.0233	"$1,718.55"	.	$343.71
0106	Insertion/Replacement of Pacemaker Leads and/or Electrodes	T	52.8526	"$3,780.92"	.	$756.19
0107	Insertion of Cardioverter-Defibrillator Pulse Generator	T	312.1605	"$22,331.03"	.	"$4,466.21"
0108	"Insertion/Replacement/Repair of AICD Leads, Generator, and Pacing Electrodes"	T	429.3365	"$30,713.45"	.	"$6,142.69"
0110	Transfusion	S	3.6370	$260.18	.	$52.04
0111	Blood Product Exchange	S	13.3379	$954.15	.	$190.83
0112	Apheresis and Stem Cell Procedures	S	40.2240	"$2,877.50"	.	$575.50
0113	Excision Lymphatic System	T	25.4594	"$1,821.29"	.	$364.26
0114	Thyroid/Lymphadenectomy Procedures	T	51.3560	"$3,673.85"	.	$734.77
0115	Cannula/Access Device Procedures	T	39.4529	"$2,822.34"	.	$564.47
0121	Level I Tube or Catheter Changes or Repositioning	T	6.1459	$439.66	.	$87.94
0126	Level I Urinary and Anal Procedures	T	1.1030	$78.91	$16.21	$15.79
0127	"Level IV Stereotactic Radiosurgery, MRgFUS, and MEG"	S	111.9857	"$8,011.12"	.	"$1,602.23"
0128	Echocardiogram with Contrast	S	7.9786	$570.77	$166.16	$114.16
0129	Level I Closed Treatment Fracture	T	1.8591	$132.99	.	$26.60
0130	Level I Laparoscopy	T	37.9697	"$2,716.24"	$657.95	$543.25
0131	Level II Laparoscopy	T	48.8897	"$3,497.42"	"$1,001.89"	$699.49
0132	Level III Laparoscopy	T	71.2368	"$5,096.07"	"$1,236.99"	"$1,019.22"
0133	Level I Skin Repair	T	1.2009	$85.91	$23.38	$17.19
0134	Level II Skin Repair	T	3.5170	$251.60	.	$50.32
0135	Level III Skin Repair	T	5.5137	$394.43	.	$78.89
0136	Level IV Skin Repair	T	15.6276	"$1,117.95"	.	$223.59
0137	Level V Skin Repair	T	21.1855	"$1,515.55"	.	$303.11
0138	Level II Closed Treatment Fracture 	T	5.5865	$399.64	.	$79.93
0139	Level III Closed Treatment Fracture 	T	12.5151	$895.29	.	$179.06
0140	Esophageal Dilation without Endoscopy	T	6.7872	$485.54	.	$97.11
0141	Level I Upper GI Procedures	T	8.7174	$623.62	$138.69	$124.73
0142	Level I Small Intestine Endoscopy	T	10.3526	$740.59	$152.78	$148.12
0143	Lower GI Endoscopy	T	9.6675	$691.58	$186.06	$138.32
0146	Level I Sigmoidoscopy and Anoscopy	T	5.8661	$419.64	.	$83.93
0147	Level II Sigmoidoscopy and Anoscopy	T	10.0248	$717.14	.	$143.43
0148	Level I Anal/Rectal Procedures	T	6.2985	$450.58	.	$90.12
0149	Level III Anal/Rectal Procedures	T	25.5694	"$1,829.16"	.	$365.84
0150	Level IV Anal/Rectal Procedures	T	33.0918	"$2,367.29"	.	$473.46
0151	Endoscopic Retrograde Cholangio-Pancreatography (ERCP)	T	24.1832	"$1,729.99"	.	$346.00
0152	Level I Percutaneous Abdominal and Biliary Procedures	T	27.4809	"$1,965.90"	.	$393.18
0153	Peritoneal and Abdominal Procedures	T	24.6167	"$1,761.00"	.	$352.20
0154	Hernia/Hydrocele Procedures	T	33.9755	"$2,430.51"	.	$486.11
0155	Level II Anal/Rectal Procedures	T	18.0581	"$1,291.82"	.	$258.37
0156	Level III Urinary and Anal Procedures	T	3.2049	$229.27	.	$45.86
0157	Colorectal Cancer Screening: Barium Enema	S	2.4454	$174.94	.	$34.99
0158	Colorectal Cancer Screening: Colonoscopy	T	8.5615	$612.46	$0.00	$0.00
0159	Colorectal Cancer Screening: Flexible Sigmoidoscopy	S	5.7865	$413.95	$0.00	$0.00
0160	Level I Cystourethroscopy and other Genitourinary Procedures	T	7.1868	$514.12	.	$102.83
0161	Level II Cystourethroscopy and other Genitourinary Procedures	T	15.7268	"$1,125.05"	.	$225.01
0162	Level III Cystourethroscopy and other Genitourinary Procedures	T	26.7444	"$1,913.21"	.	$382.65
0163	Level IV Cystourethroscopy and other Genitourinary Procedures	T	38.2928	"$2,739.35"	.	$547.87
0164	Level II Urinary and Anal Procedures	T	2.1103	$150.96	.	$30.20
0165	Level IV Urinary and Anal Procedures	T	20.0058	"$1,431.15"	.	$286.23
0166	Level I Urethral Procedures	T	21.7305	"$1,554.53"	.	$310.91
0168	Level II Urethral Procedures	T	33.2292	"$2,377.12"	.	$475.43
0169	Lithotripsy	T	39.8171	"$2,848.40"	$982.91	$569.68
0170	Dialysis	S	6.9116	$494.44	.	$98.89
0172	Level I Partial Hospitalization (3 services) for CMHCs	P	1.1965	$85.59	.	$17.12
0173	Level II Partial Hospitalization (4 or more services) for CMHCs	P	1.5254	$109.12	.	$21.83
0174	Level IV Laparoscopy	T	127.1491	"$9,095.87"	"$2,020.00"	"$1,819.18"
0175	Level I Partial Hospitalization (3 services) for Hospital-based PHPs	P	2.4903	$178.15	.	$35.63
0176	Level II Partial Hospitalization (4 or more services) for Hospital-based PHPs	P	3.1730	$226.99	.	$45.40
0181	Level II Male Genital Procedures	T	37.8242	"$2,705.83"	$607.88	$541.17
0183	Level I Male Genital Procedures	T	23.7733	"$1,700.67"	.	$340.14
0184	Prostate Biopsy	T	13.5726	$970.94	.	$194.19
0188	Level II Female Reproductive Proc	T	1.6584	$118.64	.	$23.73
0189	Level III Female Reproductive Proc	T	3.2763	$234.38	.	$46.88
0190	Level I Hysteroscopy	T	23.5219	"$1,682.69"	$424.28	$336.54
0191	Level I Female Reproductive Proc	T	0.1155	$8.26	$1.73	$1.66
0192	Level IV Female Reproductive Proc	T	7.0140	$501.76	.	$100.36
0193	Level V Female Reproductive Proc	T	20.3268	"$1,454.12"	.	$290.83
0195	Level VI Female Reproductive Procedures	T	36.9280	"$2,641.72"	.	$528.35
0202	Level VII Female Reproductive Procedures	T	47.7993	"$3,419.42"	$981.50	$683.89
0203	Level IV Nerve Injections	T	12.0337	$860.85	.	$172.17
0204	Level I Nerve Injections	T	2.5701	$183.86	.	$36.78
0206	Level II Nerve Injections	T	4.1225	$294.91	.	$58.99
0207	Level III Nerve Injections	T	7.9441	$568.30	.	$113.66
0208	Laminotomies and Laminectomies	T	52.7307	"$3,772.20"	.	$754.44
0209	"Level II Extended EEG, Sleep, and Cardiovascular Studies"	S	11.2956	$808.05	$268.73	$161.61
0213	"Level I Extended EEG, Sleep, and Cardiovascular Studies"	S	2.4206	$173.16	$53.58	$34.64
0215	Level I Nerve and Muscle Tests	S	0.6035	$43.17	.	$8.64
0216	Level III Nerve and Muscle Tests	S	2.5454	$182.09	.	$36.42
0218	Level II Nerve and Muscle Tests	S	1.1274	$80.65	.	$16.13
0220	Level I Nerve Procedures	T	18.8390	"$1,347.69"	.	$269.54
0221	Level II Nerve Procedures	T	34.1093	"$2,440.08"	.	$488.02
0224	Implantation of Catheter/Reservoir/Shunt	T	44.6585	"$3,194.74"	.	$638.95
0227	Implantation of Drug Infusion Device	T	197.6879	"$14,142.00"	.	"$2,828.40"
0229	Level II Endovascular Revascularization of the Lower Extremity 	T	121.0619	"$8,660.41"	.	"$1,732.09"
0230	Level I Eye Tests & Treatments	S	0.6755	$48.32	.	$9.67
0231	Level III Eye Tests & Treatments	S	2.0063	$143.52	.	$28.71
0232	Level I Anterior Segment Eye Procedures	T	2.1105	$150.98	$31.75	$30.20
0233	Level III Anterior Segment Eye Procedures	T	15.6845	"$1,122.02"	.	$224.41
0234	Level IV Anterior Segment Eye Procedures	T	23.3409	"$1,669.74"	$347.84	$333.95
0235	Level I Posterior Segment Eye Procedures	T	5.7978	$414.76	.	$82.96
0237	Level II Posterior Segment Eye Procedures	T	20.0163	"$1,431.91"	.	$286.39
0238	Level I Repair and Plastic Eye Procedures	T	3.2670	$233.71	.	$46.75
0239	Level II Repair and Plastic Eye Procedures	T	8.5434	$611.17	.	$122.24
0240	Level III Repair and Plastic Eye Procedures	T	19.1469	"$1,369.71"	$294.39	$273.95
0241	Level IV Repair and Plastic Eye Procedures	T	26.8526	"$1,920.95"	.	$384.19
0242	Level V Repair and Plastic Eye Procedures	T	39.1619	"$2,801.52"	$592.01	$560.31
0243	Strabismus/Muscle Procedures	T	25.2961	"$1,809.61"	$412.25	$361.93
0244	Corneal and Amniotic Membrane Transplant	T	41.5672	"$2,973.59"	$794.86	$594.72
0246	Cataract Procedures with IOL Insert	T	24.2726	"$1,736.39"	$490.32	$347.28
0247	Laser Eye Procedures	T	5.7277	$409.74	$102.26	$81.95
0249	Cataract Procedures without IOL Insert	T	29.3351	"$2,098.55"	$500.00	$419.71
0250	Level I ENT Procedures	T	1.0886	$77.88	$24.11	$15.58
0251	Level II ENT Procedures	T	3.1743	$227.08	.	$45.42
0252	Level III ENT Procedures	T	7.0106	$501.52	$100.37	$100.31
0253	Level IV ENT Procedures	T	16.1612	"$1,156.12"	.	$231.23
0254	Level V ENT Procedures	T	25.1050	"$1,795.94"	.	$359.19
0255	Level II Anterior Segment Eye Procedures	T	9.3488	$668.79	.	$133.76
0256	Level VI ENT Procedures	T	45.8191	"$3,277.76"	.	$655.56
0259	Level VII ENT Procedures	T	429.2950	"$30,710.48"	"$7,921.74"	"$6,142.10"
0260	Level I Plain Film Except Teeth	X	0.6444	$46.10	.	$9.22
0261	Level II Plain Film Except Teeth Including Bone Density Measurement	X	0.9939	$71.10	.	$14.22
0262	Plain Film of Teeth	X	0.5038	$36.04	.	$7.21
0263	Level I Miscellaneous Radiology Procedures	X	3.5937	$257.08	.	$51.42
0265	Level I Diagnostic and Screening Ultrasound	S	0.9048	$64.73	$22.26	$12.95
0266	Level II Diagnostic and Screening Ultrasound	S	1.3912	$99.52	$37.23	$19.91
0267	Level III Diagnostic and Screening Ultrasound	S	2.1724	$155.41	$59.55	$31.09
0269	Level II Echocardiogram Without Contrast 	S	5.4729	$391.51	.	$78.31
0270	Level III Echocardiogram Without Contrast 	S	7.8018	$558.12	$128.60	$111.63
0272	Fluoroscopy	X	1.5638	$111.87	$30.47	$22.38
0274	Myelography	S	7.0831	$506.70	.	$101.34
0275	Arthrography	S	4.1819	$299.16	$68.90	$59.84
0276	Level I Digestive Radiology	S	1.1580	$82.84	$32.89	$16.57
0277	Level II Digestive Radiology	S	1.7199	$123.04	$46.59	$24.61
0278	Diagnostic Urography	S	2.9140	$208.46	$58.44	$41.70
0279	Level II Angiography and Venography	S	31.0202	"$2,219.09"	.	$443.82
0280	Level III Angiography and Venography	S	50.3190	"$3,599.67"	.	$719.94
0282	Miscellaneous Computed Axial Tomography	S	1.3855	$99.11	$33.02	$19.83
0283	Computed Tomography with Contrast	S	4.1591	$297.53	$95.58	$59.51
0284	Magnetic Resonance Imaging and Magnetic Resonance Angiography with Contrast	S	6.3386	$453.44	$146.59	$90.69
0288	Bone Density:Axial Skeleton	S	1.0345	$74.01	$0.00	$0.00
0293	Level VI Anterior Segment Eye Procedures	T	122.6861	"$8,776.60"	.	"$1,755.32"
0299	Hyperthermia and Radiation Treatment Procedures	S	5.4996	$393.42	.	$78.69
0300	Level I Radiation Therapy	S	1.3445	$96.18	.	$19.24
0301	Level II Radiation Therapy	S	2.5103	$179.58	.	$35.92
0303	Treatment Device Construction	X	2.8223	$201.90	$66.95	$40.38
0304	Level I Therapeutic Radiation Treatment Preparation	X	1.5332	$109.68	$34.63	$21.94
0305	Level II Therapeutic Radiation Treatment Preparation	X	4.0619	$290.58	$88.78	$58.12
0308	Positron Emission Tomography (PET) imaging	S	14.7924	"$1,058.20"	.	$211.64
0310	Level III Therapeutic Radiation Treatment Preparation	X	13.7671	$984.86	$325.27	$196.98
0312	Radioelement Applications	S	6.0908	$435.72	.	$87.15
0313	Brachytherapy	S	9.5758	$685.02	$258.85	$137.01
0315	Level II Implantation of Neurostimulator Generator 	S	294.7618	"$21,086.37"	.	"$4,217.28"
0317	Level II Miscellaneous Radiology Procedures	X	4.5839	$327.92	.	$65.59
0318	Implantation of Neurostimulator Pulse Generator and Electrode 	S	365.4831	"$26,145.56"	"$9,121.76"	"$5,229.12"
0319	Level III Endovascular Revascularization of the Lower Extremity	T	204.5012	"$14,629.40"	"$5,559.48"	"$2,925.88"
0320	Electroconvulsive Therapy	S	6.1609	$440.73	.	$88.15
0322	Brief Individual Psychotherapy	S	1.1775	$84.23	.	$16.85
0323	Extended Individual Psychotherapy	S	1.5327	$109.64	.	$21.93
0324	Family Psychotherapy	S	1.7756	$127.02	.	$25.41
0325	Group Psychotherapy	S	0.8420	$60.23	.	$12.05
0330	Dental Procedures	S	7.4526	$533.14	.	$106.63
0331	Combined Abdomen and Pelvis CT without Contrast 	S	4.2852	$306.55	$118.52	$61.31
0332	Computed Tomography without Contrast	S	2.4318	$173.96	$67.26	$34.80
0333	Computed Tomography without Contrast followed by Contrast	S	4.6212	$330.59	$114.81	$66.12
0334	Combined Abdomen and Pelvis CT with Contrast 	S	6.7610	$483.66	$155.87	$96.74
0336	Magnetic Resonance Imaging and Magnetic Resonance Angiography without Contrast	S	4.7484	$339.69	$133.46	$67.94
0337	Magnetic Resonance Imaging and Magnetic Resonance Angiography without Contrast followed by Contrast	S	7.6939	$550.40	$197.64	$110.08
0340	Minor Ancillary Procedures	X	0.6842	$48.95	.	$9.79
0341	Skin Tests	X	0.0951	$6.80	$2.09	$1.36
0342	Level I Pathology	X	0.1745	$12.48	.	$2.50
0343	Level III Pathology	X	0.5329	$38.12	$10.84	$7.63
0344	Level IV Pathology	X	0.8437	$60.36	$15.56	$12.08
0345	Level I Transfusion Laboratory Procedures	X	0.2510	$17.96	.	$3.60
0346	Level II Transfusion Laboratory Procedures	X	0.3454	$24.71	.	$4.95
0347	Level III Transfusion Laboratory Procedures	X	0.4782	$34.21	.	$6.85
0350	Administration of flu and PPV vaccine	S	0.3785	$27.08	$0.00	$0.00
0360	Level I Alimentary Tests	X	1.9062	$136.36	$33.59	$27.28
0361	Level II Alimentary Tests	X	4.2382	$303.19	$83.23	$60.64
0363	Level I Otorhinolaryngologic Function Tests	X	0.9283	$66.41	$16.39	$13.29
0364	Level I Audiometry	X	0.5034	$36.01	.	$7.21
0365	Level II Audiometry	X	1.2436	$88.96	$18.04	$17.80
0366	Level III Audiometry	X	1.6472	$117.84	$23.61	$23.57
0367	Level I Pulmonary Test	X	0.6282	$44.94	$11.94	$8.99
0368	Level II Pulmonary Tests	X	0.8794	$62.91	$20.93	$12.59
0369	Level III Pulmonary Tests	X	2.5614	$183.23	$37.24	$36.65
0370	Multiple Allergy Tests	X	1.3608	$97.35	.	$19.47
0373	Level I Neuropsychological Testing	X	1.1894	$85.09	.	$17.02
0375	Ancillary Outpatient Services When Patient Expires	S	85.8109	"$6,138.65"	.	"$1,227.73"
0377	Level II Cardiac Imaging	S	9.5396	$682.43	.	$136.49
0378	Level II Pulmonary Imaging	S	4.6922	$335.67	$126.64	$67.14
0381	Single Allergy Tests	X	0.3666	$26.23	.	$5.25
0382	Level II Neuropsychological Testing	X	2.5082	$179.43	.	$35.89
0383	Cardiac Computed Tomographic Imaging	S	3.7434	$267.79	.	$53.56
0384	GI Procedures with Stents	T	29.5262	"$2,112.22"	.	$422.45
0385	Level I Prosthetic Urological Procedures	S	107.0250	"$7,656.25"	.	"$1,531.25"
0386	Level II Prosthetic Urological Procedures	S	175.3015	"$12,540.54"	.	"$2,508.11"
0387	Level II Hysteroscopy	T	37.4400	"$2,678.35"	$654.91	$535.67
0388	Discography	S	24.0522	"$1,720.62"	.	$344.13
0389	Level I Non-imaging Nuclear Medicine	S	1.6141	$115.47	$26.88	$23.10
0390	Level I Endocrine Imaging	S	2.1030	$150.44	$47.69	$30.09
0391	Level II Endocrine Imaging	S	3.2734	$234.17	$65.46	$46.84
0392	Level II Non-imaging Nuclear Medicine	S	2.7659	$197.86	.	$39.58
0393	Hematologic Processing & Studies	S	5.9172	$423.30	.	$84.66
0394	Hepatobiliary Imaging	S	4.4003	$314.78	$90.78	$62.96
0395	GI Tract Imaging	S	3.5975	$257.35	$87.01	$51.47
0396	Bone Imaging	S	3.6693	$262.49	$94.20	$52.50
0397	Vascular Imaging	S	2.6869	$192.21	.	$38.45
0398	Level I Cardiac Imaging	S	4.3237	$309.30	$93.33	$61.86
0400	Hematopoietic Imaging	S	3.9108	$279.77	$90.90	$55.96
0401	Level I Pulmonary Imaging	S	3.0769	$220.11	$71.16	$44.03
0402	Level II Nervous System Imaging	S	6.6677	$476.99	.	$95.40
0403	Level I Nervous System Imaging	S	3.6785	$263.15	$72.42	$52.63
0404	Renal and Genitourinary Studies	S	4.6512	$332.73	$81.55	$66.55
0406	Level I Tumor/Infection Imaging	S	4.2057	$300.86	$85.06	$60.18
0407	Level I Radionuclide Therapy	S	3.3171	$237.30	$78.13	$47.46
0408	Level III Tumor/Infection Imaging	S	13.6417	$975.89	.	$195.18
0409	Red Blood Cell Tests	X	0.1352	$9.67	$2.17	$1.94
0412	Level III Radiation Therapy	S	6.7605	$483.63	.	$96.73
0413	Level II Radionuclide Therapy	S	4.1401	$296.17	.	$59.24
0414	Level II Tumor/Infection Imaging	S	7.0927	$507.39	.	$101.48
0415	Level II Endoscopy Lower Airway	T	21.8294	"$1,561.61"	$354.68	$312.33
0419	Level II Upper GI Procedures 	T	12.9655	$927.51	$207.70	$185.51
0422	Level III Upper GI Procedures	T	26.2520	"$1,877.99"	.	$375.60
0423	Level II Percutaneous Abdominal and Biliary Procedures	T	56.8197	"$4,064.71"	.	$812.95
0424	Level II Small Intestine Endoscopy 	T	15.6413	"$1,118.93"	$240.83	$223.79
0425	Level II Arthroplasty or Implantation with Prosthesis	T	125.1124	"$8,950.17"	.	"$1,790.04"
0426	Level II Strapping and Cast Application	S	2.6537	$189.84	.	$37.97
0427	Level II Tube or Catheter Changes or Repositioning	T	16.7086	"$1,195.28"	.	$239.06
0428	Level III Sigmoidoscopy and Anoscopy	T	22.1946	"$1,587.74"	.	$317.55
0429	Level V Cystourethroscopy and other Genitourinary Procedures	T	45.6142	"$3,263.10"	.	$652.62
0432	Level II Health and Behavior Services	S	0.6335	$45.32	.	$9.07
0433	Level II Pathology	X	0.3272	$23.41	$5.17	$4.69
0434	Cardiac Defect Repair	T	168.8994	"$12,082.56"	.	"$2,416.52"
0436	Level I Drug Administration	S	0.3785	$27.08	.	$5.42
0437	Level II Drug Administration	S	0.5466	$39.10	.	$7.82
0438	Level III Drug Administration	S	1.0462	$74.84	.	$14.97
0439	Level IV Drug Administration	S	2.0425	$146.11	.	$29.23
0440	Level V Drug Administration	S	3.2265	$230.81	.	$46.17
0442	Dosimetric Drug Administration	S	28.1454	"$2,013.44"	.	$402.69
0604	Level 1 Hospital Clinic Visits	V	0.7925	$56.69	.	$11.34
0605	Level 2 Hospital Clinic Visits	V	1.0287	$73.59	.	$14.72
0606	Level 3 Hospital Clinic Visits	V	1.3504	$96.60	.	$19.32
0607	Level 4 Hospital Clinic Visits	V	1.7870	$127.84	.	$25.57
0608	Level 5 Hospital Clinic Visits	V	2.4304	$173.86	.	$34.78
0609	Level 1 Type A Emergency Visits	V	0.7230	$51.72	$12.04	$10.35
0613	Level 2 Type A Emergency Visits	V	1.2884	$92.17	$20.80	$18.44
0614	Level 3 Type A Emergency Visits	V	2.0025	$143.25	$33.60	$28.65
0615	Level 4 Type A Emergency Visits	V	3.2022	$229.08	$47.70	$45.82
0616	Level 5 Type A Emergency Visits	V	4.8085	$343.99	$71.54	$68.80
0617	Critical Care	S	7.4708	$534.44	.	$106.89
0618	Trauma Response with Critical Care	S	12.8243	$917.41	.	$183.49
0621	Level I Vascular Access Procedures	T	11.0410	$789.84	.	$157.97
0622	Level II Vascular Access Procedures	T	24.5089	"$1,753.29"	.	$350.66
0623	Level III Vascular Access Procedures	T	31.2603	"$2,236.27"	.	$447.26
0624	Phlebotomy and Minor Vascular Access Device Procedures	X	0.6874	$49.17	$12.39	$9.84
0626	Level 1 Type B Emergency Visits	V	0.9493	$67.91	.	$13.59
0627	Level 2 Type B Emergency Visits	V	0.7568	$54.14	.	$10.83
0628	Level 3 Type B Emergency Visits	V	1.2614	$90.24	.	$18.05
0629	Level 4 Type B Emergency Visits	V	1.8896	$135.18	.	$27.04
0630	Level 5 Type B Emergency Visits	V	2.8514	$203.98	.	$40.80
0648	Level IV Breast Surgery	T	64.4193	"$4,608.36"	.	$921.68
0651	Complex Interstitial Radiation Source Application	S	13.1991	$944.22	.	$188.85
0652	Insertion of Intraperitoneal and Pleural Catheters	T	31.7089	"$2,268.36"	.	$453.68
0653	Vascular Reconstruction/Fistula Repair with Device	T	34.1843	"$2,445.44"	.	$489.09
0654	Level II Insertion/Replacement of Permanent Pacemaker 	T	107.1276	"$7,663.59"	.	"$1,532.72"
0655	Insertion/Replacement/Conversion of a Permanent Dual Chamber Pacemaker or Pacing Electrode	T	143.4184	"$10,259.72"	.	"$2,051.95"
0656	Transcatheter Placement of Intracoronary Drug-Eluting Stents	T	108.0208	"$7,727.48"	.	"$1,545.50"
0659	Hyperbaric Oxygen	S	1.5107	$108.07	.	$21.62
0660	Level II Otorhinolaryngologic Function Tests	X	1.8607	$133.11	$27.10	$26.63
0661	Level V Pathology	X	2.1783	$155.83	.	$31.17
0662	CT Angiography	S	4.7607	$340.57	$114.37	$68.12
0664	Level I Proton Beam Radiation Therapy	S	6.2961	$450.40	.	$90.08
0665	Bone Density:AppendicularSkeleton	S	0.4887	$34.96	$0.00	$0.00
0667	Level II Proton Beam Radiation Therapy	S	15.5196	"$1,110.23"	.	$222.05
0668	Level I Angiography and Venography	T	10.0722	$720.53	.	$144.11
0672	Level III Posterior Segment Eye Procedures	T	40.5599	"$2,901.53"	.	$580.31
0673	Level V Anterior Segment Eye Procedures	T	41.8435	"$2,993.36"	$635.64	$598.68
0674	Prostate Cryoablation	T	108.8394	"$7,786.04"	.	"$1,557.21"
0676	Thrombolysis and Other Device Revisions 	T	2.4087	$172.31	.	$34.47
0678	External Counterpulsation	T	1.4108	$100.92	.	$20.19
0679	Level II Resuscitation and Cardioversion	S	5.5944	$400.21	$95.30	$80.05
0680	Insertion of Patient Activated Event Recorders	S	82.6419	"$5,911.95"	.	"$1,182.39"
0683	Level II Photochemotherapy	S	2.3899	$170.97	.	$34.20
0685	Level III Needle Biopsy/Aspiration Except Bone Marrow	T	9.9714	$713.32	.	$142.67
0687	Revision/Removal of Neurostimulator Electrodes	T	22.0360	"$1,576.39"	$389.48	$315.28
0688	Revision/Removal of Neurostimulator Pulse Generator Receiver	T	36.6798	"$2,623.96"	$768.94	$524.80
0690	Level I Electronic Analysis of Devices	S	0.4741	$33.92	.	$6.79
0691	Level III Electronic Analysis of Devices	S	2.6793	$191.67	.	$38.34
0692	Level II Electronic Analysis of Devices	S	1.5756	$112.71	.	$22.55
0694	Mohs Surgery	T	5.1217	$366.39	$88.07	$73.28
0697	Level I Echocardiogram Without Contrast 	S	2.9595	$211.71	.	$42.35
0698	Level II Eye Tests & Treatments	S	1.0325	$73.86	.	$14.78
0699	Level IV Eye Tests & Treatments	T	15.9003	"$1,137.46"	.	$227.50
0701	Sr89 strontium	K		$977.14	.	$195.43
0726	Dexrazoxane HCl injection	K		$199.93	.	$39.99
0728	Filgrastim 300 mcg injection	K		$260.33	.	$52.07
0731	Sargramostim injection	K		$24.83	.	$4.97
0735	Ampho b cholesteryl sulfate	K		$14.84	.	$2.97
0736	Amphotericin b liposome inj	K		$14.58	.	$2.92
0738	Rasburicase	K		$201.27	.	$40.26
0747	Chlorothiazide sodium inj	K		$277.37	.	$55.48
0751	Mechlorethamine hcl inj	K		$157.86	.	$31.58
0752	Dactinomycin injection	K		$578.75	.	$115.75
0759	"Naltrexone, depot form"	K		$2.84	.	$0.57
0800	Leuprolide acetate	K		$607.26	.	$121.46
0802	Etoposide oral	K		$47.13	.	$9.43
0807	Aldesleukin injection	K		"$1,097.99"	.	$219.60
0809	Bcg live intravesical vac	K		$119.88	.	$23.98
0810	Goserelin acetate implant	K		$172.90	.	$34.58
0812	Carmustine injection	K		$175.80	.	$35.16
0814	Asparaginase injection	K		$63.27	.	$12.66
0820	Daunorubicin injection	K		$17.64	.	$3.53
0821	Daunorubicin citrate inj	K		$57.67	.	$11.54
0823	Docetaxel injection	K		$11.72	.	$2.35
0825	Nelarabine injection	K		$119.55	.	$23.91
0827	Floxuridine injection	K		$68.03	.	$13.61
0828	Gemcitabine hcl injection	K		$35.17	.	$7.04
0831	Ifosfamide injection	K		$31.70	.	$6.34
0832	Idarubicin hcl injection	K		$104.43	.	$20.89
0835	Cosyntropin injection NOS	K		$101.68	.	$20.34
0836	Interferon alfa-2b inj	K		$17.96	.	$3.60
0838	Interferon gamma 1-b inj	K		$593.79	.	$118.76
0840	Inj melphalan hydrochl	K		"$1,352.09"	.	$270.42
0842	Fludarabine phosphate inj	K		$89.12	.	$17.83
0843	Pegaspargase injection	K		"$5,889.99"	.	"$1,178.00"
0844	Pentostatin injection	K		$839.53	.	$167.91
0849	Rituximab injection	K		$641.95	.	$128.39
0850	Streptozocin injection	K		$274.19	.	$54.84
0851	Thiotepa injection	K		$143.01	.	$28.61
0856	Porfimer sodium injection	K		"$19,325.79"	.	"$3,865.16"
0858	Inj cladribine	K		$23.15	.	$4.63
0861	Leuprolide acetate injeciton	K		$5.17	.	$1.04
0864	Mitoxantrone hydrochl	K		$29.97	.	$6.00
0868	Oral aprepitant	K		$6.18	.	$1.24
0873	Hyalgan/supartz inj per dose	K		$89.49	.	$17.90
0874	Synvisc or synvisc-one	K		$12.35	.	$2.47
0875	Euflexxa inj per dose	K		$147.39	.	$29.48
0877	Orthovisc inj per dose	K		$166.38	.	$33.28
0884	Rho d immune globulin inj	K		$83.87	.	$16.78
0887	Azathioprine parenteral	K		$119.28	.	$23.86
0890	Lymphocyte immune globulin	K		$618.09	.	$123.62
0900	Alglucerase injection	K		$41.99	.	$8.40
0901	Alpha 1 proteinase inhibitor	K		$3.93	.	$0.79
0902	"Injection,onabotulinumtoxinA"	K		$5.47	.	$1.10
0903	Cytomegalovirus imm IV /vial	K		$966.09	.	$193.22
0910	Interferon beta-1b / .25 MG	K		$224.19	.	$44.84
0913	Ganciclovir long act implant	K		"$16,960.00"	.	"$3,392.00"
0917	Adenosine injection	K		$105.06	.	$21.02
0925	Factor viii	K		$0.90	.	$0.18
0927	Factor viii recombinant	K		$1.11	.	$0.23
0928	Factor ix complex	K		$0.88	.	$0.18
0929	Anti-inhibitor	K		$1.63	.	$0.33
0931	Factor IX non-recombinant	K		$0.92	.	$0.19
0932	Factor IX recombinant	K		$1.19	.	$0.24
0934	"Capecitabine, oral"	K		$26.02	.	$5.21
0943	Octagam injection	K		$34.64	.	$6.93
0944	Gammagard liquid injection	K		$40.21	.	$8.05
0945	Rhophylac injection	K		$5.19	.	$1.04
0946	Hepagam b im injection	K		$48.16	.	$9.64
0947	Flebogamma injection	G		$34.93	.	$6.99
0948	"Gamunex, Gamunex-C, Gammaked"	K		$37.61	.	$7.53
0949	"Frozen plasma, pooled, sd"	R	1.0142	$72.55	.	$14.51
0950	Whole blood for transfusion	R	2.3764	$170.00	.	$34.00
0951	Reclast injection	K		$222.63	.	$44.53
0952	Cryoprecipitate each unit	R	1.1330	$81.05	.	$16.21
0954	RBC leukocytes reduced	R	2.7005	$193.19	.	$38.64
0955	"Plasma, frz between 8-24hour"	R	1.0513	$75.21	.	$15.05
0956	"Plasma protein fract,5%,50ml"	R	0.3485	$24.93	.	$4.99
0957	"Platelets, each unit"	R	1.2528	$89.62	.	$17.93
0958	Plaelet rich plasma unit	R	2.4364	$174.29	.	$34.86
0959	Red blood cells unit	R	2.1111	$151.02	.	$30.21
0960	Washed red blood cells unit	R	4.3667	$312.38	.	$62.48
0961	"Albumin (human),5%, 50ml"	K		$22.19	.	$4.44
0963	"Albumin (human), 5%, 250 ml"	K		$60.45	.	$12.09
0964	"Albumin (human), 25%, 20 ml"	K		$30.37	.	$6.08
0965	"Albumin (human), 25%, 50ml"	K		$69.50	.	$13.90
0966	"Plasmaprotein fract,5%,250ml"	R	0.6693	$47.88	.	$9.58
0967	Blood split unit	R	1.9812	$141.73	.	$28.35
0968	Platelets leukoreduced irrad	R	2.1351	$152.74	.	$30.55
0969	RBC leukoreduced irradiated	R	3.8041	$272.13	.	$54.43
1009	Cryoprecipitatereducedplasma	R	0.9372	$67.04	.	$13.41
1010	"Blood, l/r, cmv-neg"	R	2.5568	$182.91	.	$36.59
1011	"Platelets, hla-m, l/r, unit"	R	10.8958	$779.45	.	$155.89
1013	Platelets leukocytes reduced	R	1.6564	$118.49	.	$23.70
1015	Injection glatiramer acetate	K		$113.07	.	$22.62
1016	"Blood, l/r, froz/degly/wash"	R	1.7577	$125.74	.	$25.15
1017	"Plt, aph/pher, l/r, cmv-neg"	R	4.7739	$341.51	.	$68.31
1018	"Blood, l/r, irradiated"	R	2.4756	$177.10	.	$35.42
1019	Plate pheres leukoredu irrad	R	9.4363	$675.04	.	$135.01
1020	"Plt, pher, l/r cmv-neg, irr"	R	9.0891	$650.21	.	$130.05
1021	"RBC, frz/deg/wsh, l/r, irrad"	R	5.2432	$375.08	.	$75.02
1022	"RBC, l/r, cmv-neg, irrad"	R	4.0243	$287.89	.	$57.58
1023	Pralidoxime chloride inj	K		$84.79	.	$16.96
1052	"Injection, voriconazole"	K		$6.57	.	$1.32
1064	"I131 iodide cap, rx"	K		$17.92	.	$3.59
1083	Adalimumab injection	K		$428.51	.	$85.71
1084	Denileukin diftitox inj	K		"$1,646.18"	.	$329.24
1086	Temozolomide	K		$10.16	.	$2.04
1138	"Hepagam b intravenous, inj"	K		$48.16	.	$9.64
1139	Protein c concentrate	K		$13.11	.	$2.63
1142	Supprelin LA implant	K		"$15,936.02"	.	"$3,187.21"
1150	"I131 iodide sol, rx"	K		$11.20	.	$2.24
1166	Cytarabine liposome inj	K		$513.16	.	$102.64
1167	"Inj, epirubicin hcl"	K		$1.70	.	$0.34
1168	"Inj, temsirolimus"	K		$52.17	.	$10.44
1178	Busulfan injection	K		$19.08	.	$3.82
1203	Verteporfin injection	K		$10.06	.	$2.02
1207	"Octreotide injection, depot"	K		$123.10	.	$24.62
1213	Antihemophilic viii/vwf comp	K		$0.92	.	$0.19
1214	Inj IVIG privigen 500 mg	K		$35.04	.	$7.01
1221	Dimethyl sulfoxide 50%	K		$86.57	.	$17.32
1232	Mitomycin 5 MG inj	K		$18.15	.	$3.63
1235	Valrubicin injection	K		$991.66	.	$198.34
1236	Levoleucovorin injection	K		$1.66	.	$0.34
1237	Inj iron dextran	K		$12.10	.	$2.42
1238	Topotecan oral	K		$81.84	.	$16.37
1239	Rotavirus vacc 2 dose oral	K		$108.65	.	$21.73
1240	Apligraf skin sub	K		$36.56	.	$7.32
1241	Oasis wound matrix skin sub	K		$7.41	.	$1.49
1242	Oasis burn matrix skin sub	K		$7.41	.	$1.49
1243	Integra BMWD skin sub	K		$18.87	.	$3.78
1245	Dermagraft skin sub	K		$41.31	.	$8.27
1246	Graftjacket skin sub	K		$95.00	.	$19.00
1247	Integra matrix skin sub	K		$26.96	.	$5.40
1248	Primatrix skin sub	K		$31.49	.	$6.30
1249	Cymetra allograft	K		$163.52	.	$32.71
1250	Graftjacket express allograf	K		$276.33	.	$55.27
1251	Integra flowable wound matri	K		"$1,101.34"	.	$220.27
1252	Gammagraft skin sub	K		$7.05	.	$1.41
1253	Triamcinolone A inj PRS-free	K		$3.50	.	$0.70
1263	Antithrombin iii injection	K		$2.75	.	$0.55
1268	Xyntha inj	K		$1.09	.	$0.22
1270	Alloderm skin sub	K		$32.30	.	$6.46
1272	Acetylcysteine injection	K		$2.84	.	$0.57
1274	Edetate calcium disodium inj	K		$189.16	.	$37.84
1275	"Vivaglobin, inj"	K		$12.72	.	$2.55
1280	Corticotropin injection	K		"$2,692.84"	.	$538.57
1281	Bevacizumab injection	K		$1.53	.	$0.31
1287	Alloskin skin sub	K		$7.93	.	$1.59
1289	AbobotulinumtoxinA	K		$7.22	.	$1.45
1290	Human fibrinogen conc inj	K		$26.72	.	$5.35
1291	Rilonacept injection	K		$24.09	.	$4.82
1295	Sm 153 lexidronam	K		"$7,738.00"	.	"$1,547.60"
1296	Degarelix injection	K		$2.97	.	$0.60
1297	"Ferumoxytol, non-esrd"	K		$0.63	.	$0.13
1307	Oral busulfan	K		$4.12	.	$0.83
1311	Canakinumab injection	G		$89.13	.	$17.83
1312	Hizentra injection	K		$7.29	.	$1.46
1327	Imiglucerase injection	K		$41.99	.	$8.40
1331	Olanzapine long-acting inj	K		$2.75	.	$0.55
1332	Antithrombin recombinant	K		$103.35	.	$20.67
1338	"Methyl aminolevulinate, top"	K		$74.85	.	$14.97
1339	Oral fludarabine phosphate	K		$83.34	.	$16.67
1340	"Collagenase, clost hist inj"	K		$38.23	.	$7.65
1341	Amobarbital 125 MG inj	K		$132.55	.	$26.51
1342	Matristem micromatrix	K		$2.95	.	$0.59
1343	Ganciclovir sodium injection	K		$75.68	.	$15.14
1344	Gonadorelin hydroch/ 100 mcg	K		$3.72	.	$0.75
1345	Theraskin	K		$22.49	.	$4.50
1347	Oxacillin sodium injeciton	K		$2.81	.	$0.57
1349	Anidulafungin injection	K		$1.36	.	$0.28
1350	Topotecan injection	K		$6.71	.	$1.35
1351	Matristem wound matrix	K		$4.75	.	$0.95
1353	Belimumab injection	G		$38.32	.	$7.67
1354	Hydroxyprogesterone caproate	K		$2.30	.	$0.46
1357	Inj protirelin per 250 mcg	K		$29.82	.	$5.97
1361	Enfuvirtide injection	K		$0.53	.	$0.11
1408	Cyclophosphamide 100 MG inj	K		$14.96	.	$3.00
1413	Lumizyme injection	K		$151.16	.	$30.24
1415	Glassia injection	K		$3.88	.	$0.78
1416	Factor XIII anti-hem factor	G		$6.41	.	$1.29
1417	Gel-one	K		"$1,033.50"	.	$206.70
1418	Oral everolimus	K		$5.78	.	$1.16
1419	Dermacell	K		$34.27	.	$6.86
1422	Anthrax vaccine sc or im	K		$112.86	.	$22.58
1423	Minocycline hydrochloride	K		$0.58	.	$0.12
1424	Nabilone oral	K		$23.43	.	$4.69
1426	Eribulin mesylate injection	G		$91.04	.	$18.21
1427	Alloskin	K		$14.03	.	$2.81
1428	Arthroflex	K		$125.99	.	$25.20
1429	Flexhd or allopatch hd	K		$40.70	.	$8.14
1430	Unite biomatrix	K		$36.18	.	$7.24
1432	Arbutamine hcl injection	K		$86.37	.	$17.28
1433	Calcitonin salmon injection	K		$57.09	.	$11.42
1434	Testosterone enanthate inj	K		$33.36	.	$6.68
1435	Injection estrone per 1 MG	K		$1.54	.	$0.31
1437	Gatifloxacin injection	K		$86.53	.	$17.31
1438	Diazoxide injection	K		$88.31	.	$17.67
1440	Inj desmopressin acetate	K		$5.73	.	$1.15
1446	Visualization adjunct	K		$3.34	.	$0.67
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		$549.23	.	$109.85
1607	Eptifibatide injection	K		$23.50	.	$4.70
1608	Etanercept injection	K		$219.33	.	$43.87
1609	"Rho(D) immune globulin h, sd"	K		$16.41	.	$3.29
1612	"Daclizumab, parenteral"	K		$526.34	.	$105.27
1613	Trastuzumab injection	K		$74.34	.	$14.87
1630	"Hep b ig, im"	K		$113.12	.	$22.63
1631	Baclofen intrathecal trial	K		$76.24	.	$15.25
1633	Alefacept	K		$38.26	.	$7.66
1643	"Y90 ibritumomab, rx"	K		"$36,612.79"	.	"$7,322.56"
1645	"I131 tositumomab, rx"	K		"$30,188.56"	.	"$6,037.72"
1670	Tetanus immune globulin inj	K		$251.63	.	$50.33
1675	P32 Na phosphate	K		$178.35	.	$35.67
1676	P32 chromic phosphate	K		$56.16	.	$11.24
1683	Basiliximab	K		"$2,227.72"	.	$445.55
1684	Corticorelin ovine triflutal	K		$5.32	.	$1.07
1685	"Darbepoetin alfa, non-esrd"	K		$3.26	.	$0.66
1686	"Epoetin alfa, non-esrd"	K		$9.76	.	$1.96
1687	Digoxin immune fab (ovine)	K		$783.48	.	$156.70
1688	Ethanolamine oleate	K		$299.94	.	$59.99
1689	Fomepizole	K		$7.07	.	$1.42
1690	Hemin	K		$10.61	.	$2.13
1693	Lepirudin	K		$396.86	.	$79.38
1694	Ziconotide injection	K		$6.61	.	$1.33
1695	Nesiritide injection	K		$49.25	.	$9.85
1696	Palifermin injection	K		$11.77	.	$2.36
1697	Pegaptanib sodium injection	K		"$1,030.50"	.	$206.10
1700	Inj secretin synthetic human	K		$27.50	.	$5.50
1701	Treprostinil injection	K		$61.24	.	$12.25
1704	"Humate-P, inj"	K		$0.89	.	$0.18
1705	Factor viia	K		$1.58	.	$0.32
1709	Azacitidine injection	K		$5.39	.	$1.08
1710	Clofarabine injection	K		$122.54	.	$24.51
1711	Vantas implant	K		"$3,139.61"	.	$627.93
1712	Paclitaxel protein bound	K		$9.59	.	$1.92
1716	"Brachytx, non-str, Gold-198"	U	1.5481	$110.75	.	$22.15
1717	"Brachytx, non-str, HDR Ir-192"	U	3.4759	$248.66	.	$49.74
1719	"Brachytx, NS, Non-HDRIr-192"	U	0.5106	$36.53	.	$7.31
1738	Oxaliplatin	K		$9.78	.	$1.96
1739	"Pegademase bovine, 25 iu"	K		$259.70	.	$51.94
1741	"Urofollitropin, 75 iu"	K		$61.77	.	$12.36
1749	"Endo, colon, retro imaging"	H			.	.
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	219.8701	"$15,728.85"	.	"$3,145.77"
2632	Iodine I-125 sodium iodide	U	0.2916	$20.86	.	$4.18
2634	"Brachytx, non-str, HA, I-125"	U	0.9330	$66.74	.	$13.35
2635	"Brachytx, non-str, HA, P-103"	U	0.4232	$30.27	.	$6.06
2636	"Brachy linear, non-str,P-103"	U	0.4995	$35.73	.	$7.15
2638	"Brachytx, stranded, I-125"	U	0.6459	$46.21	.	$9.25
2639	"Brachytx, non-stranded,I-125"	U	0.5006	$35.81	.	$7.17
2640	"Brachytx, stranded, P-103"	U	1.0587	$75.74	.	$15.15
2641	"Brachytx, non-stranded,P-103"	U	0.8383	$59.97	.	$12.00
2642	"Brachytx, stranded, C-131"	U	1.5393	$110.12	.	$22.03
2643	"Brachytx, non-stranded,C-131"	U	0.9277	$66.36	.	$13.28
2698	"Brachytx, stranded, NOS"	U	0.6459	$46.21	.	$9.25
2699	"Brachytx, non-stranded, NOS"	U	0.4232	$30.27	.	$6.06
2731	"Immune globulin, powder"	K		$31.50	.	$6.30
2770	Quinupristin/dalfopristin	K		$174.44	.	$34.89
3041	Bivalirudin	K		$2.78	.	$0.56
3050	Sermorelin acetate injection	K		$1.80	.	$0.36
7000	Amifostine	K		$323.69	.	$64.74
7011	Oprelvekin injection	K		$243.70	.	$48.74
7034	Somatropin injection	K		$63.20	.	$12.64
7035	Teniposide	K		$322.24	.	$64.45
7036	"Urokinase 250,000 IU inj"	K		$457.73	.	$91.55
7038	Monoclonal antibodies	K		"$1,156.08"	.	$231.22
7041	Tirofiban HCl	K		$8.71	.	$1.75
7042	"Capecitabine, oral"	K		$7.87	.	$1.58
7043	Infliximab injection	K		$63.53	.	$12.71
7046	Doxorubicin hcl liposome inj	K		$538.79	.	$107.76
7048	Alteplase recombinant	K		$46.36	.	$9.28
7049	Filgrastim 480 mcg injection	K		$414.06	.	$82.82
7051	Leuprolide acetate implant	K		"$4,819.82"	.	$963.97
7308	Aminolevulinic acid hcl top	K		$150.74	.	$30.15
8000	Cardiac Electrophysiologic Evaluation and Ablation Composite	T	156.2062	"$11,174.52"	.	"$2,234.91"
8001	LDR Prostate Brachytherapy Composite	T	45.8369	"$3,279.03"	.	$655.81
8002	Level I Extended Assessment & Management Composite	V	6.0780	$434.80	.	$86.96
8003	Level II Extended Assessment & Management Composite	V	11.0788	$792.54	.	$158.51
8004	Ultrasound Composite	S	2.7458	$196.43	.	$39.29
8005	CT and CTA without Contrast Composite	S	5.6132	$401.55	.	$80.31
8006	CT and CTA with Contrast Composite	S	9.5434	$682.71	.	$136.55
8007	MRI and MRA without Contrast Composite	S	9.8907	$707.55	.	$141.51
8008	MRI and MRA with Contrast Composite	S	14.5362	"$1,039.88"	.	$207.98
9001	Linezolid injection	K		$37.04	.	$7.41
9002	Tenecteplase injection	K		$55.87	.	$11.18
9003	Palivizumab	K		"$1,181.14"	.	$236.23
9004	Gemtuzumab ozogamicin inj	K		"$2,742.59"	.	$548.52
9005	Reteplase injection	K		"$2,301.89"	.	$460.38
9006	Tacrolimus injection	K		$139.61	.	$27.93
9012	Arsenic trioxide injection	K		$40.58	.	$8.12
9018	"Inj, rimabotulinumtoxinB"	K		$10.93	.	$2.19
9019	Caspofungin acetate	K		$12.62	.	$2.53
9022	IM inj interferon beta 1-a	K		$250.52	.	$50.11
9023	Rho d immune globulin	K		$25.12	.	$5.03
9024	Amphotericin b lipid complex	K		$10.44	.	$2.09
9032	Baclofen 10 MG injection	K		$183.42	.	$36.69
9033	Cidofovir injection	K		$757.18	.	$151.44
9038	Inj estrogen conjugate	K		$115.05	.	$23.01
9042	Glucagon hydrochloride	K		$110.77	.	$22.16
9044	Ibutilide fumarate injection	K		$191.70	.	$38.34
9104	Antithymocyte globuln rabbit	K		$445.03	.	$89.01
9108	Thyrotropin injection	K		"$1,053.29"	.	$210.66
9110	Alemtuzumab injection	K		$586.73	.	$117.35
9115	Zoledronic acid	K		$226.20	.	$45.24
9119	"Injection, pegfilgrastim 6mg"	K		"$2,798.77"	.	$559.76
9120	"Injection, Fulvestrant"	K		$86.08	.	$17.22
9121	"Injection, argatroban"	K		$19.17	.	$3.84
9122	Triptorelin pamoate	K		$193.78	.	$38.76
9124	Daptomycin injection	K		$0.51	.	$0.11
9125	"Risperidone, long acting"	K		$5.29	.	$1.06
9126	Natalizumab injection	K		$11.11	.	$2.23
9133	"Rabies ig, im/sc"	K		$186.90	.	$37.38
9134	"Rabies ig, heat treated"	K		$174.92	.	$34.99
9135	"Varicella-zoster ig, im"	K		$76.31	.	$15.27
9137	"Bcg vaccine, percut"	K		$113.89	.	$22.78
9139	"Rabies vaccine, im"	K		$201.17	.	$40.24
9140	"Rabies vaccine, id"	K		$156.92	.	$31.39
9143	"Meningococcal vaccine, sc"	K		$112.88	.	$22.58
9144	"Encephalitis vaccine, sc"	K		$102.08	.	$20.42
9145	"Meningococcal vaccine, im"	K		$87.64	.	$17.53
9207	Bortezomib injection	K		$42.45	.	$8.49
9208	Agalsidase beta injection	K		$141.19	.	$28.24
9209	Laronidase injection	K		$26.84	.	$5.37
9210	Palonosetron hcl	K		$18.44	.	$3.69
9213	Pemetrexed injection	K		$54.96	.	$11.00
9214	Bevacizumab injection	K		$60.96	.	$12.20
9215	Cetuximab injection	K		$50.42	.	$10.09
9217	Leuprolide acetate suspnsion	K		$214.97	.	$43.00
9224	Galsulfase injection	K		$346.06	.	$69.22
9225	Fluocinolone acetonide implt	K		"$19,345.00"	.	"$3,869.00"
9227	Micafungin sodium injection	K		$0.96	.	$0.20
9228	Tigecycline injection	K		$1.33	.	$0.27
9229	Ibandronate sodium injection	K		$151.90	.	$30.38
9230	Abatacept injection	K		$21.68	.	$4.34
9231	Decitabine injection	K		$33.23	.	$6.65
9232	Idursulfase injection	K		$455.03	.	$91.01
9233	Ranibizumab injection	K		$400.71	.	$80.15
9234	Alglucosidase alfa injection	K		$205.32	.	$41.07
9235	Panitumumab injection	K		$87.22	.	$17.45
9236	Eculizumab injection	K		$195.47	.	$39.10
9237	"Inj, lanreotide acetate"	K		$33.24	.	$6.65
9240	"Injection, ixabepilone"	K		$65.60	.	$13.12
9242	"Injection, fosaprepitant"	K		$1.71	.	$0.35
9243	Bendamustine injection	K		$18.82	.	$3.77
9244	Regadenoson injection	K		$52.65	.	$10.53
9245	Romiplostim injection	K		$47.75	.	$9.55
9248	"Inj, clevidipine butyrate"	K		$3.00	.	$0.60
9249	Certolizumab pegol inj	K		$4.35	.	$0.87
9250	Artiss fibrin sealant	K		$139.81	.	$27.97
9251	C1 esterase inhibitor inj	K		$45.68	.	$9.14
9252	Plerixafor injection	K		$286.00	.	$57.20
9253	Temozolomide injection	K		$4.81	.	$0.97
9255	Paliperidone palmitate inj	K		$6.83	.	$1.37
9256	Dexamethasone intra implant	K		$195.95	.	$39.19
9258	Telavancin injection	K		$2.09	.	$0.42
9259	Pralatrexate injection	K		$168.82	.	$33.77
9260	Ofatumumab injection	K		$46.29	.	$9.26
9261	Ustekinumab injection	K		$128.04	.	$25.61
9263	Ecallantide injection	K		$290.36	.	$58.08
9264	Tocilizumab injection	K		$3.53	.	$0.71
9265	Romidepsin injection	K		$230.38	.	$46.08
9268	Capsaicin 8% patch	K		$26.04	.	$5.21
9269	"C-1 esterase, berinert"	K		$30.81	.	$6.17
9270	Gammaplex IVIG	K		$38.01	.	$7.61
9271	Velaglucerase alfa	K		$356.07	.	$71.22
9272	"Inj, denosumab"	K		$14.67	.	$2.94
9273	Sipuleucel-T auto CD54+	K		"$33,491.92"	.	"$6,698.39"
9274	Crotalidae Poly Immune Fab	K		"$2,151.96"	.	$430.40
9276	Cabazitaxel injection	K		$136.91	.	$27.39
9278	Incobotulinumtoxin A	K		$4.56	.	$0.92
9281	"Injection, pegloticase"	G		$302.04	.	$60.41
9282	"Inj, ceftaroline fosamil"	G		$0.73	.	$0.15
9283	"Injection, acetaminophen"	G		$0.11	.	$0.03
9284	Ipilimumab injection	G		$125.18	.	$25.04
9285	"Patch, lidocaine/tetracaine"	G		$13.24	$0.00	$0.00
9286	"Injection, belatacept"	G		$3.81	.	$0.77
9287	"Inj, brentuximab vedotin"	G		$95.40	.	$19.08
9288	"Inj, centruroides (scorpion)"	G		"$4,156.25"	.	$831.25
9289	"Inj, erwinia chrysanthemi"	G		$337.29	.	$67.46
9290	"Inj, bupivicaine liposome"	G		$1.14	$0.00	$0.00
9291	"Injection, aflibercept"	G		"$1,961.00"	.	$392.20
9300	Omalizumab injection	K		$22.73	.	$4.55
9358	"SurgiMend, fetal"	K		$11.33	.	$2.27
9360	"SurgiMend, neonatal"	K		$11.60	.	$2.32
9363	Integra Meshed Bil Wound Mat	K		$18.68	.	$3.74
9365	Oasis tri-layer wound matrix	G		$10.36	.	$2.08
9366	EpiFix wound cover	G		$102.05	.	$20.41
9367	Endoform Dermal Template	K		$4.43	.	$0.89
9406	Iodine I-123 ioflupane	G		"$1,905.21"	$0.00	$0.00
9500	"Platelets, irradiated"	R	1.8712	$133.86	.	$26.78
9501	Platelet pheres leukoreduced	R	7.1309	$510.12	.	$102.03
9502	Platelet pheresis irradiated	R	9.2677	$662.98	.	$132.60
9503	Fr frz plasma donor retested	R	0.8285	$59.27	.	$11.86
9504	RBC deglycerolized	R	6.8857	$492.58	.	$98.52
9505	RBC irradiated	R	2.8518	$204.01	.	$40.81
9506	"Granulocytes, pheresis unit"	R	22.6910	"$1,623.25"	.	$324.65
9507	"Platelets, pheresis"	R	6.0352	$431.74	.	$86.35
9508	Plasma 1 donor frz w/in 8 hr	R	1.0805	$77.30	.	$15.46
