	Addendum A.-Proposed OPPS APCs for CY 2014					
APC	Group Title	SI	Relative Weight 	Payment Rate 	National Unadjusted Copayment 	Minimum Unadjusted Copayment 
0001	Level I Photochemotherapy	S	0.5168	$37.59	.	$7.52
0003	Bone Marrow Biopsy/Aspiration	T	14.7619	"$1,073.60"	.	$214.72
0004	Level I Needle Biopsy/ Aspiration Except Bone Marrow	T	6.9519	$505.60	.	$101.12
0005	Level II Needle Biopsy/Aspiration Except Bone Marrow	T	11.8703	$863.30	.	$172.66
0006	Level I Incision & Drainage	T	2.2670	$164.87	.	$32.98
0007	Level II Incision & Drainage	T	12.4015	$901.94	.	$180.39
0008	Level III Incision and Drainage	T	22.2123	"$1,615.46"	.	$323.10
0012	Level I Debridement & Destruction	T	0.8547	$62.16	.	$12.44
0013	Level II Debridement & Destruction	T	1.1529	$83.85	.	$16.77
0015	Level III Debridement & Destruction	T	2.1493	$156.31	.	$31.27
0016	Level IV Debridement & Destruction	T	3.7965	$276.11	.	$55.23
0017	Level V Debridement & Destruction	T	22.3701	"$1,626.93"	.	$325.39
0019	Level I Excision/ Biopsy	T	4.7540	$345.75	.	$69.15
0020	Level II Excision/ Biopsy	T	10.2316	$744.12	.	$148.83
0021	Level III Excision/ Biopsy	T	18.3830	"$1,336.96"	.	$267.40
0022	Level IV Excision/ Biopsy	T	25.0608	"$1,822.62"	.	$364.53
0028	Level I Breast and Skin Surgery	T	29.2276	"$2,125.66"	.	$425.14
0029	Level II Breast and Skin Surgery	T	41.0399	"$2,984.75"	.	$596.95
0030	Level III Breast and Skin Surgery	T	56.1747	"$4,085.47"	.	$817.10
0031	Level I Health and Behavior Services	S	0.2973	$21.62	.	$4.33
0034	Mental Health Services Composite	S	2.9286	$212.99	.	$42.60
0035	Vascular Puncture and Minor Diagnostic Procedures	S	0.2583	$18.79	.	$3.76
0037	Level IV Needle Biopsy/Aspiration Except Bone Marrow	T	18.2654	"$1,328.41"	.	$265.69
0039	Level I Implantation of Neurostimulator Generator	J1	290.9091	"$21,157.24"	.	"$4,231.45"
0040	Level I Implantation/Revision/Replacement of Neurostimulator Electrodes 	J1	75.4072	"$5,484.21"	.	"$1,096.85"
0041	Level I Arthroscopy	T	29.7306	"$2,162.25"	.	$432.45
0042	Level II Arthroscopy	T	58.7902	"$4,275.69"	.	$855.14
0045	Bone/Joint Manipulation Under Anesthesia	T	16.5737	"$1,205.37"	$257.70	$241.08
0047	Arthroplasty without Prosthesis	T	43.4818	"$3,162.34"	.	$632.47
0048	Level I Arthroplasty or Implantation with Prosthesis	T	64.0609	"$4,659.02"	.	$931.81
0049	Level I Musculoskeletal Procedures Except Hand and Foot	T	23.1867	"$1,686.32"	.	$337.27
0050	Level II Musculoskeletal Procedures Except Hand and Foot	T	35.7266	"$2,598.32"	.	$519.67
0051	Level III Musculoskeletal Procedures Except Hand and Foot	T	52.8245	"$3,841.82"	.	$768.37
0052	Level IV Musculoskeletal Procedures Except Hand and Foot	T	91.2970	"$6,639.85"	.	"$1,327.97"
0053	Level I Hand Musculoskeletal Procedures	T	17.2718	"$1,256.14"	.	$251.23
0054	Level II Hand Musculoskeletal Procedures	T	31.1299	"$2,264.02"	.	$452.81
0055	Level I Foot Musculoskeletal Procedures	T	23.9329	"$1,740.59"	$353.37	$348.12
0056	Level II Foot Musculoskeletal Procedures	T	67.7072	"$4,924.21"	.	$984.85
0057	Bunion Procedures	T	36.7515	"$2,672.86"	.	$534.58
0058	Level I Cast Application	S	1.6811	$122.26	.	$24.46
0059	Level I Strapping	S	0.8076	$58.74	.	$11.75
0060	Manipulation Therapy	S	0.2561	$18.63	.	$3.73
0061	Level II Implantation/Revision/Replacement of Neurostimulator Electrodes 	J1	121.2432	"$8,817.78"	.	"$1,763.56"
0062	Level I Treatment Fracture/Dislocation	T	28.3363	"$2,060.84"	.	$412.17
0063	Level II Treatment Fracture/Dislocation	T	57.6895	"$4,195.64"	.	$839.13
0064	Level III Treatment Fracture/Dislocation	T	75.4192	"$5,485.09"	.	"$1,097.02"
0065	"IORT, MRgFUS, and MEG"	S	23.9366	"$1,740.86"	.	$348.18
0066	Level I Stereotactic Radiosurgery	S	34.1124	"$2,480.93"	.	$496.19
0067	Level II Stereotactic Radiosurgery	S	117.9227	"$8,576.28"	.	"$1,715.26"
0069	Thoracoscopy	T	40.3947	"$2,937.83"	$591.64	$587.57
0070	Thoracentesis/Lavage Procedures	T	6.9711	$506.99	.	$101.40
0071	Level I Endoscopy Upper Airway	T	1.2349	$89.81	.	$17.97
0072	Level II Endoscopy Upper Airway	T	2.2574	$164.18	.	$32.84
0073	Level III Endoscopy Upper Airway	T	4.7942	$348.67	.	$69.74
0074	Level IV Endoscopy Upper Airway	T	21.0645	"$1,531.98"	.	$306.40
0075	Level V Endoscopy Upper Airway	T	32.3789	"$2,354.85"	.	$470.97
0076	Level I Endoscopy Lower Airway	T	14.2837	"$1,038.82"	.	$207.77
0077	Level I Pulmonary Treatment	S	0.5408	$39.33	.	$7.87
0078	Level III Pulmonary Treatment	S	3.4176	$248.56	.	$49.72
0079	Ventilation Initiation and Management	S	5.4176	$394.01	.	$78.81
0080	Diagnostic Cardiac Catheterization	T	36.2341	"$2,635.23"	$810.73	$527.05
0082	Coronary or Non-Coronary Atherectomy	J1	142.1988	"$10,341.83"	.	"$2,068.37"
0083	"Coronary Angioplasty, Valvuloplasty, and Level I Endovascular Revascularization of the Lower Extremity "	J1	62.4497	"$4,541.84"	.	$908.37
0084	Level I Electrophysiologic Procedures	S	10.4216	$757.94	.	$151.59
0085	Level II Electrophysiologic Procedures	J1	158.3657	"$11,517.62"	.	"$2,303.53"
0088	Thrombectomy	T	45.2941	"$3,294.15"	.	$658.83
0089	Insertion/Replacement of Permanent Pacemaker and Electrodes	J1	130.0413	"$9,457.64"	.	"$1,891.53"
0090	Level I Insertion/Replacement of Permanent Pacemaker 	J1	102.3575	"$7,444.26"	"$1,593.50"	"$1,488.86"
0091	Level II Vascular Ligation	T	40.2361	"$2,926.29"	.	$585.26
0092	Level I Vascular Ligation	T	28.5685	"$2,077.73"	.	$415.55
0093	Vascular Reconstruction/Fistula Repair without Device	T	32.5782	"$2,369.35"	.	$473.87
0094	Level I Resuscitation and Cardioversion	S	2.2666	$164.85	$43.80	$32.97
0095	Cardiac Rehabilitation	S	1.4014	$101.92	.	$20.39
0096	Level II Noninvasive Physiologic Studies	S	1.8786	$136.63	$36.86	$27.33
0097	Level I Noninvasive Physiologic Studies	S	1.3151	$95.64	.	$19.13
0099	Electrocardiograms/Cardiography	S	1.0076	$73.28	.	$14.66
0100	Cardiac Stress Tests	S	3.3348	$242.53	.	$48.51
0101	Tilt Table Evaluation	S	4.7686	$346.81	$100.24	$69.37
0102	Level II Pulmonary Treatment	S	1.2720	$92.51	.	$18.51
0103	Miscellaneous Vascular Procedures	T	22.0912	"$1,606.65"	.	$321.33
0104	Transcatheter Placement of Intracoronary Stents	J1	121.0010	"$8,800.16"	.	"$1,760.04"
0105	"Repair/Revision/Removal of Pacemakers, AICDs, or Vascular Devices"	T	23.4918	"$1,708.51"	.	$341.71
0106	"Insertion/Replacement/Repair of Pacemaker Generator, Leads, and/or Electrodes"	J1	80.7562	"$5,873.24"	.	"$1,174.65"
0107	Level I Implantation of Cardioverter-Defibrillators (ICDs)	J1	346.4139	"$25,193.99"	.	"$5,038.80"
0108	Level II Implantation of Cardioverter-Defibrillators (ICDs)	J1	434.4173	"$31,594.30"	.	"$6,318.86"
0110	Transfusion	S	5.0585	$367.89	.	$73.58
0111	Blood Product Exchange	S	15.0181	"$1,092.24"	.	$218.45
0112	Apheresis and Stem Cell Procedures	S	44.4573	"$3,233.29"	.	$646.66
0113	Excision Lymphatic System	T	31.2189	"$2,270.49"	.	$454.10
0114	Thyroid/Lymphadenectomy Procedures	T	57.2691	"$4,165.07"	.	$833.02
0115	Cannula/Access Device Procedures	T	36.8306	"$2,678.62"	.	$535.73
0121	Level I Tube or Catheter Changes or Repositioning	T	6.4912	$472.09	.	$94.42
0126	Level I Urinary and Anal Procedures	T	1.9191	$139.57	.	$27.92
0129	Level I Closed Treatment Fracture	T	2.2040	$160.29	.	$32.06
0130	Level I Laparoscopy	T	41.1387	"$2,991.94"	$659.53	$598.39
0131	Level II Laparoscopy	T	51.7775	"$3,765.67"	"$1,001.89"	$753.14
0132	Level III Laparoscopy	T	74.9796	"$5,453.12"	"$1,236.99"	"$1,090.63"
0133	Level I Skin Repair	T	1.2083	$87.88	$23.38	$17.58
0134	Level II Skin Repair	T	3.0548	$222.17	.	$44.44
0135	Level IV Skin Repair	T	12.0272	$874.71	.	$174.95
0136	Level V Skin Repair	T	18.9370	"$1,377.25"	.	$275.45
0137	Level VI Skin Repair	T	22.1596	"$1,611.62"	.	$322.33
0138	Level II Closed Treatment Fracture 	T	3.6863	$268.10	.	$53.62
0139	Level III Closed Treatment Fracture 	T	14.5388	"$1,057.38"	.	$211.48
0140	Esophageal Dilation without Endoscopy	T	8.3549	$607.64	.	$121.53
0141	Level I Upper GI Procedures	T	10.1877	$740.93	.	$148.19
0142	Level I Small Intestine Endoscopy	T	11.5539	$840.29	.	$168.06
0143	Lower GI Endoscopy	T	10.7036	$778.45	$186.06	$155.69
0146	Level I Sigmoidoscopy and Anoscopy	T	6.6058	$480.43	.	$96.09
0147	Level II Sigmoidoscopy and Anoscopy	T	11.2856	$820.78	.	$164.16
0148	Level I Anal/Rectal Procedures	T	6.5088	$473.37	.	$94.68
0149	Level III Anal/Rectal Procedures	T	27.0258	"$1,965.53"	.	$393.11
0150	Level IV Anal/Rectal Procedures	T	35.1711	"$2,557.92"	.	$511.59
0151	Endoscopic Retrograde Cholangio-Pancreatography (ERCP)	T	26.7845	"$1,947.98"	.	$389.60
0152	Level I Percutaneous Abdominal and Biliary Procedures	T	24.4340	"$1,777.04"	.	$355.41
0153	Peritoneal and Abdominal Procedures	T	23.8803	"$1,736.77"	.	$347.36
0154	Hernia/Hydrocele Procedures	T	36.3252	"$2,641.86"	.	$528.38
0155	Level II Anal/Rectal Procedures	T	20.0921	"$1,461.26"	.	$292.26
0156	Level III Urinary and Anal Procedures	T	7.2631	$528.23	.	$105.65
0157	Colorectal Cancer Screening: Barium Enema	S	4.0212	$292.45	.	$58.49
0158	Colorectal Cancer Screening: Colonoscopy	T	8.8833	$646.06	$0.00	$0.00
0159	Colorectal Cancer Screening: Flexible Sigmoidoscopy	S	6.1737	$449.00	$0.00	$0.00
0160	Level I Cystourethroscopy and other Genitourinary Procedures	T	7.7370	$562.70	.	$112.54
0161	Level II Cystourethroscopy and other Genitourinary Procedures	T	16.7594	"$1,218.88"	.	$243.78
0162	Level III Cystourethroscopy and other Genitourinary Procedures	T	28.6257	"$2,081.89"	.	$416.38
0163	Level IV Cystourethroscopy and other Genitourinary Procedures	T	41.7640	"$3,037.41"	.	$607.49
0164	Level II Urinary and Anal Procedures	T	3.1956	$232.41	.	$46.49
0165	Level IV Urinary and Anal Procedures	T	19.9093	"$1,447.96"	.	$289.60
0166	Level I Urethral Procedures	T	21.7922	"$1,584.90"	.	$316.98
0168	Level II Urethral Procedures	T	34.6787	"$2,522.11"	.	$504.43
0169	Lithotripsy	T	41.8076	"$3,040.58"	$979.42	$608.12
0170	Dialysis	S	8.8040	$640.30	.	$128.06
0172	Level I Partial Hospitalization (3 services) for CMHCs	P	1.2866	$93.57	.	$18.72
0173	Level II Partial Hospitalization (4 or more services) for CMHCs	P	1.4457	$105.14	.	$21.03
0174	Level IV Laparoscopy	T	118.8167	"$8,641.30"	"$1,922.27"	"$1,728.26"
0175	Level I Partial Hospitalization (3 services) for Hospital-based PHPs	P	2.8976	$210.74	.	$42.15
0176	Level II Partial Hospitalization (4 or more services) for Hospital-based PHPs	P	2.9286	$212.99	.	$42.60
0177	Level I Echocardiogram with Contrast	S	7.2398	$526.54	$129.40	$105.31
0178	Level II Echocardiogram with Contrast	S	9.0479	$658.04	$172.48	$131.61
0181	Level II Male Genital Procedures	T	41.5033	"$3,018.45"	$607.88	$603.69
0183	Level I Male Genital Procedures	T	25.3174	"$1,841.28"	.	$368.26
0184	Prostate Biopsy	T	19.2802	"$1,402.21"	.	$280.45
0186	Level III Skin Repair	T	5.8851	$428.01	.	$85.61
0188	Level II Female Reproductive Proc	T	1.7925	$130.36	.	$26.08
0189	Level III Female Reproductive Proc	T	2.9344	$213.41	.	$42.69
0190	Level I Hysteroscopy	T	25.3568	"$1,844.15"	$424.28	$368.83
0191	Level I Female Reproductive Proc	T	0.1454	$10.57	.	$2.12
0192	Level IV Female Reproductive Proc	T	6.0413	$439.37	.	$87.88
0193	Level V Female Reproductive Proc	T	22.8509	"$1,661.90"	.	$332.38
0195	Level VI Female Reproductive Procedures	T	41.1313	"$2,991.40"	.	$598.28
0202	Level VII Female Reproductive Procedures	J1	65.9172	"$4,794.03"	$981.50	$958.81
0203	Level IV Nerve Injections	T	21.4264	"$1,558.30"	.	$311.66
0204	Level I Nerve Injections	T	2.9890	$217.38	.	$43.48
0206	Level II Nerve Injections	T	4.9587	$360.64	.	$72.13
0207	Level III Nerve Injections	T	9.3493	$679.96	.	$136.00
0208	Laminotomies and Laminectomies	T	57.3584	"$4,171.56"	.	$834.32
0209	"Level II Extended EEG, Sleep, and Cardiovascular Studies"	S	11.7723	$856.18	$268.73	$171.24
0213	"Level I Extended EEG, Sleep, and Cardiovascular Studies"	S	2.9266	$212.85	$53.58	$42.57
0215	Level I Nerve and Muscle Services	S	0.9295	$67.60	.	$13.52
0216	Level III Nerve and Muscle Services	S	4.2842	$311.58	.	$62.32
0218	Level II Nerve and Muscle Services	S	1.6755	$121.86	.	$24.38
0220	Level I Nerve Procedures	T	19.2252	"$1,398.21"	.	$279.65
0221	Level II Nerve Procedures	T	36.8638	"$2,681.03"	.	$536.21
0224	Implantation of Catheter/Reservoir/Shunt	T	49.3717	"$3,590.70"	.	$718.14
0227	Implantation of Drug Infusion Device	J1	211.3856	"$15,373.65"	.	"$3,074.73"
0229	Level II Endovascular Revascularization of the Lower Extremity 	J1	143.9720	"$10,470.80"	.	"$2,094.16"
0230	Level I Eye Tests & Treatments	S	0.7127	$51.83	.	$10.37
0231	Level III Eye Tests & Treatments	S	3.5799	$260.36	.	$52.08
0232	Level I Anterior Segment Eye Procedures	T	2.5075	$182.37	.	$36.48
0233	Level III Anterior Segment Eye Procedures	T	16.0881	"$1,170.06"	.	$234.02
0234	Level IV Anterior Segment Eye Procedures	T	24.4195	"$1,775.98"	.	$355.20
0235	Level I Posterior Segment Eye Procedures	T	5.7861	$420.81	.	$84.17
0237	Level II Posterior Segment Eye Procedures	T	21.1775	"$1,540.20"	.	$308.04
0238	Level I Repair and Plastic Eye Procedures	T	4.0745	$296.33	.	$59.27
0239	Level II Repair and Plastic Eye Procedures	T	9.5370	$693.61	.	$138.73
0240	Level III Repair and Plastic Eye Procedures	T	20.2712	"$1,474.28"	.	$294.86
0241	Level IV Repair and Plastic Eye Procedures	T	27.2387	"$1,981.02"	.	$396.21
0242	Level V Repair and Plastic Eye Procedures	T	42.4552	"$3,087.68"	.	$617.54
0243	Strabismus/Muscle Procedures	T	26.9106	"$1,957.15"	$412.25	$391.43
0244	Corneal and Amniotic Membrane Transplant	T	44.3190	"$3,223.23"	$794.86	$644.65
0246	Cataract Procedures with IOL Insert	T	24.2209	"$1,761.54"	$490.32	$352.31
0247	Laser Eye Procedures	T	5.8656	$426.59	$102.26	$85.32
0249	Cataract Procedures without IOL Insert	T	29.8351	"$2,169.85"	$499.26	$433.97
0250	Level I ENT Procedures	T	1.1672	$84.89	$24.11	$16.98
0251	Level II ENT Procedures	T	4.3174	$314.00	.	$62.80
0252	Level III ENT Procedures	T	7.7330	$562.41	.	$112.49
0253	Level IV ENT Procedures	T	17.5947	"$1,279.63"	.	$255.93
0254	Level V ENT Procedures	T	27.0108	"$1,964.44"	.	$392.89
0255	Level II Anterior Segment Eye Procedures	T	10.3127	$750.02	.	$150.01
0256	Level VI ENT Procedures	T	50.5282	"$3,674.81"	.	$734.97
0259	Level VII ENT Procedures	J1	411.6699	"$29,939.93"	"$7,820.67"	"$5,987.99"
0260	Level I Plain Film Except Teeth	S	0.8407	$61.14	.	$12.23
0261	Level II Plain Film Except Teeth Including Bone Density Measurement	S	1.4947	$108.71	.	$21.75
0262	Plain Film of Teeth	S	0.6674	$48.54	.	$9.71
0263	Level I Miscellaneous Radiology Procedures	S	4.2658	$310.24	.	$62.05
0265	Level I Diagnostic and Screening Ultrasound	S	1.2805	$93.13	$22.26	$18.63
0266	Level II Diagnostic and Screening Ultrasound	S	2.0308	$147.70	$37.23	$29.54
0267	Level III Diagnostic and Screening Ultrasound	S	3.0275	$220.18	$59.55	$44.04
0269	Level II Echocardiogram Without Contrast 	S	6.5205	$474.22	.	$94.85
0270	Level III Echocardiogram Without Contrast 	S	8.5124	$619.09	$128.73	$123.82
0272	Fluoroscopy	S	2.3237	$169.00	.	$33.80
0274	Myelography	S	8.3878	$610.03	.	$122.01
0275	Arthrography	S	4.7009	$341.89	$68.90	$68.38
0276	Level I Digestive Radiology	S	1.4362	$104.45	$32.84	$20.89
0277	Level II Digestive Radiology	S	2.1550	$156.73	$46.51	$31.35
0278	Diagnostic Urography	S	3.5682	$259.51	$58.44	$51.91
0279	Level II Angiography and Venography	S	36.7589	"$2,673.40"	.	$534.68
0280	Level III Angiography and Venography	S	59.1125	"$4,299.13"	.	$859.83
0282	Miscellaneous Computed Axial Tomography	S	1.0274	$74.72	$24.89	$14.95
0283	Computed Tomography with Contrast	S	3.2554	$236.76	$76.06	$47.36
0284	Magnetic Resonance Imaging and Magnetic Resonance Angiography with Contrast	S	5.8302	$424.02	$136.74	$84.81
0288	Bone Density:Axial Skeleton	S	1.2926	$94.01	$0.00	$0.00
0293	Level VI Anterior Segment Eye Procedures	J1	117.1225	"$8,518.09"	.	"$1,703.62"
0299	Hyperthermia and Radiation Treatment Procedures	S	15.3251	"$1,114.56"	.	$222.92
0300	Level I Radiation Therapy	S	1.6774	$121.99	.	$24.40
0301	Level II Radiation Therapy	S	3.1039	$225.74	.	$45.15
0303	Treatment Device Construction	S	6.3339	$460.65	.	$92.13
0304	Level I Therapeutic Radiation Treatment Preparation	S	2.1149	$153.81	$34.63	$30.77
0305	Level II Therapeutic Radiation Treatment Preparation	S	4.7122	$342.71	$88.78	$68.55
0308	Positron Emission Tomography (PET) imaging	S	18.0566	"$1,313.22"	.	$262.65
0310	Level III Therapeutic Radiation Treatment Preparation	S	9.2388	$671.92	$205.00	$134.39
0312	Radioelement Applications	S	15.1016	"$1,098.31"	.	$219.67
0313	Brachytherapy	S	14.7401	"$1,072.02"	$259.86	$214.41
0315	Level II Implantation of Neurostimulator Generator 	J1	319.1925	"$23,214.23"	.	"$4,642.85"
0316	Level IV Therapeutic Radiation Treatment Preparation	S	26.2305	"$1,907.69"	$630.29	$381.54
0317	Level II Miscellaneous Radiology Procedures	S	6.4532	$469.33	.	$93.87
0318	Implantation of Neurostimulator Pulse Generator and Electrode 	J1	370.6311	"$26,955.26"	"$9,121.76"	"$5,391.06"
0319	Level III Endovascular Revascularization of the Lower Extremity	J1	235.9584	"$17,160.78"	"$5,559.48"	"$3,432.16"
0320	Electroconvulsive Therapy	S	5.9669	$433.96	.	$86.80
0322	Brief Individual Psychotherapy	S	1.1610	$84.44	.	$16.89
0323	Extended Individual Psychotherapy	S	1.5647	$113.80	.	$22.76
0324	Family Psychotherapy	S	1.7711	$128.81	.	$25.77
0325	Group Psychotherapy	S	1.0067	$73.22	.	$14.65
0330	Dental Procedures	S	7.4649	$542.91	.	$108.59
0331	Combined Abdomen and Pelvis CT without Contrast 	S	3.1603	$229.84	$88.86	$45.97
0332	Computed Tomography without Contrast	S	1.5804	$114.94	$44.44	$22.99
0333	Computed Tomography without Contrast followed by Contrast	S	3.6369	$264.50	$91.86	$52.90
0334	Combined Abdomen and Pelvis CT with Contrast 	S	5.0493	$367.23	$118.35	$73.45
0336	Magnetic Resonance Imaging and Magnetic Resonance Angiography without Contrast	S	3.8938	$283.19	$111.59	$56.64
0337	Magnetic Resonance Imaging and Magnetic Resonance Angiography without Contrast followed by Contrast	S	6.5643	$477.41	$171.72	$95.49
0340	Level I Minor Procedures	S	1.0374	$75.45	.	$15.09
0341	Skin Tests	S	0.1707	$12.41	.	$2.49
0342	Level I Pathology	S	0.4805	$34.95	.	$6.99
0343	Level III Pathology	S	1.9853	$144.39	.	$28.88
0344	Level IV Pathology	S	3.8164	$277.56	.	$55.52
0345	Level I Transfusion Laboratory Procedures	S	1.1590	$84.29	.	$16.86
0346	Level II Transfusion Laboratory Procedures	S	1.9643	$142.86	.	$28.58
0347	Level III Transfusion Laboratory Procedures	S	2.3215	$168.84	.	$33.77
0351	Level VII Anterior Segment Eye Procedures	T	207.5921	"$15,097.76"	"$3,132.26"	"$3,019.56"
0360	Level I Alimentary Tests	S	1.9915	$144.84	$33.59	$28.97
0361	Level II Alimentary Tests	S	5.3531	$389.32	$83.23	$77.87
0363	Level I Otorhinolaryngologic Function Tests	S	1.4913	$108.46	.	$21.70
0364	Level I Audiometry	S	0.6084	$44.25	.	$8.85
0365	Level II Audiometry	S	1.6546	$120.34	.	$24.07
0366	Level III Audiometry	S	1.8349	$133.45	.	$26.69
0367	Level I Pulmonary Test	S	2.3191	$168.66	.	$33.74
0368	Level II Pulmonary Tests	S	1.9747	$143.62	.	$28.73
0369	Level III Pulmonary Tests	S	4.0326	$293.28	.	$58.66
0370	Multiple Allergy Tests	S	11.1836	$813.36	.	$162.68
0373	Level I Neuropsychological Testing	S	1.6008	$116.42	.	$23.29
0375	Ancillary Outpatient Services When Patient Expires	S	96.4784	"$7,016.68"	.	"$1,403.34"
0377	Level II Cardiac Imaging	S	16.9776	"$1,234.75"	.	$246.95
0378	Level II Pulmonary Imaging	S	6.6415	$483.02	$126.64	$96.61
0381	Single Allergy Tests	S	1.6001	$116.37	.	$23.28
0382	Level II Neuropsychological Testing	S	2.7486	$199.90	.	$39.98
0383	Cardiac Computed Tomographic Imaging	S	3.1890	$231.93	.	$46.39
0384	GI Procedures with Stents	T	32.2743	"$2,347.25"	.	$469.45
0385	Level I Prosthetic Urological Procedures	J1	113.7848	"$8,275.34"	.	"$1,655.07"
0386	Level II Prosthetic Urological Procedures	J1	188.7869	"$13,730.09"	.	"$2,746.02"
0387	Level II Hysteroscopy	T	39.5270	"$2,874.72"	$654.35	$574.95
0388	Discography	S	39.1006	"$2,843.71"	.	$568.75
0389	Level I Non-imaging Nuclear Medicine	S	2.0160	$146.62	.	$29.33
0390	Level I Endocrine Imaging	S	2.6786	$194.81	$47.69	$38.97
0391	Level II Endocrine Imaging	S	4.0890	$297.38	$65.46	$59.48
0392	Level II Non-imaging Nuclear Medicine	S	3.8006	$276.41	.	$55.29
0393	Hematologic Processing & Studies	S	8.0526	$585.65	.	$117.13
0394	Hepatobiliary Imaging	S	5.1576	$375.10	$90.78	$75.02
0395	GI Tract Imaging	S	4.4955	$326.95	$87.01	$65.39
0396	Bone Imaging	S	4.5955	$334.22	$94.20	$66.85
0397	Vascular Imaging	S	6.5941	$479.58	.	$95.92
0398	Level I Cardiac Imaging	S	5.4631	$397.32	$93.33	$79.47
0400	Hematopoietic Imaging	S	5.0614	$368.11	$90.90	$73.63
0401	Level I Pulmonary Imaging	S	4.8323	$351.44	$71.16	$70.29
0402	Level II Nervous System Imaging	S	14.0867	"$1,024.50"	.	$204.90
0403	Level I Nervous System Imaging	S	2.4922	$181.25	.	$36.25
0404	Renal and Genitourinary Studies	S	5.8207	$423.33	.	$84.67
0406	Level I Tumor/Infection Imaging	S	5.3508	$389.15	$85.06	$77.83
0407	Level I Radionuclide Therapy	S	3.5688	$259.55	$78.13	$51.91
0408	Level III Tumor/Infection Imaging	S	15.9467	"$1,159.77"	.	$231.96
0412	Level III Radiation Therapy	S	7.3980	$538.04	.	$107.61
0413	Level II Radionuclide Therapy	S	5.9557	$433.15	.	$86.63
0414	Level II Tumor/Infection Imaging	S	9.3222	$677.98	.	$135.60
0415	Level II Endoscopy Lower Airway	T	30.3947	"$2,210.55"	.	$442.11
0419	Level II Upper GI Procedures 	T	14.2016	"$1,032.85"	$207.70	$206.57
0420	Level II Minor Procedures	S	1.4381	$104.59	.	$20.92
0422	Level III Upper GI Procedures	T	27.4631	"$1,997.34"	.	$399.47
0423	Level II Percutaneous Abdominal and Biliary Procedures	T	57.4309	"$4,176.83"	.	$835.37
0424	Level II Small Intestine Endoscopy 	T	17.3826	"$1,264.20"	.	$252.84
0425	Level II Arthroplasty or Implantation with Prosthesis	J1	138.7372	"$10,090.08"	.	"$2,018.02"
0426	Level II Strapping and Cast Application	S	3.1429	$228.58	.	$45.72
0427	Level II Tube or Catheter Changes or Repositioning	T	17.9990	"$1,309.03"	.	$261.81
0428	Level III Sigmoidoscopy and Anoscopy	T	23.9175	"$1,739.47"	.	$347.90
0429	Level V Cystourethroscopy and other Genitourinary Procedures	T	46.2268	"$3,361.98"	.	$672.40
0432	Level II Health and Behavior Services	S	0.6248	$45.44	.	$9.09
0433	Level II Pathology	S	0.8035	$58.44	.	$11.69
0434	Cardiac Defect Repair	T	177.4446	"$12,905.19"	.	"$2,581.04"
0436	Level I Drug Administration	S	0.3387	$24.63	.	$4.93
0437	Level II Drug Administration	S	0.7439	$54.10	.	$10.82
0438	Level III Drug Administration	S	2.1432	$155.87	.	$31.18
0439	Level IV Drug Administration	S	2.7737	$201.73	.	$40.35
0440	Level V Drug Administration	S	5.6373	$409.99	.	$82.00
0442	Dosimetric Drug Administration	S	22.0575	"$1,604.20"	.	$320.84
0617	Critical Care	S	9.5123	$691.81	.	$138.37
0618	Trauma Response with Critical Care	S	13.0283	$947.52	.	$189.51
0621	Level I Vascular Access Procedures	T	11.7861	$857.18	.	$171.44
0622	Level II Vascular Access Procedures	T	26.4974	"$1,927.10"	.	$385.42
0623	Level III Vascular Access Procedures	T	32.5100	"$2,364.39"	.	$472.88
0624	Phlebotomy and Minor Vascular Access Device Procedures	S	1.1093	$80.68	.	$16.14
0631	Level 1 Examinations & Related Services 	V	1.0269	$74.68	.	$14.94
0632	Level 2 Examinations & Related Services 	V	1.4907	$108.42	.	$21.69
0633	Level 3 Examinations & Related Services 	V	4.8910	$355.71	.	$71.15
0634	Hospital Clinic Visits	V	1.2143	$88.31	.	$17.67
0635	Type A Emergency Visits	V	2.9274	$212.90	.	$42.58
0636	Type B Emergency Visits	V	1.1667	$84.85	.	$16.97
0648	Level IV Breast and Skin Surgery	J1	97.1933	"$7,068.67"	.	"$1,413.74"
0651	Complex Interstitial Radiation Source Application	S	28.4854	"$2,071.69"	.	$414.34
0652	Insertion of Intraperitoneal and Pleural Catheters	T	33.7065	"$2,451.41"	.	$490.29
0653	Vascular Reconstruction/Fistula Repair with Device	T	44.5999	"$3,243.66"	.	$648.74
0654	Level II Insertion/Replacement of Permanent Pacemaker 	J1	118.5822	"$8,624.25"	.	"$1,724.85"
0655	Insertion/Replacement/Conversion of a Permanent Dual Chamber Pacemaker or Pacing Electrode	J1	152.0137	"$11,055.65"	.	"$2,211.13"
0656	Transcatheter Placement of Intracoronary Drug-Eluting Stents	J1	143.2895	"$10,421.16"	.	"$2,084.24"
0659	Hyperbaric Oxygen	S	1.5190	$110.47	.	$22.10
0660	Level II Otorhinolaryngologic Function Tests	S	6.6071	$480.52	.	$96.11
0661	Level V Pathology	S	6.6794	$485.78	.	$97.16
0662	CT Angiography	S	3.9019	$283.78	$95.67	$56.76
0665	Bone Density:AppendicularSkeleton	S	0.7072	$51.43	$0.00	$0.00
0667	Proton Beam Radiation Therapy	S	13.5881	$988.24	.	$197.65
0668	Level I Angiography and Venography	T	11.3612	$826.28	.	$165.26
0672	Level III Posterior Segment Eye Procedures	T	42.1395	"$3,064.72"	.	$612.95
0673	Level V Anterior Segment Eye Procedures	T	41.4847	"$3,017.10"	$635.64	$603.42
0674	Prostate Cryoablation	J1	109.3121	"$7,950.05"	.	"$1,590.01"
0676	Thrombolysis and Other Device Revisions 	T	2.7838	$202.46	.	$40.50
0678	External Counterpulsation	T	1.4842	$107.94	.	$21.59
0679	Level II Resuscitation and Cardioversion	S	6.5253	$474.57	$95.30	$94.92
0680	Insertion of Patient Activated Event Recorders	J1	93.4003	"$6,792.82"	.	"$1,358.57"
0683	Level II Photochemotherapy	S	2.9228	$212.57	.	$42.52
0685	Level III Needle Biopsy/Aspiration Except Bone Marrow	T	13.0327	$947.84	.	$189.57
0687	Revision/Removal of Neurostimulator Electrodes	T	23.5971	"$1,716.17"	$389.48	$343.24
0688	Revision/Removal of Neurostimulator Pulse Generator Receiver	T	30.7116	"$2,233.59"	$661.02	$446.72
0690	Level I Electronic Analysis of Devices	S	0.5126	$37.28	.	$7.46
0691	Level III Electronic Analysis of Devices	S	3.8235	$278.08	.	$55.62
0692	Level II Electronic Analysis of Devices	S	1.9459	$141.52	.	$28.31
0694	Mohs Surgery	T	5.8788	$427.55	$88.07	$85.51
0697	Level I Echocardiogram Without Contrast 	S	3.6282	$263.87	.	$52.78
0698	Level II Eye Tests & Treatments	S	1.2796	$93.06	.	$18.62
0699	Level IV Eye Tests & Treatments	T	17.7084	"$1,287.90"	.	$257.58
0701	Sr89 strontium	K		"$1,065.63"	.	$213.13
0726	Dexrazoxane HCl injection	K		$153.07	.	$30.62
0728	Filgrastim 300 mcg injection	K		$277.25	.	$55.45
0731	Sargramostim injection	K		$26.90	.	$5.38
0736	Amphotericin b liposome inj	K		$15.23	.	$3.05
0738	Rasburicase	K		$208.17	.	$41.64
0747	Chlorothiazide sodium inj	K		$205.85	.	$41.17
0751	Mechlorethamine hcl inj	K		$154.70	.	$30.94
0752	Dactinomycin injection	K		$592.43	.	$118.49
0759	"Naltrexone, depot form"	K		$2.83	.	$0.57
0800	Leuprolide acetate	K		$680.67	.	$136.14
0802	Etoposide oral	K		$52.29	.	$10.46
0807	Aldesleukin injection	K		"$1,246.98"	.	$249.40
0809	Bcg live intravesical vac	K		$117.45	.	$23.49
0810	Goserelin acetate implant	K		$193.19	.	$38.64
0812	Carmustine injection	K		$175.81	.	$35.17
0814	"Asparaginase, NOS"	K		$63.21	.	$12.65
0820	Daunorubicin injection	K		$26.08	.	$5.22
0821	Daunorubicin citrate inj	K		$243.80	.	$48.76
0823	Docetaxel injection	K		$6.15	.	$1.23
0825	Nelarabine injection	K		$127.02	.	$25.41
0827	Floxuridine injection	K		$57.68	.	$11.54
0831	Ifosfamide injection	K		$29.83	.	$5.97
0832	Idarubicin hcl injection	K		$62.71	.	$12.55
0835	Cosyntropin injection NOS	K		$101.68	.	$20.34
0836	Interferon alfa-2b inj	K		$17.39	.	$3.48
0838	Interferon gamma 1-b inj	K		"$2,517.90"	.	$503.58
0840	Inj melphalan hydrochl	K		"$1,301.51"	.	$260.31
0842	Fludarabine phosphate inj	K		$83.74	.	$16.75
0843	Pegaspargase injection	K		"$5,890.00"	.	"$1,178.00"
0844	Pentostatin injection	K		"$1,390.65"	.	$278.13
0849	Rituximab injection	K		$677.94	.	$135.59
0850	Streptozocin injection	K		$273.31	.	$54.67
0851	Thiotepa injection	K		$265.00	.	$53.00
0856	Porfimer sodium injection	K		"$19,325.78"	.	"$3,865.16"
0858	Inj cladribine	K		$26.67	.	$5.34
0861	Leuprolide acetate injeciton	K		$8.87	.	$1.78
0864	Mitoxantrone hydrochl	K		$37.32	.	$7.47
0868	Oral aprepitant	K		$6.48	.	$1.30
0873	Hyalgan/supartz inj per dose	K		$88.84	.	$17.77
0874	Synvisc or synvisc-one	K		$12.20	.	$2.44
0875	Euflexxa inj per dose	K		$163.96	.	$32.80
0877	Orthovisc inj per dose	K		$167.50	.	$33.50
0887	Azathioprine parenteral	K		$162.95	.	$32.59
0890	Lymphocyte immune globulin	K		$705.82	.	$141.17
0900	Alglucerase injection	K		$42.03	.	$8.41
0901	Alpha 1 proteinase inhibitor	K		$3.92	.	$0.79
0902	"Injection,onabotulinumtoxinA"	K		$5.46	.	$1.10
0903	Cytomegalovirus imm IV /vial	K		"$1,013.87"	.	$202.78
0910	Interferon beta-1b / .25 MG	K		$258.23	.	$51.65
0913	Ganciclovir long act implant	K		"$16,960.00"	.	"$3,392.00"
0925	Factor viii	K		$0.91	.	$0.19
0927	Factor viii recombinant	K		$1.13	.	$0.23
0928	Factor ix complex	K		$1.09	.	$0.22
0929	Anti-inhibitor	K		$1.64	.	$0.33
0931	Factor IX non-recombinant	K		$0.95	.	$0.19
0932	Factor IX recombinant	K		$1.26	.	$0.26
0933	Gamma globulin > 10 CC inj	K		$238.62	.	$47.73
0934	"Capecitabine, oral"	K		$29.67	.	$5.94
0943	Octagam injection	K		$31.50	.	$6.30
0944	Gammagard liquid injection	K		$37.83	.	$7.57
0945	Rhophylac injection	K		$4.78	.	$0.96
0946	Hepagam b im injection	K		$52.01	.	$10.41
0947	Flebogamma injection	K		$35.52	.	$7.11
0948	Gamunex-C/Gammaked	K		$38.23	.	$7.65
0949	"Frozen plasma, pooled, sd"	R	1.0019	$72.87	.	$14.58
0950	Whole blood for transfusion	R	1.9003	$138.21	.	$27.65
0951	Reclast injection	K		$224.68	.	$44.94
0952	Cryoprecipitate each unit	R	0.9053	$65.84	.	$13.17
0954	RBC leukocytes reduced	R	2.6853	$195.30	.	$39.06
0955	"Plasma, frz between 8-24hour"	R	0.9853	$71.66	.	$14.34
0956	"Plasma protein fract,5%,50ml"	R	0.2272	$16.52	.	$3.31
0957	"Platelets, each unit"	R	1.6133	$117.33	.	$23.47
0958	Plaelet rich plasma unit	R	2.4251	$176.37	.	$35.28
0959	Red blood cells unit	R	2.1854	$158.94	.	$31.79
0960	Washed red blood cells unit	R	3.8527	$280.20	.	$56.04
0961	"Albumin (human),5%, 50ml"	K		$21.42	.	$4.29
0963	"Albumin (human), 5%, 250 ml"	K		$68.75	.	$13.75
0964	"Albumin (human), 25%, 20 ml"	K		$45.18	.	$9.04
0965	"Albumin (human), 25%, 50ml"	K		$69.68	.	$13.94
0966	"Plasmaprotein fract,5%,250ml"	R	0.5475	$39.82	.	$7.97
0967	Blood split unit	R	1.4234	$103.52	.	$20.71
0968	Platelets leukoreduced irrad	R	2.2296	$162.15	.	$32.43
0969	RBC leukoreduced irradiated	R	3.8095	$277.06	.	$55.42
1009	Cryoprecipitatereducedplasma	R	1.0959	$79.70	.	$15.94
1010	"Blood, l/r, cmv-neg"	R	2.4106	$175.32	.	$35.07
1011	"Platelets, hla-m, l/r, unit"	R	10.4509	$760.07	.	$152.02
1013	Platelets leukocytes reduced	R	1.6487	$119.91	.	$23.99
1015	Injection glatiramer acetate	K		$136.50	.	$27.30
1016	"Blood, l/r, froz/degly/wash"	R	3.3920	$246.69	.	$49.34
1017	"Plt, aph/pher, l/r, cmv-neg"	R	4.0076	$291.46	.	$58.30
1018	"Blood, l/r, irradiated"	R	2.2182	$161.33	.	$32.27
1019	Plate pheres leukoredu irrad	R	9.2452	$672.38	.	$134.48
1020	"Plt, pher, l/r cmv-neg, irr"	R	9.2735	$674.44	.	$134.89
1021	"RBC, frz/deg/wsh, l/r, irrad"	R	6.1850	$449.82	.	$89.97
1022	"RBC, l/r, cmv-neg, irrad"	R	4.0509	$294.61	.	$58.93
1023	Pralidoxime chloride inj	K		$89.52	.	$17.91
1052	"Injection, voriconazole"	K		$4.87	.	$0.98
1064	"I131 iodide cap, rx"	K		$18.70	.	$3.74
1083	Adalimumab injection	K		$490.56	.	$98.12
1084	Denileukin diftitox inj	K		"$1,646.18"	.	$329.24
1086	Temozolomide	K		$11.19	.	$2.24
1138	"Hepagam b intravenous, inj"	K		$52.01	.	$10.41
1139	Protein c concentrate	K		$13.75	.	$2.75
1142	Supprelin LA implant	K		"$16,417.13"	.	"$3,283.43"
1150	"I131 iodide sol, rx"	K		$10.83	.	$2.17
1166	Cytarabine liposome inj	K		$528.75	.	$105.75
1168	"Inj, temsirolimus"	K		$54.84	.	$10.97
1178	Busulfan injection	K		$21.92	.	$4.39
1203	Verteporfin injection	K		$10.30	.	$2.06
1207	"Octreotide injection, depot"	K		$131.13	.	$26.23
1213	Antihemophilic viii/vwf comp	K		$0.93	.	$0.19
1214	Inj IVIG privigen 500 mg	K		$36.08	.	$7.22
1232	Mitomycin injection	K		$22.25	.	$4.45
1235	Valrubicin injection	K		"$1,038.42"	.	$207.69
1236	Levoleucovorin injection	K		$1.82	.	$0.37
1237	Inj iron dextran	K		$12.15	.	$2.43
1238	Topotecan oral	K		$86.58	.	$17.32
1239	Rotavirus vacc 2 dose oral	K		$102.50	.	$20.50
1253	Triamcinolone A inj PRS-free	K		$3.67	.	$0.74
1263	Antithrombin iii injection	K		$3.04	.	$0.61
1268	Xyntha inj	K		$1.06	.	$0.22
1272	Acetylcysteine injection	K 		$3.20	.	$0.64
1274	Edetate calcium disodium inj	K 		$201.40	.	$40.28
1275	"Vivaglobin, inj"	K 		$12.72	.	$2.55
1280	Corticotropin injection	K		"$3,012.76"	.	$602.56
1281	Bevacizumab injection	K		$1.59	.	$0.32
1289	AbobotulinumtoxinA	K		$6.89	.	$1.38
1291	Rilonacept injection	K		$24.09	.	$4.82
1295	Sm 153 lexidronam	K		"$7,919.26"	.	"$1,583.86"
1296	Degarelix injection	K		$2.87	.	$0.58
1297	"Ferumoxytol, non-esrd"	K		$0.64	.	$0.13
1311	Canakinumab injection	K		$90.24	.	$18.05
1312	Hizentra injection	K		$7.29	.	$1.46
1327	Imiglucerase injection	K		$41.87	.	$8.38
1331	Olanzapine long-acting inj	K		$2.75	.	$0.55
1332	Antithrombin recombinant	K		$103.35	.	$20.67
1338	"Methyl aminolevulinate, top"	K		$78.68	.	$15.74
1340	"Collagenase, clost hist inj"	K		$37.51	.	$7.51
1341	Amobarbital 125 MG inj	K		$152.43	.	$30.49
1350	Topotecan injection	K		$2.35	.	$0.47
1352	Wilate injection	K		$0.93	.	$0.19
1353	Belimumab injection	K		$38.29	.	$7.66
1354	Hydroxyprogesterone caproate	K		$2.71	.	$0.55
1357	Inj protirelin per 250 mcg	K		$29.74	.	$5.95
1361	Enfuvirtide injection	K		$0.55	.	$0.11
1408	Cyclophosphamide 100 MG inj	K		$35.42	.	$7.09
1413	Lumizyme injection	K		$153.62	.	$30.73
1415	Glassia injection	K		$3.93	.	$0.79
1416	Factor XIII anti-hem factor	K		$6.42	.	$1.29
1417	Gel-one	K		$580.13	.	$116.03
1420	Aflibercept injection	G		$980.50	.	$196.10
1421	Imported lipodox inj	K		$498.26	.	$99.66
1422	Anthrax vaccine sc or im	K		$94.05	.	$18.81
1424	Nabilone oral	K		$27.07	.	$5.42
1426	Eribulin mesylate injection	K		$95.56	.	$19.12
1431	Centruroides immune f(ab)	G		"$3,667.49"	.	$733.50
1432	Arbutamine hcl injection	K		$86.37	.	$17.28
1435	Injection estrone per 1 MG	K		$1.54	.	$0.31
1439	"Aprotonin, 10,000 kiu"	K		$2.65	.	$0.53
1440	Inj desmopressin acetate	K		$5.60	.	$1.12
1442	Non-HEU TC-99M add-on/dose	K		$10.00	.	$2.00
1443	Icatibant injection	K		$234.77	.	$46.96
1445	Methylnaltrexone injection	K		$0.38	.	$0.08
1448	Opthalmic mitomycin	G		$380.54	.	$76.11
1449	Talymed	G		$0.55	$0.00	$0.00
1454	Mumps vaccine sc	K		$162.79	.	$32.56
1455	Foscarnet sodium injection	K		$29.95	.	$5.99
1456	Pentobarbital sodium inj	K		$32.56	.	$6.52
1457	Totazoline hcl injection	K		$41.54	.	$8.31
1458	Phentolaine mesylate inj	K		$132.52	.	$26.51
1459	Urea injection	K		$111.38	.	$22.28
1460	Interferon alfa-2a inj	K		$57.77	.	$11.56
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		$574.85	.	$114.97
1607	Eptifibatide injection	K		$25.95	.	$5.19
1608	Etanercept injection	K		$241.21	.	$48.25
1609	"Rho(D) immune globulin h, sd"	K		$18.59	.	$3.72
1612	"Daclizumab, parenteral"	K		$526.34	.	$105.27
1613	Trastuzumab injection	K		$78.55	.	$15.71
1630	"Hep b ig, im"	K		$112.11	.	$22.43
1631	Baclofen intrathecal trial	K		$75.91	.	$15.19
1633	Alefacept	K		$41.64	.	$8.33
1643	"Y90 ibritumomab, rx"	K		"$40,314.39"	.	"$8,062.88"
1645	"I131 tositumomab, rx"	K		"$30,002.45"	.	"$6,000.49"
1670	Tetanus immune globulin inj	K		$276.72	.	$55.35
1675	P32 Na phosphate	K		$232.40	.	$46.48
1676	P32 chromic phosphate	K		$302.72	.	$60.55
1683	Basiliximab	K		"$2,321.25"	.	$464.25
1684	Corticorelin ovine triflutal	K		$5.82	.	$1.17
1685	"Darbepoetin alfa, non-esrd"	K		$3.33	.	$0.67
1686	"Epoetin alfa, non-esrd"	K		$10.39	.	$2.08
1687	Digoxin immune fab (ovine)	K		"$1,045.83"	.	$209.17
1688	Ethanolamine oleate	K		$299.94	.	$59.99
1689	Fomepizole	K		$6.23	.	$1.25
1690	Hemin	K		$13.27	.	$2.66
1693	Lepirudin	K		$570.54	.	$114.11
1694	Ziconotide injection	K		$6.61	.	$1.33
1695	Nesiritide injection	K		$54.68	.	$10.94
1696	Palifermin injection	K		$13.26	.	$2.66
1697	Pegaptanib sodium injection	K		"$1,030.43"	.	$206.09
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		$1.62	.	$0.33
1709	Azacitidine injection	K		$5.72	.	$1.15
1710	Clofarabine injection	K		$126.32	.	$25.27
1711	Vantas implant	K		"$2,951.87"	.	$590.38
1712	Paclitaxel protein bound	K		$9.54	.	$1.91
1716	"Brachytx, non-str, Gold-198"	U	0.6804	$49.48	.	$9.90
1717	"Brachytx, non-str, HDR Ir-192"	U	3.8243	$278.13	.	$55.63
1719	"Brachytx, NS, Non-HDRIr-192"	U	0.9757	$70.96	.	$14.20
1738	Oxaliplatin	K		$1.06	.	$0.22
1739	"Pegademase bovine, 25 iu"	K		$267.83	.	$53.57
1741	"Urofollitropin, 75 iu"	K		$65.06	.	$13.02
2616	"Brachytx, non-str,Yttrium-90"	U	228.1532	"$16,593.13"	.	"$3,318.63"
2632	Iodine I-125 sodium iodide	U	0.2721	$19.79	.	$3.96
2634	"Brachytx, non-str, HA, I-125"	U	1.0257	$74.60	.	$14.92
2635	"Brachytx, non-str, HA, P-103"	U	0.3700	$26.91	.	$5.39
2636	"Brachy linear, non-str,P-103"	U	0.5510	$40.07	.	$8.02
2638	"Brachytx, stranded, I-125"	U	0.6254	$45.48	.	$9.10
2639	"Brachytx, non-stranded,I-125"	U	0.5513	$40.09	.	$8.02
2640	"Brachytx, stranded, P-103"	U	0.9516	$69.21	.	$13.85
2641	"Brachytx, non-stranded,P-103"	U	0.9251	$67.28	.	$13.46
2642	"Brachytx, stranded, C-131"	U	1.8442	$134.12	.	$26.83
2643	"Brachytx, non-stranded,C-131"	U	0.8453	$61.48	.	$12.30
2698	"Brachytx, stranded, NOS"	U	0.6254	$45.48	.	$9.10
2699	"Brachytx, non-stranded, NOS"	U	0.3700	$26.91	.	$5.39
2731	"Immune globulin, powder"	K		$33.12	.	$6.63
2770	Quinupristin/dalfopristin	K		$188.54	.	$37.71
3041	Bivalirudin	K		$2.99	.	$0.60
3043	Gamma globulin 1 CC inj	K		$23.86	.	$4.78
3050	Sermorelin acetate injection	K		$1.80	.	$0.36
7000	Amifostine	K		$312.76	.	$62.56
7011	Oprelvekin injection	K		$256.80	.	$51.36
7035	Teniposide	K		$321.86	.	$64.38
7036	"Urokinase 250,000 IU inj"	K		$457.73	.	$91.55
7038	Monoclonal antibodies	K		"$1,156.08"	.	$231.22
7041	Tirofiban HCl	K		$8.20	.	$1.64
7042	"Capecitabine, oral"	K		$8.92	.	$1.79
7043	Infliximab injection	K		$67.68	.	$13.54
7046	Doxil injection	K		$543.06	.	$108.62
7048	Alteplase recombinant	K		$52.19	.	$10.44
7049	Filgrastim 480 mcg injection	K		$439.90	.	$87.98
7051	Leuprolide acetate implant	K		"$4,819.82"	.	$963.97
7308	Aminolevulinic acid hcl top	K		$160.03	.	$32.01
8000	Cardiac Electrophysiologic Evaluation and Ablation Composite	T	182.4391	"$13,268.43"	.	"$2,653.69"
8001	LDR Prostate Brachytherapy Composite	T	59.0768	"$4,296.54"	.	$859.31
8004	Ultrasound Composite	S	4.3879	$319.12	.	$63.83
8005	CT and CTA without Contrast Composite	S	4.1389	$301.01	.	$60.21
8006	CT and CTA with Contrast Composite	S	7.1068	$516.86	.	$103.38
8007	MRI and MRA without Contrast Composite	S	8.3377	$606.38	.	$121.28
8008	MRI and MRA with Contrast Composite	S	12.3661	$899.36	.	$179.88
8009	Extended Assessment & Management Composite	V	18.4668	"$1,343.05"	.	$268.61
9001	Linezolid injection	K		$39.10	.	$7.82
9002	Tenecteplase injection	K		$72.44	.	$14.49
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		$138.00	.	$27.60
9012	Arsenic trioxide injection	K		$45.07	.	$9.02
9018	"Inj, rimabotulinumtoxinB"	K		$10.82	.	$2.17
9019	Caspofungin acetate	K		$13.08	.	$2.62
9022	IM inj interferon beta 1-a	K		$305.42	.	$61.09
9024	Amphotericin b lipid complex	K		$11.28	.	$2.26
9032	Baclofen 10 MG injection	K		$175.16	.	$35.04
9033	Cidofovir injection	K		$757.16	.	$151.44
9038	Inj estrogen conjugate	K		$136.72	.	$27.35
9042	Glucagon hydrochloride	K		$115.04	.	$23.01
9044	Ibutilide fumarate injection	K		$164.73	.	$32.95
9104	Antithymocyte globuln rabbit	K		$529.73	.	$105.95
9108	Thyrotropin injection	K		"$1,053.98"	.	$210.80
9110	Alemtuzumab injection	K		$623.63	.	$124.73
9115	Zoledronic acid	K		$220.95	.	$44.19
9119	"Injection, pegfilgrastim 6mg"	K		"$2,940.20"	.	$588.04
9120	"Injection, Fulvestrant"	K		$88.33	.	$17.67
9121	"Injection, argatroban"	K		$17.12	.	$3.43
9122	Triptorelin pamoate	K		$172.30	.	$34.46
9124	Daptomycin injection	K		$0.57	.	$0.12
9125	"Risperidone, long acting"	K		$5.62	.	$1.13
9126	Natalizumab injection	K		$12.29	.	$2.46
9130	"Injection, IVIG Bivigam"	G		$63.58	.	$12.72
9133	"Rabies ig, im/sc"	K		$206.53	.	$41.31
9134	"Rabies ig, heat treated"	K		$202.72	.	$40.55
9135	"Varicella-zoster ig, im"	K		$141.38	.	$28.28
9137	"Bcg vaccine, percut"	K		$117.45	.	$23.49
9139	"Rabies vaccine, im"	K		$221.98	.	$44.40
9140	"Rabies vaccine, id"	K		$156.29	.	$31.26
9143	"Meningococcal vaccine, sc"	K		$106.49	.	$21.30
9144	"Encephalitis vaccine, sc"	K		$102.08	.	$20.42
9207	Bortezomib injection	K		$44.31	.	$8.87
9208	Agalsidase beta injection	K		$140.85	.	$28.17
9209	Laronidase injection	K		$28.21	.	$5.65
9210	Palonosetron hcl	K		$19.45	.	$3.89
9213	Pemetrexed injection	K		$57.96	.	$11.60
9214	Bevacizumab injection	K		$63.56	.	$12.72
9215	Cetuximab injection	K		$51.81	.	$10.37
9217	Leuprolide acetate suspnsion	K		$207.81	.	$41.57
9224	Galsulfase injection	K		$355.39	.	$71.08
9225	Fluocinolone acetonide implt	K		"$19,345.00"	.	"$3,869.00"
9227	Micafungin sodium injection	K		$0.95	.	$0.19
9228	Tigecycline injection	K		$1.61	.	$0.33
9229	Ibandronate sodium injection	K		$151.50	.	$30.30
9230	Abatacept injection	K		$22.62	.	$4.53
9231	Decitabine injection	K		$34.09	.	$6.82
9232	Idursulfase injection	K		$470.35	.	$94.07
9233	Ranibizumab injection	K		$397.72	.	$79.55
9234	Alglucosidase alfa injection	K		$205.87	.	$41.18
9235	Panitumumab injection	K		$89.25	.	$17.85
9236	Eculizumab injection	K		$201.12	.	$40.23
9237	"Inj, lanreotide acetate"	K		$35.65	.	$7.13
9240	"Injection, ixabepilone"	K		$67.59	.	$13.52
9242	"Injection, fosaprepitant"	K		$1.72	.	$0.35
9243	Bendamustine injection	K		$20.62	.	$4.13
9245	Romiplostim injection	K		$49.84	.	$9.97
9249	Certolizumab pegol inj	K		$5.15	.	$1.03
9250	Artiss fibrin sealant	K		$100.31	.	$20.07
9251	C1 esterase inhibitor inj	K		$47.26	.	$9.46
9252	Plerixafor injection	K		$292.60	.	$58.52
9253	Temozolomide injection	K		$4.83	.	$0.97
9255	Paliperidone palmitate inj	K		$7.23	.	$1.45
9256	Dexamethasone intra implant	K		$195.92	.	$39.19
9258	Telavancin injection	K		$2.66	.	$0.54
9259	Pralatrexate injection	K		$182.60	.	$36.52
9260	Ofatumumab injection	K		$45.33	.	$9.07
9261	Ustekinumab injection	K		$134.19	.	$26.84
9263	Ecallantide injection	K		$317.14	.	$63.43
9264	Tocilizumab injection	K		$3.69	.	$0.74
9265	Romidepsin injection	K		$242.17	.	$48.44
9268	Capsaicin 8% patch	K		$25.55	.	$5.11
9269	"C-1 esterase, berinert"	K		$31.14	.	$6.23
9270	Gammaplex IVIG	K		$37.22	.	$7.45
9271	Velaglucerase alfa	K		$348.63	.	$69.73
9272	"Inj, denosumab"	K		$14.22	.	$2.85
9273	Sipuleucel-T auto CD54+	K		"$32,769.42"	.	"$6,553.89"
9274	Crotalidae Poly Immune Fab	K		"$2,220.92"	.	$444.19
9276	Cabazitaxel injection	K		$140.58	.	$28.12
9278	Incobotulinumtoxin A	K		$4.45	.	$0.89
9281	"Injection, pegloticase"	K		$365.79	.	$73.16
9284	Ipilimumab injection	K		$126.96	.	$25.40
9286	Belatacept injection	K		$3.81	.	$0.77
9287	Brentuximab vedotin inj	K		$98.77	.	$19.76
9289	Erwinaze injection	G		$334.32	.	$66.87
9290	"Inj, bupivacaine liposome"	G		$1.08	$0.00	$0.00
9292	"Injection, pertuzumab"	G		$102.27	.	$20.46
9293	"Injection, glucarpidase "	G		$233.73	.	$46.75
9294	"Inj, taliglucerase alfa"	G		$30.90	.	$6.18
9295	"Injection, carfilzomib"	G		$29.29	.	$5.86
9296	"Injection, ziv-aflibercept"	G		$15.57	.	$3.12
9297	Omacetaxine mepesuccinate	G		$25.29	.	$5.06
9298	"Injection, ocriplasmin"	G		"$4,187.00"	.	$837.40
9300	Omalizumab injection	K		$24.47	.	$4.90
9368	Grafix core	G		$163.68	$0.00	$0.00
9369	Grafix prime	G		$120.51	$0.00	$0.00
9500	"Platelets, irradiated"	R	1.9517	$141.94	.	$28.39
9501	Platelet pheres leukoreduced	R	7.1485	$519.90	.	$103.98
9502	Platelet pheresis irradiated	R	8.2854	$602.58	.	$120.52
9503	Fr frz plasma donor retested	R	0.8574	$62.36	.	$12.48
9504	RBC deglycerolized	R	5.0630	$368.22	.	$73.65
9505	RBC irradiated	R	2.8945	$210.51	.	$42.11
9506	"Granulocytes, pheresis unit"	R	24.4960	"$1,781.55"	.	$356.31
9507	"Platelets, pheresis"	R	5.7132	$415.51	.	$83.11
9508	Plasma 1 donor frz w/in 8 hr	R	1.1095	$80.69	.	$16.14
