	Addendum A.-Proposed OPPS APCs for CY 2015																																																																																																																																																																																							
APC	Group Title	SI	Relative Weight 	Payment Rate 	National Unadjusted Copayment 	Minimum Unadjusted Copayment 																																																																																																																																																																																		
0004	Level I Needle Biopsy/ Aspiration Except Bone Marrow	T	6.6620	$494.16	.	$98.84																																																																																																																																																																																		
0005	Level II Needle Biopsy/Aspiration Except Bone Marrow	T	14.3211	"$1,062.28"	.	$212.46																																																																																																																																																																																		
0006	Level I Incision & Drainage	T	2.1965	$162.93	.	$32.59																																																																																																																																																																																		
0007	Level II Incision & Drainage	T	12.2415	$908.03	.	$181.61																																																																																																																																																																																		
0008	Level III Incision and Drainage	T	22.1865	"$1,645.71"	.	$329.15																																																																																																																																																																																		
0012	Level I Debridement & Destruction	T	0.9824	$72.87	.	$14.58																																																																																																																																																																																		
0015	Level II Debridement & Destruction	T	1.9098	$141.66	.	$28.34																																																																																																																																																																																		
0016	Level III Debridement & Destruction	T	3.8335	$284.35	.	$56.87																																																																																																																																																																																		
0017	Level IV Debridement & Destruction	T	17.9799	"$1,333.68"	.	$266.74																																																																																																																																																																																		
0019	Level I Excision/ Biopsy	T	5.1272	$380.32	.	$76.07																																																																																																																																																																																		
0020	Level II Excision/ Biopsy	T	11.0768	$821.63	.	$164.33																																																																																																																																																																																		
0021	Level III Excision/ Biopsy	T	17.6294	"$1,307.68"	.	$261.54																																																																																																																																																																																		
0022	Level IV Excision/ Biopsy	T	24.5994	"$1,824.69"	.	$364.94																																																																																																																																																																																		
0028	Level I Breast and Skin Surgery	T	29.3421	"$2,176.48"	.	$435.30																																																																																																																																																																																		
0029	Level II Breast and Skin Surgery	T	40.6893	"$3,018.17"	.	$603.64																																																																																																																																																																																		
0030	Level III Breast and Skin Surgery	T	55.9502	"$4,150.16"	.	$830.04																																																																																																																																																																																		
0031	Level I Health and Behavior Services	S	0.3493	$25.91	.	$5.19																																																																																																																																																																																		
0034	Mental Health Services Composite	S	2.4491	$181.66	.	$36.34																																																																																																																																																																																		
0039	Level III Neurostimulator & Related Procedures	J1	227.8762	"$16,902.95"	.	"$3,380.59"																																																																																																																																																																																		
0041	Level I Arthroscopy	T	29.3994	"$2,180.73"	.	$436.15																																																																																																																																																																																		
0042	Level II Arthroscopy	T	58.9907	"$4,375.69"	.	$875.14																																																																																																																																																																																		
0045	Bone/Joint Manipulation Under Anesthesia	T	15.5856	"$1,156.08"	$257.70	$231.22																																																																																																																																																																																		
0047	Arthroplasty 	T	45.0191	"$3,339.34"	.	$667.87																																																																																																																																																																																		
0049	Level I Musculoskeletal Procedures Except Hand and Foot	T	22.4288	"$1,663.68"	.	$332.74																																																																																																																																																																																		
0050	Level II Musculoskeletal Procedures Except Hand and Foot	T	34.9427	"$2,591.91"	.	$518.39																																																																																																																																																																																		
0051	Level III Musculoskeletal Procedures Except Hand and Foot	T	51.1976	"$3,797.63"	.	$759.53																																																																																																																																																																																		
0052	Level IV Musculoskeletal Procedures Except Hand and Foot	T	84.6949	"$6,282.33"	.	"$1,256.47"																																																																																																																																																																																		
0053	Level I Hand Musculoskeletal Procedures	T	17.0204	"$1,262.51"	.	$252.51																																																																																																																																																																																		
0054	Level II Hand Musculoskeletal Procedures	T	29.5714	"$2,193.49"	.	$438.70																																																																																																																																																																																		
0055	Level I Foot Musculoskeletal Procedures	T	23.6709	"$1,755.81"	$353.37	$351.17																																																																																																																																																																																		
0056	Level II Foot Musculoskeletal Procedures	T	69.7901	"$5,176.75"	.	"$1,035.35"																																																																																																																																																																																		
0057	Bunion Procedures	T	35.9817	"$2,668.98"	.	$533.80																																																																																																																																																																																		
0058	Level II Strapping and Cast Application	S	3.0454	$225.90	.	$45.18																																																																																																																																																																																		
0059	Level I Strapping and Cast Application	S	1.7096	$126.81	.	$25.37																																																																																																																																																																																		
0060	Manipulation Therapy	S	0.2657	$19.71	.	$3.95																																																																																																																																																																																		
0061	Level II Neurostimulator & Related Procedures	J1	71.8762	"$5,331.49"	.	"$1,066.30"																																																																																																																																																																																		
0062	Level I Treatment Fracture/Dislocation	T	27.9930	"$2,076.41"	.	$415.29																																																																																																																																																																																		
0063	Level II Treatment Fracture/Dislocation	T	56.3193	"$4,177.54"	.	$835.51																																																																																																																																																																																		
0064	Level III Treatment Fracture/Dislocation	T	74.6693	"$5,538.67"	.	"$1,107.74"																																																																																																																																																																																		
0066	Level V Radiation Therapy	S	25.5187	"$1,892.88"	.	$378.58																																																																																																																																																																																		
0067	Single Session Cranial Stereotactic Radiosurgery	J1	131.6865	"$9,767.98"	.	"$1,953.60"																																																																																																																																																																																		
0069	Thoracoscopy	T	40.4987	"$3,004.03"	.	$600.81																																																																																																																																																																																		
0070	Thoracentesis/Lavage Procedures	T	6.6432	$492.77	.	$98.56																																																																																																																																																																																		
0071	Level I Endoscopy Upper Airway	T	2.0240	$150.13	.	$30.03																																																																																																																																																																																		
0072	Level II Endoscopy Upper Airway	T	5.1480	$381.86	.	$76.38																																																																																																																																																																																		
0073	Level III Endoscopy Upper Airway	T	17.1576	"$1,272.68"	.	$254.54																																																																																																																																																																																		
0074	Level IV Endoscopy Upper Airway	T	27.0171	"$2,004.02"	.	$400.81																																																																																																																																																																																		
0075	Level V Endoscopy Upper Airway	T	40.7118	"$3,019.84"	.	$603.97																																																																																																																																																																																		
0076	Level I Endoscopy Lower Airway	T	14.0732	"$1,043.89"	.	$208.78																																																																																																																																																																																		
0077	Level I Pulmonary Treatment	S	0.6707	$49.75	.	$9.95																																																																																																																																																																																		
0078	Level II Pulmonary Treatment	S	1.1767	$87.28	.	$17.46																																																																																																																																																																																		
0079	Ventilation Initiation and Management	S	4.6152	$342.34	.	$68.47																																																																																																																																																																																		
0080	Diagnostic Cardiac Catheterization	T	35.0526	"$2,600.06"	$795.89	$520.02																																																																																																																																																																																		
0083	Level I Endovascular Procedures	J1	58.4316	"$4,334.22"	.	$866.85																																																																																																																																																																																		
0084	Level I Electrophysiologic Procedures	J1	11.8827	$881.41	.	$176.29																																																																																																																																																																																		
0085	Level II Electrophysiologic Procedures	J1	61.9048	"$4,591.85"	.	$918.37																																																																																																																																																																																		
0086	Level III Electrophysiologic Procedures	J1	191.0191	"$14,169.03"	.	"$2,833.81"																																																																																																																																																																																		
0088	Thrombectomy	T	44.2321	"$3,280.96"	.	$656.20																																																																																																																																																																																		
0089	Level III Pacemaker and Similar Procedures	J1	127.7827	"$9,478.41"	.	"$1,895.69"																																																																																																																																																																																		
0090	Level II Pacemaker and Similar Procedures	J1	89.6370	"$6,648.91"	.	"$1,329.79"																																																																																																																																																																																		
0093	Vascular Reconstruction/Fistula Repair 	T	32.9337	"$2,442.89"	.	$488.58																																																																																																																																																																																		
0094	Resuscitation and Cardioversion	S	6.4032	$474.96	.	$95.00																																																																																																																																																																																		
0095	Cardiac Rehabilitation	S	1.3942	$103.42	.	$20.69																																																																																																																																																																																		
0096	Level II Noninvasive Physiologic Studies	S	4.5099	$334.53	.	$66.91																																																																																																																																																																																		
0097	Level I Noninvasive Physiologic Studies	S	1.5066	$111.75	.	$22.35																																																																																																																																																																																		
0099	Electrocardiograms/Cardiography	S	1.0465	$77.63	.	$15.53																																																																																																																																																																																		
0100	Cardiac Stress Tests	S	3.1934	$236.87	.	$47.38																																																																																																																																																																																		
0103	Miscellaneous Vascular Procedures	T	21.8244	"$1,618.85"	.	$323.77																																																																																																																																																																																		
0105	Level I Pacemaker & Similar Procedures	T	28.0399	"$2,079.89"	.	$415.98																																																																																																																																																																																		
0107	Level I ICD and Similar Procedures	J1	311.1895	"$23,082.79"	.	"$4,616.56"																																																																																																																																																																																		
0108	Level II ICD and Similar Procedures	J1	413.1447	"$30,645.42"	.	"$6,129.09"																																																																																																																																																																																		
0110	Transfusion	S	4.0037	$296.98	.	$59.40																																																																																																																																																																																		
0111	Blood Product Exchange	S	14.5302	"$1,077.79"	.	$215.56																																																																																																																																																																																		
0112	Apheresis and Stem Cell Procedures	S	39.1136	"$2,901.29"	.	$580.26																																																																																																																																																																																		
0113	Excision Lymphatic System	T	31.3318	"$2,324.07"	.	$464.82																																																																																																																																																																																		
0114	Thyroid/Lymphadenectomy Procedures	T	57.3663	"$4,255.20"	.	$851.04																																																																																																																																																																																		
0121	Level I Tube or Catheter Changes or Repositioning	T	6.3403	$470.30	.	$94.06																																																																																																																																																																																		
0126	Level I Urinary and Anal Procedures	T	1.4913	$110.62	.	$22.13																																																																																																																																																																																		
0129	Level I Closed Treatment Fracture	T	2.3316	$172.95	.	$34.59																																																																																																																																																																																		
0130	Level I Laparoscopy	T	39.7951	"$2,951.84"	$659.53	$590.37																																																																																																																																																																																		
0131	Level II Laparoscopy	T	51.1019	"$3,790.53"	"$1,001.89"	$758.11																																																																																																																																																																																		
0132	Level III Laparoscopy	T	73.5332	"$5,454.40"	"$1,236.99"	"$1,090.88"																																																																																																																																																																																		
0138	Level II Closed Treatment Fracture 	T	2.9951	$222.16	.	$44.44																																																																																																																																																																																		
0139	Level III Closed Treatment Fracture 	T	9.7973	$726.72	.	$145.35																																																																																																																																																																																		
0141	Level I Upper GI Procedures	T	10.0669	$746.72	.	$149.35																																																																																																																																																																																		
0142	Level I Small Intestine Endoscopy	T	11.5634	$857.73	.	$171.55																																																																																																																																																																																		
0143	Lower GI Endoscopy	T	10.6918	$793.07	$186.06	$158.62																																																																																																																																																																																		
0146	Level I Sigmoidoscopy and Anoscopy	T	6.6817	$495.62	.	$99.13																																																																																																																																																																																		
0147	Level II Sigmoidoscopy and Anoscopy	T	11.1389	$826.24	.	$165.25																																																																																																																																																																																		
0148	Level I Anal/Rectal Procedures	T	5.9597	$442.07	.	$88.42																																																																																																																																																																																		
0149	Level III Anal/Rectal Procedures	T	26.3923	"$1,957.68"	.	$391.54																																																																																																																																																																																		
0150	Level IV Anal/Rectal Procedures	T	35.2231	"$2,612.71"	.	$522.55																																																																																																																																																																																		
0151	Endoscopic Retrograde Cholangio-Pancreatography (ERCP)	T	26.1924	"$1,942.85"	.	$388.57																																																																																																																																																																																		
0152	Level I Percutaneous Abdominal and Biliary Procedures	T	24.7009	"$1,832.21"	.	$366.45																																																																																																																																																																																		
0153	Peritoneal and Abdominal Procedures	T	29.6334	"$2,198.09"	.	$439.62																																																																																																																																																																																		
0154	Hernia/Hydrocele Procedures	T	36.2323	"$2,687.57"	.	$537.52																																																																																																																																																																																		
0155	Level II Anal/Rectal Procedures	T	19.7023	"$1,461.44"	.	$292.29																																																																																																																																																																																		
0156	Level III Urinary and Anal Procedures	T	5.2937	$392.67	.	$78.54																																																																																																																																																																																		
0157	Colorectal Cancer Screening: Barium Enema	S	4.5884	$340.35	$0.00	$0.00																																																																																																																																																																																		
0158	Colorectal Cancer Screening: Colonoscopy	T	8.8599	$657.19	$0.00	$0.00																																																																																																																																																																																		
0159	Colorectal Cancer Screening: Flexible Sigmoidoscopy	S	6.2935	$466.83	$0.00	$0.00																																																																																																																																																																																		
0160	Level I Cystourethroscopy and other Genitourinary Procedures	T	7.4504	$552.64	.	$110.53																																																																																																																																																																																		
0161	Level II Cystourethroscopy and other Genitourinary Procedures	T	16.6501	"$1,235.04"	.	$247.01																																																																																																																																																																																		
0162	Level III Cystourethroscopy and other Genitourinary Procedures	T	28.1882	"$2,090.89"	.	$418.18																																																																																																																																																																																		
0163	Level IV Cystourethroscopy and other Genitourinary Procedures	T	42.0293	"$3,117.57"	.	$623.52																																																																																																																																																																																		
0164	Level II Urinary and Anal Procedures	T	2.9112	$215.94	.	$43.19																																																																																																																																																																																		
0165	Level IV Urinary and Anal Procedures	T	18.6102	"$1,380.43"	.	$276.09																																																																																																																																																																																		
0166	Level I Urethral Procedures	T	21.7632	"$1,614.31"	.	$322.87																																																																																																																																																																																		
0168	Level II Urethral Procedures	T	34.1532	"$2,533.35"	.	$506.67																																																																																																																																																																																		
0170	Dialysis	S	8.2911	$615.00	.	$123.00																																																																																																																																																																																		
0172	Level I Partial Hospitalization (3 services) for CMHCs	P	1.2546	$93.06	.	$18.62																																																																																																																																																																																		
0173	Level II Partial Hospitalization (4 or more services) for CMHCs	P	1.4798	$109.77	.	$21.96																																																																																																																																																																																		
0174	Level IV Laparoscopy	T	106.4310	"$7,894.63"	"$1,756.17"	"$1,578.93"																																																																																																																																																																																		
0175	Level I Partial Hospitalization (3 services) for Hospital-based PHPs	P	2.2832	$169.36	.	$33.88																																																																																																																																																																																		
0176	Level II Partial Hospitalization (4 or more services) for Hospital-based PHPs	P	2.4491	$181.66	.	$36.34																																																																																																																																																																																		
0177	Level I Echocardiogram with Contrast	S	6.4184	$476.09	$123.07	$95.22																																																																																																																																																																																		
0178	Level II Echocardiogram with Contrast	S	9.2783	$688.23	$172.48	$137.65																																																																																																																																																																																		
0181	Level II Male Genital Procedures	T	30.2622	"$2,244.73"	.	$448.95																																																																																																																																																																																		
0183	Level I Male Genital Procedures	T	24.6127	"$1,825.67"	.	$365.14																																																																																																																																																																																		
0184	Prostate Biopsy	T	19.9655	"$1,480.96"	.	$296.20																																																																																																																																																																																		
0188	Level I Female Reproductive Procedures	T	1.7589	$130.47	.	$26.10																																																																																																																																																																																		
0189	Level II Female Reproductive Procedures	T	3.0707	$227.77	.	$45.56																																																																																																																																																																																		
0190	Hysteroscopy	T	27.1564	"$2,014.35"	$424.28	$402.87																																																																																																																																																																																		
0192	Level III Female Reproductive Procedures	T	6.7511	$500.77	.	$100.16																																																																																																																																																																																		
0193	Level IV Female Reproductive Procedures	T	23.3152	"$1,729.43"	.	$345.89																																																																																																																																																																																		
0202	Level V Female Reproductive Procedures	J1	58.8580	"$4,365.85"	$981.50	$873.17																																																																																																																																																																																		
0203	Level IV Nerve Injections	T	20.5390	"$1,523.50"	.	$304.70																																																																																																																																																																																		
0204	Level I Nerve Injections	T	2.9367	$217.83	.	$43.57																																																																																																																																																																																		
0205	Level III Male Genital Procedures	T	45.5892	"$3,381.62"	.	$676.33																																																																																																																																																																																		
0206	Level II Nerve Injections	T	5.0610	$375.40	.	$75.08																																																																																																																																																																																		
0207	Level III Nerve Injections	T	9.2110	$683.24	.	$136.65																																																																																																																																																																																		
0208	Laminotomies and Laminectomies	T	56.1878	"$4,167.79"	.	$833.56																																																																																																																																																																																		
0209	"Level II Extended EEG, Sleep, and Cardiovascular Studies"	S	3.2269	$239.36	$70.62	$47.88																																																																																																																																																																																		
0213	"Level I Extended EEG, Sleep, and Cardiovascular Studies"	S	2.3648	$175.41	$51.75	$35.09																																																																																																																																																																																		
0215	Level I Nerve and Muscle Services	S	1.3473	$99.94	.	$19.99																																																																																																																																																																																		
0216	Level III Nerve and Muscle Services	S	3.7156	$275.61	.	$55.13																																																																																																																																																																																		
0218	Level II Nerve and Muscle Services	S	2.1560	$159.92	.	$31.99																																																																																																																																																																																		
0219	Vascular Ligation 	T	29.1153	"$2,159.66"	.	$431.94																																																																																																																																																																																		
0220	Level I Nerve Procedures	T	18.8413	"$1,397.57"	.	$279.52																																																																																																																																																																																		
0221	Level II Nerve Procedures	T	39.0425	"$2,896.02"	.	$579.21																																																																																																																																																																																		
0224	Implantation of Catheter/Reservoir/Shunt	T	50.1966	"$3,723.38"	.	$744.68																																																																																																																																																																																		
0227	Implantation of Drug Infusion Device	J1	211.4267	"$15,682.79"	.	"$3,136.56"																																																																																																																																																																																		
0229	Level II Endovascular Procedures	J1	128.7303	"$9,548.70"	.	"$1,909.74"																																																																																																																																																																																		
0230	Level I Eye Tests & Treatments	S	0.7082	$52.53	.	$10.51																																																																																																																																																																																		
0231	Level III Eye Tests & Treatments	S	4.2379	$314.35	.	$62.87																																																																																																																																																																																		
0233	Level II Intraocular Procedures	T	23.8246	"$1,767.21"	.	$353.45																																																																																																																																																																																		
0238	"Level I Extraocular, Repair, and Plastic Eye Procedures"	T	4.0444	$300.00	.	$60.00																																																																																																																																																																																		
0239	"Level II Extraocular, Repair, and Plastic Eye Procedures"	T	9.5004	$704.70	.	$140.94																																																																																																																																																																																		
0240	"Level III Extraocular, Repair, and Plastic Eye Procedures"	T	20.7017	"$1,535.57"	.	$307.12																																																																																																																																																																																		
0242	"Level IV Extraocular, Repair, and Plastic Eye Procedures"	T	36.2128	"$2,686.12"	.	$537.23																																																																																																																																																																																		
0247	Laser Eye Procedures	T	5.9831	$443.80	$102.26	$88.76																																																																																																																																																																																		
0250	Level I ENT Procedures	T	1.7338	$128.61	.	$25.73																																																																																																																																																																																		
0251	Level II ENT Procedures	T	4.8654	$360.90	.	$72.18																																																																																																																																																																																		
0252	Level III ENT Procedures	T	8.9312	$662.48	.	$132.50																																																																																																																																																																																		
0253	Level IV ENT Procedures	T	17.1471	"$1,271.90"	.	$254.38																																																																																																																																																																																		
0254	Level V ENT Procedures	T	26.2467	"$1,946.88"	.	$389.38																																																																																																																																																																																		
0255	Level I Intraocular Procedures	T	10.2261	$758.53	.	$151.71																																																																																																																																																																																		
0256	Level VI ENT Procedures	T	50.1547	"$3,720.28"	.	$744.06																																																																																																																																																																																		
0259	Level VII ENT Procedures	J1	402.6820	"$29,869.34"	"$7,691.99"	"$5,973.87"																																																																																																																																																																																		
0260	Level I Plain Film Including Bone Density Measurement	S	0.8039	$59.63	.	$11.93																																																																																																																																																																																		
0261	Level II Plain Film Including Bone Density Measurement	S	1.2856	$95.36	.	$19.08																																																																																																																																																																																		
0263	Level I Miscellaneous Radiology Procedures	S	4.6010	$341.28	.	$68.26																																																																																																																																																																																		
0265	Level I Diagnostic and Screening Ultrasound	S	1.2427	$92.18	$22.26	$18.44																																																																																																																																																																																		
0266	Level II Diagnostic and Screening Ultrasound	S	1.8245	$135.33	$37.23	$27.07																																																																																																																																																																																		
0267	Level III Diagnostic and Screening Ultrasound	S	2.5558	$189.58	$59.16	$37.92																																																																																																																																																																																		
0269	Level II Echocardiogram Without Contrast 	S	5.7265	$424.77	.	$84.96																																																																																																																																																																																		
0270	Level III Echocardiogram Without Contrast 	S	8.1130	$601.79	$128.73	$120.36																																																																																																																																																																																		
0272	Fluoroscopy and Other Radiology Services	S	2.1030	$155.99	.	$31.20																																																																																																																																																																																		
0274	Myelography	S	8.1943	$607.82	.	$121.57																																																																																																																																																																																		
0275	Arthrography	S	4.5605	$338.28	$68.69	$67.66																																																																																																																																																																																		
0276	Level I Digestive Radiology	S	1.3761	$102.07	$32.84	$20.42																																																																																																																																																																																		
0277	Level II Digestive Radiology	S	2.0376	$151.14	$46.48	$30.23																																																																																																																																																																																		
0278	Diagnostic Urography	S	3.5519	$263.47	$58.44	$52.70																																																																																																																																																																																		
0279	Level II Angiography and Venography	S	34.2432	"$2,540.02"	.	$508.01																																																																																																																																																																																		
0280	Level III Angiography and Venography	S	69.6732	"$5,168.08"	.	"$1,033.62"																																																																																																																																																																																		
0283	Computed Tomography with Contrast	S	3.2902	$244.05	$78.40	$48.81																																																																																																																																																																																		
0284	Magnetic Resonance Imaging and Magnetic Resonance Angiography with Contrast	S	5.8674	$435.22	$137.54	$87.05																																																																																																																																																																																		
0293	Level IV Intraocular Procedures	J1	116.5253	"$8,643.38"	.	"$1,728.68"																																																																																																																																																																																		
0300	Level I Radiation Therapy	S	1.3747	$101.97	.	$20.40																																																																																																																																																																																		
0301	Level II Radiation Therapy	S	2.6461	$196.28	.	$39.26																																																																																																																																																																																		
0303	Treatment Device Construction	S	2.9178	$216.43	$66.95	$43.29																																																																																																																																																																																		
0304	Level I Therapeutic Radiation Treatment Preparation	S	1.5452	$114.62	$34.62	$22.93																																																																																																																																																																																		
0305	Level II Therapeutic Radiation Treatment Preparation	S	4.2730	$316.95	$88.78	$63.39																																																																																																																																																																																		
0308	Positron Emission Tomography (PET) imaging	S	17.3433	"$1,286.46"	.	$257.30																																																																																																																																																																																		
0310	Level III Therapeutic Radiation Treatment Preparation	S	14.0443	"$1,041.75"	$325.27	$208.35																																																																																																																																																																																		
0312	Radioelement Applications	S	4.5655	$338.65	.	$67.73																																																																																																																																																																																		
0313	Brachytherapy	S	9.7872	$725.98	$257.09	$145.20																																																																																																																																																																																		
0317	Level II Miscellaneous Radiology Procedures	S	7.4337	$551.40	.	$110.28																																																																																																																																																																																		
0318	Level IV Neurostimulator & Related Procedures	J1	351.3029	"$26,058.24"	.	"$5,211.65"																																																																																																																																																																																		
0319	Level III Endovascular Procedures	J1	198.9730	"$14,759.02"	.	"$2,951.81"																																																																																																																																																																																		
0320	Electroconvulsive Therapy	S	5.9462	$441.07	.	$88.22																																																																																																																																																																																		
0322	Brief Individual Psychotherapy	S	1.2485	$92.61	.	$18.53																																																																																																																																																																																		
0323	Extended Individual Psychotherapy	S	1.5822	$117.36	.	$23.48																																																																																																																																																																																		
0324	Family Psychotherapy	S	1.7564	$130.28	.	$26.06																																																																																																																																																																																		
0325	Group Psychotherapy	S	0.8885	$65.91	.	$13.19																																																																																																																																																																																		
0326	Level I Skin Procedures	T	2.9224	$216.77	.	$43.36																																																																																																																																																																																		
0327	Level II Skin Procedures	T	5.8090	$430.89	.	$86.18																																																																																																																																																																																		
0328	Level III Skin Procedures	T	18.9821	"$1,408.02"	.	$281.61																																																																																																																																																																																		
0329	Level IV Skin Procedures	T	30.5102	"$2,263.12"	.	$452.63																																																																																																																																																																																		
0330	Dental Procedures	S	1.8957	$140.62	.	$28.13																																																																																																																																																																																		
0331	Combined Abdomen and Pelvis CT without Contrast 	S	3.2623	$241.98	$93.48	$48.40																																																																																																																																																																																		
0332	Computed Tomography without Contrast	S	1.6629	$123.35	$47.69	$24.67																																																																																																																																																																																		
0333	Computed Tomography without Contrast followed by Contrast	S	3.7004	$274.48	$95.32	$54.90																																																																																																																																																																																		
0334	Combined Abdomen and Pelvis CT with Contrast 	S	5.1717	$383.62	$123.63	$76.73																																																																																																																																																																																		
0336	Magnetic Resonance Imaging and Magnetic Resonance Angiography without Contrast	S	3.9039	$289.58	$114.11	$57.92																																																																																																																																																																																		
0337	Magnetic Resonance Imaging and Magnetic Resonance Angiography without Contrast followed by Contrast	S	6.5365	$484.85	$174.40	$96.97																																																																																																																																																																																		
0340	Level II Minor Procedures	S	0.8342	$61.88	.	$12.38																																																																																																																																																																																		
0342	Level I Pathology	S	0.7338	$54.43	.	$10.89																																																																																																																																																																																		
0345	Level I Transfusion Laboratory Procedures	S	1.0150	$75.29	.	$15.06																																																																																																																																																																																		
0346	Level II Transfusion Laboratory Procedures	S	1.6419	$121.79	.	$24.36																																																																																																																																																																																		
0351	Level V Intraocular Procedures	J1	271.1265	"$20,111.08"	.	"$4,022.22"																																																																																																																																																																																		
0360	Level I Alimentary Tests	S	1.9273	$142.96	$33.08	$28.60																																																																																																																																																																																		
0361	Level II Alimentary Tests	S	4.4537	$330.36	$83.23	$66.08																																																																																																																																																																																		
0363	Level I Otorhinolaryngologic Function Tests	S	2.0971	$155.55	.	$31.11																																																																																																																																																																																		
0364	Level I Audiometry	S	0.5497	$40.77	.	$8.16																																																																																																																																																																																		
0365	Level II Audiometry	S	1.5865	$117.68	.	$23.54																																																																																																																																																																																		
0367	Level I Pulmonary Tests	S	2.1415	$158.85	.	$31.77																																																																																																																																																																																		
0369	Level II Pulmonary Tests	S	3.1661	$234.85	.	$46.97																																																																																																																																																																																		
0373	Neuropsychological Testing	S	2.7992	$207.63	.	$41.53																																																																																																																																																																																		
0375	Ancillary Outpatient Services When Patient Expires	S	49.9374	"$3,704.16"	.	$740.84																																																																																																																																																																																		
0377	Level II Cardiac Imaging	S	15.3605	"$1,139.38"	.	$227.88																																																																																																																																																																																		
0378	Level II Pulmonary Imaging	S	5.7557	$426.93	$125.48	$85.39																																																																																																																																																																																		
0383	Cardiac Computed Tomographic Imaging	S	2.9252	$216.98	.	$43.40																																																																																																																																																																																		
0384	GI Procedures with Stents	J1	42.5933	"$3,159.40"	.	$631.88																																																																																																																																																																																		
0385	Level I Urogenital Procedures	J1	103.2592	"$7,659.35"	.	"$1,531.87"																																																																																																																																																																																		
0386	Level II Urogenital Procedures	J1	187.3364	"$13,895.86"	.	"$2,779.18"																																																																																																																																																																																		
0388	Discography	S	39.3693	"$2,920.26"	.	$584.06																																																																																																																																																																																		
0389	Level I Non-imaging Nuclear Medicine	S	2.5694	$190.59	.	$38.12																																																																																																																																																																																		
0390	Level I Endocrine Imaging	S	2.5497	$189.13	$47.69	$37.83																																																																																																																																																																																		
0391	Level II Endocrine Imaging	S	3.7937	$281.40	$64.20	$56.28																																																																																																																																																																																		
0392	Level II Non-imaging Nuclear Medicine	S	3.8486	$285.47	.	$57.10																																																																																																																																																																																		
0393	Hematologic Processing & Studies	S	8.4776	$628.83	.	$125.77																																																																																																																																																																																		
0394	Hepatobiliary Imaging	S	5.0032	$371.12	$90.43	$74.23																																																																																																																																																																																		
0395	GI Tract Imaging	S	4.3913	$325.73	$87.01	$65.15																																																																																																																																																																																		
0396	Bone Imaging	S	4.4870	$332.83	$94.20	$66.57																																																																																																																																																																																		
0398	Level I Cardiac Imaging	S	5.0433	$374.09	$91.14	$74.82																																																																																																																																																																																		
0400	Hematopoietic Imaging	S	4.9059	$363.90	$90.90	$72.78																																																																																																																																																																																		
0401	Level I Pulmonary Imaging	S	4.1123	$305.03	$70.93	$61.01																																																																																																																																																																																		
0402	Level II Nervous System Imaging	S	7.6717	$569.06	.	$113.82																																																																																																																																																																																		
0403	Level I Nervous System Imaging	S	2.3570	$174.83	$44.61	$34.97																																																																																																																																																																																		
0404	Renal and Genitourinary Studies	S	5.7104	$423.57	.	$84.72																																																																																																																																																																																		
0406	Level I Tumor/Infection Imaging	S	5.1768	$383.99	$85.06	$76.80																																																																																																																																																																																		
0407	Radionuclide Therapy	S	3.7573	$278.70	$78.13	$55.74																																																																																																																																																																																		
0408	Level III Tumor/Infection Imaging	S	16.0171	"$1,188.08"	.	$237.62																																																																																																																																																																																		
0412	Level III Radiation Therapy	S	6.9437	$515.06	.	$103.02																																																																																																																																																																																		
0414	Level II Tumor/Infection Imaging	S	9.5123	$705.58	.	$141.12																																																																																																																																																																																		
0415	Level II Endoscopy Lower Airway	T	30.4870	"$2,261.40"	.	$452.28																																																																																																																																																																																		
0419	Level II Upper GI Procedures 	T	14.3040	"$1,061.01"	.	$212.21																																																																																																																																																																																		
0420	Level III Minor Procedures	S	1.6859	$125.05	.	$25.01																																																																																																																																																																																		
0422	Level III Upper GI Procedures	T	25.3607	"$1,881.16"	.	$376.24																																																																																																																																																																																		
0423	Level II Percutaneous Abdominal and Biliary Procedures	T	54.6446	"$4,053.32"	.	$810.67																																																																																																																																																																																		
0424	Level II Small Intestine Endoscopy 	T	16.4354	"$1,219.11"	.	$243.83																																																																																																																																																																																		
0425	Level V Musculoskeletal Procedures Except Hand and Foot	J1	139.6616	"$10,359.54"	.	"$2,071.91"																																																																																																																																																																																		
0427	Level II Tube or Catheter Changes or Repositioning	J1	19.5996	"$1,453.82"	.	$290.77																																																																																																																																																																																		
0428	Level III Sigmoidoscopy and Anoscopy	T	22.5458	"$1,672.36"	.	$334.48																																																																																																																																																																																		
0431	Level IV Closed Treatment Fracture	T	18.4054	"$1,365.24"	.	$273.05																																																																																																																																																																																		
0432	Level II Health and Behavior Services	S	0.7258	$53.84	.	$10.77																																																																																																																																																																																		
0433	Level II Pathology	S	2.4491	$181.66	.	$36.34																																																																																																																																																																																		
0435	"Level III Extended EEG, Sleep, and Cardiovascular Studies"	S	11.5022	$853.19	$264.84	$170.64																																																																																																																																																																																		
0436	Level I Drug Administration	S	0.4450	$33.01	.	$6.61																																																																																																																																																																																		
0437	Level II Drug Administration	S	0.7063	$52.39	.	$10.48																																																																																																																																																																																		
0438	Level III Drug Administration	S	1.4319	$106.21	.	$21.25																																																																																																																																																																																		
0439	Level IV Drug Administration	S	2.3339	$173.12	.	$34.63																																																																																																																																																																																		
0440	Level V Drug Administration	S	3.8100	$282.61	.	$56.53																																																																																																																																																																																		
0442	Dosimetric Drug Administration	S	14.1044	"$1,046.21"	.	$209.25																																																																																																																																																																																		
0446	Level IV Nerve and Muscle Services	S	19.1601	"$1,421.22"	.	$284.25																																																																																																																																																																																		
0450	Level I Minor Procedures	S	0.3851	$28.57	.	$5.72																																																																																																																																																																																		
0609	Level 1 Type A Emergency Visits	V	0.8282	$61.43	.	$12.29																																																																																																																																																																																		
0613	Level 2 Type A Emergency Visits	V	1.5356	$113.90	.	$22.78																																																																																																																																																																																		
0614	Level 3 Type A Emergency Visits	V	2.6989	$200.19	.	$40.04																																																																																																																																																																																		
0615	Level 4 Type A Emergency Visits	V	4.5277	$335.85	.	$67.17																																																																																																																																																																																		
0616	Level 5 Type A Emergency Visits	V	6.6312	$491.88	.	$98.38																																																																																																																																																																																		
0617	Critical Care	S	8.8307	$655.03	.	$131.01																																																																																																																																																																																		
0618	Trauma Response with Critical Care	S	12.4843	$926.04	.	$185.21																																																																																																																																																																																		
0621	Level I Vascular Access Procedures	T	11.3681	$843.24	.	$168.65																																																																																																																																																																																		
0622	Level II Vascular Access Procedures	J1	33.9334	"$2,517.04"	.	$503.41																																																																																																																																																																																		
0624	Phlebotomy and Minor Vascular Access Device Procedures	S	1.0766	$79.86	.	$15.98																																																																																																																																																																																		
0626	Level 1 Type B Emergency Visits	V	0.8564	$63.52	.	$12.71																																																																																																																																																																																		
0627	Level 2 Type B Emergency Visits	V	0.9288	$68.89	.	$13.78																																																																																																																																																																																		
0628	Level 3 Type B Emergency Visits	V	1.5355	$113.90	.	$22.78																																																																																																																																																																																		
0629	Level 4 Type B Emergency Visits	V	2.6088	$193.51	.	$38.71																																																																																																																																																																																		
0630	Level 5 Type B Emergency Visits	V	4.0599	$301.15	.	$60.23																																																																																																																																																																																		
0631	Level 1 Examinations & Related Services 	V	0.7059	$52.36	.	$10.48																																																																																																																																																																																		
0632	Level 2 Examinations & Related Services 	V	1.4557	$107.98	.	$21.60																																																																																																																																																																																		
0633	Level 3 Examinations & Related Services 	V	5.0059	$371.32	.	$74.27																																																																																																																																																																																		
0634	Hospital Clinic Visits	V	1.3220	$98.06	.	$19.62																																																																																																																																																																																		
0648	Level IV Breast and Skin Surgery	J1	98.8146	"$7,329.67"	.	"$1,465.94"																																																																																																																																																																																		
0651	Complex Interstitial Radiation Source Application	S	13.4365	$996.67	.	$199.34																																																																																																																																																																																		
0652	Insertion of Intraperitoneal and Pleural Catheters	J1	35.6008	"$2,640.72"	.	$528.15																																																																																																																																																																																		
0655	Level IV Pacemaker and Similar Procedures	J1	222.9267	"$16,535.81"	.	"$3,307.17"																																																																																																																																																																																		
0659	Hyperbaric Oxygen	S	1.4895	$110.49	.	$22.10																																																																																																																																																																																		
0660	Level II Otorhinolaryngologic Function Tests	S	1.7682	$131.16	.	$26.24																																																																																																																																																																																		
0661	Level III Pathology	S	4.6193	$342.64	.	$68.53																																																																																																																																																																																		
0662	CT Angiography	S	3.8338	$284.38	$95.87	$56.88																																																																																																																																																																																		
0667	Level IV Radiation Therapy	S	14.2398	"$1,056.25"	.	$211.25																																																																																																																																																																																		
0668	Level I Angiography and Venography	T	11.3660	$843.08	.	$168.62																																																																																																																																																																																		
0673	Level III Intraocular Procedures	T	41.6898	"$3,092.38"	$635.64	$618.48																																																																																																																																																																																		
0676	Thrombolysis and Other Device Revisions 	T	2.6940	$199.83	.	$39.97																																																																																																																																																																																		
0688	Level I Neurostimulator & Related Procedures	T	28.7885	"$2,135.42"	$486.16	$427.09																																																																																																																																																																																		
0690	Level I Electronic Analysis of Devices	S	0.4796	$35.57	.	$7.12																																																																																																																																																																																		
0691	Level III Electronic Analysis of Devices	S	3.4498	$255.89	.	$51.18																																																																																																																																																																																		
0692	Level II Electronic Analysis of Devices	S	1.7343	$128.64	.	$25.73																																																																																																																																																																																		
0697	Level I Echocardiogram Without Contrast 	S	3.3341	$247.31	.	$49.47																																																																																																																																																																																		
0698	Level II Eye Tests & Treatments	S	1.3671	$101.41	.	$20.29																																																																																																																																																																																		
0701	Sr89 strontium	K		"$1,090.47"	.	$218.10																																																																																																																																																																																		
0726	Dexrazoxane HCl injection	K		$136.54	.	$27.31																																																																																																																																																																																		
0731	Sargramostim injection	K		$32.45	.	$6.49																																																																																																																																																																																		
0736	Amphotericin b liposome inj	K		$16.31	.	$3.27																																																																																																																																																																																		
0738	Rasburicase	K		$214.61	.	$42.93																																																																																																																																																																																		
0747	Chlorothiazide sodium inj	K		$141.93	.	$28.39																																																																																																																																																																																		
0751	Mechlorethamine hcl inj	K		$154.70	.	$30.94																																																																																																																																																																																		
0752	Dactinomycin injection	K		$645.75	.	$129.15																																																																																																																																																																																		
0759	"Naltrexone, depot form"	K		$2.76	.	$0.56																																																																																																																																																																																		
0800	Leuprolide acetate	K		$760.03	.	$152.01																																																																																																																																																																																		
0802	Etoposide oral	K		$58.16	.	$11.64																																																																																																																																																																																		
0807	Aldesleukin injection	K		"$1,833.94"	.	$366.79																																																																																																																																																																																		
0809	Bcg live intravesical vac	K		$122.36	.	$24.48																																																																																																																																																																																		
0810	Goserelin acetate implant	K		$216.85	.	$43.37																																																																																																																																																																																		
0812	Carmustine injection	K		"$1,414.63"	.	$282.93																																																																																																																																																																																		
0814	"Asparaginase, NOS"	K		$64.57	.	$12.92																																																																																																																																																																																		
0820	Daunorubicin injection	K		$25.45	.	$5.09																																																																																																																																																																																		
0821	Daunorubicin citrate inj	K		$243.80	.	$48.76																																																																																																																																																																																		
0823	Docetaxel injection	K		$3.83	.	$0.77																																																																																																																																																																																		
0825	Nelarabine injection	K		$134.70	.	$26.94																																																																																																																																																																																		
0827	Floxuridine injection	K		$78.26	.	$15.66																																																																																																																																																																																		
0831	Ifosfamide injection	K		$34.17	.	$6.84																																																																																																																																																																																		
0832	Idarubicin hcl injection	K		$29.38	.	$5.88																																																																																																																																																																																		
0835	Cosyntropin injection NOS	K		$101.68	.	$20.34																																																																																																																																																																																		
0836	Interferon alfa-2b inj	K		$20.66	.	$4.14																																																																																																																																																																																		
0838	Interferon gamma 1-b inj	K		"$2,879.49"	.	$575.90																																																																																																																																																																																		
0840	Inj melphalan hydrochl	K		"$1,228.70"	.	$245.74																																																																																																																																																																																		
0842	Fludarabine phosphate inj	K		$84.65	.	$16.93																																																																																																																																																																																		
0843	Pegaspargase injection	K		"$6,007.38"	.	"$1,201.48"																																																																																																																																																																																		
0844	Pentostatin injection	K		"$1,451.03"	.	$290.21																																																																																																																																																																																		
0849	Rituximab injection	K		$693.90	.	$138.78																																																																																																																																																																																		
0850	Streptozocin injection	K		$339.35	.	$67.87																																																																																																																																																																																		
0851	Thiotepa injection	K		$630.70	.	$126.14																																																																																																																																																																																		
0856	Porfimer sodium injection	K		"$19,325.78"	.	"$3,865.16"																																																																																																																																																																																		
0858	Inj cladribine	K		$23.28	.	$4.66																																																																																																																																																																																		
0864	Mitoxantrone hydrochl	K		$34.10	.	$6.82																																																																																																																																																																																		
0868	Oral aprepitant	K		$7.45	.	$1.49																																																																																																																																																																																		
0873	Hyalgan/supartz inj per dose	K		$89.62	.	$17.93																																																																																																																																																																																		
0874	Synvisc or synvisc-one	K		$12.33	.	$2.47																																																																																																																																																																																		
0875	Euflexxa inj per dose	K		$154.61	.	$30.93																																																																																																																																																																																		
0877	Orthovisc inj per dose	K		$185.11	.	$37.03																																																																																																																																																																																		
0887	Azathioprine parenteral	K		$217.30	.	$43.46																																																																																																																																																																																		
0890	Lymphocyte immune globulin	K		$742.89	.	$148.58																																																																																																																																																																																		
0901	Alpha 1 proteinase inhibitor	K		$4.11	.	$0.83																																																																																																																																																																																		
0902	"Injection,onabotulinumtoxinA"	K		$5.43	.	$1.09																																																																																																																																																																																		
0903	Cytomegalovirus imm IV /vial	K		"$1,013.87"	.	$202.78																																																																																																																																																																																		
0910	Interferon beta-1b / .25 MG	K		$306.68	.	$61.34																																																																																																																																																																																		
0913	Ganciclovir long act implant	K		"$16,960.00"	.	"$3,392.00"																																																																																																																																																																																		
0925	Factor viii	K		$0.92	.	$0.19																																																																																																																																																																																		
0927	Factor viii recombinant	K		$1.13	.	$0.23																																																																																																																																																																																		
0928	Factor ix complex	K		$1.10	.	$0.22																																																																																																																																																																																		
0929	Anti-inhibitor	K		$1.64	.	$0.33																																																																																																																																																																																		
0931	Factor IX non-recombinant	K		$0.98	.	$0.20																																																																																																																																																																																		
0932	Factor IX recombinant	K		$1.32	.	$0.27																																																																																																																																																																																		
0934	"Capecitabine, oral"	K		$33.56	.	$6.72																																																																																																																																																																																		
0943	Octagam injection	K		$30.50	.	$6.10																																																																																																																																																																																		
0944	Gammagard liquid injection	K		$39.17	.	$7.84																																																																																																																																																																																		
0945	Rhophylac injection	K		$4.75	.	$0.95																																																																																																																																																																																		
0946	Hepagam b im injection	K		$50.35	.	$10.07																																																																																																																																																																																		
0947	Flebogamma injection	K		$36.33	.	$7.27																																																																																																																																																																																		
0948	Gamunex-C/Gammaked	K		$39.50	.	$7.90																																																																																																																																																																																		
0949	"Frozen plasma, pooled, sd"	R	0.9840	$72.99	.	$14.60																																																																																																																																																																																		
0950	Whole blood for transfusion	R	3.1702	$235.15	.	$47.03																																																																																																																																																																																		
0952	Cryoprecipitate each unit	R	0.9439	$70.01	.	$14.01																																																																																																																																																																																		
0954	RBC leukocytes reduced	R	2.5796	$191.34	.	$38.27																																																																																																																																																																																		
0955	"Plasma, frz between 8-24hour"	R	0.9633	$71.45	.	$14.29																																																																																																																																																																																		
0956	"Plasma protein fract,5%,50ml"	R	2.6645	$197.64	.	$39.53																																																																																																																																																																																		
0957	"Platelets, each unit"	R	1.6343	$121.23	.	$24.25																																																																																																																																																																																		
0958	Plaelet rich plasma unit	R	1.9493	$144.59	.	$28.92																																																																																																																																																																																		
0959	Red blood cells unit	R	2.0414	$151.42	.	$30.29																																																																																																																																																																																		
0960	Washed red blood cells unit	R	4.3758	$324.58	.	$64.92																																																																																																																																																																																		
0961	"Albumin (human),5%, 50ml"	K		$21.69	.	$4.34																																																																																																																																																																																		
0963	"Albumin (human), 5%, 250 ml"	K		$66.92	.	$13.39																																																																																																																																																																																		
0964	"Albumin (human), 25%, 20 ml"	K		$32.74	.	$6.55																																																																																																																																																																																		
0965	"Albumin (human), 25%, 50ml"	K		$74.53	.	$14.91																																																																																																																																																																																		
0966	"Plasmaprotein fract,5%,250ml"	R	0.4361	$32.35	.	$6.47																																																																																																																																																																																		
0967	Blood split unit	R	1.8143	$134.58	.	$26.92																																																																																																																																																																																		
0968	Platelets leukoreduced irrad	R	2.2108	$163.99	.	$32.80																																																																																																																																																																																		
0969	RBC leukoreduced irradiated	R	3.7940	$281.42	.	$56.29																																																																																																																																																																																		
1009	Cryoprecipitatereducedplasma	R	1.1168	$82.84	.	$16.57																																																																																																																																																																																		
1010	"Blood, l/r, cmv-neg"	R	2.1824	$161.88	.	$32.38																																																																																																																																																																																		
1011	"Platelets, hla-m, l/r, unit"	R	10.1828	$755.32	.	$151.07																																																																																																																																																																																		
1013	Platelets leukocytes reduced	R	1.5313	$113.59	.	$22.72																																																																																																																																																																																		
1015	Injection glatiramer acetate	K		$149.84	.	$29.97																																																																																																																																																																																		
1016	"Blood, l/r, froz/degly/wash"	R	3.8688	$286.97	.	$57.40																																																																																																																																																																																		
1017	"Plt, aph/pher, l/r, cmv-neg"	R	5.9884	$444.20	.	$88.84																																																																																																																																																																																		
1018	"Blood, l/r, irradiated"	R	1.8716	$138.83	.	$27.77																																																																																																																																																																																		
1019	Plate pheres leukoredu irrad	R	9.1645	$679.79	.	$135.96																																																																																																																																																																																		
1020	"Plt, pher, l/r cmv-neg, irr"	R	8.9774	$665.91	.	$133.19																																																																																																																																																																																		
1021	"RBC, frz/deg/wsh, l/r, irrad"	R	6.6076	$490.13	.	$98.03																																																																																																																																																																																		
1022	"RBC, l/r, cmv-neg, irrad"	R	3.7398	$277.40	.	$55.48																																																																																																																																																																																		
1023	Pralidoxime chloride inj	K		$88.54	.	$17.71																																																																																																																																																																																		
1052	"Injection, voriconazole"	K		$3.78	.	$0.76																																																																																																																																																																																		
1064	"I131 iodide cap, rx"	K		$17.44	.	$3.49																																																																																																																																																																																		
1083	Adalimumab injection	K		$567.68	.	$113.54																																																																																																																																																																																		
1084	Denileukin diftitox inj	K		"$1,646.18"	.	$329.24																																																																																																																																																																																		
1086	Temozolomide	K		$7.37	.	$1.48																																																																																																																																																																																		
1138	"Hepagam b intravenous, inj"	K		$50.35	.	$10.07																																																																																																																																																																																		
1139	Protein c concentrate	K		$14.27	.	$2.86																																																																																																																																																																																		
1142	Supprelin LA implant	K		"$16,875.98"	.	"$3,375.20"																																																																																																																																																																																		
1150	"I131 iodide sol, rx"	K		$10.51	.	$2.11																																																																																																																																																																																		
1166	Cytarabine liposome inj	K		$544.51	.	$108.91																																																																																																																																																																																		
1168	"Inj, temsirolimus"	K		$57.09	.	$11.42																																																																																																																																																																																		
1178	Busulfan injection	K		$28.94	.	$5.79																																																																																																																																																																																		
1203	Verteporfin injection	K		$11.05	.	$2.21																																																																																																																																																																																		
1207	"Octreotide injection, depot"	K		$139.09	.	$27.82																																																																																																																																																																																		
1213	Antihemophilic viii/vwf comp	K		$0.94	.	$0.19																																																																																																																																																																																		
1214	Inj IVIG privigen 500 mg	K		$36.75	.	$7.35																																																																																																																																																																																		
1232	Mitomycin injection	K		$23.02	.	$4.61																																																																																																																																																																																		
1235	Valrubicin injection	K		"$1,071.49"	.	$214.30																																																																																																																																																																																		
1236	Levoleucovorin injection	K		$1.70	.	$0.34																																																																																																																																																																																		
1237	Inj iron dextran	K		$11.93	.	$2.39																																																																																																																																																																																		
1238	Topotecan oral	K		$91.93	.	$18.39																																																																																																																																																																																		
1253	Triamcinolone A inj PRS-free	K		$3.71	.	$0.75																																																																																																																																																																																		
1263	Antithrombin iii injection	K		$3.15	.	$0.63																																																																																																																																																																																		
1268	Xyntha inj	K		$1.13	.	$0.23																																																																																																																																																																																		
1272	Acetylcysteine injection	K 		$2.48	.	$0.50																																																																																																																																																																																		
1274	Edetate calcium disodium inj	K 		"$1,508.65"	.	$301.73																																																																																																																																																																																		
1280	Corticotropin injection	K		"$3,165.42"	.	$633.09																																																																																																																																																																																		
1281	Bevacizumab injection	K		$1.64	.	$0.33																																																																																																																																																																																		
1289	AbobotulinumtoxinA	K		$7.34	.	$1.47																																																																																																																																																																																		
1291	Rilonacept injection	K		$24.09	.	$4.82																																																																																																																																																																																		
1295	Sm 153 lexidronam	K		"$7,933.77"	.	"$1,586.76"																																																																																																																																																																																		
1296	Degarelix injection	K		$3.10	.	$0.62																																																																																																																																																																																		
1297	"Ferumoxytol, non-esrd"	K		$0.72	.	$0.15																																																																																																																																																																																		
1311	Canakinumab injection	K		$91.03	.	$18.21																																																																																																																																																																																		
1312	Hizentra injection	K		$7.68	.	$1.54																																																																																																																																																																																		
1327	Imiglucerase injection	K		$42.01	.	$8.41																																																																																																																																																																																		
1331	Olanzapine long-acting inj	K		$2.75	.	$0.55																																																																																																																																																																																		
1332	Antithrombin recombinant	K		$103.35	.	$20.67																																																																																																																																																																																		
1338	"Methyl aminolevulinate, top"	K		$83.69	.	$16.74																																																																																																																																																																																		
1340	"Collagenase, clost hist inj"	K		$38.43	.	$7.69																																																																																																																																																																																		
1341	Amobarbital 125 MG inj	K		$179.87	.	$35.98																																																																																																																																																																																		
1350	Topotecan injection	K		$2.19	.	$0.44																																																																																																																																																																																		
1352	Wilate injection	K		$0.90	.	$0.18																																																																																																																																																																																		
1353	Belimumab injection	K		$38.83	.	$7.77																																																																																																																																																																																		
1354	Hydroxyprogesterone caproate	K		$2.68	.	$0.54																																																																																																																																																																																		
1356	Zoledronic Acid 1mg	K		$81.43	.	$16.29																																																																																																																																																																																		
1361	Enfuvirtide injection	K		$26.11	.	$5.23																																																																																																																																																																																		
1408	Cyclophosphamide 100 MG inj	K		$52.45	.	$10.49																																																																																																																																																																																		
1413	Lumizyme injection	K		$153.63	.	$30.73																																																																																																																																																																																		
1415	Glassia injection	K		$3.96	.	$0.80																																																																																																																																																																																		
1417	Gel-one	K		$582.53	.	$116.51																																																																																																																																																																																		
1419	Dermacell	G		$75.40	$0.00	$0.00																																																																																																																																																																																		
1420	Aflibercept injection	K		$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		$28.42	.	$5.69																																																																																																																																																																																		
1426	Eribulin mesylate injection	K		$98.29	.	$19.66																																																																																																																																																																																		
1431	Centruroides immune f(ab)	K		"$3,661.21"	.	$732.25																																																																																																																																																																																		
1433	Calcitonin salmon injection	K		$69.02	.	$13.81																																																																																																																																																																																		
1440	Inj desmopressin acetate	K		$5.15	.	$1.03																																																																																																																																																																																		
1442	Non-HEU TC-99M add-on/dose	K		$10.00	.	$2.00																																																																																																																																																																																		
1443	Icatibant injection	K		$275.86	.	$55.18																																																																																																																																																																																		
1446	Visualization adjunct	K		$4.32	.	$0.87																																																																																																																																																																																		
1448	Opthalmic mitomycin	G		$379.66	.	$75.94																																																																																																																																																																																		
1449	Talymed	G		$13.78	$0.00	$0.00																																																																																																																																																																																		
1456	Pentobarbital sodium inj	K		$33.10	.	$6.62																																																																																																																																																																																		
1458	Phentolaine mesylate inj	K		$101.30	.	$20.26																																																																																																																																																																																		
1460	Interferon alfa-2a inj	K		$727.75	.	$145.55																																																																																																																																																																																		
1463	Tc99 Tilmanocept diag 0.5mci	G		$240.00	$0.00	$0.00																																																																																																																																																																																		
1464	Factor VIII (porcine)	K		$0.20	.	$0.04																																																																																																																																																																																		
1465	Tacrolimus ex rel oral 0.1mg	G		$0.40	.	$0.08																																																																																																																																																																																		
1466	"Inj, vincristine sul lip 1mg"	G		"$2,067.00"	.	$413.40																																																																																																																																																																																		
1467	Factor IX recombinant	G		$1.27	.	$0.26																																																																																																																																																																																		
1468	Inj Aripiprazole Ext Rel 1mg	K		$3.77	.	$0.76																																																																																																																																																																																		
1469	"Inj, Filgrastim G-CSF 1mcg"	K		$1.00	.	$0.20																																																																																																																																																																																		
1471	"Injection, Pertuzumab, 1 mg"	K		$10.21	.	$2.05																																																																																																																																																																																		
1472	Inj beta interferon im 1 mcg	K		$33.93	.	$6.79																																																																																																																																																																																		
1474	Certolizumab pegol inj 1mg	K		$5.93	.	$1.19																																																																																																																																																																																		
1475	Golimumab for iv use 1mg	K		$23.89	.	$4.78																																																																																																																																																																																		
1476	"Injection, obinutuzumab"	G		$54.70	.	$10.94																																																																																																																																																																																		
1477	"	Inj, tbo-filgrastim, 5 mcg"	K		$4.22	.	$0.85																																																																																																																																																																																		
1478	"	Human fibrinogen conc inj"	K		$0.96	.	$0.20																																																																																																																																																																																		
1479	"	Theraskin"	G		$23.18	$0.00	$0.00																																																																																																																																																																																		
1482	"	Darbepoetin alfa, esrd use"	K		$3.73	.	$0.75																																																																																																																																																																																		
1483	Epoetin alfa 1000 units esrd	K		$11.46	.	$2.30																																																																																																																																																																																		
1484	"	Pentazocine injection"	K		$159.91	.	$31.99																																																																																																																																																																																		
1485	"	Ferumoxytol, esrd use"	K		$0.72	.	$0.15																																																																																																																																																																																		
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		$741.89	.	$148.38																																																																																																																																																																																		
1607	Eptifibatide injection	K		$27.58	.	$5.52																																																																																																																																																																																		
1608	Etanercept injection	K		$266.93	.	$53.39																																																																																																																																																																																		
1609	"Rho(D) immune globulin h, sd"	K		$18.74	.	$3.75																																																																																																																																																																																		
1613	Trastuzumab injection	K		$80.64	.	$16.13																																																																																																																																																																																		
1630	"Hep b ig, im"	K		$111.45	.	$22.29																																																																																																																																																																																		
1631	Baclofen intrathecal trial	K		$75.50	.	$15.10																																																																																																																																																																																		
1633	Alefacept	K		$41.64	.	$8.33																																																																																																																																																																																		
1643	"Y90 ibritumomab, rx"	K		"$43,227.89"	.	"$8,645.58"																																																																																																																																																																																		
1670	Tetanus immune globulin inj	K		$298.41	.	$59.69																																																																																																																																																																																		
1675	P32 Na phosphate	K		$199.53	.	$39.91																																																																																																																																																																																		
1676	P32 chromic phosphate	K		$766.90	.	$153.38																																																																																																																																																																																		
1683	Basiliximab	K		"$2,561.77"	.	$512.36																																																																																																																																																																																		
1684	Corticorelin ovine triflutal	K		$7.75	.	$1.55																																																																																																																																																																																		
1685	"Darbepoetin alfa, non-esrd"	K		$3.73	.	$0.75																																																																																																																																																																																		
1686	"Epoetin alfa, non-esrd"	K		$11.46	.	$2.30																																																																																																																																																																																		
1687	Digoxin immune fab (ovine)	K		"$1,303.69"	.	$260.74																																																																																																																																																																																		
1688	Ethanolamine oleate	K		$299.94	.	$59.99																																																																																																																																																																																		
1689	Fomepizole	K		$6.70	.	$1.34																																																																																																																																																																																		
1690	Hemin	K		$16.59	.	$3.32																																																																																																																																																																																		
1693	Lepirudin	K		$275.56	.	$55.12																																																																																																																																																																																		
1694	Ziconotide injection	K		$6.60	.	$1.32																																																																																																																																																																																		
1695	Nesiritide injection	K		$60.25	.	$12.05																																																																																																																																																																																		
1696	Palifermin injection	K		$14.41	.	$2.89																																																																																																																																																																																		
1697	Pegaptanib sodium injection	K		"$1,027.98"	.	$205.60																																																																																																																																																																																		
1700	Inj secretin synthetic human	K		$27.49	.	$5.50																																																																																																																																																																																		
1701	Treprostinil injection	K		$61.24	.	$12.25																																																																																																																																																																																		
1704	"Humate-P, inj"	K		$0.95	.	$0.19																																																																																																																																																																																		
1705	Factor viia	K		$1.71	.	$0.35																																																																																																																																																																																		
1709	Azacitidine injection	K		$4.93	.	$0.99																																																																																																																																																																																		
1710	Clofarabine injection	K		$129.63	.	$25.93																																																																																																																																																																																		
1711	Vantas implant	K		"$2,980.71"	.	$596.15																																																																																																																																																																																		
1712	Paclitaxel protein bound	K		$9.47	.	$1.90																																																																																																																																																																																		
1716	"Brachytx, non-str, Gold-198"	U	0.4947	$36.69	.	$7.34																																																																																																																																																																																		
1717	"Brachytx, non-str, HDR Ir-192"	U	3.7401	$277.43	.	$55.49																																																																																																																																																																																		
1719	"Brachytx, NS, Non-HDRIr-192"	U	1.0514	$77.99	.	$15.60																																																																																																																																																																																		
1738	Oxaliplatin	K		$0.56	.	$0.12																																																																																																																																																																																		
1739	"Pegademase bovine, 25 iu"	K		$275.88	.	$55.18																																																																																																																																																																																		
1741	"Urofollitropin, 75 iu"	K		$63.43	.	$12.69																																																																																																																																																																																		
1841	Retinal prosth int/ext comp 	H			.	.																																																																																																																																																																																		
2616	"Brachytx, non-str,Yttrium-90"	U	215.9376	"$16,017.39"	.	"$3,203.48"																																																																																																																																																																																		
2632	Iodine I-125 sodium iodide	U	0.1770	$13.13	.	$2.63																																																																																																																																																																																		
2634	"Brachytx, non-str, HA, I-125"	U	1.1926	$88.46	.	$17.70																																																																																																																																																																																		
2635	"Brachytx, non-str, HA, P-103"	U	0.3359	$24.92	.	$4.99																																																																																																																																																																																		
2636	"Brachy linear, non-str,P-103"	U	0.2637	$19.56	.	$3.92																																																																																																																																																																																		
2638	"Brachytx, stranded, I-125"	U	0.6008	$44.56	.	$8.92																																																																																																																																																																																		
2639	"Brachytx, non-stranded,I-125"	U	0.5028	$37.30	.	$7.46																																																																																																																																																																																		
2640	"Brachytx, stranded, P-103"	U	0.8890	$65.94	.	$13.19																																																																																																																																																																																		
2641	"Brachytx, non-stranded,P-103"	U	0.9238	$68.52	.	$13.71																																																																																																																																																																																		
2642	"Brachytx, stranded, C-131"	U	1.5183	$112.62	.	$22.53																																																																																																																																																																																		
2643	"Brachytx, non-stranded,C-131"	U	0.7245	$53.74	.	$10.75																																																																																																																																																																																		
2698	"Brachytx, stranded, NOS"	U	0.6008	$44.56	.	$8.92																																																																																																																																																																																		
2699	"Brachytx, non-stranded, NOS"	U	0.2637	$19.56	.	$3.92																																																																																																																																																																																		
2731	"Immune globulin, powder"	K		$30.04	.	$6.01																																																																																																																																																																																		
2770	Quinupristin/dalfopristin	K		$198.70	.	$39.74																																																																																																																																																																																		
3041	Bivalirudin	K		$3.21	.	$0.65																																																																																																																																																																																		
7000	Amifostine	K		$311.76	.	$62.36																																																																																																																																																																																		
7011	Oprelvekin injection	K		$276.23	.	$55.25																																																																																																																																																																																		
7034	"	Somatropin injection"	K		$47.57	.	$9.52																																																																																																																																																																																		
7035	Teniposide	K		$676.84	.	$135.37																																																																																																																																																																																		
7041	Tirofiban HCl	K		$9.31	.	$1.87																																																																																																																																																																																		
7042	"Capecitabine, oral"	K		$10.06	.	$2.02																																																																																																																																																																																		
7043	Infliximab injection	K		$71.35	.	$14.27																																																																																																																																																																																		
7046	Doxorubicin inj 10mg	K		$487.96	.	$97.60																																																																																																																																																																																		
7048	Alteplase recombinant	K		$60.32	.	$12.07																																																																																																																																																																																		
7308	Aminolevulinic acid hcl top	K		$249.10	.	$49.82																																																																																																																																																																																		
8001	LDR Prostate Brachytherapy Composite	T	47.2393	"$3,504.02"	.	$700.81																																																																																																																																																																																		
8004	Ultrasound Composite	S	3.8472	$285.37	.	$57.08																																																																																																																																																																																		
8005	CT and CTA without Contrast Composite	S	4.3085	$319.59	.	$63.92																																																																																																																																																																																		
8006	CT and CTA with Contrast Composite	S	7.1815	$532.69	.	$106.54																																																																																																																																																																																		
8007	MRI and MRA without Contrast Composite	S	8.2432	$611.45	.	$122.29																																																																																																																																																																																		
8008	MRI and MRA with Contrast Composite	S	12.3295	$914.55	.	$182.91																																																																																																																																																																																		
8009	Extended Assessment & Management Composite	V	16.5743	"$1,229.42"	.	$245.89																																																																																																																																																																																		
9001	Linezolid injection	K		$40.97	.	$8.20																																																																																																																																																																																		
9002	Tenecteplase injection	K		$79.05	.	$15.81																																																																																																																																																																																		
9003	Palivizumab	K		"$1,308.40"	.	$261.68																																																																																																																																																																																		
9004	Gemtuzumab ozogamicin inj	K		"$2,742.59"	.	$548.52																																																																																																																																																																																		
9005	Reteplase injection	K		"$2,301.91"	.	$460.39																																																																																																																																																																																		
9006	Tacrolimus injection	K		$136.28	.	$27.26																																																																																																																																																																																		
9012	Arsenic trioxide injection	K		$49.22	.	$9.85																																																																																																																																																																																		
9018	"Inj, rimabotulinumtoxinB"	K		$11.14	.	$2.23																																																																																																																																																																																		
9019	Caspofungin acetate	K		$13.09	.	$2.62																																																																																																																																																																																		
9024	Amphotericin b lipid complex	K		$10.43	.	$2.09																																																																																																																																																																																		
9032	Baclofen 10 MG injection	K		$161.31	.	$32.27																																																																																																																																																																																		
9033	Cidofovir injection	K		$614.05	.	$122.81																																																																																																																																																																																		
9038	Inj estrogen conjugate	K		$163.74	.	$32.75																																																																																																																																																																																		
9042	Glucagon hydrochloride	K		$131.90	.	$26.38																																																																																																																																																																																		
9044	Ibutilide fumarate injection	K		$73.51	.	$14.71																																																																																																																																																																																		
9104	Antithymocyte globuln rabbit	K		$541.17	.	$108.24																																																																																																																																																																																		
9108	Thyrotropin injection	K		"$1,211.24"	.	$242.25																																																																																																																																																																																		
9110	Alemtuzumab injection	K		$533.15	.	$106.63																																																																																																																																																																																		
9119	"Injection, pegfilgrastim 6mg"	K		"$3,307.54"	.	$661.51																																																																																																																																																																																		
9120	"Injection, Fulvestrant"	K		$90.89	.	$18.18																																																																																																																																																																																		
9121	"Injection, argatroban"	K		$16.62	.	$3.33																																																																																																																																																																																		
9122	Triptorelin pamoate	K		$184.73	.	$36.95																																																																																																																																																																																		
9124	Daptomycin injection	K		$0.64	.	$0.13																																																																																																																																																																																		
9125	"Risperidone, long acting"	K		$5.98	.	$1.20																																																																																																																																																																																		
9126	Natalizumab injection	K		$13.97	.	$2.80																																																																																																																																																																																		
9130	"Inj, Imm Glob Bivigam, 500mg"	G		$38.22	.	$7.65																																																																																																																																																																																		
9131	"Inj, Ado-trastuzumab Emt 1mg"	G		$29.13	.	$5.83																																																																																																																																																																																		
9132	"Kcentra, per i.u."	G		$1.54	.	$0.31																																																																																																																																																																																		
9133	"Rabies ig, im/sc"	K		$220.15	.	$44.03																																																																																																																																																																																		
9134	"Rabies ig, heat treated"	K		$213.04	.	$42.61																																																																																																																																																																																		
9135	"Varicella-zoster ig, im"	K		$675.22	.	$135.05																																																																																																																																																																																		
9137	"Bcg vaccine, percut"	K		$122.36	.	$24.48																																																																																																																																																																																		
9139	"Rabies vaccine, im"	K		$231.77	.	$46.36																																																																																																																																																																																		
9140	"Rabies vaccine, id"	K		$170.69	.	$34.14																																																																																																																																																																																		
9143	"Meningococcal vaccine, sc"	K		$106.49	.	$21.30																																																																																																																																																																																		
9144	"Encephalitis vaccine, sc"	K		$111.00	.	$22.20																																																																																																																																																																																		
9207	Bortezomib injection	K		$45.57	.	$9.12																																																																																																																																																																																		
9208	Agalsidase beta injection	K		$146.20	.	$29.24																																																																																																																																																																																		
9209	Laronidase injection	K		$28.31	.	$5.67																																																																																																																																																																																		
9210	Palonosetron hcl	K		$19.59	.	$3.92																																																																																																																																																																																		
9213	Pemetrexed injection	K		$59.96	.	$12.00																																																																																																																																																																																		
9214	Bevacizumab injection	K		$65.58	.	$13.12																																																																																																																																																																																		
9215	Cetuximab injection	K		$52.53	.	$10.51																																																																																																																																																																																		
9217	Leuprolide acetate suspnsion	K		$206.78	.	$41.36																																																																																																																																																																																		
9224	Galsulfase injection	K		$359.82	.	$71.97																																																																																																																																																																																		
9225	Fluocinolone acetonide implt	K		"$19,345.00"	.	"$3,869.00"																																																																																																																																																																																		
9227	Micafungin sodium injection	K		$0.99	.	$0.20																																																																																																																																																																																		
9228	Tigecycline injection	K		$1.77	.	$0.36																																																																																																																																																																																		
9229	Ibandronate sodium injection	K		$158.19	.	$31.64																																																																																																																																																																																		
9230	Abatacept injection	K		$23.88	.	$4.78																																																																																																																																																																																		
9231	Decitabine injection	K		$29.86	.	$5.98																																																																																																																																																																																		
9232	Idursulfase injection	K		$482.22	.	$96.45																																																																																																																																																																																		
9233	Ranibizumab injection	K		$397.01	.	$79.41																																																																																																																																																																																		
9234	Alglucosidase alfa injection	K		$206.62	.	$41.33																																																																																																																																																																																		
9235	Panitumumab injection	K		$94.17	.	$18.84																																																																																																																																																																																		
9236	Eculizumab injection	K		$206.14	.	$41.23																																																																																																																																																																																		
9237	"Inj, lanreotide acetate"	K		$38.94	.	$7.79																																																																																																																																																																																		
9240	"Injection, ixabepilone"	K		$68.62	.	$13.73																																																																																																																																																																																		
9242	"Injection, fosaprepitant"	K		$1.72	.	$0.35																																																																																																																																																																																		
9243	Bendamustine injection	K		$21.35	.	$4.27																																																																																																																																																																																		
9245	Romiplostim injection	K		$51.82	.	$10.37																																																																																																																																																																																		
9248	"	Inj, clevidipine butyrate"	K		$3.36	.	$0.68																																																																																																																																																																																		
9251	C1 esterase inhibitor inj	K		$49.21	.	$9.85																																																																																																																																																																																		
9252	Plerixafor injection	K		$299.84	.	$59.97																																																																																																																																																																																		
9253	Temozolomide injection	K		$5.14	.	$1.03																																																																																																																																																																																		
9255	Paliperidone palmitate inj	K		$7.68	.	$1.54																																																																																																																																																																																		
9256	Dexamethasone intra implant	K		$197.26	.	$39.46																																																																																																																																																																																		
9258	Telavancin injection	K		$4.14	.	$0.83																																																																																																																																																																																		
9259	Pralatrexate injection	K		$189.72	.	$37.95																																																																																																																																																																																		
9260	Ofatumumab injection	K		$47.20	.	$9.44																																																																																																																																																																																		
9261	Ustekinumab injection	K		$151.47	.	$30.30																																																																																																																																																																																		
9263	Ecallantide injection	K		$354.67	.	$70.94																																																																																																																																																																																		
9264	Tocilizumab injection	K		$3.71	.	$0.75																																																																																																																																																																																		
9265	Romidepsin injection	K		$259.98	.	$52.00																																																																																																																																																																																		
9268	Capsaicin 8% patch	K		$23.78	.	$4.76																																																																																																																																																																																		
9269	"C-1 esterase, berinert"	K		$36.35	.	$7.27																																																																																																																																																																																		
9270	Gammaplex IVIG	K		$36.81	.	$7.37																																																																																																																																																																																		
9271	Velaglucerase alfa	K		$355.23	.	$71.05																																																																																																																																																																																		
9272	"Inj, denosumab"	K		$14.32	.	$2.87																																																																																																																																																																																		
9273	Sipuleucel-T auto CD54+	K		"$34,998.06"	.	"$6,999.62"																																																																																																																																																																																		
9274	Crotalidae Poly Immune Fab	K		"$2,420.00"	.	$484.00																																																																																																																																																																																		
9276	Cabazitaxel injection	K		$142.08	.	$28.42																																																																																																																																																																																		
9278	Incobotulinumtoxin A	K		$4.48	.	$0.90																																																																																																																																																																																		
9281	"Injection, pegloticase"	K		$566.03	.	$113.21																																																																																																																																																																																		
9282	"	Ceftaroline fosamil inj"	K		$1.02	.	$0.21																																																																																																																																																																																		
9284	Ipilimumab injection	K		$130.87	.	$26.18																																																																																																																																																																																		
9286	Belatacept injection	K		$3.79	.	$0.76																																																																																																																																																																																		
9287	Brentuximab vedotin inj	K		$106.68	.	$21.34																																																																																																																																																																																		
9289	Erwinaze injection	K		$344.38	.	$68.88																																																																																																																																																																																		
9293	"Injection, glucarpidase "	K		$245.42	.	$49.09																																																																																																																																																																																		
9294	"Inj, Taliglucerace Alfa 10 u"	G		$30.90	.	$6.18																																																																																																																																																																																		
9295	"Injection, Carfilzomib, 1 mg"	G		$29.29	.	$5.86																																																																																																																																																																																		
9296	"Inj, ziv-aflibercept, 1mg"	G		$8.07	.	$1.62																																																																																																																																																																																		
9297	"Inj, Omacetaxine Mep, 0.01mg"	G		$2.48	.	$0.50																																																																																																																																																																																		
9298	"Inj, Ocriplasmin, 0.125 mg"	G		"$1,046.70"	.	$209.34																																																																																																																																																																																		
9300	Omalizumab injection	K		$26.50	.	$5.30																																																																																																																																																																																		
9441	"Inj, ferric carboxymaltose"	G		$1.03	.	$0.21																																																																																																																																																																																		
9497	"Loxapine, inhalation powder"	G		$153.70	.	$30.74																																																																																																																																																																																		
9500	"Platelets, irradiated"	R	2.2823	$169.29	.	$33.86																																																																																																																																																																																		
9501	Platelet pheres leukoreduced	R	6.7922	$503.82	.	$100.77																																																																																																																																																																																		
9502	Platelet pheresis irradiated	R	7.7248	$572.99	.	$114.60																																																																																																																																																																																		
9503	Fr frz plasma donor retested	R	0.8146	$60.42	.	$12.09																																																																																																																																																																																		
9504	RBC deglycerolized	R	6.3806	$473.29	.	$94.66																																																																																																																																																																																		
9505	RBC irradiated	R	2.7818	$206.34	.	$41.27																																																																																																																																																																																		
9506	"Granulocytes, pheresis unit"	R	24.9241	"$1,848.77"	.	$369.76																																																																																																																																																																																		
9507	"Platelets, pheresis"	R	5.6767	$421.07	.	$84.22																																																																																																																																																																																		
9508	Plasma 1 donor frz w/in 8 hr	R	1.0197	$75.64	.	$15.13																																																																																																																																																																																		
