	Addendum A.-Proposed OPPS APCs for CY 2017																																																																																																																																																																																													
APC  	Group Title	SI	Relative Weight 	Payment Rate 	National Unadjusted Copayment 	Minimum Unadjusted Copayment 																																																																																																																																																																																								
0701	Sr89 strontium	K		"$1,178.26"	.	$235.66																																																																																																																																																																																								
0726	Dexrazoxane HCl injection	K		$163.46	.	$32.70																																																																																																																																																																																								
0731	Sargramostim injection	K		$35.12	.	$7.03																																																																																																																																																																																								
0736	Amphotericin b liposome inj	K		$18.04	.	$3.61																																																																																																																																																																																								
0738	Rasburicase	K		$241.95	.	$48.39																																																																																																																																																																																								
0747	Chlorothiazide sodium inj	K		$109.09	.	$21.82																																																																																																																																																																																								
0751	Mechlorethamine hcl inj	K		$241.71	.	$48.35																																																																																																																																																																																								
0752	Dactinomycin injection	K		"$1,160.34"	.	$232.07																																																																																																																																																																																								
0759	"Naltrexone, depot form"	K		$3.20	.	$0.64																																																																																																																																																																																								
0800	Leuprolide acetate	K		$934.40	.	$186.88																																																																																																																																																																																								
0802	Etoposide oral	K		$67.30	.	$13.46																																																																																																																																																																																								
0807	Aldesleukin injection	K		"$2,667.51"	.	$533.51																																																																																																																																																																																								
0809	Bcg live intravesical vac	K		$122.99	.	$24.60																																																																																																																																																																																								
0810	Goserelin acetate implant	K		$282.90	.	$56.58																																																																																																																																																																																								
0812	Carmustine injection	K		"$3,860.63"	.	$772.13																																																																																																																																																																																								
0820	Daunorubicin injection	K		$39.17	.	$7.84																																																																																																																																																																																								
0821	Daunorubicin citrate inj	K		$238.83	.	$47.77																																																																																																																																																																																								
0823	Docetaxel injection	K		$2.39	.	$0.48																																																																																																																																																																																								
0825	Nelarabine injection	K		$147.94	.	$29.59																																																																																																																																																																																								
0827	Floxuridine injection	K		$47.45	.	$9.49																																																																																																																																																																																								
0831	Ifosfamide injection	K		$29.78	.	$5.96																																																																																																																																																																																								
0832	Idarubicin hcl injection	K		$36.95	.	$7.39																																																																																																																																																																																								
0836	Interferon alfa-2b inj	K		$25.30	.	$5.06																																																																																																																																																																																								
0838	Interferon gamma 1-b inj	K		"$5,739.88"	.	"$1,147.98"																																																																																																																																																																																								
0840	Inj melphalan hydrochl	K		"$1,884.07"	.	$376.82																																																																																																																																																																																								
0843	Pegaspargase injection	K		"$14,275.20"	.	"$2,855.04"																																																																																																																																																																																								
0844	Pentostatin injection	K		"$1,630.95"	.	$326.19																																																																																																																																																																																								
0849	Rituximab injection	K		$769.89	.	$153.98																																																																																																																																																																																								
0850	Streptozocin injection	K		$314.59	.	$62.92																																																																																																																																																																																								
0851	Thiotepa injection	K		"$1,145.19"	.	$229.04																																																																																																																																																																																								
0856	Porfimer sodium injection	K		"$20,602.26"	.	"$4,120.46"																																																																																																																																																																																								
0858	Inj cladribine	K		$21.85	.	$4.37																																																																																																																																																																																								
0864	Mitoxantrone hydrochl	K		$33.59	.	$6.72																																																																																																																																																																																								
0868	Oral aprepitant	K		$10.03	.	$2.01																																																																																																																																																																																								
0873	Hyalgan/supartz inj per dose	K		$88.56	.	$17.72																																																																																																																																																																																								
0874	Synvisc or synvisc-one	K		$12.83	.	$2.57																																																																																																																																																																																								
0875	Euflexxa inj per dose	K		$156.86	.	$31.38																																																																																																																																																																																								
0877	Orthovisc inj per dose	K		$167.83	.	$33.57																																																																																																																																																																																								
0887	Azathioprine parenteral	K		$217.30	.	$43.46																																																																																																																																																																																								
0890	Lymphocyte immune globulin	K		"$1,137.19"	.	$227.44																																																																																																																																																																																								
0901	Alpha 1 proteinase inhibitor	K		$4.60	.	$0.92																																																																																																																																																																																								
0902	"Injection,onabotulinumtoxinA"	K		$5.72	.	$1.15																																																																																																																																																																																								
0903	Cytomegalovirus imm IV /vial	K		"$1,064.77"	.	$212.96																																																																																																																																																																																								
0910	Interferon beta-1b / .25 MG	K		$373.58	.	$74.72																																																																																																																																																																																								
0913	Ganciclovir long act implant	K		"$16,960.00"	.	"$3,392.00"																																																																																																																																																																																								
0925	Factor viii	K		$0.96	.	$0.20																																																																																																																																																																																								
0927	Factor viii recombinant	K		$1.18	.	$0.24																																																																																																																																																																																								
0928	Factor ix complex	K		$1.22	.	$0.25																																																																																																																																																																																								
0929	Anti-inhibitor	K		$1.90	.	$0.38																																																																																																																																																																																								
0931	Factor IX non-recombinant	K		$1.12	.	$0.23																																																																																																																																																																																								
0932	Factor ix recombinant nos	K		$1.45	.	$0.29																																																																																																																																																																																								
0943	Octagam injection	K		$45.86	.	$9.18																																																																																																																																																																																								
0944	Gammagard liquid injection	K		$38.82	.	$7.77																																																																																																																																																																																								
0946	Hepagam b im injection	K		$54.97	.	$11.00																																																																																																																																																																																								
0947	Flebogamma injection	K		$39.15	.	$7.83																																																																																																																																																																																								
0948	Gamunex-C/Gammaked	K		$41.82	.	$8.37																																																																																																																																																																																								
0961	"Albumin (human),5%, 50ml"	K		$11.32	.	$2.27																																																																																																																																																																																								
0963	"Albumin (human), 5%, 250 ml"	K		$54.72	.	$10.95																																																																																																																																																																																								
0964	"Albumin (human), 25%, 20 ml"	K		$22.49	.	$4.50																																																																																																																																																																																								
0965	"Albumin (human), 25%, 50ml"	K		$53.44	.	$10.69																																																																																																																																																																																								
1015	Injection glatiramer acetate	K		$186.37	.	$37.28																																																																																																																																																																																								
1052	"Injection, voriconazole"	K		$4.56	.	$0.92																																																																																																																																																																																								
1064	"I131 iodide cap, rx"	K		$40.70	.	$8.14																																																																																																																																																																																								
1083	Adalimumab injection	K		$796.67	.	$159.34																																																																																																																																																																																								
1086	Temozolomide	K		$3.58	.	$0.72																																																																																																																																																																																								
1138	"Hepagam b intravenous, inj"	K		$54.97	.	$11.00																																																																																																																																																																																								
1139	Protein c concentrate	K		$15.19	.	$3.04																																																																																																																																																																																								
1142	Supprelin LA implant	K		"$24,068.75"	.	"$4,813.75"																																																																																																																																																																																								
1150	"I131 iodide sol, rx"	K		$10.28	.	$2.06																																																																																																																																																																																								
1166	Cytarabine liposome inj	K		$576.26	.	$115.26																																																																																																																																																																																								
1168	"Inj, temsirolimus"	K		$63.74	.	$12.75																																																																																																																																																																																								
1178	Busulfan injection	K		$33.16	.	$6.64																																																																																																																																																																																								
1203	Verteporfin injection	K		$10.96	.	$2.20																																																																																																																																																																																								
1207	"Octreotide injection, depot"	K		$160.40	.	$32.08																																																																																																																																																																																								
1213	Antihemophilic viii/vwf comp	K		$0.97	.	$0.20																																																																																																																																																																																								
1214	Inj IVIG privigen 500 mg	K		$38.26	.	$7.66																																																																																																																																																																																								
1232	Mitomycin injection	K		$102.51	.	$20.51																																																																																																																																																																																								
1235	Valrubicin injection	K		"$1,134.35"	.	$226.87																																																																																																																																																																																								
1236	Levoleucovorin injection	K		$1.41	.	$0.29																																																																																																																																																																																								
1237	Inj iron dextran	K		$12.26	.	$2.46																																																																																																																																																																																								
1238	Topotecan oral	K		$101.04	.	$20.21																																																																																																																																																																																								
1253	Triamcinolone A inj PRS-free	K		$3.71	.	$0.75																																																																																																																																																																																								
1263	Antithrombin iii injection	K		$3.68	.	$0.74																																																																																																																																																																																								
1268	Xyntha inj	K		$1.20	.	$0.24																																																																																																																																																																																								
1274	Edetate calcium disodium inj	K 		"$5,594.42"	.	"$1,118.89"																																																																																																																																																																																								
1280	Corticotropin injection	K		"$3,578.55"	.	$715.71																																																																																																																																																																																								
1281	Bevacizumab injection	K		$1.77	.	$0.36																																																																																																																																																																																								
1289	AbobotulinumtoxinA	K		$7.77	.	$1.56																																																																																																																																																																																								
1295	Sm 153 lexidronam	K		"$11,006.25"	.	"$2,201.25"																																																																																																																																																																																								
1296	Degarelix injection	K		$3.68	.	$0.74																																																																																																																																																																																								
1297	"Ferumoxytol, non-esrd"	K		$0.84	.	$0.17																																																																																																																																																																																								
1311	Canakinumab injection	K		$92.40	.	$18.48																																																																																																																																																																																								
1312	Hizentra injection	K		$8.47	.	$1.70																																																																																																																																																																																								
1327	Imiglucerase injection	K		$41.96	.	$8.40																																																																																																																																																																																								
1331	Olanzapine long-acting inj	K		$2.92	.	$0.59																																																																																																																																																																																								
1332	Antithrombin recombinant	K		$103.35	.	$20.67																																																																																																																																																																																								
1338	"Methyl aminolevulinate, top"	K		$83.69	.	$16.74																																																																																																																																																																																								
1340	"Collagenase, clost hist inj"	K		$38.50	.	$7.70																																																																																																																																																																																								
1341	Amobarbital 125 MG inj	K		$194.26	.	$38.86																																																																																																																																																																																								
1352	Wilate injection	K		$0.98	.	$0.20																																																																																																																																																																																								
1353	Belimumab injection	K		$41.49	.	$8.30																																																																																																																																																																																								
1354	Hydroxyprogesterone caproate	K		$2.56	.	$0.52																																																																																																																																																																																								
1361	Enfuvirtide injection	K		$18.63	.	$3.73																																																																																																																																																																																								
1408	Cyclophosphamide 100 MG inj	K		$43.51	.	$8.71																																																																																																																																																																																								
1413	Lumizyme injection	K		$154.62	.	$30.93																																																																																																																																																																																								
1415	Glassia injection	K		$4.27	.	$0.86																																																																																																																																																																																								
1416	Factor xiii anti-hem factor	K		$7.77	.	$1.56																																																																																																																																																																																								
1417	Gel-one	K		$571.96	.	$114.40																																																																																																																																																																																								
1420	Aflibercept injection	K		$980.50	.	$196.10																																																																																																																																																																																								
1421	Imported lipodox inj	K		$508.43	.	$101.69																																																																																																																																																																																								
1424	Nabilone oral	K		$38.19	.	$7.64																																																																																																																																																																																								
1426	Eribulin mesylate injection	K		$104.78	.	$20.96																																																																																																																																																																																								
1431	Centruroides immune f(ab)	K		"$3,926.66"	.	$785.34																																																																																																																																																																																								
1433	Calcitonin salmon injection	K		"$2,369.13"	.	$473.83																																																																																																																																																																																								
1440	Inj desmopressin acetate	K		$14.11	.	$2.83																																																																																																																																																																																								
1442	Non-HEU TC-99M add-on/dose	K		$10.00	.	$2.00																																																																																																																																																																																								
1443	Icatibant injection	K		$314.28	.	$62.86																																																																																																																																																																																								
1446	Visualization adjunct	K		$11.41	.	$2.29																																																																																																																																																																																								
1457	Totazoline hcl injection	K		"$1,600.40"	.	$320.08																																																																																																																																																																																								
1458	Phentolaine mesylate inj	K		$425.79	.	$85.16																																																																																																																																																																																								
1460	Interferon alfa-2a inj	K		$733.57	.	$146.72																																																																																																																																																																																								
1464	Factor VIII (porcine)	K		$0.20	.	$0.04																																																																																																																																																																																								
1466	"Inj, vincristine sul lip 1mg"	K		"$2,412.47"	.	$482.50																																																																																																																																																																																								
1468	Inj Aripiprazole Ext Rel 1mg	K		$4.25	.	$0.85																																																																																																																																																																																								
1469	Inj filgrastim excl biosimil	K		$1.01	.	$0.21																																																																																																																																																																																								
1471	"Injection, Pertuzumab, 1 mg"	K		$10.44	.	$2.09																																																																																																																																																																																								
1472	Inj beta interferon im 1 mcg	K		$43.48	.	$8.70																																																																																																																																																																																								
1474	Certolizumab pegol inj 1mg	K		$6.49	.	$1.30																																																																																																																																																																																								
1475	Golimumab for iv use 1mg	K		$24.60	.	$4.92																																																																																																																																																																																								
1478	"	Human fibrinogen conc inj"	K		$1.09	.	$0.22																																																																																																																																																																																								
1480	"Elosulfase alfa, injection"	K		$221.66	.	$44.34																																																																																																																																																																																								
1482	"	Darbepoetin alfa, esrd use"	K		$4.14	.	$0.83																																																																																																																																																																																								
1484	"	Pentazocine injection"	K		$125.46	.	$25.10																																																																																																																																																																																								
1485	"	Ferumoxytol, esrd use"	K		$0.84	.	$0.17																																																																																																																																																																																								
1488	"Injection, ramucirumab"	K		$54.00	.	$10.80																																																																																																																																																																																								
1489	"Injection, vedolizumab"	K		$17.03	.	$3.41																																																																																																																																																																																								
1490	Inj pembrolizumab	G		$45.70	.	$9.14																																																																																																																																																																																								
1491	New Technology  - Level 1A ($0-$10)	S		$5.00	.	$1.00																																																																																																																																																																																								
1492	New Technology  - Level 1B ($11-$20)	S		$15.50	.	$3.10																																																																																																																																																																																								
1493	New Technology  - Level 1C ($21-$30)	S		$25.50	.	$5.10																																																																																																																																																																																								
1494	New Technology  - Level 1D ($31-$40)	S		$35.50	.	$7.10																																																																																																																																																																																								
1495	New Technology  - Level 1E ($41-$50)	S		$45.50	.	$9.10																																																																																																																																																																																								
1496	New Technology  - Level 1A ($0-$10)	T		$5.00	.	$1.00																																																																																																																																																																																								
1497	New Technology  - Level 1B ($11-$20)	T		$15.50	.	$3.10																																																																																																																																																																																								
1498	New Technology  - Level 1C ($21-$30)	T		$25.50	.	$5.10																																																																																																																																																																																								
1499	New Technology  - Level 1D ($31-$40)	T		$35.50	.	$7.10																																																																																																																																																																																								
1500	New Technology  - Level 1E ($41-$50)	T		$45.50	.	$9.10																																																																																																																																																																																								
1502	New Technology - Level 2 ($51 - $100)	S		$75.50	.	$15.10																																																																																																																																																																																								
1503	New Technology - Level 3 ($101 - $200)	S		$150.50	.	$30.10																																																																																																																																																																																								
1504	New Technology - Level 4 ($201 - $300)	S		$250.50	.	$50.10																																																																																																																																																																																								
1505	New Technology - Level 5 ($301 - $400)	S		$350.50	.	$70.10																																																																																																																																																																																								
1506	New Technology - Level 6 ($401 - $500)	S		$450.50	.	$90.10																																																																																																																																																																																								
1507	New Technology - Level 7 ($501 - $600)	S		$550.50	.	$110.10																																																																																																																																																																																								
1508	New Technology - Level 8 ($601 - $700)	S		$650.50	.	$130.10																																																																																																																																																																																								
1509	New Technology - Level 9 ($701 - $800)	S		$750.50	.	$150.10																																																																																																																																																																																								
1510	New Technology - Level 10 ($801 - $900)	S		$850.50	.	$170.10																																																																																																																																																																																								
1511	New Technology - Level 11 ($901 - $1000)	S		$950.50	.	$190.10																																																																																																																																																																																								
1512	New Technology - Level 12 ($1001 - $1100)	S		"$1,050.50"	.	$210.10																																																																																																																																																																																								
1513	New Technology - Level 13 ($1101 - $1200)	S		"$1,150.50"	.	$230.10																																																																																																																																																																																								
1514	New Technology - Level 14 ($1201- $1300)	S		"$1,250.50"	.	$250.10																																																																																																																																																																																								
1515	New Technology - Level 15 ($1301 - $1400)	S		"$1,350.50"	.	$270.10																																																																																																																																																																																								
1516	New Technology - Level 16  ($1401 - $1500)	S		"$1,450.50"	.	$290.10																																																																																																																																																																																								
1517	New Technology - Level 17 ($1501-$1600)	S		"$1,550.50"	.	$310.10																																																																																																																																																																																								
1518	New Technology - Level 18 ($1601-$1700)	S		"$1,650.50"	.	$330.10																																																																																																																																																																																								
1519	New Technology - Level 19 ($1701-$1800)	S		"$1,750.50"	.	$350.10																																																																																																																																																																																								
1520	New Technology - Level 20 ($1801-$1900)	S		"$1,850.50"	.	$370.10																																																																																																																																																																																								
1521	New Technology - Level 21 ($1901-$2000)	S		"$1,950.50"	.	$390.10																																																																																																																																																																																								
1522	New Technology - Level 22 ($2001-$2500)	S		"$2,250.50"	.	$450.10																																																																																																																																																																																								
1523	New Technology - Level 23 ($2501-$3000)	S		"$2,750.50"	.	$550.10																																																																																																																																																																																								
1524	New Technology - Level 24 ($3001-$3500)	S		"$3,250.50"	.	$650.10																																																																																																																																																																																								
1525	New Technology - Level 25 ($3501-$4000)	S		"$3,750.50"	.	$750.10																																																																																																																																																																																								
1526	New Technology - Level 26 ($4001-$4500)	S		"$4,250.50"	.	$850.10																																																																																																																																																																																								
1527	New Technology - Level 27 ($4501-$5000)	S		"$4,750.50"	.	$950.10																																																																																																																																																																																								
1528	New Technology - Level 28 ($5001-$5500)	S		"$5,250.50"	.	"$1,050.10"																																																																																																																																																																																								
1529	New Technology - Level 29 ($5501-$6000)	S		"$5,750.50"	.	"$1,150.10"																																																																																																																																																																																								
1530	New Technology - Level 30 ($6001-$6500)	S		"$6,250.50"	.	"$1,250.10"																																																																																																																																																																																								
1531	New Technology - Level 31 ($6501-$7000)	S		"$6,750.50"	.	"$1,350.10"																																																																																																																																																																																								
1532	New Technology - Level 32 ($7001-$7500)	S		"$7,250.50"	.	"$1,450.10"																																																																																																																																																																																								
1533	New Technology - Level 33 ($7501-$8000)	S		"$7,750.50"	.	"$1,550.10"																																																																																																																																																																																								
1534	New Technology - Level 34 ($8001-$8500)	S		"$8,250.50"	.	"$1,650.10"																																																																																																																																																																																								
1535	New Technology - Level 35 ($8501-$9000)	S		"$8,750.50"	.	"$1,750.10"																																																																																																																																																																																								
1536	New Technology - Level 36 ($9001-$9500)	S		"$9,250.50"	.	"$1,850.10"																																																																																																																																																																																								
1537	New Technology - Level 37 ($9501-$10000)	S		"$9,750.50"	.	"$1,950.10"																																																																																																																																																																																								
1539	New Technology - Level 2 ($51 - $100)	T		$75.50	.	$15.10																																																																																																																																																																																								
1540	New Technology - Level 3 ($101 - $200)	T		$150.50	.	$30.10																																																																																																																																																																																								
1541	New Technology - Level 4 ($201 - $300)	T		$250.50	.	$50.10																																																																																																																																																																																								
1542	New Technology - Level 5 ($301 - $400)	T		$350.50	.	$70.10																																																																																																																																																																																								
1543	New Technology - Level 6 ($401 - $500)	T		$450.50	.	$90.10																																																																																																																																																																																								
1544	New Technology - Level 7 ($501 - $600)	T		$550.50	.	$110.10																																																																																																																																																																																								
1545	New Technology - Level 8 ($601 - $700)	T		$650.50	.	$130.10																																																																																																																																																																																								
1546	New Technology - Level 9 ($701 - $800)	T		$750.50	.	$150.10																																																																																																																																																																																								
1547	New Technology - Level 10 ($801 - $900)	T		$850.50	.	$170.10																																																																																																																																																																																								
1548	New Technology - Level 11 ($901 - $1000)	T		$950.50	.	$190.10																																																																																																																																																																																								
1549	New Technology - Level 12 ($1001 - $1100)	T		"$1,050.50"	.	$210.10																																																																																																																																																																																								
1550	New Technology - Level 13 ($1101 - $1200)	T		"$1,150.50"	.	$230.10																																																																																																																																																																																								
1551	New Technology - Level 14 ($1201- $1300)	T		"$1,250.50"	.	$250.10																																																																																																																																																																																								
1552	New Technology - Level 15 ($1301 - $1400)	T		"$1,350.50"	.	$270.10																																																																																																																																																																																								
1553	New Technology - Level 16 ($1401 - $1500)	T		"$1,450.50"	.	$290.10																																																																																																																																																																																								
1554	New Technology - Level 17 ($1501-$1600)	T		"$1,550.50"	.	$310.10																																																																																																																																																																																								
1555	New Technology - Level 18 ($1601-$1700)	T		"$1,650.50"	.	$330.10																																																																																																																																																																																								
1556	New Technology - Level 19 ($1701-$1800)	T		"$1,750.50"	.	$350.10																																																																																																																																																																																								
1557	New Technology - Level 20 ($1801-$1900)	T		"$1,850.50"	.	$370.10																																																																																																																																																																																								
1558	New Technology - Level 21 ($1901-$2000)	T		"$1,950.50"	.	$390.10																																																																																																																																																																																								
1559	New Technology - Level 22 ($2001-$2500)	T		"$2,250.50"	.	$450.10																																																																																																																																																																																								
1560	New Technology - Level 23 ($2501-$3000)	T		"$2,750.50"	.	$550.10																																																																																																																																																																																								
1561	New Technology - Level 24 ($3001-$3500)	T		"$3,250.50"	.	$650.10																																																																																																																																																																																								
1562	New Technology - Level 25 ($3501-$4000)	T		"$3,750.50"	.	$750.10																																																																																																																																																																																								
1563	New Technology - Level 26 ($4001-$4500)	T		"$4,250.50"	.	$850.10																																																																																																																																																																																								
1564	New Technology - Level 27 ($4501-$5000)	T		"$4,750.50"	.	$950.10																																																																																																																																																																																								
1565	New Technology - Level 28 ($5001-$5500)	T		"$5,250.50"	.	"$1,050.10"																																																																																																																																																																																								
1566	New Technology - Level 29 ($5501-$6000)	T		"$5,750.50"	.	"$1,150.10"																																																																																																																																																																																								
1567	New Technology - Level 30 ($6001-$6500)	T		"$6,250.50"	.	"$1,250.10"																																																																																																																																																																																								
1568	New Technology - Level 31 ($6501-$7000)	T		"$6,750.50"	.	"$1,350.10"																																																																																																																																																																																								
1569	New Technology - Level 32 ($7001-$7500)	T		"$7,250.50"	.	"$1,450.10"																																																																																																																																																																																								
1570	New Technology - Level 33 ($7501-$8000)	T		"$7,750.50"	.	"$1,550.10"																																																																																																																																																																																								
1571	New Technology - Level 34 ($8001-$8500)	T		"$8,250.50"	.	"$1,650.10"																																																																																																																																																																																								
1572	New Technology - Level 35 ($8501-$9000)	T		"$8,750.50"	.	"$1,750.10"																																																																																																																																																																																								
1573	New Technology - Level 36 ($9001-$9500)	T		"$9,250.50"	.	"$1,850.10"																																																																																																																																																																																								
1574	New Technology - Level 37 ($9501-$10000)	T		"$9,750.50"	.	"$1,950.10"																																																																																																																																																																																								
1575	"New Technology - Level 38 ($10,001-$15,000)"	S		"$12,500.50"	.	"$2,500.10"																																																																																																																																																																																								
1576	"New Technology - Level 39 ($15,001-$20,000)"	S		"$17,500.50"	.	"$3,500.10"																																																																																																																																																																																								
1577	"New Technology - Level 40 ($20,001-$25,000)"	S		"$22,500.50"	.	"$4,500.10"																																																																																																																																																																																								
1578	"New Technology - Level 41 ($25,001-$30,000)"	S		"$27,500.50"	.	"$5,500.10"																																																																																																																																																																																								
1579	"New Technology - Level 42 ($30,001-$40,000)"	S		"$35,000.50"	.	"$7,000.10"																																																																																																																																																																																								
1580	"New Technology - Level 43 ($40,001-$50,000)"	S		"$45,000.50"	.	"$9,000.10"																																																																																																																																																																																								
1581	"New Technology - Level 44 ($50,001-$60,000)"	S		"$55,000.50"	.	"$11,000.10"																																																																																																																																																																																								
1582	"New Technology - Level 45 ($60,001-$70,000)"	S		"$65,000.50"	.	"$13,000.10"																																																																																																																																																																																								
1583	"New Technology - Level 46 ($70,001-$80,000)"	S		"$75,000.50"	.	"$15,000.10"																																																																																																																																																																																								
1584	"New Technology - Level 47 ($80,001-$90,000)"	S		"$85,000.50"	.	"$17,000.10"																																																																																																																																																																																								
1585	"New Technology - Level 48 ($90,001-$100,000)"	S		"$95,000.50"	.	"$19,000.10"																																																																																																																																																																																								
1589	"New Technology - Level 38 ($10,001-$15,000)"	T		"$12,500.50"	.	"$2,500.10"																																																																																																																																																																																								
1590	"New Technology - Level 39 ($15,001-$20,000)"	T		"$17,500.50"	.	"$3,500.10"																																																																																																																																																																																								
1591	"New Technology - Level 40 ($20,001-$25,000)"	T		"$22,500.50"	.	"$4,500.10"																																																																																																																																																																																								
1592	"New Technology - Level 41 ($25,001-$30,000)"	T		"$27,500.50"	.	"$5,500.10"																																																																																																																																																																																								
1593	"New Technology - Level 42 ($30,001-$40,000)"	T		"$35,000.50"	.	"$7,000.10"																																																																																																																																																																																								
1594	"New Technology - Level 43 ($40,001-$50,000)"	T		"$45,000.50"	.	"$9,000.10"																																																																																																																																																																																								
1595	"New Technology - Level 44 ($50,001-$60,000)"	T		"$55,000.50"	.	"$11,000.10"																																																																																																																																																																																								
1596	"New Technology - Level 45 ($60,001-$70,000)"	T		"$65,000.50"	.	"$13,000.10"																																																																																																																																																																																								
1597	"New Technology - Level 46 ($70,001-$80,000)"	T		"$75,000.50"	.	"$15,000.10"																																																																																																																																																																																								
1598	"New Technology - Level 47 ($80,001-$90,000)"	T		"$85,000.50"	.	"$17,000.10"																																																																																																																																																																																								
1599	"New Technology - Level 48 ($90,001-$100,000)"	T		"$95,000.50"	.	"$19,000.10"																																																																																																																																																																																								
1607	Eptifibatide injection	K		$32.51	.	$6.51																																																																																																																																																																																								
1608	Etanercept injection	K		$379.14	.	$75.83																																																																																																																																																																																								
1609	"Rho(D) immune globulin h, sd"	K		$20.25	.	$4.05																																																																																																																																																																																								
1612	"Daclizumab, parenteral"	K		$526.34	.	$105.27																																																																																																																																																																																								
1613	Trastuzumab injection	K		$89.67	.	$17.94																																																																																																																																																																																								
1630	"Hep b ig, im"	K		$121.92	.	$24.39																																																																																																																																																																																								
1631	Baclofen intrathecal trial	K		$77.36	.	$15.48																																																																																																																																																																																								
1633	Alefacept	K		$41.64	.	$8.33																																																																																																																																																																																								
1643	"Y90 ibritumomab, rx"	K		"$46,722.69"	.	"$9,344.54"																																																																																																																																																																																								
1656	Factor viii fc fusion recomb	K		$1.90	.	$0.38																																																																																																																																																																																								
1657	"Puraply, puraply antimic"	G		$121.38	.	$0.00																																																																																																																																																																																								
1658	"Injection, belinostat, 10mg"	G		$32.41	.	$6.49																																																																																																																																																																																								
1660	"Injection, oritavancin"	G		$24.70	.	$4.94																																																																																																																																																																																								
1661	"Gen, neuro, HF, rechg bat"	H			.	.																																																																																																																																																																																								
1662	Inj tedizolid phosphate	G		$1.21	.	$0.25																																																																																																																																																																																								
1663	"Inj, phenylephrine ketorolac"	G		$487.89	.	$0.00																																																																																																																																																																																								
1664	Florbetapir f18	G		"$2,756.00"	.	$0.00																																																																																																																																																																																								
1670	Tetanus immune globulin inj	K		$403.71	.	$80.75																																																																																																																																																																																								
1675	P32 Na phosphate	K		$213.56	.	$42.72																																																																																																																																																																																								
1676	P32 chromic phosphate	K		$906.62	.	$181.33																																																																																																																																																																																								
1683	Basiliximab	K		"$3,039.87"	.	$607.98																																																																																																																																																																																								
1684	Corticorelin ovine triflutal	K		$7.71	.	$1.55																																																																																																																																																																																								
1685	"Darbepoetin alfa, non-esrd"	K		$4.14	.	$0.83																																																																																																																																																																																								
1686	"Epoetin alfa, non-esrd"	K		$12.37	.	$2.48																																																																																																																																																																																								
1687	Digoxin immune fab (ovine)	K		"$3,039.88"	.	$607.98																																																																																																																																																																																								
1688	Ethanolamine oleate	K		$404.09	.	$80.82																																																																																																																																																																																								
1689	Fomepizole	K		$7.00	.	$1.40																																																																																																																																																																																								
1690	Hemin	K		$21.77	.	$4.36																																																																																																																																																																																								
1693	Lepirudin	K		$235.52	.	$47.11																																																																																																																																																																																								
1694	Ziconotide injection	K		$7.18	.	$1.44																																																																																																																																																																																								
1695	Nesiritide injection	K		$73.21	.	$14.65																																																																																																																																																																																								
1696	Palifermin injection	K		$16.38	.	$3.28																																																																																																																																																																																								
1697	Pegaptanib sodium injection	K		"$1,054.70"	.	$210.94																																																																																																																																																																																								
1700	Inj secretin synthetic human	K		$34.78	.	$6.96																																																																																																																																																																																								
1701	Treprostinil injection	K		$61.24	.	$12.25																																																																																																																																																																																								
1704	"Humate-P, inj"	K		$1.00	.	$0.20																																																																																																																																																																																								
1705	Factor viia	K		$1.90	.	$0.38																																																																																																																																																																																								
1709	Azacitidine injection	K		$2.94	.	$0.59																																																																																																																																																																																								
1710	Clofarabine injection	K		$138.21	.	$27.65																																																																																																																																																																																								
1711	Vantas implant	K		"$3,052.96"	.	$610.60																																																																																																																																																																																								
1712	Paclitaxel protein bound	K		$10.00	.	$2.00																																																																																																																																																																																								
1738	Oxaliplatin	K		$0.37	.	$0.08																																																																																																																																																																																								
1739	"Pegademase bovine, 25 iu"	K		$281.40	.	$56.28																																																																																																																																																																																								
1741	"Urofollitropin, 75 iu"	K		$120.61	.	$24.13																																																																																																																																																																																								
1743	Nandrolone decanoate 50 mg	K		$122.78	.	$24.56																																																																																																																																																																																								
1745	Radium ra223 dichloride ther	K		$123.11	.	$24.63																																																																																																																																																																																								
1747	Monovisc inj per dose	K		$934.44	.	$186.89																																																																																																																																																																																								
1761	"rolapitant, oral, 1mg"	K		$12.62	.	$2.53																																																																																																																																																																																								
1809	"Injection, alemtuzumab"	K		"$1,738.69"	.	$347.74																																																																																																																																																																																								
1822	Inj filgrastim gcsf biosimil	G		$0.97	.	$0.20																																																																																																																																																																																								
1823	"Injection, dalbavancin"	G		$14.70	.	$2.94																																																																																																																																																																																								
1824	"	Ceftaroline fosamil inj"	K		$2.31	.	$0.47																																																																																																																																																																																								
1825	Ceftazidime and avibactam	K		$73.90	.	$14.78																																																																																																																																																																																								
1826	Hyqvia 100mg immuneglobulin	K		$11.47	.	$2.30																																																																																																																																																																																								
1827	Factor viii recomb obizur	K		$4.37	.	$0.88																																																																																																																																																																																								
1828	Carbidopa levodopa enteral	K		$2.14	.	$0.43																																																																																																																																																																																								
1829	"	Penicillin g benzathine inj"	K		$8.38	.	$1.68																																																																																																																																																																																								
1832	Dimethyl sulfoxide 50% 50 ml	K		$315.55	.	$63.11																																																																																																																																																																																								
1836	"	Penicillin g procaine inj"	K		$22.99	.	$4.60																																																																																																																																																																																								
1838	"Urokinase 250,000 iu inj"	K		$262.79	.	$52.56																																																																																																																																																																																								
1842	"	Leuprolide acetate implant"	K		$168.48	.	$33.70																																																																																																																																																																																								
1844	Adynovate Factor VIII recom	G		$1.89	.	$0.38																																																																																																																																																																																								
1845	Tacrol envarsus ex rel oral	G		$1.03	.	$0.21																																																																																																																																																																																								
1846	Nuwiq Factor VIII recomb	G		$1.99	.	$0.40																																																																																																																																																																																								
1847	"Inj., infliximab biosimilar"	K		$0.00	.	$0.00																																																																																																																																																																																								
1848	Artiss fibrin sealant	K		$253.40	.	$50.68																																																																																																																																																																																								
1849	Foscarnet sodium injection	K		$44.70	.	$8.94																																																																																																																																																																																								
1850	Gamma globulin 1 cc inj	K		$21.24	.	$4.25																																																																																																																																																																																								
1851	Gamma globulin > 10 cc inj	K		$38.73	.	$7.75																																																																																																																																																																																								
1852	Interferon beta-1a inj	K		$413.79	.	$82.76																																																																																																																																																																																								
1853	Minocycline hydrochloride	K		$1.02	.	$0.21																																																																																																																																																																																								
1854	Pentobarbital sodium inj	K		$29.30	.	$5.86																																																																																																																																																																																								
1855	Pralidoxime chloride inj	K		$217.69	.	$43.54																																																																																																																																																																																								
1856	Factor viii recomb novoeight	K		$1.62	.	$0.33																																																																																																																																																																																								
1857	Levonorgestrel iu 13.5 mg	K		$745.62	.	$149.13																																																																																																																																																																																								
1858	Leuprolide acetate injeciton	K		$106.74	.	$21.35																																																																																																																																																																																								
1901	"New Technology - Level 49 ($100,001-$120,000)"	S		"$110,000.50"	.	"$22,000.10"																																																																																																																																																																																								
1902	"New Technology - Level 49 ($100,001-$120,000)"	T		"$110,000.50"	.	"$22,000.10"																																																																																																																																																																																								
1903	"New Technology - Level 50 ($120,001-$140,000)"	S		"$130,000.50"	.	"$26,000.10"																																																																																																																																																																																								
1904	"New Technology - Level 50 ($120,001-$140,000)"	T		"$130,000.50"	.	"$26,000.10"																																																																																																																																																																																								
1905	"New Technology - Level 51 ($140,001-$160,000)"	S		"$150,000.50"	.	"$30,000.10"																																																																																																																																																																																								
1906	"New Technology - Level 51 ($140,001-$160,000)"	T		"$150,000.50"	.	"$30,000.10"																																																																																																																																																																																								
2613	Lung bx plug w/del sys	H			.	.																																																																																																																																																																																								
2616	"Brachytx, non-str,Yttrium-90"	U	217.4057	"$16,285.64"	.	"$3,257.13"																																																																																																																																																																																								
2623	"Cath, translumin, drug-coat"	H			.	.																																																																																																																																																																																								
2632	Iodine I-125 sodium iodide	U	1.0706	$80.20	.	$16.04																																																																																																																																																																																								
2634	"Brachytx, non-str, HA, I-125"	U	1.6275	$121.91	.	$24.39																																																																																																																																																																																								
2635	"Brachytx, non-str, HA, P-103"	U	0.3339	$25.01	.	$5.01																																																																																																																																																																																								
2636	"Brachy linear, non-str,P-103"	U	0.2418	$18.11	.	$3.63																																																																																																																																																																																								
2638	"Brachytx, stranded, I-125"	U	0.5063	$37.93	.	$7.59																																																																																																																																																																																								
2639	"Brachytx, non-stranded,I-125"	U	0.4853	$36.35	.	$7.27																																																																																																																																																																																								
2640	"Brachytx, stranded, P-103"	U	0.9869	$73.93	.	$14.79																																																																																																																																																																																								
2641	"Brachytx, non-stranded,P-103"	U	0.8878	$66.50	.	$13.30																																																																																																																																																																																								
2642	"Brachytx, stranded, C-131"	U	1.1459	$85.84	.	$17.17																																																																																																																																																																																								
2643	"Brachytx, non-stranded,C-131"	U	0.8019	$60.07	.	$12.02																																																																																																																																																																																								
2645	"Brachytx, non-str, Gold-198"	U	1.7834	$133.59	.	$26.72																																																																																																																																																																																								
2646	"Brachytx, non-str, HDR Ir-192"	U	3.6797	$275.64	.	$55.13																																																																																																																																																																																								
2647	"Brachytx, NS, Non-HDRIr-192"	U	0.4818	$36.09	.	$7.22																																																																																																																																																																																								
2648	"Brachytx planar, p-103"	U	0.0626	$4.69	.	$0.94																																																																																																																																																																																								
2698	"Brachytx, stranded, NOS"	U	0.5063	$37.93	.	$7.59																																																																																																																																																																																								
2699	"Brachytx, non-stranded, NOS"	U	0.2418	$18.11	.	$3.63																																																																																																																																																																																								
2731	"Immune globulin, powder"	K		$35.02	.	$7.01																																																																																																																																																																																								
2770	Quinupristin/dalfopristin	K		$332.14	.	$66.43																																																																																																																																																																																								
5012	Clinic Visits and Related Services	V	1.4059	$105.31	.	$21.07																																																																																																																																																																																								
5021	Level 1 Type A ED Visits	V	0.8247	$61.78	.	$12.36																																																																																																																																																																																								
5022	Level 2 Type A ED Visits	V	1.4931	$111.85	.	$22.37																																																																																																																																																																																								
5023	Level 3 Type A ED Visits	V	2.7019	$202.40	.	$40.48																																																																																																																																																																																								
5024	Level 4 Type A ED Visits	V	4.4791	$335.52	.	$67.11																																																																																																																																																																																								
5025	Level 5 Type A ED Visits	V	6.5776	$492.72	.	$98.55																																																																																																																																																																																								
5031	Level 1 Type B ED Visits	V	1.1670	$87.42	.	$17.49																																																																																																																																																																																								
5032	Level 2 Type B ED Visits	V	1.0534	$78.91	.	$15.79																																																																																																																																																																																								
5033	Level 3 Type B ED Visits	V	1.6964	$127.08	.	$25.42																																																																																																																																																																																								
5034	Level 4 Type B ED Visits	V	2.3750	$177.91	.	$35.59																																																																																																																																																																																								
5035	Level 5 Type B ED Visits	V	4.9493	$370.75	.	$74.15																																																																																																																																																																																								
5041	Critical Care	S	9.3002	$696.67	.	$139.34																																																																																																																																																																																								
5045	Trauma Response with Critical Care	S	11.6510	$872.76	.	$174.56																																																																																																																																																																																								
5051	Level 1 Skin Procedures	T	2.0573	$154.11	.	$30.83																																																																																																																																																																																								
5052	Level 2 Skin Procedures	T	3.8655	$289.56	.	$57.92																																																																																																																																																																																								
5053	Level 3 Skin Procedures	T	6.0596	$453.92	.	$90.79																																																																																																																																																																																								
5054	Level 4 Skin Procedures	T	18.8485	"$1,411.92"	.	$282.39																																																																																																																																																																																								
5055	Level 5 Skin Procedures	T	32.6793	"$2,447.97"	.	$489.60																																																																																																																																																																																								
5061	Hyperbaric Oxygen	S	1.4666	$109.86	.	$21.98																																																																																																																																																																																								
5071	Level 1 Excision/ Biopsy/ Incision and Drainage	T	7.0928	$531.31	.	$106.27																																																																																																																																																																																								
5072	Level 2 Excision/ Biopsy/ Incision and Drainage	J1	16.5036	"$1,236.27"	.	$247.26																																																																																																																																																																																								
5073	Level 3 Excision/ Biopsy/ Incision and Drainage	J1	30.1175	"$2,256.07"	.	$451.22																																																																																																																																																																																								
5091	Level 1 Breast/Lymphatic Surgery and Related Procedures	J1	33.3838	"$2,500.75"	.	$500.15																																																																																																																																																																																								
5092	Level 2 Breast/Lymphatic Surgery and Related Procedures	J1	58.6710	"$4,394.99"	.	$879.00																																																																																																																																																																																								
5093	Level 3 Breast/Lymphatic Surgery and Related Procedures	J1	89.4003	"$6,696.89"	.	"$1,339.38"																																																																																																																																																																																								
5094	Level 4 Breast/Lymphatic Surgery and Related Procedures	J1	130.5294	"$9,777.83"	.	"$1,955.57"																																																																																																																																																																																								
5101	Level 1 Strapping and Cast Application	T	1.7016	$127.47	.	$25.50																																																																																																																																																																																								
5102	Level 2 Strapping and Cast Application	T	2.9739	$222.77	.	$44.56																																																																																																																																																																																								
5111	Level 1 Musculoskeletal Procedures	T	2.6324	$197.19	.	$39.44																																																																																																																																																																																								
5112	Level 2 Musculoskeletal Procedures	J1	16.2678	"$1,218.60"	.	$243.72																																																																																																																																																																																								
5113	Level 3 Musculoskeletal Procedures	J1	32.3707	"$2,424.86"	.	$484.98																																																																																																																																																																																								
5114	Level 4 Musculoskeletal Procedures	J1	69.4046	"$5,199.03"	.	"$1,039.81"																																																																																																																																																																																								
5115	Level 5 Musculoskeletal Procedures	J1	126.7004	"$9,491.00"	.	"$1,898.20"																																																																																																																																																																																								
5116	Level 6 Musculoskeletal Procedures	J1	192.8206	"$14,444.00"	.	"$2,888.80"																																																																																																																																																																																								
5151	Level 1 Airway Endoscopy	T	1.9507	$146.12	.	$29.23																																																																																																																																																																																								
5152	Level 2 Airway Endoscopy	T	4.8468	$363.07	.	$72.62																																																																																																																																																																																								
5153	Level 3 Airway Endoscopy	J1	16.8791	"$1,264.40"	.	$252.88																																																																																																																																																																																								
5154	Level 4 Airway Endoscopy	J1	32.0832	"$2,403.32"	.	$480.67																																																																																																																																																																																								
5155	Level 5 Airway Endoscopy	J1	57.7347	"$4,324.85"	.	$864.97																																																																																																																																																																																								
5161	Level 1 ENT Procedures	T	2.3750	$177.91	.	$35.59																																																																																																																																																																																								
5162	Level 2 ENT Procedures	T	5.9141	$443.02	.	$88.61																																																																																																																																																																																								
5163	Level 3 ENT Procedures	T	13.8048	"$1,034.10"	.	$206.82																																																																																																																																																																																								
5164	Level 4 ENT Procedures	J1	28.9891	"$2,171.54"	.	$434.31																																																																																																																																																																																								
5165	Level 5 ENT Procedures	J1	54.5538	"$4,086.57"	.	$817.32																																																																																																																																																																																								
5166	Cochlear Implant Procedure	J1	414.4382	"$31,045.15"	"$7,835.75"	"$6,209.03"																																																																																																																																																																																								
5181	Level 1 Vascular Procedures	T	11.5831	$867.68	.	$173.54																																																																																																																																																																																								
5182	Level 2 Vascular Procedures	T	31.2425	"$2,340.34"	.	$468.07																																																																																																																																																																																								
5183	Level 3 Vascular Procedures	T	51.3807	"$3,848.88"	.	$769.78																																																																																																																																																																																								
5191	Level 1 Endovascular Procedures	J1	37.6622	"$2,821.24"	$867.97	$564.25																																																																																																																																																																																								
5192	Level 2 Endovascular Procedures	J1	64.0837	"$4,800.45"	.	$960.09																																																																																																																																																																																								
5193	Level 3 Endovascular Procedures	J1	129.8447	"$9,726.54"	.	"$1,945.31"																																																																																																																																																																																								
5194	Level 4 Endovascular Procedures	J1	193.7178	"$14,511.21"	.	"$2,902.25"																																																																																																																																																																																								
5200	Implantation Wireless PA Pressure Monitor	J1	378.2934	"$28,337.58"	"$8,718.20"	"$5,667.52"																																																																																																																																																																																								
5211	Level 1 Electrophysiologic Procedures	J1	11.4792	$859.90	.	$171.98																																																																																																																																																																																								
5212	Level 2 Electrophysiologic Procedures	J1	62.4186	"$4,675.71"	.	$935.15																																																																																																																																																																																								
5213	Level 3 Electrophysiologic Procedures	J1	219.2588	"$16,424.46"	.	"$3,284.90"																																																																																																																																																																																								
5221	Level1 Pacemaker and Similar Procedures	T	31.8878	"$2,388.68"	.	$477.74																																																																																																																																																																																								
5222	Level 2 Pacemaker and Similar Procedures	J1	94.1190	"$7,050.36"	.	"$1,410.08"																																																																																																																																																																																								
5223	Level 3 Pacemaker and Similar Procedures	J1	125.5469	"$9,404.59"	.	"$1,880.92"																																																																																																																																																																																								
5224	Level 4 Pacemaker and Similar Procedures	J1	227.6123	"$17,050.21"	.	"$3,410.05"																																																																																																																																																																																								
5231	Level 1 ICD and Similar Procedures	J1	293.2281	"$21,965.42"	.	"$4,393.09"																																																																																																																																																																																								
5232	Level 2 ICD and Similar Procedures	J1	403.8116	"$30,249.12"	.	"$6,049.83"																																																																																																																																																																																								
5241	Level 1 Blood Product Exchange and Related Services	S	4.8716	$364.93	.	$72.99																																																																																																																																																																																								
5242	Level 2 Blood Product Exchange and Related Services	S	14.3878	"$1,077.78"	.	$215.56																																																																																																																																																																																								
5243	Level 3 Blood Product Exchange and Related Services	S	39.8443	"$2,984.70"	.	$596.94																																																																																																																																																																																								
5244	Level 4 Blood Product Exchange and Related Services	J1	203.8050	"$15,266.83"	.	"$3,053.37"																																																																																																																																																																																								
5301	Level 1 Upper GI Procedures	T	8.9730	$672.16	.	$134.44																																																																																																																																																																																								
5302	Level 2 Upper GI Procedures 	J1	17.6151	"$1,319.53"	.	$263.91																																																																																																																																																																																								
5303	Level 3 Upper GI Procedures	J1	33.1825	"$2,485.67"	.	$497.14																																																																																																																																																																																								
5311	Level 1 Lower GI Procedures 	T	8.9180	$668.04	.	$133.61																																																																																																																																																																																								
5312	Level 2 Lower GI Procedures 	T	11.6621	$873.60	.	$174.72																																																																																																																																																																																								
5313	Level 3 Lower GI Procedures 	J1	28.7672	"$2,154.92"	.	$430.99																																																																																																																																																																																								
5331	Complex GI Procedures	J1	51.7432	"$3,876.03"	.	$775.21																																																																																																																																																																																								
5341	Abdominal/Peritoneal/Biliary and Related Procedures	J1	38.0609	"$2,851.10"	.	$570.22																																																																																																																																																																																								
5361	Level 1 Laparoscopy and Related Services	J1	55.7788	"$4,178.33"	.	$835.67																																																																																																																																																																																								
5362	Level 2 Laparoscopy and Related Services	J1	91.7510	"$6,872.98"	"$1,526.22"	"$1,374.60"																																																																																																																																																																																								
5371	Level 1 Urology and Related Services	T	2.8782	$215.60	.	$43.12																																																																																																																																																																																								
5372	Level 2 Urology and Related Services	T	7.4927	$561.27	.	$112.26																																																																																																																																																																																								
5373	Level 3 Urology and Related Services	J1	21.9147	"$1,641.61"	.	$328.33																																																																																																																																																																																								
5374	Level 4 Urology and Related Services	J1	33.7382	"$2,527.29"	.	$505.46																																																																																																																																																																																								
5375	Level 5 Urology and Related Services	J1	46.1948	"$3,460.41"	.	$692.09																																																																																																																																																																																								
5376	Level 6 Urology and Related Services	J1	98.6486	"$7,389.67"	.	"$1,477.94"																																																																																																																																																																																								
5377	Level 7 Urology and Related Services	J1	196.4023	"$14,712.30"	.	"$2,942.46"																																																																																																																																																																																								
5401	Dialysis	S	7.4711	$559.65	.	$111.93																																																																																																																																																																																								
5411	Level 1 Gynecologic Procedures	T	2.0075	$150.38	.	$30.08																																																																																																																																																																																								
5412	Level 2 Gynecologic Procedures	T	3.6951	$276.80	.	$55.36																																																																																																																																																																																								
5413	Level 3 Gynecologic Procedures	T	8.9019	$666.83	.	$133.37																																																																																																																																																																																								
5414	Level 4 Gynecologic Procedures	J1	27.6899	"$2,074.22"	.	$414.85																																																																																																																																																																																								
5415	Level 5 Gynecologic Procedures	J1	55.5028	"$4,157.66"	$902.82	$831.54																																																																																																																																																																																								
5416	Level 6 Gynecologic Procedures	J1	79.2705	"$5,938.07"	"$1,405.70"	"$1,187.62"																																																																																																																																																																																								
5431	Level 1 Nerve Procedures	J1	20.7851	"$1,556.99"	.	$311.40																																																																																																																																																																																								
5432	Level 2 Nerve Procedures	J1	54.7978	"$4,104.85"	.	$820.97																																																																																																																																																																																								
5441	Level 1 Nerve Injections	T	3.0843	$231.04	.	$46.21																																																																																																																																																																																								
5442	Level 2 Nerve Injections	T	7.6440	$572.60	.	$114.52																																																																																																																																																																																								
5443	Level 3 Nerve Injections	T	9.4917	$711.01	.	$142.21																																																																																																																																																																																								
5461	Level 1 Neurostimulator and Related Procedures	T	35.5797	"$2,665.24"	.	$533.05																																																																																																																																																																																								
5462	Level 2 Neurostimulator and Related Procedures	J1	77.9590	"$5,839.83"	.	"$1,167.97"																																																																																																																																																																																								
5463	Level 3 Neurostimulator and Related Procedures	J1	234.0662	"$17,533.66"	.	"$3,506.74"																																																																																																																																																																																								
5464	Level 4 Neurostimulator and Related Procedures	J1	356.4519	"$26,701.46"	.	"$5,340.30"																																																																																																																																																																																								
5471	Implantation of Drug Infusion Device	J1	207.0162	"$15,507.38"	.	"$3,101.48"																																																																																																																																																																																								
5481	Laser Eye Procedures	T	6.2721	$469.84	$101.51	$93.97																																																																																																																																																																																								
5491	Level 1 Intraocular Procedures	J1	24.1049	"$1,805.67"	.	$361.14																																																																																																																																																																																								
5492	Level 2 Intraocular Procedures	J1	44.9378	"$3,366.25"	.	$673.25																																																																																																																																																																																								
5493	Level 3 Intraocular Procedures	J1	107.4338	"$8,047.76"	.	"$1,609.56"																																																																																																																																																																																								
5494	Level 4 Intraocular Procedures	J1	151.0822	"$11,317.42"	.	"$2,263.49"																																																																																																																																																																																								
5495	Level 5 Intraocular Procedures	J1	229.4637	"$17,188.90"	.	"$3,437.78"																																																																																																																																																																																								
5501	"Level 1 Extraocular, Repair, and Plastic Eye Procedures"	T	3.5974	$269.48	.	$53.90																																																																																																																																																																																								
5502	"Level 2 Extraocular, Repair, and Plastic Eye Procedures"	T	10.1645	$761.41	.	$152.29																																																																																																																																																																																								
5503	"Level 3 Extraocular, Repair, and Plastic Eye Procedures"	J1	22.4183	"$1,679.33"	.	$335.87																																																																																																																																																																																								
5504	"Level 4 Extraocular, Repair, and Plastic Eye Procedures"	J1	36.7606	"$2,753.70"	.	$550.74																																																																																																																																																																																								
5521	Level 1 Diagnostic Radiology without Contrast	S	0.8454	$63.33	.	$12.67																																																																																																																																																																																								
5522	Level 2 Diagnostic Radiology without Contrast	S	1.5672	$117.40	.	$23.48																																																																																																																																																																																								
5523	Level 3 Diagnostic Radiology without Contrast	S	2.9201	$218.74	.	$43.75																																																																																																																																																																																								
5524	Level 4 Diagnostic Radiology without Contrast	S	5.8861	$440.92	.	$88.19																																																																																																																																																																																								
5525	Level 5 Diagnostic Radiology without Contrast	S	9.1756	$687.34	.	$137.47																																																																																																																																																																																								
5571	Level 1 Diagnostic Radiology with Contrast	S	3.7228	$278.87	.	$55.78																																																																																																																																																																																								
5572	Level 2 Diagnostic Radiology with Contrast	S	6.2394	$467.39	$111.70	$93.48																																																																																																																																																																																								
5573	Level 3 Diagnostic Radiology with Contrast	S	10.3767	$777.31	.	$155.47																																																																																																																																																																																								
5591	Level 1 Nuclear Medicine and Related Services 	S	4.4613	$334.19	.	$66.84																																																																																																																																																																																								
5592	Level 2 Nuclear Medicine and Related Services	S	5.7542	$431.04	.	$86.21																																																																																																																																																																																								
5593	Level 3 Nuclear Medicine and Related Services 	S	15.2547	"$1,142.71"	.	$228.55																																																																																																																																																																																								
5594	Level 4 Nuclear Medicine and Related Services	S	17.4888	"$1,310.07"	.	$262.02																																																																																																																																																																																								
5611	Level 1 Therapeutic Radiation Treatment Preparation	S	1.5555	$116.52	$32.44	$23.31																																																																																																																																																																																								
5612	Level 2 Therapeutic Radiation Treatment Preparation	S	4.1082	$307.74	.	$61.55																																																																																																																																																																																								
5613	Level 3 Therapeutic Radiation Treatment Preparation	S	14.1344	"$1,058.79"	.	$211.76																																																																																																																																																																																								
5621	Level 1 Radiation Therapy	S	1.4825	$111.05	.	$22.21																																																																																																																																																																																								
5622	Level 2 Radiation Therapy	S	2.6953	$201.90	.	$40.38																																																																																																																																																																																								
5623	Level 3 Radiation Therapy	S	6.5799	$492.89	.	$98.58																																																																																																																																																																																								
5624	Level 4 Radiation Therapy	S	9.7637	$731.39	.	$146.28																																																																																																																																																																																								
5625	Level 5 Radiation Therapy	S	14.8933	"$1,115.64"	.	$223.13																																																																																																																																																																																								
5626	Level 6 Radiation Therapy	S 	22.2072	"$1,663.52"	.	$332.71																																																																																																																																																																																								
5627	Level 7 Radiation Therapy	J1	100.8279	"$7,552.92"	.	"$1,510.59"																																																																																																																																																																																								
5661	Therapeutic Nuclear Medicine	S	2.8419	$212.88	.	$42.58																																																																																																																																																																																								
5671	Level 1 Pathology	S	0.5258	$39.39	.	$7.88																																																																																																																																																																																								
5672	Level 2 Pathology	S	1.3536	$101.40	.	$20.28																																																																																																																																																																																								
5673	Level 3 Pathology	S	2.3121	$173.20	.	$34.64																																																																																																																																																																																								
5674	Level 4 Pathology	S	5.6945	$426.57	.	$85.32																																																																																																																																																																																								
5691	Level 1 Drug Administration	S	0.4658	$34.89	.	$6.98																																																																																																																																																																																								
5692	Level 2 Drug Administration	S	0.7034	$52.69	.	$10.54																																																																																																																																																																																								
5693	Level 3 Drug Administration	S	2.4055	$180.19	.	$36.04																																																																																																																																																																																								
5694	Level 4 Drug Administration	S	3.7567	$281.41	.	$56.29																																																																																																																																																																																								
5721	Level1 Diagnostic Tests and Related Services	S	1.7010	$127.42	.	$25.49																																																																																																																																																																																								
5722	Level 2 Diagnostic Tests and Related Services	S	3.0927	$231.67	.	$46.34																																																																																																																																																																																								
5723	Level 3 Diagnostic Tests and Related Services	S	5.4768	$410.26	.	$82.06																																																																																																																																																																																								
5724	Level 4 Diagnostic Tests and Related Services	S	11.6224	$870.62	.	$174.13																																																																																																																																																																																								
5731	Level 1 Minor Procedures	S	0.1643	$12.31	.	$2.47																																																																																																																																																																																								
5732	Level 2 Minor Procedures	S	0.3364	$25.20	.	$5.04																																																																																																																																																																																								
5733	Level 3 Minor Procedures	S	0.7613	$57.03	.	$11.41																																																																																																																																																																																								
5734	Level 4 Minor Procedures	S	1.2770	$95.66	.	$19.14																																																																																																																																																																																								
5735	Level 5 Minor Procedures	S	3.5451	$265.56	.	$53.12																																																																																																																																																																																								
5741	Level 1 Electronic Analysis of Devices	S	0.4634	$34.71	.	$6.95																																																																																																																																																																																								
5742	Level 2 Electronic Analysis of Devices	S	1.4423	$108.04	.	$21.61																																																																																																																																																																																								
5743	Level 3 Electronic Analysis of Devices	S	3.4092	$255.38	.	$51.08																																																																																																																																																																																								
5771	Cardiac Rehabilitation	S	1.4717	$110.24	.	$22.05																																																																																																																																																																																								
5781	Resuscitation and Cardioversion	S	6.3891	$478.60	.	$95.72																																																																																																																																																																																								
5791	Pulmonary Treatment	S	2.1531	$161.29	.	$32.26																																																																																																																																																																																								
5801	Ventilation Initiation and Management	S	5.9229	$443.68	.	$88.74																																																																																																																																																																																								
5811	Manipulation Therapy	S	0.3210	$24.05	.	$4.81																																																																																																																																																																																								
5821	Level 1 Health and Behavior Services	S	0.3349	$25.09	.	$5.02																																																																																																																																																																																								
5822	Level 2 Health and Behavior Services	S	0.9272	$69.46	.	$13.90																																																																																																																																																																																								
5841	Psychotherapy	S	1.7167	$128.60	.	$25.72																																																																																																																																																																																								
5853	Partial Hospitalization (3 or more services) for CMHCs	P	1.7281	$129.45	.	$25.89																																																																																																																																																																																								
5863	Partial Hospitalization (3 or more services) for Hospital-based PHPs	P	2.4596	$184.25	.	$36.85																																																																																																																																																																																								
5871	Dental Procedures	S	6.6791	$500.32	.	$100.07																																																																																																																																																																																								
5881	Ancillary Outpatient Services When Patient Dies	J1	94.3830	"$7,070.14"	.	"$1,414.03"																																																																																																																																																																																								
7000	Amifostine	K		$390.34	.	$78.07																																																																																																																																																																																								
7011	Oprelvekin injection	K		$439.87	.	$87.98																																																																																																																																																																																								
7034	"	Somatropin injection"	K		$81.59	.	$16.32																																																																																																																																																																																								
7035	Teniposide	K		"$2,025.66"	.	$405.14																																																																																																																																																																																								
7041	Tirofiban HCl	K		$9.82	.	$1.97																																																																																																																																																																																								
7043	Infliximab injection	K		$81.60	.	$16.32																																																																																																																																																																																								
7046	Doxorubicin inj 10mg	K		$435.93	.	$87.19																																																																																																																																																																																								
7048	Alteplase recombinant	K		$74.66	.	$14.94																																																																																																																																																																																								
7308	Aminolevulinic acid hcl top	K		$327.41	.	$65.49																																																																																																																																																																																								
8001	LDR Prostate Brachytherapy Composite	T	45.7388	"$3,426.25"	.	$685.25																																																																																																																																																																																								
8004	Ultrasound Composite	S	3.8661	$289.61	.	$57.93																																																																																																																																																																																								
8005	CT and CTA without Contrast Composite	S	3.7251	$279.04	.	$55.81																																																																																																																																																																																								
8006	CT and CTA with Contrast Composite	S	6.5792	$492.84	.	$98.57																																																																																																																																																																																								
8007	MRI and MRA without Contrast Composite	S	7.5029	$562.03	.	$112.41																																																																																																																																																																																								
8008	MRI and MRA with Contrast Composite	S	11.4990	$861.38	.	$172.28																																																																																																																																																																																								
8010	Mental Health Services Composite	S	2.4596	$184.25	.	$36.85																																																																																																																																																																																								
8011	Comprehensive Observation Services	J2	29.7299	"$2,227.04"	.	$445.41																																																																																																																																																																																								
9002	Tenecteplase injection	K		$93.98	.	$18.80																																																																																																																																																																																								
9005	Reteplase injection	K		"$2,301.91"	.	$460.39																																																																																																																																																																																								
9006	Tacrolimus injection	K		$164.16	.	$32.84																																																																																																																																																																																								
9012	Arsenic trioxide injection	K		$59.24	.	$11.85																																																																																																																																																																																								
9018	"Inj, rimabotulinumtoxinB"	K		$11.67	.	$2.34																																																																																																																																																																																								
9019	Caspofungin acetate	K		$13.26	.	$2.66																																																																																																																																																																																								
9024	Amphotericin b lipid complex	K		$13.75	.	$2.75																																																																																																																																																																																								
9032	Baclofen 10 MG injection	K		$182.76	.	$36.56																																																																																																																																																																																								
9033	Cidofovir injection	K		$594.16	.	$118.84																																																																																																																																																																																								
9038	Inj estrogen conjugate	K		$228.37	.	$45.68																																																																																																																																																																																								
9042	Glucagon hydrochloride	K		$196.57	.	$39.32																																																																																																																																																																																								
9044	Ibutilide fumarate injection	K		$109.03	.	$21.81																																																																																																																																																																																								
9104	Antithymocyte globuln rabbit	K		$649.58	.	$129.92																																																																																																																																																																																								
9108	Thyrotropin injection	K		"$1,457.99"	.	$291.60																																																																																																																																																																																								
9119	"Injection, pegfilgrastim 6mg"	K		"$3,898.41"	.	$779.69																																																																																																																																																																																								
9120	"Injection, Fulvestrant"	K		$94.02	.	$18.81																																																																																																																																																																																								
9121	"Injection, argatroban"	K		$12.40	.	$2.48																																																																																																																																																																																								
9122	Triptorelin pamoate	K		$234.96	.	$47.00																																																																																																																																																																																								
9124	Daptomycin injection	K		$0.83	.	$0.17																																																																																																																																																																																								
9125	"Risperidone, long acting"	K		$7.32	.	$1.47																																																																																																																																																																																								
9126	Natalizumab injection	K		$17.06	.	$3.42																																																																																																																																																																																								
9130	"Inj, Imm Glob Bivigam, 500mg"	K		$39.23	.	$7.85																																																																																																																																																																																								
9131	"Inj, Ado-trastuzumab Emt 1mg"	K		$29.22	.	$5.85																																																																																																																																																																																								
9132	"Kcentra, per i.u."	K		$1.69	.	$0.34																																																																																																																																																																																								
9133	"Rabies ig, im/sc"	K		$289.83	.	$57.97																																																																																																																																																																																								
9134	"Rabies ig, heat treated"	K		$279.13	.	$55.83																																																																																																																																																																																								
9139	"Rabies vaccine, im"	K		$273.97	.	$54.80																																																																																																																																																																																								
9140	"Rabies vaccine, id"	K		$172.30	.	$34.46																																																																																																																																																																																								
9207	Bortezomib injection	K		$46.82	.	$9.37																																																																																																																																																																																								
9208	Agalsidase beta injection	K		$159.66	.	$31.94																																																																																																																																																																																								
9209	Laronidase injection	K		$29.65	.	$5.93																																																																																																																																																																																								
9210	Palonosetron hcl	K		$22.27	.	$4.46																																																																																																																																																																																								
9213	Pemetrexed injection	K		$61.68	.	$12.34																																																																																																																																																																																								
9214	Bevacizumab injection	K		$70.96	.	$14.20																																																																																																																																																																																								
9215	Cetuximab injection	K		$54.37	.	$10.88																																																																																																																																																																																								
9217	Leuprolide acetate suspnsion	K		$231.79	.	$46.36																																																																																																																																																																																								
9224	Galsulfase injection	K		$364.20	.	$72.84																																																																																																																																																																																								
9225	Fluocinolone acetonide implt	K		"$20,136.40"	.	"$4,027.28"																																																																																																																																																																																								
9228	Tigecycline injection	K		$2.42	.	$0.49																																																																																																																																																																																								
9229	Ibandronate sodium injection	K		$104.13	.	$20.83																																																																																																																																																																																								
9230	Abatacept injection	K		$41.05	.	$8.21																																																																																																																																																																																								
9231	Decitabine injection	K		$22.97	.	$4.60																																																																																																																																																																																								
9232	Idursulfase injection	K		$522.65	.	$104.53																																																																																																																																																																																								
9233	Ranibizumab injection	K		$386.33	.	$77.27																																																																																																																																																																																								
9234	Alglucosidase alfa injection	K		$206.70	.	$41.34																																																																																																																																																																																								
9235	Panitumumab injection	K		$104.02	.	$20.81																																																																																																																																																																																								
9236	Eculizumab injection	K		$215.92	.	$43.19																																																																																																																																																																																								
9237	"Inj, lanreotide acetate"	K		$48.44	.	$9.69																																																																																																																																																																																								
9240	"Injection, ixabepilone"	K		$73.85	.	$14.77																																																																																																																																																																																								
9242	"Injection, fosaprepitant"	K		$1.81	.	$0.37																																																																																																																																																																																								
9243	Bendamustine injection	K		$24.63	.	$4.93																																																																																																																																																																																								
9245	Romiplostim injection	K		$59.73	.	$11.95																																																																																																																																																																																								
9248	"	Inj, clevidipine butyrate"	K		$2.37	.	$0.48																																																																																																																																																																																								
9251	C1 esterase inhibitor inj	K		$54.51	.	$10.91																																																																																																																																																																																								
9252	Plerixafor injection	K		$308.16	.	$61.64																																																																																																																																																																																								
9253	Temozolomide injection	K		$7.33	.	$1.47																																																																																																																																																																																								
9255	Paliperidone palmitate inj	K		$8.68	.	$1.74																																																																																																																																																																																								
9256	Dexamethasone intra implant	K		$201.11	.	$40.23																																																																																																																																																																																								
9258	Telavancin injection	K		$5.22	.	$1.05																																																																																																																																																																																								
9259	Pralatrexate injection	K		$221.07	.	$44.22																																																																																																																																																																																								
9260	Ofatumumab injection	K		$50.61	.	$10.13																																																																																																																																																																																								
9261	Ustekinumab injection	K		$169.34	.	$33.87																																																																																																																																																																																								
9263	Ecallantide injection	K		$400.42	.	$80.09																																																																																																																																																																																								
9264	Tocilizumab injection	K		$3.98	.	$0.80																																																																																																																																																																																								
9265	Romidepsin injection	K		$298.21	.	$59.65																																																																																																																																																																																								
9269	"C-1 esterase, berinert"	K		$46.32	.	$9.27																																																																																																																																																																																								
9270	Gammaplex IVIG	K		$37.28	.	$7.46																																																																																																																																																																																								
9271	Velaglucerase alfa	K		$342.29	.	$68.46																																																																																																																																																																																								
9272	"Inj, denosumab"	K		$15.61	.	$3.13																																																																																																																																																																																								
9273	Sipuleucel-T auto CD54+	K		"$38,347.31"	.	"$7,669.47"																																																																																																																																																																																								
9274	Crotalidae Poly Immune Fab	K		"$2,670.39"	.	$534.08																																																																																																																																																																																								
9276	Cabazitaxel injection	K		$150.25	.	$30.05																																																																																																																																																																																								
9278	Incobotulinumtoxin A	K		$4.82	.	$0.97																																																																																																																																																																																								
9281	"Injection, pegloticase"	K		"$1,379.99"	.	$276.00																																																																																																																																																																																								
9284	Ipilimumab injection	K		$140.75	.	$28.15																																																																																																																																																																																								
9286	Belatacept injection	K		$3.80	.	$0.76																																																																																																																																																																																								
9287	Brentuximab vedotin inj	K		$124.24	.	$24.85																																																																																																																																																																																								
9289	Erwinaze injection	K		$391.01	.	$78.21																																																																																																																																																																																								
9293	"Injection, glucarpidase "	K		$270.72	.	$54.15																																																																																																																																																																																								
9294	"Inj, Taliglucerace Alfa 10 u"	K		$38.56	.	$7.72																																																																																																																																																																																								
9295	"Injection, Carfilzomib, 1 mg"	K		$32.09	.	$6.42																																																																																																																																																																																								
9296	"Inj, ziv-aflibercept, 1mg"	K		$8.06	.	$1.62																																																																																																																																																																																								
9297	"Inj, Omacetaxine Mep, 0.01mg"	K		$2.58	.	$0.52																																																																																																																																																																																								
9298	"Inj, Ocriplasmin, 0.125 mg"	K		"$1,046.75"	.	$209.35																																																																																																																																																																																								
9300	Omalizumab injection	K		$31.13	.	$6.23																																																																																																																																																																																								
9445	"Injection, ruconest"	G		$26.75	.	$5.35																																																																																																																																																																																								
9448	Netupitant palonosetron oral	G		$395.65	.	$79.13																																																																																																																																																																																								
9449	"Injection, blinatumomab"	G		$95.10	.	$19.02																																																																																																																																																																																								
9450	Fluocinol acet intravit imp	G		$490.95	.	$98.19																																																																																																																																																																																								
9451	"Injection, peramivir"	G		$1.65	.	$0.33																																																																																																																																																																																								
9452	Inj ceftolozane tazobactam	G		$4.29	.	$0.86																																																																																																																																																																																								
9453	"Injection, nivolumab"	G		$25.62	.	$5.13																																																																																																																																																																																								
9454	"Inj, pasireotide long acting"	G		$239.45	.	$47.89																																																																																																																																																																																								
9455	"Injection, siltuximab"	G		$9.00	.	$1.80																																																																																																																																																																																								
9456	"Injection, isavuconazonium"	G		$0.63	.	$0.13																																																																																																																																																																																								
9457	Inj sulf hexa lipid microsph	G		$24.16	.	$0.00																																																																																																																																																																																								
9458	florbetaben f18 diagnostic	G		"$2,968.00"	.	$0.00																																																																																																																																																																																								
9459	flutemetamol f18 diagnostic	G		"$3,135.00"	.	$0.00																																																																																																																																																																																								
9460	"Injection, cangrelor"	G		$15.53	.	$3.11																																																																																																																																																																																								
9461	"Choline C 11, diagnostic"	G		"$5,700.00"	.	$0.00																																																																																																																																																																																								
9470	Aripiprazole lauroxil im	G		$2.53	.	$0.51																																																																																																																																																																																								
9471	"Hymovis, 1 mg"	G		$19.00	.	$3.80																																																																																																																																																																																								
9472	Inj talimogene laherparepvec	G		$46.64	.	$9.33																																																																																																																																																																																								
9473	"Injection, mepolizumab"	G		$26.50	.	$5.30																																																																																																																																																																																								
9474	"Inj, irinotecan liposome"	G		$39.93	.	$7.99																																																																																																																																																																																								
9475	"Injection, necitumumab"	G		$5.30	.	$1.06																																																																																																																																																																																								
9476	"Injection, daratumumab"	G		$46.43	.	$9.29																																																																																																																																																																																								
9477	"Injection, elotuzumab"	G		$6.25	.	$1.25																																																																																																																																																																																								
9478	"Injection, sebelipase alfa"	G		$530.00	.	$106.00																																																																																																																																																																																								
9479	"Instill, ciprofloxacin otic"	G		$30.02	.	$6.01																																																																																																																																																																																								
9480	"Injection, trabectedin"	G		$280.57	.	$56.12																																																																																																																																																																																								
9497	"Loxapine, inhalation powder"	K		$144.70	.	$28.94																																																																																																																																																																																								
9500	"Platelets, irradiated"	R	2.2348	$167.41	.	$33.49																																																																																																																																																																																								
9501	Platelet pheres leukoreduced	R	6.8718	$514.76	.	$102.96																																																																																																																																																																																								
9502	Platelet pheresis irradiated	R	7.7423	$579.97	.	$116.00																																																																																																																																																																																								
9503	Fr frz plasma donor retested	R	0.8461	$63.38	.	$12.68																																																																																																																																																																																								
9504	RBC deglycerolized	R	5.1670	$387.05	.	$77.41																																																																																																																																																																																								
9505	RBC irradiated	R	2.9963	$224.45	.	$44.89																																																																																																																																																																																								
9507	"Platelets, pheresis"	R	5.6956	$426.65	.	$85.33																																																																																																																																																																																								
9508	Plasma 1 donor frz w/in 8 hr	R	1.0082	$75.52	.	$15.11																																																																																																																																																																																								
9509	"Frozen plasma, pooled, sd"	R	1.0246	$76.75	.	$15.35																																																																																																																																																																																								
9510	Whole blood for transfusion	R	1.0676	$79.97	.	$16.00																																																																																																																																																																																								
9511	Cryoprecipitate each unit	R	0.7422	$55.60	.	$11.12																																																																																																																																																																																								
9512	RBC leukocytes reduced	R	2.5434	$190.52	.	$38.11																																																																																																																																																																																								
9513	"Plasma, frz between 8-24hour"	R	1.0016	$75.03	.	$15.01																																																																																																																																																																																								
9514	"Plasma protein fract,5%,50ml"	R	0.3470	$25.99	.	$5.20																																																																																																																																																																																								
9515	"Platelets, each unit"	R	1.3296	$99.60	.	$19.92																																																																																																																																																																																								
9516	Plaelet rich plasma unit	R	1.9431	$145.56	.	$29.12																																																																																																																																																																																								
9517	Red blood cells unit	R	1.9581	$146.68	.	$29.34																																																																																																																																																																																								
9518	Washed red blood cells unit	R	4.6407	$347.63	.	$69.53																																																																																																																																																																																								
9519	"Plasmaprotein fract,5%,250ml"	R	1.2500	$93.64	.	$18.73																																																																																																																																																																																								
9520	Blood split unit	R	1.7818	$133.47	.	$26.70																																																																																																																																																																																								
9521	Platelets leukoreduced irrad	R	2.1559	$161.50	.	$32.30																																																																																																																																																																																								
9522	RBC leukoreduced irradiated	R	3.6320	$272.07	.	$54.42																																																																																																																																																																																								
9523	Cryoprecipitatereducedplasma	R	0.8833	$66.17	.	$13.24																																																																																																																																																																																								
9524	"Blood, l/r, cmv-neg"	R	2.9522	$221.15	.	$44.23																																																																																																																																																																																								
9525	"Platelets, hla-m, l/r, unit"	R	10.0416	$752.21	.	$150.45																																																																																																																																																																																								
9526	Platelets leukocytes reduced	R	1.7125	$128.28	.	$25.66																																																																																																																																																																																								
9527	"Blood, l/r, froz/degly/wash"	R	4.2766	$320.36	.	$64.08																																																																																																																																																																																								
9528	"Plt, aph/pher, l/r, cmv-neg"	R	5.6966	$426.73	.	$85.35																																																																																																																																																																																								
9529	"Blood, l/r, irradiated"	R	1.7082	$127.96	.	$25.60																																																																																																																																																																																								
9530	Plate pheres leukoredu irrad	R	8.8178	$660.53	.	$132.11																																																																																																																																																																																								
9531	"Plt, pher, l/r cmv-neg, irr"	R	8.2966	$621.49	.	$124.30																																																																																																																																																																																								
9532	"RBC, frz/deg/wsh, l/r, irrad"	R	2.5996	$194.73	.	$38.95																																																																																																																																																																																								
9533	"RBC, l/r, cmv-neg, irrad"	R	3.3801	$253.20	.	$50.64																																																																																																																																																																																								
9534	Pathogen reduced plasma pool	R	1.0016	$75.03	.	$15.01																																																																																																																																																																																								
9535	Pathogen reduced plasma sing	R	1.0082	$75.52	.	$15.11																																																																																																																																																																																								
9536	Pathogen reduced platelets	R	8.8178	$660.53	.	$132.11																																																																																																																																																																																								
