	Addendum A.-OPPS APCs for CY 2011																																																																																																																																																																																																																								
APC	Group Title	SI	Relative Weight 	Payment Rate 	National Unadjusted Copayment 	Minimum Unadjusted Copayment 																																																																																																																																																																																																																			
0001	Level I Photochemotherapy	S	0.5543	$38.18	.	$7.64																																																																																																																																																																																																																			
0002	Fine Needle Biopsy/Aspiration	T	1.5703	$108.16	.	$21.64																																																																																																																																																																																																																			
0003	Bone Marrow Biopsy/Aspiration	T	3.7390	$257.53	.	$51.51																																																																																																																																																																																																																			
0004	Level I Needle Biopsy/ Aspiration Except Bone Marrow	T	4.5843	$315.75	.	$63.15																																																																																																																																																																																																																			
0005	Level II Needle Biopsy/Aspiration Except Bone Marrow	T	8.1362	$560.39	.	$112.08																																																																																																																																																																																																																			
0006	Level I Incision & Drainage	T	1.4906	$102.67	.	$20.54																																																																																																																																																																																																																			
0007	Level II Incision & Drainage	T	13.0129	$896.28	.	$179.26																																																																																																																																																																																																																			
0008	Level III Incision and Drainage	T	20.1996	"$1,391.27"	.	$278.26																																																																																																																																																																																																																			
0012	Level I Debridement & Destruction	T	0.4326	$29.80	.	$5.96																																																																																																																																																																																																																			
0013	Level II Debridement & Destruction	T	0.9103	$62.70	.	$12.54																																																																																																																																																																																																																			
0015	Level III Debridement & Destruction	T	1.4975	$103.14	.	$20.63																																																																																																																																																																																																																			
0016	Level IV Debridement & Destruction	T	2.7318	$188.16	.	$37.64																																																																																																																																																																																																																			
0017	Level V Debridement & Destruction	T	21.7969	"$1,501.28"	.	$300.26																																																																																																																																																																																																																			
0019	Level I Excision/ Biopsy	T	5.0887	$350.49	.	$70.10																																																																																																																																																																																																																			
0020	Level II Excision/ Biopsy	T	8.4929	$584.96	.	$117.00																																																																																																																																																																																																																			
0021	Level III Excision/ Biopsy	T	18.0784	"$1,245.17"	.	$249.04																																																																																																																																																																																																																			
0022	Level IV Excision/ Biopsy	T	23.8986	"$1,646.04"	$354.45	$329.21																																																																																																																																																																																																																			
0028	Level I Breast Surgery	T	25.5910	"$1,762.61"	.	$352.53																																																																																																																																																																																																																			
0029	Level II Breast Surgery	T	33.9253	"$2,336.64"	$581.52	$467.33																																																																																																																																																																																																																			
0030	Level III Breast Surgery	T	45.0028	"$3,099.61"	$747.07	$619.93																																																																																																																																																																																																																			
0031	Smoking Cessation Services	X	0.3010	$20.73	.	$4.15																																																																																																																																																																																																																			
0034	Mental Health Services Composite	S	3.4603	$238.33	.	$47.67																																																																																																																																																																																																																			
0035	Vascular Puncture and Minor Diagnostic Procedures	X	0.2674	$18.42	.	$3.69																																																																																																																																																																																																																			
0037	Level IV Needle Biopsy/Aspiration Except Bone Marrow	T	15.7009	"$1,081.42"	$228.76	$216.29																																																																																																																																																																																																																			
0039	Level I Implantation of Neurostimulator Generator	S	214.0597	"$14,743.58"	.	"$2,948.72"																																																																																																																																																																																																																			
0040	Percutaneous Implantation of Neurostimulator Electrodes	S	66.1046	"$4,553.02"	.	$910.61																																																																																																																																																																																																																			
0041	Level I Arthroscopy	T	29.9672	"$2,064.02"	.	$412.81																																																																																																																																																																																																																			
0042	Level II Arthroscopy	T	48.4428	"$3,336.55"	$804.74	$667.31																																																																																																																																																																																																																			
0045	Bone/Joint Manipulation Under Anesthesia	T	15.5512	"$1,071.10"	$268.44	$214.22																																																																																																																																																																																																																			
0047	Arthroplasty without Prosthesis	T	39.2855	"$2,705.83"	.	$541.17																																																																																																																																																																																																																			
0048	Level I Arthroplasty or Implantation with Prosthesis	T	59.9568	"$4,129.58"	.	$825.92																																																																																																																																																																																																																			
0049	Level I Musculoskeletal Procedures Except Hand and Foot	T	22.9744	"$1,582.38"	.	$316.48																																																																																																																																																																																																																			
0050	Level II Musculoskeletal Procedures Except Hand and Foot	T	32.2439	"$2,220.83"	.	$444.17																																																																																																																																																																																																																			
0051	Level III Musculoskeletal Procedures Except Hand and Foot	T	47.3213	"$3,259.30"	.	$651.86																																																																																																																																																																																																																			
0052	Level IV Musculoskeletal Procedures Except Hand and Foot	T	88.9869	"$6,129.06"	.	"$1,225.82"																																																																																																																																																																																																																			
0053	Level I Hand Musculoskeletal Procedures	T	17.1642	"$1,182.20"	$253.49	$236.44																																																																																																																																																																																																																			
0054	Level II Hand Musculoskeletal Procedures	T	29.7686	"$2,050.34"	.	$410.07																																																																																																																																																																																																																			
0055	Level I Foot Musculoskeletal Procedures	T	22.5951	"$1,556.26"	$355.34	$311.26																																																																																																																																																																																																																			
0056	Level II Foot Musculoskeletal Procedures	T	55.2578	"$3,805.94"	.	$761.19																																																																																																																																																																																																																			
0057	Bunion Procedures	T	33.2448	"$2,289.77"	$475.91	$457.96																																																																																																																																																																																																																			
0058	Level I Strapping and Cast Application	S	1.1201	$77.15	.	$15.43																																																																																																																																																																																																																			
0060	Manipulation Therapy	S	0.2864	$19.73	.	$3.95																																																																																																																																																																																																																			
0061	"Laminectomy, Laparoscopy, or Incision for Implantation of Neurostimulator Electr"	S	90.0429	"$6,201.79"	.	"$1,240.36"																																																																																																																																																																																																																			
0062	Level I Treatment Fracture/Dislocation	T	26.5543	"$1,828.95"	$372.87	$365.79																																																																																																																																																																																																																			
0063	Level II Treatment Fracture/Dislocation	T	48.1318	"$3,315.13"	.	$663.03																																																																																																																																																																																																																			
0064	Level III Treatment Fracture/Dislocation	T	66.9057	"$4,608.20"	.	$921.64																																																																																																																																																																																																																			
0065	"Level I Stereotactic Radiosurgery, MRgFUS, and MEG"	S	14.1866	$977.12	.	$195.43																																																																																																																																																																																																																			
0066	"Level II Stereotactic Radiosurgery, MRgFUS, and MEG"	S	36.3649	"$2,504.67"	.	$500.94																																																																																																																																																																																																																			
0067	"Level III Stereotactic Radiosurgery, MRgFUS, and MEG"	S	49.4903	"$3,408.69"	.	$681.74																																																																																																																																																																																																																			
0069	Thoracoscopy	T	34.8422	"$2,399.79"	$591.64	$479.96																																																																																																																																																																																																																			
0070	Thoracentesis/Lavage Procedures	T	5.5631	$383.16	.	$76.64																																																																																																																																																																																																																			
0071	Level I Endoscopy Upper Airway	T	0.9297	$64.03	.	$12.81																																																																																																																																																																																																																			
0072	Level II Endoscopy Upper Airway	T	2.0114	$138.54	.	$27.71																																																																																																																																																																																																																			
0073	Level III Endoscopy Upper Airway	T	4.2250	$291.00	$67.83	$58.20																																																																																																																																																																																																																			
0074	Level IV Endoscopy Upper Airway	T	21.9448	"$1,511.47"	.	$302.30																																																																																																																																																																																																																			
0075	Level V Endoscopy Upper Airway	T	30.9463	"$2,131.46"	$445.92	$426.30																																																																																																																																																																																																																			
0076	Level I Endoscopy Lower Airway	T	10.5006	$723.24	$189.82	$144.65																																																																																																																																																																																																																			
0077	Level I Pulmonary Treatment	S	0.4171	$28.73	$7.74	$5.75																																																																																																																																																																																																																			
0078	Level III Pulmonary Treatment	S	1.4318	$98.62	.	$19.73																																																																																																																																																																																																																			
0079	Ventilation Initiation and Management	S	2.9048	$200.07	.	$40.02																																																																																																																																																																																																																			
0080	Diagnostic Cardiac Catheterization	T	39.5907	"$2,726.85"	$838.92	$545.37																																																																																																																																																																																																																			
0082	Coronary or Non-Coronary Atherectomy	T	92.7252	"$6,386.54"	.	"$1,277.31"																																																																																																																																																																																																																			
0083	Coronary or Non-Coronary Angioplasty and Percutaneous Valvuloplasty	T	54.8838	"$3,780.18"	.	$756.04																																																																																																																																																																																																																			
0084	Level I Electrophysiologic Procedures	S	10.3020	$709.56	.	$141.92																																																																																																																																																																																																																			
0085	Level II Electrophysiologic Procedures	T	53.6428	"$3,694.70"	.	$738.94																																																																																																																																																																																																																			
0086	Level III Electrophysiologic Procedures	T	122.6468	"$8,447.42"	.	"$1,689.49"																																																																																																																																																																																																																			
0088	Thrombectomy	T	41.7208	"$2,873.56"	$655.22	$574.72																																																																																																																																																																																																																			
0089	Insertion/Replacement of Permanent Pacemaker and Electrodes	T	113.4179	"$7,811.77"	"$1,643.98"	"$1,562.36"																																																																																																																																																																																																																			
0090	Insertion/Replacement of Pacemaker Pulse Generator	T	95.5918	"$6,583.98"	"$1,593.50"	"$1,316.80"																																																																																																																																																																																																																			
0091	Level II Vascular Ligation	T	43.9936	"$3,030.10"	.	$606.02																																																																																																																																																																																																																			
0092	Level I Vascular Ligation	T	27.4530	"$1,890.85"	.	$378.17																																																																																																																																																																																																																			
0093	Vascular Reconstruction/Fistula Repair without Device	T	36.4868	"$2,513.06"	.	$502.62																																																																																																																																																																																																																			
0094	Level I Resuscitation and Cardioversion	S	2.3671	$163.04	$45.71	$32.61																																																																																																																																																																																																																			
0095	Cardiac Rehabilitation	S	0.9991	$68.81	$13.86	$13.77																																																																																																																																																																																																																			
0096	Level II Noninvasive Physiologic Studies	S	1.5460	$106.48	$36.86	$21.30																																																																																																																																																																																																																			
0097	Level I Noninvasive Physiologic Studies	S	0.9619	$66.25	$23.79	$13.25																																																																																																																																																																																																																			
0099	Electrocardiograms/Cardiography	S	0.3958	$27.26	.	$5.46																																																																																																																																																																																																																			
0100	Cardiac Stress Tests	X	2.5904	$178.42	$41.44	$35.69																																																																																																																																																																																																																			
0101	Tilt Table Evaluation	S	4.2671	$293.90	$100.24	$58.78																																																																																																																																																																																																																			
0102	Level II Pulmonary Treatment	S	0.9144	$62.98	.	$12.60																																																																																																																																																																																																																			
0103	Miscellaneous Vascular Procedures	T	19.1361	"$1,318.02"	.	$263.61																																																																																																																																																																																																																			
0104	Transcatheter Placement of Intracoronary Stents	T	82.1118	"$5,655.53"	.	"$1,131.11"																																																																																																																																																																																																																			
0105	"Repair/Revision/Removal of Pacemakers, AICDs, or Vascular Devices"	T	22.7342	"$1,565.84"	.	$313.17																																																																																																																																																																																																																			
0106	Insertion/Replacement of Pacemaker Leads and/or Electrodes	T	52.2139	"$3,596.28"	.	$719.26																																																																																																																																																																																																																			
0107	Insertion of Cardioverter-Defibrillator	T	339.8079	"$23,404.61"	.	"$4,680.93"																																																																																																																																																																																																																			
0108	Insertion/Replacement/Repair of Cardioverter-Defibrillator Leads	T	389.5350	"$26,829.61"	.	"$5,365.93"																																																																																																																																																																																																																			
0110	Transfusion	S	3.3918	$233.61	.	$46.73																																																																																																																																																																																																																			
0111	Blood Product Exchange	S	12.3872	$853.18	$198.40	$170.64																																																																																																																																																																																																																			
0112	Apheresis and Stem Cell Procedures	S	31.4526	"$2,166.33"	.	$433.27																																																																																																																																																																																																																			
0113	Excision Lymphatic System	T	25.0607	"$1,726.08"	.	$345.22																																																																																																																																																																																																																			
0114	Thyroid/Lymphadenectomy Procedures	T	50.7814	"$3,497.62"	.	$699.53																																																																																																																																																																																																																			
0115	Cannula/Access Device Procedures	T	35.0863	"$2,416.60"	.	$483.32																																																																																																																																																																																																																			
0121	Level I Tube or Catheter Changes or Repositioning	T	6.3298	$435.97	.	$87.20																																																																																																																																																																																																																			
0126	Level I Urinary and Anal Procedures	T	1.1110	$76.52	$16.21	$15.31																																																																																																																																																																																																																			
0127	"Level IV Stereotactic Radiosurgery, MRgFUS, and MEG"	S	111.2310	"$7,661.15"	.	"$1,532.23"																																																																																																																																																																																																																			
0128	Echocardiogram with Contrast	S	7.2453	$499.03	$166.16	$99.81																																																																																																																																																																																																																			
0129	Level I Closed Treatment Fracture Finger/Toe/Trunk	T	1.5787	$108.73	.	$21.75																																																																																																																																																																																																																			
0130	Level I Laparoscopy	T	38.6514	"$2,662.15"	$659.53	$532.43																																																																																																																																																																																																																			
0131	Level II Laparoscopy	T	47.8453	"$3,295.39"	"$1,001.89"	$659.08																																																																																																																																																																																																																			
0132	Level III Laparoscopy	T	71.0980	"$4,896.95"	"$1,236.99"	$979.39																																																																																																																																																																																																																			
0133	Level I Skin Repair	T	1.3330	$91.81	$25.67	$18.37																																																																																																																																																																																																																			
0134	Level II Skin Repair	T	3.1618	$217.77	.	$43.56																																																																																																																																																																																																																			
0135	Level III Skin Repair	T	4.6422	$319.74	.	$63.95																																																																																																																																																																																																																			
0136	Level IV Skin Repair	T	17.2117	"$1,185.47"	.	$237.10																																																																																																																																																																																																																			
0137	Level V Skin Repair	T	22.2821	"$1,534.70"	.	$306.94																																																																																																																																																																																																																			
0138	Level II Closed Treatment Fracture Finger/Toe/Trunk	T	5.5050	$379.16	.	$75.84																																																																																																																																																																																																																			
0139	Level III Closed Treatment Fracture Finger/Toe/Trunk	T	20.8356	"$1,435.07"	.	$287.02																																																																																																																																																																																																																			
0140	Esophageal Dilation without Endoscopy	T	6.5637	$452.08	.	$90.42																																																																																																																																																																																																																			
0141	Level I Upper GI Procedures	T	8.8816	$611.73	$143.38	$122.35																																																																																																																																																																																																																			
0142	Small Intestine Endoscopy	T	10.1857	$701.55	$152.78	$140.31																																																																																																																																																																																																																			
0143	Lower GI Endoscopy	T	9.3416	$643.41	$186.06	$128.69																																																																																																																																																																																																																			
0146	Level I Sigmoidoscopy and Anoscopy	T	5.7982	$399.36	.	$79.88																																																																																																																																																																																																																			
0147	Level II Sigmoidoscopy and Anoscopy	T	9.5044	$654.63	.	$130.93																																																																																																																																																																																																																			
0148	Level I Anal/Rectal Procedures	T	6.0158	$414.34	.	$82.87																																																																																																																																																																																																																			
0149	Level III Anal/Rectal Procedures	T	24.3450	"$1,676.79"	.	$335.36																																																																																																																																																																																																																			
0150	Level IV Anal/Rectal Procedures	T	32.6594	"$2,249.45"	.	$449.89																																																																																																																																																																																																																			
0151	Endoscopic Retrograde Cholangio-Pancreatography (ERCP)	T	23.2357	"$1,600.38"	.	$320.08																																																																																																																																																																																																																			
0152	Level I Percutaneous Abdominal and Biliary Procedures	T	31.7356	"$2,185.82"	.	$437.17																																																																																																																																																																																																																			
0153	Peritoneal and Abdominal Procedures	T	26.4829	"$1,824.04"	$375.24	$364.81																																																																																																																																																																																																																			
0154	Hernia/Hydrocele Procedures	T	33.0791	"$2,278.36"	$464.85	$455.68																																																																																																																																																																																																																			
0155	Level II Anal/Rectal Procedures	T	16.1126	"$1,109.77"	.	$221.96																																																																																																																																																																																																																			
0156	Level III Urinary and Anal Procedures	T	3.2116	$221.20	.	$44.24																																																																																																																																																																																																																			
0157	Colorectal Cancer Screening: Barium Enema	S	1.2404	$85.43	.	$17.09																																																																																																																																																																																																																			
0158	Colorectal Cancer Screening: Colonoscopy	T	8.2742	$569.89	$0.00	$0.00																																																																																																																																																																																																																			
0159	Colorectal Cancer Screening: Flexible Sigmoidoscopy	S	5.5084	$379.40	$0.00	$0.00																																																																																																																																																																																																																			
0160	Level I Cystourethroscopy and other Genitourinary Procedures	T	7.4406	$512.48	.	$102.50																																																																																																																																																																																																																			
0161	Level II Cystourethroscopy and other Genitourinary Procedures	T	17.5738	"$1,210.41"	.	$242.09																																																																																																																																																																																																																			
0162	Level III Cystourethroscopy and other Genitourinary Procedures	T	26.3334	"$1,813.74"	.	$362.75																																																																																																																																																																																																																			
0163	Level IV Cystourethroscopy and other Genitourinary Procedures	T	37.3582	"$2,573.08"	.	$514.62																																																																																																																																																																																																																			
0164	Level II Urinary and Anal Procedures	T	2.0369	$140.29	.	$28.06																																																																																																																																																																																																																			
0165	Level IV Urinary and Anal Procedures	T	20.0886	"$1,383.62"	.	$276.73																																																																																																																																																																																																																			
0166	Level I Urethral Procedures	T	21.6923	"$1,494.08"	.	$298.82																																																																																																																																																																																																																			
0168	Level II Urethral Procedures	T	32.6605	"$2,249.52"	.	$449.91																																																																																																																																																																																																																			
0169	Lithotripsy	T	41.9797	"$2,891.39"	$997.74	$578.28																																																																																																																																																																																																																			
0170	Dialysis	S	6.9317	$477.43	.	$95.49																																																																																																																																																																																																																			
0172	Level I Partial Hospitalization (3 services) for CMHCs	P	1.8822	$129.64	.	$25.93																																																																																																																																																																																																																			
0173	Level II Partial Hospitalization (4 or more services) for CMHCs	P	2.3873	$164.43	.	$32.89																																																																																																																																																																																																																			
0174	Level IV Laparoscopy	T	113.9757	"$7,850.19"	"$2,064.24"	"$1,570.04"																																																																																																																																																																																																																			
0175	Level I Partial Hospitalization (3 services) for Hospital-based PHPs	P	2.9747	$204.89	.	$40.98																																																																																																																																																																																																																			
0176	Level II Partial Hospitalization (4 or more services) for Hospital-based PHPs	P	3.4603	$238.33	.	$47.67																																																																																																																																																																																																																			
0181	Level II Male Genital Procedures	T	35.9464	"$2,475.84"	$620.84	$495.17																																																																																																																																																																																																																			
0183	Level I Male Genital Procedures	T	23.7359	"$1,634.83"	.	$326.97																																																																																																																																																																																																																			
0184	Prostate Biopsy	T	13.0286	$897.36	.	$179.48																																																																																																																																																																																																																			
0188	Level II Female Reproductive Proc	T	1.6350	$112.61	.	$22.53																																																																																																																																																																																																																			
0189	Level III Female Reproductive Proc	T	3.6204	$249.36	.	$49.88																																																																																																																																																																																																																			
0190	Level I Hysteroscopy	T	23.0829	"$1,589.86"	$424.28	$317.98																																																																																																																																																																																																																			
0191	Level I Female Reproductive Proc	T	0.1446	$9.96	$2.08	$2.00																																																																																																																																																																																																																			
0192	Level IV Female Reproductive Proc	T	6.5660	$452.24	.	$90.45																																																																																																																																																																																																																			
0193	Level V Female Reproductive Proc	T	20.6779	"$1,424.21"	.	$284.85																																																																																																																																																																																																																			
0195	Level VI Female Reproductive Procedures	T	35.6739	"$2,457.08"	.	$491.42																																																																																																																																																																																																																			
0202	Level VII Female Reproductive Procedures	T	45.3938	"$3,126.54"	$981.50	$625.31																																																																																																																																																																																																																			
0203	Level IV Nerve Injections	T	12.7951	$881.28	.	$176.26																																																																																																																																																																																																																			
0204	Level I Nerve Injections	T	2.6683	$183.78	$40.13	$36.76																																																																																																																																																																																																																			
0206	Level II Nerve Injections	T	3.8823	$267.40	.	$53.48																																																																																																																																																																																																																			
0207	Level III Nerve Injections	T	7.5886	$522.67	.	$104.54																																																																																																																																																																																																																			
0208	Laminotomies and Laminectomies	T	51.3375	"$3,535.92"	.	$707.19																																																																																																																																																																																																																			
0209	"Level II Extended EEG, Sleep, and Cardiovascular Studies"	S	11.3359	$780.77	$268.73	$156.16																																																																																																																																																																																																																			
0213	"Level I Extended EEG, Sleep, and Cardiovascular Studies"	S	2.4194	$166.64	$53.58	$33.33																																																																																																																																																																																																																			
0215	Level I Nerve and Muscle Tests	S	0.6518	$44.89	.	$8.98																																																																																																																																																																																																																			
0216	Level III Nerve and Muscle Tests	S	2.7030	$186.17	.	$37.24																																																																																																																																																																																																																			
0218	Level II Nerve and Muscle Tests	S	1.1728	$80.78	.	$16.16																																																																																																																																																																																																																			
0220	Level I Nerve Procedures	T	19.1325	"$1,317.77"	.	$263.56																																																																																																																																																																																																																			
0221	Level II Nerve Procedures	T	37.2747	"$2,567.33"	.	$513.47																																																																																																																																																																																																																			
0224	Implantation of Catheter/Reservoir/Shunt	T	41.9167	"$2,887.05"	.	$577.41																																																																																																																																																																																																																			
0227	Implantation of Drug Infusion Device	T	193.1752	"$13,305.14"	.	"$2,661.03"																																																																																																																																																																																																																			
0229	Transcatherter Placement of Intravascular Shunt and Stents 	T	116.5174	"$8,025.25"	.	"$1,605.05"																																																																																																																																																																																																																			
0230	Level I Eye Tests & Treatments	S	0.6053	$41.69	.	$8.34																																																																																																																																																																																																																			
0231	Level III Eye Tests & Treatments	S	2.3078	$158.95	.	$31.79																																																																																																																																																																																																																			
0232	Level I Anterior Segment Eye Procedures	T	2.5480	$175.50	$42.27	$35.10																																																																																																																																																																																																																			
0233	Level III Anterior Segment Eye Procedures	T	17.9021	"$1,233.03"	$263.12	$246.61																																																																																																																																																																																																																			
0234	Level IV Anterior Segment Eye Procedures	T	24.4149	"$1,681.60"	$511.31	$336.32																																																																																																																																																																																																																			
0235	Level I Posterior Segment Eye Procedures	T	5.8452	$402.59	.	$80.52																																																																																																																																																																																																																			
0237	Level II Posterior Segment Eye Procedures	T	23.4306	"$1,613.81"	.	$322.77																																																																																																																																																																																																																			
0238	Level I Repair and Plastic Eye Procedures	T	3.2520	$223.98	.	$44.80																																																																																																																																																																																																																			
0239	Level II Repair and Plastic Eye Procedures	T	8.1226	$559.45	.	$111.89																																																																																																																																																																																																																			
0240	Level III Repair and Plastic Eye Procedures	T	20.0091	"$1,378.15"	$296.20	$275.63																																																																																																																																																																																																																			
0241	Level IV Repair and Plastic Eye Procedures	T	26.5964	"$1,831.85"	$383.45	$366.37																																																																																																																																																																																																																			
0242	Level V Repair and Plastic Eye Procedures	T	38.8370	"$2,674.94"	$597.36	$534.99																																																																																																																																																																																																																			
0243	Strabismus/Muscle Procedures	T	25.5895	"$1,762.50"	$416.98	$352.50																																																																																																																																																																																																																			
0244	Corneal and Amniotic Membrane Transplant	T	38.9282	"$2,681.22"	$803.26	$536.25																																																																																																																																																																																																																			
0245	Level I Cataract Procedures without IOL Insert	T	14.7683	"$1,017.18"	$204.88	$203.44																																																																																																																																																																																																																			
0246	Cataract Procedures with IOL Insert	T	24.5531	"$1,691.12"	$495.96	$338.23																																																																																																																																																																																																																			
0247	Laser Eye Procedures	T	5.6106	$386.44	$104.31	$77.29																																																																																																																																																																																																																			
0249	Level II Cataract Procedures without IOL Insert	T	30.8241	"$2,123.04"	$516.99	$424.61																																																																																																																																																																																																																			
0250	Level I ENT Procedures	T	1.1331	$78.04	$25.10	$15.61																																																																																																																																																																																																																			
0251	Level II ENT Procedures	T	3.5538	$244.77	.	$48.96																																																																																																																																																																																																																			
0252	Level III ENT Procedures	T	7.9194	$545.46	$109.16	$109.10																																																																																																																																																																																																																			
0253	Level IV ENT Procedures	T	17.3388	"$1,194.23"	$282.29	$238.85																																																																																																																																																																																																																			
0254	Level V ENT Procedures	T	25.6472	"$1,766.48"	.	$353.30																																																																																																																																																																																																																			
0255	Level II Anterior Segment Eye Procedures	T	7.5341	$518.92	$124.97	$103.79																																																																																																																																																																																																																			
0256	Level VI ENT Procedures	T	44.6899	"$3,078.06"	.	$615.62																																																																																																																																																																																																																			
0259	Level VII ENT Procedures	T	450.9625	"$31,060.49"	"$8,543.66"	"$6,212.10"																																																																																																																																																																																																																			
0260	Level I Plain Film Except Teeth	X	0.6539	$45.04	.	$9.01																																																																																																																																																																																																																			
0261	Level II Plain Film Except Teeth Including Bone Density Measurement	X	1.1014	$75.86	.	$15.18																																																																																																																																																																																																																			
0262	Plain Film of Teeth	X	0.4426	$30.48	.	$6.10																																																																																																																																																																																																																			
0263	Level I Miscellaneous Radiology Procedures	X	3.3387	$229.96	.	$46.00																																																																																																																																																																																																																			
0265	Level I Diagnostic and Screening Ultrasound	S	0.9038	$62.25	$22.26	$12.45																																																																																																																																																																																																																			
0266	Level II Diagnostic and Screening Ultrasound	S	1.3979	$96.28	$37.23	$19.26																																																																																																																																																																																																																			
0267	Level III Diagnostic and Screening Ultrasound	S	2.2212	$152.99	$59.84	$30.60																																																																																																																																																																																																																			
0269	Level II Echocardiogram Without Contrast 	S	5.8423	$402.39	.	$80.48																																																																																																																																																																																																																			
0270	Level III Echocardiogram Without Contrast 	S	8.1617	$562.15	$133.61	$112.43																																																																																																																																																																																																																			
0272	Fluoroscopy	X	1.2123	$83.50	$30.47	$16.70																																																																																																																																																																																																																			
0274	Myelography	S	7.2463	$499.10	.	$99.82																																																																																																																																																																																																																			
0275	Arthrography	S	3.9933	$275.04	$68.90	$55.01																																																																																																																																																																																																																			
0276	Level I Digestive Radiology	S	1.2591	$86.72	$34.43	$17.35																																																																																																																																																																																																																			
0277	Level II Digestive Radiology	S	2.0614	$141.98	$53.90	$28.40																																																																																																																																																																																																																			
0278	Diagnostic Urography	S	2.5571	$176.12	$58.44	$35.23																																																																																																																																																																																																																			
0279	Level II Angiography and Venography	S	29.4238	"$2,026.59"	.	$405.32																																																																																																																																																																																																																			
0280	Level III Angiography and Venography	S	47.7637	"$3,289.77"	.	$657.96																																																																																																																																																																																																																			
0282	Miscellaneous Computed Axial Tomography	S	1.6478	$113.49	$37.81	$22.70																																																																																																																																																																																																																			
0283	Computed Tomography with Contrast	S	4.3529	$299.81	$96.62	$59.97																																																																																																																																																																																																																			
0284	Magnetic Resonance Imaging and Magnetic Resonance Angiography with Contrast	S	6.3444	$436.98	$146.85	$87.40																																																																																																																																																																																																																			
0288	Bone Density:Axial Skeleton	S	1.0238	$70.52	$0.00	$0.00																																																																																																																																																																																																																			
0293	Level VI Anterior Segment Eye Procedures	T	109.7404	"$7,558.48"	.	"$1,511.70"																																																																																																																																																																																																																			
0299	Hyperthermia and Radiation Treatment Procedures	S	5.6418	$388.58	.	$77.72																																																																																																																																																																																																																			
0300	Level I Radiation Therapy	S	1.4202	$97.82	.	$19.57																																																																																																																																																																																																																			
0301	Level II Radiation Therapy	S	2.3309	$160.54	.	$32.11																																																																																																																																																																																																																			
0303	Treatment Device Construction	X	2.8996	$199.71	$66.95	$39.95																																																																																																																																																																																																																			
0304	Level I Therapeutic Radiation Treatment Preparation	X	1.5169	$104.48	$34.63	$20.90																																																																																																																																																																																																																			
0305	Level II Therapeutic Radiation Treatment Preparation	X	3.9434	$271.61	$91.38	$54.33																																																																																																																																																																																																																			
0307	Myocardial Positron Emission Tomography (PET) imaging	S	16.0776	"$1,107.36"	.	$221.48																																																																																																																																																																																																																			
0308	Non-Myocardial Positron Emission Tomography (PET) imaging	S	15.1285	"$1,041.99"	.	$208.40																																																																																																																																																																																																																			
0310	Level III Therapeutic Radiation Treatment Preparation	X	13.4552	$926.74	$325.27	$185.35																																																																																																																																																																																																																			
0312	Radioelement Applications	S	5.1535	$354.95	.	$70.99																																																																																																																																																																																																																			
0313	Brachytherapy	S	10.1646	$700.10	$264.73	$140.02																																																																																																																																																																																																																			
0315	Level II Implantation of Neurostimulator Generator 	S	273.6914	"$18,850.77"	.	"$3,770.16"																																																																																																																																																																																																																			
0317	Level II Miscellaneous Radiology Procedures	X	5.9108	$407.11	.	$81.43																																																																																																																																																																																																																			
0318	Implantation of Cranial Neurostimulator Pulse Generator and Electrode 	S	331.0938	"$22,804.42"	"$9,121.76"	"$4,560.89"																																																																																																																																																																																																																			
0319	Endovascular Revascularization of the Lower Extremity	T	201.7932	"$13,898.71"	"$5,559.48"	"$2,779.75"																																																																																																																																																																																																																			
0320	Electroconvulsive Therapy	S	5.8800	$404.99	.	$81.00																																																																																																																																																																																																																			
0322	Brief Individual Psychotherapy	S	1.2012	$82.73	.	$16.55																																																																																																																																																																																																																			
0323	Extended Individual Psychotherapy	S	1.6414	$113.05	.	$22.61																																																																																																																																																																																																																			
0324	Family Psychotherapy	S	1.8703	$128.82	.	$25.77																																																																																																																																																																																																																			
0325	Group Psychotherapy	S	0.7967	$54.87	$11.70	$10.98																																																																																																																																																																																																																			
0330	Dental Procedures	S	8.1928	$564.29	.	$112.86																																																																																																																																																																																																																			
0332	Computed Tomography without Contrast	S	2.8145	$193.85	$74.95	$38.77																																																																																																																																																																																																																			
0333	Computed Tomography without Contrast followed by Contrast	S	4.8528	$334.24	$116.13	$66.85																																																																																																																																																																																																																			
0336	Magnetic Resonance Imaging and Magnetic Resonance Angiography without Contrast	S	4.9789	$342.93	$135.13	$68.59																																																																																																																																																																																																																			
0337	Magnetic Resonance Imaging and Magnetic Resonance Angiography without Contrast followed by Contrast	S	7.7472	$533.60	$197.64	$106.72																																																																																																																																																																																																																			
0340	Minor Ancillary Procedures	X	0.6712	$46.23	.	$9.25																																																																																																																																																																																																																			
0341	Skin Tests	X	0.0809	$5.57	$2.09	$1.12																																																																																																																																																																																																																			
0342	Level I Pathology	X	0.1603	$11.04	.	$2.21																																																																																																																																																																																																																			
0343	Level III Pathology	X	0.5296	$36.48	$10.84	$7.30																																																																																																																																																																																																																			
0344	Level IV Pathology	X	0.8191	$56.42	$15.56	$11.29																																																																																																																																																																																																																			
0345	Level I Transfusion Laboratory Procedures	X	0.2167	$14.93	.	$2.99																																																																																																																																																																																																																			
0346	Level II Transfusion Laboratory Procedures	X	0.3642	$25.08	.	$5.02																																																																																																																																																																																																																			
0347	Level III Transfusion Laboratory Procedures	X	0.7059	$48.62	.	$9.73																																																																																																																																																																																																																			
0350	Administration of flu and PPV vaccine	S	0.3826	$26.35	$0.00	$0.00																																																																																																																																																																																																																			
0360	Level I Alimentary Tests	X	1.7442	$120.13	$33.88	$24.03																																																																																																																																																																																																																			
0361	Level II Alimentary Tests	X	4.1013	$282.48	$83.23	$56.50																																																																																																																																																																																																																			
0363	Level I Otorhinolaryngologic Function Tests	X	0.9181	$63.24	$17.10	$12.65																																																																																																																																																																																																																			
0364	Level I Audiometry	X	0.4748	$32.70	$7.06	$6.54																																																																																																																																																																																																																			
0365	Level II Audiometry	X	1.2699	$87.47	$18.52	$17.50																																																																																																																																																																																																																			
0366	Level III Audiometry	X	1.8077	$124.51	$24.94	$24.91																																																																																																																																																																																																																			
0367	Level I Pulmonary Test	X	0.5892	$40.58	$13.76	$8.12																																																																																																																																																																																																																			
0368	Level II Pulmonary Tests	X	0.8657	$59.63	$20.93	$11.93																																																																																																																																																																																																																			
0369	Level III Pulmonary Tests	X	3.0144	$207.62	$42.19	$41.53																																																																																																																																																																																																																			
0370	Allergy Tests	X	1.3134	$90.46	.	$18.10																																																																																																																																																																																																																			
0373	Level I Neuropsychological Testing	X	1.3342	$91.89	.	$18.38																																																																																																																																																																																																																			
0375	Ancillary Outpatient Services When Patient Expires	S	92.5156	"$6,372.10"	.	"$1,274.42"																																																																																																																																																																																																																			
0377	Level II Cardiac Imaging	S	11.0328	$759.90	.	$151.98																																																																																																																																																																																																																			
0378	Level II Pulmonary Imaging	S	4.6449	$319.92	$123.46	$63.99																																																																																																																																																																																																																			
0381	Single Allergy Tests	X	0.4819	$33.19	.	$6.64																																																																																																																																																																																																																			
0382	Level II Neuropsychological Testing	X	2.6972	$185.77	.	$37.16																																																																																																																																																																																																																			
0383	Cardiac Computed Tomographic Imaging	S	3.7293	$256.86	.	$51.38																																																																																																																																																																																																																			
0384	GI Procedures with Stents	T	27.8099	"$1,915.43"	.	$383.09																																																																																																																																																																																																																			
0385	Level I Prosthetic Urological Procedures	S	102.4439	"$7,055.93"	.	"$1,411.19"																																																																																																																																																																																																																			
0386	Level II Prosthetic Urological Procedures	S	168.7831	"$11,625.10"	.	"$2,325.02"																																																																																																																																																																																																																			
0387	Level II Hysteroscopy	T	38.4941	"$2,651.32"	$655.55	$530.27																																																																																																																																																																																																																			
0388	Discography	S	24.2795	"$1,672.27"	.	$334.46																																																																																																																																																																																																																			
0389	Level I Non-imaging Nuclear Medicine	S	1.4630	$100.77	$26.88	$20.16																																																																																																																																																																																																																			
0390	Level I Endocrine Imaging	S	1.9280	$132.79	$47.69	$26.56																																																																																																																																																																																																																			
0391	Level II Endocrine Imaging	S	3.1868	$219.49	$65.46	$43.90																																																																																																																																																																																																																			
0392	Level II Non-imaging Nuclear Medicine	S	2.5248	$173.90	$42.39	$34.78																																																																																																																																																																																																																			
0393	Hematologic Processing & Studies	S	6.0745	$418.39	.	$83.68																																																																																																																																																																																																																			
0394	Hepatobiliary Imaging	S	3.8494	$265.13	$90.78	$53.03																																																																																																																																																																																																																			
0395	GI Tract Imaging	S	3.4743	$239.30	$87.01	$47.86																																																																																																																																																																																																																			
0396	Bone Imaging	S	3.5527	$244.70	$94.20	$48.94																																																																																																																																																																																																																			
0397	Vascular Imaging	S	2.9089	$200.35	$46.29	$40.07																																																																																																																																																																																																																			
0398	Level I Cardiac Imaging	S	4.2306	$291.39	$93.33	$58.28																																																																																																																																																																																																																			
0400	Hematopoietic Imaging	S	3.7316	$257.02	$91.24	$51.41																																																																																																																																																																																																																			
0401	Level I Pulmonary Imaging	S	2.8578	$196.83	$71.16	$39.37																																																																																																																																																																																																																			
0402	Level II Nervous System Imaging	S	8.6571	$596.27	.	$119.26																																																																																																																																																																																																																			
0403	Level I Nervous System Imaging	S	3.4879	$240.23	$72.42	$48.05																																																																																																																																																																																																																			
0404	Renal and Genitourinary Studies	S	4.6672	$321.46	$82.19	$64.30																																																																																																																																																																																																																			
0406	Level I Tumor/Infection Imaging	S	4.2121	$290.11	$88.01	$58.03																																																																																																																																																																																																																			
0407	Level I Radionuclide Therapy	S	3.2539	$224.12	$78.13	$44.83																																																																																																																																																																																																																			
0408	Level III Tumor/Infection Imaging	S	11.9819	$825.27	.	$165.06																																																																																																																																																																																																																			
0409	Red Blood Cell Tests	X	0.1129	$7.78	$2.19	$1.56																																																																																																																																																																																																																			
0412	IMRT Treatment Delivery	S	6.3625	$438.22	.	$87.65																																																																																																																																																																																																																			
0413	Level II Radionuclide Therapy	S	4.7474	$326.98	.	$65.40																																																																																																																																																																																																																			
0414	Level II Tumor/Infection Imaging	S	6.8961	$474.98	.	$95.00																																																																																																																																																																																																																			
0415	Level II Endoscopy Lower Airway	T	28.6278	"$1,971.77"	$459.92	$394.36																																																																																																																																																																																																																			
0418	Insertion of Left Ventricular Pacing Elect.	T	154.3377	"$10,630.16"	.	"$2,126.04"																																																																																																																																																																																																																			
0422	Level II Upper GI Procedures	T	16.6785	"$1,148.75"	$280.07	$229.75																																																																																																																																																																																																																			
0423	Level II Percutaneous Abdominal and Biliary Procedures	T	56.5664	"$3,896.07"	.	$779.22																																																																																																																																																																																																																			
0425	Level II Arthroplasty or Implantation with Prosthesis	T	124.8075	"$8,596.24"	.	"$1,719.25"																																																																																																																																																																																																																			
0426	Level II Strapping and Cast Application	S	2.5465	$175.39	.	$35.08																																																																																																																																																																																																																			
0427	Level II Tube or Catheter Changes or Repositioning	T	16.3172	"$1,123.86"	.	$224.78																																																																																																																																																																																																																			
0428	Level III Sigmoidoscopy and Anoscopy	T	24.4042	"$1,680.86"	.	$336.18																																																																																																																																																																																																																			
0429	Level V Cystourethroscopy and other Genitourinary Procedures	T	46.4709	"$3,200.73"	.	$640.15																																																																																																																																																																																																																			
0432	Health and Behavior Services	S	0.4795	$33.03	.	$6.61																																																																																																																																																																																																																			
0433	Level II Pathology	X	0.2478	$17.07	$5.17	$3.42																																																																																																																																																																																																																			
0434	Cardiac Defect Repair	T	157.0167	"$10,814.68"	.	"$2,162.94"																																																																																																																																																																																																																			
0436	Level I Drug Administration	S	0.3826	$26.35	.	$5.27																																																																																																																																																																																																																			
0437	Level II Drug Administration	S	0.5354	$36.88	.	$7.38																																																																																																																																																																																																																			
0438	Level III Drug Administration	S	1.0974	$75.58	.	$15.12																																																																																																																																																																																																																			
0439	Level IV Drug Administration	S	1.8648	$128.44	.	$25.69																																																																																																																																																																																																																			
0440	Level V Drug Administration	S	2.9888	$205.86	.	$41.18																																																																																																																																																																																																																			
0442	Dosimetric Drug Administration	S	32.5110	"$2,239.23"	.	$447.85																																																																																																																																																																																																																			
0604	Level 1 Hospital Clinic Visits	V	0.7602	$52.36	.	$10.48																																																																																																																																																																																																																			
0605	Level 2 Hospital Clinic Visits	V	1.0908	$75.13	.	$15.03																																																																																																																																																																																																																			
0606	Level 3 Hospital Clinic Visits	V	1.4477	$99.71	.	$19.95																																																																																																																																																																																																																			
0607	Level 4 Hospital Clinic Visits	V	1.8654	$128.48	.	$25.70																																																																																																																																																																																																																			
0608	Level 5 Hospital Clinic Visits	V	2.4525	$168.92	.	$33.79																																																																																																																																																																																																																			
0609	Level 1 Type A Emergency Visits	V	0.7516	$51.77	$12.40	$10.36																																																																																																																																																																																																																			
0613	Level 2 Type A Emergency Visits	V	1.2667	$87.25	$20.97	$17.45																																																																																																																																																																																																																			
0614	Level 3 Type A Emergency Visits	V	2.0201	$139.14	$34.33	$27.83																																																																																																																																																																																																																			
0615	Level 4 Type A Emergency Visits	V	3.2316	$222.58	$48.48	$44.52																																																																																																																																																																																																																			
0616	Level 5 Type A Emergency Visits	V	4.7846	$329.54	$72.86	$65.91																																																																																																																																																																																																																			
0617	Critical Care	S	6.7477	$464.75	$104.95	$92.95																																																																																																																																																																																																																			
0618	Trauma Response with Critical Care	S	13.4224	$924.48	.	$184.90																																																																																																																																																																																																																			
0621	Level I Vascular Access Procedures	T	11.3694	$783.08	.	$156.62																																																																																																																																																																																																																			
0622	Level II Vascular Access Procedures	T	25.6718	"$1,768.17"	.	$353.64																																																																																																																																																																																																																			
0623	Level III Vascular Access Procedures	T	30.7762	"$2,119.74"	.	$423.95																																																																																																																																																																																																																			
0624	Phlebotomy and Minor Vascular Access Device Procedures	X	0.6328	$43.58	$12.65	$8.72																																																																																																																																																																																																																			
0626	Level 1 Type B Emergency Visits	V	0.6005	$41.36	.	$8.28																																																																																																																																																																																																																			
0627	Level 2 Type B Emergency Visits	V	0.8599	$59.23	.	$11.85																																																																																																																																																																																																																			
0628	Level 3 Type B Emergency Visits	V	1.4740	$101.52	.	$20.31																																																																																																																																																																																																																			
0629	Level 4 Type B Emergency Visits	V	2.4026	$165.48	.	$33.10																																																																																																																																																																																																																			
0630	Level 5 Type B Emergency Visits	V	3.9671	$273.24	.	$54.65																																																																																																																																																																																																																			
0648	Level IV Breast Surgery	T	63.9911	"$4,407.45"	.	$881.49																																																																																																																																																																																																																			
0651	Complex Interstitial Radiation Source Application	S	16.3985	"$1,129.46"	.	$225.90																																																																																																																																																																																																																			
0652	Insertion of Intraperitoneal and Pleural Catheters	T	31.0010	"$2,135.22"	.	$427.05																																																																																																																																																																																																																			
0653	Vascular Reconstruction/Fistula Repair with Device	T	45.1001	"$3,106.31"	.	$621.27																																																																																																																																																																																																																			
0654	Insertion/Replacement of a permanent dual chamber pacemaker	T	108.0987	"$7,445.41"	.	"$1,489.09"																																																																																																																																																																																																																			
0655	Insertion/Replacement/Conversion of a permanent dual chamber pacemaker	T	137.7042	"$9,484.51"	.	"$1,896.91"																																																																																																																																																																																																																			
0656	Transcatheter Placement of Intracoronary Drug-Eluting Stents	T	105.6783	"$7,278.70"	.	"$1,455.74"																																																																																																																																																																																																																			
0659	Hyperbaric Oxygen	S	1.5244	$104.99	.	$21.00																																																																																																																																																																																																																			
0660	Level II Otorhinolaryngologic Function Tests	X	1.4693	$101.20	$27.10	$20.24																																																																																																																																																																																																																			
0661	Level V Pathology	X	2.1892	$150.78	.	$30.16																																																																																																																																																																																																																			
0662	CT Angiography	S	4.9151	$338.53	$114.37	$67.71																																																																																																																																																																																																																			
0664	Level I Proton Beam Radiation Therapy	S	14.9792	"$1,031.71"	.	$206.35																																																																																																																																																																																																																			
0665	Bone Density:AppendicularSkeleton	S	0.4662	$32.11	$0.00	$0.00																																																																																																																																																																																																																			
0667	Level II Proton Beam Radiation Therapy	S	19.5948	"$1,349.61"	.	$269.93																																																																																																																																																																																																																			
0668	Level I Angiography and Venography	S	10.4347	$718.70	.	$143.74																																																																																																																																																																																																																			
0672	Level III Posterior Segment Eye Procedures	T	40.9566	"$2,820.93"	.	$564.19																																																																																																																																																																																																																			
0673	Level V Anterior Segment Eye Procedures	T	43.2387	"$2,978.11"	$649.56	$595.63																																																																																																																																																																																																																			
0674	Prostate Cryoablation	T	116.4217	"$8,018.66"	.	"$1,603.74"																																																																																																																																																																																																																			
0676	Thrombolysis and Other Device Revisions 	T	2.3474	$161.68	.	$32.34																																																																																																																																																																																																																			
0678	External Counterpulsation	T	1.4754	$101.62	.	$20.33																																																																																																																																																																																																																			
0679	Level II Resuscitation and Cardioversion	S	5.4006	$371.97	$95.30	$74.40																																																																																																																																																																																																																			
0680	Insertion of Patient Activated Event Recorders	S	78.3883	"$5,399.07"	.	"$1,079.82"																																																																																																																																																																																																																			
0683	Level II Photochemotherapy	S	2.9132	$200.65	.	$40.13																																																																																																																																																																																																																			
0685	Level III Needle Biopsy/Aspiration Except Bone Marrow	T	9.7353	$670.53	.	$134.11																																																																																																																																																																																																																			
0687	Revision/Removal of Neurostimulator Electrodes	T	21.7224	"$1,496.15"	$397.37	$299.23																																																																																																																																																																																																																			
0688	Revision/Removal of Neurostimulator Pulse Generator Receiver	T	29.0860	"$2,003.33"	$768.94	$400.67																																																																																																																																																																																																																			
0690	Level I Electronic Analysis of Devices	S	0.5093	$35.08	$8.67	$7.02																																																																																																																																																																																																																			
0691	Level III Electronic Analysis of Devices	S	2.4221	$166.82	.	$33.37																																																																																																																																																																																																																			
0692	Level II Electronic Analysis of Devices	S	1.6109	$110.95	.	$22.19																																																																																																																																																																																																																			
0694	Mohs Surgery	T	5.3665	$369.62	$91.69	$73.93																																																																																																																																																																																																																			
0697	Level I Echocardiogram Without Contrast 	S	3.0827	$212.32	.	$42.47																																																																																																																																																																																																																			
0698	Level II Eye Tests & Treatments	S	0.9697	$66.79	.	$13.36																																																																																																																																																																																																																			
0699	Level IV Eye Tests & Treatments	T	16.7862	"$1,156.17"	.	$231.24																																																																																																																																																																																																																			
0701	Sr89 strontium	K		$874.94	.	$174.99																																																																																																																																																																																																																			
0726	Dexrazoxane HCl injection	K		$207.22	.	$41.45																																																																																																																																																																																																																			
0728	Filgrastim 300 mcg injection	K		$231.22	.	$46.25																																																																																																																																																																																																																			
0731	Sargramostim injection	K		$23.65	.	$4.73																																																																																																																																																																																																																			
0735	Ampho b cholesteryl sulfate	K		$11.89	.	$2.38																																																																																																																																																																																																																			
0736	Amphotericin b liposome inj	K		$15.53	.	$3.11																																																																																																																																																																																																																			
0738	Rasburicase	K		$177.57	.	$35.52																																																																																																																																																																																																																			
0747	Chlorothiazide sodium inj	K		$432.82	.	$86.57																																																																																																																																																																																																																			
0751	Mechlorethamine hcl inj	K		$153.01	.	$30.61																																																																																																																																																																																																																			
0752	Dactinomycin injection	K		$586.82	.	$117.37																																																																																																																																																																																																																			
0759	"Naltrexone, depot form"	K		$2.36	.	$0.48																																																																																																																																																																																																																			
0800	Leuprolide acetate	K		$520.49	.	$104.10																																																																																																																																																																																																																			
0802	Etoposide oral	K		$28.21	.	$5.65																																																																																																																																																																																																																			
0807	Aldesleukin injection	K		$913.37	.	$182.68																																																																																																																																																																																																																			
0809	Bcg live intravesical vac	K		$113.85	.	$22.77																																																																																																																																																																																																																			
0810	Goserelin acetate implant	K		$192.46	.	$38.50																																																																																																																																																																																																																			
0812	Carmustine injection	K		$174.22	.	$34.85																																																																																																																																																																																																																			
0814	Asparaginase injection	K		$62.87	.	$12.58																																																																																																																																																																																																																			
0820	Daunorubicin injection	K		$15.35	.	$3.07																																																																																																																																																																																																																			
0821	Daunorubicin citrate inj	K		$57.12	.	$11.43																																																																																																																																																																																																																			
0823	Docetaxel injection	K		$17.84	.	$3.57																																																																																																																																																																																																																			
0825	Nelarabine injection	K		$108.42	.	$21.69																																																																																																																																																																																																																			
0827	Floxuridine injection	K		$41.33	.	$8.27																																																																																																																																																																																																																			
0828	Gemcitabine hcl injection	K		$146.95	.	$29.39																																																																																																																																																																																																																			
0830	Irinotecan injection	K		$6.07	.	$1.22																																																																																																																																																																																																																			
0831	Ifosfomide injection	K		$33.82	.	$6.77																																																																																																																																																																																																																			
0832	Idarubicin hcl injection	K		$102.98	.	$20.60																																																																																																																																																																																																																			
0835	Cosyntropin injection NOS	K		$69.81	.	$13.97																																																																																																																																																																																																																			
0836	Interferon alfa-2b inj	K		$15.91	.	$3.19																																																																																																																																																																																																																			
0838	Interferon gamma 1-b inj	K		$426.87	.	$85.38																																																																																																																																																																																																																			
0840	Inj melphalan hydrochl	K		"$1,388.61"	.	$277.73																																																																																																																																																																																																																			
0842	Fludarabine phosphate inj	K		$138.26	.	$27.66																																																																																																																																																																																																																			
0843	Pegaspargase injection	K		"$2,460.13"	.	$492.03																																																																																																																																																																																																																			
0844	Pentostatin injection	K		"$1,217.22"	.	$243.45																																																																																																																																																																																																																			
0849	Rituximab injection	K		$588.27	.	$117.66																																																																																																																																																																																																																			
0850	Streptozocin injection	K		$275.09	.	$55.02																																																																																																																																																																																																																			
0851	Thiotepa injection	K		$113.01	.	$22.61																																																																																																																																																																																																																			
0856	Porfimer sodium injection	K		"$2,907.23"	.	$581.45																																																																																																																																																																																																																			
0858	Inj cladribine	K		$24.10	.	$4.82																																																																																																																																																																																																																			
0861	Leuprolide acetate injeciton	K		$4.74	.	$0.95																																																																																																																																																																																																																			
0864	Mitoxantrone hydrochl	K		$40.45	.	$8.09																																																																																																																																																																																																																			
0865	Interferon alfa-n3 inj	K		$18.06	.	$3.62																																																																																																																																																																																																																			
0868	Oral aprepitant	K		$5.79	.	$1.16																																																																																																																																																																																																																			
0873	Hyalgan/supartz inj per dose	K		$89.67	.	$17.94																																																																																																																																																																																																																			
0874	Synvisc or synvisc-one	K		$11.83	.	$2.37																																																																																																																																																																																																																			
0875	Euflexxa inj per dose	K		$125.97	.	$25.20																																																																																																																																																																																																																			
0877	Orthovisc inj per dose	K		$173.45	.	$34.69																																																																																																																																																																																																																			
0878	Gallium nitrate injection	K		$2.01	.	$0.41																																																																																																																																																																																																																			
0884	Rho d immune globulin inj	K		$83.54	.	$16.71																																																																																																																																																																																																																			
0887	Azathioprine parenteral	K		$102.84	.	$20.57																																																																																																																																																																																																																			
0890	Lymphocyte immune globulin	K		$492.26	.	$98.46																																																																																																																																																																																																																			
0900	Alglucerase injection	K		$41.58	.	$8.32																																																																																																																																																																																																																			
0901	Alpha 1 proteinase inhibitor	K		$3.72	.	$0.75																																																																																																																																																																																																																			
0902	"Injection,onabotulinumtoxinA"	K		$5.44	.	$1.09																																																																																																																																																																																																																			
0903	Cytomegalovirus imm IV /vial	K		$870.53	.	$174.11																																																																																																																																																																																																																			
0910	Interferon beta-1b / .25 MG	K		$182.83	.	$36.57																																																																																																																																																																																																																			
0913	Ganciclovir long act implant	K		"$16,800.00"	.	"$3,360.00"																																																																																																																																																																																																																			
0917	Adenosine injection	K		$84.21	.	$16.85																																																																																																																																																																																																																			
0925	Factor viii	K		$0.88	.	$0.18																																																																																																																																																																																																																			
0927	Factor viii recombinant	K		$1.09	.	$0.22																																																																																																																																																																																																																			
0928	Factor ix complex	K		$0.88	.	$0.18																																																																																																																																																																																																																			
0929	Anti-inhibitor	K		$1.58	.	$0.32																																																																																																																																																																																																																			
0931	Factor IX non-recombinant	K		$0.89	.	$0.18																																																																																																																																																																																																																			
0932	Factor IX recombinant	K		$1.11	.	$0.23																																																																																																																																																																																																																			
0933	Gamma globulin > 10 CC inj	K		$187.06	.	$37.42																																																																																																																																																																																																																			
0934	"Capecitabine, oral"	K		$22.37	.	$4.48																																																																																																																																																																																																																			
0935	Clonidine hydrochloride	K		$24.52	.	$4.91																																																																																																																																																																																																																			
0943	Octagam injection	K		$36.42	.	$7.29																																																																																																																																																																																																																			
0944	Gammagard liquid injection	K		$38.13	.	$7.63																																																																																																																																																																																																																			
0945	Rhophylac injection	K		$5.13	.	$1.03																																																																																																																																																																																																																			
0946	Hepagam b im injection	K		$50.43	.	$10.09																																																																																																																																																																																																																			
0947	Flebogamma injection	K		$35.79	.	$7.16																																																																																																																																																																																																																			
0948	Gamunex injection	K		$37.29	.	$7.46																																																																																																																																																																																																																			
0949	"Frozen plasma, pooled, sd"	R	0.8848	$60.94	.	$12.19																																																																																																																																																																																																																			
0950	Whole blood for transfusion	R	2.9448	$202.83	.	$40.57																																																																																																																																																																																																																			
0951	Reclast injection	K		$220.55	.	$44.11																																																																																																																																																																																																																			
0952	Cryoprecipitate each unit	R	0.7330	$50.49	.	$10.10																																																																																																																																																																																																																			
0954	RBC leukocytes reduced	R	2.8292	$194.86	.	$38.98																																																																																																																																																																																																																			
0955	"Plasma, frz between 8-24hour"	R	1.0620	$73.15	.	$14.63																																																																																																																																																																																																																			
0956	"Plasma protein fract,5%,50ml"	R	0.4019	$27.68	.	$5.54																																																																																																																																																																																																																			
0957	"Platelets, each unit"	R	1.0780	$74.25	.	$14.85																																																																																																																																																																																																																			
0958	Plaelet rich plasma unit	R	2.0756	$142.96	.	$28.60																																																																																																																																																																																																																			
0959	Red blood cells unit	R	2.2405	$154.32	.	$30.87																																																																																																																																																																																																																			
0960	Washed red blood cells unit	R	4.1493	$285.79	.	$57.16																																																																																																																																																																																																																			
0961	"Albumin (human),5%, 50ml"	K		$20.37	.	$4.08																																																																																																																																																																																																																			
0963	"Albumin (human), 5%, 250 ml"	K		$67.07	.	$13.42																																																																																																																																																																																																																			
0964	"Albumin (human), 25%, 20 ml"	K		$29.16	.	$5.84																																																																																																																																																																																																																			
0965	"Albumin (human), 25%, 50ml"	K		$70.39	.	$14.08																																																																																																																																																																																																																			
0966	"Plasmaprotein fract,5%,250ml"	R	1.4345	$98.80	.	$19.76																																																																																																																																																																																																																			
0967	Blood split unit	R	3.0703	$211.47	.	$42.30																																																																																																																																																																																																																			
0968	Platelets leukoreduced irrad	R	2.0647	$142.21	.	$28.45																																																																																																																																																																																																																			
0969	RBC leukoreduced irradiated	R	3.5983	$247.84	.	$49.57																																																																																																																																																																																																																			
1009	Cryoprecipitatereducedplasma	R	1.2488	$86.01	.	$17.21																																																																																																																																																																																																																			
1010	"Blood, l/r, cmv-neg"	R	2.6086	$179.67	.	$35.94																																																																																																																																																																																																																			
1011	"Platelets, hla-m, l/r, unit"	R	11.8651	$817.22	.	$163.45																																																																																																																																																																																																																			
1013	Platelets leukocytes reduced	R	1.6045	$110.51	.	$22.11																																																																																																																																																																																																																			
1015	Injection glatiramer acetate	K		$93.19	.	$18.64																																																																																																																																																																																																																			
1016	"Blood, l/r, froz/degly/wash"	R	1.6688	$114.94	.	$22.99																																																																																																																																																																																																																			
1017	"Plt, aph/pher, l/r, cmv-neg"	R	6.4027	$440.99	.	$88.20																																																																																																																																																																																																																			
1018	"Blood, l/r, irradiated"	R	2.4995	$172.16	.	$34.44																																																																																																																																																																																																																			
1019	Plate pheres leukoredu irrad	R	9.5146	$655.33	.	$131.07																																																																																																																																																																																																																			
1020	"Plt, pher, l/r cmv-neg, irr"	R	9.0642	$624.31	.	$124.87																																																																																																																																																																																																																			
1021	"RBC, frz/deg/wsh, l/r, irrad"	R	4.3260	$297.96	.	$59.60																																																																																																																																																																																																																			
1022	"RBC, l/r, cmv-neg, irrad"	R	4.1488	$285.75	.	$57.15																																																																																																																																																																																																																			
1023	Pralidoxime chloride inj	K		$89.82	.	$17.97																																																																																																																																																																																																																			
1052	"Injection, voriconazole"	K		$5.88	.	$1.18																																																																																																																																																																																																																			
1064	"I131 iodide cap, rx"	K		$17.58	.	$3.52																																																																																																																																																																																																																			
1083	Adalimumab injection	K		$384.61	.	$76.93																																																																																																																																																																																																																			
1084	Denileukin diftitox inj	K		"$1,526.44"	.	$305.29																																																																																																																																																																																																																			
1086	Temozolomide	K		$9.07	.	$1.82																																																																																																																																																																																																																			
1138	"Hepagam b intravenous, inj"	K		$50.43	.	$10.09																																																																																																																																																																																																																			
1139	Protein c concentrate	K		$12.43	.	$2.49																																																																																																																																																																																																																			
1142	Supprelin LA implant	K		"$15,141.06"	.	"$3,028.22"																																																																																																																																																																																																																			
1150	"I131 iodide sol, rx"	K		$13.26	.	$2.66																																																																																																																																																																																																																			
1166	Cytarabine liposome inj	K		$466.07	.	$93.22																																																																																																																																																																																																																			
1167	"Inj, epirubicin hcl"	K		$1.78	.	$0.36																																																																																																																																																																																																																			
1168	"Inj, temsirolimus"	K		$50.35	.	$10.07																																																																																																																																																																																																																			
1178	Busulfan injection	K		$16.45	.	$3.29																																																																																																																																																																																																																			
1203	Verteporfin injection	K		$9.49	.	$1.90																																																																																																																																																																																																																			
1207	"Octreotide injection, depot"	K		$110.99	.	$22.20																																																																																																																																																																																																																			
1213	Antihemophilic viii/vwf comp	K		$0.91	.	$0.19																																																																																																																																																																																																																			
1214	Inj IVIG privigen 500 mg	K		$34.76	.	$6.96																																																																																																																																																																																																																			
1220	Calcitonin salmon injection	K		$51.46	.	$10.30																																																																																																																																																																																																																			
1221	Dimethyl sulfoxide 50%	K		$70.46	.	$14.10																																																																																																																																																																																																																			
1222	Pentastarch 10% solution	K		$160.29	.	$32.06																																																																																																																																																																																																																			
1226	Inj streptokinase /250000 IU	K		$47.57	.	$9.52																																																																																																																																																																																																																			
1232	Mitomycin 5 MG inj	K		$20.57	.	$4.12																																																																																																																																																																																																																			
1235	Valrubicin injection	K		$954.10	.	$190.82																																																																																																																																																																																																																			
1236	Levoleucovorin injection	G		$1.14	.	$0.23																																																																																																																																																																																																																			
1237	Inj iron dextran	K		$11.88	.	$2.38																																																																																																																																																																																																																			
1238	Topotecan oral	G		$77.10	.	$15.27																																																																																																																																																																																																																			
1239	Rotavirus vacc 2 dose oral	K		$101.53	.	$20.31																																																																																																																																																																																																																			
1240	Apligraf skin sub	K		$33.77	.	$6.76																																																																																																																																																																																																																			
1241	Oasis wound matrix skin sub	K		$4.38	.	$0.88																																																																																																																																																																																																																			
1242	Oasis burn matrix skin sub	K		$4.38	.	$0.88																																																																																																																																																																																																																			
1243	Integra BMWD skin sub	K		$14.91	.	$2.99																																																																																																																																																																																																																			
1244	Integra DRT skin sub	K		$10.13	.	$2.03																																																																																																																																																																																																																			
1245	Dermagraft skin sub	K		$39.73	.	$7.95																																																																																																																																																																																																																			
1246	Graftjacket skin sub	K		$94.23	.	$18.85																																																																																																																																																																																																																			
1247	Integra matrix skin sub	K		$19.04	.	$3.81																																																																																																																																																																																																																			
1248	Primatrix skin sub	K		$34.71	.	$6.95																																																																																																																																																																																																																			
1249	Cymetra allograft	K		$350.04	.	$70.01																																																																																																																																																																																																																			
1250	Graftjacket express allograf	K		$350.04	.	$70.01																																																																																																																																																																																																																			
1251	Integra flowable wound matri	K		$948.50	.	$189.70																																																																																																																																																																																																																			
1252	Gammagraft skin sub	K		$7.03	.	$1.41																																																																																																																																																																																																																			
1253	Triamcinolone A inj PRS-free	K		$3.19	.	$0.64																																																																																																																																																																																																																			
1254	"Adenovirus vaccine, type 4"	K		$23.24	.	$4.65																																																																																																																																																																																																																			
1255	"Rotovirus vacc 3 dose, oral"	K		$73.07	.	$14.62																																																																																																																																																																																																																			
1256	Brompheniramine maleate inj	K		$7.50	.	$1.50																																																																																																																																																																																																																			
1263	Antithrombin iii injection	K		$2.51	.	$0.51																																																																																																																																																																																																																			
1266	Interferon alfacon-1 inj	K		$6.49	.	$1.30																																																																																																																																																																																																																			
1268	Xyntha inj	K		$1.05	.	$0.21																																																																																																																																																																																																																			
1270	Alloderm skin sub	K		$32.31	.	$6.47																																																																																																																																																																																																																			
1272	Acetylcysteine injection	K		$2.69	.	$0.54																																																																																																																																																																																																																			
1274	Edetate calcium disodium inj	K		$194.86	.	$38.98																																																																																																																																																																																																																			
1275	"Vivaglobin, inj"	K		$7.10	.	$1.42																																																																																																																																																																																																																			
1279	Factor VIII (porcine)	K		$1.17	.	$0.24																																																																																																																																																																																																																			
1280	Corticotropin injection	K		"$2,418.30"	.	$483.66																																																																																																																																																																																																																			
1281	Bevacizumab injection	K		$1.45	.	$0.29																																																																																																																																																																																																																			
1285	Nandrolone decanoate 50 MG	K		$9.27	.	$1.86																																																																																																																																																																																																																			
1287	Alloskin skin sub	K		$6.63	.	$1.33																																																																																																																																																																																																																			
1288	Visualization adjunct	K		$1.44	.	$0.29																																																																																																																																																																																																																			
1289	AbobotulinumtoxinA	K		$7.62	.	$1.53																																																																																																																																																																																																																			
1290	Human fibrinogen conc inj	G		$72.89	.	$14.44																																																																																																																																																																																																																			
1291	Rilonacept injection	K		$23.86	.	$4.78																																																																																																																																																																																																																			
1295	Sm 153 lexidronam	K		"$7,484.58"	.	"$1,496.92"																																																																																																																																																																																																																			
1296	Degarelix injection	G		$2.52	.	$0.50																																																																																																																																																																																																																			
1297	"Ferumoxytol, non-esrd"	G		$0.77	.	$0.15																																																																																																																																																																																																																			
1298	Cosyntropin cortrosyn inj	K		$82.31	.	$16.47																																																																																																																																																																																																																			
1299	Gadofosveset trisodium inj	G		$12.82		$0.00																																																																																																																																																																																																																			
1302	Inj benztropine mesylate	K		$58.24	.	$11.65																																																																																																																																																																																																																			
1304	Perphenazine injeciton	K		$30.91	.	$6.19																																																																																																																																																																																																																			
1306	Urea injection	K		$82.18	.	$16.44																																																																																																																																																																																																																			
1307	Oral busulfan	K		$3.66	.	$0.74																																																																																																																																																																																																																			
1308	Mecasermin injection	K		$20.37	.	$4.08																																																																																																																																																																																																																			
1309	Paclitaxel injection	K		$7.38	.	$1.48																																																																																																																																																																																																																			
1311	Canakinumab injection	K		$88.62	.	$17.73																																																																																																																																																																																																																			
1312	Hizentra injection	K		$13.23	.	$2.65																																																																																																																																																																																																																			
1327	Imiglucerase injection	K		$41.58	.	$8.32																																																																																																																																																																																																																			
1331	Olanzapine long-acting inj	K		$2.73	.	$0.55																																																																																																																																																																																																																			
1332	Antithrombin recombinant	K		$2.93	.	$0.59																																																																																																																																																																																																																			
1338	"Methyl aminolevulinate, top"	K		$0.72	.	$0.15																																																																																																																																																																																																																			
1339	Oral fludarabine phosphate	G		$80.14	.	$15.88																																																																																																																																																																																																																			
1340	"Collagenase, clost hist inj"	G		$37.51	.	$7.43																																																																																																																																																																																																																			
1342	Matristem micromatrix	K		$1.80	.	$0.36																																																																																																																																																																																																																			
1345	Theraskin	K		$21.27	.	$4.26																																																																																																																																																																																																																			
1346	Penicillin g procaine inj	K		$11.59	.	$2.32																																																																																																																																																																																																																			
1347	Oxacillin sodium injeciton	K		$2.18	.	$0.44																																																																																																																																																																																																																			
1348	Sincalide injection	K		$71.95	.	$14.39																																																																																																																																																																																																																			
1349	Anidulafungin injection	K		$1.13	.	$0.23																																																																																																																																																																																																																			
1350	Topotecan injection	K		$27.01	.	$5.41																																																																																																																																																																																																																			
1491	New Technology  - Level IA ($0-$10)	S		$5.00	.	$1.00																																																																																																																																																																																																																			
1492	New Technology  - Level IB ($10-$20)	S		$15.00	.	$3.00																																																																																																																																																																																																																			
1493	New Technology  - Level IC ($20-$30)	S		$25.00	.	$5.00																																																																																																																																																																																																																			
1494	New Technology  - Level ID ($30-$40)	S		$35.00	.	$7.00																																																																																																																																																																																																																			
1495	New Technology  - Level IE ($40-$50)	S		$45.00	.	$9.00																																																																																																																																																																																																																			
1496	New Technology  - Level IA ($0-$10)	T		$5.00	.	$1.00																																																																																																																																																																																																																			
1497	New Technology  - Level IB($10-$20)	T		$15.00	.	$3.00																																																																																																																																																																																																																			
1498	New Technology  - Level IC ($20-$30)	T		$25.00	.	$5.00																																																																																																																																																																																																																			
1499	New Technology  - Level ID($30-$40)	T		$35.00	.	$7.00																																																																																																																																																																																																																			
1500	New Technology  - Level IE ($40-$50)	T		$45.00	.	$9.00																																																																																																																																																																																																																			
1502	New Technology - Level II   ($50 - $100)	S		$75.00	.	$15.00																																																																																																																																																																																																																			
1503	New Technology - Level III   ($100 - $200)	S		$150.00	.	$30.00																																																																																																																																																																																																																			
1504	New Technology - Level IV  ($200 - $300)	S		$250.00	.	$50.00																																																																																																																																																																																																																			
1505	New Technology - Level V   ($300 - $400)	S		$350.00	.	$70.00																																																																																																																																																																																																																			
1506	New Technology - Level VI  ($400 - $500)	S		$450.00	.	$90.00																																																																																																																																																																																																																			
1507	New Technology - Level VII  ($500 - $600)	S		$550.00	.	$110.00																																																																																																																																																																																																																			
1508	New Technology - Level VIII ($600 - $700)	S		$650.00	.	$130.00																																																																																																																																																																																																																			
1509	New Technology - Level IX   ($700 - $800)	S		$750.00	.	$150.00																																																																																																																																																																																																																			
1510	New Technology - Level X    ($800 - $900)	S		$850.00	.	$170.00																																																																																																																																																																																																																			
1511	New Technology - Level XI   ($900 - $1000)	S		$950.00	.	$190.00																																																																																																																																																																																																																			
1512	New Technology - Level XII  ($1000 - $1100)	S		"$1,050.00"	.	$210.00																																																																																																																																																																																																																			
1513	New Technology - Level XIII  ($1100 - $1200)	S		"$1,150.00"	.	$230.00																																																																																																																																																																																																																			
1514	New Technology - Level XIV ($1200- $1300)	S		"$1,250.00"	.	$250.00																																																																																																																																																																																																																			
1515	New Technology - Level XV ($1300 - $1400)	S		"$1,350.00"	.	$270.00																																																																																																																																																																																																																			
1516	New Technology - Level XVI  ($1400 - $1500)	S		"$1,450.00"	.	$290.00																																																																																																																																																																																																																			
1517	New Technology - Level XVII ($1500-$1600)	S		"$1,550.00"	.	$310.00																																																																																																																																																																																																																			
1518	New Technology - Level XVIII ($1600-$1700)	S		"$1,650.00"	.	$330.00																																																																																																																																																																																																																			
1519	New Technology - Level IXX ($1700-$1800)	S		"$1,750.00"	.	$350.00																																																																																																																																																																																																																			
1520	New Technology - Level XX ($1800-$1900)	S		"$1,850.00"	.	$370.00																																																																																																																																																																																																																			
1521	New Technology - Level XXI ($1900-$2000)	S		"$1,950.00"	.	$390.00																																																																																																																																																																																																																			
1522	New Technology - Level XXII ($2000-$2500)	S		"$2,250.00"	.	$450.00																																																																																																																																																																																																																			
1523	New Technology - Level XXIII ($2500-$3000)	S		"$2,750.00"	.	$550.00																																																																																																																																																																																																																			
1524	New Technology - Level XXIV ($3000-$3500)	S		"$3,250.00"	.	$650.00																																																																																																																																																																																																																			
1525	New Technology - Level XXV ($3500-$4000)	S		"$3,750.00"	.	$750.00																																																																																																																																																																																																																			
1526	New Technology - Level XXVI ($4000-$4500)	S		"$4,250.00"	.	$850.00																																																																																																																																																																																																																			
1527	New Technology - Level XXVII ($4500-$5000)	S		"$4,750.00"	.	$950.00																																																																																																																																																																																																																			
1528	New Technology - Level XXVIII ($5000-$5500)	S		"$5,250.00"	.	"$1,050.00"																																																																																																																																																																																																																			
1529	New Technology - Level XXIX ($5500-$6000)	S		"$5,750.00"	.	"$1,150.00"																																																																																																																																																																																																																			
1530	New Technology - Level XXX ($6000-$6500)	S		"$6,250.00"	.	"$1,250.00"																																																																																																																																																																																																																			
1531	New Technology - Level XXXI ($6500-$7000)	S		"$6,750.00"	.	"$1,350.00"																																																																																																																																																																																																																			
1532	New Technology - Level XXXII ($7000-$7500)	S		"$7,250.00"	.	"$1,450.00"																																																																																																																																																																																																																			
1533	New Technology - Level XXXIII ($7500-$8000)	S		"$7,750.00"	.	"$1,550.00"																																																																																																																																																																																																																			
1534	New Technology - Level XXXIV ($8000-$8500)	S		"$8,250.00"	.	"$1,650.00"																																																																																																																																																																																																																			
1535	New Technology - Level XXXV ($8500-$9000)	S		"$8,750.00"	.	"$1,750.00"																																																																																																																																																																																																																			
1536	New Technology - Level XXXVI ($9000-$9500)	S		"$9,250.00"	.	"$1,850.00"																																																																																																																																																																																																																			
1537	New Technology - Level XXXVII ($9500-$10000)	S		"$9,750.00"	.	"$1,950.00"																																																																																																																																																																																																																			
1539	New Technology - Level II   ($50 - $100)	T		$75.00	.	$15.00																																																																																																																																																																																																																			
1540	New Technology - Level III   ($100 - $200)	T		$150.00	.	$30.00																																																																																																																																																																																																																			
1541	New Technology - Level IV  ($200 - $300)	T		$250.00	.	$50.00																																																																																																																																																																																																																			
1542	New Technology - Level V   ($300 - $400)	T		$350.00	.	$70.00																																																																																																																																																																																																																			
1543	New Technology - Level VI  ($400 - $500)	T		$450.00	.	$90.00																																																																																																																																																																																																																			
1544	New Technology - Level VII  ($500 - $600)	T		$550.00	.	$110.00																																																																																																																																																																																																																			
1545	New Technology - Level VIII ($600 - $700)	T		$650.00	.	$130.00																																																																																																																																																																																																																			
1546	New Technology - Level IX   ($700 - $800)	T		$750.00	.	$150.00																																																																																																																																																																																																																			
1547	New Technology - Level X    ($800 - $900)	T		$850.00	.	$170.00																																																																																																																																																																																																																			
1548	New Technology - Level XI   ($900 - $1000)	T		$950.00	.	$190.00																																																																																																																																																																																																																			
1549	New Technology - Level XII  ($1000 - $1100)	T		"$1,050.00"	.	$210.00																																																																																																																																																																																																																			
1550	New Technology - Level XIII  ($1100 - $1200)	T		"$1,150.00"	.	$230.00																																																																																																																																																																																																																			
1551	New Technology - Level XIV ($1200- $1300)	T		"$1,250.00"	.	$250.00																																																																																																																																																																																																																			
1552	New Technology - Level XV ($1300 - $1400)	T		"$1,350.00"	.	$270.00																																																																																																																																																																																																																			
1553	New Technology - Level XVI  ($1400 - $1500)	T		"$1,450.00"	.	$290.00																																																																																																																																																																																																																			
1554	New Technology - Level XVII ($1500-$1600)	T		"$1,550.00"	.	$310.00																																																																																																																																																																																																																			
1555	New Technology - Level XVIII ($1600-$1700)	T		"$1,650.00"	.	$330.00																																																																																																																																																																																																																			
1556	New Technology - Level XIX ($1700-$1800)	T		"$1,750.00"	.	$350.00																																																																																																																																																																																																																			
1557	New Technology - Level XX ($1800-$1900)	T		"$1,850.00"	.	$370.00																																																																																																																																																																																																																			
1558	New Technology - Level XXI ($1900-$2000)	T		"$1,950.00"	.	$390.00																																																																																																																																																																																																																			
1559	New Technology - Level XXII ($2000-$2500)	T		"$2,250.00"	.	$450.00																																																																																																																																																																																																																			
1560	New Technology - Level XXIII ($2500-$3000)	T		"$2,750.00"	.	$550.00																																																																																																																																																																																																																			
1561	New Technology - Level XXIV ($3000-$3500)	T		"$3,250.00"	.	$650.00																																																																																																																																																																																																																			
1562	New Technology - Level XXV ($3500-$4000)	T		"$3,750.00"	.	$750.00																																																																																																																																																																																																																			
1563	New Technology - Level XXVI ($4000-$4500)	T		"$4,250.00"	.	$850.00																																																																																																																																																																																																																			
1564	New Technology - Level XXVII ($4500-$5000)	T		"$4,750.00"	.	$950.00																																																																																																																																																																																																																			
1565	New Technology - Level XXVIII ($5000-$5500)	T		"$5,250.00"	.	"$1,050.00"																																																																																																																																																																																																																			
1566	New Technology - Level XXIX ($5500-$6000)	T		"$5,750.00"	.	"$1,150.00"																																																																																																																																																																																																																			
1567	New Technology - Level XXX ($6000-$6500)	T		"$6,250.00"	.	"$1,250.00"																																																																																																																																																																																																																			
1568	New Technology - Level XXXI ($6500-$7000)	T		"$6,750.00"	.	"$1,350.00"																																																																																																																																																																																																																			
1569	New Technology - Level XXXII ($7000-$7500)	T		"$7,250.00"	.	"$1,450.00"																																																																																																																																																																																																																			
1570	New Technology - Level XXXIII ($7500-$8000)	T		"$7,750.00"	.	"$1,550.00"																																																																																																																																																																																																																			
1571	New Technology - Level XXXIV ($8000-$8500)	T		"$8,250.00"	.	"$1,650.00"																																																																																																																																																																																																																			
1572	New Technology - Level XXXV ($8500-$9000)	T		"$8,750.00"	.	"$1,750.00"																																																																																																																																																																																																																			
1573	New Technology - Level XXXVI ($9000-$9500)	T		"$9,250.00"	.	"$1,850.00"																																																																																																																																																																																																																			
1574	New Technology - Level XXXVII ($9500-$10000)	T		"$9,750.00"	.	"$1,950.00"																																																																																																																																																																																																																			
1605	Abciximab injection	K		$486.03	.	$97.21																																																																																																																																																																																																																			
1607	Eptifibatide injection	K		$19.91	.	$3.99																																																																																																																																																																																																																			
1608	Etanercept injection	K		$198.44	.	$39.69																																																																																																																																																																																																																			
1609	"Rho(D) immune globulin h, sd"	K		$17.25	.	$3.45																																																																																																																																																																																																																			
1612	"Daclizumab, parenteral"	K		$521.38	.	$104.28																																																																																																																																																																																																																			
1613	Trastuzumab injection	K		$67.64	.	$13.53																																																																																																																																																																																																																			
1630	"Hep b ig, im"	K		$114.18	.	$22.84																																																																																																																																																																																																																			
1631	Baclofen intrathecal trial	K		$72.46	.	$14.50																																																																																																																																																																																																																			
1633	Alefacept	K		$33.05	.	$6.61																																																																																																																																																																																																																			
1643	"Y90 ibritumomab, rx"	K		"$30,717.68"	.	"$6,143.54"																																																																																																																																																																																																																			
1645	"I131 tositumomab, rx"	K		"$29,697.39"	.	"$5,939.48"																																																																																																																																																																																																																			
1670	Tetanus immune globulin inj	K		$230.10	.	$46.02																																																																																																																																																																																																																			
1675	P32 Na phosphate	K		$162.87	.	$32.58																																																																																																																																																																																																																			
1676	P32 chromic phosphate	K		$154.15	.	$30.83																																																																																																																																																																																																																			
1683	Basiliximab	K		"$2,017.51"	.	$403.51																																																																																																																																																																																																																			
1684	Corticorelin ovine triflutal	K		$4.77	.	$0.96																																																																																																																																																																																																																			
1685	"Darbepoetin alfa, non-esrd"	K		$2.87	.	$0.58																																																																																																																																																																																																																			
1686	"Epoetin alfa, non-esrd"	K		$9.59	.	$1.92																																																																																																																																																																																																																			
1687	Digoxin immune fab (ovine)	K		$500.91	.	$100.19																																																																																																																																																																																																																			
1688	Ethanolamine oleate	K		$148.55	.	$29.71																																																																																																																																																																																																																			
1689	Fomepizole	K		$7.49	.	$1.50																																																																																																																																																																																																																			
1690	Hemin	K		$8.41	.	$1.69																																																																																																																																																																																																																			
1693	Lepirudin	K		$277.67	.	$55.54																																																																																																																																																																																																																			
1694	Ziconotide injection	K		$6.54	.	$1.31																																																																																																																																																																																																																			
1695	Nesiritide injection	K		$39.90	.	$7.98																																																																																																																																																																																																																			
1696	Palifermin injection	K		$11.25	.	$2.25																																																																																																																																																																																																																			
1697	Pegaptanib sodium injection	K		"$1,011.14"	.	$202.23																																																																																																																																																																																																																			
1700	Inj secretin synthetic human	K		$27.23	.	$5.45																																																																																																																																																																																																																			
1701	Treprostinil injection	K		$59.92	.	$11.99																																																																																																																																																																																																																			
1704	"Humate-P, inj"	K		$0.87	.	$0.18																																																																																																																																																																																																																			
1705	Factor viia	K		$1.36	.	$0.28																																																																																																																																																																																																																			
1709	Azacitidine injection	K		$5.08	.	$1.02																																																																																																																																																																																																																			
1710	Clofarabine injection	K		$114.32	.	$22.87																																																																																																																																																																																																																			
1711	Vantas implant	K		"$1,470.47"	.	$294.10																																																																																																																																																																																																																			
1712	Paclitaxel protein bound	K		$9.30	.	$1.86																																																																																																																																																																																																																			
1716	"Brachytx, non-str, Gold-198"	U	2.7603	$190.12	.	$38.03																																																																																																																																																																																																																			
1717	"Brachytx, non-str, HDR Ir-192"	U	3.1777	$218.87	.	$43.78																																																																																																																																																																																																																			
1719	"Brachytx, NS, Non-HDRIr-192"	U	0.4075	$28.07	.	$5.62																																																																																																																																																																																																																			
1738	Oxaliplatin	K		$4.67	.	$0.94																																																																																																																																																																																																																			
1739	"Pegademase bovine, 25 iu"	K		$245.00	.	$49.00																																																																																																																																																																																																																			
1740	Diazoxide injection	K		$1.04	.	$0.21																																																																																																																																																																																																																			
1741	"Urofollitropin, 75 iu"	K		$59.28	.	$11.86																																																																																																																																																																																																																			
1749	"Endo, colon, retro imaging"	H																																																																																																																																																																																																																							
2210	Methyldopate hcl injection	K		$39.84	.	$7.97																																																																																																																																																																																																																			
2616	"Brachytx, non-str,Yttrium-90"	U	240.5603	"$16,568.83"	.	"$3,313.77"																																																																																																																																																																																																																			
2632	Iodine I-125 sodium iodide	U	0.3143	$21.65	.	$4.33																																																																																																																																																																																																																			
2634	"Brachytx, non-str, HA, I-125"	U	0.8166	$56.24	.	$11.25																																																																																																																																																																																																																			
2635	"Brachytx, non-str, HA, P-103"	U	0.4159	$28.65	.	$5.73																																																																																																																																																																																																																			
2636	"Brachy linear, non-str,P-103"	U	0.5394	$37.15	.	$7.43																																																																																																																																																																																																																			
2638	"Brachytx, stranded, I-125"	U	0.6043	$41.62	.	$8.33																																																																																																																																																																																																																			
2639	"Brachytx, non-stranded,I-125"	U	0.5307	$36.55	.	$7.31																																																																																																																																																																																																																			
2640	"Brachytx, stranded, P-103"	U	1.0560	$72.73	.	$14.55																																																																																																																																																																																																																			
2641	"Brachytx, non-stranded,P-103"	U	0.9519	$65.56	.	$13.12																																																																																																																																																																																																																			
2642	"Brachytx, stranded, C-131"	U	1.8044	$124.28	.	$24.86																																																																																																																																																																																																																			
2643	"Brachytx, non-stranded,C-131"	U	0.9665	$66.57	.	$13.32																																																																																																																																																																																																																			
2698	"Brachytx, stranded, NOS"	U	0.6043	$41.62	.	$8.33																																																																																																																																																																																																																			
2699	"Brachytx, non-stranded, NOS"	U	0.4075	$28.07	.	$5.62																																																																																																																																																																																																																			
2731	"Immune globulin, powder"	K		$29.12	.	$5.83																																																																																																																																																																																																																			
2770	Quinupristin/dalfopristin	K		$158.36	.	$31.68																																																																																																																																																																																																																			
3041	Bivalirudin	K		$2.52	.	$0.51																																																																																																																																																																																																																			
3043	Gamma globulin 1 CC inj	K		$18.71	.	$3.75																																																																																																																																																																																																																			
3050	Sermorelin acetate injection	K		$1.78	.	$0.36																																																																																																																																																																																																																			
7000	Amifostine	K		$315.66	.	$63.14																																																																																																																																																																																																																			
7011	Oprelvekin injection	K		$242.29	.	$48.46																																																																																																																																																																																																																			
7034	Somatropin injection	K		$57.51	.	$11.51																																																																																																																																																																																																																			
7035	Teniposide	K		$320.61	.	$64.13																																																																																																																																																																																																																			
7036	"Urokinase 250,000 IU inj"	K		$453.41	.	$90.69																																																																																																																																																																																																																			
7038	Monoclonal antibodies	K		"$1,122.83"	.	$224.57																																																																																																																																																																																																																			
7041	Tirofiban HCl	K		$7.96	.	$1.60																																																																																																																																																																																																																			
7042	"Capecitabine, oral"	K		$6.78	.	$1.36																																																																																																																																																																																																																			
7043	Infliximab injection	K		$59.96	.	$12.00																																																																																																																																																																																																																			
7046	Doxorubicin hcl liposome inj	K		$482.21	.	$96.45																																																																																																																																																																																																																			
7048	Alteplase recombinant	K		$38.34	.	$7.67																																																																																																																																																																																																																			
7049	Filgrastim 480 mcg injection	K		$363.35	.	$72.67																																																																																																																																																																																																																			
7051	Leuprolide acetate implant	K		"$4,774.35"	.	$954.87																																																																																																																																																																																																																			
7308	Aminolevulinic acid hcl top	K		$137.64	.	$27.53																																																																																																																																																																																																																			
8000	Cardiac Electrophysiologic Evaluation and Ablation Composite	T	156.6215	"$10,787.46"	.	"$2,157.50"																																																																																																																																																																																																																			
8001	LDR Prostate Brachytherapy Composite	T	46.8848	"$3,229.24"	.	$645.85																																																																																																																																																																																																																			
8002	Level I Extended Assessment & Management Composite	V	5.7236	$394.22	.	$78.85																																																																																																																																																																																																																			
8003	Level II Extended Assessment & Management Composite	V	10.3712	$714.33	.	$142.87																																																																																																																																																																																																																			
8004	Ultrasound Composite	S	2.7650	$190.44	.	$38.09																																																																																																																																																																																																																			
8005	CT and CTA without Contrast Composite	S	6.1103	$420.85	.	$84.17																																																																																																																																																																																																																			
8006	CT and CTA with Contrast Composite	S	9.1267	$628.61	.	$125.73																																																																																																																																																																																																																			
8007	MRI and MRA without Contrast Composite	S	10.2516	$706.09	.	$141.22																																																																																																																																																																																																																			
8008	MRI and MRA with Contrast Composite	S	14.4444	$994.87	.	$198.98																																																																																																																																																																																																																			
9001	Linezolid injection	K		$33.05	.	$6.61																																																																																																																																																																																																																			
9002	Tenecteplase injection	K		$47.18	.	$9.44																																																																																																																																																																																																																			
9003	Palivizumab	K		$74.65	.	$14.93																																																																																																																																																																																																																			
9004	Gemtuzumab ozogamicin inj	K		"$2,660.02"	.	$532.01																																																																																																																																																																																																																			
9005	Reteplase injection	K		"$1,300.11"	.	$260.03																																																																																																																																																																																																																			
9006	Tacrolimus injection	K		$138.17	.	$27.64																																																																																																																																																																																																																			
9012	Arsenic trioxide injection	K		$36.90	.	$7.38																																																																																																																																																																																																																			
9018	"Inj, rimabotulinumtoxinB"	K		$10.48	.	$2.10																																																																																																																																																																																																																			
9019	Caspofungin acetate	K		$11.99	.	$2.40																																																																																																																																																																																																																			
9022	IM inj interferon beta 1-a	K		$212.28	.	$42.46																																																																																																																																																																																																																			
9023	Rho d immune globulin	K		$22.45	.	$4.49																																																																																																																																																																																																																			
9024	Amphotericin b lipid complex	K		$9.73	.	$1.95																																																																																																																																																																																																																			
9032	Baclofen 10 MG injection	K		$202.00	.	$40.40																																																																																																																																																																																																																			
9033	Cidofovir injection	K		$754.01	.	$150.81																																																																																																																																																																																																																			
9038	Inj estrogen conjugate	K		$92.21	.	$18.45																																																																																																																																																																																																																			
9042	Glucagon hydrochloride	K		$85.12	.	$17.03																																																																																																																																																																																																																			
9044	Ibutilide fumarate injection	K		$188.42	.	$37.69																																																																																																																																																																																																																			
9046	Iron sucrose injection	K		$0.36	.	$0.08																																																																																																																																																																																																																			
9104	Antithymocyte globuln rabbit	K		$413.57	.	$82.72																																																																																																																																																																																																																			
9108	Thyrotropin injection	K		"$1,043.12"	.	$208.63																																																																																																																																																																																																																			
9110	Alemtuzumab injection	K		$567.94	.	$113.59																																																																																																																																																																																																																			
9115	Zoledronic acid	K		$220.99	.	$44.20																																																																																																																																																																																																																			
9119	"Injection, pegfilgrastim 6mg"	K		"$2,441.95"	.	$488.39																																																																																																																																																																																																																			
9120	"Injection, Fulvestrant"	K		$82.23	.	$16.45																																																																																																																																																																																																																			
9121	"Injection, argatroban"	K		$19.03	.	$3.81																																																																																																																																																																																																																			
9122	Triptorelin pamoate	K		$180.22	.	$36.05																																																																																																																																																																																																																			
9124	Daptomycin injection	K		$0.45	.	$0.09																																																																																																																																																																																																																			
9125	"Risperidone, long acting"	K		$5.00	.	$1.00																																																																																																																																																																																																																			
9126	Natalizumab injection	K		$8.68	.	$1.74																																																																																																																																																																																																																			
9133	"Rabies ig, im/sc"	K		$165.12	.	$33.03																																																																																																																																																																																																																			
9134	"Rabies ig, heat treated"	K		$159.71	.	$31.95																																																																																																																																																																																																																			
9135	"Varicella-zoster ig, im"	K		$129.48	.	$25.90																																																																																																																																																																																																																			
9137	"Bcg vaccine, percut"	K		$110.93	.	$22.19																																																																																																																																																																																																																			
9139	"Rabies vaccine, im"	K		$200.66	.	$40.14																																																																																																																																																																																																																			
9140	"Rabies vaccine, id"	K		$107.83	.	$21.57																																																																																																																																																																																																																			
9143	"Meningococcal vaccine, sc"	K		$102.44	.	$20.49																																																																																																																																																																																																																			
9144	"Encephalitis vaccine, sc"	K		$101.12	.	$20.23																																																																																																																																																																																																																			
9145	"Meningococcal vaccine, im"	K		$95.06	.	$19.02																																																																																																																																																																																																																			
9207	Bortezomib injection	K		$38.92	.	$7.79																																																																																																																																																																																																																			
9208	Agalsidase beta injection	K		$134.90	.	$26.98																																																																																																																																																																																																																			
9209	Laronidase injection	K		$25.31	.	$5.07																																																																																																																																																																																																																			
9210	Palonosetron hcl	K		$18.23	.	$3.65																																																																																																																																																																																																																			
9213	Pemetrexed injection	K		$50.96	.	$10.20																																																																																																																																																																																																																			
9214	Bevacizumab injection	K		$57.89	.	$11.58																																																																																																																																																																																																																			
9215	Cetuximab injection	K		$49.27	.	$9.86																																																																																																																																																																																																																			
9217	Leuprolide acetate suspnsion	K		$206.25	.	$41.25																																																																																																																																																																																																																			
9224	Galsulfase injection	K		$333.68	.	$66.74																																																																																																																																																																																																																			
9225	Fluocinolone acetonide implt	K		"$19,162.50"	.	"$3,832.50"																																																																																																																																																																																																																			
9227	Micafungin sodium injection	K		$1.06	.	$0.22																																																																																																																																																																																																																			
9228	Tigecycline injection	K		$1.23	.	$0.25																																																																																																																																																																																																																			
9229	Ibandronate sodium injection	K		$142.82	.	$28.57																																																																																																																																																																																																																			
9230	Abatacept injection	K		$19.99	.	$4.00																																																																																																																																																																																																																			
9231	Decitabine injection	K		$30.45	.	$6.09																																																																																																																																																																																																																			
9232	Idursulfase injection	K		$450.74	.	$90.15																																																																																																																																																																																																																			
9233	Ranibizumab injection	K		$401.39	.	$80.28																																																																																																																																																																																																																			
9234	Alglucosidase alfa injection	K		$133.92	.	$26.79																																																																																																																																																																																																																			
9235	Panitumumab injection	K		$86.56	.	$17.32																																																																																																																																																																																																																			
9236	Eculizumab injection	K		$183.75	.	$36.75																																																																																																																																																																																																																			
9237	"Inj, lanreotide acetate"	K		$29.75	.	$5.95																																																																																																																																																																																																																			
9240	"Injection, ixabepilone"	K		$63.14	.	$12.63																																																																																																																																																																																																																			
9242	"Injection, fosaprepitant"	K		$1.67	.	$0.34																																																																																																																																																																																																																			
9243	Bendamustine injection	K		$18.33	.	$3.67																																																																																																																																																																																																																			
9244	Regadenoson injection	K		$50.80	.	$10.16																																																																																																																																																																																																																			
9245	Romiplostim injection	K		$44.71	.	$8.95																																																																																																																																																																																																																			
9247	"Inj, iobenguane, I-123, dx"	G		"$2,394.59"		$0.00																																																																																																																																																																																																																			
9248	"Inj, clevidipine butyrate"	K		$2.97	.	$0.60																																																																																																																																																																																																																			
9249	Certolizumab pegol inj	G		$3.96	.	$0.78																																																																																																																																																																																																																			
9250	Artiss fibrin sealant	G		$122.05	.	$24.18																																																																																																																																																																																																																			
9251	C1 esterase inhibitor inj	G		$42.75	.	$8.47																																																																																																																																																																																																																			
9252	Plerixafor injection	G		$281.67	.	$55.80																																																																																																																																																																																																																			
9253	Temozolomide injection	G		$4.90	.	$0.97																																																																																																																																																																																																																			
9254	"Injection, lacosamide"	K		$0.16	.	$0.04																																																																																																																																																																																																																			
9255	Paliperidone palmitate inj	G		$6.52	.	$1.29																																																																																																																																																																																																																			
9256	Dexamethasone intra implant	G		$196.10	.	$38.85																																																																																																																																																																																																																			
9258	Telavancin injection	G		$1.87	.	$0.37																																																																																																																																																																																																																			
9259	Pralatrexate injection	G		$165.63	.	$32.81																																																																																																																																																																																																																			
9260	Ofatumumab injection	G		$45.47	.	$9.01																																																																																																																																																																																																																			
9261	Ustekinumab injection	G		$107.11	.	$21.22																																																																																																																																																																																																																			
9263	Ecallantide injection	G		$275.28	.	$54.54																																																																																																																																																																																																																			
9264	Tocilizumab injection	G		$3.48	.	$0.69																																																																																																																																																																																																																			
9265	Romidepsin injection	G		$219.30	.	$43.45																																																																																																																																																																																																																			
9267	Wilate injection	G		$71.19	.	$14.10																																																																																																																																																																																																																			
9268	Capsaicin 8% patch	G		$25.55	.	$5.06																																																																																																																																																																																																																			
9269	"C-1 esterase, berinert"	G		$27.53	.	$5.45																																																																																																																																																																																																																			
9270	Gammaplex IVIG	G		$60.42	.	$11.97																																																																																																																																																																																																																			
9271	Velaglucerase alfa	G		$350.60	.	$69.46																																																																																																																																																																																																																			
9272	"Inj, denosumab"	G		$14.58	.	$2.89																																																																																																																																																																																																																			
9273	"Sipuleucel-T, per infusion"	G		"$32,860.00"	.	"$6,510.00"																																																																																																																																																																																																																			
9274	Crotalidae Poly Immune Fab	G		"$1,947.49"	.	$385.82																																																																																																																																																																																																																			
9275	Hexaminolevulinate HCl	G		$636.00		$0.00																																																																																																																																																																																																																			
9276	Cabazitaxel injection	G		$141.33	.	$28.00																																																																																																																																																																																																																			
9277	"Lumizyme, 1 mg"	G		$14.84	.	$2.94																																																																																																																																																																																																																			
9278	Incobotulinumtoxin A	G		$5.57	.	$1.10																																																																																																																																																																																																																			
9279	"Injection, ibuprofen"	G		$1.40		$0.28																																																																																																																																																																																																																			
9300	Omalizumab injection	K		$20.19	.	$4.04																																																																																																																																																																																																																			
9358	"SurgiMend, fetal"	K		$10.60	.	$2.12																																																																																																																																																																																																																			
9360	"SurgiMend, neonatal"	G		$11.26	.	$2.23																																																																																																																																																																																																																			
9361	NeuroMend nerve wrap	G		$251.08		$0.00																																																																																																																																																																																																																			
9362	"Implnt,bon void filler-strip"	G		$50.09	.	$9.92																																																																																																																																																																																																																			
9363	Integra Meshed Bil Wound Mat	G		$19.56	.	$3.88																																																																																																																																																																																																																			
9364	"Porcine implant, Permacol"	G		$18.85		$0.00																																																																																																																																																																																																																			
9367	Endoform Dermal Template	G		$4.35	.	$0.86																																																																																																																																																																																																																			
9500	"Platelets, irradiated"	R	2.1010	$144.71	.	$28.95																																																																																																																																																																																																																			
9501	Platelet pheres leukoreduced	R	7.8186	$538.51	.	$107.71																																																																																																																																																																																																																			
9502	Platelet pheresis irradiated	R	6.5749	$452.85	.	$90.57																																																																																																																																																																																																																			
9503	Fr frz plasma donor retested	R	1.0328	$71.14	.	$14.23																																																																																																																																																																																																																			
9504	RBC deglycerolized	R	5.2989	$364.97	.	$73.00																																																																																																																																																																																																																			
9505	RBC irradiated	R	3.2550	$224.19	.	$44.84																																																																																																																																																																																																																			
9506	"Granulocytes, pheresis unit"	R	21.8976	"$1,508.22"	.	$301.65																																																																																																																																																																																																																			
9507	"Platelets, pheresis"	R	6.6574	$458.54	.	$91.71																																																																																																																																																																																																																			
9508	Plasma 1 donor frz w/in 8 hr	R	1.1521	$79.35	.	$15.87																																																																																																																																																																																																																			
