	Addendum A.-Proposed OPPS APCs for CY 2011																																																																																																																																																																																																																																																																																								
APC	Group Title	   SI	Relative Weight 	Payment Rate 	National Unadjusted Copayment 	Minimum Unadjusted Copayment 																																																																																																																																																																																																																																																																																			
0001	Level I Photochemotherapy	S	0.5422	$37.01	.	$7.41																																																																																																																																																																																																																																																																																			
0002	Fine Needle Biopsy/Aspiration	T	1.7752	$121.19	.	$24.24																																																																																																																																																																																																																																																																																			
0003	Bone Marrow Biopsy/Aspiration	T	3.6353	$248.17	.	$49.64																																																																																																																																																																																																																																																																																			
0004	Level I Needle Biopsy/ Aspiration Except Bone Marrow	T	4.6624	$318.29	.	$63.66																																																																																																																																																																																																																																																																																			
0005	Level II Needle Biopsy/Aspiration Except Bone Marrow	T	8.1600	$557.06	.	$111.42																																																																																																																																																																																																																																																																																			
0006	Level I Incision & Drainage	T	1.4939	$101.98	.	$20.40																																																																																																																																																																																																																																																																																			
0007	Level II Incision & Drainage	T	13.3268	$909.78	.	$181.96																																																																																																																																																																																																																																																																																			
0008	Level III Incision and Drainage	T	20.2481	"$1,382.28"	.	$276.46																																																																																																																																																																																																																																																																																			
0012	Level I Debridement & Destruction	T	0.4253	$29.03	.	$5.81																																																																																																																																																																																																																																																																																			
0013	Level II Debridement & Destruction	T	0.8782	$59.95	.	$11.99																																																																																																																																																																																																																																																																																			
0015	Level III Debridement & Destruction	T	1.5303	$104.47	.	$20.90																																																																																																																																																																																																																																																																																			
0016	Level IV Debridement & Destruction	T	2.8176	$192.35	.	$38.47																																																																																																																																																																																																																																																																																			
0017	Level V Debridement & Destruction	T	21.8217	"$1,489.70"	.	$297.94																																																																																																																																																																																																																																																																																			
0019	Level I Excision/ Biopsy	T	4.9184	$335.76	.	$67.16																																																																																																																																																																																																																																																																																			
0020	Level II Excision/ Biopsy	T	8.7772	$599.19	.	$119.84																																																																																																																																																																																																																																																																																			
0021	Level III Excision/ Biopsy	T	18.2223	"$1,243.98"	.	$248.80																																																																																																																																																																																																																																																																																			
0022	Level IV Excision/ Biopsy	T	24.1269	"$1,647.07"	$354.45	$329.42																																																																																																																																																																																																																																																																																			
0028	Level I Breast Surgery	T	25.7651	"$1,758.91"	.	$351.79																																																																																																																																																																																																																																																																																			
0029	Level II Breast Surgery	T	34.3618	"$2,345.78"	$581.52	$469.16																																																																																																																																																																																																																																																																																			
0030	Level III Breast Surgery	T	45.1924	"$3,085.15"	$747.07	$617.03																																																																																																																																																																																																																																																																																			
0031	Smoking Cessation Services	X	0.3066	$20.93	.	$4.19																																																																																																																																																																																																																																																																																			
0034	Mental Health Services Composite	S	3.3838	$231.00	.	$46.20																																																																																																																																																																																																																																																																																			
0035	Vascular Puncture and Minor Diagnostic Procedures	X	0.2446	$16.70	.	$3.34																																																																																																																																																																																																																																																																																			
0037	Level IV Needle Biopsy/Aspiration Except Bone Marrow	T	15.7640	"$1,076.16"	$228.76	$215.24																																																																																																																																																																																																																																																																																			
0039	Level I Implantation of Neurostimulator Generator	S	210.3341	"$14,358.88"	.	"$2,871.78"																																																																																																																																																																																																																																																																																			
0040	Percutaneous Implantation of Neurostimulator Electrodes	S	65.4002	"$4,464.68"	.	$892.94																																																																																																																																																																																																																																																																																			
0041	Level I Arthroscopy	T	30.3175	"$2,069.68"	.	$413.94																																																																																																																																																																																																																																																																																			
0042	Level II Arthroscopy	T	48.2063	"$3,290.90"	$804.74	$658.18																																																																																																																																																																																																																																																																																			
0045	Bone/Joint Manipulation Under Anesthesia	T	15.5647	"$1,062.56"	$268.44	$212.52																																																																																																																																																																																																																																																																																			
0047	Arthroplasty without Prosthesis	T	39.0731	"$2,667.40"	$534.09	$533.48																																																																																																																																																																																																																																																																																			
0048	Level I Arthroplasty or Implantation with Prosthesis	T	60.2668	"$4,114.23"	.	$822.85																																																																																																																																																																																																																																																																																			
0049	Level I Musculoskeletal Procedures Except Hand and Foot	T	23.2249	"$1,585.49"	.	$317.10																																																																																																																																																																																																																																																																																			
0050	Level II Musculoskeletal Procedures Except Hand and Foot	T	32.4253	"$2,213.58"	.	$442.72																																																																																																																																																																																																																																																																																			
0051	Level III Musculoskeletal Procedures Except Hand and Foot	T	47.3761	"$3,234.22"	.	$646.85																																																																																																																																																																																																																																																																																			
0052	Level IV Musculoskeletal Procedures Except Hand and Foot	T	88.5249	"$6,043.33"	.	"$1,208.67"																																																																																																																																																																																																																																																																																			
0053	Level I Hand Musculoskeletal Procedures	T	17.3655	"$1,185.49"	$253.49	$237.10																																																																																																																																																																																																																																																																																			
0054	Level II Hand Musculoskeletal Procedures	T	29.8184	"$2,035.61"	.	$407.13																																																																																																																																																																																																																																																																																			
0055	Level I Foot Musculoskeletal Procedures	T	22.6974	"$1,549.48"	$355.34	$309.90																																																																																																																																																																																																																																																																																			
0056	Level II Foot Musculoskeletal Procedures	T	55.5064	"$3,789.26"	.	$757.86																																																																																																																																																																																																																																																																																			
0057	Bunion Procedures	T	33.3853	"$2,279.11"	$475.91	$455.83																																																																																																																																																																																																																																																																																			
0058	Level I Strapping and Cast Application	S	1.1409	$77.89	.	$15.58																																																																																																																																																																																																																																																																																			
0060	Manipulation Therapy	S	0.3636	$24.82	.	$4.97																																																																																																																																																																																																																																																																																			
0061	"Laminectomy, Laparoscopy, or Incision for Implantation of Neurostimulator Electr"	S	88.8954	"$6,068.62"	.	"$1,213.73"																																																																																																																																																																																																																																																																																			
0062	Level I Treatment Fracture/Dislocation	T	26.6924	"$1,822.21"	$372.87	$364.45																																																																																																																																																																																																																																																																																			
0063	Level II Treatment Fracture/Dislocation	T	48.0827	"$3,282.46"	.	$656.50																																																																																																																																																																																																																																																																																			
0064	Level III Treatment Fracture/Dislocation	T	66.5750	"$4,544.88"	.	$908.98																																																																																																																																																																																																																																																																																			
0065	"Level I Stereotactic Radiosurgery, MRgFUS, and MEG"	S	13.7821	$940.86	.	$188.18																																																																																																																																																																																																																																																																																			
0066	"Level II Stereotactic Radiosurgery, MRgFUS, and MEG"	S	36.8580	"$2,516.19"	.	$503.24																																																																																																																																																																																																																																																																																			
0067	"Level III Stereotactic Radiosurgery, MRgFUS, and MEG"	S	50.0116	"$3,414.14"	.	$682.83																																																																																																																																																																																																																																																																																			
0069	Thoracoscopy	T	35.4455	"$2,419.76"	$591.64	$483.96																																																																																																																																																																																																																																																																																			
0070	Thoracentesis/Lavage Procedures	T	5.6491	$385.65	.	$77.13																																																																																																																																																																																																																																																																																			
0071	Level I Endoscopy Upper Airway	T	0.9225	$62.98	.	$12.60																																																																																																																																																																																																																																																																																			
0072	Level II Endoscopy Upper Airway	T	1.8778	$128.19	.	$25.64																																																																																																																																																																																																																																																																																			
0073	Level III Endoscopy Upper Airway	T	4.0416	$275.91	$64.31	$55.19																																																																																																																																																																																																																																																																																			
0074	Level IV Endoscopy Upper Airway	T	21.9959	"$1,501.59"	.	$300.32																																																																																																																																																																																																																																																																																			
0075	Level V Endoscopy Upper Airway	T	31.4168	"$2,144.73"	$445.92	$428.95																																																																																																																																																																																																																																																																																			
0076	Level I Endoscopy Lower Airway	T	10.5445	$719.84	$189.82	$143.97																																																																																																																																																																																																																																																																																			
0077	Level I Pulmonary Treatment	S	0.4180	$28.54	$7.74	$5.71																																																																																																																																																																																																																																																																																			
0078	Level III Pulmonary Treatment	S	1.4237	$97.19	.	$19.44																																																																																																																																																																																																																																																																																			
0079	Ventilation Initiation and Management	S	2.8784	$196.50	.	$39.30																																																																																																																																																																																																																																																																																			
0080	Diagnostic Cardiac Catheterization	T	39.8374	"$2,719.58"	$838.92	$543.92																																																																																																																																																																																																																																																																																			
0082	Coronary or Non-Coronary Atherectomy	T	97.8929	"$6,682.85"	.	"$1,336.57"																																																																																																																																																																																																																																																																																			
0083	Coronary or Non-Coronary Angioplasty and Percutaneous Valvuloplasty	T	52.1947	"$3,563.18"	.	$712.64																																																																																																																																																																																																																																																																																			
0084	Level I Electrophysiologic Procedures	S	10.1429	$692.43	.	$138.49																																																																																																																																																																																																																																																																																			
0085	Level II Electrophysiologic Procedures	T	53.4167	"$3,646.60"	.	$729.32																																																																																																																																																																																																																																																																																			
0086	Level III Electrophysiologic Procedures	T	116.6136	"$7,960.86"	.	"$1,592.18"																																																																																																																																																																																																																																																																																			
0088	Thrombectomy	T	41.8116	"$2,854.35"	$655.22	$570.87																																																																																																																																																																																																																																																																																			
0089	Insertion/Replacement of Permanent Pacemaker and Electrodes	T	112.4202	"$7,674.59"	"$1,615.11"	"$1,534.92"																																																																																																																																																																																																																																																																																			
0090	Insertion/Replacement of Pacemaker Pulse Generator	T	92.6057	"$6,321.91"	"$1,530.07"	"$1,264.39"																																																																																																																																																																																																																																																																																			
0091	Level II Vascular Ligation	T	44.4254	"$3,032.79"	.	$606.56																																																																																																																																																																																																																																																																																			
0092	Level I Vascular Ligation	T	27.5456	"$1,880.46"	.	$376.10																																																																																																																																																																																																																																																																																			
0093	Vascular Reconstruction/Fistula Repair without Device	T	36.5266	"$2,493.56"	.	$498.72																																																																																																																																																																																																																																																																																			
0094	Level I Resuscitation and Cardioversion	S	2.4281	$165.76	$46.29	$33.16																																																																																																																																																																																																																																																																																			
0095	Cardiac Rehabilitation	S	0.5678	$38.76	$13.86	$7.76																																																																																																																																																																																																																																																																																			
0096	Level II Noninvasive Physiologic Studies	S	1.5710	$107.25	$37.13	$21.45																																																																																																																																																																																																																																																																																			
0097	Level I Noninvasive Physiologic Studies	S	0.9646	$65.85	$23.66	$13.17																																																																																																																																																																																																																																																																																			
0099	Electrocardiograms/Cardiography	S	0.3998	$27.29	.	$5.46																																																																																																																																																																																																																																																																																			
0100	Cardiac Stress Tests	X	2.6301	$179.55	$41.44	$35.91																																																																																																																																																																																																																																																																																			
0101	Tilt Table Evaluation	S	4.3590	$297.58	$100.24	$59.52																																																																																																																																																																																																																																																																																			
0102	Level II Pulmonary Treatment	S	0.9754	$66.59	.	$13.32																																																																																																																																																																																																																																																																																			
0103	Miscellaneous Vascular Procedures	T	19.1796	"$1,309.33"	.	$261.87																																																																																																																																																																																																																																																																																			
0104	Transcatheter Placement of Intracoronary Stents	T	81.9089	"$5,591.67"	.	"$1,118.34"																																																																																																																																																																																																																																																																																			
0105	"Repair/Revision/Removal of Pacemakers, AICDs, or Vascular Devices"	T	23.2281	"$1,585.71"	.	$317.15																																																																																																																																																																																																																																																																																			
0106	Insertion/Replacement of Pacemaker Leads and/or Electrodes	T	52.6182	"$3,592.09"	.	$718.42																																																																																																																																																																																																																																																																																			
0107	Insertion of Cardioverter-Defibrillator	T	335.0724	"$22,874.39"	.	"$4,574.88"																																																																																																																																																																																																																																																																																			
0108	Insertion/Replacement/Repair of Cardioverter-Defibrillator Leads	T	389.7128	"$26,604.52"	.	"$5,320.91"																																																																																																																																																																																																																																																																																			
0110	Transfusion	S	3.4107	$232.84	.	$46.57																																																																																																																																																																																																																																																																																			
0111	Blood Product Exchange	S	12.5247	$855.02	$198.40	$171.01																																																																																																																																																																																																																																																																																			
0112	Apheresis and Stem Cell Procedures	S	33.8904	"$2,313.60"	.	$462.72																																																																																																																																																																																																																																																																																			
0113	Excision Lymphatic System	T	25.2939	"$1,726.74"	.	$345.35																																																																																																																																																																																																																																																																																			
0114	Thyroid/Lymphadenectomy Procedures	T	50.9844	"$3,480.55"	.	$696.11																																																																																																																																																																																																																																																																																			
0115	Cannula/Access Device Procedures	T	33.3074	"$2,273.80"	.	$454.76																																																																																																																																																																																																																																																																																			
0121	Level I Tube or Catheter Changes or Repositioning	T	6.3264	$431.88	.	$86.38																																																																																																																																																																																																																																																																																			
0126	Level I Urinary and Anal Procedures	T	1.0983	$74.98	$16.21	$15.00																																																																																																																																																																																																																																																																																			
0127	"Level IV Stereotactic Radiosurgery, MRgFUS, and MEG"	S	105.7702	"$7,220.61"	.	"$1,444.13"																																																																																																																																																																																																																																																																																			
0128	Echocardiogram with Contrast	S	7.1663	$489.22	$162.90	$97.85																																																																																																																																																																																																																																																																																			
0129	Level I Closed Treatment Fracture Finger/Toe/Trunk	T	1.6325	$111.45	.	$22.29																																																																																																																																																																																																																																																																																			
0130	Level I Laparoscopy	T	38.7195	"$2,643.26"	$659.53	$528.66																																																																																																																																																																																																																																																																																			
0131	Level II Laparoscopy	T	48.0382	"$3,279.42"	"$1,001.89"	$655.89																																																																																																																																																																																																																																																																																			
0132	Level III Laparoscopy	T	71.1086	"$4,854.37"	"$1,226.23"	$970.88																																																																																																																																																																																																																																																																																			
0133	Level I Skin Repair	T	1.3598	$92.83	$25.67	$18.57																																																																																																																																																																																																																																																																																			
0134	Level II Skin Repair	T	3.1890	$217.70	.	$43.54																																																																																																																																																																																																																																																																																			
0135	Level III Skin Repair	T	4.6616	$318.23	.	$63.65																																																																																																																																																																																																																																																																																			
0136	Level IV Skin Repair	T	17.1353	"$1,169.78"	.	$233.96																																																																																																																																																																																																																																																																																			
0137	Level V Skin Repair	T	22.1186	"$1,509.97"	.	$302.00																																																																																																																																																																																																																																																																																			
0138	Level II Closed Treatment Fracture Finger/Toe/Trunk	T	5.2593	$359.04	.	$71.81																																																																																																																																																																																																																																																																																			
0139	Level III Closed Treatment Fracture Finger/Toe/Trunk	T	20.9892	"$1,432.87"	.	$286.58																																																																																																																																																																																																																																																																																			
0140	Esophageal Dilation without Endoscopy	T	6.4279	$438.81	.	$87.77																																																																																																																																																																																																																																																																																			
0141	Level I Upper GI Procedures	T	8.8811	$606.29	$143.38	$121.26																																																																																																																																																																																																																																																																																			
0142	Small Intestine Endoscopy	T	10.1443	$692.52	$152.78	$138.51																																																																																																																																																																																																																																																																																			
0143	Lower GI Endoscopy	T	9.3206	$636.29	$186.06	$127.26																																																																																																																																																																																																																																																																																			
0146	Level I Sigmoidoscopy and Anoscopy	T	5.7839	$394.85	.	$78.97																																																																																																																																																																																																																																																																																			
0147	Level II Sigmoidoscopy and Anoscopy	T	9.5024	$648.70	.	$129.74																																																																																																																																																																																																																																																																																			
0148	Level I Anal/Rectal Procedures	T	6.2678	$427.88	.	$85.58																																																																																																																																																																																																																																																																																			
0149	Level III Anal/Rectal Procedures	T	24.5978	"$1,679.22"	.	$335.85																																																																																																																																																																																																																																																																																			
0150	Level IV Anal/Rectal Procedures	T	32.6184	"$2,226.76"	.	$445.36																																																																																																																																																																																																																																																																																			
0151	Endoscopic Retrograde Cholangio-Pancreatography (ERCP)	T	23.0632	"$1,574.46"	.	$314.90																																																																																																																																																																																																																																																																																			
0152	Level I Percutaneous Abdominal and Biliary Procedures	T	32.3789	"$2,210.41"	.	$442.09																																																																																																																																																																																																																																																																																			
0153	Peritoneal and Abdominal Procedures	T	26.2068	"$1,789.06"	$368.04	$357.82																																																																																																																																																																																																																																																																																			
0154	Hernia/Hydrocele Procedures	T	33.3680	"$2,277.93"	$464.85	$455.59																																																																																																																																																																																																																																																																																			
0155	Level II Anal/Rectal Procedures	T	16.1014	"$1,099.19"	.	$219.84																																																																																																																																																																																																																																																																																			
0156	Level III Urinary and Anal Procedures	T	3.0859	$210.67	.	$42.14																																																																																																																																																																																																																																																																																			
0157	Colorectal Cancer Screening: Barium Enema	S	1.3220	$90.25	.	$18.05																																																																																																																																																																																																																																																																																			
0158	Colorectal Cancer Screening: Colonoscopy	T	8.2505	$563.24																																																																																																																																																																																																																																																																																					
0159	Colorectal Cancer Screening: Flexible Sigmoidoscopy	S	5.1653	$352.62																																																																																																																																																																																																																																																																																					
0160	Level I Cystourethroscopy and other Genitourinary Procedures	T	7.2012	$491.60	.	$98.32																																																																																																																																																																																																																																																																																			
0161	Level II Cystourethroscopy and other Genitourinary Procedures	T	17.7215	"$1,209.79"	.	$241.96																																																																																																																																																																																																																																																																																			
0162	Level III Cystourethroscopy and other Genitourinary Procedures	T	26.4198	"$1,803.60"	.	$360.72																																																																																																																																																																																																																																																																																			
0163	Level IV Cystourethroscopy and other Genitourinary Procedures	T	37.4369	"$2,555.70"	.	$511.14																																																																																																																																																																																																																																																																																			
0164	Level II Urinary and Anal Procedures	T	2.0672	$141.12	.	$28.23																																																																																																																																																																																																																																																																																			
0165	Level IV Urinary and Anal Procedures	T	20.5471	"$1,402.69"	.	$280.54																																																																																																																																																																																																																																																																																			
0166	Level I Urethral Procedures	T	21.3781	"$1,459.42"	.	$291.89																																																																																																																																																																																																																																																																																			
0168	Level II Urethral Procedures	T	32.3809	"$2,210.55"	.	$442.11																																																																																																																																																																																																																																																																																			
0169	Lithotripsy	T	41.7267	"$2,848.56"	$997.74	$569.72																																																																																																																																																																																																																																																																																			
0170	Dialysis	S	7.0059	$478.27	.	$95.66																																																																																																																																																																																																																																																																																			
0172	Level I Partial Hospitalization (3 services) for CMHCs	P	1.6977	$115.90	.	$23.18																																																																																																																																																																																																																																																																																			
0173	Level II Partial Hospitalization (4 or more services) for CMHCs	P	1.7718	$120.96	.	$24.20																																																																																																																																																																																																																																																																																			
0174	Level IV Laparoscopy	T	112.2008	"$7,659.61"	"$2,064.24"	"$1,531.93"																																																																																																																																																																																																																																																																																			
0175	Level I Partial Hospitalization (3 services) for Hospital-based PHPs	P	2.6497	$180.89	.	$36.18																																																																																																																																																																																																																																																																																			
0176	Level II Partial Hospitalization (4 or more services) for Hospital-based PHPs	P	3.3838	$231.00	.	$46.20																																																																																																																																																																																																																																																																																			
0181	Level II Male Genital Procedures	T	36.4186	"$2,486.19"	$620.84	$497.24																																																																																																																																																																																																																																																																																			
0183	Level I Male Genital Procedures	T	23.7895	"$1,624.04"	.	$324.81																																																																																																																																																																																																																																																																																			
0184	Prostate Biopsy	T	13.3380	$910.55	.	$182.11																																																																																																																																																																																																																																																																																			
0188	Level II Female Reproductive Proc	T	1.5975	$109.06	.	$21.82																																																																																																																																																																																																																																																																																			
0189	Level III Female Reproductive Proc	T	3.5572	$242.84	.	$48.57																																																																																																																																																																																																																																																																																			
0190	Level I Hysteroscopy	T	23.1990	"$1,583.73"	$424.28	$316.75																																																																																																																																																																																																																																																																																			
0191	Level I Female Reproductive Proc	T	0.1514	$10.34	$2.08	$2.07																																																																																																																																																																																																																																																																																			
0192	Level IV Female Reproductive Proc	T	6.7542	$461.09	.	$92.22																																																																																																																																																																																																																																																																																			
0193	Level V Female Reproductive Proc	T	20.7158	"$1,414.21"	.	$282.85																																																																																																																																																																																																																																																																																			
0195	Level VI Female Reproductive Procedures	T	35.7350	"$2,439.52"	.	$487.91																																																																																																																																																																																																																																																																																			
0202	Level VII Female Reproductive Procedures	T	45.2093	"$3,086.30"	$981.50	$617.26																																																																																																																																																																																																																																																																																			
0203	Level IV Nerve Injections	T	13.3062	$908.37	$225.43	$181.68																																																																																																																																																																																																																																																																																			
0204	Level I Nerve Injections	T	2.6660	$182.00	$40.13	$36.40																																																																																																																																																																																																																																																																																			
0206	Level II Nerve Injections	T	3.8796	$264.85	.	$52.97																																																																																																																																																																																																																																																																																			
0207	Level III Nerve Injections	T	7.7204	$527.05	.	$105.41																																																																																																																																																																																																																																																																																			
0208	Laminotomies and Laminectomies	T	51.7137	"$3,530.34"	.	$706.07																																																																																																																																																																																																																																																																																			
0209	"Level II Extended EEG, Sleep, and Cardiovascular Studies"	S	11.4620	$782.48	$268.73	$156.50																																																																																																																																																																																																																																																																																			
0213	"Level I Extended EEG, Sleep, and Cardiovascular Studies"	S	2.4455	$166.95	$53.58	$33.39																																																																																																																																																																																																																																																																																			
0215	Level I Nerve and Muscle Tests	S	0.6295	$42.97	.	$8.60																																																																																																																																																																																																																																																																																			
0216	Level III Nerve and Muscle Tests	S	2.7192	$185.63	.	$37.13																																																																																																																																																																																																																																																																																			
0218	Level II Nerve and Muscle Tests	S	1.1923	$81.39	.	$16.28																																																																																																																																																																																																																																																																																			
0220	Level I Nerve Procedures	T	19.3535	"$1,321.21"	.	$264.25																																																																																																																																																																																																																																																																																			
0221	Level II Nerve Procedures	T	37.5345	"$2,562.37"	.	$512.48																																																																																																																																																																																																																																																																																			
0224	Implantation of Catheter/Reservoir/Shunt	T	41.9698	"$2,865.15"	.	$573.03																																																																																																																																																																																																																																																																																			
0225	"Implantation of Neurostimulator Electrodes, Cranial Nerve"	S	212.7796	"$14,525.82"	.	"$2,905.17"																																																																																																																																																																																																																																																																																			
0227	Implantation of Drug Infusion Device	T	194.6115	"$13,285.54"	.	"$2,657.11"																																																																																																																																																																																																																																																																																			
0229	Transcatherter Placement of Intravascular Shunts	T	96.8443	"$6,611.27"	.	"$1,322.26"																																																																																																																																																																																																																																																																																			
0230	Level I Eye Tests & Treatments	S	0.5913	$40.37	.	$8.08																																																																																																																																																																																																																																																																																			
0231	Level III Eye Tests & Treatments	S	2.2924	$156.50	.	$31.30																																																																																																																																																																																																																																																																																			
0232	Level I Anterior Segment Eye Procedures	T	2.4827	$169.49	$40.82	$33.90																																																																																																																																																																																																																																																																																			
0233	Level III Anterior Segment Eye Procedures	T	17.0898	"$1,166.67"	$263.12	$233.34																																																																																																																																																																																																																																																																																			
0234	Level IV Anterior Segment Eye Procedures	T	24.5236	"$1,674.15"	$511.31	$334.83																																																																																																																																																																																																																																																																																			
0235	Level I Posterior Segment Eye Procedures	T	5.2921	$361.28	.	$72.26																																																																																																																																																																																																																																																																																			
0237	Level II Posterior Segment Eye Procedures	T	23.2772	"$1,589.06"	.	$317.82																																																																																																																																																																																																																																																																																			
0238	Level I Repair and Plastic Eye Procedures	T	3.1607	$215.77	.	$43.16																																																																																																																																																																																																																																																																																			
0239	Level II Repair and Plastic Eye Procedures	T	7.7830	$531.32	.	$106.27																																																																																																																																																																																																																																																																																			
0240	Level III Repair and Plastic Eye Procedures	T	19.9889	"$1,364.58"	$296.20	$272.92																																																																																																																																																																																																																																																																																			
0241	Level IV Repair and Plastic Eye Procedures	T	26.8719	"$1,834.46"	$383.45	$366.90																																																																																																																																																																																																																																																																																			
0242	Level V Repair and Plastic Eye Procedures	T	39.3413	"$2,685.71"	$597.36	$537.15																																																																																																																																																																																																																																																																																			
0243	Strabismus/Muscle Procedures	T	25.3150	"$1,728.18"	$416.98	$345.64																																																																																																																																																																																																																																																																																			
0244	Corneal and Amniotic Membrane Transplant	T	39.0380	"$2,665.01"	$803.26	$533.01																																																																																																																																																																																																																																																																																			
0245	Level I Cataract Procedures without IOL Insert	T	14.3198	$977.57	$196.91	$195.52																																																																																																																																																																																																																																																																																			
0246	Cataract Procedures with IOL Insert	T	24.7788	"$1,691.57"	$495.96	$338.32																																																																																																																																																																																																																																																																																			
0247	Laser Eye Procedures	T	5.5659	$379.97	$104.31	$76.00																																																																																																																																																																																																																																																																																			
0249	Level II Cataract Procedures without IOL Insert	T	31.0191	"$2,117.58"	$516.99	$423.52																																																																																																																																																																																																																																																																																			
0250	Level I ENT Procedures	T	1.1743	$80.17	$25.10	$16.04																																																																																																																																																																																																																																																																																			
0251	Level II ENT Procedures	T	3.4369	$234.63	.	$46.93																																																																																																																																																																																																																																																																																			
0252	Level III ENT Procedures	T	7.8743	$537.55	$109.16	$107.51																																																																																																																																																																																																																																																																																			
0253	Level IV ENT Procedures	T	17.4151	"$1,188.88"	$282.29	$237.78																																																																																																																																																																																																																																																																																			
0254	Level V ENT Procedures	T	25.5397	"$1,743.52"	.	$348.71																																																																																																																																																																																																																																																																																			
0255	Level II Anterior Segment Eye Procedures	T	7.8769	$537.73	$129.50	$107.55																																																																																																																																																																																																																																																																																			
0256	Level VI ENT Procedures	T	44.8441	"$3,061.37"	.	$612.28																																																																																																																																																																																																																																																																																			
0259	Level VII ENT Procedures	T	454.7997	"$31,047.81"	"$8,543.66"	"$6,209.57"																																																																																																																																																																																																																																																																																			
0260	Level I Plain Film Except Teeth	X	0.6683	$45.62	.	$9.13																																																																																																																																																																																																																																																																																			
0261	Level II Plain Film Except Teeth Including Bone Density Measurement	X	1.1314	$77.24	.	$15.45																																																																																																																																																																																																																																																																																			
0262	Plain Film of Teeth	X	0.4853	$33.13	.	$6.63																																																																																																																																																																																																																																																																																			
0263	Level I Miscellaneous Radiology Procedures	X	3.3875	$231.25	.	$46.25																																																																																																																																																																																																																																																																																			
0265	Level I Diagnostic and Screening Ultrasound	S	0.9262	$63.23	$22.28	$12.65																																																																																																																																																																																																																																																																																			
0266	Level II Diagnostic and Screening Ultrasound	S	1.4262	$97.36	$37.53	$19.48																																																																																																																																																																																																																																																																																			
0267	Level III Diagnostic and Screening Ultrasound	S	2.2748	$155.29	$60.50	$31.06																																																																																																																																																																																																																																																																																			
0269	Level II Echocardiogram Without Contrast 	S	5.7019	$389.25	.	$77.85																																																																																																																																																																																																																																																																																			
0270	Level III Echocardiogram Without Contrast 	S	8.1944	$559.41	$132.96	$111.89																																																																																																																																																																																																																																																																																			
0272	Fluoroscopy	X	1.2472	$85.14	$31.07	$17.03																																																																																																																																																																																																																																																																																			
0274	Myelography	S	7.4103	$505.88	.	$101.18																																																																																																																																																																																																																																																																																			
0275	Arthrography	S	4.0041	$273.35	$68.90	$54.67																																																																																																																																																																																																																																																																																			
0276	Level I Digestive Radiology	S	1.2890	$88.00	$34.66	$17.60																																																																																																																																																																																																																																																																																			
0277	Level II Digestive Radiology	S	2.0916	$142.79	$53.90	$28.56																																																																																																																																																																																																																																																																																			
0278	Diagnostic Urography	S	2.5910	$176.88	$58.44	$35.38																																																																																																																																																																																																																																																																																			
0279	Level II Angiography and Venography	S	29.7399	"$2,030.25"	.	$406.05																																																																																																																																																																																																																																																																																			
0280	Level III Angiography and Venography	S	48.7134	"$3,325.52"	.	$665.11																																																																																																																																																																																																																																																																																			
0282	Miscellaneous Computed Axial Tomography	S	1.7637	$120.40	$37.80	$24.08																																																																																																																																																																																																																																																																																			
0283	Computed Tomography with Contrast	S	4.4120	$301.19	$96.62	$60.24																																																																																																																																																																																																																																																																																			
0284	Magnetic Resonance Imaging and Magnetic Resonance Angiography with Contrast	S	6.4555	$440.70	$146.85	$88.14																																																																																																																																																																																																																																																																																			
0288	Bone Density:Axial Skeleton	S	1.0562	$72.10	$28.51	$14.42																																																																																																																																																																																																																																																																																			
0293	Level VI Anterior Segment Eye Procedures	T	113.4961	"$7,748.04"	.	"$1,549.61"																																																																																																																																																																																																																																																																																			
0299	Hyperthermia and Radiation Treatment Procedures	S	5.7142	$390.09	.	$78.02																																																																																																																																																																																																																																																																																			
0300	Level I Radiation Therapy	S	1.4418	$98.43	.	$19.69																																																																																																																																																																																																																																																																																			
0301	Level II Radiation Therapy	S	2.3741	$162.07	.	$32.42																																																																																																																																																																																																																																																																																			
0303	Treatment Device Construction	X	2.9021	$198.12	$66.95	$39.63																																																																																																																																																																																																																																																																																			
0304	Level I Therapeutic Radiation Treatment Preparation	X	1.5401	$105.14	$34.63	$21.03																																																																																																																																																																																																																																																																																			
0305	Level II Therapeutic Radiation Treatment Preparation	X	4.0762	$278.27	$91.38	$55.66																																																																																																																																																																																																																																																																																			
0307	Myocardial Positron Emission Tomography (PET) imaging	S	16.1009	"$1,099.16"	.	$219.84																																																																																																																																																																																																																																																																																			
0308	Non-Myocardial Positron Emission Tomography (PET) imaging	S	15.3994	"$1,051.27"	.	$210.26																																																																																																																																																																																																																																																																																			
0310	Level III Therapeutic Radiation Treatment Preparation	X	13.5651	$926.05	$325.27	$185.21																																																																																																																																																																																																																																																																																			
0312	Radioelement Applications	S	5.0976	$348.00	.	$69.60																																																																																																																																																																																																																																																																																			
0313	Brachytherapy	S	10.4062	$710.40	$268.63	$142.08																																																																																																																																																																																																																																																																																			
0315	Level II Implantation of Neurostimulator Generator 	S	270.0348	"$18,434.47"	.	"$3,686.90"																																																																																																																																																																																																																																																																																			
0317	Level II Miscellaneous Radiology Procedures	X	5.9820	$408.37	.	$81.68																																																																																																																																																																																																																																																																																			
0320	Electroconvulsive Therapy	S	6.0291	$411.59	.	$82.32																																																																																																																																																																																																																																																																																			
0322	Brief Individual Psychotherapy	S	1.1744	$80.17	.	$16.04																																																																																																																																																																																																																																																																																			
0323	Extended Individual Psychotherapy	S	1.6309	$111.34	.	$22.27																																																																																																																																																																																																																																																																																			
0324	Family Psychotherapy	S	1.8392	$125.56	.	$25.12																																																																																																																																																																																																																																																																																			
0325	Group Psychotherapy	S	0.7880	$53.79	$11.47	$10.76																																																																																																																																																																																																																																																																																			
0330	Dental Procedures	S	9.9085	$676.42	.	$135.29																																																																																																																																																																																																																																																																																			
0332	Computed Tomography without Contrast	S	2.8569	$195.03	$75.24	$39.01																																																																																																																																																																																																																																																																																			
0333	Computed Tomography without Contrast followed by Contrast	S	4.8922	$333.98	$116.13	$66.80																																																																																																																																																																																																																																																																																			
0336	Magnetic Resonance Imaging and Magnetic Resonance Angiography without Contrast	S	5.1052	$348.52	$137.34	$69.71																																																																																																																																																																																																																																																																																			
0337	Magnetic Resonance Imaging and Magnetic Resonance Angiography without Contrast followed by Contrast	S	7.9271	$541.16	$197.83	$108.24																																																																																																																																																																																																																																																																																			
0340	Minor Ancillary Procedures	X	0.6899	$47.10	.	$9.42																																																																																																																																																																																																																																																																																			
0341	Skin Tests	X	0.0804	$5.49	$2.09	$1.10																																																																																																																																																																																																																																																																																			
0342	Level I Pathology	X	0.1596	$10.90	.	$2.18																																																																																																																																																																																																																																																																																			
0343	Level III Pathology	X	0.5351	$36.53	$10.84	$7.31																																																																																																																																																																																																																																																																																			
0344	Level IV Pathology	X	0.8227	$56.16	$15.56	$11.24																																																																																																																																																																																																																																																																																			
0345	Level I Transfusion Laboratory Procedures	X	0.2168	$14.80	.	$2.96																																																																																																																																																																																																																																																																																			
0346	Level II Transfusion Laboratory Procedures	X	0.3619	$24.71	.	$4.95																																																																																																																																																																																																																																																																																			
0347	Level III Transfusion Laboratory Procedures	X	0.6903	$47.12	$9.43	$9.43																																																																																																																																																																																																																																																																																			
0350	Administration of flu and PPV vaccine	S	0.3853	$26.30																																																																																																																																																																																																																																																																																					
0360	Level I Alimentary Tests	X	1.7011	$116.13	$33.88	$23.23																																																																																																																																																																																																																																																																																			
0361	Level II Alimentary Tests	X	4.0753	$278.21	$83.23	$55.65																																																																																																																																																																																																																																																																																			
0363	Level I Otorhinolaryngologic Function Tests	X	0.8721	$59.54	$16.71	$11.91																																																																																																																																																																																																																																																																																			
0364	Level I Audiometry	X	0.4612	$31.48	$7.03	$6.30																																																																																																																																																																																																																																																																																			
0365	Level II Audiometry	X	1.2498	$85.32	$18.52	$17.07																																																																																																																																																																																																																																																																																			
0366	Level III Audiometry	X	1.5786	$107.77	$24.61	$21.56																																																																																																																																																																																																																																																																																			
0367	Level I Pulmonary Test	X	0.5872	$40.09	$13.75	$8.02																																																																																																																																																																																																																																																																																			
0368	Level II Pulmonary Tests	X	0.8679	$59.25	$20.93	$11.85																																																																																																																																																																																																																																																																																			
0369	Level III Pulmonary Tests	X	3.0374	$207.35	$42.19	$41.47																																																																																																																																																																																																																																																																																			
0370	Allergy Tests	X	1.4793	$100.99	.	$20.20																																																																																																																																																																																																																																																																																			
0373	Level I Neuropsychological Testing	X	1.1738	$80.13	.	$16.03																																																																																																																																																																																																																																																																																			
0375	Ancillary Outpatient Services When Patient Expires	S	94.3159	"$6,438.66"	.	"$1,287.74"																																																																																																																																																																																																																																																																																			
0377	Level II Cardiac Imaging	S	11.2555	$768.38	.	$153.68																																																																																																																																																																																																																																																																																			
0378	Level II Pulmonary Imaging	S	4.7678	$325.48	$124.64	$65.10																																																																																																																																																																																																																																																																																			
0381	Single Allergy Tests	X	0.4215	$28.77	.	$5.76																																																																																																																																																																																																																																																																																			
0382	Level II Neuropsychological Testing	X	2.5561	$174.50	.	$34.90																																																																																																																																																																																																																																																																																			
0383	Cardiac Computed Tomographic Imaging	S	3.7795	$258.02	.	$51.61																																																																																																																																																																																																																																																																																			
0384	GI Procedures with Stents	T	27.4802	"$1,875.99"	.	$375.20																																																																																																																																																																																																																																																																																			
0385	Level I Prosthetic Urological Procedures	S	102.2894	"$6,982.99"	.	"$1,396.60"																																																																																																																																																																																																																																																																																			
0386	Level II Prosthetic Urological Procedures	S	168.1193	"$11,477.00"	.	"$2,295.40"																																																																																																																																																																																																																																																																																			
0387	Level II Hysteroscopy	T	38.2775	"$2,613.09"	$655.55	$522.62																																																																																																																																																																																																																																																																																			
0388	Discography	S	24.9242	"$1,701.50"	.	$340.30																																																																																																																																																																																																																																																																																			
0389	Level I Non-imaging Nuclear Medicine	S	1.5770	$107.66	$28.71	$21.54																																																																																																																																																																																																																																																																																			
0390	Level I Endocrine Imaging	S	2.0375	$139.09	$49.95	$27.82																																																																																																																																																																																																																																																																																			
0391	Level II Endocrine Imaging	S	3.2886	$224.50	$65.96	$44.90																																																																																																																																																																																																																																																																																			
0392	Level II Non-imaging Nuclear Medicine	S	2.6029	$177.69	$43.31	$35.54																																																																																																																																																																																																																																																																																			
0393	Hematologic Processing & Studies	S	5.8770	$401.21	.	$80.25																																																																																																																																																																																																																																																																																			
0394	Hepatobiliary Imaging	S	4.2112	$287.49	$98.44	$57.50																																																																																																																																																																																																																																																																																			
0395	GI Tract Imaging	S	3.6081	$246.31	$89.56	$49.27																																																																																																																																																																																																																																																																																			
0396	Bone Imaging	S	3.6637	$250.11	$95.02	$50.03																																																																																																																																																																																																																																																																																			
0397	Vascular Imaging	S	3.5928	$245.27	.	$49.06																																																																																																																																																																																																																																																																																			
0398	Level I Cardiac Imaging	S	4.3724	$298.49	$95.61	$59.70																																																																																																																																																																																																																																																																																			
0400	Hematopoietic Imaging	S	3.7861	$258.47	$91.52	$51.70																																																																																																																																																																																																																																																																																			
0401	Level I Pulmonary Imaging	S	2.9903	$204.14	$73.80	$40.83																																																																																																																																																																																																																																																																																			
0402	Level II Nervous System Imaging	S	9.0850	$620.21	.	$124.05																																																																																																																																																																																																																																																																																			
0403	Level I Nervous System Imaging	S	3.4106	$232.83	$72.42	$46.57																																																																																																																																																																																																																																																																																			
0404	Renal and Genitourinary Studies	S	4.7288	$322.82	$82.54	$64.57																																																																																																																																																																																																																																																																																			
0406	Level I Tumor/Infection Imaging	S	4.2872	$292.67	$88.01	$58.54																																																																																																																																																																																																																																																																																			
0407	Level I Radionuclide Therapy	S	3.2871	$224.40	$78.13	$44.88																																																																																																																																																																																																																																																																																			
0408	Level III Tumor/Infection Imaging	S	12.6011	$860.24	.	$172.05																																																																																																																																																																																																																																																																																			
0409	Red Blood Cell Tests	X	0.1134	$7.74	$2.18	$1.55																																																																																																																																																																																																																																																																																			
0412	IMRT Treatment Delivery	S	6.4458	$440.04	.	$88.01																																																																																																																																																																																																																																																																																			
0413	Level II Radionuclide Therapy	S	5.1912	$354.39	.	$70.88																																																																																																																																																																																																																																																																																			
0414	Level II Tumor/Infection Imaging	S	7.1451	$487.77	.	$97.56																																																																																																																																																																																																																																																																																			
0415	Level II Endoscopy Lower Airway	T	28.5180	"$1,946.84"	$459.92	$389.37																																																																																																																																																																																																																																																																																			
0418	Insertion of Left Ventricular Pacing Elect.	T	143.1583	"$9,772.99"	.	"$1,954.60"																																																																																																																																																																																																																																																																																			
0422	Level II Upper GI Procedures	T	16.3107	"$1,113.48"	$271.47	$222.70																																																																																																																																																																																																																																																																																			
0423	Level II Percutaneous Abdominal and Biliary Procedures	T	57.2089	"$3,905.48"	.	$781.10																																																																																																																																																																																																																																																																																			
0425	Level II Arthroplasty or Implantation with Prosthesis	T	122.1766	"$8,340.63"	.	"$1,668.13"																																																																																																																																																																																																																																																																																			
0426	Level II Strapping and Cast Application	S	2.4913	$170.07	.	$34.02																																																																																																																																																																																																																																																																																			
0427	Level II Tube or Catheter Changes or Repositioning	T	16.3601	"$1,116.85"	.	$223.37																																																																																																																																																																																																																																																																																			
0428	Level III Sigmoidoscopy and Anoscopy	T	24.5869	"$1,678.47"	.	$335.70																																																																																																																																																																																																																																																																																			
0429	Level V Cystourethroscopy and other Genitourinary Procedures	T	46.5713	"$3,179.28"	.	$635.86																																																																																																																																																																																																																																																																																			
0432	Health and Behavior Services	S	0.4597	$31.38	.	$6.28																																																																																																																																																																																																																																																																																			
0433	Level II Pathology	X	0.2465	$16.83	$5.17	$3.37																																																																																																																																																																																																																																																																																			
0434	Cardiac Defect Repair	T	158.2753	"$10,804.98"	.	"$2,161.00"																																																																																																																																																																																																																																																																																			
0436	Level I Drug Administration	S	0.3853	$26.30	.	$5.26																																																																																																																																																																																																																																																																																			
0437	Level II Drug Administration	S	0.5491	$37.49	.	$7.50																																																																																																																																																																																																																																																																																			
0438	Level III Drug Administration	S	1.1156	$76.16	.	$15.24																																																																																																																																																																																																																																																																																			
0439	Level IV Drug Administration	S	1.8498	$126.28	.	$25.26																																																																																																																																																																																																																																																																																			
0440	Level V Drug Administration	S	2.9855	$203.81	.	$40.77																																																																																																																																																																																																																																																																																			
0442	Dosimetric Drug Administration	S	31.9890	"$2,183.79"	.	$436.76																																																																																																																																																																																																																																																																																			
0604	Level 1 Hospital Clinic Visits	V	0.7431	$50.73	.	$10.15																																																																																																																																																																																																																																																																																			
0605	Level 2 Hospital Clinic Visits	V	1.0573	$72.18	.	$14.44																																																																																																																																																																																																																																																																																			
0606	Level 3 Hospital Clinic Visits	V	1.3650	$93.18	.	$18.64																																																																																																																																																																																																																																																																																			
0607	Level 4 Hospital Clinic Visits	V	1.7939	$122.46	.	$24.50																																																																																																																																																																																																																																																																																			
0608	Level 5 Hospital Clinic Visits	V	2.4657	$168.33	.	$33.67																																																																																																																																																																																																																																																																																			
0609	Level 1 Type A Emergency Visits	V	0.7735	$52.80	$12.64	$10.56																																																																																																																																																																																																																																																																																			
0613	Level 2 Type A Emergency Visits	V	1.3150	$89.77	$21.06	$17.96																																																																																																																																																																																																																																																																																			
0614	Level 3 Type A Emergency Visits	V	2.1031	$143.57	$34.50	$28.72																																																																																																																																																																																																																																																																																			
0615	Level 4 Type A Emergency Visits	V	3.3549	$229.03	$48.49	$45.81																																																																																																																																																																																																																																																																																			
0616	Level 5 Type A Emergency Visits	V	4.9888	$340.57	$72.86	$68.12																																																																																																																																																																																																																																																																																			
0617	Critical Care	S	7.7626	$529.93	$111.59	$105.99																																																																																																																																																																																																																																																																																			
0618	Trauma Response with Critical Care	S	13.9990	$955.67	.	$191.14																																																																																																																																																																																																																																																																																			
0621	Level I Vascular Access Procedures	T	11.4058	$778.64	.	$155.73																																																																																																																																																																																																																																																																																			
0622	Level II Vascular Access Procedures	T	25.6930	"$1,753.98"	.	$350.80																																																																																																																																																																																																																																																																																			
0623	Level III Vascular Access Procedures	T	30.8594	"$2,106.68"	.	$421.34																																																																																																																																																																																																																																																																																			
0624	Phlebotomy and Minor Vascular Access Device Procedures	X	0.6338	$43.27	$12.65	$8.66																																																																																																																																																																																																																																																																																			
0626	Level 1 Type B Emergency Visits	V	0.6250	$42.67	.	$8.54																																																																																																																																																																																																																																																																																			
0627	Level 2 Type B Emergency Visits	V	0.9279	$63.34	.	$12.67																																																																																																																																																																																																																																																																																			
0628	Level 3 Type B Emergency Visits	V	1.4941	$102.00	.	$20.40																																																																																																																																																																																																																																																																																			
0629	Level 4 Type B Emergency Visits	V	2.4251	$165.55	.	$33.11																																																																																																																																																																																																																																																																																			
0630	Level 5 Type B Emergency Visits	V	3.8788	$264.79	.	$52.96																																																																																																																																																																																																																																																																																			
0648	Level IV Breast Surgery	T	62.9000	"$4,293.99"	.	$858.80																																																																																																																																																																																																																																																																																			
0651	Complex Interstitial Radiation Source Application	S	14.3321	$978.41	.	$195.69																																																																																																																																																																																																																																																																																			
0652	Insertion of Intraperitoneal and Pleural Catheters	T	31.1286	"$2,125.06"	.	$425.02																																																																																																																																																																																																																																																																																			
0653	Vascular Reconstruction/Fistula Repair with Device	T	44.7437	"$3,054.52"	.	$610.91																																																																																																																																																																																																																																																																																			
0654	Insertion/Replacement of a permanent dual chamber pacemaker	T	108.1716	"$7,384.55"	.	"$1,476.91"																																																																																																																																																																																																																																																																																			
0655	Insertion/Replacement/Conversion of a permanent dual chamber pacemaker	T	138.0708	"$9,425.68"	.	"$1,885.14"																																																																																																																																																																																																																																																																																			
0656	Transcatheter Placement of Intracoronary Drug-Eluting Stents	T	104.6619	"$7,144.95"	.	"$1,428.99"																																																																																																																																																																																																																																																																																			
0659	Hyperbaric Oxygen	S	1.5650	$106.84	.	$21.37																																																																																																																																																																																																																																																																																			
0660	Level II Otorhinolaryngologic Function Tests	X	1.4013	$95.66	$25.67	$19.14																																																																																																																																																																																																																																																																																			
0661	Level V Pathology	X	2.3687	$161.70	.	$32.34																																																																																																																																																																																																																																																																																			
0662	CT Angiography	S	5.0605	$345.47	$114.75	$69.10																																																																																																																																																																																																																																																																																			
0664	Level I Proton Beam Radiation Therapy	S	13.2159	$902.21	.	$180.45																																																																																																																																																																																																																																																																																			
0665	Bone Density:AppendicularSkeleton	S	0.4667	$31.86	$11.60	$6.38																																																																																																																																																																																																																																																																																			
0667	Level II Proton Beam Radiation Therapy	S	17.2884	"$1,180.23"	.	$236.05																																																																																																																																																																																																																																																																																			
0668	Level I Angiography and Venography	S	10.6287	$725.59	.	$145.12																																																																																																																																																																																																																																																																																			
0672	Level III Posterior Segment Eye Procedures	T	40.6474	"$2,774.88"	.	$554.98																																																																																																																																																																																																																																																																																			
0673	Level V Anterior Segment Eye Procedures	T	44.5131	"$3,038.78"	$649.56	$607.76																																																																																																																																																																																																																																																																																			
0674	Prostate Cryoablation	T	116.8825	"$7,979.22"	.	"$1,595.85"																																																																																																																																																																																																																																																																																			
0676	Thrombolysis and Other Device Revisions 	T	2.3844	$162.78	.	$32.56																																																																																																																																																																																																																																																																																			
0678	External Counterpulsation	T	1.4509	$99.05	.	$19.81																																																																																																																																																																																																																																																																																			
0679	Level II Resuscitation and Cardioversion	S	5.4877	$374.63	$95.30	$74.93																																																																																																																																																																																																																																																																																			
0680	Insertion of Patient Activated Event Recorders	S	78.5933	"$5,365.33"	.	"$1,073.07"																																																																																																																																																																																																																																																																																			
0683	Level II Photochemotherapy	S	2.8503	$194.58	.	$38.92																																																																																																																																																																																																																																																																																			
0685	Level III Needle Biopsy/Aspiration Except Bone Marrow	T	9.9046	$676.16	.	$135.24																																																																																																																																																																																																																																																																																			
0687	Revision/Removal of Neurostimulator Electrodes	T	21.9323	"$1,497.25"	$397.37	$299.45																																																																																																																																																																																																																																																																																			
0688	Revision/Removal of Neurostimulator Pulse Generator Receiver	T	29.5816	"$2,019.45"	$768.94	$403.89																																																																																																																																																																																																																																																																																			
0690	Level I Electronic Analysis of Devices	S	0.5225	$35.67	$8.67	$7.14																																																																																																																																																																																																																																																																																			
0691	Level III Electronic Analysis of Devices	S	2.4765	$169.06	.	$33.82																																																																																																																																																																																																																																																																																			
0692	Level II Electronic Analysis of Devices	S	1.6175	$110.42	.	$22.09																																																																																																																																																																																																																																																																																			
0694	Mohs Surgery	T	5.0842	$347.08	$91.69	$69.42																																																																																																																																																																																																																																																																																			
0697	Level I Echocardiogram Without Contrast 	S	3.1630	$215.93	.	$43.19																																																																																																																																																																																																																																																																																			
0698	Level II Eye Tests & Treatments	S	0.9316	$63.60	.	$12.72																																																																																																																																																																																																																																																																																			
0699	Level IV Eye Tests & Treatments	T	16.6419	"$1,136.09"	.	$227.22																																																																																																																																																																																																																																																																																			
0701	Sr89 strontium	K		$805.83	.	$161.17																																																																																																																																																																																																																																																																																			
0726	Dexrazoxane HCl injection	K		$261.24	.	$52.25																																																																																																																																																																																																																																																																																			
0728	Filgrastim 300 mcg injection	K		$223.05	.	$44.61																																																																																																																																																																																																																																																																																			
0731	Sargramostim injection	K		$25.25	.	$5.05																																																																																																																																																																																																																																																																																			
0735	Ampho b cholesteryl sulfate	K		$14.00	.	$2.80																																																																																																																																																																																																																																																																																			
0736	Amphotericin b liposome inj	K		$15.78	.	$3.16																																																																																																																																																																																																																																																																																			
0738	Rasburicase	K		$172.53	.	$34.51																																																																																																																																																																																																																																																																																			
0747	Chlorothiazide sodium inj	K		$352.37	.	$70.48																																																																																																																																																																																																																																																																																			
0751	Mechlorethamine hcl inj	K		$154.50	.	$30.90																																																																																																																																																																																																																																																																																			
0752	Dactinomycin injection	K		$570.53	.	$114.11																																																																																																																																																																																																																																																																																			
0759	"Naltrexone, depot form"	K		$2.43	.	$0.49																																																																																																																																																																																																																																																																																			
0800	Leuprolide acetate	K		$516.09	.	$103.22																																																																																																																																																																																																																																																																																			
0802	Etoposide oral	K		$28.26	.	$5.66																																																																																																																																																																																																																																																																																			
0807	Aldesleukin injection	K		$844.43	.	$168.89																																																																																																																																																																																																																																																																																			
0809	Bcg live intravesical vac	K		$121.25	.	$24.25																																																																																																																																																																																																																																																																																			
0810	Goserelin acetate implant	K		$195.23	.	$39.05																																																																																																																																																																																																																																																																																			
0812	Carmustine injection	K		$176.41	.	$35.29																																																																																																																																																																																																																																																																																			
0814	Asparaginase injection	K		$60.94	.	$12.19																																																																																																																																																																																																																																																																																			
0820	Daunorubicin injection	K		$19.46	.	$3.90																																																																																																																																																																																																																																																																																			
0821	Daunorubicin citrate inj	K		$56.31	.	$11.27																																																																																																																																																																																																																																																																																			
0823	Docetaxel injection	K		$17.86	.	$3.58																																																																																																																																																																																																																																																																																			
0825	Nelarabine injection	K		$105.91	.	$21.19																																																																																																																																																																																																																																																																																			
0827	Floxuridine injection	K		$42.99	.	$8.60																																																																																																																																																																																																																																																																																			
0828	Gemcitabine hcl injection	K		$145.10	.	$29.02																																																																																																																																																																																																																																																																																			
0830	Irinotecan injection	K		$9.15	.	$1.83																																																																																																																																																																																																																																																																																			
0831	Ifosfomide injection	K		$30.76	.	$6.16																																																																																																																																																																																																																																																																																			
0832	Idarubicin hcl injection	K		$63.57	.	$12.72																																																																																																																																																																																																																																																																																			
0835	Cosyntropin injection NOS	K		$73.19	.	$14.64																																																																																																																																																																																																																																																																																			
0836	Interferon alfa-2b inj	K		$15.84	.	$3.17																																																																																																																																																																																																																																																																																			
0838	Interferon gamma 1-b inj	K		$430.93	.	$86.19																																																																																																																																																																																																																																																																																			
0840	Inj melphalan hydrochl	K		"$1,500.32"	.	$300.07																																																																																																																																																																																																																																																																																			
0842	Fludarabine phosphate inj	K		$205.81	.	$41.17																																																																																																																																																																																																																																																																																			
0843	Pegaspargase injection	K		"$2,747.44"	.	$549.49																																																																																																																																																																																																																																																																																			
0844	Pentostatin injection	K		"$1,246.38"	.	$249.28																																																																																																																																																																																																																																																																																			
0849	Rituximab injection	K		$578.40	.	$115.68																																																																																																																																																																																																																																																																																			
0850	Streptozocin injection	K		$282.86	.	$56.58																																																																																																																																																																																																																																																																																			
0851	Thiotepa injection	K		$113.52	.	$22.71																																																																																																																																																																																																																																																																																			
0852	Topotecan injection	K		"$1,058.90"	.	$211.78																																																																																																																																																																																																																																																																																			
0856	Porfimer sodium injection	K		"$2,934.28"	.	$586.86																																																																																																																																																																																																																																																																																			
0858	Inj cladribine	K		$28.22	.	$5.65																																																																																																																																																																																																																																																																																			
0861	Leuprolide acetate injeciton	K		$4.27	.	$0.86																																																																																																																																																																																																																																																																																			
0864	Mitoxantrone hydrochl	K		$45.26	.	$9.06																																																																																																																																																																																																																																																																																			
0865	Interferon alfa-n3 inj	K		$18.23	.	$3.65																																																																																																																																																																																																																																																																																			
0868	Oral aprepitant	K		$5.67	.	$1.14																																																																																																																																																																																																																																																																																			
0873	Hyalgan/supartz inj per dose	K		$91.96	.	$18.40																																																																																																																																																																																																																																																																																			
0874	Synvisc or synvisc-one	K		$11.78	.	$2.36																																																																																																																																																																																																																																																																																			
0875	Euflexxa inj per dose	K		$113.79	.	$22.76																																																																																																																																																																																																																																																																																			
0877	Orthovisc inj per dose	K		$176.70	.	$35.34																																																																																																																																																																																																																																																																																			
0878	Gallium nitrate injection	K		$2.03	.	$0.41																																																																																																																																																																																																																																																																																			
0884	Rho d immune globulin inj	K		$77.47	.	$15.50																																																																																																																																																																																																																																																																																			
0887	Azathioprine parenteral	K		$96.29	.	$19.26																																																																																																																																																																																																																																																																																			
0890	Lymphocyte immune globulin	K		$487.88	.	$97.58																																																																																																																																																																																																																																																																																			
0900	Alglucerase injection	K		$41.98	.	$8.40																																																																																																																																																																																																																																																																																			
0901	Alpha 1 proteinase inhibitor	K		$3.77	.	$0.76																																																																																																																																																																																																																																																																																			
0902	"Injection,onabotulinumtoxinA"	K		$5.49	.	$1.10																																																																																																																																																																																																																																																																																			
0903	Cytomegalovirus imm IV /vial	K		$878.82	.	$175.77																																																																																																																																																																																																																																																																																			
0904	Gamma globulin 4 CC inj	K		$64.13	.	$12.83																																																																																																																																																																																																																																																																																			
0910	Interferon beta-1b / .25 MG	K		$176.67	.	$35.34																																																																																																																																																																																																																																																																																			
0913	Ganciclovir long act implant	K		"$16,960.00"	.	"$3,392.00"																																																																																																																																																																																																																																																																																			
0916	Injection imiglucerase /unit	K		$4.20	.	$0.84																																																																																																																																																																																																																																																																																			
0917	Adenosine injection	K		$82.72	.	$16.55																																																																																																																																																																																																																																																																																			
0920	Gamma globulin 6 CC inj	K		$96.23	.	$19.25																																																																																																																																																																																																																																																																																			
0921	Gamma globulin 7 CC inj	K		$112.17	.	$22.44																																																																																																																																																																																																																																																																																			
0922	Gamma globulin 8 CC inj	K		$128.27	.	$25.66																																																																																																																																																																																																																																																																																			
0923	Gamma globulin 9 CC inj	K		$160.34	.	$32.07																																																																																																																																																																																																																																																																																			
0924	Gamma globulin 10 CC inj	K		$160.34	.	$32.07																																																																																																																																																																																																																																																																																			
0925	Factor viii	K		$0.87	.	$0.18																																																																																																																																																																																																																																																																																			
0927	Factor viii recombinant	K		$1.09	.	$0.22																																																																																																																																																																																																																																																																																			
0928	Factor ix complex	K		$0.88	.	$0.18																																																																																																																																																																																																																																																																																			
0929	Anti-inhibitor	K		$1.55	.	$0.31																																																																																																																																																																																																																																																																																			
0931	Factor IX non-recombinant	K		$0.91	.	$0.19																																																																																																																																																																																																																																																																																			
0932	Factor IX recombinant	K		$1.11	.	$0.23																																																																																																																																																																																																																																																																																			
0933	Gamma globulin > 10 CC inj	K		$160.34	.	$32.07																																																																																																																																																																																																																																																																																			
0934	"Capecitabine, oral"	K		$20.66	.	$4.14																																																																																																																																																																																																																																																																																			
0935	Clonidine hydrochloride	K		$98.64	.	$19.73																																																																																																																																																																																																																																																																																			
0943	Octagam injection	K		$37.69	.	$7.54																																																																																																																																																																																																																																																																																			
0944	Gammagard liquid injection	K		$38.53	.	$7.71																																																																																																																																																																																																																																																																																			
0945	Rhophylac injection	K		$5.21	.	$1.05																																																																																																																																																																																																																																																																																			
0946	Hepagam b im injection	K		$50.63	.	$10.13																																																																																																																																																																																																																																																																																			
0947	Flebogamma injection	K		$37.01	.	$7.41																																																																																																																																																																																																																																																																																			
0948	Gamunex injection	K		$37.63	.	$7.53																																																																																																																																																																																																																																																																																			
0949	"Frozen plasma, pooled, sd"	R	0.8126	$55.47	.	$11.10																																																																																																																																																																																																																																																																																			
0950	Whole blood for transfusion	R	2.9637	$202.32	.	$40.47																																																																																																																																																																																																																																																																																			
0951	Reclast injection	K		$222.92	.	$44.59																																																																																																																																																																																																																																																																																			
0952	Cryoprecipitate each unit	R	0.7391	$50.46	.	$10.10																																																																																																																																																																																																																																																																																			
0954	RBC leukocytes reduced	R	2.7694	$189.06	.	$37.82																																																																																																																																																																																																																																																																																			
0955	"Plasma, frz between 8-24hour"	R	1.0672	$72.85	.	$14.57																																																																																																																																																																																																																																																																																			
0956	"Plasma protein fract,5%,50ml"	R	0.3751	$25.61	.	$5.13																																																																																																																																																																																																																																																																																			
0957	"Platelets, each unit"	R	1.0506	$71.72	.	$14.35																																																																																																																																																																																																																																																																																			
0958	Plaelet rich plasma unit	R	2.0520	$140.08	.	$28.02																																																																																																																																																																																																																																																																																			
0959	Red blood cells unit	R	2.1860	$149.23	.	$29.85																																																																																																																																																																																																																																																																																			
0960	Washed red blood cells unit	R	4.3079	$294.09	.	$58.82																																																																																																																																																																																																																																																																																			
0961	"Albumin (human),5%, 50ml"	K		$16.89	.	$3.38																																																																																																																																																																																																																																																																																			
0963	"Albumin (human), 5%, 250 ml"	K		$60.58	.	$12.12																																																																																																																																																																																																																																																																																			
0964	"Albumin (human), 25%, 20 ml"	K		$25.67	.	$5.14																																																																																																																																																																																																																																																																																			
0965	"Albumin (human), 25%, 50ml"	K		$62.05	.	$12.41																																																																																																																																																																																																																																																																																			
0966	"Plasmaprotein fract,5%,250ml"	R	1.6989	$115.98	.	$23.20																																																																																																																																																																																																																																																																																			
0967	Blood split unit	R	2.9552	$201.74	.	$40.35																																																																																																																																																																																																																																																																																			
0968	Platelets leukoreduced irrad	R	2.0209	$137.96	.	$27.60																																																																																																																																																																																																																																																																																			
0969	RBC leukoreduced irradiated	R	3.6796	$251.20	.	$50.24																																																																																																																																																																																																																																																																																			
1009	Cryoprecipitatereducedplasma	R	1.1663	$79.62	.	$15.93																																																																																																																																																																																																																																																																																			
1010	"Blood, l/r, cmv-neg"	R	2.7600	$188.42	.	$37.69																																																																																																																																																																																																																																																																																			
1011	"Platelets, hla-m, l/r, unit"	R	10.5854	$722.63	.	$144.53																																																																																																																																																																																																																																																																																			
1013	Platelets leukocytes reduced	R	1.5839	$108.13	.	$21.63																																																																																																																																																																																																																																																																																			
1015	Injection glatiramer acetate	K		$82.34	.	$16.47																																																																																																																																																																																																																																																																																			
1016	"Blood, l/r, froz/degly/wash"	R	1.4749	$100.69	.	$20.14																																																																																																																																																																																																																																																																																			
1017	"Plt, aph/pher, l/r, cmv-neg"	R	6.2876	$429.24	.	$85.85																																																																																																																																																																																																																																																																																			
1018	"Blood, l/r, irradiated"	R	2.4465	$167.02	.	$33.41																																																																																																																																																																																																																																																																																			
1019	Plate pheres leukoredu irrad	R	9.6439	$658.36	.	$131.68																																																																																																																																																																																																																																																																																			
1020	"Plt, pher, l/r cmv-neg, irr"	R	8.5688	$584.97	.	$117.00																																																																																																																																																																																																																																																																																			
1021	"RBC, frz/deg/wsh, l/r, irrad"	R	4.1093	$280.53	.	$56.11																																																																																																																																																																																																																																																																																			
1022	"RBC, l/r, cmv-neg, irrad"	R	4.3870	$299.49	.	$59.90																																																																																																																																																																																																																																																																																			
1023	Pralidoxime chloride inj	K		$90.79	.	$18.16																																																																																																																																																																																																																																																																																			
1052	"Injection, voriconazole"	K		$5.82	.	$1.17																																																																																																																																																																																																																																																																																			
1064	"I131 iodide cap, rx"	K		$18.20	.	$3.64																																																																																																																																																																																																																																																																																			
1083	Adalimumab injection	K		$374.48	.	$74.90																																																																																																																																																																																																																																																																																			
1084	Denileukin diftitox inj	K		"$1,494.82"	.	$298.97																																																																																																																																																																																																																																																																																			
1086	Temozolomide	K		$8.83	.	$1.77																																																																																																																																																																																																																																																																																			
1138	"Hepagam b intravenous, inj"	K		$50.63	.	$10.13																																																																																																																																																																																																																																																																																			
1139	Protein c concentrate	K		$12.19	.	$2.44																																																																																																																																																																																																																																																																																			
1142	Supprelin LA implant	K		"$14,990.44"	.	"$2,998.09"																																																																																																																																																																																																																																																																																			
1150	"I131 iodide sol, rx"	K		$13.72	.	$2.75																																																																																																																																																																																																																																																																																			
1166	Cytarabine liposome inj	K		$488.90	.	$97.78																																																																																																																																																																																																																																																																																			
1167	"Inj, epirubicin hcl"	K		$2.48	.	$0.50																																																																																																																																																																																																																																																																																			
1168	"Inj, temsirolimus"	K		$49.83	.	$9.97																																																																																																																																																																																																																																																																																			
1178	Busulfan injection	K		$14.45	.	$2.89																																																																																																																																																																																																																																																																																			
1203	Verteporfin injection	K		$9.50	.	$1.90																																																																																																																																																																																																																																																																																			
1207	"Octreotide injection, depot"	K		$109.01	.	$21.81																																																																																																																																																																																																																																																																																			
1213	Antihemophilic viii/vwf comp	K		$0.92	.	$0.19																																																																																																																																																																																																																																																																																			
1214	Inj IVIG privigen 500 mg	K		$35.10	.	$7.02																																																																																																																																																																																																																																																																																			
1220	Calcitonin salmon injection	K		$49.26	.	$9.86																																																																																																																																																																																																																																																																																			
1221	Dimethyl sulfoxide 50%	K		$69.98	.	$14.00																																																																																																																																																																																																																																																																																			
1222	Pentastarch 10% solution	K		$161.82	.	$32.37																																																																																																																																																																																																																																																																																			
1226	Inj streptokinase /250000 IU	K		$32.12	.	$6.43																																																																																																																																																																																																																																																																																			
1232	Mitomycin 5 MG inj	K		$20.35	.	$4.07																																																																																																																																																																																																																																																																																			
1233	Mitomycin 20 MG inj	K		$81.44	.	$16.29																																																																																																																																																																																																																																																																																			
1234	Mitomycin 40 MG inj	K		$162.86	.	$32.58																																																																																																																																																																																																																																																																																			
1235	Valrubicin injection	K		$960.22	.	$192.05																																																																																																																																																																																																																																																																																			
1236	Levoleucovorin injection	G		$0.78	.	$0.16																																																																																																																																																																																																																																																																																			
1237	Inj iron dextran	K		$12.63	.	$2.53																																																																																																																																																																																																																																																																																			
1238	Topotecan oral	G		$74.66	.	$14.94																																																																																																																																																																																																																																																																																			
1239	Rotavirus vacc 2 dose oral	K		$102.50	.	$20.50																																																																																																																																																																																																																																																																																			
1240	Apligraf skin sub	K		$32.71	.	$6.55																																																																																																																																																																																																																																																																																			
1241	Oasis wound matrix skin sub	K		$4.62	.	$0.93																																																																																																																																																																																																																																																																																			
1242	Oasis burn matrix skin sub	K		$4.62	.	$0.93																																																																																																																																																																																																																																																																																			
1243	Integra BMWD skin sub	K		$14.84	.	$2.97																																																																																																																																																																																																																																																																																			
1244	Integra DRT skin sub	K		$10.00	.	$2.00																																																																																																																																																																																																																																																																																			
1245	Dermagraft skin sub	K		$40.10	.	$8.02																																																																																																																																																																																																																																																																																			
1246	Graftjacket skin sub	K		$92.04	.	$18.41																																																																																																																																																																																																																																																																																			
1247	Integra matrix skin sub	K		$17.99	.	$3.60																																																																																																																																																																																																																																																																																			
1248	Primatrix skin sub	K		$34.35	.	$6.87																																																																																																																																																																																																																																																																																			
1249	Cymetra allograft	K		$342.34	.	$68.47																																																																																																																																																																																																																																																																																			
1250	Graftjacket express allograf	K		$342.34	.	$68.47																																																																																																																																																																																																																																																																																			
1251	Integra flowable wound matri	K		$914.43	.	$182.89																																																																																																																																																																																																																																																																																			
1252	Gammagraft skin sub	K 		$7.40	.	$1.48																																																																																																																																																																																																																																																																																			
1253	Triamcinolone A inj PRS-free	K		$3.21	.	$0.65																																																																																																																																																																																																																																																																																			
1254	"Adenovirus vaccine, type 4"	K 		$173.84	.	$34.77																																																																																																																																																																																																																																																																																			
1255	"Rotovirus vacc 3 dose, oral"	K 		$73.76	.	$14.76																																																																																																																																																																																																																																																																																			
1256	Brompheniramine maleate inj	K 		$9.24	.	$1.85																																																																																																																																																																																																																																																																																			
1260	Nandrolone decanoate 100 MG	K 		$71.34	.	$14.27																																																																																																																																																																																																																																																																																			
1263	Antithrombin iii injection	K 		$2.31	.	$0.47																																																																																																																																																																																																																																																																																			
1266	Interferon alfacon-1 inj	K 		$4.80	.	$0.96																																																																																																																																																																																																																																																																																			
1268	Xyntha inj	K 		$1.08	.	$0.22																																																																																																																																																																																																																																																																																			
1270	Alloderm skin sub	K 		$32.57	.	$6.52																																																																																																																																																																																																																																																																																			
1271	"Cholera vaccine, injectable"	K 		$103.90	.	$20.78																																																																																																																																																																																																																																																																																			
1272	Acetylcysteine injection	K 		$2.45	.	$0.49																																																																																																																																																																																																																																																																																			
1274	Edetate calcium disodium inj	K 		$197.37	.	$39.48																																																																																																																																																																																																																																																																																			
1275	"Vivaglobin, inj"	K 		$7.20	.	$1.44																																																																																																																																																																																																																																																																																			
1279	Factor VIII (porcine)	K 		$8.21	.	$1.65																																																																																																																																																																																																																																																																																			
1280	Corticotropin injection	K		"$2,441.70"	.	$488.34																																																																																																																																																																																																																																																																																			
1281	Bevacizumab injection	K		$1.44	.	$0.29																																																																																																																																																																																																																																																																																			
1282	Gamma globulin 2 CC inj	K		$32.07	.	$6.42																																																																																																																																																																																																																																																																																			
1283	Gamma globulin 3 CC inj	K		$48.10	.	$9.62																																																																																																																																																																																																																																																																																			
1284	Gamma globulin 5 CC inj	K		$80.16	.	$16.04																																																																																																																																																																																																																																																																																			
1285	Nandrolone decanoate 50 MG	K		$7.08	.	$1.42																																																																																																																																																																																																																																																																																			
1286	Nandrolone decanoate 200 MG	K		$43.59	.	$8.72																																																																																																																																																																																																																																																																																			
1287	Alloskin skin sub	K		$7.34	.	$1.47																																																																																																																																																																																																																																																																																			
1288	Visualization adjunct	K		$1.82	.	$0.37																																																																																																																																																																																																																																																																																			
1289	AbobotulinumtoxinA	K		$7.71	.	$1.55																																																																																																																																																																																																																																																																																			
1290	Human fibrinogen conc inj	G		$72.89	.	$14.58																																																																																																																																																																																																																																																																																			
1291	Rilonacept injection	K		$24.09	.	$4.82																																																																																																																																																																																																																																																																																			
1295	Sm 153 lexidronam	K		"$5,613.99"	.	"$1,122.80"																																																																																																																																																																																																																																																																																			
1296	Degarelix injection	G		$2.60	.	$0.52																																																																																																																																																																																																																																																																																			
1297	"Ferumoxytol, non-esrd"	G		$0.82	.	$0.17																																																																																																																																																																																																																																																																																			
1298	Cosyntropin cortrosyn inj	K		$90.95	.	$18.19																																																																																																																																																																																																																																																																																			
1299	Gadofosveset trisodium inj	G		$12.89																																																																																																																																																																																																																																																																																					
1302	Inj benztropine mesylate	K		$42.16	.	$8.44																																																																																																																																																																																																																																																																																			
1303	Itraconazole injection	K		$42.28	.	$8.46																																																																																																																																																																																																																																																																																			
1304	Perphenazine injeciton	K		$29.11	.	$5.83																																																																																																																																																																																																																																																																																			
1306	Urea injection	K		$83.87	.	$16.78																																																																																																																																																																																																																																																																																			
1307	Oral busulfan	K		$3.65	.	$0.73																																																																																																																																																																																																																																																																																			
1308	Mecasermin injection	K		$125.21	.	$25.05																																																																																																																																																																																																																																																																																			
1309	Paclitaxel injection	K		$11.46	.	$2.30																																																																																																																																																																																																																																																																																			
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		$462.83	.	$92.57																																																																																																																																																																																																																																																																																			
1607	Eptifibatide injection	K		$19.00	.	$3.80																																																																																																																																																																																																																																																																																			
1608	Etanercept injection	K		$191.55	.	$38.31																																																																																																																																																																																																																																																																																			
1609	"Rho(D) immune globulin h, sd"	K		$18.55	.	$3.71																																																																																																																																																																																																																																																																																			
1612	"Daclizumab, parenteral"	K		$351.10	.	$70.22																																																																																																																																																																																																																																																																																			
1613	Trastuzumab injection	K		$66.41	.	$13.29																																																																																																																																																																																																																																																																																			
1630	"Hep b ig, im"	K		$115.97	.	$23.20																																																																																																																																																																																																																																																																																			
1631	Baclofen intrathecal trial	K		$73.50	.	$14.70																																																																																																																																																																																																																																																																																			
1633	Alefacept	K		$30.63	.	$6.13																																																																																																																																																																																																																																																																																			
1643	"Y90 ibritumomab, rx"	K		"$31,434.63"	.	"$6,286.93"																																																																																																																																																																																																																																																																																			
1645	"I131 tositumomab, rx"	K		"$23,132.09"	.	"$4,626.42"																																																																																																																																																																																																																																																																																			
1670	Tetanus immune globulin inj	K		$136.81	.	$27.37																																																																																																																																																																																																																																																																																			
1675	P32 Na phosphate	K		$196.49	.	$39.30																																																																																																																																																																																																																																																																																			
1676	P32 chromic phosphate	K		$113.44	.	$22.69																																																																																																																																																																																																																																																																																			
1683	Basiliximab	K		"$1,755.73"	.	$351.15																																																																																																																																																																																																																																																																																			
1684	Corticorelin ovine triflutal	K		$4.48	.	$0.90																																																																																																																																																																																																																																																																																			
1685	"Darbepoetin alfa, non-esrd"	K		$2.88	.	$0.58																																																																																																																																																																																																																																																																																			
1686	"Epoetin alfa, non-esrd"	K		$9.44	.	$1.89																																																																																																																																																																																																																																																																																			
1687	Digoxin immune fab (ovine)	K		$487.78	.	$97.56																																																																																																																																																																																																																																																																																			
1688	Ethanolamine oleate	K		$149.97	.	$30.00																																																																																																																																																																																																																																																																																			
1689	Fomepizole	K		$7.64	.	$1.53																																																																																																																																																																																																																																																																																			
1690	Hemin	K		$8.18	.	$1.64																																																																																																																																																																																																																																																																																			
1693	Lepirudin	K		$234.37	.	$46.88																																																																																																																																																																																																																																																																																			
1694	Ziconotide injection	K		$6.50	.	$1.30																																																																																																																																																																																																																																																																																			
1695	Nesiritide injection	K		$38.37	.	$7.68																																																																																																																																																																																																																																																																																			
1696	Palifermin injection	K		$11.34	.	$2.27																																																																																																																																																																																																																																																																																			
1697	Pegaptanib sodium injection	K		"$1,030.34"	.	$206.07																																																																																																																																																																																																																																																																																			
1700	Inj secretin synthetic human	K		$20.31	.	$4.07																																																																																																																																																																																																																																																																																			
1701	Treprostinil injection	K		$55.88	.	$11.18																																																																																																																																																																																																																																																																																			
1704	"Humate-P, inj"	K		$0.88	.	$0.18																																																																																																																																																																																																																																																																																			
1705	Factor viia	K		$1.36	.	$0.28																																																																																																																																																																																																																																																																																			
1709	Azacitidine injection	K		$4.99	.	$1.00																																																																																																																																																																																																																																																																																			
1710	Clofarabine injection	K		$116.49	.	$23.30																																																																																																																																																																																																																																																																																			
1711	Vantas implant	K		"$1,515.25"	.	$303.05																																																																																																																																																																																																																																																																																			
1712	Paclitaxel protein bound	K		$9.43	.	$1.89																																																																																																																																																																																																																																																																																			
1716	"Brachytx, non-str, Gold-198"	U	2.7019	$184.45	.	$36.89																																																																																																																																																																																																																																																																																			
1717	"Brachytx, non-str, HDR Ir-192"	U	3.2259	$220.22	.	$44.05																																																																																																																																																																																																																																																																																			
1719	"Brachytx, NS, Non-HDRIr-192"	U	0.3366	$22.98	.	$4.60																																																																																																																																																																																																																																																																																			
1738	Oxaliplatin	K		$6.83	.	$1.37																																																																																																																																																																																																																																																																																			
1739	"Pegademase bovine, 25 iu"	K		$247.34	.	$49.47																																																																																																																																																																																																																																																																																			
1740	Diazoxide injection	K		$114.32	.	$22.87																																																																																																																																																																																																																																																																																			
1741	"Urofollitropin, 75 iu"	K		$60.01	.	$12.01																																																																																																																																																																																																																																																																																			
2210	Methyldopate hcl injection	K		$36.34	.	$7.27																																																																																																																																																																																																																																																																																			
2616	"Brachytx, non-str,Yttrium-90"	U	245.7374	"$16,775.76"	.	"$3,355.16"																																																																																																																																																																																																																																																																																			
2632	Iodine I-125 sodium iodide	U	0.3077	$21.01	.	$4.21																																																																																																																																																																																																																																																																																			
2634	"Brachytx, non-str, HA, I-125"	U	0.7596	$51.86	.	$10.38																																																																																																																																																																																																																																																																																			
2635	"Brachytx, non-str, HA, P-103"	U	0.4337	$29.61	.	$5.93																																																																																																																																																																																																																																																																																			
2636	"Brachy linear, non-str,P-103"	U	0.5280	$36.04	.	$7.21																																																																																																																																																																																																																																																																																			
2638	"Brachytx, stranded, I-125"	U	0.5662	$38.65	.	$7.73																																																																																																																																																																																																																																																																																			
2639	"Brachytx, non-stranded,I-125"	U	0.5292	$36.13	.	$7.23																																																																																																																																																																																																																																																																																			
2640	"Brachytx, stranded, P-103"	U	0.9334	$63.72	.	$12.75																																																																																																																																																																																																																																																																																			
2641	"Brachytx, non-stranded,P-103"	U	0.9135	$62.36	.	$12.48																																																																																																																																																																																																																																																																																			
2642	"Brachytx, stranded, C-131"	U	1.6774	$114.51	.	$22.91																																																																																																																																																																																																																																																																																			
2643	"Brachytx, non-stranded,C-131"	U	0.9143	$62.42	.	$12.49																																																																																																																																																																																																																																																																																			
2698	"Brachytx, stranded, NOS"	U	0.5662	$38.65	.	$7.73																																																																																																																																																																																																																																																																																			
2699	"Brachytx, non-stranded, NOS"	U	0.3366	$22.98	.	$4.60																																																																																																																																																																																																																																																																																			
2731	"Immune globulin, powder"	K		$30.86	.	$6.18																																																																																																																																																																																																																																																																																			
2770	Quinupristin/dalfopristin	K		$147.06	.	$29.42																																																																																																																																																																																																																																																																																			
3041	Bivalirudin	K		$2.41	.	$0.49																																																																																																																																																																																																																																																																																			
3043	Gamma globulin 1 CC inj	K		$16.03	.	$3.21																																																																																																																																																																																																																																																																																			
3050	Sermorelin acetate injection	K		$1.80	.	$0.36																																																																																																																																																																																																																																																																																			
7000	Amifostine	K		$327.97	.	$65.60																																																																																																																																																																																																																																																																																			
7011	Oprelvekin injection	K		$245.08	.	$49.02																																																																																																																																																																																																																																																																																			
7034	Somatropin injection	K		$55.46	.	$11.10																																																																																																																																																																																																																																																																																			
7035	Teniposide	K		$324.55	.	$64.91																																																																																																																																																																																																																																																																																			
7036	"Urokinase 250,000 IU inj"	K		$457.73	.	$91.55																																																																																																																																																																																																																																																																																			
7038	Monoclonal antibodies	K		"$1,133.50"	.	$226.70																																																																																																																																																																																																																																																																																			
7041	Tirofiban HCl	K		$7.39	.	$1.48																																																																																																																																																																																																																																																																																			
7042	"Capecitabine, oral"	K		$6.28	.	$1.26																																																																																																																																																																																																																																																																																			
7043	Infliximab injection	K		$58.74	.	$11.75																																																																																																																																																																																																																																																																																			
7046	Doxorubicin hcl liposome inj	K		$472.01	.	$94.41																																																																																																																																																																																																																																																																																			
7048	Alteplase recombinant	K		$37.35	.	$7.47																																																																																																																																																																																																																																																																																			
7049	Filgrastim 480 mcg injection	K		$348.68	.	$69.74																																																																																																																																																																																																																																																																																			
7051	Leuprolide acetate implant	K		"$4,819.82"	.	$963.97																																																																																																																																																																																																																																																																																			
7308	Aminolevulinic acid hcl top	K		$134.54	.	$26.91																																																																																																																																																																																																																																																																																			
8000	Cardiac Electrophysiologic Evaluation and Ablation Composite	T	155.6137	"$10,623.28"	.	"$2,124.66"																																																																																																																																																																																																																																																																																			
8001	LDR Prostate Brachytherapy Composite	T	46.9015	"$3,201.82"	.	$640.37																																																																																																																																																																																																																																																																																			
8002	Level I Extended Assessment & Management Composite	V	5.7633	$393.44	.	$78.69																																																																																																																																																																																																																																																																																			
8003	Level II Extended Assessment & Management Composite	V	10.6788	$729.01	.	$145.81																																																																																																																																																																																																																																																																																			
8004	Ultrasound Composite	S	2.8299	$193.19	.	$38.64																																																																																																																																																																																																																																																																																			
8005	CT and CTA without Contrast Composite	S	6.1855	$422.27	.	$84.46																																																																																																																																																																																																																																																																																			
8006	CT and CTA with Contrast Composite	S	9.3145	$635.87	.	$127.18																																																																																																																																																																																																																																																																																			
8007	MRI and MRA without Contrast Composite	S	10.5169	$717.96	.	$143.60																																																																																																																																																																																																																																																																																			
8008	MRI and MRA with Contrast Composite	S	14.7671	"$1,008.11"	.	$201.63																																																																																																																																																																																																																																																																																			
9001	Linezolid injection	K		$32.57	.	$6.52																																																																																																																																																																																																																																																																																			
9002	Tenecteplase injection	K		$46.74	.	$9.35																																																																																																																																																																																																																																																																																			
9003	Palivizumab	K		$510.69	.	$102.14																																																																																																																																																																																																																																																																																			
9004	Gemtuzumab ozogamicin inj	K		"$2,687.21"	.	$537.45																																																																																																																																																																																																																																																																																			
9005	Reteplase injection	K		"$1,555.98"	.	$311.20																																																																																																																																																																																																																																																																																			
9006	Tacrolimus injection	K		$139.41	.	$27.89																																																																																																																																																																																																																																																																																			
9012	Arsenic trioxide injection	K		$37.43	.	$7.49																																																																																																																																																																																																																																																																																			
9018	"Inj, rimabotulinumtoxinB"	K		$10.58	.	$2.12																																																																																																																																																																																																																																																																																			
9019	Caspofungin acetate	K		$11.59	.	$2.32																																																																																																																																																																																																																																																																																			
9022	IM inj interferon beta 1-a	K		$193.93	.	$38.79																																																																																																																																																																																																																																																																																			
9023	Rho d immune globulin	K		$25.14	.	$5.03																																																																																																																																																																																																																																																																																			
9024	Amphotericin b lipid complex	K		$9.84	.	$1.97																																																																																																																																																																																																																																																																																			
9032	Baclofen 10 MG injection	K		$203.89	.	$40.78																																																																																																																																																																																																																																																																																			
9033	Cidofovir injection	K		$761.10	.	$152.22																																																																																																																																																																																																																																																																																			
9038	Inj estrogen conjugate	K		$88.68	.	$17.74																																																																																																																																																																																																																																																																																			
9042	Glucagon hydrochloride	K		$81.41	.	$16.29																																																																																																																																																																																																																																																																																			
9044	Ibutilide fumarate injection	K		$416.61	.	$83.33																																																																																																																																																																																																																																																																																			
9046	Iron sucrose injection	K		$0.37	.	$0.08																																																																																																																																																																																																																																																																																			
9104	Antithymocyte globuln rabbit	K		$386.48	.	$77.30																																																																																																																																																																																																																																																																																			
9108	Thyrotropin injection	K		"$1,053.42"	.	$210.69																																																																																																																																																																																																																																																																																			
9110	Alemtuzumab injection	K		$578.02	.	$115.61																																																																																																																																																																																																																																																																																			
9115	Zoledronic acid	K		$221.12	.	$44.23																																																																																																																																																																																																																																																																																			
9119	"Injection, pegfilgrastim 6mg"	K		"$2,432.50"	.	$486.50																																																																																																																																																																																																																																																																																			
9120	"Injection, Fulvestrant"	K		$82.22	.	$16.45																																																																																																																																																																																																																																																																																			
9121	"Injection, argatroban"	K		$18.39	.	$3.68																																																																																																																																																																																																																																																																																			
9122	Triptorelin pamoate	K		$164.10	.	$32.82																																																																																																																																																																																																																																																																																			
9124	Daptomycin injection	K		$0.43	.	$0.09																																																																																																																																																																																																																																																																																			
9125	"Risperidone, long acting"	K		$5.06	.	$1.02																																																																																																																																																																																																																																																																																			
9126	Natalizumab injection	K		$7.97	.	$1.60																																																																																																																																																																																																																																																																																			
9133	"Rabies ig, im/sc"	K		$139.75	.	$27.95																																																																																																																																																																																																																																																																																			
9134	"Rabies ig, heat treated"	K		$152.38	.	$30.48																																																																																																																																																																																																																																																																																			
9135	"Varicella-zoster ig, im"	K		$147.58	.	$29.52																																																																																																																																																																																																																																																																																			
9137	"Bcg vaccine, percut"	K		$109.47	.	$21.90																																																																																																																																																																																																																																																																																			
9139	"Rabies vaccine, im"	K		$181.27	.	$36.26																																																																																																																																																																																																																																																																																			
9140	"Rabies vaccine, id"	K		$98.12	.	$19.63																																																																																																																																																																																																																																																																																			
9143	"Meningococcal vaccine, sc"	K		$103.41	.	$20.69																																																																																																																																																																																																																																																																																			
9144	"Encephalitis vaccine, sc"	K		$102.08	.	$20.42																																																																																																																																																																																																																																																																																			
9145	"Meningococcal vaccine, im"	K		$103.41	.	$20.69																																																																																																																																																																																																																																																																																			
9207	Bortezomib injection	K		$38.24	.	$7.65																																																																																																																																																																																																																																																																																			
9208	Agalsidase beta injection	K		$136.24	.	$27.25																																																																																																																																																																																																																																																																																			
9209	Laronidase injection	K		$25.56	.	$5.12																																																																																																																																																																																																																																																																																			
9210	Palonosetron hcl	K		$17.62	.	$3.53																																																																																																																																																																																																																																																																																			
9213	Pemetrexed injection	K		$50.63	.	$10.13																																																																																																																																																																																																																																																																																			
9214	Bevacizumab injection	K		$57.57	.	$11.52																																																																																																																																																																																																																																																																																			
9215	Cetuximab injection	K		$49.73	.	$9.95																																																																																																																																																																																																																																																																																			
9217	Leuprolide acetate suspnsion	K		$220.41	.	$44.09																																																																																																																																																																																																																																																																																			
9224	Galsulfase injection	K		$339.90	.	$67.98																																																																																																																																																																																																																																																																																			
9225	Fluocinolone acetonide implt	K		"$19,345.00"	.	"$3,869.00"																																																																																																																																																																																																																																																																																			
9227	Micafungin sodium injection	K		$1.10	.	$0.22																																																																																																																																																																																																																																																																																			
9228	Tigecycline injection	K		$1.16	.	$0.24																																																																																																																																																																																																																																																																																			
9229	Ibandronate sodium injection	K		$141.39	.	$28.28																																																																																																																																																																																																																																																																																			
9230	Abatacept injection	K		$19.96	.	$4.00																																																																																																																																																																																																																																																																																			
9231	Decitabine injection	K		$29.65	.	$5.93																																																																																																																																																																																																																																																																																			
9232	Idursulfase injection	K		$455.03	.	$91.01																																																																																																																																																																																																																																																																																			
9233	Ranibizumab injection	K		$404.70	.	$80.94																																																																																																																																																																																																																																																																																			
9234	Alglucosidase alfa injection	K		$127.08	.	$25.42																																																																																																																																																																																																																																																																																			
9235	Panitumumab injection	K		$87.24	.	$17.45																																																																																																																																																																																																																																																																																			
9236	Eculizumab injection	K		$182.61	.	$36.53																																																																																																																																																																																																																																																																																			
9237	"Inj, lanreotide acetate"	K		$29.30	.	$5.86																																																																																																																																																																																																																																																																																			
9240	"Injection, ixabepilone"	K		$63.74	.	$12.75																																																																																																																																																																																																																																																																																			
9242	"Injection, fosaprepitant"	K		$1.62	.	$0.33																																																																																																																																																																																																																																																																																			
9243	Bendamustine injection	K		$18.47	.	$3.70																																																																																																																																																																																																																																																																																			
9244	Regadenoson injection	K		$50.73	.	$10.15																																																																																																																																																																																																																																																																																			
9245	Romiplostim injection	K		$44.18	.	$8.84																																																																																																																																																																																																																																																																																			
9247	"Inj, iobenguane, I-123, dx"	G		"$2,282.67"																																																																																																																																																																																																																																																																																					
9248	"Inj, clevidipine butyrate"	K		$2.98	.	$0.60																																																																																																																																																																																																																																																																																			
9249	Certolizumab pegol inj	G		$3.78	.	$0.76																																																																																																																																																																																																																																																																																			
9250	Artiss fibrin sealant	G		$136.64	.	$27.33																																																																																																																																																																																																																																																																																			
9251	C1 esterase inhibitor inj	G		$42.75	.	$8.55																																																																																																																																																																																																																																																																																			
9252	Plerixafor injection	G		$268.58	.	$53.72																																																																																																																																																																																																																																																																																			
9253	Temozolomide injection	G		$4.90	.	$0.98																																																																																																																																																																																																																																																																																			
9254	"Injection, lacosamide"	K		$0.18	.	$0.04																																																																																																																																																																																																																																																																																			
9255	Paliperidone palmitate inj	G		$6.54	.	$1.31																																																																																																																																																																																																																																																																																			
9256	Dexamethasone intravitreal	G		$196.10	.	$39.22																																																																																																																																																																																																																																																																																			
9258	Telavancin injection	G		$0.21	.	$0.05																																																																																																																																																																																																																																																																																			
9259	Pralatrexate injection	G		$165.63	.	$33.13																																																																																																																																																																																																																																																																																			
9260	Ofatumumab injection	G		$46.64	.	$9.33																																																																																																																																																																																																																																																																																			
9261	Ustekinumab injection	G		$107.43	.	$21.49																																																																																																																																																																																																																																																																																			
9262 	"Fludarabine phosphate, oral"	G		$81.77	.	$16.36																																																																																																																																																																																																																																																																																			
9263	Ecallantide injection	G		$280.90	.	$56.18																																																																																																																																																																																																																																																																																			
9300	Omalizumab injection	K		$19.77	.	$3.96																																																																																																																																																																																																																																																																																			
9358	"SurgiMend, fetal"	K		$10.67	.	$2.14																																																																																																																																																																																																																																																																																			
9360	"SurgiMend, neonatal"	G		$11.24	.	$2.25																																																																																																																																																																																																																																																																																			
9361	NeuroMend nerve wrap	G		$265.18																																																																																																																																																																																																																																																																																					
9362	"Implnt,bon void filler-strip"	G		$50.88																																																																																																																																																																																																																																																																																					
9363	Integra Meshed Bil Wound Mat	G		$17.88	.	$3.58																																																																																																																																																																																																																																																																																			
9364	"Porcine implant, Permacol"	G		$17.67																																																																																																																																																																																																																																																																																					
9500	"Platelets, irradiated"	R	2.2804	$155.68	.	$31.14																																																																																																																																																																																																																																																																																			
9501	Platelet pheres leukoreduced	R	7.7397	$528.37	.	$105.68																																																																																																																																																																																																																																																																																			
9502	Platelet pheresis irradiated	R	6.8837	$469.93	.	$93.99																																																																																																																																																																																																																																																																																			
9503	Fr frz plasma donor retested	R	0.9734	$66.45	.	$13.29																																																																																																																																																																																																																																																																																			
9504	RBC deglycerolized	R	5.1865	$354.07	.	$70.82																																																																																																																																																																																																																																																																																			
9505	RBC irradiated	R	3.1620	$215.86	.	$43.18																																																																																																																																																																																																																																																																																			
9506	"Granulocytes, pheresis unit"	R	23.7666	"$1,622.47"	.	$324.50																																																																																																																																																																																																																																																																																			
9507	"Platelets, pheresis"	R	6.5766	$448.96	.	$89.80																																																																																																																																																																																																																																																																																			
9508	Plasma 1 donor frz w/in 8 hr	R	1.1671	$79.67	.	$15.94																																																																																																																																																																																																																																																																																			
