
0001	Level I Photochemotherapy	S	0.5112	33.58	7.00	6.72
0002	Fine Needle Biopsy/Aspiration	T	1.5340	100.76	.	20.16
0003	Bone Marrow Biopsy/Aspiration	T	3.2496	213.45	.	42.69
0004	Level I Needle Biopsy/ Aspiration Except Bone Marrow	T	4.5254	297.25	.	59.45
0005	Level II Needle Biopsy/Aspiration Except Bone Marrow	T	7.3814	484.84	.	96.97
0006	Level I Incision & Drainage	T	1.4267	93.71	.	18.75
0007	Level II Incision & Drainage	T	12.8052	841.10	.	168.22
0008	Level III Incision and Drainage	T	19.5771	1285.90	.	257.18
0012	Level I Debridement & Destruction	T	0.3156	20.73	.	4.15
0013	Level II Debridement & Destruction	T	0.8332	54.73	.	10.95
0015	Level III Debridement & Destruction	T	1.5126	99.35	.	19.87
0016	Level IV Debridement & Destruction	T	2.7062	177.75	.	35.55
0017	Level VI Debridement & Destruction	T	20.6214	1354.50	.	270.90
0019	Level I Excision/ Biopsy	T	4.3877	288.20	71.87	57.64
0020	Level II Excision/ Biopsy	T	7.9864	524.58	.	104.92
0021	Level III Excision/ Biopsy	T	15.8699	1042.40	219.48	208.48
0022	Level IV Excision/ Biopsy	T	21.7477	1428.48	354.45	285.70
0028	Level I Breast Surgery	T	21.5003	1412.23	303.74	282.45
0029	Level II Breast Surgery	T	33.7028	2213.73	581.52	442.75
0030	Level III Breast Surgery	T	40.6119	2667.55	747.07	533.51
0031	Smoking Cessation Services	X	0.1717	11.28	.	2.26
0034	Mental Health Services Composite	S	2.6501	174.07	.	34.82
0035	Vascular Puncture and Minor Diagnostic Procedures	X	0.2298	15.09	.	3.02
0037	Level IV Needle Biopsy/Aspiration Except Bone Marrow	T	13.5257	888.42	228.76	177.69
0039	Level I Implantation of Neurostimulator	S	182.4712	11985.44	.	2397.09
0040	"Percutaneous Implantation of Neurostimulator Electrodes, Excluding Cranial Nerve"	S	64.4162	4231.11	.	846.23
0041	Level I Arthroscopy	T	29.4350	1933.41	.	386.69
0042	Level II Arthroscopy	T	49.2291	3233.56	804.74	646.72
0045	Bone/Joint Manipulation Under Anesthesia	T	15.5334	1020.30	268.47	204.06
0047	Arthroplasty without Prosthesis	T	37.8828	2488.29	537.03	497.66
0048	Level I Arthroplasty or Implantation with Prosthesis	T	52.8676	3472.56	.	694.52
0049	Level I Musculoskeletal Procedures Except Hand and Foot	T	22.3967	1471.10	.	294.22
0050	Level II Musculoskeletal Procedures Except Hand and Foot	T	29.4401	1933.74	.	386.75
0051	Level III Musculoskeletal Procedures Except Hand and Foot	T	45.4359	2984.41	.	596.89
0052	Level IV Musculoskeletal Procedures Except Hand and Foot	T	85.4915	5615.42	.	1123.09
0053	Level I Hand Musculoskeletal Procedures	T	16.9978	1116.48	253.49	223.30
0054	Level II Hand Musculoskeletal Procedures	T	28.1744	1850.61	.	370.13
0055	Level I Foot Musculoskeletal Procedures	T	21.6078	1419.29	355.34	283.86
0056	Level II Foot Musculoskeletal Procedures	T	47.1767	3098.75	.	619.75
0057	Bunion Procedures	T	31.0283	2038.06	475.91	407.62
0058	Level I Strapping and Cast Application	S	1.1147	73.22	.	14.65
0060	Manipulation Therapy	S	0.4025	26.44	.	5.29
0061	"Laminectomy, Laparoscopy, or Incision for Implantation of Neurostimulator Electr"	S	80.4914	5287.00	.	1057.40
0062	Level I Treatment Fracture/Dislocation	T	25.6821	1686.90	372.87	337.38
0063	Level II Treatment Fracture/Dislocation	T	42.5770	2796.63	.	559.33
0064	Level III Treatment Fracture/Dislocation	T	62.0926	4078.49	835.79	815.70
0065	"Level I Stereotactic Radiosurgery, MRgFUS, and MEG"	S	15.1533	995.33	.	199.07
0066	"Level II Stereotactic Radiosurgery, MRgFUS, and MEG"	S	40.4116	2654.40	.	530.88
0067	"Level III Stereotactic Radiosurgery, MRgFUS, and MEG"	S	55.7874	3664.34	.	732.87
0069	Thoracoscopy	T	33.8939	2226.29	591.64	445.26
0070	Thoracentesis/Lavage Procedures	T	5.3627	352.24	.	70.45
0071	Level I Endoscopy Upper Airway	T	0.9326	61.26	.	12.26
0072	Level II Endoscopy Upper Airway	T	1.7542	115.22	.	23.05
0073	Level III Endoscopy Upper Airway	T	4.3638	286.63	69.15	57.33
0074	Level IV Endoscopy Upper Airway	T	17.9233	1177.27	292.25	235.46
0075	Level V Endoscopy Upper Airway	T	23.4400	1539.63	445.92	307.93
0076	Level I Endoscopy Lower Airway	T	10.2410	672.67	189.82	134.54
0077	Level I Pulmonary Treatment	S	0.3971	26.08	7.74	5.22
0078	Level II Pulmonary Treatment	S	1.4146	92.92	.	18.59
0079	Ventilation Initiation and Management	S	2.7751	182.28	.	36.46
0080	Diagnostic Cardiac Catheterization	T	39.5675	2598.95	838.92	519.79
0082	Coronary or Non-Coronary Atherectomy	T	89.0122	5846.68	.	1169.34
0083	Coronary or Non-Coronary Angioplasty and Percutaneous Valvuloplasty	T	48.2679	3170.43	.	634.09
0084	Level I Electrophysiologic Procedures	S	10.5097	690.32	.	138.07
0085	Level II Electrophysiologic Procedures	T	48.8767	3210.42	.	642.09
0086	Level III Electrophysiologic Procedures	T	99.5911	6541.54	.	1308.31
0088	Thrombectomy	T	40.2393	2643.08	655.22	528.62
0089	Insertion/Replacement of Permanent Pacemaker and Electrodes	T	114.6104	7528.07	1634.44	1505.62
0090	Insertion/Replacement of Pacemaker Pulse Generator	T	94.7306	6222.28	1562.51	1244.46
0091	Level II Vascular Ligation	T	43.1274	2832.78	.	566.56
0092	Level I Vascular Ligation	T	27.1216	1781.46	.	356.30
0093	Vascular Reconstruction/Fistula Repair without Device	T	27.2558	1790.27	.	358.06
0094	Level I Resuscitation and Cardioversion	S	2.4550	161.25	46.29	32.25
0095	Cardiac Rehabilitation	S	0.5713	37.53	13.86	7.51
0096	Non-Invasive Vascular Studies	S	1.4496	95.22	37.42	19.05
0097	Cardiac and Ambulatory Blood Pressure Monitoring	X	1.0044	65.97	23.79	13.20
0099	Electrocardiograms	S	0.4021	26.41	.	5.29
0100	Cardiac Stress Tests	X	2.5931	170.33	41.44	34.07
0101	Tilt Table Evaluation	S	4.3029	282.63	100.24	56.53
0103	Miscellaneous Vascular Procedures	T	15.8354	1040.13	.	208.03
0104	Transcatheter Placement of Intracoronary Stents	T	83.1148	5459.31	.	1091.87
0105	"Repair/Revision/Removal of Pacemakers, AICDs, or Vascular Devices"	T	22.2934	1464.32	.	292.87
0106	Insertion/Replacement of Pacemaker Leads and/or Electrodes	T	49.6204	3259.27	.	651.86
0107	Insertion of Cardioverter-Defibrillator	T	327.1195	21486.52	.	4297.31
0108	Insertion/Replacement/Repair of Cardioverter-Defibrillator Leads	T	406.8227	26721.74	.	5344.35
0110	Transfusion	S	3.3941	222.94	.	44.59
0111	Blood Product Exchange	S	11.7199	769.81	198.40	153.97
0112	Apheresis and Stem Cell Procedures	S	30.7556	2020.15	433.29	404.03
0113	Excision Lymphatic System	T	23.7542	1560.27	.	312.06
0114	Thyroid/Lymphadenectomy Procedures	T	47.1418	3096.46	.	619.30
0115	Cannula/Access Device Procedures	T	30.5339	2005.59	.	401.12
0121	Level I Tube or Catheter Changes or Repositioning	T	4.5975	301.98	.	60.40
0126	Level I Urinary and Anal Procedures	T	1.0401	68.32	16.21	13.67
0127	"Level IV Stereotactic Radiosurgery, MRgFUS, and MEG"	S	115.8206	7607.56	.	1521.52
0128	Echocardiogram with Contrast	S	8.5914	564.32	216.29	112.87
0129	Level I Closed Treatment Fracture Finger/Toe/Trunk	T	1.5788	103.70	.	20.74
0130	Level I Laparoscopy	T	37.5470	2466.24	659.53	493.25
0131	Level II Laparoscopy	T	46.3867	3046.86	1001.89	609.38
0132	Level III Laparoscopy	T	71.7816	4714.90	1239.22	942.98
0133	Level I Skin Repair	T	1.3704	90.01	25.67	18.01
0134	Level II Skin Repair	T	3.5321	232.00	.	46.40
0135	Level III Skin Repair	T	4.7503	312.02	.	62.41
0136	Level IV Skin Repair	T	16.0086	1051.51	.	210.31
0137	Level V Skin Repair	T	20.8007	1366.27	.	273.26
0138	Level II Closed Treatment Fracture Finger/Toe/Trunk	T	6.0607	398.09	.	79.62
0139	Level III Closed Treatment Fracture Finger/Toe/Trunk	T	20.4295	1341.89	.	268.38
0140	Esophageal Dilation without Endoscopy	T	6.4892	426.24	91.40	85.25
0141	Level I Upper GI Procedures	T	8.7109	572.17	143.38	114.44
0142	Small Intestine Endoscopy	T	9.5559	627.67	152.78	125.54
0143	Lower GI Endoscopy	T	9.0436	594.02	186.06	118.81
0146	Level I Sigmoidoscopy and Anoscopy	T	5.5535	364.78	.	72.96
0147	Level II Sigmoidoscopy and Anoscopy	T	9.1698	602.31	.	120.47
0148	Level I Anal/Rectal Procedures	T	5.7614	378.43	.	75.69
0149	Level III Anal/Rectal Procedures	T	23.3417	1533.18	.	306.64
0150	Level IV Anal/Rectal Procedures	T	31.2003	2049.36	437.12	409.88
0151	Endoscopic Retrograde Cholangio-Pancreatography (ERCP)	T	21.7949	1431.58	.	286.32
0152	Level I Percutaneous Abdominal and Biliary Procedures	T	30.1057	1977.46	.	395.50
0153	Peritoneal and Abdominal Procedures	T	23.2665	1528.24	371.60	305.65
0154	Hernia/Hydrocele Procedures	T	31.6898	2081.51	464.85	416.31
0155	Level II Anal/Rectal Procedures	T	12.2474	804.46	.	160.90
0156	Level III Urinary and Anal Procedures	T	3.1503	206.92	.	41.39
0157	Colorectal Cancer Screening: Barium Enema	S	2.6593	174.67	.	34.94
0158	Colorectal Cancer Screening: Colonoscopy	T	7.9982	525.35	.	131.34
0159	Colorectal Cancer Screening: Flexible Sigmoidoscopy	S	5.0526	331.87	.	82.97
0160	Level I Cystourethroscopy and other Genitourinary Procedures	T	7.1684	470.85	.	94.17
0161	Level II Cystourethroscopy and other Genitourinary Procedures	T	18.9529	1244.90	.	248.98
0162	Level III Cystourethroscopy and other Genitourinary Procedures	T	25.6811	1686.84	.	337.37
0163	Level IV Cystourethroscopy and other Genitourinary Procedures	T	36.4225	2392.38	.	478.48
0164	Level II Urinary and Anal Procedures	T	2.2063	144.92	.	28.99
0165	Level IV Urinary and Anal Procedures	T	20.2632	1330.97	.	266.20
0166	Level I Urethral Procedures	T	20.0824	1319.09	.	263.82
0168	Level II Urethral Procedures	T	30.5507	2006.69	.	401.34
0169	Lithotripsy	T	42.4594	2788.90	997.74	557.78
0170	Dialysis	S	6.5091	427.54	.	85.51
0172	Level I Partial Hospitalization (3 services)	P	2.1284	139.80	.	27.96
0173	Level II Partial Hospitalization (4 or more services)	P	2.6501	174.07	.	34.82
0181	Level II Male Genital Procedures	T	35.5509	2335.13	621.82	467.03
0183	Level I Male Genital Procedures	T	22.8775	1502.69	.	300.54
0184	Prostate Biopsy	T	11.8068	775.52	.	155.11
0188	Level II Female Reproductive Proc	T	1.4203	93.29	.	18.66
0189	Level III Female Reproductive Proc	T	3.0399	199.67	.	39.94
0190	Level I Hysteroscopy	T	22.0023	1445.20	424.28	289.04
0191	Level I Female Reproductive Proc	T	0.1824	11.98	.	2.40
0192	Level IV Female Reproductive Proc	T	6.3303	415.80	.	83.16
0193	Level V Female Reproductive Proc	T	19.8841	1306.07	.	261.22
0195	Level VI Female Reproductive Procedures	T	33.9125	2227.51	483.80	445.51
0202	Level VII Female Reproductive Procedures	T	43.6282	2865.67	981.50	573.14
0203	Level IV Nerve Injections	T	14.6571	962.74	240.33	192.55
0204	Level I Nerve Injections	T	2.5055	164.57	40.13	32.92
0206	Level II Nerve Injections	T	3.6940	242.64	52.09	48.53
0207	Level III Nerve Injections	T	7.3510	482.84	.	96.57
0208	Laminotomies and Laminectomies	T	48.3964	3178.87	.	635.78
0209	Level II Extended EEG and Sleep Studies	S	11.4227	750.29	268.73	150.06
0213	Level I Extended EEG and Sleep Studies	S	2.3220	152.52	53.58	30.51
0215	Level I Nerve and Muscle Tests	S	0.5969	39.21	.	7.85
0216	Level III Nerve and Muscle Tests	S	2.7194	178.62	.	35.73
0218	Level II Nerve and Muscle Tests	S	1.2004	78.85	.	15.77
0220	Level I Nerve Procedures	T	18.4356	1210.92	.	242.19
0221	Level II Nerve Procedures	T	36.1780	2376.32	.	475.27
0222	Level II Implantation of Neurostimulator	S	241.9400	15891.59	.	3178.32
0224	Implantation of Catheter/Reservoir/Shunt	T	42.2017	2771.98	.	554.40
0225	"Implantation of Neurostimulator Electrodes, Cranial Nerve"	S	101.1630	6644.79	.	1328.96
0227	Implantation of Drug Infusion Device	T	184.6865	12130.95	.	2426.19
0229	Transcatherter Placement of Intravascular Shunts	T	90.7212	5958.93	.	1191.79
0230	Level I Eye Tests & Treatments	S	0.6359	41.77	.	8.36
0231	Level III Eye Tests & Treatments	S	2.1019	138.06	.	27.62
0232	Level I Anterior Segment Eye Procedures	T	4.5980	302.02	75.66	60.41
0233	Level II Anterior Segment Eye Procedures	T	16.3116	1071.41	266.33	214.29
0234	Level III Anterior Segment Eye Procedures	T	23.9886	1575.67	511.31	315.14
0235	Level I Posterior Segment Eye Procedures	T	5.8210	382.35	.	76.47
0237	Level II Posterior Segment Eye Procedures	T	22.0653	1449.34	.	289.87
0238	Level I Repair and Plastic Eye Procedures	T	2.9984	196.95	.	39.39
0239	Level II Repair and Plastic Eye Procedures	T	7.8833	517.81	.	103.57
0240	Level III Repair and Plastic Eye Procedures	T	19.1444	1257.48	309.52	251.50
0241	Level IV Repair and Plastic Eye Procedures	T	25.4908	1674.34	383.45	334.87
0242	Level V Repair and Plastic Eye Procedures	T	38.2210	2510.51	597.36	502.11
0243	Strabismus/Muscle Procedures	T	24.5085	1609.82	430.35	321.97
0244	Corneal and Amniotic Membrane Transplant	T	37.6829	2475.16	803.26	495.04
0245	Level I Cataract Procedures without IOL Insert	T	14.1643	930.37	212.54	186.08
0246	Cataract Procedures with IOL Insert	T	24.1528	1586.45	495.96	317.29
0247	Laser Eye Procedures	T	5.3324	350.25	104.31	70.05
0249	Level II Cataract Procedures without IOL Insert	T	31.3050	2056.24	524.67	411.25
0250	Level I ENT Procedures	T	1.1335	74.45	25.10	14.89
0251	Level II ENT Procedures	T	3.1568	207.35	.	41.47
0252	Level III ENT Procedures	T	7.7504	509.08	109.16	101.82
0253	Level IV ENT Procedures	T	17.1953	1129.46	282.29	225.90
0254	Level V ENT Procedures	T	24.6341	1618.07	.	323.62
0256	Level VI ENT Procedures	T	41.6247	2734.08	.	546.82
0259	Level VII ENT Procedures	T	383.6563	25200.08	8543.66	5040.02
0260	Level I Plain Film Except Teeth	X	0.6979	45.84	.	9.17
0261	Level II Plain Film Except Teeth Including Bone Density Measurement	X	1.1555	75.90	.	15.18
0262	Plain Film of Teeth	X	0.5358	35.19	.	7.04
0263	Level I Miscellaneous Radiology Procedures	X	2.9629	194.62	.	38.93
0265	Level I Diagnostic and Screening Ultrasound	S	0.9644	63.35	22.35	12.67
0266	Level II Diagnostic and Screening Ultrasound	S	1.5058	98.91	37.80	19.79
0267	Level III Diagnostic and Screening Ultrasound	S	2.3495	154.32	60.50	30.87
0269	Level II Echocardiogram Without Contrast Except Transesophageal	S	6.4958	426.67	.	85.34
0270	Transesophageal Echocardiogram Without Contrast	S	8.3205	546.52	141.32	109.31
0272	Fluoroscopy	X	1.2985	85.29	31.64	17.06
0274	Myelography	S	5.8631	385.11	.	77.03
0275	Arthrography	S	4.0974	269.13	69.09	53.83
0276	Level I Digestive Radiology	S	1.3716	90.09	34.97	18.02
0277	Level II Digestive Radiology	S	2.2278	146.33	54.52	29.27
0278	Diagnostic Urography	S	2.6725	175.54	59.40	35.11
0279	Level II Angiography and Venography	S	29.6349	1946.54	.	389.31
0280	Level III Angiography and Venography	S	45.0529	2959.25	.	591.85
0282	Miscellaneous Computed Axial Tomography	S	1.6117	105.86	37.81	21.18
0283	Computed Tomography with Contrast	S	4.7266	310.46	100.37	62.10
0284	Magnetic Resonance Imaging and Magnetic Resonance Angiography with Contrast	S	6.5748	431.86	148.40	86.38
0288	Bone Density:Axial Skeleton	S	1.1143	73.19	28.90	14.64
0293	Level V Anterior Segment Eye Procedures	T	113.2439	7438.31	.	1487.67
0299	Hyperthermia and Radiation Treatment Procedures	S	5.8229	382.47	.	76.50
0300	Level I Radiation Therapy	S	1.3962	91.71	.	18.35
0301	Level II Radiation Therapy	S	2.2319	146.60	.	29.32
0303	Treatment Device Construction	X	2.9327	192.63	66.95	38.53
0304	Level I Therapeutic Radiation Treatment Preparation	X	1.5618	102.59	38.68	20.52
0305	Level II Therapeutic Radiation Treatment Preparation	X	3.9871	261.89	91.38	52.38
0307	Myocardial Positron Emission Tomography (PET) imaging	S	17.4083	1143.45	238.72	228.69
0308	Non-Myocardial Positron Emission Tomography (PET) imaging	S	16.1159	1058.56	.	211.72
0310	Level III Therapeutic Radiation Treatment Preparation	X	13.7096	900.50	325.27	180.10
0312	Radioelement Applications	S	7.9492	522.14	.	104.43
0313	Brachytherapy	S	11.4819	754.18	.	150.84
0315	Level III Implantation of Neurostimulator	S	269.8886	17727.36	.	3545.48
0317	Level II Miscellaneous Radiology Procedures	X	5.1751	339.92	.	67.99
0320	Electroconvulsive Therapy	S	5.8540	384.51	80.06	76.91
0322	Brief Individual Psychotherapy	S	1.3362	87.77	.	17.56
0323	Extended Individual Psychotherapy	S	1.6400	107.72	.	21.55
0324	Family Psychotherapy	S	2.5065	164.64	.	32.93
0325	Group Psychotherapy	S	0.9540	62.66	13.71	12.54
0330	Dental Procedures	S	7.9447	521.84	.	104.37
0332	Computed Tomography without Contrast	S	2.9900	196.40	75.24	39.28
0333	Computed Tomography without Contrast followed by Contrast)	S	5.2620	345.63	119.01	69.13
0336	Magnetic Resonance Imaging and Magnetic Resonance Angiography without Contrast	S	5.4285	356.57	137.40	71.32
0337	Magnetic Resonance Imaging and Magnetic Resonance Angiography without Contrast f	S	8.3173	546.31	199.53	109.27
0340	Minor Ancillary Procedures	X	0.6481	42.57	.	8.52
0341	Skin Tests	X	0.0847	5.56	2.14	1.12
0342	Level I Pathology	X	0.1558	10.23	.	2.05
0343	Level III Pathology	X	0.5322	34.96	10.84	7.00
0344	Level IV Pathology	X	0.8373	55.00	15.66	11.00
0345	Level I Transfusion Laboratory Procedures	X	0.2210	14.52	.	2.91
0346	Level II Transfusion Laboratory Procedures	X	0.3909	25.68	.	5.14
0347	Level III Transfusion Laboratory Procedures	X	0.8145	53.50	11.28	10.70
0350	Administration of flu and PPV vaccine	S	0.3810	25.03	.	0.00
0360	Level I Alimentary Tests	X	1.5404	101.18	33.88	20.24
0361	Level II Alimentary Tests	X	4.0162	263.80	83.23	52.76
0363	Level I Otorhinolaryngologic Function Tests	X	0.8762	57.55	17.10	11.51
0364	Level I Audiometry	X	0.4638	30.46	7.06	6.10
0365	Level II Audiometry	X	1.2904	84.76	18.52	16.96
0366	Level III Audiometry	X	1.7950	117.90	25.79	23.58
0367	Level I Pulmonary Test	X	0.5744	37.73	13.76	7.55
0368	Level II Pulmonary Tests	X	0.8437	55.42	21.09	11.09
0369	Level III Pulmonary Tests	X	2.7139	178.26	44.18	35.66
0370	Allergy Tests	X	1.3792	90.59	.	18.12
0373	Level I Neuropsychological Testing	X	1.3147	86.35	.	17.27
0375	Ancillary Outpatient Services When Patient Expires	S	72.6284	4770.52	.	954.11
0377	Level II Cardiac Imaging	S	11.9216	783.06	158.84	156.62
0378	Level II Pulmonary Imaging	S	5.0294	330.35	125.33	66.07
0379	Injection adenosine 6 MG	K	.	12.60	.	2.52
0381	Single Allergy Tests	X	0.3866	25.39	.	5.08
0382	Level II Neuropsychological Testing	X	2.5409	166.90	.	33.38
0383	Cardiac Computed Tomographic Imaging	S	4.3282	284.29	111.16	56.86
0384	GI Procedures with Stents	T	25.7802	1693.35	.	338.67
0385	Level I Prosthetic Urological Procedures	S	95.4091	6266.85	.	1253.37
0386	Level II Prosthetic Urological Procedures	S	149.3352	9808.93	.	1961.79
0387	Level II Hysteroscopy	T	36.4505	2394.21	655.55	478.85
0388	Discography	S	20.6787	1358.26	289.72	271.66
0389	Level I Non-imaging Nuclear Medicine	S	1.8483	121.40	33.81	24.28
0390	Level I Endocrine Imaging	S	2.0747	136.27	52.15	27.26
0391	Level II Endocrine Imaging	S	3.4189	224.57	66.18	44.92
0392	Level II Non-imaging Nuclear Medicine	S	2.8090	184.51	49.22	36.91
0393	Hematologic Processing & Studies	S	6.0567	397.83	82.04	79.57
0394	Hepatobiliary Imaging	S	4.4916	295.03	102.61	59.01
0395	GI Tract Imaging	S	3.7913	249.03	89.73	49.81
0396	Bone Imaging	S	3.8172	250.73	95.02	50.15
0397	Vascular Imaging	S	3.0344	199.31	49.36	39.87
0398	Level I Cardiac Imaging	S	4.8197	316.58	100.06	63.32
0400	Hematopoietic Imaging	S	3.9437	259.04	93.22	51.81
0401	Level I Pulmonary Imaging	S	3.2732	215.00	77.73	43.00
0402	Level II Nervous System Imaging	S	8.8659	582.35	.	116.47
0403	Level I Nervous System Imaging	S	2.8408	186.60	72.45	37.32
0404	Renal and Genitourinary Studies	S	5.0433	331.26	84.11	66.26
0406	Level I Tumor/Infection Imaging	S	4.6416	304.88	92.73	60.98
0407	Level I Radionuclide Therapy	S	3.3609	220.76	78.13	44.16
0408	Level III Tumor/Infection Imaging	S	16.4653	1081.51	.	216.31
0409	Red Blood Cell Tests	X	0.1187	7.80	2.20	1.56
0412	IMRT Treatment Delivery	S	5.5272	363.05	.	72.61
0413	Level II Radionuclide Therapy	S	5.6710	372.49	.	74.50
0414	Level II Tumor/Infection Imaging	S	8.5213	559.71	214.44	111.95
0415	Level II Endoscopy Lower Airway	T	25.1730	1653.46	459.92	330.70
0418	Insertion of Left Ventricular Pacing Elect.	T	131.5909	8643.42	.	1728.69
0422	Level II Upper GI Procedures	T	26.4591	1737.94	448.81	347.59
0423	Level II Percutaneous Abdominal and Biliary Procedures	T	46.0975	3027.87	.	605.58
0425	Level II Arthroplasty or Implantation with Prosthesis	T	120.5685	7919.42	.	1583.89
0426	Level II Strapping and Cast Application	S	2.4021	157.78	.	31.56
0427	Level II Tube or Catheter Changes or Repositioning	T	15.5051	1018.44	.	203.69
0428	Level III Sigmoidoscopy and Anoscopy	T	23.8940	1569.45	.	313.89
0429	Level V Cystourethroscopy and other Genitourinary Procedures	T	45.9136	3015.79	.	603.16
0432	Health and Behavior Services	S	0.4341	28.51	.	5.71
0433	Level II Pathology	X	0.2499	16.41	5.17	3.29
0434	Cardiac Defect Repair	T	138.5843	9102.77	.	1820.56
0436	Level I Drug Administration	S	0.3810	25.03	.	5.01
0437	Level II Drug Administration	S	0.5581	36.66	.	7.34
0438	Level III Drug Administration	S	1.1315	74.32	.	14.87
0439	Level IV Drug Administration	S	1.9305	126.80	.	25.36
0440	Level V Drug Administration	S	2.9088	191.06	.	38.22
0442	Dosimetric Drug Administration	S	29.7403	1953.46	.	390.70
0604	Level 1 Hospital Clinic Visits	V	0.8425	55.34	.	11.07
0605	Level 2 Hospital Clinic Visits	V	1.0387	68.23	.	13.65
0606	Level 3 Hospital Clinic Visits	V	1.3354	87.71	.	17.55
0607	Level 4 Hospital Clinic Visits	V	1.7777	116.77	.	23.36
0608	Level 5 Hospital Clinic Visits	V	2.3605	155.05	.	31.01
0609	Level 1 Type A Emergency Visits	V	0.8162	53.61	12.70	10.73
0613	Level 2 Type A Emergency Visits	V	1.3239	86.96	21.06	17.40
0614	Level 3 Type A Emergency Visits	V	2.0761	136.37	34.50	27.28
0615	Level 4 Type A Emergency Visits	V	3.3393	219.34	48.49	43.87
0616	Level 5 Emergency Visits	V	4.9566	325.57	72.86	65.12
0617	Critical Care	S	7.4380	488.56	111.59	97.72
0618	Trauma Response with Critical Care	S	15.0884	991.07	.	198.22
0621	Level I Vascular Access Procedures	T	11.1392	731.67	.	146.34
0622	Level II Vascular Access Procedures	T	24.7775	1627.49	.	325.50
0623	Level III Vascular Access Procedures	T	29.5674	1942.11	.	388.43
0624	Phlebotomy and Minor Vascular Access Device Procedures	X	0.6000	39.41	12.65	7.89
0626	Level 1 Type B Emergency Visits	V	0.7385	48.51	.	9.71
0627	Level 2 Type B Emergency Visits	V	0.9869	64.82	.	12.97
0628	Level 3 Type B Emergency Visits	V	1.4056	92.33	.	18.47
0629	Level 4 Type B Emergency Visits	V	2.3836	156.56	.	31.32
0648	Level IV Breast Surgery	T	57.9012	3803.18	.	760.64
0651	Complex Interstitial Radiation Source Application	S	18.1875	1194.63	.	238.93
0652	Insertion of Intraperitoneal and Pleural Catheters	T	29.6599	1948.18	.	389.64
0653	Vascular Reconstruction/Fistula Repair with Device	T	45.5184	2989.83	.	597.97
0654	Insertion/Replacement of a permanent dual chamber pacemaker	T	108.2256	7108.69	.	1421.74
0655	Insertion/Replacement/Conversion of a permanent dual chamber pacemaker	T	141.3486	9284.34	.	1856.87
0656	Transcatheter Placement of Intracoronary Drug-Eluting Stents	T	113.6926	7467.78	.	1493.56
0659	Hyperbaric Oxygen	S	1.5663	102.88	.	20.58
0660	Level II Otorhinolaryngologic Function Tests	X	1.5269	100.29	28.06	20.06
0661	Level V Pathology	X	2.5473	167.32	60.52	33.47
0662	CT Angiography	S	5.4448	357.64	118.88	71.53
0664	Level I Proton Beam Radiation Therapy	S	14.0758	924.55	.	184.91
0665	Bone Density:AppendicularSkeleton	S	0.5032	33.05	12.95	6.61
0667	Level II Proton Beam Radiation Therapy	S	16.8212	1104.88	.	220.98
0668	Level I Angiography and Venography	S	10.3886	682.36	.	136.48
0672	Level III Posterior Segment Eye Procedures	T	37.8896	2488.74	.	497.75
0673	Level IV Anterior Segment Eye Procedures	T	40.1189	2635.17	649.56	527.04
0674	Prostate Cryoablation	T	120.7521	7931.48	.	1586.30
0676	Thrombolysis and Thrombectomy	T	2.4493	160.88	.	32.18
0678	External Counterpulsation	T	1.5515	101.91	.	20.39
0679	Level II Resuscitation and Cardioversion	S	5.4894	360.57	95.30	72.12
0680	Insertion of Patient Activated Event Recorders	S	71.5537	4699.93	.	939.99
0681	Knee Arthroplasty	T	214.1624	14067.04	.	2813.41
0682	Level V Debridement & Destruction	T	7.3423	482.27	158.65	96.46
0683	Level II Photochemotherapy	S	2.9323	192.61	.	38.53
0685	Level III Needle Biopsy/Aspiration Except Bone Marrow	T	9.6161	631.62	.	126.33
0687	Revision/Removal of Neurostimulator Electrodes	T	19.4577	1278.06	391.49	255.62
0688	Revision/Removal of Neurostimulator Pulse Generator Receiver	T	29.1033	1911.62	762.66	382.33
0689	Level II Electronic Analysis of Devices	S	0.5805	38.13	.	7.63
0690	Level I Electronic Analysis of Devices	S	0.3456	22.70	8.67	4.54
0691	Level IV Electronic Analysis of Devices	S	2.6410	173.47	50.49	34.70
0692	Level III Electronic Analysis of Devices	S	1.7241	113.25	.	22.65
0694	Mohs Surgery	T	4.3668	286.83	91.69	57.37
0697	Level I Echocardiogram Without Contrast Except Transesophageal	S	3.4563	227.02	.	45.41
0698	Level II Eye Tests & Treatments	S	0.9139	60.03	.	12.01
0699	Level IV Eye Tests & Treatments	T	14.3730	944.08	.	188.82
0701	Sr89 strontium	K	9.6387	633.11	.	126.63
0702	Sm 153 lexidronm	K	22.6536	1487.98	.	297.60
0726	Dexrazoxane HCl injection	K	.	177.53	.	35.51
0728	Filgrastim 300 mcg injection	K	.	195.48	.	39.10
0730	Pamidronate disodium	K	.	27.79	.	5.56
0731	Sargramostim injection	K	.	24.63	.	4.93
0732	Mesna injection	K	.	7.72	.	1.55
0735	Ampho b cholesteryl sulfate	K	.	11.77	.	2.36
0736	Amphotericin b liposome inj	K	.	16.84	.	3.37
0738	Rasburicase	K	.	147.46	.	29.50
0747	Chlorothiazide sodium inj	K	.	162.00	.	32.40
0750	Dolasetron mesylate	K	.	4.11	.	0.83
0751	Mechlorethamine hcl inj	K	.	141.72	.	28.35
0752	Dactinomycin actinomycin d	K	.	484.12	.	96.83
0759	"Naltrexone, depot form"	K	.	1.85	.	0.37
0760	Anadulafungin injection	K	.	1.50	.	0.30
0763	Dolasetron mesylate oral	K	.	48.24	.	9.65
0764	Granisetron HCl injection	K	.	4.86	.	0.98
0765	Granisetron HCl 1 mg oral	K	.	46.07	.	9.22
0768	Ondansetron hcl injection	K	.	0.22	.	0.05
0769	Ondansetron HCl 8mg oral	K	.	4.52	.	0.91
0800	Leuprolide acetate	K	.	433.32	.	86.67
0802	Etoposide oral	K	.	28.99	.	5.80
0804	"Vivaglobin, inj"	K	.	6.94	.	1.39
0807	Aldesleukin/single use vial	K	.	752.92	.	150.59
0809	Bcg live intravesical vac	K	.	111.60	.	22.32
0810	Goserelin acetate implant	K	.	186.15	.	37.23
0812	Carmus bischl nitro inj	K	.	153.87	.	30.78
0814	Asparaginase injection	K	.	55.94	.	11.19
0820	Daunorubicin	K	.	16.82	.	3.37
0821	Daunorubicin citrate liposom	K	.	55.01	.	11.01
0823	Docetaxel	K	.	319.70	.	63.94
0825	Nelarabine injection	G	.	89.95	.	17.66
0827	Floxuridine injection	K	.	50.16	.	10.04
0828	Gemcitabine HCl	K	.	129.29	.	25.86
0830	Irinotecan injection	K	.	123.85	.	24.77
0831	Ifosfomide injection	K	.	37.21	.	7.45
0832	Idarubicin hcl injection	K	.	270.86	.	54.18
0834	Interferon alfa-2a inj	K	.	40.15	.	8.03
0835	Inj cosyntropin	K	.	64.36	.	12.88
0836	Interferon alfa-2b inj	K	.	13.89	.	2.78
0838	Interferon gamma 1-b inj	K	.	303.74	.	60.75
0840	Inj melphalan hydrochl	K	.	1534.12	.	306.83
0842	Fludarabine phosphate inj	K	.	196.97	.	39.40
0843	Pegaspargase/singl dose vial	K	.	2054.11	.	410.83
0844	Pentostatin injection	K	.	1794.41	.	358.89
0849	Rituximab cancer treatment	K	.	510.74	.	102.15
0850	Streptozocin injection	K	.	187.04	.	37.41
0851	Thiotepa injection	K	.	39.63	.	7.93
0852	Topotecan	K	.	881.59	.	176.32
0855	Vinorelbine tartrate	K	.	15.91	.	3.19
0856	Porfimer sodium	K	.	2456.31	.	491.27
0858	Inj cladribine	K	.	30.05	.	6.01
0861	Leuprolide acetate injeciton	K	.	7.32	.	1.47
0863	Paclitaxel injection	K	.	11.72	.	2.35
0864	Mitoxantrone hydrochl	K	.	87.02	.	17.41
0865	Interferon alfa-n3 inj	K	.	8.95	.	1.79
0868	Oral aprepitant	K	.	5.17	.	1.04
0873	Hyalgan/supartz inj per dose	K	.	99.33	.	19.87
0874	Synvisc inj per dose	K	.	176.66	.	35.34
0875	Euflexxa inj per dose	K	.	107.97	.	21.60
0877	Orthovisc inj per dose	K	.	174.32	.	34.87
0878	Gallium nitrate injection	K	.	1.59	.	0.32
0883	Fondaparinux sodium	K	.	5.61	.	1.13
0884	Rho d immune globulin inj	K	.	88.01	.	17.61
0887	Azathioprine parenteral	K	.	49.10	.	9.82
0888	Cyclosporine oral	K	.	3.59	.	0.72
0890	Lymphocyte immune globulin	K	.	376.55	.	75.31
0891	Tacrolimus oral	K	.	3.84	.	0.77
0898	Gamma globulin 2 CC inj	K	.	22.67	.	4.54
0899	Gamma globulin 3 CC inj	K	.	34.00	.	6.80
0900	Alglucerase injection	K	.	38.92	.	7.79
0901	Alpha 1 proteinase inhibitor	K	.	3.59	.	0.72
0902	Botulinum toxin a per unit	K	.	5.12	.	1.03
0903	Cytomegalovirus imm IV /vial	K	.	862.24	.	172.45
0904	Gamma globulin 4 CC inj	K	.	45.34	.	9.07
0906	RSV-ivig	K	.	15.87	.	3.18
0910	Interferon beta-1b / .25 MG	K	.	114.42	.	22.89
0913	Ganciclovir long act implant	K	.	4680.00	.	936.00
0916	Injection imiglucerase /unit	K	.	3.93	.	0.79
0917	Adenosine injection	K	.	66.89	.	13.38
0919	Gamma globulin 5 CC inj	K	.	56.68	.	11.34
0920	Gamma globulin 6 CC inj	K	.	68.02	.	13.61
0921	Gamma globulin 7 CC inj	K	.	79.31	.	15.87
0922	Gamma globulin 8 CC inj	K	.	90.68	.	18.14
0923	Gamma globulin 9 CC inj	K	.	102.05	.	20.41
0924	Gamma globulin 10 CC inj	K	.	113.35	.	22.67
0925	Factor viii	K	.	0.74	.	0.15
0927	Factor viii recombinant	K	.	1.06	.	0.22
0928	Factor ix complex	K	.	0.79	.	0.16
0929	Anti-inhibitor	K	.	1.41	.	0.29
0931	Factor IX non-recombinant	K	.	0.88	.	0.18
0932	Factor IX recombinant	K	.	1.05	.	0.21
0933	Gamma globulin > 10 CC inj	K	.	113.35	.	22.67
0934	"Capecitabine, oral"	K	.	15.00	.	3.00
0935	Clonidine hydrochloride	K	.	54.95	.	10.99
0943	Octagam injection	K	.	33.43	.	6.69
0944	Gammagard liquid injection	K	.	31.19	.	6.24
0945	Rhophylac injection	K	.	5.22	.	1.05
0946	HepaGam B IM injection	K	.	47.43	.	9.49
0947	Flebogamma injection	K	.	31.92	.	6.39
0948	Gamunex injection	K	.	32.82	.	6.57
0949	"Frozen plasma, pooled, sd"	R	0.9487	62.31	.	12.47
0950	Whole blood for transfusion	R	3.6167	237.56	.	47.52
0951	Reclast injection	G	.	216.61	.	42.50
0952	Cryoprecipitate each unit	R	0.6677	43.86	.	8.78
0954	RBC leukocytes reduced	R	2.9296	192.43	.	38.49
0955	"Plasma, frz between 8-24hour"	R	1.1188	73.49	.	14.70
0956	"Plasma protein fract,5%,50ml"	R	1.1645	76.49	.	15.30
0957	"Platelets, each unit"	R	1.2019	78.95	.	15.79
0958	Plaelet rich plasma unit	R	5.8879	386.74	.	77.35
0959	Red blood cells unit	R	2.1306	139.95	.	27.99
0960	Washed red blood cells unit	R	4.7822	314.11	.	62.83
0961	"Albumin (human),5%, 50ml"	K	0.3094	20.32	.	4.07
0963	"Albumin (human), 5%, 250 ml"	K	1.1065	72.68	.	14.54
0964	"Albumin (human), 25%, 20 ml"	K	0.3777	24.81	.	4.97
0965	"Albumin (human), 25%, 50ml"	K	1.0888	71.52	.	14.31
0966	"Plasmaprotein fract,5%,250ml"	R	3.2250	211.83	.	42.37
0967	Blood split unit	R	0.4667	30.65	.	6.13
0968	Platelets leukoreduced irrad	R	2.1748	142.85	.	28.57
0969	RBC leukoreduced irradiated	R	3.9175	257.32	.	51.47
0999	Edetate calcium disodium inj	K	.	49.28	.	9.86
1009	Cryoprecipitatereducedplasma	R	1.3214	86.79	.	17.36
1010	"Blood, l/r, cmv-neg"	R	2.4044	157.93	.	31.59
1011	"Platelets, hla-m, l/r, unit"	R	10.3632	680.70	.	136.14
1013	Platelets leukocytes reduced	R	1.6253	106.76	.	21.36
1015	Injection glatiramer acetate	K	.	54.24	.	10.85
1016	"Blood, l/r, froz/degly/wash"	R	4.5799	300.83	.	60.17
1017	"Plt, aph/pher, l/r, cmv-neg"	R	7.3121	480.29	.	96.06
1018	"Blood, l/r, irradiated"	R	3.6066	236.90	.	47.38
1019	Plate pheres leukoredu irrad	R	10.0323	658.96	.	131.80
1020	"Plt, pher, l/r cmv-neg, irr"	R	9.9964	656.60	.	131.32
1021	"RBC, frz/deg/wsh, l/r, irrad"	R	7.2738	477.77	.	95.56
1022	"RBC, l/r, cmv-neg, irrad"	R	4.5604	299.55	.	59.91
1023	Pralidoxime chloride inj	K	.	86.41	.	17.29
1052	"Injection, voriconazole"	K	.	5.14	.	1.03
1064	"I131 iodide cap, rx"	K	0.2447	16.07	.	3.22
1083	Adalimumab injection	K	.	324.32	.	64.87
1084	Denileukin diftitox	K	.	1383.43	.	276.69
1086	Temozolomide	K	.	7.52	.	1.51
1138	"Hepagam B intravenous, inj"	K	.	47.43	.	9.49
1139	Protein C concentrate	K	.	11.96	.	2.40
1140	Integra matrix tissue	K	.	18.94	.	3.79
1141	Primatrix tissue	K	.	37.74	.	7.55
1142	Supprelin LA implant	G	.	14379.26	.	2821.59
1150	"I131 iodide sol, rx"	K	0.1603	10.53	.	2.11
1166	Cytarabine liposome	K	.	407.12	.	81.43
1167	"Inj, epirubicin hcl"	K	.	6.12	.	1.23
1168	"Inj, temsirolimus"	G	.	47.78	.	9.38
1178	Busulfan injection	K	.	9.53	.	1.91
1186	Acetylcysteine injection	K	.	2.13	.	0.43
1189	Foscarnet sodium injection	K	.	10.19	.	2.04
1203	Verteporfin injection	K	.	8.98	.	1.80
1204	Cyclosporin parenteral	K	.	19.44	.	3.89
1206	Dimecaprol injection	K	.	26.17	.	5.24
1207	"Octreotide injection, depot"	K	.	99.84	.	19.97
1208	Factor VIII (porcine)	K	0.0178	1.17	.	0.24
1209	Diethylstilbestrol injection	K	1.2964	85.15	.	17.03
1211	Oxytetracycline injection	K	2.5729	169.00	.	33.80
1212	Diphtheria antitoxin	K	1.5227	100.02	.	20.01
1213	"VWF complex, not Humate-P"	K	.	0.64	.	0.13
1214	Inj IVIG Privigen 500 mg	K	.	33.54	.	6.71
1215	Inj iron dextran	K	.	11.38	.	2.28
1216	"Lyme disease vaccine, im"	K	1.2166	79.91	.	15.99
1217	Penicillin g benzathine inj	K	.	32.28	.	6.46
1218	Triflupromazine hcl inj	K	0.3066	20.14	.	4.03
1280	Corticotropin injection	K	.	2311.08	.	462.22
1436	Etidronate disodium inj	K	.	70.06	.	14.02
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	.	1050.00	.	210.00
1513	New Technology - Level XIII  ($1100 - $1200)	S	.	1150.00	.	230.00
1514	New Technology - Level XIV ($1200- $1300)	S	.	1250.00	.	250.00
1515	New Technology - Level XV ($1300 - $1400)	S	.	1350.00	.	270.00
1516	New Technology - Level XVI  ($1400 - $1500)	S	.	1450.00	.	290.00
1517	New Technology - Level XVII ($1500-$1600)	S	.	1550.00	.	310.00
1518	New Technology - Level XVIII ($1600-$1700)	S	.	1650.00	.	330.00
1519	New Technology - Level IXX ($1700-$1800)	S	.	1750.00	.	350.00
1520	New Technology - Level XX ($1800-$1900)	S	.	1850.00	.	370.00
1521	New Technology - Level XXI ($1900-$2000)	S	.	1950.00	.	390.00
1522	New Technology - Level XXII ($2000-$2500)	S	.	2250.00	.	450.00
1523	New Technology - Level XXIII ($2500-$3000)	S	.	2750.00	.	550.00
1524	New Technology - Level XXIV ($3000-$3500)	S	.	3250.00	.	650.00
1525	New Technology - Level XXV ($3500-$4000)	S	.	3750.00	.	750.00
1526	New Technology - Level XXVI ($4000-$4500)	S	.	4250.00	.	850.00
1527	New Technology - Level XXVII ($4500-$5000)	S	.	4750.00	.	950.00
1528	New Technology - Level XXVIII ($5000-$5500)	S	.	5250.00	.	1050.00
1529	New Technology - Level XXIX ($5500-$6000)	S	.	5750.00	.	1150.00
1530	New Technology - Level XXX ($6000-$6500)	S	.	6250.00	.	1250.00
1531	New Technology - Level XXXI ($6500-$7000)	S	.	6750.00	.	1350.00
1532	New Technology - Level XXXII ($7000-$7500)	S	.	7250.00	.	1450.00
1533	New Technology - Level XXXIII ($7500-$8000)	S	.	7750.00	.	1550.00
1534	New Technology - Level XXXIV ($8000-$8500)	S	.	8250.00	.	1650.00
1535	New Technology - Level XXXV ($8500-$9000)	S	.	8750.00	.	1750.00
1536	New Technology - Level XXXVI ($9000-$9500)	S	.	9250.00	.	1850.00
1537	New Technology - Level XXXVII ($9500-$10000)	S	.	9750.00	.	1950.00
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	.	1050.00	.	210.00
1550	New Technology - Level XIII  ($1100 - $1200)	T	.	1150.00	.	230.00
1551	New Technology - Level XIV ($1200- $1300)	T	.	1250.00	.	250.00
1552	New Technology - Level XV ($1300 - $1400)	T	.	1350.00	.	270.00
1553	New Technology - Level XVI  ($1400 - $1500)	T	.	1450.00	.	290.00
1554	New Technology - Level XVII ($1500-$1600)	T	.	1550.00	.	310.00
1555	New Technology - Level XVIII ($1600-$1700)	T	.	1650.00	.	330.00
1556	New Technology - Level XIX ($1700-$1800)	T	.	1750.00	.	350.00
1557	New Technology - Level XX ($1800-$1900)	T	.	1850.00	.	370.00
1558	New Technology - Level XXI ($1900-$2000)	T	.	1950.00	.	390.00
1559	New Technology - Level XXII ($2000-$2500)	T	.	2250.00	.	450.00
1560	New Technology - Level XXIII ($2500-$3000)	T	.	2750.00	.	550.00
1561	New Technology - Level XXIV ($3000-$3500)	T	.	3250.00	.	650.00
1562	New Technology - Level XXV ($3500-$4000)	T	.	3750.00	.	750.00
1563	New Technology - Level XXVI ($4000-$4500)	T	.	4250.00	.	850.00
1564	New Technology - Level XXVII ($4500-$5000)	T	.	4750.00	.	950.00
1565	New Technology - Level XXVIII ($5000-$5500)	T	.	5250.00	.	1050.00
1566	New Technology - Level XXIX ($5500-$6000)	T	.	5750.00	.	1150.00
1567	New Technology - Level XXX ($6000-$6500)	T	.	6250.00	.	1250.00
1568	New Technology - Level XXXI ($6500-$7000)	T	.	6750.00	.	1350.00
1569	New Technology - Level XXXII ($7000-$7500)	T	.	7250.00	.	1450.00
1570	New Technology - Level XXXIII ($7500-$8000)	T	.	7750.00	.	1550.00
1571	New Technology - Level XXXIV ($8000-$8500)	T	.	8250.00	.	1650.00
1572	New Technology - Level XXXV ($8500-$9000)	T	.	8750.00	.	1750.00
1573	New Technology - Level XXXVI ($9000-$9500)	T	.	9250.00	.	1850.00
1574	New Technology - Level XXXVII ($9500-$10000)	T	.	9750.00	.	1950.00
1605	Abciximab injection	K	.	415.06	.	83.02
1607	Eptifibatide injection	K	.	16.70	.	3.34
1608	Etanercept injection	K	.	163.89	.	32.78
1609	"Rho(D) immune globulin h, sd"	K	.	15.32	.	3.07
1612	"Daclizumab, parenteral"	K	.	309.72	.	61.95
1613	Trastuzumab	K	.	58.95	.	11.79
1629	Nonmetabolic act d/e tissue	K	.	10.61	.	2.13
1630	"Hep b ig, im"	K	.	117.70	.	23.54
1631	Baclofen intrathecal trial	K	.	68.44	.	13.69
1632	Metabolic active D/E tissue	K	.	29.60	.	5.92
1633	Alefacept	K	.	26.16	.	5.24
1643	"Y90 ibritumomab, rx"	K	230.7968	15159.66	.	3031.94
1645	"I131 tositumomab, rx"	K	160.6856	10554.47	.	2110.90
1670	Tetanus immune globulin inj	K	.	97.86	.	19.58
1675	P32 Na phosphate	K	1.5948	104.75	.	20.95
1676	P32 chromic phosphate	K	2.4062	158.05	.	31.61
1682	"Aprotonin, 10,000 kiu"	K	.	2.60	.	0.52
1683	Basiliximab	K	.	1471.15	.	294.23
1684	Corticorelin ovine triflutal	K	.	4.19	.	0.84
1685	"Darbepoetin alfa, non-esrd"	K	.	2.72	.	0.55
1686	"Epoetin alfa, non-esrd"	K	.	8.90	.	1.78
1687	Digoxin immune fab (ovine)	K	.	479.14	.	95.83
1688	Ethanolamine oleate	K	.	118.22	.	23.65
1689	Fomepizole	K	.	13.85	.	2.77
1690	Hemin	K	.	7.23	.	1.45
1693	Lepirudin	K	.	157.97	.	31.60
1694	Ziconotide injection	K	.	6.39	.	1.28
1695	Nesiritide injection	K	.	32.86	.	6.58
1696	Palifermin injection	K	.	11.15	.	2.23
1697	Pegaptanib sodium injection	K	.	1011.57	.	202.32
1700	Inj secretin synthetic human	K	.	19.93	.	3.99
1701	Treprostinil injection	K	.	54.83	.	10.97
1703	"Ovine, 1000 USP units"	K	.	132.50	.	26.50
1704	"Humate-P, inj"	K	.	0.88	.	0.18
1705	Factor viia	K	.	1.17	.	0.24
1709	Azacitidine injection	K	.	4.39	.	0.88
1710	Clofarabine injection	K	.	113.00	.	22.60
1711	Vantas implant	K	.	1479.64	.	295.93
1712	Paclitaxel protein bound	K	.	8.69	.	1.74
1716	"Brachytx, non-str, Gold-198"	U	0.5161	33.90	.	6.78
1717	"Brachytx, non-str, HDR Ir-192"	U	3.2258	211.88	.	42.38
1719	"Brachytx, NS, Non-HDRIr-192"	U	0.9851	64.71	.	12.95
1738	Oxaliplatin	K	.	9.31	.	1.87
1739	"Pegademase bovine, 25 iu"	K	.	195.62	.	39.13
1740	Diazoxide injection	K	.	112.16	.	22.44
1741	"Urofollitropin, 75 iu"	K	.	48.25	.	9.65
2210	Methyldopate hcl injection	K	.	14.91	.	2.99
2616	"Brachytx, non-str,Yttrium-90"	U	204.7634	13449.68	.	2689.94
2632	Iodine I-125 sodium iodide	U	0.5488	36.05	.	7.21
2634	"Brachytx, non-str, HA, I-125"	U	0.6518	42.81	.	8.57
2635	"Brachytx, non-str, HA, P-103"	U	0.4101	26.94	.	5.39
2636	"Brachy linear, non-str,P-103"	U	0.9201	60.44	.	12.09
2638	"Brachytx, stranded, I-125"	U	0.6144	40.36	.	8.08
2639	"Brachytx, non-stranded,I-125"	U	0.5553	36.47	.	7.30
2640	"Brachytx, stranded, P-103"	U	1.0130	66.54	.	13.31
2641	"Brachytx, non-stranded,P-103"	U	0.9658	63.44	.	12.69
2642	"Brachytx, stranded, C-131"	U	1.5178	99.70	.	19.94
2643	"Brachytx, non-stranded,C-131"	U	0.9051	59.45	.	11.89
2698	"Brachytx, stranded, NOS"	U	0.6144	40.36	.	8.08
2699	"Brachytx, non-stranded, NOS"	U	0.4101	26.94	.	5.39
2731	"Immune globulin, powder"	K	.	27.54	.	5.51
2770	Quinupristin/dalfopristin	K	.	125.56	.	25.12
3030	Sumatriptan succinate	K	.	65.35	.	13.07
3041	Bivalirudin	K	.	2.04	.	0.41
3043	Gamma globulin 1 CC inj	K	.	11.34	.	2.27
3050	Sermorelin acetate injection	K	.	1.72	.	0.35
7000	Amifostine	K	.	501.57	.	100.32
7005	Gonadorelin hydroch	K	.	176.89	.	35.38
7011	Oprelvekin injection	K	.	242.32	.	48.47
7015	Oral busulfan	K	.	2.45	.	0.49
7034	Somatropin injection	K	.	47.18	.	9.44
7035	Teniposide	K	.	281.98	.	56.40
7036	"Urokinase 250,000 IU inj"	K	.	449.09	.	89.82
7038	Monoclonal antibodies	K	.	968.26	.	193.66
7041	Tirofiban HCl	K	.	7.28	.	1.46
7042	"Capecitabine, oral"	K	.	4.52	.	0.91
7043	Infliximab injection	K	.	54.00	.	10.80
7045	Inj trimetrexate glucoronate	K	.	146.89	.	29.38
7046	Doxorubicin hcl liposome inj	K	.	405.69	.	81.14
7048	Alteplase recombinant	K	.	31.57	.	6.32
7049	Filgrastim 480 mcg injection	K	.	300.85	.	60.17
7051	Leuprolide acetate implant	K	.	1577.83	.	315.57
7308	Aminolevulinic acid hcl top	K	.	107.67	.	21.54
8000	Cardiac Electrophysiologic Evaluation and Ablation Composite	T	139.9160	9190.24	.	1838.05
8001	LDR Prostate Brachytherapy Composite	T	53.5230	3515.60	.	703.12
8002	Level I Extended Assessment & Management Composite	V	5.5444	364.18	.	72.84
8003	Level II Extended Assessment & Management Composite	V	10.2222	671.43	.	134.29
8004	Ultrasound Composite	S	2.9608	194.48	.	38.90
8005	CT and CTA without Contrast Composite	S	6.4509	423.72	.	84.75
8006	CT and CTA with Contrast Composite	S	9.7470	640.22	.	128.05
8007	MRI and MRA without Contrast Composite	S	11.0520	725.94	.	145.19
8008	MRI and MRA with Contrast Composite	S	15.2927	1004.49	.	200.90
9001	Linezolid injection	K	.	27.56	.	5.52
9002	Tenecteplase injection	K	.	2007.72	.	401.55
9003	Palivizumab	K	.	802.95	.	160.59
9004	Gemtuzumab ozogamicin	K	.	2383.14	.	476.63
9005	Reteplase injection	K	.	818.01	.	163.61
9006	Tacrolimus injection	K	.	137.38	.	27.48
9012	Arsenic trioxide	K	.	33.83	.	6.77
9015	Mycophenolate mofetil oral	K	.	2.85	.	0.57
9018	Botulinum toxin type B	K	.	8.55	.	1.71
9019	Caspofungin acetate	K	.	17.53	.	3.51
9020	"Sirolimus, oral"	K	.	7.78	.	1.56
9022	IM inj interferon beta 1-a	K	.	129.80	.	25.96
9023	Rho d immune globulin	K	.	27.89	.	5.58
9024	Amphotericin b lipid complex	K	.	10.26	.	2.06
9032	Baclofen 10 MG injection	K	.	187.25	.	37.45
9033	Cidofovir injection	K	.	748.06	.	149.62
9038	Inj estrogen conjugate	K	.	69.91	.	13.99
9042	Glucagon hydrochloride	K	.	67.37	.	13.48
9044	Ibutilide fumarate injection	K	.	317.20	.	63.44
9046	Iron sucrose injection	K	.	0.35	.	0.07
9047	Itraconazole injection	K	.	39.15	.	7.83
9054	Metabolically active tissue	K	.	36.02	.	7.21
9104	Antithymocyte globuln rabbit	K	.	338.22	.	67.65
9108	Thyrotropin injection	K	.	823.13	.	164.63
9110	Alemtuzumab injection	K	.	540.67	.	108.14
9115	Zoledronic acid	K	.	206.68	.	41.34
9119	"Injection, pegfilgrastim 6mg"	K	.	2158.59	.	431.72
9120	"Injection, Fulvestrant"	K	.	79.83	.	15.97
9121	"Injection, argatroban"	K	.	19.82	.	3.97
9122	Triptorelin pamoate	K	.	146.35	.	29.27
9124	Daptomycin injection	K	.	0.34	.	0.07
9125	"Risperidone, long acting"	K	.	4.84	.	0.97
9126	Natalizumab injection	K	.	7.39	.	1.48
9133	"Rabies ig, im/sc"	K	.	66.55	.	13.31
9134	"Rabies ig, heat treated"	K	.	76.60	.	15.32
9135	"Varicella-zoster ig, im"	K	.	109.89	.	21.98
9137	"Bcg vaccine, percut"	K	.	114.69	.	22.94
9139	"Rabies vaccine, im"	K	.	149.67	.	29.94
9140	"Rabies vaccine, id"	K	1.9332	126.98	.	25.40
9143	"Meningococcal vaccine, sc"	K	.	92.10	.	18.42
9144	"Encephalitis vaccine, sc"	K	.	100.15	.	20.03
9145	"Meningococcal vaccine, im"	K	.	80.45	.	16.09
9156	Nonmetabolic active tissue	K	.	84.67	.	16.94
9207	Bortezomib injection	K	.	33.78	.	6.76
9208	Agalsidase beta injection	K	.	127.14	.	25.43
9209	Laronidase injection	K	.	23.89	.	4.78
9210	Palonosetron HCl	K	.	16.89	.	3.38
9213	Pemetrexed injection	K	.	45.33	.	9.07
9214	Bevacizumab injection	K	.	56.35	.	11.27
9215	Cetuximab injection	K	.	48.87	.	9.78
9216	Abarelix injection	K	.	67.33	.	13.47
9217	Leuprolide acetate suspnsion	K	.	216.69	.	43.34
9219	Mycophenolic acid	K	.	2.41	.	0.49
9222	Injectable human tissue	K	.	764.93	.	152.99
9224	Galsulfase injection	K	.	314.00	.	62.80
9225	Fluocinolone acetonide implt	K	.	18980.00	.	3796.00
9227	Micafungin sodium injection	K	.	1.32	.	0.27
9228	Tigecycline injection	K	.	1.00	.	0.20
9229	Ibandronate sodium injection	K	.	136.35	.	27.27
9230	Abatacept injection	K	.	18.34	.	3.67
9231	Decitabine injection	K	.	26.60	.	5.32
9232	Idursulfase injection	K	.	446.44	.	89.29
9233	Ranibizumab injection	K	.	397.53	.	79.51
9234	Alglucosidase alfa injection	K	.	124.80	.	24.96
9235	Panitumumab injection	K	.	80.70	.	16.14
9236	Eculizumab injection	G	.	173.06	.	33.96
9237	"Inj, lanreotide acetate"	K	.	23.90	.	4.78
9238	"Inj, levetiracetam"	G	.	0.43	.	0.09
9240	"Injection, ixabepilone"	G	.	65.15	.	12.79
9241	"Injection, doripenem"	G	.	0.81	.	0.16
9300	Omalizumab injection	K	.	17.48	.	3.50
9354	"Veritas collagen matrix, cm2"	G	.	11.77	.	2.31
9355	"Neuromatrix nerve cuff, cm"	G	.	208.67	.	40.95
9500	"Platelets, irradiated"	R	2.5730	169.00	.	33.80
9501	Platelet pheres leukoreduced	R	7.8915	518.35	.	103.67
9502	Platelet pheresis irradiated	R	7.0111	460.52	.	92.11
9503	Fr frz plasma donor retested	R	1.0046	65.99	.	13.20
9504	RBC deglycerolized	R	5.5204	362.60	.	72.52
9505	RBC irradiated	R	3.9231	257.68	.	51.54
9506	"Granulocytes, pheresis unit"	R	25.5369	1677.37	.	335.48
9507	"Platelets, pheresis"	R	7.2005	472.96	.	94.60
9508	Plasma 1 donor frz w/in 8 hr	R	1.1757	77.22	.	15.45
						
