"Procedural APCs with the CY 2015 portions of the APC payment amounts uniquely associated with the cost of devices and two types of non-pass-through drugs: ""threshold packaged"" drugs that are packaged under the packaging threshold and ""policy packaged"" drugs that are always packaged. These portions will be used as the APC offset amounts to evaluate whether the cost of a device or type of drug in an application for pass-through payment is not insignificant in relation to the APC payment amount for the service related to the device or type of drug."			"Portion of APC Payment Associated with Devices, Including Implantable Biologicals"		"Portion of APC Payment Associated with ""Threshold Packaged"" Drugs (Drugs that May Be Packaged under the Packaging Threshold)"		"Portion of APC Payment Associated with ""Policy Packaged"" Drugs (Drugs that Are Always Packaged, i.e. Diagnostic Radiopharmaceuticals, Contrast Agents, Skin Substitutes, and Stress Agents)"				
APC	APC Title	CY 2015 APC Payment Rate	Percent	Dollar Amount	Percent	Dollar Amount	Percent	Dollar Amount			
0004	Level I Needle Biopsy/ Aspiration Except Bone Marrow	$487.34	0.19%	$0.93	0.90%	$4.39	0.03%	$0.15			
0005	Level II Needle Biopsy/Aspiration Except Bone Marrow	"$1,052.63"	2.36%	$24.84	1.53%	$16.11	0.09%	$0.95			
0006	Level I Incision & Drainage	$161.96	0.51%	$0.83	1.40%	$2.27	0.05%	$0.08			
0007	Level II Incision & Drainage	$865.96	1.02%	$8.83	3.53%	$30.57	0.07%	$0.61			
0008	Level III Incision and Drainage	"$1,635.77"	0.53%	$8.67	5.81%	$95.04	0.16%	$2.62			
0012	Level I Debridement & Destruction	$98.49	0.02%	$0.02	1.11%	$1.09	0.06%	$0.06			
0015	Level II Debridement & Destruction	$146.14	0.01%	$0.01	0.80%	$1.17	0.03%	$0.04			
0016	Level III Debridement & Destruction	$283.14	0.03%	$0.08	0.73%	$2.07	0.06%	$0.17			
0017	Level IV Debridement & Destruction	"$1,287.72"	0.29%	$3.73	4.26%	$54.86	0.09%	$1.16			
0019	Level I Excision/ Biopsy	$378.56	0.04%	$0.15	1.60%	$6.06	0.06%	$0.23			
0020	Level II Excision/ Biopsy	$826.58	0.47%	$3.88	2.45%	$20.25	0.07%	$0.58			
0021	Level III Excision/ Biopsy	"$1,341.41"	0.36%	$4.83	4.00%	$53.66	0.11%	$1.48			
0022	Level IV Excision/ Biopsy	"$1,824.31"	0.67%	$12.22	5.39%	$98.33	0.16%	$2.92			
0028	Level I Breast and Skin Surgery	"$2,167.64"	0.40%	$8.67	4.69%	$101.66	0.13%	$2.82			
0029	Level II Breast and Skin Surgery	"$3,012.77"	2.12%	$63.87	6.15%	$185.29	0.20%	$6.03			
0030	Level III Breast and Skin Surgery	"$4,150.45"	5.55%	$230.35	5.63%	$233.67	0.82%	$34.03			
0031	Level I Health and Behavior Services	$26.02	0.00%	$0.00	0.04%	$0.01	0.00%	$0.00			
0039	Level III Neurostimulator & Related Procedures	"$17,106.04"	85.30%	"$14,591.45"	0.80%	$136.85	0.02%	$3.42			
0041	Level I Arthroscopy	"$2,151.57"	0.29%	$6.24	5.49%	$118.12	0.09%	$1.94			
0042	Level II Arthroscopy	"$4,345.55"	14.71%	$639.23	4.63%	$201.20	0.08%	$3.48			
0045	Bone/Joint Manipulation Under Anesthesia	"$1,150.68"	0.23%	$2.65	7.12%	$81.93	0.14%	$1.61			
0047	Arthroplasty 	"$3,364.30"	24.49%	$823.92	3.86%	$129.86	0.46%	$15.48			
0049	Level I Musculoskeletal Procedures Except Hand and Foot	"$1,660.83"	0.80%	$13.29	5.58%	$92.67	0.16%	$2.66			
0050	Level II Musculoskeletal Procedures Except Hand and Foot	"$2,602.13"	9.85%	$256.31	4.29%	$111.63	0.17%	$4.42			
0051	Level III Musculoskeletal Procedures Except Hand and Foot	"$3,763.00"	20.22%	$760.88	4.90%	$184.39	0.44%	$16.56			
0052	Level IV Musculoskeletal Procedures Except Hand and Foot	"$6,322.79"	21.93%	"$1,386.59"	2.14%	$135.31	0.42%	$26.56			
0053	Level I Hand Musculoskeletal Procedures	"$1,228.33"	0.31%	$3.81	4.83%	$59.33	0.12%	$1.47			
0054	Level II Hand Musculoskeletal Procedures	"$2,210.11"	5.46%	$120.67	4.73%	$104.54	0.11%	$2.43			
0055	Level I Foot Musculoskeletal Procedures	"$1,743.52"	3.74%	$65.21	4.95%	$86.30	0.19%	$3.31			
0056	Level II Foot Musculoskeletal Procedures	"$5,219.15"	38.71%	"$2,020.33"	2.96%	$154.49	0.19%	$9.92			
0057	Bunion Procedures	"$2,676.46"	16.21%	$433.85	3.96%	$105.99	0.11%	$2.94			
0058	Level II Strapping and Cast Application	$223.29	0.01%	$0.02	0.15%	$0.33	0.08%	$0.18			
0059	Level I Strapping and Cast Application	$127.87	0.02%	$0.03	0.46%	$0.59	0.08%	$0.10			
0060	Manipulation Therapy	$19.83	0.00%	$0.00	0.05%	$0.01	0.00%	$0.00			
0061	Level II Neurostimulator & Related Procedures	"$5,290.65"	55.76%	"$2,950.07"	1.76%	$93.12	0.05%	$2.65			
0062	Level I Treatment Fracture/Dislocation	"$2,042.65"	7.08%	$144.62	5.05%	$103.15	0.12%	$2.45			
0063	Level II Treatment Fracture/Dislocation	"$4,228.40"	27.15%	"$1,148.01"	3.84%	$162.37	0.08%	$3.38			
0064	Level III Treatment Fracture/Dislocation	"$5,569.47"	43.19%	"$2,405.45"	2.86%	$159.29	0.05%	$2.78			
0066	Level V Radiation Therapy	"$1,903.22"	0.00%	$0.00	0.01%	$0.19	0.00%	$0.00			
0067	Single Session Cranial Stereotactic Radiosurgery	"$9,769.22"	0.02%	$1.95	0.25%	$24.42	0.51%	$49.82			
0069	Thoracoscopy	"$3,073.86"	0.75%	$23.05	5.35%	$164.45	0.13%	$4.00			
0070	Thoracentesis/Lavage Procedures	$489.35	3.87%	$18.94	1.59%	$7.78	0.02%	$0.10			
0071	Level I Endoscopy Upper Airway	$150.68	0.04%	$0.06	0.10%	$0.15	0.01%	$0.02			
0072	Level II Endoscopy Upper Airway	$386.40	0.42%	$1.62	0.09%	$0.35	0.03%	$0.12			
0073	Level III Endoscopy Upper Airway	"$1,259.55"	2.29%	$28.84	2.55%	$32.12	0.19%	$2.39			
0074	Level IV Endoscopy Upper Airway	"$2,010.26"	2.70%	$54.28	5.67%	$113.98	0.22%	$4.42			
0075	Level V Endoscopy Upper Airway	"$3,070.76"	7.75%	$237.98	5.03%	$154.46	0.12%	$3.68			
0076	Level I Endoscopy Lower Airway	"$1,055.12"	0.20%	$2.11	5.54%	$58.45	0.10%	$1.06			
0077	Pulmonary Treatment	$164.63	0.09%	$0.15	15.37%	$25.30	0.32%	$0.53			
0079	Ventilation Initiation and Management	$374.20	0.25%	$0.94	11.50%	$43.03	0.19%	$0.71			
0080	Diagnostic Cardiac Catheterization	"$2,576.34"	12.05%	$310.45	2.77%	$71.36	3.11%	$80.12			
0083	Level I Endovascular Procedures	"$4,539.22"	23.86%	"$1,083.06"	1.64%	$74.44	1.47%	$66.73			
0084	Level I Electrophysiologic Procedures	$873.26	0.59%	$5.15	4.18%	$36.50	0.17%	$1.48			
0085	Level II Electrophysiologic Procedures	"$4,635.14"	32.20%	"$1,492.52"	2.11%	$97.80	0.13%	$6.03			
0086	Level III Electrophysiologic Procedures	"$14,362.24"	37.90%	"$5,443.29"	1.37%	$196.76	0.10%	$14.36			
0088	Thrombectomy	"$3,220.86"	8.31%	$267.65	4.99%	$160.72	0.13%	$4.19			
0089	Level III Pacemaker and Similar Procedures	"$9,493.45"	67.24%	"$6,383.40"	1.26%	$119.62	0.08%	$7.59			
0090	Level II Pacemaker and Similar Procedures	"$6,545.34"	64.36%	"$4,212.58"	1.67%	$109.31	0.11%	$7.20			
0093	Vascular Reconstruction/Fistula Repair 	"$2,501.17"	24.87%	$622.04	3.89%	$97.30	1.05%	$26.26			
0094	Resuscitation and Cardioversion	$470.50	0.08%	$0.38	6.70%	$31.52	0.18%	$0.85			
0095	Cardiac Rehabilitation	$103.30	0.00%	$0.00	0.00%	$0.00	0.00%	$0.00			
0096	Level II Noninvasive Physiologic Studies	$329.77	0.04%	$0.13	3.87%	$12.76	0.12%	$0.40			
0097	Level I Noninvasive Physiologic Studies	$112.71	0.03%	$0.03	0.86%	$0.97	0.03%	$0.03			
0099	Electrocardiograms/Cardiography	$78.47	0.10%	$0.08	3.08%	$2.42	0.21%	$0.16			
0100	Cardiac Stress Tests	$238.04	0.01%	$0.02	1.15%	$2.74	13.85%	$32.97			
0103	Miscellaneous Vascular Procedures	"$1,576.05"	4.50%	$70.92	4.19%	$66.04	0.14%	$2.21			
0105	Level I Pacemaker & Similar Procedures	"$2,347.24"	26.86%	$630.47	5.93%	$139.19	0.22%	$5.16			
0107	Level I ICD and Similar Procedures	"$22,916.60"	78.34%	"$17,952.86"	0.47%	$107.71	0.01%	$2.29			
0108	Level II ICD and Similar Procedures	"$30,818.44"	79.64%	"$24,543.81"	0.49%	$151.01	0.06%	$18.49			
0110	Transfusion	$297.30	0.03%	$0.09	4.93%	$14.66	0.02%	$0.06			
0111	Blood Product Exchange	"$1,055.40"	0.02%	$0.21	5.61%	$59.21	0.13%	$1.37			
0112	Apheresis and Stem Cell Procedures	"$2,845.80"	0.02%	$0.57	2.36%	$67.16	0.55%	$15.65			
0113	Excision Lymphatic System	"$2,344.50"	0.40%	$9.38	4.80%	$112.54	0.18%	$4.22			
0114	Thyroid/Lymphadenectomy Procedures	"$4,239.61"	0.63%	$26.71	5.04%	$213.68	0.09%	$3.82			
0121	Level I Tube or Catheter Changes or Repositioning	$488.06	9.16%	$44.71	2.17%	$10.59	1.69%	$8.25			
0126	Level I Urinary and Anal Procedures	$113.23	0.18%	$0.20	0.19%	$0.22	0.01%	$0.01			
0129	Level I Closed Treatment Fracture	$169.09	0.09%	$0.15	0.17%	$0.29	0.01%	$0.02			
0130	Level I Laparoscopy	"$3,016.93"	5.01%	$151.15	5.39%	$162.61	0.12%	$3.62			
0131	Level II Laparoscopy	"$3,779.40"	3.81%	$144.00	5.17%	$195.39	0.20%	$7.56			
0132	Level III Laparoscopy	"$5,479.13"	18.64%	"$1,021.31"	4.39%	$240.53	0.10%	$5.48			
0138	Level II Closed Treatment Fracture 	$213.83	0.16%	$0.34	0.49%	$1.05	0.02%	$0.04			
0139	Level III Closed Treatment Fracture 	$713.25	2.33%	$16.62	3.98%	$28.39	0.05%	$0.36			
0141	Level I Upper GI Procedures	$745.60	0.31%	$2.31	4.62%	$34.45	0.11%	$0.82			
0142	Level I Small Intestine Endoscopy	$852.43	1.97%	$16.79	1.53%	$13.04	0.04%	$0.34			
0143	Lower GI Endoscopy	$789.86	0.16%	$1.26	4.56%	$36.02	0.11%	$0.87			
0146	Level I Sigmoidoscopy and Anoscopy	$493.69	0.16%	$0.79	3.86%	$19.06	0.10%	$0.49			
0147	Level II Sigmoidoscopy and Anoscopy	$827.42	3.40%	$28.13	3.46%	$28.63	0.11%	$0.91			
0148	Level I Anal/Rectal Procedures	$442.51	0.30%	$1.33	2.04%	$9.03	0.04%	$0.18			
0149	Level III Anal/Rectal Procedures	"$1,941.43"	0.29%	$5.63	6.28%	$121.92	0.12%	$2.33			
0150	Level IV Anal/Rectal Procedures	"$2,601.06"	2.90%	$75.43	6.48%	$168.55	0.21%	$5.46			
0151	Endoscopic Retrograde Cholangio-Pancreatography (ERCP)	"$1,953.06"	10.80%	$210.93	4.42%	$86.33	1.02%	$19.92			
0152	Level I Percutaneous Abdominal and Biliary Procedures	"$1,833.49"	17.60%	$322.69	3.64%	$66.74	2.06%	$37.77			
0153	Peritoneal and Abdominal Procedures	"$2,285.91"	1.80%	$41.15	6.06%	$138.53	0.17%	$3.89			
0154	Hernia/Hydrocele Procedures	"$2,675.43"	12.52%	$334.96	5.33%	$142.60	0.20%	$5.35			
0155	Level II Anal/Rectal Procedures	"$1,455.16"	0.25%	$3.64	6.31%	$91.82	0.18%	$2.62			
0156	Level III Urinary and Anal Procedures	$373.81	0.95%	$3.55	0.42%	$1.57	0.77%	$2.88			
0157	Colorectal Cancer Screening: Barium Enema	$343.53	0.00%	$0.00	6.66%	$22.88	0.40%	$1.37			
0158	Colorectal Cancer Screening: Colonoscopy	$655.04	0.02%	$0.13	5.40%	$35.37	0.11%	$0.72			
0159	Colorectal Cancer Screening: Flexible Sigmoidoscopy	$468.91	0.22%	$1.03	5.10%	$23.91	0.15%	$0.70			
0160	Level I Cystourethroscopy and other Genitourinary Procedures	$548.93	0.32%	$1.76	1.65%	$9.06	0.15%	$0.82			
0161	Level II Cystourethroscopy and other Genitourinary Procedures	"$1,226.95"	2.81%	$34.48	4.15%	$50.92	0.27%	$3.31			
0162	Level III Cystourethroscopy and other Genitourinary Procedures	"$2,084.85"	4.74%	$98.82	4.84%	$100.91	0.35%	$7.30			
0163	Level IV Cystourethroscopy and other Genitourinary Procedures	"$3,113.76"	0.77%	$23.98	4.31%	$134.20	0.08%	$2.49			
0164	Level II Urinary and Anal Procedures	$213.78	1.29%	$2.76	4.64%	$9.92	0.45%	$0.96			
0165	Level IV Urinary and Anal Procedures	"$1,375.76"	7.58%	$104.28	4.53%	$62.32	0.83%	$11.42			
0166	Level I Urethral Procedures	"$1,628.76"	0.62%	$10.10	5.24%	$85.35	0.10%	$1.63			
0168	Level II Urethral Procedures	"$2,509.57"	34.53%	$866.55	3.73%	$93.61	0.09%	$2.26			
0170	Dialysis	$613.57	0.30%	$1.84	4.52%	$27.73	0.07%	$0.43			
0174	Level IV Laparoscopy	"$8,069.91"	15.96%	"$1,287.96"	3.25%	$262.27	0.04%	$3.23			
0177	Level I Echocardiogram with Contrast	$490.48	0.02%	$0.10	1.15%	$5.64	14.79%	$72.54			
0178	Level II Echocardiogram with Contrast	$688.62	0.01%	$0.07	0.84%	$5.78	10.47%	$72.10			
0181	Level II Male Genital Procedures	"$2,235.20"	0.64%	$14.31	5.98%	$133.66	0.12%	$2.68			
0183	Level I Male Genital Procedures	"$1,812.18"	0.17%	$3.08	5.60%	$101.48	0.11%	$1.99			
0184	Prostate Biopsy	"$1,462.30"	0.07%	$1.02	3.74%	$54.69	0.07%	$1.02			
0188	Level I Gynecologic Procedures	$130.98	0.32%	$0.42	0.49%	$0.64	0.01%	$0.01			
0189	Level II Gynecologic Procedures	$226.16	0.06%	$0.14	0.55%	$1.24	0.01%	$0.02			
0192	Level III Gynecologic Procedures	$487.25	0.12%	$0.58	1.39%	$6.77	0.05%	$0.24			
0193	Level IV Gynecologic Procedures	"$1,846.20"	0.90%	$16.62	4.74%	$87.51	0.12%	$2.22			
0202	Level V Gynecologic Procedures	"$3,979.18"	18.60%	$740.13	5.40%	$214.88	0.14%	$5.57			
0203	Level IV Nerve Injections	"$1,470.03"	0.18%	$2.65	3.49%	$51.30	0.13%	$1.91			
0204	Level I Nerve Injections	$211.21	0.01%	$0.02	6.62%	$13.98	0.70%	$1.48			
0205	Level III Male Genital Procedures	"$3,416.33"	16.18%	$552.76	5.56%	$189.95	0.10%	$3.42			
0206	Level II Nerve Injections	$372.76	0.06%	$0.22	3.13%	$11.67	0.29%	$1.08			
0207	Level III Nerve Injections	$672.06	0.08%	$0.54	5.87%	$39.45	2.02%	$13.58			
0208	Laminotomies and Laminectomies	"$4,113.17"	1.97%	$81.03	8.34%	$343.04	0.15%	$6.17			
0209	"Level II Extended EEG, Sleep, and Cardiovascular Studies"	$230.83	0.00%	$0.00	0.03%	$0.07	0.02%	$0.05			
0213	"Level I Extended EEG, Sleep, and Cardiovascular Studies"	$176.63	0.00%	$0.00	0.02%	$0.04	0.01%	$0.02			
0215	Level I Nerve and Muscle Services	$94.97	0.01%	$0.01	0.10%	$0.09	0.05%	$0.05			
0216	Level III Nerve and Muscle Services	$272.70	0.02%	$0.05	0.06%	$0.16	0.01%	$0.03			
0218	Level II Nerve and Muscle Services	$158.86	0.00%	$0.00	0.10%	$0.16	0.01%	$0.02			
0219	Vascular Ligation 	"$2,171.72"	10.89%	$236.50	3.74%	$81.22	0.09%	$1.95			
0220	Level I Nerve Procedures	"$1,384.07"	0.27%	$3.74	5.49%	$75.99	0.14%	$1.94			
0221	Level II Nerve Procedures	"$2,947.54"	12.10%	$356.65	5.47%	$161.23	0.11%	$3.24			
0224	Implantation of Catheter/Reservoir/Shunt	"$3,662.54"	30.16%	"$1,104.62"	5.53%	$202.54	0.57%	$20.88			
0227	Implantation of Drug Infusion Device	"$15,572.43"	77.44%	"$12,059.29"	1.58%	$246.04	0.05%	$7.79			
0229	Level II Endovascular Procedures	"$9,627.86"	40.43%	"$3,892.54"	1.42%	$136.72	1.30%	$125.16			
0230	Level I Eye Tests & Treatments	$52.06	0.00%	$0.00	0.11%	$0.06	0.02%	$0.01			
0231	Level III Eye Tests & Treatments	$314.41	0.00%	$0.00	2.47%	$7.77	0.40%	$1.26			
0233	Level II Intraocular Procedures	"$1,752.62"	14.35%	$251.50	11.65%	$204.18	0.14%	$2.45			
0238	"Level I Extraocular, Repair, and Plastic Eye Procedures"	$298.35	0.92%	$2.74	1.37%	$4.09	0.05%	$0.15			
0239	"Level II Extraocular, Repair, and Plastic Eye Procedures"	$701.66	1.69%	$11.86	3.55%	$24.91	0.04%	$0.28			
0240	"Level III Extraocular, Repair, and Plastic Eye Procedures"	"$1,534.67"	1.92%	$29.47	6.62%	$101.60	0.11%	$1.69			
0242	"Level IV Extraocular, Repair, and Plastic Eye Procedures"	"$2,668.00"	10.36%	$276.40	6.85%	$182.76	0.10%	$2.67			
0247	Laser Eye Procedures	$443.63	0.04%	$0.18	4.29%	$19.03	0.01%	$0.04			
0250	Level I ENT Procedures	$129.72	0.17%	$0.22	1.04%	$1.35	0.04%	$0.05			
0251	Level II ENT Procedures	$363.29	0.50%	$1.82	1.10%	$4.00	0.02%	$0.07			
0252	Level III ENT Procedures	$646.66	0.42%	$2.72	2.64%	$17.07	0.57%	$3.69			
0253	Level IV ENT Procedures	"$1,266.86"	1.66%	$21.03	5.27%	$66.76	0.08%	$1.01			
0254	Level V ENT Procedures	"$1,946.20"	1.05%	$20.44	5.95%	$115.80	0.15%	$2.92			
0255	Level I Intraocular Procedures	$752.18	0.56%	$4.21	5.88%	$44.23	0.13%	$0.98			
0256	Level VI ENT Procedures	"$3,730.03"	2.90%	$108.17	4.99%	$186.13	0.34%	$12.68			
0259	Level VII ENT Procedures	"$29,718.47"	81.98%	"$24,363.20"	0.91%	$270.44	0.02%	$5.94			
0260	Level I Plain Film Including Bone Density Measurement	$59.37	0.00%	$0.00	0.10%	$0.06	0.00%	$0.00			
0261	Level II Plain Film Including Bone Density Measurement	$95.02	0.01%	$0.01	0.29%	$0.28	0.02%	$0.02			
0263	Level I Miscellaneous Radiology Procedures	$337.03	2.73%	$9.20	1.97%	$6.64	5.75%	$19.38			
0265	Level I Diagnostic and Screening Ultrasound	$91.69	0.00%	$0.00	0.05%	$0.05	0.01%	$0.01			
0266	Level II Diagnostic and Screening Ultrasound	$134.85	0.00%	$0.00	0.02%	$0.03	0.01%	$0.01			
0267	Level III Diagnostic and Screening Ultrasound	$189.62	0.01%	$0.02	0.04%	$0.08	0.04%	$0.08			
0269	Level I Echocardiogram Without Contrast 	$422.75	0.00%	$0.00	0.08%	$0.34	0.27%	$1.14			
0270	Level II Echocardiogram Without Contrast 	$594.44	0.05%	$0.30	2.33%	$13.85	1.00%	$5.94			
0272	Fluoroscopy and Other Radiology Services	$159.53	3.24%	$5.17	1.14%	$1.82	0.60%	$0.96			
0274	Myelography	$614.28	0.02%	$0.12	1.17%	$7.19	5.23%	$32.13			
0275	Arthrography	$338.65	0.03%	$0.10	3.58%	$12.12	6.23%	$21.10			
0276	Level I Digestive Radiology	$101.69	0.00%	$0.00	0.58%	$0.59	0.62%	$0.63			
0277	Level II Digestive Radiology	$150.99	0.08%	$0.12	0.83%	$1.25	1.98%	$2.99			
0278	Diagnostic Urography	$265.25	1.11%	$2.94	1.24%	$3.29	15.15%	$40.19			
0279	Level II Angiography and Venography	"$2,560.42"	16.31%	$417.60	2.95%	$75.53	4.10%	$104.98			
0280	Level III Angiography and Venography	"$5,324.61"	10.86%	$578.25	1.62%	$86.26	2.43%	$129.39			
0283	Computed Tomography with Contrast	$240.92	0.02%	$0.05	0.96%	$2.31	25.74%	$62.01			
0284	Magnetic Resonance Imaging and Magnetic Resonance Angiography with Contrast	$427.04	0.00%	$0.00	0.87%	$3.72	13.68%	$58.42			
0293	Level IV Intraocular Procedures	"$8,449.85"	55.16%	"$4,660.94"	4.69%	$396.30	0.18%	$15.21			
0300	Level I Radiation Therapy	$100.13	0.00%	$0.00	0.03%	$0.03	0.00%	$0.00			
0301	Level II Radiation Therapy	$193.24	0.00%	$0.00	0.03%	$0.06	0.00%	$0.00			
0303	Treatment Device Construction	$215.63	0.02%	$0.04	0.00%	$0.00	0.13%	$0.28			
0304	Level I Therapeutic Radiation Treatment Preparation	$113.17	0.00%	$0.00	0.00%	$0.00	0.00%	$0.00			
0305	Level II Therapeutic Radiation Treatment Preparation	$314.55	0.00%	$0.00	0.01%	$0.03	0.06%	$0.19			
0308	Positron Emission Tomography (PET) imaging	"$1,286.23"	0.01%	$0.13	0.08%	$1.03	17.70%	$227.66			
0310	Level III Therapeutic Radiation Treatment Preparation	"$1,038.53"	0.71%	$7.37	0.06%	$0.62	0.00%	$0.00			
0312	Radioelement Applications	$395.92	0.00%	$0.00	0.37%	$1.46	0.00%	$0.00			
0313	Brachytherapy	$729.68	0.03%	$0.22	0.01%	$0.07	0.00%	$0.00			
0317	Level II Miscellaneous Radiology Procedures	$813.20	6.67%	$54.24	2.00%	$16.26	6.77%	$55.05			
0318	Level IV Neurostimulator & Related Procedures	"$26,162.39"	84.54%	"$22,117.68"	0.82%	$214.53	0.02%	$5.23			
0319	Level III Endovascular Procedures	"$14,846.45"	48.01%	"$7,127.78"	1.04%	$154.40	0.99%	$146.98			
0320	Electroconvulsive Therapy	$446.29	0.00%	$0.00	9.93%	$44.32	0.36%	$1.61			
0322	Brief Individual Psychotherapy	$89.49	0.00%	$0.00	0.01%	$0.01	0.00%	$0.00			
0323	Extended Individual Psychotherapy	$115.52	0.00%	$0.00	0.03%	$0.03	0.01%	$0.01			
0324	Family Psychotherapy	$124.00	0.00%	$0.00	0.01%	$0.01	0.00%	$0.00			
0325	Group Psychotherapy	$66.05	0.00%	$0.00	0.00%	$0.00	0.00%	$0.00			
0326	Level I Skin Procedures	$219.93	0.03%	$0.07	1.19%	$2.62	0.03%	$0.07			
0327	Level II Skin Procedures	$430.12	0.11%	$0.47	0.46%	$1.98	21.26%	$91.44			
0328	Level III Skin Procedures	"$1,407.42"	0.18%	$2.53	2.44%	$34.34	55.32%	$778.58			
0329	Level IV Skin Procedures	"$2,301.54"	1.31%	$30.15	5.00%	$115.08	14.62%	$336.49			
0330	Dental Procedures	$252.97	0.01%	$0.03	2.42%	$6.12	0.01%	$0.03			
0331	Combined Abdomen and Pelvis CT without Contrast 	$236.86	0.02%	$0.05	0.95%	$2.25	0.42%	$0.99			
0332	Computed Tomography without Contrast	$120.02	0.00%	$0.00	0.02%	$0.02	0.02%	$0.02			
0333	Computed Tomography without Contrast followed by Contrast	$269.71	0.01%	$0.03	0.86%	$2.32	24.08%	$64.95			
0334	Combined Abdomen and Pelvis CT with Contrast 	$375.57	0.02%	$0.08	0.97%	$3.64	19.29%	$72.45			
0336	Magnetic Resonance Imaging and Magnetic Resonance Angiography without Contrast	$286.41	0.01%	$0.03	0.07%	$0.20	0.05%	$0.14			
0337	Magnetic Resonance Imaging and Magnetic Resonance Angiography without Contrast followed by Contrast	$483.08	0.07%	$0.34	0.53%	$2.56	12.15%	$58.69			
0340	Level II Minor Procedures	$52.37	0.00%	$0.00	0.42%	$0.22	0.02%	$0.01			
0342	Level I Pathology	$54.28	0.04%	$0.02	0.41%	$0.22	0.02%	$0.01			
0345	Level I Transfusion Laboratory Procedures	$76.07	0.09%	$0.07	2.26%	$1.72	0.06%	$0.05			
0346	Level II Transfusion Laboratory Procedures	$125.12	0.22%	$0.28	1.78%	$2.23	0.04%	$0.05			
0351	Level V Intraocular Procedures	"$23,084.33"	89.81%	"$20,732.04"	1.45%	$334.72	0.24%	$55.40			
0360	Level I Alimentary Tests	$141.17	0.05%	$0.07	0.59%	$0.83	0.03%	$0.04			
0361	Level II Alimentary Tests	$328.73	0.59%	$1.94	0.88%	$2.89	0.02%	$0.07			
0363	Otorhinolaryngologic and Related Tests	$143.01	0.00%	$0.00	0.01%	$0.01	0.01%	$0.01			
0364	Level I Audiometry	$43.32	0.00%	$0.00	0.07%	$0.03	0.00%	$0.00			
0365	Level II Audiometry	$117.95	0.00%	$0.00	0.02%	$0.02	0.01%	$0.01			
0367	Level I Pulmonary Tests	$161.28	0.03%	$0.05	1.09%	$1.76	0.10%	$0.16			
0369	Level II Pulmonary Tests	$236.86	0.03%	$0.07	0.79%	$1.87	0.05%	$0.12			
0373	Neuropsychological Testing	$199.33	0.00%	$0.00	0.00%	$0.00	0.00%	$0.00			
0375	Ancillary Outpatient Services When Patient Expires	"$6,290.95"	17.56%	"$1,104.69"	5.77%	$362.99	0.93%	$58.51			
0377	Level II Cardiac Imaging	"$1,140.54"	0.00%	$0.00	0.62%	$7.07	24.37%	$277.95			
0378	Level II Pulmonary Imaging	$440.34	0.04%	$0.18	1.75%	$7.71	16.89%	$74.37			
0383	Cardiac Computed Tomographic Imaging	$216.05	0.03%	$0.06	4.74%	$10.24	29.83%	$64.45			
0384	GI Procedures with Stents	"$3,175.07"	22.95%	$728.68	3.19%	$101.28	0.63%	$20.00			
0385	Level I Urogenital Procedures	"$6,825.01"	39.72%	"$2,710.89"	4.19%	$285.97	0.20%	$13.65			
0386	Level II Urogenital Procedures	"$13,973.43"	69.42%	"$9,700.36"	2.21%	$308.81	0.04%	$5.59			
0388	Discography	"$3,332.75"	0.21%	$7.00	3.40%	$113.31	1.03%	$34.33			
0389	Level I Non-imaging Nuclear Medicine	$189.16	0.00%	$0.00	0.14%	$0.26	32.26%	$61.02			
0390	Level I Endocrine Imaging	$189.92	0.00%	$0.00	0.05%	$0.09	30.72%	$58.34			
0391	Level II Endocrine Imaging	$282.00	0.00%	$0.00	0.10%	$0.28	29.23%	$82.43			
0392	Level II Non-imaging Nuclear Medicine	$280.27	0.06%	$0.17	2.24%	$6.28	26.37%	$73.91			
0393	Hematologic Processing & Studies	$628.19	0.01%	$0.06	0.26%	$1.63	51.21%	$321.70			
0394	Hepatobiliary Imaging	$373.05	0.01%	$0.04	11.49%	$42.86	12.35%	$46.07			
0395	GI Tract Imaging	$326.95	0.00%	$0.00	0.35%	$1.14	15.54%	$50.81			
0396	Bone Imaging	$332.31	0.00%	$0.00	0.16%	$0.53	8.69%	$28.88			
0398	Level I Cardiac Imaging	$373.56	0.02%	$0.07	0.45%	$1.68	18.45%	$68.92			
0400	Hematopoietic Imaging	$369.60	0.17%	$0.63	1.53%	$5.65	17.04%	$62.98			
0401	Level I Pulmonary Imaging	$315.89	0.09%	$0.28	2.00%	$6.32	13.64%	$43.09			
0402	Level II Nervous System Imaging	$557.25	0.00%	$0.00	0.21%	$1.17	47.20%	$263.02			
0403	Level I Nervous System Imaging	$177.06	0.00%	$0.00	0.00%	$0.00	14.05%	$24.88			
0404	Renal and Genitourinary Studies	$420.66	0.02%	$0.08	1.21%	$5.09	31.07%	$130.70			
0406	Level I Tumor/Infection Imaging	$377.33	0.02%	$0.08	0.06%	$0.23	21.45%	$80.94			
0407	Radionuclide Therapy	$276.93	0.05%	$0.14	10.51%	$29.11	4.00%	$11.08			
0408	Level III Tumor/Infection Imaging	"$1,188.74"	0.00%	$0.00	0.20%	$2.38	68.23%	$811.08			
0412	Level III Radiation Therapy	$507.75	0.00%	$0.00	0.02%	$0.10	0.00%	$0.00			
0414	Level II Tumor/Infection Imaging	$706.73	0.03%	$0.21	0.26%	$1.84	52.86%	$373.58			
0415	Level II Endoscopy Lower Airway	"$2,256.36"	7.01%	$158.17	3.67%	$82.81	0.12%	$2.71			
0419	Level II Upper GI Procedures 	"$1,064.86"	7.78%	$82.85	4.43%	$47.17	0.21%	$2.24			
0420	Level III Minor Procedures	$131.75	0.22%	$0.29	3.15%	$4.15	0.34%	$0.45			
0422	Level III Upper GI Procedures	"$1,915.15"	22.92%	$438.95	3.20%	$61.28	0.07%	$1.34			
0423	Level II Percutaneous Abdominal and Biliary Procedures	"$4,095.89"	24.42%	"$1,000.22"	2.96%	$121.24	0.60%	$24.58			
0424	Level II Small Intestine Endoscopy 	"$1,249.40"	2.67%	$33.36	4.67%	$58.35	0.20%	$2.50			
0425	Level V Musculoskeletal Procedures Except Hand and Foot	"$10,224.00"	52.32%	"$5,349.20"	3.05%	$311.83	0.10%	$10.22			
0427	Level II Tube or Catheter Changes or Repositioning	"$1,289.07"	22.98%	$296.23	2.28%	$29.39	2.26%	$29.13			
0428	Level III Sigmoidoscopy and Anoscopy	"$1,657.67"	0.22%	$3.65	5.08%	$84.21	0.17%	$2.82			
0431	Level IV Closed Treatment Fracture	"$1,312.18"	5.40%	$70.86	4.22%	$55.37	0.06%	$0.79			
0432	Level II Health and Behavior Services	$50.24	0.00%	$0.00	0.02%	$0.01	0.00%	$0.00			
0433	Level II Pathology	$183.69	0.39%	$0.72	0.89%	$1.63	0.05%	$0.09			
0435	"Level III Extended EEG, Sleep, and Cardiovascular Studies"	$854.29	0.00%	$0.00	0.02%	$0.17	0.00%	$0.00			
0436	Level I Drug Administration	$32.58	0.00%	$0.00	0.03%	$0.01	0.00%	$0.00			
0437	Level II Drug Administration	$53.54	0.00%	$0.00	7.38%	$3.95	0.05%	$0.03			
0438	Level III Drug Administration	$108.24	0.04%	$0.04	15.84%	$17.15	0.25%	$0.27			
0439	Level IV Drug Administration	$173.59	0.04%	$0.07	28.40%	$49.30	0.23%	$0.40			
0440	Level V Drug Administration	$285.11	0.02%	$0.06	37.39%	$106.60	0.14%	$0.40			
0442	Dosimetric Drug Administration	"$1,151.59"	0.00%	$0.00	0.02%	$0.23	13.74%	$158.23			
0446	Level IV Nerve and Muscle Services	"$1,300.96"	0.00%	$0.00	0.03%	$0.39	1.47%	$19.12			
0450	Level I Minor Procedures	$29.24	0.10%	$0.03	0.76%	$0.22	0.07%	$0.02			
0609	Level 1 Type A Emergency Visits	$60.49	0.02%	$0.01	0.88%	$0.53	0.03%	$0.02			
0613	Level 2 Type A Emergency Visits	$112.79	0.01%	$0.01	1.10%	$1.24	0.03%	$0.03			
0614	Level 3 Type A Emergency Visits	$198.39	0.02%	$0.04	0.94%	$1.86	0.02%	$0.04			
0615	Level 4 Type A Emergency Visits	$333.80	0.01%	$0.03	0.85%	$2.84	0.03%	$0.10			
0616	Level 5 Type A Emergency Visits	$492.69	0.01%	$0.05	0.97%	$4.78	0.03%	$0.15			
0617	Critical Care	$656.94	0.04%	$0.26	1.93%	$12.68	0.06%	$0.39			
0618	Trauma Response with Critical Care	$889.32	0.00%	$0.00	0.00%	$0.00	0.00%	$0.00			
0621	Level I Vascular Access Procedures	$843.50	14.41%	$121.55	3.02%	$25.47	0.19%	$1.60			
0622	Level II Vascular Access Procedures	"$2,236.28"	30.37%	$679.16	3.51%	$78.49	0.28%	$6.26			
0624	Phlebotomy and Minor Vascular Access Device Procedures	$78.82	0.06%	$0.05	7.53%	$5.94	0.05%	$0.04			
0626	Level 1 Type B Emergency Visits	$62.72	0.02%	$0.01	0.28%	$0.18	0.00%	$0.00			
0627	Level 2 Type B Emergency Visits	$69.51	0.00%	$0.00	0.62%	$0.43	0.03%	$0.02			
0628	Level 3 Type B Emergency Visits	$112.97	0.00%	$0.00	0.69%	$0.78	0.02%	$0.02			
0629	Level 4 Type B Emergency Visits	$198.98	0.01%	$0.02	0.78%	$1.55	0.01%	$0.02			
0630	Level 5 Type B Emergency Visits	$304.38	0.00%	$0.00	0.80%	$2.44	0.00%	$0.00			
0631	Level 1 Examinations & Related Services 	$53.72	0.00%	$0.00	0.07%	$0.04	0.00%	$0.00			
0632	Level 2 Examinations & Related Services 	$106.27	0.00%	$0.00	0.04%	$0.04	0.00%	$0.00			
0633	Level 3 Examinations & Related Services 	$386.95	0.13%	$0.50	5.14%	$19.89	0.07%	$0.27			
0634	Hospital Clinic Visits	$96.25	0.00%	$0.00	0.12%	$0.12	0.01%	$0.01			
0648	Level IV Breast and Skin Surgery	"$7,464.32"	33.73%	"$2,517.72"	3.73%	$278.42	7.13%	$532.21			
0651	Complex Interstitial Radiation Source Application	$952.48	2.08%	$19.81	1.82%	$17.34	0.15%	$1.43			
0652	Insertion of Intraperitoneal and Pleural Catheters	"$2,288.24"	23.32%	$533.62	3.55%	$81.23	0.15%	$3.43			
0655	Level IV Pacemaker and Similar Procedures	"$16,407.39"	70.78%	"$11,613.15"	0.89%	$146.03	0.12%	$19.69			
0659	Hyperbaric Oxygen	$109.29	0.00%	$0.00	0.00%	$0.00	0.00%	$0.00			
0661	Level III Pathology	$294.25	0.44%	$1.29	0.81%	$2.38	0.08%	$0.24			
0662	CT Angiography	$281.94	0.03%	$0.08	1.58%	$4.45	24.42%	$68.85			
0667	Level IV Radiation Therapy	"$1,072.37"	0.00%	$0.00	0.01%	$0.11	0.00%	$0.00			
0668	Level I Angiography and Venography	$827.52	13.16%	$108.90	4.26%	$35.25	6.47%	$53.54			
0673	Level III Intraocular Procedures	"$3,122.56"	5.58%	$174.24	8.65%	$270.10	0.14%	$4.37			
0676	Thrombolysis and Other Device Revisions 	$195.20	1.76%	$3.44	2.69%	$5.25	2.98%	$5.82			
0688	Level I Neurostimulator & Related Procedures	"$2,128.81"	2.37%	$50.45	6.61%	$140.71	0.14%	$2.98			
0690	Level I Electronic Analysis of Devices	$35.15	0.00%	$0.00	0.08%	$0.03	0.03%	$0.01			
0691	Level III Electronic Analysis of Devices	$247.54	0.03%	$0.07	20.94%	$51.83	2.07%	$5.12			
0692	Level II Electronic Analysis of Devices	$128.23	0.06%	$0.08	0.06%	$0.08	0.02%	$0.03			
0698	Level II Eye Tests & Treatments	$100.85	0.00%	$0.00	0.25%	$0.25	0.02%	$0.02			
8001	LDR Prostate Brachytherapy Composite	"$3,609.85"	9.06%	$327.05	3.71%	$133.93	0.23%	$8.30			
8004	Ultrasound Composite	$285.31	0.01%	$0.03	0.20%	$0.57	0.01%	$0.03			
8005	CT and CTA without Contrast Composite	$313.37	0.01%	$0.03	0.59%	$1.85	0.21%	$0.66			
8006	CT and CTA with Contrast Composite	$528.56	0.01%	$0.05	0.56%	$2.96	14.26%	$75.37			
8007	MRI and MRA without Contrast Composite	$607.88	0.00%	$0.00	0.36%	$2.19	0.04%	$0.24			
8008	MRI and MRA with Contrast Composite	$911.22	0.01%	$0.09	0.49%	$4.46	6.85%	$62.42			
8009	Extended Assessment & Management Composite	"$1,234.70"	0.03%	$0.37	2.95%	$36.42	0.11%	$1.36			
											
											
											
											
											
											
											
											
											
											
											
											
											
											
											
											
											
											
											
											
											
											
											
											
											
											
											
											
											
											
											
											
											
											
											
											
											
											
											
											
											
											
											
											
											
											
											
											
											
											
											
											
											
											
											
											
											
