April 2024 ASP Changes

Every quarter, the Centers for Medicare and Medicaid Services (CMS) publish a file mapping HCPCS coded drugs to their Medicare reimbursement rates. This reimbursement rate is referred to as the ‘Payment Limit’ and is calculated based on ASP, or the real average selling price of a drug. The CMS file can be found here: https://www.cms.gov/medicare/payment/all-fee-service-providers/medicare-part-b-drug-average-sales-price/asp-pricing-files.

Below, you will find a graph displaying Medicare Payment Limits for April, 1st 2024. You can filter and search the graph for a HCPCS code or drug of choice. 

HCPCS CodeShort DescriptionPayment Limit
90371Hep b ig im141.115
90375Rabies ig im/sc285.652
90377Rabies ig ht&sol human im/sc250.980
90586Bcg vaccine intravesical144.479
90632Hepa vaccine adult im70.541
90662Iiv no prsv increased ag im73.403
90670Pcv13 vaccine im257.989
90671PCV15 vaccine IM253.560
90672Laiv4 vaccine intranasal27.788
90674Cciiv4 vac no prsv 0.5 ml im34.172
90675Rabies vaccine im322.765
90677Pcv20 vaccine im298.036
90682Riv4 vacc recombinant dna im73.403
90686Iiv4 vacc no prsv 0.5 ml im22.350
90687Iiv4 vaccine splt 0.25 ml im10.439
90688Iiv4 vaccine splt 0.5 ml im20.878
90694Vacc AIIV4 no prsrv 0.5ML IM77.359
90714Td vacc no presv 7 yrs+ im18.828
90715Tdap vaccine 7 yrs/> im39.086
90732Ppsv23 vacc 2 yrs+ subq/im133.472
90739Hepb vacc 2 dose adult im160.284
90740Hepb vacc 3 dose immunsup im158.152
90743Hep b vacc, adol, 2 dose, im75.145
90744Hepb vacc 3 dose ped/adol im30.770
90746Hepb vaccine 3 dose adult im70.376
90747Hepb vacc 4 dose immunsup im140.752
90756Cciiv4 vacc abx free im32.374
90759Hep b vac 3ag 10mcg 3 dos im73.815
91304SARSCOV2 VAC 5MCG/0.5ML IM148.200
91318SARSCOV2 VAC 3MCG TRS-SUC IM65.550
91319SARSCV2 VAC 10MCG TRS-SUC IM87.780
91320SARSCV2 VAC 30MCG TRS-SUC IM131.100
91321SARSCOV2 VAC 25 MCG/.25ML IM145.920
91322SARSCOV2 VAC 50 MCG/0.5ML IM145.920
A9575Inj gadoterate meglumi 0.1ml0.128
A9576Inj prohance multipack1.493
A9577Inj multihance1.821
A9578Inj multihance multipack1.734
A9579Gad-base mr contrast nos,1ml1.509
A9581Gadoxetate disodium inj14.764
A9585Gadobutrol injection0.347
A9589Insti hexaminolevulinate hcl1321.841
A9606Radium ra223 dichloride therN/A
J0121Inj., omadacycline, 1 mg3.750
J0122Inj., eravacycline, 1 mg1.112
J0129Abatacept injection42.840
J0131Inj, acetaminophen (nos)0.050
J0132Acetylcysteine injection0.770
J0133Acyclovir injection0.059
J0134Inj acetaminophen -fresenius0.050
J0136Inj, acetaminophen (b braun)0.052
J0137Inj, acetaminophen (hikma)0.066
J0153Adenosine inj 1mg0.556
J0171Adrenalin epinephrine inject0.812
J0172Inj, aducanumab-avwa, 2 mg5.978
J0173Inj, epinephrine (belcher)1.886
J0174Inj, lecanemab-irmb, 1 mg1.339
J0177Inj, aflibercept hd, 1 mg341.749
J0178Aflibercept injection841.128
J0179Inj, brolucizumab-dbll, 1 mg325.679
J0180Agalsidase beta injection218.275
J0185Inj., aprepitant, 1 mg1.666
J0202Injection, alemtuzumab2347.582
J0206Inj allopurinol sodium 1 mg5.430
J0218Inj olipudase alfa-rpcp 1mg376.580
J0219Inj aval alfa-nqpt 4mg75.996
J0221Lumizyme injection197.303
J0222Inj., patisiran, 0.1 mg99.204
J0223Inj givosiran 0.5 mg112.020
J0224Inj. lumasiran, 0.5 mg318.100
J0225Inj, vutrisiran, 1 mg4935.214
J0248Inj, remdesivir, 1 mg6.058
J0256Alpha 1 proteinase inhibitor4.912
J0257Glassia injection5.395
J0278Amikacin sulfate injection0.860
J0280Aminophyllin 250 mg inj8.836
J0283Inj, amiodarone (nexterone)2.545
J0285Amphotericin b38.574
J0289Amphotericin b liposome inj27.682
J0290Ampicillin 500 mg inj0.997
J0291Inj., plazomicin, 5 mg3.598
J0295Ampicillin sulbactam 1.5 gm2.123
J0348Anidulafungin injection0.464
J0360Hydralazine hcl injection5.556
J0401Inj aripiprazole ext rel 1mg6.814
J0402Inj, abilify asimtufii, 1 mg5.807
J0456Azithromycin2.408
J0457Injection, aztreonam, 100 mg2.575
J0461Atropine sulfate injection0.068
J0475Baclofen 10 mg injection177.873
J0476Baclofen intrathecal trial57.913
J0480Basiliximab4487.000
J0485Belatacept injection3.870
J0490Belimumab injection54.102
J0491Inj anifrolumab-fnia 1mg17.135
J0500Dicyclomine injection24.985
J0515Inj benztropine mesylate16.448
J0517Inj., benralizumab, 1 mg165.247
J0558Peng benzathine/procaine inj17.368
J0561Penicillin g benzathine inj21.998
J0565Inj, bezlotoxumab, 10 mg39.872
J0577Inj, brixadi, 7 days or less404.086
J0578Inj,brixadi, more than 7 day1616.346
J0583Bivalirudin0.246
J0584Injection, burosumab-twza 1m447.863
J0585Injection,onabotulinumtoxina6.319
J0586Abobotulinumtoxina10.815
J0587Inj, rimabotulinumtoxinb13.035
J0588Incobotulinumtoxin a5.197
J0592Buprenorphine hydrochloride3.934
J0594Busulfan injection1.042
J0595Butorphanol tartrate 1 mg3.578
J0596Injection, ruconest33.400
J0597C-1 esterase, berinert64.427
J0598C-1 esterase, cinryze62.562
J0612Calcium glucon (fresenius)0.049
J0613Calcium glucon (wg critical)0.086
J0630Calcitonin salmon injection1101.736
J0637Caspofungin acetate6.629
J0638Canakinumab injection124.484
J0640Leucovorin calcium injection5.137
J0641Inj levoleucovorin nos 0.5mg0.053
J0642Injection, khapzory, 0.5 mg1.709
J0665Inj, bupivacaine, nos, 0.5mg0.015
J0670Inj mepivacaine hcl/10 ml3.557
J0688Inj cefazolin sodium, hikma1.084
J0689Inj cefazolin sodium, baxter1.241
J0690Cefazolin sodium injection0.815
J0692Cefepime hcl for injection1.337
J0694Cefoxitin sodium injection4.896
J0695Inj ceftolozane tazobactam7.289
J0696Ceftriaxone sodium injection0.454
J0697Sterile cefuroxime injection1.894
J0699Inj, cefiderocol, 10 mg2.173
J0701Inj. cefepime hcl (baxter)5.760
J0702Betamethasone acet&sod phosp6.885
J0703Inj, cefepime hcl (b braun)4.951
J0712Ceftaroline fosamil inj3.859
J0713Inj ceftazidime per 500 mg1.657
J0714Ceftazidime and avibactam95.436
J0717Certolizumab pegol inj 1mg4.624
J0725Chorionic gonadotropin/1000u23.293
J0735Clonidine hydrochloride17.021
J0736Inj, clindamycin phosp 300mg2.266
J0737Inj, clindamycin (baxter)2.207
J0740Cidofovir injection581.057
J0741Inj, cabote rilpivir 2mg 3mg22.617
J0742Inj imip 4 cilas 4 releb 2mg2.447
J0743Cilastatin sodium injection7.561
J0744Ciprofloxacin iv1.858
J0770Colistimethate sodium inj12.841
J0775Collagenase, clost hist inj68.968
J0780Prochlorperazine injection3.944
J0791Inj crizanlizumab-tmca 5mg127.351
J0801Inj. acthar gel to 40 units3370.387
J0802Inj. (ani), up to 40 units3365.303
J0834Inj., cosyntropin, 0.25 mg28.593
J0840Crotalidae poly immune fab1979.873
J0841Inj crotalidae im f(ab')2 eq1047.293
J0850Cytomegalovirus imm iv /vial1808.222
J0873Inj, daptomycin (xellia)0.036
J0874Inj, daptomycin (baxter)0.069
J0875Injection, dalbavancin15.122
J0877Inj, daptomycin (hospira)0.062
J0878Daptomycin injection0.104
J0881Darbepoetin alfa, non-esrd2.901
J0882Darbepoetin alfa, esrd use2.901
J0885Epoetin alfa, non-esrd8.273
J0887Epoetin beta esrd use1.436
J0888Epoetin beta non esrd1.384
J0891Argatroban nonesrd (accord)1.815
J0892Argatroban dialysis (accord)1.815
J0894Decitabine injection1.641
J0895Deferoxamine mesylate inj9.021
J0896Inj luspatercept-aamt 0.25mg39.983
J0897Denosumab injection25.189
J1000Depo-estradiol cypionate inj35.754
J1010Inj, methylpred acetate 1 mg0.134
J1071Inj testosterone cypionate0.010
J1100Dexamethasone sodium phos0.117
J1110Inj dihydroergotamine mesylt37.117
J1120Acetazolamid sodium injectio26.234
J1160Digoxin injection9.064
J1162Digoxin immune fab (ovine)4777.441
J1165Phenytoin sodium injection0.640
J1170Hydromorphone injection4.755
J1190Dexrazoxane hcl injection91.090
J1200Diphenhydramine hcl injectio0.823
J1201Inj. cetirizine hcl 0.5mg14.971
J1205Chlorothiazide sodium inj87.755
J1212Dimethyl sulfoxide 50% 50 ml680.161
J1230Methadone injection20.607
J1240Dimenhydrinate injection8.857
J1245Dipyridamole injection3.738
J1250Inj dobutamine hcl/250 mg9.261
J1265Dopamine injection0.815
J1270Injection, doxercalciferol0.835
J1290Ecallantide injection545.617
J1300Eculizumab injection225.703
J1301Injection, edaravone, 1 mg21.832
J1302Inj, sutimlimab-jome, 10 mg17.769
J1303Inj., ravulizumab-cwvz 10 mg221.745
J1304Inj tofersen intrathec 1 mg150.838
J1305Inj, evinacumab-dgnb, 5mg179.140
J1306Injection, inclisiran, 1 mg12.119
J1322Elosulfase alfa, injection283.224
J1323Inj, elranatamab-bcmm, 1 mg181.673
J1325Epoprostenol injection15.648
J1335Ertapenem injection11.898
J1364Erythro lactobionate /500 mg77.850
J1380Estradiol valerate 10 mg inj8.656
J1410Inj estrogen conjugate 25 mg372.367
J1430Ethanolamine oleate 100 mg474.444
J1437Inj. fe derisomaltose 10 mg19.936
J1439Inj ferric carboxymaltos 1mg1.094
J1440Fecal microbiota jslm 1 ml63.206
J1442Inj filgrastim excl biosimil0.994
J1447Inj tbo filgrastim 1 microg0.407
J1448Injection, trilaciclib, 1mg5.287
J1449Inj eflapegrastim-xnst 0.1mg27.735
J1450Fluconazole2.772
J1453Fosaprepitant injection0.131
J1454Inj fosnetupitant, palonoset708.345
J1456Inj, fosaprepitant (teva)2.043
J1458Galsulfase injection466.915
J1459Inj ivig privigen 500 mg47.858
J1460Gamma globulin 1 cc inj49.061
J1551Inj cutaquig 100 mg13.800
J1554Inj. asceniv491.405
J1555Inj cuvitru, 100 mg15.827
J1556Inj, imm glob bivigam, 500mg72.965
J1557Gammaplex injection55.009
J1558Inj. xembify, 100 mg14.132
J1559Hizentra injection12.907
J1560Gamma globulin > 10 cc inj490.615
J1561Gamunex-c/gammaked48.883
J1566Immune globulin, powder78.464
J1568Octagam injection46.980
J1569Gammagard liquid injection43.223
J1570Ganciclovir sodium injection44.095
J1571Hepagam b im injection60.767
J1575Hyqvia 100mg immuneglobulin16.941
J1576Inj, panzyga, 500 mg64.949
J1580Garamycin gentamicin inj2.733
J1596Inj, glycopyrrolate, 0.1 mg0.497
J1602Golimumab for iv use 1mg11.801
J1610Glucagon hydrochloride/1 mg191.521
J1611Inj glucagon hcl, fresenius128.884
J1626Granisetron hcl injection0.328
J1627Inj, granisetron, xr, 0.1 mg5.424
J1630Haloperidol injection1.262
J1631Haloperidol decanoate inj6.747
J1640Hemin, 1 mg31.354
J1642Inj heparin sodium per 10 u0.017
J1643Inj heparin, pfizer, 1000u4.339
J1644Inj heparin sodium per 1000u0.273
J1645Dalteparin sodium16.596
J1650Inj enoxaparin sodium0.619
J1652Fondaparinux sodium1.031
J1670Tetanus immune globulin inj578.781
J1720Hydrocortisone sodium succ i18.459
J1740Ibandronate sodium injection31.713
J1743Idursulfase injection542.894
J1745Infliximab not biosimil 10mg31.671
J1746Inj., ibalizumab-uiyk, 10 mg74.645
J1747Inj, spesolimab-sbzo, 1 mg60.148
J1750Inj iron dextran17.314
J1756Iron sucrose injection0.229
J1786Imuglucerase injection43.942
J1805Inj, esmolol hcl, 10mg0.221
J1806Inj esmolol hcl wg crit care0.424
J1811Fiasp for insulin pump use7.423
J1813Lyumjev for insulin pump use15.678
J1817Insulin for insulin pump use7.556
J1823Inj. inebilizumab-cdon, 1 mg473.513
J1836Inj, metronidazole, 10 mg0.025
J1885Ketorolac tromethamine inj0.702
J1920Inj, labetalol hcl, 5mg0.165
J1921Inj labetalol hcl hikma, 5mg2.373
J1930Lanreotide injection56.300
J1931Laronidase injection37.441
J1932Inj, lanreotide, (cipla) 1mg44.024
J1939Inj, bumetanide, 0.5 mg0.632
J1940Furosemide injection0.608
J1943Inj., aristada initio, 1 mg3.082
J1944Aripiprazole lauroxil 1 mg3.123
J1950Leuprolide acetate /3.75 mg1576.119
J1951Inj fensolvi 0.25 mg131.705
J1952Leuprolide inj, camcevi, 1mg60.754
J1953Levetiracetam injection0.065
J1954Leuprolide depot cipla 7.5mg281.572
J1955Inj levocarnitine per 1 gm35.136
J1956Levofloxacin injection0.962
J1961Inj, lenacapavir, 1 mg22.013
J2001Lidocaine injection0.027
J2010Lincomycin injection10.326
J2020Linezolid injection3.622
J2021Inj, linezolid (hospira)16.432
J2060Lorazepam injection0.962
J2150Mannitol injection4.523
J2175Meperidine hydrochl /100 mg6.900
J2182Injection, mepolizumab, 1mg30.480
J2184Inj, meropenem (b. braun)2.020
J2185Meropenem0.387
J2210Methylergonovin maleate inj20.870
J2247Inj, micafungin (par pharm)0.270
J2248Micafungin sodium injection0.704
J2250Inj midazolam hydrochloride0.136
J2251Inj midazolam (wg crit care)0.260
J2260Inj milrinone lactate / 5 mg1.551
J2270Morphine sulfate injection4.456
J2272Inj, morphine (fresenius)7.276
J2274Inj morphine pf epid ithc14.434
J2278Ziconotide injection9.041
J2280Inj, moxifloxacin 100 mg8.765
J2281Inj moxifloxacin (fres kabi)7.485
J2300Inj nalbuphine hydrochloride2.821
J2305Inj, nitroglycerin, 5 mg1.441
J2310Inj naloxone hydrochloride8.057
J2311Inj, naloxone hcl (zimhi)6.292
J2315Naltrexone, depot form3.967
J2323Natalizumab injection24.225
J2327Inj risankizumab-rzaa 1 mg15.003
J2329Inj ublituximab-xiiy, 1 mg67.232
J2350Injection, ocrelizumab, 1 mg58.756
J2353Octreotide injection, depot210.560
J2354Octreotide inj, non-depot1.122
J2356Inj tezepelumab-ekko, 1mg17.799
J2357Omalizumab injection36.806
J2358Olanzapine long-acting inj2.917
J2359Inj. olanzapine, 0.5mg0.956
J2360Orphenadrine injection9.120
J2372Inj, biorphen, 20 micrograms0.174
J2401Chloroprocaine hcl injection0.039
J2403Chloroprocaine opht gel, 1mg0.664
J2405Ondansetron hcl injection0.095
J2406Injection, oritavancin 10 mg40.895
J2407Injection, oritavancin26.907
J2426Inj, invega sustenna, 1 mg14.279
J2427Inj, invega hafyera/trinza12.185
J2430Pamidronate disodium /30 mg14.097
J2469Palonosetron hcl1.192
J2501Paricalcitol0.753
J2506Inj pegfilgrast ex bio 0.5mg109.754
J2507Pegloticase injection3391.914
J2540Penicillin g potassium inj0.828
J2543Piperacillin/tazobactam1.050
J2545Pentamidine non-comp unit87.097
J2550Promethazine hcl injection3.099
J2560Phenobarbital sodium inj32.801
J2562Plerixafor injection123.579
J2597Inj desmopressin acetate6.273
J2598Inj, vasopressin, 1 unit1.884
J2599Inj vasopressin (am reg) 1 u0.282
J2675Inj progesterone per 50 mg0.705
J2679Inj fluphenazine hcl 1.25 mg7.885
J2680Fluphenazine decanoate 25 mg9.720
J2690Procainamide hcl injection187.202
J2700Oxacillin sodium injeciton1.125
J2704Inj, propofol, 10 mg0.122
J2720Inj protamine sulfate/10 mg2.127
J2724Protein c concentrate15.025
J2760Phentolaine mesylate inj444.317
J2765Metoclopramide hcl injection1.040
J2777Inj, faricimab-svoa, 0.1mg35.441
J2778Ranibizumab injection173.378
J2779Inj, susvimo 0.1 mg80.374
J2781Inj, pegcetacoplan, 1mg149.904
J2782Inj avacincapted pegol 0.1mg109.074
J2783Rasburicase367.482
J2785Regadenoson injection7.051
J2786Injection, reslizumab, 1mg10.225
J2788Rho d immune globulin 50 mcg21.878
J2790Rho d immune globulin inj79.976
J2791Rhophylac injection4.796
J2792Rho(d) immune globulin h, sd30.641
J2794Inj risperdal consta, 0.5 mg12.180
J2795Ropivacaine hcl injection0.068
J2796Romiplostim injection96.382
J2798Inj., perseris, 0.5 mg11.629
J2799Inj, uzedy, 1 mg24.408
J2800Methocarbamol injection6.168
J2805Sincalide injection129.743
J2820Sargramostim injection59.455
J2860Injection, siltuximab151.308
J2916Na ferric gluconate complex2.184
J2919Inj, methylpred sod succ 5mg0.273
J2997Alteplase recombinant88.822
J3000Streptomycin injection23.062
J3010Fentanyl citrate injection0.991
J3032Inj. eptinezumab-jjmr 1 mg18.048
J3055Inj talquetamab-tgvs 0.25 mg67.716
J3060Inj, taliglucerase alfa 10 u45.000
J3090Inj tedizolid phosphate1.815
J3095Telavancin injection7.131
J3101Tenecteplase injection153.112
J3105Terbutaline sulfate inj6.087
J3111Inj. romosozumab-aqqg 1 mg10.692
J3121Inj testostero enanthate 1mg0.050
J3145Testosterone undecanoate 1mg1.926
J3230Chlorpromazine hcl injection27.936
J3240Thyrotropin injection2022.366
J3241Inj. teprotumumab-trbw 10 mg333.401
J3243Tigecycline injection0.667
J3245Inj., tildrakizumab, 1 mg140.227
J3246Tirofiban hcl4.103
J3250Trimethobenzamide hcl inj48.569
J3260Tobramycin sulfate injection2.553
J3262Tocilizumab injection6.042
J3285Treprostinil injection54.549
J3299Inj xipere 1 mg48.583
J3301Triamcinolone acet inj nos1.083
J3304Inj triamcinolone ace xr 1mg17.491
J3315Triptorelin pamoate416.690
J3357Ustekinumab sub cu inj, 1 mg152.565
J3358Ustekinumab, iv inject, 1 mg12.494
J3360Diazepam injection6.539
J3370Vancomycin hcl injection2.578
J3371Inj, vancomycin hcl (mylan)5.865
J3372Inj, vancomycin hcl (xellia)6.401
J3380Injection, vedolizumab21.853
J3385Velaglucerase alfa367.841
J3396Verteporfin injection11.441
J3401Vyjuvek 5x10^9pfu/ml, 0.1 ml2519.090
J3410Hydroxyzine hcl injection13.869
J3411Thiamine hcl 100 mg2.261
J3415Pyridoxine hcl 100 mg15.002
J3420Vitamin b12 injection1.423
J3425Inj, hydroxocobalamin0.009
J3430Vitamin k phytonadione inj2.803
J3465Injection, voriconazole1.102
J3473Hyaluronidase recombinant0.361
J3475Inj magnesium sulfate0.643
J3480Inj potassium chloride0.110
J3485Zidovudine1.511
J3486Ziprasidone mesylate10.221
J3489Zoledronic acid 1mg6.935
J7030Normal saline solution infus2.609
J7040Normal saline solution infus1.304
J70425% dextrose/normal saline1.132
J7050Normal saline solution infus0.652
J70605% dextrose/water1.801
J7070D5w infusion3.603
J7120Ringers lactate infusion2.426
J7170Inj., emicizumab-kxwh 0.5 mg50.842
J7175Inj, factor x, (human), 1iu9.112
J7177Inj., fibryga, 1 mg1.416
J7178Inj human fibrinogen con nos1.445
J7179Vonvendi inj 1 iu vwf:rco1.869
J7180Factor xiii anti-hem factor10.154
J7181Factor xiii recomb a-subunit17.104
J7182Factor viii recomb novoeight1.377
J7183Wilate injection1.258
J7185Xyntha inj1.374
J7186Antihemophilic viii/vwf comp1.186
J7187Humate-p, inj1.397
J7188Factor viii recomb obizur3.221
J7189Factor viia recomb novoseven2.451
J7190Factor viii1.110
J7192Factor viii recombinant nos1.514
J7193Factor ix non-recombinant1.323
J7194Factor ix complex1.610
J7195Factor ix recombinant nos1.752
J7197Antithrombin iii injection3.737
J7198Anti-inhibitor2.287
J7200Factor ix recombinan rixubis1.529
J7201Factor ix alprolix recomb3.465
J7202Factor ix idelvion inj5.091
J7203Factor ix recomb gly rebinyn4.474
J7204Inj recombin esperoct per iu2.111
J7205Factor viii fc fusion recomb2.206
J7207Factor viii pegylated recomb2.053
J7208Inj. jivi 1 iu2.336
J7209Factor viii nuwiq recomb 1iu1.254
J7210Inj, afstyla, 1 i.u.1.455
J7211Inj, kovaltry, 1 i.u.1.424
J7212Factor viia recomb sevenfact2.154
J7213Inj, ixinity, 1 i.u.1.838
J7214Altuviiio per factor viii iu4.630
J7308Aminolevulinic acid hcl top396.534
J7312Dexamethasone intra implant205.595
J7313Inj., iluvien, 0.01 mg487.538
J7314Inj., yutiq, 0.01 mg527.084
J7318Inj, durolane 1 mg6.550
J7320Genvisc 850, inj, 1mg5.163
J7321Hyalgan supartz visco-3 dose73.118
J7322Hymovis injection 1 mg17.509
J7323Euflexxa inj per dose115.573
J7324Orthovisc inj per dose131.561
J7325Synvisc or synvisc-one8.876
J7326Gel-one522.371
J7327Monovisc inj per dose711.543
J7328Gelsyn-3 injection 0.1 mg0.494
J7329Inj, trivisc 1 mg7.421
J7331Synojoynt, inj., 1 mg10.464
J7332Inj., triluron, 1 mg10.488
J7336Capsaicin 8% patch3.324
J7340Carbidopa levodopa ent 100ml228.010
J7345Aminolevulinic acid, 10% gel1.698
J7351Inj bimatoprost itc imp1mcg206.194
J7402Mometasone sinus sinuva11.345
J7500Azathioprine oral 50mg2.558
J7502Cyclosporine oral 100 mg2.295
J7503Tacrol envarsus ex rel oral1.733
J7504Lymphocyte immune globulin3614.804
J7507Tacrolimus imme rel oral 1mg0.271
J7508Tacrol astagraf ex rel oral0.551
J7509Methylprednisolone oral0.245
J7510Prednisolone oral per 5 mg0.287
J7511Antithymocyte globuln rabbit927.943
J7512Prednisone ir or dr oral 1mg0.006
J7515Cyclosporine oral 25 mg0.921
J7517Mycophenolate mofetil oral0.198
J7518Mycophenolic acid0.498
J7519Inj. mycophenolate mofetil0.707
J7520Sirolimus, oral2.460
J7525Tacrolimus injection248.770
J7527Oral everolimus2.684
J7605Arformoterol non-comp unit1.846
J7606Formoterol fumarate, inh3.568
J7608Acetylcysteine non-comp unit9.358
J7611Albuterol non-comp con0.162
J7612Levalbuterol non-comp con0.233
J7613Albuterol non-comp unit0.039
J7614Levalbuterol non-comp unit0.044
J7620Albuterol ipratrop non-comp0.197
J7626Budesonide non-comp unit1.203
J7631Cromolyn sodium noncomp unit0.929
J7639Dornase alfa non-comp unit52.034
J7644Ipratropium bromide non-comp0.331
J7674Methacholine chloride, neb1.119
J7677Revefenacin inh non-com 1mcg0.186
J7682Tobramycin non-comp unit16.532
J7686Treprostinil, non-comp unit725.266
J8501Oral aprepitant3.497
J8520Capecitabine, oral, 150 mg0.322
J8521Capecitabine, oral, 500 mg0.785
J8530Cyclophosphamide oral 25 mg0.859
J8540Oral dexamethasone0.067
J8560Etoposide oral 50 mg76.487
J8610Methotrexate oral 2.5 mg0.243
J8655Oral netupitant, palonosetro409.047
J8670Rolapitant, oral, 1mg1.631
J8700Temozolomide0.187
J8705Topotecan oral113.238
J9000Doxorubicin hcl injection3.646
J9017Arsenic trioxide injection11.899
J9021Inj, aspara, rylaze, 0.1 mg51.198
J9022Inj, atezolizumab,10 mg83.935
J9023Injection, avelumab, 10 mg92.534
J9025Azacitidine injection0.408
J9027Clofarabine injection18.043
J9029Inj, adstiladrin, per tx dos63505.400
J9030Bcg live intravesical 1mg2.890
J9032Injection, belinostat, 10mg48.837
J9033Inj., treanda 1 mg8.356
J9034Inj., bendeka 1 mg13.831
J9035Bevacizumab injection74.156
J9036Inj. belrapzo/bendamustine8.875
J9039Injection, blinatumomab145.355
J9040Bleomycin sulfate injection23.118
J9041Injection, bortezomib, 0.1mg2.071
J9042Brentuximab vedotin inj230.742
J9043Cabazitaxel injection211.755
J9045Carboplatin injection3.722
J9047Injection, carfilzomib, 1 mg47.179
J9049Inj, bortezomib, hospira1.718
J9050Carmustine injection280.920
J9052Inj, carmustine (accord)0.051
J9055Cetuximab injection73.487
J9058Inj apotex/bendamustine 1 mg24.134
J9059Inj bendamustine, baxter 1mg24.134
J9060Cisplatin 10 mg injection3.271
J9061Inj, amivantamab-vmjw19.985
J9063Inj, elahere, 1 mg65.682
J9065Inj cladribine per 1 mg16.597
J9071Inj cyclophosphamd auromedic1.757
J9073Inj cyclophosphamd (ingenus)0.981
J9075Inj, cyclophosphamide, nos0.918
J9100Cytarabine hcl 100 mg inj0.915
J9118Inj. calaspargase pegol-mknl72.883
J9119Inj., cemiplimab-rwlc, 1 mg27.576
J9120Dactinomycin injection547.795
J9130Dacarbazine 100 mg inj3.688
J9144Daratumumab, hyaluronidase48.799
J9145Injection, daratumumab 10 mg61.132
J9150Daunorubicin injection31.504
J9153Inj daunorubicin, cytarabine232.803
J9155Degarelix injection4.353
J9171Docetaxel injection0.871
J9173Inj., durvalumab, 10 mg80.515
J9176Injection, elotuzumab, 1mg7.403
J9177Inj enfort vedo-ejfv 0.25mg36.201
J9178Inj, epirubicin hcl, 2 mg1.334
J9179Eribulin mesylate injection137.665
J9181Etoposide injection1.046
J9185Fludarabine phosphate inj190.895
J9190Fluorouracil injection2.951
J9196Inj gemcitabine hcl (accord)4.235
J9200Floxuridine injection3728.550
J9201In gemcitabine hcl nos 200mg3.654
J9202Goserelin acetate implant599.340
J9203Gemtuzumab ozogamicin 0.1 mg226.280
J9204Inj mogamulizumab-kpkc, 1 mg234.165
J9205Inj irinotecan liposome 1 mg63.443
J9206Irinotecan injection3.508
J9207Ixabepilone injection127.496
J9208Ifosfamide injection26.446
J9209Mesna injection1.761
J9210Inj., emapalumab-lzsg, 1 mg364.873
J9211Idarubicin hcl injection38.937
J9217Leuprolide acetate suspnsion185.662
J9218Leuprolide acetate injeciton11.024
J9223Inj. lurbinectedin, 0.1 mg199.523
J9226Supprelin la implant44578.751
J9227Inj. isatuximab-irfc 10 mg76.420
J9228Ipilimumab injection172.709
J9229Inj inotuzumab ozogam 0.1 mg2580.145
J9245Inj melpha hydroch nos 50 mg167.760
J9246Inj., evomela, 1 mg16.889
J9259Paclitaxel (american regent)15.144
J9260Methotrexate sodium inj2.572
J9261Nelarabine injection101.925
J9262Inj, omacetaxine mep, 0.01mg3.953
J9263Oxaliplatin0.072
J9264Paclitaxel protein bound13.714
J9266Pegaspargase injection25781.458
J9267Paclitaxel injection0.107
J9268Pentostatin injection2335.723
J9269Inj. tagraxofusp-erzs 10 mcg326.652
J9271Inj pembrolizumab57.307
J9272Inj, dostarlimab-gxly, 10 mg232.554
J9273Inj tisotu vedotin-tftv, 1mg174.799
J9274Inj, tebentafusp-tebn, 1 mcg208.926
J9280Mitomycin injection67.031
J9281Mitomycin instillation300.591
J9286Inj glofitamab gxbm, 2.5 mg2707.252
J9293Mitoxantrone hydrochl / 5 mg42.669
J9294Inj pemetrexed, hospira 10mg3.617
J9295Injection, necitumumab, 1 mg5.737
J9297Inj pemetrexed (sandoz) 10mg1.418
J9298Inj nivol relatlimab 3mg/1mg187.003
J9299Injection, nivolumab31.094
J9301Obinutuzumab inj70.216
J9303Panitumumab injection151.238
J9304Inj. pemetrexed, 10 mg63.078
J9305Inj. pemetrexed nos 10mg3.970
J9306Injection, pertuzumab, 1 mg15.418
J9307Pralatrexate injection299.279
J9308Injection, ramucirumab69.653
J9309Inj, polatuzumab vedotin 1mg124.033
J9311Inj rituximab, hyaluronidase37.239
J9312Inj., rituximab, 10 mg78.872
J9314Inj pemetrexed (teva) 10mg9.960
J9316Pertuzu, trastuzu, 10 mg65.324
J9317Sacituzumab govitecan-hziy34.104
J9319Inj romidepsin lyophil 0.1mg30.549
J9321Inj epcoritamab-bysp 0.16 mg53.775
J9323Inj pemetrexed ditromethamin10.343
J9325Inj talimogene laherparepvec66.802
J9328Temozolomide injection10.399
J9330Temsirolimus injection28.863
J9331Inj sirolimus prot part 1 mg109.288
J9332Inj efgartigimod 2mg32.066
J9333Inj ronzanolixizum-noli 1 mg22.851
J9334Inj efgart-alfa 2mg hya-qvfc33.167
J9340Thiotepa injection228.364
J9345Inj, retifanlimab-dlwr, 1 mg29.500
J9347Inj, tremelimumab-actl, 1 mg135.746
J9348Inj. naxitamab-gqgk, 1 mg610.029
J9349Inj., tafasitamab-cxix13.578
J9350Inj mosunetuzumab-axgb, 1 mg629.147
J9351Topotecan injection1.169
J9352Injection trabectedin 0.1mg338.386
J9353Inj. margetuximab-cmkb, 5 mg47.036
J9354Inj, ado-trastuzumab emt 1mg38.438
J9355Inj trastuzumab excl biosimi80.048
J9356Inj. herceptin hylecta, 10mg65.929
J9357Valrubicin injection1347.685
J9358Inj fam-trastu deru-nxki 1mg27.268
J9359Inj lon tesirin-lpyl 0.075mg200.493
J9360Vinblastine sulfate inj5.023
J9370Vincristine sulfate 1 mg inj7.914
J9380Inj teclistamab cqyv 0.5 mg30.762
J9381Inj teplizumab mzwv 5 mcg36.380
J9390Vinorelbine tartrate inj8.499
J9394Inj, fulvestrant (fresenius)5.286
J9395Injection, fulvestrant8.169
J9400Inj, ziv-aflibercept, 1mg6.682
P9041Albumin (human),5%, 50ml10.615
P9045Albumin (human), 5%, 250 ml53.077
P9046Albumin (human), 25%, 20 ml21.231
P9047Albumin (human), 25%, 50ml53.077
Q0138Ferumoxytol, non-esrd0.394
Q0139Ferumoxytol, esrd use0.394
Q0162Ondansetron oral0.017
Q0167Dronabinol 2.5mg oral0.842
Q2041Axicabtagene ciloleucel car+459381.446
Q2042Tisagenlecleucel car-pos t518240.680
Q2043Sipuleucel-t auto cd54+55453.567
Q0249Tocilizumab for COVID-196.572
Q2050Doxorubicin inj 10mg114.936
Q2053Brexucabtagene car pos t449440.000
Q2054Lisocabtagene mara car pos t474060.620
Q2055Idecabtagene vicleucel car484690.300
Q2056Ciltacabtagene car-pos t507495.551
Q3027Inj beta interferon im 1 mcg54.280
Q4074Iloprost non-comp unit dose146.892
Q4081Epoetin alfa, 100 units esrd0.827
Q4101Apligraf30.620
Q4102Oasis wound matrix12.417
Q4103Oasis burn matrix12.561
Q4104Integra bmwd48.875
Q4105Integra drt or omnigraft24.599
Q4108Integra matrix49.681
Q4111Gammagraft7.216
Q4114Integra flowable wound matri1497.923
Q4118Matristem micromatrix2.561
Q4121Theraskin46.134
Q4124Oasis tri-layer wound matrix8.968
Q4126Memoderm/derma/tranz/integup89.110
Q4128Flexhd/allopatchhd/sq cm30.689
Q4132Grafix core, grafixpl core110.441
Q4133Grafix stravix prime pl sqcm143.226
Q4137Amnioexcel biodexcel 1sq cm104.907
Q4141Alloskin ac, 1 cm41.351
Q4143Repriza, 1cm29.149
Q4147Architect ecm px fx 1 sq cm147.222
Q4148Neox neox rt or clarix cord10.455
Q4150Allowrap ds or dry 1 sq cm78.273
Q4151Amnioband, guardian 1 sq cm132.875
Q4152Dermapure 1 square cm44.903
Q4153Dermavest, plurivest sq cm125.556
Q4154Biovance 1 square cm155.454
Q4155Neoxflo or clarixflo 1 mg0.527
Q4156Neox 100 or clarix 1002.105
Q4159Affinity1 square cm309.578
Q4160Nushield 1 square cm94.918
Q4163Woundex, bioskin, per sq cm171.450
Q4164Helicoll, per square cm1571.962
Q4166Cytal, per square centimeter19.205
Q4168Amnioband, 1 mg17.052
Q4170Cygnus, per sq cm56.733
Q4171Interfyl, 1 mg11.527
Q4173Palingen or palingen xplus394.057
Q4175Miroderm65.511
Q4178Floweramniopatch, per sq cm74.470
Q4180Revita, per sq cm372.656
Q4184Cellesta or duo per sq cm624.340
Q4186Epifix 1 sq cm153.452
Q4187Epicord 1 sq cm248.371
Q4188Amnioarmor 1 sq cm637.632
Q4190Artacent ac 1 sq cm320.381
Q4191Restorigin 1 sq cm1537.000
Q4196Puraply am 1 sq cm104.163
Q4197Puraply xt 1 sq cm121.626
Q4199Cygnus matrix, per sq cm317.637
Q4203Derma-gide, 1 sq cm300.181
Q4205Membrane graft or wrap sq cm1248.213
Q4210Axolotl graf dualgraf sq cm848.000
Q4217Woundfix biowound plus xplus525.180
Q4221Amniowrap2 per sq cm1696.000
Q4222Progenamatrix, per sq cm115.289
Q4231Corplex p, per cc1528.704
Q4232Corplex, per sq cm150.813
Q4235Amniorepair or altiply sq cm149.772
Q4236Carepatch per sq cm601.070
Q4238Derm-maxx, per sq cm1346.790
Q4246Coretext or protext, per cc2968.000
Q4247Amniotext patch, per sq cm530.000
Q4248Dermacyte amn mem allo sq cm1083.874
Q4252Vendaje, per square centimet127.454
Q4253Zenith amniotic membrane psc244.100
Q4258Enverse, per sq cm71.332
Q4259Celera per sq cm1007.000
Q4262Dual layer impax, per sq cm631.059
Q4263Surgraft tl, per sq cm1004.130
Q4267Neostim dl per sq cm874.500
Q4271Complete ft per sq cm1749.000
Q4278Epieffect, per sq cm406.362
Q4281Barrera slor dl per sq cm884.667
Q4282Cygnus dual per sq cm875.190
Q4283Biovance tri or 3l, sq cm1297.537
Q4310Procenta, per 100 mg 3409.596
Q5101Injection, zarxio0.423
Q5103Injection, inflectra11.092
Q5104Injection, renflexis30.579
Q5105Inj retacrit esrd on dialysi0.751
Q5106Inj retacrit non-esrd use7.511
Q5107Inj mvasi 10 mg26.750
Q5108Injection, fulphila164.037
Q5110Nivestym0.285
Q5111Injection, udenyca 0.5 mg135.486
Q5112Inj ontruzant 10 mg34.057
Q5113Inj herzuma 10 mg55.797
Q5114Inj ogivri 10 mg62.618
Q5115Inj truxima 10 mg30.980
Q5116Inj., trazimera, 10 mg12.765
Q5117Inj., kanjinti, 10 mg17.681
Q5118Inj., zirabev, 10 mg20.755
Q5119Inj ruxience, 10 mg20.275
Q5121Inj. avsola, 10 mg24.373
Q5122Inj, nyvepria65.506
Q5123Inj. riabni, 10 mg41.418
Q5124Inj. byooviz, 0.1 mg175.058
Q5125Inj, releuko 1 mcg0.526
Q5126Inj alymsys 10 mg58.811
Q5127Inj, stimufend, 0.5 mg344.101
Q5128Inj, cimerli, 0.1 mg256.167
Q5129Inj, vegzelma, 10 mg69.268
Q5130Inj, fylnetra, 0.5 mg201.315
Q9950Inj sulf hexa lipid microsph18.938
Q9956Inj octafluoropropane mic,ml44.479
Q9957Inj perflutren lip micros,ml44.479
Q9958Hocm <=149 mg/ml iodine, 1ml0.074
Q9963Hocm 350-399mg/ml iodine,1ml0.217
Q9965Locm 100-199mg/ml iodine,1ml1.016
Q9966Locm 200-299mg/ml iodine,1ml0.388
Q9967Locm 300-399mg/ml iodine,1ml0.137
Q9991Buprenorph xr 100 mg or less1874.902
Q9992Buprenorphine xr over 100 mg1874.902