JANUARY 2024 ASP CHANGES: QUARTER 1 ASP

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 January, 1st 2024. You can filter and search the graph for a HCPCS code or drug of choice. 

HCPCS CodeShort DescriptionPayment Limit
90371Hep b ig im137.892
90375Rabies ig im/sc289.979
90376Rabies ig heat treated479.719
90377Rabies ig ht&sol human im/sc256.305
90586Bcg vaccine intravesical144.495
90632Hepa vaccine adult im70.261
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 im324.744
90677Pcv20 vaccine im288.664
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+ im30.344
90715Tdap vaccine 7 yrs/> im38.305
90732Ppsv23 vacc 2 yrs+ subq/im133.472
90739Hepb vacc 2 dose adult im160.284
90740Hepb vacc 3 dose immunsup im152.124
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 0.1ml0.129
A9576Inj prohance multipack1.525
A9577Inj multihance1.841
A9578Inj multihance multipack1.772
A9579Gad-base mr contrast nos,1ml1.518
A9581Gadoxetate disodium inj14.741
A9585Gadobutrol injection0.344
A9589Insti hexaminolevulinate hcl1321.841
A9606Radium ra223 dichloride therN/A
J0121Inj., omadacycline, 1 mg3.658
J0122Inj., eravacycline, 1 mg1.128
J0129Abatacept injection43.163
J0131Inj, acetaminophen (nos)0.046
J0132Acetylcysteine injection0.704
J0133Acyclovir injection0.056
J0134Inj acetaminophen -fresenius0.047
J0136Inj, acetaminophen (b braun)0.056
J0137Inj, acetaminophen (hikma)0.051
J0153Adenosine inj 1mg0.601
J0171Adrenalin epinephrine inject0.748
J0172Inj, aducanumab-avwa, 2 mg5.978
J0173Inj, epinephrine (belcher)1.790
J0174Inj, lecanemab-irmb, 1 mg1.346
J0178Aflibercept injection862.280
J0179Inj, brolucizumab-dbll, 1 mg325.240
J0180Agalsidase beta injection218.341
J0185Inj., aprepitant, 1 mg1.729
J0202Injection, alemtuzumab2324.344
J0206Inj allopurinol sodium 1 mg5.553
J0218Inj olipudase alfa-rpcp 1mg376.965
J0219Inj aval alfa-nqpt 4mg76.017
J0221Lumizyme injection197.278
J0222Inj., patisiran, 0.1 mg99.979
J0223Inj givosiran 0.5 mg112.080
J0224Inj. lumasiran, 0.5 mg319.555
J0225Inj, vutrisiran, 1 mg4947.383
J0248Inj, remdesivir, 1 mg6.058
J0256Alpha 1 proteinase inhibitor4.883
J0257Glassia injection5.353
J0278Amikacin sulfate injection0.829
J0280Aminophyllin 250 mg inj5.132
J0285Amphotericin b9.536
J0289Amphotericin b liposome inj26.658
J0290Ampicillin 500 mg inj1.011
J0291Inj., plazomicin, 5 mg3.599
J0295Ampicillin sulbactam 1.5 gm1.769
J0348Anidulafungin injection0.460
J0360Hydralazine hcl injection5.587
J0401Inj aripiprazole ext rel 1mg6.809
J0402Inj, abilify asimtufii, 1 mg5.884
J0456Azithromycin2.600
J0457Injection, aztreonam, 100 mg2.539
J0461Atropine sulfate injection0.076
J0475Baclofen 10 mg injection177.804
J0476Baclofen intrathecal trial37.444
J0480Basiliximab4476.265
J0485Belatacept injection3.874
J0490Belimumab injection51.998
J0491Inj anifrolumab-fnia 1mg17.180
J0500Dicyclomine injection24.965
J0515Inj benztropine mesylate16.435
J0517Inj., benralizumab, 1 mg169.501
J0558Peng benzathine/procaine inj17.578
J0561Penicillin g benzathine inj21.730
J0565Inj, bezlotoxumab, 10 mg39.858
J0583Bivalirudin0.214
J0584Injection, burosumab-twza 1m443.503
J0585Injection,onabotulinumtoxina6.327
J0586Abobotulinumtoxina8.805
J0587Inj, rimabotulinumtoxinb13.026
J0588Incobotulinumtoxin a5.186
J0592Buprenorphine hydrochloride4.126
J0594Busulfan injection1.414
J0595Butorphanol tartrate 1 mg2.798
J0596Injection, ruconest33.507
J0597C-1 esterase, berinert64.356
J0598C-1 esterase, cinryze62.556
J0612Calcium glucon (fresenius)0.050
J0613Calcium glucon (wg critical)0.089
J0630Calcitonin salmon injection1069.499
J0637Caspofungin acetate5.427
J0638Canakinumab injection124.326
J0640Leucovorin calcium injection4.470
J0641Inj levoleucovorin nos 0.5mg0.068
J0642Injection, khapzory, 0.5 mg1.530
J0665Inj, bupivacaine, nos, 0.5mg0.014
J0670Inj mepivacaine hcl/10 ml3.290
J0688Inj cefazolin sodium, hikma1.042
J0689Inj cefazolin sodium, baxter1.228
J0690Cefazolin sodium injection0.763
J0692Cefepime hcl for injection1.262
J0694Cefoxitin sodium injection5.079
J0695Inj ceftolozane tazobactam7.370
J0696Ceftriaxone sodium injection0.491
J0697Sterile cefuroxime injection2.026
J0699Inj, cefiderocol, 10 mg2.173
J0701Inj. cefepime hcl (baxter)5.637
J0702Betamethasone acet&sod phosp6.816
J0703Inj, cefepime hcl (b braun)5.268
J0712Ceftaroline fosamil inj3.835
J0713Inj ceftazidime per 500 mg1.694
J0714Ceftazidime and avibactam95.449
J0717Certolizumab pegol inj 1mg4.816
J0725Chorionic gonadotropin/1000u23.174
J0735Clonidine hydrochloride19.267
J0736Inj, clindamycin phosp 300mg1.904
J0737Inj, clindamycin (baxter)1.751
J0740Cidofovir injection554.192
J0741Inj, cabote rilpivir 2mg 3mg22.597
J0742Inj imip 4 cilas 4 releb 2mg2.462
J0743Cilastatin sodium injection8.103
J0744Ciprofloxacin iv1.933
J0770Colistimethate sodium inj13.916
J0775Collagenase, clost hist inj66.269
J0780Prochlorperazine injection3.429
J0791Inj crizanlizumab-tmca 5mg127.102
J0801Inj. acthar gel to 40 units4095.318
J0802Inj. (ani), up to 40 units3348.991
J0834Inj., cosyntropin, 0.25 mg27.114
J0840Crotalidae poly immune fab1949.917
J0841Inj crotalidae im f(ab')2 eq912.076
J0850Cytomegalovirus imm iv /vial1807.872
J0873Inj, daptomycin (xellia)0.050
J0875Injection, dalbavancin15.293
J0877Inj, daptomycin (hospira)0.065
J0878Daptomycin injection0.038
J0881Darbepoetin alfa, non-esrd2.930
J0882Darbepoetin alfa, esrd use2.930
J0885Epoetin alfa, non-esrd8.886
J0887Epoetin beta esrd use1.618
J0888Epoetin beta non esrd1.618
J0891Argatroban nonesrd (accord)1.821
J0892Argatroban dialysis (accord)1.821
J0893Inj, decitabine (sun pharma)0.777
J0894Decitabine injection1.694
J0895Deferoxamine mesylate inj8.597
J0896Inj luspatercept-aamt 0.25mg39.971
J0897Denosumab injection25.198
J1000Depo-estradiol cypionate inj35.754
J1020Methylprednisolone 20 mg inj7.038
J1030Methylprednisolone 40 mg inj6.419
J1040Methylprednisolone 80 mg inj9.803
J1071Inj testosterone cypionate0.027
J1100Dexamethasone sodium phos0.119
J1110Inj dihydroergotamine mesylt42.341
J1120Acetazolamid sodium injectio28.119
J1160Digoxin injection9.408
J1162Digoxin immune fab (ovine)4777.441
J1165Phenytoin sodium injection0.630
J1170Hydromorphone injection4.591
J1190Dexrazoxane hcl injection108.006
J1200Diphenhydramine hcl injectio0.804
J1201Inj. cetirizine hcl 0.5mg15.073
J1205Chlorothiazide sodium inj121.346
J1212Dimethyl sulfoxide 50% 50 ml680.820
J1230Methadone injection19.671
J1240Dimenhydrinate injection8.951
J1245Dipyridamole injection3.718
J1250Inj dobutamine hcl/250 mg9.848
J1265Dopamine injection0.772
J1270Injection, doxercalciferol0.378
J1290Ecallantide injection539.327
J1300Eculizumab injection225.685
J1301Injection, edaravone, 1 mg21.815
J1302Inj, sutimlimab-jome, 10 mg17.766
J1303Inj., ravulizumab-cwvz 10 mg221.773
J1304Inj tofersen intrathec 1 mg150.838
J1305Inj, evinacumab-dgnb, 5mg179.140
J1306Injection, inclisiran, 1 mg12.134
J1322Elosulfase alfa, injection280.909
J1325Epoprostenol injection15.962
J1335Ertapenem injection12.965
J1364Erythro lactobionate /500 mg80.775
J1380Estradiol valerate 10 mg inj9.236
J1410Inj estrogen conjugate 25 mg372.146
J1430Ethanolamine oleate 100 mg473.933
J1437Inj. fe derisomaltose 10 mg18.863
J1439Inj ferric carboxymaltos 1mg1.147
J1440Fecal microbiota jslm 1 ml62.984
J1442Inj filgrastim excl biosimil0.985
J1447Inj tbo filgrastim 1 microg0.439
J1448Injection, trilaciclib, 1mg5.201
J1449Inj eflapegrastim-xnst 0.1mg29.679
J1450Fluconazole2.797
J1453Fosaprepitant injection0.138
J1454Inj fosnetupitant, palonoset694.178
J1456Inj, fosaprepitant (teva)0.441
J1458Galsulfase injection462.992
J1459Inj ivig privigen 500 mg48.290
J1460Gamma globulin 1 cc inj50.726
J1551Inj cutaquig 100 mg13.888
J1554Inj. asceniv491.405
J1555Inj cuvitru, 100 mg15.922
J1556Inj, imm glob bivigam, 500mg72.962
J1557Gammaplex injection55.153
J1558Inj. xembify, 100 mg14.183
J1559Hizentra injection12.945
J1560Gamma globulin > 10 cc inj507.258
J1561Gamunex-c/gammaked49.786
J1566Immune globulin, powder78.500
J1568Octagam injection44.978
J1569Gammagard liquid injection44.152
J1570Ganciclovir sodium injection44.922
J1571Hepagam b im injection59.619
J1575Hyqvia 100mg immuneglobulin17.085
J1576Inj, panzyga, 500 mg66.441
J1580Garamycin gentamicin inj2.685
J1596Inj, glycopyrrolate, 0.1 mg0.616
J1602Golimumab for iv use 1mg12.341
J1610Glucagon hydrochloride/1 mg188.367
J1611Inj glucagon hcl, fresenius123.830
J1626Granisetron hcl injection0.381
J1627Inj, granisetron, xr, 0.1 mg5.674
J1630Haloperidol injection1.416
J1631Haloperidol decanoate inj8.777
J1640Hemin, 1 mg31.348
J1642Inj heparin sodium per 10 u0.016
J1643Inj heparin, pfizer, 1000u4.580
J1644Inj heparin sodium per 1000u0.268
J1645Dalteparin sodium17.399
J1650Inj enoxaparin sodium0.680
J1652Fondaparinux sodium1.093
J1670Tetanus immune globulin inj578.613
J1720Hydrocortisone sodium succ i17.845
J1740Ibandronate sodium injection25.596
J1743Idursulfase injection542.917
J1745Infliximab not biosimil 10mg32.161
J1746Inj., ibalizumab-uiyk, 10 mg74.624
J1747Inj, spesolimab-sbzo, 1 mg60.223
J1750Inj iron dextran17.324
J1756Iron sucrose injection0.221
J1786Imuglucerase injection44.023
J1805Inj, esmolol hcl, 10mg0.260
J1806Inj esmolol hcl wg crit care0.453
J1811Fiasp for insulin pump use6.798
J1813Lyumjev for insulin pump use15.573
J1817Insulin for insulin pump use7.959
J1823Inj. inebilizumab-cdon, 1 mg473.513
J1836Inj, metronidazole, 10 mg0.024
J1885Ketorolac tromethamine inj0.488
J1920Inj, labetalol hcl, 5mg0.186
J1921Inj labetalol hcl hikma, 5mg2.556
J1930Lanreotide injection48.443
J1931Laronidase injection37.441
J1932Inj, lanreotide, (cipla) 1mg48.777
J1939Inj, bumetanide, 0.5 mg0.665
J1940Furosemide injection0.573
J1943Inj., aristada initio, 1 mg3.091
J1944Aripiprazole lauroxil 1 mg3.109
J1950Leuprolide acetate /3.75 mg1564.604
J1951Inj fensolvi 0.25 mg131.824
J1952Leuprolide inj, camcevi, 1mg59.800
J1953Levetiracetam injection0.063
J1954Leuprolide depot cipla 7.5mg355.279
J1955Inj levocarnitine per 1 gm35.321
J1956Levofloxacin injection0.908
J1961Inj, lenacapavir, 1 mg21.933
J1980Hyoscyamine sulfate inj35.464
J2001Lidocaine injection0.027
J2010Lincomycin injection9.844
J2020Linezolid injection3.298
J2021Inj, linezolid (hospira)20.061
J2060Lorazepam injection1.122
J2150Mannitol injection2.595
J2175Meperidine hydrochl /100 mg7.299
J2182Injection, mepolizumab, 1mg30.505
J2184Inj, meropenem (b. braun)2.113
J2185Meropenem0.452
J2210Methylergonovin maleate inj19.603
J2247Inj, micafungin (par pharm)0.337
J2248Micafungin sodium injection0.757
J2250Inj midazolam hydrochloride0.142
J2251Inj midazolam (wg crit care)0.284
J2260Inj milrinone lactate / 5 mg1.562
J2270Morphine sulfate injection4.665
J2272Inj, morphine (fresenius)7.434
J2274Inj morphine pf epid ithc11.244
J2278Ziconotide injection9.040
J2280Inj, moxifloxacin 100 mg9.426
J2281Inj moxifloxacin (fres kabi)5.806
J2300Inj nalbuphine hydrochloride2.811
J2305Inj, nitroglycerin, 5 mg1.286
J2310Inj naloxone hydrochloride7.288
J2311Inj, naloxone hcl (zimhi)5.759
J2315Naltrexone, depot form3.959
J2323Natalizumab injection24.452
J2327Inj risankizumab-rzaa 1 mg15.363
J2329Inj ublituximab-xiiy, 1 mg67.663
J2350Injection, ocrelizumab, 1 mg59.751
J2353Octreotide injection, depot210.829
J2354Octreotide inj, non-depot1.188
J2356Inj tezepelumab-ekko, 1mg18.587
J2357Omalizumab injection39.459
J2358Olanzapine long-acting inj2.917
J2359Inj. olanzapine, 0.5mg0.947
J2360Orphenadrine injection9.705
J2372Inj, biorphen, 20 micrograms0.177
J2401Chloroprocaine hcl injection0.037
J2405Ondansetron hcl injection0.100
J2406Injection, oritavancin 10 mg40.917
J2407Injection, oritavancin27.595
J2426Inj, invega sustenna, 1 mg14.318
J2427Inj, invega hafyera/trinza12.210
J2430Pamidronate disodium /30 mg8.874
J2469Palonosetron hcl0.845
J2501Paricalcitol0.665
J2506Inj pegfilgrast ex bio 0.5mg50.678
J2507Pegloticase injection3371.076
J2540Penicillin g potassium inj0.771
J2543Piperacillin/tazobactam1.177
J2545Pentamidine non-comp unit52.220
J2550Promethazine hcl injection3.590
J2560Phenobarbital sodium inj31.432
J2562Plerixafor injection172.883
J2597Inj desmopressin acetate6.328
J2598Inj, vasopressin, 1 unit1.815
J2599Inj vasopressin (am reg) 1 u0.463
J2675Inj progesterone per 50 mg0.914
J2679Inj fluphenazine hcl 1.25 mg7.545
J2680Fluphenazine decanoate 25 mg9.150
J2690Procainamide hcl injection146.317
J2700Oxacillin sodium injeciton1.048
J2704Inj, propofol, 10 mg0.128
J2720Inj protamine sulfate/10 mg1.658
J2724Protein c concentrate15.070
J2760Phentolaine mesylate inj446.797
J2765Metoclopramide hcl injection1.094
J2777Inj, faricimab-svoa, 0.1mg36.092
J2778Ranibizumab injection187.553
J2779Inj, susvimo 0.1 mg80.782
J2781Inj, pegcetacoplan, 1mg151.462
J2783Rasburicase367.268
J2785Regadenoson injection14.280
J2786Injection, reslizumab, 1mg10.168
J2788Rho d immune globulin 50 mcg23.799
J2790Rho d immune globulin inj81.161
J2791Rhophylac injection4.827
J2792Rho(d) immune globulin h, sd32.964
J2794Inj risperdal consta, 0.5 mg12.151
J2795Ropivacaine hcl injection0.077
J2796Romiplostim injection96.027
J2798Inj., perseris, 0.5 mg11.624
J2799Inj, uzedy, 1 mg24.700
J2800Methocarbamol injection5.656
J2805Sincalide injection133.099
J2820Sargramostim injection59.317
J2860Injection, siltuximab148.943
J2916Na ferric gluconate complex2.374
J2920Methylprednisolone injection4.188
J2930Methylprednisolone injection5.882
J2997Alteplase recombinant88.974
J3000Streptomycin injection32.516
J3010Fentanyl citrate injection0.968
J3032Inj. eptinezumab-jjmr 1 mg18.059
J3060Inj, taliglucerase alfa 10 u45.034
J3090Inj tedizolid phosphate1.781
J3095Telavancin injection7.048
J3101Tenecteplase injection153.114
J3105Terbutaline sulfate inj7.794
J3111Inj. romosozumab-aqqg 1 mg10.727
J3121Inj testostero enanthate 1mg0.050
J3145Testosterone undecanoate 1mg1.837
J3230Chlorpromazine hcl injection29.786
J3240Thyrotropin injection2021.170
J3241Inj. teprotumumab-trbw 10 mg327.998
J3243Tigecycline injection0.736
J3245Inj., tildrakizumab, 1 mg140.655
J3246Tirofiban hcl4.320
J3250Trimethobenzamide hcl inj47.839
J3260Tobramycin sulfate injection2.664
J3262Tocilizumab injection6.120
J3285Treprostinil injection56.383
J3299Inj xipere 1 mg48.583
J3301Triamcinolone acet inj nos0.946
J3304Inj triamcinolone ace xr 1mg17.541
J3315Triptorelin pamoate413.585
J3357Ustekinumab sub cu inj, 1 mg153.955
J3358Ustekinumab, iv inject, 1 mg12.619
J3360Diazepam injection5.465
J3370Vancomycin hcl injection2.307
J3371Inj, vancomycin hcl (mylan)5.974
J3372Inj, vancomycin hcl (xellia)6.578
J3380Injection, vedolizumab22.063
J3385Velaglucerase alfa367.406
J3396Verteporfin injection11.531
J3410Hydroxyzine hcl injection9.908
J3411Thiamine hcl 100 mg2.458
J3415Pyridoxine hcl 100 mg14.825
J3420Vitamin b12 injection1.443
J3425Inj, hydroxocobalamin0.005
J3430Vitamin k phytonadione inj2.899
J3465Injection, voriconazole1.158
J3471Ovine, up to 999 usp units0.499
J3473Hyaluronidase recombinant0.361
J3475Inj magnesium sulfate0.691
J3480Inj potassium chloride0.120
J3485Zidovudine1.511
J3486Ziprasidone mesylate9.755
J3489Zoledronic acid 1mg7.213
J7030Normal saline solution infus2.691
J7040Normal saline solution infus1.346
J70425% dextrose/normal saline1.587
J7050Normal saline solution infus0.673
J70605% dextrose/water1.931
J7070D5w infusion3.861
J7120Ringers lactate infusion2.591
J7170Inj., emicizumab-kxwh 0.5 mg50.652
J7175Inj, factor x, (human), 1iu9.112
J7177Inj., fibryga, 1 mg1.100
J7178Inj human fibrinogen con nos1.382
J7179Vonvendi inj 1 iu vwf:rco1.823
J7180Factor xiii anti-hem factor9.676
J7181Factor xiii recomb a-subunit17.133
J7182Factor viii recomb novoeight1.339
J7183Wilate injection1.296
J7185Xyntha inj1.294
J7186Antihemophilic viii/vwf comp1.202
J7187Humate-p, inj1.348
J7188Factor viii recomb obizur3.221
J7189Factor viia recomb novoseven2.428
J7190Factor viii1.027
J7192Factor viii recombinant nos1.512
J7193Factor ix non-recombinant1.322
J7194Factor ix complex1.606
J7195Factor ix recombinant nos1.751
J7197Antithrombin iii injection3.871
J7198Anti-inhibitor2.267
J7200Factor ix recombinan rixubis1.550
J7201Factor ix alprolix recomb3.465
J7202Factor ix idelvion inj4.941
J7203Factor ix recomb gly rebinyn4.409
J7204Inj recombin esperoct per iu2.076
J7205Factor viii fc fusion recomb2.188
J7207Factor viii pegylated recomb1.980
J7208Inj. jivi 1 iu2.342
J7209Factor viii nuwiq recomb 1iu1.282
J7210Inj, afstyla, 1 i.u.1.443
J7211Inj, kovaltry, 1 i.u.1.426
J7212Factor viia recomb sevenfact2.029
J7213Inj, ixinity, 1 i.u.1.815
J7214Altuviiio per factor viii iu4.629
J7308Aminolevulinic acid hcl top392.319
J7311Inj., retisert, 0.01 mg299.050
J7312Dexamethasone intra implant205.612
J7313Inj., iluvien, 0.01 mg490.947
J7314Inj., yutiq, 0.01 mg528.999
J7318Inj, durolane 1 mg6.143
J7320Genvisc 850, inj, 1mg5.744
J7321Hyalgan supartz visco-3 dose73.095
J7322Hymovis injection 1 mg17.264
J7323Euflexxa inj per dose127.300
J7324Orthovisc inj per dose130.639
J7325Synvisc or synvisc-one9.122
J7326Gel-one497.289
J7327Monovisc inj per dose714.367
J7328Gelsyn-3 injection 0.1 mg0.489
J7329Inj, trivisc 1 mg7.907
J7331Synojoynt, inj., 1 mg11.335
J7332Inj., triluron, 1 mg10.270
J7336Capsaicin 8% patch3.272
J7340Carbidopa levodopa ent 100ml227.757
J7345Aminolevulinic acid, 10% gel1.647
J7351Inj bimatoprost itc imp1mcg206.205
J7402Mometasone sinus sinuva11.345
J7500Azathioprine oral 50mg4.559
J7502Cyclosporine oral 100 mg2.264
J7503Tacrol envarsus ex rel oral1.733
J7504Lymphocyte immune globulin3591.458
J7507Tacrolimus imme rel oral 1mg0.236
J7508Tacrol astagraf ex rel oral0.552
J7509Methylprednisolone oral0.227
J7510Prednisolone oral per 5 mg0.419
J7511Antithymocyte globuln rabbit929.026
J7512Prednisone ir or dr oral 1mg0.007
J7515Cyclosporine oral 25 mg0.837
J7517Mycophenolate mofetil oral0.188
J7518Mycophenolic acid0.628
J7519Inj. mycophenolate mofetil0.727
J7520Sirolimus, oral2.672
J7525Tacrolimus injection248.735
J7527Oral everolimus2.751
J7605Arformoterol non-comp unit2.316
J7606Formoterol fumarate, inh4.101
J7608Acetylcysteine non-comp unit6.825
J7611Albuterol non-comp con0.149
J7612Levalbuterol non-comp con0.308
J7613Albuterol non-comp unit0.040
J7614Levalbuterol non-comp unit0.045
J7620Albuterol ipratrop non-comp0.173
J7626Budesonide non-comp unit1.006
J7631Cromolyn sodium noncomp unit1.031
J7639Dornase alfa non-comp unit52.077
J7644Ipratropium bromide non-comp0.323
J7674Methacholine chloride, neb0.860
J7677Revefenacin inh non-com 1mcg0.187
J7682Tobramycin non-comp unit21.794
J7686Treprostinil, non-comp unit730.320
J8501Oral aprepitant4.225
J8520Capecitabine, oral, 150 mg0.245
J8521Capecitabine, oral, 500 mg0.574
J8530Cyclophosphamide oral 25 mg0.618
J8540Oral dexamethasone0.083
J8560Etoposide oral 50 mg76.610
J8610Methotrexate oral 2.5 mg0.267
J8655Oral netupitant, palonosetro410.058
J8670Rolapitant, oral, 1mg1.593
J8700Temozolomide0.281
J8705Topotecan oral113.491
J9000Doxorubicin hcl injection3.279
J9017Arsenic trioxide injection15.783
J9021Inj, aspara, rylaze, 0.1 mg50.957
J9022Inj, atezolizumab,10 mg85.011
J9023Injection, avelumab, 10 mg92.369
J9025Azacitidine injection0.353
J9027Clofarabine injection21.385
J9030Bcg live intravesical 1mg2.890
J9032Injection, belinostat, 10mg48.884
J9033Inj., treanda 1 mg9.191
J9034Inj., bendeka 1 mg14.756
J9035Bevacizumab injection74.073
J9036Inj. belrapzo/bendamustine13.089
J9039Injection, blinatumomab145.565
J9040Bleomycin sulfate injection21.024
J9041Injection, bortezomib, 0.1mg1.959
J9042Brentuximab vedotin inj230.614
J9043Cabazitaxel injection210.453
J9045Carboplatin injection3.599
J9047Injection, carfilzomib, 1 mg47.085
J9049Inj, bortezomib, hospira1.520
J9050Carmustine injection271.465
J9052Inj, carmustine (accord)18.401
J9055Cetuximab injection73.720
J9056Inj, bendamustine, 1 mg33.453
J9058Inj apotex/bendamustine 1 mg20.778
J9059Inj bendamustine, baxter 1mg20.778
J9060Cisplatin 10 mg injection4.039
J9061Inj, amivantamab-vmjw19.975
J9063Inj, elahere, 1 mg65.710
J9065Inj cladribine per 1 mg15.773
J9070Cyclophosphamide 100 mg inj20.153
J9071Inj cyclophosphamd auromedic1.791
J9100Cytarabine hcl 100 mg inj0.973
J9118Inj. calaspargase pegol-mknl72.883
J9119Inj., cemiplimab-rwlc, 1 mg27.461
J9120Dactinomycin injection668.904
J9130Dacarbazine 100 mg inj3.733
J9144Daratumumab, hyaluronidase49.051
J9145Injection, daratumumab 10 mg61.705
J9150Daunorubicin injection35.671
J9153Inj daunorubicin, cytarabine231.764
J9155Degarelix injection4.187
J9171Docetaxel injection0.995
J9173Inj., durvalumab, 10 mg80.706
J9176Injection, elotuzumab, 1mg7.380
J9177Inj enfort vedo-ejfv 0.25mg35.028
J9178Inj, epirubicin hcl, 2 mg1.380
J9179Eribulin mesylate injection134.017
J9181Etoposide injection0.993
J9185Fludarabine phosphate inj173.969
J9190Fluorouracil injection3.215
J9196Inj gemcitabine hcl (accord)8.775
J9198Inj. infugem, 100 mg40.280
J9200Floxuridine injection3722.039
J9201In gemcitabine hcl nos 200mg3.651
J9202Goserelin acetate implant609.009
J9203Gemtuzumab ozogamicin 0.1 mg226.280
J9204Inj mogamulizumab-kpkc, 1 mg234.165
J9205Inj irinotecan liposome 1 mg62.020
J9206Irinotecan injection1.945
J9207Ixabepilone injection128.074
J9208Ifosfamide injection26.752
J9209Mesna injection1.372
J9210Inj., emapalumab-lzsg, 1 mg375.657
J9211Idarubicin hcl injection42.930
J9217Leuprolide acetate suspnsion181.302
J9218Leuprolide acetate injeciton13.745
J9223Inj. lurbinectedin, 0.1 mg200.009
J9226Supprelin la implant44575.935
J9227Inj. isatuximab-irfc 10 mg76.497
J9228Ipilimumab injection172.419
J9229Inj inotuzumab ozogam 0.1 mg2580.145
J9245Inj melpha hydroch nos 50 mg148.021
J9246Inj., evomela, 1 mg16.487
J9250Methotrexate sodium inj0.307
J9259Paclitaxel (american regent)15.453
J9260Methotrexate sodium inj3.033
J9261Nelarabine injection110.982
J9262Inj, omacetaxine mep, 0.01mg3.960
J9263Oxaliplatin0.071
J9264Paclitaxel protein bound14.294
J9266Pegaspargase injection25781.458
J9267Paclitaxel injection0.108
J9268Pentostatin injection2273.153
J9269Inj. tagraxofusp-erzs 10 mcg325.555
J9271Inj pembrolizumab55.730
J9272Inj, dostarlimab-gxly, 10 mg233.258
J9273Inj tisotu vedotin-tftv, 1mg168.310
J9274Inj, tebentafusp-tebn, 1 mcg208.926
J9280Mitomycin injection63.348
J9281Mitomycin instillation300.747
J9286Inj glofitamab gxbm, 2.5 mg2707.928
J9293Mitoxantrone hydrochl / 5 mg43.578
J9294Inj pemetrexed, hospira 10mg10.554
J9295Injection, necitumumab, 1 mg5.737
J9297Inj pemetrexed (sandoz) 10mg1.296
J9298Inj nivol relatlimab 3mg/1mg187.153
J9299Injection, nivolumab31.089
J9301Obinutuzumab inj70.342
J9303Panitumumab injection150.659
J9304Inj. pemetrexed, 10 mg62.318
J9305Inj. pemetrexed nos 10mg4.371
J9306Injection, pertuzumab, 1 mg15.427
J9307Pralatrexate injection289.141
J9308Injection, ramucirumab70.244
J9309Inj, polatuzumab vedotin 1mg124.289
J9311Inj rituximab, hyaluronidase37.405
J9312Inj., rituximab, 10 mg79.198
J9313Inj., lumoxiti, 0.01 mg23.394
J9316Pertuzu, trastuzu, 10 mg67.051
J9317Sacituzumab govitecan-hziy34.077
J9319Inj romidepsin lyophil 0.1mg31.961
J9321Inj epcoritamab-bysp 0.16 mg53.797
J9323Inj pemetrexed ditromethamin6.011
J9325Inj talimogene laherparepvec66.587
J9328Temozolomide injection10.403
J9330Temsirolimus injection30.993
J9331Inj sirolimus prot part 1 mg109.288
J9332Inj efgartigimod 2mg32.080
J9340Thiotepa injection251.205
J9345Inj, retifanlimab-dlwr, 1 mg29.834
J9347Inj, tremelimumab-actl, 1 mg136.093
J9348Inj. naxitamab-gqgk, 1 mg609.765
J9349Inj., tafasitamab-cxix13.596
J9350Inj mosunetuzumab-axgb, 1 mg629.635
J9351Topotecan injection0.781
J9352Injection trabectedin 0.1mg338.399
J9353Inj. margetuximab-cmkb, 5 mg47.051
J9354Inj, ado-trastuzumab emt 1mg38.368
J9355Inj trastuzumab excl biosimi80.465
J9356Inj. herceptin hylecta, 10mg66.022
J9357Valrubicin injection1363.848
J9358Inj fam-trastu deru-nxki 1mg27.240
J9359Inj lon tesirin-lpyl 0.075mg200.627
J9360Vinblastine sulfate inj4.216
J9370Vincristine sulfate 1 mg inj7.725
J9380Inj teclistamab cqyv 0.5 mg30.847
J9381Inj teplizumab mzwv 5 mcg36.255
J9390Vinorelbine tartrate inj7.416
J9394Inj, fulvestrant (fresenius)53.000
J9395Injection, fulvestrant8.445
J9400Inj, ziv-aflibercept, 1mg7.282
P9041Albumin (human),5%, 50ml10.615
P9045Albumin (human), 5%, 250 ml53.077
P9046Albumin (human), 25%, 20 ml21.231
P9047Albumin (human), 25%, 50ml53.077
Q0138Ferumoxytol, non-esrd0.357
Q0139Ferumoxytol, esrd use0.357
Q0162Ondansetron oral0.014
Q0167Dronabinol 2.5mg oral0.811
Q2041Axicabtagene ciloleucel car+449440.000
Q2042Tisagenlecleucel car-pos t511072.497
Q2043Sipuleucel-t auto cd54+53426.656
Q2050Doxorubicin inj 10mg85.484
Q2053Brexucabtagene car pos t449440.000
Q2054Lisocabtagene mara car pos t473853.516
Q2055Idecabtagene vicleucel car484690.300
Q2056Ciltacabtagene car-pos t507195.920
Q3027Inj beta interferon im 1 mcg53.691
Q4074Iloprost non-comp unit dose146.666
Q4081Epoetin alfa, 100 units esrd0.889
Q4101Apligraf30.401
Q4102Oasis wound matrix13.407
Q4103Oasis burn matrix12.989
Q4104Integra bmwd49.534
Q4105Integra drt or omnigraft25.344
Q4106Dermagraft44.944
Q4108Integra matrix44.360
Q4110Primatrix39.055
Q4111Gammagraft7.437
Q4114Integra flowable wound matri1507.000
Q4115Alloskin12.130
Q4117Hyalomatrix16.913
Q4118Matristem micromatrix2.548
Q4121Theraskin45.000
Q4123Alloskin37.602
Q4124Oasis tri-layer wound matrix9.284
Q4126Memoderm/derma/tranz/integup78.343
Q4127Talymed68.487
Q4128Flexhd/allopatchhd/sq cm30.732
Q4132Grafix core, grafixpl core158.237
Q4133Grafix stravix prime pl sqcm136.324
Q4137Amnioexcel biodexcel 1sq cm113.678
Q4141Alloskin ac, 1 cm39.449
Q4143Repriza, 1cm29.680
Q4147Architect ecm px fx 1 sq cm147.222
Q4150Allowrap ds or dry 1 sq cm77.655
Q4151Amnioband, guardian 1 sq cm132.875
Q4152Dermapure 1 square cm50.416
Q4153Dermavest, plurivest sq cm116.257
Q4154Biovance 1 square cm148.462
Q4159Affinity1 square cm359.662
Q4160Nushield 1 square cm97.987
Q4161Bio-connekt per square cm138.294
Q4163Woundex, bioskin, per sq cm168.638
Q4164Helicoll, per square cm1335.383
Q4166Cytal, per square centimeter18.554
Q4169Artacent wound, per sq cm176.057
Q4170Cygnus, per sq cm46.156
Q4171Interfyl, 1 mg11.743
Q4173Palingen or palingen xplus383.249
Q4175Miroderm63.677
Q4178Floweramniopatch, per sq cm86.515
Q4180Revita, per sq cm614.649
Q4186Epifix 1 sq cm151.600
Q4187Epicord 1 sq cm245.773
Q4190Artacent ac 1 sq cm442.118
Q4191Restorigin 1 sq cm1537.000
Q4196Puraply am 1 sq cm103.771
Q4197Puraply xt 1 sq cm122.982
Q4199Cygnus matrix, per sq cm317.835
Q4201Matrion 1 sq cm104.216
Q4203Derma-gide, 1 sq cm206.735
Q4205Membrane graft or wrap sq cm1463.274
Q4210Axolotl graf dualgraf sq cm848.000
Q4217Woundfix biowound plus xplus781.154
Q4221Amniowrap2 per sq cm1696.000
Q4222Progenamatrix, per sq cm91.082
Q4226Myown harv prep proc sq cm386.492
Q4227Amniocore per sq cm96.187
Q4229Cogenex amnio memb per sq cm106.016
Q4231Corplex p, per cc1487.180
Q4232Corplex, per sq cm69.615
Q4234Xcellerate, per sq cm628.886
Q4235Amniorepair or altiply sq cm147.064
Q4236Carepatch per sq cm868.138
Q4238Derm-maxx, per sq cm1590.000
Q4239Amnio-maxx or lite per sq cm68.678
Q4246Coretext or protext, per cc2968.000
Q4247Amniotext patch, per sq cm530.000
Q4248Dermacyte amn mem allo sq cm1079.089
Q4252Vendaje, per square centimet295.979
Q4253Zenith amniotic membrane psc470.747
Q4258Enverse, per sq cm73.648
Q4262Dual layer impax, per sq cm1170.957
Q4263Surgraft tl, per sq cm1054.305
Q4267Neostim dl per sq cm874.500
Q4278Epieffect, per sq cm527.995
Q4282Cygnus dual per sq cm903.276
Q5101Injection, zarxio0.319
Q5103Injection, inflectra14.294
Q5104Injection, renflexis31.499
Q5105Inj retacrit esrd on dialysi0.782
Q5106Inj retacrit non-esrd use7.824
Q5107Inj mvasi 10 mg25.620
Q5108Injection, fulphila122.540
Q5110Nivestym0.291
Q5111Injection, udenyca 0.5 mg122.103
Q5112Inj ontruzant 10 mg38.936
Q5113Inj herzuma 10 mg40.307
Q5114Inj ogivri 10 mg44.428
Q5115Inj truxima 10 mg35.892
Q5116Inj., trazimera, 10 mg16.367
Q5117Inj., kanjinti, 10 mg13.450
Q5118Inj., zirabev, 10 mg21.511
Q5119Inj ruxience, 10 mg20.447
Q5121Inj. avsola, 10 mg25.555
Q5122Inj, nyvepria62.377
Q5123Inj. riabni, 10 mg41.419
Q5124Inj. byooviz, 0.1 mg187.511
Q5125Inj, releuko 1 mcg0.539
Q5126Inj alymsys 10 mg60.584
Q5127Inj, stimufend, 0.5 mg328.640
Q5128Inj, cimerli, 0.1 mg262.079
Q5129Inj, vegzelma, 10 mg72.412
Q5130Inj, fylnetra, 0.5 mg201.974
Q9950Inj sulf hexa lipid microsph18.907
Q9956Inj octafluoropropane mic,ml42.159
Q9957Inj perflutren lip micros,ml42.159
Q9958Hocm <=149 mg/ml iodine, 1ml0.084
Q9961Hocm 250-299mg/ml iodine,1ml0.276
Q9963Hocm 350-399mg/ml iodine,1ml0.210
Q9965Locm 100-199mg/ml iodine,1ml1.366
Q9966Locm 200-299mg/ml iodine,1ml0.373
Q9967Locm 300-399mg/ml iodine,1ml0.118
Q9991Buprenorph xr 100 mg or less1887.113
Q9992Buprenorphine xr over 100 mg1887.113