October 2023 ASP Changes: Quarter 4 ASP

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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/medicare-part-b-drug-average-sales-price/2023-asp-drug-pricing-files 

Below, you will find a graph displaying Medicare Payment Limits for October, 1st 2023. You can filter and search the graph for a HCPCS code or drug of choice.

 

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HCPCS CodeShort DescriptionPayment Limit
90371Hep b ig im137.581
90375Rabies ig im/sc277.744
90376Rabies ig heat treated170.900
90377Rabies ig ht&sol human im/sc250.491
90586Bcg vaccine intravesical145.833
90632Hepa vaccine adult im70.078
90662Iiv no prsv increased ag im73.403
90670Pcv13 vaccine im257.989
90671PCV15 vaccine IM246.195
90672Laiv4 vaccine intranasal27.788
90674Cciiv4 vac no prsv 0.5 ml im34.172
90675Rabies vaccine im328.549
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+ im28.645
90715Tdap vaccine 7 yrs/> im38.671
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, im73.847
90744Hepb vacc 3 dose ped/adol im29.895
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
A9575Inj gadoterate meglumi 0.1ml0.123
A9576Inj prohance multipack1.403
A9577Inj multihance1.819
A9578Inj multihance multipack1.821
A9579Gad-base mr contrast nos,1ml1.531
A9581Gadoxetate disodium inj14.750
A9585Gadobutrol injection0.324
A9589Insti hexaminolevulinate hcl1265.417
A9606Radium ra223 dichloride therN/A
J0121Inj., omadacycline, 1 mg3.604
J0122Inj., eravacycline, 1 mg1.126
J0129Abatacept injection42.700
J0131Inj, acetaminophen (nos)0.072
J0132Acetylcysteine injection0.653
J0133Acyclovir injection0.051
J0134Inj acetaminophen -fresenius0.051
J0136Inj, acetaminophen (b braun)0.054
J0137Inj, acetaminophen (hikma)0.067
J0153Adenosine inj 1mg0.536
J0171Adrenalin epinephrine inject0.780
J0172Inj, aducanumab-avwa, 2 mg5.978
J0173Inj, epinephrine (belcher)1.706
J0174Inj, lecanemab-irmb, 1 mg1.274
J0178Aflibercept injection868.241
J0179Inj, brolucizumab-dbll, 1 mg319.249
J0180Agalsidase beta injection217.597
J0185Inj., aprepitant, 1 mg1.738
J0202Injection, alemtuzumab2292.770
J0206Inj allopurinol sodium 1 mg5.634
J0218Inj olipudase alfa-rpcp 1mg377.113
J0219Inj aval alfa-nqpt 4mg75.632
J0221Lumizyme injection197.073
J0222Inj., patisiran, 0.1 mg100.171
J0223Inj givosiran 0.5 mg112.096
J0224Inj. lumasiran, 0.5 mg319.496
J0225Inj, vutrisiran, 1 mg4950.374
J0248Inj, remdesivir, 1 mg6.058
J0256Alpha 1 proteinase inhibitor4.806
J0257Glassia injection5.417
J0278Amikacin sulfate injection0.935
J0280Aminophyllin 250 mg inj10.593
J0285Amphotericin b24.620
J0289Amphotericin b liposome inj27.923
J0290Ampicillin 500 mg inj0.945
J0291Inj., plazomicin, 5 mg3.578
J0295Ampicillin sulbactam 1.5 gm2.048
J0348Anidulafungin injection0.545
J0360Hydralazine hcl injection5.758
J0401Inj aripiprazole ext rel 1mg6.815
J0456Azithromycin1.787
J0457Injection, aztreonam, 100 mg2.519
J0461Atropine sulfate injection0.088
J0475Baclofen 10 mg injection182.263
J0476Baclofen intrathecal trial46.921
J0480Basiliximab4393.541
J0485Belatacept injection3.786
J0490Belimumab injection51.970
J0491Inj anifrolumab-fnia 1mg16.595
J0500Dicyclomine injection21.800
J0515Inj benztropine mesylate22.277
J0517Inj., benralizumab, 1 mg170.559
J0558Peng benzathine/procaine inj15.742
J0561Penicillin g benzathine inj20.157
J0565Inj, bezlotoxumab, 10 mg39.844
J0583Bivalirudin0.186
J0584Injection, burosumab-twza 1m433.522
J0585Injection,onabotulinumtoxina6.325
J0586Abobotulinumtoxina8.219
J0587Inj, rimabotulinumtoxinb13.042
J0588Incobotulinumtoxin a5.189
J0592Buprenorphine hydrochloride4.180
J0594Busulfan injection1.044
J0595Butorphanol tartrate 1 mg2.543
J0596Injection, ruconest33.700
J0597C-1 esterase, berinert64.406
J0598C-1 esterase, cinryze60.725
J0612Calcium glucon (fresenius)0.051
J0613Calcium glucon (wg critical)0.085
J0630Calcitonin salmon injection1296.363
J0637Caspofungin acetate5.500
J0638Canakinumab injection122.055
J0640Leucovorin calcium injection4.461
J0642Injection, khapzory, 0.5 mg1.057
J0665Inj, bupivacaine, nos, 0.5mg0.016
J0670Inj mepivacaine hcl/10 ml2.453
J0689Inj cefazolin sodium, baxter1.208
J0690Cefazolin sodium injection0.727
J0692Cefepime hcl for injection1.270
J0694Cefoxitin sodium injection5.172
J0695Inj ceftolozane tazobactam7.481
J0696Ceftriaxone sodium injection0.472
J0697Sterile cefuroxime injection1.868
J0699Inj, cefiderocol, 10 mg2.173
J0701Inj. cefepime hcl (baxter)5.688
J0702Betamethasone acet&sod phosp6.406
J0703Inj, cefepime hcl (b braun)5.092
J0712Ceftaroline fosamil inj3.856
J0713Inj ceftazidime per 500 mg1.779
J0714Ceftazidime and avibactam95.437
J0717Certolizumab pegol inj 1mg4.900
J0725Chorionic gonadotropin/1000u21.778
J0735Clonidine hydrochloride19.585
J0736Inj, clindamycin phosp 300mg2.015
J0737Inj, clindamycin (baxter)2.594
J0740Cidofovir injection550.376
J0741Inj, cabote rilpivir 2mg 3mg22.286
J0742Inj imip 4 cilas 4 releb 2mg2.460
J0743Cilastatin sodium injection7.925
J0744Ciprofloxacin iv1.831
J0770Colistimethate sodium inj13.878
J0775Collagenase, clost hist inj67.747
J0780Prochlorperazine injection2.848
J0791Inj crizanlizumab-tmca 5mg126.857
J0801Corticotropin injection4090.086
J0834Inj., cosyntropin, 0.25 mg32.681
J0840Crotalidae poly immune fab2076.463
J0841Inj crotalidae im f(ab')2 eq1113.511
J0850Cytomegalovirus imm iv /vial1667.586
J0875Injection, dalbavancin15.214
J0877Inj, daptomycin (hospira)0.064
J0878Daptomycin injection0.040
J0881Darbepoetin alfa, non-esrd2.945
J0882Darbepoetin alfa, esrd use2.945
J0885Epoetin alfa, non-esrd7.092
J0887Epoetin beta esrd use1.709
J0888Epoetin beta non esrd1.710
J0891Argatroban nonesrd (accord)0.371
J0892Argatroban dialysis (accord)0.371
J0893Inj, decitabine (sun pharma)2.120
J0894Decitabine injection1.147
J0895Deferoxamine mesylate inj8.591
J0896Inj luspatercept-aamt 0.25mg39.205
J0897Denosumab injection24.217
J1000Depo-estradiol cypionate inj32.669
J1020Methylprednisolone 20 mg inj7.099
J1030Methylprednisolone 40 mg inj7.202
J1040Methylprednisolone 80 mg inj10.757
J1071Inj testosterone cypionate0.029
J1100Dexamethasone sodium phos0.126
J1110Inj dihydroergotamine mesylt46.517
J1120Acetazolamid sodium injectio26.316
J1160Digoxin injection11.357
J1162Digoxin immune fab (ovine)4593.574
J1165Phenytoin sodium injection0.461
J1170Hydromorphone injection4.023
J1190Dexrazoxane hcl injection123.879
J1200Diphenhydramine hcl injectio0.846
J1201Inj. cetirizine hcl 0.5mg15.178
J1205Chlorothiazide sodium inj76.733
J1212Dimethyl sulfoxide 50% 50 ml681.744
J1230Methadone injection17.516
J1240Dimenhydrinate injection8.988
J1245Dipyridamole injection3.688
J1250Inj dobutamine hcl/250 mg9.822
J1265Dopamine injection0.630
J1270Injection, doxercalciferol0.424
J1290Ecallantide injection532.245
J1300Eculizumab injection225.263
J1301Injection, edaravone, 1 mg21.385
J1302Inj, sutimlimab-jome, 10 mg17.743
J1303Inj., ravulizumab-cwvz 10 mg221.669
J1305Inj, evinacumab-dgnb, 5mg179.140
J1306Injection, inclisiran, 1 mg12.021
J1322Elosulfase alfa, injection280.922
J1325Epoprostenol injection16.023
J1335Ertapenem injection13.192
J1364Erythro lactobionate /500 mg83.636
J1380Estradiol valerate 10 mg inj10.622
J1410Inj estrogen conjugate 25 mg372.476
J1430Ethanolamine oleate 100 mg469.257
J1437Inj. fe derisomaltose 10 mg20.059
J1439Inj ferric carboxymaltos 1mg1.123
J1440Fecal microbiota jslm 1 ml62.423
J1442Inj filgrastim excl biosimil0.986
J1447Inj tbo filgrastim 1 microg0.416
J1448Injection, trilaciclib, 1mg5.200
J1449Inj eflapegrastim-xnst 0.1mg31.344
J1450Fluconazole2.306
J1453Fosaprepitant injection0.120
J1454Inj fosnetupitant, palonoset528.379
J1456Inj, fosaprepitant (teva)0.174
J1458Galsulfase injection463.043
J1459Inj ivig privigen 500 mg47.589
J1460Gamma globulin 1 cc inj48.766
J1551Inj cutaquig 100 mg14.042
J1554Inj. asceniv491.405
J1555Inj cuvitru, 100 mg15.725
J1556Inj, imm glob bivigam, 500mg72.962
J1557Gammaplex injection57.010
J1558Inj. xembify, 100 mg13.971
J1559Hizentra injection12.728
J1560Gamma globulin > 10 cc inj487.656
J1561Gamunex-c/gammaked49.262
J1566Immune globulin, powder76.567
J1568Octagam injection44.786
J1569Gammagard liquid injection44.460
J1570Ganciclovir sodium injection29.992
J1571Hepagam b im injection62.164
J1575Hyqvia 100mg immuneglobulin16.888
J1576Inj, panzyga, 500 mg65.704
J1580Garamycin gentamicin inj2.922
J1602Golimumab for iv use 1mg12.931
J1610Glucagon hydrochloride/1 mg187.503
J1611Inj glucagon hcl, fresenius110.762
J1626Granisetron hcl injection0.385
J1627Inj, granisetron, xr, 0.1 mg5.780
J1630Haloperidol injection1.241
J1631Haloperidol decanoate inj8.038
J1640Hemin, 1 mg31.395
J1642Inj heparin sodium per 10 u0.016
J1643Inj heparin, pfizer, 1000u5.183
J1644Inj heparin sodium per 1000u0.284
J1645Dalteparin sodium15.214
J1650Inj enoxaparin sodium0.655
J1652Fondaparinux sodium1.019
J1670Tetanus immune globulin inj584.386
J1720Hydrocortisone sodium succ i17.672
J1740Ibandronate sodium injection24.903
J1743Idursulfase injection542.917
J1745Infliximab not biosimil 10mg32.637
J1746Inj., ibalizumab-uiyk, 10 mg74.455
J1747Inj, spesolimab-sbzo, 1 mg60.223
J1750Inj iron dextran17.407
J1756Iron sucrose injection0.205
J1786Imuglucerase injection44.141
J1805Inj, esmolol hcl, 10mg0.245
J1806Inj esmolol hcl wg crit care0.469
J1811Fiasp for insulin pump use6.673
J1813Lyumjev for insulin pump use15.675
J1817Insulin for insulin pump use8.302
J1823Inj. inebilizumab-cdon, 1 mg473.513
J1836Inj, metronidazole, 10 mg0.024
J1885Ketorolac tromethamine inj0.605
J1920Inj, labetalol hcl, 5mg0.183
J1921Inj labetalol hcl hikma, 5mg2.721
J1930Lanreotide injection51.156
J1931Laronidase injection37.438
J1932Inj, lanreotide, (cipla) 1mg49.971
J1940Furosemide injection0.582
J1943Inj., aristada initio, 1 mg3.053
J1944Aripiprazole lauroxil 1 mg3.105
J1950Leuprolide acetate /3.75 mg1524.336
J1951Inj fensolvi 0.25 mg133.639
J1952Leuprolide inj, camcevi, 1mg74.349
J1953Levetiracetam injection0.065
J1954Leuprolide depot cipla 7.5mg362.053
J1955Inj levocarnitine per 1 gm35.438
J1956Levofloxacin injection0.928
J1961Inj, lenacapavir, 1 mg21.793
J1980Hyoscyamine sulfate inj35.464
J2001Lidocaine injection0.026
J2010Lincomycin injection11.041
J2020Linezolid injection3.648
J2021Inj, linezolid (hospira)13.736
J2060Lorazepam injection1.010
J2150Mannitol injection5.260
J2175Meperidine hydrochl /100 mg6.746
J2182Injection, mepolizumab, 1mg30.166
J2184Inj, meropenem (b. braun)2.100
J2185Meropenem0.562
J2210Methylergonovin maleate inj21.086
J2247Inj, micafungin (par pharm)0.395
J2248Micafungin sodium injection0.749
J2250Inj midazolam hydrochloride0.166
J2251Inj midazolam (wg crit care)0.292
J2260Inj milrinone lactate / 5 mg1.770
J2270Morphine sulfate injection4.316
J2272Inj, morphine (fresenius)7.071
J2274Inj morphine pf epid ithc11.190
J2278Ziconotide injection9.036
J2280Inj, moxifloxacin 100 mg9.759
J2281Inj moxifloxacin (fres kabi)5.315
J2300Inj nalbuphine hydrochloride2.873
J2305Inj, nitroglycerin, 5 mg1.294
J2310Inj naloxone hydrochloride9.541
J2311Inj, naloxone hcl (zimhi)4.311
J2315Naltrexone, depot form3.961
J2323Natalizumab injection24.600
J2327Inj risankizumab-rzaa 1 mg15.332
J2329Inj ublituximab-xiiy, 1 mg67.078
J2350Injection, ocrelizumab, 1 mg60.545
J2353Octreotide injection, depot207.156
J2354Octreotide inj, non-depot1.116
J2356Inj tezepelumab-ekko, 1mg18.580
J2357Omalizumab injection39.090
J2358Olanzapine long-acting inj2.917
J2359Inj. olanzapine, 0.5mg0.886
J2360Orphenadrine injection4.672
J2372Inj, biorphen, 20 micrograms0.181
J2401Chloroprocaine hcl injection0.038
J2405Ondansetron hcl injection0.090
J2406Injection, oritavancin 10 mg40.694
J2407Injection, oritavancin27.537
J2426Inj, invega sustenna, 1 mgj14.340
J2427Inj, invega hafyera/trinza12.199
J2430Pamidronate disodium /30 mg10.332
J2469Palonosetron hcl0.884
J2501Paricalcitol0.898
J2506Inj pegfilgrast ex bio 0.5mg74.948
J2507Pegloticase injection3307.045
J2540Penicillin g potassium inj0.817
J2543Piperacillin/tazobactam0.886
J2545Pentamidine non-comp unit92.416
J2550Promethazine hcl injection3.479
J2560Phenobarbital sodium inj36.252
J2562Plerixafor injection429.053
J2597Inj desmopressin acetate6.145
J2598Inj, vasopressin, 1 unit2.555
J2599Inj vasopressin (am reg) 1 u0.561
J2675Inj progesterone per 50 mg0.888
J2680Fluphenazine decanoate 25 mg9.873
J2690Procainamide hcl injection340.441
J2700Oxacillin sodium injeciton0.974
J2704Inj, propofol, 10 mg0.096
J2720Inj protamine sulfate/10 mg0.793
J2724Protein c concentrate15.135
J2760Phentolaine mesylate inj453.659
J2765Metoclopramide hcl injection1.108
J2777Inj, faricimab-svoa, 0.1mg36.573
J2778Ranibizumab injection197.372
J2779Inj, susvimo 0.1 mg81.432
J2781Inj, pegcetacoplan, 1mg153.521
J2783Rasburicase358.429
J2785Regadenoson injection34.762
J2786Injection, reslizumab, 1mg10.301
J2788Rho d immune globulin 50 mcg25.510
J2790Rho d immune globulin inj77.296
J2791Rhophylac injection4.854
J2792Rho(d) immune globulin h, sd33.457
J2794Inj risperdal consta, 0.5 mg12.148
J2795Ropivacaine hcl injection0.068
J2796Romiplostim injection95.752
J2798Inj., perseris, 0.5 mg11.641
J2800Methocarbamol injection6.066
J2805Sincalide injection129.036
J2820Sargramostim injection58.261
J2860Injection, siltuximab148.963
J2916Na ferric gluconate complex2.095
J2920Methylprednisolone injection3.433
J2930Methylprednisolone injection4.985
J2997Alteplase recombinant89.161
J3000Streptomycin injection33.368
J3010Fentanyl citrate injection0.850
J3032Inj. eptinezumab-jjmr 1 mg17.434
J3060Inj, taliglucerase alfa 10 u45.175
J3090Inj tedizolid phosphate1.740
J3095Telavancin injection7.153
J3101Tenecteplase injection153.096
J3105Terbutaline sulfate inj14.304
J3111Inj. romosozumab-aqqg 1 mg10.347
J3121Inj testostero enanthate 1mg0.046
J3145Testosterone undecanoate 1mg1.735
J3230Chlorpromazine hcl injection31.784
J3240Thyrotropin injection2011.265
J3241Inj. teprotumumab-trbw 10 mg327.998
J3243Tigecycline injection0.617
J3245Inj., tildrakizumab, 1 mg142.222
J3246Tirofiban hcl4.405
J3250Trimethobenzamide hcl inj44.945
J3260Tobramycin sulfate injection2.651
J3262Tocilizumab injection6.188
J3285Treprostinil injection56.005
J3299Inj xipere 1 mg48.583
J3301Triamcinolone acet inj nos1.156
J3304Inj triamcinolone ace xr 1mg17.125
J3315Triptorelin pamoate401.745
J3357Ustekinumab sub cu inj, 1 mg151.458
J3358Ustekinumab, iv inject, 1 mg12.619
J3360Diazepam injection7.479
J3370Vancomycin hcl injection2.086
J3371Inj, vancomycin hcl (mylan)6.245
J3372Inj, vancomycin hcl (xellia)6.491
J3380Injection, vedolizumab22.296
J3385Velaglucerase alfa366.395
J3396Verteporfin injection11.237
J3410Hydroxyzine hcl injection13.150
J3411Thiamine hcl 100 mg2.591
J3415Pyridoxine hcl 100 mg13.929
J3420Vitamin b12 injection1.325
J3430Vitamin k phytonadione inj2.982
J3465Injection, voriconazole0.680
J3471Ovine, up to 999 usp units0.501
J3473Hyaluronidase recombinant0.359
J3475Inj magnesium sulfate0.761
J3480Inj potassium chloride0.112
J3485Zidovudine1.511
J3486Ziprasidone mesylate9.945
J3489Zoledronic acid 1mg6.934
J7030Normal saline solution infus2.578
J7040Normal saline solution infus1.289
J70425% dextrose/normal saline1.171
J7050Normal saline solution infus0.645
J70605% dextrose/water1.629
J7070D5w infusion3.259
J7120Ringers lactate infusion2.448
J7170Inj., emicizumab-kxwh 0.5 mg51.222
J7175Inj, factor x, (human), 1iu9.112
J7177Inj., fibryga, 1 mg1.098
J7178Inj human fibrinogen con nos1.381
J7179Vonvendi inj 1 iu vwf:rco1.832
J7180Factor xiii anti-hem factor9.673
J7181Factor xiii recomb a-subunit17.101
J7182Factor viii recomb novoeight1.309
J7183Wilate injection1.298
J7185Xyntha inj1.308
J7186Antihemophilic viii/vwf comp1.218
J7187Humate-p, inj1.346
J7188Factor viii recomb obizur3.221
J7189Factor viia recomb novoseven2.407
J7190Factor viii1.188
J7192Factor viii recombinant nos1.503
J7193Factor ix non-recombinant1.320
J7194Factor ix complex1.612
J7195Factor ix recombinant nos1.744
J7197Antithrombin iii injection3.714
J7198Anti-inhibitor2.298
J7200Factor ix recombinan rixubis1.603
J7201Factor ix alprolix recomb3.466
J7202Factor ix idelvion inj4.931
J7203Factor ix recomb gly rebinyn4.404
J7204Inj recombin esperoct per iu2.055
J7205Factor viii fc fusion recomb2.180
J7207Factor viii pegylated recomb2.030
J7208Inj. jivi 1 iu2.346
J7209Factor viii nuwiq recomb 1iu1.298
J7210Inj, afstyla, 1 i.u.1.448
J7211Inj, kovaltry, 1 i.u.1.425
J7212Factor viia recomb sevenfact2.022
J7213Inj, ixinity, 1 i.u.1.764
J7214Altuviiio per factor viii iu4.733
J7308Aminolevulinic acid hcl top390.561
J7311Inj., retisert, 0.01 mg341.400
J7312Dexamethasone intra implant205.685
J7313Inj., iluvien, 0.01 mg490.947
J7314Inj., yutiq, 0.01 mg529.062
J7318Inj, durolane 1 mg6.271
J7320Genvisc 850, inj, 1mg5.775
J7321Hyalgan supartz visco-3 dose75.766
J7322Hymovis injection 1 mg17.295
J7323Euflexxa inj per dose123.142
J7324Orthovisc inj per dose136.255
J7325Synvisc or synvisc-one8.770
J7326Gel-one515.302
J7327Monovisc inj per dose728.291
J7328Gelsyn-3 injection 0.1 mg0.541
J7329Inj, trivisc 1 mg8.564
J7331Synojoynt, inj., 1 mg11.827
J7332Inj., triluron, 1 mg10.338
J7336Capsaicin 8% patch3.272
J7340Carbidopa levodopa ent 100ml226.800
J7345Aminolevulinic acid, 10% gel1.660
J7351Inj bimatoprost itc imp1mcg206.225
J7402Mometasone sinus sinuva11.345
J7500Azathioprine oral 50mg11.752
J7502Cyclosporine oral 100 mg2.207
J7503Tacrol envarsus ex rel oral1.675
J7504Lymphocyte immune globulin3254.873
J7507Tacrolimus imme rel oral 1mg0.300
J7508Tacrol astagraf ex rel oral0.553
J7509Methylprednisolone oral0.241
J7510Prednisolone oral per 5 mg0.241
J7511Antithymocyte globuln rabbit921.169
J7512Prednisone ir or dr oral 1mg0.008
J7515Cyclosporine oral 25 mg0.685
J7517Mycophenolate mofetil oral0.198
J7518Mycophenolic acid0.873
J7520Sirolimus, oral3.155
J7525Tacrolimus injection248.745
J7527Oral everolimus2.866
J7605Arformoterol non-comp unit2.648
J7606Formoterol fumarate, inh4.879
J7608Acetylcysteine non-comp unit9.874
J7611Albuterol non-comp con0.124
J7612Levalbuterol non-comp con0.225
J7613Albuterol non-comp unit0.042
J7614Levalbuterol non-comp unit0.050
J7620Albuterol ipratrop non-comp0.153
J7626Budesonide non-comp unit1.148
J7631Cromolyn sodium noncomp unit1.311
J7639Dornase alfa non-comp unit52.254
J7644Ipratropium bromide non-comp0.318
J7674Methacholine chloride, neb0.863
J7677Revefenacin inh non-com 1mcg0.189
J7682Tobramycin non-comp unit24.076
J7686Treprostinil, non-comp unit733.638
J8501Oral aprepitant3.458
J8520Capecitabine, oral, 150 mg0.291
J8521Capecitabine, oral, 500 mg1.169
J8530Cyclophosphamide oral 25 mg1.006
J8540Oral dexamethasone0.078
J8560Etoposide oral 50 mg76.534
J8610Methotrexate oral 2.5 mg0.255
J8655Oral netupitant, palonosetro407.833
J8670Rolapitant, oral, 1mg1.731
J8700Temozolomide0.187
J8705Topotecan oral113.779
J9000Doxorubicin hcl injection2.684
J9017Arsenic trioxide injection18.499
J9021Inj, aspara, rylaze, 0.1 mg49.714
J9022Inj, atezolizumab,10 mg82.622
J9023Injection, avelumab, 10 mg90.894
J9025Azacitidine injection0.414
J9027Clofarabine injection23.290
J9030Bcg live intravesical 1mg2.917
J9032Injection, belinostat, 10mg48.393
J9033Inj., treanda 1 mg11.415
J9034Inj., bendeka 1 mg15.861
J9035Bevacizumab injection73.810
J9036Inj. belrapzo/bendamustine15.033
J9039Injection, blinatumomab145.313
J9040Bleomycin sulfate injection24.581
J9041Injection, bortezomib, 0.1mg2.289
J9042Brentuximab vedotin inj222.114
J9043Cabazitaxel injection209.340
J9045Carboplatin injection2.758
J9047Injection, carfilzomib, 1 mg46.897
J9049Inj, bortezomib, hospira3.091
J9050Carmustine injection409.703
J9055Cetuximab injection72.276
J9056Inj, bendamustine, 1 mg33.183
J9058Inj apotex/bendamustine 1 mg33.058
J9059Inj bendamustine, baxter 1mg23.130
J9060Cisplatin 10 mg injection2.188
J9061Inj, amivantamab-vmjw19.988
J9063Inj, elahere, 1 mg65.754
J9065Inj cladribine per 1 mg16.757
J9070Cyclophosphamide 100 mg inj17.942
J9071Inj cyclophosphamd auromedic3.869
J9100Cytarabine hcl 100 mg inj0.941
J9118Inj. calaspargase pegol-mknl72.883
J9119Inj., cemiplimab-rwlc, 1 mg26.921
J9120Dactinomycin injection838.464
J9130Dacarbazine 100 mg inj3.761
J9144Daratumumab, hyaluronidase49.310
J9145Injection, daratumumab 10 mg62.134
J9150Daunorubicin injection31.636
J9153Inj daunorubicin, cytarabine227.936
J9155Degarelix injection4.127
J9171Docetaxel injection0.804
J9173Inj., durvalumab, 10 mg79.741
J9176Injection, elotuzumab, 1mg7.218
J9177Inj enfort vedo-ejfv 0.25mg35.057
J9178Inj, epirubicin hcl, 2 mg1.446
J9179Eribulin mesylate injection130.874
J9181Etoposide injection0.766
J9185Fludarabine phosphate inj500.459
J9190Fluorouracil injection2.838
J9196Inj gemcitabine hcl (accord)3.689
J9198Inj. infugem, 100 mg40.280
J9200Floxuridine injection3551.000
J9201In gemcitabine hcl nos 200mg3.932
J9202Goserelin acetate implant611.346
J9203Gemtuzumab ozogamicin 0.1 mg221.843
J9204Inj mogamulizumab-kpkc, 1 mg227.344
J9205Inj irinotecan liposome 1 mg62.485
J9206Irinotecan injection2.064
J9207Ixabepilone injection127.574
J9208Ifosfamide injection25.891
J9209Mesna injection1.524
J9210Inj., emapalumab-lzsg, 1 mg390.158
J9211Idarubicin hcl injection36.346
J9217Leuprolide acetate suspnsion166.685
J9218Leuprolide acetate injeciton7.875
J9223Inj. lurbinectedin, 0.1 mg196.820
J9226Supprelin la implant44695.101
J9227Inj. isatuximab-irfc 10 mg74.641
J9228Ipilimumab injection168.560
J9229Inj inotuzumab ozogam 0.1 mg2529.553
J9245Inj melpha hydroch nos 50 mg176.252
J9246Inj., evomela, 1 mg16.083
J9250Methotrexate sodium inj0.233
J9259 Paclitaxel (american regent)16.226
J9260Methotrexate sodium inj2.325
J9261Nelarabine injection116.647
J9262Inj, omacetaxine mep, 0.01mg3.962
J9263Oxaliplatin0.069
J9264Paclitaxel protein bound14.785
J9266Pegaspargase injection25781.458
J9267Paclitaxel injection0.118
J9268Pentostatin injection2336.979
J9269Inj. tagraxofusp-erzs 10 mcg324.482
J9271Inj pembrolizumab56.412
J9272Inj, dostarlimab-gxly, 10 mg230.819
J9273Inj tisotu vedotin-tftv, 1mg168.262
J9274Inj, tebentafusp-tebn, 1 mcg203.827
J9280Mitomycin injection95.610
J9281Mitomycin instillation294.366
J9293Mitoxantrone hydrochl / 5 mg41.393
J9294Inj pemetrexed, hospira 10mg4.978
J9295Injection, necitumumab, 1 mg5.737
J9297Inj pemetrexed (sandoz) 10mg2.285
J9298Inj nivol relatlimab 3mg/1mg183.617
J9299Injection, nivolumab30.426
J9301Obinutuzumab inj70.286
J9303Panitumumab injection149.717
J9304Inj. pemetrexed, 10 mg66.230
J9305Inj. pemetrexed nos 10mg3.223
J9306Injection, pertuzumab, 1 mg15.423
J9307Pralatrexate injection298.179
J9308Injection, ramucirumab69.003
J9309Inj, polatuzumab vedotin 1mg121.234
J9311Inj rituximab, hyaluronidase37.133
J9312Inj., rituximab, 10 mg80.192
J9313Inj., lumoxiti, 0.01 mg23.394
J9316Pertuzu, trastuzu, 10 mg67.906
J9317Sacituzumab govitecan-hziy33.260
J9319Inj romidepsin lyophil 0.1mg30.659
J9325Inj talimogene laherparepvec66.295
J9328Temozolomide injection10.400
J9330Temsirolimus injection29.679
J9331Inj sirolimus prot part 1 mg107.658
J9332Inj efgartigimod 2mg32.108
J9340Thiotepa injection260.251
J9347Inj, tremelimumab-actl, 1 mg136.306
J9348Inj. naxitamab-gqgk, 1 mg579.537
J9349Inj., tafasitamab-cxix13.288
J9350Inj mosunetuzumab-axgb, 1 mg629.703
J9351Topotecan injection1.085
J9352Injection trabectedin 0.1mg338.410
J9353Inj. margetuximab-cmkb, 5 mg45.930
J9354Inj, ado-trastuzumab emt 1mg38.339
J9355Inj trastuzumab excl biosimi80.785
J9356Inj. herceptin hylecta, 10mg66.000
J9357Valrubicin injection1426.652
J9358Inj fam-trastu deru-nxki 1mg26.384
J9359Inj lon tesirin-lpyl 0.075mg195.936
J9360Vinblastine sulfate inj4.071
J9370Vincristine sulfate 1 mg inj7.939
J9380Inj teclistamab cqyv 0.5 mg30.899
J9381Inj teplizumab mzwv 5 mcg36.230
J9390Vinorelbine tartrate inj8.106
J9394Inj, fulvestrant (fresenius)53.000
J9395Injection, fulvestrant8.357
J9400Inj, ziv-aflibercept, 1mg7.806
P9041Albumin (human),5%, 50ml10.615
P9045Albumin (human), 5%, 250 ml53.077
P9046Albumin (human), 25%, 20 ml21.231
P9047Albumin (human), 25%, 50ml53.077
Q0138Ferumoxytol, non-esrd0.503
Q0139Ferumoxytol, esrd use0.503
Q0162Ondansetron oral0.016
Q0167Dronabinol 2.5mg oral0.624
Q2041Axicabtagene ciloleucel car+449341.851
Q2042Tisagenlecleucel car-pos t484623.489
Q2043Sipuleucel-t auto cd54+53472.873
Q2050Doxorubicin inj 10mg144.845
Q2053Brexucabtagene car pos t449440.000
Q2054Lisocabtagene mara car pos t473458.426
Q2055Idecabtagene vicleucel car483453.660
Q2056Ciltacabtagene car-pos t497024.646
Q3027Inj beta interferon im 1 mcg53.875
Q4074Iloprost non-comp unit dose146.709
Q4081Epoetin alfa, 100 units esrd0.709
Q4101Apligraf30.300
Q4102Oasis wound matrix12.500
Q4103Oasis burn matrix12.622
Q4104Integra bmwd49.347
Q4105Integra drt or omnigraft23.489
Q4106Dermagraft27.816
Q4108Integra matrix44.627
Q4110Primatrix41.359
Q4111Gammagraft7.332
Q4114Integra flowable wound matri1537.550
Q4115Alloskin12.824
Q4117Hyalomatrix20.454
Q4118Matristem micromatrix2.515
Q4121Theraskin45.596
Q4123Alloskin32.993
Q4124Oasis tri-layer wound matrix8.902
Q4126Memoderm/derma/tranz/integup92.456
Q4127Talymed66.707
Q4128Flexhd/allopatchhd/sq cm30.699
Q4132Grafix core, grafixpl core207.724
Q4133Grafix stravix prime pl sqcm147.660
Q4137Amnioexcel biodexcel 1sq cm102.900
Q4141Alloskin ac, 1 cm74.214
Q4143Repriza, 1cm29.680
Q4150Allowrap ds or dry 1 sq cm79.908
Q4151Amnioband, guardian 1 sq cm135.290
Q4152Dermapure 1 square cm52.118
Q4153Dermavest, plurivest sq cm169.060
Q4154Biovance 1 square cm133.594
Q4159Affinity1 square cm367.052
Q4160Nushield 1 square cm96.261
Q4161Bio-connekt per square cm134.816
Q4163Woundex, bioskin, per sq cm178.825
Q4164Helicoll, per square cm1337.847
Q4166Cytal, per square centimeter19.269
Q4168Amnioband, 1 mg17.256
Q4169Artacent wound, per sq cm193.841
Q4170Cygnus, per sq cm56.900
Q4171Interfyl, 1 mg14.264
Q4173Palingen or palingen xplus12.609
Q4175Miroderm64.613
Q4178Floweramniopatch, per sq cm77.976
Q4180Revita, per sq cm650.161
Q4186Epifix 1 sq cm149.729
Q4187Epicord 1 sq cm244.080
Q4190Artacent ac 1 sq cm433.016
Q4196Puraply am 1 sq cm103.471
Q4197Puraply xt 1 sq cm148.072
Q4199Cygnus matrix, per sq cm352.248
Q4201Matrion 1 sq cm121.388
Q4203Derma-gide, 1 sq cm289.409
Q4205Membrane graft or wrap sq cm1484.000
Q4210Axolotl graf dualgraf sq cm848.000
Q4217Woundfix biowound plus xplus784.230
Q4222Progenamatrix, per sq cm102.034
Q4226Myown harv prep proc sq cm246.969
Q4227Amniocore per sq cm147.210
Q4229Cogenex amnio memb per sq cm162.008
Q4232Corplex, per sq cm148.990
Q4234Xcellerate, per sq cm513.177
Q4235Amniorepair or altiply sq cm148.456
Q4236Carepatch per sq cm1111.365
Q4246Coretext or protext, per cc2968.000
Q4247Amniotext patch, per sq cm530.000
Q4248Dermacyte amn mem allo sq cm1049.398
Q4252Vendaje, per square centimet121.707
Q4253Zenith amniotic membrane psc424.000
Q4258Enverse, per sq cm69.617
Q4259Celera per sq cm997.699
Q5101Injection, zarxio0.170
Q5103Injection, inflectra13.931
Q5104Injection, renflexis32.562
Q5105Inj retacrit esrd on dialysi0.725
Q5106Inj retacrit non-esrd use7.252
Q5107Inj mvasi 10 mg27.853
Q5108Injection, fulphila96.464
Q5110Nivestym0.297
Q5111Injection, udenyca 0.5 mg150.780
Q5112Inj ontruzant 10 mg41.651
Q5113Inj herzuma 10 mg20.183
Q5114Inj ogivri 10 mg40.040
Q5115Inj truxima 10 mg37.626
Q5116Inj., trazimera, 10 mg19.622
Q5117Inj., kanjinti, 10 mg24.341
Q5118Inj., zirabev, 10 mg23.737
Q5119Inj ruxience, 10 mg22.304
Q5121Inj. avsola, 10 mg26.468
Q5122Inj, nyvepria88.980
Q5123Inj. riabni, 10 mg43.475
Q5124Inj. byooviz, 0.1 mg199.552
Q5125Inj, releuko 1 mcg0.525
Q5126Inj alymsys 10 mg63.916
Q5127Inj, stimufend, 0.5 mg349.140
Q5128Inj, cimerli, 0.1 mg273.264
Q5129Inj, vegzelma, 10 mg69.772
Q5130Inj, fylnetra, 0.5 mg208.796
Q9950Inj sulf hexa lipid microsph18.778
Q9956Inj octafluoropropane mic,ml42.666
Q9957Inj perflutren lip micros,ml42.666
Q9958Hocm <=149 mg/ml iodine, 1ml0.077
Q9961Hocm 250-299mg/ml iodine,1ml0.277
Q9963Hocm 350-399mg/ml iodine,1ml0.215
Q9965Locm 100-199mg/ml iodine,1ml1.074
Q9966Locm 200-299mg/ml iodine,1ml0.407
Q9967Locm 300-399mg/ml iodine,1ml0.131
Q9991Buprenorph xr 100 mg or less1886.977
Q9992Buprenorphine xr over 100 mg1886.977
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