HCPCS Code	HCPCS Unit	HCPCS Code Descriptor
C9257	0.25 MG
Manufacturer	Brand Name	Short Description
Genentech, Inc.	Avastin	Bevacizumab injection

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	<	June 2019	July 2019	August 2019	September 2019	October 2019	>
Total NDC's Aligned to this HCPCS Code (?)		2	2	2	2	2
ASP: Average Sales Price		$.00	$.00	$.00	$.00	$.00
ASP+4.3%: Effective Payment Limit (?)		$.00	$.00	$.00	$.00	$.00
ASP+6%: Medicare Payment Limit		N/A	N/A	N/A	N/A	N/A
APC: Ambulatory Procedure Code Payment Limit						$2.03
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HCPCS Code	HCPCS Unit	HCPCS Code Descriptor
J9035	10 MG	INJECTION, BEVACIZUMAB, 10 MG
Manufacturer	Brand Name	Short Description
Genentech, Inc.	AVASTIN	Bevacizumab injection

	<	June 2019	July 2019	August 2019	September 2019	October 2019	>
Total NDC's Aligned to this HCPCS Code (?)		2	2	2	2	2
ASP: Average Sales Price		$76.62	$76.68	$76.68	$76.68	$76.59
ASP+4.3%: Effective Payment Limit (?)		$79.92	$79.98	$79.98	$79.98	$79.88
ASP+6%: Medicare Payment Limit		$81.22	$81.28	$81.28	$81.28	$81.18
APC: Ambulatory Procedure Code Payment Limit						$81.18
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