Service line · Pharmacy

Pharmacy Medicaid rates by code

1,422 pharmacy codes with published Medicaid rates in five or more states. Each page compares every state's rate, unit and managed-care rule.

Codes: 1,422
In 40+ states: 169

Index

All pharmacy codes

Code	Service	States	Median rate
0081A	Physician-administered drugs (J-codes)	5	$40.00
0082A	Physician-administered drugs (J-codes)	5	$40.00
90281	Physician-administered drugs (J-codes)	13	$26.37
90283	Vaccines and immune globulins	7	$75.37
90284	Vaccines and immune globulins	10	$19.28
90296	Vaccines and immune globulins	5	$45.49
90384	Vaccines and immune globulins	24	$85.31
90386	Vaccines and immune globulins	9	$37.75
90389	Vaccines and immune globulins	19	$272.93
90477	Vaccines and immune globulins	5	$22.01
90484	Vaccines and immune globulins	17	$33.07
90585	Vaccines and immune globulins	27	$159.08
90616	Physician-administered drugs (J-codes)	12	$171.21
90620	Vaccines and immune globulins	42	$229.18
90621	Vaccines and immune globulins	42	$206.95
90630	Vaccines and immune globulins	8	$22.57
90633	Vaccines and immune globulins	35	$37.27
90634	Vaccines and immune globulins	19	$32.30
90647	Vaccines and immune globulins	40	$27.65
90651	Vaccines and immune globulins	44	$307.52
90653	Physician-administered drugs (J-codes)	44	$98.16
90656	Vaccines and immune globulins	45	$21.68
90657	Vaccines and immune globulins	41	$11.03
90658	Vaccines and immune globulins	45	$21.60
90662	Physician-administered drugs (J-codes)	44	$96.84
90673	Physician-administered drugs (J-codes)	43	$98.16
90680	Vaccines and immune globulins	32	$83.57
90696	Vaccines and immune globulins	31	$59.64
90698	Vaccines and immune globulins	33	$107.24
90700	Vaccines and immune globulins	32	$24.13
90702	Vaccines and immune globulins	29	$24.74
90740	Vaccines and immune globulins	46	$164.42
90744	Vaccines and immune globulins	40	$29.63
90747	Physician-administered drugs (J-codes)	44	$155.52
90749	Vaccines and immune globulins	7	$10.00
A2022	Innovaburn or innovamatrix xl, per square centimeter	7	$92.95
A2025	Miro3d, per cubic centimeter (add-on	7	$92.95
A2042	Foundation drs+ solo (add-on	6	$87.05
A9596	Gallium ga-68 gozetotide, diagnostic, (illuccix)	23	$1,018.02
C9046	Cocaine hydrochloride nasal solution (goprelto), 1 mg	5	$1.90
C9047	Injection, caplacizumab-yhdp, 1 mg	8	$803.93
C9101	Injection, oliceridine, 0.1 mg	10	$1.28
C9143	Cocaine hydrochloride nasal solution (numbrino), 1 mg	7	$2.02
C9144	Injection, bupivacaine (posimir), 1 mg	6	$0.48
C9254	Injection, lacosamide, 1 mg	8	$0.25
C9257	Injection, bevacizumab, 0.25 mg	13	$1.99
C9285	Lidocaine 70 mg/tetracaine 70 mg, per patch	5	$16.68
C9293	Injection, glucarpidase, 10 units	6	$405.11
C9460	Injection, cangrelor, 1 mg	10	$21.01
C9462	Injection, delafloxacin, 1 mg	11	$0.50
C9482	Injection, sotalol hydrochloride, 1 mg	7	$21.97
C9488	Injection, conivaptan hydrochloride, 1 mg	7	$45.68
C9507	Plasma, high titer covid-19 convalescent, each unit	6	$750.50
C9818	Suzetrigine, oral, 1 mg	5	$0.31
J0013	Esketamine, nasal spray, 1 mg	19	$15.73
J0014	Cocaine hydrochloride nasal solution (goprelto), 1 mg	7	$1.83
J0120	Injection, tetracycline, up to 250 mg	16	$8.84
J0121	Injection, omadacycline, 1 mg	36	$4.19
J0122	Injection, eravacycline, 1 mg	38	$1.33
J0129	Injection, abatacept, 10 mg	39	$45.86
J0130	Injection abciximab, 10 mg	20	$1,429.07
J0131	Injection, acetaminophen, not otherwise specified,10 mg	29	$0.05
J0132	Injection, acetylcysteine, 100 mg	35	$0.39
J0133	Injection, acyclovir, 5 mg	40	$0.04
J0134	Injection, acetaminophen (fresenius kabi)	35	$0.05
J0135	Injection, adalimumab, 20 mg	5	$909.22
J0136	Injection, acetaminophen (b braun)	34	$0.05
J0137	Injection, acetaminophen (hikma)	34	$0.05
J0138	Injection, acetaminophen 10 mg and ibuprofen 3 mg	31	$0.09
J0139	Injection, adalimumab, 1 mg	13	$86.53
J0153	Injection, adenosine, 1 mg	38	$0.39
J0162	Injection, epinephrine (fresenius)	34	$0.36
J0163	Injection, epinephrine in sodium chloride (endo), 0.1 mg	33	$0.71
J0164	Injection, epinephrine in sodium chloride (baxter), 0.1 mg	31	$0.91
J0165	Injection, epinephrine, not otherwise specified, 0.1 mg	36	$0.23
J0166	Injection, epinephrine (bpi)	31	$0.83
J0167	Injection, epinephrine (hospira)	34	$1.42
J0168	Injection, epinephrine (international medication systems)	34	$2.60
J0169	Injection, epinephrine (adrenalin)	34	$0.87
J0171	Injection, adrenalin, epinephrine, 0.1 mg	10	$0.745
J0172	Injection, aducanumab-avwa, 2 mg	6	$5.98
J0173	Injection, epinephrine (belcher)	6	$2.25
J0174	Lecanemab-irmb, for intravenous injection, 1 mg	34	$1.34
J0175	Injection, donanemab-azbt, 2 mg	32	$4.17
J0177	Injection, aflibercept hd, 1 mg	38	$298.68
J0178	Injection, aflibercept, 1 mg	40	$743.61
J0179	Injection, brolucizumab-dbll, 1 mg	38	$359.71
J0180	Injection, agalsidase beta, 1 mg	38	$230.54
J0184	Injection, amisulpride, 1 mg	24	$9.54
J0185	Injection, aprepitant, 1 mg	40	$1.62
J0202	Injection, alemtuzumab, 1 mg	40	$2,506.20
J0206	Injection, allopurinol sodium, 1 mg	35	$4.29
J0207	Injection, amifostine, 500 mg	26	$1,073.64
J0208	Injection, sodium thiosulfate (pedmark), 100 mg	28	$95.90
J0209	Injection, sodium thiosulfate (hope), 100 mg	7	$0.77
J0210	Injection, methyldopate hcl, up to 250 mg	23	$40.51
J0211	Injection, sodium nitrite 3 mg and sodium thiosulfate 125 mg...	7	$2.17
J0215	Injection, alefacept, 0.5 mg	5	$39.56
J0216	Injection, alfentanil hydrochloride, 500 micrograms	17	$2.57
J0217	Injection, velmanase alfa-tycv, 1 mg	35	$474.67
J0218	Injection, olipudase alfa-rpcp, 1 mg	37	$404.78
J0219	Injection, avalglucosidase alfa-ngpt, 4 mg	36	$81.30
J0220	Injection, alglucosidase alfa, 10 mg	21	$206.09
J0221	Injection, alglucosidase alfa, (lumizyme), 10 mg	39	$211.06
J0222	Injection, patisiran, 0.1 mg	37	$101.02
J0223	Injection, givosiran, 0.5 mg	37	$120.74
J0224	Injection, lumasiran, 0.5 mg	33	$336.64
J0225	Injection, vutrisiran, 1 mg	34	$5,009.56
J0248	Injection, remdesivir, 1 mg	37	$7.51
J0256	Injection, alpha 1 proteinase inhibitor (human)	38	$5.13
J0257	Injection, alpha 1 proteinase inhibitor (human), (glassia)	39	$5.58
J0270	Injection, alprostadil, 1.25 mcg	19	$0.67
J0275	Alprostadil urethral suppository	10	$25.72
J0278	Injection, amikacin sulfate, 100 mg	38	$0.61
J0280	Injection, aminophyllin, up to 250 mg	38	$10.76
J0281	Injection, aminocaproic acid, 1 gram	34	$1.71
J0282	Injection, amiodarone hydrochloride, 30 mg	31	$0.40
J0283	Injection, amiodarone hydrochloride (nexterone), 30 mg	34	$2.51
J0285	Injection, amphotericin b, 50 mg	40	$42.47
J0287	Injection, amphotericin b lipid complex, 10 mg	34	$10.30
J0288	Injection, amphotericin b cholesteryl sulfate complex, 10 mg	6	$13.71
J0289	Injection, amphotericin b liposome, 10 mg	40	$19.85
J0290	Injection, ampicillin sodium, 500 mg	40	$0.6145
J0291	Injection, plazomicin, 5 mg	38	$3.52
J0295	Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm	39	$1.45
J0300	Injection, amobarbital, up to 125 mg	30	$107.62
J0330	Injection, succinylcholine chloride, up to 20 mg	32	$0.32
J0348	Injection, anidulafungin, 1 mg	37	$0.49
J0349	Injection, rezafungin, 1 mg	34	$11.00
J0360	Injection, hydralazine hcl, up to 20 mg	40	$3.45
J0364	Injection, apomorphine hydrochloride, 1 mg	29	$34.65
J0380	Injection, metaraminol bitartrate, per 10 mg	5	$1.20
J0390	Injection, chloroquine hydrochloride, up to 250 mg	15	$17.27
J0391	Injection, artesunate, 1 mg	24	$48.90
J0395	Injection, arbutamine hcl, 1 mg	5	$183.78
J0400	Injection, aripiprazole, intramuscular, 0.25 mg	21	$0.76
J0401	Injection, aripiprazole (abilify maintena), 1 mg	40	$7.46
J0402	Injection, aripiprazole (abilify asimtufii), 1 mg	36	$6.18
J0456	Injection, azithromycin, 500 mg	37	$1.96
J0457	Injection, aztreonam, 100 mg	35	$2.27
J0458	Injection, aztreonam/avibactam, 7.5 mg/2.5 mg (10 mg)	34	$1.76
J0461	Injection, atropine sulfate, 0.01 mg	40	$0.10
J0462	Injection, atropine sulfate	33	$0.13
J0463	Injection, atropine sulfate	22	$0.02
J0470	Injection, dimercaprol, per 100 mg	24	$57.83
J0475	Injection, baclofen, 10 mg	40	$186.11
J0476	Injection, baclofen, 50 mcg for intrathecal trial	37	$45.49
J0480	Injection, basiliximab, 20 mg	34	$4,905.04
J0485	Injection, belatacept, 1 mg	39	$3.89
J0490	Injection, belimumab, 10 mg	39	$58.29
J0491	Injection, anifrolumab-fnia, 1 mg	39	$18.46
J0500	Injection, dicyclomine hcl, up to 20 mg	39	$11.33
J0515	Injection, benztropine mesylate, per 1 mg	39	$13.54
J0517	Injection, benralizumab, 1 mg	38	$165.32
J0520	Injection, bethanechol chloride, myotonachol or urecholine	13	$4.49
J0525	Injection, cefotetan disodium, 10 mg	18	$0.24
J0528	Injection, fosfomycin disodium, 20 mg	21	$0.63
J0558	Injection, penicillin g benzathine and penicillin g...	40	$19.52
J0561	Injection, penicillin g benzathine, 100,000 units	40	$31.72
J0565	Injection, bezlotoxumab, 10 mg	37	$39.83
J0567	Injection, cerliponase alfa, 1 mg	24	$118.63
J0570	Buprenorphine implant, 74.2 mg	13	$1,311.75
J0571	Buprenorphine, oral, 1 mg	23	$0.68
J0572	Buprenorphine/naloxone, oral	23	$3.85
J0573	Buprenorphine/naloxone, oral, greater than 3 mg	23	$7.33
J0574	Buprenorphine/naloxone, oral, greater than 6 mg	23	$7.46
J0575	Buprenorphine/naloxone, oral	24	$14.55
J0577	Injection, buprenorphine extended-release (brixadi)	37	$430.57
J0578	Injection, buprenorphine extended release (brixadi)	37	$1,722.30
J0582	Injection, bivalirudin (endo)	31	$0.16
J0583	Injection, bivalirudin, 1 mg	32	$0.1675
J0584	Injection, burosumab-twza 1 mg	37	$504.53
J0585	Injection, onabotulinumtoxina, 1 unit	39	$6.51
J0586	Injection, abobotulinumtoxina, 5 units	39	$8.94
J0587	Injection, rimabotulinumtoxinb, 100 units	39	$13.29
J0588	Injection, incobotulinumtoxin a, 1 unit	39	$5.28
J0589	Injection, daxibotulinumtoxina-lanm, 1 unit	30	$3.09
J0592	Injection, buprenorphine hydrochloride, 0.1 mg	34	$4.47
J0593	Injection, lanadelumab-flyo, 1 mg	34	$88.21
J0594	Injection, busulfan, 1 mg	37	$1.03
J0595	Injection, butorphanol tartrate, 1 mg	38	$10.50
J0596	Injection, c1 esterase inhibitor (recombinant), ruconest	37	$37.81
J0597	Injection, c-1 esterase inhibitor (human), berinert	37	$79.26
J0598	Injection, c-1 esterase inhibitor (human), cinryze, 10 units	37	$66.75
J0599	Injection, c-1 esterase inhibitor (human), (haegarda)	25	$12.38
J0600	Injection, edetate calcium disodium, up to 1000 mg	36	$6,189.49
J0601	Sevelamer carbonate (renvela or therapeutically equivalent)	6	$0.07
J0602	Sevelamer carbonate (renvela or therapeutically equivalent)	9	$0.05
J0603	Sevelamer hydrochloride	12	$0.06
J0604	Cinacalcet, oral, 1 mg, (for esrd on dialysis)	16	$0.355
J0605	Sucroferric oxyhydroxide, oral, 5 mg (for esrd on dialysis)	17	$0.17
J0606	Injection, etelcalcetide, 0.1 mg	26	$4.15
J0607	Lanthanum carbonate, oral, 5 mg (for esrd on dialysis)	13	$0.04
J0608	Lanthanum carbonate, oral, powder, 5 mg	14	$0.06
J0609	Ferric citrate, oral, 3 mg ferric iron,	16	$0.10
J0610	Injection, calcium gluconate (fresenius kabi), per 10 ml	6	$4.65
J0611	Injection, calcium gluconate (wg critical care), per 10 ml	5	$1.69
J0612	Injection, calcium gluconate, not otherwise specified, 10 mg	37	$0.03
J0613	Injection, calcium gluconate (wg critical care)	37	$0.05
J0614	Injection, treosulfan, 50 mg	32	$32.33
J0616	Injection, metoprolol tartrate, 1 mg	32	$0.14
J0618	Injection, calcium chloride, 2 mg	15	$0.03
J0620	Injection, calcium glycerophosphate and calcium lactate	17	$8.96
J0630	Injection, calcitonin salmon, up to 400 units	34	$993.52
J0636	Injection, calcitriol, 0.1 mcg	34	$0.80
J0637	Injection, caspofungin acetate, 5 mg	36	$2.88
J0638	Injection, canakinumab, 1 mg	38	$150.67
J0640	Injection, leucovorin calcium, per 50 mg	32	$2.93
J0641	Injection, levoleucovorin, not otherwise specified, 0.5 mg	40	$0.05
J0642	Injection, levoleucovorin (khapzory), 0.5 mg	37	$1.34
J0643	Injection, leucovorin calcium, not otherwise specified, 1 mg	9	$0.05
J0644	Injection, leucovorin calcium (avyxa), 1 mg	9	$2.63
J0650	Injection, levothyroxine sodium, not otherwise specified	32	$6.17
J0651	Injection, levothyroxine sodium (fresenius kabi)	32	$6.90
J0652	Injection, levothyroxine sodium (hikma)	31	$6.32
J0654	Injection, liothyronine, 1 mcg	15	$42.30
J0666	Injection, bupivacaine liposome, 1 mg	34	$1.44
J0668	Instillation, bupivacaine and meloxicam, 1 mg/0.03 mg	15	$0.79
J0670	Injection, mepivacaine hydrochloride, per 10 ml	36	$4.15
J0675	Injection, carboprost tromethamine, 0.1 mg	16	$20.44
J0681	Injection, ceftobiprole medocaril sodium, 3 mg	21	$1.10
J0687	Injection, cefazolin sodium (wg critical care)	37	$0.66
J0688	Injection, cefazolin sodium (hikma)	39	$0.85
J0689	Injection, cefazolin sodium (baxter)	38	$1.28
J0690	Injection, cefazolin sodium, 500 mg	41	$0.80
J0691	Injection, lefamulin, 1 mg	26	$0.72
J0692	Injection, cefepime hydrochloride, 500 mg	38	$1.29
J0694	Injection, cefoxitin sodium, 1 gm	39	$4.45
J0695	Injection, ceftolozane 50 mg and tazobactam 25 mg	36	$10.02
J0696	Injection, ceftriaxone sodium, per 250 mg	41	$0.40
J0697	Injection, sterile cefuroxime sodium, per 750 mg	39	$2.05
J0698	Injection, cefotaxime sodium, per gm	33	$4.09
J0699	Injection, cefiderocol, 10 mg	35	$2.54
J0701	Injection, cefepime hydrochloride (baxter)	38	$6.03
J0702	Injection, betamethasone acetate 3 mg and betamethasone...	39	$7.13
J0703	Injection, cefepime hydrochloride (b braun)	37	$4.75
J0706	Injection, caffeine citrate, 5 mg	28	$0.715
J0710	Injection, cephapirin sodium, up to 1 gm	5	$3.90
J0712	Injection, ceftaroline fosamil, 10 mg	39	$4.24
J0713	Injection, ceftazidime, per 500 mg	39	$1.49
J0714	Injection, ceftazidime and avibactam, 0.5 g/0.125 g	38	$109.45
J0715	Injection, ceftizoxime sodium, per 500 mg	5	$5.25
J0716	Injection, centruroides immune f(ab)2, up to 120 milligrams	17	$5,250.56
J0717	Injection, certolizumab pegol, 1 mg	38	$3.44
J0720	Injection, chloramphenicol sodium succinate, up to 1 gm	36	$48.65
J0725	Injection, chorionic gonadotropin, per 1,000 usp units	37	$15.07
J0735	Injection, clonidine hydrochloride, 1 mg	37	$15.08
J0736	Injection, clindamycin phosphate, 300 mg	36	$1.91
J0737	Injection, clindamycin phosphate (baxter)	34	$2.19
J0738	Injection, lenacapavir, 1 mg, fda approved prescription	34	$16.05
J0739	Injection, cabotegravir, 1mg, fda approved prescription	34	$7.28
J0740	Injection, cidofovir, 375 mg	37	$535.74
J0741	Injection, cabotegravir and rilpivirine, 2mg/3mg	38	$24.65
J0742	Injection, imipenem 4 mg	35	$2.69
J0743	Injection, cilastatin sodium; imipenem, per 250 mg	38	$6.78
J0744	Injection, ciprofloxacin for intravenous infusion, 200 mg	38	$1.76
J0745	Injection, codeine phosphate, per 30 mg	18	$1.35
J0750	Emtricitabine 200mg and tenofovir disoproxil fumarate 300mg	24	$0.4505
J0751	Emtricitabine 200mg and tenofovir alafenamide 25mg, oral	24	$71.43
J0752	Oral, lenacapavir, 300 mg, fda approved prescription	27	$617.95
J0759	Injection, clevidipine butyrate, 1 mg	25	$2.85
J0770	Injection, colistimethate sodium, up to 150 mg	38	$14.49
J0775	Injection, collagenase, clostridium histolyticum, 0.01 mg	37	$78.30
J0780	Injection, prochlorperazine, up to 10 mg	40	$2.76
J0791	Injection, crizanlizumab-tmca, 5 mg	38	$129.93
J0795	Injection, corticorelin ovine triflutate, 1 microgram	6	$9.46
J0801	Injection, corticotropin (acthar gel), up to 40 units	33	$4,133.45
J0802	Injection, corticotropin (ani), up to 40 units	35	$3,646.46
J0834	Injection, cosyntropin, 0.25 mg	39	$20.65
J0840	Injection, crotalidae polyvalent immune fab (ovine)	32	$1,906.91
J0841	Injection, crotalidae immune f(ab')2 (equine), 120 mg	29	$1,320.00
J0850	Injection, cytomegalovirus immune globulin intravenous	35	$1,857.13
J0870	Injection, imetelstat, 1 mg	35	$59.36
J0871	Injection, daptomycin (endo)	8	$0.54
J0872	Injection, daptomycin (xellia), unrefrigerated	37	$0.05
J0873	Injection, daptomycin (xellia)	37	$0.05
J0874	Injection, daptomycin (baxter)	33	$0.06
J0875	Injection, dalbavancin, 5 mg	40	$11.29
J0877	Injection, daptomycin (hospira)	37	$0.06
J0878	Injection, daptomycin, 1 mg	38	$0.03
J0879	Injection, difelikefalin, 0.1 microgram,	25	$0.23
J0881	Injection, darbepoetin alfa, 1 microgram (non-esrd use)	40	$3.02
J0882	Injection, darbepoetin alfa, 1 microgram	41	$3.02
J0883	Injection, argatroban, 1 mg (for non-esrd use)	31	$0.86
J0884	Injection, argatroban, 1 mg (for esrd on dialysis)	29	$0.80
J0885	Injection, epoetin alfa, (for non-esrd use), 1000 units	41	$6.88
J0887	Injection, epoetin beta, 1 microgram, (for esrd on dialysis)	35	$1.20
J0888	Injection, epoetin beta, 1 microgram, (for non esrd use)	34	$1.20
J0890	Injection, peginesatide, 0.1 mg (for esrd on dialysis)	11	$8.69
J0891	Injection, argatroban (accord)	31	$1.82
J0892	Injection, argatroban (accord)	28	$1.82
J0893	Injection, decitabine (sun pharma)	35	$0.78
J0894	Injection, decitabine, 1 mg	40	$1.06
J0895	Injection, deferoxamine mesylate, 500 mg	41	$8.78
J0896	Injection, luspatercept-aamt, 0.25 mg	36	$43.13
J0897	Injection, denosumab, 1 mg	40	$29.86
J0898	Injection, argatroban (auromedics)	33	$1.21
J0899	Injection, argatroban (auromedics)	30	$1.21
J0901	Vadadustat, oral, 1 mg (for esrd on dialysis)	23	$0.13
J0911	Instillation, taurolidine 1.35 mg and heparin sodium 100...	22	$8.33
J0945	Injection, brompheniramine maleate, per 10 mg	13	$0.80
J1000	Injection, depo-estradiol cypionate, up to 5 mg	39	$53.81
J1010	Injection, methylprednisolone acetate, 1 mg	39	$0.12
J1020	Injection, methylprednisolone acetate, 20 mg	5	$7.04
J1030	Injection, methylprednisolone acetate, 40 mg	5	$6.42
J1040	Injection, methylprednisolone acetate, 80 mg	5	$9.80
J1050	Injection, medroxyprogesterone acetate, 1 mg	37	$0.47
J1071	Injection, testosterone cypionate, 1 mg	37	$0.03
J1072	Injection, testosterone cypionate (azmiro), 1 mg	30	$1.30
J1073	Testosterone pellet, implant, 75 mg	18	$108.18
J1094	Injection, dexamethasone acetate, 1 mg	7	$0.24
J1095	Injection, dexamethasone 9 percent, intraocular, 1 microgram	17	$1.19
J1096	Dexamethasone, lacrimal ophthalmic insert, 0.1 mg	33	$90.02
J1097	Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml...	22	$118.00
J1100	Injection, dexamethasone sodium phosphate, 1 mg	39	$0.10
J1105	Dexmedetomidine, oral, 1 mcg	17	$0.63
J1110	Injection, dihydroergotamine mesylate, per 1 mg	38	$54.98
J1120	Injection, acetazolamide sodium, up to 500 mg	38	$24.98
J1130	Injection, diclofenac sodium, 0.5 mg	14	$0.22
J1160	Injection, digoxin, up to 0.5 mg	39	$3.91
J1162	Injection, digoxin immune fab (ovine), per vial	30	$5,383.32
J1163	Injection, diltiazem hydrochloride, 0.5 mg	33	$0.03
J1164	Injection, diltiazem hydrochloride in 0.72% sodium chloride	30	$0.18
J1165	Injection, phenytoin sodium, per 50 mg	39	$0.54
J1170	Injection, hydromorphone, up to 4 mg	7	$2.70
J1171	Injection, hydromorphone, 0.1 mg	36	$0.14
J1180	Injection, dyphylline, up to 500 mg	14	$8.05
J1190	Injection, dexrazoxane hydrochloride, per 250 mg	39	$41.44
J1200	Injection, diphenhydramine hcl, up to 50 mg	41	$0.75
J1201	Injection, cetirizine hydrochloride, 0.5 mg	31	$17.07
J1202	Miglustat, oral, 65 mg	21	$35.50
J1203	Injection, cipaglucosidase alfa-atga, 5 mg	34	$96.30
J1205	Injection, chlorothiazide sodium, per 500 mg	36	$63.40
J1212	Injection, dmso, dimethyl sulfoxide, 50%, 50 ml	34	$748.81
J1230	Injection, methadone hcl, up to 10 mg	35	$12.71
J1240	Injection, dimenhydrinate, up to 50 mg	37	$8.64
J1245	Injection, dipyridamole, per 10 mg	38	$8.41
J1246	Physician-administered drugs (J-codes)	5	$96.11
J1250	Injection, dobutamine hydrochloride, per 250 mg	40	$7.69
J1260	Injection, dolasetron mesylate, 10 mg	22	$6.17
J1265	Injection, dopamine hcl, 40 mg	37	$0.80
J1267	Injection, doripenem, 10 mg	7	$0.80
J1270	Injection, doxercalciferol, 1 mcg	40	$0.33
J1271	Injection, doxycycline hyclate, 1 mg	35	$0.09
J1289	Injection, narsoplimab-wuug, 1 mg	20	$103.46
J1290	Injection, ecallantide, 1 mg	38	$595.94
J1299	Injection, eculizumab, 2 mg	35	$44.20
J1300	Injection, eculizumab, 10 mg	8	$224.16
J1301	Injection, edaravone, 1 mg	36	$6.46
J1302	Injection, sutimlimab-jome, 10 mg	36	$19.64
J1303	Injection, ravulizumab-cwvz, 10 mg	39	$226.45
J1304	Injection, tofersen, 1 mg	36	$164.04
J1305	Injection, evinacumab-dgnb, 5mg	37	$197.63
J1306	Injection, inclisiran, 1 mg	38	$12.90
J1307	Injection, crovalimab-akkz, 10 mg	34	$551.51
J1320	Injection, amitriptyline hcl, up to 20 mg	15	$2.24
J1322	Injection, elosulfase alfa, 1 mg	38	$319.51
J1323	Injection, elranatamab-bcmm, 1 mg	37	$191.31
J1324	Injection, enfuvirtide, 1 mg	21	$0.68
J1325	Injection, epoprostenol, 0.5 mg	36	$16.92
J1326	Injection, zolbetuximab-clzb, 2 mg	38	$33.92
J1327	Injection, eptifibatide, 5 mg	27	$21.13
J1335	Injection, ertapenem sodium, 500 mg	39	$6.75
J1364	Injection, erythromycin lactobionate, per 500 mg	39	$160.43
J1370	Injection, esomeprazole sodium, 1 mg	16	$0.21
J1380	Injection, estradiol valerate, up to 10 mg	37	$7.70
J1410	Injection, estrogen conjugated, per 25 mg	38	$401.50
J1411	Injection, etranacogene dezaparvovec-drlb	11	$3,500,000.00
J1412	Injection, valoctocogene roxaparvovec-rvox, per ml	17	$11,843.13
J1413	Injection, delandistrogene moxeparvovec-rokl	13	$3,200,000.00
J1414	Injection, fidanacogene elaparvovec-dzkt	7	$3,500,000.00
J1426	Injection, casimersen, 10 mg	29	$161.60
J1427	Injection, viltolarsen, 10 mg	27	$56.40
J1428	Injection, eteplirsen, 10 mg	25	$160.00
J1429	Injection, golodirsen, 10 mg	24	$160.00
J1430	Injection, ethanolamine oleate, 100 mg	30	$533.77
J1434	Injection, fosaprepitant (focinvez), 1 mg	34	$2.46
J1435	Injection, estrone, per 1 mg	13	$0.25
J1436	Injection, etidronate disodium, per 300 mg	14	$71.41
J1437	Injection, ferric derisomaltose, 10 mg	38	$21.61
J1438	Injection, etanercept, 25 mg	28	$824.87
J1439	Injection, ferric carboxymaltose, 1 mg	40	$1.12
J1440	Fecal microbiota, live - jslm, 1 ml	34	$65.60
J1442	Injection, filgrastim (g-csf), excludes biosimilars	40	$1.00
J1447	Injection, tbo-filgrastim, 1 microgram	40	$0.25
J1448	Injection, trilaciclib, 1mg	38	$5.46
J1449	Injection, eflapegrastim-xnst, 0.1 mg	40	$37.42
J1450	Injection fluconazole, 200 mg	38	$5.65
J1451	Injection, fomepizole, 15 mg	28	$9.73
J1453	Injection, fosaprepitant, 1 mg	40	$0.12
J1454	Injection, fosnetupitant 235 mg and palonosetron 0.25 mg	39	$503.85
J1455	Injection, foscarnet sodium, per 1000 mg	39	$8.36
J1456	Injection, fosaprepitant (teva)	35	$0.04
J1458	Injection, galsulfase, 1 mg	39	$525.96
J1459	Injection, immune globulin (privigen), intravenous	40	$49.91
J1460	Injection, gamma globulin, intramuscular, 1 cc	39	$48.87
J1551	Injection, immune globulin (cutaquig), 100 mg	36	$14.03
J1552	Injection, immune globulin (alyglo), 500 mg	36	$121.54
J1553	Injection, immune globulin (yimmugo), 100 mg	23	$24.14
J1554	Injection, immune globulin (asceniv), 500 mg	38	$500.93
J1555	Injection, immune globulin (cuvitru), 100 mg	38	$17.99
J1556	Injection, immune globulin (bivigam), 500 mg	39	$79.65
J1557	Injection, immune globulin, (gammaplex), intravenous	38	$63.93
J1558	Injection, immune globulin (xembify), 100 mg	37	$15.24
J1559	Injection, immune globulin (hizentra), 100 mg	37	$14.79
J1560	Injection, gamma globulin, intramuscular, over 10 cc	36	$160.29
J1561	Injection, immune globulin, (gamunex-c/gammaked)	40	$49.01
J1562	Injection, immune globulin (vivaglobin), 100 mg	5	$7.69
J1566	Injection, immune globulin, intravenous, lyophilized (e.g.	40	$80.96
J1568	Injection, immune globulin, (octagam), intravenous	40	$47.06
J1569	Injection, immune globulin,	40	$49.30
J1570	Injection, ganciclovir sodium, 500 mg	39	$31.46
J1571	Injection, hepatitis b immune globulin (hepagam b)	38	$69.41
J1572	Injection, immune globulin, (flebogamma/flebogamma dif)	23	$56.12
J1573	Injection, hepatitis b immune globulin (hepagam b)	35	$69.22
J1574	Injection, ganciclovir sodium (exela)	20	$50.00
J1575	Injection, immune globulin/hyaluronidase, (hyqvia)	40	$18.35
J1576	Injection, immune globulin (panzyga), intravenous	38	$71.22
J1577	Injection, immune globulin (qivigy), 100 mg	21	$29.28
J1580	Injection, garamycin, gentamicin, up to 80 mg	41	$1.93
J1595	Injection, glatiramer acetate, 20 mg	23	$67.64
J1596	Injection, glycopyrrolate, 0.1 mg	37	$0.37
J1597	Injection, glycopyrrolate (glyrx-pf), 0.1 mg	29	$1.28
J1598	Injection, glycopyrrolate (fresenius kabi)	31	$1.34
J1599	Injection, immune globulin, intravenous, non-lyophilized	15	$115.01
J1600	Injection, gold sodium thiomalate, up to 50 mg	20	$26.51
J1602	Injection, golimumab, 1 mg, for intravenous use	38	$11.04
J1610	Injection, glucagon hydrochloride, per 1 mg	37	$117.33
J1611	Injection, glucagon hydrochloride (fresenius kabi)	38	$134.89
J1612	Injection, glucagon (gvoke), 0.01 mg	25	$1.80
J1620	Injection, gonadorelin hydrochloride, per 100 mcg	5	$180.30
J1626	Injection, granisetron hydrochloride, 100 mcg	40	$0.185
J1627	Injection, granisetron, extended-release, 0.1 mg	40	$3.22
J1628	Injection, guselkumab, 1 mg	34	$67.00
J1630	Injection, haloperidol, up to 5 mg	39	$0.75
J1631	Injection, haloperidol decanoate, per 50 mg	39	$5.29
J1632	Injection, brexanolone, 1 mg	17	$74.50
J1640	Injection, hemin, 1 mg	37	$35.82
J1642	Injection, heparin sodium, (heparin lock flush)	31	$0.02
J1643	Injection, heparin sodium (pfizer)	35	$1.71
J1644	Injection, heparin sodium, per 1000 units	40	$0.20
J1645	Injection, dalteparin sodium, per 2500 iu	36	$45.67
J1650	Injection, enoxaparin sodium, 10 mg	39	$0.54
J1652	Injection, fondaparinux sodium, 0.5 mg	37	$0.92
J1670	Injection, tetanus immune globulin, human, up to 250 units	37	$595.02
J1675	Injection, histrelin acetate, 10 micrograms	9	$10.04
J1700	Injection, hydrocortisone acetate, up to 25 mg	13	$0.63
J1710	Injection, hydrocortisone sodium phosphate, up to 50 mg	5	$5.83
J1720	Injection, hydrocortisone sodium succinate, up to 100 mg	41	$23.05
J1726	Injection, hydroxyprogesterone caproate, (makena), 10 mg	16	$30.19
J1729	Injection, hydroxyprogesterone caproate	17	$14.57
J1730	Injection, diazoxide, up to 300 mg	13	$112.09
J1737	Injection, meloxicam (azurity), 1 mg	20	$1.06
J1738	Injection, meloxicam, 1 mg	22	$3.31
J1740	Injection, ibandronate sodium, 1 mg	38	$44.42
J1741	Injection, ibuprofen, 100 mg	31	$3.25
J1742	Injection, ibutilide fumarate, 1 mg	32	$222.66
J1743	Injection, idursulfase, 1 mg	38	$570.04
J1744	Injection, icatibant, 1 mg	26	$120.86
J1745	Injection, infliximab, excludes biosimilar, 10 mg	39	$31.48
J1746	Injection, ibalizumab-uiyk, 10 mg	38	$79.51
J1747	Injection, spesolimab-sbzo, 1 mg	36	$65.73
J1748	Injection, infliximab-dyyb (zymfentra), 10 mg	28	$264.72
J1749	Injection, iloprost, 0.1 mcg	18	$5.65
J1750	Injection, iron dextran, 50 mg	39	$18.99
J1756	Injection, iron sucrose, 1 mg	41	$0.23
J1786	Injection, imiglucerase, 10 units	38	$43.23
J1790	Injection, droperidol, up to 5 mg	38	$7.18
J1800	Injection, propranolol hcl, up to 1 mg	35	$6.42
J1805	Injection, esmolol hydrochloride, 10 mg	34	$0.23
J1806	Injection, esmolol hydrochloride (wg critical care)	35	$0.20
J1807	Injection, ethacrynate sodium, 1 mg	16	$28.55
J1808	Injection, folic acid, 0.1 mg	33	$0.05
J1809	Injection, fosdenopterin, 0.1 mg	30	$17.73
J1810	Injection, droperidol and fentanyl citrate	5	$9.50
J1811	Insulin (fiasp) for administration through dme (i.e.	28	$1.73
J1812	Insulin (fiasp), per 5 units	22	$0.385
J1813	Insulin (lyumjev) for administration through dme (i.e.	29	$4.80
J1814	Insulin (lyumjev), per 5 units	23	$0.45
J1815	Injection, insulin, per 5 units	34	$0.665
J1817	Insulin for administration through dme (i.e.	29	$3.06
J1818	Injection, pegzilarginase-nbln, 0.05 mg	5	$286.73
J1823	Injection, inebilizumab-cdon, 1 mg	37	$497.80
J1826	Injection, interferon beta-1a, 30 mcg	21	$2,210.26
J1830	Injection, interferon beta-1b, 0.25 mg	28	$414.46
J1833	Injection, isavuconazonium, 1 mg	25	$1.09
J1834	Injection, isoniazid, 1 mg	18	$0.32
J1835	Injection, itraconazole, 50 mg	14	$42.28
J1836	Injection, metronidazole, 10 mg	36	$0.03
J1837	Injection, posaconazole, 1 mg	33	$0.34
J1885	Injection, ketorolac tromethamine, per 15 mg	39	$0.33
J1890	Injection, cephalothin sodium, up to 1 gram	5	$9.45
J1920	Injection, labetalol hydrochloride, 5 mg	34	$0.26
J1921	Injection, labetalol hydrochloride (hikma)	35	$0.91
J1930	Injection, lanreotide, 1 mg	40	$37.43
J1931	Injection, laronidase, 0.1 mg	37	$41.48
J1932	Injection, lanreotide, (cipla), 1 mg	38	$20.82
J1938	Injection, furosemide, 1 mg	35	$0.02
J1939	Injection, bumetanide, 0.5 mg	36	$0.49
J1940	Injection, furosemide, up to 20 mg	8	$0.39
J1941	Injection, furosemide (furoscix), 20 mg	19	$245.15
J1943	Injection, aripiprazole lauroxil, (aristada initio), 1 mg	38	$3.46
J1944	Injection, aripiprazole lauroxil, (aristada), 1 mg	38	$3.55
J1945	Injection, lepirudin, 50 mg	5	$536.09
J1950	Injection, leuprolide acetate (for depot suspension)	40	$1,799.05
J1951	Injection, leuprolide acetate for depot suspension	39	$141.70
J1952	Leuprolide injectable, camcevi, 1 mg	33	$42.06
J1953	Injection, levetiracetam, 10 mg	30	$0.03
J1954	Injection, leuprolide acetate for depot suspension	30	$683.86
J1955	Injection, levocarnitine, per 1 gm	39	$23.09
J1956	Injection, levofloxacin, 250 mg	37	$2.16
J1958	Injection, levetiracetam in sodium chloride, 5 mg	9	$0.03
J1960	Injection, levorphanol tartrate, up to 2 mg	14	$3.52
J1961	Injection, lenacapavir (only for use as hiv treatment), 1 mg	36	$22.93
J1980	Injection, hyoscyamine sulfate, up to 0.25 mg	27	$35.46
J1990	Injection, chlordiazepoxide hcl, up to 100 mg	16	$21.07
J2001	Injection, lidocaine hcl for intravenous infusion, 10 mg	6	$0.03
J2003	Injection, lidocaine hydrochloride, 1 mg	5	$0.02
J2004	Injection, lidocaine hcl with epinephrine, 1 mg	7	$0.05
J2010	Injection, lincomycin hcl, up to 300 mg	40	$4.23
J2020	Injection, linezolid, 200 mg	39	$2.43
J2021	Injection, linezolid (hospira)	38	$31.61
J2060	Injection, lorazepam, 2 mg	39	$2.20
J2062	Loxapine for inhalation, 1 mg	19	$15.00
J2150	Injection, mannitol, 25% in 50 ml	10	$2.24
J2151	Injection, mannitol, 250 mg	34	$0.07
J2170	Injection, mecasermin, 1 mg	18	$258.28
J2175	Injection, meperidine hydrochloride, per 100 mg	41	$7.04
J2180	Injection, meperidine and promethazine hcl, up to 50 mg	13	$3.79
J2182	Injection, mepolizumab, 1 mg	38	$32.18
J2183	Injection, meropenem (wg critical care)	36	$1.41
J2184	Injection, meropenem (b. braun)	38	$1.92
J2185	Injection, meropenem, 100 mg	37	$0.36
J2186	Injection, meropenem and vaborbactam, 10mg/10mg (20mg)	21	$2.19
J2210	Injection, methylergonovine maleate, up to 0.2 mg	38	$21.55
J2212	Injection, methylnaltrexone, 0.1 mg	19	$1.56
J2246	Injection, micafungin in sodium (baxter)	33	$0.41
J2247	Injection, micafungin sodium	37	$0.22
J2248	Injection, micafungin sodium, 1 mg	39	$0.20
J2249	Injection, remimazolam, 1 mg	22	$2.26
J2250	Injection, midazolam hydrochloride, per 1 mg	38	$0.145
J2251	Injection, midazolam in 0.9% sodium chloride, intravenous	37	$0.12
J2252	Injection, midazolam in 0.8% sodium chloride, intravenous	20	$0.09
J2260	Injection, milrinone lactate, 5 mg	38	$1.14
J2265	Injection, minocycline hydrochloride, 1 mg	16	$2.66
J2267	Injection, mirikizumab-mrkz, 1 mg	38	$32.66
J2270	Injection, morphine sulfate, up to 10 mg	40	$7.14
J2272	Injection, morphine sulfate (fresenius kabi)	39	$8.45
J2274	Injection, morphine sulfate	38	$16.04
J2277	Injection, motixafortide, 0.25 mg	35	$26.48
J2278	Injection, ziconotide, 1 microgram	34	$10.66
J2280	Injection, moxifloxacin, 100 mg	35	$8.74
J2281	Injection, moxifloxacin (fresenius kabi)	36	$6.64
J2290	Injection, nafcillin sodium, 20 mg	34	$0.05
J2291	Injection, nafcillin sodium (baxter), 20 mg	32	$0.15
J2300	Injection, nalbuphine hydrochloride, per 10 mg	39	$4.07
J2305	Injection, nitroglycerin, 5 mg	32	$1.55
J2310	Injection, naloxone hydrochloride, per 1 mg	9	$9.21
J2311	Injection, naloxone hydrochloride (zimhi), 1 mg	6	$1.50
J2312	Injection, naloxone hydrochloride, not otherwise specified	35	$0.07
J2313	Injection, naloxone hydrochloride (zimhi), 0.01 mg	24	$0.02
J2320	Injection, nandrolone decanoate, up to 50 mg	17	$3.79
J2323	Injection, natalizumab, 1 mg	38	$24.41
J2325	Injection, nesiritide, 0.1 mg	21	$60.25
J2326	Injection, nusinersen, 0.1 mg	25	$1,193.52
J2327	Injection, risankizumab-rzaa, intravenous, 1 mg	39	$14.53
J2329	Injection, ublituximab-xiiy, 1mg	39	$71.09
J2350	Injection, ocrelizumab, 1 mg	38	$60.69
J2351	Injection, ocrelizumab, 1 mg and hyaluronidase-ocsq	35	$47.24
J2353	Injection, octreotide	40	$208.10
J2354	Injection, octreotide	38	$0.60
J2355	Injection, oprelvekin, 5 mg	24	$426.92
J2356	Injection, tezepelumab-ekko, 1 mg	37	$17.84
J2357	Injection, omalizumab, 5 mg	38	$45.69
J2358	Injection, olanzapine, long-acting, 1 mg	38	$3.20
J2359	Injection, olanzapine, 0.5 mg	36	$0.69
J2360	Injection, orphenadrine citrate, up to 60 mg	38	$7.78
J2361	Injection, depemokimab-ulaa, 1 mg	20	$270.40
J2372	Injection, phenylephrine hydrochloride (biorphen)	31	$0.16
J2373	Injection, phenylephrine hydrochloride (immphentiv)	32	$0.133
J2374	Apraclonidine hydrochloride ophthalmic, 1% solution, 0.1 ml	16	$28.80
J2401	Injection, chloroprocaine hydrochloride, per 1 mg	34	$0.04
J2402	Injection, chloroprocaine hydrochloride (clorotekal)	18	$0.31
J2403	Chloroprocaine hcl ophthalmic, 3% gel, 1 mg	27	$0.72
J2404	Injection, nicardipine, 0.1 mg	32	$0.07
J2405	Injection, ondansetron hydrochloride, per 1 mg	40	$0.09
J2406	Injection, oritavancin (kimyrsa), 10 mg	38	$44.39
J2407	Injection, oritavancin (orbactiv), 10 mg	40	$29.73
J2410	Injection, oxymorphone hcl, up to 1 mg	23	$2.85
J2425	Injection, palifermin, 50 micrograms	38	$38.69
J2426	Injection, paliperidone palmitate extended release	39	$15.43
J2427	Injection, paliperidone palmitate extended release	38	$13.25
J2428	Injection, paliperidone palmitate extended release	31	$15.59
J2430	Injection, pamidronate disodium, per 30 mg	40	$12.03
J2440	Injection, papaverine hcl, up to 60 mg	29	$30.10
J2460	Injection, oxytetracycline hcl, up to 50 mg	14	$0.94
J2468	Injection, palonosetron hydrochloride (posfrea)	33	$55.23
J2469	Injection, palonosetron hcl, 25 mcg	40	$0.57
J2470	Injection, pantoprazole sodium, 40 mg	20	$2.92
J2471	Injection, pantoprazole (hikma)	21	$3.44
J2472	Injection, pantoprazole sodium in sodium chloride (baxter)	21	$7.94
J2501	Injection, paricalcitol, 1 mcg	41	$0.90
J2502	Injection, pasireotide long acting, 1 mg	33	$592.44
J2503	Injection, pegaptanib sodium, 0.3 mg	7	$785.50
J2504	Injection, pegademase bovine, 25 iu	6	$367.96
J2506	Injection, pegfilgrastim, excludes biosimilar, 0.5 mg	40	$143.23
J2507	Injection, pegloticase, 1 mg	39	$3,929.33
J2508	Injection, pegunigalsidase alfa-iwxj, 1 mg	35	$225.93
J2510	Injection, penicillin g procaine, aqueous	28	$43.38
J2515	Injection, pentobarbital sodium, per 50 mg	32	$24.72
J2516	Injection, pentamidine isethionate, 1 mg	33	$0.24
J2540	Injection, penicillin g potassium, up to 600,000 units	40	$0.68
J2543	Injection, piperacillin sodium/tazobactam sodium	38	$1.18
J2545	Pentamidine isethionate, inhalation solution	35	$73.00
J2547	Injection, peramivir, 1 mg	22	$1.58
J2550	Injection, promethazine hcl, up to 50 mg	41	$3.63
J2560	Injection, phenobarbital sodium, up to 120 mg	39	$24.77
J2561	Injection, phenobarbital sodium (sezaby), 1 mg	25	$1.33
J2562	Injection, plerixafor, 1 mg	40	$30.66
J2590	Injection, oxytocin, up to 10 units	32	$0.87
J2596	Injection, vasopressin (long grove)	31	$1.70
J2597	Injection, desmopressin acetate, per 1 mcg	37	$3.56
J2598	Injection, vasopressin, 1 unit	34	$0.53
J2599	Injection, vasopressin (american regent)	34	$0.83
J2601	Injection, vasopressin (baxter), 1 unit	29	$2.22
J2650	Injection, prednisolone acetate, up to 1 ml	15	$0.52
J2670	Injection, tolazoline hcl, up to 25 mg	10	$3.44
J2675	Injection, progesterone, per 50 mg	37	$0.62
J2679	Injection, fluphenazine hcl, 1.25 mg	36	$7.27
J2680	Injection, fluphenazine decanoate, up to 25 mg	39	$6.17
J2690	Injection, procainamide hcl, up to 1 gm	38	$295.36
J2700	Injection, oxacillin sodium, up to 250 mg	39	$0.76
J2704	Injection, propofol, 10 mg	32	$0.09
J2710	Injection, neostigmine methylsulfate, up to 0.5 mg	33	$0.40
J2711	Injection, neostigmine methylsulfate 0.1 mg and...	18	$0.71
J2720	Injection, protamine sulfate, per 10 mg	39	$1.76
J2724	Injection, protein c concentrate, intravenous, human, 10 iu	37	$15.03
J2725	Injection, protirelin, per 250 mcg	15	$22.08
J2730	Injection, pralidoxime chloride, up to 1 gm	31	$87.81
J2760	Injection, phentolamine mesylate, up to 5 mg	35	$296.85
J2765	Injection, metoclopramide hcl, up to 10 mg	41	$1.00
J2770	Injection, quinupristin/dalfopristin, 500 mg (150/350)	22	$493.97
J2777	Injection, faricimab-svoa, 0.1 mg	39	$32.38
J2778	Injection, ranibizumab, 0.1 mg	39	$51.09
J2779	Injection, ranibizumab, via intravitreal implant (susvimo)	34	$74.80
J2781	Injection, pegcetacoplan, intravitreal, 1 mg	38	$147.81
J2782	Injection, avacincaptad pegol, 0.1 mg	37	$102.92
J2783	Injection, rasburicase, 0.5 mg	36	$386.63
J2785	Injection, regadenoson, 0.1 mg	40	$2.79
J2786	Injection, reslizumab, 1 mg	36	$11.72
J2787	Riboflavin 5'-phosphate, ophthalmic solution	20	$2,280.00
J2788	Injection, rho d immune globulin, human, minidose	39	$26.51
J2789	Riboflavin 5'-phosphate, ophthalmic solution	17	$41,359.62
J2790	Injection, rho d immune globulin, human, full dose	40	$83.10
J2791	Injection, rho(d) immune globulin (human), (rhophylac)	40	$4.86
J2792	Injection, rho d immune globulin, intravenous, human	40	$35.40
J2793	Injection, rilonacept, 1 mg	21	$28.59
J2794	Injection, risperidone (risperdal consta), 0.5 mg	38	$11.10
J2795	Injection, ropivacaine hydrochloride, 1 mg	33	$0.04
J2796	Injection, romiplostim, 10 micrograms	7	$101.05
J2797	Injection, rolapitant, 0.5 mg	17	$0.93
J2798	Injection, risperidone, (perseris), 0.5 mg	37	$12.19
J2799	Injection, risperidone (uzedy), 1 mg	37	$26.18
J2800	Injection, methocarbamol, up to 10 ml	38	$4.51
J2801	Injection, risperidone (rykindo), 0.5 mg	21	$12.29
J2802	Injection, romiplostim, 1 microgram	38	$11.62
J2804	Injection, rifampin, 1 mg	33	$0.17
J2805	Injection, sincalide, 5 micrograms	30	$110.46
J2810	Injection, theophylline, per 40 mg	14	$0.41
J2820	Injection, sargramostim (gm-csf), 50 mcg	39	$62.47
J2840	Injection, sebelipase alfa, 1 mg	29	$510.50
J2850	Injection, secretin, synthetic, human, 1 microgram	24	$34.78
J2860	Injection, siltuximab, 10 mg	36	$173.30
J2865	Injection, sulfamethoxazole 5 mg and trimethoprim 1 mg	33	$0.04
J2916	Injection, sodium ferric gluconate complex in sucrose...	40	$2.20
J2919	Injection, methylprednisolone sodium succinate, 5 mg	39	$0.25
J2941	Injection, somatropin, 1 mg	26	$56.85
J2950	Injection, promazine hcl, up to 25 mg	12	$0.38
J2993	Injection, reteplase, 18.1 mg	20	$2,370.96
J2997	Injection, alteplase recombinant, 1 mg	40	$97.81
J2998	Injection, plasminogen, human-tvmh, 1 mg	29	$37.11
J3000	Injection, streptomycin, up to 1 gm	37	$26.88
J3010	Injection, fentanyl citrate, 0.1 mg	39	$1.36
J3030	Injection, sumatriptan succinate, 6 mg	33	$50.00
J3031	Injection, fremanezumab-vfrm, 1 mg	25	$3.47
J3032	Injection, eptinezumab-jjmr, 1 mg	39	$21.10
J3055	Injection, talquetamab-tgvs, 0.25 mg	37	$76.72
J3060	Injection, taliglucerase alfa, 10 units	38	$42.47
J3070	Injection, pentazocine, 30 mg	25	$108.39
J3090	Injection, tedizolid phosphate, 1 mg	38	$2.06
J3095	Injection, telavancin, 10 mg	38	$7.48
J3101	Injection, tenecteplase, 1 mg	34	$217.42
J3105	Injection, terbutaline sulfate, up to 1 mg	39	$2.47
J3110	Injection, teriparatide, 10 mcg	22	$20.79
J3111	Injection, romosozumab-aqqg, 1 mg	39	$12.73
J3121	Injection, testosterone enanthate, 1 mg	38	$0.05
J3145	Injection, testosterone undecanoate, 1 mg	36	$2.15
J3230	Injection, chlorpromazine hcl, up to 50 mg	39	$18.14
J3240	Injection, thyrotropin alpha, 0.9 mg	39	$2,155.11
J3241	Injection, teprotumumab-trbw, 10 mg	39	$379.90
J3243	Injection, tigecycline, 1 mg	39	$0.52
J3244	Injection, tigecycline (accord)	28	$2.37
J3245	Injection, tildrakizumab, 1 mg	35	$124.27
J3246	Injection, tirofiban hcl, 0.25 mg	30	$2.92
J3247	Injection, secukinumab, intravenous, 1 mg	37	$18.13
J3250	Injection, trimethobenzamide hcl, up to 200 mg	40	$62.42
J3260	Injection, tobramycin sulfate, up to 80 mg	41	$2.19
J3262	Injection, tocilizumab, 1 mg	39	$5.41
J3263	Injection, toripalimab-tpzi, 1 mg	38	$40.65
J3265	Injection, torsemide, 10 mg/ml	16	$2.19
J3268	Injection, delafloxacin, 1 mg	8	$0.48
J3285	Injection, treprostinil, 1 mg	38	$54.74
J3290	Injection, tranexamic acid, 5 mg	16	$0.03
J3291	Injection, tranexamic acid in sodium chloride, 5 mg	17	$0.09
J3299	Injection, triamcinolone acetonide (xipere), 1 mg	35	$47.77
J3300	Injection, triamcinolone acetonide (triesence)	38	$18.78
J3301	Injection, triamcinolone acetonide, not otherwise specified	40	$0.90
J3302	Injection, triamcinolone diacetate, per 5 mg	16	$0.28
J3303	Injection, triamcinolone hexacetonide, per 5 mg	26	$3.61
J3304	Injection, triamcinolone acetonide, preservative-free	39	$19.16
J3305	Injection, trimetrexate glucuronate, per 25 mg	5	$143.58
J3315	Injection, triptorelin pamoate, 3.75 mg	39	$466.37
J3316	Injection, triptorelin, extended-release, 3.75 mg	36	$3,819.93
J3350	Injection, urea, up to 40 gm	10	$67.50
J3357	Ustekinumab, for subcutaneous injection, 1 mg	34	$155.88
J3358	Ustekinumab, for intravenous injection, 1 mg	39	$11.36
J3360	Injection, diazepam, up to 5 mg	41	$6.69
J3364	Injection, urokinase, 5000 iu vial	5	$10.31
J3370	Injection, vancomycin hcl, 500 mg	10	$1.95
J3371	Injection, vancomycin hcl (mylan)	9	$6.31
J3372	Injection, vancomycin hcl (xellia)	9	$6.54
J3373	Injection, vancomycin hydrochloride, 10 mg	39	$0.03
J3374	Injection, vancomycin hydrochloride	36	$0.10
J3375	Injection, vancomycin hydrochloride (tyzavan)	36	$0.14
J3376	Injection, vancomycin hcl (hikma)	31	$0.02
J3379	Injection, valproate sodium, 5 mg	23	$0.04
J3380	Injection, vedolizumab, intravenous, 1 mg	39	$21.37
J3385	Injection, velaglucerase alfa, 100 units	38	$390.50
J3387	Injection, elivaldogene autotemcel, per treatment	5	$3,000,000.00
J3389	Topical administration, prademagene zamikeracel	5	$3,147,000.00
J3391	Injection, atidarsagene autotemcel, per treatment	5	$4,250,000.00
J3392	Injection, exagamglogene autotemcel, per treatment	9	$2,200,490.28
J3393	Injection, betibeglogene autotemcel, per treatment	10	$2,800,000.00
J3394	Injection, lovotibeglogene autotemcel, per treatment	11	$3,100,000.00
J3396	Injection, verteporfin, 0.1 mg	38	$11.37
J3397	Injection, vestronidase alfa-vjbk, 1 mg	24	$282.50
J3398	Injection, voretigene neparvovec-rzyl	20	$3,059.37
J3399	Injection, onasemnogene abeparvovec-xioi, per treatment	12	$2,612,724.78
J3400	Injection, triflupromazine hcl, up to 20 mg	5	$12.69
J3401	Beremagene geperpavec-svdt for topical administration	34	$1,029.47
J3402	Injection, remestemcel-l-rknd, per therapeutic dose	24	$202,159.94
J3403	Revakinagene taroretcel-lwey, per implant	19	$262,233.77
J3404	Injection, zopapogene imadenovec-drba suspension	20	$119,675.51
J3405	Injection, onasemnogene abeparvovec-brve, per treatment	10	$2,664,473.73
J3410	Injection, hydroxyzine hcl, up to 25 mg	38	$14.33
J3411	Injection, thiamine hcl, 100 mg	33	$1.60
J3415	Injection, pyridoxine hcl, 100 mg	31	$15.56
J3420	Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg	40	$0.68
J3424	Injection, hydroxocobalamin, intravenous, 25 mg	14	$5.27
J3430	Injection, phytonadione (vitamin k), per 1 mg	39	$3.25
J3465	Injection, voriconazole, 10 mg	35	$0.58
J3470	Injection, hyaluronidase, up to 150 units	32	$31.78
J3471	Injection, hyaluronidase, ovine, preservative free	26	$0.50
J3472	Injection, hyaluronidase, ovine, preservative free	22	$144.13
J3473	Injection, hyaluronidase, recombinant, 1 usp unit	34	$0.36
J3475	Injection, magnesium sulfate, per 500 mg	39	$0.44
J3480	Injection, potassium chloride, per 2 meq	37	$0.13
J3485	Injection, zidovudine, 10 mg	35	$1.51
J3486	Injection, ziprasidone mesylate, 10 mg	36	$5.94
J3489	Injection, zoledronic acid, 1 mg	40	$5.08
J3490	Unclassified drugs	10	$21.02
J3520	Edetate disodium, per 150 mg	11	$2.86
J7030	Infusion, normal saline solution , 1000 cc	39	$2.19
J7040	Infusion, normal saline solution, sterile (500 ml = 1 unit)	37	$1.35
J7042	5% dextrose/normal saline (500 ml = 1 unit)	37	$1.27
J7050	Infusion, normal saline solution, 250 cc	38	$0.70
J7060	5% dextrose/water (500 ml = 1 unit)	38	$1.75
J7070	Infusion, d5w, 1000 cc	38	$2.95
J7100	Infusion, dextran 40, 500 ml	27	$28.86
J7110	Infusion, dextran 75, 500 ml	17	$14.52
J7120	Ringers lactate infusion, up to 1000 cc	37	$2.37
J7121	5% dextrose in lactated ringers infusion, up to 1000 cc	19	$4.85
J7131	Hypertonic saline solution, 1 ml	12	$0.13
J7165	Injection, prothrombin complex concentrate, human-lans	24	$3.15
J7168	Prothrombin complex concentrate (human), kcentra	23	$2.98
J7169	Injection, coagulation factor xa (recombinant)	24	$133.00
J7170	Injection, emicizumab-kxwh, 0.5 mg	34	$58.03
J7171	Injection, adamts13, recombinant-krhn, 10 iu	35	$35.70
J7172	Injection, marstacimab-hncq, 0.5 mg	30	$50.76
J7173	Injection, concizumab-mtci, 0.5 mg	27	$85.50
J7174	Injection, fitusiran, 0.04 mg	26	$131.91
J7175	Injection, factor x, (human), 1 i.u.	34	$9.95
J7176	Injection, human fibrinogen - chmt (fesilty), 1 mg	10	$1.10
J7177	Injection, human fibrinogen concentrate (fibryga), 1 mg	34	$1.23
J7178	Injection, human fibrinogen concentrate	34	$1.48
J7179	Injection, von willebrand factor (recombinant), (vonvendi)	33	$1.81
J7180	Injection, factor xiii (antihemophilic factor, human)	33	$11.23
J7181	Injection, factor xiii a-subunit, (recombinant), per iu	35	$19.08
J7182	Injection, factor viii, (antihemophilic factor	29	$1.44
J7183	Injection, von willebrand factor complex (human), wilate	34	$1.32
J7185	Injection, factor viii (antihemophilic factor, recombinant)	34	$1.37
J7186	Injection, antihemophilic factor viii/von willebrand factor...	34	$1.26
J7187	Injection, von willebrand factor complex (humate-p)	34	$1.53
J7188	Injection, factor viii (antihemophilic factor, recombinant)	31	$3.24
J7189	Factor viia (antihemophilic factor, recombinant),	33	$2.68
J7190	Factor viii (antihemophilic factor, human) per i.u.	34	$1.25
J7191	Factor viii (antihemophilic factor (porcine)), per i.u.	13	$1.87
J7192	Factor viii (antihemophilic factor, recombinant) per i.u.	34	$1.58
J7193	Factor ix (antihemophilic factor, purified	32	$1.40
J7194	Factor ix, complex, per i.u.	31	$1.74
J7195	Injection, factor ix (antihemophilic factor	32	$1.85
J7196	Injection, antithrombin recombinant, 50 i.u.	15	$102.37
J7197	Antithrombin iii (human), per i.u.	33	$4.17
J7198	Anti-inhibitor, per i.u.	32	$2.44
J7200	Injection, factor ix, (antihemophilic factor, recombinant)	32	$1.71
J7201	Injection, factor ix, fc fusion protein, (recombinant)	33	$3.60
J7202	Injection, factor ix, albumin fusion protein, (recombinant)	35	$5.32
J7203	Injection factor ix, (antihemophilic factor, recombinant)	33	$4.67
J7204	Injection, factor viii, antihemophilic factor (recombinant)	32	$2.29
J7205	Injection, factor viii fc fusion protein (recombinant)	34	$2.47
J7207	Injection, factor viii, (antihemophilic factor	34	$2.12
J7208	Injection, factor viii, (antihemophilic factor	33	$2.74
J7209	Injection, factor viii, (antihemophilic factor	34	$1.18
J7210	Injection, factor viii, (antihemophilic factor	33	$1.61
J7211	Injection, factor viii, (antihemophilic factor	34	$1.57
J7212	Factor viia (antihemophilic factor, recombinant)-jncw	30	$2.25
J7213	Injection, coagulation factor ix (recombinant), ixinity	32	$1.96
J7214	Injection, factor viii/von willebrand factor complex	31	$4.63
J7294	Segesterone acetate and ethinyl estradiol 0.15mg	33	$2,334.79
J7295	Ethinyl estradiol and etonogestrel 0.015mg	29	$140.00
J7296	Levonorgestrel-releasing intrauterine contraceptive system,	41	$1,272.44
J7297	Levonorgestrel-releasing intrauterine contraceptive system	41	$978.32
J7298	Levonorgestrel-releasing intrauterine contraceptive system	41	$1,272.44
J7299	Intrauterine copper contraceptive (miudella)	10	$1,194.86
J7300	Intrauterine copper contraceptive (paragard)	41	$1,187.00
J7301	Levonorgestrel-releasing intrauterine contraceptive system	41	$1,059.52
J7304	Contraceptive supply, hormone containing patch, each	24	$40.72
J7306	Levonorgestrel (contraceptive) implant system	7	$427.50
J7307	Etonogestrel (contraceptive) implant system	41	$1,275.36
J7308	Aminolevulinic acid hcl for topical administration, 20%	33	$389.28
J7309	Methyl aminolevulinate (mal) for topical administration	5	$79.50
J7311	Injection, fluocinolone acetonide, intravitreal implant	33	$338.80
J7312	Injection, dexamethasone, intravitreal implant, 0.1 mg	40	$203.66
J7313	Injection, fluocinolone acetonide, intravitreal implant	39	$516.32
J7314	Injection, fluocinolone acetonide, intravitreal implant	35	$529.89
J7315	Mitomycin, ophthalmic, 0.2 mg	12	$426.56
J7316	Injection, ocriplasmin, 0.125 mg	24	$1,046.93
J7318	Hyaluronan or derivative, durolane	26	$6.31
J7320	Hyaluronan or derivitive, genvisc 850	29	$4.23
J7321	Hyaluronan or derivative, hyalgan, supartz or visco-3	35	$72.14
J7322	Hyaluronan or derivative, hymovis or hymovis one	27	$17.94
J7323	Hyaluronan or derivative, euflexxa	34	$103.60
J7324	Hyaluronan or derivative, orthovisc	34	$111.26
J7325	Hyaluronan or derivative, synvisc or synvisc-one	32	$6.28
J7326	Hyaluronan or derivative, gel-one	29	$528.05
J7327	Hyaluronan or derivative, monovisc	31	$604.76
J7328	Hyaluronan or derivative, gelsyn-3	26	$0.58
J7329	Hyaluronan or derivative, trivisc	24	$3.61
J7330	Autologous cultured chondrocytes, implant	11	$31,905.54
J7331	Hyaluronan or derivative, synojoynt	22	$3.12
J7332	Hyaluronan or derivative, triluron	24	$10.23
J7336	Capsaicin 8% patch, per square centimeter	32	$3.50
J7340	Carbidopa 5 mg/levodopa 20 mg enteral suspension, 100 ml	32	$243.79
J7342	Instillation, ciprofloxacin otic suspension, 6 mg	25	$29.99
J7345	Aminolevulinic acid hcl for topical administration, 10% gel	24	$1.82
J7351	Injection, bimatoprost, intracameral implant, 1 microgram	40	$213.76
J7352	Afamelanotide implant, 1 mg	14	$3,069.13
J7353	Anacaulase-bcdb, 8.8% gel, 1 gram	9	$57.27
J7354	Cantharidin for topical administration, 0.7%	35	$683.47
J7355	Injection, travoprost, intracameral implant, 1 microgram	34	$196.75
J7356	Injection, foscarbidopa 0.25 mg/foslevodopa 5 mg	29	$0.70
J7402	Mometasone furoate sinus implant, (sinuva), 10 micrograms	34	$11.35
J7500	Azathioprine, oral, 50 mg	30	$0.13
J7501	Azathioprine, parenteral, 100 mg	32	$243.30
J7502	Cyclosporine, oral, 100 mg	30	$1.56
J7503	Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg	27	$1.86
J7504	Lymphocyte immune globulin, antithymocyte globulin, equine	36	$5,320.83
J7505	Muromonab-cd3, parenteral, 5 mg	5	$829.70
J7507	Tacrolimus, immediate release, oral, 1 mg	32	$0.20
J7508	Tacrolimus, extended release, (astagraf xl), oral, 0.1 mg	31	$0.60
J7509	Methylprednisolone oral, per 4 mg	31	$0.16
J7510	Prednisolone oral, per 5 mg	29	$0.77
J7511	Lymphocyte immune globulin, antithymocyte globulin, rabbit	36	$1,057.79
J7512	Prednisone, immediate release or delayed release, oral, 1 mg	5	$0.07
J7513	Daclizumab, parenteral, 25 mg	5	$447.39
J7514	Mycophenolate mofetil (myhibbin), oral suspension, 100 mg	16	$2.24
J7515	Cyclosporine, oral, 25 mg	32	$0.578
J7516	Injection, cyclosporine, 250 mg	33	$75.64
J7517	Mycophenolate mofetil, oral, 250 mg	23	$0.14
J7518	Mycophenolic acid, oral, 180 mg	28	$0.32
J7519	Injection, mycophenolate mofetil, 10 mg	26	$0.40
J7520	Sirolimus, oral, 1 mg	29	$0.77
J7521	Tacrolimus, granules, oral suspension, 0.1 mg	26	$1.31
J7525	Tacrolimus, parenteral, 5 mg	35	$254.67
J7526	Injection, mycophenolate mofetil, 5 mg	9	$0.20
J7527	Everolimus, oral, 0.25 mg	27	$1.16
J7528	Mycophenolate mofetil, for suspension, oral, 100 mg	19	$0.20
J7529	Mycophenolate mofetil, for suspension, oral, 5 mg	8	$0.03
J7530	Mycophenolate mofetil (myhibbin), oral suspension, 5 mg	6	$0.12
J7601	Ensifentrine, inhalation suspension	24	$52.12
J7604	Acetylcysteine, inhalation solution, compounded product	6	$3.62
J7605	Arformoterol, inhalation solution	32	$0.72
J7606	Formoterol fumarate, inhalation solution	30	$1.55
J7607	Levalbuterol, inhalation solution, compounded product	6	$1.72
J7608	Acetylcysteine, inhalation solution	32	$7.27
J7609	Albuterol, inhalation solution, compounded product	10	$0.12
J7610	Albuterol, inhalation solution, compounded product	5	$0.12
J7611	Albuterol, inhalation solution, fda-approved final product	32	$0.23
J7612	Levalbuterol, inhalation solution	31	$0.34
J7613	Albuterol, inhalation solution, fda-approved final product	33	$0.07
J7614	Levalbuterol, inhalation solution	31	$0.08
J7615	Levalbuterol, inhalation solution, compounded product	6	$1.32
J7620	Albuterol, up to 2.5 mg and ipratropium bromide	34	$0.20
J7622	Beclomethasone, inhalation solution, compounded product	5	$0.04
J7624	Betamethasone, inhalation solution, compounded product	7	$0.73
J7626	Budesonide, inhalation solution, fda-approved final product	30	$1.05
J7627	Budesonide, inhalation solution, compounded product	14	$2.26
J7628	Bitolterol mesylate, inhalation solution	7	$0.18
J7629	Bitolterol mesylate, inhalation solution	8	$0.18
J7631	Cromolyn sodium, inhalation solution	29	$0.69
J7632	Cromolyn sodium, inhalation solution, compounded product	7	$0.35
J7633	Budesonide, inhalation solution, fda-approved final product	11	$1.94
J7635	Atropine, inhalation solution, compounded product	9	$0.12
J7636	Atropine, inhalation solution, compounded product	8	$0.12
J7637	Dexamethasone, inhalation solution, compounded product	9	$0.11
J7638	Dexamethasone, inhalation solution, compounded product	9	$0.12
J7639	Dornase alfa, inhalation solution	32	$56.78
J7640	Formoterol, inhalation solution, compounded product	8	$2.27
J7641	Flunisolide, inhalation solution, compounded product	6	$0.19
J7642	Glycopyrrolate, inhalation solution, compounded product	9	$1.19
J7643	Glycopyrrolate, inhalation solution, compounded product	7	$1.19
J7644	Ipratropium bromide, inhalation solution	32	$0.44
J7645	Ipratropium bromide, inhalation solution	6	$0.87
J7648	Isoetharine hcl, inhalation solution	8	$0.15
J7649	Isoetharine hcl, inhalation solution	8	$0.18
J7658	Isoproterenol hcl, inhalation solution	7	$4.17
J7659	Isoproterenol hcl, inhalation solution	7	$4.17
J7665	Mannitol, administered through an inhaler, 5 mg	15	$0.71
J7668	Metaproterenol sulfate, inhalation solution	9	$0.22
J7669	Metaproterenol sulfate, inhalation solution	13	$0.43
J7674	Methacholine chloride administered as inhalation solution...	27	$1.90
J7676	Pentamidine isethionate, inhalation solution	7	$97.70
J7677	Revefenacin inhalation solution, fda-approved final product	26	$0.20
J7682	Tobramycin, inhalation solution, fda-approved final product	30	$12.31
J7683	Triamcinolone, inhalation solution, compounded product	7	$0.56
J7684	Triamcinolone, inhalation solution, compounded product	8	$0.56
J7686	Treprostinil, inhalation solution	30	$816.68
J8501	Aprepitant, oral, 5 mg	27	$2.86
J8502	Injection, aprepitant (aponvie), 1 mg	31	$2.00
J8510	Busulfan; oral, 2 mg	20	$24.18
J8515	Cabergoline, oral, 0.25 mg	18	$0.34
J8522	Capecitabine, oral, 50 mg	28	$0.04
J8530	Cyclophosphamide; oral, 25 mg	33	$1.49
J8540	Dexamethasone, oral, 0.25 mg	20	$0.02
J8541	Dexamethasone (hemady), oral, 0.25 mg	18	$0.37
J8560	Etoposide; oral, 50 mg	29	$88.05
J8562	Fludarabine phosphate, oral, 10 mg	5	$74.75
J8565	Gefitinib, oral, 250 mg	8	$133.17
J8600	Melphalan; oral, 2 mg	21	$10.01
J8610	Methotrexate; oral, 2.5 mg	29	$0.15
J8611	Methotrexate (jylamvo), oral, 2.5 mg	22	$18.17
J8612	Methotrexate (xatmep), oral, 2.5 mg	22	$22.43
J8655	Netupitant 300 mg and palonosetron 0.5 mg, oral	32	$455.76
J8670	Rolapitant, oral, 1 mg	20	$2.00
J8700	Temozolomide, oral, 5 mg	30	$0.425
J8705	Topotecan, oral, 0.25 mg	27	$125.33
J9000	Injection, doxorubicin hydrochloride, 10 mg	41	$2.78
J9011	Injection, datopotamab deruxtecan-dlnk, 1 mg	37	$52.38
J9015	Injection, aldesleukin, per single use vial	28	$2,788.07
J9017	Injection, arsenic trioxide, 1 mg	40	$5.07
J9019	Injection, asparaginase (erwinaze), 1,000 iu	7	$427.27
J9020	Injection, asparaginase, not otherwise specified	6	$64.56
J9021	Injection, asparaginase, recombinant, (rylaze), 0.1 mg	39	$58.69
J9022	Injection, atezolizumab, 10 mg	40	$95.86
J9023	Injection, avelumab, 10 mg	40	$108.63
J9024	Injection, atezolizumab, 5 mg and hyaluronidase-tqjs	36	$32.10
J9025	Injection, azacitidine, 1 mg	40	$0.40
J9026	Injection, tarlatamab-dlle, 1 mg	37	$1,575.42
J9027	Injection, clofarabine, 1 mg	37	$15.52
J9028	Injection, nogapendekin alfa inbakicept-pmln	37	$94.14
J9029	Intravesical instillation, nadofaragene firadenovec-vncg	32	$64,306.96
J9030	Bcg live intravesical instillation, 1 mg	39	$3.38
J9032	Injection, belinostat, 10 mg	40	$53.66
J9033	Injection, bendamustine hydrochloride	41	$2.16
J9034	Injection, bendamustine hcl (bendeka), 1 mg	40	$12.53
J9035	Injection, bevacizumab, 10 mg	40	$74.82
J9036	Injection, bendamustine hydrochloride,	36	$11.60
J9037	Injection, belantamab mafodotin-blmf, 0.5 mg	7	$44.13
J9038	Injection, axatilimab-csfr, 0.1 mg	32	$55.65
J9039	Injection, blinatumomab, 1 microgram	40	$168.08
J9040	Injection, bleomycin sulfate, 15 units	41	$23.12
J9041	Injection, bortezomib, 0.1 mg	40	$2.28
J9042	Injection, brentuximab vedotin, 1 mg	40	$269.36
J9043	Injection, cabazitaxel, 1 mg	39	$231.69
J9045	Injection, carboplatin, 50 mg	40	$3.10
J9046	Injection, bortezomib (dr. reddy's)	32	$46.56
J9047	Injection, carfilzomib, 1 mg	40	$60.29
J9048	Injection, bortezomib (fresenius kabi)	32	$2.70
J9049	Injection, bortezomib (hospira)	38	$1.53
J9050	Injection, carmustine, 100 mg	40	$232.62
J9051	Injection, bortezomib (maia)	11	$3.49
J9052	Injection, carmustine (accord)	32	$18.40
J9053	Injection, belantamab mafodotin-blmf, 0.1 mg	28	$36.20
J9054	Injection, bortezomib (boruzu), 0.1 mg	34	$24.75
J9055	Injection, cetuximab, 10 mg	40	$80.86
J9056	Injection, bendamustine hydrochloride (vivimusta), 1 mg	38	$29.91
J9057	Injection, copanlisib, 1 mg	23	$87.56
J9058	Injection, bendamustine hydrochloride (apotex), 1 mg	5	$15.22
J9059	Injection, bendamustine hydrochloride (baxter), 1 mg	5	$15.22
J9060	Injection, cisplatin, powder or solution, 10 mg	40	$2.15
J9061	Injection, amivantamab-vmjw, 2 mg	38	$22.91
J9062	Injection, amivantamab 5 mg and hyaluronidase-lpuj	27	$40.49
J9063	Injection, mirvetuximab soravtansine-gynx, 1 mg	39	$71.58
J9065	Injection, cladribine, per 1 mg	41	$8.19
J9071	Injection, cyclophosphamide (auromedics), 5 mg	35	$0.49
J9072	Injection, cyclophosphamide (frindovyx), 5 mg	37	$8.92
J9073	Injection, cyclophosphamide (dr. reddy's), 5 mg	40	$0.50
J9074	Injection, cyclophosphamide (sandoz), 5 mg	35	$3.44
J9075	Injection, cyclophosphamide, not otherwise specified, 5 mg	39	$0.59
J9076	Injection, cyclophosphamide (baxter), 5 mg	35	$4.45
J9098	Injection, cytarabine liposome, 10 mg	7	$574.42
J9100	Injection, cytarabine, 100 mg	41	$0.85
J9118	Injection, calaspargase pegol-mknl, 10 units	39	$85.37
J9119	Injection, cemiplimab-rwlc, 1 mg	39	$29.67
J9120	Injection, dactinomycin, 0.5 mg	40	$307.99
J9130	Dacarbazine, 100 mg	40	$3.58
J9144	Injection, daratumumab, 10 mg and hyaluronidase-fihj	40	$56.80
J9145	Injection, daratumumab, 10 mg	40	$73.77
J9150	Injection, daunorubicin, 10 mg	40	$26.91
J9151	Injection, daunorubicin citrate, liposomal formulation	5	$65.09
J9153	Injection, liposomal	39	$272.88
J9155	Injection, degarelix, 1 mg	40	$4.48
J9161	Injection, denileukin diftitox-cxdl, 1 mcg	23	$12.83
J9171	Injection, docetaxel, 1 mg	40	$0.47
J9172	Injection, docetaxel (docivyx), 1 mg	36	$46.29
J9173	Injection, durvalumab, 10 mg	40	$87.66
J9174	Injection, docetaxel (beizray), 1 mg	22	$46.53
J9175	Injection, elliotts' b solution, 1 ml	22	$4.16
J9176	Injection, elotuzumab, 1 mg	40	$8.11
J9177	Injection, enfortumab vedotin-ejfv, 0.25 mg	40	$36.65
J9178	Injection, epirubicin hcl, 2 mg	40	$1.97
J9179	Injection, eribulin mesylate, 0.1 mg	40	$63.97
J9181	Injection, etoposide, 10 mg	32	$1.02
J9183	Gemcitabine intravesical system, 225 mg	31	$72,984.24
J9184	Injection, gemcitabine hydrochloride (avyxa), 200 mg	31	$400.33
J9185	Injection, fludarabine phosphate, 50 mg	40	$177.92
J9186	Injection, etoposide (avyxa), 1 mg	8	$4.24
J9187	Injection, etoposide, 1 mg	8	$0.09
J9190	Injection, fluorouracil, 500 mg	33	$2.02
J9191	Injection, fluorouracil (avyxa), 10 mg	9	$14.84
J9192	Injection, fluorouracil, 10 mg	8	$0.04
J9196	Injection, gemcitabine hydrochloride (accord)	36	$5.29
J9198	Injection, gemcitabine hydrochloride, (infugem), 100 mg	24	$40.28
J9200	Injection, floxuridine, 500 mg	40	$4,389.85
J9201	Injection, gemcitabine hydrochloride	40	$2.88
J9202	Goserelin acetate implant, per 3.6 mg	26	$777.50
J9203	Injection, gemtuzumab ozogamicin, 0.1 mg	36	$243.87
J9204	Injection, mogamulizumab-kpkc, 1 mg	39	$253.47
J9205	Injection, irinotecan liposome, 1 mg	40	$65.86
J9206	Injection, irinotecan, 20 mg	40	$1.79
J9207	Injection, ixabepilone, 1 mg	40	$139.75
J9208	Injection, ifosfamide, 1 gram	41	$27.61
J9209	Injection, mesna, 200 mg	40	$1.32
J9210	Injection, emapalumab-lzsg, 1 mg	35	$391.86
J9211	Injection, idarubicin hydrochloride, 5 mg	38	$38.13
J9213	Injection, interferon, alfa-2a, recombinant, 3 million units	16	$40.53
J9214	Injection, interferon, alfa-2b, recombinant, 1 million units	26	$32.57
J9215	Injection, interferon, alfa-n3, (human leukocyte derived)	19	$18.46
J9216	Injection, interferon, gamma 1-b, 3 million units	30	$6,665.02
J9217	Leuprolide acetate (for depot suspension), 7.5 mg	40	$170.78
J9218	Leuprolide acetate, per 1 mg	32	$8.96
J9219	Leuprolide acetate implant, 65 mg	19	$4,819.82
J9220	Injection, indigotindisulfonate sodium, 1 mg	12	$10.00
J9223	Injection, lurbinectedin, 0.1 mg	39	$215.72
J9225	Histrelin implant (vantas), 50 mg	25	$5,166.29
J9226	Histrelin implant (supprelin la), 50 mg	35	$37,837.55
J9227	Injection, isatuximab-irfc, 10 mg	40	$88.16
J9228	Injection, ipilimumab, 1 mg	40	$187.17
J9229	Injection, inotuzumab ozogamicin, 0.1 mg	36	$2,816.77
J9230	Injection, mechlorethamine hydrochloride,	24	$321.72
J9232	Injection, docetaxel (hospira)	27	$0.51
J9245	Injection, melphalan hydrochloride, not otherwise specified	39	$104.89
J9246	Injection, melphalan (evomela), 1 mg	32	$18.57
J9247	Injection, melphalan flufenamide, 1mg	6	$492.29
J9248	Injection, melphalan (hepzato), 1 mg	26	$796.21
J9249	Injection, melphalan (apotex), 1 mg	13	$61.11
J9255	Injection, methotrexate (accord)	12	$1.90
J9256	Injection, nipocalimab-aahu, 3 mg	33	$32.32
J9259	Injection, paclitaxel protein-bound particles	5	$15.45
J9260	Injection, methotrexate sodium, 50 mg	40	$2.91
J9261	Injection, nelarabine, 50 mg	39	$65.16
J9262	Injection, omacetaxine mepesuccinate, 0.01 mg	27	$3.95
J9263	Injection, oxaliplatin, 0.5 mg	40	$0.06
J9264	Injection, paclitaxel protein-bound particles, 1 mg	40	$6.59
J9266	Injection, pegaspargase, per single dose vial	38	$28,642.22
J9267	Injection, paclitaxel, 1 mg	40	$0.11
J9268	Injection, pentostatin, 10 mg	38	$2,612.89
J9269	Injection, tagraxofusp-erzs, 10 micrograms	37	$357.02
J9270	Injection, plicamycin, 2.5 mg	5	$94.50
J9271	Injection, pembrolizumab, 1 mg	40	$60.65
J9272	Injection, dostarlimab-gxly, 10 mg	39	$247.44
J9273	Injection, tisotumab vedotin-tftv, 1 mg	36	$196.07
J9274	Injection, tebentafusp-tebn, 1 microgram	38	$222.49
J9275	Injection, cosibelimab-ipdl, 2 mg	15	$21.99
J9276	Injection, zanidatamab-hrii, 2 mg	37	$25.66
J9277	Injection, pembrolizumab	34	$32.03
J9278	Injection, carboplatin (avyxa), 1 mg	33	$5.20
J9280	Injection, mitomycin, 5 mg	40	$34.11
J9281	Mitomycin pyelocalyceal instillation, 1 mg	37	$323.91
J9282	Mitomycin, intravesical instillation, 1 mg	27	$272.92
J9285	Injection, olaratumab, 10 mg	23	$52.07
J9286	Injection, glofitamab-gxbm, 2.5 mg	37	$2,859.12
J9289	Injection, nivolumab, 2 mg and hyaluronidase-nvhy	35	$27.99
J9292	Injection, pemetrexed dipotassium, 10 mg	34	$76.69
J9293	Injection, mitoxantrone hydrochloride, per 5 mg	40	$29.70
J9294	Injection, pemetrexed (hospira)	39	$3.68
J9295	Injection, necitumumab, 1 mg	36	$5.73
J9296	Injection, pemetrexed (accord)	37	$9.66
J9297	Injection, pemetrexed (sandoz)	38	$4.88
J9298	Injection, nivolumab and relatlimab-rmbw, 3 mg/1 mg	40	$201.76
J9299	Injection, nivolumab, 1 mg	40	$33.69
J9301	Injection, obinutuzumab, 10 mg	40	$84.46
J9302	Injection, ofatumumab, 10 mg	33	$63.69
J9303	Injection, panitumumab, 10 mg	40	$182.19
J9304	Injection, pemetrexed (pemfexy), 10 mg	36	$37.22
J9305	Injection, pemetrexed, not otherwise specified, 10 mg	40	$3.99
J9306	Injection, pertuzumab, 1 mg	40	$17.02
J9307	Injection, pralatrexate, 1 mg	40	$384.57
J9308	Injection, ramucirumab, 5 mg	40	$76.40
J9309	Injection, polatuzumab vedotin-piiq, 1 mg	39	$140.92
J9311	Injection, rituximab 10 mg and hyaluronidase	40	$36.39
J9312	Injection, rituximab, 10 mg	39	$73.28
J9313	Injection, moxetumomab pasudotox-tdfk, 0.01 mg	31	$23.39
J9314	Injection, pemetrexed (teva)	36	$10.99
J9315	Injection, romidepsin, 1 mg	5	$319.87
J9316	Injection, pertuzumab, trastuzumab, and hyaluronidase-zzxf	39	$59.90
J9317	Injection, sacituzumab govitecan-hziy, 2.5 mg	39	$37.20
J9318	Injection, romidepsin, non-lyophilized, 0.1 mg	33	$31.67
J9319	Injection, romidepsin, lyophilized, 0.1 mg	37	$30.91
J9320	Injection, streptozocin, 1 gram	32	$370.18
J9321	Injection, epcoritamab-bysp, 0.16 mg	39	$56.92
J9322	Injection, pemetrexed (bluepoint)	19	$10.00
J9323	Injection, pemetrexed ditromethamine, 10 mg	33	$0.13
J9324	Injection, pemetrexed (pemrydi rtu), 10 mg	32	$67.94
J9325	Injection, talimogene laherparepvec	39	$77.02
J9326	Injection, telisotuzumab vedotin-tllv, 1 mg	34	$145.95
J9328	Injection, temozolomide, 1 mg	38	$10.40
J9329	Injection, tislelizumab-jsgr, 1mg	34	$58.17
J9330	Injection, temsirolimus, 1 mg	40	$31.46
J9331	Injection, sirolimus protein-bound particles, 1 mg	36	$89.10
J9332	Injection, efgartigimod alfa-fcab, 2mg	36	$32.35
J9333	Injection, rozanolixizumab-noli, 1 mg	37	$23.58
J9334	Injection, efgartigimod alfa, 2 mg and hyaluronidase-qvfc	37	$34.12
J9340	Injection, thiotepa, 15 mg	9	$245.05
J9341	Injection, thiotepa (tepylute), 1 mg	34	$37.84
J9342	Injection, thiotepa, not otherwise specified, 1 mg	36	$5.87
J9345	Injection, retifanlimab-dlwr, 1 mg	38	$30.93
J9347	Injection, tremelimumab-actl, 1 mg	38	$146.89
J9348	Injection, naxitamab-gqgk, 1 mg	36	$684.90
J9349	Injection, tafasitamab-cxix, 2 mg	38	$14.40
J9350	Injection, mosunetuzumab-axgb, 1 mg	37	$674.49
J9351	Injection, topotecan, 0.1 mg	40	$2.11
J9352	Injection, trabectedin, 0.1 mg	32	$391.07
J9353	Injection, margetuximab-cmkb, 5 mg	36	$55.28
J9354	Injection, ado-trastuzumab emtansine, 1 mg	40	$43.12
J9355	Injection, trastuzumab, excludes biosimilar, 10 mg	40	$70.24
J9356	Injection, trastuzumab, 10 mg and hyaluronidase-oysk	39	$58.34
J9357	Injection, valrubicin, intravesical, 200 mg	37	$1,247.05
J9358	Injection, fam-trastuzumab deruxtecan-nxki, 1 mg	40	$32.65
J9359	Injection, loncastuximab tesirine-lpyl, 0.075 mg	35	$221.49
J9360	Injection, vinblastine sulfate, 1 mg	41	$5.60
J9361	Injection, efbemalenograstim alfa-vuxw, 0.5 mg	15	$117.30
J9362	Injection, trabectedin, 0.01 mg	8	$41.84
J9370	Vincristine sulfate, 1 mg	41	$9.43
J9376	Injection, pozelimab-bbfg, 1 mg	20	$86.54
J9380	Injection, teclistamab-cqyv, 0.5 mg	36	$35.32
J9381	Injection, teplizumab-mzwv, 5 mcg	38	$39.21
J9382	Injection, zenocutuzumab-zbco, 1 mg	33	$33.86
J9390	Injection, vinorelbine tartrate, 10 mg	40	$4.29
J9393	Injection, fulvestrant (teva)	30	$21.20
J9394	Injection, fulvestrant	38	$27.11
J9395	Injection, fulvestrant, 25 mg	39	$5.28
J9400	Injection, ziv-aflibercept, 1 mg	40	$8.67
J9600	Injection, porfimer sodium, 75 mg	21	$18,603.95
J9601	Injection, linvoseltamab-gcpt, 1 mg	33	$99.13
M0249	Intravenous infusion, tocilizumab	27	$450.00
M0250	Intravenous infusion, tocilizumab	27	$450.00
P9043	Infusion, plasma protein fraction (human), 5%, 50 ml	19	$10.00
Q0083	Chemotherapy administration by other than infusion technique...	7	$18.49
Q0084	Chemotherapy administration by infusion technique only	8	$40.69
Q0085	Chemotherapy administration by both infusion technique and...	6	$51.81
Q0091	Screening papanicolaou smear; obtaining	19	$29.39
Q0111	Wet mounts, including preparations of vaginal	41	$14.83
Q0112	All potassium hydroxide (koh) preparations	42	$5.17
Q0114	Fern test	36	$8.77
Q0138	Injection, ferumoxytol	40	$0.36
Q0139	Injection, ferumoxytol	35	$0.37
Q0163	Diphenhydramine hydrochloride, 50 mg, oral	22	$0.25
Q0169	Promethazine hydrochloride, 12.5 mg, oral	23	$0.04
Q0175	Perphenazine, 4 mg, oral	21	$0.55
Q0180	Dolasetron mesylate, 100 mg, oral	20	$77.09
Q0238	Injection, tocilizumab-aazg	13	$5.58
Q0247	Injection, sotrovimab, 500 mg	8	$2,394.00
Q0510	Pharmacy supply fee for initial immunosuppressive drug(s)	5	$10.90
Q0511	Pharmacy supply fee for oral anti-cancer	6	$12.60
Q0512	Pharmacy supply fee for oral anti-cancer	6	$8.40
Q0514	Pharmacy dispensing fee for inhalation drug(s); per 90 days	5	$17.30
Q2004	Irrigation solution for treatment of bladder calculi	8	$61.78
Q2035	Influenza virus vaccine, split virus	17	$18.24
Q2036	Influenza virus vaccine, split virus	12	$9.11
Q2038	Influenza virus vaccine, split virus	13	$14.75
Q2039	Influenza virus vaccine, not otherwise specified	8	$16.90
Q2041	Axicabtagene ciloleucel	18	$555,700.45
Q2042	Tisagenlecleucel, up to 600 million car-positive viable t...	17	$611,693.17
Q2043	Sipuleucel-t, minimum of 50 million autologous cd54+ cells...	33	$55,663.13
Q2049	Injection, doxorubicin hydrochloride, liposomal	23	$503.63
Q2053	Brexucabtagene autoleucel	20	$489,450.20
Q2054	Lisocabtagene maraleucel	20	$562,231.04
Q2055	Idecabtagene vicleucel	21	$558,081.73
Q2056	Ciltacabtagene autoleucel	19	$587,649.57
Q2057	Afamitresgene autoleucel	20	$773,096.35
Q2058	Obecabtagene autoleucel	14	$293,725.70
Q3027	Injection, interferon beta-1a, 1 mcg for intramuscular use	30	$55.62
Q3028	Injection, interferon beta-1a, 1 mcg for subcutaneous use	17	$22.73
Q4001	Casting supplies, body cast adult, with or without head	25	$53.88
Q4002	Cast supplies, body cast adult, with or without head	26	$200.56
Q4003	Cast supplies, shoulder cast, adult (11 years +), plaster	26	$38.11
Q4004	Cast supplies, shoulder cast, adult (11 years +), fiberglass	26	$131.95
Q4005	Cast supplies, long arm cast, adult (11 years +), plaster	27	$14.27
Q4006	Cast supplies, long arm cast, adult (11 years +), fiberglass	27	$32.14
Q4007	Cast supplies, long arm cast, pediatric (0-10 years)	27	$7.13
Q4008	Cast supplies, long arm cast, pediatric (0-10 years)	27	$16.06
Q4009	Cast supplies, short arm cast, adult (11 years +), plaster	27	$9.53
Q4010	Cast supplies, short arm cast, adult (11 years +)	28	$21.11
Q4011	Cast supplies, short arm cast, pediatric (0-10 years)	28	$4.85
Q4012	Cast supplies, short arm cast, pediatric (0-10 years)	26	$10.58
Q4013	Cast supplies, gauntlet cast	27	$17.34
Q4014	Cast supplies, gauntlet cast	27	$29.24
Q4015	Cast supplies, gauntlet cast	27	$8.69
Q4016	Cast supplies, gauntlet cast	27	$14.61
Q4017	Cast supplies, long arm splint, adult (11 years +), plaster	27	$10.02
Q4018	Cast supplies, long arm splint, adult (11 years +)	27	$15.96
Q4019	Cast supplies, long arm splint, pediatric (0-10 years)	27	$5.01
Q4020	Cast supplies, long arm splint, pediatric (0-10 years)	27	$7.78
Q4021	Cast supplies, short arm splint, adult (11 years +), plaster	27	$7.42
Q4022	Cast supplies, short arm splint, adult (11 years +)	28	$13.20
Q4023	Cast supplies, short arm splint, pediatric (0-10 years)	27	$3.72
Q4024	Cast supplies, short arm splint, pediatric (0-10 years)	27	$6.70
Q4025	Cast supplies, hip spica (one or both legs), adult	26	$40.96
Q4026	Cast supplies, hip spica (one or both legs), adult	26	$127.94
Q4027	Cast supplies, hip spica (one or both legs), pediatric	26	$20.50
Q4028	Cast supplies, hip spica (one or both legs), pediatric	26	$64.01
Q4029	Cast supplies, long leg cast, adult (11 years +), plaster	27	$31.81
Q4030	Cast supplies, long leg cast, adult (11 years +), fiberglass	27	$83.74
Q4031	Cast supplies, long leg cast, pediatric (0-10 years)	27	$15.89
Q4032	Cast supplies, long leg cast, pediatric (0-10 years)	27	$41.87
Q4033	Cast supplies, long leg cylinder cast, adult (11 years +)	27	$29.68
Q4034	Cast supplies, long leg cylinder cast, adult (11 years +)	27	$72.68
Q4035	Cast supplies, long leg cylinder cast, pediatric	27	$14.83
Q4036	Cast supplies, long leg cylinder cast, pediatric	27	$36.92
Q4037	Cast supplies, short leg cast, adult (11 years +), plaster	27	$18.08
Q4038	Cast supplies, short leg cast, adult (11 years +)	29	$43.99
Q4039	Cast supplies, short leg cast, pediatric (0-10 years)	27	$9.07
Q4040	Cast supplies, short leg cast, pediatric (0-10 years)	27	$22.67
Q4041	Cast supplies, long leg splint, adult (11 years +), plaster	27	$22.01
Q4042	Cast supplies, long leg splint, adult (11 years +)	27	$37.57
Q4043	Cast supplies, long leg splint, pediatric (0-10 years)	27	$11.01
Q4044	Cast supplies, long leg splint, pediatric (0-10 years)	27	$18.82
Q4045	Cast supplies, short leg splint, adult (11 years +), plaster	28	$12.59
Q4046	Cast supplies, short leg splint, adult (11 years +)	27	$20.55
Q4047	Cast supplies, short leg splint, pediatric (0-10 years)	27	$6.36
Q4048	Cast supplies, short leg splint, pediatric (0-10 years)	27	$10.28
Q4049	Finger splint, static	26	$2.26
Q4074	Iloprost, inhalation solution, fda-approved final product	25	$158.91
Q4081	Injection, epoetin alfa, 100 units (for esrd on dialysis)	40	$0.69
Q4101	Apligraf, per square centimeter (add-on	41	$31.01
Q4106	Dermagraft, per square centimeter	10	$37.75
Q4114	Integra flowable wound matrix, injectable, 1 cc	19	$1,494.41
Q4118	Matristem micromatrix, 1 mg	15	$2.54
Q4133	Grafix prime, grafixpl prime, stravix and stravixpl	33	$131.49
Q4137	Amnioexcel, amnioexcel plus or biodexcel	17	$101.72
Q4145	Epifix, injectable, 1 mg	13	$19.48
Q4147	Architect, architect px, or architect fx	9	$101.16
Q4148	Neox cord 1k, neox cord rt, or clarix cord 1k	10	$110.55
Q4151	Amnioband or guardian, per square centimeter (add-on	24	$124.10
Q4154	Biovance, per square centimeter (add-on	19	$127.14
Q4161	Bio-connekt wound matrix, per square centimeter (add-on	12	$127.27
Q4163	Woundex, bioskin, per square centimeter (add-on	14	$127.20
Q4164	Helicoll, per square centimeter (add-on	12	$872.81
Q4168	Amnioband, 1 mg	10	$17.16
Q4173	Palingen or palingen xplus, per square centimeter (add-on	14	$168.54
Q4174	Palingen or promatrx, 0.36 mg per 0.25 cc	10	$291.27
Q4180	Revita, per square centimeter (add-on	13	$127.28
Q4186	Epifix, per square centimeter (add-on	39	$151.16
Q4188	Amnioarmor, per square centimeter (add-on	12	$127.20
Q4190	Artacent ac, per square centimeter (add-on	11	$112.32
Q4191	Restorigin, per square centimeter (add-on	13	$163.83
Q4195	Puraply, per square centimeter (add-on	23	$101.84
Q4196	Puraply am, per square centimeter (add-on	25	$103.75
Q4197	Puraply xt, per square centimeter (add-on	21	$83.49
Q4204	Xwrap, per square centimeter (add-on	10	$123.60
Q4205	Membrane graft or membrane wrap, per square centimeter	13	$309.32
Q4208	Novafix, per square cenitmeter (add-on	8	$106.44
Q4217	Woundfix, biowound, woundfix plus, biowound plus	13	$127.28
Q4226	Myown skin, includes harvesting and preparation procedures	12	$386.49
Q4229	Cogenex amniotic membrane, per square centimeter (add-on	12	$117.64
Q4235	Amniorepair or altiply, per square centimeter (add-on	12	$95.15
Q4236	Carepatch, per square centimeter (add-on	10	$288.34
Q4246	Coretext or protext, per cc	11	$2,968.00
Q4250	Amnioamp-mp, per square centimeter (add-on	9	$119.93
Q4252	Vendaje, per square centimeter (add-on	14	$82.32
Q4253	Zenith amniotic membrane, per square centimeter (add-on	12	$110.64
Q4256	Mlg-complete, per square centimeter (add-on	11	$183.76
Q4259	Celera dual layer or celera dual membrane	14	$445.94
Q4261	Tag, per square centimeter (add-on	7	$92.95
Q4264	Cocoon membrane, per square centimeter (add-on	10	$93.09
Q4266	Neostim membrane, per square centimeter (add-on	12	$131.18
Q4267	Neostim dl, per square centimeter (add-on	13	$127.26
Q4269	Surgraft xt, per square centimeter (add-on	9	$119.93
Q4270	Complete sl, per square centimeter (add-on	9	$119.93
Q4271	Complete ft, per square centimeter (add-on	15	$285.34
Q4274	Esano ac, per square centimeter (add-on	10	$123.60
Q4275	Esano aca, per square centimeter (add-on	10	$123.60
Q4278	Epieffect, per square centimeter (add-on	14	$158.99
Q4281	Barrera sl or barrera dl, per square centimeter (add-on	12	$127.27
Q4282	Cygnus dual, per square centimeter (add-on	15	$127.28
Q4283	Biovance tri-layer or biovance 3l, per square centimeter	12	$127.27
Q4285	Nudyn dl or nudyn dl mesh, per square centimeter (add-on	8	$106.44
Q4286	Nudyn sl or nudyn slw, per square centimeter (add-on	8	$106.44
Q4290	Membrane wrap-hydro, per square centimeter (add-on	11	$119.93
Q4293	Acesso dl, per square centimeter (add-on	11	$119.93
Q4294	Amnio quad-core, per square centimeter (add-on	11	$127.26
Q4295	Amnio tri-core amniotic, per square centimeter (add-on	10	$106.44
Q4296	Rebound matrix, per square centimeter (add-on	11	$119.93
Q4297	Emerge matrix, per square centimeter (add-on	11	$119.93
Q4299	Amniocore pro+, per square centimeter (add-on	10	$106.44
Q4301	Activate matrix, per square centimeter (add-on	11	$119.93
Q4304	Grafix plus, per square centimeter (add-on	12	$123.60
Q4309	Via matrix, per square centimeter (add-on	10	$106.44
Q4310	Procenta, per 100 mg	15	$1,411.09
Q4313	Dermabind fm, per square centimeter (add-on	9	$92.95
Q4319	Sanograft, per square centimeter (add-on	9	$92.95
Q4322	Caregraft, per square centimeter (add-on	10	$106.44
Q4323	Alloply, per square centimeter (add-on	9	$92.95
Q4325	Acapatch, per square centimeter (add-on	9	$92.95
Q4328	Most, per square centimeter (add-on	9	$92.95
Q4343	Dermacyte ac matrix amniotic membrane allograft	10	$106.44
Q4355	Abiomend xplus membrane and abiomend xplus hydromembrane	9	$92.95
Q4358	Xwrap dual, per square centimeter (add-on	9	$92.95
Q4359	Choriply, per square centimeter (add-on	9	$92.95
Q5098	Injection, ustekinumab-srlf (imuldosa), biosimilar, 1 mg	24	$11.48
Q5099	Injection, ustekinumab-stba (steqeyma), biosimilar, 1 mg	31	$3.07
Q5100	Injection, ustekinumab-kfce (yesintek), biosimilar, 1 mg	32	$3.29
Q5101	Injection, filgrastim-sndz, biosimilar, (zarxio)	40	$0.35
Q5103	Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg	38	$27.71
Q5104	Injection, infliximab-abda, biosimilar, (renflexis), 10 mg	39	$26.62
Q5105	Injection, epoetin alfa-epbx, biosimilar, (retacrit)	37	$0.79
Q5106	Injection, epoetin alfa-epbx, biosimilar, (retacrit)	39	$7.97
Q5107	Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg	40	$24.53
Q5110	Injection, filgrastim-aafi, biosimilar, (nivestym)	36	$0.32
Q5111	Injection, pegfilgrastim-cbqv (udenyca), biosimilar, 0.5 mg	39	$149.13
Q5112	Injection, trastuzumab-dttb, biosimilar, (ontruzant), 10 mg	35	$27.27
Q5116	Injection, trastuzumab-qyyp, biosimilar, (trazimera), 10 mg	36	$12.17
Q5117	Injection, trastuzumab-anns, biosimilar, (kanjinti), 10 mg	37	$60.52
Q5118	Injection, bevacizumab-bvzr, biosimilar, (zirabev), 10 mg	37	$25.89
Q5119	Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg	39	$14.54
Q5120	Injection, pegfilgrastim-bmez (ziextenzo), biosimilar	38	$132.10
Q5121	Injection, infliximab-axxq, biosimilar, (avsola), 10 mg	38	$30.83
Q5123	Injection, rituximab-arrx, biosimilar, (riabni), 10 mg	38	$20.90
Q5124	Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg	34	$240.97
Q5125	Injection, filgrastim-ayow, biosimilar, (releuko)	38	$0.31
Q5126	Injection, bevacizumab-maly, biosimilar, (alymsys), 10 mg	36	$74.12
Q5129	Injection, bevacizumab-adcd (vegzelma), biosimilar, 10 mg	38	$23.65
Q5133	Injection, tocilizumab-bavi (tofidence), biosimilar, 1 mg	31	$5.01
Q5134	Injection, natalizumab-sztn (tyruko), biosimilar, 1 mg	23	$24.40
Q5135	Injection, tocilizumab-aazg (tyenne), biosimilar, 1 mg	35	$4.20
Q5136	Injection, denosumab-bbdz (jubbonti/wyost), biosimilar, 1 mg	28	$27.22
Q5138	Injection, ustekinumab-auub (wezlana), biosimilar	19	$2.35
Q5140	Injection, adalimumab-fkjp, biosimilar, 1 mg	13	$24.88
Q5143	Injection, adalimumab-adbm, biosimilar, 1 mg	14	$33.59
Q5145	Injection, adalimumab-afzb (abrilada), biosimilar, 1 mg	12	$19.79
Q5146	Injection, trastuzumab-strf (hercessi), biosimilar, 10 mg	30	$32.46
Q5147	Injection, aflibercept-ayyh (pavblu), biosimilar, 1 mg	36	$803.26
Q5148	Injection, filgrastim-txid (nypozi), biosimilar, 1 microgram	27	$1.03
Q5156	Injection, tocilizumab-anoh (avtozma), biosimilar, 1 mg	27	$4.60
Q5158	Injection, denosumab-bnht (bomyntra/conexxence), biosimilar	30	$28.76
Q5160	Injection, bevacizumab-nwgd (jobevne), biosimilar, 10 mg	24	$82.19
Q5161	Injection, denosumab-kyqq (aukelso/bosaya), biosimilar, 1 mg	20	$27.34
Q5162	Injection, denosumab-nxxp (bildyos/bilprevda), biosimilar	31	$15.41
Q5164	Injection, ustekinumab-hmny (starjemza), biosimilar, 1 mg	15	$4.52
Q5167	Injection, denosumab-qbde (enoby/xtrenbo), biosimilar, 1 mg	21	$6.56
Q9950	Injection, sulfur hexafluoride lipid microspheres, per ml	27	$18.13
Q9953	Injection, iron-based magnetic resonance contrast agent	19	$62.05
Q9954	Oral magnetic resonance contrast agent, per 100 ml	19	$11.66
Q9955	Injection, perflexane lipid microspheres, per ml	8	$14.86
Q9957	Injection, perflutren lipid microspheres, per ml	33	$40.85
Q9961	High osmolar contrast material	24	$0.22
Q9966	Low osmolar contrast material	37	$0.43
Q9968	Injection, non-radioactive, non-contrast	15	$3.83
Q9982	Flutemetamol f18, diagnostic, per study dose	7	$3,342.24
Q9983	Florbetaben f18, diagnostic, per study dose	8	$3,317.76
Q9991	Injection, buprenorphine extended-release (sublocade)	37	$2,060.13
Q9992	Injection, buprenorphine extended-release (sublocade)	37	$2,060.13
Q9997	Injection, ustekinumab-ttwe (pyzchiva), intravenous, 1 mg	30	$8.55
Q9998	Injection, ustekinumab-aekn (selarsdi), biosimilar, 1 mg	30	$10.69
Q9999	Injection, ustekinumab-aauz (otulfi), biosimilar, 1 mg	29	$13.25
S0013	Esketamine, nasal spray, 1 mg	7	$14.19
S0078	Injection, fosphenytoin sodium, 750 mg	6	$29.97
S0088	Imatinib, 100 mg	6	$12.52
S0093	Injection, morphine sulfate, 500 mg	5	$26.54
S0106	Bupropion hcl sustained release tablet, 150 mg	5	$20.45
S0108	Mercaptopurine, oral, 50 mg	6	$1.64
S0119	Ondansetron, oral, 4 mg	8	$0.215
S0156	Exemestane, 25 mg	5	$10.67
S0175	Flutamide, oral, 125 mg	5	$2.21
S0182	Procarbazine hydrochloride, oral, 50 mg	6	$145.24
S1091	Stent, non-coronary, temporary, with delivery system	7	$1,350.00
S4993	Contraceptive pills for birth control	25	$12.69
S5550	Insulin, rapid onset, 5 units	5	$0.42
S5551	Insulin, most rapid onset (lispro or aspart); 5 units	5	$0.37
S5552	Insulin, intermediate acting (nph or lente); 5 units	5	$0.22
S5553	Insulin, long acting; 5 units	5	$0.33

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