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

About this line

What the pharmacy line covers

The pharmacy line groups the codes billed mostly by practices and clinics that administer vaccines and drugs. Across the 51 state programs we cover, 1,422 codes in this line have a published fee-for-service rate in five or more states. By code set, the line is made up of 1,131 HCPCS Level II drug codes, 218 HCPCS Level II temporary codes, 33 CPT medicine codes and 16 HCPCS Level II temporary national codes and a few others.

How to read the index

Code opens the code's page: every state's rate ranked, the unit, a per-hour figure for timed codes, the managed-care rule and a Medicare comparison where the units match.
States is the number of state Medicaid programs that publish a fee-for-service rate for the code. A higher count makes the median more representative.
Median rate is the middle published amount across those states, in the units they use. When states publish a code in different units, the median mixes them, so open the code before relying on it.

Why pharmacy rates differ between states

Drugs given in a practice or clinic are commonly priced from a benchmark such as average sales price or wholesale acquisition cost, which moves every quarter.
For children, many vaccines are supplied through the federal Vaccines for Children program, so the Medicaid payment can be for administration only.
States differ in whether they pay a fixed fee, a percentage of a benchmark or invoice cost.

Billing and units

Drug codes are billed in units of the dose stated in the code, so a larger dose bills more units. Many states require the National Drug Code (NDC) on the claim alongside the billing code.

FAQ

Frequently asked questions

How many pharmacy codes have Medicaid rates here?

1,422 codes with a published fee-for-service rate in at least five state Medicaid programs, 169 of them in 40 or more states. The typical code in this line is published by 32 states.

Which pharmacy codes are published by the most states?

90740 (46 states), 90656 (45 states), 90658 (45 states), 90651 (44 states) and 90653 (44 states).

Can I compare the median rates in this list?

Only with care. Each median is taken across the states that publish the code, in the units they publish it in. Open a code to see the unit each state uses and whether the code is ranked like-for-like.

How are pharmacy services billed?

Drug codes are billed in units of the dose stated in the code, so a larger dose bills more units. Many states require the National Drug Code (NDC) on the claim alongside the billing code.

Where do these rates come from?

From each state's official Medicaid fee schedules, rate notices and provider bulletins. Every rate on a code page links to its source document and effective date.

Keep exploring

Most widely published pharmacy codes

By number of states

Browse another way

MedicaidRate workspacePharmacy rates in your statesRates, managed-care rules, Medicare comparison and changes, for the codes you bill.

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