Pharmacy Medicaid rates by code
1,293 pharmacy codes with published Medicaid rates in five or more states. Each page compares every state's rate, unit and managed-care rule.
| Code | Service | States | Median rate |
|---|---|---|---|
| 0034A | Physician-administered drugs (J-codes) | 5 | $40.00 |
| 0081A | Physician-administered drugs (J-codes) | 5 | $40.00 |
| 0082A | Physician-administered drugs (J-codes) | 5 | $40.00 |
| 90284 | Vaccines and immune globulins | 5 | $25.32 |
| 90371 | Vaccines and immune globulins | 17 | $136.95 |
| 90384 | Vaccines and immune globulins | 13 | $89.58 |
| 90385 | Vaccines and immune globulins | 12 | $29.22 |
| 90389 | Vaccines and immune globulins | 8 | $135.67 |
| 90484 | Vaccines and immune globulins | 9 | $32.21 |
| 90585 | Vaccines and immune globulins | 14 | $168.26 |
| 90620 | Vaccines and immune globulins | 23 | $237.13 |
| 90621 | Vaccines and immune globulins | 23 | $222.91 |
| 90630 | Vaccines and immune globulins | 6 | $20.34 |
| 90633 | Vaccines and immune globulins | 17 | $39.13 |
| 90634 | Vaccines and immune globulins | 9 | $32.30 |
| 90647 | Vaccines and immune globulins | 21 | $29.83 |
| 90651 | Vaccines and immune globulins | 23 | $325.06 |
| 90656 | Vaccines and immune globulins | 23 | $21.08 |
| 90657 | Vaccines and immune globulins | 20 | $11.09 |
| 90658 | Vaccines and immune globulins | 23 | $21.60 |
| 90680 | Vaccines and immune globulins | 15 | $75.20 |
| 90696 | Vaccines and immune globulins | 15 | $55.81 |
| 90698 | Vaccines and immune globulins | 17 | $103.86 |
| 90700 | Vaccines and immune globulins | 15 | $24.20 |
| 90702 | Vaccines and immune globulins | 12 | $24.67 |
| 90714 | Vaccines and immune globulins | 23 | $39.56 |
| 90733 | Vaccines and immune globulins | 10 | $119.74 |
| 90739 | Physician-administered drugs (J-codes) | 22 | $171.70 |
| 90740 | Vaccines and immune globulins | 21 | $170.94 |
| 90744 | Vaccines and immune globulins | 18 | $28.59 |
| 90747 | Physician-administered drugs (J-codes) | 20 | $155.52 |
| 91323 | Vaccines and immune globulins | 20 | $201.91 |
| A2022 | Innovaburn or innovamatrix xl, per square centimeter | 5 | $83.49 |
| A2025 | Miro3d, per cubic centimeter (add-on | 5 | $83.49 |
| A2042 | Foundation drs+ solo (add-on | 5 | $81.15 |
| A9596 | Gallium ga-68 gozetotide, diagnostic, (illuccix) | 10 | $1,050.32 |
| C9047 | Injection, caplacizumab-yhdp, 1 mg | 5 | $814.87 |
| C9254 | Injection, lacosamide, 1 mg | 5 | $0.29 |
| C9257 | Injection, bevacizumab, 0.25 mg | 6 | $2.06 |
| C9310 | Injection, leucovorin calcium (avyxa), 1 mg | 5 | $2.50 |
| C9460 | Injection, cangrelor, 1 mg | 5 | $21.43 |
| C9462 | Injection, delafloxacin, 1 mg | 5 | $0.52 |
| C9507 | Plasma, high titer covid-19 convalescent, each unit | 5 | $750.50 |
| J0013 | Esketamine, nasal spray, 1 mg | 14 | $15.48 |
| J0120 | Injection, tetracycline, up to 250 mg | 7 | $4.71 |
| J0121 | Injection, omadacycline, 1 mg | 18 | $4.19 |
| J0122 | Injection, eravacycline, 1 mg | 18 | $1.33 |
| J0129 | Injection, abatacept, 10 mg | 18 | $45.86 |
| J0130 | Injection abciximab, 10 mg | 10 | $1,429.07 |
| J0131 | Injection, acetaminophen, not otherwise specified,10 mg | 13 | $0.05 |
| J0132 | Injection, acetylcysteine, 100 mg | 15 | $0.39 |
| J0133 | Injection, acyclovir, 5 mg | 19 | $0.04 |
| J0134 | Injection, acetaminophen (fresenius kabi) | 17 | $0.05 |
| J0136 | Injection, acetaminophen (b braun) | 17 | $0.05 |
| J0137 | Injection, acetaminophen (hikma) | 17 | $0.05 |
| J0138 | Injection, acetaminophen 10 mg and ibuprofen 3 mg | 15 | $0.09 |
| J0139 | Injection, adalimumab, 1 mg | 7 | $85.83 |
| J0153 | Injection, adenosine, 1 mg | 18 | $0.39 |
| J0162 | Injection, epinephrine (fresenius) | 17 | $0.36 |
| J0163 | Injection, epinephrine in sodium chloride (endo), 0.1 mg | 16 | $0.70 |
| J0164 | Injection, epinephrine in sodium chloride (baxter), 0.1 mg | 15 | $0.91 |
| J0165 | Injection, epinephrine, not otherwise specified, 0.1 mg | 18 | $0.23 |
| J0166 | Injection, epinephrine (bpi) | 14 | $0.815 |
| J0167 | Injection, epinephrine (hospira) | 17 | $1.42 |
| J0168 | Injection, epinephrine (international medication systems) | 17 | $2.56 |
| J0169 | Injection, epinephrine (adrenalin) | 17 | $0.84 |
| J0171 | Injection, adrenalin, epinephrine, 0.1 mg | 7 | $0.73 |
| J0174 | Lecanemab-irmb, for intravenous injection, 1 mg | 17 | $1.34 |
| J0175 | Injection, donanemab-azbt, 2 mg | 17 | $4.17 |
| J0177 | Injection, aflibercept hd, 1 mg | 18 | $298.68 |
| J0178 | Injection, aflibercept, 1 mg | 19 | $743.61 |
| J0179 | Injection, brolucizumab-dbll, 1 mg | 19 | $359.71 |
| J0180 | Injection, agalsidase beta, 1 mg | 18 | $230.54 |
| J0184 | Injection, amisulpride, 1 mg | 14 | $9.54 |
| J0185 | Injection, aprepitant, 1 mg | 19 | $1.59 |
| J0202 | Injection, alemtuzumab, 1 mg | 19 | $2,506.20 |
| J0206 | Injection, allopurinol sodium, 1 mg | 15 | $4.29 |
| J0207 | Injection, amifostine, 500 mg | 14 | $1,024.36 |
| J0208 | Injection, sodium thiosulfate (pedmark), 100 mg | 16 | $96.36 |
| J0210 | Injection, methyldopate hcl, up to 250 mg | 11 | $42.00 |
| J0216 | Injection, alfentanil hydrochloride, 500 micrograms | 10 | $2.57 |
| J0217 | Injection, velmanase alfa-tycv, 1 mg | 17 | $479.19 |
| J0218 | Injection, olipudase alfa-rpcp, 1 mg | 18 | $404.78 |
| J0219 | Injection, avalglucosidase alfa-ngpt, 4 mg | 17 | $83.82 |
| J0220 | Injection, alglucosidase alfa, 10 mg | 11 | $206.64 |
| J0221 | Injection, alglucosidase alfa, (lumizyme), 10 mg | 18 | $211.06 |
| J0222 | Injection, patisiran, 0.1 mg | 17 | $101.02 |
| J0223 | Injection, givosiran, 0.5 mg | 17 | $120.74 |
| J0224 | Injection, lumasiran, 0.5 mg | 14 | $336.81 |
| J0225 | Injection, vutrisiran, 1 mg | 16 | $5,011.08 |
| J0248 | Injection, remdesivir, 1 mg | 18 | $7.51 |
| J0256 | Injection, alpha 1 proteinase inhibitor (human) | 18 | $5.13 |
| J0257 | Injection, alpha 1 proteinase inhibitor (human), (glassia) | 18 | $5.58 |
| J0270 | Injection, alprostadil, 1.25 mcg | 8 | $0.67 |
| J0275 | Alprostadil urethral suppository | 5 | $25.72 |
| J0278 | Injection, amikacin sulfate, 100 mg | 19 | $0.61 |
| J0280 | Injection, aminophyllin, up to 250 mg | 17 | $10.76 |
| J0281 | Injection, aminocaproic acid, 1 gram | 17 | $1.74 |
| J0282 | Injection, amiodarone hydrochloride, 30 mg | 15 | $0.40 |
| J0283 | Injection, amiodarone hydrochloride (nexterone), 30 mg | 16 | $2.48 |
| J0285 | Injection, amphotericin b, 50 mg | 20 | $41.92 |
| J0287 | Injection, amphotericin b lipid complex, 10 mg | 19 | $10.30 |
| J0289 | Injection, amphotericin b liposome, 10 mg | 19 | $19.85 |
| J0290 | Injection, ampicillin sodium, 500 mg | 19 | $0.61 |
| J0291 | Injection, plazomicin, 5 mg | 18 | $3.52 |
| J0295 | Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm | 18 | $1.45 |
| J0300 | Injection, amobarbital, up to 125 mg | 16 | $180.95 |
| J0330 | Injection, succinylcholine chloride, up to 20 mg | 14 | $0.29 |
| J0348 | Injection, anidulafungin, 1 mg | 17 | $0.48 |
| J0349 | Injection, rezafungin, 1 mg | 18 | $11.00 |
| J0360 | Injection, hydralazine hcl, up to 20 mg | 19 | $3.40 |
| J0364 | Injection, apomorphine hydrochloride, 1 mg | 13 | $32.69 |
| J0390 | Injection, chloroquine hydrochloride, up to 250 mg | 8 | $17.27 |
| J0391 | Injection, artesunate, 1 mg | 14 | $48.90 |
| J0400 | Injection, aripiprazole, intramuscular, 0.25 mg | 11 | $0.76 |
| J0401 | Injection, aripiprazole (abilify maintena), 1 mg | 19 | $7.46 |
| J0402 | Injection, aripiprazole (abilify asimtufii), 1 mg | 17 | $6.19 |
| J0456 | Injection, azithromycin, 500 mg | 17 | $1.96 |
| J0457 | Injection, aztreonam, 100 mg | 15 | $2.27 |
| J0458 | Injection, aztreonam/avibactam, 7.5 mg/2.5 mg (10 mg) | 18 | $1.77 |
| J0461 | Injection, atropine sulfate, 0.01 mg | 19 | $0.10 |
| J0462 | Injection, atropine sulfate | 16 | $0.13 |
| J0463 | Injection, atropine sulfate | 15 | $0.02 |
| J0470 | Injection, dimercaprol, per 100 mg | 12 | $56.42 |
| J0475 | Injection, baclofen, 10 mg | 19 | $186.11 |
| J0476 | Injection, baclofen, 50 mcg for intrathecal trial | 18 | $43.84 |
| J0480 | Injection, basiliximab, 20 mg | 15 | $4,905.04 |
| J0485 | Injection, belatacept, 1 mg | 18 | $3.88 |
| J0490 | Injection, belimumab, 10 mg | 18 | $58.30 |
| J0491 | Injection, anifrolumab-fnia, 1 mg | 18 | $18.46 |
| J0500 | Injection, dicyclomine hcl, up to 20 mg | 18 | $11.50 |
| J0515 | Injection, benztropine mesylate, per 1 mg | 18 | $13.53 |
| J0517 | Injection, benralizumab, 1 mg | 17 | $165.08 |
| J0520 | Injection, bethanechol chloride, myotonachol or urecholine | 7 | $4.49 |
| J0525 | Injection, cefotetan disodium, 10 mg | 10 | $0.24 |
| J0528 | Injection, fosfomycin disodium, 20 mg | 12 | $0.63 |
| J0558 | Injection, penicillin g benzathine and penicillin g... | 19 | $19.52 |
| J0561 | Injection, penicillin g benzathine, 100,000 units | 19 | $31.97 |
| J0565 | Injection, bezlotoxumab, 10 mg | 18 | $39.83 |
| J0567 | Injection, cerliponase alfa, 1 mg | 12 | $119.58 |
| J0570 | Buprenorphine implant, 74.2 mg | 7 | $1,237.50 |
| J0571 | Buprenorphine, oral, 1 mg | 12 | $0.395 |
| J0572 | Buprenorphine/naloxone, oral | 11 | $3.65 |
| J0573 | Buprenorphine/naloxone, oral, greater than 3 mg | 11 | $7.33 |
| J0574 | Buprenorphine/naloxone, oral, greater than 6 mg | 11 | $7.76 |
| J0575 | Buprenorphine/naloxone, oral | 12 | $14.55 |
| J0577 | Injection, buprenorphine extended-release (brixadi) | 18 | $430.57 |
| J0578 | Injection, buprenorphine extended release (brixadi) | 18 | $1,722.30 |
| J0582 | Injection, bivalirudin (endo) | 15 | $0.16 |
| J0583 | Injection, bivalirudin, 1 mg | 14 | $0.16 |
| J0584 | Injection, burosumab-twza 1 mg | 16 | $513.37 |
| J0585 | Injection, onabotulinumtoxina, 1 unit | 18 | $6.51 |
| J0586 | Injection, abobotulinumtoxina, 5 units | 18 | $8.94 |
| J0587 | Injection, rimabotulinumtoxinb, 100 units | 19 | $13.29 |
| J0588 | Injection, incobotulinumtoxin a, 1 unit | 18 | $5.27 |
| J0589 | Injection, daxibotulinumtoxina-lanm, 1 unit | 15 | $3.07 |
| J0592 | Injection, buprenorphine hydrochloride, 0.1 mg | 16 | $4.47 |
| J0593 | Injection, lanadelumab-flyo, 1 mg | 16 | $88.22 |
| J0594 | Injection, busulfan, 1 mg | 17 | $1.03 |
| J0595 | Injection, butorphanol tartrate, 1 mg | 18 | $10.51 |
| J0596 | Injection, c1 esterase inhibitor (recombinant), ruconest | 18 | $37.81 |
| J0597 | Injection, c-1 esterase inhibitor (human), berinert | 17 | $79.26 |
| J0598 | Injection, c-1 esterase inhibitor (human), cinryze, 10 units | 18 | $66.75 |
| J0599 | Injection, c-1 esterase inhibitor (human), (haegarda) | 14 | $12.59 |
| J0600 | Injection, edetate calcium disodium, up to 1000 mg | 15 | $6,189.49 |
| J0601 | Sevelamer carbonate (renvela or therapeutically equivalent) | 7 | $0.01 |
| J0602 | Sevelamer carbonate (renvela or therapeutically equivalent) | 7 | $0.02 |
| J0603 | Sevelamer hydrochloride | 7 | $0.06 |
| J0604 | Cinacalcet, oral, 1 mg, (for esrd on dialysis) | 7 | $0.02 |
| J0605 | Sucroferric oxyhydroxide, oral, 5 mg (for esrd on dialysis) | 9 | $0.18 |
| J0606 | Injection, etelcalcetide, 0.1 mg | 15 | $4.03 |
| J0607 | Lanthanum carbonate, oral, 5 mg (for esrd on dialysis) | 8 | $0.03 |
| J0608 | Lanthanum carbonate, oral, powder, 5 mg | 7 | $0.06 |
| J0609 | Ferric citrate, oral, 3 mg ferric iron, | 8 | $0.10 |
| J0610 | Injection, calcium gluconate (fresenius kabi), per 10 ml | 5 | $4.13 |
| J0612 | Injection, calcium gluconate, not otherwise specified, 10 mg | 17 | $0.028 |
| J0613 | Injection, calcium gluconate (wg critical care) | 18 | $0.05 |
| J0614 | Injection, treosulfan, 50 mg | 16 | $32.33 |
| J0615 | Calcium acetate, oral, 23 mg (for esrd on dialysis) | 8 | $0.01 |
| J0616 | Injection, metoprolol tartrate, 1 mg | 14 | $0.145 |
| J0618 | Injection, calcium chloride, 2 mg | 8 | $0.03 |
| J0620 | Injection, calcium glycerophosphate and calcium lactate | 9 | $11.96 |
| J0630 | Injection, calcitonin salmon, up to 400 units | 16 | $846.68 |
| J0636 | Injection, calcitriol, 0.1 mcg | 17 | $0.80 |
| J0637 | Injection, caspofungin acetate, 5 mg | 16 | $2.88 |
| J0638 | Injection, canakinumab, 1 mg | 17 | $156.54 |
| J0640 | Injection, leucovorin calcium, per 50 mg | 15 | $2.93 |
| J0641 | Injection, levoleucovorin, not otherwise specified, 0.5 mg | 19 | $0.05 |
| J0642 | Injection, levoleucovorin (khapzory), 0.5 mg | 18 | $1.30 |
| J0643 | Injection, leucovorin calcium, not otherwise specified, 1 mg | 5 | $0.05 |
| J0644 | Injection, leucovorin calcium (avyxa), 1 mg | 5 | $2.63 |
| J0650 | Injection, levothyroxine sodium, not otherwise specified | 15 | $5.98 |
| J0651 | Injection, levothyroxine sodium (fresenius kabi) | 16 | $6.85 |
| J0652 | Injection, levothyroxine sodium (hikma) | 15 | $6.32 |
| J0654 | Injection, liothyronine, 1 mcg | 10 | $42.30 |
| J0665 | Injection, bupivicaine, not otherwise specified, 0.5 mg | 19 | $0.01 |
| J0666 | Injection, bupivacaine liposome, 1 mg | 17 | $1.45 |
| J0668 | Instillation, bupivacaine and meloxicam, 1 mg/0.03 mg | 10 | $0.79 |
| J0670 | Injection, mepivacaine hydrochloride, per 10 ml | 16 | $4.14 |
| J0675 | Injection, carboprost tromethamine, 0.1 mg | 9 | $21.60 |
| J0681 | Injection, ceftobiprole medocaril sodium, 3 mg | 12 | $1.09 |
| J0687 | Injection, cefazolin sodium (wg critical care) | 19 | $0.64 |
| J0688 | Injection, cefazolin sodium (hikma) | 19 | $0.85 |
| J0689 | Injection, cefazolin sodium (baxter) | 18 | $1.29 |
| J0690 | Injection, cefazolin sodium, 500 mg | 20 | $0.80 |
| J0691 | Injection, lefamulin, 1 mg | 12 | $0.72 |
| J0692 | Injection, cefepime hydrochloride, 500 mg | 17 | $1.29 |
| J0694 | Injection, cefoxitin sodium, 1 gm | 19 | $4.74 |
| J0695 | Injection, ceftolozane 50 mg and tazobactam 25 mg | 17 | $10.02 |
| J0696 | Injection, ceftriaxone sodium, per 250 mg | 20 | $0.40 |
| J0697 | Injection, sterile cefuroxime sodium, per 750 mg | 18 | $2.05 |
| J0698 | Injection, cefotaxime sodium, per gm | 17 | $4.09 |
| J0699 | Injection, cefiderocol, 10 mg | 16 | $2.55 |
| J0701 | Injection, cefepime hydrochloride (baxter) | 18 | $6.03 |
| J0702 | Injection, betamethasone acetate 3 mg and betamethasone... | 18 | $7.13 |
| J0703 | Injection, cefepime hydrochloride (b braun) | 17 | $4.48 |
| J0706 | Injection, caffeine citrate, 5 mg | 13 | $0.60 |
| J0712 | Injection, ceftaroline fosamil, 10 mg | 18 | $4.24 |
| J0713 | Injection, ceftazidime, per 500 mg | 19 | $1.47 |
| J0714 | Injection, ceftazidime and avibactam, 0.5 g/0.125 g | 18 | $109.45 |
| J0716 | Injection, centruroides immune f(ab)2, up to 120 milligrams | 9 | $5,246.10 |
| J0717 | Injection, certolizumab pegol, 1 mg | 17 | $3.44 |
| J0720 | Injection, chloramphenicol sodium succinate, up to 1 gm | 18 | $48.65 |
| J0725 | Injection, chorionic gonadotropin, per 1,000 usp units | 17 | $15.06 |
| J0735 | Injection, clonidine hydrochloride, 1 mg | 17 | $15.08 |
| J0736 | Injection, clindamycin phosphate, 300 mg | 16 | $1.91 |
| J0737 | Injection, clindamycin phosphate (baxter) | 15 | $2.19 |
| J0738 | Injection, lenacapavir, 1 mg, fda approved prescription | 17 | $16.02 |
| J0739 | Injection, cabotegravir, 1mg, fda approved prescription | 16 | $7.28 |
| J0740 | Injection, cidofovir, 375 mg | 17 | $535.73 |
| J0741 | Injection, cabotegravir and rilpivirine, 2mg/3mg | 19 | $24.66 |
| J0742 | Injection, imipenem 4 mg | 17 | $2.69 |
| J0743 | Injection, cilastatin sodium; imipenem, per 250 mg | 17 | $6.57 |
| J0744 | Injection, ciprofloxacin for intravenous infusion, 200 mg | 18 | $1.72 |
| J0745 | Injection, codeine phosphate, per 30 mg | 9 | $1.35 |
| J0750 | Emtricitabine 200mg and tenofovir disoproxil fumarate 300mg | 9 | $0.45 |
| J0751 | Emtricitabine 200mg and tenofovir alafenamide 25mg, oral | 9 | $71.43 |
| J0752 | Oral, lenacapavir, 300 mg, fda approved prescription | 12 | $617.61 |
| J0759 | Injection, clevidipine butyrate, 1 mg | 15 | $2.85 |
| J0770 | Injection, colistimethate sodium, up to 150 mg | 18 | $14.49 |
| J0775 | Injection, collagenase, clostridium histolyticum, 0.01 mg | 18 | $78.30 |
| J0780 | Injection, prochlorperazine, up to 10 mg | 19 | $2.76 |
| J0791 | Injection, crizanlizumab-tmca, 5 mg | 17 | $129.93 |
| J0801 | Injection, corticotropin (acthar gel), up to 40 units | 16 | $4,133.45 |
| J0802 | Injection, corticotropin (ani), up to 40 units | 17 | $3,646.46 |
| J0834 | Injection, cosyntropin, 0.25 mg | 18 | $20.69 |
| J0840 | Injection, crotalidae polyvalent immune fab (ovine) | 14 | $1,906.91 |
| J0841 | Injection, crotalidae immune f(ab')2 (equine), 120 mg | 13 | $1,317.60 |
| J0850 | Injection, cytomegalovirus immune globulin intravenous | 15 | $1,857.13 |
| J0870 | Injection, imetelstat, 1 mg | 17 | $59.36 |
| J0872 | Injection, daptomycin (xellia), unrefrigerated | 19 | $0.06 |
| J0873 | Injection, daptomycin (xellia) | 19 | $0.05 |
| J0874 | Injection, daptomycin (baxter) | 17 | $0.06 |
| J0875 | Injection, dalbavancin, 5 mg | 19 | $11.29 |
| J0877 | Injection, daptomycin (hospira) | 19 | $0.05 |
| J0878 | Injection, daptomycin, 1 mg | 18 | $0.03 |
| J0879 | Injection, difelikefalin, 0.1 microgram, | 13 | $0.23 |
| J0881 | Injection, darbepoetin alfa, 1 microgram (non-esrd use) | 19 | $3.02 |
| J0882 | Injection, darbepoetin alfa, 1 microgram | 20 | $3.02 |
| J0883 | Injection, argatroban, 1 mg (for non-esrd use) | 13 | $0.80 |
| J0884 | Injection, argatroban, 1 mg (for esrd on dialysis) | 12 | $0.83 |
| J0885 | Injection, epoetin alfa, (for non-esrd use), 1000 units | 20 | $6.88 |
| J0887 | Injection, epoetin beta, 1 microgram, (for esrd on dialysis) | 16 | $1.13 |
| J0888 | Injection, epoetin beta, 1 microgram, (for non esrd use) | 16 | $1.18 |
| J0890 | Injection, peginesatide, 0.1 mg (for esrd on dialysis) | 6 | $9.77 |
| J0891 | Injection, argatroban (accord) | 15 | $3.90 |
| J0892 | Injection, argatroban (accord) | 14 | $3.73 |
| J0893 | Injection, decitabine (sun pharma) | 17 | $1.80 |
| J0894 | Injection, decitabine, 1 mg | 19 | $1.06 |
| J0895 | Injection, deferoxamine mesylate, 500 mg | 20 | $8.81 |
| J0896 | Injection, luspatercept-aamt, 0.25 mg | 18 | $43.48 |
| J0897 | Injection, denosumab, 1 mg | 19 | $29.86 |
| J0898 | Injection, argatroban (auromedics) | 14 | $1.21 |
| J0899 | Injection, argatroban (auromedics) | 13 | $1.21 |
| J0901 | Vadadustat, oral, 1 mg (for esrd on dialysis) | 8 | $0.13 |
| J0911 | Instillation, taurolidine 1.35 mg and heparin sodium 100... | 14 | $8.33 |
| J0945 | Injection, brompheniramine maleate, per 10 mg | 6 | $0.80 |
| J1000 | Injection, depo-estradiol cypionate, up to 5 mg | 18 | $53.81 |
| J1010 | Injection, methylprednisolone acetate, 1 mg | 18 | $0.12 |
| J1050 | Injection, medroxyprogesterone acetate, 1 mg | 18 | $0.535 |
| J1071 | Injection, testosterone cypionate, 1 mg | 18 | $0.02 |
| J1072 | Injection, testosterone cypionate (azmiro), 1 mg | 15 | $1.30 |
| J1073 | Testosterone pellet, implant, 75 mg | 11 | $108.18 |
| J1094 | Injection, dexamethasone acetate, 1 mg | 5 | $0.22 |
| J1095 | Injection, dexamethasone 9 percent, intraocular, 1 microgram | 11 | $1.22 |
| J1096 | Dexamethasone, lacrimal ophthalmic insert, 0.1 mg | 17 | $90.02 |
| J1097 | Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml... | 11 | $118.00 |
| J1100 | Injection, dexamethasone sodium phosphate, 1 mg | 19 | $0.10 |
| J1105 | Dexmedetomidine, oral, 1 mcg | 10 | $0.625 |
| J1110 | Injection, dihydroergotamine mesylate, per 1 mg | 18 | $54.98 |
| J1120 | Injection, acetazolamide sodium, up to 500 mg | 18 | $24.05 |
| J1130 | Injection, diclofenac sodium, 0.5 mg | 8 | $0.21 |
| J1160 | Injection, digoxin, up to 0.5 mg | 18 | $3.91 |
| J1162 | Injection, digoxin immune fab (ovine), per vial | 11 | $5,383.32 |
| J1163 | Injection, diltiazem hydrochloride, 0.5 mg | 15 | $0.03 |
| J1164 | Injection, diltiazem hydrochloride in 0.72% sodium chloride | 14 | $0.18 |
| J1165 | Injection, phenytoin sodium, per 50 mg | 18 | $0.54 |
| J1170 | Injection, hydromorphone, up to 4 mg | 5 | $2.70 |
| J1171 | Injection, hydromorphone, 0.1 mg | 18 | $0.14 |
| J1180 | Injection, dyphylline, up to 500 mg | 6 | $8.05 |
| J1190 | Injection, dexrazoxane hydrochloride, per 250 mg | 18 | $41.44 |
| J1200 | Injection, diphenhydramine hcl, up to 50 mg | 19 | $0.75 |
| J1201 | Injection, cetirizine hydrochloride, 0.5 mg | 14 | $17.08 |
| J1202 | Miglustat, oral, 65 mg | 13 | $35.55 |
| J1203 | Injection, cipaglucosidase alfa-atga, 5 mg | 17 | $96.30 |
| J1205 | Injection, chlorothiazide sodium, per 500 mg | 16 | $70.32 |
| J1212 | Injection, dmso, dimethyl sulfoxide, 50%, 50 ml | 16 | $748.84 |
| J1230 | Injection, methadone hcl, up to 10 mg | 16 | $12.70 |
| J1240 | Injection, dimenhydrinate, up to 50 mg | 16 | $8.64 |
| J1245 | Injection, dipyridamole, per 10 mg | 17 | $8.41 |
| J1250 | Injection, dobutamine hydrochloride, per 250 mg | 19 | $7.69 |
| J1260 | Injection, dolasetron mesylate, 10 mg | 12 | $6.13 |
| J1265 | Injection, dopamine hcl, 40 mg | 18 | $0.81 |
| J1270 | Injection, doxercalciferol, 1 mcg | 19 | $0.33 |
| J1271 | Injection, doxycycline hyclate, 1 mg | 17 | $0.088 |
| J1289 | Injection, narsoplimab-wuug, 1 mg | 11 | $101.96 |
| J1290 | Injection, ecallantide, 1 mg | 18 | $595.94 |
| J1299 | Injection, eculizumab, 2 mg | 17 | $44.19 |
| J1300 | Injection, eculizumab, 10 mg | 6 | $224.16 |
| J1301 | Injection, edaravone, 1 mg | 17 | $6.46 |
| J1302 | Injection, sutimlimab-jome, 10 mg | 17 | $19.64 |
| J1303 | Injection, ravulizumab-cwvz, 10 mg | 18 | $226.69 |
| J1304 | Injection, tofersen, 1 mg | 16 | $164.81 |
| J1305 | Injection, evinacumab-dgnb, 5mg | 18 | $197.63 |
| J1306 | Injection, inclisiran, 1 mg | 18 | $12.90 |
| J1307 | Injection, crovalimab-akkz, 10 mg | 18 | $551.51 |
| J1308 | Injection, famotidine, 0.25 mg | 18 | $0.01 |
| J1320 | Injection, amitriptyline hcl, up to 20 mg | 7 | $2.24 |
| J1322 | Injection, elosulfase alfa, 1 mg | 18 | $319.52 |
| J1323 | Injection, elranatamab-bcmm, 1 mg | 18 | $191.31 |
| J1324 | Injection, enfuvirtide, 1 mg | 12 | $0.67 |
| J1325 | Injection, epoprostenol, 0.5 mg | 17 | $16.91 |
| J1326 | Injection, zolbetuximab-clzb, 2 mg | 19 | $33.92 |
| J1327 | Injection, eptifibatide, 5 mg | 13 | $21.13 |
| J1335 | Injection, ertapenem sodium, 500 mg | 18 | $6.75 |
| J1364 | Injection, erythromycin lactobionate, per 500 mg | 19 | $160.43 |
| J1370 | Injection, esomeprazole sodium, 1 mg | 10 | $0.37 |
| J1380 | Injection, estradiol valerate, up to 10 mg | 17 | $7.70 |
| J1410 | Injection, estrogen conjugated, per 25 mg | 18 | $401.50 |
| J1411 | Injection, etranacogene dezaparvovec-drlb | 8 | $3,500,000.00 |
| J1412 | Injection, valoctocogene roxaparvovec-rvox, per ml | 10 | $11,843.13 |
| J1413 | Injection, delandistrogene moxeparvovec-rokl | 8 | $3,200,000.00 |
| J1426 | Injection, casimersen, 10 mg | 13 | $161.60 |
| J1427 | Injection, viltolarsen, 10 mg | 13 | $56.96 |
| J1428 | Injection, eteplirsen, 10 mg | 13 | $161.60 |
| J1429 | Injection, golodirsen, 10 mg | 13 | $161.60 |
| J1430 | Injection, ethanolamine oleate, 100 mg | 12 | $525.43 |
| J1434 | Injection, fosaprepitant (focinvez), 1 mg | 18 | $2.46 |
| J1435 | Injection, estrone, per 1 mg | 5 | $0.24 |
| J1436 | Injection, etidronate disodium, per 300 mg | 7 | $70.88 |
| J1437 | Injection, ferric derisomaltose, 10 mg | 17 | $21.16 |
| J1438 | Injection, etanercept, 25 mg | 15 | $807.33 |
| J1439 | Injection, ferric carboxymaltose, 1 mg | 19 | $1.13 |
| J1440 | Fecal microbiota, live - jslm, 1 ml | 17 | $65.60 |
| J1442 | Injection, filgrastim (g-csf), excludes biosimilars | 19 | $1.00 |
| J1447 | Injection, tbo-filgrastim, 1 microgram | 19 | $0.25 |
| J1448 | Injection, trilaciclib, 1mg | 19 | $5.46 |
| J1449 | Injection, eflapegrastim-xnst, 0.1 mg | 19 | $37.90 |
| J1450 | Injection fluconazole, 200 mg | 17 | $5.65 |
| J1451 | Injection, fomepizole, 15 mg | 14 | $10.41 |
| J1453 | Injection, fosaprepitant, 1 mg | 19 | $0.12 |
| J1454 | Injection, fosnetupitant 235 mg and palonosetron 0.25 mg | 19 | $503.85 |
| J1455 | Injection, foscarnet sodium, per 1000 mg | 18 | $8.35 |
| J1456 | Injection, fosaprepitant (teva) | 17 | $0.04 |
| J1458 | Injection, galsulfase, 1 mg | 18 | $525.97 |
| J1459 | Injection, immune globulin (privigen), intravenous | 19 | $50.28 |
| J1460 | Injection, gamma globulin, intramuscular, 1 cc | 18 | $48.91 |
| J1551 | Injection, immune globulin (cutaquig), 100 mg | 17 | $14.03 |
| J1552 | Injection, immune globulin (alyglo), 500 mg | 18 | $121.54 |
| J1553 | Injection, immune globulin (yimmugo), 100 mg | 12 | $24.14 |
| J1554 | Injection, immune globulin (asceniv), 500 mg | 19 | $508.45 |
| J1555 | Injection, immune globulin (cuvitru), 100 mg | 18 | $17.99 |
| J1556 | Injection, immune globulin (bivigam), 500 mg | 18 | $80.79 |
| J1557 | Injection, immune globulin, (gammaplex), intravenous | 18 | $63.42 |
| J1558 | Injection, immune globulin (xembify), 100 mg | 17 | $15.24 |
| J1559 | Injection, immune globulin (hizentra), 100 mg | 18 | $14.79 |
| J1560 | Injection, gamma globulin, intramuscular, over 10 cc | 16 | $159.24 |
| J1561 | Injection, immune globulin, (gamunex-c/gammaked) | 19 | $49.01 |
| J1566 | Injection, immune globulin, intravenous, lyophilized (e.g. | 19 | $80.96 |
| J1568 | Injection, immune globulin, (octagam), intravenous | 19 | $47.06 |
| J1569 | Injection, immune globulin, | 19 | $49.30 |
| J1570 | Injection, ganciclovir sodium, 500 mg | 18 | $31.46 |
| J1571 | Injection, hepatitis b immune globulin (hepagam b) | 17 | $68.34 |
| J1572 | Injection, immune globulin, (flebogamma/flebogamma dif) | 12 | $55.86 |
| J1573 | Injection, hepatitis b immune globulin (hepagam b) | 16 | $68.78 |
| J1574 | Injection, ganciclovir sodium (exela) | 13 | $51.00 |
| J1575 | Injection, immune globulin/hyaluronidase, (hyqvia) | 19 | $18.35 |
| J1576 | Injection, immune globulin (panzyga), intravenous | 19 | $71.34 |
| J1577 | Injection, immune globulin (qivigy), 100 mg | 12 | $28.72 |
| J1580 | Injection, garamycin, gentamicin, up to 80 mg | 20 | $1.92 |
| J1595 | Injection, glatiramer acetate, 20 mg | 9 | $67.64 |
| J1596 | Injection, glycopyrrolate, 0.1 mg | 17 | $0.36 |
| J1597 | Injection, glycopyrrolate (glyrx-pf), 0.1 mg | 14 | $1.30 |
| J1598 | Injection, glycopyrrolate (fresenius kabi) | 14 | $1.59 |
| J1599 | Injection, immune globulin, intravenous, non-lyophilized | 7 | $146.62 |
| J1600 | Injection, gold sodium thiomalate, up to 50 mg | 11 | $26.97 |
| J1602 | Injection, golimumab, 1 mg, for intravenous use | 17 | $11.04 |
| J1610 | Injection, glucagon hydrochloride, per 1 mg | 17 | $117.33 |
| J1611 | Injection, glucagon hydrochloride (fresenius kabi) | 18 | $132.55 |
| J1612 | Injection, glucagon (gvoke), 0.01 mg | 15 | $1.80 |
| J1626 | Injection, granisetron hydrochloride, 100 mcg | 19 | $0.19 |
| J1627 | Injection, granisetron, extended-release, 0.1 mg | 19 | $3.21 |
| J1628 | Injection, guselkumab, 1 mg | 17 | $67.00 |
| J1630 | Injection, haloperidol, up to 5 mg | 18 | $0.74 |
| J1631 | Injection, haloperidol decanoate, per 50 mg | 18 | $4.85 |
| J1632 | Injection, brexanolone, 1 mg | 8 | $75.25 |
| J1640 | Injection, hemin, 1 mg | 18 | $35.82 |
| J1642 | Injection, heparin sodium, (heparin lock flush) | 17 | $0.02 |
| J1643 | Injection, heparin sodium (pfizer) | 18 | $1.71 |
| J1644 | Injection, heparin sodium, per 1000 units | 19 | $0.20 |
| J1645 | Injection, dalteparin sodium, per 2500 iu | 16 | $45.67 |
| J1650 | Injection, enoxaparin sodium, 10 mg | 18 | $0.53 |
| J1652 | Injection, fondaparinux sodium, 0.5 mg | 17 | $0.92 |
| J1670 | Injection, tetanus immune globulin, human, up to 250 units | 17 | $595.01 |
| J1700 | Injection, hydrocortisone acetate, up to 25 mg | 5 | $0.66 |
| J1720 | Injection, hydrocortisone sodium succinate, up to 100 mg | 20 | $23.05 |
| J1726 | Injection, hydroxyprogesterone caproate, (makena), 10 mg | 7 | $19.89 |
| J1729 | Injection, hydroxyprogesterone caproate | 10 | $14.11 |
| J1730 | Injection, diazoxide, up to 300 mg | 6 | $111.97 |
| J1737 | Injection, meloxicam (azurity), 1 mg | 11 | $1.05 |
| J1738 | Injection, meloxicam, 1 mg | 11 | $3.29 |
| J1740 | Injection, ibandronate sodium, 1 mg | 17 | $45.15 |
| J1741 | Injection, ibuprofen, 100 mg | 13 | $3.25 |
| J1742 | Injection, ibutilide fumarate, 1 mg | 15 | $205.06 |
| J1743 | Injection, idursulfase, 1 mg | 17 | $570.04 |
| J1744 | Injection, icatibant, 1 mg | 13 | $49.84 |
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg | 18 | $31.48 |
| J1746 | Injection, ibalizumab-uiyk, 10 mg | 18 | $79.51 |
| J1747 | Injection, spesolimab-sbzo, 1 mg | 17 | $65.73 |
| J1748 | Injection, infliximab-dyyb (zymfentra), 10 mg | 13 | $261.23 |
| J1749 | Injection, iloprost, 0.1 mcg | 7 | $5.65 |
| J1750 | Injection, iron dextran, 50 mg | 18 | $18.99 |
| J1756 | Injection, iron sucrose, 1 mg | 20 | $0.2265 |
| J1786 | Injection, imiglucerase, 10 units | 17 | $43.23 |
| J1790 | Injection, droperidol, up to 5 mg | 17 | $7.18 |
| J1800 | Injection, propranolol hcl, up to 1 mg | 17 | $8.00 |
| J1805 | Injection, esmolol hydrochloride, 10 mg | 14 | $0.23 |
| J1806 | Injection, esmolol hydrochloride (wg critical care) | 15 | $0.20 |
| J1807 | Injection, ethacrynate sodium, 1 mg | 11 | $28.10 |
| J1808 | Injection, folic acid, 0.1 mg | 16 | $0.05 |
| J1809 | Injection, fosdenopterin, 0.1 mg | 16 | $17.73 |
| J1811 | Insulin (fiasp) for administration through dme (i.e. | 13 | $1.73 |
| J1812 | Insulin (fiasp), per 5 units | 11 | $0.38 |
| J1813 | Insulin (lyumjev) for administration through dme (i.e. | 13 | $4.80 |
| J1814 | Insulin (lyumjev), per 5 units | 12 | $0.435 |
| J1815 | Injection, insulin, per 5 units | 17 | $0.34 |
| J1817 | Insulin for administration through dme (i.e. | 14 | $3.06 |
| J1823 | Injection, inebilizumab-cdon, 1 mg | 17 | $510.65 |
| J1826 | Injection, interferon beta-1a, 30 mcg | 11 | $1,125.64 |
| J1830 | Injection, interferon beta-1b, 0.25 mg | 12 | $449.64 |
| J1833 | Injection, isavuconazonium, 1 mg | 13 | $1.09 |
| J1834 | Injection, isoniazid, 1 mg | 10 | $0.32 |
| J1835 | Injection, itraconazole, 50 mg | 7 | $42.28 |
| J1836 | Injection, metronidazole, 10 mg | 16 | $0.03 |
| J1837 | Injection, posaconazole, 1 mg | 17 | $0.34 |
| J1885 | Injection, ketorolac tromethamine, per 15 mg | 18 | $0.33 |
| J1920 | Injection, labetalol hydrochloride, 5 mg | 14 | $0.22 |
| J1921 | Injection, labetalol hydrochloride (hikma) | 15 | $0.91 |
| J1930 | Injection, lanreotide, 1 mg | 19 | $37.43 |
| J1931 | Injection, laronidase, 0.1 mg | 17 | $41.48 |
| J1932 | Injection, lanreotide, (cipla), 1 mg | 18 | $20.33 |
| J1938 | Injection, furosemide, 1 mg | 19 | $0.02 |
| J1939 | Injection, bumetanide, 0.5 mg | 17 | $0.49 |
| J1940 | Injection, furosemide, up to 20 mg | 6 | $0.39 |
| J1941 | Injection, furosemide (furoscix), 20 mg | 9 | $245.15 |
| J1943 | Injection, aripiprazole lauroxil, (aristada initio), 1 mg | 18 | $3.46 |
| J1944 | Injection, aripiprazole lauroxil, (aristada), 1 mg | 18 | $3.55 |
| J1950 | Injection, leuprolide acetate (for depot suspension) | 19 | $1,799.05 |
| J1951 | Injection, leuprolide acetate for depot suspension | 18 | $141.70 |
| J1952 | Leuprolide injectable, camcevi, 1 mg | 17 | $42.05 |
| J1953 | Injection, levetiracetam, 10 mg | 13 | $0.03 |
| J1954 | Injection, leuprolide acetate for depot suspension | 14 | $683.86 |
| J1955 | Injection, levocarnitine, per 1 gm | 18 | $23.18 |
| J1956 | Injection, levofloxacin, 250 mg | 18 | $2.01 |
| J1957 | Injection, levetiracetam, 5 mg | 5 | $0.01 |
| J1958 | Injection, levetiracetam in sodium chloride, 5 mg | 5 | $0.03 |
| J1960 | Injection, levorphanol tartrate, up to 2 mg | 7 | $3.18 |
| J1961 | Injection, lenacapavir (only for use as hiv treatment), 1 mg | 17 | $22.94 |
| J1980 | Injection, hyoscyamine sulfate, up to 0.25 mg | 14 | $35.46 |
| J1990 | Injection, chlordiazepoxide hcl, up to 100 mg | 7 | $22.10 |
| J2002 | Injection, lidocaine hcl in 5% dextrose, 1 mg | 11 | $0.01 |
| J2003 | Injection, lidocaine hydrochloride, 1 mg | 9 | $0.01 |
| J2004 | Injection, lidocaine hcl with epinephrine, 1 mg | 10 | $0.01 |
| J2010 | Injection, lincomycin hcl, up to 300 mg | 19 | $4.23 |
| J2020 | Injection, linezolid, 200 mg | 19 | $2.35 |
| J2021 | Injection, linezolid (hospira) | 20 | $31.61 |
| J2060 | Injection, lorazepam, 2 mg | 18 | $2.20 |
| J2062 | Loxapine for inhalation, 1 mg | 9 | $15.00 |
| J2150 | Injection, mannitol, 25% in 50 ml | 7 | $2.24 |
| J2151 | Injection, mannitol, 250 mg | 17 | $0.07 |
| J2170 | Injection, mecasermin, 1 mg | 9 | $67.95 |
| J2175 | Injection, meperidine hydrochloride, per 100 mg | 20 | $6.46 |
| J2180 | Injection, meperidine and promethazine hcl, up to 50 mg | 5 | $3.79 |
| J2182 | Injection, mepolizumab, 1 mg | 17 | $32.18 |
| J2183 | Injection, meropenem (wg critical care) | 18 | $1.40 |
| J2184 | Injection, meropenem (b. braun) | 18 | $1.90 |
| J2185 | Injection, meropenem, 100 mg | 16 | $0.36 |
| J2186 | Injection, meropenem and vaborbactam, 10mg/10mg (20mg) | 11 | $2.25 |
| J2210 | Injection, methylergonovine maleate, up to 0.2 mg | 17 | $21.55 |
| J2212 | Injection, methylnaltrexone, 0.1 mg | 9 | $1.56 |
| J2246 | Injection, micafungin in sodium (baxter) | 17 | $0.41 |
| J2247 | Injection, micafungin sodium | 18 | $0.22 |
| J2248 | Injection, micafungin sodium, 1 mg | 18 | $0.20 |
| J2249 | Injection, remimazolam, 1 mg | 12 | $2.28 |
| J2250 | Injection, midazolam hydrochloride, per 1 mg | 17 | $0.15 |
| J2251 | Injection, midazolam in 0.9% sodium chloride, intravenous | 17 | $0.12 |
| J2252 | Injection, midazolam in 0.8% sodium chloride, intravenous | 11 | $0.12 |
| J2260 | Injection, milrinone lactate, 5 mg | 17 | $1.14 |
| J2265 | Injection, minocycline hydrochloride, 1 mg | 7 | $2.66 |
| J2267 | Injection, mirikizumab-mrkz, 1 mg | 19 | $32.65 |
| J2270 | Injection, morphine sulfate, up to 10 mg | 19 | $7.26 |
| J2272 | Injection, morphine sulfate (fresenius kabi) | 19 | $8.45 |
| J2274 | Injection, morphine sulfate | 17 | $16.04 |
| J2277 | Injection, motixafortide, 0.25 mg | 18 | $26.48 |
| J2278 | Injection, ziconotide, 1 microgram | 15 | $10.66 |
| J2280 | Injection, moxifloxacin, 100 mg | 15 | $8.74 |
| J2281 | Injection, moxifloxacin (fresenius kabi) | 17 | $6.64 |
| J2290 | Injection, nafcillin sodium, 20 mg | 18 | $0.05 |
| J2291 | Injection, nafcillin sodium (baxter), 20 mg | 15 | $0.15 |
| J2300 | Injection, nalbuphine hydrochloride, per 10 mg | 18 | $4.07 |
| J2305 | Injection, nitroglycerin, 5 mg | 14 | $1.55 |
| J2310 | Injection, naloxone hydrochloride, per 1 mg | 6 | $9.21 |
| J2312 | Injection, naloxone hydrochloride, not otherwise specified | 17 | $0.07 |
| J2313 | Injection, naloxone hydrochloride (zimhi), 0.01 mg | 14 | $0.02 |
| J2315 | Injection, naltrexone, depot form, 1 mg | 18 | $4.53 |
| J2320 | Injection, nandrolone decanoate, up to 50 mg | 9 | $3.79 |
| J2323 | Injection, natalizumab, 1 mg | 18 | $24.40 |
| J2325 | Injection, nesiritide, 0.1 mg | 9 | $60.25 |
| J2326 | Injection, nusinersen, 0.1 mg | 12 | $1,259.78 |
| J2327 | Injection, risankizumab-rzaa, intravenous, 1 mg | 18 | $14.53 |
| J2329 | Injection, ublituximab-xiiy, 1mg | 18 | $71.09 |
| J2350 | Injection, ocrelizumab, 1 mg | 17 | $60.69 |
| J2351 | Injection, ocrelizumab, 1 mg and hyaluronidase-ocsq | 17 | $47.29 |
| J2353 | Injection, octreotide | 19 | $208.09 |
| J2354 | Injection, octreotide | 19 | $0.60 |
| J2355 | Injection, oprelvekin, 5 mg | 12 | $426.92 |
| J2356 | Injection, tezepelumab-ekko, 1 mg | 17 | $17.84 |
| J2357 | Injection, omalizumab, 5 mg | 17 | $45.69 |
| J2358 | Injection, olanzapine, long-acting, 1 mg | 17 | $3.19 |
| J2359 | Injection, olanzapine, 0.5 mg | 17 | $0.69 |
| J2360 | Injection, orphenadrine citrate, up to 60 mg | 18 | $7.77 |
| J2361 | Injection, depemokimab-ulaa, 1 mg | 11 | $266.30 |
| J2371 | Injection, phenylephrine hydrochloride, 20 micrograms | 8 | $0.01 |
| J2372 | Injection, phenylephrine hydrochloride (biorphen) | 14 | $0.16 |
| J2373 | Injection, phenylephrine hydrochloride (immphentiv) | 16 | $0.14 |
| J2374 | Apraclonidine hydrochloride ophthalmic, 1% solution, 0.1 ml | 8 | $28.80 |
| J2401 | Injection, chloroprocaine hydrochloride, per 1 mg | 15 | $0.04 |
| J2402 | Injection, chloroprocaine hydrochloride (clorotekal) | 11 | $0.31 |
| J2403 | Chloroprocaine hcl ophthalmic, 3% gel, 1 mg | 12 | $0.72 |
| J2404 | Injection, nicardipine, 0.1 mg | 15 | $0.07 |
| J2405 | Injection, ondansetron hydrochloride, per 1 mg | 19 | $0.088 |
| J2406 | Injection, oritavancin (kimyrsa), 10 mg | 19 | $45.05 |
| J2407 | Injection, oritavancin (orbactiv), 10 mg | 19 | $29.73 |
| J2410 | Injection, oxymorphone hcl, up to 1 mg | 12 | $2.85 |
| J2425 | Injection, palifermin, 50 micrograms | 18 | $38.69 |
| J2426 | Injection, paliperidone palmitate extended release | 18 | $15.43 |
| J2427 | Injection, paliperidone palmitate extended release | 17 | $13.25 |
| J2428 | Injection, paliperidone palmitate extended release | 16 | $15.87 |
| J2430 | Injection, pamidronate disodium, per 30 mg | 19 | $12.02 |
| J2440 | Injection, papaverine hcl, up to 60 mg | 13 | $30.10 |
| J2460 | Injection, oxytetracycline hcl, up to 50 mg | 7 | $0.94 |
| J2468 | Injection, palonosetron hydrochloride (posfrea) | 17 | $55.23 |
| J2469 | Injection, palonosetron hcl, 25 mcg | 19 | $0.57 |
| J2470 | Injection, pantoprazole sodium, 40 mg | 12 | $2.70 |
| J2471 | Injection, pantoprazole (hikma) | 13 | $2.94 |
| J2472 | Injection, pantoprazole sodium in sodium chloride (baxter) | 11 | $7.94 |
| J2501 | Injection, paricalcitol, 1 mcg | 20 | $0.90 |
| J2502 | Injection, pasireotide long acting, 1 mg | 16 | $592.68 |
| J2506 | Injection, pegfilgrastim, excludes biosimilar, 0.5 mg | 19 | $143.23 |
| J2507 | Injection, pegloticase, 1 mg | 18 | $3,929.33 |
| J2508 | Injection, pegunigalsidase alfa-iwxj, 1 mg | 17 | $225.67 |
| J2510 | Injection, penicillin g procaine, aqueous | 15 | $43.38 |
| J2515 | Injection, pentobarbital sodium, per 50 mg | 15 | $30.40 |
| J2516 | Injection, pentamidine isethionate, 1 mg | 16 | $0.22 |
| J2540 | Injection, penicillin g potassium, up to 600,000 units | 19 | $0.66 |
| J2543 | Injection, piperacillin sodium/tazobactam sodium | 17 | $1.18 |
| J2545 | Pentamidine isethionate, inhalation solution | 17 | $72.99 |
| J2547 | Injection, peramivir, 1 mg | 13 | $1.58 |
| J2550 | Injection, promethazine hcl, up to 50 mg | 20 | $3.51 |
| J2560 | Injection, phenobarbital sodium, up to 120 mg | 18 | $24.76 |
| J2561 | Injection, phenobarbital sodium (sezaby), 1 mg | 13 | $1.33 |
| J2562 | Injection, plerixafor, 1 mg | 19 | $30.66 |
| J2590 | Injection, oxytocin, up to 10 units | 14 | $1.08 |
| J2596 | Injection, vasopressin (long grove) | 14 | $1.59 |
| J2597 | Injection, desmopressin acetate, per 1 mcg | 16 | $3.56 |
| J2598 | Injection, vasopressin, 1 unit | 14 | $0.54 |
| J2599 | Injection, vasopressin (american regent) | 15 | $0.83 |
| J2601 | Injection, vasopressin (baxter), 1 unit | 13 | $2.22 |
| J2650 | Injection, prednisolone acetate, up to 1 ml | 8 | $0.465 |
| J2670 | Injection, tolazoline hcl, up to 25 mg | 5 | $3.44 |
| J2675 | Injection, progesterone, per 50 mg | 17 | $0.62 |
| J2679 | Injection, fluphenazine hcl, 1.25 mg | 17 | $7.27 |
| J2680 | Injection, fluphenazine decanoate, up to 25 mg | 18 | $6.07 |
| J2690 | Injection, procainamide hcl, up to 1 gm | 17 | $295.36 |
| J2700 | Injection, oxacillin sodium, up to 250 mg | 19 | $0.76 |
| J2704 | Injection, propofol, 10 mg | 14 | $0.09 |
| J2710 | Injection, neostigmine methylsulfate, up to 0.5 mg | 15 | $0.40 |
| J2711 | Injection, neostigmine methylsulfate 0.1 mg and... | 11 | $0.71 |
| J2720 | Injection, protamine sulfate, per 10 mg | 18 | $1.76 |
| J2724 | Injection, protein c concentrate, intravenous, human, 10 iu | 17 | $15.03 |
| J2725 | Injection, protirelin, per 250 mcg | 7 | $21.78 |
| J2730 | Injection, pralidoxime chloride, up to 1 gm | 15 | $91.04 |
| J2760 | Injection, phentolamine mesylate, up to 5 mg | 16 | $288.63 |
| J2765 | Injection, metoclopramide hcl, up to 10 mg | 20 | $0.98 |
| J2770 | Injection, quinupristin/dalfopristin, 500 mg (150/350) | 10 | $466.01 |
| J2777 | Injection, faricimab-svoa, 0.1 mg | 18 | $32.38 |
| J2778 | Injection, ranibizumab, 0.1 mg | 18 | $51.09 |
| J2779 | Injection, ranibizumab, via intravitreal implant (susvimo) | 17 | $74.80 |
| J2781 | Injection, pegcetacoplan, intravitreal, 1 mg | 17 | $147.80 |
| J2782 | Injection, avacincaptad pegol, 0.1 mg | 18 | $103.06 |
| J2783 | Injection, rasburicase, 0.5 mg | 15 | $386.63 |
| J2785 | Injection, regadenoson, 0.1 mg | 19 | $2.79 |
| J2786 | Injection, reslizumab, 1 mg | 18 | $11.73 |
| J2787 | Riboflavin 5'-phosphate, ophthalmic solution | 10 | $2,280.00 |
| J2788 | Injection, rho d immune globulin, human, minidose | 19 | $26.51 |
| J2789 | Riboflavin 5'-phosphate, ophthalmic solution | 9 | $41,359.62 |
| J2790 | Injection, rho d immune globulin, human, full dose | 19 | $85.12 |
| J2791 | Injection, rho(d) immune globulin (human), (rhophylac) | 19 | $4.87 |
| J2792 | Injection, rho d immune globulin, intravenous, human | 19 | $35.79 |
| J2793 | Injection, rilonacept, 1 mg | 11 | $28.59 |
| J2794 | Injection, risperidone (risperdal consta), 0.5 mg | 18 | $11.10 |
| J2795 | Injection, ropivacaine hydrochloride, 1 mg | 15 | $0.04 |
| J2796 | Injection, romiplostim, 10 micrograms | 5 | $101.05 |
| J2797 | Injection, rolapitant, 0.5 mg | 10 | $0.89 |
| J2798 | Injection, risperidone, (perseris), 0.5 mg | 17 | $12.19 |
| J2799 | Injection, risperidone (uzedy), 1 mg | 17 | $26.18 |
| J2800 | Injection, methocarbamol, up to 10 ml | 17 | $4.50 |
| J2801 | Injection, risperidone (rykindo), 0.5 mg | 12 | $12.60 |
| J2802 | Injection, romiplostim, 1 microgram | 19 | $11.61 |
| J2804 | Injection, rifampin, 1 mg | 16 | $0.17 |
| J2805 | Injection, sincalide, 5 micrograms | 13 | $110.46 |
| J2810 | Injection, theophylline, per 40 mg | 7 | $0.39 |
| J2820 | Injection, sargramostim (gm-csf), 50 mcg | 19 | $62.47 |
| J2840 | Injection, sebelipase alfa, 1 mg | 16 | $510.50 |
| J2850 | Injection, secretin, synthetic, human, 1 microgram | 10 | $34.78 |
| J2860 | Injection, siltuximab, 10 mg | 17 | $174.06 |
| J2865 | Injection, sulfamethoxazole 5 mg and trimethoprim 1 mg | 17 | $0.04 |
| J2916 | Injection, sodium ferric gluconate complex in sucrose... | 20 | $2.20 |
| J2919 | Injection, methylprednisolone sodium succinate, 5 mg | 19 | $0.25 |
| J2941 | Injection, somatropin, 1 mg | 14 | $71.72 |
| J2950 | Injection, promazine hcl, up to 25 mg | 5 | $0.38 |
| J2993 | Injection, reteplase, 18.1 mg | 11 | $2,301.91 |
| J2997 | Injection, alteplase recombinant, 1 mg | 19 | $98.42 |
| J2998 | Injection, plasminogen, human-tvmh, 1 mg | 16 | $38.19 |
| J3000 | Injection, streptomycin, up to 1 gm | 18 | $26.88 |
| J3010 | Injection, fentanyl citrate, 0.1 mg | 18 | $1.34 |
| J3030 | Injection, sumatriptan succinate, 6 mg | 16 | $50.00 |
| J3031 | Injection, fremanezumab-vfrm, 1 mg | 12 | $3.53 |
| J3032 | Injection, eptinezumab-jjmr, 1 mg | 18 | $21.10 |
| J3055 | Injection, talquetamab-tgvs, 0.25 mg | 18 | $76.72 |
| J3060 | Injection, taliglucerase alfa, 10 units | 18 | $42.47 |
| J3070 | Injection, pentazocine, 30 mg | 13 | $108.39 |
| J3090 | Injection, tedizolid phosphate, 1 mg | 17 | $2.06 |
| J3095 | Injection, telavancin, 10 mg | 17 | $7.48 |
| J3101 | Injection, tenecteplase, 1 mg | 14 | $217.42 |
| J3105 | Injection, terbutaline sulfate, up to 1 mg | 18 | $2.65 |
| J3110 | Injection, teriparatide, 10 mcg | 10 | $19.38 |
| J3111 | Injection, romosozumab-aqqg, 1 mg | 18 | $12.73 |
| J3121 | Injection, testosterone enanthate, 1 mg | 17 | $0.05 |
| J3145 | Injection, testosterone undecanoate, 1 mg | 17 | $2.15 |
| J3230 | Injection, chlorpromazine hcl, up to 50 mg | 18 | $18.14 |
| J3240 | Injection, thyrotropin alpha, 0.9 mg | 18 | $2,155.11 |
| J3241 | Injection, teprotumumab-trbw, 10 mg | 18 | $379.90 |
| J3243 | Injection, tigecycline, 1 mg | 18 | $0.52 |
| J3244 | Injection, tigecycline (accord) | 16 | $2.49 |
| J3245 | Injection, tildrakizumab, 1 mg | 16 | $124.27 |
| J3246 | Injection, tirofiban hcl, 0.25 mg | 14 | $2.92 |
| J3247 | Injection, secukinumab, intravenous, 1 mg | 19 | $18.13 |
| J3250 | Injection, trimethobenzamide hcl, up to 200 mg | 19 | $62.42 |
| J3260 | Injection, tobramycin sulfate, up to 80 mg | 20 | $2.19 |
| J3262 | Injection, tocilizumab, 1 mg | 18 | $5.41 |
| J3263 | Injection, toripalimab-tpzi, 1 mg | 20 | $40.66 |
| J3265 | Injection, torsemide, 10 mg/ml | 8 | $2.19 |
| J3285 | Injection, treprostinil, 1 mg | 18 | $54.74 |
| J3290 | Injection, tranexamic acid, 5 mg | 10 | $0.025 |
| J3291 | Injection, tranexamic acid in sodium chloride, 5 mg | 10 | $0.09 |
| J3299 | Injection, triamcinolone acetonide (xipere), 1 mg | 18 | $47.77 |
| J3300 | Injection, triamcinolone acetonide (triesence) | 17 | $17.20 |
| J3301 | Injection, triamcinolone acetonide, not otherwise specified | 19 | $0.99 |
| J3302 | Injection, triamcinolone diacetate, per 5 mg | 9 | $0.28 |
| J3303 | Injection, triamcinolone hexacetonide, per 5 mg | 15 | $3.61 |
| J3304 | Injection, triamcinolone acetonide, preservative-free | 18 | $19.16 |
| J3315 | Injection, triptorelin pamoate, 3.75 mg | 19 | $466.37 |
| J3316 | Injection, triptorelin, extended-release, 3.75 mg | 19 | $3,819.93 |
| J3350 | Injection, urea, up to 40 gm | 5 | $70.25 |
| J3357 | Ustekinumab, for subcutaneous injection, 1 mg | 17 | $155.88 |
| J3358 | Ustekinumab, for intravenous injection, 1 mg | 18 | $11.36 |
| J3360 | Injection, diazepam, up to 5 mg | 20 | $6.77 |
| J3370 | Injection, vancomycin hcl, 500 mg | 7 | $1.95 |
| J3371 | Injection, vancomycin hcl (mylan) | 6 | $6.31 |
| J3372 | Injection, vancomycin hcl (xellia) | 6 | $6.54 |
| J3373 | Injection, vancomycin hydrochloride, 10 mg | 20 | $0.03 |
| J3374 | Injection, vancomycin hydrochloride | 18 | $0.094 |
| J3375 | Injection, vancomycin hydrochloride (tyzavan) | 18 | $0.14 |
| J3376 | Injection, vancomycin hcl (hikma) | 18 | $0.02 |
| J3379 | Injection, valproate sodium, 5 mg | 17 | $0.03 |
| J3380 | Injection, vedolizumab, intravenous, 1 mg | 18 | $21.37 |
| J3385 | Injection, velaglucerase alfa, 100 units | 17 | $392.84 |
| J3392 | Injection, exagamglogene autotemcel, per treatment | 6 | $2,123,206.80 |
| J3394 | Injection, lovotibeglogene autotemcel, per treatment | 5 | $2,883,582.80 |
| J3396 | Injection, verteporfin, 0.1 mg | 17 | $11.37 |
| J3397 | Injection, vestronidase alfa-vjbk, 1 mg | 12 | $282.50 |
| J3398 | Injection, voretigene neparvovec-rzyl | 8 | $3,047.47 |
| J3399 | Injection, onasemnogene abeparvovec-xioi, per treatment | 8 | $2,522,207.10 |
| J3401 | Beremagene geperpavec-svdt for topical administration | 15 | $1,029.47 |
| J3402 | Injection, remestemcel-l-rknd, per therapeutic dose | 12 | $202,159.94 |
| J3403 | Revakinagene taroretcel-lwey, per implant | 9 | $262,233.77 |
| J3404 | Injection, zopapogene imadenovec-drba suspension | 11 | $115,000.00 |
| J3405 | Injection, onasemnogene abeparvovec-brve, per treatment | 6 | $2,532,431.58 |
| J3410 | Injection, hydroxyzine hcl, up to 25 mg | 18 | $14.11 |
| J3411 | Injection, thiamine hcl, 100 mg | 14 | $1.59 |
| J3415 | Injection, pyridoxine hcl, 100 mg | 14 | $14.88 |
| J3420 | Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg | 19 | $0.68 |
| J3424 | Injection, hydroxocobalamin, intravenous, 25 mg | 7 | $5.24 |
| J3425 | Injection, hydroxocobalamin, intramuscular, 10 mcg | 14 | $0.01 |
| J3430 | Injection, phytonadione (vitamin k), per 1 mg | 18 | $3.25 |
| J3465 | Injection, voriconazole, 10 mg | 15 | $0.56 |
| J3470 | Injection, hyaluronidase, up to 150 units | 14 | $31.76 |
| J3471 | Injection, hyaluronidase, ovine, preservative free | 10 | $0.50 |
| J3472 | Injection, hyaluronidase, ovine, preservative free | 10 | $219.54 |
| J3473 | Injection, hyaluronidase, recombinant, 1 usp unit | 14 | $0.36 |
| J3475 | Injection, magnesium sulfate, per 500 mg | 18 | $0.44 |
| J3480 | Injection, potassium chloride, per 2 meq | 18 | $0.13 |
| J3485 | Injection, zidovudine, 10 mg | 16 | $1.51 |
| J3486 | Injection, ziprasidone mesylate, 10 mg | 17 | $5.94 |
| J3489 | Injection, zoledronic acid, 1 mg | 19 | $3.94 |
| J3490 | Unclassified drugs | 7 | $19.40 |
| J7030 | Infusion, normal saline solution , 1000 cc | 18 | $2.18 |
| J7040 | Infusion, normal saline solution, sterile (500 ml = 1 unit) | 18 | $1.35 |
| J7042 | 5% dextrose/normal saline (500 ml = 1 unit) | 17 | $1.22 |
| J7050 | Infusion, normal saline solution, 250 cc | 18 | $0.70 |
| J7060 | 5% dextrose/water (500 ml = 1 unit) | 18 | $1.73 |
| J7070 | Infusion, d5w, 1000 cc | 18 | $2.94 |
| J7100 | Infusion, dextran 40, 500 ml | 13 | $54.49 |
| J7110 | Infusion, dextran 75, 500 ml | 9 | $14.52 |
| J7120 | Ringers lactate infusion, up to 1000 cc | 18 | $2.34 |
| J7121 | 5% dextrose in lactated ringers infusion, up to 1000 cc | 9 | $5.95 |
| J7131 | Hypertonic saline solution, 1 ml | 5 | $0.17 |
| J7165 | Injection, prothrombin complex concentrate, human-lans | 14 | $3.15 |
| J7168 | Prothrombin complex concentrate (human), kcentra | 13 | $2.98 |
| J7169 | Injection, coagulation factor xa (recombinant) | 14 | $131.88 |
| J7170 | Injection, emicizumab-kxwh, 0.5 mg | 15 | $58.03 |
| J7171 | Injection, adamts13, recombinant-krhn, 10 iu | 18 | $36.21 |
| J7172 | Injection, marstacimab-hncq, 0.5 mg | 16 | $50.98 |
| J7173 | Injection, concizumab-mtci, 0.5 mg | 13 | $85.50 |
| J7174 | Injection, fitusiran, 0.04 mg | 13 | $131.20 |
| J7175 | Injection, factor x, (human), 1 i.u. | 15 | $9.92 |
| J7176 | Injection, human fibrinogen - chmt (fesilty), 1 mg | 8 | $1.05 |
| J7177 | Injection, human fibrinogen concentrate (fibryga), 1 mg | 17 | $1.23 |
| J7178 | Injection, human fibrinogen concentrate | 16 | $1.43 |
| J7179 | Injection, von willebrand factor (recombinant), (vonvendi) | 14 | $1.81 |
| J7180 | Injection, factor xiii (antihemophilic factor, human) | 14 | $10.93 |
| J7181 | Injection, factor xiii a-subunit, (recombinant), per iu | 15 | $19.08 |
| J7182 | Injection, factor viii, (antihemophilic factor | 14 | $1.44 |
| J7183 | Injection, von willebrand factor complex (human), wilate | 14 | $1.30 |
| J7185 | Injection, factor viii (antihemophilic factor, recombinant) | 15 | $1.37 |
| J7186 | Injection, antihemophilic factor viii/von willebrand factor... | 14 | $1.24 |
| J7187 | Injection, von willebrand factor complex (humate-p) | 14 | $1.49 |
| J7188 | Injection, factor viii (antihemophilic factor, recombinant) | 14 | $3.23 |
| J7189 | Factor viia (antihemophilic factor, recombinant), | 14 | $2.62 |
| J7190 | Factor viii (antihemophilic factor, human) per i.u. | 14 | $1.23 |
| J7191 | Factor viii (antihemophilic factor (porcine)), per i.u. | 7 | $1.86 |
| J7192 | Factor viii (antihemophilic factor, recombinant) per i.u. | 14 | $1.58 |
| J7193 | Factor ix (antihemophilic factor, purified | 14 | $1.37 |
| J7194 | Factor ix, complex, per i.u. | 14 | $1.70 |
| J7195 | Injection, factor ix (antihemophilic factor | 14 | $1.83 |
| J7196 | Injection, antithrombin recombinant, 50 i.u. | 8 | $98.99 |
| J7197 | Antithrombin iii (human), per i.u. | 13 | $4.17 |
| J7198 | Anti-inhibitor, per i.u. | 14 | $2.44 |
| J7200 | Injection, factor ix, (antihemophilic factor, recombinant) | 14 | $1.71 |
| J7201 | Injection, factor ix, fc fusion protein, (recombinant) | 14 | $3.60 |
| J7202 | Injection, factor ix, albumin fusion protein, (recombinant) | 14 | $5.32 |
| J7203 | Injection factor ix, (antihemophilic factor, recombinant) | 14 | $4.56 |
| J7204 | Injection, factor viii, antihemophilic factor (recombinant) | 14 | $2.27 |
| J7205 | Injection, factor viii fc fusion protein (recombinant) | 14 | $2.47 |
| J7207 | Injection, factor viii, (antihemophilic factor | 14 | $2.11 |
| J7208 | Injection, factor viii, (antihemophilic factor | 14 | $2.70 |
| J7209 | Injection, factor viii, (antihemophilic factor | 14 | $1.17 |
| J7210 | Injection, factor viii, (antihemophilic factor | 14 | $1.60 |
| J7211 | Injection, factor viii, (antihemophilic factor | 14 | $1.57 |
| J7212 | Factor viia (antihemophilic factor, recombinant)-jncw | 13 | $2.19 |
| J7213 | Injection, coagulation factor ix (recombinant), ixinity | 13 | $1.94 |
| J7214 | Injection, factor viii/von willebrand factor complex | 13 | $4.62 |
| J7294 | Segesterone acetate and ethinyl estradiol 0.15mg | 17 | $2,316.51 |
| J7295 | Ethinyl estradiol and etonogestrel 0.015mg | 16 | $118.00 |
| J7296 | Levonorgestrel-releasing intrauterine contraceptive system, | 21 | $1,272.44 |
| J7297 | Levonorgestrel-releasing intrauterine contraceptive system | 21 | $978.32 |
| J7298 | Levonorgestrel-releasing intrauterine contraceptive system | 21 | $1,272.44 |
| J7299 | Intrauterine copper contraceptive (miudella) | 6 | $1,139.00 |
| J7300 | Intrauterine copper contraceptive (paragard) | 21 | $1,187.00 |
| J7301 | Levonorgestrel-releasing intrauterine contraceptive system | 21 | $1,059.52 |
| J7304 | Contraceptive supply, hormone containing patch, each | 12 | $41.28 |
| J7307 | Etonogestrel (contraceptive) implant system | 21 | $1,275.36 |
| J7308 | Aminolevulinic acid hcl for topical administration, 20% | 15 | $389.28 |
| J7311 | Injection, fluocinolone acetonide, intravitreal implant | 16 | $338.80 |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 19 | $203.65 |
| J7313 | Injection, fluocinolone acetonide, intravitreal implant | 18 | $516.36 |
| J7314 | Injection, fluocinolone acetonide, intravitreal implant | 17 | $529.89 |
| J7315 | Mitomycin, ophthalmic, 0.2 mg | 6 | $426.56 |
| J7316 | Injection, ocriplasmin, 0.125 mg | 12 | $1,046.93 |
| J7318 | Hyaluronan or derivative, durolane | 11 | $6.31 |
| J7320 | Hyaluronan or derivitive, genvisc 850 | 13 | $3.81 |
| J7321 | Hyaluronan or derivative, hyalgan, supartz or visco-3 | 16 | $72.28 |
| J7322 | Hyaluronan or derivative, hymovis or hymovis one | 12 | $18.13 |
| J7323 | Hyaluronan or derivative, euflexxa | 15 | $103.60 |
| J7324 | Hyaluronan or derivative, orthovisc | 15 | $111.26 |
| J7325 | Hyaluronan or derivative, synvisc or synvisc-one | 14 | $6.40 |
| J7326 | Hyaluronan or derivative, gel-one | 12 | $530.82 |
| J7327 | Hyaluronan or derivative, monovisc | 13 | $626.14 |
| J7328 | Hyaluronan or derivative, gelsyn-3 | 12 | $0.58 |
| J7329 | Hyaluronan or derivative, trivisc | 10 | $3.40 |
| J7331 | Hyaluronan or derivative, synojoynt | 8 | $3.12 |
| J7332 | Hyaluronan or derivative, triluron | 10 | $10.43 |
| J7336 | Capsaicin 8% patch, per square centimeter | 14 | $3.50 |
| J7340 | Carbidopa 5 mg/levodopa 20 mg enteral suspension, 100 ml | 14 | $243.79 |
| J7342 | Instillation, ciprofloxacin otic suspension, 6 mg | 13 | $28.88 |
| J7345 | Aminolevulinic acid hcl for topical administration, 10% gel | 9 | $1.79 |
| J7351 | Injection, bimatoprost, intracameral implant, 1 microgram | 19 | $213.76 |
| J7352 | Afamelanotide implant, 1 mg | 9 | $2,880.10 |
| J7353 | Anacaulase-bcdb, 8.8% gel, 1 gram | 5 | $57.27 |
| J7354 | Cantharidin for topical administration, 0.7% | 17 | $683.47 |
| J7355 | Injection, travoprost, intracameral implant, 1 microgram | 17 | $196.74 |
| J7356 | Injection, foscarbidopa 0.25 mg/foslevodopa 5 mg | 15 | $0.70 |
| J7402 | Mometasone furoate sinus implant, (sinuva), 10 micrograms | 18 | $11.35 |
| J7500 | Azathioprine, oral, 50 mg | 13 | $0.13 |
| J7501 | Azathioprine, parenteral, 100 mg | 15 | $217.30 |
| J7502 | Cyclosporine, oral, 100 mg | 12 | $1.56 |
| J7503 | Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg | 11 | $1.86 |
| J7504 | Lymphocyte immune globulin, antithymocyte globulin, equine | 17 | $5,509.07 |
| J7507 | Tacrolimus, immediate release, oral, 1 mg | 13 | $0.20 |
| J7508 | Tacrolimus, extended release, (astagraf xl), oral, 0.1 mg | 12 | $0.60 |
| J7509 | Methylprednisolone oral, per 4 mg | 14 | $0.16 |
| J7510 | Prednisolone oral, per 5 mg | 13 | $0.50 |
| J7511 | Lymphocyte immune globulin, antithymocyte globulin, rabbit | 16 | $1,057.79 |
| J7512 | Prednisone, immediate release or delayed release, oral, 1 mg | 9 | $0.01 |
| J7514 | Mycophenolate mofetil (myhibbin), oral suspension, 100 mg | 7 | $2.24 |
| J7515 | Cyclosporine, oral, 25 mg | 13 | $0.58 |
| J7516 | Injection, cyclosporine, 250 mg | 14 | $75.64 |
| J7517 | Mycophenolate mofetil, oral, 250 mg | 8 | $0.13 |
| J7518 | Mycophenolic acid, oral, 180 mg | 12 | $0.32 |
| J7519 | Injection, mycophenolate mofetil, 10 mg | 12 | $0.395 |
| J7520 | Sirolimus, oral, 1 mg | 12 | $0.74 |
| J7521 | Tacrolimus, granules, oral suspension, 0.1 mg | 11 | $1.30 |
| J7525 | Tacrolimus, parenteral, 5 mg | 16 | $257.70 |
| J7526 | Injection, mycophenolate mofetil, 5 mg | 5 | $0.20 |
| J7527 | Everolimus, oral, 0.25 mg | 11 | $1.16 |
| J7528 | Mycophenolate mofetil, for suspension, oral, 100 mg | 7 | $0.16 |
| J7601 | Ensifentrine, inhalation suspension | 11 | $52.11 |
| J7605 | Arformoterol, inhalation solution | 13 | $0.73 |
| J7606 | Formoterol fumarate, inhalation solution | 13 | $1.55 |
| J7608 | Acetylcysteine, inhalation solution | 14 | $7.27 |
| J7609 | Albuterol, inhalation solution, compounded product | 5 | $0.05 |
| J7611 | Albuterol, inhalation solution, fda-approved final product | 15 | $0.21 |
| J7612 | Levalbuterol, inhalation solution | 14 | $0.325 |
| J7613 | Albuterol, inhalation solution, fda-approved final product | 15 | $0.07 |
| J7614 | Levalbuterol, inhalation solution | 14 | $0.08 |
| J7620 | Albuterol, up to 2.5 mg and ipratropium bromide | 16 | $0.20 |
| J7626 | Budesonide, inhalation solution, fda-approved final product | 13 | $1.09 |
| J7627 | Budesonide, inhalation solution, compounded product | 6 | $1.04 |
| J7629 | Bitolterol mesylate, inhalation solution | 5 | $0.17 |
| J7631 | Cromolyn sodium, inhalation solution | 13 | $0.69 |
| J7633 | Budesonide, inhalation solution, fda-approved final product | 7 | $4.74 |
| J7635 | Atropine, inhalation solution, compounded product | 7 | $0.12 |
| J7636 | Atropine, inhalation solution, compounded product | 5 | $0.12 |
| J7637 | Dexamethasone, inhalation solution, compounded product | 7 | $0.11 |
| J7638 | Dexamethasone, inhalation solution, compounded product | 6 | $0.12 |
| J7639 | Dornase alfa, inhalation solution | 15 | $56.78 |
| J7642 | Glycopyrrolate, inhalation solution, compounded product | 6 | $1.19 |
| J7643 | Glycopyrrolate, inhalation solution, compounded product | 5 | $1.19 |
| J7644 | Ipratropium bromide, inhalation solution | 15 | $0.44 |
| J7665 | Mannitol, administered through an inhaler, 5 mg | 8 | $1.41 |
| J7669 | Metaproterenol sulfate, inhalation solution | 8 | $0.43 |
| J7674 | Methacholine chloride administered as inhalation solution... | 11 | $1.90 |
| J7677 | Revefenacin inhalation solution, fda-approved final product | 10 | $0.20 |
| J7682 | Tobramycin, inhalation solution, fda-approved final product | 13 | $12.30 |
| J7684 | Triamcinolone, inhalation solution, compounded product | 5 | $0.56 |
| J7686 | Treprostinil, inhalation solution | 13 | $830.38 |
| J8501 | Aprepitant, oral, 5 mg | 11 | $2.89 |
| J8502 | Injection, aprepitant (aponvie), 1 mg | 16 | $2.00 |
| J8510 | Busulfan; oral, 2 mg | 10 | $24.18 |
| J8515 | Cabergoline, oral, 0.25 mg | 6 | $0.34 |
| J8522 | Capecitabine, oral, 50 mg | 12 | $0.035 |
| J8530 | Cyclophosphamide; oral, 25 mg | 14 | $1.49 |
| J8540 | Dexamethasone, oral, 0.25 mg | 10 | $0.02 |
| J8541 | Dexamethasone (hemady), oral, 0.25 mg | 8 | $0.36 |
| J8560 | Etoposide; oral, 50 mg | 12 | $88.06 |
| J8600 | Melphalan; oral, 2 mg | 10 | $9.90 |
| J8610 | Methotrexate; oral, 2.5 mg | 12 | $0.15 |
| J8611 | Methotrexate (jylamvo), oral, 2.5 mg | 10 | $17.87 |
| J8612 | Methotrexate (xatmep), oral, 2.5 mg | 10 | $22.43 |
| J8655 | Netupitant 300 mg and palonosetron 0.5 mg, oral | 14 | $455.76 |
| J8670 | Rolapitant, oral, 1 mg | 8 | $2.00 |
| J8700 | Temozolomide, oral, 5 mg | 13 | $0.42 |
| J8705 | Topotecan, oral, 0.25 mg | 10 | $125.33 |
| J9000 | Injection, doxorubicin hydrochloride, 10 mg | 20 | $2.74 |
| J9011 | Injection, datopotamab deruxtecan-dlnk, 1 mg | 19 | $52.49 |
| J9015 | Injection, aldesleukin, per single use vial | 14 | $3,397.12 |
| J9017 | Injection, arsenic trioxide, 1 mg | 19 | $5.07 |
| J9019 | Injection, asparaginase (erwinaze), 1,000 iu | 5 | $427.27 |
| J9021 | Injection, asparaginase, recombinant, (rylaze), 0.1 mg | 19 | $58.69 |
| J9022 | Injection, atezolizumab, 10 mg | 19 | $96.54 |
| J9023 | Injection, avelumab, 10 mg | 19 | $108.63 |
| J9024 | Injection, atezolizumab, 5 mg and hyaluronidase-tqjs | 19 | $32.42 |
| J9025 | Injection, azacitidine, 1 mg | 19 | $0.40 |
| J9026 | Injection, tarlatamab-dlle, 1 mg | 19 | $1,612.42 |
| J9027 | Injection, clofarabine, 1 mg | 18 | $16.24 |
| J9028 | Injection, nogapendekin alfa inbakicept-pmln | 19 | $94.14 |
| J9029 | Intravesical instillation, nadofaragene firadenovec-vncg | 15 | $64,331.61 |
| J9030 | Bcg live intravesical instillation, 1 mg | 19 | $3.38 |
| J9032 | Injection, belinostat, 10 mg | 19 | $54.44 |
| J9033 | Injection, bendamustine hydrochloride | 20 | $2.96 |
| J9034 | Injection, bendamustine hcl (bendeka), 1 mg | 19 | $12.53 |
| J9035 | Injection, bevacizumab, 10 mg | 19 | $74.82 |
| J9036 | Injection, bendamustine hydrochloride, | 17 | $11.60 |
| J9037 | Injection, belantamab mafodotin-blmf, 0.5 mg | 5 | $44.13 |
| J9038 | Injection, axatilimab-csfr, 0.1 mg | 15 | $56.46 |
| J9039 | Injection, blinatumomab, 1 microgram | 20 | $172.90 |
| J9040 | Injection, bleomycin sulfate, 15 units | 20 | $24.83 |
| J9041 | Injection, bortezomib, 0.1 mg | 19 | $2.04 |
| J9042 | Injection, brentuximab vedotin, 1 mg | 19 | $279.20 |
| J9043 | Injection, cabazitaxel, 1 mg | 19 | $231.69 |
| J9045 | Injection, carboplatin, 50 mg | 19 | $3.15 |
| J9046 | Injection, bortezomib (dr. reddy's) | 18 | $45.80 |
| J9047 | Injection, carfilzomib, 1 mg | 19 | $60.29 |
| J9048 | Injection, bortezomib (fresenius kabi) | 17 | $8.57 |
| J9049 | Injection, bortezomib (hospira) | 18 | $1.63 |
| J9050 | Injection, carmustine, 100 mg | 19 | $235.27 |
| J9051 | Injection, bortezomib (maia) | 7 | $3.66 |
| J9052 | Injection, carmustine (accord) | 18 | $107.58 |
| J9053 | Injection, belantamab mafodotin-blmf, 0.1 mg | 15 | $36.20 |
| J9054 | Injection, bortezomib (boruzu), 0.1 mg | 17 | $24.74 |
| J9055 | Injection, cetuximab, 10 mg | 19 | $81.66 |
| J9056 | Injection, bendamustine hydrochloride (vivimusta), 1 mg | 18 | $29.91 |
| J9057 | Injection, copanlisib, 1 mg | 13 | $87.56 |
| J9060 | Injection, cisplatin, powder or solution, 10 mg | 19 | $2.13 |
| J9061 | Injection, amivantamab-vmjw, 2 mg | 18 | $23.21 |
| J9062 | Injection, amivantamab 5 mg and hyaluronidase-lpuj | 15 | $40.49 |
| J9063 | Injection, mirvetuximab soravtansine-gynx, 1 mg | 19 | $71.58 |
| J9065 | Injection, cladribine, per 1 mg | 20 | $8.19 |
| J9071 | Injection, cyclophosphamide (auromedics), 5 mg | 17 | $0.49 |
| J9072 | Injection, cyclophosphamide (frindovyx), 5 mg | 18 | $8.92 |
| J9073 | Injection, cyclophosphamide (dr. reddy's), 5 mg | 20 | $0.495 |
| J9074 | Injection, cyclophosphamide (sandoz), 5 mg | 19 | $3.44 |
| J9075 | Injection, cyclophosphamide, not otherwise specified, 5 mg | 19 | $0.59 |
| J9076 | Injection, cyclophosphamide (baxter), 5 mg | 17 | $4.39 |
| J9100 | Injection, cytarabine, 100 mg | 20 | $0.85 |
| J9118 | Injection, calaspargase pegol-mknl, 10 units | 19 | $85.78 |
| J9119 | Injection, cemiplimab-rwlc, 1 mg | 19 | $29.67 |
| J9120 | Injection, dactinomycin, 0.5 mg | 19 | $307.99 |
| J9130 | Dacarbazine, 100 mg | 19 | $3.58 |
| J9144 | Injection, daratumumab, 10 mg and hyaluronidase-fihj | 19 | $57.05 |
| J9145 | Injection, daratumumab, 10 mg | 19 | $73.77 |
| J9150 | Injection, daunorubicin, 10 mg | 19 | $28.81 |
| J9153 | Injection, liposomal | 19 | $272.89 |
| J9155 | Injection, degarelix, 1 mg | 19 | $4.48 |
| J9161 | Injection, denileukin diftitox-cxdl, 1 mcg | 14 | $12.83 |
| J9171 | Injection, docetaxel, 1 mg | 19 | $0.46 |
| J9172 | Injection, docetaxel (docivyx), 1 mg | 19 | $46.29 |
| J9173 | Injection, durvalumab, 10 mg | 19 | $87.66 |
| J9174 | Injection, docetaxel (beizray), 1 mg | 12 | $46.80 |
| J9175 | Injection, elliotts' b solution, 1 ml | 10 | $4.23 |
| J9176 | Injection, elotuzumab, 1 mg | 19 | $8.19 |
| J9177 | Injection, enfortumab vedotin-ejfv, 0.25 mg | 19 | $36.65 |
| J9178 | Injection, epirubicin hcl, 2 mg | 19 | $1.99 |
| J9179 | Injection, eribulin mesylate, 0.1 mg | 19 | $61.86 |
| J9181 | Injection, etoposide, 10 mg | 15 | $1.02 |
| J9183 | Gemcitabine intravesical system, 225 mg | 16 | $72,984.24 |
| J9184 | Injection, gemcitabine hydrochloride (avyxa), 200 mg | 18 | $400.33 |
| J9185 | Injection, fludarabine phosphate, 50 mg | 19 | $206.29 |
| J9190 | Injection, fluorouracil, 500 mg | 16 | $2.02 |
| J9191 | Injection, fluorouracil (avyxa), 10 mg | 5 | $14.84 |
| J9196 | Injection, gemcitabine hydrochloride (accord) | 16 | $5.29 |
| J9198 | Injection, gemcitabine hydrochloride, (infugem), 100 mg | 12 | $40.09 |
| J9200 | Injection, floxuridine, 500 mg | 19 | $4,389.85 |
| J9201 | Injection, gemcitabine hydrochloride | 19 | $2.88 |
| J9202 | Goserelin acetate implant, per 3.6 mg | 11 | $777.50 |
| J9203 | Injection, gemtuzumab ozogamicin, 0.1 mg | 17 | $247.37 |
| J9204 | Injection, mogamulizumab-kpkc, 1 mg | 19 | $256.10 |
| J9205 | Injection, irinotecan liposome, 1 mg | 19 | $65.86 |
| J9206 | Injection, irinotecan, 20 mg | 19 | $1.85 |
| J9207 | Injection, ixabepilone, 1 mg | 19 | $139.75 |
| J9208 | Injection, ifosfamide, 1 gram | 20 | $27.61 |
| J9209 | Injection, mesna, 200 mg | 19 | $1.31 |
| J9210 | Injection, emapalumab-lzsg, 1 mg | 17 | $392.78 |
| J9211 | Injection, idarubicin hydrochloride, 5 mg | 17 | $38.13 |
| J9213 | Injection, interferon, alfa-2a, recombinant, 3 million units | 7 | $40.53 |
| J9214 | Injection, interferon, alfa-2b, recombinant, 1 million units | 13 | $32.57 |
| J9215 | Injection, interferon, alfa-n3, (human leukocyte derived) | 11 | $18.46 |
| J9216 | Injection, interferon, gamma 1-b, 3 million units | 15 | $5,393.25 |
| J9217 | Leuprolide acetate (for depot suspension), 7.5 mg | 19 | $170.78 |
| J9218 | Leuprolide acetate, per 1 mg | 14 | $8.96 |
| J9219 | Leuprolide acetate implant, 65 mg | 10 | $4,819.82 |
| J9220 | Injection, indigotindisulfonate sodium, 1 mg | 9 | $10.50 |
| J9223 | Injection, lurbinectedin, 0.1 mg | 19 | $215.72 |
| J9225 | Histrelin implant (vantas), 50 mg | 12 | $5,166.29 |
| J9226 | Histrelin implant (supprelin la), 50 mg | 16 | $37,491.97 |
| J9227 | Injection, isatuximab-irfc, 10 mg | 19 | $88.16 |
| J9228 | Injection, ipilimumab, 1 mg | 19 | $190.43 |
| J9229 | Injection, inotuzumab ozogamicin, 0.1 mg | 17 | $2,873.10 |
| J9230 | Injection, mechlorethamine hydrochloride, | 12 | $321.72 |
| J9232 | Injection, docetaxel (hospira) | 14 | $0.51 |
| J9245 | Injection, melphalan hydrochloride, not otherwise specified | 19 | $104.89 |
| J9246 | Injection, melphalan (evomela), 1 mg | 16 | $18.04 |
| J9248 | Injection, melphalan (hepzato), 1 mg | 11 | $797.42 |
| J9249 | Injection, melphalan (apotex), 1 mg | 9 | $61.11 |
| J9255 | Injection, methotrexate (accord) | 8 | $1.90 |
| J9256 | Injection, nipocalimab-aahu, 3 mg | 17 | $32.56 |
| J9260 | Injection, methotrexate sodium, 50 mg | 19 | $2.91 |
| J9261 | Injection, nelarabine, 50 mg | 18 | $65.40 |
| J9262 | Injection, omacetaxine mepesuccinate, 0.01 mg | 14 | $3.95 |
| J9263 | Injection, oxaliplatin, 0.5 mg | 19 | $0.06 |
| J9264 | Injection, paclitaxel protein-bound particles, 1 mg | 19 | $6.59 |
| J9266 | Injection, pegaspargase, per single dose vial | 17 | $29,663.96 |
| J9267 | Injection, paclitaxel, 1 mg | 19 | $0.11 |
| J9268 | Injection, pentostatin, 10 mg | 18 | $2,655.44 |
| J9269 | Injection, tagraxofusp-erzs, 10 micrograms | 19 | $357.29 |
| J9271 | Injection, pembrolizumab, 1 mg | 19 | $60.64 |
| J9272 | Injection, dostarlimab-gxly, 10 mg | 18 | $250.55 |
| J9273 | Injection, tisotumab vedotin-tftv, 1 mg | 18 | $196.12 |
| J9274 | Injection, tebentafusp-tebn, 1 microgram | 18 | $228.00 |
| J9275 | Injection, cosibelimab-ipdl, 2 mg | 6 | $21.81 |
| J9276 | Injection, zanidatamab-hrii, 2 mg | 19 | $25.66 |
| J9277 | Injection, pembrolizumab | 17 | $31.94 |
| J9278 | Injection, carboplatin (avyxa), 1 mg | 17 | $5.20 |
| J9280 | Injection, mitomycin, 5 mg | 19 | $34.11 |
| J9281 | Mitomycin pyelocalyceal instillation, 1 mg | 18 | $329.07 |
| J9282 | Mitomycin, intravesical instillation, 1 mg | 15 | $274.34 |
| J9285 | Injection, olaratumab, 10 mg | 12 | $52.07 |
| J9286 | Injection, glofitamab-gxbm, 2.5 mg | 17 | $2,859.12 |
| J9289 | Injection, nivolumab, 2 mg and hyaluronidase-nvhy | 18 | $28.07 |
| J9292 | Injection, pemetrexed dipotassium, 10 mg | 16 | $73.92 |
| J9293 | Injection, mitoxantrone hydrochloride, per 5 mg | 19 | $29.70 |
| J9294 | Injection, pemetrexed (hospira) | 18 | $2.94 |
| J9295 | Injection, necitumumab, 1 mg | 17 | $5.73 |
| J9296 | Injection, pemetrexed (accord) | 17 | $9.66 |
| J9297 | Injection, pemetrexed (sandoz) | 18 | $4.88 |
| J9298 | Injection, nivolumab and relatlimab-rmbw, 3 mg/1 mg | 19 | $205.44 |
| J9299 | Injection, nivolumab, 1 mg | 19 | $34.19 |
| J9301 | Injection, obinutuzumab, 10 mg | 19 | $84.46 |
| J9302 | Injection, ofatumumab, 10 mg | 18 | $63.96 |
| J9303 | Injection, panitumumab, 10 mg | 19 | $182.19 |
| J9304 | Injection, pemetrexed (pemfexy), 10 mg | 17 | $7.99 |
| J9305 | Injection, pemetrexed, not otherwise specified, 10 mg | 19 | $6.95 |
| J9306 | Injection, pertuzumab, 1 mg | 19 | $17.20 |
| J9307 | Injection, pralatrexate, 1 mg | 19 | $384.57 |
| J9308 | Injection, ramucirumab, 5 mg | 19 | $76.40 |
| J9309 | Injection, polatuzumab vedotin-piiq, 1 mg | 19 | $143.61 |
| J9311 | Injection, rituximab 10 mg and hyaluronidase | 19 | $36.38 |
| J9312 | Injection, rituximab, 10 mg | 19 | $73.27 |
| J9313 | Injection, moxetumomab pasudotox-tdfk, 0.01 mg | 17 | $23.39 |
| J9314 | Injection, pemetrexed (teva) | 17 | $10.98 |
| J9316 | Injection, pertuzumab, trastuzumab, and hyaluronidase-zzxf | 19 | $59.89 |
| J9317 | Injection, sacituzumab govitecan-hziy, 2.5 mg | 19 | $37.54 |
| J9318 | Injection, romidepsin, non-lyophilized, 0.1 mg | 17 | $31.78 |
| J9319 | Injection, romidepsin, lyophilized, 0.1 mg | 18 | $30.71 |
| J9320 | Injection, streptozocin, 1 gram | 16 | $368.44 |
| J9321 | Injection, epcoritamab-bysp, 0.16 mg | 19 | $57.98 |
| J9322 | Injection, pemetrexed (bluepoint) | 11 | $9.73 |
| J9323 | Injection, pemetrexed ditromethamine, 10 mg | 17 | $1.06 |
| J9324 | Injection, pemetrexed (pemrydi rtu), 10 mg | 16 | $67.94 |
| J9325 | Injection, talimogene laherparepvec | 19 | $77.33 |
| J9326 | Injection, telisotuzumab vedotin-tllv, 1 mg | 17 | $145.95 |
| J9328 | Injection, temozolomide, 1 mg | 18 | $10.41 |
| J9329 | Injection, tislelizumab-jsgr, 1mg | 17 | $58.16 |
| J9330 | Injection, temsirolimus, 1 mg | 19 | $32.68 |
| J9331 | Injection, sirolimus protein-bound particles, 1 mg | 18 | $91.03 |
| J9332 | Injection, efgartigimod alfa-fcab, 2mg | 17 | $32.35 |
| J9333 | Injection, rozanolixizumab-noli, 1 mg | 17 | $23.58 |
| J9334 | Injection, efgartigimod alfa, 2 mg and hyaluronidase-qvfc | 17 | $34.19 |
| J9340 | Injection, thiotepa, 15 mg | 6 | $245.05 |
| J9341 | Injection, thiotepa (tepylute), 1 mg | 19 | $36.64 |
| J9342 | Injection, thiotepa, not otherwise specified, 1 mg | 18 | $5.78 |
| J9345 | Injection, retifanlimab-dlwr, 1 mg | 19 | $30.93 |
| J9347 | Injection, tremelimumab-actl, 1 mg | 18 | $146.89 |
| J9348 | Injection, naxitamab-gqgk, 1 mg | 18 | $684.90 |
| J9349 | Injection, tafasitamab-cxix, 2 mg | 19 | $14.42 |
| J9350 | Injection, mosunetuzumab-axgb, 1 mg | 18 | $674.50 |
| J9351 | Injection, topotecan, 0.1 mg | 19 | $2.75 |
| J9352 | Injection, trabectedin, 0.1 mg | 15 | $394.76 |
| J9353 | Injection, margetuximab-cmkb, 5 mg | 18 | $56.05 |
| J9354 | Injection, ado-trastuzumab emtansine, 1 mg | 19 | $43.62 |
| J9355 | Injection, trastuzumab, excludes biosimilar, 10 mg | 19 | $70.24 |
| J9356 | Injection, trastuzumab, 10 mg and hyaluronidase-oysk | 19 | $58.34 |
| J9357 | Injection, valrubicin, intravesical, 200 mg | 18 | $1,247.04 |
| J9358 | Injection, fam-trastuzumab deruxtecan-nxki, 1 mg | 19 | $32.65 |
| J9359 | Injection, loncastuximab tesirine-lpyl, 0.075 mg | 17 | $226.57 |
| J9360 | Injection, vinblastine sulfate, 1 mg | 20 | $5.61 |
| J9361 | Injection, efbemalenograstim alfa-vuxw, 0.5 mg | 8 | $116.15 |
| J9370 | Vincristine sulfate, 1 mg | 20 | $9.48 |
| J9376 | Injection, pozelimab-bbfg, 1 mg | 11 | $86.54 |
| J9380 | Injection, teclistamab-cqyv, 0.5 mg | 17 | $35.32 |
| J9381 | Injection, teplizumab-mzwv, 5 mcg | 17 | $39.22 |
| J9382 | Injection, zenocutuzumab-zbco, 1 mg | 17 | $33.86 |
| J9390 | Injection, vinorelbine tartrate, 10 mg | 19 | $4.29 |
| J9393 | Injection, fulvestrant (teva) | 14 | $21.20 |
| J9394 | Injection, fulvestrant | 19 | $27.11 |
| J9395 | Injection, fulvestrant, 25 mg | 19 | $5.27 |
| J9400 | Injection, ziv-aflibercept, 1 mg | 19 | $8.67 |
| J9600 | Injection, porfimer sodium, 75 mg | 9 | $19,906.23 |
| J9601 | Injection, linvoseltamab-gcpt, 1 mg | 17 | $99.13 |
| M0240 | Intravenous infusion or subcutaneous injection | 9 | $413.61 |
| M0241 | Intravenous infusion or subcutaneous injection | 9 | $688.92 |
| M0243 | Intravenous infusion or subcutaneous injection | 10 | $409.27 |
| M0244 | Intravenous infusion or subcutaneous injection | 10 | $719.46 |
| M0245 | Intravenous infusion, bamlanivimab and etesevimab | 10 | $431.81 |
| M0246 | Intravenous infusion, bamlanivimab and etesevimab | 9 | $688.92 |
| M0247 | Intravenous infusion, sotrovimab | 10 | $431.81 |
| M0248 | Intravenous infusion, sotrovimab | 11 | $750.00 |
| M0249 | Intravenous infusion, tocilizumab | 11 | $450.00 |
| M0250 | Intravenous infusion, tocilizumab | 11 | $450.00 |
| P9043 | Infusion, plasma protein fraction (human), 5%, 50 ml | 10 | $12.23 |
| P9045 | Infusion, albumin (human), 5%, 250 ml | 12 | $53.08 |
| Q0138 | Injection, ferumoxytol | 19 | $0.37 |
| Q0139 | Injection, ferumoxytol | 15 | $0.37 |
| Q0144 | Azithromycin dihydrate, oral, capsules/powder, 1 gram | 9 | $14.01 |
| Q0162 | Ondansetron 1 mg, oral | 10 | $0.015 |
| Q0173 | Trimethobenzamide hydrochloride, 250 mg, oral | 9 | $0.70 |
| Q0222 | Injection, bebtelovimab, 175 mg | 5 | $2,394.00 |
| Q0224 | Injection, pemivibart | 12 | $7,239.00 |
| Q0234 | Injection, tocilizumab-bavi | 6 | $6.33 |
| Q0237 | Injection, tocilizumab-anoh | 6 | $4.92 |
| Q0238 | Injection, tocilizumab-aazg | 5 | $5.58 |
| Q0247 | Injection, sotrovimab, 500 mg | 7 | $2,394.00 |
| Q0249 | Injection, tocilizumab | 10 | $6.57 |
| Q2035 | Influenza virus vaccine, split virus | 6 | $18.24 |
| Q2037 | Influenza virus vaccine, split virus | 5 | $17.68 |
| Q2041 | Axicabtagene ciloleucel | 9 | $562,500.89 |
| Q2042 | Tisagenlecleucel, up to 600 million car-positive viable t... | 8 | $611,693.17 |
| Q2043 | Sipuleucel-t, minimum of 50 million autologous cd54+ cells... | 15 | $55,663.13 |
| Q2053 | Brexucabtagene autoleucel | 10 | $499,777.06 |
| Q2054 | Lisocabtagene maraleucel | 10 | $566,321.33 |
| Q2055 | Idecabtagene vicleucel | 11 | $558,081.73 |
| Q2056 | Ciltacabtagene autoleucel | 10 | $587,813.67 |
| Q2057 | Afamitresgene autoleucel | 9 | $787,106.45 |
| Q2058 | Obecabtagene autoleucel | 9 | $286,125.00 |
| Q3027 | Injection, interferon beta-1a, 1 mcg for intramuscular use | 15 | $55.62 |
| Q4074 | Iloprost, inhalation solution, fda-approved final product | 13 | $149.92 |
| Q4081 | Injection, epoetin alfa, 100 units (for esrd on dialysis) | 19 | $0.69 |
| Q4101 | Apligraf, per square centimeter (add-on | 23 | $30.96 |
| Q4102 | Oasis wound matrix, per square centimeter (add-on | 18 | $11.98 |
| Q4103 | Oasis burn matrix, per square centimeter (add-on | 13 | $12.59 |
| Q4104 | Integra bilayer matrix wound dressing (bmwd) | 16 | $50.78 |
| Q4106 | Dermagraft, per square centimeter | 9 | $34.99 |
| Q4108 | Integra matrix, per square centimeter (add-on | 13 | $49.12 |
| Q4111 | Gammagraft, per square centimeter (add-on | 12 | $7.60 |
| Q4112 | Cymetra, injectable, 1 cc | 9 | $370.00 |
| Q4113 | Graftjacket xpress, injectable, 1 cc | 9 | $811.16 |
| Q4114 | Integra flowable wound matrix, injectable, 1 cc | 11 | $1,494.41 |
| Q4115 | Alloskin, per square centimeter (add-on | 11 | $15.92 |
| Q4118 | Matristem micromatrix, 1 mg | 9 | $2.56 |
| Q4122 | Dermacell, dermacell awm or dermacell awm porous | 5 | $81.15 |
| Q4123 | Alloskin rt, per square centimeter (add-on | 9 | $71.55 |
| Q4124 | Oasis ultra tri-layer wound matrix, per square centimeter | 12 | $11.11 |
| Q4126 | Memoderm, dermaspan, tranzgraft or integuply | 8 | $71.67 |
| Q4127 | Talymed, per square centimeter (add-on | 8 | $68.49 |
| Q4133 | Grafix prime, grafixpl prime, stravix and stravixpl | 18 | $132.78 |
| Q4134 | Hmatrix, per square centimeter (add-on | 5 | $83.49 |
| Q4138 | Biodfence dryflex, per square centimeter (add-on | 5 | $83.49 |
| Q4140 | Biodfence, per square centimeter (add-on | 5 | $83.49 |
| Q4141 | Alloskin ac, per square centimeter (add-on | 6 | $57.65 |
| Q4143 | Repriza, per square centimeter (add-on | 7 | $33.92 |
| Q4145 | Epifix, injectable, 1 mg | 6 | $19.48 |
| Q4147 | Architect, architect px, or architect fx | 5 | $83.49 |
| Q4148 | Neox cord 1k, neox cord rt, or clarix cord 1k | 5 | $83.49 |
| Q4150 | Allowrap ds or dry, per square centimeter (add-on | 7 | $81.15 |
| Q4151 | Amnioband or guardian, per square centimeter (add-on | 14 | $117.14 |
| Q4152 | Dermapure, per square centimeter (add-on | 7 | $50.71 |
| Q4153 | Dermavest and plurivest, per square centimeter (add-on | 7 | $83.49 |
| Q4156 | Neox 100 or clarix 100, per square centimeter (add-on | 6 | $67.39 |
| Q4160 | Nushield, per square centimeter (add-on | 14 | $93.80 |
| Q4161 | Bio-connekt wound matrix, per square centimeter (add-on | 7 | $92.95 |
| Q4163 | Woundex, bioskin, per square centimeter (add-on | 8 | $110.05 |
| Q4164 | Helicoll, per square centimeter (add-on | 7 | $92.95 |
| Q4165 | Keramatrix or kerasorb, per square centimeter (add-on | 5 | $50.55 |
| Q4166 | Cytal, per square centimeter (add-on | 5 | $50.55 |
| Q4168 | Amnioband, 1 mg | 5 | $17.05 |
| Q4174 | Palingen or promatrx, 0.36 mg per 0.25 cc | 6 | $291.27 |
| Q4175 | Miroderm, per square centimeter (add-on | 7 | $81.15 |
| Q4178 | Floweramniopatch, per square centimeter (add-on | 6 | $83.49 |
| Q4180 | Revita, per square centimeter (add-on | 7 | $92.95 |
| Q4186 | Epifix, per square centimeter (add-on | 22 | $151.45 |
| Q4193 | Coll-e-derm, per square centimeter (add-on | 5 | $83.49 |
| Q4195 | Puraply, per square centimeter (add-on | 14 | $90.72 |
| Q4196 | Puraply am, per square centimeter (add-on | 14 | $101.44 |
| Q4197 | Puraply xt, per square centimeter (add-on | 12 | $88.22 |
| Q4201 | Matrion, per square centimeter (add-on | 7 | $83.49 |
| Q4203 | Derma-gide, per square centimeter (add-on | 6 | $88.22 |
| Q4204 | Xwrap, per square centimeter (add-on | 5 | $83.49 |
| Q4205 | Membrane graft or membrane wrap, per square centimeter | 6 | $88.22 |
| Q4208 | Novafix, per square cenitmeter (add-on | 5 | $83.49 |
| Q4221 | Amniowrap2, per square centimeter (add-on | 8 | $110.05 |
| Q4222 | Progenamatrix, per square centimeter (add-on | 7 | $91.08 |
| Q4226 | Myown skin, includes harvesting and preparation procedures | 6 | $386.49 |
| Q4227 | Amniocore, per square centimeter (add-on | 6 | $88.22 |
| Q4232 | Corplex, per square centimeter (add-on | 6 | $82.32 |
| Q4235 | Amniorepair or altiply, per square centimeter (add-on | 6 | $88.22 |
| Q4239 | Amnio-maxx or amnio-maxx lite, per square centimeter | 7 | $81.15 |
| Q4246 | Coretext or protext, per cc | 6 | $2,968.00 |
| Q4248 | Dermacyte amniotic membrane allograft | 6 | $88.22 |
| Q4250 | Amnioamp-mp, per square centimeter (add-on | 5 | $83.49 |
| Q4252 | Vendaje, per square centimeter (add-on | 8 | $82.32 |
| Q4257 | Relese, per square centimeter (add-on | 6 | $88.22 |
| Q4258 | Enverse, per square centimeter (add-on | 6 | $78.81 |
| Q4261 | Tag, per square centimeter (add-on | 5 | $83.49 |
| Q4264 | Cocoon membrane, per square centimeter (add-on | 6 | $82.32 |
| Q4268 | Surgraft ft, per square centimeter (add-on | 5 | $83.49 |
| Q4269 | Surgraft xt, per square centimeter (add-on | 5 | $83.49 |
| Q4270 | Complete sl, per square centimeter (add-on | 5 | $83.49 |
| Q4274 | Esano ac, per square centimeter (add-on | 5 | $83.49 |
| Q4275 | Esano aca, per square centimeter (add-on | 5 | $83.49 |
| Q4278 | Epieffect, per square centimeter (add-on | 6 | $88.22 |
| Q4282 | Cygnus dual, per square centimeter (add-on | 8 | $110.05 |
| Q4285 | Nudyn dl or nudyn dl mesh, per square centimeter (add-on | 5 | $83.49 |
| Q4286 | Nudyn sl or nudyn slw, per square centimeter (add-on | 5 | $83.49 |
| Q4290 | Membrane wrap-hydro, per square centimeter (add-on | 7 | $91.83 |
| Q4293 | Acesso dl, per square centimeter (add-on | 7 | $91.83 |
| Q4294 | Amnio quad-core, per square centimeter (add-on | 7 | $91.83 |
| Q4295 | Amnio tri-core amniotic, per square centimeter (add-on | 6 | $87.66 |
| Q4296 | Rebound matrix, per square centimeter (add-on | 7 | $91.83 |
| Q4297 | Emerge matrix, per square centimeter (add-on | 7 | $83.49 |
| Q4299 | Amniocore pro+, per square centimeter (add-on | 6 | $87.66 |
| Q4301 | Activate matrix, per square centimeter (add-on | 7 | $91.83 |
| Q4304 | Grafix plus, per square centimeter (add-on | 8 | $92.39 |
| Q4309 | Via matrix, per square centimeter (add-on | 6 | $85.69 |
| Q4310 | Procenta, per 100 mg | 8 | $1,773.30 |
| Q4313 | Dermabind fm, per square centimeter (add-on | 6 | $86.57 |
| Q4319 | Sanograft, per square centimeter (add-on | 6 | $86.57 |
| Q4322 | Caregraft, per square centimeter (add-on | 6 | $86.57 |
| Q4323 | Alloply, per square centimeter (add-on | 6 | $86.57 |
| Q4325 | Acapatch, per square centimeter (add-on | 6 | $86.57 |
| Q4328 | Most, per square centimeter (add-on | 6 | $86.57 |
| Q4332 | Axolotl dualgraft, per square centimeter (add-on | 6 | $86.57 |
| Q4343 | Dermacyte ac matrix amniotic membrane allograft | 6 | $82.32 |
| Q5098 | Injection, ustekinumab-srlf (imuldosa), biosimilar, 1 mg | 15 | $11.55 |
| Q5099 | Injection, ustekinumab-stba (steqeyma), biosimilar, 1 mg | 16 | $3.01 |
| Q5100 | Injection, ustekinumab-kfce (yesintek), biosimilar, 1 mg | 17 | $3.22 |
| Q5101 | Injection, filgrastim-sndz, biosimilar, (zarxio) | 19 | $0.34 |
| Q5103 | Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg | 18 | $27.71 |
| Q5104 | Injection, infliximab-abda, biosimilar, (renflexis), 10 mg | 18 | $26.37 |
| Q5105 | Injection, epoetin alfa-epbx, biosimilar, (retacrit) | 17 | $0.79 |
| Q5106 | Injection, epoetin alfa-epbx, biosimilar, (retacrit) | 19 | $7.97 |
| Q5107 | Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg | 19 | $24.53 |
| Q5110 | Injection, filgrastim-aafi, biosimilar, (nivestym) | 18 | $0.32 |
| Q5111 | Injection, pegfilgrastim-cbqv (udenyca), biosimilar, 0.5 mg | 18 | $149.13 |
| Q5112 | Injection, trastuzumab-dttb, biosimilar, (ontruzant), 10 mg | 17 | $27.27 |
| Q5113 | Injection, trastuzumab-pkrb, biosimilar, (herzuma), 10 mg | 18 | $54.94 |
| Q5115 | Injection, rituximab-abbs, biosimilar, (truxima), 10 mg | 18 | $34.56 |
| Q5116 | Injection, trastuzumab-qyyp, biosimilar, (trazimera), 10 mg | 18 | $12.79 |
| Q5117 | Injection, trastuzumab-anns, biosimilar, (kanjinti), 10 mg | 18 | $60.52 |
| Q5118 | Injection, bevacizumab-bvzr, biosimilar, (zirabev), 10 mg | 18 | $25.89 |
| Q5119 | Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg | 18 | $15.32 |
| Q5120 | Injection, pegfilgrastim-bmez (ziextenzo), biosimilar | 17 | $132.10 |
| Q5121 | Injection, infliximab-axxq, biosimilar, (avsola), 10 mg | 18 | $30.83 |
| Q5122 | Injection, pegfilgrastim-apgf (nyvepria), biosimilar, 0.5 mg | 18 | $136.91 |
| Q5123 | Injection, rituximab-arrx, biosimilar, (riabni), 10 mg | 19 | $20.39 |
| Q5124 | Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg | 17 | $240.97 |
| Q5125 | Injection, filgrastim-ayow, biosimilar, (releuko) | 18 | $0.31 |
| Q5126 | Injection, bevacizumab-maly, biosimilar, (alymsys), 10 mg | 16 | $78.64 |
| Q5127 | Injection, pegfilgrastim-fpgk (stimufend), biosimilar | 18 | $147.69 |
| Q5129 | Injection, bevacizumab-adcd (vegzelma), biosimilar, 10 mg | 18 | $23.65 |
| Q5130 | Injection, pegfilgrastim-pbbk (fylnetra), biosimilar, 0.5 mg | 18 | $104.13 |
| Q5133 | Injection, tocilizumab-bavi (tofidence), biosimilar, 1 mg | 17 | $5.01 |
| Q5134 | Injection, natalizumab-sztn (tyruko), biosimilar, 1 mg | 14 | $24.45 |
| Q5135 | Injection, tocilizumab-aazg (tyenne), biosimilar, 1 mg | 18 | $4.21 |
| Q5136 | Injection, denosumab-bbdz (jubbonti/wyost), biosimilar, 1 mg | 15 | $27.16 |
| Q5138 | Injection, ustekinumab-auub (wezlana), biosimilar | 8 | $2.35 |
| Q5147 | Injection, aflibercept-ayyh (pavblu), biosimilar, 1 mg | 19 | $803.25 |
| Q5148 | Injection, filgrastim-txid (nypozi), biosimilar, 1 microgram | 14 | $1.03 |
| Q5151 | Injection, eculizumab-aagh (epysqli), biosimilar, 2 mg | 15 | $31.55 |
| Q5152 | Injection, eculizumab-aeeb (bkemv), biosimilar, 2 mg | 14 | $40.54 |
| Q5156 | Injection, tocilizumab-anoh (avtozma), biosimilar, 1 mg | 15 | $4.53 |
| Q5157 | Injection, denosumab-bmwo (stoboclo/osenvelt), biosimilar | 18 | $25.74 |
| Q5158 | Injection, denosumab-bnht (bomyntra/conexxence), biosimilar | 18 | $28.70 |
| Q5160 | Injection, bevacizumab-nwgd (jobevne), biosimilar, 10 mg | 15 | $82.23 |
| Q5161 | Injection, denosumab-kyqq (aukelso/bosaya), biosimilar, 1 mg | 11 | $27.18 |
| Q5162 | Injection, denosumab-nxxp (bildyos/bilprevda), biosimilar | 16 | $15.36 |
| Q5164 | Injection, ustekinumab-hmny (starjemza), biosimilar, 1 mg | 9 | $5.33 |
| Q5166 | Injection, denosumab-desu (osvyrti/jubereq), biosimilar | 9 | $28.80 |
| Q5167 | Injection, denosumab-qbde (enoby/xtrenbo), biosimilar, 1 mg | 12 | $6.82 |
| Q5168 | Injection, ranibizumab-leyk (nufymco), biosimilar, 0.1 mg | 7 | $250.78 |
| Q5169 | Injection, pegfilgrastim-unne (armlupeg), biosimilar, 0.5 mg | 7 | $512.55 |
| Q9953 | Injection, iron-based magnetic resonance contrast agent | 8 | $61.56 |
| Q9957 | Injection, perflutren lipid microspheres, per ml | 15 | $40.85 |
| Q9968 | Injection, non-radioactive, non-contrast | 7 | $2.70 |
| Q9982 | Flutemetamol f18, diagnostic, per study dose | 5 | $3,200.00 |
| Q9991 | Injection, buprenorphine extended-release (sublocade) | 18 | $2,060.13 |
| Q9992 | Injection, buprenorphine extended-release (sublocade) | 18 | $2,060.13 |
| Q9998 | Injection, ustekinumab-aekn (selarsdi), biosimilar, 1 mg | 14 | $10.53 |
| Q9999 | Injection, ustekinumab-aauz (otulfi), biosimilar, 1 mg | 15 | $13.25 |
| S0013 | Esketamine, nasal spray, 1 mg | 6 | $14.41 |
| S0145 | Injection, pegylated interferon alfa-2a, 180 mcg per ml | 7 | $1,113.42 |
| S0148 | Injection, pegylated interferon alfa-2b, 10 mcg | 5 | $100.29 |
| S4993 | Contraceptive pills for birth control | 14 | $12.35 |
Pharmacy rates in your statesRates, managed-care rules, Medicare comparison and changes, for the codes you bill.