CodeMap®
CodeMap® 




2017 ICD-10 Diagnosis Code Set Loaded     


7/3/2017 NCD Edits Loaded     


2017 Lab Fee Schedule     


2017-C DME Fee Schedule     


2017-A PEN Fee Schedule-no changes for Q2/2017     


2017 July ASC Fee Schedule Updated     


2017 July APC Fee Schedule Updated     


July 2017 ASP Drug Pricing Updated     


Q3 2017 CCI Edits Loaded     


Q3 2017 MUE Edits Loaded     


LCD Database Current Through 09/18/2017     

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Laboratory Fee Schedule

2018 Preliminary PAMA
2017
2016

Physician Fee Schedule

2017
2016

OPPS Fee Schedule

2017
2016

ASC Fee Schedule

2017
2016

APC Codes

2017
2016

DRG Codes

2017

ASP Drug Pricing Files




Fall 2017 Webinar Series Announcement-Click here for details

ALERT: Preliminary 2018 PAMA Rates Posted by CMS-Click here for details


Payment Allowance Limits for Medicare Part B Drugs


Procedure
Short Descriptor
HCPC Code Dosage
Payment Limit
90371
Hep b ig im 1 ML
$109.47
90375
Rabies ig im/sc 150 IU
$281.91
90376
Rabies ig heat treated 150 IU
$296.24
90585
Bcg vaccine percut 50 MG
$127.01
90586
Bcg vaccine intravesical 1 EACH
$127.01
90630
Flu vacc iiv4 no preserv id 0.1 ml
$20.34
90632
Hepa vaccine adult im 1 ML
$52.72
90653
Iiv adjuvant vaccine im 0.5 ml
$37.38
90656
Iiv3 vacc no prsv 0.5 ml im 0.5 ML
$17.72
90662
Iiv no prsv increased ag im 0.5 ML
$42.72
90670
Pcv13 vaccine im 0.5 ML
$181.06
90672
Laiv4 vaccine intranasal 0.2 ml
$26.88
90673
Riv3 vaccine no preserv im 0.5 ML
$40.61
90674
Cciiv4 vac no prsv 0.5 ml im 0.5 ML
$22.94
90675
Rabies vaccine im 1 ML
$262.98
90685
Iiv4 vacc no prsv 0.25 ml im 0.25 mL
$26.27
90686
Iiv4 vacc no prsv 0.5 ml im 0.5 ml
$19.03
90687
Iiv4 vaccine splt 0.25 ml im 0.25 ML
$9.40
90688
Iiv4 vaccine splt 0.5 ml im 0.5 ML
$17.84
90691
Typhoid vaccine im 0.5 ML
$77.59
90714
Td vacc no presv 7 yrs+ im 0.5 ML
$23.23
90715
Tdap vaccine 7 yrs/> im 0.5 ML
$29.99
90732
Ppsv23 vacc 2 yrs+ subq/im 0.5 ML
$89.95
90740
Hepb vacc 3 dose immunsup im 40 MCG
$122.96
90743
Hepb vacc 2 dose adolesc im 1 DOSE
$25.39
90744
Hepb vacc 3 dose ped/adol im 1 DOSE
$25.39
90746
Hepb vaccine 3 dose adult im 20 MCG
$61.47
90747
Hepb vacc 4 dose immunsup im 40 MCG
$122.96
A9575
Inj gadoterate meglumi 0.1ml 0.1 ml
$0.20
A9576
Inj prohance multipack 1 ML
$1.63
A9577
Inj multihance 1 ML
$2.07
A9578
Inj multihance multipack 1 ML
$2.03
A9579
Gad-base mr contrast nos,1ml 1 ML
$1.82
A9581
Gadoxetate disodium inj 1 ML
$14.02
A9583
Gadofosveset trisodium inj 1 ML
$18.11
A9585
Gadobutrol injection 0.1 ML
$0.39
A9606
Radium ra223 dichloride ther 1 microCurie
N/A
J0129
Abatacept injection 10 MG
$45.88
J0130
Abciximab injection 10 MG
$1147.52
J0132
Acetylcysteine injection 100 MG
$1.53
J0133
Acyclovir injection 5 MG
$0.08
J0135
Adalimumab injection 20 MG
$909.22
J0153
Adenosine inj 1mg 1 MG
$0.60
J0171
Adrenalin epinephrine inject 0.1 MG
$0.34
J0178
Aflibercept injection 1 MG
$980.38
J0180
Agalsidase beta injection 1 MG
$164.80
J0202
Injection, alemtuzumab 1 MG
$1750.71
J0207
Amifostine 500 MG
$412.27
J0221
Lumizyme injection 10 MG
$159.73
J0256
Alpha 1 proteinase inhibitor 10 MG
$4.85
J0257
Glassia injection 10 MG
$4.37
J0278
Amikacin sulfate injection 100 MG
$1.77
J0280
Aminophyllin 250 mg inj 250 MG
$9.04
J0285
Amphotericin b 50 MG
$30.24
J0287
Amphotericin b lipid complex 10 MG
$14.50
J0289
Amphotericin b liposome inj 10 MG
$19.77
J0290
Ampicillin 500 mg inj 500 MG
$1.26
J0295
Ampicillin sodium per 1.5 gm 1.5 GM
$3.01
J0348
Anidulafungin injection 1 MG
$0.50
J0360
Hydralazine hcl injection 20 MG
$4.57
J0401
Inj aripiprazole ext rel 1mg 1 MG
$4.59
J0456
Azithromycin 500 MG
$3.27
J0461
Atropine sulfate injection 0.01 MG
$0.06
J0470
Dimecaprol injection 100 MG
$45.28
J0475
Baclofen 10 mg injection 10 MG
$167.24
J0476
Baclofen intrathecal trial 50 MCG
$76.52
J0480
Basiliximab 20 MG
$3341.06
J0485
Belatacept injection 1 MG
$3.83
J0490
Belimumab injection 10 MG
$41.94
J0500
Dicyclomine injection 20 MG
$69.25
J0515
Inj benztropine mesylate 1 MG
$25.78
J0558
Peng benzathine/procaine inj 100,000 UNITS
$8.51
J0561
Penicillin g benzathine inj 100,000 UNITS
$10.66
J0570
Buprenorphine implant 74.2mg 74.2 MG
$1280.52
J0583
Bivalirudin 1 MG
$1.33
J0585
Injection,onabotulinumtoxina 1 UNIT
$5.94
J0586
Abobotulinumtoxina 5 Unit
$7.80
J0587
Inj, rimabotulinumtoxinb 100 UNITS
$11.69
J0588
Incobotulinumtoxin a 1 UNIT
$4.90
J0592
Buprenorphine hydrochloride 0.1 MG
$3.40
J0594
Busulfan injection 1 MG
$37.29
J0595
Butorphanol tartrate 1 mg 1 MG
$2.40
J0597
C-1 esterase, berinert 10 UNITS
$46.63
J0598
C-1 esterase, cinryze 10 UNITS
$55.55
J0600
Edetate calcium disodium inj 1000 MG
$5594.42
J0610
Calcium gluconate injection 10 ML
$3.51
J0630
Calcitonin salmon injection 400 UNITS
$2301.57
J0636
Inj calcitriol per 0.1 mcg 0.1 MCG
$0.46
J0637
Caspofungin acetate 5 MG
$11.65
J0638
Canakinumab injection 1 MG
$92.51
J0640
Leucovorin calcium injection 50 MG
$3.09
J0641
Levoleucovorin injection 0.5 MG
$0.69
J0670
Inj mepivacaine hcl/10 ml 10 ML
$2.74
J0690
Cefazolin sodium injection 500 MG
$1.00
J0692
Cefepime hcl for injection 500 MG
$2.45
J0694
Cefoxitin sodium injection 1 GM
$4.32
J0696
Ceftriaxone sodium injection 250 MG
$0.70
J0697
Sterile cefuroxime injection 750 MG
$2.64
J0698
Cefotaxime sodium injection 1 GM
$1.53
J0702
Betamethasone acet&sod phosp 3 MG & 3 MG
$6.06
J0712
Ceftaroline fosamil inj 10 MG
$2.46
J0713
Inj ceftazidime per 500 mg 500 MG
$2.24
J0717
Certolizumab pegol inj 1mg 1 MG
$7.38
J0720
Chloramphenicol sodium injec 1 GM
$40.12
J0725
Chorionic gonadotropin/1000u 1000 UNITS
$24.04
J0735
Clonidine hydrochloride 1 MG
$13.55
J0740
Cidofovir injection 375 MG
$509.41
J0743
Cilastatin sodium injection 250 MG
$6.88
J0744
Ciprofloxacin iv 200 MG
$1.46
J0770
Colistimethate sodium inj 150 MG
$11.04
J0775
Collagenase, clost hist inj 0.01 MG
$41.15
J0780
Prochlorperazine injection 10 MG
$12.17
J0795
Corticorelin ovine triflutal 1 MCG
$8.12
J0800
Corticotropin injection 40 UNITS
$3536.42
J0834
Cosyntropin cortrosyn inj 0.25 MG
$38.43
J0840
Crotalidae poly immune fab UP TO 1 GM
$2670.24
J0850
Cytomegalovirus imm iv /vial PER VIAL
$1127.63
J0875
Injection, dalbavancin 5 MG
$14.89
J0878
Daptomycin injection 1 MG
$0.89
J0881
Darbepoetin alfa, non-esrd 1 MCG
$3.85
J0882
Darbepoetin alfa, esrd use 1 MCG
$3.85
J0885
Epoetin alfa, non-esrd 1000 UNITS
$12.32
J0887
Epoetin beta esrd use 1 MCG
$1.57
J0888
Epoetin beta non esrd 1 MCG
$1.57
J0894
Decitabine injection 1 MG
$19.66
J0895
Deferoxamine mesylate inj 500 MG
$8.71
J0897
Denosumab injection 1 MG
$16.52
J1000
Depo-estradiol cypionate inj 5 MG
$17.77
J1020
Methylprednisolone 20 mg inj 20 MG
$4.99
J1030
Methylprednisolone 40 mg inj 40 MG
$5.47
J1040
Methylprednisolone 80 mg inj 80 MG
$10.27
J1050
Medroxyprogesterone acetate 1 MG
$0.44
J1071
Inj testosterone cypionate 1 MG
$0.02
J1100
Dexamethasone sodium phos 1 MG
$0.12
J1110
Inj dihydroergotamine mesylt 1 MG
$135.58
J1120
Acetazolamid sodium injectio 500 MG
$19.69
J1160
Digoxin injection 0.5 MG
$8.34
J1162
Digoxin immune fab (ovine) PER VIAL
$3039.53
J1165
Phenytoin sodium injection 50 MG
$0.57
J1170
Hydromorphone injection 4 MG
$2.10
J1190
Dexrazoxane hcl injection 250 MG
$196.90
J1200
Diphenhydramine hcl injectio 50 MG
$0.62
J1205
Chlorothiazide sodium inj 500 MG
$84.52
J1212
Dimethyl sulfoxide 50% 50 ml 50 ML
$497.80
J1230
Methadone injection 10 MG
$18.91
J1240
Dimenhydrinate injection 50 MG
$7.55
J1245
Dipyridamole injection 10 MG
$0.80
J1250
Inj dobutamine hcl/250 mg 250 MG
$5.47
J1265
Dopamine injection 40 MG
$0.45
J1267
Doripenem injection 10 MG
$0.72
J1270
Injection, doxercalciferol 1 MCG
$0.73
J1290
Ecallantide injection 1 MG
$419.75
J1300
Eculizumab injection 10 MG
$223.20
J1325
Epoprostenol injection 0.5 MG
$15.51
J1335
Ertapenem injection 500 MG
$48.89
J1364
Erythro lactobionate /500 mg 500 MG
$59.70
J1380
Estradiol valerate 10 mg inj 10 MG
$17.25
J1410
Inj estrogen conjugate 25 mg 25 MG
$278.53
J1430
Ethanolamine oleate 100 mg 100 MG
$404.09
J1439
Inj ferric carboxymaltos 1mg 1 MG
$1.05
J1442
Inj filgrastim excl biosimil 1 MCG
$1.00
J1447
Inj tbo filgrastim 1 microg 1 MCG
$0.71
J1450
Fluconazole 200 MG
$4.32
J1453
Fosaprepitant injection 1 MG
$1.86
J1458
Galsulfase injection 1 MG
$364.45
J1459
Inj ivig privigen 500 mg 500 MG
$38.67
J1460
Gamma globulin 1 cc inj 1 CC
$35.85
J1556
Inj, imm glob bivigam, 500mg 500 MG
$37.14
J1557
Gammaplex injection 500 MG
$39.01
J1559
Hizentra injection 100 MG
$9.85
J1560
Gamma globulin > 10 cc inj 10 CC
$358.49
J1561
Gamunex-c/gammaked 500 MG
$36.44
J1566
Immune globulin, powder 500 MG
$32.04
J1568
Octagam injection 500 MG
$35.40
J1569
Gammagard liquid injection 500 MG
$40.20
J1570
Ganciclovir sodium injection 500 MG
$61.64
J1571
Hepagam b im injection 0.5 ML
$58.55
J1572
Flebogamma injection 500 MG
$32.68
J1575
Hyqvia 100mg immuneglobulin 100 MG
$12.97
J1580
Garamycin gentamicin inj 80 MG
$1.51
J1602
Golimumab for iv use 1mg 1 MG
$24.39
J1610
Glucagon hydrochloride/1 mg 1 MG
$215.87
J1626
Granisetron hcl injection 100 MCG
$0.33
J1630
Haloperidol injection 5 MG
$0.86
J1631
Haloperidol decanoate inj 50 MG
$17.83
J1640
Hemin, 1 mg 1 MG
$22.86
J1642
Inj heparin sodium per 10 u 10 UNITS
$0.18
J1644
Inj heparin sodium per 1000u 1000 UNITS
$0.22
J1645
Dalteparin sodium 2500 IU
$15.92
J1650
Inj enoxaparin sodium 10 MG
$0.80
J1652
Fondaparinux sodium 0.5 MG
$2.25
J1670
Tetanus immune globulin inj 250 UNITS
$376.51
J1720
Hydrocortisone sodium succ i 100 MG
$9.12
J1740
Ibandronate sodium injection 1 MG
$96.52
J1742
Ibutilide fumarate injection 1 MG
$182.89
J1743
Idursulfase injection 1 MG
$522.04
J1745
Infliximab not biosimil 10mg 10 MG
$82.22
J1750
Inj iron dextran 50 MG
$12.46
J1756
Iron sucrose injection 1 MG
$0.25
J1786
Imuglucerase injection 10 UNITS
$41.83
J1800
Propranolol injection 1 MG
$1.66
J1815
Insulin injection 5 UNITS
$0.87
J1817
Insulin for insulin pump use 50 UNITS
$9.83
J1885
Ketorolac tromethamine inj 15 MG
$0.81
J1930
Lanreotide injection 1 MG
$52.23
J1931
Laronidase injection 0.1 MG
$30.61
J1940
Furosemide injection 20 MG
$1.45
J1950
Leuprolide acetate /3.75 mg 3.75 MG
$1031.56
J1953
Levetiracetam injection 10 MG
$0.17
J1955
Inj levocarnitine per 1 gm 1 GM
$20.90
J1956
Levofloxacin injection 250 MG
$1.61
J1980
Hyoscyamine sulfate inj 0.25 MG
$27.66
J2001
Lidocaine injection 10 MG
$0.02
J2010
Lincomycin injection 300 MG
$12.21
J2020
Linezolid injection 200 MG
$15.87
J2060
Lorazepam injection 2 MG
$0.72
J2150
Mannitol injection 50 ML
$2.02
J2175
Meperidine hydrochl /100 mg 100 MG
$4.92
J2185
Meropenem 100 MG
$1.34
J2210
Methylergonovin maleate inj 0.2 MG
$7.59
J2248
Micafungin sodium injection 1 MG
$0.97
J2250
Inj midazolam hydrochloride 1 MG
$0.12
J2270
Morphine sulfate injection 10 MG
$1.84
J2274
In morphine preservativ free 10 MG
$9.78
J2278
Ziconotide injection 1 MCG
$7.33
J2280
Inj, moxifloxacin 100 mg 100 MG
$8.43
J2300
Inj nalbuphine hydrochloride 10 MG
$2.41
J2310
Inj naloxone hydrochloride 1 MG
$29.21
J2315
Naltrexone, depot form 1 MG
$3.25
J2323
Natalizumab injection 1 MG
$18.78
J2353
Octreotide injection, depot 1 MG
$174.52
J2354
Octreotide inj, non-depot 25 MCG
$1.17
J2355
Oprelvekin injection 5 MG
$467.22
J2357
Omalizumab injection 5 MG
$32.36
J2358
Olanzapine long-acting inj 1 MG
$2.92
J2360
Orphenadrine injection 60 MG
$3.50
J2400
Chloroprocaine hcl injection 30 ML
$27.45
J2405
Ondansetron hcl injection 1 MG
$0.09
J2407
Injection, oritavancin 10 MG
$24.66
J2410
Oxymorphone hcl injection 1 MG
$2.91
J2425
Palifermin injection 50 MCG
$17.68
J2426
Paliperidone palmitate inj 1 MG
$9.46
J2430
Pamidronate disodium /30 mg 30 MG
$10.08
J2469
Palonosetron hcl 25 MCG
$22.54
J2501
Paricalcitol 1 MCG
$1.07
J2503
Pegaptanib sodium injection 0.3 MG
$1054.70
J2504
Pegademase bovine, 25 iu 25 IU
$343.50
J2505
Injection, pegfilgrastim 6mg 6 MG
$4117.23
J2507
Pegloticase injection 1 MG
$1794.26
J2510
Penicillin g procaine inj 600000 UNITS
$28.04
J2515
Pentobarbital sodium inj 50 MG
$49.44
J2540
Penicillin g potassium inj 600000 UNITS
$1.05
J2543
Piperacillin/tazobactam 1.125 GM
$2.68
J2545
Pentamidine non-comp unit 300 MG
$126.26
J2550
Promethazine hcl injection 50 MG
$2.10
J2560
Phenobarbital sodium inj 120 MG
$29.59
J2562
Plerixafor injection 1 MG
$312.14
J2597
Inj desmopressin acetate 1 MCG
$13.36
J2675
Inj progesterone per 50 mg 50 MG
$1.36
J2680
Fluphenazine decanoate 25 mg 25 MG
$21.51
J2690
Procainamide hcl injection 1 GM
$56.33
J2700
Oxacillin sodium injeciton 250 MG
$1.78
J2704
Inj, propofol, 10 mg 10 MG
$0.12
J2720
Inj protamine sulfate/10 mg 10 MG
$1.08
J2724
Protein c concentrate 10 UNITS
$15.22
J2765
Metoclopramide hcl injection 10 MG
$0.85
J2770
Quinupristin/dalfopristin 500 MG
$435.31
J2778
Ranibizumab injection 0.1 mg
$380.22
J2780
Ranitidine hydrochloride inj 25 MG
$1.19
J2783
Rasburicase 0.5 MG
$255.06
J2785
Regadenoson injection 0.1 MG
$55.29
J2788
Rho d immune globulin 50 mcg 50 MCG (250 IU)
$25.29
J2790
Rho d immune globulin inj 300 MCG (1500 IU)
$80.19
J2791
Rhophylac injection 100 IU
$4.79
J2792
Rho(d) immune globulin h, sd 100 IU
$22.32
J2794
Risperidone, long acting 0.5 MG
$8.13
J2795
Ropivacaine hcl injection 1 MG
$0.07
J2796
Romiplostim injection 10 MCG
$64.20
J2800
Methocarbamol injection 10 ML
$39.19
J2805
Sincalide injection 5 MCG
$96.99
J2810
Inj theophylline per 40 mg 40 MG
$0.30
J2820
Sargramostim injection 50 MCG
$37.13
J2850
Inj secretin synthetic human 1 MCG
$34.78
J2916
Na ferric gluconate complex 12.5 MG
$2.28
J2920
Methylprednisolone injection 40 MG
$4.00
J2930
Methylprednisolone injection 125 MG
$5.50
J2997
Alteplase recombinant 1 MG
$81.22
J3000
Streptomycin injection 1 GM
$12.86
J3010
Fentanyl citrate injeciton 0.1 MG
$0.48
J3060
Inj, taliglucerace alfa 10 u 10 UNITS
$40.42
J3070
Pentazocine injection 30 MG
$140.49
J3090
Inj tedizolid phosphate 1 MG
$1.27
J3095
Telavancin injection 10 MG
$5.13
J3101
Tenecteplase injection 1 MG
$102.43
J3105
Terbutaline sulfate inj 1 MG
$3.30
J3121
Inj testostero enanthate 1mg 1 MG
$0.04
J3230
Chlorpromazine hcl injection 50 MG
$24.52
J3240
Thyrotropin injection 0.9 MG
$1574.82
J3243
Tigecycline injection 1 MG
$3.19
J3250
Trimethobenzamide hcl inj 200 MG
$26.90
J3260
Tobramycin sulfate injection 80 MG
$2.28
J3262
Tocilizumab injection 1 MG
$4.26
J3285
Treprostinil injection 1 MG
$61.24
J3300
Triamcinolone a inj prs-free 1 MG
$3.72
J3301
Triamcinolone acet inj nos 10 MG
$1.79
J3303
Triamcinolone hexacetonl inj 5 MG
$3.61
J3315
Triptorelin pamoate 3.75 MG
$402.38
J3357
Ustekinumab sub cu inj, 1 mg 1 MG
$173.19
J3360
Diazepam injection 5 MG
$9.53
J3370
Vancomycin hcl injection 500 MG
$2.82
J3380
Injection, vedolizumab 1 MG
$17.58
J3385
Velaglucerase alfa 100 UNITS
$342.99
J3396
Verteporfin injection 0.1 MG
$10.74
J3410
Hydroxyzine hcl injection 25 MG
$2.02
J3411
Thiamine hcl 100 mg 100 MG
$3.19
J3415
Pyridoxine hcl 100 mg 100 MG
$12.00
J3420
Vitamin b12 injection 1000 MCG
$3.90
J3430
Vitamin k phytonadione inj 1 MG
$3.51
J3465
Injection, voriconazole 10 MG
$3.60
J3471
Ovine, up to 999 usp units 1 UNIT
$0.35
J3473
Hyaluronidase recombinant 1 USP UNIT
$0.36
J3475
Inj magnesium sulfate 500 MG
$0.48
J3480
Inj potassium chloride 2 MEQ
$0.14
J3485
Zidovudine 10 MG
$1.51
J3486
Ziprasidone mesylate 10 MG
$19.87
J3489
Zoledronic acid 1mg 1 MG
$12.45
J7030
Normal saline solution infus 1000 ML
$1.86
J7040
Normal saline solution infus 500 ML
$0.93
J7042
5% dextrose/normal saline 500 ML
$0.86
J7050
Normal saline solution infus 250 ML
$0.46
J7060
5% dextrose/water 500 ML
$1.91
J7070
D5w infusion 1000 CC
$3.68
J7120
Ringers lactate infusion 1000 CC
$2.28
J7180
Factor xiii anti-hem factor 1 IU
$8.19
J7182
Factor viii recomb novoeight 1 IU
$1.29
J7183
Wilate injection 1 I.U. VWF:RCO
$0.95
J7185
Xyntha inj 1 IU
$1.22
J7186
Antihemophilic viii/vwf comp PER FACTOR VIII IU
$0.98
J7187
Humate-p, inj 1 IU
$1.04
J7189
Factor viia 1 MCG
$1.92
J7190
Factor viii 1 IU
$1.02
J7192
Factor viii recombinant nos 1 IU
$1.20
J7193
Factor ix non-recombinant 1 IU
$1.12
J7194
Factor ix complex 1 IU
$1.31
J7195
Factor ix recombinant nos 1 IU
$1.52
J7197
Antithrombin iii injection 1 IU
$3.34
J7198
Anti-inhibitor 1 IU
$1.93
J7200
Factor ix recombinan rixubis 1 IU
$1.25
J7201
Factor ix alprolix recomb 1 IU
$2.92
J7205
Factor viii fc fusion recomb 1 IU
$1.97
J7308
Aminolevulinic acid hcl top 354 MG
$347.02
J7311
Fluocinolone acetonide implt 0.59 MG
$20114.60
J7312
Dexamethasone intra implant 0.1 MG
$200.83
J7313
Fluocinol acet intravit imp 0.01 MG
$490.95
J7316
Inj, ocriplasmin, 0.125 mg 0.125 MG
$1046.75
J7320
Genvisc 850, inj, 1mg 1 MG
$8.00
J7321
Hyalgan/supartz inj per dose per dose
$86.14
J7323
Euflexxa inj per dose per dose
$157.35
J7324
Orthovisc inj per dose per dose
$150.99
J7325
Synvisc or synvisc-one 1 MG
$13.03
J7326
Gel-one per dose
$612.61
J7327
Monovisc inj per dose Per Dose
$906.47
J7336
Capsaicin 8% patch 1 SQ CM
$2.98
J7500
Azathioprine oral 50mg 50 MG
$0.31
J7502
Cyclosporine oral 100 mg 100 MG
$3.05
J7503
Tacrol envarsus ex rel oral 0.25 MG
$1.23
J7504
Lymphocyte immune globulin 250 MG
$1479.34
J7507
Tacrolimus imme rel oral 1mg 1 MG
$0.75
J7508
Tacrol astagraf ex rel oral 0.1 MG
$0.39
J7509
Methylprednisolone oral 4 MG
$0.35
J7510
Prednisolone oral per 5 mg 5 MG
$0.11
J7511
Antithymocyte globuln rabbit 25 MG
$688.44
J7512
Prednisone ir or dr oral 1mg 1 MG
$0.01
J7515
Cyclosporine oral 25 mg 25 MG
$0.83
J7516
Cyclosporin parenteral 250mg 250 MG
$40.45
J7517
Mycophenolate mofetil oral 250 MG
$1.07
J7518
Mycophenolic acid 180 MG
$2.78
J7520
Sirolimus, oral 1 MG
$7.84
J7525
Tacrolimus injection 5 MG
$170.75
J7527
Oral everolimus 0.25 MG
$7.89
J7605
Arformoterol non-comp unit 15 mcg
$9.37
J7606
Formoterol fumarate, inh 20 MCG
$10.49
J7608
Acetylcysteine non-comp unit 1 GM
$4.26
J7611
Albuterol non-comp con 1 MG
$0.11
J7612
Levalbuterol non-comp con 0.5 MG
$0.18
J7613
Albuterol non-comp unit 1 MG
$0.05
J7614
Levalbuterol non-comp unit 0.5 MG
$0.07
J7620
Albuterol ipratrop non-comp 2.5 MG/0.5 MG
$0.17
J7626
Budesonide non-comp unit 0.5 MG
$2.53
J7631
Cromolyn sodium noncomp unit 10 MG
$0.83
J7639
Dornase alfa non-comp unit 1 MG
$42.50
J7644
Ipratropium bromide non-comp 1 MG
$0.22
J7674
Methacholine chloride, neb 1 MG
$0.52
J7682
Tobramycin non-comp unit 300 MG
$44.16
J7686
Treprostinil, non-comp unit 1.74 MG
$531.29
J8501
Oral aprepitant 5 MG
$12.27
J8510
Oral busulfan 2 MG
$23.72
J8520
Capecitabine, oral, 150 mg 150 MG
$4.13
J8521
Capecitabine, oral, 500 mg 500 MG
$11.85
J8530
Cyclophosphamide oral 25 mg 25 MG
$3.26
J8540
Oral dexamethasone 0.25 MG
$0.02
J8560
Etoposide oral 50 mg 50 MG
$73.55
J8600
Melphalan oral 2 mg 2 MG
$11.71
J8610
Methotrexate oral 2.5 mg 2.5 MG
$0.56
J8655
Netupitant palonosetron oral 0.5 MG
$444.99
J8700
Temozolomide 5 MG
$1.95
J8705
Topotecan oral 0.25 mg
$103.82
J9000
Doxorubicin hcl injection 10 MG
$2.42
J9017
Arsenic trioxide injection 1 MG
$64.98
J9019
Erwinaze injection 1,000 IU
$402.74
J9025
Azacitidine injection 1 MG
$2.43
J9027
Clofarabine injection 1 MG
$152.43
J9031
Bcg live intravesical vac 1 EA
$127.01
J9032
Injection, belinostat, 10mg 10 MG
$34.53
J9033
Inj., treanda 1 mg 1 MG
$27.98
J9034
Inj., bendeka 1 mg 1 MG
$23.69
J9035
Bevacizumab injection 10 MG
$73.73
J9040
Bleomycin sulfate injection 15 UNITS
$50.30
J9041
Bortezomib injection 0.1 MG
$46.26
J9042
Brentuximab vedotin inj 1 MG
$134.44
J9043
Cabazitaxel injection 1 MG
$154.22
J9045
Carboplatin injection 50 MG
$3.62
J9047
Injection, carfilzomib, 1 mg 1 MG
$31.81
J9050
Carmustine injection 100 MG
$3850.06
J9055
Cetuximab injection 10 MG
$56.65
J9060
Cisplatin 10 mg injection 10 MG
$2.08
J9065
Inj cladribine per 1 mg 1 MG
$23.20
J9070
Cyclophosphamide 100 mg inj 100 MG
$42.31
J9098
Cytarabine liposome inj 10 MG
$595.18
J9100
Cytarabine hcl 100 mg inj 100 MG
$0.80
J9120
Dactinomycin injection 0.5 MG
$1276.38
J9130
Dacarbazine 100 mg inj 100 MG
$4.20
J9145
Injection, daratumumab 10 mg 10 MG
$46.92
J9150
Daunorubicin injection 10 MG
$31.39
J9155
Degarelix injection 1 MG
$3.68
J9171
Docetaxel injection 1 MG
$2.56
J9176
Injection, elotuzumab, 1mg 1 MG
$6.23
J9178
Inj, epirubicin hcl, 2 mg 2 MG
$1.30
J9179
Eribulin mesylate injection 0.1 MG
$108.08
J9181
Etoposide injection 10 MG
$0.62
J9185
Fludarabine phosphate inj 50 MG
$59.68
J9190
Fluorouracil injection 500 MG
$1.69
J9200
Floxuridine injection 500 MG
$74.79
J9201
Gemcitabine hcl injection 200 MG
$5.55
J9202
Goserelin acetate implant 3.6 MG
$327.37
J9205
Inj irinotecan liposome 1 mg 1 MG
$39.51
J9206
Irinotecan injection 20 MG
$3.55
J9207
Ixabepilone injection 1 MG
$76.75
J9208
Ifosfamide injection 1 GM
$28.33
J9209
Mesna injection 200 MG
$1.99
J9211
Idarubicin hcl injection 5 MG
$34.37
J9214
Interferon alfa-2b inj 1 MIL UNITS
$26.73
J9217
Leuprolide acetate suspnsion 7.5 MG
$220.98
J9218
Leuprolide acetate injeciton 1 MG
$22.48
J9225
Vantas implant 50 MG
$3152.29
J9226
Supprelin la implant 50 MG
$27762.44
J9228
Ipilimumab injection 1 MG
$142.59
J9230
Mechlorethamine hcl inj 10 MG
$265.89
J9245
Inj melphalan hydrochl 50 mg 50 MG
$2017.04
J9250
Methotrexate sodium inj 5 MG
$0.24
J9260
Methotrexate sodium inj 50 MG
$2.36
J9261
Nelarabine injection 50 MG
$151.91
J9263
Oxaliplatin 0.5 MG
$0.32
J9264
Paclitaxel protein bound 1 MG
$10.35
J9266
Pegaspargase injection 1 EA
$13913.32
J9267
Paclitaxel injection 1 MG
$0.18
J9268
Pentostatin injection 10 MG
$1881.67
J9271
Inj pembrolizumab 1 MG
$46.54
J9280
Mitomycin injection 5 MG
$104.81
J9293
Mitoxantrone hydrochl / 5 mg 5 MG
$39.54
J9295
Injection, necitumumab, 1 mg 1 MG
$5.26
J9299
Injection, nivolumab 1 MG
$26.05
J9301
Obinutuzumab inj 10 MG
$57.43
J9302
Ofatumumab injection 10 MG
$53.26
J9303
Panitumumab injection 10 MG
$107.44
J9305
Pemetrexed injection 10 MG
$63.81
J9306
Injection, pertuzumab, 1 mg 1 MG
$10.90
J9307
Pralatrexate injection 1 MG
$237.37
J9308
Injection, ramucirumab 5 MG
$56.39
J9310
Rituximab injection 100 MG
$818.50
J9315
Romidepsin injection 1 MG
$306.14
J9320
Streptozocin injection 1 GM
$318.61
J9325
Inj talimogene laherparepvec 1 million PFU
$46.13
J9328
Temozolomide injection 1 MG
$8.17
J9330
Temsirolimus injection 1 MG
$67.93
J9351
Topotecan injection 0.1 MG
$1.07
J9352
Injection trabectedin 0.1mg 0.1 MG
$283.34
J9354
Inj, ado-trastuzumab emt 1mg 1 MG
$29.56
J9355
Trastuzumab injection 10 MG
$94.53
J9357
Valrubicin injection 200 MG
$1148.89
J9360
Vinblastine sulfate inj 1 MG
$3.74
J9370
Vincristine sulfate 1 mg inj 1 MG
$4.47
J9371
Inj, vincristine sul lip 1mg 1 MG
$2502.76
J9390
Vinorelbine tartrate inj 10 MG
$8.73
J9395
Injection, fulvestrant 25 MG
$95.74
J9400
Inj, ziv-aflibercept, 1mg 1 MG
$8.17
P9041
Albumin (human),5%, 50ml 50 ML
$11.32
P9045
Albumin (human), 5%, 250 ml 250 ML
$54.72
P9046
Albumin (human), 25%, 20 ml 20 ML
$22.49
P9047
Albumin (human), 25%, 50ml 50 ML
$53.44
Q0138
Ferumoxytol, non-esrd 1 MG
$0.89
Q0139
Ferumoxytol, esrd use 1 MG
$0.89
Q0162
Ondansetron oral 1 MG
$0.04
Q0163
Diphenhydramine hcl 50mg 50 MG
$0.26
Q0164
Prochlorperazine maleate 5mg 5 MG
$0.04
Q0166
Granisetron hcl 1 mg oral 1 MG
$4.92
Q0167
Dronabinol 2.5mg oral 2.5 MG
$9.23
Q0169
Promethazine hcl 12.5mg oral 12.5 MG
$0.02
Q0180
Dolasetron mesylate oral 100 MG
$101.24
Q2035
Afluria vacc, 3 yrs & >, im 0.5 ml
$16.28
Q2037
Fluvirin vacc, 3 yrs & >, im 0.5 ML
$16.28
Q2043
Sipuleucel-t auto cd54+ Per infusion (minimum 50 million cells)
$37941.91
Q2050
Doxorubicin inj 10mg 10 MG
$429.60
Q3027
Inj beta interferon im 1 mcg 1 MCG
$46.34
Q4074
Iloprost non-comp unit dose UP TO 20 MCG
$123.93
Q4081
Epoetin alfa, 100 units esrd 100 UNITS
$1.23
Q4101
Apligraf 1 SQ CM
$31.01
Q4102
Oasis wound matrix 1 SQ CM
$11.02
Q4106
Dermagraft 1 SQ CM
$32.78
Q4107
Graftjacket 1 SQ CM
$91.30
Q4111
Gammagraft 1 SQ CM
$6.92
Q4112
Cymetra injectable 1 CC
$227.87
Q4113
Graftjacket xpress 1 CC
$227.87
Q4115
Alloskin 1 SQ CM
$10.09
Q4116
Alloderm 1 SQ CM
$32.15
Q4121
Theraskin 1 SQ CM
$43.35
Q4123
Alloskin 1 SQ CM
$30.74
Q4131
Epifix or epicord 1 SQ CM
$161.50
Q5101
Inj filgrastim gcsf biosimil 1 MCG
$0.78
Q5102
Inj., infliximab biosimilar 10 MG
$100.31
Q9950
Inj sulf hexa lipid microsph 1 ML
$21.66
Q9956
Inj octafluoropropane mic,ml 1 ML
$34.42
Q9957
Inj perflutren lip micros,ml 1 ML
$51.63
Q9958
Hocm <=149 mg/ml iodine, 1ml 1 ML
$0.08
Q9960
Hocm 200-249mg/ml iodine,1ml 1 ML
$0.23
Q9961
Hocm 250-299mg/ml iodine,1ml 1 ML
$0.24
Q9963
Hocm 350-399mg/ml iodine,1ml 1 ML
$0.19
Q9965
Locm 100-199mg/ml iodine,1ml 1 ML
$0.77
Q9966
Locm 200-299mg/ml iodine,1ml 1 ML
$0.16
Q9967
Locm 300-399mg/ml iodine,1ml 1 ML
$0.12



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