April 2023 NDC - HCPCS Crosswalk

Effective April 1, 2023 through June 30, 2023

Page #1

Average Sales Price

HCPCS Description Labeler name NDC Drug name Dosage Package size Package quantity Billable units Billable units / pkg
A9575 Inj gadoterate meglumi 0.1ml GE HEALTHCARE 00407-2943-01 Clariscan 0.1 ML 10 10 100 1000
A9575 Inj gadoterate meglumi 0.1ml GE HEALTHCARE 00407-2943-02 Clariscan 0.1 ML 15 10 150 1500
A9575 Inj gadoterate meglumi 0.1ml GE HEALTHCARE 00407-2943-05 Clariscan 0.1 ML 20 10 200 2000
A9575 Inj gadoterate meglumi 0.1ml GUERBET LLC 67684-2000-00 Dotarem 0.1 ML 5 10 50 500
A9575 Inj gadoterate meglumi 0.1ml GUERBET LLC 67684-2000-01 Dotarem 0.1 ML 10 10 100 1000
A9575 Inj gadoterate meglumi 0.1ml GUERBET LLC 67684-2000-05 Dotarem 0.1 ML 10 5 100 500
A9575 Inj gadoterate meglumi 0.1ml GUERBET LLC 67684-2000-06 Dotarem 0.1 ML 15 5 150 750
A9575 Inj gadoterate meglumi 0.1ml Guerbet, Llc 67684-2001-00 Dotarem 0.1 ML 5 10 50 500
A9575 Inj gadoterate meglumi 0.1ml GUERBET LLC 67684-2001-01 Dotarem 0.1 ML 10 10 100 1000
A9575 Inj gadoterate meglumi 0.1ml GUERBET LLC 67684-2001-02 Dotarem 0.1 ML 15 10 150 1500
A9575 Inj gadoterate meglumi 0.1ml GUERBET LLC 67684-2001-03 Dotarem 0.1 ML 20 10 200 2000
A9575 Inj gadoterate meglumi 0.1ml GUERBET LLC 67684-2001-04 Dotarem 0.1 ML 100 6 1000 6000
A9575 Inj gadoterate meglumi 0.1ml GUERBET LLC 67684-3001-01 Dotarem 0.1 ML 10 10 100 1000
A9575 Inj gadoterate meglumi 0.1ml GUERBET LLC 67684-3001-02 Dotarem 0.1 ML 15 10 150 1500
A9575 Inj gadoterate meglumi 0.1ml GUERBET LLC 67684-3001-03 Dotarem 0.1 ml 20 mL 10 EA 10 200 2000
A9575 Inj gadoterate meglumi 0.1ml GE HEALTHCARE 00407-2943-06 Gadoterate Meglumine 0.1 ML 5 10 50 500
A9575 Inj gadoterate meglumi 0.1ml GE HEALTHCARE 00407-2943-12 Gadoterate Meglumine 0.1 ML 10 10 100 1000
A9575 Inj gadoterate meglumi 0.1ml GE HEALTHCARE 00407-2943-17 Gadoterate Meglumine 0.1 ML 15 10 150 1500
A9575 Inj gadoterate meglumi 0.1ml GE HEALTHCARE 00407-2943-22 Gadoterate Meglumine 0.1 ML 20 10 200 2000
A9575 Inj gadoterate meglumi 0.1ml GE HEALTHCARE 00407-2943-70 Gadoterate Meglumine 0.1 ML 100 10 1000 10000
A9575 Inj gadoterate meglumi 0.1ml FRESENIUS KABI USA, LLC 65219-0080-05 GADOTERATE MEGLUMINE 0.1 ML 5 10 50 500
A9575 Inj gadoterate meglumi 0.1ml FRESENIUS KABI USA, LLC 65219-0082-10 GADOTERATE MEGLUMINE 0.1 ML 10 10 100 1000
A9575 Inj gadoterate meglumi 0.1ml FRESENIUS KABI USA, LLC 65219-0084-15 GADOTERATE MEGLUMINE 0.1 ML 15 10 150 1500
A9575 Inj gadoterate meglumi 0.1ml FRESENIUS KABI USA, LLC 65219-0086-20 GADOTERATE MEGLUMINE 0.1 ML 20 10 200 2000
A9575 Inj gadoterate meglumi 0.1ml FRESENIUS KABI USA, LLC 65219-0088-50 GADOTERATE MEGLUMINE 0.1 ML 100 6 1000 6000
A9576 Inj prohance multipack BRACCO DIAGNOSTICS 00270-1111-70 Prohance Multipack 1 ML 50 5 50 250
A9577 Inj multihance BRACCO DIAGNOSTICS 00270-5164-12 Multihance 1 ML 5 5 5 25
A9577 Inj multihance BRACCO DIAGNOSTICS 00270-5164-13 Multihance 1 ML 10 5 10 50
A9577 Inj multihance BRACCO DIAGNOSTICS 00270-5164-14 Multihance 1 ML 15 5 15 75
A9577 Inj multihance BRACCO DIAGNOSTICS 00270-5164-15 Multihance 1 ML 20 5 20 100
A9578 Inj multihance multipack BRACCO DIAGNOSTICS 00270-5264-16 Multihance Multipack 1 ML 50 5 50 250
A9578 Inj multihance multipack BRACCO DIAGNOSTICS 00270-5264-17 Multihance Multipack 1 ML 100 5 100 500
A9579 Gad-base mr contrast nos,1ml GE HEALTHCARE 00407-0690-05 Omniscan 1 ML 5 10 5 50
A9579 Gad-base mr contrast nos,1ml GE HEALTHCARE 00407-0690-10 Omniscan 1 ML 10 10 10 100
A9579 Gad-base mr contrast nos,1ml GE HEALTHCARE 00407-0690-12 Omniscan 1 ML 10 10 10 100
A9579 Gad-base mr contrast nos,1ml GE HEALTHCARE 00407-0690-15 Omniscan 1 ML 15 10 15 150
A9579 Gad-base mr contrast nos,1ml GE HEALTHCARE 00407-0690-17 Omniscan 1 ML 15 10 15 150
A9579 Gad-base mr contrast nos,1ml GE HEALTHCARE 00407-0690-20 Omniscan 1 ML 20 10 20 200
A9579 Gad-base mr contrast nos,1ml GE HEALTHCARE 00407-0690-22 Omniscan 1 ML 20 10 20 200
A9579 Gad-base mr contrast nos,1ml GE HEALTHCARE 00407-0690-70 Omniscan 1 ML 100 10 100 1000
A9579 Gad-base mr contrast nos,1ml GE HEALTHCARE 00407-0691-62 Omniscan 1 ML 15 10 15 150
A9579 Gad-base mr contrast nos,1ml BAYER HEALTHCARE PHARMACEUTICALS INC. 50419-0188-01 Magnevist 46.9% 1 ML 10 20 10 200
A9579 Gad-base mr contrast nos,1ml BAYER HEALTHCARE PHARMACEUTICALS INC. 50419-0188-02 Magnevist 46.9% 1 ML 20 20 20 400
A9579 Gad-base mr contrast nos,1ml BAYER HEALTHCARE PHARMACEUTICALS INC. 50419-0188-05 Magnevist 46.9% 1 ML 5 20 5 100
A9579 Gad-base mr contrast nos,1ml BAYER HEALTHCARE PHARMACEUTICALS INC. 50419-0188-11 Magnevist 46.9% 1 ML 100 10 100 1000
A9579 Gad-base mr contrast nos,1ml BAYER HEALTHCARE PHARMACEUTICALS INC. 50419-0188-15 Magnevist 46.9% 1 ML 15 20 15 300
A9579 Gad-base mr contrast nos,1ml BAYER HEALTHCARE PHARMACEUTICALS INC. 50419-0188-36 Magnevist 46.9% 1 ML 10 5 10 50
A9579 Gad-base mr contrast nos,1ml BAYER HEALTHCARE PHARMACEUTICALS INC. 50419-0188-37 Magnevist 46.9% 1 ML 15 5 15 75
A9579 Gad-base mr contrast nos,1ml BAYER HEALTHCARE PHARMACEUTICALS INC. 50419-0188-38 Magnevist 46.9% 1 ML 20 5 20 100
A9579 Gad-base mr contrast nos,1ml BAYER HEALTHCARE PHARMACEUTICALS INC. 50419-0188-58 Magnevist 46.9% 1 ML 50 10 50 500

Average Wholesale Price

HCPCS Description Labeler name NDC Drug name Dosage Package size Package quantity Billable units Billable units / pkg
P9041 Albumin (human),5%, 50ml Octapharma USA 68982-0623-01 Albumin (Human) 50 ML 100 1 2 2
P9041 Albumin (human),5%, 50ml Grifols 68516-5214-05 Albutein 5% 50 ML 50 1 1 1
P9045 Albumin (human), 5%, 250 ml Grifols 68516-5214-02 Albutein® 5% Albumin 500 ml 250 ML 500 1 2 2
P9045 Albumin (human), 5%, 250 ml Kedrion Biopharma 76125-0790-25 Albuked 5 250 ML 250 1 1 1
P9045 Albumin (human), 5%, 250 ml Talecris 13533-0685-20 Plasbumin-5 250 ML 50 1 0.2 0.2
P9045 Albumin (human), 5%, 250 ml Talecris 13533-0685-25 Plasbumin-5 250 ML 250 1 1 1
P9045 Albumin (human), 5%, 250 ml Talecris 13533-0690-20 Plasbumin-5 250 ML 50 1 0.2 0.2
P9045 Albumin (human), 5%, 250 ml Talecris 13533-0690-25 Plasbumin-5 250 ML 250 1 1 1
P9045 Albumin (human), 5%, 250 ml Octapharma USA 68982-0623-02 Albumin (Human) 250 ML 250 1 1 1
P9045 Albumin (human), 5%, 250 ml Octapharma USA 68982-0623-03 Albumin (Human) 250 ML 500 1 2 2
P9045 Albumin (human), 5%, 250 ml CSL Behring 00053-7670-31 Albuminar-5 250 ML 250 1 1 1
P9045 Albumin (human), 5%, 250 ml CSL Behring 00053-7670-32 Albuminar-5 250 ML 500 1 2 2
P9045 Albumin (human), 5%, 250 ml Bio Products Laboratory USA, Inc. 64208-2510-01 ALBUMINEX 5% 250 ML 250 1 1 1
P9045 Albumin (human), 5%, 250 ml Bio Products Laboratory USA, Inc. 64208-2510-05 ALBUMINEX 5% 250 ML 500 1 2 2
P9045 Albumin (human), 5%, 250 ml CSL Behring 44206-0310-25 Alburx 250 ML 250 1 1 1
P9045 Albumin (human), 5%, 250 ml CSL Behring 44206-0310-50 Alburx 250 ML 500 1 2 2
P9045 Albumin (human), 5%, 250 ml Grifols 68516-5214-01 Albutein® 5% 250 ML 250 1 1 1
P9045 Albumin (human), 5%, 250 ml Baxter 00944-0491-01 Buminate 250 ML 250 1 1 1
P9045 Albumin (human), 5%, 250 ml Baxter 00944-0491-02 Buminate 250 ML 500 1 2 2
P9046 Albumin (human), 25%, 20 ml Grifols 68516-5216-05 Albutein 25% 20 ML 20 1 1 1
P9047 Albumin (human), 25%, 50ml Kedrion Biopharma 76125-0784-10 Albuked 25 50 ML 100 1 2 2
P9047 Albumin (human), 25%, 50ml Kedrion Biopharma 76125-0784-25 Albuked 25 50 ML 50 1 1 1
P9047 Albumin (human), 25%, 50ml Grifols 68516-5216-01 Albutein® 25% 50 ML 50 1 1 1
P9047 Albumin (human), 25%, 50ml Grifols 68516-5216-02 Albutein® 25% Albumin 100 ml 50 ML 100 1 2 2
P9047 Albumin (human), 25%, 50ml Baxter 00944-0490-01 Buminate 50 ML 20 1 0.4 0.4
P9047 Albumin (human), 25%, 50ml Baxter 00944-0493-01 Flexbumin 50 ML 50 1 1 1
P9047 Albumin (human), 25%, 50ml Baxter 00944-0493-02 Flexbumin 50 ML 100 1 1 2
P9047 Albumin (human), 25%, 50ml Grifols 61953-0002-01 Human Albumin Grifols 50 ML 50 1 1 1
P9047 Albumin (human), 25%, 50ml Grifols 61953-0002-02 Human Albumin Grifols 50 ML 100 1 2 2
P9047 Albumin (human), 25%, 50ml Kedrion Biopharma 76179-0025-01 Kedbumin 50 ML 50 1 1 1
P9047 Albumin (human), 25%, 50ml Kedrion Biopharma 76179-0025-02 Kedbumin 50 ML 50 1 1 1
P9047 Albumin (human), 25%, 50ml Kedrion Biopharma 76179-0025-04 Kedbumin 50 ML 100 1 2 2
P9047 Albumin (human), 25%, 50ml Talecris 13533-0684-16 Plasbumin-25 50 ML 20 1 0.4 0.4
P9047 Albumin (human), 25%, 50ml Talecris 13533-0684-20 Plasbumin-25 50 ML 50 1 1 1
P9047 Albumin (human), 25%, 50ml Talecris 13533-0684-71 Plasbumin-25 50 ML 100 1 2 2
P9047 Albumin (human), 25%, 50ml Talecris 13533-0692-16 Plasbumin-25 50 ML 20 1 0.4 0.4
P9047 Albumin (human), 25%, 50ml Talecris 13533-0692-20 Plasbumin-25 50 ML 50 1 1 1
P9047 Albumin (human), 25%, 50ml Talecris 13533-0692-71 Plasbumin-25 50 ML 100 1 2 2
P9047 Albumin (human), 25%, 50ml CSL Behring 44206-0251-05 Alburx 50 ML 50 1 1 1
P9047 Albumin (human), 25%, 50ml CSL Behring 44206-0251-10 Alburx 50 ML 100 1 2 2
P9047 Albumin (human), 25%, 50ml Grifols 68516-5216-07 Albutein 50 ML 50 1 1 1
P9047 Albumin (human), 25%, 50ml Grifols 68516-5216-08 Albutein 50 ML 100 1 2 2
P9047 Albumin (human), 25%, 50ml Bio Products Laboratory USA, Inc. 64208-2512-03 ALBUMINEX 25% 50 ML 50 1 1 1
P9047 Albumin (human), 25%, 50ml Bio Products Laboratory USA, Inc. 64208-2512-07 ALBUMINEX 25% 50 ML 100 1 2 2
P9047 Albumin (human), 25%, 50ml Octapharma USA 68982-0643-01 Albumin (Human) 50 ML 50 1 1 1
P9047 Albumin (human), 25%, 50ml Octapharma USA 68982-0643-02 Albumin (Human) 50 ML 100 1 2 2
P9047 Albumin (human), 25%, 50ml CSL Behring 00053-7680-32 Albuminar-25 50 ML 50 1 1 1
P9047 Albumin (human), 25%, 50ml CSL Behring 00053-7680-33 Albuminar-25 50 ML 100 1 2 2

Not Otherwise Classified

Description Labeler name NDC Drug name Dosage Package size Package quantity Billable units Billable units / pkg
Alfentanil Hcl AKORN 17478-0067-02 ALFENTA 500 MCG 2 10 2 20
Alfentanil Hcl AKORN 17478-0067-05 Alfenta 500 MCG 5 10 5 50
Allopurinol Sodium FRESENIUS KABI USA, LLC 65219-0380-30 Allopurinol 500 MG 1 1 1 1
Allopurinol Sodium HIKMA PHARMACEUTICALS USA INC. 00143-9533-01 Allopurinol Sodium 500 MG 1 1 1 1
Allopurinol Sodium MYLAN INSTITUTIONAL LLC 67457-0187-50 Aloprim 500 MG 1 1 1 1
Allopurinol Sodium MYLAN INSTITUTIONAL LLC 67457-0978-50 Aloprim 500 MG 1 1 1 1
Aminocaproic acid AMERICAN REGENT 00517-9191-25 Aminocaproic Acid 250 MG 20 25 20 500
Aminocaproic acid CIVICA INC 72572-0015-25 Aminocaproic Acid 250 MG 20 25 20 500
Aminocaproic acid PFIZER INC. 00409-4346-73 AMINOCAPROIC ACID INJ 250 MG 20 25 20 500
Aztreonam BRISTOL-MYERS SQUIBB COMPANY 00003-2560-16 AZACTAM 500 MG 1 10 2 20
Aztreonam BRISTOL-MYERS SQUIBB COMPANY 00003-2570-16 AZACTAM 500 MG 1 10 4 40
Aztreonam FRESENIUS KABI 63323-0401-20 Aztreonam 500 MG 1 10 2 20
Aztreonam FRESENIUS KABI 63323-0401-24 Aztreonam 500 MG 1 10 2 20
Aztreonam FRESENIUS KABI 63323-0401-26 Aztreonam 500 MG 1 10 2 20
Aztreonam FRESENIUS KABI 63323-0402-20 Aztreonam 500 MG 1 10 4 40
Aztreonam FRESENIUS KABI 63323-0402-24 Aztreonam 500 MG 1 10 4 40
Aztreonam FRESENIUS KABI 63323-0402-30 Aztreonam 500 MG 1 10 4 40
Esmolol Hydrochloride BAXTER 10019-0075-87 Brevibloc 10 MG 100 1 200 200
Esmolol Hydrochloride BAXTER 10019-0115-01 Brevibloc 10 MG 10 25 10 250
Esmolol Hydrochloride BAXTER 10019-0666-10 BREVIBLOC 10 MG 100 10 200 2000
Esmolol Hydrochloride BAXTER 10019-0668-10 BREVIBLOC 10 MG 100 10 200 2000
Esmolol Hydrochloride BAXTER 10019-0670-10 BREVIBLOC 10 MG 250 10 250 2500
Esmolol Hydrochloride BAXTER 10019-0672-10 BREVIBLOC 10 MG 250 10 250 2500
Esmolol Hydrochloride BAXTER 10019-0055-61 Brevibloc In Nacl 10 MG 250 1 250 250
Bumetanide PFIZER INC. 00409-1412-04 Bumetanide 0.25 MG 4 10 4 40
Bumetanide PFIZER INC. 00409-1412-10 Bumetanide 0.25 MG 10 10 10 100
Bumetanide HIKMA PHARMACEUTICALS USA INC. 00641-6007-10 Bumetanide 0.25 MG 10 10 10 100
Bumetanide HIKMA PHARMACEUTICALS USA INC. 00641-6008-10 Bumetanide 0.25 MG 4 10 4 40
Bumetanide HIKMA PHARMACEUTICALS USA INC. 00641-6161-10 Bumetanide 0.25 MG 4 10 4 40
Bumetanide HIKMA PHARMACEUTICALS USA INC. 00641-6162-10 Bumetanide 0.25 MG 10 10 10 100
Bumetanide ATHENEX PHARMACEUTICAL 70860-0405-04 Bumetanide 0.25 MG 4 10 4 40
Bumetanide ATHENEX PHARMACEUTICAL 70860-0406-10 Bumetanide 0.25 MG 10 10 10 100
Bumetanide CIVICA, INC. 72572-0040-10 Bumetanide 0.25 MG 4 10 4 40
Bumetanide CIVICA, INC. 72572-0041-10 Bumetanide 0.25 MG 10 10 10 100
Bupivacaine Hikma Pharmaceuticals Usa 00143-9328-10 Bupivacaine HCl 1 ML 50 10 50 500
Bupivacaine HIKMA PHARMACEUTICALS USA INC. 00143-9330-10 BUPIVACAINE HCL 1 ML 10 10 10 100
Bupivacaine HIKMA PHARMACEUTICALS USA INC. 00143-9331-10 BUPIVACAINE HCL 1 ML 10 10 10 100
Bupivacaine AUROMEDICS PHARMA, LLC 00143-9332-10 BUPIVACAINE HCL 1 ML 10 10 10 100
Bupivacaine HIKMA PHARMACEUTICALS USA INC. 00143-9333-10 Bupivacaine HCl 1 ML 30 10 30 300
Bupivacaine HIKMA PHARMACEUTICALS USA INC. 00143-9334-10 Bupivacaine HCl 1 ML 30 10 30 300
Bupivacaine HIKMA PHARMACEUTICALS USA INC. 00143-9335-10 Bupivacaine HCl 1 ML 30 10 30 300
Bupivacaine PFIZER INC. 00409-1159-01 Bupivacaine Hcl 1 ML 10 25 10 250
Bupivacaine PFIZER INC. 00409-1159-10 Bupivacaine HCl 1 ML 30 25 30 750
Bupivacaine PFIZER INC. 00409-1160-01 Bupivacaine Hcl 1 ML 50 25 50 1250
Bupivacaine PFIZER INC. 00409-1162-01 Bupivacaine Hcl 1 ML 10 25 10 250
Bupivacaine PFIZER INC. 00409-1162-10 Bupivacaine Hcl 1 ML 30 25 30 750
Bupivacaine PFIZER INC. 00409-1163-01 Bupivacaine Hcl 1 ML 50 25 50 1250
Bupivacaine PFIZER INC. 00409-1165-02 Bupivacaine Hcl 1 ML 30 25 30 750
Bupivacaine PFIZER INC. 00409-1582-10 Bupivacaine HCl 1 ML 10 10 5 50
Bupivacaine BAXTER 36000-0092-10 Bupivacaine Hcl 1 ML 2 10 2 20
Bupivacaine AUROMEDICS PHARMA LLC 55150-0167-10 Bupivacaine HCl 1 ML 10 25 10 250
Bupivacaine AUROMEDICS PHARMA LLC 55150-0168-30 Bupivacaine HCl 1 ML 30 25 30 750
Bupivacaine AUROMEDICS PHARMA LLC 55150-0169-10 Bupivacaine HCl 1 ML 10 25 10 250
Bupivacaine AUROMEDICS PHARMA LLC 55150-0170-30 Bupivacaine HCl 1 ML 30 25 30 750
Bupivacaine AUROMEDICS PHARMA LLC 55150-0171-10 Bupivacaine HCl 1 ML 10 25 10 250
Bupivacaine AUROMEDICS PHARMA LLC 55150-0172-30 Bupivacaine HCl 1 ML 30 25 30 750
Bupivacaine AUROMEDICS PHARMA LLC 55150-0249-50 Bupivacaine Hcl 1 ML 50 25 50 1250
Bupivacaine AUROMEDICS PHARMA LLC 55150-0250-50 Bupivacaine Hcl 1 ML 50 25 50 1250
Bupivacaine PFIZER INC. 00409-1159-02 BUPIVICAINE HCL 1 ML 30 25 30 750
Carmustine (Accord) ACCORD HEALTHCARE INC. 16729-0545-63 Carmustine 100 MG 1 1 0.5 0.5
Carmustine (Accord) ACCORD HEALTHCARE 16729-0548-63 CARMUSTINE 100 MG 1 1 3 3
Clindamycin Phosphate PFIZER INC. 00009-0728-09 Cleocin 150 MG 60 5 1 5
Clindamycin Phosphate PFIZER INC. 00009-0775-26 Cleocin 150 MG 4 25 4 100
Clindamycin Phosphate PFIZER INC. 00009-0870-26 Cleocin 150 MG 2 25 2 50
Clindamycin Phosphate PFIZER INC. 00009-0902-18 Cleocin 150 MG 6 25 6 150
Clindamycin Phosphate PFIZER INC. 00009-3051-02 Cleocin 150 MG 2 25 2 50
Clindamycin Phosphate PFIZER INC. 00009-4073-04 Cleocin 150 MG 4 25 4 100
Clindamycin Phosphate PFIZER INC. 00009-5095-06 Cleocin 150 MG 6 25 6 150
Clindamycin Phosphate BAXTER 00338-3616-24 Clindamycin in D5W 150 MG 50 24 4 96
Clindamycin Phosphate BAXTER 00338-4114-24 Clindamycin in D5W 150 MG 50 24 6 144
Clindamycin Phosphate BAXTER 00338-9545-24 Clindamycin in D5W 150 MG 50 24 2 48
Clindamycin Phosphate BAXTER 00338-9549-24 Clindamycin in D5W 150 MG 50 24 4 96
Clindamycin Phosphate BAXTER 00338-9553-24 Clindamycin in D5W 150 MG 50 24 6 144
Clindamycin Phosphate SANDOZ 00781-9220-09 Clindamycin in D5W 150 MG 50 24 2 48
Clindamycin Phosphate SANDOZ 00781-9221-09 Clindamycin in D5W 150 MG 50 24 4 96
Clindamycin Phosphate SANDOZ 00781-9222-09 Clindamycin in D5W 150 MG 50 24 6 144
Clindamycin Phosphate Civica 72572-0074-24 Clindamycin in D5W 150 MG 50 24 4 96
Clindamycin Phosphate Civica 72572-0076-24 Clindamycin in D5W 150 MG 50 24 6 144
Clindamycin Phosphate PFIZER INC. 00009-0302-25 Clindamycin Phosphate 150 MG 2 25 2 50
Clindamycin Phosphate PFIZER INC. 00009-0602-25 Clindamycin Phosphate 150 MG 4 25 4 100
Clindamycin Phosphate PFIZER INC. 00009-0901-25 Clindamycin Phosphate 150 MG 6 25 6 150
Clindamycin Phosphate BAXTER 00338-3410-24 Clindamycin Phosphate 150 MG 50 24 2 48
Clindamycin Phosphate BAXTER 00338-3612-24 Clindamycin Phosphate 150 MG 50 24 4 96
Clindamycin Phosphate BAXTER 00338-3814-24 Clindamycin Phosphate 150 MG 50 24 6 144
Clindamycin Phosphate SANDOZ 00781-3288-09 Clindamycin Phosphate 150 MG 50 24 2 48
Clindamycin Phosphate SANDOZ 00781-3289-09 Clindamycin Phosphate 150 MG 50 24 4 96
Clindamycin Phosphate SANDOZ 00781-3290-09 Clindamycin Phosphate 150 MG 50 24 6 144
Clindamycin Phosphate SAGENT PHARMACEUTICALS INC 25021-0115-02 Clindamycin Phosphate 150 MG 2 25 2 50
Clindamycin Phosphate SAGENT PHARMACEUTICALS INC 25021-0115-04 Clindamycin Phosphate 150 MG 4 25 4 100
Clindamycin Phosphate SAGENT PHARMACEUTICALS INC 25021-0115-06 Clindamycin Phosphate 150 MG 6 25 6 150
Clindamycin Phosphate SAGENT PHARMACEUTICALS INC 25021-0115-51 Clindamycin Phosphate 150 MG 60 1 60 60
Clindamycin Phosphate ALVOGEN 47781-0459-68 Clindamycin Phosphate 150 MG 2 25 2 50
Clindamycin Phosphate ALVOGEN 47781-0460-68 Clindamycin Phosphate 150 MG 4 25 4 100
Clindamycin Phosphate ALVOGEN 47781-0461-68 Clindamycin Phosphate 150 MG 6 25 6 150
Clindamycin Phosphate ALVOGEN 47781-0465-70 Clindamycin Phosphate 150 MG 60 1 60 60
Clindamycin Phosphate ALVOGEN 47781-0619-69 Clindamycin Phosphate 150 MG 2 25 2 50
Clindamycin Phosphate ALVOGEN 47781-0620-69 Clindamycin Phosphate 150 MG 4 25 4 100
Clindamycin Phosphate ALVOGEN 47781-0621-69 Clindamycin Phosphate 150 MG 6 25 6 150
Clindamycin Phosphate MYLAN INSTITUTIONAL LLC 67457-0814-02 Clindamycin Phosphate 150 MG 2 25 2 50
Clindamycin Phosphate MYLAN INSTITUTIONAL LLC 67457-0815-04 Clindamycin Phosphate 150 MG 4 25 4 100
Clindamycin Phosphate MYLAN INSTITUTIONAL LLC 67457-0816-06 Clindamycin Phosphate 150 MG 6 25 6 150
Clindamycin Phosphate ALMAJECT 72611-0634-25 Clindamycin Phosphate 150 MG 2 25 2 50
Clindamycin Phosphate ALMAJECT 72611-0639-25 Clindamycin Phosphate 150 MG 4 25 4 100
Clindamycin Phosphate ALMAJECT 72611-0642-25 Clindamycin Phosphate 150 MG 6 25 6 150
Clindamycin Phosphate ALMAJECT 72611-0645-55 Clindamycin Phosphate 150 MG 60 5 60 300
Diltiazem Hydrochloride HIKMA PHARMACEUTICALS USA INC. 00641-6013-10 Diltiazem Hcl 5 MG 5 10 5 50
Diltiazem Hydrochloride HIKMA PHARMACEUTICALS USA INC. 00641-6014-10 Diltiazem Hcl 5 MG 10 10 10 100
Diltiazem Hydrochloride HIKMA PHARMACEUTICALS USA INC. 00641-6015-10 Diltiazem Hcl 5 MG 25 10 25 250
Diltiazem Hydrochloride HIKMA PHARMACEUTICALS USA INC. 00641-9217-10 Diltiazem Hcl 5 MG 5 10 5 50
Diltiazem Hydrochloride HIKMA PHARMACEUTICALS USA INC. 00641-9218-10 Diltiazem Hcl 5 MG 10 10 10 100
Diltiazem Hydrochloride HIKMA PHARMACEUTICALS USA INC. 00641-9219-10 Diltiazem Hcl 5 MG 25 10 25 250
Diltiazem Hydrochloride AKORN 17478-0937-05 Diltiazem Hcl 5 MG 5 10 5 50
Diltiazem Hydrochloride AKORN 17478-0937-10 Diltiazem Hcl 5 MG 10 10 10 100
Diltiazem Hydrochloride AKORN 17478-0937-25 Diltiazem Hcl 5 MG 25 10 25 25
Diltiazem Hydrochloride AKORN 17478-0937-26 Diltiazem Hcl 5 MG 25 10 25 250
Diltiazem Hydrochloride ATHENEX 70860-0301-05 Diltiazem HCl 5 MG 5 10 5 50
Diltiazem Hydrochloride ATHENEX 70860-0301-10 Diltiazem HCl 5 MG 10 10 10 100
Diltiazem Hydrochloride ATHENEX 70860-0301-25 Diltiazem HCl 5 MG 25 10 25 250
Doxycycline Hyclate HIKMA PHARMACEUTICALS USA INC. 00143-9381-10 Doxycycline Hyclate 100 MG 1 10 1 10
Doxycycline Hyclate FRESENIUS KABI 63323-0130-11 Doxycycline Hyclate 100 MG 1 10 1 10
Doxycycline Hyclate FRESENIUS KABI 63323-0130-13 Doxycycline Hyclate 100 MG 1 10 1 10
Doxycycline Hyclate FRESENIUS KABI 63323-0130-17 Doxycycline Hyclate 100 MG 1 10 1 10
Doxycycline Hyclate MYLAN INSTITUTIONAL LLC 67457-0437-10 Doxycycline Hyclate 100 MG 1 10 1 10
Doxycycline Hyclate ZYDUS PHARMACEUTICALS 68382-0910-10 Doxycycline Hyclate 100 MG 1 10 1 10
Esmolol Hydrochloride BAXTER 10019-0120-01 Esmolol HCl 10 MG 10 25 10 250
Esmolol Hydrochloride SAGENT PHARMACEUTICALS INC 25021-0308-84 Esmolol HCl 10 MG 250 10 250 2500
Esmolol Hydrochloride SAGENT PHARMACEUTICALS INC 25021-0309-82 Esmolol HCl 10 MG 100 10 200 2000
Esmolol Hydrochloride SAGENT PHARMACEUTICALS INC 25021-0314-10 Esmolol HCl 10 MG 10 10 10 100
Esmolol Hydrochloride WG CRITICAL CARE 44567-0811-10 Esmolol HCl 10 MG 250 10 250 2500
Esmolol Hydrochloride WG CRITICAL CARE 44567-0812-10 Esmolol Hcl 10 MG 100 10 200 2000
Esmolol Hydrochloride AUROMEDICS PHARMA LLC 55150-0194-10 Esmolol Hcl 10 MG 10 25 10 250
Esmolol Hydrochloride AUROMEDICS PHARMA 55150-0420-10 Esmolol HCl 10 MG 250 10 250 2500
Esmolol Hydrochloride AUROMEDICS PHARMA 55150-0421-10 Esmolol HCl 10 MG 100 10 200 2000
Esmolol Hydrochloride FRESENIUS KABI 63323-0652-10 Esmolol Hcl 10 MG 10 25 10 250
Esmolol Hydrochloride MYLAN INSTITUTIONAL LLC 67457-0182-10 Esmolol Hcl 10 MG 10 10 10 100
Esmolol Hydrochloride MYLAN INSTITUTIONAL LLC 67457-0657-25 Esmolol HCl 10 MG 250 10 250 2500
Esmolol Hydrochloride MYLAN INSTITUTIONAL LLC 67457-0658-10 Esmolol Hcl 10 MG 100 10 200 2000
Famotidine HIKMA PHARMACEUTICALS USA INC. 00641-6021-10 Famotidine 10 MG 20 10 20 200
Famotidine HIKMA PHARMACEUTICALS USA INC. 00641-6022-25 Famotidine 10 MG 2 25 2 50
Famotidine HIKMA PHARMACEUTICALS USA INC. 00641-6023-25 Famotidine 10 MG 4 25 4 100
Famotidine FRESENIUS KABI 63323-0738-09 Famotidine 10 MG 4 10 4 40
Famotidine FRESENIUS KABI 63323-0738-20 Famotidine 10 MG 20 10 20 200
Famotidine FRESENIUS KABI 63323-0739-12 Famotidine 10 MG 2 25 2 50
Famotidine FRESENIUS KABI 63323-0739-16 Famotidine 10 MG 2 25 2 50
Famotidine MYLAN INSTITUTIONAL LLC 67457-0448-43 Famotidine 10 MG 4 10 4 40
Famotidine MYLAN INSTITUTIONAL LLC 67457-0457-20 Famotidine 10 MG 20 10 20 200
Famotidine ATHENEX 70860-0751-02 Famotidine 10 MG 2 25 2 50
Famotidine ATHENEX 70860-0753-20 Famotidine 10 MG 20 10 20 200
Famotidine BAXTER 00338-5197-41 Famotidine Premixed 10 MG 50 12 2 24
Insulin aspart (Fiasp) administration through dme (i.e., insulin pump) NOVO NORDISK INC 00169-3201-11 Fiasp 50 UNITS 10 1 20 20
Insulin aspart (Fiasp) administration through dme (i.e., insulin pump) NOVO NORDISK INC 00169-3204-15 Fiasp FlexTouch 50 UNITS 3 5 6 30
Insulin aspart (Fiasp) administration through dme (i.e., insulin pump) NOVO NORDISK INC 00169-3205-15 Fiasp Penfill 50 UNITS 3 5 6 30
Flumazenil HIKMA PHARMACEUTICALS USA INC. 00143-9683-10 Flumazenil 0.1 MG 10 10 10 100
Flumazenil HIKMA PHARMACEUTICALS USA INC. 00143-9684-10 Flumazenil 0.1 MG 5 10 5 50
Flumazenil HIKMA PHARMACEUTICALS USA INC. 00143-9783-10 Flumazenil 0.1 MG 10 10 10 100
Flumazenil HIKMA PHARMACEUTICALS USA INC. 00143-9784-10 Flumazenil 0.1 MG 5 10 5 50
Flumazenil BAXTER 36000-0148-10 Flumazenil 0.1 MG 5 10 5 50
Flumazenil BAXTER 36000-0149-10 Flumazenil 0.1 MG 10 10 10 100
Flumazenil FRESENIUS KABI 63323-0424-05 Flumazenil 0.1 MG 5 10 5 50
Flumazenil FRESENIUS KABI 63323-0424-10 Flumazenil 0.1 MG 10 1 10 10
Folic Acid X-GEN PHARMACEUTICALS INC 39822-1100-01 Folic Acid 5 MG 10 1 10 10
Folic Acid FRESENIUS KABI 63323-0184-10 Folic Acid 5 MG 10 1 10 10
Furosemide (Phlow Corporation) PHLOW CORPORATION 81565-0201-02 Furosemide 20 MG 2 25 1 25
Glycopyrrolate injection AMERICAN REGENT 00517-4601-25 Glycopyrrolate 0.2 MG 1 25 1 25
Glycopyrrolate injection AMERICAN REGENT 00517-4602-25 Glycopyrrolate 0.2 MG 2 25 2 50
Glycopyrrolate injection AMERICAN REGENT 00517-4605-25 Glycopyrrolate 0.2 MG 5 25 5 125
Glycopyrrolate injection AMERICAN REGENT 00517-4620-25 Glycopyrrolate 0.2 MG 20 25 20 500
Glycopyrrolate injection (Fresenius Kabi) Fresenius Kabi USA, LLC 76045-0023-30 Glycopyrrolate 0.2 MG 3 10 3 30
Glycopyrrolate injection FRESENIUS KABI 63323-0578-11 Glycopyrrolate (injection) 0.2 MG 1 25 1 25
Glycopyrrolate injection FRESENIUS KABI 63323-0578-12 Glycopyrrolate (injection) 0.2 MG 2 25 2 50
Glycopyrrolate injection HIKMA PHARMACEUTICALS USA INC. 00143-9584-10 Glycopyrrolate INJECTION 0.2 MG 20 10 20 200
Glycopyrrolate injection HIKMA PHARMACEUTICALS USA INC. 00143-9585-25 Glycopyrrolate INJECTION 0.2 MG 5 25 5 125
Glycopyrrolate injection HIKMA PHARMACEUTICALS USA INC. 00143-9586-25 Glycopyrrolate INJECTION 0.2 MG 2 25 2 50
Glycopyrrolate injection HIKMA PHARMACEUTICALS USA INC. 00143-9587-25 Glycopyrrolate INJECTION 0.2 MG 1 25 1 25
Glycopyrrolate injection HIKMA PHARMACEUTICALS USA INC. 00143-9679-10 Glycopyrrolate INJECTION 0.2 MG 20 10 20 200
Glycopyrrolate injection HIKMA PHARMACEUTICALS USA INC. 00143-9680-25 Glycopyrrolate INJECTION 0.2 MG 5 25 5 125
Glycopyrrolate injection HIKMA PHARMACEUTICALS USA INC. 00143-9681-25 Glycopyrrolate INJECTION 0.2 MG 2 25 2 50
Glycopyrrolate injection HIKMA PHARMACEUTICALS USA INC. 00143-9682-25 Glycopyrrolate INJECTION 0.2 MG 1 25 1 25
Glycopyrrolate injection SANDOZ 00781-3825-96 Glycopyrrolate Injection 0.2 MG 1 25 1 25
Glycopyrrolate injection SANDOZ 00781-3827-96 Glycopyrrolate Injection 0.2 MG 2 25 2 50
Glycopyrrolate injection SANDOZ 00781-3829-96 Glycopyrrolate Injection 0.2 MG 5 25 5 125
Glycopyrrolate injection SANDOZ 00781-3831-95 Glycopyrrolate Injection 0.2 MG 20 10 20 200
Glycopyrrolate injection A-S MEDICATION SOLUTIONS 50090-5226-00 Glycopyrrolate Injection 0.2 MG 1 25 1 25
Glycopyrrolate injection AUROMEDICS PHARMA LLC 55150-0292-01 Glycopyrrolate Injection 0.2 MG 1 25 1 25
Glycopyrrolate injection AUROMEDICS PHARMA LLC 55150-0293-02 Glycopyrrolate Injection 0.2 MG 2 25 2 50
Glycopyrrolate injection AUROMEDICS PHARMA LLC 55150-0294-05 Glycopyrrolate Injection 0.2 MG 5 25 5 125
Glycopyrrolate injection AUROMEDICS PHARMA LLC 55150-0295-20 Glycopyrrolate Injection 0.2 MG 20 25 20 500
Glycopyrrolate injection APOTEX CORP. 60505-6179-05 Glycopyrrolate Injection 0.2 MG 1 25 1 25
Glycopyrrolate injection APOTEX CORP. 60505-6180-05 Glycopyrrolate Injection 0.2 MG 2 25 2 50
Glycopyrrolate injection APOTEX CORP. 60505-6181-05 Glycopyrrolate Injection 0.2 MG 5 25 5 125
Glycopyrrolate injection APOTEX CORP. 60505-6182-04 Glycopyrrolate Injection 0.2 MG 20 10 20 200
Glycopyrrolate injection FRESENIUS KABI 63323-0578-01 Glycopyrrolate Injection 0.2 MG 1 25 1 25
Glycopyrrolate injection FRESENIUS KABI 63323-0578-02 Glycopyrrolate Injection 0.2 MG 2 25 2 50
Glycopyrrolate injection FRESENIUS KABI 63323-0578-05 Glycopyrrolate Injection 0.2 MG 5 25 5 125
Glycopyrrolate injection PIRAMAL CRITICAL CARE 66794-0202-42 Glycopyrrolate Injection 0.2 MG 1 25 1 25
Glycopyrrolate injection PIRAMAL CRITICAL CARE 66794-0203-42 Glycopyrrolate Injection 0.2 MG 2 25 2 50
Glycopyrrolate injection PIRAMAL CRITICAL CARE 66794-0204-42 Glycopyrrolate Injection 0.2 MG 5 25 5 125
Glycopyrrolate injection PIRAMAL CRITICAL CARE 66794-0205-41 Glycopyrrolate Injection 0.2 MG 20 10 20 200
Glycopyrrolate injection AMERICAN HEALTH PACKAGING 68001-0351-60 Glycopyrrolate Injection 0.2 MG 1 25 1 25
Glycopyrrolate injection AMERICAN HEALTH PACKAGING 68001-0352-71 Glycopyrrolate Injection 0.2 MG 2 25 2 50
Glycopyrrolate injection AMERICAN HEALTH PACKAGING 68001-0353-72 Glycopyrrolate Injection 0.2 MG 5 25 5 125
Glycopyrrolate injection AMNEAL BIOSCIENCES 70121-1394-05 Glycopyrrolate Injection 0.2 MG 1 25 1 25
Glycopyrrolate injection AMNEAL BIOSCIENCES 70121-1395-05 Glycopyrrolate Injection 0.2 MG 2 25 2 50
Glycopyrrolate injection AMNEAL BIOSCIENCES 70121-1396-05 Glycopyrrolate Injection 0.2 MG 5 25 5 125
Glycopyrrolate injection AMNEAL BIOSCIENCES 70121-1397-07 Glycopyrrolate Injection 0.2 MG 20 10 20 200
Glycopyrrolate injection BE PHARMACEUTICALS, INC. 71839-0123-25 Glycopyrrolate INJECTION 0.2 MG 1 25 1 25
Glycopyrrolate injection BE PHARMACEUTICALS, INC. 71839-0124-25 Glycopyrrolate INJECTION 0.2 MG 2 25 2 50
Glycopyrrolate injection BE PHARMACEUTICALS, INC. 71839-0125-25 Glycopyrrolate INJECTION 0.2 MG 5 25 5 125
Glycopyrrolate injection CIVICA INC 72572-0225-25 Glycopyrrolate Injection 0.2 MG 1 25 1 25
Glycopyrrolate injection CIVICA INC 72572-0226-25 Glycopyrrolate Injection 0.2 MG 1 25 1 25
Glycopyrrolate injection FRESENIUS KABI 76045-0203-10 Glycopyrrolate Injection 0.2 MG 1 24 1 24
Glycopyrrolate injection FRESENIUS KABI 76045-0203-20 Glycopyrrolate Injection 0.2 MG 2 24 2 48
Paliperidone Palmitate (Invega Trinza) JANSSEN PHARMACEUTICALS, INC. 50458-0606-01 INVEGA TRINZA 1 MG 0.875 1 273 273
Paliperidone Palmitate (Invega Trinza) JANSSEN PHARMACEUTICALS, INC. 50458-0607-01 INVEGA TRINZA 1 MG 1.315 1 410 410
Paliperidone Palmitate (Invega Trinza) JANSSEN PHARMACEUTICALS, INC. 50458-0608-01 INVEGA TRINZA 1 MG 1.75 1 546 546
Paliperidone Palmitate (Invega Trinza) JANSSEN PHARMACEUTICALS, INC. 50458-0609-01 INVEGA TRINZA 1 MG 2.625 1 819 819
Coagulation Factor IX, Recombinant (Ixinity) MEDEXUS PHARMA, INC. 59137-0282-05 Ixinity 1 IU 1 1 1 1
Coagulation Factor IX, Recombinant (Ixinity) MEDEXUS PHARMA, INC. 59137-0283-05 Ixinity 1 IU 1 1 1 1
Coagulation Factor IX, Recombinant (Ixinity) MEDEXUS PHARMA, INC. 59137-0284-05 Ixinity 1 IU 1 1 1 1
Coagulation Factor IX, Recombinant (Ixinity) MEDEXUS PHARMA, INC. 59137-0289-05 Ixinity 1 IU 1 1 1 1
Coagulation Factor IX, Recombinant (Ixinity) APTEVO BIOTHERAPEUTICS, LLC. 70504-0282-05 IXINITY 1 IU 1 1 1 1
Coagulation Factor IX, Recombinant (Ixinity) APTEVO BIOTHERAPEUTICS, LLC. 70504-0283-05 IXINITY 1 IU 1 1 1 1
Coagulation Factor IX, Recombinant (Ixinity) APTEVO BIOTHERAPEUTICS, LLC. 70504-0284-05 IXINITY 1 IU 1 1 1 1
Coagulation Factor IX, Recombinant (Ixinity) APTEVO BIOTHERAPEUTICS, LLC. 70504-0289-05 IXINITY 1 IU 1 1 1 1
Labetalol Hcl HIKMA PHARMACEUTICALS USA INC. 00143-9320-01 Labetalol HCl 5 MG 20 1 20 20
Labetalol Hcl HIKMA PHARMACEUTICALS USA INC. 00143-9363-10 Labetalol HCl 5 MG 100 10 20 200
Labetalol Hcl HIKMA PHARMACEUTICALS USA INC. 00143-9364-10 Labetalol HCl 5 MG 200 10 40 400
Labetalol Hcl HIKMA PHARMACEUTICALS USA INC. 00143-9365-10 Labetalol HCl 5 MG 300 10 60 600
Labetalol Hcl HIKMA PHARMACEUTICALS USA INC. 00143-9366-10 Labetalol HCl 5 MG 200 10 40 400
Labetalol Hcl HIKMA PHARMACEUTICALS USA INC. 00143-9622-01 Labetalol Hcl 5 MG 20 1 20 20
Labetalol Hcl HIKMA PHARMACEUTICALS USA INC. 00143-9623-01 Labetalol Hcl 5 MG 40 1 40 40
Labetalol Hcl AKORN 17478-0420-20 Labetalol Hcl 5 MG 20 1 20 20
Labetalol Hcl AKORN 17478-0420-40 Labetalol Hcl 5 MG 40 1 40 40
Labetalol Hcl SAGENT PHARMACEUTICALS, INC. 25021-0317-20 Labetalol HCl 5 MG 20 1 20 20
Labetalol Hcl SAGENT PHARMACEUTICALS, INC. 25021-0317-40 Labetalol HCl 5 MG 40 1 40 40
Labetalol Hcl BAXTER 36000-0320-10 Labetalol Hcl 5 MG 4 1 4 40
Labetalol Hcl BAXTER 36000-0322-02 Labetalol Hcl 5 MG 20 1 20 20
Labetalol Hcl BAXTER 36000-0324-02 Labetalol Hcl 5 MG 40 1 40 40
Labetalol Hcl ALVOGEN 47781-0586-29 Labetalol Hcl 5 MG 20 1 20 20
Labetalol Hcl ALVOGEN 47781-0586-56 Labetalol Hcl 5 MG 40 1 40 40
Labetalol Hcl FOSUN PHARMA 72266-0102-01 Labetalol Hcl 5 MG 20 1 20 20
Labetalol Hcl FOSUN PHARMA 72266-0103-01 Labetalol Hcl 5 MG 40 1 40 40
Labetalol Hcl FOSUN PHARMA 72266-0103-41 Labetalol HCl 5 MG 40 1 40 40
Labetalol Hcl CIVICA INC 72572-0350-01 Labetalol HCl 5 MG 20 1 20 20
Insulin lispro-aabc (Lyumjev) administration through dme (i.e., insulin pump) ELI LILLY AND COMPANY 00002-8207-05 Lyumjev Kwikpen U-100 50 UNITS 3 5 6 30
Insulin lispro-aabc (Lyumjev) administration through dme (i.e., insulin pump) ELI LILLY AND COMPANY 00002-8228-27 Lyumjev Kwikpen U-200 50 UNITS 3 2 12 24
Insulin lispro-aabc (Lyumjev) administration through dme (i.e., insulin pump) Lilly, Eli & Company 00002-8235-05 Lyumjev Tempo Pen 50 UNITS 3 5 6 30
Insulin lispro-aabc (Lyumjev) administration through dme (i.e., insulin pump) ELI LILLY AND COMPANY 00002-7728-01 Lyumjev U-100 50 UNITS 10 1 20 20
Bupivacaine PFIZER INC. 00409-1559-10 MARCAINE 1 ML 10 10 10 100
Bupivacaine PFIZER INC. 00409-1559-30 MARCAINE 1 ML 30 10 30 300
Bupivacaine PFIZER INC. 00409-1560-10 MARCAINE 1 ML 10 10 10 100
Bupivacaine PFIZER INC. 00409-1560-29 MARCAINE 1 ML 30 10 30 300
Bupivacaine HOSPIRA, INC. 00409-1761-10 MARCAINE SPINAL 1 ML 2 10 15 150
Bupivacaine PFIZER INC. 00409-1761-62 MARCAINE SPINAL 1 ML 2 800 2 1600
Bupivacaine PFIZER INC. 00409-1582-29 MARCAINE WITHOUT EPI 1 ML 30 10 30 300
Metoprolol Tartrate HIKMA PHARMACEUTICALS USA INC. 00143-9873-25 METOPROLOL INJ 1 MG 5 25 5 125
Metoprolol Tartrate HIKMA PHARMACEUTICALS USA INC. 00143-9660-10 Metoprolol Tartrate 1 MG 5 10 5 50
Metoprolol Tartrate PFIZER INC. 00409-1778-05 Metoprolol Tartrate 1 MG 5 10 5 50
Metoprolol Tartrate HOSPIRA, INC. 00409-2016-10 Metoprolol Tartrate 1 MG 5 10 5 50
Metoprolol Tartrate BAXTER 36000-0033-10 Metoprolol Tartrate 1 MG 5 10 5 50
Metoprolol Tartrate ALVOGEN 47781-0587-17 Metoprolol Tartrate 1 MG 5 10 5 50
Metoprolol Tartrate FRESENIUS KABI 63323-0660-05 METOPROLOL TARTRATE 1 MG 5 10 5 50
Metoprolol Tartrate FOSUN PHARMA USA 72266-0122-05 Metoprolol Tartrate 1 MG 5 5 5 25
Metoprolol Tartrate FOSUN PHARMA 72266-0122-25 Metoprolol Tartrate 1 MG 5 25 5 125
Metoprolol Tartrate CIVICA INC 72572-0420-10 Metoprolol Tartrate 1 MG 5 10 5 50
Metoprolol Tartrate ALMAJECT 72611-0740-10 Metoprolol Tartrate 1 MG 5 10 5 50
Metronidazole inj PFIZER INC. 00409-7811-24 METRONIDAZL 500MG 500 MG 100 24 1 24
Metronidazole inj BAXTER 00338-9541-24 METRONIDAZOLE 500 MG 100 24 1 24
Metronidazole inj SAGENT PHARMACEUTICALS INC 25021-0131-82 Metronidazole 500 MG 100 24 1 24
Metronidazole inj PFIZER INC. 00409-7811-37 METRONIDAZOLE 500 MG INJ USP LIFECARE 100ML FILL 500 MG 100 80 1 80
Metronidazole inj B. BRAUN MEDICAL INC. 00264-5535-32 Metronidazole In Nacl 500 MG 100 24 1 24
Metronidazole inj BAXTER 00338-1055-48 Metronidazole In Nacl 500 MG 100 24 1 24
Metronidazole inj Hospira, Inc. 00409-0152-24 Metronidazole In NaCl 500 MG 100 24 1 24
Nitroglycerin AMERICAN REGENT 00517-4810-25 Nitroglycerin 5 MG 10 25 10 250
Nitroglycerin BAXTER 00338-1047-02 Nitroglycerin In D5W 5 MG 250 12 5 60
Nitroglycerin BAXTER 00338-1049-02 Nitroglycerin In D5W 5 MG 250 12 10 120
Nitroglycerin BAXTER 00338-1051-02 Nitroglycerin In D5W 5 MG 250 12 20 240
Olanzapine short acting intramuscular injection AMERICAN REGENT 00517-0955-01 Olanzapine (Immediate Release) 0.5 MG 1 1 20 20
Olanzapine short acting intramuscular injection SANDOZ 00781-3159-72 Olanzapine (Immediate Release) 0.5 MG 1 1 20 20
Olanzapine short acting intramuscular injection SANDOZ 00781-9105-72 Olanzapine (Immediate Release) 0.5 MG 1 1 20 20
Olanzapine short acting intramuscular injection AUROMEDICS PHARMA LLC 55150-0308-01 Olanzapine (Immediate Release) 0.5 MG 1 1 20 20
Immune Globulin (Panzyga) PFIZER INC. 00069-1109-02 PANZYGA 500 MG 25 1 5 5
Immune Globulin (Panzyga) PFIZER INC. 00069-1224-02 PANZYGA 500 MG 50 1 10 10
Immune Globulin (Panzyga) PFIZER INC. 00069-1312-02 PANZYGA 500 MG 100 1 20 20
Immune Globulin (Panzyga) PFIZER INC. 00069-1415-02 PANZYGA 500 MG 200 1 40 40
Immune Globulin (Panzyga) PFIZER INC. 00069-1558-02 PANZYGA 500 MG 300 1 60 60
Immune Globulin (Panzyga) PFIZER INC. 68982-0820-02 PANZYGA 500 MG 25 1 5 5
Immune Globulin (Panzyga) PFIZER INC. 68982-0820-04 PANZYGA 500 MG 100 1 20 20
Immune Globulin (Panzyga) PFIZER INC. 68982-0820-05 PANZYGA 500 MG 200 1 40 40
Immune Globulin (Panzyga) PFIZER INC. 68982-0820-06 PANZYGA 500 MG 300 1 60 60
Immune Globulin (Panzyga) OCTAPHARMA 68982-0822-02 PANZYGA 500 MG 25 1 5 5
Immune Globulin (Panzyga) OCTAPHARMA 68982-0822-03 PANZYGA 500 MG 50 1 10 10
Immune Globulin (Panzyga) OCTAPHARMA 68982-0822-04 PANZYGA 500 MG 100 1 20 20
Immune Globulin (Panzyga) OCTAPHARMA 68982-0822-05 PANZYGA 500 MG 200 1 40 40
Immune Globulin (Panzyga) OCTAPHARMA 68982-0822-06 PANZYGA 500 MG 300 1 60 60
Rifampin FRESENIUS KABI 63323-0351-20 Rifampin 600 MG 1 1 1 1
Rifampin MYLAN INSTITUTIONAL LLC 67457-0445-60 Rifampin 600 MG 1 1 1 1
Bupivacaine FRESENIUS KABI 63323-0465-57 Sensorcaine 1 ML 50 25 50 1250
Bupivacaine FRESENIUS KABI 63323-0467-57 Sensorcaine 1 ML 50 25 50 1250
Bupivacaine FRESENIUS KABI 63323-0472-17 Sensorcaine 1 ML 10 25 10 250
Bupivacaine FRESENIUS KABI 63323-0464-17 SENSORCAINE-MPF 1 ML 10 25 10 250
Bupivacaine FRESENIUS KABI 63323-0464-37 SENSORCAINE-MPF 1 ML 30 25 30 750
Bupivacaine FRESENIUS KABI 63323-0466-17 Sensorcaine-MPF 1 ML 10 25 10 250
Bupivacaine FRESENIUS KABI 63323-0466-37 SENSORCAINE-MPF 1 ML 30 25 30 750
Bupivacaine FRESENIUS KABI 63323-0472-37 SENSORCAINE-MPF 1 ML 30 25 30 750
Sodium Chloride, Hypertonic (3% - 5% infusion) B. BRAUN MEDICAL INC. 00264-7805-10 Sodium Chloride 250 CC 500 24 2 48
Sodium Chloride, Hypertonic (3% - 5% infusion) B. BRAUN MEDICAL INC. 00264-7806-10 Sodium Chloride 250 CC 500 24 2 48
Sodium Chloride, Hypertonic (3% - 5% infusion) BAXTER 00338-0054-03 Sodium Chloride 250 CC 500 1 2 2
Sodium Chloride, Hypertonic (3% - 5% infusion) BAXTER 00338-0056-03 Sodium Chloride 250 CC 500 1 2 2
Sulfamethoxazole-Trimethoprim SICOR PHARMACEUTICALS, INC. 00703-9503-03 Sulfamethoxazole-Trimethoprim 400-80 MG 50 10 10 100
Sulfamethoxazole-Trimethoprim SICOR PHARMACEUTICALS, INC. 00703-9514-03 Sulfamethoxazole-Trimethoprim 400-80 MG 100 10 20 200
Sulfamethoxazole-Trimethoprim SICOR PHARMACEUTICALS, INC. 00703-9514-93 Sulfamethoxazole-Trimethoprim 400-80 MG 10 10 2 20
Sulfamethoxazole-Trimethoprim SICOR PHARMACEUTICALS, INC. 00703-9526-01 Sulfamethoxazole-Trimethoprim 400-80 MG 30 1 6 6
Sulfamethoxazole-Trimethoprim MYLAN INSTITUTIONAL LLC 67457-0778-05 Sulfamethoxazole-Trimethoprim 400-80 MG 5 10 1 10
Sulfamethoxazole-Trimethoprim MYLAN INSTITUTIONAL LLC 67457-0779-30 Sulfamethoxazole-Trimethoprim 400-80 MG 30 1 6 6
Sulfamethoxazole-Trimethoprim MYLAN INSTITUTIONAL LLC 67457-0921-05 Sulfamethoxazole-Trimethoprim 400-80 MG 5 10 1 10
Sulfamethoxazole-Trimethoprim MYLAN INSTITUTIONAL LLC 67457-0922-30 Sulfamethoxazole-Trimethoprim 400-80 MG 30 1 6 6
Vasopressin Amphastar Pharmaceuticals, Inc. 00548-9701-00 Vasopressin 20 UNITS 1 10 1 10
Vasopressin PAR PHARMACEUTICAL, INC 42023-0164-25 Vasopressin 20 UNITS 1 25 1 25
Vasopressin EAGLE PHARMACEUTICALS INC. 42367-0570-87 Vasopressin 20 UNITS 1 25 1 25
Vasopressin DR. REDDY'S LABORATORIES, INC. 43598-0085-25 Vasopressin 20 UNITS 1 25 1 25
Vasopressin AUROMEDICS PHARMA 55150-0370-25 VASOPRESSIN 20 UNITS 1 25 1 25
Vasopressin AUROMEDICS PHARMA 55150-0371-25 Vasopressin 20 UNITS 1 25 1 25
Vasopressin AMNEAL BIOSCIENCES 70121-1642-05 VASOPRESSIN 20 UNITS 1 25 1 25
Vasopressin AMNEAL BIOSCIENCES 70121-1642-07 Vasopressin 20 UNITS 1 10 1 10
Vasopressin (American Regent) AMERICAN REGENT 00517-1020-25 Vasopressin 20 UNITS 1 25 1 25
Vasopressin PAR PHARMACEUTICAL, INC 42023-0164-10 VASOSTRICT 20 UNITS 1 10 1 10
Vasopressin PAR PHARMACEUTICAL, INC 42023-0190-01 VASOSTRICT 20 UNITS 10 1 10 10
Vasopressin PAR PHARMACEUTICAL 42023-0219-10 VASOSTRICT 20 UNITS 100 10 2 20
Vasopressin PAR PHARMACEUTICAL 42023-0237-10 VASOSTRICT 20 UNITS 100 10 1 10
Glucarpidase BTG INTERNATIONAL INC. 50633-0210-11 Voraxaze 10 UNITS 1 1 100 100

Outpatient Prospective Payment System

HCPCS Description Labeler name NDC Drug name Dosage Package size Package quantity Billable units Billable units / pkg
A9513 Lutetium Lu 177 dotatat ther ADVANCED ACCELERATOR APPLICATIONS 69488-0003-01 LUTATHERA 1 MCI 20 1 200 200
A9543 Y90 ibritumomab, rx SPECTRUM PHARMACEUTICALS 68152-0103-03 ZEVALIN Y-90 UP TO 40 millicuries 1 1 1 1
A9543 Y90 ibritumomab, rx ACROTECH BIOPHARMA 72893-0007-04 ZEVALIN Y-90 UP TO 40 millicuries 1 1 1 1
A9590 Iodine i-131 therapeutic PROGENICS PHARMACEUTICALS, INC. 71258-0015-22 AZEDRA therapeutic 1 mCi 1 1 1 1
A9591 Fluoroestradiol F 18 ZIONEXA US CORPORATION 72874-0001-01 Cerianna 1 mCi 50 1 6 6
A9592 Copper cu 64 dotatate diag CURIUM US LLC 69945-0064-01 Detectnet 1 mCi 4 1 4 4
A9593 Gallium ga-68 psma-11 ucsf UCSF RADIOPHARMACEUTICAL FACILITY 24275-0525-01 Gallium Ga 68 PSMA (UCSF) 1 mCi 11 1 1 1
A9594 Gallium ga-68 psma-11, ucla UCLA BIOMEDICAL CYCLOTRON 76394-2642-03 Gallium Ga 68 PSMA (UCLA) 1 mCi 12 1 1 1
A9595 Piflu f-18, dia 1 millicurie PROGENICS PHARMACEUTICALS, INC 71258-0022-00 Pylarify 1 millicurie 1 1 9 9
A9596 Gallium illuccix 1 millicure TELIX PHARMACEUTICALS, INC. 74725-0100-25 ILLUCCIX 1 mCi 1 1 1 1
A9596 Gallium illuccix 1 millicure TELIX PHARMACEUTICALS, INC. 74725-0100-64 ILLUCCIX 1 mCi 1 1 1 1
A9600 Sr89 strontium QBIOMED INC 72928-0089-01 Strontium Chloride Sr 89 PER MILLICURIE 4 1 1 4
A9602 Fluorodopa f-18 diag per mci THE FEINSTEIN INSTITUTES FOR MEDICAL RESEARCH 13267-0346-57 Fluorodopa F18 1 mCi 1 1 1 1
A9604 Sm 153 lexidronam LANTHEUS MEDICAL IMAGING, INC. 11994-0016-01 QUADRAMET up to 150 millicuries 3 1 1 1
A9606 Radium Ra223 dichloride ther BAYER HEALTHCARE PHARMACEUTICALS INC. 50419-0208-01 Xofigo 1 mCi 6 1 1 1
A9607 Lutetium lu 177 vipivotide ADVANCED ACCELERATOR APPLICATIONS USA, INC 69488-0010-61 PLUVICTO 1 mCi 1 1 1 1
A9800 Gallium locametz 1 millicuri ADVANCED ACCELERATOR APPLICATIONS USA, INC 69488-0017-61 LOCAMETZ 1 mCi 1 1 1 1
C9047 Injection, caplacizumab-yhdp GENZYME CORPORATION 58468-0225-01 Cablivi 1 MG 1 1 11 11
C9067 Gallium ga-68 Dotatoc UIHC-PET IMAGING CENTER 24417-0681-30 Dotatoc Ga 68 0.01 mCi 14 1 400 400
C9088 Instill, bupivac and meloxic HERON THERAPEUTICS 47426-0301-02 Zynrelef 1 mg - 0.03 mg 14 ML 1 400 400
C9088 Instill, bupivac and meloxic HERON THERAPEUTICS, INC. 47426-0302-02 Zynrelef 1 mg - 0.03 mg 10.5 ML 1 300 300
C9088 Instill, bupivac and meloxic HERON THERAPEUTICS 47426-0303-01 Zynrelef 1 mg - 0.03 mg 7 ML 1 200 200
C9088 Instill, bupivac and meloxic HERON THERAPEUTICS, INC. 47426-0304-01 Zynrelef 1 mg - 0.03 mg 2.3 ML 1 60 60
C9089 Bupivacaine implant, 1 mg INNOCOLL PHARMACEUTICALS LIMITED 51715-0100-04 Xaracoll 1 mg 1 12 100 1200
C9089 Bupivacaine implant, 1 mg INNOCOLL PHARMACEUTICALS LIMITED 51715-0100-10 Xaracoll 1 mg 1 30 100 3000
C9101 Inj, oliceridine 0.1 mg TREVENA, INC. 71308-0011-10 Olinvyk 0.1 MG 1 10 10 100
C9101 Inj, oliceridine 0.1 mg TREVENA, INC. 71308-0021-10 Olinvyk 0.1 MG 2 10 20 200
C9101 Inj, oliceridine 0.1 mg TREVENA, INC. 71308-0301-10 Olinvyk 0.1 MG 30 10 300 3000
C9144 Inj, bupivacaine (posimir) INNOCOLL PHARMACEUTICALS 51715-0660-10 Posimir 1 MG 5 10 660 6600
C9145 Inj, aponvie, 1 mg HERON THERAPEUTICS, INC. 47426-0401-10 APONVIE 1 MG 4.4 10 32 320
C9146 Inj, elahere, 1 mg Immunogen, Inc. 72903-0853-01 ELAHERE 1 MG 20 1 100 100
C9147 Inj, tremelimumab-actl, 1 mg Astrazeneca Pharmaceuticals, Lp 00310-4505-25 IMJUDO 1 MG 1.25 1 25 25
C9147 Inj, tremelimumab-actl, 1 mg Astrazeneca Pharmaceuticals, Lp 00310-4535-30 IMJUDO 1 MG 15 1 300 300
C9148 Inj, teclistamab-cqyv, 0.5mg Janssen Biotech, Inc. 57894-0449-01 TECVAYLI 0.5 MG 3 1 60 60
C9148 Inj, teclistamab-cqyv, 0.5mg Janssen Biotech, Inc. 57894-0450-01 TECVAYLI 0.5 MG 1.7 1 306 306
C9149 Inj, teplizumab-mzwv, 5 mcg Provention Bio, Inc. 73650-0316-01 TZIELD 5 MCG 2 1 400 400
C9149 Inj, teplizumab-mzwv, 5 mcg Provention Bio, Inc. 73650-0316-10 TZIELD 5 MCG 2 10 400 4000
C9149 Inj, teplizumab-mzwv, 5 mcg Provention Bio, Inc. 73650-0316-14 TZIELD 5 MCG 2 14 400 5600
C9248 Inj, clevidipine butyrate CHIESI USA, INC. 10122-0610-10 CLEVIPREX 1 MG 50 10 25 250
C9248 Inj, clevidipine butyrate CHIESI USA, INC. 10122-0611-10 CLEVIPREX 1 MG 100 10 50 500
C9257 Bevacizumab injection GENENTECH, INC. 50242-0060-01 Avastin 0.25 MG 4 1 400 400
C9257 Bevacizumab injection GENENTECH, INC. 50242-0060-10 Avastin 0.25 MG 4 10 400 4000
C9257 Bevacizumab injection GENENTECH, INC. 50242-0061-01 Avastin 0.25 MG 16 1 1600 1600
C9257 Bevacizumab injection GENENTECH, INC. 50242-0061-10 Avastin 0.25 MG 16 10 1600 16000
C9290 Inj, bupivacaine liposome PACIRA PHARMACEUTICALS 65250-0133-04 EXPAREL 1 MG 10 4 133 532
C9290 Inj, bupivacaine liposome PACIRA PHARMACEUTICALS 65250-0133-09 EXPAREL 1 MG 10 10 133 1330
C9290 Inj, bupivacaine liposome PACIRA PHARMACEUTICALS 65250-0266-04 EXPAREL 1 MG 20 4 266 1064
C9290 Inj, bupivacaine liposome PACIRA PHARMACEUTICALS 65250-0266-09 EXPAREL 1 MG 20 10 266 2660
C9460 Injection, cangrelor CHIESI USA, INC. 10122-0620-10 KENGREAL 1 MG 1 10 50 500
C9482 Sotalol hydrochloride IV ALTATHERA PHARMACEUTICALS 69724-0112-10 Sotalol 1MG 10 1 150 150
C9488 Conivaptan HCL CUMBERLAND PHARMACEUTICALS 66220-0160-10 VAPRISOL 1 MG 100 1 20 20
J0135 Adalimumab injection ABBVIE US, LLC 00074-3799-02 Humira 20 MG 0.8 2 2 4
J0135 Adalimumab injection ABBVIE US, LLC 00074-4339-02 Humira 20 MG 0.8 2 2 4
J0135 Adalimumab injection ABBVIE US, LLC 00074-4339-06 Humira 20 MG 0.8 6 2 12
J0135 Adalimumab injection ABBVIE US, LLC 00074-4339-07 Humira 20 MG 0.8 4 2 8
J0208 Inj sodium thiosulfate 100mg FENNEC PHARMACEUTICALS INC. 73077-0010-01 Sodium Thiosulfate 100 MG 100 1 125 125
J0470 Dimecaprol injection AKORN 17478-0526-03 Bal In Oil 100 MG 3 10 3 30
J0570 Buprenorphine implant 74.2mg TITAN PHARMACEUTICALS 52440-0100-14 PROBUPHINE SYSTEM KIT 74.2 MG 1 4 1 4
J0641 Levoleucovorin injection HIKMA PHARMACEUTICALS USA INC. 00143-9558-01 Levoleucovorin Calcium 0.5 MG 1 1 100 100
J0641 Levoleucovorin injection SANDOZ 00781-3201-94 Levoleucovorin Calcium 0.5 MG 17.5 1 350 350
J0641 Levoleucovorin injection NORTHSTAR RX LLC 16714-0890-01 Levoleucovorin Calcium 0.5 MG 17.5 1 350 350
J0641 Levoleucovorin injection NORTHSTAR RX LLC 16714-0915-01 Levoleucovorin Calcium 0.5 MG 25 1 500 500
J0641 Levoleucovorin injection DR. REDDY'S LABORATORIES, INC. 43598-0771-11 Levoleucovorin Calcium 0.5 MG 17.5 1 350 350
J0641 Levoleucovorin injection DR. REDDY'S LABORATORIES, INC. 43598-0773-11 Levoleucovorin Calcium 0.5 MG 25 1 500 500
J0641 Levoleucovorin injection INGENUS PHARMACEUTICALS, LLC 50742-0494-17 Levoleucovorin Calcium 0.5 MG 17.5 1 350 350
J0641 Levoleucovorin injection INGENUS PHARMACEUTICALS, LLC 50742-0495-25 Levoleucovorin Calcium 0.5 MG 25 1 500 500
J0641 Levoleucovorin injection AMNEAL BIOSCIENCES 70121-1099-01 Levoleucovorin Calcium 0.5 MG 1 1 100 100
J0641 Levoleucovorin injection AMNEAL BIOSCIENCES 70121-1572-01 Levoleucovorin Calcium 0.5 MG 17.5 1 350 350
J0641 Levoleucovorin injection FOSUN PHARMA 72266-0120-01 Levoleucovorin Calcium 0.5 MG 17.5 1 350 350
J0699 Inj, cefiderocol, 10 mg SHIONOGI INC 59630-0266-10 Fetroja 10 MG 1 10 100 1000
J0716 Centruroides immune f(ab) RARE DISEASE THERAPEUTICS, INC. 66621-0150-02 ANASCORP UP TO 120MG 1 1 1 1
J0879 Difelikefalin, esrd on dialy Vifor 59353-0065-01 Korsuva 0.1 mcg 1.3 1 65 650
J0879 Difelikefalin, esrd on dialy Vifor 59353-0065-12 Korsuva 0.1 mcg 1.3 1 65 7800
J0884 Argatroban esrd dialysis 1mg NOVARTIS PHARMACEUTICALS CORPORATION 00078-0930-61 Argatroban 1 MG 2.5 1 250 250
J0884 Argatroban esrd dialysis 1mg HIKMA PHARMACEUTICALS USA INC. 00143-9288-01 Argatroban 1 MG 2.5 1 250 250
J0884 Argatroban esrd dialysis 1mg HIKMA PHARMACEUTICALS USA INC. 00143-9377-01 Argatroban 1 MG 50 1 50 50
J0884 Argatroban esrd dialysis 1mg HIKMA PHARMACEUTICALS USA INC. 00143-9559-01 ARGATROBAN 1 MG 50 1 50 50
J0884 Argatroban esrd dialysis 1mg HIKMA PHARMACEUTICALS USA INC. 00143-9674-01 Argatroban 1 MG 2.5 1 250 250
J0884 Argatroban esrd dialysis 1mg PFIZER INC. 00409-1140-01 Argatroban 1 MG 2.5 1 250 250
J0884 Argatroban esrd dialysis 1mg SAGENT PHARMACEUTICALS INC 25021-0414-50 ARGATROBAN 1 MG 50 1 50 50
J0884 Argatroban esrd dialysis 1mg PAR PHARMACEUTICAL, INC 42023-0182-01 Argatroban 1 MG 2.5 1 250 250
J0884 Argatroban esrd dialysis 1mg FRESENIUS KABI 63323-0526-03 Argatroban 1 MG 2.5 1 250 250
J0884 Argatroban esrd dialysis 1mg FRESENIUS KABI 65219-0429-50 ARGATROBAN 1 MG 50 1 50 50
J0884 Argatroban esrd dialysis 1mg MYLAN INSTITUTIONAL LLC 67457-0212-02 Argatroban 1 MG 2.5 1 250 250
J1096 Dexametha opth insert 0.1 mg OCULAR THERAPEUTIX 70382-0204-01 Dextenza 0.1 MG 1 1 4 4
J1096 Dexametha opth insert 0.1 mg OCULAR THERAPEUTIX 70382-0204-10 Dextenza 0.1 MG 1 10 4 40
J1097 Phenylep ketorolac opth soln OMEROS CORPORATION 62225-0600-04 Omidria (phenylephrine 1% + ketorolac 0.3% irrigation) 1 ML 4 4 4 16
J1411 Inj, hemgenix, per tx dose CSL Behring 0053-0100-10 Hemgenix Per Therapeutic Dose 10 10 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring 0053-0110-11 Hemgenix Per Therapeutic Dose 10 11 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring 0053-0120-12 Hemgenix Per Therapeutic Dose 10 12 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring 0053-0130-13 Hemgenix Per Therapeutic Dose 10 13 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring 0053-0140-14 Hemgenix Per Therapeutic Dose 10 14 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring 0053-0150-15 Hemgenix Per Therapeutic Dose 10 15 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring 0053-0160-16 Hemgenix Per Therapeutic Dose 10 16 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring 0053-0170-17 Hemgenix Per Therapeutic Dose 10 17 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring 0053-0180-18 Hemgenix Per Therapeutic Dose 10 18 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring 0053-0190-19 Hemgenix Per Therapeutic Dose 10 19 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring 0053-0200-20 Hemgenix Per Therapeutic Dose 10 20 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring 0053-0210-21 Hemgenix Per Therapeutic Dose 10 21 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring 0053-0220-22 Hemgenix Per Therapeutic Dose 10 22 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring 0053-0230-23 Hemgenix Per Therapeutic Dose 10 23 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring 0053-0240-24 Hemgenix Per Therapeutic Dose 10 24 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring 0053-0250-25 Hemgenix Per Therapeutic Dose 10 25 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring 0053-0260-26 Hemgenix Per Therapeutic Dose 10 26 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring 0053-0270-27 Hemgenix Per Therapeutic Dose 10 27 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring 0053-0280-28 Hemgenix Per Therapeutic Dose 10 28 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring 0053-0290-29 Hemgenix Per Therapeutic Dose 10 29 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring 0053-0300-30 Hemgenix Per Therapeutic Dose 10 30 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring 0053-0310-31 Hemgenix Per Therapeutic Dose 10 31 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring 0053-0320-32 Hemgenix Per Therapeutic Dose 10 32 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring 0053-0330-33 Hemgenix Per Therapeutic Dose 10 33 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring 0053-0340-34 Hemgenix Per Therapeutic Dose 10 34 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring 0053-0350-35 Hemgenix Per Therapeutic Dose 10 35 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring 0053-0360-36 Hemgenix Per Therapeutic Dose 10 36 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring 0053-0370-37 Hemgenix Per Therapeutic Dose 10 37 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring 0053-0380-38 Hemgenix Per Therapeutic Dose 10 38 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring 0053-0390-39 Hemgenix Per Therapeutic Dose 10 39 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring 0053-0400-40 Hemgenix Per Therapeutic Dose 10 40 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring 0053-0410-41 Hemgenix Per Therapeutic Dose 10 41 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring 0053-0420-42 Hemgenix Per Therapeutic Dose 10 42 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring 0053-0430-43 Hemgenix Per Therapeutic Dose 10 43 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring 0053-0440-44 Hemgenix Per Therapeutic Dose 10 44 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring 0053-0450-45 Hemgenix Per Therapeutic Dose 10 45 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring 0053-0460-46 Hemgenix Per Therapeutic Dose 10 46 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring 0053-0470-47 Hemgenix Per Therapeutic Dose 10 47 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring 0053-0480-48 Hemgenix Per Therapeutic Dose 10 48 1 1
J1426 Injection, casimersen, 10 mg SAREPTA 60923-0227-02 Amondys 45 10 MG 2 1 10 10
J1427 Inj. viltolarsen NS PHARMA INC 73292-0011-01 Viltepso 10 MG 5 1 25 25
J1429 Inj golodirsen 10 mg SAREPTA 60923-0465-02 Vyondys 53 10 MG 2 1 10 10
J1438 Etanercept injection AMGEN USA, INC. 58406-0425-34 Enbrel 25 MG 1 4 1 4
J1438 Etanercept injection AMGEN USA, INC. 58406-0445-04 Enbrel 25 MG 1 4 2 8
J1438 Etanercept injection AMGEN USA, INC. 58406-0455-04 Enbrel 25 MG 0.5 4 1 4
J1438 Etanercept injection AMGEN USA, INC. 58406-0435-04 Enbrel (Etanercept) 25 MG 1 4 2 8
J1449 Inj eflapegrastim-xnst 0.1mg Spectrum Pharmaceuticals, Inc. 76961-0101-01 ROLVEDON 0.1 MG 0.6 1 132 132
J1451 Fomepizole, 15 mg AMERICAN REGENT 00517-0710-01 FOMEPIZOLE 15 MG 1.5 1 100 100
J1451 Fomepizole, 15 mg MYLAN INSTITUTIONAL LLC 67457-0211-02 FOMEPIZOLE 15 MG 1.5 1 100 100
J1451 Fomepizole, 15 mg ZYDUS PHARMACEUTICALS 70710-1478-01 Fomepizole 15 MG 1.5 1 100 100
J1455 Foscarnet sodium injection SAGENT PHARMACEUTICALS INC 25021-0189-84 FOSCARNET SODIUM 1000 MG 250 10 6 60
J1455 Foscarnet sodium injection FRESENIUS KABI 63323-0875-50 Foscarnet Sodium 1000 MG 250 1 6 6
J1573 Hepagam b intravenous, inj SAOL THERAPEUTICS 70257-0051-51 Hepagam B 0.5 ML 5 1 10 10
J1573 Hepagam b intravenous, inj SAOL THERAPEUTICS 70257-0052-51 HEPAGAM B 0.5 ML 1 1 2 2
J1573 Hepagam b intravenous, inj SAOL THERAPEUTICS 70257-0053-51 Hepagam B 0.5 ML 1 1 2 2
J1573 Hepagam b intravenous, inj SAOL THERAPEUTICS 70257-0054-51 Hepagam B 0.5 ML 5 1 10 10
J1595 Injection glatiramer acetate TEVA NEUROSCIENCE, INC. 68546-0317-30 Copaxone 20 MG 1 30 1 30
J1595 Injection glatiramer acetate TEVA NEUROSCIENCE, INC. 68546-0325-12 Copaxone 20 MG 1 12 2 24
J1628 Inj., guselkumab, 1 mg JANSSEN BIOTECH, INC. 57894-0640-01 Tremfya 1 MG 1 1 100 100
J1628 Inj., guselkumab, 1 mg JANSSEN BIOTECH, INC. 57894-0640-11 Tremfya 1 MG 1 1 100 100
J1632 Inj, brexanolone SAGE THERAPEUTICS 72152-0547-20 Zulresso 1 MG 20 1 100 100
J1726 Inj, Makena AMERICAN REGENT 00517-1767-01 MAKENA 10 MG 1 1 25 25
J1726 Inj, Makena AMAG PHARMACEUTICALS, INC. 64011-0247-02 MAKENA 10 MG 1 1 25 25
J1726 Inj, Makena AMAG PHARMACEUTICALS, INC. 64011-0301-03 Makena Auto Injector 10 MG 1.1 1 27.5 27.5
J1726 Inj, Makena AMERICAN REGENT 00517-1791-01 Hydroxyprogesterone Caproate 10 MG 1 1 25 25
J1726 Inj, Makena AUROMEDICS PHARMA LLC 55150-0309-01 Hydroxyprogesterone Caproate 10 MG 1 1 25 25
J1726 Inj, Makena AUROMEDICS PHARMA LLC 55150-0310-01 Hydroxyprogesterone Caproate 10 MG 5 1 125 125
J1726 Inj, Makena MYLAN INSTITUTIONAL LLC 67457-0886-05 Hydroxyprogesterone Caproate 10 MG 1 1 125 125
J1726 Inj, Makena MYLAN INSTITUTIONAL LLC 67457-0967-01 Hydroxyprogesterone Caproate 10 MG 1 1 25 25
J1726 Inj, Makena AMNEAL PHARMACEUTICALS, LLC 69238-1797-01 Hydroxyprogesterone Caproate 10 MG 1 1 25 25
J1726 Inj, Makena SLAYBACK PHARMA 71225-0104-01 Hydroxyprogesterone Caproate 10 MG 5 1 125 125
J1726 Inj, Makena SLAYBACK PHARMA 71225-0105-01 Hydroxyprogesterone Caproate 10 MG 1 1 25 25
J1742 Ibutilide fumarate injection MYLAN INSTITUTIONAL LLC 67457-0366-10 IBUTILIDE FUMARATE 1 MG 10 1 1 1
J1742 Ibutilide fumarate injection PFIZER INC. 00009-3794-01 Corvert 1 MG 10 1 1 1
J1742 Ibutilide fumarate injection PFIZER INC. 00009-3794-22 Corvert 1 MG 10 1 1 1
J1744 Icatibant injection LEUCADIA PHARMACEUTICALS 24201-0207-01 ICATIBANT 1 MG 3 1 30 30
J1744 Icatibant injection LEUCADIA PHARMACEUTICALS 24201-0207-03 ICATIBANT 1 MG 3 3 30 90
J1744 Icatibant injection TAKEDA PHARMACEUTICALS AMERICA, INC. 54092-0702-02 ICATIBANT 1 MG 3 1 30 30
J1744 Icatibant injection TAKEDA PHARMACEUTICALS AMERICA, INC. 54092-0702-03 ICATIBANT 1 MG 3 3 30 90
J1744 Icatibant injection FRESENIUS KABI 63323-0574-86 ICATIBANT 1 MG 3 1 30 30
J1744 Icatibant injection FRESENIUS KABI 63323-0574-93 ICATIBANT 1 MG 3 3 30 90
J1744 Icatibant injection CIPLA USA INC. 69097-0664-34 ICATIBANT 1 MG 3 1 30 30
J1744 Icatibant injection CIPLA USA INC. 69097-0664-68 ICATIBANT 1 MG 3 3 30 90
J1833 Inj, isavuconazonium sulfate ASTELLAS PHARMA US INC. 00469-0420-99 CRESEMBA injection 1mg (as sulfate) 1 10 372 3720
J1954 Injection, leuprolide acetate for depot suspension (cipla), 7.5 mg Cipla Usa, Inc. 69097-0909-50 Leuprolide Acetate 7.5 MG 1 1 3 3
J2186 Inj., meropenem, vaborbactam MELINTA THERAPEUTICS, INC. 70842-0120-06 Vabomere (meropenem-vaborbactam) (10 MG/10MG) 20 MG 1 6 100 600
J2265 Minocycline hydrochloride MELINTA THERAPEUTICS, INC. 70842-0160-10 MINOCIN 1 MG 1 10 100 1000
J2326 Injection, nusinersen BIOGEN 64406-0058-01 Spinraza 0.1 MG 5 1 120 120
J2403 Chloroprocaine opht gel, 1mg Harrow Eye, Llc. 82667-0300-01 IHEEZO 1 MG 1 1 800 800
J2403 Chloroprocaine opht gel, 1mg Harrow Eye, Llc. 82667-0300-10 IHEEZO 1 MG 1 10 800 8000
J2502 Inj, pasireotide long acting NOVARTIS PHARMACEUTICALS CORPORATION 00078-0641-81 Signifor LAR 1 MG 1 1 20 20
J2502 Inj, pasireotide long acting NOVARTIS PHARMACEUTICALS CORPORATION 00078-0642-81 Signifor LAR 1 MG 1 1 40 40
J2502 Inj, pasireotide long acting NOVARTIS PHARMACEUTICALS CORPORATION 00078-0643-81 Signifor LAR 1 MG 1 1 60 60
J2502 Inj, pasireotide long acting NOVARTIS PHARMACEUTICALS CORPORATION 00078-0741-81 Signifor LAR 1 MG 1 1 30 30
J2502 Inj, pasireotide long acting NOVARTIS PHARMACEUTICALS CORPORATION 00078-0748-81 Signifor LAR 1 MG 1 1 10 10
J2502 Inj, pasireotide long acting RECORDATI RARE DISEASES 55292-0139-01 Signifor Lar 1 MG 1 1 10 10
J2502 Inj, pasireotide long acting RECORDATI RARE DISEASES 55292-0140-01 Signifor Lar 1 MG 1 1 20 20
J2502 Inj, pasireotide long acting RECORDATI RARE DISEASES 55292-0141-01 Signifor Lar 1 MG 1 1 30 30
J2502 Inj, pasireotide long acting RECORDATI RARE DISEASES 55292-0142-01 Signifor Lar 1 MG 1 1 40 40
J2502 Inj, pasireotide long acting RECORDATI RARE DISEASES 55292-0143-01 Signifor Lar 1 MG 1 1 60 60
J2515 Pentobarbital sodium inj AKORN 17478-0181-20 Pentobarbital 50 MG 20 1 20 20
J2515 Pentobarbital sodium inj AKORN 17478-0181-50 Pentobarbital 50 MG 50 1 50 50
J2515 Pentobarbital sodium inj LEUCADIA PHARMACEUTICALS 24201-0010-20 Pentobarbital 50 MG 20 1 20 20
J2515 Pentobarbital sodium inj LEUCADIA PHARMACEUTICALS 24201-0010-50 Pentobarbital 50 MG 50 1 50 50
J2515 Pentobarbital sodium inj SAGENT PHARMACEUTICALS INC 25021-0676-20 Pentobarbital 50 MG 20 1 20 20
J2515 Pentobarbital sodium inj SAGENT PHARMACEUTICALS INC 25021-0676-50 Pentobarbital 50 MG 50 1 50 50
J2515 Pentobarbital sodium inj OAK 76478-0501-20 Nembutal 50 MG 20 1 20 20
J2515 Pentobarbital sodium inj OAK 76478-0501-50 Nembutal 50 MG 50 1 50 50
J2547 Injection, peramivir BIOCRYST 72769-0181-03 Rapivab 1 MG 20 3 200 600
J2770 Quinupristin/dalfopristin PFIZER INC. 61570-0260-10 Synercid 500 MG 1 10 1 10
J2840 Injection, sebelipase alfa ALEXION PHARMACEUTICALS 25682-0007-01 Kanuma 1 MG 10 1 20 20
J2850 Inj secretin synthetic human CHIRHOCLIN, INC. 67066-0005-01 CHIRHOSTIM 1 MCG 1 1 16 16
J2993 Reteplase injection CHIESI USA, INC. 10122-0141-02 RETAVASE KIT 18.1 MG 1 2 1 2
J2998 Inj plasminogen tvmh 1mg Prometic 70573-0099-01 Ryplazim 1 mg 1 1 68.8 68.8
J2998 Inj plasminogen tvmh 1mg Prometic 70573-0099-02 Ryplazim 1 mg 1 1 68.8 68.8
J3031 Inj., fremanezumab-vfrm 1 mg NUPATHE INC 51759-0202-10 Ajovy 1 MG 1.5 1 225 225
J3031 Inj., fremanezumab-vfrm 1 mg NUPATHE INC 51759-0202-22 Ajovy 1 MG 1.5 3 225 675
J3031 Inj., fremanezumab-vfrm 1 mg NUPATHE INC 51759-0204-10 Ajovy 1 MG 1.5 1 225 225
J3316 Inj., triptorelin xr 3.75 mg ARBOR PHARMACEUTICAL 24338-0150-20 Triptodur 3.75 MG 1 1 6 6
J3398 Inj luxturna 1 billion vec g SPARK THERAPEUTICS, INC. 71394-0415-01 LUXTURNA 1 billion vector genomes 0.5 1 150 150
J3399 Inj onase abepar-xioi treat AVEXIS 71894-0122-03 Zolgensma 1x5.5 mL vial and 2x8.3 mL vial Kit per tx dose (up to 5 x10^15 vg?) 22.1 1 1 1
J3399 Inj onase abepar-xioi treat AVEXIS 71894-0125-04 Zolgensma 1x5.5 mL vial and 3x8.3 mL vial Kit per tx dose (up to 5 x10^15 vg?) 30.4 1 1 1
J3399 Inj onase abepar-xioi treat AVEXIS 71894-0128-05 Zolgensma 1x5.5 mL vial and 4x8.3 mL vial Kit per tx dose (up to 5 x10^15 vg?) 38.7 1 1 1
J3399 Inj onase abepar-xioi treat AVEXIS 71894-0131-06 Zolgensma 1x5.5 mL vial and 5x8.3 mL vial Kit per tx dose (up to 5 x10^15 vg?) 47 1 1 1
J3399 Inj onase abepar-xioi treat AVEXIS 71894-0134-07 Zolgensma 1x5.5 mL vial and 6x8.3 mL vial Kit per tx dose (up to 5 x10^15 vg?) 55.3 1 1 1
J3399 Inj onase abepar-xioi treat AVEXIS 71894-0137-08 Zolgensma 1x5.5 mL vial and 7x8.3 mL vial Kit per tx dose (up to 5 x10^15 vg?) 63.6 1 1 1
J3399 Inj onase abepar-xioi treat AVEXIS 71894-0140-09 Zolgensma 1x5.5 mL vial and 9x8.3 mL vial Kit per tx dose (up to 5 x10^15 vg?) 71.9 1 1 1
J3399 Inj onase abepar-xioi treat AVEXIS 71894-0121-03 Zolgensma 2x5.5 mL vial and 1x8.3 mL vial Kit per tx dose (up to 5 x10^15 vg?) 19.3 1 1 1
J3399 Inj onase abepar-xioi treat AVEXIS 71894-0124-04 Zolgensma 2x5.5 mL vial and 2x8.3 mL vial Kit per tx dose (up to 5 x10^15 vg?) 27.6 1 1 1
J3399 Inj onase abepar-xioi treat AVEXIS 71894-0127-05 Zolgensma 2x5.5 mL vial and 3x8.3 mL vial Kit per tx dose (up to 5 x10^15 vg?) 35.9 1 1 1
J3399 Inj onase abepar-xioi treat AVEXIS 71894-0130-06 Zolgensma 2x5.5 mL vial and 4x8.3 mL vial Kit per tx dose (up to 5 x10^15 vg?) 44.2 1 1 1
J3399 Inj onase abepar-xioi treat AVEXIS 71894-0133-07 Zolgensma 2x5.5 mL vial and 5x8.3 mL vial Kit per tx dose (up to 5 x10^15 vg?) 52.5 1 1 1
J3399 Inj onase abepar-xioi treat AVEXIS 71894-0136-08 Zolgensma 2x5.5 mL vial and 6x8.3 mL vial Kit per tx dose (up to 5 x10^15 vg?) 60.8 1 1 1
J3399 Inj onase abepar-xioi treat AVEXIS 71894-0139-09 Zolgensma 2x5.5 mL vial and 7x8.3 mL vial Kit per tx dose (up to 5 x10^15 vg?) 69.1 1 1 1
J3399 Inj onase abepar-xioi treat AVEXIS 71894-0120-02 Zolgensma 2x8.3 mL vial Kit per tx dose (up to 5 x10^15 vg?) 16.6 1 1 1
J3399 Inj onase abepar-xioi treat AVEXIS 71894-0123-03 Zolgensma 3x8.3 mL vial Kit per tx dose (up to 5 x10^15 vg?) 24.9 1 1 1
J3399 Inj onase abepar-xioi treat AVEXIS 71894-0126-04 Zolgensma 4x8.3 mL vial Kit per tx dose (up to 5 x10^15 vg?) 33.2 1 1 1
J3399 Inj onase abepar-xioi treat AVEXIS 71894-0129-05 Zolgensma 5x8.3 mL vial Kit per tx dose (up to 5 x10^15 vg?) 41.5 1 1 1
J3399 Inj onase abepar-xioi treat AVEXIS 71894-0132-06 Zolgensma 6x8.3 mL vial Kit per tx dose (up to 5 x10^15 vg?) 49.8 1 1 1
J3399 Inj onase abepar-xioi treat AVEXIS 71894-0135-07 Zolgensma 7x8.3 mL vial Kit per tx dose (up to 5 x10^15 vg?) 58.1 1 1 1
J3399 Inj onase abepar-xioi treat AVEXIS 71894-0138-08 Zolgensma 8x8.3 mL vial Kit per tx dose (up to 5 x10^15 vg?) 66.4 1 1 1
J3399 Inj onase abepar-xioi treat AVEXIS 71894-0141-09 Zolgensma 9x8.3 mL vial Kit per tx dose (up to 5 x10^15 vg?) 74.7 1 1 1
J7168 Prothrombin complex kcentra CSL BEHRING LLC 63833-0386-02 Kcentra 1 IU 1 1 1 1
J7168 Prothrombin complex kcentra CSL BEHRING LLC 63833-0387-02 Kcentra 1 IU 1 1 1 1
J7169 Inj andexxa, 10 mg ALEXION PHARMACEUTICALS 69853-0102-01 Andexxa 10 MG 1 4 20 80
J7352 Afamelanotide implant, 1 mg CLINUVEL 73372-0116-01 Scenesse 1 MG 1 1 16 16
J7501 Azathioprine parenteral HIKMA PHARMACEUTICALS USA INC. 00143-9566-01 AZATHIOPRINE INJECTION 100 MG 1 1 1 1
J9019 Erwinaze injection JAZZ PHARMACEUTICALS, INC. 57902-0249-05 ERWINAZE 1,000 IU 1 5 10 50
J9048 Inj, bortezomib freseniuskab FRESENIUS KABI 63323-0721-10 Bortezomib 0.1 MG 1 1 35 35
J9057 Inj., copanlisib, 1 mg BAYER HEALTHCARE PHARMACEUTICALS INC. 50419-0385-01 ALIQOPA 1 MG 1 1 60 60
J9225 Vantas implant ENDO PHARMACEUTICALS VALERA INC. 67979-0500-01 Vantas implant 50 MG 1 1 1 1
J9247 Inj, melphalan flufenami 1mg ONCOPEPTIDES, INC. 73657-0020-01 Pepaxto 1 MG 1 1 20 20
J9318 Inj romidepsin non-lyo 0.1mg SICOR PHARMACEUTICALS, INC. 00703-4004-01 Romidepsin non-lyophilized 0.1 MG 5.5 1 275 275
J9348 Inj. naxitamab-gqgk, 1 mg Y-MABS THERAPEUTICS 73042-0201-01 Danyelza 1 MG 10 1 40 40
J9371 Inj, Vincristine sul lip 1mg SPECTRUM PHARMACEUTICALS 20536-0322-01 Vincristine Sulfate 1 MG 1 1 5 5
J9371 Inj, Vincristine sul lip 1mg ACROTECH BIOPHARMA 72893-0008-03 Vincristine Sulfate 1 MG 1 1 5 5
J9600 Porfimer sodium injection PINNACLE BIOLOGICS, INC. 76128-0155-75 Photofrin 75 MG 1 1 1 1
Q2042 Tisagenlecleucel car-pos t NOVARTIS PHARMACEUTICALS CORPORATION 00078-0958-19 Kymriah (adult dose) up to 600 million CAR-positive viable T cells 1 1 1 1
Q2042 Tisagenlecleucel car-pos t NOVARTIS PHARMACEUTICALS CORPORATION 00078-0846-19 Kymriah (pediatric dose) up to 600 million CAR-positive viable T cells 1 1 1 1
Q2054 lisocabtagene car pos t JUNO THERAPEUTICS, INC. WHOLLY OWNED SUBSIDIARIES OF BRISTOL MYERS SQUIBB 73153-0900-01 Breyanzi Up to 110 million CAR-positive viable T cells, per therapeutic d 1 1 1 1
Q2055 Idecabtagene car pos t CELGENE CORPORATION 59572-0515-01 Abecma UP TO 460 MILLION AUTOLOGOUS ANTI-BCMA CAR-POSITIVE VIABLE T CEL 1 1 1 1
Q2055 Idecabtagene car pos t CELGENE CORPORATION 59572-0515-02 Abecma UP TO 460 MILLION AUTOLOGOUS ANTI-BCMA CAR-POSITIVE VIABLE T CEL 1 1 1 1
Q2055 Idecabtagene car pos t CELGENE CORPORATION 59572-0515-03 Abecma UP TO 460 MILLION AUTOLOGOUS ANTI-BCMA CAR-POSITIVE VIABLE T CEL 1 1 1 1
Q2056 Ciltacabtagene car-pos t Janssen Biotech, Inc. 57894-0111-01 Carvykti up to 100 million autologous b-cell maturation antigen (bcma) di 1 1 1 1
Q2056 Ciltacabtagene car-pos t Janssen Biotech, Inc. 57894-0111-02 Carvykti up to 100 million autologous b-cell maturation antigen (bcma) di 1 1 1 1
Q5128 Inj, cimerli, 0.1 mg Coherus Biosciences, Inc. 70114-0440-01 Cimerli 0.1 MG 0.05 1 3 3
Q5128 Inj, cimerli, 0.1 mg Coherus Biosciences, Inc. 70114-0441-01 Cimerli 0.1 MG 0.05 1 5 5
Q9968 Visualization adjunct MYLAN INSTITUTIONAL LLC 67457-0220-05 ISOSULFAN BLUE INJECTION 1 MG 5 6 50 300
Q9968 Visualization adjunct AMERICAN REGENT 00517-0374-05 Provayblue 1 MG 10 5 50 250

Past NDC - HCPCS Crosswalk