April 2025 NDC - HCPCS Crosswalk

Effective April 1, 2025 through June 30, 2025

Page #10

Average Sales Price

HCPCS Description Labeler name NDC Drug name Dosage Package size Package quantity Billable units Billable units / pkg
J0476 Baclofen intrathecal trial Saol Therapeutics Inc. 70257-0562-55 Lioresal 50 MCG 1 5 1 5
J0480 Basiliximab Novartis Pharmaceuticals Corporation 00078-0331-84 Simulect 20 MG 1 1 1 1
J0480 Basiliximab Novartis Pharmaceuticals Corporation 00078-0393-61 Simulect 20 MG 1 1 0.5 0.5
J0485 Belatacept injection E.R. Squibb & Sons, L.L.C. 00003-0371-13 Nulojix 1 MG 1 1 250 250
J0490 Belimumab injection GlaxoSmithKline LLC 49401-0101-01 Benlysta 10 MG 5 1 12 12
J0490 Belimumab injection GlaxoSmithKline LLC 49401-0102-01 Benlysta 10 MG 20 1 40 40
J0491 Inj anifrolumab-fnia 1mg AstraZeneca Pharmaceuticals LP 00310-3040-00 Saphnelo 1 mg 2 1 300 300
J0500 Dicyclomine injection A-S Medication Solutions 50090-4553-00 Bentyl 20 MG 2 1 1 1
J0500 Dicyclomine injection Allergan, Inc. 58914-0080-52 Bentyl 20 MG 2 5 1 5
J0500 Dicyclomine injection American Regent, Inc. 00517-1980-05 Dicyclomine HCl 20 MG 2 5 1 5
J0500 Dicyclomine injection Hikma Pharmaceuticals USA Inc. 00641-6173-10 Dicyclomine HCl 20 MG 2 10 1 10
J0500 Dicyclomine injection Nexus Pharmaceuticals, LLC 14789-0010-02 Dicyclomine HCl 20 MG 2 5 1 5
J0500 Dicyclomine injection HF Acquisition Co. LLC, DBA HealthFirst 51662-1559-03 Dicyclomine HCl 20 MG 2 5 1 5
J0500 Dicyclomine injection FreseniUS Kabi USA, LLC 63323-0842-02 Dicyclomine HCl 20 MG 2 5 1 5
J0500 Dicyclomine injection Slate Run Pharmaceuticals 70436-0147-81 Dicyclomine HCl 20 MG 2 5 1 5
J0500 Dicyclomine injection Fosun Pharma USA Inc. 72266-0127-05 Dicyclomine HCl 20 MG 2 5 1 5
J0515 Inj benztropine mesylate Hikma Pharmaceuticals USA Inc. 00143-9729-05 Cogentin 1 MG 2 5 2 10
J0515 Inj benztropine mesylate Hikma Pharmaceuticals USA Inc. 00143-9233-05 Benztropine 1 MG 2 5 2 10
J0515 Inj benztropine mesylate FreseniUS Kabi USA, LLC 63323-0970-02 Benztropine 1 MG 2 5 2 10
J0515 Inj benztropine mesylate Zydus Pharmaceuticals (USA) Inc. 68382-0860-10 Benztropine 1 MG 2 5 2 10
J0517 Inj., benralizumab, 1 mg AstraZeneca Pharmaceuticals LP 00310-1730-30 Fasenra 1 MG 1 1 30 30
J0517 Inj., benralizumab, 1 mg ASTRAZENECA PHARMACEUTICALS, LP 00310-1745-01 Fasenra 1 MG 0.5 1 10 10
J0517 Inj., benralizumab, 1 mg AstraZeneca Pharmaceuticals LP 00310-1830-30 Fasenra 1 MG 1 1 30 30
J0558 Peng benzathine/procaine inj Pfizer Inc 60793-0600-10 Bicillin CR 100,000 UNITS 2 10 12 120
J0558 Peng benzathine/procaine inj Pfizer Inc 60793-0601-10 Bicillin CR 100,000 UNITS 2 10 12 120
J0558 Peng benzathine/procaine inj Pfizer Inc 60793-0602-10 Bicillin CR 100,000 UNITS 2 10 12 120
J0561 Penicillin g benzathine inj A-S Medication Solutions 50090-1016-00 Bicillin L-A 100,000 UNITS 2 10 12 120
J0561 Penicillin g benzathine inj A-S Medication Solutions 50090-1016-01 Bicillin L-A 100,000 UNITS 2 1 12 12
J0561 Penicillin g benzathine inj Pfizer Inc 60793-0700-10 Bicillin L-A 100,000 UNITS 1 10 6 60
J0561 Penicillin g benzathine inj Pfizer Inc 60793-0701-10 Bicillin L-A 100,000 UNITS 2 10 12 120
J0561 Penicillin g benzathine inj Pfizer Inc 60793-0702-10 Bicillin L-A 100,000 UNITS 4 10 24 240
J0565 Inj, bezlotoxumab, 10 mg Merck Sharp & Dohme LLC 00006-3025-00 Zinplava 10 MG 40 1 100 100
J0577 Inj, brixadi, 7 days or less Braeburn Inc. 58284-0208-01 Brixadi (weekly dosing) Less than or equal to 7 days of therapy 0.16 1 1 1
J0577 Inj, brixadi, 7 days or less Braeburn Inc. 58284-0216-01 Brixadi (weekly dosing) Less than or equal to 7 days of therapy 0.32 1 1 1
J0577 Inj, brixadi, 7 days or less Braeburn Inc. 58284-0224-01 Brixadi (weekly dosing) Less than or equal to 7 days of therapy 0.48 1 1 1
J0577 Inj, brixadi, 7 days or less Braeburn Inc. 58284-0232-01 Brixadi (weekly dosing) Less than or equal to 7 days of therapy 0.64 1 1 1
J0578 Inj brixadi, more than 7 day Braeburn Inc. 58284-0228-01 Brixadi (monthly dosing) Greater than 7 days and up to 28 days of therapy 0.36 1 1 1
J0578 Inj brixadi, more than 7 day Braeburn Inc. 58284-0264-01 Brixadi (monthly dosing) Greater than 7 days and up to 28 days of therapy 0.18 1 1 1
J0578 Inj brixadi, more than 7 day Braeburn Inc. 58284-0296-01 Brixadi (monthly dosing) Greater than 7 days and up to 28 days of therapy 0.27 1 1 1
J0583 Bivalirudin Sandoz Inc. 00781-3158-95 Bivalirudin 1 MG 1 10 250 2500
J0583 Bivalirudin Sandoz Inc. 00781-9158-95 Bivalirudin 1 MG 1 10 250 2500
J0583 Bivalirudin ACCORD HEALTHCARE INC 16729-0275-67 Bivalirudin 1 MG 1 10 250 2500
J0583 Bivalirudin Dr. Reddy's Laboratories Inc. 55111-0652-37 Bivalirudin 1 MG 1 10 250 2500
J0583 Bivalirudin Eugia US LLC 55150-0210-10 Bivalirudin 1 MG 1 10 250 2500
J0583 Bivalirudin FreseniUS Kabi USA, LLC 63323-0562-10 Bivalirudin 1 MG 1 10 250 2500
J0583 Bivalirudin FreseniUS Kabi USA, LLC 63323-0562-15 Bivalirudin 1 MG 1 10 250 2500
J0583 Bivalirudin Mylan Institutional LLC 67457-0256-10 Bivalirudin 1 MG 1 10 250 2500
J0583 Bivalirudin Slate Run Pharmaceuticals 70436-0025-82 Bivalirudin 1 MG 1 10 250 2500
J0583 Bivalirudin Athenex Pharmaceutical Division, LLC 70860-0402-10 Bivalirudin 1 MG 1 10 250 2500
J0583 Bivalirudin Athenex Pharmaceutical Division, LLC 70860-0403-51 Bivalirudin 1 MG 50 10 250 2500

Average Wholesale Price

HCPCS Description Labeler name NDC Drug name Dosage Package size Package quantity Billable units Billable units / pkg
90656 IIV3 VACC NO PRSV 0.5 ML IM Sanofi Pasteur 49281-0424-50 Fluzone Trivalent (2024/2025) Preservative Free 0.5 ML 0.5 10 1 10
90658 IIV3 VACCINE SPLT 0.5 ML IM Sanofi Pasteur 49281-0641-15 Fluzone Trivalent (2024/2025) 0.5 ML 5 1 10 10
91304 SARSCOV2 VAC 5MCG/0.5ML IM Novavax 80631-0107-10 Novavax COVID-19 Vaccine (2024-2025) Preservative Free 0.5 ML 0.5 10 1 10
91318 SARSCOV2 VAC 3MCG TRS-SUC IM Pfizer 59267-4426-02 Pfizer-BioNTech COVID-19 Vaccine mRNA (2024-2025) 0.3 ML 1 10 3 30
91319 SARSCV2 VAC 10MCG TRS-SUC IM Pfizer 59267-4438-02 Pfizer-BioNTech COVID-19 Vaccine mRNA (2024-2025) Preservative Free 0.3 ML 0.3 10 1 10
91321 SARSCOV2 VAC 25 MCG/.25ML IM Moderna 80777-0291-80 Moderna COVID-19 Vaccine (2024-2025) Preservative Free 0.25 ML 0.25 10 1 10
91321 SARSCOV2 VAC 25 MCG/.25ML IM Moderna 80777-0291-81 Moderna COVID-19 Vaccine (2024-2025) Preservative Free 0.25 ML 0.25 10 1 10
91322 SARSCOV2 VAC 50 MCG/0.5ML IM Moderna 80777-0110-96 SPIKEVAX (2024-2025) Preservative Free 0.5 ML 0.5 10 1 10
91322 SARSCOV2 VAC 50 MCG/0.5ML IM Moderna 80777-0110-93 SPIKEVAX (2024-2025) Preservative Free 0.5 ML 0.5 10 1 10
P9041 Albumin (human),5%, 50ml Grifols 68516-5214-05 Albutein 5% 50 ML 50 1 1 1
P9041 Albumin (human),5%, 50ml Octapharma USA 68982-0623-01 Albumin (Human) 50 ML 100 1 2 2
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 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 68516-5214-02 Albutein® 5% Albumin 500 ml 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 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
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
P9046 Albumin (human), 25%, 20 ml Grifols 68516-5216-05 Albutein 25% 20 ML 20 1 1 1
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 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 Takeda Pharmaceuticals America, Inc. 00944-0493-03 Flexbumin 50 ML 50 1 1 1
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 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 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 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 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
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
Q0224 Pemivibart injection Invivyd, Inc 81960-0031-03 Pemgarda 4500 MG 1 1 1 1
Q0249 Tocilizumab for covid-19 Genentech, Inc 50242-0135-01 Actemra IV 1 MG 4 1 80 80
Q0249 Tocilizumab for covid-19 Genentech, Inc 50242-0136-01 Actemra IV 1 MG 10 1 200 200
Q0249 Tocilizumab for covid-19 Genentech, Inc 50242-0137-01 Actemra IV 1 MG 20 1 400 400

Not Otherwise Classified

Description Labeler name NDC Drug name Dosage Package size Package quantity Billable units Billable units / pkg
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 SAGENT PHARMACEUTICAL 25021-0319-05 Diltiazem HCl 5 MG 5 10 5 50
Diltiazem Hydrochloride SAGENT PHARMACEUTICAL 25021-0319-10 Diltiazem HCl 5 MG 10 10 10 100
Diltiazem Hydrochloride HF Acquisition Co. LLC, DBA HealthFirst 51662-1335-01 Diltiazem HCl 5 MG 5 1 5 5
Diltiazem Hydrochloride HF Acquisition Co. LLC, DBA HealthFirst 51662-1335-02 Diltiazem HCl 5 MG 5 1 5 5
Diltiazem Hydrochloride HF Acquisition Co. LLC, DBA HealthFirst 51662-1457-01 Diltiazem HCl 5 MG 1 1 20 20
Diltiazem Hydrochloride HF Acquisition Co. LLC, DBA HealthFirst 51662-1457-03 Diltiazem HCl 5 MG 1 10 20 200
Diltiazem Hydrochloride Eugia US LLC 55150-0425-10 Diltiazem HCl 5 MG 5 10 5 50
Diltiazem Hydrochloride Eugia US LLC 55150-0426-10 Diltiazem HCl 5 MG 10 10 10 100
Diltiazem Hydrochloride Eugia US LLC 55150-0427-10 Diltiazem HCl 5 MG 25 10 25 250
Diltiazem Hydrochloride Athenex Pharmaceutical Division, LLC 70860-0301-05 Diltiazem HCl 5 MG 5 10 5 50
Diltiazem Hydrochloride Athenex Pharmaceutical Division, LLC 70860-0301-10 Diltiazem HCl 5 MG 10 10 10 100
Diltiazem Hydrochloride Athenex Pharmaceutical Division, LLC 70860-0301-25 Diltiazem HCl 5 MG 25 10 25 250
Diltiazem Hydrochloride Hikma Injectables USA Inc. 63037-0119-05 Diltiazem in Dextrose 5 MG 125 5 25 125
Diltiazem Hydrochloride Hikma Injectables USA Inc. 63037-0117-05 Diltiazem in Sodium Chloride 5 MG 125 5 25 125
Metoprolol Tartrate Hikma Pharmaceuticals USA Inc. 00143-9660-10 Metoprolol Tartrate 1 MG 5 10 5 50
Metoprolol Tartrate Hikma Pharmaceuticals USA Inc. 00143-9873-25 Metoprolol Tartrate 1 MG 5 25 5 125
Metoprolol Tartrate Pfizer Inc 00409-1778-05 Metoprolol Tartrate 1 MG 5 10 5 50
Metoprolol Tartrate Pfizer Inc 00409-2016-10 Metoprolol Tartrate 1 MG 5 10 5 50
Metoprolol Tartrate Sagent Pharmaceuticals 25021-0303-05 Metoprolol Tartrate 1 MG 5 10 5 50
Metoprolol Tartrate Baxter Healthcare Corporation 36000-0033-10 Metoprolol Tartrate 1 MG 5 10 5 50
Metoprolol Tartrate HF Acquisition Co. LLC, DBA HealthFirst 51662-1365-01 Metoprolol Tartrate 1 MG 5 1 5 5
Metoprolol Tartrate HF Acquisition Co. LLC, DBA HealthFirst 51662-1478-01 Metoprolol Tartrate 1 MG 5 1 5 5
Metoprolol Tartrate HF Acquisition Co. LLC, DBA HealthFirst 51662-1478-03 Metoprolol Tartrate 1 MG 5 10 5 50
Metoprolol Tartrate FreseniUS Kabi USA, LLC 63323-0660-05 Metoprolol Tartrate 1 MG 5 10 5 50
Metoprolol Tartrate Fosun Pharma USA Inc. 72266-0122-05 Metoprolol Tartrate 1 MG 5 5 5 25
Metoprolol Tartrate Fosun Pharma USA Inc. 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 Alvogen, Inc. 72611-0740-10 Metoprolol Tartrate 1 MG 5 10 5 50
Vasopressin (Long Grove) LONG GROVE PHARMACEUTICALS, LLC 81298-8552-03 Vasopressin 1 UNIT 100 10 20 200
Vasopressin (Long Grove) LONG GROVE PHARMACEUTICALS, LLC 81298-8554-03 Vasopressin 1 UNIT 100 10 40 400

Outpatient Prospective Payment System

HCPCS Description Labeler name NDC Drug name Dosage Package size Package quantity Billable units Billable units / pkg
A9506 Tc-99m graphite crucible CYCLOMEDICA AUSTRALIA PTY LIMITED 73814-0986-20 Technegas EACH 1 50 50 50
A9513 Lutetium Lu 177 dotatat ther Advanced Accelerator Applications USA, Inc. 69488-0003-01 Lutathera 1 MCI 20 1 200 200
A9521 Tc99m exametazime Jubilant Draximage Inc., dba Jubilant Radiopharma 65174-0200-05 Technetium TC-99M Exametazime PER STUDY DOSE, UP TO 25 MILLICURIES 1 1 1 1
A9543 Y90 ibritumomab, rx Acrotech Biopharma LLC 72893-0007-04 Zevalin Y-91 UP TO 40 millicuries 1 1 1 1
A9582 Iodine I-123 iobenguane GE Healthcare Inc. 17156-0235-01 Adreview up to 15 millicuries 5 1 1 1
A9584 Iodine I-123 ioflupane GE Healthcare Inc. 17156-0210-01 Datscan per study dose, up to 5 millicuries 2.5 1 1 1
A9587 Gallium Ga-68 Advanced Accelerator Applications USA, Inc. 69488-0001-40 Netspot 0.1 mCi 1 1 1 1
A9588 Fluciclovine F-18 Blue Earth Diagnostics Limited 69932-0001-01 Axumin 1mCi 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 MALLINCKRODT NuCLEAR MEDICINE 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 1 mCi 11 1 1 1
A9594 Gallium ga-68 psma-11, ucla UCLA Biomedical Cyclotron 76394-2642-03 Gallium Ga 68 PSMA 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 US Inc. 74725-0100-25 Illuccix 1 mCi 1 1 1 1
A9596 Gallium illuccix 1 millicure Telix Pharmaceuticals US Inc. 74725-0100-64 Illuccix 1 mCi 1 1 1 1
A9600 Sr89 strontium Q Biomed Inc 72928-0089-01 Strontium Chloride Sr 89 PER MILLICURIE 4 1 1 4
A9601 Flortaucipir inj 1 millicuri ELI LILLY AND COMPANY 00002-1220-01 Tauvid 1 MCI 1 1 1 1
A9602 Fluorodopa f-18 diag per mci THE FEINSTEIN INSTITuTE FOR MEDICAL RESEARCH 13267-0346-57 Fluorodopa F18 1 mCi 1 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
A9608 Flotufolastat f18 diag 1 mci Blue Earth Diagnostics Limited 69932-0002-01 Posluma 1 mCi 1 1 1 8
A9608 Flotufolastat f18 diag 1 mci BLUE EARTH DIAGNOSTICS 69932-0002-50 Posluma 1 MILLICURIE 25 1 1 1
A9611 Flurpiridaz f18, diag, 1 mci GE Healthcare 00407-8787-01 Flyrcado 1 MCI 1 1 1 1
A9615 Inj, pegulicianine, 1 mg Lumicell Inc. 82292-0040-10 Lumisight 1 MG 1 10 39 390
A9697 Inj, magtrace per study dose Endomagnetics Inc. 60391-021024 Magtrace PER STUDY DOSE 2 10 1 10
A9800 Gallium locametz 1 millicuri Advanced Accelerator Applications USA, Inc. 69488-0017-61 Locametz 1 mCi 1 1 1 1
C9088 Instill, bupivac and meloxic Heron Therapeutics 47426-0301-02 Zynrelef 1 mg - 0.03 mg 14 1 400 400
C9088 Instill, bupivac and meloxic Heron Therapeutics 47426-0303-01 Zynrelef 1 mg - 0.03 mg 7 1 200 200
C9088 Instill, bupivac and meloxic HERON THERAPEUTICS, INC. 47426-0501-02 Zynrelef 1 mg - 0.03 mg 14 1 400 400
C9089 Bupivacaine implant, 1 mg Innocoll Pharmaceuticals 51715-0100-04 Xaracoll 1 mg 1 12 100 1200
C9089 Bupivacaine implant, 1 mg Innocoll Pharmaceuticals 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 47426-0401-10 Aponvie 1 MG 4.4 10 32 320
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
C9250 Artiss fibrin sealant Baxter Healthcare Corporation 00338-9637-01 Artiss 2 ML 2 1 1 1
C9250 Artiss fibrin sealant Baxter Healthcare Corporation 00338-9639-01 Artiss 2 ML 4 1 2 2
C9250 Artiss fibrin sealant Baxter Healthcare Corporation 00338-9641-01 Artiss 2 ML 10 1 5 5
C9257 Bevacizumab injection Genentech, Inc. 50242-0060-01 Avastin 0.25 MG 4 1 400 400
C9257 Bevacizumab injection Genentech, Inc. 50242-0061-01 Avastin 0.25 MG 16 1 1600 1600
C9300 Indigotindisulfonate, 1 mg APOLLO PHARMACEUTICALS 81284-0315-05 Bludigo 1 MG 5 5 40 200
C9301 Obecabtagene car pos t Autolus Inc. 83047-0410-04 Aucatzyl Per therapeutic dose 1 1 1 1
C9302 Inj zanidatamab, 2 mg Jazz Pharmaceuticals, Inc. 68727-0950-02 Ziihera 2 MG 1 2 150 300
C9303 Inj zolbetuximab, 1 mg Astellas Pharma US, Inc. 00469-3425-10 Vyloy 1 MG 1 1 100 100
C9304 Inj marstacimab, 0.5 mg Pfizer Inc. 00069-2151-01 Hympavzi 0.5 MG 1 1 300 300
C9460 Injection, cangrelor Chiesi USA, Inc. 10122-0620-10 Kengreal 1 MG 1 10 50 500
C9482 Sotalol hydrochloride IV ALTATHERA Pharmaceuticals, LLC 69724-0112-10 Sotalol 1MG 10 1 150 150
J0139 Inj, adalimumab, 1 mg ABBVIE US, LLC 00074-3799-02 Humira 1 MG 0.8 2 40 80
J0139 Inj, adalimumab, 1 mg ABBVIE US, LLC 00074-4339-02 Humira 1 MG 0.8 2 40 80
J0139 Inj, adalimumab, 1 mg ABBVIE US, LLC 00074-4339-06 Humira 1 MG 0.8 6 40 240
J0139 Inj, adalimumab, 1 mg ABBVIE US, LLC 00074-4339-07 Humira 1 MG 0.8 4 40 160
J0184 Inj, amisulpride, 1 mg Acacia Pharma Ltd 71390-0125-20 Barhemsys 1 MG 2 10 5 50
J0184 Inj, amisulpride, 1 mg ACACIA PHARMA, INC. 71390-0125-50 Barhemsys 1 MG 4 10 10 100
J0208 Inj, pedmark, 100 mg Fennec Pharmaceuticals, Inc. 73077-0010-01 Sodium Thiosulfate 100 MG 100 1 125 125
J0211 Inj, nithiodote, 3mg / 125mg HOPE PHARMACEUTICALS 60267-0812-00 Nithiodote 3 MG AND 125 MG 10 ML 1 EA AND 50 ML 1 EA 1 100 100
J0391 Inj, artesunate, 1mg Amivas, Inc 73607-0011-11 Artesunate 1 MG 1 2 110 220
J0630 Calcitonin salmon injection Hikma Pharmaceuticals USA Inc. 24201-0400-02 Calcitonin Salmon 400 UNITS 2 1 1 1
J0630 Calcitonin salmon injection Endo USA 42023-0205-01 Calcitonin Salmon 400 UNITS 2 1 1 1
J0630 Calcitonin salmon injection DR REDDY'S LABORATORIES, INC. 43598-0051-11 Calcitonin Salmon 400 UNITS 2 1 1 1
J0630 Calcitonin salmon injection CIPLA USA, INC. 69097-0770-32 Calcitonin-Salmon 400 UNITS 2 1 1 1
J0630 Calcitonin salmon injection Mylan Institutional LLC 67457-0675-02 Miacalcin 400 UNITS 2 1 1 1
J0630 Calcitonin salmon injection Mylan Institutional LLC 72078-0038-02 Miacalcin 400 UNITS 2 1 1 1
J0630 Calcitonin salmon injection Mylan Institutional LLC 72078-0039-02 Miacalcin 400 units 2 1 1 1
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 (INTERNATIONAL) LTD. 59353-0065-01 Korsuva 0.1 mcg 1.3 1 65 650
J0879 Difelikefalin, esrd on dialy Vifor (International) Inc. 59353-0065-12 Korsuva 0.1 mcg 1.3 1 65 7800
J0891 Argatroban nonesrd (accord) ACCORD HEALTHCARE INC 16729-0430-43 Argatroban 1 MG 50 10 50 500
J0911 Inst tauro 1.35mg/hep 100u CORMEDIX INC. 72990-0103-10 Defencath taurolidine 1.35 mg and heparin sodium 100 units 3 10 30 300
J0911 Inst tauro 1.35mg/hep 100u CORMEDIX INC. 72990-0105-10 Defencath taurolidine 1.35 mg and heparin sodium 100 units 5 10 50 500
J1072 Inj, testosterone, azmiro Azurity Pharmaceuticals Inc. 24338-0055-01 Azmiro 1 MG 1 1 200 200
J1072 Inj, testosterone, azmiro Azurity Pharmaceuticals Inc. 24338-0056-01 Azmiro 1 MG 1 1 200 200
J1097 Phenylep ketorolac opth soln Omeros Corporation 62225-0600-04 Omidria 1 ML 4 4 4 16
J1097 Phenylep ketorolac opth soln Rayner Surgical Inc. 82604-0600-04 Omidria 1 ML 4 4 4 16
J1105 Dexmedetomidine film, 1 mcg BioXcel Therapeutics, Inc. 81092-1120-01 Igalmi 1 MCG 10 1 1200 1200
J1105 Dexmedetomidine film, 1 mcg BioXcel Therapeutics, Inc. 81092-1180-01 Igalmi 1 MCG 10 1 1800 1800
J1307 Inj, crovalimab-akkz, 10 mg Genentech Inc 50242-0115-01 Piasky 10 MG 2 1 34 34
J1411 Inj, hemgenix, per tx dose CSL BEHRING LLC 00053-0100-10 Hemgenix Per Therapeutic Dose 10 10 1 1
J1411 Inj, hemgenix, per tx dose CSL BEHRING LLC 00053-0110-11 Hemgenix Per Therapeutic Dose 10 11 1 1
J1411 Inj, hemgenix, per tx dose CSL BEHRING LLC 00053-0120-12 Hemgenix Per Therapeutic Dose 10 12 1 1
J1411 Inj, hemgenix, per tx dose CSL BEHRING LLC 00053-0130-13 Hemgenix Per Therapeutic Dose 10 13 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring L.L.C. 00053-0140-14 Hemgenix Per Therapeutic Dose 10 14 1 1
J1411 Inj, hemgenix, per tx dose CSL BEHRING LLC 00053-0150-15 Hemgenix Per Therapeutic Dose 10 15 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring L.L.C. 00053-0160-16 Hemgenix Per Therapeutic Dose 10 16 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring L.L.C. 00053-0170-17 Hemgenix Per Therapeutic Dose 10 17 1 1
J1411 Inj, hemgenix, per tx dose CSL BEHRING LLC 00053-0180-18 Hemgenix Per Therapeutic Dose 10 18 1 1
J1411 Inj, hemgenix, per tx dose CSL BEHRING LLC 00053-0190-19 Hemgenix Per Therapeutic Dose 10 19 1 1
J1411 Inj, hemgenix, per tx dose CSL BEHRING LLC 00053-0200-20 Hemgenix Per Therapeutic Dose 10 20 1 1
J1411 Inj, hemgenix, per tx dose CSL BEHRING LLC 00053-0210-21 Hemgenix Per Therapeutic Dose 10 21 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring L.L.C. 00053-0220-22 Hemgenix Per Therapeutic Dose 10 22 1 1
J1411 Inj, hemgenix, per tx dose CSL BEHRING LLC 00053-0230-23 Hemgenix Per Therapeutic Dose 10 23 1 1
J1411 Inj, hemgenix, per tx dose CSL BEHRING LLC 00053-0240-24 Hemgenix Per Therapeutic Dose 10 24 1 1
J1411 Inj, hemgenix, per tx dose CSL BEHRING LLC 00053-0250-25 Hemgenix Per Therapeutic Dose 10 25 1 1
J1411 Inj, hemgenix, per tx dose CSL BEHRING LLC 00053-0260-26 Hemgenix Per Therapeutic Dose 10 26 1 1
J1411 Inj, hemgenix, per tx dose CSL BEHRING LLC 00053-0270-27 Hemgenix Per Therapeutic Dose 10 27 1 1
J1411 Inj, hemgenix, per tx dose CSL BEHRING LLC 00053-0280-28 Hemgenix Per Therapeutic Dose 10 28 1 1
J1411 Inj, hemgenix, per tx dose CSL BEHRING LLC 00053-0290-29 Hemgenix Per Therapeutic Dose 10 29 1 1
J1411 Inj, hemgenix, per tx dose CSL BEHRING LLC 00053-0300-30 Hemgenix Per Therapeutic Dose 10 30 1 1
J1411 Inj, hemgenix, per tx dose CSL BEHRING LLC 00053-0310-31 Hemgenix Per Therapeutic Dose 10 31 1 1
J1411 Inj, hemgenix, per tx dose CSL BEHRING LLC 00053-0320-32 Hemgenix Per Therapeutic Dose 10 32 1 1
J1411 Inj, hemgenix, per tx dose CSL BEHRING LLC 00053-0330-33 Hemgenix Per Therapeutic Dose 10 33 1 1
J1411 Inj, hemgenix, per tx dose CSL BEHRING LLC 00053-0340-34 Hemgenix Per Therapeutic Dose 10 34 1 1
J1411 Inj, hemgenix, per tx dose CSL BEHRING LLC 00053-0350-35 Hemgenix Per Therapeutic Dose 10 35 1 1
J1411 Inj, hemgenix, per tx dose CSL BEHRING LLC 00053-0360-36 Hemgenix Per Therapeutic Dose 10 36 1 1
J1411 Inj, hemgenix, per tx dose CSL BEHRING LLC 00053-0370-37 Hemgenix Per Therapeutic Dose 10 37 1 1
J1411 Inj, hemgenix, per tx dose CSL BEHRING LLC 00053-0380-38 Hemgenix Per Therapeutic Dose 10 38 1 1
J1411 Inj, hemgenix, per tx dose CSL BEHRING LLC 00053-0390-39 Hemgenix Per Therapeutic Dose 10 39 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring L.L.C. 00053-0400-40 Hemgenix Per Therapeutic Dose 10 40 1 1
J1411 Inj, hemgenix, per tx dose CSL BEHRING LLC 00053-0410-41 Hemgenix Per Therapeutic Dose 10 41 1 1
J1411 Inj, hemgenix, per tx dose CSL BEHRING LLC 00053-0420-42 Hemgenix Per Therapeutic Dose 10 42 1 1
J1411 Inj, hemgenix, per tx dose CSL BEHRING LLC 00053-0430-43 Hemgenix Per Therapeutic Dose 10 43 1 1
J1411 Inj, hemgenix, per tx dose CSL BEHRING LLC 00053-0440-44 Hemgenix Per Therapeutic Dose 10 44 1 1
J1411 Inj, hemgenix, per tx dose CSL BEHRING LLC 00053-0450-45 Hemgenix Per Therapeutic Dose 10 45 1 1
J1411 Inj, hemgenix, per tx dose CSL BEHRING LLC 00053-0460-46 Hemgenix Per Therapeutic Dose 10 46 1 1
J1411 Inj, hemgenix, per tx dose CSL BEHRING LLC 00053-0470-47 Hemgenix Per Therapeutic Dose 10 47 1 1
J1411 Inj, hemgenix, per tx dose CSL BEHRING LLC 00053-0480-48 Hemgenix Per Therapeutic Dose 10 48 1 1
J1412 Inj roctavian ml 2x10^13vc g BioMarin Pharmaceutical Inc. 68135-0927-48 Roctavian 1 ML 8 1 8 8
J1413 Inj delandistrogene mox rokl SAREPTA 60923-0501-10 Elevidys PER THERAPEUTIC DOSE 1 10 1 1
J1413 Inj delandistrogene mox rokl SAREPTA 60923-0502-11 Elevidys PER THERAPEUTIC DOSE 1 11 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0503-12 Elevidys PER THERAPEUTIC DOSE 1 12 1 1
J1413 Inj delandistrogene mox rokl SAREPTA 60923-0504-13 Elevidys PER THERAPEUTIC DOSE 1 13 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0505-14 Elevidys PER THERAPEUTIC DOSE 1 14 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0506-15 Elevidys PER THERAPEUTIC DOSE 1 15 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0507-16 Elevidys PER THERAPEUTIC DOSE 1 16 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0508-17 Elevidys PER THERAPEUTIC DOSE 1 17 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0509-18 Elevidys PER THERAPEUTIC DOSE 1 18 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0510-19 Elevidys PER THERAPEUTIC DOSE 1 19 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0511-20 Elevidys PER THERAPEUTIC DOSE 1 20 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0512-21 Elevidys PER THERAPEUTIC DOSE 1 21 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0513-22 Elevidys PER THERAPEUTIC DOSE 1 22 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0514-23 Elevidys PER THERAPEUTIC DOSE 1 23 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0515-24 Elevidys PER THERAPEUTIC DOSE 1 24 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0516-25 Elevidys PER THERAPEUTIC DOSE 1 25 1 1
J1413 Inj delandistrogene mox rokl SAREPTA 60923-0517-26 Elevidys PER THERAPEUTIC DOSE 1 26 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0518-27 Elevidys PER THERAPEUTIC DOSE 1 27 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0519-28 Elevidys PER THERAPEUTIC DOSE 1 28 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0520-29 Elevidys PER THERAPEUTIC DOSE 1 29 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0521-30 Elevidys PER THERAPEUTIC DOSE 1 30 1 1
J1413 Inj delandistrogene mox rokl SAREPTA 60923-0522-31 Elevidys PER THERAPEUTIC DOSE 1 31 1 1
J1413 Inj delandistrogene mox rokl SAREPTA 60923-0523-32 Elevidys PER THERAPEUTIC DOSE 1 32 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0524-33 Elevidys PER THERAPEUTIC DOSE 1 33 1 1
J1413 Inj delandistrogene mox rokl SAREPTA 60923-0525-34 Elevidys PER THERAPEUTIC DOSE 1 34 1 1
J1413 Inj delandistrogene mox rokl SAREPTA 60923-0526-35 Elevidys PER THERAPEUTIC DOSE 1 35 1 1
J1413 Inj delandistrogene mox rokl SAREPTA 60923-0527-36 Elevidys PER THERAPEUTIC DOSE 1 36 1 1
J1413 Inj delandistrogene mox rokl SAREPTA 60923-0528-37 Elevidys PER THERAPEUTIC DOSE 1 37 1 1
J1413 Inj delandistrogene mox rokl SAREPTA 60923-0529-38 Elevidys PER THERAPEUTIC DOSE 1 38 1 1
J1413 Inj delandistrogene mox rokl SAREPTA 60923-0530-39 Elevidys PER THERAPEUTIC DOSE 1 39 1 1
J1413 Inj delandistrogene mox rokl SAREPTA 60923-0531-40 Elevidys PER THERAPEUTIC DOSE 1 40 1 1
J1413 Inj delandistrogene mox rokl SAREPTA 60923-0532-41 Elevidys PER THERAPEUTIC DOSE 1 41 1 1
J1413 Inj delandistrogene mox rokl SAREPTA 60923-0533-42 Elevidys PER THERAPEUTIC DOSE 1 42 1 1
J1413 Inj delandistrogene mox rokl SAREPTA 60923-0534-43 Elevidys PER THERAPEUTIC DOSE 1 43 1 1
J1413 Inj delandistrogene mox rokl SAREPTA 60923-0535-44 Elevidys PER THERAPEUTIC DOSE 1 44 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0536-45 Elevidys PER THERAPEUTIC DOSE 1 45 1 1
J1413 Inj delandistrogene mox rokl SAREPTA 60923-0537-46 Elevidys PER THERAPEUTIC DOSE 1 46 1 1
J1413 Inj delandistrogene mox rokl SAREPTA 60923-0538-47 Elevidys PER THERAPEUTIC DOSE 1 47 1 1
J1413 Inj delandistrogene mox rokl SAREPTA 60923-0539-48 Elevidys PER THERAPEUTIC DOSE 1 48 1 1
J1413 Inj delandistrogene mox rokl SAREPTA 60923-0540-49 Elevidys PER THERAPEUTIC DOSE 1 49 1 1
J1413 Inj delandistrogene mox rokl SAREPTA 60923-0541-50 Elevidys PER THERAPEUTIC DOSE 1 50 1 1
J1413 Inj delandistrogene mox rokl SAREPTA 60923-0542-51 Elevidys PER THERAPEUTIC DOSE 1 51 1 1
J1413 Inj delandistrogene mox rokl SAREPTA 60923-0543-52 Elevidys PER THERAPEUTIC DOSE 1 52 1 1
J1413 Inj delandistrogene mox rokl SAREPTA 60923-0544-53 Elevidys PER THERAPEUTIC DOSE 1 53 1 1
J1413 Inj delandistrogene mox rokl SAREPTA 60923-0545-54 Elevidys PER THERAPEUTIC DOSE 1 54 1 1
J1413 Inj delandistrogene mox rokl SAREPTA 60923-0546-55 Elevidys PER THERAPEUTIC DOSE 1 55 1 1
J1413 Inj delandistrogene mox rokl SAREPTA 60923-0547-56 Elevidys PER THERAPEUTIC DOSE 1 56 1 1
J1413 Inj delandistrogene mox rokl SAREPTA 60923-0548-57 Elevidys PER THERAPEUTIC DOSE 1 57 1 1
J1413 Inj delandistrogene mox rokl SAREPTA 60923-0549-58 Elevidys PER THERAPEUTIC DOSE 1 58 1 1
J1413 Inj delandistrogene mox rokl SAREPTA 60923-0550-59 Elevidys PER THERAPEUTIC DOSE 1 59 1 1
J1413 Inj delandistrogene mox rokl SAREPTA 60923-0551-60 Elevidys PER THERAPEUTIC DOSE 1 60 1 1
J1413 Inj delandistrogene mox rokl SAREPTA 60923-0552-61 Elevidys PER THERAPEUTIC DOSE 1 61 1 1
J1413 Inj delandistrogene mox rokl SAREPTA 60923-0553-62 Elevidys PER THERAPEUTIC DOSE 1 62 1 1
J1413 Inj delandistrogene mox rokl SAREPTA 60923-0554-63 Elevidys PER THERAPEUTIC DOSE 1 63 1 1
J1413 Inj delandistrogene mox rokl SAREPTA 60923-0555-64 Elevidys PER THERAPEUTIC DOSE 1 64 1 1
J1413 Inj delandistrogene mox rokl SAREPTA 60923-0556-65 Elevidys PER THERAPEUTIC DOSE 1 65 1 1
J1413 Inj delandistrogene mox rokl SAREPTA 60923-0557-66 Elevidys PER THERAPEUTIC DOSE 1 66 1 1
J1413 Inj delandistrogene mox rokl SAREPTA 60923-0558-67 Elevidys PER THERAPEUTIC DOSE 1 67 1 1
J1413 Inj delandistrogene mox rokl SAREPTA 60923-0559-68 Elevidys PER THERAPEUTIC DOSE 1 68 1 1
J1413 Inj delandistrogene mox rokl SAREPTA 60923-0560-69 Elevidys PER THERAPEUTIC DOSE 1 69 1 1
J1413 Inj delandistrogene mox rokl SAREPTA 60923-0561-70 Elevidys PER THERAPEUTIC DOSE 1 70 1 1
J1414 Inj, beqvez, per tx dose Pfizer 00069-2004-04 Beqvez PER THERAPEUTIC DOSE 1 4 1 1
J1414 Inj, beqvez, per tx dose Pfizer 00069-2005-05 Beqvez PER THERAPEUTIC DOSE 1 5 1 1
J1414 Inj, beqvez, per tx dose Pfizer 00069-2006-06 Beqvez PER THERAPEUTIC DOSE 1 6 1 1
J1414 Inj, beqvez, per tx dose Pfizer 00069-2007-07 Beqvez PER THERAPEUTIC DOSE 1 7 1 1
J1438 Etanercept injection AMGEN USA, INC. 58406-0425-34 Enbrel 25 MG 1 4 1 4
J1438 Etanercept injection AMGEN USA, INC. 58406-0435-04 Enbrel 25 MG 1 4 2 8
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
J1451 Fomepizole, 15 mg American Regent, Inc. 00517-0710-01 Fomepizole 15 MG 1.5 1 100 100
J1451 Fomepizole, 15 mg Sagent Pharmaceuticals 25021-0829-02 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 (USA) Inc. 70710-1478-01 Fomepizole 15 MG 1.5 1 100 100
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
J1726 Inj, Makena Eugia US LLC 55150-0309-01 Hydroxyprogesterone Caproate 10 MG 1 1 25 25
J1726 Inj, Makena Covis Pharma US, Inc 64011-0301-03 Makena Auto Injector 10 MG 1.1 1 27.5 27.5
J1742 Ibutilide fumarate injection AVET PHARMACEUTICALS, INC. 23155-0326-31 Ibutilide Fumarate 1 MG 10 1 1 1
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
J1833 Inj, isavuconazonium sulfate Astellas Pharma US, Inc. 00469-0420-01 Cresemba 1 MG 1 1 372 372
J2186 Inj., meropenem, vaborbactam Melinta Therapeutics, LLC 70842-0120-06 Vabomere (10 MG/10MG) 20 MG 1 6 100 600
J2265 Minocycline hydrochloride Melinta Therapeutics, LLC 70842-0160-10 Minocin 1 MG 1 10 100 1000
J2326 Injection, nusinersen Biogen Inc. 64406-0058-01 Spinraza 0.1 MG 5 1 120 120
J2428 Inj, erzofri, 1 mg Shandong Luye Pharmaceutical 72526-0105-11 Erzofri 1 MG 0.25 1 39 39
J2428 Inj, erzofri, 1 mg Shandong Luye Pharmaceutical 72526-0106-11 Erzofri 1 MG 0.5 1 78 78
J2428 Inj, erzofri, 1 mg Shandong Luye Pharmaceutical 72526-0107-11 Erzofri 1 MG 0.75 1 117 117
J2428 Inj, erzofri, 1 mg Shandong Luye Pharmaceutical 72526-0108-11 Erzofri 1 MG 1 1 156 156
J2428 Inj, erzofri, 1 mg Shandong Luye Pharmaceutical 72526-0109-11 Erzofri 1 MG 1.5 1 234 234
J2428 Inj, erzofri, 1 mg Shandong Luye Pharmaceutical 72526-0110-11 Erzofri 1 MG 2.25 1 351 351
J2547 Injection, peramivir BioCryst Pharmaceuticals, Inc. 72769-0181-03 Rapivab 1 MG 20 3 200 600
J2561 Inj, sezaby, 1 mg Sun Pharmaceutical Industries, Inc. 62756-0301-01 Sezaby 1 MG 1 1 100 100
J2801 Inj, rykindo, 0.5 mg SHANGONG LUYE PHARMACEUTICA 72526-0101-11 Rykindo 0.5 MG 1 1 25 25
J2801 Inj, rykindo, 0.5 mg SHANGONG LUYE PHARMACEUTICA 72526-0102-11 Rykindo 0.5 MG 1 1 50 50
J2801 Inj, rykindo, 0.5 mg SHANGONG LUYE PHARMACEUTICA 72526-0103-11 Rykindo 0.5 MG 1 1 75 75
J2801 Inj, rykindo, 0.5 mg SHANGONG LUYE PHARMACEUTICA 72526-0104-11 Rykindo 0.5 MG 1 1 100 100
J2840 Injection, sebelipase alfa Alexion Pharmaceuticals, Inc. 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 18.1 MG 1 2 1 2
J2998 Inj plasminogen tvmh 1mg Kedrion Biopharma Inc 70573-0099-02 Ryplazim 1 mg 1 1 68.8 68.8
J3357 Ustekinumab injection Janssen Biotech, Inc. 57894-0060-02 Stelara 1 MG 0.5 1 45 45
J3357 Ustekinumab injection Janssen Biotech, Inc. 57894-0060-03 Stelara 1 MG 0.5 1 45 45
J3357 Ustekinumab injection Janssen Biotech, Inc. 57894-0061-03 Stelara 1 MG 1 1 90 90
J3392 Inj, exagamglogene autotem Vertex Pharmaceuticals Incorporated 51167-0290-09 Casgevy PER TREATMENT 1 1 1 1
J3392 Inj, exagamglogene autotem Roslin Cell Therapies Limited 83932-0290-09 Casgevy PER TREATMENT 1 1 1 1
J3393 Inj, betibeglogene autotemce bluebird bio, Inc. 73554-3111-01 Zynteglo PER THERAPEUTIC DOSE 20 1 1 1
J3394 Inj, lovotibeglogene autotem Bluebird Bio, Inc. 73554-1111-01 Lyfgenia per treatment 20 1 1 1
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 Novartis Gene Therapies, Inc. 71894-0120-02 Zolgensma per tx dose (up to 5 x10^15 vg?) 16.6 1 1 1
J3399 Inj onase abepar-xioi treat Novartis Gene Therapies, Inc. 71894-0121-03 Zolgensma per tx dose (up to 5 x10^15 vg?) 19.3 1 1 1
J3399 Inj onase abepar-xioi treat Novartis Gene Therapies, Inc. 71894-0122-03 Zolgensma per tx dose (up to 5 x10^15 vg?) 22.1 1 1 1
J3399 Inj onase abepar-xioi treat Novartis Gene Therapies, Inc. 71894-0123-03 Zolgensma per tx dose (up to 5 x10^15 vg?) 24.9 1 1 1
J3399 Inj onase abepar-xioi treat Novartis Gene Therapies, Inc. 71894-0124-04 Zolgensma per tx dose (up to 5 x10^15 vg?) 27.6 1 1 1
J3399 Inj onase abepar-xioi treat Novartis Gene Therapies, Inc. 71894-0125-04 Zolgensma per tx dose (up to 5 x10^15 vg?) 30.4 1 1 1
J3399 Inj onase abepar-xioi treat Novartis Gene Therapies, Inc. 71894-0126-04 Zolgensma per tx dose (up to 5 x10^15 vg?) 33.2 1 1 1
J3399 Inj onase abepar-xioi treat Novartis Gene Therapies, Inc. 71894-0127-05 Zolgensma per tx dose (up to 5 x10^15 vg?) 35.9 1 1 1
J3399 Inj onase abepar-xioi treat Novartis Gene Therapies, Inc. 71894-0128-05 Zolgensma per tx dose (up to 5 x10^15 vg?) 38.7 1 1 1
J3399 Inj onase abepar-xioi treat Novartis Gene Therapies, Inc. 71894-0129-05 Zolgensma per tx dose (up to 5 x10^15 vg?) 41.5 1 1 1
J3399 Inj onase abepar-xioi treat Novartis Gene Therapies, Inc. 71894-0130-06 Zolgensma per tx dose (up to 5 x10^15 vg?) 44.2 1 1 1
J3399 Inj onase abepar-xioi treat Novartis Gene Therapies, Inc. 71894-0131-06 Zolgensma per tx dose (up to 5 x10^15 vg?) 47 1 1 1
J3399 Inj onase abepar-xioi treat Novartis Gene Therapies, Inc. 71894-0132-06 Zolgensma per tx dose (up to 5 x10^15 vg?) 49.8 1 1 1
J3399 Inj onase abepar-xioi treat Novartis Gene Therapies, Inc. 71894-0133-07 Zolgensma per tx dose (up to 5 x10^15 vg?) 52.5 1 1 1
J3399 Inj onase abepar-xioi treat Novartis Gene Therapies, Inc. 71894-0134-07 Zolgensma per tx dose (up to 5 x10^15 vg?) 55.3 1 1 1
J3399 Inj onase abepar-xioi treat Novartis Gene Therapies, Inc. 71894-0135-07 Zolgensma per tx dose (up to 5 x10^15 vg?) 58.1 1 1 1
J3399 Inj onase abepar-xioi treat Novartis Gene Therapies, Inc. 71894-0136-08 Zolgensma per tx dose (up to 5 x10^15 vg?) 60.8 1 1 1
J3399 Inj onase abepar-xioi treat Novartis Gene Therapies, Inc. 71894-0137-08 Zolgensma per tx dose (up to 5 x10^15 vg?) 63.6 1 1 1
J3399 Inj onase abepar-xioi treat Novartis Gene Therapies, Inc. 71894-0138-08 Zolgensma per tx dose (up to 5 x10^15 vg?) 66.4 1 1 1
J3399 Inj onase abepar-xioi treat Novartis Gene Therapies, Inc. 71894-0139-09 Zolgensma per tx dose (up to 5 x10^15 vg?) 69.1 1 1 1
J3399 Inj onase abepar-xioi treat Novartis Gene Therapies, Inc. 71894-0140-09 Zolgensma per tx dose (up to 5 x10^15 vg?) 71.9 1 1 1
J3399 Inj onase abepar-xioi treat Novartis Gene Therapies, Inc. 71894-0141-09 Zolgensma per tx dose (up to 5 x10^15 vg?) 74.7 1 1 1
J3424 Inj hydroxocobalamin iv 25mg MERIDIAN MEDICAL TECHNOLOGIES 11704-0370-01 Cyanokit 25 MG 1 1 200 200
J3424 Inj hydroxocobalamin iv 25mg BTG International Inc. 50633-0310-11 Cyanokit 25 MG 1 1 200 200
J7165 Inj, human-lans, per i.u Octapharma USA Inc. 68982-0261-01 Balfaxar PER FACTOR IX IU 1 1 1 1
J7165 Inj, human-lans, per i.u Octapharma USA Inc. 68982-0261-02 Balfaxar PER FACTOR IX IU 1 1 1 1
J7168 Prothrombin complex kcentra CSL Behring L.L.C. 63833-0386-02 Kcentra 1 IU 1 1 1 1
J7168 Prothrombin complex kcentra CSL Behring L.L.C. 63833-0387-02 Kcentra 1 IU 1 1 1 1
J7169 Inj andexxa, 10 mg AstraZeneca Pharmaceuticals LP 00310-3200-04 Andexxa 10 MG 1 4 20 80
J7169 Inj andexxa, 10 mg AstraZeneca Pharmaceuticals LP 00310-3200-05 Andexxa 10 MG 1 5 20 100
J7169 Inj andexxa, 10 mg AstraZeneca Pharmaceuticals LP 69853-0102-01 Andexxa 10 MG 1 4 20 80
J7352 Afamelanotide implant, 1 mg CLINuVEL INC. 73372-0116-01 Scenesse 1 MG 1 1 16 16
J7353 Anacaulase-bcdb 8.8% gel 1 g VERICEL CORPORATION 69866-2002-03 NexoBrid 1 GM (OF 8.8% GEL) 1 1 22 22
J7353 Anacaulase-bcdb 8.8% gel 1 g Vericel Corporation 69866-2005-03 NexoBrid 1 GM (OF 8.8% GEL) 1 1 55 55
J7501 Azathioprine parenteral Hikma Pharmaceuticals USA Inc. 00143-9566-01 Azathioprine 100 MG 1 1 1 1
J8611 Oral methotrexate (jylamvo) SHORLA ONCOLOGY INC. 81927-0204-01 Jylamvo 2.5 MG 60 1 48 48
J8612 Oral methotrexate (xatmep) Azurity Pharmaceuticals, Inc. 52652-2001-01 Xatmep 2.5 MG 120 1 120 120
J8612 Oral methotrexate (xatmep) Azurity Pharmaceuticals, Inc. 52652-2001-06 Xatmep 2.5 MG 60 1 60 60
J9054 Inj bortezomib boruzu 0.1 mg AMNEAL BIOSCIENCES 70121-2484-01 Boruzu 0.1 MG 1.4 1 35 35
J9057 Inj., copanlisib, 1 mg Bayer HealthCare Pharmaceuticals Inc. 50419-0385-01 Aliqopa 1 MG 1 1 60 60
J9292 Inj, pemetrexed (avyxa) 10mg Avyxa Pharma, LLC 83831-0111-01 Pemetrexed 10 MG 1 1 10 10
J9292 Inj, pemetrexed (avyxa) 10mg Avyxa Pharma, LLC 83831-0112-01 Pemetrexed 10 MG 1 1 50 50
J9302 Ofatumumab injection Novartis Pharmaceuticals Corporation 00078-0669-13 Arzerra 10 MG 5 3 10 30
J9302 Ofatumumab injection Novartis Pharmaceuticals Corporation 00078-0690-61 Arzerra 10 MG 50 1 100 100
J9313 Inj., lumoxiti, 0.01 mg AstraZeneca Pharmaceuticals LP 00310-4700-01 Lumoxiti 0.01 MG 1 1 100 100
J9313 Inj., lumoxiti, 0.01 mg AstraZeneca Pharmaceuticals LP 73380-4700-01 Lumoxiti 0.01 MG 1 1 100 100
J9318 Inj romidepsin non-lyo 0.1mg Teva Parenteral Medicines, Inc. 00703-4004-01 Romidepsin non-lyophilized 0.1 MG 5.5 1 275 275
J9329 Inj, tislelizumab-jsgr Beigene USA 72579-0121-01 Tevimbra 1 MG 10 1 10 10
J9600 Porfimer sodium injection Pinnacle Biologics, Inc. 76128-0155-75 Photofrin 75 MG 1 1 1 1
Q2057 Afamitresgene autoleucel Adaptimmune 83205-0001-02 Tecelra PER THERAPEUTIC DOSE 1 1 1 1
Q3027 Inj beta interferon im 1 mcg Biogen Inc. 59627-0222-05 Avonex 1 MCG 1 4 30 120
Q3027 Inj beta interferon im 1 mcg Biogen Inc. 59627-0333-04 Avonex Pen 1 MCG 1 4 30 120
Q5140 Inj adalimumab-fkjp, 1 mg Mylan Specialty L.P. 49502-0380-02 Hulio 1 MG 0.8 1 40 80
Q5140 Inj adalimumab-fkjp, 1 mg Mylan Specialty L.P. 49502-0381-02 Hulio 1 MG 0.4 1 20 40
Q5140 Inj adalimumab-fkjp, 1 mg Mylan Specialty L.P. 49502-0382-02 Hulio 1 MG 0.8 1 40 80
Q5140 Inj adalimumab-fkjp, 1 mg Biocon Biologics Inc 83257-0016-42 Hulio 1 MG 0.4 2 20 40
Q5140 Inj adalimumab-fkjp, 1 mg Biocon Biologics Inc 83257-0017-42 Hulio 1 MG 0.8 1 40 80
Q5140 Inj adalimumab-fkjp, 1 mg Biocon Biologics Inc 83257-0019-32 Hulio 1 MG 0.8 1 40 80
Q5141 Inj adalimumab-aaty, 1 mg Celltrion USA Inc. 72606-0023-01 Yuflyma 1 MG 0.8 1 80 80
Q5141 Inj adalimumab-aaty, 1 mg Celltrion USA Inc. 72606-0023-02 Yuflyma 1 MG 0.8 1 80 80
Q5141 Inj adalimumab-aaty, 1 mg Celltrion USA Inc. 72606-0023-03 Yuflyma 1 MG 0.8 2 80 160
Q5141 Inj adalimumab-aaty, 1 mg Celltrion USA Inc. 72606-0023-04 Yuflyma 1 MG 0.8 1 80 80
Q5141 Inj adalimumab-aaty, 1 mg Celltrion USA Inc. 72606-0023-05 Yuflyma 1 MG 0.8 2 80 160
Q5141 Inj adalimumab-aaty, 1 mg Celltrion USA Inc. 72606-0023-07 Yuflyma 1 MG 0.8 3 80 240
Q5141 Inj adalimumab-aaty, 1 mg Celltrion USA Inc. 72606-0023-08 Yuflyma 1 MG 0.8 3 80 240
Q5141 Inj adalimumab-aaty, 1 mg Celltrion USA Inc. 72606-0024-01 Yuflyma 1 MG 0.2 2 20 40
Q5141 Inj adalimumab-aaty, 1 mg Celltrion USA Inc. 72606-0030-01 Yuflyma 1 MG 0.4 1 40 40
Q5141 Inj adalimumab-aaty, 1 mg Celltrion USA Inc. 72606-0030-02 Yuflyma 1 MG 0.4 2 40 80
Q5141 Inj adalimumab-aaty, 1 mg Celltrion USA Inc. 72606-0030-03 Yuflyma 1 MG 0.4 4 40 160
Q5141 Inj adalimumab-aaty, 1 mg Celltrion USA Inc. 72606-0030-04 Yuflyma 1 MG 0.4 6 40 240
Q5141 Inj adalimumab-aaty, 1 mg Celltrion USA Inc. 72606-0030-05 Yuflyma 1 MG 0.4 1 40 40
Q5141 Inj adalimumab-aaty, 1 mg Celltrion USA Inc. 72606-0030-06 Yuflyma 1 MG 0.4 2 40 80
Q5141 Inj adalimumab-aaty, 1 mg Celltrion USA Inc. 72606-0030-07 Yuflyma 1 MG 0.4 4 40 160
Q5141 Inj adalimumab-aaty, 1 mg Celltrion USA Inc. 72606-0030-08 Yuflyma 1 MG 0.4 6 40 240
Q5141 Inj adalimumab-aaty, 1 mg Celltrion USA Inc. 72606-0030-09 Yuflyma 1 MG 0.4 1 40 40
Q5141 Inj adalimumab-aaty, 1 mg Celltrion USA Inc. 72606-0030-10 Yuflyma 1 MG 0.4 2 40 80
Q5141 Inj adalimumab-aaty, 1 mg Celltrion USA Inc. 72606-0030-11 Yuflyma 1 MG 0.4 4 40 160
Q5141 Inj adalimumab-aaty, 1 mg Celltrion USA Inc. 72606-0030-12 Yuflyma 1 MG 0.4 6 40 240
Q5141 Inj adalimumab-aaty, 1 mg Celltrion USA Inc. 72606-0030-13 Yuflyma 1 MG 0.4 4 40 160
Q5141 Inj adalimumab-aaty, 1 mg Celltrion USA Inc. 72606-0030-14 Yuflyma 1 MG 0.4 6 40 240
Q5142 Inj adalimumab-ryvk, 1 mg Teva Pharmaceuticals USA 51759-0386-22 Simlandi 1 MG 0.2 2 20 40
Q5142 Inj adalimumab-ryvk, 1 mg Teva Pharmaceuticals USA 51759-0402-02 Simlandi 1 MG 0.4 2 40 80
Q5142 Inj adalimumab-ryvk, 1 mg Teva Pharmaceuticals USA 51759-0402-17 Simlandi 1 MG 0.4 1 40 40
Q5142 Inj adalimumab-ryvk, 1 mg Teva Pharmaceuticals USA 51759-0412-22 Simlandi 1 MG 0.4 2 40 80
Q5142 Inj adalimumab-ryvk, 1 mg Teva Pharmaceuticals USA 51759-0523-21 Simlandi 1 MG 0.8 1 80 80
Q5142 Inj adalimumab-ryvk, 1 mg QUALLENT PHARMACEUTICALS HEALTH LLC 82009-0156-22 Adalimumab-ryvk 1 MG 0.4 2 40 80
Q5142 Inj adalimumab-ryvk, 1 mg QUALLENT PHARMACEUTICALS HEALTH LLC 82009-0158-22 Adalimumab-ryvk 1 MG 0.4 2 40 80
Q5143 Inj adalimumab-adbm, 1 mg QUALLENT PHARMACEUTICALS HEALTH LLC 82009-0148-22 Adalimumab-adbm 1 MG 0.8 2 40 80
Q5143 Inj adalimumab-adbm, 1 mg QUALLENT PHARMACEUTICALS HEALTH LLC 82009-0150-22 Adalimumab-adbm 1 MG 0.8 2 40 80
Q5143 Inj adalimumab-adbm, 1 mg Boehringer Ingelheim Pharmaceuticals Inc 00597-0370-82 Cyltezo 1 MG 0.8 2 40 80
Q5143 Inj adalimumab-adbm, 1 mg Boehringer Ingelheim Pharmaceuticals Inc 00597-0375-16 Cyltezo 1 MG 0.8 6 40 240
Q5143 Inj adalimumab-adbm, 1 mg Boehringer Ingelheim Pharmaceuticals Inc 00597-0375-23 Cyltezo 1 MG 0.8 4 40 160
Q5143 Inj adalimumab-adbm, 1 mg Boehringer Ingelheim Pharmaceuticals Inc 00597-0375-97 Cyltezo 1 MG 0.8 2 40 80
Q5143 Inj adalimumab-adbm, 1 mg Boehringer Ingelheim Pharmaceuticals Inc 00597-0400-89 Cyltezo 1 MG 0.2 2 10 20
Q5143 Inj adalimumab-adbm, 1 mg Boehringer Ingelheim Pharmaceuticals Inc 00597-0405-80 Cyltezo 1 MG 0.4 2 20 40
Q5143 Inj adalimumab-adbm, 1 mg Boehringer Ingelheim Pharmaceuticals Inc 00597-0485-20 Cyltezo 1 MG 0.4 2 40 80
Q5143 Inj adalimumab-adbm, 1 mg Boehringer Ingelheim Pharmaceuticals Inc 00597-0495-40 Cyltezo 1 MG 0.4 4 40 160
Q5143 Inj adalimumab-adbm, 1 mg Boehringer Ingelheim Pharmaceuticals Inc 00597-0495-50 Cyltezo 1 MG 0.4 2 40 80
Q5143 Inj adalimumab-adbm, 1 mg Boehringer Ingelheim Pharmaceuticals Inc 00597-0495-60 Cyltezo 1 MG 0.4 6 40 240
Q5144 Inj, idacio, 1 mg FreseniUS Kabi USA, LLC 65219-0612-69 Adalimumab-aacf 1 MG 0.8 4 40 160
Q5144 Inj, idacio, 1 mg FreseniUS Kabi USA, LLC 65219-0612-89 Adalimumab-aacf 1 MG 0.8 6 40 240
Q5144 Inj, idacio, 1 mg FreseniUS Kabi USA, LLC 65219-0612-99 Adalimumab-aacf 1 MG 0.8 2 40 80
Q5144 Inj, idacio, 1 mg FreseniUS Kabi USA, LLC 65219-0620-20 Adalimumab-Aacf 1 MG 0.8 2 40 80
Q5144 Inj, idacio, 1 mg FreseniUS Kabi USA, LLC 65219-0554-08 Idacio 1 MG 0.8 2 40 80
Q5144 Inj, idacio, 1 mg FreseniUS Kabi USA, LLC 65219-0554-28 Idacio 1 MG 0.8 4 40 160
Q5144 Inj, idacio, 1 mg FreseniUS Kabi USA, LLC 65219-0554-38 Idacio 1 MG 0.8 6 40 240
Q5144 Inj, idacio, 1 mg FreseniUS Kabi USA, LLC 65219-0556-18 Idacio 1 MG 0.8 2 40 80
Q5145 Inj, abrilada, 1 mg PFIZER LABS 00025-0325-02 Abrilada 1 MG 0.8 2 40 80
Q5145 Inj, abrilada, 1 mg Pfizer Inc 00069-0319-01 Abrilada 1 MG 0.8 1 40 40
Q5145 Inj, abrilada, 1 mg Pfizer Inc 00069-0325-01 Abrilada 1 MG 0.8 1 40 40
Q5145 Inj, abrilada, 1 mg Pfizer Inc 00069-0325-02 Abrilada 1 MG 0.8 2 40 80
Q5145 Inj, abrilada, 1 mg Pfizer Inc 00069-0328-01 Abrilada 1 MG 0.8 1 40 40
Q5145 Inj, abrilada, 1 mg Pfizer Inc 00069-0328-02 Abrilada 1 MG 0.8 2 40 80
Q5145 Inj, abrilada, 1 mg Pfizer Inc 00069-0333-02 Abrilada 1 MG 0.4 2 20 40
Q5145 Inj, abrilada, 1 mg PFIZER INC. 00069-0347-02 Abrilada 1 MG 0.2 2 10 20
Q5148 Inj, nyposi 1 mcg Tanvex Biopharma USA 72374-0101-01 Nypozi 1 MCG 0.5 1 300 300
Q5148 Inj, nyposi 1 mcg Tanvex Biopharma USA 72374-0101-10 Nypozi 1 MCG 0.5 10 300 3000
Q5148 Inj, nyposi 1 mcg Tanvex Biopharma USA 72374-0102-01 Nypozi 1 MCG 0.8 1 480 480
Q5148 Inj, nyposi 1 mcg Tanvex Biopharma USA 72374-0102-10 Nypozi 1 MCG 0.8 10 480 4800
Q9968 Visualization adjunct American Regent, Inc. 00517-0374-05 Provayblue 1 MG 10 5 50 250
Q9968 Visualization adjunct Mylan Institutional LLC 67457-0220-05 Isosulfan Blue 1 MG 5 6 50 300
Q9982 Flutemetamol F18 Medi-Physics, Inc. dba GE Healthcare 17156-0067-30 Vizamyl Per Study Dose, up to 5 mCi 1 1 1 1

Past NDC - HCPCS Crosswalk