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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 67684-2000-02 Dotarem 0.1 ML 15 10 150 1500
A9575 Inj gadoterate meglumi 0.1ml Guerbet LLC 67684-2000-03 Dotarem 0.1 ML 20 10 200 2000
A9575 Inj gadoterate meglumi 0.1ml Guerbet LLC 67684-2000-04 Dotarem 0.1 ML 100 6 1000 6000
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 67684-2000-07 Dotarem 0.1 ML 20 5 200 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 67684-3001-03 Dotarem 0.1 ml 20 mL 10 EA 10 200 2000
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 00407-0690-30 NovaPlus® Omniscan 1 ML 10 10 10 100
A9579 Gad-base mr contrast nos,1ml GE Healthcare 00407-0690-40 NovaPlus® Omniscan 1 ML 15 10 15 150
A9579 Gad-base mr contrast nos,1ml GE Healthcare 00407-0690-42 NovaPlus® Omniscan 1 ML 15 10 15 150
A9579 Gad-base mr contrast nos,1ml GE Healthcare 00407-0690-43 NovaPlus® Omniscan 1 ML 20 10 20 200
A9579 Gad-base mr contrast nos,1ml GE Healthcare 00407-0690-50 NovaPlus® Omniscan 1 ML 20 10 20 200
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 GE Healthcare 00407-0691-63 Omniscan 1 ML 20 10 20 200
A9579 Gad-base mr contrast nos,1ml Liebel Flarsheim 00019-1177-02 Optimark 1 ML 5 10 5 50
A9579 Gad-base mr contrast nos,1ml Liebel Flarsheim 00019-1177-04 Optimark 1 ML 10 10 10 100
A9579 Gad-base mr contrast nos,1ml Liebel Flarsheim 00019-1177-06 Optimark 1 ML 15 10 15 150
A9579 Gad-base mr contrast nos,1ml Liebel Flarsheim 00019-1177-08 Optimark 1 ML 20 10 20 200
A9579 Gad-base mr contrast nos,1ml Liebel Flarsheim 00019-1177-11 Optimark 1 ML 10 10 10 100
A9579 Gad-base mr contrast nos,1ml Liebel Flarsheim 00019-1177-16 Optimark 1 ML 15 10 15 150
A9579 Gad-base mr contrast nos,1ml Liebel Flarsheim 00019-1177-21 Optimark 1 ML 20 10 20 200
A9579 Gad-base mr contrast nos,1ml Liebel Flarsheim 00019-1177-31 Optimark 1 ML 30 10 30 300
A9579 Gad-base mr contrast nos,1ml Liebel Flarsheim 00019-1177-50 Optimark 1 ML 50 5 50 250
A9579 Gad-base mr contrast nos,1ml Bracco Diagnostics 00270-1111-16 Prohance Prefilled Syringes 1 ML 10 5 10 50
A9579 Gad-base mr contrast nos,1ml Bracco Diagnostics 00270-1111-45 Prohance Prefilled Syringes 1 ML 17 5 17 85
A9579 Gad-base mr contrast nos,1ml Bracco Diagnostics 00270-1111-01 Prohance 1 ML 10 5 10 50
A9579 Gad-base mr contrast nos,1ml Bracco Diagnostics 00270-1111-02 Prohance 1 ML 15 5 15 75

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 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 Kedrion Biopharma 76125-0790-25 Albuked 5 250 ML 250 1 1 1
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 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 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 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 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
Q2035 Afluria vacc, 3 yrs & >, im Seqirus Inc 33332-0118-10 Afluria (2018/2019) 0.5 ML 5 1 10 10

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 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
Aminocaproic acid Pfizer Inc. 00409-4346-10 Aminocaproic Acid 250 MG 20 25 20 500
Aminocaproic acid American Regent 00517-9191-25 Aminocaproic Acid 250 MG 20 25 20 500
Aminocaproic acid Pfizer Inc. 00409-4346-73 AMINOCAPROIC ACID INJ 250 MG 20 25 20 500
Immune Globulin (Asceniv) ADMA Biologics 69800-0250-01 Asceniv 500 MG 50 1 10 10
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 Bristol-Myers Squibb Company 00003-2230-11 Azactam In Galaxy Container 500 MG 50 24 2 48
Aztreonam Bristol-Myers Squibb Company 00003-2240-11 Azactam In Galaxy Container 500 MG 50 24 4 96
Aztreonam Fresenius Kabi USA LLC 63323-0401-20 Aztreonam 500 MG 1 10 2 20
Aztreonam Fresenius Kabi USA LLC 63323-0401-24 Aztreonam 500 MG 1 10 2 20
Aztreonam Fresenius Kabi USA LLC 63323-0401-26 Aztreonam 500 MG 1 10 2 20
Aztreonam Fresenius Kabi USA LLC 63323-0402-20 Aztreonam 500 MG 1 10 4 40
Aztreonam Fresenius Kabi USA LLC 63323-0402-24 Aztreonam 500 MG 1 10 4 40
Aztreonam Fresenius Kabi USA LLC 63323-0402-30 Aztreonam 500 MG 1 10 4 40
Esmolol Hydrochloride Baxter Healthcare Corporation 10019-0075-87 Brevibloc 10 MG 100 1 200 200
Esmolol Hydrochloride Baxter Healthcare Corporation 10019-0115-01 Brevibloc 10 MG 10 25 10 250
Esmolol Hydrochloride Baxter Healthcare Corporation 10019-0666-10 BREVIBLOC 10 MG 100 10 200 2000
Esmolol Hydrochloride Baxter Healthcare Corporation 10019-0668-10 BREVIBLOC 10 MG 100 10 200 2000
Esmolol Hydrochloride Baxter Healthcare Corporation 10019-0670-10 BREVIBLOC 10 MG 250 10 250 2500
Esmolol Hydrochloride Baxter Healthcare Corporation 10019-0672-10 BREVIBLOC 10 MG 250 10 250 2500
Esmolol Hydrochloride Baxter Healthcare Corporation 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
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 Healthcare Corporation 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
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 Pfizer Inc. 00009-6582-01 Cleocin 150 MG 2 25 2 50
Clindamycin Phosphate Pfizer Inc. 00009-3375-02 Cleocin In D5W 150 MG 50 24 4 96
Clindamycin Phosphate Pfizer Inc. 00009-3381-02 Cleocin In D5W 150 MG 50 24 2 48
Clindamycin Phosphate Pfizer Inc. 00009-3382-02 Cleocin In D5W 150 MG 50 24 6 144
Clindamycin Phosphate Pfizer Inc. 00009-3470-02 Cleocin in D5W 150 MG 50 24 2 48
Clindamycin Phosphate Pfizer Inc. 00009-6780-02 Cleocin in D5W 150 MG 50 24 4 96
Clindamycin Phosphate Pfizer Inc. 00009-9890-02 Cleocin in D5W 150 MG 50 24 6 144
Clindamycin Phosphate Baxter Healthcare Corporation 00338-3616-24 Clindamycin in D5W 150 MG 50 24 4 96
Clindamycin Phosphate Baxter Healthcare Corporation 00338-4114-24 Clindamycin in D5W 150 MG 50 24 6 144
Clindamycin Phosphate Baxter Healthcare Corporation 00338-9545-24 Clindamycin in D5W 150 MG 50 24 2 48
Clindamycin Phosphate Baxter Healthcare Corporation 00338-9549-24 Clindamycin in D5W 150 MG 50 24 4 96
Clindamycin Phosphate Baxter Healthcare Corporation 00338-9553-24 Clindamycin in D5W 150 MG 50 24 6 144
Clindamycin Phosphate Sandoz, Inc. 00781-9220-09 Clindamycin in D5W 150 MG 50 24 2 48
Clindamycin Phosphate Sandoz, Inc. 00781-9221-09 Clindamycin in D5W 150 MG 50 24 4 96
Clindamycin Phosphate Sandoz, Inc. 00781-9222-09 Clindamycin in D5W 150 MG 50 24 6 144
Clindamycin Phosphate Akorn 17478-0120-50 Clindamycin In D5W 150 MG 50 1 2 2
Clindamycin Phosphate Akorn 17478-0121-50 Clindamycin In D5W 150 MG 50 1 4 4
Clindamycin Phosphate Akorn 17478-0122-50 Clindamycin In D5W 150 MG 50 1 6 6
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 Healthcare Corporation 00338-3410-24 Clindamycin Phosphate 150 MG 50 24 2 48
Clindamycin Phosphate Baxter Healthcare Corporation 00338-3612-24 Clindamycin Phosphate 150 MG 50 24 4 96
Clindamycin Phosphate Baxter Healthcare Corporation 00338-3814-24 Clindamycin Phosphate 150 MG 50 24 6 144
Clindamycin Phosphate Sandoz, Inc. 00781-3288-09 Clindamycin Phosphate 150 MG 50 24 2 48
Clindamycin Phosphate Sandoz, Inc. 00781-3289-09 Clindamycin Phosphate 150 MG 50 24 4 96
Clindamycin Phosphate Sandoz, Inc. 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 Inc 47781-0459-68 Clindamycin Phosphate 150 MG 2 25 2 50
Clindamycin Phosphate Alvogen Inc 47781-0460-68 Clindamycin Phosphate 150 MG 4 25 4 100
Clindamycin Phosphate Alvogen Inc 47781-0461-68 Clindamycin Phosphate 150 MG 6 25 6 150
Clindamycin Phosphate Alvogen Inc 47781-0462-69 Clindamycin Phosphate 150 MG 2 25 2 50
Clindamycin Phosphate Alvogen Inc 47781-0463-69 Clindamycin Phosphate 150 MG 4 25 4 100
Clindamycin Phosphate Alvogen Inc 47781-0464-69 Clindamycin Phosphate 150 MG 6 25 6 150
Clindamycin Phosphate Alvogen Inc 47781-0465-70 Clindamycin Phosphate 150 MG 60 1 60 60
Clindamycin Phosphate Alvogen Inc 47781-0619-69 Clindamycin Phosphate 150 MG 2 25 2 50
Clindamycin Phosphate Alvogen Inc 47781-0620-69 Clindamycin Phosphate 150 MG 4 25 4 100
Clindamycin Phosphate Alvogen Inc 47781-0621-69 Clindamycin Phosphate 150 MG 6 25 6 150
Clindamycin Phosphate Fresenius Kabi USA LLC 63323-0282-02 Clindamycin Phosphate 150 MG 2 25 2 50
Clindamycin Phosphate Fresenius Kabi USA LLC 63323-0282-04 Clindamycin Phosphate 150 MG 4 25 4 100
Clindamycin Phosphate Fresenius Kabi USA LLC 63323-0282-06 Clindamycin Phosphate 150 MG 6 25 6 150
Clindamycin Phosphate Fresenius Kabi USA LLC 63323-0282-60 Clindamycin Phosphate 150 MG 60 1 60 60
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, Inc. 72611-0634-25 Clindamycin Phosphate 150 MG 2 25 2 50
Clindamycin Phosphate Almaject, Inc. 72611-0639-25 Clindamycin Phosphate 150 MG 4 25 4 100
Clindamycin Phosphate Almaject, Inc. 72611-0642-25 Clindamycin Phosphate 150 MG 6 25 6 150
Clindamycin Phosphate Almaject, Inc. 72611-0645-55 Clindamycin Phosphate 150 MG 60 5 60 300
Immune Globulin (Cutaquig) Octapharma USA 00069-1061-02 Cutaquig 100 MG 6 1 10 10
Immune Globulin (Cutaquig) Octapharma USA 00069-1476-02 Cutaquig 100 MG 12 1 20 20
Immune Globulin (Cutaquig) Octapharma USA 00069-1509-02 Cutaquig 100 MG 24 1 40 40
Immune Globulin (Cutaquig) Octapharma USA 00069-1965-02 Cutaquig 100 MG 48 1 80 80
Immune Globulin (Cutaquig) Octapharma USA 68982-0810-01 Cutaquig 100 MG 6 1 10 10
Immune Globulin (Cutaquig) Octapharma USA 68982-0810-03 Cutaquig 100 MG 12 1 20 20
Immune Globulin (Cutaquig) Octapharma USA 68982-0810-04 Cutaquig 100 MG 20 1 33 33
Immune Globulin (Cutaquig) Octapharma USA 68982-0810-05 Cutaquig 100 MG 24 1 40 40
Immune Globulin (Cutaquig) Octapharma USA 68982-0810-06 Cutaquig 100 MG 48 1 80 80
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 17478-0817-05 Diltiazem Hcl 5 MG 5 10 5 50
Diltiazem Hydrochloride Akorn 17478-0817-10 Diltiazem Hcl 5 MG 10 10 10 100
Diltiazem Hydrochloride Akorn 17478-0817-25 Diltiazem Hcl 5 MG 25 10 25 25
Diltiazem Hydrochloride Akorn 17478-0817-26 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 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
Doxycycline Hyclate Fresenius Kabi USA LLC 63323-0130-11 Doxycycline Hyclate 100 MG 1 10 1 10
Doxycycline Hyclate Fresenius Kabi USA LLC 63323-0130-13 Doxycycline Hyclate 100 MG 1 10 1 10
Doxycycline Hyclate Fresenius Kabi USA LLC 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 Healthcare Corporation 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 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 Fresenius Kabi USA LLC 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 USA LLC 63323-0738-09 Famotidine 10 MG 4 10 4 40
Famotidine Fresenius Kabi USA LLC 63323-0738-20 Famotidine 10 MG 20 10 20 200
Famotidine Fresenius Kabi USA LLC 63323-0739-12 Famotidine 10 MG 2 25 2 50
Famotidine Fresenius Kabi USA LLC 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 Baxter Healthcare Corporation 00338-5197-41 Famotidine Premixed 10 MG 50 12 2 24
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 Healthcare Corporation 36000-0148-10 Flumazenil 0.1 MG 5 10 5 50
Flumazenil Baxter Healthcare Corporation 36000-0149-10 Flumazenil 0.1 MG 10 10 10 100
Flumazenil Fresenius Kabi USA LLC 63323-0424-05 Flumazenil 0.1 MG 5 10 5 50
Flumazenil Fresenius Kabi USA LLC 63323-0424-10 Flumazenil 0.1 MG 10 1 10 10
Flumazenil Mylan Institutional 67457-0444-10 Flumazenil 0.1 MG 10 10 10 100
Flumazenil Mylan Institutional LLC 67457-0447-53 Flumazenil 0.1 MG 5 10 5 50
Folic Acid Fresenius Kabi USA LLC 63323-0184-10 Folic Acid 5 MG 10 1 10 10
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 USA LLC 63323-0578-11 Glycopyrrolate (injection) 0.2 MG 1 25 1 25
Glycopyrrolate injection Fresenius Kabi USA LLC 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, Inc. 00781-3825-96 Glycopyrrolate Injection 0.2 MG 1 25 1 25
Glycopyrrolate injection Sandoz, Inc. 00781-3827-96 Glycopyrrolate Injection 0.2 MG 2 25 2 50
Glycopyrrolate injection Sandoz, Inc. 00781-3829-96 Glycopyrrolate Injection 0.2 MG 5 25 5 125
Glycopyrrolate injection Sandoz, Inc. 00781-3831-95 Glycopyrrolate Injection 0.2 MG 20 10 20 200
Glycopyrrolate injection A-S Medication Solutions 50090-4513-00 Glycopyrrolate Injection 0.2 MG 1 1 1 1
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 Fresenius Kabi USA LLC 63323-0578-01 Glycopyrrolate Injection 0.2 MG 1 25 1 25
Glycopyrrolate injection Fresenius Kabi USA LLC 63323-0578-02 Glycopyrrolate Injection 0.2 MG 2 25 2 50
Glycopyrrolate injection Fresenius Kabi USA LLC 63323-0578-05 Glycopyrrolate Injection 0.2 MG 5 25 5 125
Glycopyrrolate injection Fresenius Kabi USA LLC 63323-0578-20 Glycopyrrolate Injection 0.2 MG 20 10 20 200
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 Par Pharmaceutical, Inc 70069-0011-25 Glycopyrrolate INJECTION 0.2 MG 1 25 1 25
Glycopyrrolate injection Par Pharmaceutical, Inc 70069-0012-25 Glycopyrrolate INJECTION 0.2 MG 2 25 2 50
Glycopyrrolate injection Par Pharmaceutical, Inc 70069-0013-25 Glycopyrrolate INJECTION 0.2 MG 5 25 5 125
Glycopyrrolate injection Par Pharmaceutical, Inc 70069-0014-10 Glycopyrrolate INJECTION 0.2 MG 20 10 20 200
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 Civica, Inc. 72572-0225-25 Glycopyrrolate Injection 0.2 MG 1 25 1 25
Glycopyrrolate injection Fresenius Kabi USA LLC 76045-0203-10 Glycopyrrolate Injection 0.2 MG 1 24 1 24
Glycopyrrolate injection Fresenius Kabi USA LLC 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) 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
Rabies Immune Globulin (Kedrab) Kedrion BioPharma, Inc. 76125-0150-02 KEDRAB 150 IU 2 1 2 2
Rabies Immune Globulin (Kedrab) Kedrion BioPharma, Inc. 76125-0150-10 KEDRAB 150 IU 10 1 10 10
Labetalol Hcl Hikma Pharmaceuticals USA Inc 00143-9320-01 Labetalol HCl 5 MG 20 1 20 20
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 Alvogen Inc 47781-0586-29 Labetalol Hcl 5 MG 20 1 20 20
Labetalol Hcl Alvogen Inc 47781-0586-56 Labetalol Hcl 5 MG 40 1 40 40
Labetalol Hcl Breckenridge Pharmaceutical 51991-0934-98 Labetalol Hcl 5 MG 20 1 20 20
Labetalol Hcl Breckenridge Pharmaceutical 51991-0935-98 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 Civica, Inc. 72572-0350-01 Labetalol HCl 5 MG 20 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 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 Baxter Healthcare Corporation 36000-0033-10 Metoprolol Tartrate 1 MG 5 10 5 50
Metoprolol Tartrate Alvogen Inc 47781-0587-17 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 Athenex Pharmaceutical Division, LLC. 70860-0300-05 Metoprolol Tartrate 1 MG 5 10 5 50
Metoprolol Tartrate Fosun Pharma 72266-0122-25 Metoprolol Tartrate 1 MG 5 25 5 125
Metronidazole inj Pfizer Inc. 00409-7811-24 METRONIDAZL 500MG 500 MG 100 24 1 24
Metronidazole inj Baxter Healthcare Corporation 00338-9541-24 METRONIDAZOLE 500 MG 100 24 1 24
Metronidazole inj Baxter Healthcare Corporation 00338-9554-50 METRONIDAZOLE 500 MG 100 50 1 50
Metronidazole inj Pfizer Inc. 00409-7811-10 METRONIDAZOLE 500 MG 100 24 1 24
Metronidazole inj Sagent Pharmaceuticals Inc 25021-0131-82 Metronidazole 500 MG 100 24 1 24
Metronidazole inj Baxter Healthcare Corporation 36000-0001-24 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 Healthcare Corporation 00338-1055-48 Metronidazole In Nacl 500 MG 100 24 1 24
Nitroglycerin American Regent 00517-4810-25 Nitroglycerin 5 MG 10 25 10 250
Nitroglycerin Baxter Healthcare Corporation 00338-1047-02 Nitroglycerin In D5W 5 MG 250 12 5 60
Nitroglycerin Baxter Healthcare Corporation 00338-1049-02 Nitroglycerin In D5W 5 MG 250 12 10 120
Nitroglycerin Baxter Healthcare Corporation 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, Inc. 00781-3159-72 Olanzapine (Immediate Release) 0.5 MG 1 1 20 20
Olanzapine short acting intramuscular injection Sandoz, Inc. 00781-9105-72 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) Octapharma USA 68982-0820-02 PANZYGA 500 MG 25 1 5 5
Immune Globulin (Panzyga) Octapharma USA 68982-0820-03 PANZYGA 500 MG 50 1 10 10
Immune Globulin (Panzyga) Octapharma USA 68982-0820-04 PANZYGA 500 MG 100 1 20 20
Immune Globulin (Panzyga) Octapharma USA 68982-0820-05 PANZYGA 500 MG 200 1 40 40
Immune Globulin (Panzyga) Octapharma USA 68982-0820-06 PANZYGA 500 MG 300 1 60 60
Rifampin Fresenius Kabi USA LLC 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 USA LLC 63323-0465-57 Sensorcaine 1 ML 50 25 50 1250
Bupivacaine Fresenius Kabi USA LLC 63323-0467-57 Sensorcaine 1 ML 50 25 50 1250
Bupivacaine Fresenius Kabi USA LLC 63323-0472-17 Sensorcaine 1 ML 10 25 10 250
Bupivacaine Fresenius Kabi USA LLC 63323-0464-17 SENSORCAINE-MPF 1 ML 10 25 10 250
Bupivacaine Fresenius Kabi USA LLC 63323-0464-37 SENSORCAINE-MPF 1 ML 30 25 30 750
Bupivacaine Fresenius Kabi USA LLC 63323-0466-17 Sensorcaine-MPF 1 ML 10 25 10 250
Bupivacaine Fresenius Kabi USA LLC 63323-0466-37 SENSORCAINE-MPF 1 ML 30 25 30 750
Bupivacaine Fresenius Kabi USA LLC 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 Healthcare Corporation 00338-0054-03 Sodium Chloride 250 CC 500 1 2 2
Sodium Chloride, Hypertonic (3% - 5% infusion) Baxter Healthcare Corporation 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. 00703-9514-83 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
Vasopressin Par Pharmaceutical, Inc 42023-0164-25 Vasopressin 20 UNITS 1 25 1 25
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
A9590 Iodine i-131 therapeutic Progenics Pharmaceuticals Inc. 71258-0015-22 AZEDRA therapeutic 1 mCi 1 1 1 1
A9600 Sr89 strontium GE Healthcare 17156-0524-01 METASTRON PER MILLICURIE 4 1 4 4
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
C9046 Cocaine hcl nasal solution Genus Lifesciences 64950-0359-04 Goprelto 1 MG 4 1 160 160
C9046 Cocaine hcl nasal solution Genus Lifesciences 64950-0362-04 Cocaine HCl (Goprelto Auth. Generic) 1 MG 4 1 160 160
C9047 Injection, caplacizumab-yhdp Genzyme Corporation 58468-0225-01 Cablivi 1 MG 1 1 11 11
C9055 Inj, brexanolone Sage Therapeutics 72152-0547-20 Zulresso 1 MG 20 1 100 100
C9059 Injection, meloxicam Baudax Bio, Inc. 71518-0001-01 ANJESO 1 MG 1 1 30 30
C9061 Injection, teprotumumab-trbw Horizon Therapeutics USA, Inc. 75987-0130-15 Tepezza 10 MG 1 1 50 50
C9063 Injection, eptinezumab-jjmr Lundbeck, LLC 67386-0130-51 Vyepti 1 MG 1 1 100 100
C9122 Mometasone furoate (Sinuva) Intersect ENT, Inc. 10599-0003-01 Sinuva 10 MCG 1 1 135 135
C9132 Kcentra, per i.u. CSL Behring LLC 63833-0386-02 Kcentra 1 IU 1 1 1 1
C9132 Kcentra, per i.u. CSL Behring LLC 63833-0387-02 Kcentra 1 IU 1 1 1 1
C9250 Artiss fibrin sealant Baxter Healthcare Corporation 00944-8503-02 ARTISS 2 ML 1 1 1 1
C9250 Artiss fibrin sealant Baxter Healthcare Corporation 00944-8503-10 ARTISS 2 ML 1 1 5 5
C9257 Bevacizumab injection Genentech, Inc. 50242-0060-01 Avastin 0.25 MG 4 1 400 400
C9257 Bevacizumab injection Genentech, Inc. 50242-0060-10 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
C9460 Injection, cangrelor The Medicines Company 65293-0003-10 KENGREAL 1 MG 1 10 50 500
C9462 Injection, delafloxacin Melinta Therapeutics 70842-0102-03 Baxdela 1 MG 1 10 300 3000
C9482 Sotalol hydrochloride IV Altathera Pharmaceuticals LLC 69724-0112-10 Sotalol 1MG 10 1 150 150
C9488 Conivaptan HCL Cumberland Pharmaceuticals Inc 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
J0135 Adalimumab injection AbbVie US, LLC 00074-6347-02 Humira 20 MG 0.2 2 0.5 1
J0135 Adalimumab injection AbbVie US, LLC 00074-9374-02 Humira 20 MG 0.4 2 1 2
J0567 Inj., cerliponase alfa 1 mg BioMarin Pharmaceutical, Inc. 68135-0811-02 Brineura 1 MG 1 2 150 300
J0593 Inj., lanadelumab-flyo, 1 mg Dyax Corp. 47783-0644-01 Takhzyro 1 mg 2 1 300 300
J0599 Inj., haegarda 10 units CSL Behring LLC 63833-0828-02 Haegarda 10 UNITS 1 1 200 200
J0599 Inj., haegarda 10 units CSL Behring LLC 63833-0829-02 Haegarda 10 UNITS 1 1 300 300
J0606 Inj, etelcalcetide, 0.1 mg Amgen USA, Inc. 55513-0740-10 Parsabiv 0.1 MG 0.5 10 25 250
J0606 Inj, etelcalcetide, 0.1 mg Amgen USA, Inc. 55513-0741-10 Parsabiv 0.1 MG 1 10 50 500
J0606 Inj, etelcalcetide, 0.1 mg Amgen USA, Inc. 55513-0742-10 Parsabiv 0.1 MG 2 10 100 1000
J0716 Centruroides immune f(ab) Rare Disease Therapeutics, Inc. 66621-0150-02 ANASCORP UP TO 120MG 1 1 1 1
J0742 Inj imip 4 cilas 4 releb 2mg Merck Sharp & Dohme Corp. 00006-3856-02 Recarbrio 4 MG-4 MG-2 MG 1 25 125 3125
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 00143-9559-01 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 Sandoz, Inc. 00781-3285-12 ARGATROBAN 1 MG 125 2 125 250
J0884 Argatroban esrd dialysis 1mg Sandoz, Inc. 00781-3314-95 ARGATROBAN 1 MG 50 10 50 500
J0884 Argatroban esrd dialysis 1mg Sandoz, Inc. 00781-9314-95 ARGATROBAN 1 MG 50 10 50 500
J0884 Argatroban esrd dialysis 1mg Par Pharmaceutical, Inc 42023-0182-01 Argatroban 1 MG 2.5 1 250 250
J0884 Argatroban esrd dialysis 1mg AuroMedics Pharma LLC 55150-0241-10 ARGATROBAN 1 MG 50 10 50 500
J0884 Argatroban esrd dialysis 1mg Fresenius Kabi USA LLC 63323-0526-03 Argatroban 1 MG 2.5 1 250 250
J0884 Argatroban esrd dialysis 1mg Mylan Institutional LLC 67457-0212-02 Argatroban 1 MG 2.5 1 250 250
J0896 Inj luspatercept-aamt 0.25mg Celgene Corporation 59572-0711-01 Reblozyl 0.25 MG 1 1 100 100
J0896 Inj luspatercept-aamt 0.25mg Celgene Corporation 59572-0775-01 Reblozyl 0.25 MG 1 1 300 300
J1095 Injection, dexamethasone 9%, EyePoint Pharmaceuticals US, Inc 71879-0001-01 DEXYCU (intraocular suspension) 1 MCG 0.005 1 517 517
J1096 Dexametha opth insert 0.1 mg Ocular Therapeutix, Inc. 70382-0204-01 Dextenza 0.1 MG 1 1 4 4
J1096 Dexametha opth insert 0.1 mg Ocular Therapeutix, Inc. 70382-0204-10 Dextenza 0.1 MG 1 10 4 40
J1097 Phenylep ketorolac opth soln Omeros 62225-0600-04 Omidria (phenylephrine 1% + ketorolac 0.3% irrigation) 1 ML 4 4 4 16
J1201 Inj cetirizine hydrochloride TerSera Therapeutics LLC 70720-0100-25 QUZYTTIR 0.5 mg 1 25 20 500
J1327 Eptifibatide injection Schering Corporation 00085-1136-01 Integrilin 5 MG 100 1 15 15
J1327 Eptifibatide injection Schering Corporation 00085-1136-02 Integrilin 5 MG 100 1 15 15
J1327 Eptifibatide injection Schering Corporation 00085-1136-03 Integrilin 5 MG 100 1 15 15
J1327 Eptifibatide injection Schering Corporation 00085-1177-01 Integrilin 5 MG 10 1 4 4
J1327 Eptifibatide injection Schering Corporation 00085-1177-02 Integrilin 5 MG 100 1 40 40
J1327 Eptifibatide injection Schering Corporation 00085-1177-03 Integrilin 5 MG 10 1 4 4
J1327 Eptifibatide injection Schering Corporation 00085-1177-05 Integrilin 5 MG 10 1 4 4
J1327 Eptifibatide injection Baxter Healthcare Corporation 00338-9558-10 Eptifibatide 5 MG 100 12 15 180
J1327 Eptifibatide injection Sicor Pharmaceuticals, Inc. 00703-1165-01 Eptifibatide 5 MG 10 1 4 4
J1327 Eptifibatide injection Accord Healthcare Inc. 16729-0259-38 Eptifibatide 5 MG 100 1 15 15
J1327 Eptifibatide injection Accord Healthcare Inc. 16729-0260-03 Eptifibatide 5 MG 10 1 4 4
J1327 Eptifibatide injection Accord Healthcare Inc. 16729-0260-38 Eptifibatide 5 MG 100 1 40 40
J1327 Eptifibatide injection Akorn 17478-0902-10 Eptifibatide 5 MG 10 1 4 4
J1327 Eptifibatide injection Akorn 17478-0902-90 Eptifibatide 5 MG 100 1 40 40
J1327 Eptifibatide injection Akorn 17478-0903-90 Eptifibatide 5 MG 100 1 15 15
J1327 Eptifibatide injection Sagent Pharmaceuticals Inc 25021-0408-51 Eptifibatide 5 MG 100 1 15 15
J1327 Eptifibatide injection Sagent Pharmaceuticals Inc 25021-0409-10 Eptifibatide 5 MG 10 1 4 4
J1327 Eptifibatide injection AuroMedics Pharma LLC 55150-0218-99 Eptifibatide 5 MG 100 1 15 15
J1327 Eptifibatide injection AuroMedics Pharma LLC 55150-0219-10 Eptifibatide 5 MG 10 1 4 4
J1327 Eptifibatide injection AuroMedics Pharma LLC 55150-0220-99 Eptifibatide 5 MG 100 1 40 40
J1327 Eptifibatide injection Mylan Institutional LLC 67457-0629-10 Eptifibatide 5 MG 10 1 4 4
J1327 Eptifibatide injection Mylan Institutional LLC 67457-0630-10 Eptifibatide 5 MG 100 1 40 40
J1327 Eptifibatide injection Mylan Institutional LLC 67457-0631-10 Eptifibatide 5 MG 100 1 15 15
J1327 Eptifibatide injection Amneal Biosciences 70121-1002-01 Eptifibatide 5 MG 10 1 4 4
J1327 Eptifibatide injection Amneal Biosciences 70121-1003-01 Eptifibatide 5 MG 100 1 15 15
J1327 Eptifibatide injection Slate Run Pharmaceuticals 70436-0026-80 Eptifibatide 5 MG 10 1 4 4
J1327 Eptifibatide injection Slate Run Pharmaceuticals 70436-0027-80 Eptifibatide 5 MG 100 1 15 15
J1428 Injection, eteplirsen Sarepta Therapeutics, Inc. 60923-0363-02 EXONDYS 51 10 MG 2 1 10 10
J1428 Injection, eteplirsen Sarepta Therapeutics, Inc. 60923-0284-10 EXONDYS 51 10mL 10 MG 10 1 50 50
J1429 Inj golodirsen 10 mg Sarepta Therapeutics, Inc. 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
J1451 Fomepizole, 15 mg American Regent 00517-0710-01 FOMEPIZOLE 15 MG 1.5 1 100 100
J1451 Fomepizole, 15 mg X-Gen Pharmaceuticals, Inc. 39822-0710-01 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 Clinigen Healthcare Ltd. 76310-0024-01 FOSCAVIR 1000 MG 250 10 6 60
J1573 Hepagam b intravenous, inj Saol Therapeutics 53270-0052-01 CBI HepaGam B 1 mL 0.5 ML 1 1 2 2
J1573 Hepagam b intravenous, inj Saol Therapeutics 70504-0052-02 CBI HepaGam B 1 mL 0.5 ML 1 1 2 2
J1573 Hepagam b intravenous, inj Saol Therapeutics 70504-0053-02 CBI HepaGam B 1 mL 0.5 ML 1 1 2 2
J1573 Hepagam b intravenous, inj Saol Therapeutics 53270-0051-01 CBI HepaGam B 5 mL 0.5 ML 5 1 10 10
J1573 Hepagam b intravenous, inj Saol Therapeutics 70504-0051-02 CBI HepaGam B 5 mL 0.5 ML 5 1 10 10
J1573 Hepagam b intravenous, inj Saol Therapeutics 70504-0054-02 CBI HepaGam B 5 mL 0.5 ML 5 1 10 10
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 53270-0053-01 Nova HepaGam B 1 mL 0.5 ML 1 1 2 2
J1573 Hepagam b intravenous, inj Saol Therapeutics 53270-0054-01 Nova HepaGam B 5 mL 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
J1726 Inj, Makena American Regent 00517-1767-01 MAKENA 10 MG 1 1 25 25
J1726 Inj, Makena AMAG Pharmaceuticals 64011-0243-01 MAKENA 10 mg 5 1 125 125
J1726 Inj, Makena AMAG Pharmaceuticals 64011-0247-02 MAKENA 10 MG 1 1 25 25
J1726 Inj, Makena AMAG Pharmaceuticals 64011-0301-03 Makena Auto Injector 10 MG 1.1 1 27.5 27.5
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 Prasco Laboratories 66993-0038-83 Hydroxyprogesterone Caproate 10 MG 1 1 25 25
J1726 Inj, Makena Prasco Laboratories 66993-0039-01 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 LLC 71225-0104-01 Hydroxyprogesterone Caproate 10 MG 5 1 125 125
J1726 Inj, Makena Slayback Pharma LLC 71225-0105-01 Hydroxyprogesterone Caproate 10 MG 1 1 25 25
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 Shire US, Inc. 54092-0702-02 ICATIBANT 1 MG 3 1 30 30
J1744 Icatibant injection Shire US, Inc. 54092-0702-03 ICATIBANT 1 MG 3 3 30 90
J1830 Interferon beta-1b / .25 MG Bayer HealthCare Pharmaceuticals Inc. 50419-0524-35 Betaseron 0.25 MG 1 14 1 14
J1833 Inj, isavuconazonium sulfate Astellas Pharma US, Inc. 00469-0420-99 CRESEMBA injection 1mg (as sulfate) 1 1 372 372
J2186 Inj., meropenem, vaborbactam Melinta Therapeutics 65293-0009-06 Vabomere (meropenem-vaborbactam) (10 MG/10MG) 20 MG 1 6 100 600
J2186 Inj., meropenem, vaborbactam Melinta Therapeutics 70842-0120-06 Vabomere (meropenem-vaborbactam) (10 MG/10MG) 20 MG 1 6 100 600
J2265 Minocycline hydrochloride Melinta Therapeutics 65293-0014-10 MINOCIN 1 MG 1 10 100 1000
J2265 Minocycline hydrochloride Melinta Therapeutics 70842-0160-10 MINOCIN 1 MG 1 10 100 1000
J2325 Nesiritide injection Scios, Inc. 65847-0205-25 Natrecor 0.1 MG 1 1 15 15
J2326 Injection, nusinersen Biogen 64406-0058-01 Spinraza 0.1 MG 5 1 120 120
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
J2504 Pegademase bovine, 25 iu Leadiant Biosciences, Inc. 57665-0001-01 Adagen 25 IU 1.5 1 15 15
J2547 Injection, peramivir Seqirus USA, Inc. 61364-0181-03 Rapivab 1 MG 20 3 200 600
J2797 Inj., rolapitant, 0.5 mg Tesaro Inc. 69656-0102-10 VARUBI INJECTION 0.5 MG 92.5 1 333 333
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
J3031 Inj., fremanezumab-vfrm 1 mg NuPathe Inc 51759-0204-10 Ajovy 1 MG 1.5 1 225 225
J3246 Tirofiban HCl Medicure Pharma Inc. 25208-0001-04 Aggrastat 0.25 MG 15 1 15 15
J3246 Tirofiban HCl Medicure Pharma Inc. 25208-0002-01 Aggrastat 0.25 MG 100 1 20 20
J3246 Tirofiban HCl Medicure Pharma Inc. 25208-0002-02 Aggrastat 0.25 MG 250 1 50 50
J3246 Tirofiban HCl Medicure Pharma Inc. 25208-0002-03 Aggrastat 0.25 MG 100 1 20 20
J3316 Inj., triptorelin xr 3.75 mg Arbor Pharmaceuticals 24338-0150-20 Triptodur 3.75 MG 1 1 6 6
J3397 Inj., vestronidase alfa-vjbk Ultragenyx Pharmaceutical, Inc 69794-0001-01 Mepsevii 1 MG 5 1 10 10
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 71894-0121-03 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 71894-0120-02 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
J7169 Inj, coagulation faxtor Xa Portola Pharmaceuticals 68953-0102-01 Andexxa 10 MG 1 4 20 80
J7204 Inj recombin esperoct per iu Novo Nordisk® Inc. 00169-8100-01 Esperoct 1 IU 1 1 1 1
J7204 Inj recombin esperoct per iu Novo Nordisk® Inc. 00169-8150-01 Esperoct 1 IU 1 1 1 1
J7204 Inj recombin esperoct per iu Novo Nordisk® Inc. 00169-8200-01 Esperoct 1 IU 1 1 1 1
J7204 Inj recombin esperoct per iu Novo Nordisk® Inc. 00169-8300-01 Esperoct 1 IU 1 1 1 1
J7204 Inj recombin esperoct per iu Novo Nordisk® Inc. 00169-8500-01 Esperoct 1 IU 1 1 1 1
J7318 Inj, durolane 1 mg Bioventus LLC 89130-2020-01 Durolane 1 MG 3 ML 1 EA 1 1 60
J7320 Genvisc, inj, 1mg OrthogenRx Inc. 50653-0006-01 GenVisc 850 1 MG 2.5 1 25 25
J7322 Hymovis, 1 mg Fidia Pharma US, Inc 89122-0496-63 Hymovis 1 mg 3 2 24 48
J7326 Gel-one Zimmer US, Inc. 87541-0300-91 Gel-One PER DOSE 3 1 1 1
J7328 Gelsyn-3 injection 0.1 mg Bioventus LLC 89130-3111-01 Gelsyn-3 0.1 MG 2 1 168 168
J7329 Inj, trivisc 1 mg OrthogenRx Inc. 50653-0006-04 TriVisc 1 MG 2.5 1 25 25
J7331 Synojoynt, inj., 1 mg Gate Pharmaceuticals 57844-0181-13 Synojoynt 1 MG 2 3 20 60
J7332 Inj., triluron, 1 mg Fidia Pharma US, Inc 89122-0879-01 Triluron 1 MG 2 1 20 20
J7333 Visco-3 inj dose Zimmer US, Inc. 87541-0301-31 VISCO-3 per dose 2.5 3 1 3
J7501 Azathioprine parenteral Hikma Pharmaceuticals USA Inc 00143-9566-01 AZATHIOPRINE INJECTION 100 MG 1 1 1 1
J8510 Oral busulfan Aspen Global Inc. 76388-0713-25 Myleran 2 MG 1 25 1 25
J9015 Aldesleukin injection Prometheus Laboratories Inc. 65483-0116-07 Proleukin 1 EA 1 1 1 1
J9057 Inj., copanlisib, 1 mg Bayer HealthCare Pharmaceuticals Inc. 50419-0385-01 ALIQOPA 1 MG 1 1 60 60
J9210 Inj., emapalumab-lzsg, 1 mg Novimmune S.A. 72171-0501-01 Gamifant 1 MG 2 1 10 10
J9210 Inj., emapalumab-lzsg, 1 mg Novimmune S.A. 72171-0505-01 Gamifant 1 MG 10 1 50 50
J9230 Mechlorethamine hcl inj Recordati Rare Diseases 55292-0911-51 Mustargen 10 MG 1 4 1 4
J9246 Inj., evomela, 1 mg Spectrum Pharmaceuticals 68152-0109-00 EVOMELA 50 MG 1 1 1 1
J9246 Inj., evomela, 1 mg Acrotech Biopharma, LLC 72893-0001-01 Evomela 1 MG 1 1 50 50
J9269 Inj. tagraxofusp-erzs 10 mcg Stemline Therapeutics, Inc. 72187-0401-01 Elzonris 10 MCG 1 1 100 100
J9313 Inj., lumoxiti, 0.01 mg AstraZeneca Pharmaceuticals LP 00310-4700-01 Lumoxiti 0.01 MG 1 1 100 100
J9600 Porfimer sodium injection Pinnacle Biologics, Inc. 76128-0155-75 Photofrin 75 MG 1 1 1 1
Q2009 Fosphenytoin inj PE Hikma Pharmaceuticals USA Inc 00641-6136-25 FOSPHENYTOIN SODIUM 50 MG PE/ML 2 25 2 50
Q2009 Fosphenytoin inj PE Hikma Pharmaceuticals USA Inc 00641-6137-10 FOSPHENYTOIN SODIUM 50 MG PE/ML 10 10 10 100
Q2009 Fosphenytoin inj PE Fresenius Kabi USA LLC 63323-0403-02 FOSPHENYTOIN SODIUM 50 MG PE/ML 2 25 2 50
Q2009 Fosphenytoin inj PE Fresenius Kabi USA LLC 63323-0403-10 FOSPHENYTOIN SODIUM 50 MG PE/ML 10 10 10 100
Q2009 Fosphenytoin inj PE Amneal Biosciences 70121-1381-05 FOSPHENYTOIN SODIUM 50 MG PE/ML 2 25 2 50
Q2009 Fosphenytoin inj PE Amneal Biosciences 70121-1390-07 FOSPHENYTOIN SODIUM 50 MG PE/ML 10 10 10 100
Q2009 Fosphenytoin inj PE Pfizer Inc. 00069-5471-02 CEREBYX 50 MG PE/ML 2 25 2 50
Q2009 Fosphenytoin inj PE Pfizer Inc. 00069-5474-02 CEREBYX 50 MG PE/ML 10 10 10 100
Q2009 Fosphenytoin inj PE Pfizer Inc. 00069-6001-21 CEREBYX 50 MG PE/ML 10 10 10 100
Q2009 Fosphenytoin inj PE Pfizer Inc. 00069-6001-25 CEREBYX 50 MG PE/ML 2 25 2 50
Q2017 Teniposide, 50 mg WG Critical Care 44567-0507-01 TENIPOSIDE 50 MG 5 1 1 1
Q2041 Axicabtagene ciloleucel car+ Gilead Sciences, Inc. 71287-0119-01 Yescarta up to 200 million CAR T cells 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
Q9968 Visualization adjunct Mylan Institutional LLC 67457-0220-05 ISOSULFAN BLUE INJECTION 1 MG 5 6 50 300
Q9968 Visualization adjunct Akorn 17478-0504-01 Methylene Blue 1 MG 1 10 10 100
Q9968 Visualization adjunct Akorn 17478-0504-10 Methylene Blue 1 MG 10 10 100 1000
Q9968 Visualization adjunct American Regent 00517-0374-05 Provayblue 1 MG 10 5 50 250
Q9982 Flutemetamol F18 Medi-Physics Inc. 17156-0067-01 Vizamyl up to 5 millicuries 1 1 1 1