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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 67684-2001-01 Dotarem 0.1 ML 10 10 100 1000
A9575 Inj gadoterate meglumi 0.1ml GUERBET LLC 67684-2001-02 Dotarem 0.1 ML 15 10 150 1500
A9575 Inj gadoterate meglumi 0.1ml GUERBET LLC 67684-2001-03 Dotarem 0.1 ML 20 10 200 2000
A9575 Inj gadoterate meglumi 0.1ml GUERBET LLC 67684-2001-04 Dotarem 0.1 ML 100 6 1000 6000
A9575 Inj gadoterate meglumi 0.1ml GUERBET LLC 67684-3001-01 Dotarem 0.1 ML 10 10 100 1000
A9575 Inj gadoterate meglumi 0.1ml GUERBET LLC 67684-3001-02 Dotarem 0.1 ML 15 10 150 1500
A9575 Inj gadoterate meglumi 0.1ml GUERBET LLC 67684-3001-03 Dotarem 0.1 ml 20 mL 10 EA 10 200 2000
A9575 Inj gadoterate meglumi 0.1ml GE HEALTHCARE 00407-2943-12 Gadoterate Meglumine 0.1 ML 10 10 100 1000
A9575 Inj gadoterate meglumi 0.1ml GE HEALTHCARE 00407-2943-17 Gadoterate Meglumine 0.1 ML 15 10 150 1500
A9575 Inj gadoterate meglumi 0.1ml GE HEALTHCARE 00407-2943-22 Gadoterate Meglumine 0.1 ML 20 10 200 2000
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 BAYER HEALTHCARE PHARMACEUTICALS INC. 50419-0188-01 Magnevist 46.9% 1 ML 10 20 10 200
A9579 Gad-base mr contrast nos,1ml BAYER HEALTHCARE PHARMACEUTICALS INC. 50419-0188-02 Magnevist 46.9% 1 ML 20 20 20 400
A9579 Gad-base mr contrast nos,1ml BAYER HEALTHCARE PHARMACEUTICALS INC. 50419-0188-05 Magnevist 46.9% 1 ML 5 20 5 100
A9579 Gad-base mr contrast nos,1ml BAYER HEALTHCARE PHARMACEUTICALS INC. 50419-0188-11 Magnevist 46.9% 1 ML 100 10 100 1000
A9579 Gad-base mr contrast nos,1ml BAYER HEALTHCARE PHARMACEUTICALS INC. 50419-0188-15 Magnevist 46.9% 1 ML 15 20 15 300
A9579 Gad-base mr contrast nos,1ml BAYER HEALTHCARE PHARMACEUTICALS INC. 50419-0188-36 Magnevist 46.9% 1 ML 10 5 10 50
A9579 Gad-base mr contrast nos,1ml BAYER HEALTHCARE PHARMACEUTICALS INC. 50419-0188-37 Magnevist 46.9% 1 ML 15 5 15 75

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 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 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 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 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 Baxter 00944-0490-01 Buminate 50 ML 20 1 0.4 0.4
P9047 Albumin (human), 25%, 50ml Baxter 00944-0493-01 Flexbumin 50 ML 50 1 1 1
P9047 Albumin (human), 25%, 50ml Baxter 00944-0493-02 Flexbumin 50 ML 100 1 1 2
P9047 Albumin (human), 25%, 50ml Grifols 61953-0002-01 Human Albumin Grifols 50 ML 50 1 1 1
P9047 Albumin (human), 25%, 50ml Grifols 61953-0002-02 Human Albumin Grifols 50 ML 100 1 2 2
P9047 Albumin (human), 25%, 50ml Kedrion Biopharma 76179-0025-01 Kedbumin 50 ML 50 1 1 1
P9047 Albumin (human), 25%, 50ml Kedrion Biopharma 76179-0025-02 Kedbumin 50 ML 50 1 1 1
P9047 Albumin (human), 25%, 50ml Kedrion Biopharma 76179-0025-04 Kedbumin 50 ML 100 1 2 2
P9047 Albumin (human), 25%, 50ml Talecris 13533-0684-16 Plasbumin-25 50 ML 20 1 0.4 0.4
P9047 Albumin (human), 25%, 50ml Talecris 13533-0684-20 Plasbumin-25 50 ML 50 1 1 1
P9047 Albumin (human), 25%, 50ml Talecris 13533-0684-71 Plasbumin-25 50 ML 100 1 2 2
P9047 Albumin (human), 25%, 50ml Talecris 13533-0692-16 Plasbumin-25 50 ML 20 1 0.4 0.4
P9047 Albumin (human), 25%, 50ml Talecris 13533-0692-20 Plasbumin-25 50 ML 50 1 1 1
P9047 Albumin (human), 25%, 50ml Talecris 13533-0692-71 Plasbumin-25 50 ML 100 1 2 2
P9047 Albumin (human), 25%, 50ml CSL Behring 44206-0251-05 Alburx 50 ML 50 1 1 1
P9047 Albumin (human), 25%, 50ml CSL Behring 44206-0251-10 Alburx 50 ML 100 1 2 2
P9047 Albumin (human), 25%, 50ml Grifols 68516-5216-07 Albutein 50 ML 50 1 1 1
P9047 Albumin (human), 25%, 50ml Grifols 68516-5216-08 Albutein 50 ML 100 1 2 2
P9047 Albumin (human), 25%, 50ml 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
Allopurinol Sodium MYLAN INSTITUTIONAL LLC 67457-0978-50 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 CIVICA INC 72572-0015-25 Aminocaproic Acid 250 MG 20 25 20 500
Aminocaproic acid PFIZER INC. 00409-4346-73 AMINOCAPROIC ACID INJ 250 MG 20 25 20 500
Aztreonam BRISTOL-MYERS SQUIBB COMPANY 00003-2560-16 AZACTAM 500 MG 1 10 2 20
Aztreonam BRISTOL-MYERS SQUIBB COMPANY 00003-2570-16 AZACTAM 500 MG 1 10 4 40
Aztreonam FRESENIUS KABI 63323-0401-20 Aztreonam 500 MG 1 10 2 20
Aztreonam FRESENIUS KABI 63323-0401-24 Aztreonam 500 MG 1 10 2 20
Aztreonam FRESENIUS KABI 63323-0401-26 Aztreonam 500 MG 1 10 2 20
Aztreonam FRESENIUS KABI 63323-0402-20 Aztreonam 500 MG 1 10 4 40
Aztreonam FRESENIUS KABI 63323-0402-24 Aztreonam 500 MG 1 10 4 40
Aztreonam FRESENIUS KABI 63323-0402-30 Aztreonam 500 MG 1 10 4 40
Esmolol Hydrochloride BAXTER 10019-0075-87 Brevibloc 10 MG 100 1 200 200
Esmolol Hydrochloride BAXTER 10019-0115-01 Brevibloc 10 MG 10 25 10 250
Esmolol Hydrochloride BAXTER 10019-0666-10 BREVIBLOC 10 MG 100 10 200 2000
Esmolol Hydrochloride BAXTER 10019-0668-10 BREVIBLOC 10 MG 100 10 200 2000
Esmolol Hydrochloride BAXTER 10019-0670-10 BREVIBLOC 10 MG 250 10 250 2500
Esmolol Hydrochloride BAXTER 10019-0672-10 BREVIBLOC 10 MG 250 10 250 2500
Esmolol Hydrochloride BAXTER 10019-0055-61 Brevibloc In Nacl 10 MG 250 1 250 250
Bumetanide PFIZER INC. 00409-1412-04 Bumetanide 0.25 MG 4 10 4 40
Bumetanide PFIZER INC. 00409-1412-10 Bumetanide 0.25 MG 10 10 10 100
Bumetanide HIKMA PHARMACEUTICALS USA INC. 00641-6007-10 Bumetanide 0.25 MG 10 10 10 100
Bumetanide HIKMA PHARMACEUTICALS USA INC. 00641-6008-10 Bumetanide 0.25 MG 4 10 4 40
Bumetanide HIKMA PHARMACEUTICALS USA INC. 00641-6161-10 Bumetanide 0.25 MG 4 10 4 40
Bumetanide HIKMA PHARMACEUTICALS USA INC. 00641-6162-10 Bumetanide 0.25 MG 10 10 10 100
Bupivacaine PFIZER INC. 00409-1159-01 Bupivacaine Hcl 1 ML 10 25 10 250
Bupivacaine PFIZER INC. 00409-1159-10 Bupivacaine HCl 1 ML 30 25 30 750
Bupivacaine PFIZER INC. 00409-1160-01 Bupivacaine Hcl 1 ML 50 25 50 1250
Bupivacaine PFIZER INC. 00409-1162-01 Bupivacaine Hcl 1 ML 10 25 10 250
Bupivacaine PFIZER INC. 00409-1162-10 Bupivacaine Hcl 1 ML 30 25 30 750
Bupivacaine PFIZER INC. 00409-1163-01 Bupivacaine Hcl 1 ML 50 25 50 1250
Bupivacaine PFIZER INC. 00409-1165-02 Bupivacaine Hcl 1 ML 30 25 30 750
Bupivacaine PFIZER INC. 00409-1582-10 Bupivacaine Hcl 1 ML 10 10 5 50
Bupivacaine BAXTER 36000-0092-10 Bupivacaine Hcl 1 ML 2 10 2 20
Bupivacaine AUROMEDICS PHARMA LLC 55150-0167-10 Bupivacaine HCl 1 ML 10 25 10 250
Bupivacaine AUROMEDICS PHARMA LLC 55150-0168-30 Bupivacaine HCl 1 ML 30 25 30 750
Bupivacaine AUROMEDICS PHARMA LLC 55150-0169-10 Bupivacaine HCl 1 ML 10 25 10 250
Bupivacaine AUROMEDICS PHARMA LLC 55150-0170-30 Bupivacaine HCl 1 ML 30 25 30 750
Bupivacaine AUROMEDICS PHARMA LLC 55150-0171-10 Bupivacaine HCl 1 ML 10 25 10 250
Bupivacaine AUROMEDICS PHARMA LLC 55150-0172-30 Bupivacaine HCl 1 ML 30 25 30 750
Bupivacaine AUROMEDICS PHARMA LLC 55150-0249-50 Bupivacaine Hcl 1 ML 50 25 50 1250
Bupivacaine AUROMEDICS PHARMA LLC 55150-0250-50 Bupivacaine Hcl 1 ML 50 25 50 1250
Bupivacaine PFIZER INC. 00409-1159-02 BUPIVICAINE HCL 1 ML 30 25 30 750
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 BAXTER 00338-3616-24 Clindamycin in D5W 150 MG 50 24 4 96
Clindamycin Phosphate BAXTER 00338-4114-24 Clindamycin in D5W 150 MG 50 24 6 144
Clindamycin Phosphate BAXTER 00338-9545-24 Clindamycin in D5W 150 MG 50 24 2 48
Clindamycin Phosphate BAXTER 00338-9549-24 Clindamycin in D5W 150 MG 50 24 4 96
Clindamycin Phosphate BAXTER 00338-9553-24 Clindamycin in D5W 150 MG 50 24 6 144
Clindamycin Phosphate SANDOZ 00781-9220-09 Clindamycin in D5W 150 MG 50 24 2 48
Clindamycin Phosphate SANDOZ 00781-9221-09 Clindamycin in D5W 150 MG 50 24 4 96
Clindamycin Phosphate SANDOZ 00781-9222-09 Clindamycin in D5W 150 MG 50 24 6 144
Clindamycin Phosphate 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 00338-3410-24 Clindamycin Phosphate 150 MG 50 24 2 48
Clindamycin Phosphate BAXTER 00338-3612-24 Clindamycin Phosphate 150 MG 50 24 4 96
Clindamycin Phosphate BAXTER 00338-3814-24 Clindamycin Phosphate 150 MG 50 24 6 144
Clindamycin Phosphate SANDOZ 00781-3288-09 Clindamycin Phosphate 150 MG 50 24 2 48
Clindamycin Phosphate SANDOZ 00781-3289-09 Clindamycin Phosphate 150 MG 50 24 4 96
Clindamycin Phosphate SANDOZ 00781-3290-09 Clindamycin Phosphate 150 MG 50 24 6 144
Clindamycin Phosphate SAGENT PHARMACEUTICALS INC 25021-0115-02 Clindamycin Phosphate 150 MG 2 25 2 50
Clindamycin Phosphate SAGENT PHARMACEUTICALS INC 25021-0115-04 Clindamycin Phosphate 150 MG 4 25 4 100
Clindamycin Phosphate SAGENT PHARMACEUTICALS INC 25021-0115-06 Clindamycin Phosphate 150 MG 6 25 6 150
Clindamycin Phosphate SAGENT PHARMACEUTICALS INC 25021-0115-51 Clindamycin Phosphate 150 MG 60 1 60 60
Clindamycin Phosphate ALVOGEN 47781-0459-68 Clindamycin Phosphate 150 MG 2 25 2 50
Clindamycin Phosphate ALVOGEN 47781-0460-68 Clindamycin Phosphate 150 MG 4 25 4 100
Clindamycin Phosphate ALVOGEN 47781-0461-68 Clindamycin Phosphate 150 MG 6 25 6 150
Clindamycin Phosphate ALVOGEN 47781-0465-70 Clindamycin Phosphate 150 MG 60 1 60 60
Clindamycin Phosphate ALVOGEN 47781-0619-69 Clindamycin Phosphate 150 MG 2 25 2 50
Clindamycin Phosphate ALVOGEN 47781-0620-69 Clindamycin Phosphate 150 MG 4 25 4 100
Clindamycin Phosphate ALVOGEN 47781-0621-69 Clindamycin Phosphate 150 MG 6 25 6 150
Clindamycin Phosphate FRESENIUS KABI 63323-0282-02 Clindamycin Phosphate 150 MG 2 25 2 50
Clindamycin Phosphate FRESENIUS KABI 63323-0282-04 Clindamycin Phosphate 150 MG 4 25 4 100
Clindamycin Phosphate FRESENIUS KABI 63323-0282-06 Clindamycin Phosphate 150 MG 6 25 6 150
Clindamycin Phosphate FRESENIUS KABI 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 72611-0634-25 Clindamycin Phosphate 150 MG 2 25 2 50
Clindamycin Phosphate ALMAJECT 72611-0639-25 Clindamycin Phosphate 150 MG 4 25 4 100
Clindamycin Phosphate ALMAJECT 72611-0642-25 Clindamycin Phosphate 150 MG 6 25 6 150
Clindamycin Phosphate ALMAJECT 72611-0645-55 Clindamycin Phosphate 150 MG 60 5 60 300
Immune Globulin (Cutaquig) PFIZER INC. 00069-1061-02 Cutaquig 100 MG 6 1 10 10
Immune Globulin (Cutaquig) PFIZER INC. 00069-1476-02 Cutaquig 100 MG 12 1 20 20
Immune Globulin (Cutaquig) PFIZER INC. 00069-1509-02 Cutaquig 100 MG 24 1 40 40
Immune Globulin (Cutaquig) PFIZER INC. 00069-1965-02 Cutaquig 100 MG 48 1 80 80
Immune Globulin (Cutaquig) OCTAPHARMA 68982-0810-01 Cutaquig 100 MG 6 1 10 10
Immune Globulin (Cutaquig) OCTAPHARMA 68982-0810-03 Cutaquig 100 MG 12 1 20 20
Immune Globulin (Cutaquig) OCTAPHARMA 68982-0810-04 Cutaquig 100 MG 20 1 33 33
Immune Globulin (Cutaquig) OCTAPHARMA 68982-0810-05 Cutaquig 100 MG 24 1 40 40
Immune Globulin (Cutaquig) OCTAPHARMA 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 70860-0301-05 Diltiazem HCl 5 MG 5 10 5 50
Diltiazem Hydrochloride ATHENEX 70860-0301-10 Diltiazem HCl 5 MG 10 10 10 100
Diltiazem Hydrochloride ATHENEX 70860-0301-25 Diltiazem HCl 5 MG 25 10 25 250
Doxycycline Hyclate FRESENIUS KABI 63323-0130-11 Doxycycline Hyclate 100 MG 1 10 1 10
Doxycycline Hyclate FRESENIUS KABI 63323-0130-13 Doxycycline Hyclate 100 MG 1 10 1 10
Doxycycline Hyclate FRESENIUS KABI 63323-0130-17 Doxycycline Hyclate 100 MG 1 10 1 10
Doxycycline Hyclate MYLAN INSTITUTIONAL LLC 67457-0437-10 Doxycycline Hyclate 100 MG 1 10 1 10
Doxycycline Hyclate ZYDUS PHARMACEUTICALS 68382-0910-10 Doxycycline Hyclate 100 MG 1 10 1 10
Esmolol Hydrochloride BAXTER 10019-0120-01 Esmolol HCl 10 MG 10 25 10 250
Esmolol Hydrochloride SAGENT PHARMACEUTICALS INC 25021-0308-84 Esmolol HCl 10 MG 250 10 250 2500
Esmolol Hydrochloride SAGENT PHARMACEUTICALS INC 25021-0309-82 Esmolol HCl 10 MG 100 10 200 2000
Esmolol Hydrochloride SAGENT PHARMACEUTICALS INC 25021-0314-10 Esmolol HCl 10 MG 10 10 10 100
Esmolol Hydrochloride WG CRITICAL CARE 44567-0811-10 Esmolol HCl 10 MG 250 10 250 2500
Esmolol Hydrochloride WG CRITICAL CARE 44567-0812-10 Esmolol Hcl 10 MG 100 10 200 2000
Esmolol Hydrochloride AUROMEDICS PHARMA LLC 55150-0194-10 Esmolol Hcl 10 MG 10 25 10 250
Esmolol Hydrochloride FRESENIUS KABI 63323-0652-10 Esmolol Hcl 10 MG 10 25 10 250
Esmolol Hydrochloride MYLAN INSTITUTIONAL LLC 67457-0182-10 Esmolol Hcl 10 MG 10 10 10 100
Esmolol Hydrochloride MYLAN INSTITUTIONAL LLC 67457-0657-25 Esmolol HCl 10 MG 250 10 250 2500
Esmolol Hydrochloride MYLAN INSTITUTIONAL LLC 67457-0658-10 Esmolol Hcl 10 MG 100 10 200 2000
Famotidine HIKMA PHARMACEUTICALS USA INC. 00641-6021-10 Famotidine 10 MG 20 10 20 200
Famotidine HIKMA PHARMACEUTICALS USA INC. 00641-6022-25 Famotidine 10 MG 2 25 2 50
Famotidine HIKMA PHARMACEUTICALS USA INC. 00641-6023-25 Famotidine 10 MG 4 25 4 100
Famotidine FRESENIUS KABI 63323-0738-09 Famotidine 10 MG 4 10 4 40
Famotidine FRESENIUS KABI 63323-0738-20 Famotidine 10 MG 20 10 20 200
Famotidine FRESENIUS KABI 63323-0739-12 Famotidine 10 MG 2 25 2 50
Famotidine FRESENIUS KABI 63323-0739-16 Famotidine 10 MG 2 25 2 50
Famotidine MYLAN INSTITUTIONAL LLC 67457-0448-43 Famotidine 10 MG 4 10 4 40
Famotidine MYLAN INSTITUTIONAL LLC 67457-0457-20 Famotidine 10 MG 20 10 20 200
Famotidine ATHENEX 70860-0751-02 Famotidine 10 MG 2 25 2 50
Famotidine Athenex Pharmaceutical Division, Ll 70860-0753-20 Famotidine 10 MG 20 10 20 200
Famotidine BAXTER 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 36000-0148-10 Flumazenil 0.1 MG 5 10 5 50
Flumazenil BAXTER 36000-0149-10 Flumazenil 0.1 MG 10 10 10 100
Flumazenil FRESENIUS KABI 63323-0424-05 Flumazenil 0.1 MG 5 10 5 50
Flumazenil FRESENIUS KABI 63323-0424-10 Flumazenil 0.1 MG 10 1 10 10
Flumazenil MYLAN INSTITUTIONAL LLC 67457-0447-53 Flumazenil 0.1 MG 5 10 5 50
Folic Acid X-GEN PHARMACEUTICALS INC 39822-1100-01 Folic Acid 5 MG 10 1 10 10
Folic Acid FRESENIUS KABI 63323-0184-10 Folic Acid 5 MG 10 1 10 10
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 63323-0578-11 Glycopyrrolate (injection) 0.2 MG 1 25 1 25
Glycopyrrolate injection FRESENIUS KABI 63323-0578-12 Glycopyrrolate (injection) 0.2 MG 2 25 2 50
Glycopyrrolate injection HIKMA PHARMACEUTICALS USA INC. 00143-9584-10 Glycopyrrolate INJECTION 0.2 MG 20 10 20 200
Glycopyrrolate injection HIKMA PHARMACEUTICALS USA INC. 00143-9585-25 Glycopyrrolate INJECTION 0.2 MG 5 25 5 125
Glycopyrrolate injection HIKMA PHARMACEUTICALS USA INC. 00143-9586-25 Glycopyrrolate INJECTION 0.2 MG 2 25 2 50
Glycopyrrolate injection HIKMA PHARMACEUTICALS USA INC. 00143-9587-25 Glycopyrrolate INJECTION 0.2 MG 1 25 1 25
Glycopyrrolate injection HIKMA PHARMACEUTICALS USA INC. 00143-9679-10 Glycopyrrolate INJECTION 0.2 MG 20 10 20 200
Glycopyrrolate injection HIKMA PHARMACEUTICALS USA INC. 00143-9680-25 Glycopyrrolate INJECTION 0.2 MG 5 25 5 125
Glycopyrrolate injection HIKMA PHARMACEUTICALS USA INC. 00143-9681-25 Glycopyrrolate INJECTION 0.2 MG 2 25 2 50
Glycopyrrolate injection HIKMA PHARMACEUTICALS USA INC. 00143-9682-25 Glycopyrrolate INJECTION 0.2 MG 1 25 1 25
Glycopyrrolate injection SANDOZ 00781-3825-96 Glycopyrrolate Injection 0.2 MG 1 25 1 25
Glycopyrrolate injection SANDOZ 00781-3827-96 Glycopyrrolate Injection 0.2 MG 2 25 2 50
Glycopyrrolate injection SANDOZ 00781-3829-96 Glycopyrrolate Injection 0.2 MG 5 25 5 125
Glycopyrrolate injection SANDOZ 00781-3831-95 Glycopyrrolate Injection 0.2 MG 20 10 20 200
Glycopyrrolate injection A-S MEDICATION SOLUTIONS 50090-4513-00 Glycopyrrolate Injection 0.2 MG 1 1 1 1
Glycopyrrolate injection A-S MEDICATION SOLUTIONS 50090-5226-00 Glycopyrrolate Injection 0.2 MG 1 25 1 25
Glycopyrrolate injection AUROMEDICS PHARMA LLC 55150-0292-01 Glycopyrrolate Injection 0.2 MG 1 25 1 25
Glycopyrrolate injection AUROMEDICS PHARMA LLC 55150-0293-02 Glycopyrrolate Injection 0.2 MG 2 25 2 50
Glycopyrrolate injection AUROMEDICS PHARMA LLC 55150-0294-05 Glycopyrrolate Injection 0.2 MG 5 25 5 125
Glycopyrrolate injection AUROMEDICS PHARMA LLC 55150-0295-20 Glycopyrrolate Injection 0.2 MG 20 25 20 500
Glycopyrrolate injection APOTEX CORP. 60505-6179-05 Glycopyrrolate Injection 0.2 MG 1 25 1 25
Glycopyrrolate injection APOTEX CORP. 60505-6180-05 Glycopyrrolate Injection 0.2 MG 2 25 2 50
Glycopyrrolate injection APOTEX CORP. 60505-6181-05 Glycopyrrolate Injection 0.2 MG 5 25 5 125
Glycopyrrolate injection APOTEX CORP. 60505-6182-04 Glycopyrrolate Injection 0.2 MG 20 10 20 200
Glycopyrrolate injection FRESENIUS KABI 63323-0578-01 Glycopyrrolate Injection 0.2 MG 1 25 1 25
Glycopyrrolate injection FRESENIUS KABI 63323-0578-02 Glycopyrrolate Injection 0.2 MG 2 25 2 50
Glycopyrrolate injection FRESENIUS KABI 63323-0578-05 Glycopyrrolate Injection 0.2 MG 5 25 5 125
Glycopyrrolate injection FRESENIUS KABI 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 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 76045-0203-10 Glycopyrrolate Injection 0.2 MG 1 24 1 24
Glycopyrrolate injection FRESENIUS KABI 76045-0203-20 Glycopyrrolate Injection 0.2 MG 2 24 2 48
Paliperidone Palmitate (Invega Trinza) JANSSEN PHARMACEUTICALS, INC. 50458-0606-01 INVEGA TRINZA 1 MG 0.875 1 273 273
Paliperidone Palmitate (Invega Trinza) JANSSEN PHARMACEUTICALS, INC. 50458-0607-01 INVEGA TRINZA 1 MG 1.315 1 410 410
Paliperidone Palmitate (Invega Trinza) JANSSEN PHARMACEUTICALS, INC. 50458-0608-01 INVEGA TRINZA 1 MG 1.75 1 546 546
Paliperidone Palmitate (Invega Trinza) JANSSEN PHARMACEUTICALS, INC. 50458-0609-01 INVEGA TRINZA 1 MG 2.625 1 819 819
Coagulation Factor IX, Recombinant (Ixinity) 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 47781-0586-29 Labetalol Hcl 5 MG 20 1 20 20
Labetalol Hcl ALVOGEN 47781-0586-56 Labetalol Hcl 5 MG 40 1 40 40
Labetalol Hcl 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 36000-0033-10 Metoprolol Tartrate 1 MG 5 10 5 50
Metoprolol Tartrate ALVOGEN 47781-0587-17 Metoprolol Tartrate 1 MG 5 10 5 50
Metoprolol Tartrate FRESENIUS KABI 63323-0660-05 METOPROLOL TARTRATE 1 MG 5 10 5 50
Metoprolol Tartrate ATHENEX 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
Metoprolol Tartrate CIVICA INC 72572-0420-10 Metoprolol Tartrate 1 MG 5 10 5 50
Metoprolol Tartrate ALMAJECT 72611-0740-10 Metoprolol Tartrate 1 MG 5 10 5 50
Metronidazole inj PFIZER INC. 00409-7811-24 METRONIDAZL 500MG 500 MG 100 24 1 24
Metronidazole inj BAXTER 00338-9541-24 METRONIDAZOLE 500 MG 100 24 1 24
Metronidazole inj BAXTER 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 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 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 00338-1047-02 Nitroglycerin In D5W 5 MG 250 12 5 60
Nitroglycerin BAXTER 00338-1049-02 Nitroglycerin In D5W 5 MG 250 12 10 120
Nitroglycerin BAXTER 00338-1051-02 Nitroglycerin In D5W 5 MG 250 12 20 240
Olanzapine short acting intramuscular injection AMERICAN REGENT 00517-0955-01 Olanzapine (Immediate Release) 0.5 MG 1 1 20 20
Olanzapine short acting intramuscular injection SANDOZ 00781-3159-72 Olanzapine (Immediate Release) 0.5 MG 1 1 20 20
Olanzapine short acting intramuscular injection SANDOZ 00781-9105-72 Olanzapine (Immediate Release) 0.5 MG 1 1 20 20
Immune Globulin (Panzyga) PFIZER INC. 00069-1109-02 PANZYGA 500 MG 25 1 5 5
Immune Globulin (Panzyga) PFIZER INC. 00069-1224-02 PANZYGA 500 MG 50 1 10 10
Immune Globulin (Panzyga) PFIZER INC. 00069-1312-02 PANZYGA 500 MG 100 1 20 20
Immune Globulin (Panzyga) PFIZER INC. 00069-1415-02 PANZYGA 500 MG 200 1 40 40
Immune Globulin (Panzyga) PFIZER INC. 00069-1558-02 PANZYGA 500 MG 300 1 60 60
Immune Globulin (Panzyga) PFIZER INC. 68982-0820-02 PANZYGA 500 MG 25 1 5 5
Immune Globulin (Panzyga) PFIZER INC. 68982-0820-03 PANZYGA 500 MG 50 1 10 10
Immune Globulin (Panzyga) PFIZER INC. 68982-0820-04 PANZYGA 500 MG 100 1 20 20
Immune Globulin (Panzyga) PFIZER INC. 68982-0820-05 PANZYGA 500 MG 200 1 40 40
Immune Globulin (Panzyga) PFIZER INC. 68982-0820-06 PANZYGA 500 MG 300 1 60 60
Rifampin FRESENIUS KABI 63323-0351-20 Rifampin 600 MG 1 1 1 1
Rifampin MYLAN INSTITUTIONAL LLC 67457-0445-60 Rifampin 600 MG 1 1 1 1
Bupivacaine FRESENIUS KABI 63323-0465-57 Sensorcaine 1 ML 50 25 50 1250
Bupivacaine FRESENIUS KABI 63323-0467-57 Sensorcaine 1 ML 50 25 50 1250
Bupivacaine FRESENIUS KABI 63323-0472-17 Sensorcaine 1 ML 10 25 10 250
Bupivacaine FRESENIUS KABI 63323-0464-17 SENSORCAINE-MPF 1 ML 10 25 10 250
Bupivacaine FRESENIUS KABI 63323-0464-37 SENSORCAINE-MPF 1 ML 30 25 30 750
Bupivacaine FRESENIUS KABI 63323-0466-17 Sensorcaine-MPF 1 ML 10 25 10 250
Bupivacaine FRESENIUS KABI 63323-0466-37 SENSORCAINE-MPF 1 ML 30 25 30 750
Bupivacaine FRESENIUS KABI 63323-0472-37 SENSORCAINE-MPF 1 ML 30 25 30 750
Sodium Chloride, Hypertonic (3% - 5% infusion) B. BRAUN MEDICAL INC. 00264-7805-10 Sodium Chloride 250 CC 500 24 2 48
Sodium Chloride, Hypertonic (3% - 5% infusion) B. BRAUN MEDICAL INC. 00264-7806-10 Sodium Chloride 250 CC 500 24 2 48
Sodium Chloride, Hypertonic (3% - 5% infusion) BAXTER 00338-0054-03 Sodium Chloride 250 CC 500 1 2 2
Sodium Chloride, Hypertonic (3% - 5% infusion) BAXTER 00338-0056-03 Sodium Chloride 250 CC 500 1 2 2
Sulfamethoxazole-Trimethoprim SICOR PHARMACEUTICALS, INC. 00703-9503-03 Sulfamethoxazole-Trimethoprim 400-80 MG 50 10 10 100
Sulfamethoxazole-Trimethoprim SICOR PHARMACEUTICALS, INC. 00703-9514-03 Sulfamethoxazole-Trimethoprim 400-80 MG 100 10 20 200
Sulfamethoxazole-Trimethoprim SICOR PHARMACEUTICALS, INC. 00703-9514-93 Sulfamethoxazole-Trimethoprim 400-80 MG 10 10 2 20
Sulfamethoxazole-Trimethoprim SICOR PHARMACEUTICALS, INC. 00703-9526-01 Sulfamethoxazole-Trimethoprim 400-80 MG 30 1 6 6
Sulfamethoxazole-Trimethoprim MYLAN INSTITUTIONAL LLC 67457-0778-05 Sulfamethoxazole-Trimethoprim 400-80 MG 5 10 1 10
Sulfamethoxazole-Trimethoprim MYLAN INSTITUTIONAL LLC 67457-0779-30 Sulfamethoxazole-Trimethoprim 400-80 MG 30 1 6 6
Sulfamethoxazole-Trimethoprim MYLAN INSTITUTIONAL LLC 67457-0921-05 Sulfamethoxazole-Trimethoprim 400-80 MG 5 10 1 10
Sulfamethoxazole-Trimethoprim MYLAN INSTITUTIONAL LLC 67457-0922-30 Sulfamethoxazole-Trimethoprim 400-80 MG 30 1 6 6
Vasopressin PAR PHARMACEUTICAL, INC 42023-0164-25 Vasopressin 20 UNITS 1 25 1 25
Vasopressin PAR PHARMACEUTICAL, INC 42023-0164-10 VASOSTRICT 20 UNITS 1 10 1 10
Glucarpidase BTG INTERNATIONAL INC. 50633-0210-11 Voraxaze 10 UNITS 1 1 100 100

Outpatient Prospective Payment System

HCPCS Description Labeler name NDC Drug name Dosage Package size Package quantity Billable units Billable units / pkg
90396 Varicella-zoster ig im SAOL THERAPEUTICS 70257-0126-51 VARIZIG (Liquid) 125 IU 1.2 1 1 1
90396 Varicella-zoster ig im SAOL THERAPEUTICS 70504-0126-02 VARIZIG (Liquid) 125 IU 1.2 1 1 1
A9513 Lutetium Lu 177 dotatat ther ADVANCED ACCELERATOR APPLICATIONS 69488-0003-01 LUTATHERA 1 MCI 20 1 200 200
A9543 Y90 ibritumomab, rx SPECTRUM PHARMACEUTICALS 68152-0103-03 ZEVALIN Y-90 UP TO 40 millicuries 1 1 1 1
A9543 Y90 ibritumomab, rx ACROTECH BIOPHARMA 72893-0007-04 ZEVALIN Y-90 UP TO 40 millicuries 1 1 1 1
A9590 Iodine i-131 therapeutic PROGENICS PHARMACEUTICALS, INC. 71258-0015-02 AZEDRA dosimetric 1 mCi 1 1 1 1
A9590 Iodine i-131 therapeutic PROGENICS PHARMACEUTICALS, INC. 71258-0015-22 AZEDRA therapeutic 1 mCi 1 1 1 1
A9591 Fluoroestradiol F 18 ZIONEXA US CORPORATION 72874-0001-01 Cerianna 1 mCi 50 1 6 6
A9592 Copper cu 64 dotatate diag CURIUM US LLC 69945-0064-01 Detectnet 1 mCi 4 1 4 4
A9600 Sr89 strontium GE HEALTHCARE 17156-0524-01 METASTRON PER MILLICURIE 4 1 4 4
A9600 Sr89 strontium Q BIOMED 72928-0089-01 Strontium Chloride Sr 89 PER MILLICURIE 4 1 1 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 LIFESCIENES 64950-0359-04 Goprelto 1 MG 4 1 160 160
C9046 Cocaine hcl nasal solution GENUS LIFESCIENES 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
C9065 Romidepsin non-lyophilized SICOR PHARMACEUTICALS, INC. 00703-4004-01 Romidepsin 1 MG 5.5 1 27.5 27.5
C9067 Gallium ga-68 Dotatoc UIHC-PET IMAGING CENTER 24417-0681-30 Dotatoc Ga 68 0.01 mCi 14 1 400 400
C9075 Injection, casimersen, 10 mg SAREPTA THERAPEUTICS, INC. 60923-0227-02 Amondys 45 10 MG 2 1 10 10
C9076 lisocabtagene car pos t JUNO THERAPEUTICS, INC., A BRISTOL- 73153-0900-01 Breyanzi Up to 110 million CAR-positive viable T cells, per therapeutic d 1 1 1 1
C9077 Inj cabotegravir/rilpivirine GLAXOSMITHKLINE 49702-0240-15 Cabenuva 2 MG - 3 MG 6 1 300 300
C9077 Inj cabotegravir/rilpivirine VIIV HEALTHCARE 49702-0253-15 Cabenuva 2 MG - 3 MG 4 1 200 200
C9078 Inj, trilaciclib, 1 mg G1 THERAPEUTICS, INC. 73462-0101-01 Cosela 1 MG 1 1 300 300
C9079 Inj, evinacumab-dgnb, 5 mg REGENERON PHARMACEUTICALS. INC. 61755-0010-01 Evkeeza 5 MG 8 1 240 240
C9079 Inj, evinacumab-dgnb, 5 mg REGENERON PHARMACEUTICALS. INC. 61755-0013-01 Evkeeza 5 MG 2.3 1 69 69
C9080 Inj, melphalan flufen, 1 mg ONCOPEPTIDES, INC. 73657-0020-01 Pepaxto 1 MG 1 1 20 20
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 00944-8503-02 ARTISS 2 ML 1 1 1 1
C9250 Artiss fibrin sealant BAXTER 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
C9462 Injection, delafloxacin MELINTA THERAPEUTICS, INC. 70842-0102-03 Baxdela 1 MG 1 10 300 3000
C9482 Sotalol hydrochloride IV ALTATHERA PHARMACEUTICALS 69724-0112-10 Sotalol 1MG 10 1 150 150
C9488 Conivaptan HCL CUMBERLAND PHARMACEUTICALS 66220-0160-10 VAPRISOL 1 MG 100 1 20 20
J0135 Adalimumab injection ABBVIE US, LLC 00074-3799-02 Humira 20 MG 0.8 2 2 4
J0135 Adalimumab injection ABBVIE US, LLC 00074-4339-02 Humira 20 MG 0.8 2 2 4
J0135 Adalimumab injection ABBVIE US, LLC 00074-4339-06 Humira 20 MG 0.8 6 2 12
J0135 Adalimumab injection ABBVIE US, LLC 00074-4339-07 Humira 20 MG 0.8 4 2 8
J0207 Amifostine CUMBERLAND PHARMACEUTICALS 66220-0017-03 Ethyol 500 MG 1 3 1 3
J0224 Inj. lumasiran, 0.5 mg ALNYLAM PHARMACEUTICALS, INC. 71336-1002-01 Oxlumo 0.5 MG 0.5 1 189 189
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
J0693 Inj., cefiderocol, 5 mg SHIONOGI INC 59630-0266-10 Fetroja 5 MG 1 10 200 2000
J0716 Centruroides immune f(ab) RARE DISEASE THERAPEUTICS, INC. 66621-0150-02 ANASCORP UP TO 120MG 1 1 1 1
J0884 Argatroban esrd dialysis 1mg NOVARTIS PHARMACEUTICALS CORPORATION 00078-0930-61 Argatroban 1 MG 2.5 1 250 250
J0884 Argatroban esrd dialysis 1mg HIKMA PHARMACEUTICALS USA INC. 00143-9288-01 Argatroban 1 MG 2.5 1 250 250
J0884 Argatroban esrd dialysis 1mg HIKMA PHARMACEUTICALS USA INC. 00143-9377-01 Argatroban 1 MG 50 1 50 50
J0884 Argatroban esrd dialysis 1mg HIKMA PHARMACEUTICALS USA INC. 00143-9559-01 ARGATROBAN 1 MG 50 1 50 50
J0884 Argatroban esrd dialysis 1mg HIKMA PHARMACEUTICALS USA INC. 00143-9674-01 Argatroban 1 MG 2.5 1 250 250
J0884 Argatroban esrd dialysis 1mg PFIZER INC. 00409-1140-01 Argatroban 1 MG 2.5 1 250 250
J0884 Argatroban esrd dialysis 1mg SANDOZ 00781-3285-12 ARGATROBAN 1 MG 125 2 125 250
J0884 Argatroban esrd dialysis 1mg SANDOZ 00781-3314-95 ARGATROBAN 1 MG 50 10 50 500
J0884 Argatroban esrd dialysis 1mg SANDOZ 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 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
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 70382-0204-01 Dextenza 0.1 MG 1 1 4 4
J1096 Dexametha opth insert 0.1 mg OCULAR THERAPEUTIX 70382-0204-10 Dextenza 0.1 MG 1 10 4 40
J1097 Phenylep ketorolac opth soln OMEROS CORPORATION 62225-0600-04 Omidria (phenylephrine 1% + ketorolac 0.3% irrigation) 1 ML 4 4 4 16
J1201 Inj. cetirizine hcl 0.5mg TERSERA THERAPEUTICS LLC 70720-0100-10 QUZYTTIR 0.5 mg 1 1 20 20
J1201 Inj. cetirizine hcl 0.5mg TERSERA THERAPEUTICS LLC 70720-0100-25 QUZYTTIR 0.5 mg 1 25 20 500
J1427 Inj. viltolarsen NS PHARMA INC 73292-0011-01 Viltepso 10 MG 5 1 25 25
J1429 Inj golodirsen 10 mg SAREPTA 60923-0465-02 Vyondys 53 10 MG 2 1 10 10
J1438 Etanercept injection AMGEN USA, INC. 58406-0425-34 Enbrel 25 MG 1 4 1 4
J1438 Etanercept injection AMGEN USA, INC. 58406-0445-04 Enbrel 25 MG 1 4 2 8
J1438 Etanercept injection AMGEN USA, INC. 58406-0455-04 Enbrel 25 MG 0.5 4 1 4
J1438 Etanercept injection AMGEN USA, INC. 58406-0435-04 Enbrel (Etanercept) 25 MG 1 4 2 8
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 Fresenius Kabi Usa, Llc 63323-0875-50 Foscarnet Sodium 1000 MG 250 1 6 6
J1455 Foscarnet sodium injection CLINIGEN HEALTHCARE LTD. 76310-0024-01 FOSCAVIR 1000 MG 250 10 6 60
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 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 70257-0053-51 Hepagam B 0.5 ML 1 1 2 2
J1573 Hepagam b intravenous, inj SAOL THERAPEUTICS 70257-0054-51 Hepagam B 0.5 ML 5 1 10 10
J1595 Injection glatiramer acetate TEVA NEUROSCIENCE, INC. 68546-0317-30 Copaxone 20 MG 1 30 1 30
J1595 Injection glatiramer acetate TEVA NEUROSCIENCE, INC. 68546-0325-12 Copaxone 20 MG 1 12 2 24
J1628 Inj., guselkumab, 1 mg JANSSEN BIOTECH, INC. 57894-0640-01 Tremfya 1 MG 1 1 100 100
J1628 Inj., guselkumab, 1 mg JANSSEN BIOTECH, INC. 57894-0640-11 Tremfya 1 MG 1 1 100 100
J1632 Inj, brexanolone SAGE THERAPEUTICS 72152-0547-20 Zulresso 1 MG 20 1 100 100
J1726 Inj, Makena AMERICAN REGENT 00517-1767-01 MAKENA 10 MG 1 1 25 25
J1726 Inj, Makena AMAG PHARMACEUTICALS, INC. 64011-0243-01 MAKENA 10 mg 5 1 125 125
J1726 Inj, Makena AMAG PHARMACEUTICALS, INC. 64011-0247-02 MAKENA 10 MG 1 1 25 25
J1726 Inj, Makena AMAG PHARMACEUTICALS, INC. 64011-0301-03 Makena Auto Injector 10 MG 1.1 1 27.5 27.5
J1726 Inj, Makena AMERICAN REGENT 00517-1791-01 Hydroxyprogesterone Caproate 10 MG 1 1 25 25
J1726 Inj, Makena AUROMEDICS PHARMA LLC 55150-0309-01 Hydroxyprogesterone Caproate 10 MG 1 1 25 25
J1726 Inj, Makena AUROMEDICS PHARMA LLC 55150-0310-01 Hydroxyprogesterone Caproate 10 MG 5 1 125 125
J1726 Inj, Makena 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 71225-0104-01 Hydroxyprogesterone Caproate 10 MG 5 1 125 125
J1726 Inj, Makena SLAYBACK PHARMA 71225-0105-01 Hydroxyprogesterone Caproate 10 MG 1 1 25 25
J1738 Injection, meloxicam BAUDAX BIO, INC. 71518-0001-01 ANJESO 1 MG 1 1 30 30
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
J1744 Icatibant injection FRESENIUS KABI 63323-0574-86 ICATIBANT 1 MG 3 1 30 30
J1744 Icatibant injection FRESENIUS KABI 63323-0574-93 ICATIBANT 1 MG 3 3 30 90
J1744 Icatibant injection CIPLA USA INC. 69097-0664-34 ICATIBANT 1 MG 3 1 30 30
J1744 Icatibant injection CIPLA USA INC. 69097-0664-68 ICATIBANT 1 MG 3 3 30 90
J1823 Inj. inebilizumab-cdon, 1 mg VIELA BIO, INC. 72677-0551-01 Uplizna 1 MG 10 3 100 300
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 10 372 3720
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, INC. 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, INC. 70842-0160-10 MINOCIN 1 MG 1 10 100 1000
J2326 Injection, nusinersen BIOGEN 64406-0058-01 Spinraza 0.1 MG 5 1 120 120
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
J2547 Injection, peramivir SEQIRUS USA, INC. 61364-0181-03 Rapivab 1 MG 20 3 200 600
J2547 Injection, peramivir BIOCRYST 72769-0181-03 Rapivab 1 MG 20 3 200 600
J2840 Injection, sebelipase alfa ALEXION PHARMACEUTICALS 25682-0007-01 Kanuma 1 MG 10 1 20 20
J2850 Inj secretin synthetic human CHIRHOCLIN, INC. 67066-0005-01 CHIRHOSTIM 1 MCG 1 1 16 16
J2993 Reteplase injection CHIESI USA, INC. 10122-0141-02 RETAVASE KIT 18.1 MG 1 2 1 2
J3031 Inj., fremanezumab-vfrm 1 mg NUPATHE INC 51759-0202-10 Ajovy 1 MG 1.5 1 225 225
J3031 Inj., fremanezumab-vfrm 1 mg Teva Pharmaceuticals Usa 51759-0202-22 Ajovy 1 MG 1.5 3 225 675
J3031 Inj., fremanezumab-vfrm 1 mg NUPATHE INC 51759-0204-10 Ajovy 1 MG 1.5 1 225 225
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
J3398 Inj luxturna 1 billion vec g SPARK THERAPEUTICS, INC. 71394-0415-01 LUXTURNA 1 billion vector genomes 0.5 1 150 150
J7168 Prothrombin complex kcentra CSL BEHRING LLC 63833-0386-02 Kcentra 1 IU 1 1 1 1
J7168 Prothrombin complex kcentra CSL BEHRING LLC 63833-0387-02 Kcentra 1 IU 1 1 1 1
J7169 Inj andexxa, 10 mg PORTOLA PHARMACEUTICALS 68953-0101-01 Andexxa 10 MG 1 4 10 40
J7169 Inj andexxa, 10 mg PORTOLA PHARMACEUTICALS 68953-0102-01 Andexxa 10 MG 1 4 20 80
J7169 Inj andexxa, 10 mg ALEXION PHARMACEUTICALS 69853-0102-01 Andexxa 10 MG 1 4 20 80
J7316 Inj, Ocriplasmin, 0.125 mg THROMBOGENICS, INC. 24856-0002-01 JETREA 0.125 MG 0.3 1 3 3
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
J7352 Afamelanotide implant, 1 mg CLINUVEL 73372-0116-01 Scenesse 1 MG 1 1 16 16
J7501 Azathioprine parenteral HIKMA PHARMACEUTICALS USA INC. 00143-9566-01 AZATHIOPRINE INJECTION 100 MG 1 1 1 1
J9057 Inj., copanlisib, 1 mg BAYER HEALTHCARE PHARMACEUTICALS INC. 50419-0385-01 ALIQOPA 1 MG 1 1 60 60
J9246 Inj., evomela, 1 mg SPECTRUM PHARMACEUTICALS 68152-0109-00 EVOMELA 50 MG 1 1 1 1
J9246 Inj., evomela, 1 mg ACROTECH BIOPHARMA 72893-0001-01 Evomela 1 MG 1 1 50 50
J9285 Injection, olaratumab ELI LILLY AND COMPANY 00002-7190-01 LARTRUVO 10 MG 19 1 19 19
J9285 Injection, olaratumab ELI LILLY AND COMPANY 00002-8926-01 LARTRUVO 10 MG 50 1 50 50
J9348 Inj. naxitamab-gqgk, 1 mg Y-MABS THERAPEUTICS, INC. 73042-0201-01 Danyelza 1 MG 10 1 40 40
J9353 Inj. margetuximab-cmkb, 5 mg MACROGENICS, INC. 74527-0022-02 Margenza 5 MG 10 1 50 50
J9353 Inj. margetuximab-cmkb, 5 mg MACROGENICS INC 74527-0022-03 Margenza 5 MG 10 4 50 200
J9600 Porfimer sodium injection PINNACLE BIOLOGICS, INC. 76128-0155-75 Photofrin 75 MG 1 1 1 1
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
Q2053 Brexucabtagene car pos t GILEAD SCIENCES, INC. 71287-0219-01 Tecartus UP TO 200 MILLION AUTOLOGOUS ANTI-CD19 CAR POSITIVE VIABLE T CEL 1 1 1 1
Q9968 Visualization adjunct AMERICAN REGENT 00517-0374-05 Provayblue 1 MG 10 5 50 250
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 MYLAN INSTITUTIONAL LLC 67457-0220-05 ISOSULFAN BLUE INJECTION 1 MG 5 6 50 300

COVID-19 NDC Crosswalk

HCPCS Description Labeler name NDC Drug name Dosage Package size Package quantity Billable units Billable units / pkg
91300 SARSCOV2 VAC 30MCG/0.3ML IM Pfizer 59267-1000-02 Pfizer-Biontech Covid-19 Vaccine 0.3 ML 1 195 5 975
91300 SARSCOV2 VAC 30MCG/0.3ML IM Pfizer 59267-1000-03 Pfizer-Biontech Covid-19 Vaccine 0.3 ML 1 25 5 125
91301 SARSCOV2 VAC 100MCG/0.5ML IM Moderna 80777-0273-99 Moderna Covid-19 Vaccine 0.5 ML 5 10 10 100
91302 SARSCOV2 VAC 5X1010VP/.5MLIM AstraZeneca 00310-1222-15 AstraZeneca COVID-19 Vaccine 0.5 ML 5 10 10 100
91303 SARSCOV2 VAC AD26 .5ML IM Janssen 59676-0580-05 Janssen COVID-19 Vaccine 0.5 ML 2.5 10 5 50
91304 SARSCOV2 VAC 5MCG/0.5ML IM Novavax 80631-0100-10 Novavax Covid-19 Vaccine 0.5 ML 5 10 10 100
M0201 COVID-19 vaccine home admin N/A N/A COVID-19 vaccine administration inside a patient's home; reported only once per individual home per date of service when only COVID-19 vaccine administration is performed at the patient's home. 1 EA
M0248 sotrovimab inf, home admin GSK Intravenous infusion, sotrovimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency 1 EA
Q0243 casirivimab and imdevimab Regeneron 61755-0025-01 Imdevimab (use with casirivimab) 2400 MG 11.1 1 0.5 0.5
Q0243 casirivimab and imdevimab Regeneron 61755-0027-01 Imdevimab (use with casirivimab) 2400 MG 2.5 1 0.125 0.125
Q0243 casirivimab and imdevimab Regeneron 61755-0024-01 Casirivimab (use with imdevimab) 2400 MG 11.1 1 0.5 0.5
Q0243 casirivimab and imdevimab Regeneron 61755-0026-01 Casirivimab (use with imdevimab) 2400 MG 2.5 1 0.125 0.125
Q0244 casirivi and imdevi 1200 mg Regeneron 61755-0039-01 REGEN-COV ((casirivimab and imdevimab 600mg/600mg) 1200 MG 1 1 1 1
Q0245 Bamlanivimab and etesevimab Eli Lilly and Company 00002-7910-01 Bamlanivimab (use with etesevimab) 2100 MG 20 1 0.33 0.33
Q0245 Bamlanivimab and etesevimab Eli Lilly and Company 00002-7950-01 Etesevimab (use with bamlanivimab) 2100 MG 20 2 0.67 0.67
Q0247 sotrovimab GSK 00173-0901-86 Sotrovimab Injection 500 MG 8 ML 1 1 1

Past NDC - HCPCS Crosswalk