October 2025 NDC - HCPCS Crosswalk

Effective October 1, 2025 - December 31, 2025

Page #112

Average Sales Price

HCPCS Description Labeler name NDC Drug name Dosage Package size Package quantity Billable units Billable units / pkg
J9075 Inj, cyclophosphamide, nos Civica, Inc. 72572-0083-01 Cyclophosphamide 5 MG 1 1 400 400
J9075 Inj, cyclophosphamide, nos Civica, Inc. 72572-0085-01 Cyclophosphamide 5 MG 1 1 200 200
J9075 Inj, cyclophosphamide, nos Civica, Inc. 72572-0087-01 Cyclophosphamide 5 MG 1 1 100 100
J9075 Inj, cyclophosphamide, nos Northstar RxLLC 72603-0104-01 Cyclophosphamide 5 MG 1 1 100 100
J9075 Inj, cyclophosphamide, nos Northstar RxLLC 72603-0326-01 Cyclophosphamide 5 MG 1 1 200 200
J9075 Inj, cyclophosphamide, nos Long Grove Pharmaceuticals, LLC 81298-8110-01 Cyclophosphamide 5 MG 1 1 100 100
J9075 Inj, cyclophosphamide, nos Long Grove Pharmaceuticals, LLC 81298-8112-01 Cyclophosphamide 5 MG 1 1 200 200
J9075 Inj, cyclophosphamide, nos Long Grove Pharmaceuticals, LLC 81298-8114-01 Cyclophosphamide 5 MG 1 1 400 400
J9076 Inj, cyclophos (baxter) 5mg Baxter Healthcare Corporation 00338-9777-01 Cyclophosphamide 5 MG 2.5 1 100 100
J9076 Inj, cyclophos (baxter) 5mg Baxter Healthcare Corporation 00338-9779-01 Cyclophosphamide 5 MG 5 1 200 200
J9100 Cytarabine hcl 100 mg inj Sagent Pharmaceuticals 25021-0223-20 Cytarabine 100 MG 20 1 20 20
J9100 Cytarabine hcl 100 mg inj Sagent Pharmaceuticals 25021-0229-05 Cytarabine 100 MG 5 5 1 5
J9100 Cytarabine hcl 100 mg inj Pfizer Inc 61703-0155-01 Cytarabine 100 MG 20 1 20 20
J9100 Cytarabine hcl 100 mg inj Pfizer Inc 61703-0303-46 Cytarabine 100 MG 50 1 10 10
J9100 Cytarabine hcl 100 mg inj Pfizer Inc 61703-0304-36 Cytarabine 100 MG 25 1 5 5
J9100 Cytarabine hcl 100 mg inj Pfizer Inc 61703-0305-38 Cytarabine 100 MG 5 5 1 5
J9100 Cytarabine hcl 100 mg inj Pfizer Inc 61703-0319-22 Cytarabine 100 MG 20 1 20 20
J9100 Cytarabine hcl 100 mg inj FreseniUS Kabi USA, LLC 63323-0120-20 Cytarabine 100 MG 1 1 20 20
J9100 Cytarabine hcl 100 mg inj Meitheal Pharmaceuticals Inc. 71288-0109-20 Cytarabine 100 MG 20 1 20 20
J9118 Inj. calaspargase pegol-mknl Servier Pharmaceuticals LLC 72694-0515-01 Asparlas 10 UNITS 5 1 375 375
J9119 Inj., cemiplimab-rwlc, 1 mg Regeneron Pharmaceuticals, Inc. 61755-0008-01 Libtayo 1 MG 7 1 350 350
J9120 Dactinomycin injection XGen Pharmaceuticals DJB, Inc. 39822-2100-02 Dactinomycin 0.5 MG 1 1 1 1
J9120 Dactinomycin injection Hisun Pharmaceuticals USA, Inc 42658-0008-01 Dactinomycin 0.5 MG 1 1 1 1
J9120 Dactinomycin injection Eugia US LLC 55150-0431-01 Dactinomycin 0.5 MG 1 1 1 1
J9120 Dactinomycin injection Eugia US LLC 55150-0928-02 Dactinomycin 0.5 MG 1 1 1 1
J9120 Dactinomycin injection Prasco Laboratories 66993-0489-83 Dactinomycin 0.5 MG 1 1 1 1
J9120 Dactinomycin injection Mylan Institutional Inc. 67457-0513-05 Dactinomycin 0.5 MG 1 1 1 1
J9120 Dactinomycin injection Mylan Institutional Inc. 67457-0928-02 Dactinomycin 0.5 MG 1 1 1 1
J9120 Dactinomycin injection Meitheal Pharmaceuticals Inc. 71288-0129-02 Dactinomycin 0.5 MG 1 1 1 1
J9120 Dactinomycin injection Recordati Rare Diseases Inc. 55292-0811-55 Cosmegen 0.5 MG 1 1 1 1
J9130 Dacarbazine 100 mg inj Hikma Pharmaceuticals USA Inc. 00143-9245-10 Dacarbazine 100 MG 1 10 2 20
J9130 Dacarbazine 100 mg inj FreseniUS Kabi USA, LLC 63323-0127-10 Dacarbazine 100 MG 1 10 1 10
J9130 Dacarbazine 100 mg inj FreseniUS Kabi USA, LLC 63323-0128-20 Dacarbazine 100 MG 1 10 2 20
J9130 Dacarbazine 100 mg inj Meitheal Pharmaceuticals Inc. 71288-0174-21 Dacarbazine 100 MG 1 10 2 20
J9144 Daratumumab, hyaluronidase Janssen Biotech, Inc. 57894-0503-01 Darzalex Faspro 10 MG 15 1 180 180
J9145 Injection, daratumumab 10 mg Janssen Biotech, Inc. 57894-0502-05 Darzalex 10 MG 5 1 10 10
J9145 Injection, daratumumab 10 mg Janssen Biotech, Inc. 57894-0502-20 Darzalex 10 MG 20 1 40 40
J9145 Injection, daratumumab 10 mg Janssen Biotech, Inc. 57894-0505-05 Darzalex 10 MG 5 1 10 10
J9145 Injection, daratumumab 10 mg Janssen Biotech, Inc. 57894-0505-20 Darzalex 10 MG 20 1 40 40
J9150 Daunorubicin injection Hikma Pharmaceuticals USA Inc. 00143-9550-01 Daunorubicin HCl 10 MG 10 1 5 5
J9150 Daunorubicin injection Hikma Pharmaceuticals USA Inc. 00143-9551-10 Daunorubicin HCl 10 MG 4 10 2 20
J9150 Daunorubicin injection Hisun Pharmaceuticals USA, Inc 42658-0019-01 Daunorubicin Hcl 10 MG 10 1 5 5
J9150 Daunorubicin injection Hisun Pharmaceuticals USA, Inc 42658-0021-01 Daunorubicin HCl 10 MG 4 1 2 2
J9150 Daunorubicin injection Hisun Pharmaceuticals USA, Inc 42658-0021-02 Daunorubicin HCl 10 MG 4 10 2 20
J9150 Daunorubicin injection Hisun Pharmaceuticals USA, Inc 42658-0021-91 Daunorubicin HCl 10 MG 4 1 2 2
J9150 Daunorubicin injection Hisun Pharmaceuticals USA, Inc 42658-0021-92 Daunorubicin HCl 10 MG 4 10 2 20
J9153 Inj daunorubicin, cytarabine Jazz Pharmaceuticals, Inc. 68727-0745-02 Vyxeos 1 MG/2.27 MG 1 2 44 88
J9155 Degarelix injection Ferring Pharmaceuticals Inc. 55566-8303-01 Firmagon 1 MG 1 1 80 80
J9155 Degarelix injection Ferring Pharmaceuticals Inc. 55566-8403-01 Firmagon 1 MG 1 2 120 240
J9171 Docetaxel injection Hikma Pharmaceuticals USA Inc. 00143-9204-01 Docetaxel 1 MG 1 1 20 20

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 50 ML 50 1 1 1
P9045 Albumin (human), 5%, 250 ml Grifols 68516-5214-00 Albutein 250 ML 500 2 2 4
P9045 Albumin (human), 5%, 250 ml Grifols 68516-5214-09 Albutein 250 ML 250 4 1 4
P9045 Albumin (human), 5%, 250 ml Grifols 68516-5218-04 Albutein 250 ML 250 4 1 4
P9045 Albumin (human), 5%, 250 ml Grifols 68516-5219-02 Albutein 250 ML 500 2 2 4
P9045 Albumin (human), 5%, 250 ml Baxter 00944-0491-01 Buminate 250 ML 250 1 1 1
P9045 Albumin (human), 5%, 250 ml Baxter 00944-0491-02 Buminate 250 ML 500 1 2 2
P9045 Albumin (human), 5%, 250 ml Octapharma USA 68982-0623-02 Albumin (Human) 250 ML 250 1 1 1
P9045 Albumin (human), 5%, 250 ml Octapharma USA 68982-0623-03 Albumin (Human) 250 ML 500 1 2 2
P9045 Albumin (human), 5%, 250 ml CSL Behring 00053-7670-31 Albuminar-5 250 ML 250 1 1 1
P9045 Albumin (human), 5%, 250 ml CSL Behring 00053-7670-32 Albuminar-5 250 ML 500 1 2 2
P9045 Albumin (human), 5%, 250 ml Bio Products Laboratory USA, Inc. 64208-2510-01 ALBUMINEX 5% 250 ML 250 1 1 1
P9045 Albumin (human), 5%, 250 ml Bio Products Laboratory USA, Inc. 64208-2510-05 ALBUMINEX 5% 250 ML 500 1 2 2
P9045 Albumin (human), 5%, 250 ml CSL Behring 44206-0310-25 Alburx 250 ML 250 1 1 1
P9045 Albumin (human), 5%, 250 ml CSL Behring 44206-0310-50 Alburx 250 ML 500 1 2 2
P9045 Albumin (human), 5%, 250 ml 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 Grifols 68516-5214-01 Albutein 250 ML 250 1 1 1
P9045 Albumin (human), 5%, 250 ml Grifols 68516-5214-02 Albutein 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
P9046 Albumin (human), 25%, 20 ml Grifols 68516-5216-05 Albutein 20 ML 20 1 1 1
P9047 Albumin (human), 25%, 50ml Grifols 68516-5216-09 Albutein 50 ML 50 5 1 5
P9047 Albumin (human), 25%, 50ml Grifols 68516-5216-00 Albutein 50 ML 100 5 2 10
P9047 Albumin (human), 25%, 50ml Grifols 68516-5216-01 Albutein 50 ML 50 1 1 1
P9047 Albumin (human), 25%, 50ml Grifols 68516-5216-02 Albutein 50 ML 100 1 2 2
P9047 Albumin (human), 25%, 50ml Baxter 00944-0490-01 Buminate 50 ML 20 1 0.4 0.4
P9047 Albumin (human), 25%, 50ml Baxter 00944-0493-01 Flexbumin 50 ML 50 1 1 1
P9047 Albumin (human), 25%, 50ml Baxter 00944-0493-02 Flexbumin 50 ML 100 1 1 2
P9047 Albumin (human), 25%, 50ml Takeda Pharmaceuticals America, Inc. 00944-0493-03 Flexbumin 50 ML 50 1 1 1
P9047 Albumin (human), 25%, 50ml 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 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 Octapharma USA 68982-0643-01 Albumin (Human) 50 ML 50 1 1 1
P9047 Albumin (human), 25%, 50ml Octapharma USA 68982-0643-02 Albumin (Human) 50 ML 100 1 2 2
P9047 Albumin (human), 25%, 50ml CSL Behring 00053-7680-32 Albuminar-25 50 ML 50 1 1 1
P9047 Albumin (human), 25%, 50ml CSL Behring 00053-7680-33 Albuminar-25 50 ML 100 1 2 2
P9047 Albumin (human), 25%, 50ml Kedrion Biopharma 76125-0784-10 Albuked 25 50 ML 100 1 2 2
P9047 Albumin (human), 25%, 50ml Kedrion Biopharma 76125-0784-25 Albuked 25 50 ML 50 1 1 1
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
Q0224 Pemivibart injection Invivyd, Inc 81960-0031-03 Pemgarda 4500 MG 1 1 1 1
Q0249 Tocilizumab for covid-19 Genentech, Inc 50242-0135-01 Actemra IV 1 MG 4 1 80 80
Q0249 Tocilizumab for covid-19 Genentech, Inc 50242-0136-01 Actemra IV 1 MG 10 1 200 200
Q0249 Tocilizumab for covid-19 Genentech, Inc 50242-0137-01 Actemra IV 1 MG 20 1 400 400

Not Otherwise Classified

Description Labeler name NDC Drug name Dosage Package size Package quantity Billable units Billable units / pkg
Long Grove Pharmaceuticals, LLC 81298-8554-03 Vasopressin 1 UNIT 100 10 40 400

Outpatient Prospective Payment System

HCPCS Description Labeler name NDC Drug name Dosage Package size Package quantity Billable units Billable units / pkg
A9506 Tc-99m graphite crucible Cyclomedica Australia PTY Limited 73814-0986-20 Technegas EACH 1 50 50 50
A9513 Lutetium Lu 177 dotatat ther Advanced Accelerator Applications USA, Inc. 69488-0003-01 Lutathera 1 mCi 20 1 200 200
A9521 Tc99m exametazime Jubilant Draximage Inc., dba Jubilant Radiopharma 65174-0200-05 Technetium TC-99M Exametazime Per Study Dose, up to 25 millicuries 1 1 1 1
A9543 Y90 ibritumomab, rx Acrotech Biopharma LLC 72893-0007-04 Zevalin Y-91 UP TO 40 millicuries 1 1 1 1
A9582 Iodine I-123 iobenguane GE Healthcare Inc. 17156-0235-01 Adreview UP TO 15 millicuries 5 1 1 1
A9584 Iodine I-123 ioflupane GE Healthcare Inc. 17156-0210-01 Datscan Per Study Dose, up to 5 millicuries 2.5 1 1 1
A9587 Gallium Ga-68 Advanced Accelerator Applications USA, Inc. 69488-0001-40 Netspot 0.1 mCi 1 1 1 1
A9588 Fluciclovine F-18 Blue Earth Diagnostics Limited 69932-0001-01 Axumin 1 mCi 1 1 1 1
A9591 Fluoroestradiol F 18 GE Healthcare Inc. 72874-0001-01 Cerianna 1 mCi 50 1 6 6
A9592 Copper cu 64 dotatate diag Curium US LLC 69945-0064-01 Detectnet 1 mCi 4 1 4 4
A9593 Gallium ga-68 psma-11 ucsf UCSF Radiopharmaceutical Facility 24275-0525-01 Gallium Ga 68 PSMA 1 mCi 11 1 1 1
A9594 Gallium ga-68 psma-11, ucla UCLA Biomedical Cyclotron 76394-2642-03 Gallium Ga 68 PSMA 1 mCi 12 1 1 1
A9595 Piflu f-18, dia 1 millicurie Progenics Pharmaceuticals, Inc. 71258-0022-00 Pylarify 1 millicurie 1 1 9 9
A9595 Piflu f-18, dia 1 millicurie Progenics Pharmaceuticals, Inc. 71258-0022-01 Pylarify 1 mCi 50 1 1 1
A9596 Gallium illuccix 1 millicure Telix Pharmaceuticals US Inc. 74725-0100-25 Illuccix 1 mCi 1 1 1 1
A9596 Gallium illuccix 1 millicure Telix Pharmaceuticals US Inc. 74725-0100-64 Illuccix 1 mCi 1 1 1 1
A9600 Sr89 strontium Q Biomed Inc 72928-0089-01 Strontium Chloride Sr 89 PER MILLICURIE 4 1 1 4
A9601 Flortaucipir inj 1 millicuri Eli Lilly and Company 00002-1220-01 Tauvid 1 mCi 1 1 1 1
A9602 Fluorodopa f-18 diag per mci The Feinstein Institute for Medical Research 13267-0346-57 Fluorodopa F18 1 mCi 1 1 1 1
A9606 Radium Ra223 dichloride ther Bayer HealthCare Pharmaceuticals Inc. 50419-0208-01 Xofigo 1 mCi 6 1 1 1
A9607 Lutetium lu 177 vipivotide Advanced Accelerator Applications USA, Inc. 69488-0010-61 Pluvicto 1 mCi 1 1 1 1
A9608 Flotufolastat f18 diag 1 mci Blue Earth Diagnostics Limited 69932-0002-01 Posluma 1 mCi 1 1 1 8
A9608 Flotufolastat f18 diag 1 mci Blue Earth Diagnostics Limited 69932-0002-50 Posluma 1 millicurie 25 1 1 1
A9611 Flurpiridaz f18, diag, 1 mci GE Healthcare Inc. 00407-8787-01 Flyrcado 1 mCi 1 1 1 1
A9615 Inj, pegulicianine, 1 mg Lumicell Inc. 82292-0040-10 Lumisight 1 MG 1 10 39 390
A9616 Gallium gozellix 1 millicuri Telix Innovations SA 84552-0500-25 Gozellix 1 MCI 1 1 1 1
A9616 Gallium gozellix 1 millicuri Telix Innovations SA 84552-0500-64 Gozellix 1 MCI 1 1 1 1
A9697 Inj, magtrace per study dose Endomagnetics Inc. 60391-021024 Magtrace PER STUDY DOSE 2 10 1 10
A9800 Gallium locametz 1 millicuri Advanced Accelerator Applications USA, Inc. 69488-0017-61 Locametz 1 mCi 1 1 1 1
C9089 Bupivacaine implant, 1 mg Innocoll Pharmaceuticals 51715-0100-04 Xaracoll 1 MG 1 12 100 1200
C9089 Bupivacaine implant, 1 mg Innocoll Pharmaceuticals 51715-0100-10 Xaracoll 1 MG 1 30 100 3000
C9144 Inj, bupivacaine (posimir) Innocoll Pharmaceuticals 51715-0660-10 Posimir 1 MG 5 10 660 6600
C9145 Inj, aponvie, 1 mg Heron Therapeutics 47426-0401-10 Aponvie 1 MG 4.4 10 32 320
C9250 Artiss fibrin sealant Baxter Healthcare Corporation 00338-9637-01 Artiss 2 ML 2 1 1 1
C9250 Artiss fibrin sealant Baxter Healthcare Corporation 00338-9639-01 Artiss 2 ML 4 1 2 2
C9250 Artiss fibrin sealant Baxter Healthcare Corporation 00338-9641-01 Artiss 2 ML 10 1 5 5
C9257 Bevacizumab injection Genentech, Inc. 50242-0060-01 Avastin 0.25 MG 4 1 400 400
C9257 Bevacizumab injection Genentech, Inc. 50242-0061-01 Avastin 0.25 MG 16 1 1600 1600
C9305 Inj, nipocalimab-aahu, 3 mg Janssen Biotech, Inc. 57894-0800-01 Imaavy 3 MG 1.62 1 100 100
C9305 Inj, nipocalimab-aahu, 3 mg Janssen Biotech, Inc. 57894-0801-01 Imaavy 3 MG 6.5 1 400 400
C9306 Telisotuzumab vedotin-tllv AbbVie Inc. 00074-1044-01 Emrelis 1 MG 1 1 20 20
C9306 Telisotuzumab vedotin-tllv AbbVie Inc. 00074-1055-01 Emrelis 1 MG 1 1 100 100
C9460 Injection, cangrelor Chiesi USA, Inc. 10122-0620-10 Kengreal 1 MG 1 10 50 500
C9482 Sotalol hydrochloride IV Altathera Pharmaceuticals, LLC 69724-0112-10 Sotalol 1 MG 10 1 150 150
J0139 Inj, adalimumab, 1 mg AbbVie Inc. 00074-3799-02 Humira 1 MG 0.8 2 40 80
J0139 Inj, adalimumab, 1 mg AbbVie Inc. 00074-4339-02 Humira 1 MG 0.8 2 40 80
J0139 Inj, adalimumab, 1 mg AbbVie Inc. 00074-4339-06 Humira 1 MG 0.8 6 40 240
J0139 Inj, adalimumab, 1 mg AbbVie Inc. 00074-4339-07 Humira 1 MG 0.8 4 40 160
J0184 Inj, amisulpride, 1 mg Acacia Pharma Ltd 71390-0125-20 Barhemsys 1 MG 2 10 5 50
J0184 Inj, amisulpride, 1 mg Acacia Pharma Ltd 71390-0125-50 Barhemsys 1 MG 4 10 10 100
J0208 Inj, pedmark, 100 mg Fennec Pharmaceuticals, Inc. 73077-0010-01 Sodium Thiosulfate 100 MG 100 1 125 125
J0211 Inj, nithiodote, 3mg / 125mg Hope Pharmaceuticals 60267-0812-00 Nithiodote 3 MG AND 125 MG 60 1 100 100
J0391 Inj, artesunate, 1mg Amivas, Inc 73607-0011-11 Artesunate 1 MG 1 2 110 220
J0458 Aztreonam/avibactam 10 mg AbbVie Inc 00074-3878-10 Emblaveo 10 MG 1 10 200 2000
J0567 Inj., cerliponase alfa 1 mg BioMarin Pharmaceutical Inc. 68135-0811-02 Brineura 1 MG 1 2 150 300
J0599 Inj., haegarda 10 units CSL Behring L.L.C. 63833-0828-02 Haegarda 10 UNITS 1 1 200 200
J0599 Inj., haegarda 10 units CSL Behring L.L.C. 63833-0829-02 Haegarda 10 UNITS 1 1 300 300
J0630 Calcitonin salmon injection Hikma Pharmaceuticals USA Inc. 24201-0400-02 Calcitonin Salmon 400 UNITS 2 1 1 1
J0630 Calcitonin salmon injection Endo USA, Inc. 42023-0205-01 Calcitonin Salmon 400 UNITS 2 1 1 1
J0630 Calcitonin salmon injection Dr Reddy's Laboratories, Inc. 43598-0051-11 Calcitonin Salmon 400 UNITS 2 1 1 1
J0630 Calcitonin salmon injection FreseniUS Kabi USA, LLC 63323-0865-02 Calcitonin-Salmon 400 UNITS 2 1 1 1
J0630 Calcitonin salmon injection Cipla USA, Inc. 69097-0770-32 Calcitonin-Salmon 400 UNITS 2 1 1 1
J0630 Calcitonin salmon injection Mylan Institutional LLC 67457-0675-02 Miacalcin 400 UNITS 2 1 1 1
J0630 Calcitonin salmon injection Mylan Institutional LLC 72078-0038-02 Miacalcin 400 UNITS 2 1 1 1
J0630 Calcitonin salmon injection Mylan Institutional LLC 72078-0039-02 Miacalcin 400 UNITS 2 1 1 1
J0668 Instill, bupivac and meloxic Heron Therapeutics 47426-0301-02 Zynrelef 1 MG - 0.03 MG 14 1 400 400
J0668 Instill, bupivac and meloxic Heron Therapeutics 47426-0303-01 Zynrelef 1 MG - 0.03 MG 7 1 200 200
J0668 Instill, bupivac and meloxic Heron Therapeutics 47426-0501-02 Zynrelef 1 MG - 0.03 MG 14 1 400 400
J0675 Inj, carboprost, 0.1 mg Pfizer Inc 00009-0856-08 Hemabate 0.1 MG 1 10 2.5 25
J0681 Inj ceftobipole medocarl 3mg La Jolla Pharmaceutical Company 68547-0578-10 Zevtera 3 MG 1 10 166.666666666667 1667
J0716 Centruroides immune f(ab) Rare Disease Therapeutics, Inc. 66621-0150-02 Anascorp UP TO 120 MG 1 1 1 1
J0759 Inj, clevidipine, 1 mg Chiesi USA, Inc. 10122-0610-10 Cleviprex 1 MG 50 10 25 250
J0759 Inj, clevidipine, 1 mg Chiesi USA, Inc. 10122-0611-10 Cleviprex 1 MG 100 10 50 500
J0879 Difelikefalin, esrd on dialy Vifor (International) Inc. 59353-0065-01 Korsuva 0.1 MCG 1.3 1 65 650
J0879 Difelikefalin, esrd on dialy Vifor (International) Inc. 59353-0065-12 Korsuva 0.1 MCG 1.3 1 65 7800
J0891 Argatroban nonesrd (accord) Accord Healthcare Inc 16729-0430-43 Argatroban 1 MG 50 10 50 500
J0911 Inst tauro 1.35mg/hep 100u CorMedix Inc. 72990-0103-10 Defencath taurolidine 1.35 mg and heparin sodium 100 units 3 10 30 300
J0911 Inst tauro 1.35mg/hep 100u CorMedix Inc. 72990-0105-10 Defencath taurolidine 1.35 mg and heparin sodium 100 units 5 10 50 500
J1097 Phenylep ketorolac opth soln Omeros Corporation 62225-0600-04 Omidria 1 ML 4 4 4 16
J1097 Phenylep ketorolac opth soln Rayner Surgical Inc. 82604-0600-04 Omidria 1 ML 4 4 4 16
J1105 Dexmedetomidine film, 1 mcg BioXcel Therapeutics, Inc. 81092-1120-01 Igalmi 1 MCG 10 1 1200 1200
J1105 Dexmedetomidine film, 1 mcg BioXcel Therapeutics, Inc. 81092-1180-01 Igalmi 1 MCG 10 1 1800 1800
J1307 Inj, crovalimab-akkz, 10 mg Genentech, Inc. 50242-0115-01 Piasky 10 MG 2 1 34 34
J1411 Inj, hemgenix, per tx dose CSL Behring L.L.C. 00053-0100-10 Hemgenix Per Therapeutic Dose 10 10 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring L.L.C. 00053-0110-11 Hemgenix Per Therapeutic Dose 10 11 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring L.L.C. 00053-0120-12 Hemgenix Per Therapeutic Dose 10 12 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring L.L.C. 00053-0130-13 Hemgenix Per Therapeutic Dose 10 13 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring L.L.C. 00053-0140-14 Hemgenix Per Therapeutic Dose 10 14 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring L.L.C. 00053-0150-15 Hemgenix Per Therapeutic Dose 10 15 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring L.L.C. 00053-0160-16 Hemgenix Per Therapeutic Dose 10 16 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring L.L.C. 00053-0170-17 Hemgenix Per Therapeutic Dose 10 17 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring L.L.C. 00053-0180-18 Hemgenix Per Therapeutic Dose 10 18 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring L.L.C. 00053-0190-19 Hemgenix Per Therapeutic Dose 10 19 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring L.L.C. 00053-0200-20 Hemgenix Per Therapeutic Dose 10 20 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring L.L.C. 00053-0210-21 Hemgenix Per Therapeutic Dose 10 21 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring L.L.C. 00053-0220-22 Hemgenix Per Therapeutic Dose 10 22 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring L.L.C. 00053-0230-23 Hemgenix Per Therapeutic Dose 10 23 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring L.L.C. 00053-0240-24 Hemgenix Per Therapeutic Dose 10 24 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring L.L.C. 00053-0250-25 Hemgenix Per Therapeutic Dose 10 25 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring L.L.C. 00053-0260-26 Hemgenix Per Therapeutic Dose 10 26 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring L.L.C. 00053-0270-27 Hemgenix Per Therapeutic Dose 10 27 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring L.L.C. 00053-0280-28 Hemgenix Per Therapeutic Dose 10 28 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring L.L.C. 00053-0290-29 Hemgenix Per Therapeutic Dose 10 29 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring L.L.C. 00053-0300-30 Hemgenix Per Therapeutic Dose 10 30 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring L.L.C. 00053-0310-31 Hemgenix Per Therapeutic Dose 10 31 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring L.L.C. 00053-0320-32 Hemgenix Per Therapeutic Dose 10 32 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring L.L.C. 00053-0330-33 Hemgenix Per Therapeutic Dose 10 33 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring L.L.C. 00053-0340-34 Hemgenix Per Therapeutic Dose 10 34 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring L.L.C. 00053-0350-35 Hemgenix Per Therapeutic Dose 10 35 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring L.L.C. 00053-0360-36 Hemgenix Per Therapeutic Dose 10 36 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring L.L.C. 00053-0370-37 Hemgenix Per Therapeutic Dose 10 37 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring L.L.C. 00053-0380-38 Hemgenix Per Therapeutic Dose 10 38 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring L.L.C. 00053-0390-39 Hemgenix Per Therapeutic Dose 10 39 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring L.L.C. 00053-0400-40 Hemgenix Per Therapeutic Dose 10 40 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring L.L.C. 00053-0410-41 Hemgenix Per Therapeutic Dose 10 41 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring L.L.C. 00053-0420-42 Hemgenix Per Therapeutic Dose 10 42 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring L.L.C. 00053-0430-43 Hemgenix Per Therapeutic Dose 10 43 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring L.L.C. 00053-0440-44 Hemgenix Per Therapeutic Dose 10 44 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring L.L.C. 00053-0450-45 Hemgenix Per Therapeutic Dose 10 45 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring L.L.C. 00053-0460-46 Hemgenix Per Therapeutic Dose 10 46 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring L.L.C. 00053-0470-47 Hemgenix Per Therapeutic Dose 10 47 1 1
J1411 Inj, hemgenix, per tx dose CSL Behring L.L.C. 00053-0480-48 Hemgenix Per Therapeutic Dose 10 48 1 1
J1412 Inj roctavian ml 2x10^13vc g BioMarin Pharmaceutical Inc. 68135-0927-48 Roctavian 1 ML 8 1 8 8
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0501-10 Elevidys Per Therapeutic Dose 1 10 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0502-11 Elevidys Per Therapeutic Dose 1 11 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0503-12 Elevidys Per Therapeutic Dose 1 12 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0504-13 Elevidys Per Therapeutic Dose 1 13 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0505-14 Elevidys Per Therapeutic Dose 1 14 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0506-15 Elevidys Per Therapeutic Dose 1 15 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0507-16 Elevidys Per Therapeutic Dose 1 16 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0508-17 Elevidys Per Therapeutic Dose 1 17 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0509-18 Elevidys Per Therapeutic Dose 1 18 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0510-19 Elevidys Per Therapeutic Dose 1 19 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0511-20 Elevidys Per Therapeutic Dose 1 20 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0512-21 Elevidys Per Therapeutic Dose 1 21 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0513-22 Elevidys Per Therapeutic Dose 1 22 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0514-23 Elevidys Per Therapeutic Dose 1 23 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0515-24 Elevidys Per Therapeutic Dose 1 24 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0516-25 Elevidys Per Therapeutic Dose 1 25 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0517-26 Elevidys Per Therapeutic Dose 1 26 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0518-27 Elevidys Per Therapeutic Dose 1 27 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0519-28 Elevidys Per Therapeutic Dose 1 28 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0520-29 Elevidys Per Therapeutic Dose 1 29 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0521-30 Elevidys Per Therapeutic Dose 1 30 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0522-31 Elevidys Per Therapeutic Dose 1 31 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0523-32 Elevidys Per Therapeutic Dose 1 32 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0524-33 Elevidys Per Therapeutic Dose 1 33 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0525-34 Elevidys Per Therapeutic Dose 1 34 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0526-35 Elevidys Per Therapeutic Dose 1 35 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0527-36 Elevidys Per Therapeutic Dose 1 36 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0528-37 Elevidys Per Therapeutic Dose 1 37 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0529-38 Elevidys Per Therapeutic Dose 1 38 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0530-39 Elevidys Per Therapeutic Dose 1 39 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0531-40 Elevidys Per Therapeutic Dose 1 40 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0532-41 Elevidys Per Therapeutic Dose 1 41 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0533-42 Elevidys Per Therapeutic Dose 1 42 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0534-43 Elevidys Per Therapeutic Dose 1 43 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0535-44 Elevidys Per Therapeutic Dose 1 44 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0536-45 Elevidys Per Therapeutic Dose 1 45 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0537-46 Elevidys Per Therapeutic Dose 1 46 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0538-47 Elevidys Per Therapeutic Dose 1 47 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0539-48 Elevidys Per Therapeutic Dose 1 48 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0540-49 Elevidys Per Therapeutic Dose 1 49 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0541-50 Elevidys Per Therapeutic Dose 1 50 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0542-51 Elevidys Per Therapeutic Dose 1 51 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0543-52 Elevidys Per Therapeutic Dose 1 52 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0544-53 Elevidys Per Therapeutic Dose 1 53 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0545-54 Elevidys Per Therapeutic Dose 1 54 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0546-55 Elevidys Per Therapeutic Dose 1 55 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0547-56 Elevidys Per Therapeutic Dose 1 56 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0548-57 Elevidys Per Therapeutic Dose 1 57 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0549-58 Elevidys Per Therapeutic Dose 1 58 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0550-59 Elevidys Per Therapeutic Dose 1 59 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0551-60 Elevidys Per Therapeutic Dose 1 60 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0552-61 Elevidys Per Therapeutic Dose 1 61 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0553-62 Elevidys Per Therapeutic Dose 1 62 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0554-63 Elevidys Per Therapeutic Dose 1 63 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0555-64 Elevidys Per Therapeutic Dose 1 64 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0556-65 Elevidys Per Therapeutic Dose 1 65 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0557-66 Elevidys Per Therapeutic Dose 1 66 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0558-67 Elevidys Per Therapeutic Dose 1 67 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0559-68 Elevidys Per Therapeutic Dose 1 68 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0560-69 Elevidys Per Therapeutic Dose 1 69 1 1
J1413 Inj delandistrogene mox rokl Sarepta Therapeutics, Inc. 60923-0561-70 Elevidys Per Therapeutic Dose 1 70 1 1
J1414 Inj, beqvez, per tx dose Pfizer Inc 00069-2004-04 Beqvez Per Therapeutic Dose 1 4 1 1
J1414 Inj, beqvez, per tx dose Pfizer Inc 00069-2005-05 Beqvez Per Therapeutic Dose 1 5 1 1
J1414 Inj, beqvez, per tx dose Pfizer Inc 00069-2006-06 Beqvez Per Therapeutic Dose 1 6 1 1
J1414 Inj, beqvez, per tx dose Pfizer Inc 00069-2007-07 Beqvez Per Therapeutic Dose 1 7 1 1
J1426 Injection, casimersen, 10 mg Sarepta Therapeutics, Inc. 60923-0227-02 Amondys 45 10 MG 2 1 10 10
J1428 Injection, eteplirsen Sarepta Therapeutics, Inc. 60923-0284-10 Exondys 51 10 MG 10 1 50 50
J1428 Injection, eteplirsen Sarepta Therapeutics, Inc. 60923-0363-02 Exondys 51 10 MG 2 1 10 10
J1438 Etanercept injection Amgen Inc. 58406-0425-34 Enbrel 25 MG 1 4 1 4
J1451 Fomepizole, 15 mg American Regent, Inc. 00517-0710-01 Fomepizole 15 MG 1.5 1 100 100
J1451 Fomepizole, 15 mg Sagent Pharmaceuticals 25021-0829-02 Fomepizole 15 MG 1.5 1 100 100
J1451 Fomepizole, 15 mg Mylan Institutional LLC 67457-0211-02 Fomepizole 15 MG 1.5 1 100 100
J1451 Fomepizole, 15 mg Zydus Pharmaceuticals (USA) Inc. 70710-1478-01 Fomepizole 15 MG 1.5 1 100 100
J1595 Injection glatiramer acetate Teva Neuroscience, Inc. 68546-0317-30 Copaxone 20 MG 1 30 1 30
J1595 Injection glatiramer acetate Teva Neuroscience, Inc. 68546-0325-12 Copaxone 20 MG 1 12 2 24
J1612 Inj glucagon (gvoke) 0.01 mg Xeris Pharmaceuticals, Inc. 72065-0140-11 Gvoke Kit 0.01 MG 1 1 100 100
J1742 Ibutilide fumarate injection Heritage Pharmaceuticals Inc. 23155-0326-31 Ibutilide Fumarate 1 MG 10 1 1 1
J1742 Ibutilide fumarate injection Mylan Institutional LLC 67457-0366-10 Ibutilide Fumarate 1 MG 10 1 1 1
J1742 Ibutilide fumarate injection Pfizer Inc 00009-3794-01 Corvert 1 MG 10 1 1 1
J1742 Ibutilide fumarate injection Pfizer Inc 00009-3794-22 Corvert 1 MG 10 1 1 1
J1744 Icatibant injection Hikma Pharmaceuticals USA Inc. 24201-0207-01 Icatibant 1 MG 3 1 30 30
J1744 Icatibant injection Takeda Pharmaceuticals America, Inc. 54092-0702-02 Icatibant 1 MG 3 1 30 30
J1744 Icatibant injection Takeda Pharmaceuticals America, Inc. 54092-0702-03 Icatibant 1 MG 3 3 30 90
J1744 Icatibant injection Apotex Corp 60505-6214-01 Icatibant 1 MG 3 1 30 30
J1744 Icatibant injection FreseniUS Kabi USA, LLC 63323-0574-86 Icatibant 1 MG 3 1 30 30
J1744 Icatibant injection FreseniUS Kabi USA, LLC 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
J1807 Inj, ethacrynate sod, 1 mg Endo USA, Inc. 42023-0157-01 Ethacrynate Sodium 1 MG 1 1 50 50
J1833 Inj, isavuconazonium sulfate Astellas Pharma US, Inc. 00469-0420-01 Cresemba 1 MG 1 1 372 372
J1834 Inj, isoniazid, 1 mg Sandoz Inc. 00781-3056-70 Isoniazid Injection 1 MG 10 1 1000 1000
J2186 Inj., meropenem, vaborbactam Melinta Therapeutics, LLC 70842-0120-06 Vabomere (10 MG/10MG) 20 MG 1 6 100 600
J2265 Minocycline hydrochloride Melinta Therapeutics, LLC 70842-0160-10 Minocin 1 MG 1 10 100 1000
J2326 Injection, nusinersen Biogen Inc. 64406-0058-01 Spinraza 0.1 MG 5 1 120 120
J2547 Injection, peramivir BioCryst Pharmaceuticals, Inc. 72769-0181-03 Rapivab 1 MG 20 3 200 600
J2561 Inj, sezaby, 1 mg Sun Pharmaceutical Industries, Inc. 62756-0301-01 Sezaby 1 MG 1 1 100 100
J2801 Inj, rykindo, 0.5 mg Shandong Luye Pharmaceutical 72526-0101-11 Rykindo 0.5 MG 1 1 25 25
J2801 Inj, rykindo, 0.5 mg Shandong Luye Pharmaceutical 72526-0102-11 Rykindo 0.5 MG 1 1 50 50
J2801 Inj, rykindo, 0.5 mg Shandong Luye Pharmaceutical 72526-0103-11 Rykindo 0.5 MG 1 1 75 75
J2801 Inj, rykindo, 0.5 mg Shandong Luye Pharmaceutical 72526-0104-11 Rykindo 0.5 MG 1 1 100 100
J2840 Injection, sebelipase alfa Alexion Pharmaceuticals, Inc. 25682-0007-01 Kanuma 1 MG 10 1 20 20
J2850 Inj secretin synthetic human ChiRhoClin, Inc 67066-0005-01 Chirhostim 1 MCG 1 1 16 16
J2993 Reteplase injection Chiesi USA, Inc. 10122-0141-02 Retavase 18.1 MG 1 2 1 2
J2998 Inj plasminogen tvmh 1mg Kedrion Biopharma Inc 70573-0099-02 Ryplazim 1 MG 1 1 68.8 69
J3357 Ustekinumab injection Janssen Biotech, Inc. 57894-0060-02 Stelara 1 MG 0.5 1 45 45
J3357 Ustekinumab injection Janssen Biotech, Inc. 57894-0060-03 Stelara 1 MG 0.5 1 45 45
J3357 Ustekinumab injection Janssen Biotech, Inc. 57894-0061-03 Stelara 1 MG 1 1 90 90
J3357 Ustekinumab injection JANSSEN BIOTECH, INC. 57894-0440-01 Ustekinumab 1 MG 0.5 1 45 45
J3357 Ustekinumab injection JANSSEN BIOTECH, INC. 57894-0440-03 Ustekinumab 1 MG 0.5 1 45 45
J3357 Ustekinumab injection JANSSEN BIOTECH, INC. 57894-0441-01 Ustekinumab 1 MG 1 1 90 90
J3391 Inj, atidarsagene autotemcel Orchard Therapeutics Ltd 83222-0200-01 Lenmeldy Per Treatment Dose 1 1 1 1
J3392 Inj, exagamglogene autotem Vertex Pharmaceuticals, Inc. 51167-0290-09 Casgevy Per Treatment 1 1 1 1
J3392 Inj, exagamglogene autotem Roslin Cell Therapies Limited 83932-0290-09 Casgevy Per Treatment 1 1 1 1
J3393 Inj, betibeglogene autotemce Bluebird Bio, Inc. 73554-3111-01 Zynteglo Per Therapeutic Dose 20 1 1 1
J3394 Inj, lovotibeglogene autotem Bluebird Bio, Inc. 73554-1111-01 Lyfgenia Per Treatment 20 1 1 1
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 Novartis Gene Therapies, Inc. 71894-0120-02 Zolgensma Per tx dose (up to 5 x10^15 vg?) 16.6 1 1 1
J3399 Inj onase abepar-xioi treat Novartis Gene Therapies, Inc. 71894-0121-03 Zolgensma Per tx dose (up to 5 x10^15 vg?) 19.3 1 1 1
J3399 Inj onase abepar-xioi treat Novartis Gene Therapies, Inc. 71894-0122-03 Zolgensma Per tx dose (up to 5 x10^15 vg?) 22.1 1 1 1
J3399 Inj onase abepar-xioi treat Novartis Gene Therapies, Inc. 71894-0123-03 Zolgensma Per tx dose (up to 5 x10^15 vg?) 24.9 1 1 1
J3399 Inj onase abepar-xioi treat Novartis Gene Therapies, Inc. 71894-0124-04 Zolgensma Per tx dose (up to 5 x10^15 vg?) 27.6 1 1 1
J3399 Inj onase abepar-xioi treat Novartis Gene Therapies, Inc. 71894-0125-04 Zolgensma Per tx dose (up to 5 x10^15 vg?) 30.4 1 1 1
J3399 Inj onase abepar-xioi treat Novartis Gene Therapies, Inc. 71894-0126-04 Zolgensma Per tx dose (up to 5 x10^15 vg?) 33.2 1 1 1
J3399 Inj onase abepar-xioi treat Novartis Gene Therapies, Inc. 71894-0127-05 Zolgensma Per tx dose (up to 5 x10^15 vg?) 35.9 1 1 1
J3399 Inj onase abepar-xioi treat Novartis Gene Therapies, Inc. 71894-0128-05 Zolgensma Per tx dose (up to 5 x10^15 vg?) 38.7 1 1 1
J3399 Inj onase abepar-xioi treat Novartis Gene Therapies, Inc. 71894-0129-05 Zolgensma Per tx dose (up to 5 x10^15 vg?) 41.5 1 1 1
J3399 Inj onase abepar-xioi treat Novartis Gene Therapies, Inc. 71894-0130-06 Zolgensma Per tx dose (up to 5 x10^15 vg?) 44.2 1 1 1
J3399 Inj onase abepar-xioi treat Novartis Gene Therapies, Inc. 71894-0131-06 Zolgensma Per tx dose (up to 5 x10^15 vg?) 47 1 1 1
J3399 Inj onase abepar-xioi treat Novartis Gene Therapies, Inc. 71894-0132-06 Zolgensma Per tx dose (up to 5 x10^15 vg?) 49.8 1 1 1
J3399 Inj onase abepar-xioi treat Novartis Gene Therapies, Inc. 71894-0133-07 Zolgensma Per tx dose (up to 5 x10^15 vg?) 52.5 1 1 1
J3399 Inj onase abepar-xioi treat Novartis Gene Therapies, Inc. 71894-0134-07 Zolgensma Per tx dose (up to 5 x10^15 vg?) 55.3 1 1 1
J3399 Inj onase abepar-xioi treat Novartis Gene Therapies, Inc. 71894-0135-07 Zolgensma Per tx dose (up to 5 x10^15 vg?) 58.1 1 1 1
J3399 Inj onase abepar-xioi treat Novartis Gene Therapies, Inc. 71894-0136-08 Zolgensma Per tx dose (up to 5 x10^15 vg?) 60.8 1 1 1
J3399 Inj onase abepar-xioi treat Novartis Gene Therapies, Inc. 71894-0137-08 Zolgensma Per tx dose (up to 5 x10^15 vg?) 63.6 1 1 1
J3399 Inj onase abepar-xioi treat Novartis Gene Therapies, Inc. 71894-0138-08 Zolgensma Per tx dose (up to 5 x10^15 vg?) 66.4 1 1 1
J3399 Inj onase abepar-xioi treat Novartis Gene Therapies, Inc. 71894-0139-09 Zolgensma Per tx dose (up to 5 x10^15 vg?) 69.1 1 1 1
J3399 Inj onase abepar-xioi treat Novartis Gene Therapies, Inc. 71894-0140-09 Zolgensma Per tx dose (up to 5 x10^15 vg?) 71.9 1 1 1
J3399 Inj onase abepar-xioi treat Novartis Gene Therapies, Inc. 71894-0141-09 Zolgensma Per tx dose (up to 5 x10^15 vg?) 74.7 1 1 1
J3403 Revakinagene, per implant Neurotech Pharmaceuticals Inc 82958-0501-01 Encelto PER IMPLANT 1 1 1 1
J3424 Inj hydroxocobalamin iv 25mg Meridian Medical Technologies LLC 11704-0370-01 Cyanokit 25 MG 1 1 200 200
J3424 Inj hydroxocobalamin iv 25mg BTG International Inc. 50633-0310-11 Cyanokit 25 MG 1 1 200 200
J7165 Inj, human-lans, per i.u Octapharma USA Inc. 68982-0261-01 Balfaxar PER FACTOR IX IU 1 1 1 1
J7165 Inj, human-lans, per i.u Octapharma USA Inc. 68982-0261-02 Balfaxar PER FACTOR IX IU 1 1 1 1
J7168 Prothrombin complex kcentra CSL Behring L.L.C. 63833-0386-02 Kcentra 1 IU 1 1 1 1
J7168 Prothrombin complex kcentra CSL Behring L.L.C. 63833-0387-02 Kcentra 1 IU 1 1 1 1
J7169 Inj andexxa, 10 mg AstraZeneca Pharmaceuticals LP 00310-3200-04 Andexxa 10 MG 1 4 20 80
J7169 Inj andexxa, 10 mg AstraZeneca Pharmaceuticals LP 00310-3200-05 Andexxa 10 MG 1 5 20 100
J7169 Inj andexxa, 10 mg AstraZeneca Pharmaceuticals LP 69853-0102-01 Andexxa 10 MG 1 4 20 80
J7174 Injection fitusiran 0.04 mg Genzyme Corporation 58468-0347-01 Qfitlia 0.04 MG 0.2 1 500 500
J7174 Injection fitusiran 0.04 mg Genzyme Corporation 58468-0348-01 Qfitlia 0.04 MG 0.5 1 1250 1250
J7352 Afamelanotide implant, 1 mg Clinuvel Inc. 73372-0116-01 Scenesse 1 MG 1 1 16 16
J7353 Anacaulase-bcdb 8.8% gel 1 g Vericel Corporation 69866-2002-03 NexoBrid 1 GM (OF 8.8% GEL) 1 1 22 22
J7353 Anacaulase-bcdb 8.8% gel 1 g Vericel Corporation 69866-2005-03 NexoBrid 1 GM (OF 8.8% GEL) 1 1 55 55
J7501 Azathioprine parenteral Hikma Pharmaceuticals USA Inc. 00143-9566-01 Azathioprine 100 MG 1 1 1 1
J9174 Inj, docetaxel (beizray) 1mg Zhuhai Beihai Biotech Ltd 83513-0010-01 Beizray 1 MG 4 2 80 160
J9220 Indigotindisulfonate sod 1mg Apollo Pharmaceuticals 81284-0315-05 Bludigo 1 MG 5 5 40 200
J9302 Ofatumumab injection Novartis Pharmaceuticals Corporation 00078-0669-13 Arzerra 10 MG 5 3 10 30
J9302 Ofatumumab injection Novartis Pharmaceuticals Corporation 00078-0690-61 Arzerra 10 MG 50 1 100 100
J9313 Inj., lumoxiti, 0.01 mg AstraZeneca Pharmaceuticals LP 00310-4700-01 Lumoxiti 0.01 MG 1 1 100 100
J9313 Inj., lumoxiti, 0.01 mg AstraZeneca Pharmaceuticals LP 73380-4700-01 Lumoxiti 0.01 MG 1 1 100 100
J9376 Inj pozelimab-bbfg, 1 mg Regeneron Pharmaceuticals, Inc. 61755-0014-01 Veopoz 1 MG 2 1 400 400
J9600 Porfimer sodium injection Pinnacle Biologics, Inc. 76128-0155-75 Photofrin 75 MG 1 1 1 1
Q2058 Obecbtge autol up to 400 mil Autolus Inc. 83047-0410-04 Aucatzyl Per Therapeutic Dose 1 1 1 2
Q3027 Inj beta interferon im 1 mcg Biogen Inc. 59627-0222-05 Avonex 1 MCG 1 4 30 120
Q3027 Inj beta interferon im 1 mcg Biogen Inc. 59627-0333-04 Avonex Pen 1 MCG 1 4 30 120
Q5136 Inj. denosumab-bbdz, 1 mg Sandoz Inc. 61314-0228-94 Wyost 1 MG 1.7 1 120 120
Q5136 Inj. denosumab-bbdz, 1 mg Sandoz Inc. 61314-0240-63 Jubbonti 1 MG 1 1 60 60
Q5140 Inj adalimumab-fkjp, 1 mg Mylan Specialty L.P. 49502-0380-02 Hulio 1 MG 0.8 1 40 80
Q5140 Inj adalimumab-fkjp, 1 mg Mylan Specialty L.P. 49502-0381-02 Hulio 1 MG 0.4 1 20 40
Q5140 Inj adalimumab-fkjp, 1 mg Mylan Specialty L.P. 49502-0382-02 Hulio 1 MG 0.8 1 40 80
Q5140 Inj adalimumab-fkjp, 1 mg Biocon Biologics Inc 83257-0016-42 Hulio 1 MG 0.4 2 20 40
Q5140 Inj adalimumab-fkjp, 1 mg Biocon Biologics Inc 83257-0017-42 Hulio 1 MG 0.8 1 40 80
Q5140 Inj adalimumab-fkjp, 1 mg Biocon Biologics Inc 83257-0019-32 Hulio 1 MG 0.8 1 40 80
Q5141 Inj adalimumab-aaty, 1 mg Celltrion USA Inc. 72606-0023-01 Yuflyma 1 MG 0.8 1 80 80
Q5141 Inj adalimumab-aaty, 1 mg Celltrion USA Inc. 72606-0023-02 Yuflyma 1 MG 0.8 1 80 80
Q5141 Inj adalimumab-aaty, 1 mg Celltrion USA Inc. 72606-0023-03 Yuflyma 1 MG 0.8 2 80 160
Q5141 Inj adalimumab-aaty, 1 mg Celltrion USA Inc. 72606-0023-04 Yuflyma 1 MG 0.8 1 80 80
Q5141 Inj adalimumab-aaty, 1 mg Celltrion USA Inc. 72606-0023-05 Yuflyma 1 MG 0.8 2 80 160
Q5141 Inj adalimumab-aaty, 1 mg Celltrion USA Inc. 72606-0023-07 Yuflyma 1 MG 0.8 3 80 240
Q5141 Inj adalimumab-aaty, 1 mg Celltrion USA Inc. 72606-0023-08 Yuflyma 1 MG 0.8 3 80 240
Q5141 Inj adalimumab-aaty, 1 mg Celltrion USA Inc. 72606-0024-01 Yuflyma 1 MG 0.2 2 20 40
Q5141 Inj adalimumab-aaty, 1 mg Celltrion USA Inc. 72606-0030-01 Yuflyma 1 MG 0.4 1 40 40
Q5141 Inj adalimumab-aaty, 1 mg Celltrion USA Inc. 72606-0030-02 Yuflyma 1 MG 0.4 2 40 80
Q5141 Inj adalimumab-aaty, 1 mg Celltrion USA Inc. 72606-0030-03 Yuflyma 1 MG 0.4 4 40 160
Q5141 Inj adalimumab-aaty, 1 mg Celltrion USA Inc. 72606-0030-04 Yuflyma 1 MG 0.4 6 40 240
Q5141 Inj adalimumab-aaty, 1 mg Celltrion USA Inc. 72606-0030-05 Yuflyma 1 MG 0.4 1 40 40
Q5141 Inj adalimumab-aaty, 1 mg Celltrion USA Inc. 72606-0030-06 Yuflyma 1 MG 0.4 2 40 80
Q5141 Inj adalimumab-aaty, 1 mg Celltrion USA Inc. 72606-0030-07 Yuflyma 1 MG 0.4 4 40 160
Q5141 Inj adalimumab-aaty, 1 mg Celltrion USA Inc. 72606-0030-08 Yuflyma 1 MG 0.4 6 40 240
Q5141 Inj adalimumab-aaty, 1 mg Celltrion USA Inc. 72606-0030-09 Yuflyma 1 MG 0.4 1 40 40
Q5141 Inj adalimumab-aaty, 1 mg Celltrion USA Inc. 72606-0030-10 Yuflyma 1 MG 0.4 2 40 80
Q5141 Inj adalimumab-aaty, 1 mg Celltrion USA Inc. 72606-0030-11 Yuflyma 1 MG 0.4 4 40 160
Q5141 Inj adalimumab-aaty, 1 mg Celltrion USA Inc. 72606-0030-12 Yuflyma 1 MG 0.4 6 40 240
Q5141 Inj adalimumab-aaty, 1 mg Celltrion USA Inc. 72606-0030-13 Yuflyma 1 MG 0.4 4 40 160
Q5141 Inj adalimumab-aaty, 1 mg Celltrion USA Inc. 72606-0030-14 Yuflyma 1 MG 0.4 6 40 240
Q5142 Inj adalimumab-ryvk, 1 mg Teva Pharmaceuticals USA, Inc. 51759-0274-17 Simlandi 1 MG 0.8 1 80 80
Q5142 Inj adalimumab-ryvk, 1 mg Nupathe Inc 51759-0386-22 Simlandi 1 MG 0.2 2 20 40
Q5142 Inj adalimumab-ryvk, 1 mg Nupathe Inc 51759-0402-02 Simlandi 1 MG 0.4 2 40 80
Q5142 Inj adalimumab-ryvk, 1 mg Nupathe Inc 51759-0402-17 Simlandi 1 MG 0.4 1 40 40
Q5142 Inj adalimumab-ryvk, 1 mg Nupathe Inc 51759-0412-22 Simlandi 1 MG 0.4 2 40 80
Q5142 Inj adalimumab-ryvk, 1 mg Nupathe Inc 51759-0523-21 Simlandi 1 MG 0.8 1 80 80
Q5142 Inj adalimumab-ryvk, 1 mg Quallent Pharmaceuticals 82009-0156-22 Adalimumab-ryvk 1 MG 0.4 2 40 80
Q5142 Inj adalimumab-ryvk, 1 mg Quallent Pharmaceuticals 82009-0158-22 Adalimumab-ryvk 1 MG 0.4 2 40 80
Q5143 Inj adalimumab-adbm, 1 mg Quallent Pharmaceuticals 82009-0144-22 Adalimumab-adbm 1 MG 0.4 2 40 80
Q5143 Inj adalimumab-adbm, 1 mg Quallent Pharmaceuticals 82009-0146-22 Adalimumab-adbm 1 MG 0.4 2 40 80
Q5143 Inj adalimumab-adbm, 1 mg Quallent Pharmaceuticals 82009-0148-22 Adalimumab-adbm 1 MG 0.8 2 40 80
Q5143 Inj adalimumab-adbm, 1 mg Quallent Pharmaceuticals 82009-0150-22 Adalimumab-adbm 1 MG 0.8 2 40 80
Q5143 Inj adalimumab-adbm, 1 mg Boehringer Ingelheim Pharmaceuticals Inc 00597-0370-82 Cyltezo 1 MG 0.8 2 40 80
Q5143 Inj adalimumab-adbm, 1 mg Boehringer Ingelheim Pharmaceuticals Inc 00597-0375-16 Cyltezo 1 MG 0.8 6 40 240
Q5143 Inj adalimumab-adbm, 1 mg Boehringer Ingelheim Pharmaceuticals Inc 00597-0375-23 Cyltezo 1 MG 0.8 4 40 160
Q5143 Inj adalimumab-adbm, 1 mg Boehringer Ingelheim Pharmaceuticals Inc 00597-0375-97 Cyltezo 1 MG 0.8 2 40 80
Q5143 Inj adalimumab-adbm, 1 mg Boehringer Ingelheim Pharmaceuticals Inc 00597-0400-89 Cyltezo 1 MG 0.2 2 10 20
Q5143 Inj adalimumab-adbm, 1 mg Boehringer Ingelheim Pharmaceuticals Inc 00597-0405-80 Cyltezo 1 MG 0.4 2 20 40
Q5143 Inj adalimumab-adbm, 1 mg Boehringer Ingelheim Pharmaceuticals Inc 00597-0485-20 Cyltezo 1 MG 0.4 2 40 80
Q5143 Inj adalimumab-adbm, 1 mg Boehringer Ingelheim Pharmaceuticals Inc 00597-0495-40 Cyltezo 1 MG 0.4 4 40 160
Q5143 Inj adalimumab-adbm, 1 mg Boehringer Ingelheim Pharmaceuticals Inc 00597-0495-50 Cyltezo 1 MG 0.4 2 40 80
Q5143 Inj adalimumab-adbm, 1 mg Boehringer Ingelheim Pharmaceuticals Inc 00597-0495-60 Cyltezo 1 MG 0.4 6 40 240
Q5144 Inj, idacio, 1 mg FreseniUS Kabi USA, LLC 65219-0612-69 Adalimumab-aacf 1 MG 0.8 4 40 160
Q5144 Inj, idacio, 1 mg FreseniUS Kabi USA, LLC 65219-0612-89 Adalimumab-aacf 1 MG 0.8 6 40 240
Q5144 Inj, idacio, 1 mg FreseniUS Kabi USA, LLC 65219-0612-99 Adalimumab-aacf 1 MG 0.8 2 40 80
Q5144 Inj, idacio, 1 mg FreseniUS Kabi USA, LLC 65219-0620-20 Adalimumab-Aacf 1 MG 0.8 2 40 80
Q5144 Inj, idacio, 1 mg FreseniUS Kabi USA, LLC 65219-0554-08 Idacio 1 MG 0.8 2 40 80
Q5144 Inj, idacio, 1 mg FreseniUS Kabi USA, LLC 65219-0554-28 Idacio 1 MG 0.8 4 40 160
Q5144 Inj, idacio, 1 mg FreseniUS Kabi USA, LLC 65219-0554-38 Idacio 1 MG 0.8 6 40 240
Q5144 Inj, idacio, 1 mg FreseniUS Kabi USA, LLC 65219-0556-18 Idacio 1 MG 0.8 2 40 80
Q5145 Inj, abrilada, 1 mg PFIZER LABS 00025-0325-01 Abrilada 1 MG 0.8 1 40 40
Q5145 Inj, abrilada, 1 mg Pfizer Inc. 00025-0325-02 Abrilada 1 MG 0.8 2 40 80
Q5145 Inj, abrilada, 1 mg Pfizer Inc. 00025-0328-02 Abrilada 1 MG 0.8 2 40 80
Q5145 Inj, abrilada, 1 mg Pfizer Inc 00069-0319-01 Abrilada 1 MG 0.8 1 40 40
Q5145 Inj, abrilada, 1 mg Pfizer Inc 00069-0325-01 Abrilada 1 MG 0.8 1 40 40
Q5145 Inj, abrilada, 1 mg Pfizer Inc 00069-0325-02 Abrilada 1 MG 0.8 2 40 80
Q5145 Inj, abrilada, 1 mg Pfizer Inc 00069-0328-01 Abrilada 1 MG 0.8 1 40 40
Q5145 Inj, abrilada, 1 mg Pfizer Inc 00069-0328-02 Abrilada 1 MG 0.8 2 40 80
Q5145 Inj, abrilada, 1 mg Pfizer Inc 00069-0333-02 Abrilada 1 MG 0.4 2 20 40
Q5145 Inj, abrilada, 1 mg Pfizer Inc 00069-0347-02 Abrilada 1 MG 0.2 2 10 20
Q5148 Inj, nyposi 1 mcg Tanvex Biopharma USA 72374-0101-01 Nypozi 1 MCG 0.5 1 300 300
Q5148 Inj, nyposi 1 mcg Tanvex Biopharma USA 72374-0101-10 Nypozi 1 MCG 0.5 10 300 3000
Q5148 Inj, nyposi 1 mcg Tanvex Biopharma USA 72374-0102-01 Nypozi 1 MCG 0.8 1 480 480
Q5148 Inj, nyposi 1 mcg Tanvex Biopharma USA 72374-0102-10 Nypozi 1 MCG 0.8 10 480 4800
Q5151 Inj, eculizumab-aagh, 2 mg Teva Pharmaceuticals USA, Inc. 51759-0208-13 Epysqli 2 MG 30 1 150 150
Q5151 Inj, eculizumab-aagh, 2 mg Samsung Bioepis 71202-0010-01 Epysqli 2 MG 30 1 150 150
Q5152 Inj, eculizumab-aeeb, 2 mg  Amgen Inc 55513-0180-01 Bkemv 2 MG 30 1 150 150
Q5157 Inj, denosumab-bmwo, 1 mg Celltrion USA Inc. 72606-0038-01 Osenvelt 1 MG 1.7 1 120 120
Q5157 Inj, denosumab-bmwo, 1 mg Celltrion USA Inc. 72606-0037-01 Stoboclo 1 MG 1 1 60 60
Q5158 Inj, denosumab-bnht, 1 mg Fresenius Kabi USA, LLC 65219-0670-01 Bomyntra 1 MG 1.7 1 120 120
Q5158 Inj, denosumab-bnht, 1 mg Fresenius Kabi USA, LLC 65219-0672-01 Bomyntra 1 MG 1.7 1 120 120
Q5158 Inj, denosumab-bnht, 1 mg Fresenius Kabi USA, LLC 65219-0668-01 Conexxence 1 MG 1 1 60 60
Q9968 Visualization adjunct Mylan Institutional LLC 67457-0220-05 Isosulfan Blue 1 MG 5 6 50 300
Q9968 Visualization adjunct American Regent, Inc. 00517-0374-05 Provayblue 1 MG 10 5 50 250
Q9982 Flutemetamol F18 GE Healthcare Inc. 17156-0067-30 Vizamyl Per Study Dose, up to 5 millicuries 1 1 1 1

Past NDC - HCPCS Crosswalk