|
Brompheniramine maleate inj
|
HCPCS J0945 |
— |
—
|
— |
0 |
|
Budesonide comp unit
|
HCPCS J7627 |
— |
—
|
— |
0 |
|
Budesonide non-comp con
|
HCPCS J7633 |
$58.20 |
$604.80
|
$1,396.00 |
14 |
|
Budesonide non-comp unit
|
HCPCS J7626 |
$1.45 |
$20.52
|
$162.86 |
210 |
|
Bumetanide in d5w IV syringe 0.04 mg/ml (neo/ped) - cnr
|
HCPCS J1939 |
$1.57 |
$23.92
|
$218.54 |
517 |
|
Bupivacaine 0.1 % epidural pca - 1 hour dose limit
|
HCPCS J0665 |
$1.68 |
$32.47
|
$319.44 |
500 |
|
Bupren/nal 3.1 to 6mg bupren
|
HCPCS J0573 |
$1.95 |
$22.73
|
$120.75 |
75 |
|
Buprenorphine 2 mg-naloxone 0.5 mg sublingual tablet
|
HCPCS J0572 |
$1.05 |
$11.72
|
$89.40 |
264 |
|
Buprenorphine 8 mg-naloxone 2 mg sublingual tablet
|
HCPCS J0574 |
$1.00 |
$14.42
|
$144.07 |
292 |
|
Buprenorphine hydrochloride
|
HCPCS J0592 |
$4.83 |
$42.08
|
$389.37 |
327 |
|
Buprenorphine oral 1mg
|
HCPCS J0571 |
$0.60 |
$10.70
|
$107.82 |
339 |
|
Busulfan injection
|
HCPCS J0594 |
$29.56 |
$834.60
|
$2,905.77 |
125 |
|
Butorphanol tartrate 1 mg
|
HCPCS J0595 |
$2.70 |
$41.79
|
$391.69 |
559 |
|
C-1 esterase, berinert
|
HCPCS J0597 |
$728.00 |
$8,114.40
|
$68,431.20 |
315 |
|
C-1 esterase, cinryze
|
HCPCS J0598 |
$283.37 |
$7,189.05
|
$46,266.05 |
108 |
|
Cabazitaxel 10 mg/ml (first dilution) intravenous solution
|
HCPCS J9043 |
$992.55 |
$27,013.07
|
$151,180.21 |
359 |
|
Cabergoline, oral 0.25mg
|
HCPCS J8515 |
$3.52 |
$66.09
|
$609.00 |
168 |
|
Cabotegravir ER 400 mg/2 ml-rilpivirine ER 600 mg/2ml im suspension,er
|
HCPCS J0741 |
$632.22 |
$13,247.32
|
$61,378.32 |
139 |
|
Caffeine citrate 20 mg/ml inj for po
|
HCPCS J0706 |
$2.35 |
$46.09
|
$459.96 |
479 |
|
Calaspargase pegol-mknl 750 unit/ml intravenous solution
|
HCPCS J9118 |
$4,073.73 |
$48,025.40
|
$183,830.67 |
115 |
|
Calcitonin (salmon) 200 unit/ml injection solution
|
HCPCS J0630 |
$158.03 |
$2,210.98
|
$21,012.58 |
669 |
|
Calcium acetate(phosphate binders) 667 mg tablet
|
HCPCS J0615 |
$0.16 |
$3.00
|
$27.00 |
133 |
|
Calcium chloride 100 mg/ml (10 %) intravenous syringe
|
HCPCS J0618 |
$2.53 |
$48.00
|
$427.58 |
330 |
|
Calcium gluconate 100 mg/ml (10 %) intravenous solution
|
HCPCS J0612 |
$3.00 |
$64.49
|
$574.31 |
530 |
|
Calcium gluconate 2 gram/100 ml in sodium chloride,iso-osm IV solution
|
HCPCS J0613 |
$4.30 |
$91.60
|
$778.00 |
425 |
|
Calcium glycer & lact/10 ml
|
HCPCS J0620 |
— |
—
|
— |
0 |
|
Canakinumab injection
|
HCPCS J0638 |
$7,876.92 |
$35,959.82
|
$124,807.55 |
133 |
|
Cantharidin top, applicator
|
HCPCS J7354 |
$315.00 |
$1,113.94
|
$1,664.34 |
81 |
|
Capecitabine, oral, 50 mg
|
HCPCS J8522 |
$3.26 |
$59.42
|
$432.46 |
229 |
|
Capsaicin 8% patch
|
HCPCS J7336 |
$394.89 |
$5,668.65
|
$14,389.61 |
91 |
|
Carbidopa levodopa ent 100ml
|
HCPCS J7340 |
$118.28 |
$243.99
|
$548.67 |
79 |
|
Carboplatin 10 mg/ml desensitization
|
HCPCS J9045 |
$10.06 |
$196.00
|
$1,696.00 |
551 |
|
Carboprost tromethamine 250 mcg/ml intramuscular solution
|
HCPCS J0675 |
$29.74 |
$455.11
|
$4,132.11 |
314 |
|
Carfilzomib 10 mg intravenous solution
|
HCPCS J9047 |
$306.80 |
$6,306.47
|
$30,136.86 |
387 |
|
Carmustine 100 mg intravenous powder for solution
|
HCPCS J9050 |
$110.10 |
$1,854.00
|
$18,340.04 |
360 |
|
Caspofungin acetate
|
HCPCS J0637 |
$32.37 |
$633.91
|
$5,805.00 |
300 |
|
Cefazolin 10 mg/10 ml (dilution #2) IV desensitization - cnr
|
HCPCS J0690 |
$3.17 |
$39.52
|
$457.62 |
599 |
|
Cefepime 1 gram solution for injection
|
HCPCS J0692 |
$2.49 |
$45.47
|
$413.35 |
645 |
|
Cefotaxime sodium injection
|
HCPCS J0698 |
$2.93 |
$43.10
|
$445.20 |
245 |
|
Cefoxitin 1 gram intravenous solution
|
HCPCS J0694 |
$6.00 |
$74.82
|
$732.38 |
613 |
|
Ceftaroline fosamil 600 mg intravenous solution
|
HCPCS J0712 |
$25.22 |
$602.45
|
$4,245.42 |
518 |
|
Ceftazidime 4.5 mg/0.2 ml intraocular injection - cnr
|
HCPCS J0713 |
$2.96 |
$58.89
|
$467.54 |
622 |
|
Ceftazidime and avibactam
|
HCPCS J0714 |
$53.41 |
$904.66
|
$7,551.36 |
581 |
|
Ceftizoxime sodium / 500 mg
|
HCPCS J0715 |
$8.00 |
$8.00
|
$24.00 |
18 |
|
Ceftriaxone 1 gram solution for injection
|
HCPCS J0696 |
$4.14 |
$83.39
|
$800.00 |
652 |
|
Cefuroxime in ns IV syringe 30 mg/ml (neo/ped) - cnr
|
HCPCS J0697 |
$2.23 |
$30.66
|
$311.40 |
431 |
|
Cemiplimab-rwlc 50 mg/ml intravenous solution
|
HCPCS J9119 |
$1,221.03 |
$21,625.43
|
$103,630.35 |
337 |
|
Centruroides immune f(ab)
|
HCPCS J0716 |
$1,450.85 |
$4,804.24
|
$18,555.20 |
35 |
|
Certolizumab pegol 400 mg (200 mg x 2 vials) subcutaneous kit
|
HCPCS J0717 |
$1,525.57 |
$10,638.62
|
$71,265.50 |
299 |
|
Cetuximab 100 mg/50 ml intravenous solution
|
HCPCS J9055 |
$149.60 |
$3,011.40
|
$23,123.54 |
458 |
|
Chloramphenicol sodium injec
|
HCPCS J0720 |
$7.38 |
$113.84
|
$895.35 |
236 |
|
Chlordiazepoxide injection
|
HCPCS J1990 |
$273.80 |
$274.53
|
$517.41 |
3 |
|
Chloroprocaine (clorotekal)
|
HCPCS J2402 |
$23.05 |
$37.89
|
$152.84 |
62 |
|
Chloroprocaine hcl injection
|
HCPCS J2401 |
$2.94 |
$69.08
|
$582.25 |
478 |
|
Chloroprocaine opht gel, 1mg
|
HCPCS J2403 |
$0.60 |
$0.63
|
$0.80 |
24 |
|
Chlorothiazide sodium 500 mg intravenous solution
|
HCPCS J1205 |
$26.39 |
$406.36
|
$3,934.14 |
569 |
|
Chlorpromazine 0.125 mg/ml IV syringe - cnr
|
HCPCS J3230 |
$4.19 |
$79.74
|
$710.77 |
692 |
|
Chorionic gonadotropin/1000u
|
HCPCS J0725 |
$30.21 |
$548.36
|
$1,564.55 |
143 |
|
Cidofovir injection
|
HCPCS J0740 |
$71.75 |
$1,352.09
|
$13,309.00 |
393 |
|
Cilastatin sodium injection
|
HCPCS J0743 |
$9.80 |
$77.40
|
$697.00 |
434 |
|
Cinacalcet 30 mg tablet
|
HCPCS J0604 |
$2.30 |
$41.25
|
$309.65 |
60 |
|
Ciprofloxacin 400 mg/200 ml in 5 % dextrose intravenous piggyback
|
HCPCS J0744 |
$1.78 |
$35.65
|
$348.38 |
585 |
|
Ciprofloxacin otic susp 6 mg
|
HCPCS J7342 |
$3.89 |
$63.31
|
$683.20 |
86 |
|
Cisplatin 1 mg/ml desensitization
|
HCPCS J9060 |
$11.22 |
$205.56
|
$1,920.66 |
504 |
|
Cladribine 10 mg/10 ml intravenous solution
|
HCPCS J9065 |
$33.90 |
$576.60
|
$5,346.00 |
439 |
|
Clindamycin 600 mg/50 ml in 5 % dextrose intravenous piggyback
|
HCPCS J0736 |
$4.00 |
$55.20
|
$509.95 |
598 |
|
Clofarabine 1 mg/ml intravenous solution
|
HCPCS J9027 |
$224.80 |
$4,784.71
|
$37,310.00 |
243 |
|
Clonidine (pf) 1,000 mcg/10 ml (100 mcg/ml) epidural solution
|
HCPCS J0735 |
$4.83 |
$85.37
|
$734.02 |
518 |
|
Coagulation factor viia 1,000 mcg/ml inj 1 ml
|
HCPCS J7189 |
$746.08 |
$11,888.50
|
$30,871.79 |
194 |
|
Codeine 15 mg/ml inj 2 ml
|
HCPCS J0745 |
$3.24 |
$54.65
|
$266.26 |
37 |
|
Colistimethate sodium inj
|
HCPCS J0770 |
$12.00 |
$82.71
|
$835.00 |
448 |
|
Collagenase, clost hist inj
|
HCPCS J0775 |
$1,027.33 |
$12,906.28
|
$79,648.34 |
122 |
|
Conjugated estrogens 25 mg solution for injection
|
HCPCS J1410 |
$48.72 |
$860.00
|
$6,851.70 |
626 |
|
Copper intrauterine device
|
HCPCS J7300 |
$142.52 |
$1,953.00
|
$7,249.00 |
332 |
|
Corticorelin ovine triflutal
|
HCPCS J0795 |
$89.05 |
$1,462.49
|
$2,971.01 |
28 |
|
Cosyntropin 0.25 mg solution for injection
|
HCPCS J0834 |
$10.71 |
$189.22
|
$1,880.17 |
688 |
|
Crizanlizumab-tmca 10 mg/ml intravenous solution
|
HCPCS J0791 |
$271.28 |
$4,288.58
|
$23,137.00 |
178 |
|
Cromolyn sodium noncomp unit
|
HCPCS J7631 |
$1.26 |
$10.57
|
$48.14 |
41 |
|
Crotalidae poly immune fab
|
HCPCS J0840 |
$495.09 |
$5,760.00
|
$50,366.52 |
461 |
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
HCPCS J3420 |
$1.40 |
$25.32
|
$247.00 |
764 |
|
Cyclophosphamide 100 mg inj
|
HCPCS J9070 |
$35.75 |
$287.88
|
$2,431.38 |
48 |
|
Cyclophosphamide 1 gram intravenous powder for solution
|
HCPCS J9075 |
$58.41 |
$1,305.02
|
$6,630.54 |
399 |
|
Cyclophosphamide 25 mg capsule
|
HCPCS J8530 |
$1.26 |
$19.49
|
$209.52 |
373 |
|
Cyclosporine 250 mg/5 ml intravenous solution
|
HCPCS J7516 |
$7.54 |
$140.78
|
$1,301.31 |
414 |
|
Cyclosporine modified 25 mg capsule
|
HCPCS J7515 |
$0.52 |
$7.48
|
$87.72 |
522 |
|
Cyclosporine oral 100 mg
|
HCPCS J7502 |
$3.93 |
$37.31
|
$751.97 |
337 |
|
Cytarabine 20 mg/ml injection solution
|
HCPCS J9100 |
$4.74 |
$90.00
|
$863.60 |
469 |
|
Cytarabine liposome inj
|
HCPCS J9098 |
$226.71 |
$4,529.43
|
$22,715.55 |
31 |
|
Cytomegalovirus imm IV /vial
|
HCPCS J0850 |
$935.10 |
$3,072.34
|
$17,223.00 |
206 |
|
Dacarbazine 100 mg intravenous solution
|
HCPCS J9130 |
$4.97 |
$62.41
|
$567.00 |
514 |
|
Dactinomycin 0.5 mg intravenous solution
|
HCPCS J9120 |
$153.88 |
$3,264.26
|
$28,114.64 |
378 |
|
Dalbavancin 500 mg intravenous solution
|
HCPCS J0875 |
$276.45 |
$3,493.11
|
$28,608.42 |
406 |
|
Dalteparin sodium
|
HCPCS J1645 |
$28.06 |
$469.55
|
$2,554.24 |
135 |
|
Daptomycin 500 mg/10 ml intravenous solution
|
HCPCS J0878 |
$9.51 |
$171.19
|
$1,390.97 |
418 |
|
Daptomycin (xellia) unrefrig
|
HCPCS J0872 |
$18.73 |
$56.19
|
$208.23 |
28 |
|
Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln
|
HCPCS J9144 |
$1,649.21 |
$21,063.03
|
$105,334.14 |
383 |
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
HCPCS J0881 |
$259.38 |
$6,281.29
|
$41,409.32 |
482 |
|
Darbepoetin alfa, esrd use
|
HCPCS J0882 |
$2.26 |
$7.20
|
$161.25 |
107 |
|
Daunorubicin 44 mg and cytarabine 100 mg in liposome IV solution
|
HCPCS J9153 |
$995.80 |
$20,196.00
|
$88,215.00 |
228 |
|
Daunorubicin 5 mg/ml intravenous solution
|
HCPCS J9150 |
$15.55 |
$259.58
|
$1,911.50 |
381 |