Payment Allowance Limits for Medicare Part B Drugs
Effective July 1, 2006 through September 30, 2006

Note 1: Payment allowance limits subject to the ASP methodology are based on 1Q06 ASP data.
Note 2: The absence or presence of a HCPCS code and the payment allowance limits in this table does not indicate Medicare coverage of the drug.
Similarly, the inclusion of a payment allowance limit within a specific column does not indicate Medicare coverage of the drug in that specific category.
These determinations shall be made by the local Medicare contractor processing the claim.
 
HCPCS Code Short Description HCPCS Code Dosage Payment Limit Vaccine AWP% Vaccine Limit Infusion AWP% DME Infusion Limit Blood AWP% Blood Limit Notes
90371 Hep b ig, im 1 ML $117.357            
90375 Rabies ig, im/sc 150 IU $65.132            
90376 Rabies ig, heat treated 150 IU $67.891            
90385 Rh ig, minidose, im 50 MCG $11.174            
90585 Bcg vaccine, percut 50 MG $115.847            
90586 Bcg vaccine, intravesical 1 EACH $112.686            
90632 Hep a vaccine, adult im 1 ML $41.643            
90633 Hep a vacc, ped/adol, 2 dose 1 ML $23.906            
90634 Hep a vacc, ped/adol, 3 dose 3 EACH $23.906            
90645 Hib vaccine, hboc, im 1 EACH $21.492            
90647 Hib vaccine, prp-omp, im 0.5 ML $21.492            
90648 Hib vaccine, prp-t, im 0.5 ML $21.782            
90655 Flu vaccine no preserv 6-35m 0.25 ML $14.678 95% $14.678        
90656 Flu vaccine no preserv 3 & > 0.50 ML $15.818 95% $15.818        
90657 Flu vaccine, 6-35 mo, im 0.25 ML $6.028 95% $6.028        
90658 Flu vaccine age 3 & over, im 0.5 ML $12.056 95% $12.056        
90660 Flu vaccine, nasal 0.5 ML $21.176 95% $21.176        
90675 Rabies vaccine, im 1 ML $157.820            
90691 Typhoid vaccine, im 0.5 ML $52.343            
90700 Dtap vaccine, < 7 yrs, im 0.5 ML $30.457            
90702 Dt vaccine < 7, im 0.5 ML $18.300            
90703 Tetanus vaccine, im 0.5 ML $19.260            
90704 Mumps vaccine, sc 0.5 ML $19.169            
90705 Measles vaccine, sc 0.5 ML $14.593            
90706 Rubella vaccine, sc 0.5 ML $16.243            
90707 Mmr vaccine, sc 0.5 ML $38.514            
90713 Poliovirus, ipv, sc/im 0.5 ML $26.228            
90714 Td vaccine no prsrv >/= 7 im 0.5 ML $18.481            
90716 Chicken pox vaccine, sc 0.5 ML $67.739            
90717 Yellow fever vaccine, sc 0.5 ML $54.440            
90718 Td vaccine > 7, im 0.5 ML $18.468            
90721 Dtap/hib vaccine, im 1 EACH $41.724            
90732 Pneumococcal vaccine 0.5 ML $27.028 95% $27.028        
90733 Meningococcal vaccine, sc 0.5 ML $84.460            
90735 Encephalitis vaccine, sc 1 ML $96.220            
90740 Hepb vacc, ill pat 3 dose im 40 MCG $113.914 95% $113.914        
90743 Hep b vacc, adol, 2 dose, im 1 DOSE $24.358 95% $24.358        
90744 Hepb vacc ped/adol 3 dose im 1 DOSE $24.358 95% $24.358        
90746 Hep b vaccine, adult, im 20 MCG $58.435 95% $58.435        
90747 Hepb vacc, ill pat 4 dose im 40 MCG $113.914 95% $113.914        
J0128 Abarelix injection 10 MG $68.620            
J0130 Abciximab injection 10 MG $443.737            
J0132 Acetylcysteine injection 100 MG $1.894            
J0133 Acyclovir injection 5 MG $0.028            
J0135 Adalimumab injection 20 MG $303.359            
J0150 Injection adenosine 6 MG 6 MG $30.766            
J0152 Adenosine injection 30 MG $70.051            
J0170 Adrenalin epinephrin inject 1 ML $0.602            
J0180 Agalsidase beta injection 1 MG $127.200            
J0205 Alglucerase injection 10 UNITS $39.220            
J0207 Amifostine 500 MG $451.224            
J0210 Methyldopate hcl injection 250 MG $9.970            
J0215 Alefacept 0.5 MG $25.938            
J0256 Alpha 1 proteinase inhibitor 10 MG $3.253            
J0270 Alprostadil for injection 1.25 MCG $1.854            
J0275 Alprostadil urethral suppos 125 MCG $21.681            
J0278 Amikacin sulfate injection 100 MG $1.142            
J0280 Aminophyllin 250 MG inj 250 MG $0.401            
J0282 Amiodarone HCl 30 MG $0.245            
J0285 Amphotericin B 50 MG $8.330     95% $10.280    
J0287 Amphotericin b lipid complex 10 MG $11.036     95% $21.850    
J0288 Ampho b cholesteryl sulfate 10 MG $12.000     95% $15.200    
J0289 Amphotericin b liposome inj 10 MG $15.417     95% $35.800    
J0290 Ampicillin 500 MG inj 500 MG $2.308            
J0295 Ampicillin sodium per 1.5 gm 1.5 GM $4.611            
J0300 Amobarbital 125 MG inj 125 MG $2.415            
J0330 Succinycholine chloride inj 20 MG $0.192            
J0350 Injection anistreplase 30 u 30 UNITS $2,268.460            
J0360 Hydralazine hcl injection 20 MG $6.361            
J0365 Aprotonin, 10,000 kiu 10000 KIU $2.499            
J0456 Azithromycin 500 MG $20.232            
J0460 Atropine sulfate injection 0.3 MG $0.284            
J0470 Dimecaprol injection 100 MG $21.999            
J0475 Baclofen 10 MG injection 10 MG $198.984     95% $215.180    
J0476 Baclofen intrathecal trial 50 MCG $71.391     95% $79.800    
J0480 Basiliximab 20 MG $1,414.533            
J0500 Dicyclomine injection 20 MG $15.531            
J0515 Inj benztropine mesylate 1 MG $14.003            
J0530 Penicillin g benzathine inj 600000 UNITS $13.227            
J0540 Penicillin g benzathine inj 1200000 UNITS $27.833            
J0550 Penicillin g benzathine inj 2400000 UNITS $29.730            
J0560 Penicillin g benzathine inj 600000 UNITS $20.511            
J0570 Penicillin g benzathine inj 1200000 UNITS $35.927            
J0580 Penicillin g benzathine inj 2400000 UNITS $42.104            
J0583 Bivalirudin 1 MG $1.589            
J0585 Botulinum toxin a per unit 1 UNIT $5.029            
J0587 Botulinum toxin type B 100 UNITS $8.077            
J0592 Buprenorphine hydrochloride 0.1 MG $0.737            
J0595 Butorphanol tartrate 1 mg 1 MG $0.757            
J0600 Edetate calcium disodium inj 1000 MG $40.123            
J0610 Calcium gluconate injection 10 ML $0.390            
J0630 Calcitonin salmon injection 400 UNITS $40.598            
J0636 Inj calcitriol per 0.1 mcg 0.1 MCG $0.507            
J0637 Caspofungin acetate 5 MG $32.443            
J0640 Leucovorin calcium injection 50 MG $1.023            
J0670 Inj mepivacaine HCL/10 ml 10 ML $1.463            
J0690 Cefazolin sodium injection 500 MG $1.339            
J0692 Cefepime HCl for injection 500 MG $8.131            
J0694 Cefoxitin sodium injection 1 GM $6.911            
J0696 Ceftriaxone sodium injection 250 MG $2.033            
J0697 Sterile cefuroxime injection 750 MG $1.463            
J0698 Cefotaxime sodium injection 1 GM $4.346            
J0702 Betamethasone acet&sod phosp 3 MG $5.147            
J0704 Betamethasone sod phosp/4 MG 4 MG $1.133            
J0706 Caffeine citrate injection 5 MG $3.480            
J0713 Inj ceftazidime per 500 mg 500 MG $3.989            
J0715 Ceftizoxime sodium / 500 MG 500 MG $3.352            
J0720 Chloramphenicol sodium injec 1 GM $10.137            
J0725 Chorionic gonadotropin/1000u 1000 UNITS $3.489            
J0735 Clonidine hydrochloride 1 MG $65.336            
J0740 Cidofovir injection 375 MG $748.519            
J0743 Cilastatin sodium injection 250 MG $13.209            
J0744 Ciprofloxacin iv 200 MG $8.287            
J0745 Inj codeine phosphate /30 MG 30 MG $1.148            
J0760 Colchicine injection 1 MG $4.479            
J0770 Colistimethate sodium inj 150 MG $25.517            
J0780 Prochlorperazine injection 10 MG $2.353            
J0795 Corticorelin ovine triflutal 1 MCG $4.097            
J0800 Corticotropin injection 40 UNITS $114.805            
J0835 Inj cosyntropin per 0.25 MG 0.25 MG $62.328            
J0850 Cytomegalovirus imm IV /vial PER VIAL $776.132            
J0878 Daptomycin injection 1 MG $0.313            
J0881 Darbepoetin alfa, non-esrd 1 MCG $3.026            
J0882 Darbepoetin alfa, esrd use 1 MCG $3.026            
J0885 Epoetin alfa, non-esrd 1000 UNITS $9.403            
J0886 Epoetin alfa, esrd 1000 UNITS $9.479            
J0895 Deferoxamine mesylate inj 500 MG $15.524     95% $15.630    
J0900 Testosterone enanthate inj 1 CC $1.379            
J0945 Brompheniramine maleate inj 10 MG $0.732            
J0970 Estradiol valerate injection 40 MG $33.866            
J1000 Depo-estradiol cypionate inj 5 MG $5.491            
J1020 Methylprednisolone 20 MG inj 20 MG $2.928            
J1030 Methylprednisolone 40 MG inj 40 MG $5.220            
J1040 Methylprednisolone 80 MG inj 80 MG $9.490            
J1051 Medroxyprogesterone inj 50 MG $5.467            
J1056 MA/EC contraceptiveinjection 5 MG $22.885            
J1060 Testosterone cypionate 1 ML 1 ML $4.142            
J1070 Testosterone cypionat 100 MG 100 MG $5.409            
J1080 Testosterone cypionat 200 MG 200 MG $12.707            
J1094 Inj dexamethasone acetate 1 MG $0.230            
J1100 Dexamethasone sodium phos 1 MG $0.135            
J1110 Inj dihydroergotamine mesylt 1 MG $27.642            
J1120 Acetazolamid sodium injectio 500 MG $15.063            
J1160 Digoxin injection 0.5 MG $1.022            
J1162 Digoxin immune fab (ovine) PER VIAL $521.841            
J1165 Phenytoin sodium injection 50 MG $0.910            
J1170 Hydromorphone injection 4 MG $1.752     95% $1.490    
J1180 Dyphylline injection 500 MG $8.045            
J1190 Dexrazoxane HCl injection 250 MG $183.289            
J1200 Diphenhydramine hcl injectio 50 MG $0.738            
J1205 Chlorothiazide sodium inj 500 MG $76.756            
J1212 Dimethyl sulfoxide 50% 50 ML 50 ML $42.803            
J1230 Methadone injection 10 MG $3.281     95% $0.750    
J1240 Dimenhydrinate injection 50 MG $3.652            
J1245 Dipyridamole injection 10 MG $1.619            
J1250 Inj dobutamine HCL/250 mg 250 MG $4.865     95% $4.740    
J1260 Dolasetron mesylate 10 MG $6.612            
J1265 Dopamine injection 40 MG $0.805            
J1270 Injection, doxercalciferol 1 MCG $3.159            
J1320 Amitriptyline injection 20 MG $2.237            
J1325 Epoprostenol injection 0.5 MG $13.708     95% $12.640    
J1327 Eptifibatide injection 5 MG $14.560            
J1335 Ertapenem injection 500 MG $23.135            
J1364 Erythro lactobionate /500 MG 500 MG $5.796            
J1380 Estradiol valerate 10 MG inj 10 MG $12.637            
J1390 Estradiol valerate 20 MG inj 20 MG $16.933            
J1410 Inj estrogen conjugate 25 MG 25 MG $58.183            
J1430 Ethanolamine oleate 100 mg 100 MG $69.596            
J1435 Injection estrone per 1 MG 1 MG $0.138            
J1436 Etidronate disodium inj 300 MG $71.407            
J1438 Etanercept injection 25 MG $155.461             Revised 10/1/2006
J1440 Filgrastim 300 mcg injection 300 MCG $184.236            
J1441 Filgrastim 480 mcg injection 480 MCG $292.613            
J1450 Fluconazole 200 MG $13.382            
J1451 Fomepizole, 15 mg 15 MG $12.275            
J1452 Intraocular Fomivirsen na 1.65 MG $212.000            
J1455 Foscarnet sodium injection 1000 MG $10.710     95% $13.070    
J1457 Gallium nitrate injection 1 MG $1.247            
J1460 Gamma globulin 1 CC inj 1 CC $10.867            
J1470 Gamma globulin 2 CC inj 2 CC $21.734            
J1480 Gamma globulin 3 CC inj 3CC $32.596            
J1490 Gamma globulin 4 CC inj 4 CC $43.468            
J1500 Gamma globulin 5 CC inj 5 CC $54.334            
J1510 Gamma globulin 6 CC inj 6 CC $65.221            
J1520 Gamma globulin 7 CC inj 7 CC $76.023            
J1530 Gamma globulin 8 CC inj 8 CC $86.935            
J1540 Gamma globulin 9 CC inj 9 CC $97.848            
J1550 Gamma globulin 10 CC inj 10 CC $108.669            
J1560 Gamma globulin > 10 CC inj 10 CC $108.669            
J1565 RSV-ivig 50 MG $16.176            
J1566 Immune globulin, powder 500 MG $24.899            
J1567 Immune globulin, liquid 500 MG $30.116            
J1570 Ganciclovir sodium injection 500 MG $37.361     95% $35.250     Revised 10/1/2006
J1580 Garamycin gentamicin inj 80 MG $1.090            
J1590 Gatifloxacin injection 10 MG $0.480            
J1595 Injection glatiramer acetate 20 MG $44.715            
J1600 Gold sodium thiomaleate inj 50 MG $6.876            
J1610 Glucagon hydrochloride/1 MG 1 MG $63.608            
J1620 Gonadorelin hydroch/ 100 mcg 100 MCG $180.295            
J1626 Granisetron HCl injection 100 MCG $7.394             Revised 10/1/2006
J1630 Haloperidol injection 5 MG $2.676            
J1631 Haloperidol decanoate inj 50 MG $5.757            
J1640 Hemin, 1 mg 1 MG $6.799            
J1642 Inj heparin sodium per 10 u 10 UNITS $0.049            
J1644 Inj heparin sodium per 1000u 1000 UNITS $0.115            
J1645 Dalteparin sodium 2500 IU $10.886            
J1650 Inj enoxaparin sodium 10 MG $5.521            
J1652 Fondaparinux sodium 0.5 MG $5.712            
J1655 Tinzaparin sodium injection 1000 IU $2.311            
J1670 Tetanus immune globulin inj 250 UNITS $88.876            
J1720 Hydrocortisone sodium succ i 100 MG $1.963            
J1730 Diazoxide injection 300 MG $111.936            
J1742 Ibutilide fumarate injection 1 MG $264.131            
J1745 Infliximab injection 10 MG $54.556            
J1751 Iron dextran 165 injection 50 MG $11.693            
J1752 Iron dextran 267 injection 50 MG $10.344            
J1756 Iron sucrose injection 1 MG $0.366            
J1785 Injection imiglucerase /unit 1 UNIT $3.908            
J1790 Droperidol injection 5 MG $1.175            
J1800 Propranolol injection 1 MG $4.245            
J1810 Droperidol/fentanyl inj 2 ML $5.576            
J1815 Insulin injection 5 UNITS $0.225            
J1817 Insulin for insulin pump use 50 UNITS $2.300     95% $2.800    
J1830 Interferon beta-1b / .25 MG 0.25 MG $92.279            
J1835 Itraconazole injection 50 MG $36.530            
J1840 Kanamycin sulfate 500 MG inj 500 MG $4.621            
J1850 Kanamycin sulfate 75 MG inj 75 MG $0.693            
J1885 Ketorolac tromethamine inj 15 MG $0.542            
J1931 Laronidase injection 0.1 MG $23.868            
J1940 Furosemide injection 20 MG $0.334            
J1945 Lepirudin 50 MG $150.534            
J1950 Leuprolide acetate /3.75 MG 3.75 MG $431.351            
J1955 Inj levocarnitine per 1 gm 1 GM $9.084             Revised 10/1/2006
J1956 Levofloxacin injection 250 MG $7.403            
J1980 Hyoscyamine sulfate inj 0.25 MG $9.648            
J1990 Chlordiazepoxide injection 100 MG $21.050            
J2001 Lidocaine injection 10 MG $0.018            
J2010 Lincomycin injection 300 MG $3.791            
J2020 Linezolid injection 200 MG $23.996            
J2060 Lorazepam injection 2 MG $1.013            
J2150 Mannitol injection 50 ML $0.786            
J2175 Meperidine hydrochl /100 MG 100 MG $1.687     95% $0.560    
J2180 Meperidine/promethazine inj 50 MG $3.788            
J2185 Meropenem 100 MG $3.738            
J2210 Methylergonovin maleate inj 0.2 MG $4.630            
J2250 Inj midazolam hydrochloride 1 MG $0.218            
J2260 Inj milrinone lactate / 5 MG 5 MG $4.106     95% $51.580    
J2270 Morphine sulfate injection 10 MG $1.367     95% $0.710    
J2271 Morphine so4 injection 100mg 100 MG $5.563     95% $11.070    
J2275 Morphine sulfate injection 10 MG $5.178     95% $4.390     Revised 10/1/2006
J2278 Ziconotide injection 1 MCG $6.327            
J2280 Inj, moxifloxacin 100 mg 100 MG $4.046            
J2300 Inj nalbuphine hydrochloride 10 MG $0.700            
J2310 Inj naloxone hydrochloride 1 MG $2.091            
J2320 Nandrolone decanoate 50 MG 50 MG $3.166            
J2321 Nandrolone decanoate 100 MG 100 MG $6.188            
J2322 Nandrolone decanoate 200 MG 200 MG $12.820            
J2325 Nesiritide injection 0.1 MG $29.906            
J2353 Octreotide injection, depot 1 MG $92.602            
J2354 Octreotide inj, non-depot 25 MCG $3.714            
J2355 Oprelvekin injection 5 MG $245.873            
J2357 Omalizumab injection 5 MG $16.304            
J2360 Orphenadrine injection 60 MG $12.078            
J2370 Phenylephrine hcl injection 1 ML $0.496            
J2400 Chloroprocaine hcl injection 30 ML $14.700            
J2405 Ondansetron hcl injection 1 MG $3.690            
J2410 Oxymorphone hcl injection 1 MG $2.344            
J2425 Palifermin injection 50 MCG $11.429            
J2430 Pamidronate disodium /30 MG 30 MG $35.566            
J2440 Papaverin hcl injection 60 MG $0.602            
J2460 Oxytetracycline injection 50 MG $0.936            
J2469 Palonosetron HCl 25 MCG $18.437            
J2501 Paricalcitol 1 MCG $3.810            
J2503 Pegaptanib sodium injection 0.3 MG $1,054.700            
J2504 Pegademase bovine, 25 iu 25 IU $177.833            
J2505 Injection, pegfilgrastim 6mg 6 MG $2,148.705            
J2510 Penicillin g procaine inj 600000 UNITS $8.720            
J2513 Pentastarch 10% solution 100 ML $12.722            
J2515 Pentobarbital sodium inj 50 MG $5.356            
J2540 Penicillin g potassium inj 600000 UNITS $0.677            
J2543 Piperacillin/tazobactam 1.125 GM $4.931            
J2545 Pentamidine isethionte/300mg 300 MG $44.520            
J2550 Promethazine hcl injection 50 MG $2.071            
J2560 Phenobarbital sodium inj 120 MG $2.183            
J2590 Oxytocin injection 10 UNITS $2.264            
J2597 Inj desmopressin acetate 1 MCG $2.392            
J2650 Prednisolone acetate inj 1 ML $0.366            
J2675 Inj progesterone per 50 MG 50 MG $1.655            
J2680 Fluphenazine decanoate 25 MG 25 MG $1.772            
J2690 Procainamide hcl injection 1 GM $1.886            
J2700 Oxacillin sodium injeciton 250 MG $1.467            
J2710 Neostigmine methylslfte inj 0.5 MG $0.088            
J2720 Inj protamine sulfate/10 MG 10 MG $0.362            
J2725 Inj protirelin per 250 mcg 250 MCG $21.778            
J2730 Pralidoxime chloride inj 1 GM $45.571            
J2760 Phentolaine mesylate inj 5 MG $23.723            
J2765 Metoclopramide hcl injection 10 MG $0.488            
J2770 Quinupristin/dalfopristin 500 MG $114.583            
J2780 Ranitidine hydrochloride inj 25 MG $0.714            
J2783 Rasburicase 0.5 MG $120.838            
J2788 Rho d immune globulin 50 mcg 50 MCG $25.856            
J2790 Rho d immune globulin inj 300 MCG $81.942            
J2792 Rho(D) immune globulin h, sd 100 IU $14.083            
J2794 Risperidone, long acting 0.5 MG $4.789            
J2795 Ropivacaine HCl injection 1 MG $0.071            
J2800 Methocarbamol injection 10 ML $11.545            
J2805 Sincalide injection 5 MCG $51.535            
J2810 Inj theophylline per 40 MG 40 MG $0.027            
J2820 Sargramostim injection 50 MCG $24.861            
J2850 Inj secretin synthetic human 1 MCG $20.313            
J2910 Aurothioglucose injeciton 50 MG $24.500            
J2912 Sodium chloride injection 2 ML $0.115            
J2916 Na ferric gluconate complex 12.5 MG $4.749            
J2920 Methylprednisolone injection 40 MG $2.006            
J2930 Methylprednisolone injection 125 MG $2.557            
J2941 Somatropin injection 1 MG $46.299            
J2950 Promazine hcl injection UP TO 25 MG $0.384            
J2993 Reteplase injection 18.1 MG $914.623            
J2995 Inj streptokinase /250000 IU 250000 IU $79.500            
J2997 Alteplase recombinant 1 MG $31.670            
J3000 Streptomycin injection 1 GM $6.381            
J3010 Fentanyl citrate injeciton 0.1 MG $0.316     95% $0.700    
J3030 Sumatriptan succinate / 6 MG 6 MG $54.381            
J3070 Pentazocine injection 30 MG $4.550            
J3100 Tenecteplase injection 50 MG $2,045.885            
J3105 Terbutaline sulfate inj 1 MG $4.662            
J3120 Testosterone enanthate inj 100 MG $5.727            
J3130 Testosterone enanthate inj 200 MG $9.667            
J3230 Chlorpromazine hcl injection 50 MG $3.782            
J3240 Thyrotropin injection 0.9 MG $769.761            
J3246 Tirofiban HCl 0.25 MG $8.139            
J3250 Trimethobenzamide hcl inj 200 MG $4.971            
J3260 Tobramycin sulfate injection 80 MG $1.511            
J3265 Injection torsemide 10 mg/ml 10 MG $2.370            
J3285 Treprostinil injection 1 MG $54.018            
J3301 Triamcinolone acetonide inj 10 MG $1.421            
J3302 Triamcinolone diacetate inj 5 MG $0.280            
J3303 Triamcinolone hexacetonl inj 5 MG $1.300            
J3305 Inj trimetrexate glucoronate 25 MG $145.702            
J3315 Triptorelin pamoate 3.75 MG $260.225            
J3320 Spectinomycn di-hcl inj 2 GM $30.083            
J3355 Urofollitropin, 75 iu 75 IU $48.626            
J3360 Diazepam injection 5 MG $0.635            
J3364 Urokinase 5000 IU injection 5000 IU $9.155            
J3365 Urokinase 250,000 IU inj 250000 IU $457.729            
J3370 Vancomycin hcl injection 500 MG $3.233            
J3396 Verteporfin injection 0.1 MG $8.946            
J3410 Hydroxyzine hcl injection 25 MG $0.204            
J3411 Thiamine hcl 100 mg 100 MG $2.019            
J3415 Pyridoxine hcl 100 mg 100 MG $3.337            
J3420 Vitamin b12 injection 1000 MCG $0.363            
J3430 Vitamin k phytonadione inj 1 MG $2.710            
J3465 Injection, voriconazole 10 MG $4.687            
J3470 Hyaluronidase injection 150 UNITS $17.162            
J3471 Ovine, up to 999 USP units 1 USP UNIT $0.113            
J3472 Ovine, 1000 USP units 1000 USP UNITS $135.044            
J3475 Inj magnesium sulfate 500 MG $0.140            
J3480 Inj potassium chloride 2 MEQ $0.018            
J3485 Zidovudine 10 MG $1.044            
J3486 Ziprasidone mesylate 10 MG $7.090            
J3487 Zoledronic acid 1 MG $203.099            
J7030 Normal saline solution infus 1000 CC $1.001            
J7040 Normal saline solution infus 500 ML $0.500            
J7042 5% dextrose/normal saline 500 ML $0.392            
J7050 Normal saline solution infus 250 CC $0.250            
J7060 5% dextrose/water 500 ML $1.227            
J7070 D5w infusion 1000 CC $2.453            
J7100 Dextran 40 infusion 500 ML $14.361            
J7110 Dextran 75 infusion 500 ML $9.154            
J7120 Ringers lactate infusion 1000 CC $0.899            
J7188 Inj Vonwillebrand factor iu 1 IU $0.878            
J7189 Factor viia 1 MCG $1.076            
J7190 Factor viii 1 IU $0.677            
J7192 Factor viii recombinant 1 IU $1.062            
J7193 Factor IX non-recombinant 1 IU $0.889            
J7194 Factor ix complex 1 IU $0.727            
J7195 Factor IX recombinant 1 IU $0.987            
J7197 Antithrombin iii injection 1 IU $1.754            
J7198 Anti-inhibitor 1 IU $1.348            
J7308 Aminolevulinic acid hcl top 354 MG $106.975            
J7310 Ganciclovir long act implant 4.5 MG $4,240.000            
J7317 Sodium hyaluronate injection 20 - 25 MG $107.235            
J7320 Hylan G-F 20 injection 16 MG $198.496            
J7330 Cultured chondrocytes implnt 1 EA $17,610.109            
J7340 Metabolic active D/E tissue 1 SQ CM $27.958            
J7341 Non-human, metabolic tissue 1 SQ CM $1.717            
J7342 Metabolically active tissue 1 SQ CM $13.980            
J7343 Nonmetabolic act d/e tissue 1 SQ CM $16.522            
J7344 Nonmetabolic active tissue 1 SQ CM $72.178            
J7350 Injectable human tissue 10 MG $20.819            
J7500 Azathioprine oral 50mg 50 MG $0.174            
J7501 Azathioprine parenteral 100 MG $50.032            
J7502 Cyclosporine oral 100 mg 100 MG $3.968            
J7504 Lymphocyte immune globulin 250 MG $311.793            
J7505 Monoclonal antibodies 5 MG $855.409            
J7506 Prednisone oral 5 MG $0.200            
J7507 Tacrolimus oral per 1 MG 1 MG $3.541            
J7509 Methylprednisolone oral 4 MG $0.072            
J7510 Prednisolone oral per 5 mg 5 MG $0.073            
J7511 Antithymocyte globuln rabbit 25 MG $330.540            
J7513 Daclizumab, parenteral 25 MG $337.006             Revised 10/1/2006
J7515 Cyclosporine oral 25 mg 25 MG $1.003            
J7516 Cyclosporin parenteral 250mg 250 MG $19.213            
J7517 Mycophenolate mofetil oral 250 MG $2.517             Revised 10/1/2006
J7518 Mycophenolic acid 180 MG $2.161            
J7520 Sirolimus, oral 1 MG $7.151            
J7525 Tacrolimus injection 5 MG $140.567            
J7608 Acetylcysteine inh sol u d 1 GM $3.051            
J7611 Albuterol concentrated form 1 MG $0.087            
J7613 Albuterol unit dose 1 MG $0.082            
J7614 Levalbuterol unit dose 0.5 MG $1.504            
J7620 Duoneb 2.5 MG/0.5 MG $1.075            
J7626 Pulmicort 0.5 MG $4.545            
J7631 Cromolyn sodium inh sol u d 10 MG $0.085            
J7639 Dornase alpha inhal sol u d 1 MG $18.757            
J7644 Ipratropium brom inh sol u d 1 MG $0.208            
J7669 Metaproterenol inh sol u d 10 MG $0.227            
J7674 Methacholine chloride, neb 1 MG $0.408            
J7682 Tobramycin inhalation sol 300 MG $54.003            
J8501 Oral aprepitant 5 MG $4.843            
J8510 Oral busulfan 2 MG $2.127            
J8515 Cabergoline, oral 0.25mg 0.25 MG $16.843            
J8520 Capecitabine, oral, 150 mg 150 MG $3.749             Revised 10/1/2006
J8521 Capecitabine, oral, 500 mg 500 MG $12.464             Revised 10/1/2006
J8530 Cyclophosphamide oral 25 MG 25 MG $0.997            
J8540 Oral dexamethasone 0.25 MG $0.059            
J8560 Etoposide oral 50 MG 50 MG $32.500            
J8610 Methotrexate oral 2.5 MG 2.5 MG $0.228            
J8700 Temozolomide 5 MG $7.271            
J9000 Doxorubic hcl 10 MG vl chemo 10 MG $6.153            
J9001 Doxorubicin hcl liposome inj 10 MG $377.746     95% $393.480    
J9010 Alemtuzumab injection 10 MG $530.243            
J9015 Aldesleukin/single use vial 1 EA $723.355            
J9017 Arsenic trioxide 1 MG $33.226            
J9020 Asparaginase injection 10000 UNITS $54.155            
J9025 Azacitidine injection 1 MG $4.133            
J9027 Clofarabine injection 1 MG $116.698            
J9031 Bcg live intravesical vac 1 EA $112.678            
J9035 Bevacizumab injection 10 MG $56.893            
J9040 Bleomycin sulfate injection 15 UNITS $32.475     95% $289.370    
J9041 Bortezomib injection 0.1 MG $31.894            
J9045 Carboplatin injection 50 MG $8.825            
J9050 Carmus bischl nitro inj 100 MG $139.655            
J9055 Cetuximab injection 10 MG $49.862            
J9060 Cisplatin 10 MG injection 10 MG $1.904            
J9062 Cisplatin 50 MG injection 50 MG $11.233            
J9065 Inj cladribine per 1 MG 1 MG $37.845     95% $61.720    
J9070 Cyclophosphamide 100 MG inj 100 MG $1.899            
J9080 Cyclophosphamide 200 MG inj 200 MG $3.798            
J9090 Cyclophosphamide 500 MG inj 500 MG $15.293            
J9091 Cyclophosphamide 1.0 grm inj 1 GM $18.991            
J9092 Cyclophosphamide 2.0 grm inj 2 GM $37.981            
J9098 Cytarabine liposome 10 MG $397.901            
J9100 Cytarabine hcl 100 MG inj 100 MG $1.515     95% $8.190    
J9110 Cytarabine hcl 500 MG inj 500 MG $7.576     95% $8.550    
J9120 Dactinomycin actinomycin d 0.5 MG $274.121            
J9130 Dacarbazine 100 mg inj 100 MG $5.532            
J9140 Dacarbazine 200 MG inj 200 MG $11.063            
J9150 Daunorubicin 10 MG $23.257            
J9151 Daunorubicin citrate liposom 10 MG $56.125            
J9160 Denileukin diftitox, 300 mcg 300 MCG $1,407.479            
J9170 Docetaxel 20 MG $301.154            
J9175 Elliotts b solution per ml 1 ML $3.395            
J9178 Inj, epirubicin hcl, 2 mg 2 MG $24.636            
J9181 Etoposide 10 MG inj 10 MG $0.484            
J9182 Etoposide 100 MG inj 100 MG $4.844            
J9185 Fludarabine phosphate inj 50 MG $235.449            
J9190 Fluorouracil injection 500 MG $2.061     95% $2.070    
J9200 Floxuridine injection 500 MG $62.963     95% $136.800    
J9201 Gemcitabine HCl 200 MG $121.539            
J9202 Goserelin acetate implant 3.6 MG $196.481            
J9206 Irinotecan injection 20 MG $126.853            
J9208 Ifosfomide injection 1 GM $44.134     95% $150.380    
J9209 Mesna injection 200 MG $10.280            
J9211 Idarubicin hcl injection 5 MG $305.360            
J9212 Interferon alfacon-1 1 MCG $4.645            
J9213 Interferon alfa-2a inj 3 MIL UNITS $35.899             Revised 10/1/2006
J9214 Interferon alfa-2b inj 1 MIL UNITS $13.729            
J9216 Interferon gamma 1-b inj 3 MIL UNITS $289.865            
J9217 Leuprolide acetate suspnsion 7.5 MG $231.893            
J9218 Leuprolide acetate injeciton 1 MG $10.065            
J9219 Leuprolide acetate implant 65 MG $2,256.814         &nb