Table III: 2012 Medicare Drug Fee Schedule*
CY 2012 2nd Quarter Average Sales Price (ASP) Data Plus 6 Percent
*The Medicare payments allowance limits are effective April 1 - June 30, 2012.
| Code | Description | Dosage | CY 2012 Effective Jan 1 Through Mar 31 ASP plus 6 percent |
CY 2012 Effective Apr 1 Through June. 30 ASP plus 6 percent |
|---|---|---|---|---|
| J0129 | Abatacept | 10mg | $21.39 | $21.68 |
| J0130 | Abciximab injection | 10mg | $555.98 | $549.23 |
| J0133 | Acyclovir, 5 mg | 5mg | $0.03 | $0.03 |
| J0150 | Injection adenosine 6MG | 6mg | $6.71 | $7.01 |
| J0152 | Adenosine injection | 30mg | $99.82 | $105.06 |
| J0171 | Adrenalin epinephrin inject | 0.1mg | $0.05 | $0.04 |
| J0205 | Alglucerase injection | 10units | $42.03 | $41.99 |
| J0207 | Amifostine | 500mg | $318.58 | $323.69 |
| J0210 | Methyldopate hcl injection | 250mg | $42.40 | $42.40 |
| J0215 | Alefacept | 0.5mg | $39.53 | $38.26 |
| J0256 | Alpha 1 proteinase inhibitor | 10mg | $3.82 | $3.93 |
| J0270 | Alprostadil for injection | 1.25mcg | $0.66 | $0.67 |
| J0280 | Aminophyllin 250 MG inj | 250mg | $0.38 | $0.48 |
| J0289 | Amphotericin b liposome inj | 10mg | $15.18 | $14.58 |
| J0295 | Ampicillin sodium per 1.5 gm | 1.5gm | $3.08 | $2.97 |
| J0360 | Hydralazine hcl injection | 20mg | $4.81 | $4.94 |
| J0456 | Azithromycin | 500mg | $7.22 | $4.73 |
| J0461 | Atropine sulfate injection | 0.01mg | $0.02 | $0.01 |
| J0475 | Baclofen 10 MG injection | 10mg | $188.72 | $183.42 |
| J0476 | Baclofen intrathecal trial | 50mcg | $77.67 | $76.24 |
| J0480 | Basiliximab | 20mg | $2,220.17 | $2,227.72 |
| J0490 | Belimumab | 10mg | $38.42 | $38.32 |
| J0500 | Dicyclomine injection | 20mg | $26.08 | $28.68 |
| J0515 | Inj benztropine mesylate | 1mg | $24.03 | $25.50 |
| J0583 | Bivalirudin | 1mg | $2.77 | $2.78 |
| J0585 | Botulinum toxin a per unit | 1unit | $5.48 | $5.48 |
| J0587 | Botulinum toxin type B | 100units | $10.92 | $10.93 |
| J0592 | Buprenorphine hydrochloride | 0.1mg | $0.75 | $0.75 |
| J0595 | Butorphanol tartrate 1 mg | 1mg | $1.05 | $0.91 |
| J0600 | Edetate calcium disodium inj | 1000mg | $09.52 | $189.15 |
| J0610 | Calcium gluconate injection | 10ml | $0.57 | $0.66 |
| J0630 | Calcitonin salmon injection | 400units | $57.05 | $57.09 |
| J0636 | Inj calcitriol per 0.1 mcg | 0.1mcg | $1.03 | $0.56 |
| J0637 | Caspofungin acetate | 5mg | $13.34 | $12.61 |
| J0640 | Leucovorin calcium injection | 50mg | $1.53 | $2.09 |
| J0690 | Cefazolin sodium injection | 500mg | $0.66 | $0.69 |
| J0692 | Cefepime HCl for injection | 500mg | $3.28 | $2.93 |
| J0694 | Cefoxitin sodium injection | 1gm | $5.76 | $6.13 |
| J0696 | Ceftriaxone sodium injection | 250mg | $0.89 | $0.82 |
| J0697 | Sterile cefuroxime injection | 750mg | $2.40 | $2.32 |
| J0698 | Cefotaxime sodium injection | 1gm | $1.71 | $1.84 |
| J0702 | Betamethasone acet&sod phosp | 3mg | $5.53 | $5.50 |
| J0706 | Caffeine citrate injection | 5mg | $0.39 | $0.34 |
| J0713 | Inj ceftazidime per 500 mg | 500mg | $2.30 | $2.43 |
| J0718 | Certolizum | 1mg | $4.21 | $4.35 |
| J0720 | Chloramphenicol sodium injec | 1gm | $20.35 | $19.97 |
| J0725 | Chorionic gonadotropin/1000u | 1,000units | $11.52 | $12.14 |
| J0740 | Cidofovir injection | 375mg | $754.51 | $757.18 |
| J0743 | Cilastatin sodium injection | 250mg | $11.05 | $10.29 |
| J0745 | Inj codeine phosphate /30 MG | 30mg | $1.35 | $1.35 |
| J0760 | Colchicine injection | 1mg | $6.57 | $6.57 |
| J0770 | Colistimethate sodium inj | 150mg | $13.61 | $12.09 |
| J0780 | Prochlorperazine injection | 10mg | $2.12 | $1.40 |
| J0800 | Corticotropin injection | 1-40units | $2,694.39 | $2,692.83 |
| J0882 | Darbepoetin alfa, non-esrd | 1mcg | $3.21 | $3.26 |
| J0885 | Non esrd epoetin alpha inj | 1,000units | $9.62 | $9.76 |
| J0895 | Deferoxamine mesylate inj | 500mg | $9.76 | $10.07 |
| J0897 | Denosumab injection | 1 mg | $14.43 | $14.39 |
| J1000 | Depo-estradiol cypionate inj | 5mg | $6.83 | $6.83 |
| J1020 | Methylprednisolone 20 MG inj | 20mg | $3.12 | $3.17 |
| J1030 | Methylprednisolone 40 MG inj | 40mg | $3.10 | $3.35 |
| J1040 | Methylprednisolone 80 MG inj | 80mg | $7.09 | $6.49 |
| J1051 | Medroxyprogesterone inj | 50mg | $8.23 | $8.29 |
| J1070 | Testosterone cypionat 100 MG | 100mg | $4.16 | $3.51 |
| J1080 | Testosterone cypionat 200 MG | 1cc_200mg | $5.44 | $6.42 |
| J1100 | Dexamethasone sodium phos | 1mg | $0.11 | $0.12 |
| J1110 | Inj dihydroergotamine mesylt | 1mg | $26.27 | $25.84 |
| J1120 | Acetazolamid sodium injectio | 50mg | $30.50 | $30.60 |
| J1160 | Digoxin injection | 0.5mg | $0.73 | $1.66 |
| J1165 | Phenytoin sodium injection | 50mg | $0.35 | $0.35 |
| J1190 | Dexrazoxane HCl injection | 250mg | $185.09 | $199.93 |
| J1200 | Diphenhydramine hcl injectio | 1-50mg | $0.67 | $0.70 |
| J1205 | Chlorothiazide sodium inj | 500mg | $279.79 | $277.38 |
| J1230 | Methadone injection | 10mg | $6.95 | $6.97 |
| J1245 | Dipyridamole injection | 10mg | $0.81 | $0.82 |
| J1250 | Inj dobutamine HCL/250 mg | 250mg | $5.34 | $5.79 |
| J1260 | Dolasetron mesylate | 10mg | $5.07 | $5.35 |
| J1265 | DopAMIne injection | 40mg | $0.55 | $0.53 |
| J1270 | Injection, doxercalciferol | 1mcg | $1.43 | $0.67 |
| J1325 | Epoprostenol injection | 0.5mg | $14.13 | $14.28 |
| J1327 | Eptifibatide injection | 5mg | $22.83 | $23.51 |
| J1335 | Ertapenem injection | 500mg | $30.04 | $29.92 |
| J1364 | Erythro lactobionate /500 MG | 500mg | $10.12 | $10.49 |
| J1410 | Inj estrogen conjugate 25 MG | 25mg | $114.63 | $115.05 |
| J1430 | Ethanolamine oleate 100 mg | 100mg | $299.94 | $299.94 |
| J1440 | Filgrastim 300 mcg injection | 300mcg | $257.49 | $260.35 |
| J1441 | Filgrastim 480 mcg injection | 480mcg | $408.13 | $414.07 |
| J1450 | Fluconazole | 200mg | $4.33 | $4.56 |
| J1451 | Fomepizole, 15 mg | 15mg | $7.76 | $7.07 |
| J1455 | Foscarnet sodium injection | 1000mg | $13.32 | $13.32 |
| J1566 | Inj immune globulin, lyophilzed 500mg | 500mg | $30.82 | $31.51 |
| J1570 | Ganciclovir sodium injection | 500mg | $67.31 | $75.68 |
| J1580 | Garamycin gentamicin inj | 80mg | $1.17 | $1.25 |
| J1610 | Glucagon hydrochloride/1 MG | 1mg | $106.46 | $110.77 |
| J1626 | Granisetron HCl injection | 100mcg | $0.74 | $1.12 |
| J1630 | Haloperidol injection | 5mg | $3.17 | $2.72 |
| J1631 | Haloperidol decanoate inj | 50mg | $16.96 | $17.69 |
| J1642 | Inj heparin sodium per 10 u | 10units | $0.16 | $0.15 |
| J1644 | Inj heparin sodium per 1000u | 1000units | $0.27 | $0.23 |
| J1645 | Dalteparin sodium | 2500I.U. | $10.97 | $11.03 |
| J1650 | Inj enoxaparin sodium | 10mg | $5.51 | $5.18 |
| J1652 | Fondaparinux sodium | 0.5mg | $6.16 | $5.49 |
| J1720 | Hydrocortisone sodium succ i | 100mg | $4.08 | $4.11 |
| J1740 | Ibandronate sodium | 1mg | $151.26 | $151.89 |
| J1742 | Ibutilide fumarate injection | 1mg | $182.77 | $191.69 |
| J1745 | Infliximab injection | 10mg | $62.68 | $63.53 |
| J1756 | Iron sucrose injection | 1mg | $0.32 | $0.29 |
| J1786 | Imuglucerase injection | 10units | $41.99 | $41.99 |
| J1790 | Droperidol injection | 5mg | $3.23 | $2.66 |
| J1800 | Propranolol injection | 1mg | $3.11 | $3.01 |
| J1815 | Insulin injection | 5units | $0.47 | $0.48 |
| J1817 | Insulin for insulin pump use | 50units | $2.70 | $2.83 |
| J1940 | Furosemide injection | 20mg | $0.70 | $0.48 |
| J1945 | Lepirudin | 50mg | $396.81 | $396.86 |
| J1950 | Leuprolide acetate /3.75 MG | 3.75mg | $637.30 | $607.25 |
| J1955 | Inj levocarnitine per 1 gm | 1gm | $8.02 | $8.10 |
| J1956 | Levofloxacin injection | 250mg | $3.94 | $3.99 |
| J1980 | Hyoscyamine sulfate inj | 0.25mg | $14.03 | $14.39 |
| J2001 | Lidocaine injection | 10mg | $0.02 | $0.02 |
| J2010 | Lincomycin injection | 300mg | $6.41 | $6.41 |
| J2020 | Linezolid injection | 200mg | $36.04 | $37.04 |
| J2060 | Lorazepam injection | 2mg | $0.67 | $0.79 |
| J2150 | Mannitol injection | 50ml | $0.98 | $1.20 |
| J2185 | Meropenem | 100mg | $2.02 | $1.72 |
| J2210 | Methylergonovin maleate inj | 0.2mg | $5.55 | $5.27 |
| J2250 | Inj midazolam hydrochloride | 1mg | $0.14 | $0.13 |
| J2260 | Inj milrinone lactate / 5 MG | 5mg | $4.53 | $4.50 |
| J2300 | Inj nalbuphine hydrochloride | 10mg | $0.87 | $0.91 |
| J2310 | Inj naloxone hydrochloride | 1mg | $10.44 | $8.15 |
| J2353 | Octreotide injection, depot | 1mg | $121.59 | $123.10 |
| J2354 | Octreotide inj, non-depot | 25mcg | $1.40 | $1.65 |
| J2355 | Oprelvekin injection | 5mg | $244.32 | $243.69 |
| J2370 | Phenylephrine hcl injection | 1ml | $0.81 | $1.14 |
| J2400 | Chloroprocaine hcl injection | 30ml | $15.88 | $15.09 |
| J2405 | Ondansetron hcl injection | 1mg | $0.09 | $0.12 |
| J2410 | Oxymorphone hcl injection | 1mg | $2.31 | $2.29 |
| J2430 | Pamidronate disodium /30 MG | 30mg | $12.65 | $9.72 |
| J2440 | Papaverin hcl injection | 60mg | $1.54 | $1.27 |
| J2501 | Paricalcitol | 1mcg | $2.20 | $2.01 |
| J2505 | Injection, pegfilgrastim 6mg | 6mg | $2,754.07 | $2,798.77 |
| J2510 | Penicillin g procaine inj | 600,000units | $12.29 | $12.72 |
| J2515 | Pentobarbital sodium inj | 50mg | $21.75 | $21.78 |
| J2543 | Piperacillin/tazobactam | 1.125gm | $3.49 | $3.03 |
| J2550 | Promethazine hcl injection | 1-50mg | $1.74 | $1.67 |
| J2560 | Phenobarbital sodium inj | 120mg | $2.71 | $19.66 |
| J2590 | Oxytocin injection | 10units | $0.62 | $0.53 |
| J2597 | Inj desmopressin acetate | 1mcg | $3.98 | $5.73 |
| J2675 | Inj progesterone per 50 MG | 50mg | $1.59 | $3.61 |
| J2680 | Fluphenazine decanoate 25 MG | 25mg | $11.34 | $14.69 |
| J2690 | Procainamide hcl injection | 1gm | $7.78 | $9.70 |
| J2700 | Oxacillin sodium injection | 250mg | $2.84 | $2.81 |
| J2730 | Pralidoxime chloride inj | 1gm | $90.20 | $84.79 |
| J2760 | Phentolaine mesylate inj | 5mg | $54.58 | $54.58 |
| J2765 | Metoclopramide hcl injection | 10mg | $0.32 | $0.34 |
| J2770 | Quinupristin/dalfopristin | 500mg | $174.78 | $174.45 |
| J2780 | Ranitidine hydrochloride inj | 25mg | $0.76 | $0.85 |
| J2783 | Rasburicase | 0.5mg | $197.49 | $201.27 |
| J2788 | Rho d immune globulin 50 mcg | 50mcg | $24.99 | $25.13 |
| J2792 | Rho(D) immune globulin h, sd | 100IU | $15.71 | $16.41 |
| J2795 | Ropivacaine HCl injection | 1mg | $0.07 | $0.04 |
| J2810 | Inj theophylline per 40 MG | 40mg | $0.23 | $0.25 |
| J2820 | Sargramostim injection | 50mcg | $24.76 | $24.83 |
| J2916 | Na ferric gluconate complex | 12.5mg | $4.74 | $3.87 |
| J2920 | Methylprednisolone injection | 40mg | $1.87 | $1.94 |
| J2930 | Methylprednisolone injection | 125mg | $2.58 | $2.87 |
| J2993 | Reteplase injection | 18.1mg | $2,301.91 | $2,301.90 |
| J2997 | Alteplase recombinant | 1mg | $45.68 | $46.36 |
| J3010 | Fentanyl citrate injection | 0.1mg | $0.35 | $0.33 |
| J3030 | Sumatriptan succinate / 6 MG | 6mg | $75.20 | $62.39 |
| J3101 | Tenecteplase injection | 1mg | $64.18 | $66.24 |
| J3105 | Terbutaline sulfate inj | 1mg | $3.66 | $5.65 |
| J3120 | Testosterone enanthate inj | 100mg | $4.73 | $4.74 |
| J3130 | Testosterone enanthate inj | 1-200mg | $9.47 | $9.48 |
| J3230 | Chlorpromazine hcl injection | 50mg | $9.07 | $9.04 |
| J3240 | Thyrotropin injection | 0.9mg_1.1mg | $1,052.40 | $1,053.30 |
| J3246 | Tirofiban hydrochloride | 0.25mg | $10.31 | $8.71 |
| J3250 | Trimethobenzamide hcl inj | 200mg | $5.78 | $5.77 |
| J3260 | Tobramycin sulfate injection | 80mg | $1.95 | $2.61 |
| J3262 | Tocilizumab injection | 1mg | $3.47 | $3.46 |
| J3285 | Treprostinil, 1 mg | 1mg | $61.24 | $61.24 |
| J3301 | Triamcinolone acetonide inj | 10mg | $1.69 | $1.70 |
| J3315 | Triptorelin pamoate | 3.75mg | $178.08 | $193.77 |
| J3360 | Diazepam injection | 5mg | $0.91 | $1.02 |
| J3365 | Urokinase 250,000 IU inj | 250,000I.U. | $457.73 | $457.73 |
| J3370 | Vancomycin hcl injection | 500mg | $2.56 | $2.73 |
| J3396 | Verteporfin injection | 0.1mg | $10.05 | $10.06 |
| J3410 | Hydroxyzine hcl injection | 25mg | $1.24 | $1.27 |
| J3420 | Vitamin b12 injection | 1000mcg | $0.66 | $0.45 |
| J3430 | Vitamin k phytonadione inj | 1mg | $1.43 | $1.43 |
| J3465 | Injection, voriconazole | 10mg | $6.51 | $6.57 |
| J3475 | Inj magnesium sulfate | 500mg | $0.08 | $0.10 |
| J3480 | Inj potassium chloride | 2meq | $0.02 | $0.01 |
| J3485 | Zidovudine | 10mg | $1.41 | $1.44 |
| J3486 | Ziprasidone mesylate | 10mg | $7.56 | $7.88 |
| J3488 | Zoledronic acid (Reclast) | 1mg | $222.64 | $222.63 |
| J7030 | Normal saline solution infus | 1000cc | $1.15 | $1.15 |
| J7040 | Normal saline solution infus | 500ML | $0.57 | $0.57 |
| J7042 | 5% dextrose/normal saline | 500ML | $0.36 | $0.35 |
| J7050 | Normal saline solution infus | 250cc | $0.29 | $0.29 |
| J7060 | 5% dextrose/water | 500ML | $1.07 | $1.05 |
| J7070 | D5w infusion | 1000cc | $2.10 | $2.07 |
| J7100 | Dextran 40 infusion | 500ml | $20.46 | $21.71 |
| J7110 | Dextran 75 infusion | 500ml | $14.52 | $14.52 |
| J7120 | Ringers lactate infusion | 1000cc | $1.06 | $1.03 |
| J7189 | Factor viia recombinant | 1mcg | $1.56 | $1.58 |
| J7190 | Factor viii | 1I.U. | $0.89 | $0.90 |
| J7192 | Factor viii recombinant | 1I.U. | $1.11 | $1.11 |
| J7193 | Factor IX non-recombinant | 1I.U. | $0.91 | $0.92 |
| J7194 | Factor ix complex | 1I.U. | $0.89 | $0.88 |
| J7195 | Factor IX recombinant | 1I.U. | $1.18 | $1.19 |
| J7197 | Antithrombin iii injection | 1I.U. | $2.76 | $2.76 |
| J7198 | Anti-inhibitor | 1I.U. | $1.64 | $1.63 |
| J7308 | Aminolevulinic acid hcl top | 354mg | $151.40 | $150.74 |
| J7310 | Ganciclovir long act implant | 4.5mg | $16,960.00 | $16,960.00 |
| J7321 | Hyalgan or Supartz, inj | PER DOSE | $90.55 | $89.49 |
| J7323 | Euflexxa, inj | PER DOSE | $154.08 | $147.39 |
| J7324 | Orthovisc, inj | PER DOSE | $165.38 | $166.38 |
| J7325 | Synvisc and Synvisc-One | 1mg | $12.27 | $12.35 |
| J7330 | Cultured chondrocytes implnt | 1dose | $27,533.66 | $27,550.19 |
| J7500 | Azathioprine oral 50mg | 50mg | $0.10 | $0.22 |
| J7501 | Azathioprine parenteral | 100mg | $119.28 | $119.28 |
| J7502 | Cyclosporine oral 100 mg | 100mg | $3.19 | $3.61 |
| J7504 | Lymphocyte immune globulin | 250mg | $616.22 | $618.09 |
| J7505 | Monoclonal antibodies | 5mg | $1,132.96 | $1,156.08 |
| J7506 | Prednisone oral | 5mg | $0.02 | $2.26 |
| J7507 | Tacrolimus oral per 1 MG | 1mg | $2.56 | $2.26 |
| J7509 | Methylprednisolone oral | 4mg | $0.88 | $0.93 |
| J7511 | Antithymocyte globuln rabbit | 25mg | $441.66 | $445.03 |
| J7513 | Daclizumab, parenteral | 25mg | $526.34 | $526.34 |
| J7515 | Cyclosporine oral 25 mg | 25mg | $0.84 | $0.98 |
| J7516 | Cyclosporin parenteral 250mg | 250mg | $25.94 | $34.04 |
| J7517 | Mycophenolate mofetil oral | 250mg | $1.31 | $1.50 |
| J7520 | Sirolimus, oral | 1mg | $11.00 | $11.00 |
| J7525 | Tacrolimus injection | 5mg | $139.59 | $139.62 |
| J7608 | Acetylcysteine inh sol u d | 1gm | $2.15 | $3.18 |
| J7626 | Budesonide inhalation sol | 0.25-0.50mg | $4.63 | $4.96 |
| J7631 | Cromolyn sodium inh sol u d | 10mg | $0.39 | $0.36 |
| J7639 | Dornase alpha inhal sol u d | 1mg | $28.11 | $28.11 |
| J7644 | Ipratropium brom inh sol u d | 1mg | $0.27 | $0.27 |
| J7669 | Metaproterenol inh sol u d | 10mg | $0.25 | $0.25 |
| J7682 | Tobramycin inhalation sol | 300mg | $84.13 | $84.32 |
| J8510 | Oral busulfan | 2mg | $3.90 | $4.12 |
| J8520 | Capecitabine, oral, 150 mg | 150mg | $7.83 | $7.86 |
| J8521 | Capecitabine, oral, 500 mg | 500mg | $25.85 | $26.02 |
| J8530 | Cyclophosphamide oral 25 MG | 25mg | $0.82 | $0.82 |
| J8560 | Etoposide oral 50 MG | 50mg | $40.70 | $47.13 |
| J8610 | Methotrexate oral 2.5 MG | 2.5mg | $0.13 | $0.12 |
| J8700 | Temozolomide | 5mg | $9.75 | $10.16 |
| J9000 | Doxorubic hcl 10 MG vl chemo | 10mg | $3.88 | $3.48 |
| J9001 | Doxorubicin hcl liposome inj | 10mg | $543.03 | $538.79 |
| J9010 | Alemtuzumab injection | 10mg | $589.08 | $586.73 |
| J9015 | Aldesleukin/single use vial | pervial | $1,054.34 | $1,097.99 |
| J9017 | Arsenic trioxide | 1mg | $40.84 | $40.58 |
| J9020 | Asparaginase injection | 10,000units | $63.27 | $63.27 |
| J9031 | Bcg live intravesical vac | perinstallation | $115.47 | $119.88 |
| J9040 | Bleomycin sulfate injection | 15units | $25.58 | $30.20 |
| J9045 | Carboplatin injection | 50mg | $4.21 | $3.56 |
| J9050 | Carmus bischl nitro inj | 200mg | $175.80 | $175.80 |
| J9060 | Cisplatin 10 MG injection | 10mg | $1.78 | $1.80 |
| J9065 | Inj cladribine per 1 MG | 1mg | $23.40 | $23.15 |
| J9070 | Cyclophosphamide 500 MG inj | 100mg | $14.91 | $14.96 |
| J9100 | Cytarabine hcl 100 MG inj | 100mg | $0.94 | $0.87 |
| J9120 | Dactinomycin actinomycin d | 0.5mg | $577.38 | $578.75 |
| J9150 | Daunorubicin | 10mg | $14.34 | $17.64 |
| J9151 | Daunorubicin citrate liposom | 10mg | $57.66 | $57.66 |
| J9160 | Denileukin diftitox, 300 mcg | 300mcg | $1,646.18 | $1,646.18 |
| J9171 | Docetaxel injection | 1mg | $13.96 | $11.72 |
| J9175 | Elliotts b solution per ml | 1ml | $4.07 | $4.07 |
| J9178 | Inj, epirubicin hcl, 2 mg | 2mg | $1.73 | $1.70 |
| J9181 | Etoposide 10 MG inj | 10mg | $0.76 | $0.80 |
| J9185 | Fludarabine phosphate inj | 50mg | $95.24 | $89.12 |
| J9190 | Fluorouracil injection | 500mg | $1.43 | $1.52 |
| J9200 | Floxuridine injection | 500mg | $62.01 | $68.04 |
| J9201 | Gemcitabine HCl | 200mg | $51.19 | $35.17 |
| J9202 | Goserelin acetate implant | 3.6mg | $176.68 | $172.90 |
| J9206 | Irinotecan injection | 20mg | $4.67 | $4.65 |
| J9208 | Ifosfomide injection | 1gm | $32.04 | $31.70 |
| J9209 | Mesna injection | 200mg | $4.19 | $4.49 |
| J9211 | Idarubicin hcl injection | 5mg | $116.51 | $104.43 |
| J9214 | Interferon alfa-2b inj | 1millionunits | $17.76 | $17.96 |
| J9217 | Leuprolide acetate suspension | 7.5mg | $215.04 | $214.97 |
| J9218 | Leuprolide acetate injection | 1mg | $4.86 | $5.17 |
| J9219 | Leuprolide acetate implant | 65mg | $4,819.82 | $4,819.82 |
| J9230 | Mechlorethamine hcl inj | 10mg | $157.86 | $157.86 |
| J9245 | Inj melphalan hydrochl 50 MG | 50mg | $1,315.21 | $1,315.09 |
| J9250 | Methotrexate sodium inj | 5mg | $0.16 | $0.20 |
| J9260 | Methotrexate sodium inj | 50mg | $1.55 | $1.95 |
| J9263 | Oxaliplatin | 0.5mg | $10.26 | $9.79 |
| J9265 | Paclitaxel injection | 30mg | $7.55 | $7.23 |
| J9268 | Pentostatin injection | 10mg | $1,088.96 | $839.53 |
| J9280 | Mitomycin 5 MG inj | 5mg | $17.84 | $18.15 |
| J9293 | Mitoxantrone hydrochl / 5 MG | 5mg | $39.57 | $29.97 |
| J9300 | Gemtuzumab ozogamicin | 5mg | $2,742.59 | $2,742.59 |
| J9310 | Rituximab cancer treatment | 100mg | $626.92 | $641.96 |
| J9320 | Streptozocin injection | 1gm | $269.20 | $274.19 |
| J9340 | Thiotepa injection | 15mg | $130.38 | $143.01 |
| J9355 | Trastuzumab | 10mg | $72.45 | $74.34 |
| J9360 | Vinblastine sulfate inj | 1mg | $1.01 | $1.24 |
| J9370 | Vincristine sulfate 1 MG inj | 1mg | $4.55 | $4.69 |
| J9390 | Vinorelbine tartrate/10 mg | 20mg | $11.59 | $10.75 |
| J9395 | Injection, Fulvestrant | 25mg | $86.25 | $86.08 |
| Q0167 | Dronabinol 2.5mg oral | 2.5mg | $5.00 | $4.89 |
| Q0168 | Dronabinol 5mg oral | 5mg | $13.99 | $13.66 |
| This information is from the CMS website dated March 15, 2012. | ||||
