NDC - HCPCS Crosswalk Outpatient Prospective Payment System (OPPS)
Effective October 1, 2025 through December 31, 2025
The NDC - HCPCS crosswalks are intended to help understand which drug products -identified by NDCs- are assigned to which HCPCS billing codes. The information is based on published drug and biological pricing data and information submitted to CMS by manufacturers. The crosswalks are not intended to be a comprehensive list of all NDCs available in the United States. The NDC to HCPCS Crosswalks also include information on the NDC package size and the number of billable units.
Outpatient Prospective Payment System (OPPS)
| NDC | HCPCS Code | Labeler | Drug Name | Dosage | Package Size | Package Quantity | Billable Units | Billable Units / Pkg |
|---|---|---|---|---|---|---|---|---|
| 49591-126-51 | 90396 | Kamada Ltd. | Varicella-zoster ig im | 125 IU | 1.2 | 1 | 1 | 1 |
| 70257-126-51 | 90396 | Kamada Ltd. | Varicella-zoster ig im | 125 IU | 1.2 | 1 | 1 | 1 |
| 73814-986-20 | A9506 | Cyclomedica Australia PTY Limited | Tc-99m graphite crucible | EACH | 1 | 50 | 50 | 50 |
| 69488-003-01 | A9513 | Advanced Accelerator Applications USA, Inc. | Lutetium Lu 177 dotatat ther | 1 mCi | 20 | 1 | 200 | 200 |
| 65174-200-05 | A9521 | Jubilant Draximage Inc., dba Jubilant Radiopharma | Tc99m exametazime | Per Study Dose, up to 25 millicuries | 1 | 1 | 1 | 1 |
| 72893-007-04 | A9543 | Acrotech Biopharma LLC | Y90 ibritumomab, rx | UP TO 40 millicuries | 1 | 1 | 1 | 1 |
| 17156-235-01 | A9582 | GE Healthcare Inc. | Iodine I-123 iobenguane | UP TO 15 millicuries | 5 | 1 | 1 | 1 |
| 17156-210-01 | A9584 | GE Healthcare Inc. | Iodine I-123 ioflupane | Per Study Dose, up to 5 millicuries | 2.5 | 1 | 1 | 1 |
| 69488-001-40 | A9587 | Advanced Accelerator Applications USA, Inc. | Gallium Ga-68 | 0.1 mCi | 1 | 1 | 1 | 1 |
| 72874-001-01 | A9591 | GE Healthcare Inc. | Fluoroestradiol F 18 | 1 mCi | 50 | 1 | 6 | 6 |
| 69945-064-01 | A9592 | Curium US LLC | Copper cu 64 dotatate diag | 1 mCi | 4 | 1 | 4 | 4 |
| 24275-0525-1 | A9593 | UCSF Radiopharmaceutical Facility | Gallium ga-68 psma-11 ucsf | 1 mCi | 11 | 1 | 1 | 1 |
| 76394-2642-3 | A9594 | UCLA Biomedical Cyclotron | Gallium ga-68 psma-11, ucla | 1 mCi | 12 | 1 | 1 | 1 |
| 71258-022-01 | A9595 | Progenics Pharmaceuticals, Inc. | Piflu f-18, dia 1 millicurie | 1 mCi | 50 | 1 | 1 | 1 |
| 74725-100-25 | A9596 | Telix Pharmaceuticals US Inc. | Gallium illuccix 1 millicure | 1 mCi | 1 | 1 | 1 | 1 |
| 74725-100-64 | A9596 | Telix Pharmaceuticals US Inc. | Gallium illuccix 1 millicure | 1 mCi | 1 | 1 | 1 | 1 |
| 72928-089-01 | A9600 | Q Biomed Inc | Sr89 strontium | PER MILLICURIE | 4 | 1 | 1 | 4 |
| 13267-346-57 | A9602 | The Feinstein Institute for Medical Research | Fluorodopa f-18 diag per mci | 1 mCi | 1 | 1 | 1 | 1 |
| 50419-208-01 | A9606 | Bayer HealthCare Pharmaceuticals Inc. | Radium Ra223 dichloride ther | 1 mCi | 6 | 1 | 1 | 1 |
| 69488-010-61 | A9607 | Advanced Accelerator Applications USA, Inc. | Lutetium lu 177 vipivotide | 1 mCi | 1 | 1 | 1 | 1 |
| 69932-002-50 | A9608 | Blue Earth Diagnostics Limited | Flotufolastat f18 diag 1 mci | 1 millicurie | 25 | 1 | 1 | 1 |
| 0407-8787-01 | A9611 | GE Healthcare Inc. | Flurpiridaz f18, diag, 1 mci | 1 mCi | 1 | 1 | 1 | 1 |
| 82292-040-10 | A9615 | Lumicell Inc. | Inj, pegulicianine, 1 mg | 1 MG | 1 | 10 | 39 | 390 |
| 84552-500-25 | A9616 | Telix Innovations SA | Gallium gozellix 1 millicuri | 1 MCI | 1 | 1 | 1 | 1 |
| 84552-500-64 | A9616 | Telix Innovations SA | Gallium gozellix 1 millicuri | 1 MCI | 1 | 1 | 1 | 1 |
| 69488-017-61 | A9800 | Advanced Accelerator Applications USA, Inc. | Gallium locametz 1 millicuri | 1 mCi | 1 | 1 | 1 | 1 |
| 51715-100-04 | C9089 | Innocoll Pharmaceuticals | Bupivacaine implant, 1 mg | 1 MG | 1 | 12 | 100 | 1200 |
| 51715-100-10 | C9089 | Innocoll Pharmaceuticals | Bupivacaine implant, 1 mg | 1 MG | 1 | 30 | 100 | 3000 |
| 51715-660-10 | C9144 | Innocoll Pharmaceuticals | Inj, bupivacaine (posimir) | 1 MG | 5 | 10 | 660 | 6600 |
| 47426-401-10 | C9145 | Heron Therapeutics | Inj, aponvie, 1 mg | 1 MG | 4.4 | 10 | 32 | 320 |
| 0338-9637-01 | C9250 | Baxter Healthcare Corporation | Artiss fibrin sealant | 2 ML | 2 | 1 | 1 | 1 |
| 0338-9639-01 | C9250 | Baxter Healthcare Corporation | Artiss fibrin sealant | 2 ML | 4 | 1 | 2 | 2 |
| 0338-9641-01 | C9250 | Baxter Healthcare Corporation | Artiss fibrin sealant | 2 ML | 10 | 1 | 5 | 5 |
| 50242-060-01 | C9257 | Genentech, Inc. | Bevacizumab injection | 0.25 MG | 4 | 1 | 400 | 400 |
| 50242-061-01 | C9257 | Genentech, Inc. | Bevacizumab injection | 0.25 MG | 16 | 1 | 1600 | 1600 |
| 57894-800-01 | C9305 | Janssen Biotech, Inc. | Inj, nipocalimab-aahu, 3 mg | 3 MG | 1.62 | 1 | 100 | 100 |
| 57894-801-01 | C9305 | Janssen Biotech, Inc. | Inj, nipocalimab-aahu, 3 mg | 3 MG | 6.5 | 1 | 400 | 400 |
| 0074-1044-01 | C9306 | AbbVie Inc. | Telisotuzumab vedotin-tllv | 1 MG | 1 | 1 | 20 | 20 |
| 0074-1055-01 | C9306 | AbbVie Inc. | Telisotuzumab vedotin-tllv | 1 MG | 1 | 1 | 100 | 100 |
| 10122-620-10 | C9460 | Chiesi USA, Inc. | Injection, cangrelor | 1 MG | 1 | 10 | 50 | 500 |
| 69724-112-10 | C9482 | Altathera Pharmaceuticals, LLC | Sotalol hydrochloride IV | 1 MG | 10 | 1 | 150 | 150 |
| 0074-3799-02 | J0139 | AbbVie Inc. | Inj, adalimumab, 1 mg | 1 MG | 0.8 | 2 | 40 | 80 |
| 0074-4339-02 | J0139 | AbbVie Inc. | Inj, adalimumab, 1 mg | 1 MG | 0.8 | 2 | 40 | 80 |
| 0074-4339-06 | J0139 | AbbVie Inc. | Inj, adalimumab, 1 mg | 1 MG | 0.8 | 6 | 40 | 240 |
| 0074-4339-07 | J0139 | AbbVie Inc. | Inj, adalimumab, 1 mg | 1 MG | 0.8 | 4 | 40 | 160 |
| 71390-125-20 | J0184 | Acacia Pharma Ltd | Inj, amisulpride, 1 mg | 1 MG | 2 | 10 | 5 | 50 |
| 71390-125-50 | J0184 | Acacia Pharma Ltd | Inj, amisulpride, 1 mg | 1 MG | 4 | 10 | 10 | 100 |
| 73077-010-01 | J0208 | Fennec Pharmaceuticals, Inc. | Inj, pedmark, 100 mg | 100 MG | 100 | 1 | 125 | 125 |
| 60267-812-00 | J0211 | Hope Pharmaceuticals | Inj, nithiodote, 3mg / 125mg | 3 MG AND 125 MG | 60 | 1 | 100 | 100 |
| 73607-011-11 | J0391 | Amivas, Inc | Inj, artesunate, 1mg | 1 MG | 1 | 2 | 110 | 220 |
| 0074-3878-10 | J0458 | AbbVie Inc | Aztreonam/avibactam 10 mg | 10 MG | 1 | 10 | 200 | 2000 |
| 68135-811-02 | J0567 | BioMarin Pharmaceutical Inc. | Inj., cerliponase alfa 1 mg | 1 MG | 1 | 2 | 150 | 300 |
| 63833-828-02 | J0599 | CSL Behring L.L.C. | Inj., haegarda 10 units | 10 UNITS | 1 | 1 | 200 | 200 |
| 63833-829-02 | J0599 | CSL Behring L.L.C. | Inj., haegarda 10 units | 10 UNITS | 1 | 1 | 300 | 300 |
| 24201-400-02 | J0630 | Hikma Pharmaceuticals USA Inc. | Calcitonin salmon injection | 400 UNITS | 2 | 1 | 1 | 1 |
| 42023-205-01 | J0630 | Endo USA, Inc. | Calcitonin salmon injection | 400 UNITS | 2 | 1 | 1 | 1 |
| 43598-051-11 | J0630 | Dr Reddy's Laboratories, Inc. | Calcitonin salmon injection | 400 UNITS | 2 | 1 | 1 | 1 |
| 63323-865-02 | J0630 | FreseniUS Kabi USA, LLC | Calcitonin salmon injection | 400 UNITS | 2 | 1 | 1 | 1 |
| 67457-675-02 | J0630 | Mylan Institutional LLC | Calcitonin salmon injection | 400 UNITS | 2 | 1 | 1 | 1 |
| 69097-770-32 | J0630 | Cipla USA, Inc. | Calcitonin salmon injection | 400 UNITS | 2 | 1 | 1 | 1 |
| 72078-038-02 | J0630 | Mylan Institutional LLC | Calcitonin salmon injection | 400 UNITS | 2 | 1 | 1 | 1 |
| 72078-039-02 | J0630 | Mylan Institutional LLC | Calcitonin salmon injection | 400 UNITS | 2 | 1 | 1 | 1 |
| 47426-301-02 | J0668 | Heron Therapeutics | Instill, bupivac and meloxic | 1 MG - 0.03 MG | 14 | 1 | 400 | 400 |
| 47426-303-01 | J0668 | Heron Therapeutics | Instill, bupivac and meloxic | 1 MG - 0.03 MG | 7 | 1 | 200 | 200 |
| 47426-501-02 | J0668 | Heron Therapeutics | Instill, bupivac and meloxic | 1 MG - 0.03 MG | 14 | 1 | 400 | 400 |
| 0009-0856-08 | J0675 | Pfizer Inc | Inj, carboprost, 0.1 mg | 0.1 MG | 1 | 10 | 2.5 | 25 |
| 68547-578-10 | J0681 | La Jolla Pharmaceutical Company | Inj ceftobipole medocarl 3mg | 3 MG | 1 | 10 | 166.6666667 | 1667 |
| 66621-0150-2 | J0716 | Rare Disease Therapeutics, Inc. | Centruroides immune f(ab) | UP TO 120 MG | 1 | 1 | 1 | 1 |
| 10122-610-10 | J0759 | Chiesi USA, Inc. | Inj, clevidipine, 1 mg | 1 MG | 50 | 10 | 25 | 250 |
| 10122-611-10 | J0759 | Chiesi USA, Inc. | Inj, clevidipine, 1 mg | 1 MG | 100 | 10 | 50 | 500 |
| 59353-065-12 | J0879 | Vifor (International) Inc. | Difelikefalin, esrd on dialy | 0.1 MCG | 1.3 | 1 | 65 | 7800 |
| 16729-430-43 | J0891 | Accord Healthcare Inc | Argatroban nonesrd (accord) | 1 MG | 50 | 10 | 50 | 500 |
| 72990-103-10 | J0911 | CorMedix Inc. | Inst tauro 1.35mg/hep 100u | taurolidine 1.35 mg and heparin sodium 100 units | 3 | 10 | 30 | 300 |
| 72990-105-10 | J0911 | CorMedix Inc. | Inst tauro 1.35mg/hep 100u | taurolidine 1.35 mg and heparin sodium 100 units | 5 | 10 | 50 | 500 |
| 62225-600-04 | J1097 | Omeros Corporation | Phenylep ketorolac opth soln | 1 ML | 4 | 4 | 4 | 16 |
| 82604-600-04 | J1097 | Rayner Surgical Inc. | Phenylep ketorolac opth soln | 1 ML | 4 | 4 | 4 | 16 |
| 81092-1120-1 | J1105 | BioXcel Therapeutics, Inc. | Dexmedetomidine film, 1 mcg | 1 MCG | 10 | 1 | 1200 | 1200 |
| 81092-1180-1 | J1105 | BioXcel Therapeutics, Inc. | Dexmedetomidine film, 1 mcg | 1 MCG | 10 | 1 | 1800 | 1800 |
| 50242-115-01 | J1307 | Genentech, Inc. | Inj, crovalimab-akkz, 10 mg | 10 MG | 2 | 1 | 34 | 34 |
| 0053-0100-10 | J1411 | CSL Behring L.L.C. | Inj, hemgenix, per tx dose | Per Therapeutic Dose | 10 | 10 | 1 | 1 |
| 0053-0110-11 | J1411 | CSL Behring L.L.C. | Inj, hemgenix, per tx dose | Per Therapeutic Dose | 10 | 11 | 1 | 1 |
| 0053-0120-12 | J1411 | CSL Behring L.L.C. | Inj, hemgenix, per tx dose | Per Therapeutic Dose | 10 | 12 | 1 | 1 |
| 0053-0130-13 | J1411 | CSL Behring L.L.C. | Inj, hemgenix, per tx dose | Per Therapeutic Dose | 10 | 13 | 1 | 1 |
| 0053-0140-14 | J1411 | CSL Behring L.L.C. | Inj, hemgenix, per tx dose | Per Therapeutic Dose | 10 | 14 | 1 | 1 |
| 0053-0150-15 | J1411 | CSL Behring L.L.C. | Inj, hemgenix, per tx dose | Per Therapeutic Dose | 10 | 15 | 1 | 1 |
| 0053-0160-16 | J1411 | CSL Behring L.L.C. | Inj, hemgenix, per tx dose | Per Therapeutic Dose | 10 | 16 | 1 | 1 |
| 0053-0170-17 | J1411 | CSL Behring L.L.C. | Inj, hemgenix, per tx dose | Per Therapeutic Dose | 10 | 17 | 1 | 1 |
| 0053-0180-18 | J1411 | CSL Behring L.L.C. | Inj, hemgenix, per tx dose | Per Therapeutic Dose | 10 | 18 | 1 | 1 |
| 0053-0190-19 | J1411 | CSL Behring L.L.C. | Inj, hemgenix, per tx dose | Per Therapeutic Dose | 10 | 19 | 1 | 1 |
| 0053-0200-20 | J1411 | CSL Behring L.L.C. | Inj, hemgenix, per tx dose | Per Therapeutic Dose | 10 | 20 | 1 | 1 |
| 0053-0210-21 | J1411 | CSL Behring L.L.C. | Inj, hemgenix, per tx dose | Per Therapeutic Dose | 10 | 21 | 1 | 1 |
| 0053-0220-22 | J1411 | CSL Behring L.L.C. | Inj, hemgenix, per tx dose | Per Therapeutic Dose | 10 | 22 | 1 | 1 |
| 0053-0230-23 | J1411 | CSL Behring L.L.C. | Inj, hemgenix, per tx dose | Per Therapeutic Dose | 10 | 23 | 1 | 1 |
| 0053-0240-24 | J1411 | CSL Behring L.L.C. | Inj, hemgenix, per tx dose | Per Therapeutic Dose | 10 | 24 | 1 | 1 |
| 0053-0250-25 | J1411 | CSL Behring L.L.C. | Inj, hemgenix, per tx dose | Per Therapeutic Dose | 10 | 25 | 1 | 1 |
| 0053-0260-26 | J1411 | CSL Behring L.L.C. | Inj, hemgenix, per tx dose | Per Therapeutic Dose | 10 | 26 | 1 | 1 |
| 0053-0270-27 | J1411 | CSL Behring L.L.C. | Inj, hemgenix, per tx dose | Per Therapeutic Dose | 10 | 27 | 1 | 1 |
| 0053-0280-28 | J1411 | CSL Behring L.L.C. | Inj, hemgenix, per tx dose | Per Therapeutic Dose | 10 | 28 | 1 | 1 |
| 0053-0290-29 | J1411 | CSL Behring L.L.C. | Inj, hemgenix, per tx dose | Per Therapeutic Dose | 10 | 29 | 1 | 1 |
| 0053-0300-30 | J1411 | CSL Behring L.L.C. | Inj, hemgenix, per tx dose | Per Therapeutic Dose | 10 | 30 | 1 | 1 |
| 0053-0310-31 | J1411 | CSL Behring L.L.C. | Inj, hemgenix, per tx dose | Per Therapeutic Dose | 10 | 31 | 1 | 1 |
| 0053-0320-32 | J1411 | CSL Behring L.L.C. | Inj, hemgenix, per tx dose | Per Therapeutic Dose | 10 | 32 | 1 | 1 |
| 0053-0330-33 | J1411 | CSL Behring L.L.C. | Inj, hemgenix, per tx dose | Per Therapeutic Dose | 10 | 33 | 1 | 1 |
| 0053-0340-34 | J1411 | CSL Behring L.L.C. | Inj, hemgenix, per tx dose | Per Therapeutic Dose | 10 | 34 | 1 | 1 |
| 0053-0350-35 | J1411 | CSL Behring L.L.C. | Inj, hemgenix, per tx dose | Per Therapeutic Dose | 10 | 35 | 1 | 1 |
| 0053-0360-36 | J1411 | CSL Behring L.L.C. | Inj, hemgenix, per tx dose | Per Therapeutic Dose | 10 | 36 | 1 | 1 |
| 0053-0370-37 | J1411 | CSL Behring L.L.C. | Inj, hemgenix, per tx dose | Per Therapeutic Dose | 10 | 37 | 1 | 1 |
| 0053-0380-38 | J1411 | CSL Behring L.L.C. | Inj, hemgenix, per tx dose | Per Therapeutic Dose | 10 | 38 | 1 | 1 |
| 0053-0390-39 | J1411 | CSL Behring L.L.C. | Inj, hemgenix, per tx dose | Per Therapeutic Dose | 10 | 39 | 1 | 1 |
| 0053-0400-40 | J1411 | CSL Behring L.L.C. | Inj, hemgenix, per tx dose | Per Therapeutic Dose | 10 | 40 | 1 | 1 |
| 0053-0410-41 | J1411 | CSL Behring L.L.C. | Inj, hemgenix, per tx dose | Per Therapeutic Dose | 10 | 41 | 1 | 1 |
| 0053-0420-42 | J1411 | CSL Behring L.L.C. | Inj, hemgenix, per tx dose | Per Therapeutic Dose | 10 | 42 | 1 | 1 |
| 0053-0430-43 | J1411 | CSL Behring L.L.C. | Inj, hemgenix, per tx dose | Per Therapeutic Dose | 10 | 43 | 1 | 1 |
| 0053-0440-44 | J1411 | CSL Behring L.L.C. | Inj, hemgenix, per tx dose | Per Therapeutic Dose | 10 | 44 | 1 | 1 |
| 0053-0450-45 | J1411 | CSL Behring L.L.C. | Inj, hemgenix, per tx dose | Per Therapeutic Dose | 10 | 45 | 1 | 1 |
| 0053-0460-46 | J1411 | CSL Behring L.L.C. | Inj, hemgenix, per tx dose | Per Therapeutic Dose | 10 | 46 | 1 | 1 |
| 0053-0470-47 | J1411 | CSL Behring L.L.C. | Inj, hemgenix, per tx dose | Per Therapeutic Dose | 10 | 47 | 1 | 1 |
| 0053-0480-48 | J1411 | CSL Behring L.L.C. | Inj, hemgenix, per tx dose | Per Therapeutic Dose | 10 | 48 | 1 | 1 |
| 68135-927-48 | J1412 | BioMarin Pharmaceutical Inc. | Inj roctavian ml 2x10^13vc g | 1 ML | 8 | 1 | 8 | 8 |
| 60923-501-10 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 10 | 1 | 1 |
| 60923-502-11 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 11 | 1 | 1 |
| 60923-503-12 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 12 | 1 | 1 |
| 60923-504-13 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 13 | 1 | 1 |
| 60923-505-14 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 14 | 1 | 1 |
| 60923-506-15 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 15 | 1 | 1 |
| 60923-507-16 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 16 | 1 | 1 |
| 60923-508-17 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 17 | 1 | 1 |
| 60923-509-18 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 18 | 1 | 1 |
| 60923-510-19 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 19 | 1 | 1 |
| 60923-511-20 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 20 | 1 | 1 |
| 60923-512-21 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 21 | 1 | 1 |
| 60923-513-22 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 22 | 1 | 1 |
| 60923-514-23 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 23 | 1 | 1 |
| 60923-515-24 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 24 | 1 | 1 |
| 60923-516-25 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 25 | 1 | 1 |
| 60923-517-26 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 26 | 1 | 1 |
| 60923-518-27 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 27 | 1 | 1 |
| 60923-519-28 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 28 | 1 | 1 |
| 60923-520-29 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 29 | 1 | 1 |
| 60923-521-30 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 30 | 1 | 1 |
| 60923-522-31 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 31 | 1 | 1 |
| 60923-523-32 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 32 | 1 | 1 |
| 60923-524-33 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 33 | 1 | 1 |
| 60923-525-34 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 34 | 1 | 1 |
| 60923-526-35 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 35 | 1 | 1 |
| 60923-527-36 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 36 | 1 | 1 |
| 60923-528-37 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 37 | 1 | 1 |
| 60923-529-38 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 38 | 1 | 1 |
| 60923-530-39 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 39 | 1 | 1 |
| 60923-531-40 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 40 | 1 | 1 |
| 60923-532-41 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 41 | 1 | 1 |
| 60923-533-42 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 42 | 1 | 1 |
| 60923-534-43 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 43 | 1 | 1 |
| 60923-535-44 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 44 | 1 | 1 |
| 60923-536-45 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 45 | 1 | 1 |
| 60923-537-46 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 46 | 1 | 1 |
| 60923-538-47 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 47 | 1 | 1 |
| 60923-539-48 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 48 | 1 | 1 |
| 60923-540-49 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 49 | 1 | 1 |
| 60923-541-50 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 50 | 1 | 1 |
| 60923-542-51 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 51 | 1 | 1 |
| 60923-543-52 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 52 | 1 | 1 |
| 60923-544-53 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 53 | 1 | 1 |
| 60923-545-54 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 54 | 1 | 1 |
| 60923-546-55 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 55 | 1 | 1 |
| 60923-547-56 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 56 | 1 | 1 |
| 60923-548-57 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 57 | 1 | 1 |
| 60923-549-58 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 58 | 1 | 1 |
| 60923-550-59 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 59 | 1 | 1 |
| 60923-551-60 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 60 | 1 | 1 |
| 60923-552-61 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 61 | 1 | 1 |
| 60923-553-62 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 62 | 1 | 1 |
| 60923-554-63 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 63 | 1 | 1 |
| 60923-555-64 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 64 | 1 | 1 |
| 60923-556-65 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 65 | 1 | 1 |
| 60923-557-66 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 66 | 1 | 1 |
| 60923-558-67 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 67 | 1 | 1 |
| 60923-559-68 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 68 | 1 | 1 |
| 60923-560-69 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 69 | 1 | 1 |
| 60923-561-70 | J1413 | Sarepta Therapeutics, Inc. | Inj delandistrogene mox rokl | Per Therapeutic Dose | 1 | 70 | 1 | 1 |
| 0069-2004-04 | J1414 | Pfizer Inc | Inj, beqvez, per tx dose | Per Therapeutic Dose | 1 | 4 | 1 | 1 |
| 0069-2005-05 | J1414 | Pfizer Inc | Inj, beqvez, per tx dose | Per Therapeutic Dose | 1 | 5 | 1 | 1 |
| 0069-2006-06 | J1414 | Pfizer Inc | Inj, beqvez, per tx dose | Per Therapeutic Dose | 1 | 6 | 1 | 1 |
| 0069-2007-07 | J1414 | Pfizer Inc | Inj, beqvez, per tx dose | Per Therapeutic Dose | 1 | 7 | 1 | 1 |
| 60923-227-02 | J1426 | Sarepta Therapeutics, Inc. | Injection, casimersen, 10 mg | 10 MG | 2 | 1 | 10 | 10 |
| 60923-284-10 | J1428 | Sarepta Therapeutics, Inc. | Injection, eteplirsen | 10 MG | 10 | 1 | 50 | 50 |
| 60923-363-02 | J1428 | Sarepta Therapeutics, Inc. | Injection, eteplirsen | 10 MG | 2 | 1 | 10 | 10 |
| 58406-425-34 | J1438 | Amgen Inc. | Etanercept injection | 25 MG | 1 | 4 | 1 | 4 |
| 0517-0710-01 | J1451 | American Regent, Inc. | Fomepizole, 15 mg | 15 MG | 1.5 | 1 | 100 | 100 |
| 25021-829-02 | J1451 | Sagent Pharmaceuticals | Fomepizole, 15 mg | 15 MG | 1.5 | 1 | 100 | 100 |
| 67457-211-02 | J1451 | Mylan Institutional LLC | Fomepizole, 15 mg | 15 MG | 1.5 | 1 | 100 | 100 |
| 70710-1478-1 | J1451 | Zydus Pharmaceuticals (USA) Inc. | Fomepizole, 15 mg | 15 MG | 1.5 | 1 | 100 | 100 |
| 68546-317-30 | J1595 | Teva Neuroscience, Inc. | Injection glatiramer acetate | 20 MG | 1 | 30 | 1 | 30 |
| 68546-325-12 | J1595 | Teva Neuroscience, Inc. | Injection glatiramer acetate | 20 MG | 1 | 12 | 2 | 24 |
| 72065-140-11 | J1612 | Xeris Pharmaceuticals, Inc. | Inj glucagon (gvoke) 0.01 mg | 0.01 MG | 1 | 1 | 100 | 100 |
| 0009-3794-01 | J1742 | Pfizer Inc | Ibutilide fumarate injection | 1 MG | 10 | 1 | 1 | 1 |
| 0009-3794-01 | J1742 | Pfizer Inc | Ibutilide fumarate injection | 1 MG | 10 | 1 | 1 | 1 |
| 0009-3794-22 | J1742 | Pfizer Inc | Ibutilide fumarate injection | 1 MG | 10 | 1 | 1 | 1 |
| 0009-3794-22 | J1742 | Pfizer Inc | Ibutilide fumarate injection | 1 MG | 10 | 1 | 1 | 1 |
| 23155-326-31 | J1742 | Heritage Pharmaceuticals Inc. | Ibutilide fumarate injection | 1 MG | 10 | 1 | 1 | 1 |
| 67457-366-10 | J1742 | Mylan Institutional LLC | Ibutilide fumarate injection | 1 MG | 10 | 1 | 1 | 1 |
| 24201-207-01 | J1744 | Hikma Pharmaceuticals USA Inc. | Icatibant injection | 1 MG | 3 | 1 | 30 | 30 |
| 54092-702-02 | J1744 | Takeda Pharmaceuticals America, Inc. | Icatibant injection | 1 MG | 3 | 1 | 30 | 30 |
| 54092-702-03 | J1744 | Takeda Pharmaceuticals America, Inc. | Icatibant injection | 1 MG | 3 | 3 | 30 | 90 |
| 60505-6214-1 | J1744 | Apotex Corp | Icatibant injection | 1 MG | 3 | 1 | 30 | 30 |
| 63323-574-86 | J1744 | FreseniUS Kabi USA, LLC | Icatibant injection | 1 MG | 3 | 1 | 30 | 30 |
| 63323-574-93 | J1744 | FreseniUS Kabi USA, LLC | Icatibant injection | 1 MG | 3 | 3 | 30 | 90 |
| 69097-664-34 | J1744 | Cipla USA, Inc. | Icatibant injection | 1 MG | 3 | 1 | 30 | 30 |
| 69097-664-68 | J1744 | Cipla USA, Inc. | Icatibant injection | 1 MG | 3 | 3 | 30 | 90 |
| 42023-157-01 | J1807 | Endo USA, Inc. | Inj, ethacrynate sod, 1 mg | 1 MG | 1 | 1 | 50 | 50 |
| 42023-157-01 | J1807 | Endo USA, Inc. | Inj, ethacrynate sod, 1 mg | 1 MG | 1 | 1 | 50 | 50 |
| 0469-0420-01 | J1833 | Astellas Pharma US, Inc. | Inj, isavuconazonium sulfate | 1 MG | 1 | 1 | 372 | 372 |
| 0781-3056-70 | J1834 | Sandoz Inc. | Inj, isoniazid, 1 mg | 1 MG | 10 | 1 | 1000 | 1000 |
| 70842-120-06 | J2186 | Melinta Therapeutics, LLC | Inj., meropenem, vaborbactam | (10 MG/10MG) 20 MG | 1 | 6 | 100 | 600 |
| 70842-160-10 | J2265 | Melinta Therapeutics, LLC | Minocycline hydrochloride | 1 MG | 1 | 10 | 100 | 1000 |
| 64406-058-01 | J2326 | Biogen Inc. | Injection, nusinersen | 0.1 MG | 5 | 1 | 120 | 120 |
| 72769-181-03 | J2547 | BioCryst Pharmaceuticals, Inc. | Injection, peramivir | 1 MG | 20 | 3 | 200 | 600 |
| 62756-301-01 | J2561 | Sun Pharmaceutical Industries, Inc. | Inj, sezaby, 1 mg | 1 MG | 1 | 1 | 100 | 100 |
| 72526-101-11 | J2801 | Shandong Luye Pharmaceutical | Inj, rykindo, 0.5 mg | 0.5 MG | 1 | 1 | 25 | 25 |
| 72526-102-11 | J2801 | Shandong Luye Pharmaceutical | Inj, rykindo, 0.5 mg | 0.5 MG | 1 | 1 | 50 | 50 |
| 72526-103-11 | J2801 | Shandong Luye Pharmaceutical | Inj, rykindo, 0.5 mg | 0.5 MG | 1 | 1 | 75 | 75 |
| 72526-104-11 | J2801 | Shandong Luye Pharmaceutical | Inj, rykindo, 0.5 mg | 0.5 MG | 1 | 1 | 100 | 100 |
| 25682-007-01 | J2840 | Alexion Pharmaceuticals, Inc. | Injection, sebelipase alfa | 1 MG | 10 | 1 | 20 | 20 |
| 67066-005-01 | J2850 | ChiRhoClin, Inc | Inj secretin synthetic human | 1 MCG | 1 | 1 | 16 | 16 |
| 10122-141-02 | J2993 | Chiesi USA, Inc. | Reteplase injection | 18.1 MG | 1 | 2 | 1 | 2 |
| 70573-099-02 | J2998 | Kedrion Biopharma Inc | Inj plasminogen tvmh 1mg | 1 MG | 1 | 1 | 68.8 | 69 |
| 57894-060-02 | J3357 | Janssen Biotech, Inc. | Ustekinumab injection | 1 MG | 0.5 | 1 | 45 | 45 |
| 57894-060-03 | J3357 | Janssen Biotech, Inc. | Ustekinumab injection | 1 MG | 0.5 | 1 | 45 | 45 |
| 57894-061-03 | J3357 | Janssen Biotech, Inc. | Ustekinumab injection | 1 MG | 1 | 1 | 90 | 90 |
| 57894-440-01 | J3357 | JANSSEN BIOTECH, INC. | Ustekinumab injection | 1 MG | 0.5 | 1 | 45 | 45 |
| 57894-440-03 | J3357 | JANSSEN BIOTECH, INC. | Ustekinumab injection | 1 MG | 0.5 | 1 | 45 | 45 |
| 57894-441-01 | J3357 | JANSSEN BIOTECH, INC. | Ustekinumab injection | 1 MG | 1 | 1 | 90 | 90 |
| 83222-0200-1 | J3391 | Orchard Therapeutics Ltd | Inj, atidarsagene autotemcel | Per Treatment Dose | 1 | 1 | 1 | 1 |
| 51167-290-09 | J3392 | Vertex Pharmaceuticals, Inc. | Inj, exagamglogene autotem | Per Treatment | 1 | 1 | 1 | 1 |
| 73554-3111-1 | J3393 | Bluebird Bio, Inc. | Inj, betibeglogene autotemce | Per Therapeutic Dose | 20 | 1 | 1 | 1 |
| 73554-1111-1 | J3394 | Bluebird Bio, Inc. | Inj, lovotibeglogene autotem | Per Treatment | 20 | 1 | 1 | 1 |
| 69794-001-01 | J3397 | Ultragenyx Pharmaceutical Inc. | Inj., vestronidase alfa-vjbk | 1 MG | 5 | 1 | 10 | 10 |
| 71394-415-01 | J3398 | Spark Therapeutics, Inc. | Inj luxturna 1 billion vec g | 1 billion vector genomes | 0.5 | 1 | 150 | 150 |
| 71894-120-02 | J3399 | Novartis Gene Therapies, Inc. | Inj onase abepar-xioi treat | Per tx dose (up to 5 x10^15 vg?) | 16.6 | 1 | 1 | 1 |
| 71894-121-03 | J3399 | Novartis Gene Therapies, Inc. | Inj onase abepar-xioi treat | Per tx dose (up to 5 x10^15 vg?) | 19.3 | 1 | 1 | 1 |
| 71894-122-03 | J3399 | Novartis Gene Therapies, Inc. | Inj onase abepar-xioi treat | Per tx dose (up to 5 x10^15 vg?) | 22.1 | 1 | 1 | 1 |
| 71894-123-03 | J3399 | Novartis Gene Therapies, Inc. | Inj onase abepar-xioi treat | Per tx dose (up to 5 x10^15 vg?) | 24.9 | 1 | 1 | 1 |
| 71894-124-04 | J3399 | Novartis Gene Therapies, Inc. | Inj onase abepar-xioi treat | Per tx dose (up to 5 x10^15 vg?) | 27.6 | 1 | 1 | 1 |
| 71894-125-04 | J3399 | Novartis Gene Therapies, Inc. | Inj onase abepar-xioi treat | Per tx dose (up to 5 x10^15 vg?) | 30.4 | 1 | 1 | 1 |
| 71894-126-04 | J3399 | Novartis Gene Therapies, Inc. | Inj onase abepar-xioi treat | Per tx dose (up to 5 x10^15 vg?) | 33.2 | 1 | 1 | 1 |
| 71894-127-05 | J3399 | Novartis Gene Therapies, Inc. | Inj onase abepar-xioi treat | Per tx dose (up to 5 x10^15 vg?) | 35.9 | 1 | 1 | 1 |
| 71894-128-05 | J3399 | Novartis Gene Therapies, Inc. | Inj onase abepar-xioi treat | Per tx dose (up to 5 x10^15 vg?) | 38.7 | 1 | 1 | 1 |
| 71894-129-05 | J3399 | Novartis Gene Therapies, Inc. | Inj onase abepar-xioi treat | Per tx dose (up to 5 x10^15 vg?) | 41.5 | 1 | 1 | 1 |
| 71894-130-06 | J3399 | Novartis Gene Therapies, Inc. | Inj onase abepar-xioi treat | Per tx dose (up to 5 x10^15 vg?) | 44.2 | 1 | 1 | 1 |
| 71894-131-06 | J3399 | Novartis Gene Therapies, Inc. | Inj onase abepar-xioi treat | Per tx dose (up to 5 x10^15 vg?) | 47 | 1 | 1 | 1 |
| 71894-132-06 | J3399 | Novartis Gene Therapies, Inc. | Inj onase abepar-xioi treat | Per tx dose (up to 5 x10^15 vg?) | 49.8 | 1 | 1 | 1 |
| 71894-133-07 | J3399 | Novartis Gene Therapies, Inc. | Inj onase abepar-xioi treat | Per tx dose (up to 5 x10^15 vg?) | 52.5 | 1 | 1 | 1 |
| 71894-134-07 | J3399 | Novartis Gene Therapies, Inc. | Inj onase abepar-xioi treat | Per tx dose (up to 5 x10^15 vg?) | 55.3 | 1 | 1 | 1 |
| 71894-135-07 | J3399 | Novartis Gene Therapies, Inc. | Inj onase abepar-xioi treat | Per tx dose (up to 5 x10^15 vg?) | 58.1 | 1 | 1 | 1 |
| 71894-136-08 | J3399 | Novartis Gene Therapies, Inc. | Inj onase abepar-xioi treat | Per tx dose (up to 5 x10^15 vg?) | 60.8 | 1 | 1 | 1 |
| 71894-137-08 | J3399 | Novartis Gene Therapies, Inc. | Inj onase abepar-xioi treat | Per tx dose (up to 5 x10^15 vg?) | 63.6 | 1 | 1 | 1 |
| 71894-138-08 | J3399 | Novartis Gene Therapies, Inc. | Inj onase abepar-xioi treat | Per tx dose (up to 5 x10^15 vg?) | 66.4 | 1 | 1 | 1 |
| 71894-139-09 | J3399 | Novartis Gene Therapies, Inc. | Inj onase abepar-xioi treat | Per tx dose (up to 5 x10^15 vg?) | 69.1 | 1 | 1 | 1 |
| 71894-140-09 | J3399 | Novartis Gene Therapies, Inc. | Inj onase abepar-xioi treat | Per tx dose (up to 5 x10^15 vg?) | 71.9 | 1 | 1 | 1 |
| 71894-141-09 | J3399 | Novartis Gene Therapies, Inc. | Inj onase abepar-xioi treat | Per tx dose (up to 5 x10^15 vg?) | 74.7 | 1 | 1 | 1 |
| 82958-501-01 | J3403 | Neurotech Pharmaceuticals Inc | Revakinagene, per implant | PER IMPLANT | 1 | 1 | 1 | 1 |
| 11704-370-01 | J3424 | Meridian Medical Technologies LLC | Inj hydroxocobalamin iv 25mg | 25 MG | 1 | 1 | 200 | 200 |
| 50633-310-11 | J3424 | BTG International Inc. | Inj hydroxocobalamin iv 25mg | 25 MG | 1 | 1 | 200 | 200 |
| 68982-261-01 | J7165 | Octapharma USA Inc. | Inj, human-lans, per i.u | PER FACTOR IX IU | 1 | 1 | 1 | 1 |
| 68982-261-02 | J7165 | Octapharma USA Inc. | Inj, human-lans, per i.u | PER FACTOR IX IU | 1 | 1 | 1 | 1 |
| 63833-386-02 | J7168 | CSL Behring L.L.C. | Prothrombin complex kcentra | 1 IU | 1 | 1 | 1 | 1 |
| 63833-387-02 | J7168 | CSL Behring L.L.C. | Prothrombin complex kcentra | 1 IU | 1 | 1 | 1 | 1 |
| 0310-3200-04 | J7169 | AstraZeneca Pharmaceuticals LP | Inj andexxa, 10 mg | 10 MG | 1 | 4 | 20 | 80 |
| 0310-3200-05 | J7169 | AstraZeneca Pharmaceuticals LP | Inj andexxa, 10 mg | 10 MG | 1 | 5 | 20 | 100 |
| 69853-0102-1 | J7169 | AstraZeneca Pharmaceuticals LP | Inj andexxa, 10 mg | 10 MG | 1 | 4 | 20 | 80 |
| 58468-0347-1 | J7174 | Genzyme Corporation | Injection fitusiran 0.04 mg | 0.04 MG | 0.2 | 1 | 500 | 500 |
| 58468-0348-1 | J7174 | Genzyme Corporation | Injection fitusiran 0.04 mg | 0.04 MG | 0.5 | 1 | 1250 | 1250 |
| 73372-0116-1 | J7352 | Clinuvel Inc. | Afamelanotide implant, 1 mg | 1 MG | 1 | 1 | 16 | 16 |
| 69866-2002-3 | J7353 | Vericel Corporation | Anacaulase-bcdb 8.8% gel 1 g | 1 GM (OF 8.8% GEL) | 1 | 1 | 22 | 22 |
| 69866-2005-3 | J7353 | Vericel Corporation | Anacaulase-bcdb 8.8% gel 1 g | 1 GM (OF 8.8% GEL) | 1 | 1 | 55 | 55 |
| 0143-9566-01 | J7501 | Hikma Pharmaceuticals USA Inc. | Azathioprine parenteral | 100 MG | 1 | 1 | 1 | 1 |
| 83513-010-01 | J9174 | Zhuhai Beihai Biotech Ltd | Inj, docetaxel (beizray) 1mg | 1 MG | 4 | 2 | 80 | 160 |
| 81284-315-05 | J9220 | Apollo Pharmaceuticals | Indigotindisulfonate sod 1mg | 1 MG | 5 | 5 | 40 | 200 |
| 0078-0669-13 | J9302 | Novartis Pharmaceuticals Corporation | Ofatumumab injection | 10 MG | 5 | 3 | 10 | 30 |
| 0078-0690-61 | J9302 | Novartis Pharmaceuticals Corporation | Ofatumumab injection | 10 MG | 50 | 1 | 100 | 100 |
| 0310-4700-01 | J9313 | AstraZeneca Pharmaceuticals LP | Inj., lumoxiti, 0.01 mg | 0.01 MG | 1 | 1 | 100 | 100 |
| 73380-4700-1 | J9313 | AstraZeneca Pharmaceuticals LP | Inj., lumoxiti, 0.01 mg | 0.01 MG | 1 | 1 | 100 | 100 |
| 61755-014-01 | J9376 | Regeneron Pharmaceuticals, Inc. | Inj pozelimab-bbfg, 1 mg | 1 MG | 2 | 1 | 400 | 400 |
| 76128-155-75 | J9600 | Pinnacle Biologics, Inc. | Porfimer sodium injection | 75 MG | 1 | 1 | 1 | 1 |
| 83047-410-04 | Q2058 | Autolus Inc. | Obecbtge autol up to 400 mil | Per Therapeutic Dose | 1 | 1 | 1 | 2 |
| 59627-222-05 | Q3027 | Biogen Inc. | Inj beta interferon im 1 mcg | 1 MCG | 1 | 4 | 30 | 120 |
| 59627-333-04 | Q3027 | Biogen Inc. | Inj beta interferon im 1 mcg | 1 MCG | 1 | 4 | 30 | 120 |
| 61314-228-94 | Q5136 | Sandoz Inc. | Inj. denosumab-bbdz, 1 mg | 1 MG | 1.7 | 1 | 120 | 120 |
| 61314-240-63 | Q5136 | Sandoz Inc. | Inj. denosumab-bbdz, 1 mg | 1 MG | 1 | 1 | 60 | 60 |
| 49502-380-02 | Q5140 | Mylan Specialty L.P. | Inj adalimumab-fkjp, 1 mg | 1 MG | 0.8 | 1 | 40 | 80 |
| 49502-381-02 | Q5140 | Mylan Specialty L.P. | Inj adalimumab-fkjp, 1 mg | 1 MG | 0.4 | 1 | 20 | 40 |
| 49502-382-02 | Q5140 | Mylan Specialty L.P. | Inj adalimumab-fkjp, 1 mg | 1 MG | 0.8 | 1 | 40 | 80 |
| 83257-016-42 | Q5140 | Biocon Biologics Inc | Inj adalimumab-fkjp, 1 mg | 1 MG | 0.4 | 2 | 20 | 40 |
| 83257-017-42 | Q5140 | Biocon Biologics Inc | Inj adalimumab-fkjp, 1 mg | 1 MG | 0.8 | 1 | 40 | 80 |
| 83257-019-32 | Q5140 | Biocon Biologics Inc | Inj adalimumab-fkjp, 1 mg | 1 MG | 0.8 | 1 | 40 | 80 |
| 72606-023-01 | Q5141 | Celltrion USA Inc. | Inj adalimumab-aaty, 1 mg | 1 MG | 0.8 | 1 | 80 | 80 |
| 72606-023-02 | Q5141 | Celltrion USA Inc. | Inj adalimumab-aaty, 1 mg | 1 MG | 0.8 | 1 | 80 | 80 |
| 72606-023-03 | Q5141 | Celltrion USA Inc. | Inj adalimumab-aaty, 1 mg | 1 MG | 0.8 | 2 | 80 | 160 |
| 72606-023-04 | Q5141 | Celltrion USA Inc. | Inj adalimumab-aaty, 1 mg | 1 MG | 0.8 | 1 | 80 | 80 |
| 72606-023-05 | Q5141 | Celltrion USA Inc. | Inj adalimumab-aaty, 1 mg | 1 MG | 0.8 | 2 | 80 | 160 |
| 72606-023-07 | Q5141 | Celltrion USA Inc. | Inj adalimumab-aaty, 1 mg | 1 MG | 0.8 | 3 | 80 | 240 |
| 72606-023-08 | Q5141 | Celltrion USA Inc. | Inj adalimumab-aaty, 1 mg | 1 MG | 0.8 | 3 | 80 | 240 |
| 72606-024-01 | Q5141 | Celltrion USA Inc. | Inj adalimumab-aaty, 1 mg | 1 MG | 0.2 | 2 | 20 | 40 |
| 72606-030-01 | Q5141 | Celltrion USA Inc. | Inj adalimumab-aaty, 1 mg | 1 MG | 0.4 | 1 | 40 | 40 |
| 72606-030-02 | Q5141 | Celltrion USA Inc. | Inj adalimumab-aaty, 1 mg | 1 MG | 0.4 | 2 | 40 | 80 |
| 72606-030-03 | Q5141 | Celltrion USA Inc. | Inj adalimumab-aaty, 1 mg | 1 MG | 0.4 | 4 | 40 | 160 |
| 72606-030-04 | Q5141 | Celltrion USA Inc. | Inj adalimumab-aaty, 1 mg | 1 MG | 0.4 | 6 | 40 | 240 |
| 72606-030-05 | Q5141 | Celltrion USA Inc. | Inj adalimumab-aaty, 1 mg | 1 MG | 0.4 | 1 | 40 | 40 |
| 72606-030-06 | Q5141 | Celltrion USA Inc. | Inj adalimumab-aaty, 1 mg | 1 MG | 0.4 | 2 | 40 | 80 |
| 72606-030-07 | Q5141 | Celltrion USA Inc. | Inj adalimumab-aaty, 1 mg | 1 MG | 0.4 | 4 | 40 | 160 |
| 72606-030-08 | Q5141 | Celltrion USA Inc. | Inj adalimumab-aaty, 1 mg | 1 MG | 0.4 | 6 | 40 | 240 |
| 72606-030-09 | Q5141 | Celltrion USA Inc. | Inj adalimumab-aaty, 1 mg | 1 MG | 0.4 | 1 | 40 | 40 |
| 72606-030-10 | Q5141 | Celltrion USA Inc. | Inj adalimumab-aaty, 1 mg | 1 MG | 0.4 | 2 | 40 | 80 |
| 72606-030-11 | Q5141 | Celltrion USA Inc. | Inj adalimumab-aaty, 1 mg | 1 MG | 0.4 | 4 | 40 | 160 |
| 72606-030-12 | Q5141 | Celltrion USA Inc. | Inj adalimumab-aaty, 1 mg | 1 MG | 0.4 | 6 | 40 | 240 |
| 72606-030-13 | Q5141 | Celltrion USA Inc. | Inj adalimumab-aaty, 1 mg | 1 MG | 0.4 | 4 | 40 | 160 |
| 72606-030-14 | Q5141 | Celltrion USA Inc. | Inj adalimumab-aaty, 1 mg | 1 MG | 0.4 | 6 | 40 | 240 |
| 51759-274-17 | Q5142 | Teva Pharmaceuticals USA, Inc. | Inj adalimumab-ryvk, 1 mg | 1 MG | 0.8 | 1 | 80 | 80 |
| 51759-386-22 | Q5142 | Nupathe Inc | Inj adalimumab-ryvk, 1 mg | 1 MG | 0.2 | 2 | 20 | 40 |
| 51759-402-02 | Q5142 | Nupathe Inc | Inj adalimumab-ryvk, 1 mg | 1 MG | 0.4 | 2 | 40 | 80 |
| 51759-402-17 | Q5142 | Nupathe Inc | Inj adalimumab-ryvk, 1 mg | 1 MG | 0.4 | 1 | 40 | 40 |
| 51759-412-22 | Q5142 | Nupathe Inc | Inj adalimumab-ryvk, 1 mg | 1 MG | 0.4 | 2 | 40 | 80 |
| 51759-523-21 | Q5142 | Nupathe Inc | Inj adalimumab-ryvk, 1 mg | 1 MG | 0.8 | 1 | 80 | 80 |
| 82009-156-22 | Q5142 | Quallent Pharmaceuticals | Inj adalimumab-ryvk, 1 mg | 1 MG | 0.4 | 2 | 40 | 80 |
| 82009-158-22 | Q5142 | Quallent Pharmaceuticals | Inj adalimumab-ryvk, 1 mg | 1 MG | 0.4 | 2 | 40 | 80 |
| 0597-0370-82 | Q5143 | Boehringer Ingelheim Pharmaceuticals Inc | Inj adalimumab-adbm, 1 mg | 1 MG | 0.8 | 2 | 40 | 80 |
| 0597-0375-16 | Q5143 | Boehringer Ingelheim Pharmaceuticals Inc | Inj adalimumab-adbm, 1 mg | 1 MG | 0.8 | 6 | 40 | 240 |
| 0597-0375-23 | Q5143 | Boehringer Ingelheim Pharmaceuticals Inc | Inj adalimumab-adbm, 1 mg | 1 MG | 0.8 | 4 | 40 | 160 |
| 0597-0375-97 | Q5143 | Boehringer Ingelheim Pharmaceuticals Inc | Inj adalimumab-adbm, 1 mg | 1 MG | 0.8 | 2 | 40 | 80 |
| 0597-0400-89 | Q5143 | Boehringer Ingelheim Pharmaceuticals Inc | Inj adalimumab-adbm, 1 mg | 1 MG | 0.2 | 2 | 10 | 20 |
| 0597-0405-80 | Q5143 | Boehringer Ingelheim Pharmaceuticals Inc | Inj adalimumab-adbm, 1 mg | 1 MG | 0.4 | 2 | 20 | 40 |
| 0597-0485-20 | Q5143 | Boehringer Ingelheim Pharmaceuticals Inc | Inj adalimumab-adbm, 1 mg | 1 MG | 0.4 | 2 | 40 | 80 |
| 0597-0495-40 | Q5143 | Boehringer Ingelheim Pharmaceuticals Inc | Inj adalimumab-adbm, 1 mg | 1 MG | 0.4 | 4 | 40 | 160 |
| 0597-0495-50 | Q5143 | Boehringer Ingelheim Pharmaceuticals Inc | Inj adalimumab-adbm, 1 mg | 1 MG | 0.4 | 2 | 40 | 80 |
| 0597-0495-60 | Q5143 | Boehringer Ingelheim Pharmaceuticals Inc | Inj adalimumab-adbm, 1 mg | 1 MG | 0.4 | 6 | 40 | 240 |
| 82009-144-22 | Q5143 | Quallent Pharmaceuticals | Inj adalimumab-adbm, 1 mg | 1 MG | 0.4 | 2 | 40 | 80 |
| 82009-146-22 | Q5143 | Quallent Pharmaceuticals | Inj adalimumab-adbm, 1 mg | 1 MG | 0.4 | 2 | 40 | 80 |
| 82009-148-22 | Q5143 | Quallent Pharmaceuticals | Inj adalimumab-adbm, 1 mg | 1 MG | 0.8 | 2 | 40 | 80 |
| 82009-150-22 | Q5143 | Quallent Pharmaceuticals | Inj adalimumab-adbm, 1 mg | 1 MG | 0.8 | 2 | 40 | 80 |
| 65219-554-08 | Q5144 | FreseniUS Kabi USA, LLC | Inj, idacio, 1 mg | 1 MG | 0.8 | 2 | 40 | 80 |
| 65219-554-28 | Q5144 | FreseniUS Kabi USA, LLC | Inj, idacio, 1 mg | 1 MG | 0.8 | 4 | 40 | 160 |
| 65219-554-38 | Q5144 | FreseniUS Kabi USA, LLC | Inj, idacio, 1 mg | 1 MG | 0.8 | 6 | 40 | 240 |
| 65219-556-18 | Q5144 | FreseniUS Kabi USA, LLC | Inj, idacio, 1 mg | 1 MG | 0.8 | 2 | 40 | 80 |
| 65219-612-69 | Q5144 | FreseniUS Kabi USA, LLC | Inj, idacio, 1 mg | 1 MG | 0.8 | 4 | 40 | 160 |
| 65219-612-89 | Q5144 | FreseniUS Kabi USA, LLC | Inj, idacio, 1 mg | 1 MG | 0.8 | 6 | 40 | 240 |
| 65219-612-99 | Q5144 | FreseniUS Kabi USA, LLC | Inj, idacio, 1 mg | 1 MG | 0.8 | 2 | 40 | 80 |
| 65219-620-20 | Q5144 | FreseniUS Kabi USA, LLC | Inj, idacio, 1 mg | 1 MG | 0.8 | 2 | 40 | 80 |
| 0025-0325-01 | Q5145 | PFIZER LABS | Inj, abrilada, 1 mg | 1 MG | 0.8 | 1 | 40 | 40 |
| 0025-0325-02 | Q5145 | Pfizer Inc. | Inj, abrilada, 1 mg | 1 MG | 0.8 | 2 | 40 | 80 |
| 0025-0328-02 | Q5145 | Pfizer Inc. | Inj, abrilada, 1 mg | 1 MG | 0.8 | 2 | 40 | 80 |
| 0069-0319-01 | Q5145 | Pfizer Inc | Inj, abrilada, 1 mg | 1 MG | 0.8 | 1 | 40 | 40 |
| 0069-0325-01 | Q5145 | Pfizer Inc | Inj, abrilada, 1 mg | 1 MG | 0.8 | 1 | 40 | 40 |
| 0069-0325-02 | Q5145 | Pfizer Inc | Inj, abrilada, 1 mg | 1 MG | 0.8 | 2 | 40 | 80 |
| 0069-0328-01 | Q5145 | Pfizer Inc | Inj, abrilada, 1 mg | 1 MG | 0.8 | 1 | 40 | 40 |
| 0069-0328-02 | Q5145 | Pfizer Inc | Inj, abrilada, 1 mg | 1 MG | 0.8 | 2 | 40 | 80 |
| 0069-0333-02 | Q5145 | Pfizer Inc | Inj, abrilada, 1 mg | 1 MG | 0.4 | 2 | 20 | 40 |
| 0069-0347-02 | Q5145 | Pfizer Inc | Inj, abrilada, 1 mg | 1 MG | 0.2 | 2 | 10 | 20 |
| 72374-101-01 | Q5148 | Tanvex Biopharma USA | Inj, nyposi 1 mcg | 1 MCG | 0.5 | 1 | 300 | 300 |
| 72374-101-10 | Q5148 | Tanvex Biopharma USA | Inj, nyposi 1 mcg | 1 MCG | 0.5 | 10 | 300 | 3000 |
| 72374-102-01 | Q5148 | Tanvex Biopharma USA | Inj, nyposi 1 mcg | 1 MCG | 0.8 | 1 | 480 | 480 |
| 72374-102-10 | Q5148 | Tanvex Biopharma USA | Inj, nyposi 1 mcg | 1 MCG | 0.8 | 10 | 480 | 4800 |
| 51759-208-13 | Q5151 | Teva Pharmaceuticals USA, Inc. | Inj, eculizumab-aagh, 2 mg | 2 MG | 30 | 1 | 150 | 150 |
| 71202-010-01 | Q5151 | Samsung Bioepis | Inj, eculizumab-aagh, 2 mg | 2 MG | 30 | 1 | 150 | 150 |
| 55513-180-01 | Q5152 | Amgen Inc | Inj, eculizumab-aeeb, 2 mg� | 2 MG | 30 | 1 | 150 | 150 |
| 72606-037-01 | Q5157 | Celltrion USA Inc. | Inj, denosumab-bmwo, 1 mg | 1 MG | 1 | 1 | 60 | 60 |
| 72606-038-01 | Q5157 | Celltrion USA Inc. | Inj, denosumab-bmwo, 1 mg | 1 MG | 1.7 | 1 | 120 | 120 |
| 65219-668-01 | Q5158 | Fresenius Kabi USA, LLC | Inj, denosumab-bnht, 1 mg | 1 MG | 1 | 1 | 60 | 60 |
| 65219-670-01 | Q5158 | Fresenius Kabi USA, LLC | Inj, denosumab-bnht, 1 mg | 1 MG | 1.7 | 1 | 120 | 120 |
| 65219-672-01 | Q5158 | Fresenius Kabi USA, LLC | Inj, denosumab-bnht, 1 mg | 1 MG | 1.7 | 1 | 120 | 120 |
| 0517-0374-05 | Q9968 | American Regent, Inc. | Visualization adjunct | 1 MG | 10 | 5 | 50 | 250 |
| 67457-220-05 | Q9968 | Mylan Institutional LLC | Visualization adjunct | 1 MG | 5 | 6 | 50 | 300 |
| 17156-067-30 | Q9982 | GE Healthcare Inc. | Flutemetamol F18 | Per Study Dose, up to 5 millicuries | 1 | 1 | 1 | 1 |
