Table III: 2019 Medicare Drug Fee Schedule*

CY 2019 4th Quarter Average Sales Price (ASP) Data Plus 6 Percent

*The Medicare payments allowance limits are effective Oct. 1 through Dec. 31, 2019. CY 2019 CY 2019 CY 2019 CY 2019 Effective Jan. 1 Effective Apr. 1 Effective July 1 Effective Oct. 1 Through Mar. 31 Through June 30 Throught Sept. 30 Through Dec. 31 Code Description Code Dosage ASP plus 6 percent ASP Plus 6 percent ASP Plus 6 percent ASP plus 6 percent J0129 Abatacept 10mg $51.61 $52.49 $53.94 $54.32 J0130 Abciximab injection 10mg $1,429.07 $1,429.07 $1,429.07 $1,429.07 J0133 Acyclovir, 5 mg 5mg $0.05 $0.05 $0.04 $0.04 J0171 Adrenalin epinephrin inject 0.1mg $0.74 $0.76 $0.86 $0.83 J0207 Amifostine 500mg $979.75 $990.39 $977.31 $1,003.59 J0256 Alpha 1 proteinase inhibitor 10mg $4.55 $4.56 $4.51 $4.55 J0280 Aminophyllin 250 MG inj 250mg $7.02 $7.33 $7.33 $10.88 J0289 Amphotericin b liposome inj 10mg $22.19 $23.92 $18.32 $26.09 J0295 Ampicillin sodium per 1.5 gm 1.5gm $2.62 $2.81 $3.32 $2.06 J0360 Hydralazine hcl injection 20mg $2.58 $2.58 $4.07 $4.21 J0456 Azithromycin 500mg $2.76 $2.58 $2.75 $3.05 J0461 Atropine sulfate injection 0.01mg $0.07 $0.07 $0.07 $0.06 J0475 Baclofen 10 MG injection 10mg $169.75 $174.19 $173.39 $169.51 J0476 Baclofen intrathecal trial 50mcg $44.35 $49.98 $50.44 $50.05 J0480 Basiliximab 20mg $3,677.61 $3,687.17 $3,789.63 $3,799.93 J0490 Belimumab 10mg $44.16 $44.16 $44.82 $44.82 J0500 Dicyclomine injection 20mg $69.65 $82.33 $69.97 $57.58 J0515 Inj benztropine mesylate 1mg $18.67 $18.75 $19.89 $17.74 J0570 Buprenorphine implant 74.2mg $1,269.91 $1,263.19 $1,261.87 $1,303.53 J0583 Bivalirudin 1mg $0.80 $0.70 $0.53 $0.62 J0585 Botulinum toxin a per unit 1unit $6.14 $6.12 $6.12 $6.12 J0587 Botulinum toxin type B 100units $12.00 $11.97 $12.02 $11.99 J0592 Buprenorphine hydrochloride 0.1mg $4.15 $4.22 $4.36 $4.56 J0595 Butorphanol tartrate 1 mg 1mg $2.62 $2.51 $2.26 $2.71 J0600 Edetate calcium disodium inj 1000mg $5,594.42 $5,594.42 $5,594.42 $5,594.42 J0610 Calcium gluconate injection 10ml $4.36 $3.22 $3.51 $2.70 J0630 Calcitonin salmon injection 400units $2,651.10 $2,657.54 $2,647.26 $2,661.05 J0636 Inj calcitriol per 0.1 mcg 0.1mcg $0.45 $0.52 $0.72 $0.61 J0637 Caspofungin acetate 5mg $10.02 $10.44 $9.81 $6.85 J0640 Leucovorin calcium injection 50mg $3.35 $3.32 $3.02 $3.02 J0690 Cefazolin sodium injection 500mg $0.83 $0.90 $0.75 $0.77 J0692 Cefepime HCl for injection 500mg $2.47 $1.83 $1.88 $1.91 J0694 Cefoxitin sodium injection 1gm $3.54 $4.50 $4.96 $5.22 J0696 Ceftriaxone sodium injection 250mg $0.65 $0.62 $0.49 $0.54 J0697 Sterile cefuroxime injection 750mg $2.09 $2.14 $1.83 $2.03 J0702 Betamethasone acet&sod phosp 3mg $6.89 $6.81 $6.91 $6.96 J0713 Inj ceftazidime per 500 mg 500mg $2.10 $1.96 $2.00 $2.00 J0717 Certolizum Pegol Inj 1mg $7.89 $7.87 $8.13 $8.02 J0720 Chloramphenicol sodium injec 1gm $39.34 $39.54 $38.33 $38.54 J0725 Chorionic gonadotropin/1000u 1,000units $22.60 $22.21 $22.37 $22.62 J0740 Cidofovir injection 375mg $522.74 $579.91 $643.29 $623.27 J0743 Cilastatin sodium injection 250mg $6.95 $6.29 $5.85 $6.14 J0770 Colistimethate sodium inj 150mg $15.30 $13.47 $19.24 $19.20 J0780 Prochlorperazine injection 10mg $10.06 $9.90 $10.34 $9.69 J0800 Corticotropin injection 1-40units $3,976.02 $3,977.62 $3,962.17 $3,946.50 J0882 Darbepoetin alfa, non-esrd 1mcg $3.83 $3.97 $3.83 $3.85 J0885 Non esrd epoetin alpha inj 1,000units $11.95 $11.73 $11.46 $11.03 J0895 Deferoxamine mesylate inj 500mg $9.62 $8.17 $8.20 $8.52 J0897 Denosumab injection 1 mg $18.61 $18.69 $19.10 $19.28 J1000 Depo-estradiol cypionate inj 5mg $21.94 $21.96 $21.96 $21.89 J1020 Methylprednisolone 20 MG inj 20mg $4.01 $3.89 $3.66 $3.70 J1030 Methylprednisolone 40 MG inj 40mg $6.60 $6.46 $6.24 $6.24 J1040 Methylprednisolone 80 MG inj 80mg $12.86 $12.49 $12.02 $11.93 J1100 Dexamethasone sodium phos 1mg $0.11 $0.10 $0.12 $0.14 J1110 Inj dihydroergotamine mesylt 1mg $14.18 $58.59 $57.29 $57.66 J1120 Acetazolamid sodium injectio 50mg $14.18 $13.76 $15.51 $17.19 J1160 Digoxin injection 0.5mg $4.87 $5.75 $5.21 $5.42 J1165 Phenytoin sodium injection 50mg $1.04 $0.65 $0.75 $0.85 J1190 Dexrazoxane HCl injection 250mg $220.97 $211.49 $194.71 $194.34 J1200 Diphenhydramine hcl injectio 1-50mg $0.54 $0.66 $0.86 $0.91 J1205 Chlorothiazide sodium inj 500mg $73.20 $64.46 $50.64 $49.65 J1230 Methadone injection 10mg $73.20 $18.74 $18.15 $16.54 J1245 Dipyridamole injection 10mg $1.67 $2.19 $1.43 $0.07 J1250 Inj dobutamine HCL/250 mg 250mg $7.32 $8.86 $8.52 $6.99 J1265 DopAMIne injection 40mg $0.82 $0.88 $0.76 $0.76 J1270 Injection, doxercalciferol 1mcg $0.47 $0.30 $0.23 $0.32 J1325 Epoprostenol injection 0.5mg $16.16 $16.14 $16.14 $16.19 J1335 Ertapenem injection 500mg $53.61 $48.49 $44.63 $43.47 J1364 Erythro lactobionate /500 MG 500mg $78.87 $78.87 $78.87 $75.76 J1410 Inj estrogen conjugate 25 MG 25mg $308.91 $309.21 $309.33 $308.93 J1430 Ethanolamine oleate 100 mg 100mg $444.10 $444.10 $444.10 $444.10 J1450 Fluconazole 200mg $5.57 $4.16 $5.17 $4.71 J1566 Inj immune globulin, lyophilzed 500mg 500mg $43.11 $59.81 $62.22 $61.20 J1570 Ganciclovir sodium injection 500mg $56.25 $50.49 $47.07 $48.41 J1580 Garamycin gentamicin inj 80mg $1.69 $1.73 $1.83 $1.91 J1610 Glucagon hydrochloride/1 MG 1mg $219.92 $207.13 $200.26 $199.27 J1626 Granisetron HCl injection 100mcg $0.44 $0.35 $0.30 $0.40 J1630 Haloperidol injection 5mg $1.09 $1.04 $1.13 $0.97 J1631 Haloperidol decanoate inj 50mg $17.39 $16.58 $16.65 $16.48 J1642 Inj heparin sodium per 10 u 10units $0.18 $0.16 $0.17 $0.25 J1644 Inj heparin sodium per 1000u 1000units $0.20 $0.19 $0.20 $0.20 J1645 Dalteparin sodium 2500I.U. $13.94 $13.41 $13.15 $15.58 J1650 Inj enoxaparin sodium 10mg $0.77 $0.87 $0.83 $0.82 J1652 Fondaparinux sodium 0.5mg $2.07 $2.14 $1.74 $1.72 J1720 Hydrocortisone sodium succ i 100mg $12.99 $13.04 $418.84 $12.90 J1740 Ibandronate sodium 1mg $55.44 $44.45 $45.73 $43.48 J1742 Ibutilide fumarate injection 1mg $235.48 $131.54 $152.86 $278.77 J1745 Infliximab injection 10mg $76.95 $71.83 $64.96 $63.28 J1756 Iron sucrose injection 1mg $0.24 $0.23 $0.23 $0.23 J1786 Imuglucerase injection 10units $42.12 $42.10 $42.86 $42.94 J1800 Propranolol injection 1mg $3.66 $3.52 $1.23 $8.48 J1815 Insulin injection 5units $0.89 $0.91 $0.90 $0.88 J1817 Insulin for insulin pump use 50units $10.95 $11.08 $10.99 $10.78 J1940 Furosemide injection 20mg $0.83 $0.80 $0.77 $0.69 J1950 Leuprolide acetate /3.75 MG 3.75mg $1,188.99 $1,190.20 $1,267.77 $1,269.23 J1955 Inj levocarnitine per 1 gm 1gm $20.56 $19.99 $20.14 $19.40 J1956 Levofloxacin injection 250mg $1.47 $1.21 $1.08 $0.22 J1980 Hyoscyamine sulfate inj 0.25mg $30.29 $30.33 $29.55 $29.47 J2001 Lidocaine injection 10mg $0.05 $0.03 $0.03 $0.03 J2010 Lincomycin injection 300mg $13.46 $12.34 $13.16 $11.18 J2020 Linezolid injection 200mg $8.51 $9.05 $6.91 $6.30 J2060 Lorazepam injection 2mg $0.73 $0.73 $0.64 $0.66 J2150 Mannitol injection 50ml $3.80 $3.49 $2.11 $2.62 J2185 Meropenem 100mg $1.03 $1.05 $0.98 $0.90 J2210 Methylergonovin maleate inj 0.2mg $15.77 $16.90 $17.21 $17.39 J2250 Inj midazolam hydrochloride 1mg $0.13 $0.13 $0.11 $0.12 J2260 Inj milrinone lactate / 5 MG 5mg $1.40 $1.44 $2.02 $1.78 J2310 Inj naloxone hydrochloride 1mg $17.72 $14.63 $17.46 $15.28 J2353 Octreotide injection, depot 1mg $197.88 $197.91 $204.69 $206.57 J2354 Octreotide inj, non-depot 25mcg $0.91 $0.87 $0.81 $0.78 J2400 Chloroprocaine hcl injection 30ml $28.78 $27.60 $27.05 $23.32 J2405 Ondansetron hcl injection 1mg $0.17 $0.11 $0.12 $0.11 J2430 Pamidronate disodium /30 MG 30mg $11.91 $16.18 $12.47 $12.06 J2501 Paricalcitol 1mcg $0.64 $0.75 $0.65 $0.79 J2505 Injection, pegfilgrastim 6mg 6mg $4,681.81 $4,655.48 $4,528.31 $4,432.55 J2507 Pegloticase injection 1mg 1mg $2,361.05 $2,403.30 $2,485.24 $2,512.55 J2510 Penicillin g procaine inj 600,000units $29.29 $29.79 $29.82 $29.97 J2515 Pentobarbital sodium inj 50mg $48.29 $44.40 $38.04 $37.01 J2543 Piperacillin/tazobactam 1.125gm $1.94 $1.96 $1.82 $1.83 J2560 Phenobarbital sodium inj 120mg $39.20 $39.42 $41.43 $42.04 J2597 Inj desmopressin acetate 1mcg $12.46 $12.35 $11.97 $12.14 J2675 Inj progesterone per 50 MG 50mg $1.85 $1.78 $2.26 $2.21 J2680 Fluphenazine decanoate 25 MG 25mg $15.44 $12.43 $11.45 $10.95 J2690 Procainamide hcl injection 1gm $77.30 $82.22 $70.14 $77.49 J2700 Oxacillin sodium injection 250mg $1.93 $1.60 $1.48 $1.37 J2765 Metoclopramide hcl injection 10mg $1.92 $1.25 $1.25 $1.54 J2770 Quinupristin/dalfopristin 500mg $417.76 $417.00 $418.10 $417.49 J2780 Ranitidine hydrochloride inj 25mg $5.06 $4.78 $4.53 $4.09 J2783 Rasburicase 0.5mg $279.82 $279.16 $287.64 $289.81 J2788 Rho d immune globulin 50 mcg 50mcg $28.62 $25.82 $23.61 $24.92 J2792 Rho(D) immune globulin h, sd 100IU $27.78 $28.61 $30.10 $29.78 J2795 Ropivacaine HCl injection 1mg $0.09 $0.08 $0.08 $0.07 J2810 Inj theophylline per 40 MG 40mg $0.33 $0.37 $0.42 $0.42 J2820 Sargramostim injection 50mcg $38.96 $39.67 $42.40 $43.44 J2916 Na ferric gluconate complex 12.5mg $1.94 $1.90 $1.73 $1.62 J2920 Methylprednisolone injection 40mg $4.87 $4.46 $4.49 $4.49 J2930 Methylprednisolone injection 125mg $6.93 $6.36 $6.17 $6.12 J2997 Alteplase recombinant 1mg $87.75 $87.68 $87.69 $87.64 J3010 Fentanyl citrate injection 0.1mg $0.83 $0.77 $0.81 $0.89 J3101 Tenecteplase injection 1mg $121.81 $121.78 $121.79 $121.82 J3105 Terbutaline sulfate inj 1mg $2.68 $3.18 $2.56 $1.63 J3230 Chlorpromazine hcl injection 50mg $30.34 $29.19 $33.20 $31.61 J3240 Thyrotropin injection 0.9mg_1.1mg $1,653.59 $1,652.12 $1,690.30 $1,695.12 J3250 Trimethobenzamide hcl inj 200mg $32.77 $33.58 $36.55 $36.79 J3260 Tobramycin sulfate injection 80mg $2.91 $3.70 $2.94 $3.60 J3262 Tocilizumab injection 1mg $4.93 $4.93 $4.93 $4.96 J3285 Treprostinil, 1 mg 1mg $66.12 $66.12 $64.91 $63.85 J3301 Triamcinolone acetonide inj 10mg $1.70 $1.60 $1.59 $1.57 J3315 Triptorelin pamoate 3.75mg $244.49 $240.68 $248.39 $258.74 J3360 Diazepam injection 5mg $6.88 $6.85 $10.11 $11.09 J3370 Vancomycin hcl injection 500mg $4.23 $4.77 $3.65 $3.46 J3396 Verteporfin injection 0.1mg $10.98 $10.96 $11.05 $11.08 J3410 Hydroxyzine hcl injection 25mg $6.36 $7.30 $7.28 $6.59 J3420 Vitamin b12 injection 1000mcg $1.74 $1.83 $1.83 $1.88 J3430 Vitamin k phytonadione inj 1mg $4.23 $4.20 $4.19 $4.28 J3465 Injection, voriconazole 10mg $1.78 $1.83 $2.31 $2.05 J3475 Inj magnesium sulfate 500mg $0.55 $0.64 $0.68 $0.85 J3480 Inj potassium chloride 2meq $0.14 $0.18 $0.18 $0.14 J3485 Zidovudine 10mg $1.51 $1.51 $1.51 $1.51 J3486 Ziprasidone mesylate 10mg $10.10 $17.89 $18.45 $17.71 J3489 Zoledronic acid 1mg $12.74 $10.55 $11.60 $12.47 J7030 Normal saline solution infus 1000cc $2.52 $2.50 $2.48 $2.41 J7040 Normal saline solution infus 500ML $1.26 $1.25 $1.24 $1.21 J7042 5% dextrose/normal saline 500ML $1.00 $0.95 $0.97 $0.91 J7050 Normal saline solution infus 250cc $0.63 $0.62 $0.62 $0.60 J7060 5% dextrose/water 500ML $2.48 $2.17 $1.96 $1.84 J7070 D5w infusion 1000cc $4.56 $4.23 $3.89 $3.62 J7120 Ringers lactate infusion 1000cc $2.45 $2.43 $2.37 $2.32 J7189 Factor viia recombinant 1mcg $2.08 $2.07 $2.13 $2.15 J7190 Factor viii 1I.U. $1.08 $1.04 $1.14 $1.07 J7192 Factor viii recombinant 1I.U. $1.30 $1.28 $1.28 $1.25 J7193 Factor IX non-recombinant 1I.U. $1.14 $1.14 $1.12 $1.15 J7194 Factor ix complex 1I.U. $1.43 $1.44 $1.43 $1.47 J7195 Factor IX recombinant 1I.U. $1.50 $1.50 $1.51 $1.50 J7197 Antithrombin iii injection 1I.U. $3.50 $3.40 $3.41 $3.32 J7198 Anti-inhibitor 1I.U. $2.00 $1.92 $1.93 $1.90 J7308 Aminolevulinic acid hcl top 354mg $404.59 $396.08 $401.38 $390.98 J7321 Hyalgan or Supartz, inj PER DOSE $79.91 $83.64 $74.85 $81.57 J7323 Euflexxa, inj PER DOSE $141.02 $145.29 $143.29 $145.08 J7324 Orthovisc, inj PER DOSE $146.91 $146.91 $146.91 $143.40 J7325 Synvisc and Synvisc-One 1mg $11.86 $11.32 $11.39 $11.41 J7500 Azathioprine oral 50mg 50mg $0.89 $0.93 $0.93 $0.66 J7502 Cyclosporine oral 100 mg 100mg $2.45 $2.34 $2.18 $2.34 J7504 Lymphocyte immune globulin 250mg $2,066.12 $2,071.80 $2,072.23 $2,066.02 J7507 Tacrolimus oral per 1 MG 1mg $0.58 $0.48 $0.47 $0.39 J7509 Methylprednisolone oral 4mg $0.40 $0.80 $0.24 $36.00 J7511 Antithymocyte globuln rabbit 25mg $731.32 $739.75 $761.12 $768.55 J7515 Cyclosporine oral 25 mg 25mg $0.72 $0.68 $0.67 $0.70 J7516 Cyclosporin parenteral 250mg 250mg $48.89 $56.69 $53.25 $49.25 J7517 Mycophenolate mofetil oral 250mg $1.03 $0.72 $0.63 $0.54 J7520 Sirolimus, oral 1mg $7.23 $7.08 $6.96 $5.95 J7525 Tacrolimus injection 5mg $206.01 $206.00 $211.78 $211.84 J7608 Acetylcysteine inh sol u d 1gm $5.07 $6.31 $5.97 $5.81 J7626 Budesonide inhalation sol 0.25-0.50mg $2.24 $2.35 $2.25 $2.16 J7631 Cromolyn sodium inh sol u d 10mg $5.58 $5.75 $5.31 $4.75 J7639 Dornase alpha inhal sol u d 1mg $47.79 $47.79 $47.78 $47.79 J7644 Ipratropium brom inh sol u d 1mg $0.21 $0.20 $0.20 $0.20 J7682 Tobramycin inhalation sol 300mg $39.67 $35.01 $43.98 $36.79 J8510 Oral busulfan 2mg $24.13 $24.17 $24.28 $24.18 J8520 Capecitabine, oral, 150 mg 150mg $1.15 $1.42 $1.21 $1.62 J8521 Capecitabine, oral, 500 mg 500mg $3.67 $3.70 $3.64 $3.48 J8530 Cyclophosphamide oral 25 MG 25mg $4.54 $3.91 $3.92 $3.31 J8560 Etoposide oral 50 MG 50mg $75.76 $75.86 $74.61 $75.36 J8610 Methotrexate oral 2.5 MG 2.5mg $0.38 $0.27 $0.15 $0.24 J8700 Temozolomide 5mg $0.87 $0.75 $0.76 $0.73 J9000 Doxorubic hcl 10 MG vl chemo 10mg $3.06 $3.10 $2.89 $3.73 J9017 Arsenic trioxide 1mg $46.91 $63.01 $51.23 $44.31

J9031 Bcg live intravesical vac per installation $140.00 $141.98 $140.00 $140.00 J9034 Bendeka inj 1mg $140.28 $23.98 $23.80 $22.85 J9040 Bleomycin sulfate injection 15units $28.77 $24.69 $27.64 $26.66 J9045 Carboplatin injection 50mg $3.25 $3.09 $2.89 $2.89 J9050 Carmus bischl nitro inj 200mg $4,052.35 $3,883.22 $3,534.85 $3,039.01 J9060 Cisplatin 10 MG injection 10mg $1.85 $1.96 $1.89 $1.88 J9065 Inj cladribine per 1 MG 1mg $21.88 $22.17 $19.73 $19.00 J9070 Cyclophosphamide 500 MG inj 100mg $37.82 $37.45 $34.73 $34.14 J9100 Cytarabine hcl 100 MG inj 100mg $0.77 $0.63 $0.58 $0.55 J9120 Dactinomycin actinomycin d 0.5mg $1,455.38 $1,253.86 $1,094.18 $1,098.20 J9145 Daratumumab inj 10mg $52.30 $52.29 $53.75 53.9*5 J9150 Daunorubicin 10mg $48.17 $47.23 $47.14 $46.74 J9171 Docetaxel injection 1mg $1.34 $1.15 $0.85 $0.86 J9176 Elotozumab inj 1mg $6.40 $6.40 $6.49 $6.50 J9178 Inj, epirubicin hcl, 2 mg 2mg $1.19 $1.07 $0.92 $0.95 J9181 Etoposide 10 MG inj 10mg $0.70 $0.74 $0.62 $0.59 J9185 Fludarabine phosphate inj 50mg $79.51 $69.40 $59.72 $56.58 J9190 Fluorouracil injection 500mg $1.79 $1.60 $1.84 $1.55 J9200 Floxuridine injection 500mg $75.59 $75.39 $74.83 $82.68 J9201 Gemcitabine HCl 200mg $5.93 $5.19 $4.46 $5.00 J9202 Goserelin acetate implant 3.6mg $501.20 $488.28 $500.25 $497.72 J9205 Irinotecan liposome inj 1mg $45.65 $45.74 $49.79 $49.91 J9206 Irinotecan injection 20mg $2.86 $2.83 $2.74 $2.47 J9208 Ifosfomide injection 1gm $25.45 $217.10 $25.69 $26.44 J9209 Mesna injection 200mg $2.10 $1.83 $1.47 $1.61 J9211 Idarubicin hcl injection 5mg $32.80 $35.94 $32.54 $32.72 J9214 Interferon alfa-2b inj 1millionunits $34.03 $33.58 $33.99 $34.24 J9217 Leuprolide acetate suspnsion 7.5mg $236.15 $224.29 $229.52 $224.70 J9218 Leuprolide acetate injection 1mg $20.49 $14.09 $53.97 $16.60 J9230 Mechlorethamine hcl inj 10mg $320.09 $321.72 $320.09 $320.09 J9245 Inj melphalan hydrochl 50 MG 50mg $804.63 $697.41 $636.13 $610.87 J9250 Methotrexate sodium inj 5mg $0.25 $0.26 $0.24 $0.25 J9260 Methotrexate sodium inj 50mg $2.52 $2.64 $2.40 $2.49 J9263 Oxaliplatin 0.5mg $0.19 $0.16 $0.13 $0.15 J9268 Pentostatin injection 10mg $2,017.33 $1,984.76 $2,020.30 $1,968.61 J9280 Mitomycin 5 MG inj 5mg $125.07 $115.91 $100.38 $87.75 J9293 Mitoxantrone hydrochl / 5 MG 5mg $27.58 $32.79 $27.27 $27.38 J9295 Necitumumab inj 1mg $5.61 $5.63 $5.74 $5.74 J9311 Inj, rixtuximab, hyaluronidase 10mg $46.64 $45.28 $44.32 $43.53 J9312 Inj., rixtuximab, 10mg 10mg $95.40 $95.20 $94.97 $94.67 J9320 Streptozocin injection 1gm $346.38 $344.85 $344.84 $349.70 J9325 talimogene loherparepvec 1million pfu $50.05 $49.90 $51.10 $51.47 J9352 Trabectedin inj 0.1mg $300.63 $300.65 $310.84 $312.91 J9355 Trastuzumab 10mg $107.00 $107.02 $106.97 $106.62 J9360 Vinblastine sulfate inj 1mg $3.69 $3.58 $3.09 $3.80 J9370 Vincristine sulfate 1 MG inj 1mg $4.95 $5.00 $4.79 $4.81 J9390 Vinorelbine tartrate/10 mg 20mg $8.27 $9.45 $8.84 $11.66 J9395 Injection, Fulvestrant 25mg $97.49 $97.54 $98.78 $94.87 Q0167 Dronabinol 2.5mg oral 2.5mg $1.17 $0.87 $0.75 $0.62 Q5103 Infliximab biosimiolar inj, inflectra 10mg $57.28 $54.34 $51.32 $49.25 Q5104 Injection, renflexis 10mg $61.90 $59.27 $54.65 $53.39 This information is from the CMS website dated September 04, 2019.