|
|
|
3rd Qrt |
2nd Qrt |
1st Qrt |
|
J-Code |
Description |
08 fee |
08 fee |
08 fee |
|
J7042 |
5% dextrose/normal saline |
0.302 |
0.28 |
0.451 |
|
J9264 |
Abraxane 1mg |
8.795 |
8.85 |
8.876 |
|
J9000 |
Adriamycin 10mg |
4.88 |
4.75 |
6.833 |
|
J9010 |
Alemtuzmab Inj 10mg (Campath) |
550.957 |
551.07 |
554.52 |
|
J9305 |
Alimta 10mg |
47.111 |
46.20 |
46.079 |
|
J2469 |
Aloxi .25 mcg |
16.427 |
17.22 |
16.635 |
|
J0207 |
Amifostine (Ethyol) per 500mg |
511.316 |
511.22 |
496.281 |
|
J0287 |
Amphotericin b lipid complex |
10.661 |
10.46 |
10.374 |
|
J1260 |
Anzemet 10mg |
4.793 |
4.19 |
4.798 |
|
J0881 |
Aranesp 1 mcg |
2.825 |
2.77 |
2.892 |
|
J2430 |
Aredia 30 mg (pamidronate) |
38.213 |
28.33 |
29.632 |
|
J9017 |
Arsenic trioxide |
34.43 |
34.48 |
33.985 |
|
J9020 |
Asparaginase injection |
58.056 |
57.02 |
54.781 |
|
J0460 |
Atropine sulfate injection |
0.253 |
0.33 |
0.599 |
|
J9035 |
Avastin 10 mg |
57.396 |
57.44 |
57.46 |
|
J9031 |
Bcg live intravesical vac |
113.076 |
113.75 |
117.342 |
|
J9040 |
Bleomycin Sulfate Inj 15 u |
31.517 |
29.02 |
35.875 |
|
J0610 |
Calcium gluconate injection |
0.299 |
0.36 |
0.628 |
|
J9045 |
Carboplatin 50mg |
5.231 |
6.31 |
7.052 |
|
J2997 |
Cathflo Activase, 1 mg |
32.798 |
32.18 |
34.372 |
|
J0696 |
Ceftriaxone sodium injection |
1.483 |
1.48 |
1.247 |
|
J9050 |
Cetuximab |
164.364 |
156.83 |
49.786 |
|
J9060 |
Cisplatin 10mg |
2.185 |
2.27 |
2.549 |
|
J9065 |
Cladribine 1mg |
29.667 |
30.63 |
33.663 |
|
J9070 |
Cytoxan 100 mg |
1.813 |
1.87 |
1.889 |
|
J9090 |
Cytoxan 500mg |
9.064 |
9.36 |
17.063 |
|
J7070 |
D5W infusion |
2.231 |
2.18 |
2.918 |
|
J9130 |
Dacarbazine 100 (DTIC) |
4.173 |
4.60 |
5.577 |
|
J9140 |
Dacarbazine 200 MG inj |
8.174 |
9.21 |
11.155 |
|
J1100 |
Dexamethasone sodium phos 1mg |
0.083 |
0.08 |
0.112 |
|
J1190 |
Dexrazoxane HCl injection 250mg |
352.343 |
180.94 |
163.844 |
|
J1200 |
Diphenhydramine hcl injectio |
0.677 |
0.75 |
0.798 |
|
J9001 |
Doxil, 10mg |
425.256 |
413.49 |
412.245 |
|
J9217 |
Eligard 7.5 (Lupron) |
208.139 |
220.86 |
242.787 |
|
J9178 |
Epirubicin (Ellence) 2mg |
7.972 |
6.24 |
11.451 |
|
J0885 |
Epo 1,000 |
9.071 |
9.07 |
8.96 |
|
J9055 |
Erbitux 10mg |
49.783 |
49.81 |
153.785 |
|
J9182 |
Etoposide 100mg |
4.43 |
4.03 |
4.157 |
|
J9395 |
Faslodex 25 mg |
81.324 |
81.36 |
81.369 |
|
J9185 |
Fludarabine 50mg |
171.433 |
200.75 |
237.514 |
|
J9190 |
Fluorouracil 500mg |
1.728 |
1.87 |
1.806 |
|
J1940 |
Furosemide injection 20mg |
0.197 |
0.19 |
0.25 |
|
J9201 |
Gemzar 200mg |
134.932 |
131.78 |
131.651 |
|
J1642 |
Heparin 10 u |
0.048 |
0.04 |
0.372 |
|
J1644 |
Heparin 1000 u |
0.086 |
0.07 |
0.218 |
|
J9355 |
Herceptin 10mg |
60.145 |
60.08 |
59.018 |
|
J1720 |
Hydrocortisone sodium succ i |
2.312 |
2.23 |
2.13 |
|
J1740 |
Ibandronate sodium, inj |
139.023 |
138.97 |
139.04 |
|
J9208 |
Ifosfamide (Ifex) 1g |
34.759 |
37.92 |
35.554 |
|
J1566 |
Immune Globulin 500mg Powder |
28.634 |
28.07 |
27.665 |
|
J0713 |
Inj ceftazidime per 500 mg |
3.856 |
3.47 |
3.608 |
|
J1650 |
Inj enoxaparin sodium 10mg |
6.145 |
5.9 |
5.807 |
|
J1815 |
Insulin injection 5 units |
0.294 |
0.28 |
0.276 |
|
J9214 |
Interferon 1 mil |
14.564 |
