Procedure Code	Procedure Description	Pricing Indicator	Rate Type	Mod1	Mod2	Mod3	Mod4	Max Fee	Max Fee Eff. Date	Max Fee End Date	PA
0001A	ADM SARSCOV2 30MCG/0.3ML 1ST	PRXOVR	DEF					NA	NA	NA	N
0001A	ADM SARSCOV2 30MCG/0.3ML 1ST	MAXFEE	DEF					37.66	1/1/2022	12/31/2299	N
0002A	ADM SARSCOV2 30MCG/0.3ML 2ND	PRXOVR	DEF					NA	NA	NA	N
0002A	ADM SARSCOV2 30MCG/0.3ML 2ND	MAXFEE	DEF					37.66	1/1/2022	12/31/2299	N
0003A	ADM SARSCOV2 30MCG/0.3ML 3RD	PRXOVR	DEF					NA	NA	NA	N
0003A	ADM SARSCOV2 30MCG/0.3ML 3RD	MAXFEE	DEF					37.66	1/1/2022	12/31/2299	N
0004A	ADM SARSCOV2 30MCG/0.3ML BST	PRXOVR	DEF					NA	NA	NA	N
0004A	ADM SARSCOV2 30MCG/0.3ML BST	MAXFEE	DEF					37.66	1/1/2022	12/31/2299	N
0011A	ADM SARSCOV2 100MCG/0.5ML1ST	PRXOVR	DEF					NA	NA	NA	N
0011A	ADM SARSCOV2 100MCG/0.5ML1ST	MAXFEE	DEF					37.66	1/1/2022	12/31/2299	N
0012A	ADM SARSCOV2 100MCG/0.5ML2ND	PRXOVR	DEF					NA	NA	NA	N
0012A	ADM SARSCOV2 100MCG/0.5ML2ND	MAXFEE	DEF					37.66	1/1/2022	12/31/2299	N
0013A	ADM SARSCOV2 100MCG/0.5ML3RD	PRXOVR	DEF					NA	NA	NA	N
0013A	ADM SARSCOV2 100MCG/0.5ML3RD	MAXFEE	DEF					37.66	1/1/2022	12/31/2299	N
0041A	ADM SARSCOV2 5MCG/0.5ML 1ST	PRXOVR	DEF					NA	NA	NA	N
0041A	ADM SARSCOV2 5MCG/0.5ML 1ST	MAXFEE	DEF					39.94	7/1/2023	12/31/2299	N
0042A	ADM SARSCOV2 5MCG/0.5ML 2ND	PRXOVR	DEF					NA	NA	NA	N
0042A	ADM SARSCOV2 5MCG/0.5ML 2ND	MAXFEE	DEF					39.94	7/1/2023	12/31/2299	N
0044A	ADM SARSCOV2 5MCG/0.5ML BST	PRXOVR	DEF					NA	NA	NA	N
0044A	ADM SARSCOV2 5MCG/0.5ML BST	MAXFEE	DEF					39.94	7/1/2023	12/31/2299	N
0051A	ADM SARSCV2 30MCG TRS-SUCR 1	PRXOVR	DEF					NA	NA	NA	N
0051A	ADM SARSCV2 30MCG TRS-SUCR 1	MAXFEE	DEF					37.66	1/3/2022	12/31/2299	N
0052A	ADM SARSCV2 30MCG TRS-SUCR 2	PRXOVR	DEF					NA	NA	NA	N
0052A	ADM SARSCV2 30MCG TRS-SUCR 2	MAXFEE	DEF					37.66	1/3/2022	12/31/2299	N
0053A	ADM SARSCV2 30MCG TRS-SUCR 3	PRXOVR	DEF					NA	NA	NA	N
0053A	ADM SARSCV2 30MCG TRS-SUCR 3	MAXFEE	DEF					37.66	1/3/2022	12/31/2299	N
0054A	ADM SARSCV2 30MCG TRS-SUCR B	PRXOVR	DEF					NA	NA	NA	N
0054A	ADM SARSCV2 30MCG TRS-SUCR B	MAXFEE	DEF					37.66	1/3/2022	12/31/2299	N
0064A	ADM SARSCOV2 50MCG/0.25MLBST	PRXOVR	DEF					NA	NA	NA	N
0064A	ADM SARSCOV2 50MCG/0.25MLBST	MAXFEE	DEF					37.66	1/1/2022	12/31/2299	N
0071A	ADM SARSCV2 10MCG TRS-SUCR 1	PRXOVR	DEF					NA	NA	NA	N
0071A	ADM SARSCV2 10MCG TRS-SUCR 1	MAXFEE	DEF					37.66	1/1/2022	12/31/2299	N
0072A	ADM SARSCV2 10MCG TRS-SUCR 2	PRXOVR	DEF					NA	NA	NA	N
0072A	ADM SARSCV2 10MCG TRS-SUCR 2	MAXFEE	DEF					37.66	1/1/2022	12/31/2299	N
0073A	ADM SARSCV2 10MCG TRS-SUCR 3	PRXOVR	DEF					NA	NA	NA	N
0073A	ADM SARSCV2 10MCG TRS-SUCR 3	MAXFEE	DEF					37.66	1/3/2022	12/31/2299	N
0074A	ADM SARSCV2 10MCG TRS-SUCR B	PRXOVR	DEF					NA	NA	NA	N
0074A	ADM SARSCV2 10MCG TRS-SUCR B	MAXFEE	DEF					37.66	5/17/2022	12/31/2299	N
0081A	ADM SARSCV2 3MCG TRS-SUCR 1	PRXOVR	DEF					NA	NA	NA	N
0081A	ADM SARSCV2 3MCG TRS-SUCR 1	MAXFEE	DEF					37.66	6/17/2022	12/31/2299	N
0082A	ADM SARSCV2 3MCG TRS-SUCR 2	PRXOVR	DEF					NA	NA	NA	N
0082A	ADM SARSCV2 3MCG TRS-SUCR 2	MAXFEE	DEF					37.66	6/17/2022	12/31/2299	N
0083A	ADM SARSCV2 3MCG TRS-SUCR 3	PRXOVR	DEF					NA	NA	NA	N
0083A	ADM SARSCV2 3MCG TRS-SUCR 3	MAXFEE	DEF					37.66	6/17/2022	12/31/2299	N
0091A	ADM SARSCOV2 50 MCG/.5 ML1ST	PRXOVR	DEF					NA	NA	NA	N
0091A	ADM SARSCOV2 50 MCG/.5 ML1ST	MAXFEE	DEF					37.66	6/17/2022	12/31/2299	N
0092A	ADM SARSCOV2 50 MCG/.5 ML2ND	PRXOVR	DEF					NA	NA	NA	N
0092A	ADM SARSCOV2 50 MCG/.5 ML2ND	MAXFEE	DEF					37.66	6/17/2022	12/31/2299	N
0093A	ADM SARSCOV2 50 MCG/.5 ML3RD	PRXOVR	DEF					NA	NA	NA	N
0093A	ADM SARSCOV2 50 MCG/.5 ML3RD	MAXFEE	DEF					37.66	6/17/2022	12/31/2299	N
0094A	ADM SARSCOV2 50 MCG/.5 MLBST	PRXOVR	DEF					NA	NA	NA	N
0094A	ADM SARSCOV2 50 MCG/.5 MLBST	MAXFEE	DEF					37.66	3/29/2022	12/31/2299	N
0111A	ADM SARSCOV2 25MCG/0.25ML1ST	PRXOVR	DEF					NA	NA	NA	N
0111A	ADM SARSCOV2 25MCG/0.25ML1ST	MAXFEE	DEF					37.66	6/17/2022	12/31/2299	N
0112A	ADM SARSCOV2 25MCG/0.25ML2ND	PRXOVR	DEF					NA	NA	NA	N
0112A	ADM SARSCOV2 25MCG/0.25ML2ND	MAXFEE	DEF					37.66	6/17/2022	12/31/2299	N
0113A	ADM SARSCOV2 25MCG/0.25ML3RD	PRXOVR	DEF					NA	NA	NA	N
0113A	ADM SARSCOV2 25MCG/0.25ML3RD	MAXFEE	DEF					37.66	8/31/2022	12/31/2299	N
0121A	ADM SARSCV2 BVL 30MCG/.3ML 1	PRXOVR	DEF					NA	NA	NA	N
0121A	ADM SARSCV2 BVL 30MCG/.3ML 1	MAXFEE	DEF					39.94	4/18/2023	12/31/2299	N
0124A	ADM SARSCV2 BVL 30MCG/.3ML A	PRXOVR	DEF					NA	NA	NA	N
0124A	ADM SARSCV2 BVL 30MCG/.3ML A	MAXFEE	DEF					39.94	7/1/2023	12/31/2299	N
0134A	ADM SARSCV2 BVL 50MCG/.5ML A	PRXOVR	DEF					NA	NA	NA	N
0134A	ADM SARSCV2 BVL 50MCG/.5ML A	MAXFEE	DEF					39.94	7/1/2023	12/31/2299	N
0141A	ADM SRSCV2 BVL 25MCG/.25ML 1	PRXOVR	DEF					NA	NA	NA	N
0141A	ADM SRSCV2 BVL 25MCG/.25ML 1	MAXFEE	DEF					39.94	4/18/2023	12/31/2299	N
0142A	ADM SRSCV2 BVL 25MCG/.25ML 2	PRXOVR	DEF					NA	NA	NA	N
0142A	ADM SRSCV2 BVL 25MCG/.25ML 2	MAXFEE	DEF					39.94	4/18/2023	12/31/2299	N
0144A	ADM SRSCV2 BVL 25MCG/.25ML A	PRXOVR	DEF					NA	NA	NA	N
0144A	ADM SRSCV2 BVL 25MCG/.25ML A	MAXFEE	DEF					39.94	7/1/2023	12/31/2299	N
0151A	ADM SARSCV2 BVL 10MCG/.2ML 1	PRXOVR	DEF					NA	NA	NA	N
0151A	ADM SARSCV2 BVL 10MCG/.2ML 1	MAXFEE	DEF					39.94	4/18/2023	12/31/2299	N
0154A	ADM SARSCV2 BVL 10MCG/.2ML A	PRXOVR	DEF					NA	NA	NA	N
0154A	ADM SARSCV2 BVL 10MCG/.2ML A	MAXFEE	DEF					39.94	7/1/2023	12/31/2299	N
0164A	ADM SRSCV2 BVL 10MCG/0.2ML A	PRXOVR	DEF					NA	NA	NA	N
0164A	ADM SRSCV2 BVL 10MCG/0.2ML A	MAXFEE	DEF					39.94	7/1/2023	12/31/2299	N
0171A	ADM SARSCV2 BVL 3MCG/0.2ML 1	PRXOVR	DEF					NA	NA	NA	N
0171A	ADM SARSCV2 BVL 3MCG/0.2ML 1	MAXFEE	DEF					39.94	4/18/2023	12/31/2299	N
0172A	ADM SARSCV2 BVL 3MCG/0.2ML 2	PRXOVR	DEF					NA	NA	NA	N
0172A	ADM SARSCV2 BVL 3MCG/0.2ML 2	MAXFEE	DEF					39.94	4/18/2023	12/31/2299	N
0173A	ADM SARSCV2 BVL 3MCG/0.2ML 3	PRXOVR	DEF					NA	NA	NA	N
0173A	ADM SARSCV2 BVL 3MCG/0.2ML 3	MAXFEE	DEF					39.94	7/1/2023	12/31/2299	N
0174A	ADM SARSCV2 BVL 3MCG/0.2ML A	PRXOVR	DEF					NA	NA	NA	N
0174A	ADM SARSCV2 BVL 3MCG/0.2ML A	MAXFEE	DEF					39.94	7/1/2023	12/31/2299	N
90281	HUMAN IG IM	PRXOVR	DEF					NA	NA	NA	N
90281	HUMAN IG IM	MAXFEE	DEF					26.37	9/1/2013	12/31/2299	N
90284	HUMAN IG SC	PRXOVR	DEF					NA	NA	NA	N
90284	HUMAN IG SC	MAXFEE	DEF					28.07	9/1/2013	12/31/2299	N
90287	BOTULINUM ANTITOXIN	PRXOVR	DEF					NA	NA	NA	N
90287	BOTULINUM ANTITOXIN	MAXFEE	DEF					40.99	7/1/2003	12/31/2299	N
90291	CMV IG IV	PRXOVR	DEF					NA	NA	NA	N
90291	CMV IG IV	MAXFEE	DEF					24.90	9/1/2013	12/31/2299	N
90296	DIPHTHERIA ANTITOXIN	PRXOVR	DEF					NA	NA	NA	N
90296	DIPHTHERIA ANTITOXIN	MANUAL	DEF					NA	NA	NA	N
90371	HEP B IG IM	PRXOVR	DEF					NA	NA	NA	N
90371	HEP B IG IM	MAXFEE	DEF					136.74	7/1/2023	12/31/2299	N
90375	RABIES IG IM/SC	PRXOVR	DEF					NA	NA	NA	N
90375	RABIES IG IM/SC	MAXFEE	DEF					284.68	7/1/2023	12/31/2299	N
90376	RABIES IG HEAT TREATED	PRXOVR	DEF					NA	NA	NA	N
90376	RABIES IG HEAT TREATED	MAXFEE	DEF					250.09	7/1/2023	12/31/2299	N
90377	RABIES IG HT&SOL HUMAN IM/SC	PRXOVR	DEF					NA	NA	NA	N
90377	RABIES IG HT&SOL HUMAN IM/SC	MAXFEE	DEF					234.09	7/1/2023	12/31/2299	N
90378	RSV MAB IM 50MG	PRXOVR	DEF					NA	NA	NA	N
90378	RSV MAB IM 50MG	MAXFEE	DEF					1359.81	9/1/2013	12/31/2299	N
90384	RH IG FULL-DOSE IM	PRXOVR	DEF					NA	NA	NA	N
90384	RH IG FULL-DOSE IM	MAXFEE	DEF					112.13	9/1/2013	12/31/2299	N
90385	RH IG MINIDOSE IM	PRXOVR	DEF					NA	NA	NA	N
90385	RH IG MINIDOSE IM	MAXFEE	DEF					34.66	8/1/2014	12/31/2299	N
90389	TETANUS IG IM	PRXOVR	DEF					NA	NA	NA	N
90389	TETANUS IG IM	MAXFEE	DEF					367.31	9/1/2013	12/31/2299	N
90393	VACCINA IG IM	PRXOVR	DEF					NA	NA	NA	N
90393	VACCINA IG IM	MANUAL	DEF					NA	NA	NA	N
90396	VARICELLA-ZOSTER IG IM	PRXOVR	DEF					NA	NA	NA	N
90396	VARICELLA-ZOSTER IG IM	MAXFEE	DEF					695.50	9/1/2013	12/31/2299	N
90460	IM ADMIN 1ST/ONLY COMPONENT	PRXOVR	DEF					NA	NA	NA	N
90460	IM ADMIN 1ST/ONLY COMPONENT	MAXFEE	DEF					15	1/1/2016	12/31/2299	N
90471	IMMUNIZATION ADMIN	MAXFLT	DEF					NA	NA	NA	N
90471	IMMUNIZATION ADMIN	PRXOVR	DEF					NA	NA	NA	N
90472	IMMUNIZATION ADMIN EACH ADD	PRXOVR	DEF					NA	NA	NA	N
90472	IMMUNIZATION ADMIN EACH ADD	MAXFEE	DEF					9.85	1/1/2022	12/31/2299	N
90473	IMMUNE ADMIN ORAL/NASAL	MAXFLT	DEF					NA	NA	NA	N
90473	IMMUNE ADMIN ORAL/NASAL	PRXOVR	DEF					NA	NA	NA	N
90474	IMMUNE ADMIN ORAL/NASAL ADDL	PRXOVR	DEF					NA	NA	NA	N
90474	IMMUNE ADMIN ORAL/NASAL ADDL	MAXFEE	DEF					9.85	1/1/2022	12/31/2299	N
90584	DENGUE VACC QUAD 2 DOSE SUBQ	PRXOVR	DEF					NA	NA	NA	N
90584	DENGUE VACC QUAD 2 DOSE SUBQ	MAXFEE	VFC					0	7/1/2022	12/31/2299	N
90585	BCG VACCINE PERCUT	PRXOVR	DEF					NA	NA	NA	N
90585	BCG VACCINE PERCUT	MAXFEE	VFC					NA			N
90585	BCG VACCINE PERCUT	MAXFEE	DEF					141.25	1/1/2020	12/31/2299	N
90586	BCG VACCINE INTRAVESICAL	PRXOVR	DEF					NA	NA	NA	N
90586	BCG VACCINE INTRAVESICAL	MAXFEE	VFC					NA			N
90586	BCG VACCINE INTRAVESICAL	MAXFEE	DEF					144.71	7/1/2023	12/31/2299	N
90611	SMALLPOX&MONKEYPOX VAC 0.5ML	PRXOVR	DEF					NA	NA	NA	N
90611	SMALLPOX&MONKEYPOX VAC 0.5ML	MAXFEE	DEF					0.01	7/26/2022	12/31/2299	N
90619	MENACWY-TT VACCINE IM	PRXOVR	DEF					NA	NA	NA	N
90619	MENACWY-TT VACCINE IM	MAXFEE	VFC					0	10/1/2021	12/31/2299	N
90619	MENACWY-TT VACCINE IM	MAXFEE	DEF					150.53	10/1/2021	12/31/2299	N
90620	MENB-4C VACC 2 DOSE IM	PRXOVR	DEF					NA	NA	NA	N
90620	MENB-4C VACC 2 DOSE IM	MAXFEE	VFC					0	1/1/2016	12/31/2299	N
90620	MENB-4C VACC 2 DOSE IM	MAXFEE	DEF					171.20	8/1/2015	12/31/2299	N
90621	MENB-FHBP VACC 2/3 DOSE IM	PRXOVR	DEF					NA	NA	NA	N
90621	MENB-FHBP VACC 2/3 DOSE IM	MAXFEE	VFC					0	1/1/2016	12/31/2299	N
90621	MENB-FHBP VACC 2/3 DOSE IM	MAXFEE	DEF					123.05	8/1/2015	12/31/2299	N
90622	VACCINIA VRS VAC 0.3 ML PERQ	PRXOVR	DEF					NA	NA	NA	N
90622	VACCINIA VRS VAC 0.3 ML PERQ	MAXFEE	DEF					0.01	7/26/2022	12/31/2299	N
90626	TIC-BRN ENCEPH VAC 0.25ML IM	PRXOVR	DEF					NA	NA	NA	N
90626	TIC-BRN ENCEPH VAC 0.25ML IM	MANUAL	DEF					NA	NA	NA	N
90627	TIC-BRN ENCEPH VAC 0.5ML IM	PRXOVR	DEF					NA	NA	NA	N
90627	TIC-BRN ENCEPH VAC 0.5ML IM	MANUAL	DEF					NA	NA	NA	N
90630	FLU VACC IIV4 NO PRESERV ID	PRXOVR	DEF					NA	NA	NA	N
90630	FLU VACC IIV4 NO PRESERV ID	MAXFEE	VFC					NA			N
90630	FLU VACC IIV4 NO PRESERV ID	MAXFEE	DEF					20.34	10/1/2016	12/31/2299	N
90632	HEPA VACCINE ADULT IM	PRXOVR	DEF					NA	NA	NA	N
90632	HEPA VACCINE ADULT IM	MAXFEE	VFC					NA			N
90632	HEPA VACCINE ADULT IM	MAXFEE	DEF					71.85	7/1/2023	12/31/2299	N
90633	HEPA VACC PED/ADOL 2 DOSE IM	PRXOVR	DEF					NA	NA	NA	N
90633	HEPA VACC PED/ADOL 2 DOSE IM	MAXFEE	VFC					0	1/1/2016	12/31/2299	N
90633	HEPA VACC PED/ADOL 2 DOSE IM	MAXFEE	DEF					74.60	10/1/2021	12/31/2299	N
90634	HEPA VACC PED/ADOL 3 DOSE	PRXOVR	DEF					NA	NA	NA	N
90634	HEPA VACC PED/ADOL 3 DOSE	MAXFEE	VFC					0	1/1/2016	12/31/2299	N
90634	HEPA VACC PED/ADOL 3 DOSE	MAXFEE	DEF					61.64	9/1/2013	12/31/2299	N
90636	HEP A/HEP B VACC ADULT IM	PRXOVR	DEF					NA	NA	NA	N
90636	HEP A/HEP B VACC ADULT IM	MAXFEE	VFC					NA			N
90636	HEP A/HEP B VACC ADULT IM	MAXFEE	DEF					97.37	9/1/2013	12/31/2299	N
90644	HIB-MENCY VACC 6WK-18M0 IM	PRXOVR	DEF					NA	NA	NA	N
90644	HIB-MENCY VACC 6WK-18M0 IM	MAXFEE	VFC					0	1/1/2016	12/31/2299	N
90644	HIB-MENCY VACC 6WK-18M0 IM	MAXFEE	DEF					NA			N
90647	HIB PRP-OMP VACC 3 DOSE IM	PRXOVR	DEF					NA	NA	NA	N
90647	HIB PRP-OMP VACC 3 DOSE IM	MAXFEE	VFC					0	1/1/2016	12/31/2299	N
90647	HIB PRP-OMP VACC 3 DOSE IM	MAXFEE	DEF					30.01	10/1/2022	12/31/2299	N
90648	HIB PRP-T VACCINE 4 DOSE IM	PRXOVR	DEF					NA	NA	NA	N
90648	HIB PRP-T VACCINE 4 DOSE IM	MAXFEE	VFC					0	1/1/2016	12/31/2299	N
90648	HIB PRP-T VACCINE 4 DOSE IM	MAXFEE	DEF					28.11	2/1/2015	12/31/2299	N
90649	4VHPV VACCINE 3 DOSE IM	PRXOVR	DEF					NA	NA	NA	N
90649	4VHPV VACCINE 3 DOSE IM	MAXFEE	VFC					0	1/1/2016	12/31/2299	N
90649	4VHPV VACCINE 3 DOSE IM	MAXFEE	DEF					144.43	9/1/2013	12/31/2299	N
90650	2VHPV VACCINE 3 DOSE IM	PRXOVR	DEF					NA	NA	NA	N
90650	2VHPV VACCINE 3 DOSE IM	MAXFEE	VFC					0	1/1/2016	12/31/2299	N
90650	2VHPV VACCINE 3 DOSE IM	MAXFEE	DEF					136.96	9/1/2013	12/31/2299	N
90651	9VHPV VACCINE 2/3 DOSE IM	PRXOVR	DEF					NA	NA	NA	N
90651	9VHPV VACCINE 2/3 DOSE IM	MAXFEE	VFC					0	1/1/2016	12/31/2299	N
90651	9VHPV VACCINE 2/3 DOSE IM	MAXFEE	DEF					286.78	10/1/2022	12/31/2299	N
90653	IIV ADJUVANT VACCINE IM	PRXOVR	DEF					NA	NA	NA	N
90653	IIV ADJUVANT VACCINE IM	MAXFEE	VFC					0	10/1/2016	12/31/2299	N
90653	IIV ADJUVANT VACCINE IM	MAXFEE	DEF					59.53	11/1/2019	12/31/2299	N
90654	FLU VACC IIV3 NO PRESERV ID	PRXOVR	DEF					NA	NA	NA	N
90654	FLU VACC IIV3 NO PRESERV ID	MAXFEE	VFC					NA			N
90654	FLU VACC IIV3 NO PRESERV ID	MAXFEE	DEF					18.92	11/1/2013	12/31/2299	N
90655	IIV3 VACC NO PRSV 0.25 ML IM	PRXOVR	DEF					NA	NA	NA	N
90655	IIV3 VACC NO PRSV 0.25 ML IM	MAXFEE	VFC					0	1/1/2016	12/31/2299	N
90655	IIV3 VACC NO PRSV 0.25 ML IM	MAXFEE	DEF					NA			N
90656	IIV3 VACC NO PRSV 0.5 ML IM	PRXOVR	DEF					NA	NA	NA	N
90656	IIV3 VACC NO PRSV 0.5 ML IM	MAXFEE	VFC					0	1/1/2016	12/31/2299	N
90656	IIV3 VACC NO PRSV 0.5 ML IM	MAXFEE	DEF					19.77	11/1/2018	12/31/2299	N
90657	IIV3 VACCINE SPLT 0.25 ML IM	PRXOVR	DEF					NA	NA	NA	N
90657	IIV3 VACCINE SPLT 0.25 ML IM	MAXFEE	VFC					0	1/1/2016	12/31/2299	N
90657	IIV3 VACCINE SPLT 0.25 ML IM	MAXFEE	DEF					NA			N
90658	IIV3 VACCINE SPLT 0.5 ML IM	PRXOVR	DEF					NA	NA	NA	N
90658	IIV3 VACCINE SPLT 0.5 ML IM	MAXFEE	VFC					0	1/1/2016	12/31/2299	N
90658	IIV3 VACCINE SPLT 0.5 ML IM	MAXFEE	DEF					10.39	9/1/2013	12/31/2299	N
90660	LAIV3 VACCINE INTRANASAL	PRXOVR	DEF					NA	NA	NA	N
90660	LAIV3 VACCINE INTRANASAL	MAXFEE	VFC					0	1/1/2016	12/31/2299	N
90660	LAIV3 VACCINE INTRANASAL	MAXFEE	DEF					23.46	9/1/2013	12/31/2299	N
90662	IIV NO PRSV INCREASED AG IM	PRXOVR	DEF					NA	NA	NA	N
90662	IIV NO PRSV INCREASED AG IM	MAXFEE	VFC					NA			N
90662	IIV NO PRSV INCREASED AG IM	MAXFEE	DEF					69.94	10/1/2022	12/31/2299	N
90668	IIV VACCINE PANDEMIC IM	PRXOVR	DEF					NA	NA	NA	N
90668	IIV VACCINE PANDEMIC IM	MAXFEE	VFC					0	7/1/2017	12/31/2299	N
90668	IIV VACCINE PANDEMIC IM	MAXFEE	DEF					0	1/1/2011	12/31/2299	N
90670	PCV13 VACCINE IM	PRXOVR	DEF					NA	NA	NA	N
90670	PCV13 VACCINE IM	MAXFEE	VFC					0	1/1/2016	12/31/2299	N
90670	PCV13 VACCINE IM	MAXFEE	DEF					257.99	4/1/2022	12/31/2299	N
90671	PCV15 VACCINE IM	PRXOVR	DEF					NA	NA	NA	N
90671	PCV15 VACCINE IM	MAXFEE	DEF					246.20	1/1/2022	12/31/2299	N
90672	LAIV4 VACCINE INTRANASAL	PRXOVR	DEF					NA	NA	NA	N
90672	LAIV4 VACCINE INTRANASAL	MAXFEE	VFC					0	1/1/2016	12/31/2299	N
90672	LAIV4 VACCINE INTRANASAL	MAXFEE	DEF					26.88	2/1/2016	12/31/2299	N
90673	RIV3 VACCINE NO PRESERV IM	PRXOVR	DEF					NA	NA	NA	N
90673	RIV3 VACCINE NO PRESERV IM	MAXFEE	VFC					NA			N
90673	RIV3 VACCINE NO PRESERV IM	MAXFEE	DEF					40.61	10/1/2016	12/31/2299	N
90674	CCIIV4 VAC NO PRSV 0.5 ML IM	PRXOVR	DEF					NA	NA	NA	N
90674	CCIIV4 VAC NO PRSV 0.5 ML IM	MAXFEE	VFC					0	10/1/2016	12/31/2299	N
90674	CCIIV4 VAC NO PRSV 0.5 ML IM	MAXFEE	DEF					32.28	10/1/2022	12/31/2299	N
90675	RABIES VACCINE IM	PRXOVR	DEF					NA	NA	NA	N
90675	RABIES VACCINE IM	MAXFEE	VFC					NA			N
90675	RABIES VACCINE IM	MAXFEE	DEF					329.99	7/1/2023	12/31/2299	N
90676	RABIES VACCINE ID	PRXOVR	DEF					NA	NA	NA	N
90676	RABIES VACCINE ID	MAXFEE	VFC					NA			N
90676	RABIES VACCINE ID	MAXFEE	DEF					259.13	9/1/2013	12/31/2299	N
90677	PCV20 VACCINE IM	PRXOVR	DEF					NA	NA	NA	N
90677	PCV20 VACCINE IM	MAXFEE	DEF					288.66	4/1/2023	12/31/2299	N
90680	RV5 VACC 3 DOSE LIVE ORAL	PRXOVR	DEF					NA	NA	NA	N
90680	RV5 VACC 3 DOSE LIVE ORAL	MAXFEE	VFC					0	1/1/2016	12/31/2299	N
90680	RV5 VACC 3 DOSE LIVE ORAL	MAXFEE	DEF					NA			N
90681	RV1 VACC 2 DOSE LIVE ORAL	PRXOVR	DEF					NA	NA	NA	N
90681	RV1 VACC 2 DOSE LIVE ORAL	MAXFEE	VFC					0	1/1/2016	12/31/2299	N
90681	RV1 VACC 2 DOSE LIVE ORAL	MAXFEE	DEF					NA			N
90682	RIV4 VACC RECOMBINANT DNA IM	PRXOVR	DEF					NA	NA	NA	N
90682	RIV4 VACC RECOMBINANT DNA IM	MAXFEE	VFC					0	11/1/2017	12/31/2299	N
90682	RIV4 VACC RECOMBINANT DNA IM	MAXFEE	DEF					69.94	10/1/2022	12/31/2299	N
90685	IIV4 VACC NO PRSV 0.25 ML IM	PRXOVR	DEF					NA	NA	NA	N
90685	IIV4 VACC NO PRSV 0.25 ML IM	MAXFEE	VFC					0	1/1/2016	12/31/2299	N
90685	IIV4 VACC NO PRSV 0.25 ML IM	MAXFEE	DEF					21.64	10/1/2021	12/31/2299	N
90686	IIV4 VACC NO PRSV 0.5 ML IM	PRXOVR	DEF					NA	NA	NA	N
90686	IIV4 VACC NO PRSV 0.5 ML IM	MAXFEE	VFC					0	1/1/2016	12/31/2299	N
90686	IIV4 VACC NO PRSV 0.5 ML IM	MAXFEE	DEF					21.52	10/1/2022	12/31/2299	N
90687	IIV4 VACCINE SPLT 0.25 ML IM	PRXOVR	DEF					NA	NA	NA	N
90687	IIV4 VACCINE SPLT 0.25 ML IM	MAXFEE	VFC					0	1/1/2016	12/31/2299	N
90687	IIV4 VACCINE SPLT 0.25 ML IM	MAXFEE	DEF					10.24	10/1/2022	12/31/2299	N
90688	IIV4 VACCINE SPLT 0.5 ML IM	PRXOVR	DEF					NA	NA	NA	N
90688	IIV4 VACCINE SPLT 0.5 ML IM	MAXFEE	VFC					0	1/1/2016	12/31/2299	N
90688	IIV4 VACCINE SPLT 0.5 ML IM	MAXFEE	DEF					20.48	10/1/2022	12/31/2299	N
90694	VACC AIIV4 NO PRSRV 0.5ML IM	PRXOVR	DEF					NA	NA	NA	N
90694	VACC AIIV4 NO PRSRV 0.5ML IM	MAXFEE	VFC					0	1/1/2021	12/31/2299	N
90694	VACC AIIV4 NO PRSRV 0.5ML IM	MAXFEE	DEF					71.68	10/1/2022	12/31/2299	N
90696	DTAP-IPV VACCINE 4-6 YRS IM	PRXOVR	DEF					NA	NA	NA	N
90696	DTAP-IPV VACCINE 4-6 YRS IM	MAXFEE	VFC					0	1/1/2016	12/31/2299	N
90696	DTAP-IPV VACCINE 4-6 YRS IM	MAXFEE	DEF					NA			N
90697	DTAP-IPV-HIB-HEPB VACCINE IM	PRXOVR	DEF					NA	NA	NA	N
90697	DTAP-IPV-HIB-HEPB VACCINE IM	MAXFEE	VFC					0	10/1/2021	12/31/2299	N
90698	DTAP-IPV/HIB VACCINE IM	PRXOVR	DEF					NA	NA	NA	N
90698	DTAP-IPV/HIB VACCINE IM	MAXFEE	VFC					0	1/1/2016	12/31/2299	N
90698	DTAP-IPV/HIB VACCINE IM	MAXFEE	DEF					85.33	11/1/2015	12/31/2299	N
90700	DTAP VACCINE < 7 YRS IM	PRXOVR	DEF					NA	NA	NA	N
90700	DTAP VACCINE < 7 YRS IM	MAXFEE	VFC					0	1/1/2016	12/31/2299	N
90700	DTAP VACCINE < 7 YRS IM	MAXFEE	DEF					NA			N
90702	DT VACCINE UNDER 7 YRS IM	PRXOVR	DEF					NA	NA	NA	N
90702	DT VACCINE UNDER 7 YRS IM	MAXFEE	VFC					0	1/1/2016	12/31/2299	N
90702	DT VACCINE UNDER 7 YRS IM	MAXFEE	DEF					NA			N
90707	MMR VACCINE SC	PRXOVR	DEF					NA	NA	NA	N
90707	MMR VACCINE SC	MAXFEE	VFC					0	1/1/2016	12/31/2299	N
90707	MMR VACCINE SC	MAXFEE	DEF					93.75	10/1/2022	12/31/2299	N
90710	MMRV VACCINE SC	PRXOVR	DEF					NA	NA	NA	N
90710	MMRV VACCINE SC	MAXFEE	VFC					0	1/1/2016	12/31/2299	N
90710	MMRV VACCINE SC	MAXFEE	DEF					277.52	10/1/2022	12/31/2299	N
90713	POLIOVIRUS IPV SC/IM	PRXOVR	DEF					NA	NA	NA	N
90713	POLIOVIRUS IPV SC/IM	MAXFEE	VFC					0	1/1/2016	12/31/2299	N
90713	POLIOVIRUS IPV SC/IM	MAXFEE	DEF					NA			N
90714	TD VACC NO PRESV 7 YRS+ IM	PRXOVR	DEF					NA	NA	NA	N
90714	TD VACC NO PRESV 7 YRS+ IM	MAXFEE	VFC					0	1/1/2016	12/31/2299	N
90714	TD VACC NO PRESV 7 YRS+ IM	MAXFEE	DEF					31.05	7/1/2023	12/31/2299	N
90715	TDAP VACCINE 7 YRS/> IM	PRXOVR	DEF					NA	NA	NA	N
90715	TDAP VACCINE 7 YRS/> IM	MAXFEE	VFC					0	1/1/2016	12/31/2299	N
90715	TDAP VACCINE 7 YRS/> IM	MAXFEE	DEF					38.75	7/1/2023	12/31/2299	N
90716	VAR VACCINE LIVE SUBQ	PRXOVR	DEF					NA	NA	NA	N
90716	VAR VACCINE LIVE SUBQ	MAXFEE	VFC					0	1/1/2016	12/31/2299	N
90716	VAR VACCINE LIVE SUBQ	MAXFEE	DEF					170.39	10/1/2022	12/31/2299	N
90723	DTAP-HEP B-IPV VACCINE IM	PRXOVR	DEF					NA	NA	NA	N
90723	DTAP-HEP B-IPV VACCINE IM	MAXFEE	VFC					0	1/1/2016	12/31/2299	N
90723	DTAP-HEP B-IPV VACCINE IM	MAXFEE	DEF					NA			N
90732	PPSV23 VACC 2 YRS+ SUBQ/IM	PRXOVR	DEF					NA	NA	NA	N
90732	PPSV23 VACC 2 YRS+ SUBQ/IM	MAXFEE	VFC					0	1/1/2016	12/31/2299	N
90732	PPSV23 VACC 2 YRS+ SUBQ/IM	MAXFEE	DEF					133.47	1/1/2022	12/31/2299	N
90733	MPSV4 VACCINE SUBQ	PRXOVR	DEF					NA	NA	NA	N
90733	MPSV4 VACCINE SUBQ	MAXFEE	VFC					0	1/1/2016	12/31/2299	N
90733	MPSV4 VACCINE SUBQ	MAXFEE	DEF					126.39	2/1/2015	12/31/2299	N
90734	MENACWYD/MENACWYCRM VACC IM	PRXOVR	DEF					NA	NA	NA	N
90734	MENACWYD/MENACWYCRM VACC IM	MAXFEE	VFC					0	1/1/2016	12/31/2299	N
90734	MENACWYD/MENACWYCRM VACC IM	MAXFEE	DEF					115.88	2/1/2015	12/31/2299	N
90736	HZV VACCINE LIVE SUBQ	PRXOVR	DEF					NA	NA	NA	N
90736	HZV VACCINE LIVE SUBQ	MAXFEE	VFC					NA			N
90736	HZV VACCINE LIVE SUBQ	MAXFEE	DEF					210.93	5/1/2015	12/31/2299	N
90739	HEPB VACC 2/4 DOSE ADULT IM	PRXOVR	DEF					NA	NA	NA	N
90739	HEPB VACC 2/4 DOSE ADULT IM	MAXFEE	VFC					NA			N
90739	HEPB VACC 2/4 DOSE ADULT IM	MAXFEE	DEF					160.28	7/1/2023	12/31/2299	N
90740	HEPB VACC 3 DOSE IMMUNSUP IM	PRXOVR	DEF					NA	NA	NA	N
90740	HEPB VACC 3 DOSE IMMUNSUP IM	MAXFEE	VFC					NA			N
90740	HEPB VACC 3 DOSE IMMUNSUP IM	MAXFEE	DEF					152.12	4/1/2023	12/31/2299	N
90743	HEPB VACC 2 DOSE ADOLESC IM	PRXOVR	DEF					NA	NA	NA	N
90743	HEPB VACC 2 DOSE ADOLESC IM	MAXFEE	VFC					0	4/1/2022	12/31/2299	N
90743	HEPB VACC 2 DOSE ADOLESC IM	MAXFEE	DEF					0	1/1/2001	12/31/2299	N
90744	HEPB VACC 3 DOSE PED/ADOL IM	PRXOVR	DEF					NA	NA	NA	N
90744	HEPB VACC 3 DOSE PED/ADOL IM	MAXFEE	VFC					0	1/1/2016	12/31/2299	N
90744	HEPB VACC 3 DOSE PED/ADOL IM	MAXFEE	DEF					NA			N
90746	HEPB VACCINE 3 DOSE ADULT IM	PRXOVR	DEF					NA	NA	NA	N
90746	HEPB VACCINE 3 DOSE ADULT IM	MAXFEE	VFC					NA			N
90746	HEPB VACCINE 3 DOSE ADULT IM	MAXFEE	DEF					70.38	7/1/2022	12/31/2299	N
90747	HEPB VACC 4 DOSE IMMUNSUP IM	PRXOVR	DEF					NA	NA	NA	N
90747	HEPB VACC 4 DOSE IMMUNSUP IM	MAXFEE	VFC					NA			N
90747	HEPB VACC 4 DOSE IMMUNSUP IM	MAXFEE	DEF					140.75	7/1/2023	12/31/2299	N
90749	UNLISTED VACCINE/TOXOID	PRXOVR	DEF					NA	NA	NA	N
90749	UNLISTED VACCINE/TOXOID	MAXFEE	VFC					0	1/1/2016	12/31/2299	N
90749	UNLISTED VACCINE/TOXOID	MANUAL	DEF					NA	NA	NA	N
90750	HZV VACC RECOMBINANT IM	PRXOVR	DEF					NA	NA	NA	N
90750	HZV VACC RECOMBINANT IM	MAXFEE	VFC					NA			N
90750	HZV VACC RECOMBINANT IM	MAXFEE	DEF					149.80	1/1/2018	12/31/2299	N
90756	CCIIV4 VACC ABX FREE IM	PRXOVR	DEF					NA	NA	NA	N
90756	CCIIV4 VACC ABX FREE IM	MAXFEE	VFC					NA			N
90756	CCIIV4 VACC ABX FREE IM	MAXFEE	DEF					30.58	10/1/2022	12/31/2299	N
90758	ZAIRE EBOLAVIRUS VAC LIVE IM	PRXOVR	DEF					NA	NA	NA	N
90758	ZAIRE EBOLAVIRUS VAC LIVE IM	MANUAL	DEF					NA	NA	NA	N
90759	HEP B VAC 3AG 10MCG 3 DOS IM	PRXOVR	DEF					NA	NA	NA	N
90759	HEP B VAC 3AG 10MCG 3 DOS IM	MAXFEE	VFC					0	1/1/2022	12/31/2299	N
90759	HEP B VAC 3AG 10MCG 3 DOS IM	MAXFEE	DEF					73.82	10/1/2022	12/31/2299	N
91300	SARSCOV2 VAC 30MCG/0.3ML IM	PRXOVR	DEF					NA	NA	NA	N
91300	SARSCOV2 VAC 30MCG/0.3ML IM	MAXFEE	DEF					0.01	12/11/2020	12/31/2299	N
91301	SARSCOV2 VAC 100MCG/0.5ML IM	PRXOVR	DEF					NA	NA	NA	N
91301	SARSCOV2 VAC 100MCG/0.5ML IM	MAXFEE	DEF					0.01	12/18/2020	12/31/2299	N
91304	SARSCOV2 VAC 5MCG/0.5ML IM	PRXOVR	DEF					NA	NA	NA	N
91304	SARSCOV2 VAC 5MCG/0.5ML IM	MAXFEE	DEF					0.01	7/13/2022	12/31/2299	N
91305	SARSCOV2 VAC 30 MCG TRS-SUCR	PRXOVR	DEF					NA	NA	NA	N
91305	SARSCOV2 VAC 30 MCG TRS-SUCR	MAXFEE	DEF					0.01	1/3/2022	12/31/2299	N
91306	SARSCOV2 VAC 50MCG/0.25ML IM	PRXOVR	DEF					NA	NA	NA	N
91306	SARSCOV2 VAC 50MCG/0.25ML IM	MAXFEE	DEF					0.01	10/20/2021	12/31/2299	N
91307	SARSCOV2 VAC 10 MCG TRS-SUCR	PRXOVR	DEF					NA	NA	NA	N
91307	SARSCOV2 VAC 10 MCG TRS-SUCR	MAXFEE	DEF					0.01	10/29/2021	12/31/2299	N
91308	SARSCOV2 VAC 3 MCG TRS-SUCR	PRXOVR	DEF					NA	NA	NA	N
91308	SARSCOV2 VAC 3 MCG TRS-SUCR	MAXFEE	DEF					0.01	6/17/2022	12/31/2299	N
91309	SARSCOV2 VAC 50MCG/0.5ML IM	PRXOVR	DEF					NA	NA	NA	N
91309	SARSCOV2 VAC 50MCG/0.5ML IM	MAXFEE	DEF					0.01	3/29/2022	12/31/2299	N
91311	SARSCOV2 VAC 25MCG/0.25ML IM	PRXOVR	DEF					NA	NA	NA	N
91311	SARSCOV2 VAC 25MCG/0.25ML IM	MAXFEE	DEF					0.01	6/17/2022	12/31/2299	N
91312	SARSCOV2 VAC BVL 30MCG/0.3ML	PRXOVR	DEF					NA	NA	NA	N
91312	SARSCOV2 VAC BVL 30MCG/0.3ML	MAXFEE	DEF					0.01	8/31/2022	12/31/2299	N
91313	SARSCOV2 VAC BVL 50MCG/0.5ML	PRXOVR	DEF					NA	NA	NA	N
91313	SARSCOV2 VAC BVL 50MCG/0.5ML	MAXFEE	DEF					0.01	8/31/2022	12/31/2299	N
91314	SARSCOV2 VAC BVL 25MCG/.25ML	PRXOVR	DEF					NA	NA	NA	N
91314	SARSCOV2 VAC BVL 25MCG/.25ML	MAXFEE	DEF					0.01	10/12/2022	12/31/2299	N
91315	SARSCOV2 VAC BVL 10MCG/0.2ML	PRXOVR	DEF					NA	NA	NA	N
91315	SARSCOV2 VAC BVL 10MCG/0.2ML	MAXFEE	DEF					0.01	10/12/2022	12/31/2299	N
91316	SARSCOV2 VAC BVL 10MCG/0.2ML	PRXOVR	DEF					NA	NA	NA	N
91316	SARSCOV2 VAC BVL 10MCG/0.2ML	MAXFEE	DEF					0.01	12/8/2022	12/31/2299	N
91317	SARSCOV2 VAC BVL 3MCG/0.2ML	PRXOVR	DEF					NA	NA	NA	N
91317	SARSCOV2 VAC BVL 3MCG/0.2ML	MAXFEE	DEF					0.01	12/8/2022	12/31/2299	N
96372	THER/PROPH/DIAG INJ SC/IM	PRXOVR	DEF					NA	NA	NA	N
96372	THER/PROPH/DIAG INJ SC/IM	MAXFEE	DEF					14.57	1/1/2009	12/31/2299	N
99202	OFFICE O/P NEW SF 15-29 MIN	PRXOVR	DEF					NA	NA	NA	N
99202	OFFICE O/P NEW SF 15-29 MIN	MAXFEE	FAC					20.84	1/1/2016	12/31/2299	N
99202	OFFICE O/P NEW SF 15-29 MIN	MAXFEE	NFF					38.93	1/1/2016	12/31/2299	N
99203	OFFICE O/P NEW LOW 30-44 MIN	PRXOVR	DEF					NA	NA	NA	N
99203	OFFICE O/P NEW LOW 30-44 MIN	MAXFEE	FAC					32.94	1/1/2016	12/31/2299	N
99203	OFFICE O/P NEW LOW 30-44 MIN	MAXFEE	NFF					57.76	1/1/2016	12/31/2299	N
99211	OFF/OP EST MAY X REQ PHY/QHP	PRXOVR	DEF					NA	NA	NA	N
99211	OFF/OP EST MAY X REQ PHY/QHP	MAXFEE	FAC					5.55	1/1/2016	12/31/2299	N
99211	OFF/OP EST MAY X REQ PHY/QHP	MAXFEE	NFF					14.50	1/1/2016	12/31/2299	N
99212	OFFICE O/P EST SF 10-19 MIN	PRXOVR	DEF					NA	NA	NA	N
99212	OFFICE O/P EST SF 10-19 MIN	MAXFEE	FAC					12.81	1/1/2016	12/31/2299	N
99212	OFFICE O/P EST SF 10-19 MIN	MAXFEE	NFF					26.73	1/1/2016	12/31/2299	N
99213	OFFICE O/P EST LOW 20-29 MIN	PRXOVR	DEF					NA	NA	NA	N
99213	OFFICE O/P EST LOW 20-29 MIN	MAXFEE	FAC					24.85	1/1/2016	12/31/2299	N
99213	OFFICE O/P EST LOW 20-29 MIN	MAXFEE	NFF					43.61	1/1/2016	12/31/2299	N
99401	PREVENTIVE COUNSELING INDIV	PRXOVR	DEF					NA	NA	NA	N
99401	PREVENTIVE COUNSELING INDIV	MAXFEE	FAC					17.69	1/1/2014	12/31/2299	N
99401	PREVENTIVE COUNSELING INDIV	MAXFEE	NFF					26.21	1/1/2014	12/31/2299	N
99402	PREVENTIVE COUNSELING INDIV	PRXOVR	DEF					NA	NA	NA	N
99402	PREVENTIVE COUNSELING INDIV	MAXFEE	FAC					28.87	1/1/2014	12/31/2299	N
99402	PREVENTIVE COUNSELING INDIV	MAXFEE	NFF					39.90	1/1/2014	12/31/2299	N
99441	PHONE E/M PHYS/QHP 5-10 MIN	PRXOVR	DEF					NA	NA	NA	N
99441	PHONE E/M PHYS/QHP 5-10 MIN	MAXFEE	DEF					0	1/1/2008	12/31/2299	N
99442	PHONE E/M PHYS/QHP 11-20 MIN	PRXOVR	DEF					NA	NA	NA	N
99442	PHONE E/M PHYS/QHP 11-20 MIN	MAXFEE	DEF					0	1/1/2008	12/31/2299	N
A9587	GALLIUM GA-68	PRXOVR	DEF					NA	NA	NA	N
A9587	GALLIUM GA-68	MAXFEE	DEF					3210	4/1/2022	12/31/2299	N
A9591	FLUOROESTRADIOL F 18	PRXOVR	DEF					NA	NA	NA	N
A9591	FLUOROESTRADIOL F 18	MAXFEE	DEF					4100.78	4/1/2022	12/31/2299	N
G0108	DIAB MANAGE TRN PER INDIV	PRXOVR	DEF					NA	NA	NA	N
G0108	DIAB MANAGE TRN PER INDIV	MAXFEE	DEF					40.22	1/1/2022	12/31/2299	N
G0109	DIAB MANAGE TRN IND/GROUP	PRXOVR	DEF					NA	NA	NA	N
G0109	DIAB MANAGE TRN IND/GROUP	MAXFEE	DEF					11.15	1/1/2022	12/31/2299	N
G0312	IMMUNIZE COUNS < 21YR 5-15 M	PRXOVR	DEF					NA	NA	NA	N
G0312	IMMUNIZE COUNS < 21YR 5-15 M	MAXFEE	DEF					26.21	6/8/2022	12/31/2299	N
G0313	IMMUNIZE COUNS < 21YR 6-30 M	PRXOVR	DEF					NA	NA	NA	N
G0313	IMMUNIZE COUNS < 21YR 6-30 M	MAXFEE	DEF					39.90	6/8/2022	12/31/2299	N
G2012	BRIEF CHECK IN BY MD/QHP	PRXOVR	DEF					NA	NA	NA	N
G2012	BRIEF CHECK IN BY MD/QHP	MAXFEE	FAC					10.41	3/9/2020	12/31/2299	N
G2012	BRIEF CHECK IN BY MD/QHP	MAXFEE	NFF					11.46	3/9/2020	12/31/2299	N
J0121	INJ.; OMADACYCLINE; 1 MG	PRXOVR	DEF					NA	NA	NA	N
J0121	INJ.; OMADACYCLINE; 1 MG	MAXFEE	DEF					3.68	7/1/2023	12/31/2299	N
J0122	INJ.; ERAVACYCLINE; 1 MG	PRXOVR	DEF					NA	NA	NA	N
J0122	INJ.; ERAVACYCLINE; 1 MG	MAXFEE	DEF					1.13	7/1/2023	12/31/2299	N
J0129	ABATACEPT INJECTION	PRXOVR	DEF					NA	NA	NA	N
J0129	ABATACEPT INJECTION	MAXFEE	DEF					43.27	7/1/2023	12/31/2299	N
J0130	ABCIXIMAB INJECTION	PRXOVR	DEF					NA	NA	NA	N
J0130	ABCIXIMAB INJECTION	MAXFEE	DEF					1429.07	2/1/2019	12/31/2299	N
J0131	INJ; ACETAMINOPHEN (NOS)	PRXOVR	DEF					NA	NA	NA	N
J0131	INJ; ACETAMINOPHEN (NOS)	MAXFEE	DEF					0.09	7/1/2023	12/31/2299	N
J0132	ACETYLCYSTEINE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J0132	ACETYLCYSTEINE INJECTION	MAXFEE	DEF					0.78	7/1/2023	12/31/2299	N
J0133	ACYCLOVIR INJECTION	PRXOVR	DEF					NA	NA	NA	N
J0133	ACYCLOVIR INJECTION	MAXFEE	DEF					0.05	7/1/2023	12/31/2299	N
J0134	INJ ACETAMINOPHEN -FRESENIUS	PRXOVR	DEF					NA	NA	NA	N
J0134	INJ ACETAMINOPHEN -FRESENIUS	MAXFEE	DEF					0.07	7/1/2023	12/31/2299	N
J0135	ADALIMUMAB INJECTION	PRXOVR	DEF					NA	NA	NA	N
J0135	ADALIMUMAB INJECTION	MAXFEE	DEF					909.22	1/1/2017	12/31/2299	N
J0136	INJ; ACETAMINOPHEN (B BRAUN)	PRXOVR	DEF					NA	NA	NA	N
J0136	INJ; ACETAMINOPHEN (B BRAUN)	MAXFEE	DEF					0.05	1/1/2023	12/31/2299	N
J0137	Inj; acetaminophen (hikma)	PRXOVR	DEF					NA	NA	NA	N
J0137	Inj; acetaminophen (hikma)	MAXFEE	DEF					0.08	7/1/2023	12/31/2299	N
J0153	ADENOSINE INJ 1MG	PRXOVR	DEF					NA	NA	NA	N
J0153	ADENOSINE INJ 1MG	MAXFEE	DEF					0.54	7/1/2023	12/31/2299	N
J0171	ADRENALIN EPINEPHRINE INJECT	PRXOVR	DEF					NA	NA	NA	N
J0171	ADRENALIN EPINEPHRINE INJECT	MAXFEE	DEF					0.73	7/1/2023	12/31/2299	N
J0172	INJ; ADUCANUMAB-AVWA; 2 MG	PRXOVR	DEF					NA	NA	NA	N
J0172	INJ; ADUCANUMAB-AVWA; 2 MG	MAXFEE	DEF					5.98	7/1/2022	12/31/2299	N
J0173	INJ; EPINEPHRINE (BELCHER)	PRXOVR	DEF					NA	NA	NA	N
J0173	INJ; EPINEPHRINE (BELCHER)	MANUAL	DEF					NA	NA	NA	N
J0174	INJ; LECANEMAB-IRMB; 1 MG	PRXOVR	DEF					NA	NA	NA	N
J0174	INJ; LECANEMAB-IRMB; 1 MG	MAXFEE	DEF					1.36	7/6/2023	12/31/2299	N
J0178	AFLIBERCEPT INJECTION	PRXOVR	DEF					NA	NA	NA	N
J0178	AFLIBERCEPT INJECTION	MAXFEE	DEF					875.67	7/1/2023	12/31/2299	N
J0179	INJ; BROLUCIZUMAB-DBLL; 1 MG	PRXOVR	DEF					NA	NA	NA	N
J0179	INJ; BROLUCIZUMAB-DBLL; 1 MG	MAXFEE	DEF					319.95	7/1/2023	12/31/2299	N
J0180	AGALSIDASE BETA INJECTION	PRXOVR	DEF					NA	NA	NA	N
J0180	AGALSIDASE BETA INJECTION	MAXFEE	DEF					215.38	7/1/2023	12/31/2299	N
J0185	INJ.; APREPITANT; 1 MG	PRXOVR	DEF					NA	NA	NA	N
J0185	INJ.; APREPITANT; 1 MG	MAXFEE	DEF					1.73	7/1/2023	12/31/2299	N
J0202	INJECTION; ALEMTUZUMAB	PRXOVR	DEF					NA	NA	NA	N
J0202	INJECTION; ALEMTUZUMAB	MAXFEE	DEF					2283.73	7/1/2023	12/31/2299	N
J0205	ALGLUCERASE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J0205	ALGLUCERASE INJECTION	MAXFEE	DEF					42	7/1/2009	12/31/2299	N
J0206	Inj allopurinol sodium 1 mg	PRXOVR	DEF					NA	NA	NA	N
J0206	Inj allopurinol sodium 1 mg	MAXFEE	DEF					5.81	7/1/2023	12/31/2299	N
J0207	AMIFOSTINE	PRXOVR	DEF					NA	NA	NA	N
J0207	AMIFOSTINE	MAXFEE	DEF					1135.69	7/1/2020	12/31/2299	N
J0208	INJ SODIUM THIOSULFATE 100MG	PRXOVR	DEF					NA	NA	NA	N
J0208	INJ SODIUM THIOSULFATE 100MG	MANUAL	DEF					NA	NA	NA	N
J0210	METHYLDOPATE HCL INJECTION	PRXOVR	DEF					NA	NA	NA	N
J0210	METHYLDOPATE HCL INJECTION	MAXFEE	DEF					42.40	9/1/2013	12/31/2299	N
J0215	ALEFACEPT	PRXOVR	DEF					NA	NA	NA	N
J0215	ALEFACEPT	MAXFEE	DEF					41.64	9/1/2013	12/31/2299	N
J0216	Inj; alfentanil hcl; 500mcg	PRXOVR	DEF					NA	NA	NA	N
J0216	Inj; alfentanil hcl; 500mcg	MAXFEE	DEF					2.57	7/1/2023	12/31/2299	N
J0218	INJ OLIPUDASE ALFA-RPCP 1MG	PRXOVR	DEF					NA	NA	NA	N
J0218	INJ OLIPUDASE ALFA-RPCP 1MG	MAXFEE	DEF					377.51	7/1/2023	12/31/2299	N
J0219	INJ AVAL ALFA-NQPT 4MG	PRXOVR	DEF					NA	NA	NA	N
J0219	INJ AVAL ALFA-NQPT 4MG	MAXFEE	DEF					75.04	7/1/2023	12/31/2299	N
J0220	ALGLUCOSIDASE ALFA INJECTION	PRXOVR	DEF					NA	NA	NA	N
J0220	ALGLUCOSIDASE ALFA INJECTION	MAXFEE	DEF					206.70	2/1/2016	12/31/2299	N
J0221	LUMIZYME INJECTION	PRXOVR	DEF					NA	NA	NA	N
J0221	LUMIZYME INJECTION	MAXFEE	DEF					194.92	7/1/2023	12/31/2299	N
J0222	INJ.; PATISIRAN; 0.1 MG	PRXOVR	DEF					NA	NA	NA	N
J0222	INJ.; PATISIRAN; 0.1 MG	MAXFEE	DEF					100.47	7/1/2023	12/31/2299	N
J0223	INJ GIVOSIRAN 0.5 MG	PRXOVR	DEF					NA	NA	NA	N
J0223	INJ GIVOSIRAN 0.5 MG	MAXFEE	DEF					112.49	7/1/2023	12/31/2299	N
J0224	INJ. LUMASIRAN; 0.5 MG	PRXOVR	DEF					NA	NA	NA	N
J0224	INJ. LUMASIRAN; 0.5 MG	MAXFEE	DEF					319	7/1/2023	12/31/2299	N
J0225	INJ; VUTRISIRAN; 1 MG	PRXOVR	DEF					NA	NA	NA	N
J0225	INJ; VUTRISIRAN; 1 MG	MAXFEE	DEF					4940.95	7/1/2023	12/31/2299	N
J0248	INJ; REMDESIVIR; 1 MG	PRXOVR	DEF					NA	NA	NA	N
J0248	INJ; REMDESIVIR; 1 MG	MAXFEE	DEF					6.06	7/1/2023	12/31/2299	N
J0256	ALPHA 1 PROTEINASE INHIBITOR	PRXOVR	DEF					NA	NA	NA	N
J0256	ALPHA 1 PROTEINASE INHIBITOR	MAXFEE	DEF					4.88	7/1/2023	12/31/2299	N
J0257	GLASSIA INJECTION	PRXOVR	DEF					NA	NA	NA	N
J0257	GLASSIA INJECTION	MAXFEE	DEF					5.31	7/1/2023	12/31/2299	N
J0270	ALPROSTADIL FOR INJECTION	PRXOVR	DEF					NA	NA	NA	N
J0270	ALPROSTADIL FOR INJECTION	MAXFEE	DEF					0.24	9/1/2013	12/31/2299	N
J0278	AMIKACIN SULFATE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J0278	AMIKACIN SULFATE INJECTION	MAXFEE	DEF					0.94	7/1/2023	12/31/2299	N
J0280	AMINOPHYLLIN 250 MG INJ	PRXOVR	DEF					NA	NA	NA	N
J0280	AMINOPHYLLIN 250 MG INJ	MAXFEE	DEF					4.51	7/1/2023	12/31/2299	N
J0282	AMIODARONE HCL	PRXOVR	DEF					NA	NA	NA	N
J0282	AMIODARONE HCL	MAXFEE	DEF					0.49	9/1/2013	12/31/2299	N
J0283	INJ; AMIODARONE (NEXTERONE)	PRXOVR	DEF					NA	NA	NA	N
J0283	INJ; AMIODARONE (NEXTERONE)	MANUAL	DEF					NA	NA	NA	N
J0285	AMPHOTERICIN B	PRXOVR	DEF					NA	NA	NA	N
J0285	AMPHOTERICIN B	MAXFEE	DEF					41.67	7/1/2023	12/31/2299	N
J0287	AMPHOTERICIN B LIPID COMPLEX	PRXOVR	DEF					NA	NA	NA	N
J0287	AMPHOTERICIN B LIPID COMPLEX	MAXFEE	DEF					11.13	4/1/2023	12/31/2299	N
J0288	AMPHO B CHOLESTERYL SULFATE	PRXOVR	DEF					NA	NA	NA	N
J0288	AMPHO B CHOLESTERYL SULFATE	MAXFEE	DEF					14	9/1/2011	12/31/2299	N
J0289	AMPHOTERICIN B LIPOSOME INJ	PRXOVR	DEF					NA	NA	NA	N
J0289	AMPHOTERICIN B LIPOSOME INJ	MAXFEE	DEF					27.87	7/1/2023	12/31/2299	N
J0290	AMPICILLIN 500 MG INJ	PRXOVR	DEF					NA	NA	NA	N
J0290	AMPICILLIN 500 MG INJ	MAXFEE	DEF					0.78	7/1/2023	12/31/2299	N
J0291	INJ.; PLAZOMICIN; 5 MG	PRXOVR	DEF					NA	NA	NA	N
J0291	INJ.; PLAZOMICIN; 5 MG	MAXFEE	DEF					3.36	7/1/2023	12/31/2299	N
J0295	AMPICILLIN SULBACTAM 1.5 GM	PRXOVR	DEF					NA	NA	NA	N
J0295	AMPICILLIN SULBACTAM 1.5 GM	MAXFEE	DEF					1.89	7/1/2023	12/31/2299	N
J0300	AMOBARBITAL 125 MG INJ	PRXOVR	DEF					NA	NA	NA	N
J0300	AMOBARBITAL 125 MG INJ	MAXFEE	DEF					181.57	9/1/2013	12/31/2299	N
J0330	SUCCINYCHOLINE CHLORIDE INJ	PRXOVR	DEF					NA	NA	NA	N
J0330	SUCCINYCHOLINE CHLORIDE INJ	MAXFEE	DEF					0.39	9/1/2013	12/31/2299	N
J0348	ANIDULAFUNGIN INJECTION	PRXOVR	DEF					NA	NA	NA	N
J0348	ANIDULAFUNGIN INJECTION	MAXFEE	DEF					0.48	7/1/2023	12/31/2299	N
J0360	HYDRALAZINE HCL INJECTION	PRXOVR	DEF					NA	NA	NA	N
J0360	HYDRALAZINE HCL INJECTION	MAXFEE	DEF					5.71	7/1/2023	12/31/2299	N
J0364	APOMORPHINE HYDROCHLORIDE	PRXOVR	DEF					NA	NA	NA	N
J0364	APOMORPHINE HYDROCHLORIDE	MAXFEE	DEF					32.69	4/1/2014	12/31/2299	N
J0365	APROTONIN; 10;000 KIU	PRXOVR	DEF					NA	NA	NA	N
J0365	APROTONIN; 10;000 KIU	MAXFEE	DEF					2.65	9/1/2013	12/31/2299	N
J0400	ARIPIPRAZOLE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J0400	ARIPIPRAZOLE INJECTION	MAXFEE	DEF					0.76	7/1/2016	12/31/2299	N
J0401	INJ ARIPIPRAZOLE EXT REL 1MG	PRXOVR	DEF					NA	NA	NA	N
J0401	INJ ARIPIPRAZOLE EXT REL 1MG	MAXFEE	DEF					6.72	7/1/2023	12/31/2299	N
J0456	AZITHROMYCIN	PRXOVR	DEF					NA	NA	NA	N
J0456	AZITHROMYCIN	MAXFEE	DEF					2.78	7/1/2023	12/31/2299	N
J0457	Injection; aztreonam; 100 mg	PRXOVR	DEF					NA	NA	NA	N
J0457	Injection; aztreonam; 100 mg	MAXFEE	DEF					3.10	7/1/2023	12/31/2299	N
J0461	ATROPINE SULFATE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J0461	ATROPINE SULFATE INJECTION	MAXFEE	DEF					0.09	7/1/2023	12/31/2299	N
J0470	DIMECAPROL INJECTION	PRXOVR	DEF					NA	NA	NA	N
J0470	DIMECAPROL INJECTION	MAXFEE	DEF					59.81	4/1/2020	12/31/2299	N
J0475	BACLOFEN 10 MG INJECTION	PRXOVR	DEF					NA	NA	NA	N
J0475	BACLOFEN 10 MG INJECTION	MAXFEE	DEF					182.49	7/1/2023	12/31/2299	N
J0476	BACLOFEN INTRATHECAL TRIAL	PRXOVR	DEF					NA	NA	NA	N
J0476	BACLOFEN INTRATHECAL TRIAL	MAXFEE	DEF					44.97	7/1/2023	12/31/2299	N
J0480	BASILIXIMAB	PRXOVR	DEF					NA	NA	NA	N
J0480	BASILIXIMAB	MAXFEE	DEF					4389.08	7/1/2023	12/31/2299	N
J0485	BELATACEPT INJECTION	PRXOVR	DEF					NA	NA	NA	N
J0485	BELATACEPT INJECTION	MAXFEE	DEF					3.78	7/1/2023	12/31/2299	N
J0490	BELIMUMAB INJECTION	PRXOVR	DEF					NA	NA	NA	N
J0490	BELIMUMAB INJECTION	MAXFEE	DEF					50.93	7/1/2023	12/31/2299	N
J0500	DICYCLOMINE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J0500	DICYCLOMINE INJECTION	MAXFEE	DEF					25.44	7/1/2023	12/31/2299	N
J0515	INJ BENZTROPINE MESYLATE	PRXOVR	DEF					NA	NA	NA	N
J0515	INJ BENZTROPINE MESYLATE	MAXFEE	DEF					16.21	7/1/2023	12/31/2299	N
J0517	INJ.; BENRALIZUMAB; 1 MG	PRXOVR	DEF					NA	NA	NA	N
J0517	INJ.; BENRALIZUMAB; 1 MG	MAXFEE	DEF					170.93	7/1/2023	12/31/2299	N
J0558	PENG BENZATHINE/PROCAINE INJ	PRXOVR	DEF					NA	NA	NA	N
J0558	PENG BENZATHINE/PROCAINE INJ	MAXFEE	DEF					15.67	7/1/2023	12/31/2299	N
J0561	PENICILLIN G BENZATHINE INJ	PRXOVR	DEF					NA	NA	NA	N
J0561	PENICILLIN G BENZATHINE INJ	MAXFEE	DEF					20.17	7/1/2023	12/31/2299	N
J0565	INJ; BEZLOTOXUMAB; 10 MG	PRXOVR	DEF					NA	NA	NA	N
J0565	INJ; BEZLOTOXUMAB; 10 MG	MAXFEE	DEF					39.85	7/1/2023	12/31/2299	N
J0567	INJ.; CERLIPONASE ALFA 1 MG	PRXOVR	DEF					NA	NA	NA	N
J0567	INJ.; CERLIPONASE ALFA 1 MG	MAXFEE	DEF					96.30	1/1/2019	12/31/2299	N
J0570	BUPRENORPHINE IMPLANT 74.2MG	PRXOVR	DEF					NA	NA	NA	N
J0570	BUPRENORPHINE IMPLANT 74.2MG	MAXFEE	DEF					1311.75	7/1/2021	12/31/2299	N
J0571	BUPRENORPHINE ORAL 1MG	PRXOVR	DEF					NA	NA	NA	N
J0571	BUPRENORPHINE ORAL 1MG	MAXFEE	DEF					2.85	1/1/2022	12/31/2299	N
J0572	BUPREN/NAL UP TO 3MG BUPRENO	PRXOVR	DEF					NA	NA	NA	N
J0572	BUPREN/NAL UP TO 3MG BUPRENO	MAXFEE	DEF					10.10	4/1/2022	12/31/2299	N
J0573	BUPREN/NAL 3.1 TO 6MG BUPREN	PRXOVR	DEF					NA	NA	NA	N
J0573	BUPREN/NAL 3.1 TO 6MG BUPREN	MAXFEE	DEF					9.89	1/1/2022	12/31/2299	N
J0574	BUPREN/NAL 6.1 TO 10MG BUPRE	PRXOVR	DEF					NA	NA	NA	N
J0574	BUPREN/NAL 6.1 TO 10MG BUPRE	MAXFEE	DEF					15.15	4/1/2022	12/31/2299	N
J0575	BUPREN/NAL OVER 10MG BUPRENO	PRXOVR	DEF					NA	NA	NA	N
J0575	BUPREN/NAL OVER 10MG BUPRENO	MAXFEE	DEF					19.77	1/1/2022	12/31/2299	N
J0583	BIVALIRUDIN	PRXOVR	DEF					NA	NA	NA	N
J0583	BIVALIRUDIN	MAXFEE	DEF					0.24	7/1/2023	12/31/2299	N
J0584	INJECTION; BUROSUMAB-TWZA 1M	PRXOVR	DEF					NA	NA	NA	N
J0584	INJECTION; BUROSUMAB-TWZA 1M	MAXFEE	DEF					426.07	7/1/2023	12/31/2299	N
J0585	INJECTION;ONABOTULINUMTOXINA	PRXOVR	DEF					NA	NA	NA	N
J0585	INJECTION;ONABOTULINUMTOXINA	MAXFEE	DEF					6.39	7/1/2023	12/31/2299	N
J0586	ABOBOTULINUMTOXINA	PRXOVR	DEF					NA	NA	NA	N
J0586	ABOBOTULINUMTOXINA	MAXFEE	DEF					8.25	7/1/2023	12/31/2299	N
J0587	INJ; RIMABOTULINUMTOXINB	PRXOVR	DEF					NA	NA	NA	N
J0587	INJ; RIMABOTULINUMTOXINB	MAXFEE	DEF					12.72	7/1/2023	12/31/2299	N
J0588	INCOBOTULINUMTOXIN A	PRXOVR	DEF					NA	NA	NA	N
J0588	INCOBOTULINUMTOXIN A	MAXFEE	DEF					5.20	4/1/2023	12/31/2299	N
J0592	BUPRENORPHINE HYDROCHLORIDE	PRXOVR	DEF					NA	NA	NA	N
J0592	BUPRENORPHINE HYDROCHLORIDE	MAXFEE	DEF					4.06	7/1/2023	12/31/2299	N
J0593	INJ.; LANADELUMAB-FLYO; 1 MG	PRXOVR	DEF					NA	NA	NA	N
J0593	INJ.; LANADELUMAB-FLYO; 1 MG	MANUAL	DEF					NA	NA	NA	N
J0594	BUSULFAN INJECTION	PRXOVR	DEF					NA	NA	NA	N
J0594	BUSULFAN INJECTION	MAXFEE	DEF					1.38	7/1/2023	12/31/2299	N
J0595	BUTORPHANOL TARTRATE 1 MG	PRXOVR	DEF					NA	NA	NA	N
J0595	BUTORPHANOL TARTRATE 1 MG	MAXFEE	DEF					5.05	7/1/2023	12/31/2299	N
J0596	INJECTION; RUCONEST	PRXOVR	DEF					NA	NA	NA	N
J0596	INJECTION; RUCONEST	MAXFEE	DEF					33.02	7/1/2023	12/31/2299	N
J0597	C-1 ESTERASE; BERINERT	PRXOVR	DEF					NA	NA	NA	N
J0597	C-1 ESTERASE; BERINERT	MAXFEE	DEF					64.45	7/1/2023	12/31/2299	N
J0598	C-1 ESTERASE; CINRYZE	PRXOVR	DEF					NA	NA	NA	N
J0598	C-1 ESTERASE; CINRYZE	MAXFEE	DEF					60.73	7/1/2023	12/31/2299	N
J0599	INJ.; HAEGARDA 10 UNITS	PRXOVR	DEF					NA	NA	NA	N
J0599	INJ.; HAEGARDA 10 UNITS	MAXFEE	DEF					10.06	1/1/2019	12/31/2299	N
J0600	EDETATE CALCIUM DISODIUM INJ	PRXOVR	DEF					NA	NA	NA	N
J0600	EDETATE CALCIUM DISODIUM INJ	MAXFEE	DEF					5708.59	7/1/2021	12/31/2299	N
J0604	CINACALCET; ESRD ON DIALYSIS	PRXOVR	DEF					NA	NA	NA	N
J0604	CINACALCET; ESRD ON DIALYSIS	MAXFEE	DEF					0.09	10/1/2020	12/31/2299	N
J0606	INJ; ETELCALCETIDE; 0.1 MG	PRXOVR	DEF					NA	NA	NA	N
J0606	INJ; ETELCALCETIDE; 0.1 MG	MAXFEE	DEF					2.02	10/1/2020	12/31/2299	N
J0610	CALCIUM GLUCON (FRESENIUS)	PRXOVR	DEF					NA	NA	NA	N
J0610	CALCIUM GLUCON (FRESENIUS)	MAXFEE	DEF					NA			N
J0611	CALCIUM GLUCON (WG CRITICAL)	PRXOVR	DEF					NA	NA	NA	N
J0611	CALCIUM GLUCON (WG CRITICAL)	MAXFEE	DEF					NA			N
J0612	CALCIUM GLUCON (FRESENIUS)	PRXOVR	DEF					NA	NA	NA	N
J0612	CALCIUM GLUCON (FRESENIUS)	MAXFEE	DEF					0.06	7/1/2023	12/31/2299	N
J0613	CALCIUM GLUCON (WG CRITICAL)	PRXOVR	DEF					NA	NA	NA	N
J0613	CALCIUM GLUCON (WG CRITICAL)	MAXFEE	DEF					0.08	4/1/2023	12/31/2299	N
J0630	CALCITONIN SALMON INJECTION	PRXOVR	DEF					NA	NA	NA	N
J0630	CALCITONIN SALMON INJECTION	MAXFEE	DEF					1366.44	7/1/2023	12/31/2299	N
J0636	INJ CALCITRIOL PER 0.1 MCG	PRXOVR	DEF					NA	NA	NA	N
J0636	INJ CALCITRIOL PER 0.1 MCG	MAXFEE	DEF					0.80	7/1/2023	12/31/2299	N
J0637	CASPOFUNGIN ACETATE	PRXOVR	DEF					NA	NA	NA	N
J0637	CASPOFUNGIN ACETATE	MAXFEE	DEF					8.62	7/1/2023	12/31/2299	N
J0638	CANAKINUMAB INJECTION	PRXOVR	DEF					NA	NA	NA	N
J0638	CANAKINUMAB INJECTION	MAXFEE	DEF					121.51	7/1/2023	12/31/2299	N
J0640	LEUCOVORIN CALCIUM INJECTION	PRXOVR	DEF					NA	NA	NA	N
J0640	LEUCOVORIN CALCIUM INJECTION	MAXFEE	DEF					4.70	7/1/2023	12/31/2299	N
J0641	INJ LEVOLEUCOVORIN NOS 0.5MG	PRXOVR	DEF					NA	NA	NA	N
J0641	INJ LEVOLEUCOVORIN NOS 0.5MG	MAXFEE	DEF					0.27	10/1/2022	12/31/2299	N
J0642	INJECTION; KHAPZORY; 0.5 MG	PRXOVR	DEF					NA	NA	NA	N
J0642	INJECTION; KHAPZORY; 0.5 MG	MAXFEE	DEF					1.48	7/1/2023	12/31/2299	N
J0665	Inj; bupivacaine; nos; 0.5mg	PRXOVR	DEF					NA	NA	NA	N
J0665	Inj; bupivacaine; nos; 0.5mg	MAXFEE	DEF					0.02	7/1/2023	12/31/2299	N
J0670	INJ MEPIVACAINE HCL/10 ML	PRXOVR	DEF					NA	NA	NA	N
J0670	INJ MEPIVACAINE HCL/10 ML	MAXFEE	DEF					3.08	7/1/2023	12/31/2299	N
J0689	INJ CEFAZOLIN SODIUM; BAXTER	PRXOVR	DEF					NA	NA	NA	N
J0689	INJ CEFAZOLIN SODIUM; BAXTER	MAXFEE	DEF					1.22	7/1/2023	12/31/2299	N
J0690	CEFAZOLIN SODIUM INJECTION	PRXOVR	DEF					NA	NA	NA	N
J0690	CEFAZOLIN SODIUM INJECTION	MAXFEE	DEF					0.87	7/1/2023	12/31/2299	N
J0691	INJ LEFAMULIN 1 MG	PRXOVR	DEF					NA	NA	NA	N
J0691	INJ LEFAMULIN 1 MG	MAXFEE	DEF					0.72	7/1/2020	12/31/2299	N
J0692	CEFEPIME HCL FOR INJECTION	PRXOVR	DEF					NA	NA	NA	N
J0692	CEFEPIME HCL FOR INJECTION	MAXFEE	DEF					1.23	7/1/2023	12/31/2299	N
J0693	INJ.; CEFIDEROCOL; 5 MG	PRXOVR	DEF					NA	NA	NA	N
J0693	INJ.; CEFIDEROCOL; 5 MG	MANUAL	DEF					NA	NA	NA	N
J0694	CEFOXITIN SODIUM INJECTION	PRXOVR	DEF					NA	NA	NA	N
J0694	CEFOXITIN SODIUM INJECTION	MAXFEE	DEF					5	7/1/2023	12/31/2299	N
J0695	INJ CEFTOLOZANE TAZOBACTAM	PRXOVR	DEF					NA	NA	NA	N
J0695	INJ CEFTOLOZANE TAZOBACTAM	MAXFEE	DEF					7.54	7/1/2023	12/31/2299	N
J0696	CEFTRIAXONE SODIUM INJECTION	PRXOVR	DEF					NA	NA	NA	N
J0696	CEFTRIAXONE SODIUM INJECTION	MAXFEE	DEF					0.57	7/1/2023	12/31/2299	N
J0697	STERILE CEFUROXIME INJECTION	PRXOVR	DEF					NA	NA	NA	N
J0697	STERILE CEFUROXIME INJECTION	MAXFEE	DEF					2.24	4/1/2023	12/31/2299	N
J0698	CEFOTAXIME SODIUM INJECTION	PRXOVR	DEF					NA	NA	NA	N
J0698	CEFOTAXIME SODIUM INJECTION	MAXFEE	DEF					2.78	7/1/2021	12/31/2299	N
J0699	INJ; CEFIDEROCOL; 10 MG	PRXOVR	DEF					NA	NA	NA	N
J0699	INJ; CEFIDEROCOL; 10 MG	MAXFEE	DEF					2.16	7/1/2023	12/31/2299	N
J0701	INJ. CEFEPIME HCL (BAXTER)	PRXOVR	DEF					NA	NA	NA	N
J0701	INJ. CEFEPIME HCL (BAXTER)	MAXFEE	DEF					5.72	7/1/2023	12/31/2299	N
J0702	BETAMETHASONE ACET&SOD PHOSP	PRXOVR	DEF					NA	NA	NA	N
J0702	BETAMETHASONE ACET&SOD PHOSP	MAXFEE	DEF					6.96	7/1/2023	12/31/2299	N
J0703	INJ; CEFEPIME HCL (B BRAUN)	PRXOVR	DEF					NA	NA	NA	N
J0703	INJ; CEFEPIME HCL (B BRAUN)	MAXFEE	DEF					5.10	7/1/2023	12/31/2299	N
J0706	CAFFEINE CITRATE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J0706	CAFFEINE CITRATE INJECTION	MAXFEE	DEF					0.55	4/1/2014	12/31/2299	N
J0712	CEFTAROLINE FOSAMIL INJ	PRXOVR	DEF					NA	NA	NA	N
J0712	CEFTAROLINE FOSAMIL INJ	MAXFEE	DEF					3.89	7/1/2023	12/31/2299	N
J0713	INJ CEFTAZIDIME PER 500 MG	PRXOVR	DEF					NA	NA	NA	N
J0713	INJ CEFTAZIDIME PER 500 MG	MAXFEE	DEF					1.84	7/1/2023	12/31/2299	N
J0714	CEFTAZIDIME AND AVIBACTAM	PRXOVR	DEF					NA	NA	NA	N
J0714	CEFTAZIDIME AND AVIBACTAM	MAXFEE	DEF					92.48	7/1/2023	12/31/2299	N
J0716	CENTRUROIDES IMMUNE F(AB)	PRXOVR	DEF					NA	NA	NA	N
J0716	CENTRUROIDES IMMUNE F(AB)	MAXFEE	DEF					3745	9/1/2013	12/31/2299	N
J0717	CERTOLIZUMAB PEGOL INJ 1MG	PRXOVR	DEF					NA	NA	NA	N
J0717	CERTOLIZUMAB PEGOL INJ 1MG	MAXFEE	DEF					5.07	7/1/2023	12/31/2299	N
J0718	CERTOLIZUMAB PEGOL INJ	PRXOVR	DEF					NA	NA	NA	N
J0718	CERTOLIZUMAB PEGOL INJ	MAXFEE	DEF					NA			N
J0720	CHLORAMPHENICOL SODIUM INJEC	PRXOVR	DEF					NA	NA	NA	N
J0720	CHLORAMPHENICOL SODIUM INJEC	MAXFEE	DEF					50.26	7/1/2023	12/31/2299	N
J0725	CHORIONIC GONADOTROPIN/1000U	PRXOVR	DEF					NA	NA	NA	N
J0725	CHORIONIC GONADOTROPIN/1000U	MAXFEE	DEF					23.08	7/1/2023	12/31/2299	N
J0735	CLONIDINE HYDROCHLORIDE	PRXOVR	DEF					NA	NA	NA	N
J0735	CLONIDINE HYDROCHLORIDE	MAXFEE	DEF					21.04	7/1/2023	12/31/2299	N
J0736	Inj; clindamycin phosp 300mg	PRXOVR	DEF					NA	NA	NA	N
J0736	Inj; clindamycin phosp 300mg	MAXFEE	DEF					1.61	7/1/2023	12/31/2299	N
J0737	Inj; clindamycin (baxter)	PRXOVR	DEF					NA	NA	NA	N
J0737	Inj; clindamycin (baxter)	MAXFEE	DEF					1.32	7/1/2023	12/31/2299	N
J0739	INJECTION; CABOTEGRAVIR 1 MG	PRXOVR	DEF					NA	NA	NA	N
J0739	INJECTION; CABOTEGRAVIR 1 MG	MANUAL	DEF					NA	NA	NA	N
J0740	CIDOFOVIR INJECTION	PRXOVR	DEF					NA	NA	NA	N
J0740	CIDOFOVIR INJECTION	MAXFEE	DEF					577.03	7/1/2023	12/31/2299	N
J0741	INJ; CABOTE RILPIVIR 2MG 3MG	PRXOVR	DEF					NA	NA	NA	N
J0741	INJ; CABOTE RILPIVIR 2MG 3MG	MAXFEE	DEF					21.84	7/1/2023	12/31/2299	N
J0742	INJ IMIP 4 CILAS 4 RELEB 2MG	PRXOVR	DEF					NA	NA	NA	N
J0742	INJ IMIP 4 CILAS 4 RELEB 2MG	MAXFEE	DEF					2.49	7/1/2023	12/31/2299	N
J0743	CILASTATIN SODIUM INJECTION	PRXOVR	DEF					NA	NA	NA	N
J0743	CILASTATIN SODIUM INJECTION	MAXFEE	DEF					7.15	7/1/2023	12/31/2299	N
J0744	CIPROFLOXACIN IV	PRXOVR	DEF					NA	NA	NA	N
J0744	CIPROFLOXACIN IV	MAXFEE	DEF					1.96	7/1/2023	12/31/2299	N
J0745	INJ CODEINE PHOSPHATE /30 MG	PRXOVR	DEF					NA	NA	NA	N
J0745	INJ CODEINE PHOSPHATE /30 MG	MAXFEE	DEF					1.35	9/1/2013	12/31/2299	N
J0770	COLISTIMETHATE SODIUM INJ	PRXOVR	DEF					NA	NA	NA	N
J0770	COLISTIMETHATE SODIUM INJ	MAXFEE	DEF					12.28	7/1/2023	12/31/2299	N
J0775	COLLAGENASE; CLOST HIST INJ	PRXOVR	DEF					NA	NA	NA	N
J0775	COLLAGENASE; CLOST HIST INJ	MAXFEE	DEF					65.15	7/1/2023	12/31/2299	N
J0780	PROCHLORPERAZINE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J0780	PROCHLORPERAZINE INJECTION	MAXFEE	DEF					3.01	7/1/2023	12/31/2299	N
J0791	INJ CRIZANLIZUMAB-TMCA 5MG	PRXOVR	DEF					NA	NA	NA	N
J0791	INJ CRIZANLIZUMAB-TMCA 5MG	MAXFEE	DEF					126.61	7/1/2023	12/31/2299	N
J0795	CORTICORELIN OVINE TRIFLUTAL	PRXOVR	DEF					NA	NA	NA	N
J0795	CORTICORELIN OVINE TRIFLUTAL	MAXFEE	DEF					9.67	4/1/2021	12/31/2299	N
J0800	CORTICOTROPIN INJECTION	PRXOVR	DEF					NA	NA	NA	N
J0800	CORTICOTROPIN INJECTION	MAXFEE	DEF					3819.78	7/1/2023	12/31/2299	N
J0834	INJ.; COSYNTROPIN; 0.25 MG	PRXOVR	DEF					NA	NA	NA	N
J0834	INJ.; COSYNTROPIN; 0.25 MG	MAXFEE	DEF					27.88	7/1/2023	12/31/2299	N
J0840	CROTALIDAE POLY IMMUNE FAB	PRXOVR	DEF					NA	NA	NA	N
J0840	CROTALIDAE POLY IMMUNE FAB	MAXFEE	DEF					2056.35	7/1/2023	12/31/2299	N
J0841	INJ CROTALIDAE IM F(AB')2 EQ	PRXOVR	DEF					NA	NA	NA	N
J0841	INJ CROTALIDAE IM F(AB')2 EQ	MAXFEE	DEF					1019.46	7/1/2023	12/31/2299	N
J0850	CYTOMEGALOVIRUS IMM IV /VIAL	PRXOVR	DEF					NA	NA	NA	N
J0850	CYTOMEGALOVIRUS IMM IV /VIAL	MAXFEE	DEF					1814.20	7/1/2023	12/31/2299	N
J0875	INJECTION; DALBAVANCIN	PRXOVR	DEF					NA	NA	NA	N
J0875	INJECTION; DALBAVANCIN	MAXFEE	DEF					14.70	7/1/2023	12/31/2299	N
J0877	INJ; DAPTOMYCIN (HOSPIRA)	PRXOVR	DEF					NA	NA	NA	N
J0877	INJ; DAPTOMYCIN (HOSPIRA)	MAXFEE	DEF					0.07	7/1/2023	12/31/2299	N
J0878	DAPTOMYCIN INJECTION	PRXOVR	DEF					NA	NA	NA	N
J0878	DAPTOMYCIN INJECTION	MAXFEE	DEF					0.08	7/1/2023	12/31/2299	N
J0879	DIFELIKEFALIN; ESRD ON DIALY	PRXOVR	DEF					NA	NA	NA	N
J0879	DIFELIKEFALIN; ESRD ON DIALY	MANUAL	DEF					NA	NA	NA	N
J0881	DARBEPOETIN ALFA; NON-ESRD	PRXOVR	DEF					NA	NA	NA	N
J0881	DARBEPOETIN ALFA; NON-ESRD	MAXFEE	DEF					2.94	7/1/2023	12/31/2299	N
J0882	DARBEPOETIN ALFA; ESRD USE	PRXOVR	DEF					NA	NA	NA	N
J0882	DARBEPOETIN ALFA; ESRD USE	MAXFEE	DEF					2.94	7/1/2023	12/31/2299	N
J0883	ARGATROBAN NONESRD USE 1MG	PRXOVR	DEF					NA	NA	NA	N
J0883	ARGATROBAN NONESRD USE 1MG	MAXFEE	DEF					4.31	1/1/2017	12/31/2299	N
J0884	ARGATROBAN ESRD DIALYSIS 1MG	PRXOVR	DEF					NA	NA	NA	N
J0884	ARGATROBAN ESRD DIALYSIS 1MG	MAXFEE	DEF					4.31	1/1/2017	12/31/2299	N
J0885	EPOETIN ALFA; NON-ESRD	PRXOVR	DEF					NA	NA	NA	N
J0885	EPOETIN ALFA; NON-ESRD	MAXFEE	DEF					6.88	7/1/2023	12/31/2299	N
J0887	EPOETIN BETA ESRD USE	PRXOVR	DEF					NA	NA	NA	N
J0887	EPOETIN BETA ESRD USE	MAXFEE	DEF					1.65	7/1/2023	12/31/2299	N
J0888	EPOETIN BETA NON ESRD	PRXOVR	DEF					NA	NA	NA	N
J0888	EPOETIN BETA NON ESRD	MAXFEE	DEF					1.65	7/1/2023	12/31/2299	N
J0890	PEGINESATIDE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J0890	PEGINESATIDE INJECTION	MAXFEE	DEF					8.20	9/1/2013	12/31/2299	N
J0891	ARGATROBAN NONESRD (ACCORD)	PRXOVR	DEF					NA	NA	NA	N
J0891	ARGATROBAN NONESRD (ACCORD)	MAXFEE	DEF					0.46	7/1/2023	12/31/2299	N
J0892	ARGATROBAN DIALYSIS (ACCORD)	PRXOVR	DEF					NA	NA	NA	N
J0892	ARGATROBAN DIALYSIS (ACCORD)	MAXFEE	DEF					0.46	7/1/2023	12/31/2299	N
J0893	INJ; DECITABINE (SUN PHARMA)	PRXOVR	DEF					NA	NA	NA	N
J0893	INJ; DECITABINE (SUN PHARMA)	MAXFEE	DEF					2.24	7/1/2023	12/31/2299	N
J0894	DECITABINE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J0894	DECITABINE INJECTION	MAXFEE	DEF					2	7/1/2023	12/31/2299	N
J0895	DEFEROXAMINE MESYLATE INJ	PRXOVR	DEF					NA	NA	NA	N
J0895	DEFEROXAMINE MESYLATE INJ	MAXFEE	DEF					8.59	7/1/2023	12/31/2299	N
J0896	INJ LUSPATERCEPT-AAMT 0.25MG	PRXOVR	DEF					NA	NA	NA	N
J0896	INJ LUSPATERCEPT-AAMT 0.25MG	MAXFEE	DEF					39.18	7/1/2023	12/31/2299	N
J0897	DENOSUMAB INJECTION	PRXOVR	DEF					NA	NA	NA	N
J0897	DENOSUMAB INJECTION	MAXFEE	DEF					24.19	7/1/2023	12/31/2299	N
J0898	ARGATROBAN NONESRD (AUROMED)	PRXOVR	DEF					NA	NA	NA	N
J0898	ARGATROBAN NONESRD (AUROMED)	MAXFEE	DEF					1.64	7/1/2023	12/31/2299	N
J0899	ARGATROBAN DIALYSIS; AUROMED	PRXOVR	DEF					NA	NA	NA	N
J0899	ARGATROBAN DIALYSIS; AUROMED	MAXFEE	DEF					1.64	7/1/2023	12/31/2299	N
J1000	DEPO-ESTRADIOL CYPIONATE INJ	PRXOVR	DEF					NA	NA	NA	N
J1000	DEPO-ESTRADIOL CYPIONATE INJ	MAXFEE	DEF					30.68	7/1/2023	12/31/2299	N
J1020	METHYLPREDNISOLONE 20 MG INJ	PRXOVR	DEF					NA	NA	NA	N
J1020	METHYLPREDNISOLONE 20 MG INJ	MAXFEE	DEF					7.17	7/1/2023	12/31/2299	N
J1030	METHYLPREDNISOLONE 40 MG INJ	PRXOVR	DEF					NA	NA	NA	N
J1030	METHYLPREDNISOLONE 40 MG INJ	MAXFEE	DEF					7.61	7/1/2023	12/31/2299	N
J1040	METHYLPREDNISOLONE 80 MG INJ	PRXOVR	DEF					NA	NA	NA	N
J1040	METHYLPREDNISOLONE 80 MG INJ	MAXFEE	DEF					11.91	7/1/2023	12/31/2299	N
J1050	MEDROXYPROGESTERONE ACETATE	PRXOVR	DEF					NA	NA	NA	N
J1050	MEDROXYPROGESTERONE ACETATE	MAXFEE	DEF					0.63	11/1/2017	12/31/2299	N
J1071	INJ TESTOSTERONE CYPIONATE	PRXOVR	DEF					NA	NA	NA	N
J1071	INJ TESTOSTERONE CYPIONATE	MAXFEE	DEF					0.03	1/1/2020	12/31/2299	N
J1095	INJECTION; DEXAMETHASONE 9%	PRXOVR	DEF					NA	NA	NA	N
J1095	INJECTION; DEXAMETHASONE 9%	MAXFEE	DEF					2.24	1/1/2019	12/31/2299	N
J1096	DEXAMETHA OPTH INSERT 0.1 MG	PRXOVR	DEF					NA	NA	NA	N
J1096	DEXAMETHA OPTH INSERT 0.1 MG	MANUAL	DEF					NA	NA	NA	N
J1097	PHENYLEP KETOROLAC OPTH SOLN	PRXOVR	DEF					NA	NA	NA	N
J1097	PHENYLEP KETOROLAC OPTH SOLN	MANUAL	DEF					NA	NA	NA	N
J1100	DEXAMETHASONE SODIUM PHOS	PRXOVR	DEF					NA	NA	NA	N
J1100	DEXAMETHASONE SODIUM PHOS	MAXFEE	DEF					0.12	7/1/2023	12/31/2299	N
J1110	INJ DIHYDROERGOTAMINE MESYLT	PRXOVR	DEF					NA	NA	NA	N
J1110	INJ DIHYDROERGOTAMINE MESYLT	MAXFEE	DEF					50.59	7/1/2023	12/31/2299	N
J1120	ACETAZOLAMID SODIUM INJECTIO	PRXOVR	DEF					NA	NA	NA	N
J1120	ACETAZOLAMID SODIUM INJECTIO	MAXFEE	DEF					29.70	7/1/2023	12/31/2299	N
J1130	INJ DICLOFENAC SODIUM 0.5MG	PRXOVR	DEF					NA	NA	NA	N
J1130	INJ DICLOFENAC SODIUM 0.5MG	MAXFEE	DEF					0.21	1/1/2017	12/31/2299	N
J1160	DIGOXIN INJECTION	PRXOVR	DEF					NA	NA	NA	N
J1160	DIGOXIN INJECTION	MAXFEE	DEF					10.81	7/1/2023	12/31/2299	N
J1162	DIGOXIN IMMUNE FAB (OVINE)	PRXOVR	DEF					NA	NA	NA	N
J1162	DIGOXIN IMMUNE FAB (OVINE)	MAXFEE	DEF					4593.57	4/1/2023	12/31/2299	N
J1165	PHENYTOIN SODIUM INJECTION	PRXOVR	DEF					NA	NA	NA	N
J1165	PHENYTOIN SODIUM INJECTION	MAXFEE	DEF					0.63	7/1/2023	12/31/2299	N
J1170	HYDROMORPHONE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J1170	HYDROMORPHONE INJECTION	MAXFEE	DEF					4.35	7/1/2023	12/31/2299	N
J1190	DEXRAZOXANE HCL INJECTION	PRXOVR	DEF					NA	NA	NA	N
J1190	DEXRAZOXANE HCL INJECTION	MAXFEE	DEF					113.90	7/1/2023	12/31/2299	N
J1200	DIPHENHYDRAMINE HCL INJECTIO	PRXOVR	DEF					NA	NA	NA	N
J1200	DIPHENHYDRAMINE HCL INJECTIO	MAXFEE	DEF					1.06	7/1/2023	12/31/2299	N
J1201	INJ. CETIRIZINE HCL 0.5MG	PRXOVR	DEF					NA	NA	NA	N
J1201	INJ. CETIRIZINE HCL 0.5MG	MAXFEE	DEF					15.07	7/1/2023	12/31/2299	N
J1205	CHLOROTHIAZIDE SODIUM INJ	PRXOVR	DEF					NA	NA	NA	N
J1205	CHLOROTHIAZIDE SODIUM INJ	MAXFEE	DEF					61.57	7/1/2023	12/31/2299	N
J1212	DIMETHYL SULFOXIDE 50% 50 ML	PRXOVR	DEF					NA	NA	NA	N
J1212	DIMETHYL SULFOXIDE 50% 50 ML	MAXFEE	DEF					682.52	7/1/2023	12/31/2299	N
J1230	METHADONE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J1230	METHADONE INJECTION	MAXFEE	DEF					17.14	7/1/2023	12/31/2299	N
J1240	DIMENHYDRINATE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J1240	DIMENHYDRINATE INJECTION	MAXFEE	DEF					8.98	7/1/2023	12/31/2299	N
J1245	DIPYRIDAMOLE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J1245	DIPYRIDAMOLE INJECTION	MAXFEE	DEF					3.78	7/1/2023	12/31/2299	N
J1250	INJ DOBUTAMINE HCL/250 MG	PRXOVR	DEF					NA	NA	NA	N
J1250	INJ DOBUTAMINE HCL/250 MG	MAXFEE	DEF					8.83	7/1/2023	12/31/2299	N
J1260	DOLASETRON MESYLATE	PRXOVR	DEF					NA	NA	NA	N
J1260	DOLASETRON MESYLATE	MAXFEE	DEF					6.17	10/1/2016	12/31/2299	N
J1265	DOPAMINE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J1265	DOPAMINE INJECTION	MAXFEE	DEF					0.70	7/1/2023	12/31/2299	N
J1267	DORIPENEM INJECTION	PRXOVR	DEF					NA	NA	NA	N
J1267	DORIPENEM INJECTION	MAXFEE	DEF					0.88	8/1/2018	12/31/2299	N
J1270	INJECTION; DOXERCALCIFEROL	PRXOVR	DEF					NA	NA	NA	N
J1270	INJECTION; DOXERCALCIFEROL	MAXFEE	DEF					0.44	7/1/2023	12/31/2299	N
J1290	ECALLANTIDE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J1290	ECALLANTIDE INJECTION	MAXFEE	DEF					530.72	7/1/2023	12/31/2299	N
J1300	ECULIZUMAB INJECTION	PRXOVR	DEF					NA	NA	NA	N
J1300	ECULIZUMAB INJECTION	MAXFEE	DEF					225.79	7/1/2023	12/31/2299	N
J1301	INJECTION; EDARAVONE; 1 MG	PRXOVR	DEF					NA	NA	NA	N
J1301	INJECTION; EDARAVONE; 1 MG	MAXFEE	DEF					21.40	7/1/2023	12/31/2299	N
J1302	INJ; SUTIMLIMAB-JOME; 10 MG	PRXOVR	DEF					NA	NA	NA	Y
J1302	INJ; SUTIMLIMAB-JOME; 10 MG	MAXFEE	DEF					17.75	7/1/2023	12/31/2299	Y
J1303	INJ.; RAVULIZUMAB-CWVZ 10 MG	PRXOVR	DEF					NA	NA	NA	N
J1303	INJ.; RAVULIZUMAB-CWVZ 10 MG	MAXFEE	DEF					221.88	7/1/2023	12/31/2299	N
J1305	INJ; EVINACUMAB-DGNB; 5MG	PRXOVR	DEF					NA	NA	NA	N
J1305	INJ; EVINACUMAB-DGNB; 5MG	MAXFEE	DEF					175.78	7/1/2023	12/31/2299	N
J1306	INJECTION; INCLISIRAN; 1 MG	PRXOVR	DEF					NA	NA	NA	N
J1306	INJECTION; INCLISIRAN; 1 MG	MANUAL	DEF					NA	NA	NA	N
J1322	ELOSULFASE ALFA; INJECTION	PRXOVR	DEF					NA	NA	NA	N
J1322	ELOSULFASE ALFA; INJECTION	MAXFEE	DEF					280.13	7/1/2023	12/31/2299	N
J1324	ENFUVIRTIDE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J1324	ENFUVIRTIDE INJECTION	MAXFEE	DEF					0.55	9/1/2013	12/31/2299	N
J1325	EPOPROSTENOL INJECTION	PRXOVR	DEF					NA	NA	NA	N
J1325	EPOPROSTENOL INJECTION	MAXFEE	DEF					16	7/1/2023	12/31/2299	N
J1327	EPTIFIBATIDE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J1327	EPTIFIBATIDE INJECTION	MAXFEE	DEF					27.58	4/1/2014	12/31/2299	N
J1335	ERTAPENEM INJECTION	PRXOVR	DEF					NA	NA	NA	N
J1335	ERTAPENEM INJECTION	MAXFEE	DEF					13.32	7/1/2023	12/31/2299	N
J1364	ERYTHRO LACTOBIONATE /500 MG	PRXOVR	DEF					NA	NA	NA	N
J1364	ERYTHRO LACTOBIONATE /500 MG	MAXFEE	DEF					87.33	7/1/2023	12/31/2299	N
J1380	ESTRADIOL VALERATE 10 MG INJ	PRXOVR	DEF					NA	NA	NA	N
J1380	ESTRADIOL VALERATE 10 MG INJ	MAXFEE	DEF					10.78	7/1/2023	12/31/2299	N
J1410	INJ ESTROGEN CONJUGATE 25 MG	PRXOVR	DEF					NA	NA	NA	N
J1410	INJ ESTROGEN CONJUGATE 25 MG	MAXFEE	DEF					371.89	7/1/2023	12/31/2299	N
J1411	INJ; HEMGENIX; PER TX DOSE	PRXOVR	DEF					NA	NA	NA	N
J1411	INJ; HEMGENIX; PER TX DOSE	MANUAL	DEF					NA	NA	NA	N
J1426	INJECTION; CASIMERSEN; 10 MG	PRXOVR	DEF					NA	NA	NA	N
J1426	INJECTION; CASIMERSEN; 10 MG	MAXFEE	DEF					171.20	10/1/2021	12/31/2299	N
J1427	INJ. VILTOLARSEN	PRXOVR	DEF					NA	NA	NA	N
J1427	INJ. VILTOLARSEN	MAXFEE	DEF					60.31	4/1/2022	12/31/2299	N
J1428	INJ; ETEPLIRSEN; 10 MG	PRXOVR	DEF					NA	NA	NA	N
J1428	INJ; ETEPLIRSEN; 10 MG	MAXFEE	DEF					172.60	11/1/2018	12/31/2299	N
J1429	INJ GOLODIRSEN 10 MG	PRXOVR	DEF					NA	NA	NA	N
J1429	INJ GOLODIRSEN 10 MG	MAXFEE	DEF					171.20	4/1/2022	12/31/2299	N
J1430	ETHANOLAMINE OLEATE 100 MG	PRXOVR	DEF					NA	NA	NA	N
J1430	ETHANOLAMINE OLEATE 100 MG	MAXFEE	DEF					481.06	7/1/2023	12/31/2299	N
J1437	INJ. FE DERISOMALTOSE 10 MG	PRXOVR	DEF					NA	NA	NA	N
J1437	INJ. FE DERISOMALTOSE 10 MG	MAXFEE	DEF					20.61	7/1/2023	12/31/2299	N
J1438	ETANERCEPT INJECTION	PRXOVR	DEF					NA	NA	NA	N
J1438	ETANERCEPT INJECTION	MAXFEE	DEF					411.71	7/1/2016	12/31/2299	N
J1439	INJ FERRIC CARBOXYMALTOS 1MG	PRXOVR	DEF					NA	NA	NA	N
J1439	INJ FERRIC CARBOXYMALTOS 1MG	MAXFEE	DEF					1.13	4/1/2023	12/31/2299	N
J1440	FILGRASTIM 300 MCG INJECTION	PRXOVR	DEF					NA	NA	NA	N
J1440	FILGRASTIM 300 MCG INJECTION	MAXFEE	DEF					64.20	7/1/2023	12/31/2299	N
J1441	FILGRASTIM 480 MCG INJECTION	PRXOVR	DEF					NA	NA	NA	N
J1441	FILGRASTIM 480 MCG INJECTION	MAXFEE	DEF					NA			N
J1442	INJ FILGRASTIM EXCL BIOSIMIL	PRXOVR	DEF					NA	NA	NA	N
J1442	INJ FILGRASTIM EXCL BIOSIMIL	MAXFEE	DEF					0.99	7/1/2023	12/31/2299	N
J1444	FE PYRO CIT POW 0.1 MG IRON	PRXOVR	DEF					NA	NA	NA	N
J1444	FE PYRO CIT POW 0.1 MG IRON	MANUAL	DEF					NA	NA	NA	N
J1445	INJ TRIFERIC AVNU 0.1MG IRON	PRXOVR	DEF					NA	NA	NA	N
J1445	INJ TRIFERIC AVNU 0.1MG IRON	MANUAL	DEF					NA	NA	NA	N
J1447	INJ TBO FILGRASTIM 1 MICROG	PRXOVR	DEF					NA	NA	NA	N
J1447	INJ TBO FILGRASTIM 1 MICROG	MAXFEE	DEF					0.43	7/1/2023	12/31/2299	N
J1448	INJECTION; TRILACICLIB; 1MG	PRXOVR	DEF					NA	NA	NA	N
J1448	INJECTION; TRILACICLIB; 1MG	MAXFEE	DEF					5.10	7/1/2023	12/31/2299	N
J1449	INJ EFLAPEGRASTIM-XNST 0.1MG	PRXOVR	DEF					NA	NA	NA	N
J1449	INJ EFLAPEGRASTIM-XNST 0.1MG	MAXFEE	DEF					31.77	7/1/2023	12/31/2299	N
J1450	FLUCONAZOLE	PRXOVR	DEF					NA	NA	NA	N
J1450	FLUCONAZOLE	MAXFEE	DEF					2.68	7/1/2023	12/31/2299	N
J1451	FOMEPIZOLE; 15 MG	PRXOVR	DEF					NA	NA	NA	N
J1451	FOMEPIZOLE; 15 MG	MAXFEE	DEF					6.70	4/1/2014	12/31/2299	N
J1453	FOSAPREPITANT INJECTION	PRXOVR	DEF					NA	NA	NA	N
J1453	FOSAPREPITANT INJECTION	MAXFEE	DEF					0.14	7/1/2023	12/31/2299	N
J1454	INJ FOSNETUPITANT; PALONOSET	PRXOVR	DEF					NA	NA	NA	N
J1454	INJ FOSNETUPITANT; PALONOSET	MAXFEE	DEF					372	7/1/2023	12/31/2299	N
J1455	FOSCARNET SODIUM INJECTION	PRXOVR	DEF					NA	NA	NA	N
J1455	FOSCARNET SODIUM INJECTION	MAXFEE	DEF					13.55	9/1/2013	12/31/2299	N
J1456	INJ; FOSAPREPITANT (TEVA)	PRXOVR	DEF					NA	NA	NA	N
J1456	INJ; FOSAPREPITANT (TEVA)	MAXFEE	DEF					0.10	7/1/2023	12/31/2299	N
J1457	GALLIUM NITRATE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J1457	GALLIUM NITRATE INJECTION	MAXFEE	DEF					2.14	9/1/2013	12/31/2299	N
J1458	GALSULFASE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J1458	GALSULFASE INJECTION	MAXFEE	DEF					461.92	7/1/2023	12/31/2299	N
J1459	INJ IVIG PRIVIGEN 500 MG	PRXOVR	DEF					NA	NA	NA	N
J1459	INJ IVIG PRIVIGEN 500 MG	MAXFEE	DEF					47.99	7/1/2023	12/31/2299	N
J1460	GAMMA GLOBULIN 1 CC INJ	PRXOVR	DEF					NA	NA	NA	N
J1460	GAMMA GLOBULIN 1 CC INJ	MAXFEE	DEF					48.47	7/1/2023	12/31/2299	N
J1551	INJ CUTAQUIG 100 MG	PRXOVR	DEF					NA	NA	NA	N
J1551	INJ CUTAQUIG 100 MG	MAXFEE	DEF					14.39	7/1/2023	12/31/2299	N
J1554	INJ. ASCENIV	PRXOVR	DEF					NA	NA	NA	N
J1554	INJ. ASCENIV	MAXFEE	DEF					491.41	7/1/2023	12/31/2299	N
J1555	INJ CUVITRU; 100 MG	PRXOVR	DEF					NA	NA	NA	N
J1555	INJ CUVITRU; 100 MG	MAXFEE	DEF					16.28	7/1/2023	12/31/2299	N
J1556	INJ; IMM GLOB BIVIGAM; 500MG	PRXOVR	DEF					NA	NA	NA	N
J1556	INJ; IMM GLOB BIVIGAM; 500MG	MAXFEE	DEF					72.96	7/1/2023	12/31/2299	N
J1557	GAMMAPLEX INJECTION	PRXOVR	DEF					NA	NA	NA	N
J1557	GAMMAPLEX INJECTION	MAXFEE	DEF					59.48	7/1/2023	12/31/2299	N
J1558	INJ. XEMBIFY; 100 MG	PRXOVR	DEF					NA	NA	NA	N
J1558	INJ. XEMBIFY; 100 MG	MAXFEE	DEF					14	7/1/2023	12/31/2299	N
J1559	HIZENTRA INJECTION	PRXOVR	DEF					NA	NA	NA	N
J1559	HIZENTRA INJECTION	MAXFEE	DEF					12.80	7/1/2023	12/31/2299	N
J1560	GAMMA GLOBULIN > 10 CC INJ	PRXOVR	DEF					NA	NA	NA	N
J1560	GAMMA GLOBULIN > 10 CC INJ	MAXFEE	DEF					484.65	7/1/2023	12/31/2299	N
J1561	GAMUNEX-C/GAMMAKED	PRXOVR	DEF					NA	NA	NA	N
J1561	GAMUNEX-C/GAMMAKED	MAXFEE	DEF					50.64	7/1/2023	12/31/2299	N
J1566	IMMUNE GLOBULIN; POWDER	PRXOVR	DEF					NA	NA	NA	N
J1566	IMMUNE GLOBULIN; POWDER	MAXFEE	DEF					77.77	7/1/2023	12/31/2299	N
J1568	OCTAGAM INJECTION	PRXOVR	DEF					NA	NA	NA	N
J1568	OCTAGAM INJECTION	MAXFEE	DEF					44.12	7/1/2023	12/31/2299	N
J1569	GAMMAGARD LIQUID INJECTION	PRXOVR	DEF					NA	NA	NA	N
J1569	GAMMAGARD LIQUID INJECTION	MAXFEE	DEF					46.03	7/1/2023	12/31/2299	N
J1570	GANCICLOVIR SODIUM INJECTION	PRXOVR	DEF					NA	NA	NA	N
J1570	GANCICLOVIR SODIUM INJECTION	MAXFEE	DEF					39.49	7/1/2023	12/31/2299	N
J1571	HEPAGAM B IM INJECTION	PRXOVR	DEF					NA	NA	NA	N
J1571	HEPAGAM B IM INJECTION	MAXFEE	DEF					66.26	7/1/2023	12/31/2299	N
J1572	FLEBOGAMMA INJECTION	PRXOVR	DEF					NA	NA	NA	N
J1572	FLEBOGAMMA INJECTION	MAXFEE	DEF					56.12	7/1/2023	12/31/2299	N
J1573	HEPAGAM B INTRAVENOUS; INJ	PRXOVR	DEF					NA	NA	NA	N
J1573	HEPAGAM B INTRAVENOUS; INJ	MAXFEE	DEF					51.29	1/1/2014	12/31/2299	N
J1574	INJ; GANCICLOVIR (EXELA)	PRXOVR	DEF					NA	NA	NA	N
J1574	INJ; GANCICLOVIR (EXELA)	MANUAL	DEF					NA	NA	NA	N
J1575	HYQVIA 100MG IMMUNEGLOBULIN	PRXOVR	DEF					NA	NA	NA	N
J1575	HYQVIA 100MG IMMUNEGLOBULIN	MAXFEE	DEF					16.66	7/1/2023	12/31/2299	N
J1576	Inj; panzyga; 500 mg	PRXOVR	DEF					NA	NA	NA	N
J1576	Inj; panzyga; 500 mg	MAXFEE	DEF					65.74	7/1/2023	12/31/2299	N
J1580	GARAMYCIN GENTAMICIN INJ	PRXOVR	DEF					NA	NA	NA	N
J1580	GARAMYCIN GENTAMICIN INJ	MAXFEE	DEF					2.99	7/1/2023	12/31/2299	N
J1595	INJECTION GLATIRAMER ACETATE	PRXOVR	DEF					NA	NA	NA	N
J1595	INJECTION GLATIRAMER ACETATE	MAXFEE	DEF					164.22	9/1/2013	12/31/2299	N
J1599	IVIG NON-LYOPHILIZED; NOS	PRXOVR	DEF					NA	NA	NA	N
J1599	IVIG NON-LYOPHILIZED; NOS	MAXFEE	DEF					57.09	9/1/2013	12/31/2299	N
J1600	GOLD SODIUM THIOMALEATE INJ	PRXOVR	DEF					NA	NA	NA	N
J1600	GOLD SODIUM THIOMALEATE INJ	MAXFEE	DEF					30.15	9/1/2013	12/31/2299	N
J1602	GOLIMUMAB FOR IV USE 1MG	PRXOVR	DEF					NA	NA	NA	N
J1602	GOLIMUMAB FOR IV USE 1MG	MAXFEE	DEF					13.29	7/1/2023	12/31/2299	N
J1610	GLUCAGON HYDROCHLORIDE/1 MG	PRXOVR	DEF					NA	NA	NA	N
J1610	GLUCAGON HYDROCHLORIDE/1 MG	MAXFEE	DEF					195.18	7/1/2023	12/31/2299	N
J1611	INJ GLUCAGON HCL; FRESENIUS	PRXOVR	DEF					NA	NA	NA	N
J1611	INJ GLUCAGON HCL; FRESENIUS	MAXFEE	DEF					101.41	7/1/2023	12/31/2299	N
J1626	GRANISETRON HCL INJECTION	PRXOVR	DEF					NA	NA	NA	N
J1626	GRANISETRON HCL INJECTION	MAXFEE	DEF					0.39	7/1/2023	12/31/2299	N
J1627	INJ; GRANISETRON; XR; 0.1 MG	PRXOVR	DEF					NA	NA	NA	N
J1627	INJ; GRANISETRON; XR; 0.1 MG	MAXFEE	DEF					5.88	7/1/2023	12/31/2299	N
J1628	INJ.; GUSELKUMAB; 1 MG	PRXOVR	DEF					NA	NA	NA	N
J1628	INJ.; GUSELKUMAB; 1 MG	MAXFEE	DEF					108.70	1/1/2019	12/31/2299	N
J1630	HALOPERIDOL INJECTION	PRXOVR	DEF					NA	NA	NA	N
J1630	HALOPERIDOL INJECTION	MAXFEE	DEF					1.38	7/1/2023	12/31/2299	N
J1631	HALOPERIDOL DECANOATE INJ	PRXOVR	DEF					NA	NA	NA	N
J1631	HALOPERIDOL DECANOATE INJ	MAXFEE	DEF					8.33	7/1/2023	12/31/2299	N
J1632	INJ.; BREXANOLONE; 1 MG	PRXOVR	DEF					NA	NA	NA	N
J1632	INJ.; BREXANOLONE; 1 MG	MANUAL	DEF					NA	NA	NA	N
J1640	HEMIN; 1 MG	PRXOVR	DEF					NA	NA	NA	N
J1640	HEMIN; 1 MG	MAXFEE	DEF					31.08	7/1/2023	12/31/2299	N
J1642	INJ HEPARIN SODIUM PER 10 U	PRXOVR	DEF					NA	NA	NA	N
J1642	INJ HEPARIN SODIUM PER 10 U	MAXFEE	DEF					0.07	7/1/2023	12/31/2299	N
J1643	INJ HEPARIN; PFIZER; 1000U	PRXOVR	DEF					NA	NA	NA	N
J1643	INJ HEPARIN; PFIZER; 1000U	MANUAL	DEF					NA	NA	NA	N
J1645	DALTEPARIN SODIUM	PRXOVR	DEF					NA	NA	NA	N
J1645	DALTEPARIN SODIUM	MAXFEE	DEF					16.60	7/1/2023	12/31/2299	N
J1650	INJ ENOXAPARIN SODIUM	PRXOVR	DEF					NA	NA	NA	N
J1650	INJ ENOXAPARIN SODIUM	MAXFEE	DEF					0.68	7/1/2023	12/31/2299	N
J1652	FONDAPARINUX SODIUM	PRXOVR	DEF					NA	NA	NA	N
J1652	FONDAPARINUX SODIUM	MAXFEE	DEF					1.07	4/1/2023	12/31/2299	N
J1670	TETANUS IMMUNE GLOBULIN INJ	PRXOVR	DEF					NA	NA	NA	N
J1670	TETANUS IMMUNE GLOBULIN INJ	MAXFEE	DEF					540.99	7/1/2023	12/31/2299	N
J1720	HYDROCORTISONE SODIUM SUCC I	PRXOVR	DEF					NA	NA	NA	N
J1720	HYDROCORTISONE SODIUM SUCC I	MAXFEE	DEF					17.51	7/1/2023	12/31/2299	N
J1726	MAKENA; 10 MG	PRXOVR	DEF					NA	NA	NA	N
J1726	MAKENA; 10 MG	MAXFEE	DEF					31.16	1/1/2018	12/31/2299	N
J1729	INJ HYDROXYPROGST CAPOAT NOS	PRXOVR	DEF					NA	NA	NA	N
J1729	INJ HYDROXYPROGST CAPOAT NOS	MAXFEE	DEF					3.12	1/1/2018	12/31/2299	N
J1738	INJ. MELOXICAM 1 MG	PRXOVR	DEF					NA	NA	NA	N
J1738	INJ. MELOXICAM 1 MG	MAXFEE	DEF					3.32	7/1/2023	12/31/2299	N
J1740	IBANDRONATE SODIUM INJECTION	PRXOVR	DEF					NA	NA	NA	N
J1740	IBANDRONATE SODIUM INJECTION	MAXFEE	DEF					29.31	7/1/2023	12/31/2299	N
J1741	IBUPROFEN INJECTION	PRXOVR	DEF					NA	NA	NA	N
J1741	IBUPROFEN INJECTION	MAXFEE	DEF					1.69	9/1/2013	12/31/2299	N
J1742	IBUTILIDE FUMARATE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J1742	IBUTILIDE FUMARATE INJECTION	MAXFEE	DEF					205.06	10/1/2021	12/31/2299	N
J1743	IDURSULFASE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J1743	IDURSULFASE INJECTION	MAXFEE	DEF					542.92	7/1/2023	12/31/2299	N
J1744	ICATIBANT INJECTION	PRXOVR	DEF					NA	NA	NA	N
J1744	ICATIBANT INJECTION	MAXFEE	DEF					263.15	9/1/2013	12/31/2299	N
J1745	INFLIXIMAB NOT BIOSIMIL 10MG	PRXOVR	DEF					NA	NA	NA	N
J1745	INFLIXIMAB NOT BIOSIMIL 10MG	MAXFEE	DEF					32.91	7/1/2023	12/31/2299	N
J1746	INJ.; IBALIZUMAB-UIYK; 10 MG	PRXOVR	DEF					NA	NA	NA	N
J1746	INJ.; IBALIZUMAB-UIYK; 10 MG	MAXFEE	DEF					74.29	7/1/2023	12/31/2299	N
J1747	INJ; SPESOLIMAB-SBZO; 1 MG	PRXOVR	DEF					NA	NA	NA	N
J1747	INJ; SPESOLIMAB-SBZO; 1 MG	MAXFEE	DEF					60.22	4/1/2023	12/31/2299	N
J1750	INJ IRON DEXTRAN	PRXOVR	DEF					NA	NA	NA	N
J1750	INJ IRON DEXTRAN	MAXFEE	DEF					17.18	7/1/2023	12/31/2299	N
J1756	IRON SUCROSE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J1756	IRON SUCROSE INJECTION	MAXFEE	DEF					0.21	4/1/2023	12/31/2299	N
J1786	IMUGLUCERASE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J1786	IMUGLUCERASE INJECTION	MAXFEE	DEF					44.25	7/1/2023	12/31/2299	N
J1790	DROPERIDOL INJECTION	PRXOVR	DEF					NA	NA	NA	N
J1790	DROPERIDOL INJECTION	MAXFEE	DEF					2.14	11/1/2013	12/31/2299	N
J1800	PROPRANOLOL INJECTION	PRXOVR	DEF					NA	NA	NA	N
J1800	PROPRANOLOL INJECTION	MAXFEE	DEF					3.32	7/1/2021	12/31/2299	N
J1805	Inj; esmolol hcl; 10mg	PRXOVR	DEF					NA	NA	NA	N
J1805	Inj; esmolol hcl; 10mg	MAXFEE	DEF					0.25	7/1/2023	12/31/2299	N
J1806	Inj esmolol hcl wg crit care	PRXOVR	DEF					NA	NA	NA	N
J1806	Inj esmolol hcl wg crit care	MAXFEE	DEF					0.49	7/1/2023	12/31/2299	N
J1811	Fiasp for insulin pump use	PRXOVR	DEF					NA	NA	NA	N
J1811	Fiasp for insulin pump use	MAXFEE	DEF					7.20	7/1/2023	12/31/2299	N
J1812	Inj. insulin (fiasp)	PRXOVR	DEF					NA	NA	NA	N
J1812	Inj. insulin (fiasp)	MAXFEE	DEF					1.55	7/1/2023	12/31/2299	N
J1813	Lyumjev for insulin pump use	PRXOVR	DEF					NA	NA	NA	N
J1813	Lyumjev for insulin pump use	MAXFEE	DEF					15.73	7/1/2023	12/31/2299	N
J1814	Inj. insulin (lyumjev)	PRXOVR	DEF					NA	NA	NA	N
J1814	Inj. insulin (lyumjev)	MAXFEE	DEF					1.47	7/1/2023	12/31/2299	N
J1815	INSULIN INJECTION	PRXOVR	DEF					NA	NA	NA	N
J1815	INSULIN INJECTION	MAXFEE	DEF					0.90	1/1/2022	12/31/2299	N
J1817	INSULIN FOR INSULIN PUMP USE	PRXOVR	DEF					NA	NA	NA	N
J1817	INSULIN FOR INSULIN PUMP USE	MAXFEE	DEF					8.40	7/1/2023	12/31/2299	N
J1823	INJ. INEBILIZUMAB-CDON; 1 MG	PRXOVR	DEF					NA	NA	NA	N
J1823	INJ. INEBILIZUMAB-CDON; 1 MG	MAXFEE	DEF					472.30	7/1/2023	12/31/2299	N
J1826	INTERFERON BETA-1A INJ	PRXOVR	DEF					NA	NA	NA	N
J1826	INTERFERON BETA-1A INJ	MAXFEE	DEF					1125.64	9/1/2013	12/31/2299	N
J1830	INTERFERON BETA-1B / .25 MG	PRXOVR	DEF					NA	NA	NA	N
J1830	INTERFERON BETA-1B / .25 MG	MAXFEE	DEF					301.02	9/1/2013	12/31/2299	N
J1836	Inj; metronidazole; 10 mg	PRXOVR	DEF					NA	NA	NA	N
J1836	Inj; metronidazole; 10 mg	MAXFEE	DEF					0.02	7/1/2023	12/31/2299	N
J1840	KANAMYCIN SULFATE 500 MG INJ	PRXOVR	DEF					NA	NA	NA	N
J1840	KANAMYCIN SULFATE 500 MG INJ	MAXFEE	DEF					7.69	11/1/2015	12/31/2299	N
J1850	KANAMYCIN SULFATE 75 MG INJ	PRXOVR	DEF					NA	NA	NA	N
J1850	KANAMYCIN SULFATE 75 MG INJ	MAXFEE	DEF					1.15	9/1/2011	12/31/2299	N
J1885	KETOROLAC TROMETHAMINE INJ	PRXOVR	DEF					NA	NA	NA	N
J1885	KETOROLAC TROMETHAMINE INJ	MAXFEE	DEF					0.55	7/1/2023	12/31/2299	N
J1920	Inj; labetalol hcl; 5mg	PRXOVR	DEF					NA	NA	NA	N
J1920	Inj; labetalol hcl; 5mg	MAXFEE	DEF					0.24	7/1/2023	12/31/2299	N
J1921	Inj labetalol hcl hikma; 5mg	PRXOVR	DEF					NA	NA	NA	N
J1921	Inj labetalol hcl hikma; 5mg	MAXFEE	DEF					1.24	7/1/2023	12/31/2299	N
J1930	LANREOTIDE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J1930	LANREOTIDE INJECTION	MAXFEE	DEF					54.18	7/1/2023	12/31/2299	N
J1931	LARONIDASE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J1931	LARONIDASE INJECTION	MAXFEE	DEF					37.04	7/1/2023	12/31/2299	N
J1932	INJ; LANREOTIDE; (CIPLA) 1MG	PRXOVR	DEF					NA	NA	NA	Y
J1932	INJ; LANREOTIDE; (CIPLA) 1MG	MAXFEE	DEF					51.38	7/1/2023	12/31/2299	Y
J1940	FUROSEMIDE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J1940	FUROSEMIDE INJECTION	MAXFEE	DEF					0.50	7/1/2023	12/31/2299	N
J1941	Inj; furoscix; 20 mg	PRXOVR	DEF					NA	NA	NA	N
J1941	Inj; furoscix; 20 mg	MAXFEE	DEF					0	7/1/2023	12/31/2299	N
J1943	INJ.; ARISTADA INITIO; 1 MG	PRXOVR	DEF					NA	NA	NA	N
J1943	INJ.; ARISTADA INITIO; 1 MG	MAXFEE	DEF					3.06	7/1/2023	12/31/2299	N
J1944	ARIPIPRAZOLE LAUROXIL 1 MG	PRXOVR	DEF					NA	NA	NA	N
J1944	ARIPIPRAZOLE LAUROXIL 1 MG	MAXFEE	DEF					3.07	7/1/2023	12/31/2299	N
J1945	LEPIRUDIN	PRXOVR	DEF					NA	NA	NA	N
J1945	LEPIRUDIN	MAXFEE	DEF					570.54	9/1/2013	12/31/2299	N
J1950	LEUPROLIDE ACETATE /3.75 MG	PRXOVR	DEF					NA	NA	NA	N
J1950	LEUPROLIDE ACETATE /3.75 MG	MAXFEE	DEF					1543.52	7/1/2023	12/31/2299	N
J1951	INJ FENSOLVI 0.25 MG	PRXOVR	DEF					NA	NA	NA	N
J1951	INJ FENSOLVI 0.25 MG	MAXFEE	DEF					138.81	7/1/2023	12/31/2299	N
J1952	LEUPROLIDE INJ; CAMCEVI; 1MG	PRXOVR	DEF					NA	NA	NA	N
J1952	LEUPROLIDE INJ; CAMCEVI; 1MG	MAXFEE	DEF					78.31	7/1/2023	12/31/2299	N
J1953	LEVETIRACETAM INJECTION	PRXOVR	DEF					NA	NA	NA	N
J1953	LEVETIRACETAM INJECTION	MAXFEE	DEF					0.07	7/1/2023	12/31/2299	N
J1954	LEUPROLIDE DEPOT CIPLA 7.5MG	PRXOVR	DEF					NA	NA	NA	N
J1954	LEUPROLIDE DEPOT CIPLA 7.5MG	MAXFEE	DEF					425.48	7/1/2023	12/31/2299	N
J1955	INJ LEVOCARNITINE PER 1 GM	PRXOVR	DEF					NA	NA	NA	N
J1955	INJ LEVOCARNITINE PER 1 GM	MAXFEE	DEF					35.42	7/1/2023	12/31/2299	N
J1956	LEVOFLOXACIN INJECTION	PRXOVR	DEF					NA	NA	NA	N
J1956	LEVOFLOXACIN INJECTION	MAXFEE	DEF					0.92	7/1/2023	12/31/2299	N
J1961	Inj; lenacapavir; 1 mg	PRXOVR	DEF					NA	NA	NA	N
J1961	Inj; lenacapavir; 1 mg	MAXFEE	DEF					15.01	7/1/2023	12/31/2299	N
J1980	HYOSCYAMINE SULFATE INJ	PRXOVR	DEF					NA	NA	NA	N
J1980	HYOSCYAMINE SULFATE INJ	MAXFEE	DEF					33.23	7/1/2023	12/31/2299	N
J2001	LIDOCAINE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J2001	LIDOCAINE INJECTION	MAXFEE	DEF					0.03	10/1/2022	12/31/2299	N
J2010	LINCOMYCIN INJECTION	PRXOVR	DEF					NA	NA	NA	N
J2010	LINCOMYCIN INJECTION	MAXFEE	DEF					9.99	7/1/2023	12/31/2299	N
J2020	LINEZOLID INJECTION	PRXOVR	DEF					NA	NA	NA	N
J2020	LINEZOLID INJECTION	MAXFEE	DEF					3.47	7/1/2023	12/31/2299	N
J2021	INJ; LINEZOLID (HOSPIRA)	PRXOVR	DEF					NA	NA	NA	N
J2021	INJ; LINEZOLID (HOSPIRA)	MAXFEE	DEF					9.48	7/1/2023	12/31/2299	N
J2060	LORAZEPAM INJECTION	PRXOVR	DEF					NA	NA	NA	N
J2060	LORAZEPAM INJECTION	MAXFEE	DEF					0.85	7/1/2023	12/31/2299	N
J2062	LOXAPINE FOR INHALATION 1 MG	PRXOVR	DEF					NA	NA	NA	N
J2062	LOXAPINE FOR INHALATION 1 MG	MAXFEE	DEF					16.05	1/1/2019	12/31/2299	N
J2150	MANNITOL INJECTION	PRXOVR	DEF					NA	NA	NA	N
J2150	MANNITOL INJECTION	MAXFEE	DEF					4.93	7/1/2023	12/31/2299	N
J2170	MECASERMIN INJECTION	PRXOVR	DEF					NA	NA	NA	N
J2170	MECASERMIN INJECTION	MAXFEE	DEF					35.61	9/1/2013	12/31/2299	N
J2175	MEPERIDINE HYDROCHL /100 MG	PRXOVR	DEF					NA	NA	NA	N
J2175	MEPERIDINE HYDROCHL /100 MG	MAXFEE	DEF					7.31	7/1/2023	12/31/2299	N
J2182	INJECTION; MEPOLIZUMAB; 1MG	PRXOVR	DEF					NA	NA	NA	N
J2182	INJECTION; MEPOLIZUMAB; 1MG	MAXFEE	DEF					29.75	7/1/2023	12/31/2299	N
J2184	INJ; MEROPENEM (B. BRAUN)	PRXOVR	DEF					NA	NA	NA	N
J2184	INJ; MEROPENEM (B. BRAUN)	MAXFEE	DEF					2.10	7/1/2023	12/31/2299	N
J2185	MEROPENEM	PRXOVR	DEF					NA	NA	NA	N
J2185	MEROPENEM	MAXFEE	DEF					0.52	7/1/2023	12/31/2299	N
J2186	INJ.; MEROPENEM; VABORBACTAM	PRXOVR	DEF					NA	NA	NA	N
J2186	INJ.; MEROPENEM; VABORBACTAM	MAXFEE	DEF					1.77	1/1/2019	12/31/2299	N
J2210	METHYLERGONOVIN MALEATE INJ	PRXOVR	DEF					NA	NA	NA	N
J2210	METHYLERGONOVIN MALEATE INJ	MAXFEE	DEF					20.89	7/1/2023	12/31/2299	N
J2212	METHYLNALTREXONE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J2212	METHYLNALTREXONE INJECTION	MAXFEE	DEF					0.53	9/1/2013	12/31/2299	N
J2247	INJ; MICAFUNGIN (PAR PHARM)	PRXOVR	DEF					NA	NA	NA	N
J2247	INJ; MICAFUNGIN (PAR PHARM)	MAXFEE	DEF					0.29	7/1/2023	12/31/2299	N
J2248	MICAFUNGIN SODIUM INJECTION	PRXOVR	DEF					NA	NA	NA	N
J2248	MICAFUNGIN SODIUM INJECTION	MAXFEE	DEF					0.83	4/1/2023	12/31/2299	N
J2249	Inj; remimazolam; 1 mg	PRXOVR	DEF					NA	NA	NA	N
J2249	Inj; remimazolam; 1 mg	MAXFEE	DEF					2.21	7/1/2023	12/31/2299	N
J2250	INJ MIDAZOLAM HYDROCHLORIDE	PRXOVR	DEF					NA	NA	NA	N
J2250	INJ MIDAZOLAM HYDROCHLORIDE	MAXFEE	DEF					0.14	7/1/2023	12/31/2299	N
J2251	INJ MIDAZOLAM (WG CRIT CARE)	PRXOVR	DEF					NA	NA	NA	N
J2251	INJ MIDAZOLAM (WG CRIT CARE)	MAXFEE	DEF					0.29	7/1/2023	12/31/2299	N
J2260	INJ MILRINONE LACTATE / 5 MG	PRXOVR	DEF					NA	NA	NA	N
J2260	INJ MILRINONE LACTATE / 5 MG	MAXFEE	DEF					1.87	7/1/2023	12/31/2299	N
J2270	MORPHINE SULFATE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J2270	MORPHINE SULFATE INJECTION	MAXFEE	DEF					4.60	7/1/2023	12/31/2299	N
J2272	INJ; MORPHINE (FRESENIUS)	PRXOVR	DEF					NA	NA	NA	N
J2272	INJ; MORPHINE (FRESENIUS)	MAXFEE	DEF					6.93	7/1/2023	12/31/2299	N
J2274	INJ MORPHINE PF EPID ITHC	PRXOVR	DEF					NA	NA	NA	N
J2274	INJ MORPHINE PF EPID ITHC	MAXFEE	DEF					15.70	7/1/2023	12/31/2299	N
J2278	ZICONOTIDE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J2278	ZICONOTIDE INJECTION	MAXFEE	DEF					9.08	7/1/2023	12/31/2299	N
J2280	INJ; MOXIFLOXACIN 100 MG	PRXOVR	DEF					NA	NA	NA	N
J2280	INJ; MOXIFLOXACIN 100 MG	MAXFEE	DEF					9.85	7/1/2023	12/31/2299	N
J2281	INJ MOXIFLOXACIN (FRES KABI)	PRXOVR	DEF					NA	NA	NA	N
J2281	INJ MOXIFLOXACIN (FRES KABI)	MAXFEE	DEF					4.50	7/1/2023	12/31/2299	N
J2300	INJ NALBUPHINE HYDROCHLORIDE	PRXOVR	DEF					NA	NA	NA	N
J2300	INJ NALBUPHINE HYDROCHLORIDE	MAXFEE	DEF					2.72	7/1/2023	12/31/2299	N
J2305	Inj; nitroglycerin; 5 mg	PRXOVR	DEF					NA	NA	NA	N
J2305	Inj; nitroglycerin; 5 mg	MAXFEE	DEF					1.30	7/1/2023	12/31/2299	N
J2310	INJ NALOXONE HYDROCHLORIDE	PRXOVR	DEF					NA	NA	NA	N
J2310	INJ NALOXONE HYDROCHLORIDE	MAXFEE	DEF					9.45	7/1/2023	12/31/2299	N
J2311	INJ; NALOXONE HCL (ZIMHI)	PRXOVR	DEF					NA	NA	NA	N
J2311	INJ; NALOXONE HCL (ZIMHI)	MAXFEE	DEF					8.51	7/1/2023	12/31/2299	N
J2315	NALTREXONE; DEPOT FORM	PRXOVR	DEF					NA	NA	NA	N
J2315	NALTREXONE; DEPOT FORM	MAXFEE	DEF					3.94	7/1/2023	12/31/2299	N
J2323	NATALIZUMAB INJECTION	PRXOVR	DEF					NA	NA	NA	N
J2323	NATALIZUMAB INJECTION	MAXFEE	DEF					24.86	7/1/2023	12/31/2299	N
J2325	NESIRITIDE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J2325	NESIRITIDE INJECTION	MAXFEE	DEF					60.25	4/1/2014	12/31/2299	N
J2326	INJ; NUSINERSEN; 0.1MG	PRXOVR	DEF					NA	NA	NA	N
J2326	INJ; NUSINERSEN; 0.1MG	MAXFEE	DEF					1114.58	5/1/2018	12/31/2299	N
J2327	INJ RISANKIZUMAB-RZAA 1 MG	PRXOVR	DEF					NA	NA	NA	N
J2327	INJ RISANKIZUMAB-RZAA 1 MG	MAXFEE	DEF					15.52	7/1/2023	12/31/2299	N
J2329	Inj ublituximab-xiiy; 1 mg	PRXOVR	DEF					NA	NA	NA	N
J2329	Inj ublituximab-xiiy; 1 mg	MAXFEE	DEF					70.14	7/1/2023	12/31/2299	N
J2350	INJECTION; OCRELIZUMAB; 1 MG	PRXOVR	DEF					NA	NA	NA	N
J2350	INJECTION; OCRELIZUMAB; 1 MG	MAXFEE	DEF					61.42	7/1/2023	12/31/2299	N
J2353	OCTREOTIDE INJECTION; DEPOT	PRXOVR	DEF					NA	NA	NA	N
J2353	OCTREOTIDE INJECTION; DEPOT	MAXFEE	DEF					208.12	7/1/2023	12/31/2299	N
J2354	OCTREOTIDE INJ; NON-DEPOT	PRXOVR	DEF					NA	NA	NA	N
J2354	OCTREOTIDE INJ; NON-DEPOT	MAXFEE	DEF					1.31	7/1/2023	12/31/2299	N
J2355	OPRELVEKIN INJECTION	PRXOVR	DEF					NA	NA	NA	N
J2355	OPRELVEKIN INJECTION	MAXFEE	DEF					426.92	8/1/2018	12/31/2299	N
J2356	INJ TEZEPELUMAB-EKKO; 1MG	PRXOVR	DEF					NA	NA	NA	N
J2356	INJ TEZEPELUMAB-EKKO; 1MG	MAXFEE	DEF					18.73	7/1/2023	12/31/2299	N
J2357	OMALIZUMAB INJECTION	PRXOVR	DEF					NA	NA	NA	N
J2357	OMALIZUMAB INJECTION	MAXFEE	DEF					39.38	7/1/2023	12/31/2299	N
J2358	OLANZAPINE LONG-ACTING INJ	PRXOVR	DEF					NA	NA	NA	N
J2358	OLANZAPINE LONG-ACTING INJ	MAXFEE	DEF					2.92	10/1/2022	12/31/2299	N
J2360	ORPHENADRINE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J2360	ORPHENADRINE INJECTION	MAXFEE	DEF					16.54	7/1/2023	12/31/2299	N
J2370	PHENYLEPHRINE HCL INJECTION	PRXOVR	DEF					NA	NA	NA	N
J2370	PHENYLEPHRINE HCL INJECTION	MAXFEE	DEF					3.34	2/1/2015	12/31/2299	N
J2371	Inj phenylephrine hcl 20 mcg	PRXOVR	DEF					NA	NA	NA	N
J2371	Inj phenylephrine hcl 20 mcg	MAXFEE	DEF					0.09	7/1/2023	12/31/2299	N
J2372	Inj; biorphen; 20 micrograms	PRXOVR	DEF					NA	NA	NA	N
J2372	Inj; biorphen; 20 micrograms	MAXFEE	DEF					0.19	7/1/2023	12/31/2299	N
J2400	CHLOROPROCAINE HCL INJECTION	PRXOVR	DEF					NA	NA	NA	N
J2400	CHLOROPROCAINE HCL INJECTION	MAXFEE	DEF					NA			N
J2401	CHLOROPROCAINE HCL INJECTION	PRXOVR	DEF					NA	NA	NA	N
J2401	CHLOROPROCAINE HCL INJECTION	MAXFEE	DEF					0.04	1/1/2023	12/31/2299	N
J2402	CHLOROPROCAINE (CLOROTEKAL)	PRXOVR	DEF					NA	NA	NA	N
J2402	CHLOROPROCAINE (CLOROTEKAL)	MANUAL	DEF					NA	NA	NA	N
J2403	CHLOROPROCAINE OPHT GEL; 1MG	PRXOVR	DEF					NA	NA	NA	N
J2403	CHLOROPROCAINE OPHT GEL; 1MG	MAXFEE	DEF					0.07	4/1/2023	12/31/2299	N
J2405	ONDANSETRON HCL INJECTION	PRXOVR	DEF					NA	NA	NA	N
J2405	ONDANSETRON HCL INJECTION	MAXFEE	DEF					0.11	7/1/2023	12/31/2299	N
J2406	INJECTION; ORITAVANCIN 10 MG	PRXOVR	DEF					NA	NA	NA	N
J2406	INJECTION; ORITAVANCIN 10 MG	MAXFEE	DEF					41.73	7/1/2023	12/31/2299	N
J2407	INJECTION; ORITAVANCIN	PRXOVR	DEF					NA	NA	NA	N
J2407	INJECTION; ORITAVANCIN	MAXFEE	DEF					26.89	7/1/2023	12/31/2299	N
J2410	OXYMORPHONE HCL INJECTION	PRXOVR	DEF					NA	NA	NA	N
J2410	OXYMORPHONE HCL INJECTION	MAXFEE	DEF					2.85	11/1/2017	12/31/2299	N
J2425	PALIFERMIN INJECTION	PRXOVR	DEF					NA	NA	NA	N
J2425	PALIFERMIN INJECTION	MAXFEE	DEF					25.13	4/1/2023	12/31/2299	N
J2426	PALIPERIDONE PALMITATE INJ	PRXOVR	DEF					NA	NA	NA	N
J2426	PALIPERIDONE PALMITATE INJ	MAXFEE	DEF					14.22	7/1/2023	12/31/2299	N
J2427	Inj; invega hafyera/trinza	PRXOVR	DEF					NA	NA	NA	N
J2427	Inj; invega hafyera/trinza	MAXFEE	DEF					12.11	7/1/2023	12/31/2299	N
J2430	PAMIDRONATE DISODIUM /30 MG	PRXOVR	DEF					NA	NA	NA	N
J2430	PAMIDRONATE DISODIUM /30 MG	MAXFEE	DEF					10.32	7/1/2023	12/31/2299	N
J2440	PAPAVERIN HCL INJECTION	PRXOVR	DEF					NA	NA	NA	N
J2440	PAPAVERIN HCL INJECTION	MAXFEE	DEF					4.82	9/1/2013	12/31/2299	N
J2469	PALONOSETRON HCL	PRXOVR	DEF					NA	NA	NA	N
J2469	PALONOSETRON HCL	MAXFEE	DEF					1	7/1/2023	12/31/2299	N
J2501	PARICALCITOL	PRXOVR	DEF					NA	NA	NA	N
J2501	PARICALCITOL	MAXFEE	DEF					0.50	7/1/2023	12/31/2299	N
J2503	PEGAPTANIB SODIUM INJECTION	PRXOVR	DEF					NA	NA	NA	N
J2503	PEGAPTANIB SODIUM INJECTION	MAXFEE	DEF					785.50	1/1/2021	12/31/2299	N
J2504	PEGADEMASE BOVINE; 25 IU	PRXOVR	DEF					NA	NA	NA	N
J2504	PEGADEMASE BOVINE; 25 IU	MAXFEE	DEF					367.96	8/1/2018	12/31/2299	N
J2505	INJECTION; PEGFILGRASTIM 6MG	PRXOVR	DEF					NA	NA	NA	N
J2505	INJECTION; PEGFILGRASTIM 6MG	MAXFEE	DEF					NA			N
J2506	INJ PEGFILGRAST EX BIO 0.5MG	PRXOVR	DEF					NA	NA	NA	N
J2506	INJ PEGFILGRAST EX BIO 0.5MG	MAXFEE	DEF					85.71	7/1/2023	12/31/2299	N
J2507	PEGLOTICASE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J2507	PEGLOTICASE INJECTION	MAXFEE	DEF					3268.45	7/1/2023	12/31/2299	N
J2510	PENICILLIN G PROCAINE INJ	PRXOVR	DEF					NA	NA	NA	N
J2510	PENICILLIN G PROCAINE INJ	MAXFEE	DEF					43.38	7/1/2023	12/31/2299	N
J2515	PENTOBARBITAL SODIUM INJ	PRXOVR	DEF					NA	NA	NA	N
J2515	PENTOBARBITAL SODIUM INJ	MAXFEE	DEF					22.60	1/1/2023	12/31/2299	N
J2540	PENICILLIN G POTASSIUM INJ	PRXOVR	DEF					NA	NA	NA	N
J2540	PENICILLIN G POTASSIUM INJ	MAXFEE	DEF					1.07	7/1/2023	12/31/2299	N
J2543	PIPERACILLIN/TAZOBACTAM	PRXOVR	DEF					NA	NA	NA	N
J2543	PIPERACILLIN/TAZOBACTAM	MAXFEE	DEF					1.36	7/1/2023	12/31/2299	N
J2545	PENTAMIDINE NON-COMP UNIT	PRXOVR	DEF					NA	NA	NA	N
J2545	PENTAMIDINE NON-COMP UNIT	MAXFEE	DEF					93.86	7/1/2023	12/31/2299	N
J2550	PROMETHAZINE HCL INJECTION	PRXOVR	DEF					NA	NA	NA	N
J2550	PROMETHAZINE HCL INJECTION	MAXFEE	DEF					3.15	7/1/2023	12/31/2299	N
J2560	PHENOBARBITAL SODIUM INJ	PRXOVR	DEF					NA	NA	NA	N
J2560	PHENOBARBITAL SODIUM INJ	MAXFEE	DEF					39.38	7/1/2023	12/31/2299	N
J2561	Inj; sezaby; 1 mg	PRXOVR	DEF					NA	NA	NA	N
J2561	Inj; sezaby; 1 mg	MAXFEE	DEF					1.43	7/1/2023	12/31/2299	N
J2562	PLERIXAFOR INJECTION	PRXOVR	DEF					NA	NA	NA	N
J2562	PLERIXAFOR INJECTION	MAXFEE	DEF					429.36	7/1/2023	12/31/2299	N
J2590	OXYTOCIN INJECTION	PRXOVR	DEF					NA	NA	NA	N
J2590	OXYTOCIN INJECTION	MAXFEE	DEF					0.53	4/1/2014	12/31/2299	N
J2597	INJ DESMOPRESSIN ACETATE	PRXOVR	DEF					NA	NA	NA	N
J2597	INJ DESMOPRESSIN ACETATE	MAXFEE	DEF					7.27	7/1/2023	12/31/2299	N
J2598	Inj; vasopressin; 1 unit	PRXOVR	DEF					NA	NA	NA	N
J2598	Inj; vasopressin; 1 unit	MAXFEE	DEF					2.92	7/1/2023	12/31/2299	N
J2599	Inj vasopressin (am reg) 1 u	PRXOVR	DEF					NA	NA	NA	N
J2599	Inj vasopressin (am reg) 1 u	MAXFEE	DEF					2.10	7/1/2023	12/31/2299	N
J2675	INJ PROGESTERONE PER 50 MG	PRXOVR	DEF					NA	NA	NA	N
J2675	INJ PROGESTERONE PER 50 MG	MAXFEE	DEF					0.97	7/1/2023	12/31/2299	N
J2680	FLUPHENAZINE DECANOATE 25 MG	PRXOVR	DEF					NA	NA	NA	N
J2680	FLUPHENAZINE DECANOATE 25 MG	MAXFEE	DEF					10.95	7/1/2023	12/31/2299	N
J2690	PROCAINAMIDE HCL INJECTION	PRXOVR	DEF					NA	NA	NA	N
J2690	PROCAINAMIDE HCL INJECTION	MAXFEE	DEF					307.99	7/1/2023	12/31/2299	N
J2700	OXACILLIN SODIUM INJECITON	PRXOVR	DEF					NA	NA	NA	N
J2700	OXACILLIN SODIUM INJECITON	MAXFEE	DEF					1.17	7/1/2023	12/31/2299	N
J2704	INJ; PROPOFOL; 10 MG	PRXOVR	DEF					NA	NA	NA	N
J2704	INJ; PROPOFOL; 10 MG	MAXFEE	DEF					0.10	7/1/2023	12/31/2299	N
J2710	NEOSTIGMINE METHYLSLFTE INJ	PRXOVR	DEF					NA	NA	NA	N
J2710	NEOSTIGMINE METHYLSLFTE INJ	MAXFEE	DEF					0.40	9/1/2013	12/31/2299	N
J2720	INJ PROTAMINE SULFATE/10 MG	PRXOVR	DEF					NA	NA	NA	N
J2720	INJ PROTAMINE SULFATE/10 MG	MAXFEE	DEF					0.95	7/1/2023	12/31/2299	N
J2724	PROTEIN C CONCENTRATE	PRXOVR	DEF					NA	NA	NA	N
J2724	PROTEIN C CONCENTRATE	MAXFEE	DEF					15.11	7/1/2023	12/31/2299	N
J2730	PRALIDOXIME CHLORIDE INJ	PRXOVR	DEF					NA	NA	NA	N
J2730	PRALIDOXIME CHLORIDE INJ	MAXFEE	DEF					91.90	8/1/2015	12/31/2299	N
J2760	PHENTOLAINE MESYLATE INJ	PRXOVR	DEF					NA	NA	NA	N
J2760	PHENTOLAINE MESYLATE INJ	MAXFEE	DEF					458.18	7/1/2023	12/31/2299	N
J2765	METOCLOPRAMIDE HCL INJECTION	PRXOVR	DEF					NA	NA	NA	N
J2765	METOCLOPRAMIDE HCL INJECTION	MAXFEE	DEF					1.24	7/1/2023	12/31/2299	N
J2770	QUINUPRISTIN/DALFOPRISTIN	PRXOVR	DEF					NA	NA	NA	N
J2770	QUINUPRISTIN/DALFOPRISTIN	MAXFEE	DEF					493.97	10/1/2022	12/31/2299	N
J2777	INJ; FARICIMAB-SVOA; 0.1MG	PRXOVR	DEF					NA	NA	NA	N
J2777	INJ; FARICIMAB-SVOA; 0.1MG	MAXFEE	DEF					37.09	7/1/2023	12/31/2299	N
J2778	RANIBIZUMAB INJECTION	PRXOVR	DEF					NA	NA	NA	N
J2778	RANIBIZUMAB INJECTION	MAXFEE	DEF					236.58	7/1/2023	12/31/2299	N
J2779	INJ; SUSVIMO 0.1 MG	PRXOVR	DEF					NA	NA	NA	N
J2779	INJ; SUSVIMO 0.1 MG	MAXFEE	DEF					81.02	7/1/2023	12/31/2299	N
J2780	RANITIDINE HYDROCHLORIDE INJ	PRXOVR	DEF					NA	NA	NA	N
J2780	RANITIDINE HYDROCHLORIDE INJ	MAXFEE	DEF					6.12	1/1/2021	12/31/2299	N
J2783	RASBURICASE	PRXOVR	DEF					NA	NA	NA	N
J2783	RASBURICASE	MAXFEE	DEF					357.36	7/1/2023	12/31/2299	N
J2786	INJECTION; RESLIZUMAB; 1MG	PRXOVR	DEF					NA	NA	NA	N
J2786	INJECTION; RESLIZUMAB; 1MG	MAXFEE	DEF					10.20	7/1/2023	12/31/2299	N
J2787	RIBOFLAVIN 5'PHOS OPTH<=3ML	PRXOVR	DEF					NA	NA	NA	N
J2787	RIBOFLAVIN 5'PHOS OPTH<=3ML	MAXFEE	DEF					2016.95	1/1/2023	12/31/2299	N
J2788	RHO D IMMUNE GLOBULIN 50 MCG	PRXOVR	DEF					NA	NA	NA	N
J2788	RHO D IMMUNE GLOBULIN 50 MCG	MAXFEE	DEF					26.92	7/1/2023	12/31/2299	N
J2790	RHO D IMMUNE GLOBULIN INJ	PRXOVR	DEF					NA	NA	NA	N
J2790	RHO D IMMUNE GLOBULIN INJ	MAXFEE	DEF					81.83	7/1/2023	12/31/2299	N
J2791	RHOPHYLAC INJECTION	PRXOVR	DEF					NA	NA	NA	N
J2791	RHOPHYLAC INJECTION	MAXFEE	DEF					4.90	7/1/2023	12/31/2299	N
J2792	RHO(D) IMMUNE GLOBULIN H; SD	PRXOVR	DEF					NA	NA	NA	N
J2792	RHO(D) IMMUNE GLOBULIN H; SD	MAXFEE	DEF					33.71	7/1/2023	12/31/2299	N
J2793	RILONACEPT INJECTION	PRXOVR	DEF					NA	NA	NA	N
J2793	RILONACEPT INJECTION	MAXFEE	DEF					24.32	9/1/2013	12/31/2299	N
J2794	INJ RISPERDAL CONSTA; 0.5 MG	PRXOVR	DEF					NA	NA	NA	N
J2794	INJ RISPERDAL CONSTA; 0.5 MG	MAXFEE	DEF					12.02	7/1/2023	12/31/2299	N
J2795	ROPIVACAINE HCL INJECTION	PRXOVR	DEF					NA	NA	NA	N
J2795	ROPIVACAINE HCL INJECTION	MAXFEE	DEF					0.07	7/1/2023	12/31/2299	N
J2796	ROMIPLOSTIM INJECTION	PRXOVR	DEF					NA	NA	NA	N
J2796	ROMIPLOSTIM INJECTION	MAXFEE	DEF					95.47	7/1/2023	12/31/2299	N
J2797	INJ.; ROLAPITANT; 0.5 MG	PRXOVR	DEF					NA	NA	NA	N
J2797	INJ.; ROLAPITANT; 0.5 MG	MAXFEE	DEF					0.95	1/1/2019	12/31/2299	N
J2798	INJ.; PERSERIS; 0.5 MG	PRXOVR	DEF					NA	NA	NA	N
J2798	INJ.; PERSERIS; 0.5 MG	MAXFEE	DEF					11.67	7/1/2023	12/31/2299	N
J2800	METHOCARBAMOL INJECTION	PRXOVR	DEF					NA	NA	NA	N
J2800	METHOCARBAMOL INJECTION	MAXFEE	DEF					6.65	7/1/2023	12/31/2299	N
J2805	SINCALIDE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J2805	SINCALIDE INJECTION	MAXFEE	DEF					133.54	7/1/2023	12/31/2299	N
J2806	Inj sincalide; maia; 5 mcg	PRXOVR	DEF					NA	NA	NA	N
J2806	Inj sincalide; maia; 5 mcg	MAXFEE	DEF					0	7/1/2023	12/31/2299	N
J2810	INJ THEOPHYLLINE PER 40 MG	PRXOVR	DEF					NA	NA	NA	N
J2810	INJ THEOPHYLLINE PER 40 MG	MAXFEE	DEF					0.42	8/1/2019	12/31/2299	N
J2820	SARGRAMOSTIM INJECTION	PRXOVR	DEF					NA	NA	NA	N
J2820	SARGRAMOSTIM INJECTION	MAXFEE	DEF					58.31	7/1/2023	12/31/2299	N
J2840	INJ SEBELIPASE ALFA 1 MG	PRXOVR	DEF					NA	NA	NA	N
J2840	INJ SEBELIPASE ALFA 1 MG	MAXFEE	DEF					53.50	1/1/2017	12/31/2299	N
J2850	INJ SECRETIN SYNTHETIC HUMAN	PRXOVR	DEF					NA	NA	NA	N
J2850	INJ SECRETIN SYNTHETIC HUMAN	MAXFEE	DEF					34.78	11/1/2014	12/31/2299	N
J2860	INJECTION; SILTUXIMAB	PRXOVR	DEF					NA	NA	NA	N
J2860	INJECTION; SILTUXIMAB	MAXFEE	DEF					139.22	7/1/2023	12/31/2299	N
J2916	NA FERRIC GLUCONATE COMPLEX	PRXOVR	DEF					NA	NA	NA	N
J2916	NA FERRIC GLUCONATE COMPLEX	MAXFEE	DEF					2.12	7/1/2023	12/31/2299	N
J2920	METHYLPREDNISOLONE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J2920	METHYLPREDNISOLONE INJECTION	MAXFEE	DEF					4.24	7/1/2023	12/31/2299	N
J2930	METHYLPREDNISOLONE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J2930	METHYLPREDNISOLONE INJECTION	MAXFEE	DEF					5.73	7/1/2023	12/31/2299	N
J2941	SOMATROPIN INJECTION	PRXOVR	DEF					NA	NA	NA	N
J2941	SOMATROPIN INJECTION	MAXFEE	DEF					82.53	9/1/2013	12/31/2299	N
J2993	RETEPLASE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J2993	RETEPLASE INJECTION	MAXFEE	DEF					2301.91	11/1/2013	12/31/2299	N
J2997	ALTEPLASE RECOMBINANT	PRXOVR	DEF					NA	NA	NA	N
J2997	ALTEPLASE RECOMBINANT	MAXFEE	DEF					89.15	7/1/2023	12/31/2299	N
J2998	INJ PLASMINOGEN TVMH 1MG	PRXOVR	DEF					NA	NA	NA	N
J2998	INJ PLASMINOGEN TVMH 1MG	MANUAL	DEF					NA	NA	NA	N
J3000	STREPTOMYCIN INJECTION	PRXOVR	DEF					NA	NA	NA	N
J3000	STREPTOMYCIN INJECTION	MAXFEE	DEF					31.57	7/1/2023	12/31/2299	N
J3010	FENTANYL CITRATE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J3010	FENTANYL CITRATE INJECTION	MAXFEE	DEF					0.84	7/1/2023	12/31/2299	N
J3030	SUMATRIPTAN SUCCINATE / 6 MG	PRXOVR	DEF					NA	NA	NA	N
J3030	SUMATRIPTAN SUCCINATE / 6 MG	MAXFEE	DEF					24.25	9/1/2013	12/31/2299	N
J3031	INJ.; FREMANEZUMAB-VFRM 1 MG	PRXOVR	DEF					NA	NA	NA	N
J3031	INJ.; FREMANEZUMAB-VFRM 1 MG	MANUAL	DEF					NA	NA	NA	N
J3032	INJ. EPTINEZUMAB-JJMR 1 MG	PRXOVR	DEF					NA	NA	NA	N
J3032	INJ. EPTINEZUMAB-JJMR 1 MG	MAXFEE	DEF					17.44	7/1/2023	12/31/2299	N
J3060	INJ; TALIGLUCERASE ALFA 10 U	PRXOVR	DEF					NA	NA	NA	N
J3060	INJ; TALIGLUCERASE ALFA 10 U	MAXFEE	DEF					44.56	7/1/2023	12/31/2299	N
J3070	PENTAZOCINE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J3070	PENTAZOCINE INJECTION	MAXFEE	DEF					108.39	5/1/2018	12/31/2299	N
J3090	INJ TEDIZOLID PHOSPHATE	PRXOVR	DEF					NA	NA	NA	N
J3090	INJ TEDIZOLID PHOSPHATE	MAXFEE	DEF					1.71	7/1/2023	12/31/2299	N
J3095	TELAVANCIN INJECTION	PRXOVR	DEF					NA	NA	NA	N
J3095	TELAVANCIN INJECTION	MAXFEE	DEF					6.83	7/1/2023	12/31/2299	N
J3101	TENECTEPLASE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J3101	TENECTEPLASE INJECTION	MAXFEE	DEF					152.70	7/1/2023	12/31/2299	N
J3105	TERBUTALINE SULFATE INJ	PRXOVR	DEF					NA	NA	NA	N
J3105	TERBUTALINE SULFATE INJ	MAXFEE	DEF					2.29	7/1/2023	12/31/2299	N
J3111	INJ. ROMOSOZUMAB-AQQG 1 MG	PRXOVR	DEF					NA	NA	NA	N
J3111	INJ. ROMOSOZUMAB-AQQG 1 MG	MAXFEE	DEF					10.37	7/1/2023	12/31/2299	N
J3121	INJ TESTOSTERO ENANTHATE 1MG	PRXOVR	DEF					NA	NA	NA	N
J3121	INJ TESTOSTERO ENANTHATE 1MG	MAXFEE	DEF					0.05	2/1/2019	12/31/2299	N
J3145	TESTOSTERONE UNDECANOATE 1MG	PRXOVR	DEF					NA	NA	NA	N
J3145	TESTOSTERONE UNDECANOATE 1MG	MAXFEE	DEF					1.90	7/1/2023	12/31/2299	N
J3230	CHLORPROMAZINE HCL INJECTION	PRXOVR	DEF					NA	NA	NA	N
J3230	CHLORPROMAZINE HCL INJECTION	MAXFEE	DEF					35.95	7/1/2023	12/31/2299	N
J3240	THYROTROPIN INJECTION	PRXOVR	DEF					NA	NA	NA	N
J3240	THYROTROPIN INJECTION	MAXFEE	DEF					2001.49	7/1/2023	12/31/2299	N
J3241	INJ. TEPROTUMUMAB-TRBW 10 MG	PRXOVR	DEF					NA	NA	NA	N
J3241	INJ. TEPROTUMUMAB-TRBW 10 MG	MAXFEE	DEF					328	4/1/2023	12/31/2299	N
J3243	TIGECYCLINE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J3243	TIGECYCLINE INJECTION	MAXFEE	DEF					0.74	7/1/2023	12/31/2299	N
J3244	INJ. TIGECYCLINE (ACCORD)	PRXOVR	DEF					NA	NA	NA	N
J3244	INJ. TIGECYCLINE (ACCORD)	MAXFEE	DEF					0.60	4/1/2023	12/31/2299	N
J3245	INJ.; TILDRAKIZUMAB; 1 MG	PRXOVR	DEF					NA	NA	NA	N
J3245	INJ.; TILDRAKIZUMAB; 1 MG	MAXFEE	DEF					143.27	7/1/2023	12/31/2299	N
J3246	TIROFIBAN HCL	PRXOVR	DEF					NA	NA	NA	N
J3246	TIROFIBAN HCL	MAXFEE	DEF					9.31	4/1/2014	12/31/2299	N
J3250	TRIMETHOBENZAMIDE HCL INJ	PRXOVR	DEF					NA	NA	NA	N
J3250	TRIMETHOBENZAMIDE HCL INJ	MAXFEE	DEF					45.04	7/1/2023	12/31/2299	N
J3260	TOBRAMYCIN SULFATE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J3260	TOBRAMYCIN SULFATE INJECTION	MAXFEE	DEF					2.65	7/1/2023	12/31/2299	N
J3262	TOCILIZUMAB INJECTION	PRXOVR	DEF					NA	NA	NA	N
J3262	TOCILIZUMAB INJECTION	MAXFEE	DEF					5.91	7/1/2023	12/31/2299	N
J3265	INJECTION TORSEMIDE 10 MG/ML	PRXOVR	DEF					NA	NA	NA	N
J3265	INJECTION TORSEMIDE 10 MG/ML	MAXFEE	DEF					2.20	9/1/2013	12/31/2299	N
J3285	TREPROSTINIL INJECTION	PRXOVR	DEF					NA	NA	NA	N
J3285	TREPROSTINIL INJECTION	MAXFEE	DEF					55.20	7/1/2023	12/31/2299	N
J3299	INJ XIPERE 1 MG	PRXOVR	DEF					NA	NA	NA	N
J3299	INJ XIPERE 1 MG	MAXFEE	DEF					48.49	7/1/2023	12/31/2299	N
J3300	TRIAMCINOLONE A INJ PRS-FREE	PRXOVR	DEF					NA	NA	NA	N
J3300	TRIAMCINOLONE A INJ PRS-FREE	MAXFEE	DEF					4.27	7/1/2023	12/31/2299	N
J3301	TRIAMCINOLONE ACET INJ NOS	PRXOVR	DEF					NA	NA	NA	N
J3301	TRIAMCINOLONE ACET INJ NOS	MAXFEE	DEF					1.01	7/1/2023	12/31/2299	N
J3303	TRIAMCINOLONE HEXACETONL INJ	PRXOVR	DEF					NA	NA	NA	N
J3303	TRIAMCINOLONE HEXACETONL INJ	MAXFEE	DEF					3.61	10/1/2016	12/31/2299	N
J3304	INJ TRIAMCINOLONE ACE XR 1MG	PRXOVR	DEF					NA	NA	NA	N
J3304	INJ TRIAMCINOLONE ACE XR 1MG	MAXFEE	DEF					17.11	7/1/2023	12/31/2299	N
J3315	TRIPTORELIN PAMOATE	PRXOVR	DEF					NA	NA	NA	N
J3315	TRIPTORELIN PAMOATE	MAXFEE	DEF					382.39	7/1/2023	12/31/2299	N
J3316	INJ.; TRIPTORELIN XR 3.75 MG	PRXOVR	DEF					NA	NA	NA	N
J3316	INJ.; TRIPTORELIN XR 3.75 MG	MAXFEE	DEF					870.17	1/1/2019	12/31/2299	N
J3357	USTEKINUMAB SUB CU INJ; 1 MG	PRXOVR	DEF					NA	NA	NA	N
J3357	USTEKINUMAB SUB CU INJ; 1 MG	MAXFEE	DEF					147.65	7/1/2023	12/31/2299	N
J3358	USTEKINUMAB; IV INJECT; 1 MG	PRXOVR	DEF					NA	NA	NA	N
J3358	USTEKINUMAB; IV INJECT; 1 MG	MAXFEE	DEF					12.59	7/1/2023	12/31/2299	N
J3360	DIAZEPAM INJECTION	PRXOVR	DEF					NA	NA	NA	N
J3360	DIAZEPAM INJECTION	MAXFEE	DEF					5.25	7/1/2023	12/31/2299	N
J3365	UROKINASE 250;000 IU INJ	PRXOVR	DEF					NA	NA	NA	N
J3365	UROKINASE 250;000 IU INJ	MAXFEE	DEF					457.73	9/1/2013	12/31/2299	N
J3370	VANCOMYCIN HCL INJECTION	PRXOVR	DEF					NA	NA	NA	N
J3370	VANCOMYCIN HCL INJECTION	MAXFEE	DEF					2.41	7/1/2023	12/31/2299	N
J3371	INJ; VANCOMYCIN HCL (MYLAN)	PRXOVR	DEF					NA	NA	NA	N
J3371	INJ; VANCOMYCIN HCL (MYLAN)	MAXFEE	DEF					6.30	7/1/2023	12/31/2299	N
J3372	INJ; VANCOMYCIN HCL (XELLIA)	PRXOVR	DEF					NA	NA	NA	N
J3372	INJ; VANCOMYCIN HCL (XELLIA)	MAXFEE	DEF					6.58	7/1/2023	12/31/2299	N
J3380	INJECTION; VEDOLIZUMAB	PRXOVR	DEF					NA	NA	NA	N
J3380	INJECTION; VEDOLIZUMAB	MAXFEE	DEF					22.68	7/1/2023	12/31/2299	N
J3385	VELAGLUCERASE ALFA	PRXOVR	DEF					NA	NA	NA	N
J3385	VELAGLUCERASE ALFA	MAXFEE	DEF					367.18	7/1/2023	12/31/2299	N
J3396	VERTEPORFIN INJECTION	PRXOVR	DEF					NA	NA	NA	N
J3396	VERTEPORFIN INJECTION	MAXFEE	DEF					11.42	7/1/2023	12/31/2299	N
J3397	INJ.; VESTRONIDASE ALFA-VJBK	PRXOVR	DEF					NA	NA	NA	N
J3397	INJ.; VESTRONIDASE ALFA-VJBK	MAXFEE	DEF					226.31	1/1/2019	12/31/2299	N
J3410	HYDROXYZINE HCL INJECTION	PRXOVR	DEF					NA	NA	NA	N
J3410	HYDROXYZINE HCL INJECTION	MAXFEE	DEF					13.62	7/1/2023	12/31/2299	N
J3411	THIAMINE HCL 100 MG	PRXOVR	DEF					NA	NA	NA	N
J3411	THIAMINE HCL 100 MG	MAXFEE	DEF					2.50	7/1/2023	12/31/2299	N
J3415	PYRIDOXINE HCL 100 MG	PRXOVR	DEF					NA	NA	NA	N
J3415	PYRIDOXINE HCL 100 MG	MAXFEE	DEF					15.90	7/1/2023	12/31/2299	N
J3420	VITAMIN B12 INJECTION	PRXOVR	DEF					NA	NA	NA	N
J3420	VITAMIN B12 INJECTION	MAXFEE	DEF					1.31	7/1/2023	12/31/2299	N
J3430	VITAMIN K PHYTONADIONE INJ	PRXOVR	DEF					NA	NA	NA	N
J3430	VITAMIN K PHYTONADIONE INJ	MAXFEE	DEF					2.87	7/1/2023	12/31/2299	N
J3465	INJECTION; VORICONAZOLE	PRXOVR	DEF					NA	NA	NA	N
J3465	INJECTION; VORICONAZOLE	MAXFEE	DEF					1.22	7/1/2023	12/31/2299	N
J3470	HYALURONIDASE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J3470	HYALURONIDASE INJECTION	MAXFEE	DEF					21.20	9/1/2011	12/31/2299	N
J3471	OVINE; UP TO 999 USP UNITS	PRXOVR	DEF					NA	NA	NA	N
J3471	OVINE; UP TO 999 USP UNITS	MAXFEE	DEF					0.49	7/1/2023	12/31/2299	N
J3472	OVINE; 1000 USP UNITS	PRXOVR	DEF					NA	NA	NA	N
J3472	OVINE; 1000 USP UNITS	MAXFEE	DEF					296.89	9/1/2013	12/31/2299	N
J3473	HYALURONIDASE RECOMBINANT	PRXOVR	DEF					NA	NA	NA	N
J3473	HYALURONIDASE RECOMBINANT	MAXFEE	DEF					0.36	8/1/2019	12/31/2299	N
J3480	INJ POTASSIUM CHLORIDE	PRXOVR	DEF					NA	NA	NA	N
J3480	INJ POTASSIUM CHLORIDE	MAXFEE	DEF					0.10	7/1/2023	12/31/2299	N
J3485	ZIDOVUDINE	PRXOVR	DEF					NA	NA	NA	N
J3485	ZIDOVUDINE	MAXFEE	DEF					1.51	2/1/2018	12/31/2299	N
J3486	ZIPRASIDONE MESYLATE	PRXOVR	DEF					NA	NA	NA	N
J3486	ZIPRASIDONE MESYLATE	MAXFEE	DEF					9.60	7/1/2023	12/31/2299	N
J3489	ZOLEDRONIC ACID 1MG	PRXOVR	DEF					NA	NA	NA	N
J3489	ZOLEDRONIC ACID 1MG	MAXFEE	DEF					9.09	7/1/2023	12/31/2299	N
J3490	DRUGS UNCLASSIFIED INJECTION	PRXOVR	DEF					NA	NA	NA	N
J3490	DRUGS UNCLASSIFIED INJECTION	MANUAL	DEF					NA	NA	NA	N
J3535	METERED DOSE INHALER DRUG	PRXOVR	DEF					NA	NA	NA	N
J3535	METERED DOSE INHALER DRUG	MANUAL	DEF					NA	NA	NA	N
J3590	UNCLASSIFIED BIOLOGICS	PRXOVR	DEF					NA	NA	NA	N
J3590	UNCLASSIFIED BIOLOGICS	MANUAL	DEF					NA	NA	NA	N
J3591	ESRD ON DIALYSI DRUG/BIO NOC	PRXOVR	DEF					NA	NA	NA	N
J3591	ESRD ON DIALYSI DRUG/BIO NOC	MANUAL	DEF					NA	NA	NA	N
J7030	NORMAL SALINE SOLUTION INFUS	PRXOVR	DEF					NA	NA	NA	N
J7030	NORMAL SALINE SOLUTION INFUS	MAXFEE	DEF					2.54	7/1/2023	12/31/2299	N
J7040	NORMAL SALINE SOLUTION INFUS	PRXOVR	DEF					NA	NA	NA	N
J7040	NORMAL SALINE SOLUTION INFUS	MAXFEE	DEF					1.27	7/1/2023	12/31/2299	N
J7042	5% DEXTROSE/NORMAL SALINE	PRXOVR	DEF					NA	NA	NA	N
J7042	5% DEXTROSE/NORMAL SALINE	MAXFEE	DEF					1.18	7/1/2023	12/31/2299	N
J7050	NORMAL SALINE SOLUTION INFUS	PRXOVR	DEF					NA	NA	NA	N
J7050	NORMAL SALINE SOLUTION INFUS	MAXFEE	DEF					0.64	7/1/2023	12/31/2299	N
J7060	5% DEXTROSE/WATER	PRXOVR	DEF					NA	NA	NA	N
J7060	5% DEXTROSE/WATER	MAXFEE	DEF					1.81	7/1/2023	12/31/2299	N
J7070	D5W INFUSION	PRXOVR	DEF					NA	NA	NA	N
J7070	D5W INFUSION	MAXFEE	DEF					3.62	7/1/2023	12/31/2299	N
J7100	DEXTRAN 40 INFUSION	PRXOVR	DEF					NA	NA	NA	N
J7100	DEXTRAN 40 INFUSION	MAXFEE	DEF					17.77	2/1/2015	12/31/2299	N
J7110	DEXTRAN 75 INFUSION	PRXOVR	DEF					NA	NA	NA	N
J7110	DEXTRAN 75 INFUSION	MAXFEE	DEF					14.52	9/1/2013	12/31/2299	N
J7168	PROTHROMBIN COMPLEX KCENTRA	PRXOVR	DEF					NA	NA	NA	N
J7168	PROTHROMBIN COMPLEX KCENTRA	MAXFEE	DEF					2.80	7/1/2021	12/31/2299	N
J7169	INJ ANDEXXA; 10 MG	PRXOVR	DEF					NA	NA	NA	N
J7169	INJ ANDEXXA; 10 MG	MAXFEE	DEF					294.25	7/1/2020	12/31/2299	N
J7175	INJ; FACTOR X; (HUMAN); 1IU	PRXOVR	DEF					NA	NA	NA	N
J7175	INJ; FACTOR X; (HUMAN); 1IU	MAXFEE	DEF					9.09	7/1/2023	12/31/2299	N
J7177	INJ.; FIBRYGA; 1 MG	PRXOVR	DEF					NA	NA	NA	N
J7177	INJ.; FIBRYGA; 1 MG	MAXFEE	DEF					1.10	4/1/2023	12/31/2299	N
J7178	INJ HUMAN FIBRINOGEN CON NOS	PRXOVR	DEF					NA	NA	NA	N
J7178	INJ HUMAN FIBRINOGEN CON NOS	MAXFEE	DEF					1.38	4/1/2023	12/31/2299	N
J7179	VONVENDI INJ 1 IU VWF:RCO	PRXOVR	DEF					NA	NA	NA	N
J7179	VONVENDI INJ 1 IU VWF:RCO	MAXFEE	DEF					1.78	7/1/2023	12/31/2299	N
J7180	FACTOR XIII ANTI-HEM FACTOR	PRXOVR	DEF					NA	NA	NA	N
J7180	FACTOR XIII ANTI-HEM FACTOR	MAXFEE	DEF					9.68	7/1/2023	12/31/2299	N
J7181	FACTOR XIII RECOMB A-SUBUNIT	PRXOVR	DEF					NA	NA	NA	N
J7181	FACTOR XIII RECOMB A-SUBUNIT	MAXFEE	DEF					16.89	7/1/2023	12/31/2299	N
J7182	FACTOR VIII RECOMB NOVOEIGHT	PRXOVR	DEF					NA	NA	NA	N
J7182	FACTOR VIII RECOMB NOVOEIGHT	MAXFEE	DEF					1.28	7/1/2023	12/31/2299	N
J7183	WILATE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J7183	WILATE INJECTION	MAXFEE	DEF					1.26	4/1/2023	12/31/2299	N
J7185	XYNTHA INJ	PRXOVR	DEF					NA	NA	NA	N
J7185	XYNTHA INJ	MAXFEE	DEF					1.38	7/1/2023	12/31/2299	N
J7186	ANTIHEMOPHILIC VIII/VWF COMP	PRXOVR	DEF					NA	NA	NA	N
J7186	ANTIHEMOPHILIC VIII/VWF COMP	MAXFEE	DEF					1.22	7/1/2023	12/31/2299	N
J7187	HUMATE-P; INJ	PRXOVR	DEF					NA	NA	NA	N
J7187	HUMATE-P; INJ	MAXFEE	DEF					1.35	4/1/2023	12/31/2299	N
J7188	FACTOR VIII RECOMB OBIZUR	PRXOVR	DEF					NA	NA	NA	N
J7188	FACTOR VIII RECOMB OBIZUR	MAXFEE	DEF					3.22	4/1/2023	12/31/2299	N
J7189	FACTOR VIIA RECOMB NOVOSEVEN	PRXOVR	DEF					NA	NA	NA	N
J7189	FACTOR VIIA RECOMB NOVOSEVEN	MAXFEE	DEF					2.41	7/1/2023	12/31/2299	N
J7190	FACTOR VIII	PRXOVR	DEF					NA	NA	NA	N
J7190	FACTOR VIII	MAXFEE	DEF					1.03	7/1/2023	12/31/2299	N
J7192	FACTOR VIII RECOMBINANT NOS	PRXOVR	DEF					NA	NA	NA	N
J7192	FACTOR VIII RECOMBINANT NOS	MAXFEE	DEF					1.51	7/1/2023	12/31/2299	N
J7193	FACTOR IX NON-RECOMBINANT	PRXOVR	DEF					NA	NA	NA	N
J7193	FACTOR IX NON-RECOMBINANT	MAXFEE	DEF					1.30	7/1/2023	12/31/2299	N
J7194	FACTOR IX COMPLEX	PRXOVR	DEF					NA	NA	NA	N
J7194	FACTOR IX COMPLEX	MAXFEE	DEF					1.62	7/1/2023	12/31/2299	N
J7195	FACTOR IX RECOMBINANT NOS	PRXOVR	DEF					NA	NA	NA	N
J7195	FACTOR IX RECOMBINANT NOS	MAXFEE	DEF					1.76	7/1/2023	12/31/2299	N
J7196	ANTITHROMBIN RECOMBINANT	PRXOVR	DEF					NA	NA	NA	N
J7196	ANTITHROMBIN RECOMBINANT	MAXFEE	DEF					0.09	9/1/2013	12/31/2299	N
J7197	ANTITHROMBIN III INJECTION	PRXOVR	DEF					NA	NA	NA	N
J7197	ANTITHROMBIN III INJECTION	MAXFEE	DEF					3.35	7/1/2023	12/31/2299	N
J7198	ANTI-INHIBITOR	PRXOVR	DEF					NA	NA	NA	N
J7198	ANTI-INHIBITOR	MAXFEE	DEF					2.23	7/1/2023	12/31/2299	N
J7199	HEMOPHILIA CLOT FACTOR NOC	PRXOVR	DEF					NA	NA	NA	N
J7199	HEMOPHILIA CLOT FACTOR NOC	MANUAL	DEF					NA	NA	NA	N
J7200	FACTOR IX RECOMBINAN RIXUBIS	PRXOVR	DEF					NA	NA	NA	N
J7200	FACTOR IX RECOMBINAN RIXUBIS	MAXFEE	DEF					1.61	7/1/2023	12/31/2299	N
J7201	FACTOR IX ALPROLIX RECOMB	PRXOVR	DEF					NA	NA	NA	N
J7201	FACTOR IX ALPROLIX RECOMB	MAXFEE	DEF					3.46	7/1/2023	12/31/2299	N
J7202	FACTOR IX IDELVION INJ	PRXOVR	DEF					NA	NA	NA	N
J7202	FACTOR IX IDELVION INJ	MAXFEE	DEF					4.93	7/1/2023	12/31/2299	N
J7203	FACTOR IX RECOMB GLY REBINYN	PRXOVR	DEF					NA	NA	NA	N
J7203	FACTOR IX RECOMB GLY REBINYN	MAXFEE	DEF					4.41	7/1/2023	12/31/2299	N
J7204	INJ RECOMBIN ESPEROCT PER IU	PRXOVR	DEF					NA	NA	NA	N
J7204	INJ RECOMBIN ESPEROCT PER IU	MAXFEE	DEF					2.11	7/1/2023	12/31/2299	N
J7205	FACTOR VIII FC FUSION RECOMB	PRXOVR	DEF					NA	NA	NA	N
J7205	FACTOR VIII FC FUSION RECOMB	MAXFEE	DEF					2.17	7/1/2023	12/31/2299	N
J7207	FACTOR VIII PEGYLATED RECOMB	PRXOVR	DEF					NA	NA	NA	N
J7207	FACTOR VIII PEGYLATED RECOMB	MAXFEE	DEF					2.11	7/1/2023	12/31/2299	N
J7208	INJ. JIVI 1 IU	PRXOVR	DEF					NA	NA	NA	N
J7208	INJ. JIVI 1 IU	MAXFEE	DEF					2.35	7/1/2023	12/31/2299	N
J7209	FACTOR VIII NUWIQ RECOMB 1IU	PRXOVR	DEF					NA	NA	NA	N
J7209	FACTOR VIII NUWIQ RECOMB 1IU	MAXFEE	DEF					1.36	7/1/2023	12/31/2299	N
J7210	INJ; AFSTYLA; 1 I.U.	PRXOVR	DEF					NA	NA	NA	N
J7210	INJ; AFSTYLA; 1 I.U.	MAXFEE	DEF					1.44	4/1/2023	12/31/2299	N
J7211	INJ; KOVALTRY; 1 I.U.	PRXOVR	DEF					NA	NA	NA	N
J7211	INJ; KOVALTRY; 1 I.U.	MAXFEE	DEF					1.44	7/1/2023	12/31/2299	N
J7212	FACTOR VIIA RECOMB SEVENFACT	PRXOVR	DEF					NA	NA	NA	N
J7212	FACTOR VIIA RECOMB SEVENFACT	MAXFEE	DEF					2.01	7/1/2023	12/31/2299	N
J7213	Inj; ixinity; 1 i.u.	PRXOVR	DEF					NA	NA	NA	N
J7213	Inj; ixinity; 1 i.u.	MAXFEE	DEF					1.75	7/1/2023	12/31/2299	N
J7294	SEG ACET AND ETH ESTR YEARLY	PRXOVR	DEF					NA	NA	NA	N
J7294	SEG ACET AND ETH ESTR YEARLY	MAXFEE	DEF					2236.30	10/1/2021	12/31/2299	N
J7295	ETH ESTR AND ETON MONTHLY	PRXOVR	DEF					NA	NA	NA	N
J7295	ETH ESTR AND ETON MONTHLY	MAXFEE	DEF					174.01	10/1/2021	12/31/2299	N
J7296	KYLEENA; 19.5 MG	PRXOVR	DEF					NA	NA	NA	N
J7296	KYLEENA; 19.5 MG	MAXFEE	DEF					1178.82	4/1/2023	12/31/2299	N
J7297	LILETTA; 52 MG	PRXOVR	DEF					NA	NA	NA	N
J7297	LILETTA; 52 MG	MAXFEE	DEF					732.29	4/1/2017	12/31/2299	N
J7298	MIRENA; 52 MG	PRXOVR	DEF					NA	NA	NA	N
J7298	MIRENA; 52 MG	MAXFEE	DEF					1178.82	4/1/2023	12/31/2299	N
J7300	INTRAUT COPPER CONTRACEPTIVE	PRXOVR	DEF					NA	NA	NA	N
J7300	INTRAUT COPPER CONTRACEPTIVE	MAXFEE	DEF					1096.75	1/1/2023	12/31/2299	N
J7301	SKYLA; 13.5 MG	PRXOVR	DEF					NA	NA	NA	N
J7301	SKYLA; 13.5 MG	MAXFEE	DEF					981.56	4/1/2023	12/31/2299	N
J7307	ETONOGESTREL IMPLANT SYSTEM	PRXOVR	DEF					NA	NA	NA	N
J7307	ETONOGESTREL IMPLANT SYSTEM	MAXFEE	DEF					1168.95	10/1/2022	12/31/2299	N
J7308	AMINOLEVULINIC ACID HCL TOP	PRXOVR	DEF					NA	NA	NA	N
J7308	AMINOLEVULINIC ACID HCL TOP	MAXFEE	DEF					391.23	7/1/2023	12/31/2299	N
J7309	METHYL AMINOLEVULINATE; TOP	PRXOVR	DEF					NA	NA	NA	N
J7309	METHYL AMINOLEVULINATE; TOP	MAXFEE	DEF					83.69	1/1/2014	12/31/2299	N
J7310	GANCICLOVIR LONG ACT IMPLANT	PRXOVR	DEF					NA	NA	NA	N
J7310	GANCICLOVIR LONG ACT IMPLANT	MAXFEE	DEF					16960	4/1/2009	12/31/2299	N
J7311	INJ.; RETISERT; 0.01 MG	PRXOVR	DEF					NA	NA	NA	N
J7311	INJ.; RETISERT; 0.01 MG	MAXFEE	DEF					322.38	7/1/2023	12/31/2299	N
J7312	DEXAMETHASONE INTRA IMPLANT	PRXOVR	DEF					NA	NA	NA	N
J7312	DEXAMETHASONE INTRA IMPLANT	MAXFEE	DEF					204.68	7/1/2023	12/31/2299	N
J7313	INJ.; ILUVIEN; 0.01 MG	PRXOVR	DEF					NA	NA	NA	N
J7313	INJ.; ILUVIEN; 0.01 MG	MAXFEE	DEF					490.95	4/1/2021	12/31/2299	N
J7314	INJ.; YUTIQ; 0.01 MG	PRXOVR	DEF					NA	NA	NA	N
J7314	INJ.; YUTIQ; 0.01 MG	MAXFEE	DEF					529.27	7/1/2023	12/31/2299	N
J7315	OPHTHALMIC MITOMYCIN	PRXOVR	DEF					NA	NA	NA	N
J7315	OPHTHALMIC MITOMYCIN	MAXFEE	DEF					384.13	9/1/2013	12/31/2299	N
J7316	INJ; OCRIPLASMIN; 0.125 MG	PRXOVR	DEF					NA	NA	NA	N
J7316	INJ; OCRIPLASMIN; 0.125 MG	MAXFEE	DEF					1046.93	8/1/2019	12/31/2299	N
J7318	INJ; DUROLANE 1 MG	PRXOVR	DEF					NA	NA	NA	N
J7318	INJ; DUROLANE 1 MG	MAXFEE	DEF					6.06	7/1/2023	12/31/2299	N
J7320	GENVISC 850; INJ; 1MG	PRXOVR	DEF					NA	NA	NA	N
J7320	GENVISC 850; INJ; 1MG	MAXFEE	DEF					6.11	7/1/2023	12/31/2299	N
J7321	HYALGAN SUPARTZ VISCO-3 DOSE	PRXOVR	DEF					NA	NA	NA	N
J7321	HYALGAN SUPARTZ VISCO-3 DOSE	MAXFEE	DEF					73.48	7/1/2023	12/31/2299	N
J7322	HYMOVIS INJECTION 1 MG	PRXOVR	DEF					NA	NA	NA	N
J7322	HYMOVIS INJECTION 1 MG	MAXFEE	DEF					17.02	7/1/2023	12/31/2299	N
J7323	EUFLEXXA INJ PER DOSE	PRXOVR	DEF					NA	NA	NA	N
J7323	EUFLEXXA INJ PER DOSE	MAXFEE	DEF					131.42	7/1/2023	12/31/2299	N
J7324	ORTHOVISC INJ PER DOSE	PRXOVR	DEF					NA	NA	NA	N
J7324	ORTHOVISC INJ PER DOSE	MAXFEE	DEF					117.38	7/1/2023	12/31/2299	N
J7325	SYNVISC OR SYNVISC-ONE	PRXOVR	DEF					NA	NA	NA	N
J7325	SYNVISC OR SYNVISC-ONE	MAXFEE	DEF					9.62	7/1/2023	12/31/2299	N
J7326	GEL-ONE	PRXOVR	DEF					NA	NA	NA	N
J7326	GEL-ONE	MAXFEE	DEF					516.73	7/1/2023	12/31/2299	N
J7327	MONOVISC INJ PER DOSE	PRXOVR	DEF					NA	NA	NA	N
J7327	MONOVISC INJ PER DOSE	MAXFEE	DEF					692.75	7/1/2023	12/31/2299	N
J7328	GELSYN-3 INJECTION 0.1 MG	PRXOVR	DEF					NA	NA	NA	N
J7328	GELSYN-3 INJECTION 0.1 MG	MAXFEE	DEF					0.62	7/1/2023	12/31/2299	N
J7329	INJ; TRIVISC 1 MG	PRXOVR	DEF					NA	NA	NA	N
J7329	INJ; TRIVISC 1 MG	MAXFEE	DEF					8.80	7/1/2023	12/31/2299	N
J7330	CULTURED CHONDROCYTES IMPLNT	PRXOVR	DEF					NA	NA	NA	N
J7330	CULTURED CHONDROCYTES IMPLNT	MAXFEE	DEF					55909.64	4/1/2023	12/31/2299	N
J7331	SYNOJOYNT; INJ.; 1 MG	PRXOVR	DEF					NA	NA	NA	N
J7331	SYNOJOYNT; INJ.; 1 MG	MAXFEE	DEF					13.25	4/1/2023	12/31/2299	N
J7332	INJ.; TRILURON; 1 MG	PRXOVR	DEF					NA	NA	NA	N
J7332	INJ.; TRILURON; 1 MG	MAXFEE	DEF					10.06	7/1/2023	12/31/2299	N
J7333	VISCO-3 INJ DOSE	PRXOVR	DEF					NA	NA	NA	N
J7333	VISCO-3 INJ DOSE	MAXFEE	DEF					NA			N
J7336	CAPSAICIN 8% PATCH	PRXOVR	DEF					NA	NA	NA	N
J7336	CAPSAICIN 8% PATCH	MAXFEE	DEF					3.27	7/1/2023	12/31/2299	N
J7340	CARBIDOPA LEVODOPA ENT 100ML	PRXOVR	DEF					NA	NA	NA	N
J7340	CARBIDOPA LEVODOPA ENT 100ML	MAXFEE	DEF					226.83	7/1/2023	12/31/2299	N
J7342	CIPROFLOXACIN OTIC SUSP 6 MG	PRXOVR	DEF					NA	NA	NA	N
J7342	CIPROFLOXACIN OTIC SUSP 6 MG	MAXFEE	DEF					30.02	7/1/2023	12/31/2299	N
J7345	AMINOLEVULINIC ACID; 10% GEL	PRXOVR	DEF					NA	NA	NA	N
J7345	AMINOLEVULINIC ACID; 10% GEL	MAXFEE	DEF					1.65	4/1/2023	12/31/2299	N
J7351	INJ BIMATOPROST ITC IMP1MCG	PRXOVR	DEF					NA	NA	NA	N
J7351	INJ BIMATOPROST ITC IMP1MCG	MAXFEE	DEF					206.41	7/1/2023	12/31/2299	N
J7352	AFAMELANOTIDE IMPLANT; 1 MG	PRXOVR	DEF					NA	NA	NA	N
J7352	AFAMELANOTIDE IMPLANT; 1 MG	MANUAL	DEF					NA	NA	NA	N
J7401	MOMETASONE FUROATE SINUS IMP	PRXOVR	DEF					NA	NA	NA	N
J7401	MOMETASONE FUROATE SINUS IMP	MANUAL	DEF					NA	NA	NA	N
J7402	MOMETASONE SINUS SINUVA	PRXOVR	DEF					NA	NA	NA	N
J7402	MOMETASONE SINUS SINUVA	MAXFEE	DEF					11.35	1/1/2023	12/31/2299	N
J7500	AZATHIOPRINE ORAL 50MG	PRXOVR	DEF					NA	NA	NA	N
J7500	AZATHIOPRINE ORAL 50MG	MAXFEE	DEF					13.70	7/1/2023	12/31/2299	N
J7501	AZATHIOPRINE PARENTERAL	PRXOVR	DEF					NA	NA	NA	N
J7501	AZATHIOPRINE PARENTERAL	MAXFEE	DEF					217.30	1/1/2014	12/31/2299	N
J7502	CYCLOSPORINE ORAL 100 MG	PRXOVR	DEF					NA	NA	NA	N
J7502	CYCLOSPORINE ORAL 100 MG	MAXFEE	DEF					1.76	7/1/2023	12/31/2299	N
J7503	TACROL ENVARSUS EX REL ORAL	PRXOVR	DEF					NA	NA	NA	N
J7503	TACROL ENVARSUS EX REL ORAL	MAXFEE	DEF					1.67	7/1/2023	12/31/2299	N
J7504	LYMPHOCYTE IMMUNE GLOBULIN	PRXOVR	DEF					NA	NA	NA	N
J7504	LYMPHOCYTE IMMUNE GLOBULIN	MAXFEE	DEF					2989.44	7/1/2023	12/31/2299	N
J7505	MONOCLONAL ANTIBODIES	PRXOVR	DEF					NA	NA	NA	N
J7505	MONOCLONAL ANTIBODIES	MAXFEE	DEF					1156.08	9/1/2013	12/31/2299	N
J7507	TACROLIMUS IMME REL ORAL 1MG	PRXOVR	DEF					NA	NA	NA	N
J7507	TACROLIMUS IMME REL ORAL 1MG	MAXFEE	DEF					0.29	7/1/2023	12/31/2299	N
J7508	TACROL ASTAGRAF EX REL ORAL	PRXOVR	DEF					NA	NA	NA	N
J7508	TACROL ASTAGRAF EX REL ORAL	MAXFEE	DEF					0.55	7/1/2023	12/31/2299	N
J7509	METHYLPREDNISOLONE ORAL	PRXOVR	DEF					NA	NA	NA	N
J7509	METHYLPREDNISOLONE ORAL	MAXFEE	DEF					0.26	7/1/2023	12/31/2299	N
J7510	PREDNISOLONE ORAL PER 5 MG	PRXOVR	DEF					NA	NA	NA	N
J7510	PREDNISOLONE ORAL PER 5 MG	MAXFEE	DEF					0.25	7/1/2023	12/31/2299	N
J7511	ANTITHYMOCYTE GLOBULN RABBIT	PRXOVR	DEF					NA	NA	NA	N
J7511	ANTITHYMOCYTE GLOBULN RABBIT	MAXFEE	DEF					920.53	7/1/2023	12/31/2299	N
J7512	PREDNISONE IR OR DR ORAL 1MG	PRXOVR	DEF					NA	NA	NA	N
J7512	PREDNISONE IR OR DR ORAL 1MG	MAXFEE	DEF					0.01	4/1/2023	12/31/2299	N
J7513	DACLIZUMAB; PARENTERAL	PRXOVR	DEF					NA	NA	NA	N
J7513	DACLIZUMAB; PARENTERAL	MAXFEE	DEF					526.34	9/1/2013	12/31/2299	N
J7515	CYCLOSPORINE ORAL 25 MG	PRXOVR	DEF					NA	NA	NA	N
J7515	CYCLOSPORINE ORAL 25 MG	MAXFEE	DEF					0.75	4/1/2023	12/31/2299	N
J7516	CYCLOSPORIN PARENTERAL 250MG	PRXOVR	DEF					NA	NA	NA	N
J7516	CYCLOSPORIN PARENTERAL 250MG	MAXFEE	DEF					50.12	1/1/2023	12/31/2299	N
J7517	MYCOPHENOLATE MOFETIL ORAL	PRXOVR	DEF					NA	NA	NA	N
J7517	MYCOPHENOLATE MOFETIL ORAL	MAXFEE	DEF					0.21	7/1/2023	12/31/2299	N
J7518	MYCOPHENOLIC ACID	PRXOVR	DEF					NA	NA	NA	N
J7518	MYCOPHENOLIC ACID	MAXFEE	DEF					0.67	7/1/2023	12/31/2299	N
J7520	SIROLIMUS; ORAL	PRXOVR	DEF					NA	NA	NA	N
J7520	SIROLIMUS; ORAL	MAXFEE	DEF					3.11	7/1/2023	12/31/2299	N
J7525	TACROLIMUS INJECTION	PRXOVR	DEF					NA	NA	NA	N
J7525	TACROLIMUS INJECTION	MAXFEE	DEF					246.09	7/1/2023	12/31/2299	N
J7527	ORAL EVEROLIMUS	PRXOVR	DEF					NA	NA	NA	N
J7527	ORAL EVEROLIMUS	MAXFEE	DEF					3.20	7/1/2023	12/31/2299	N
J7599	IMMUNOSUPPRESSIVE DRUG NOC	PRXOVR	DEF					NA	NA	NA	N
J7599	IMMUNOSUPPRESSIVE DRUG NOC	MANUAL	DEF					NA	NA	NA	N
J7604	ACETYLCYSTEINE COMP UNIT	PRXOVR	DEF					NA	NA	NA	N
J7604	ACETYLCYSTEINE COMP UNIT	MANUAL	DEF					NA	NA	NA	N
J7605	ARFORMOTEROL NON-COMP UNIT	PRXOVR	DEF					NA	NA	NA	N
J7605	ARFORMOTEROL NON-COMP UNIT	MAXFEE	DEF					3.29	7/1/2023	12/31/2299	N
J7606	FORMOTEROL FUMARATE; INH	PRXOVR	DEF					NA	NA	NA	N
J7606	FORMOTEROL FUMARATE; INH	MAXFEE	DEF					5.19	7/1/2023	12/31/2299	N
J7607	LEVALBUTEROL COMP CON	PRXOVR	DEF					NA	NA	NA	N
J7607	LEVALBUTEROL COMP CON	MAXFEE	DEF					0.28	9/1/2013	12/31/2299	N
J7608	ACETYLCYSTEINE NON-COMP UNIT	PRXOVR	DEF					NA	NA	NA	N
J7608	ACETYLCYSTEINE NON-COMP UNIT	MAXFEE	DEF					6.84	7/1/2023	12/31/2299	N
J7609	ALBUTEROL COMP UNIT	PRXOVR	DEF					NA	NA	NA	N
J7609	ALBUTEROL COMP UNIT	MAXFEE	DEF					0.05	9/1/2013	12/31/2299	N
J7610	ALBUTEROL COMP CON	PRXOVR	DEF					NA	NA	NA	N
J7610	ALBUTEROL COMP CON	MAXFEE	DEF					0.11	9/1/2013	12/31/2299	N
J7611	ALBUTEROL NON-COMP CON	PRXOVR	DEF					NA	NA	NA	N
J7611	ALBUTEROL NON-COMP CON	MAXFEE	DEF					0.13	7/1/2023	12/31/2299	N
J7612	LEVALBUTEROL NON-COMP CON	PRXOVR	DEF					NA	NA	NA	N
J7612	LEVALBUTEROL NON-COMP CON	MAXFEE	DEF					0.25	7/1/2023	12/31/2299	N
J7613	ALBUTEROL NON-COMP UNIT	PRXOVR	DEF					NA	NA	NA	N
J7613	ALBUTEROL NON-COMP UNIT	MAXFEE	DEF					0.03	4/1/2023	12/31/2299	N
J7614	LEVALBUTEROL NON-COMP UNIT	PRXOVR	DEF					NA	NA	NA	N
J7614	LEVALBUTEROL NON-COMP UNIT	MAXFEE	DEF					0.04	4/1/2023	12/31/2299	N
J7615	LEVALBUTEROL COMP UNIT	PRXOVR	DEF					NA	NA	NA	N
J7615	LEVALBUTEROL COMP UNIT	MAXFEE	DEF					0.12	9/1/2013	12/31/2299	N
J7620	ALBUTEROL IPRATROP NON-COMP	PRXOVR	DEF					NA	NA	NA	N
J7620	ALBUTEROL IPRATROP NON-COMP	MAXFEE	DEF					0.13	4/1/2022	12/31/2299	N
J7622	BECLOMETHASONE COMP UNIT	PRXOVR	DEF					NA	NA	NA	N
J7622	BECLOMETHASONE COMP UNIT	MAXFEE	DEF					0.03	9/1/2013	12/31/2299	N
J7624	BETAMETHASONE COMP UNIT	PRXOVR	DEF					NA	NA	NA	N
J7624	BETAMETHASONE COMP UNIT	MAXFEE	DEF					1.21	9/1/2013	12/31/2299	N
J7626	BUDESONIDE NON-COMP UNIT	PRXOVR	DEF					NA	NA	NA	N
J7626	BUDESONIDE NON-COMP UNIT	MAXFEE	DEF					0.88	7/1/2023	12/31/2299	N
J7627	BUDESONIDE COMP UNIT	PRXOVR	DEF					NA	NA	NA	N
J7627	BUDESONIDE COMP UNIT	MAXFEE	DEF					5.10	9/1/2013	12/31/2299	N
J7629	BITOLTEROL MESYLATE COMP UNT	PRXOVR	DEF					NA	NA	NA	N
J7629	BITOLTEROL MESYLATE COMP UNT	MAXFEE	DEF					0.17	9/1/2013	12/31/2299	N
J7631	CROMOLYN SODIUM NONCOMP UNIT	PRXOVR	DEF					NA	NA	NA	N
J7631	CROMOLYN SODIUM NONCOMP UNIT	MAXFEE	DEF					1.66	7/1/2023	12/31/2299	N
J7632	CROMOLYN SODIUM COMP UNIT	PRXOVR	DEF					NA	NA	NA	N
J7632	CROMOLYN SODIUM COMP UNIT	MAXFEE	DEF					0.55	9/1/2013	12/31/2299	N
J7633	BUDESONIDE NON-COMP CON	PRXOVR	DEF					NA	NA	NA	N
J7633	BUDESONIDE NON-COMP CON	MAXFEE	DEF					8.06	9/1/2013	12/31/2299	N
J7634	BUDESONIDE COMP CON	PRXOVR	DEF					NA	NA	NA	N
J7634	BUDESONIDE COMP CON	MAXFEE	DEF					8.06	9/1/2013	12/31/2299	N
J7635	ATROPINE COMP CON	PRXOVR	DEF					NA	NA	NA	N
J7635	ATROPINE COMP CON	MAXFEE	DEF					0.11	9/1/2013	12/31/2299	N
J7636	ATROPINE COMP UNIT	PRXOVR	DEF					NA	NA	NA	N
J7636	ATROPINE COMP UNIT	MAXFEE	DEF					0.11	9/1/2013	12/31/2299	N
J7637	DEXAMETHASONE COMP CON	PRXOVR	DEF					NA	NA	NA	N
J7637	DEXAMETHASONE COMP CON	MAXFEE	DEF					0.06	9/1/2013	12/31/2299	N
J7638	DEXAMETHASONE COMP UNIT	PRXOVR	DEF					NA	NA	NA	N
J7638	DEXAMETHASONE COMP UNIT	MAXFEE	DEF					0.12	9/1/2013	12/31/2299	N
J7639	DORNASE ALFA NON-COMP UNIT	PRXOVR	DEF					NA	NA	NA	N
J7639	DORNASE ALFA NON-COMP UNIT	MAXFEE	DEF					52.23	7/1/2023	12/31/2299	N
J7640	FORMOTEROL COMP UNIT	PRXOVR	DEF					NA	NA	NA	N
J7640	FORMOTEROL COMP UNIT	MAXFEE	DEF					5.91	9/1/2013	12/31/2299	N
J7641	FLUNISOLIDE COMP UNIT	PRXOVR	DEF					NA	NA	NA	N
J7641	FLUNISOLIDE COMP UNIT	MAXFEE	DEF					0.14	9/1/2013	12/31/2299	N
J7642	GLYCOPYRROLATE COMP CON	PRXOVR	DEF					NA	NA	NA	N
J7642	GLYCOPYRROLATE COMP CON	MAXFEE	DEF					1.04	9/1/2013	12/31/2299	N
J7643	GLYCOPYRROLATE COMP UNIT	PRXOVR	DEF					NA	NA	NA	N
J7643	GLYCOPYRROLATE COMP UNIT	MAXFEE	DEF					1.04	9/1/2013	12/31/2299	N
J7644	IPRATROPIUM BROMIDE NON-COMP	PRXOVR	DEF					NA	NA	NA	N
J7644	IPRATROPIUM BROMIDE NON-COMP	MAXFEE	DEF					0.26	7/1/2023	12/31/2299	N
J7645	IPRATROPIUM BROMIDE COMP	PRXOVR	DEF					NA	NA	NA	N
J7645	IPRATROPIUM BROMIDE COMP	MAXFEE	DEF					0.23	9/1/2013	12/31/2299	N
J7669	METAPROTERENOL NON-COMP UNIT	PRXOVR	DEF					NA	NA	NA	N
J7669	METAPROTERENOL NON-COMP UNIT	MAXFEE	DEF					0.44	11/1/2013	12/31/2299	N
J7674	METHACHOLINE CHLORIDE; NEB	PRXOVR	DEF					NA	NA	NA	N
J7674	METHACHOLINE CHLORIDE; NEB	MAXFEE	DEF					0.86	7/1/2023	12/31/2299	N
J7676	PENTAMIDINE COMP UNIT DOSE	PRXOVR	DEF					NA	NA	NA	N
J7676	PENTAMIDINE COMP UNIT DOSE	MAXFEE	DEF					80.73	9/1/2013	12/31/2299	N
J7677	REVEFENACIN INH NON-COM 1MCG	PRXOVR	DEF					NA	NA	NA	N
J7677	REVEFENACIN INH NON-COM 1MCG	MAXFEE	DEF					0.20	7/1/2023	12/31/2299	N
J7680	TERBUTALINE SULF COMP CON	PRXOVR	DEF					NA	NA	NA	N
J7680	TERBUTALINE SULF COMP CON	MAXFEE	DEF					4.44	9/1/2013	12/31/2299	N
J7681	TERBUTALINE SULF COMP UNIT	PRXOVR	DEF					NA	NA	NA	N
J7681	TERBUTALINE SULF COMP UNIT	MAXFEE	DEF					4.62	9/1/2013	12/31/2299	N
J7682	TOBRAMYCIN NON-COMP UNIT	PRXOVR	DEF					NA	NA	NA	N
J7682	TOBRAMYCIN NON-COMP UNIT	MAXFEE	DEF					29.62	7/1/2023	12/31/2299	N
J7683	TRIAMCINOLONE COMP CON	PRXOVR	DEF					NA	NA	NA	N
J7683	TRIAMCINOLONE COMP CON	MAXFEE	DEF					0.10	9/1/2013	12/31/2299	N
J7684	TRIAMCINOLONE COMP UNIT	PRXOVR	DEF					NA	NA	NA	N
J7684	TRIAMCINOLONE COMP UNIT	MAXFEE	DEF					0.17	9/1/2013	12/31/2299	N
J7685	TOBRAMYCIN COMP UNIT	PRXOVR	DEF					NA	NA	NA	N
J7685	TOBRAMYCIN COMP UNIT	MAXFEE	DEF					118.58	9/1/2013	12/31/2299	N
J7686	TREPROSTINIL; NON-COMP UNIT	PRXOVR	DEF					NA	NA	NA	N
J7686	TREPROSTINIL; NON-COMP UNIT	MAXFEE	DEF					737.38	7/1/2023	12/31/2299	N
J7699	INHALATION SOLUTION FOR DME	PRXOVR	DEF					NA	NA	NA	N
J7699	INHALATION SOLUTION FOR DME	MANUAL	DEF					NA	NA	NA	N
J7799	NON-INHALATION DRUG FOR DME	PRXOVR	DEF					NA	NA	NA	N
J7799	NON-INHALATION DRUG FOR DME	MANUAL	DEF					NA	NA	NA	N
J8498	ANTIEMETIC RECTAL/SUPP NOS	PRXOVR	DEF					NA	NA	NA	N
J8498	ANTIEMETIC RECTAL/SUPP NOS	MANUAL	DEF					NA	NA	NA	N
J8499	ORAL PRESCRIP DRUG NON CHEMO	PRXOVR	DEF					NA	NA	NA	N
J8499	ORAL PRESCRIP DRUG NON CHEMO	MANUAL	DEF					NA	NA	NA	N
J8501	ORAL APREPITANT	PRXOVR	DEF					NA	NA	NA	N
J8501	ORAL APREPITANT	MAXFEE	DEF					3.12	7/1/2023	12/31/2299	N
J8510	ORAL BUSULFAN	PRXOVR	DEF					NA	NA	NA	N
J8510	ORAL BUSULFAN	MAXFEE	DEF					24.18	11/1/2019	12/31/2299	N
J8515	CABERGOLINE; ORAL 0.25MG	PRXOVR	DEF					NA	NA	NA	N
J8515	CABERGOLINE; ORAL 0.25MG	MAXFEE	DEF					24.38	9/1/2013	12/31/2299	N
J8520	CAPECITABINE; ORAL; 150 MG	PRXOVR	DEF					NA	NA	NA	N
J8520	CAPECITABINE; ORAL; 150 MG	MAXFEE	DEF					0.80	7/1/2023	12/31/2299	N
J8521	CAPECITABINE; ORAL; 500 MG	PRXOVR	DEF					NA	NA	NA	N
J8521	CAPECITABINE; ORAL; 500 MG	MAXFEE	DEF					22.88	7/1/2023	12/31/2299	N
J8530	CYCLOPHOSPHAMIDE ORAL 25 MG	PRXOVR	DEF					NA	NA	NA	N
J8530	CYCLOPHOSPHAMIDE ORAL 25 MG	MAXFEE	DEF					0.95	7/1/2023	12/31/2299	N
J8540	ORAL DEXAMETHASONE	PRXOVR	DEF					NA	NA	NA	N
J8540	ORAL DEXAMETHASONE	MAXFEE	DEF					0.10	7/1/2023	12/31/2299	N
J8560	ETOPOSIDE ORAL 50 MG	PRXOVR	DEF					NA	NA	NA	N
J8560	ETOPOSIDE ORAL 50 MG	MAXFEE	DEF					77.39	7/1/2023	12/31/2299	N
J8562	ORAL FLUDARABINE PHOSPHATE	PRXOVR	DEF					NA	NA	NA	N
J8562	ORAL FLUDARABINE PHOSPHATE	MAXFEE	DEF					81.77	9/1/2013	12/31/2299	N
J8597	ANTIEMETIC DRUG ORAL NOS	PRXOVR	DEF					NA	NA	NA	N
J8597	ANTIEMETIC DRUG ORAL NOS	MANUAL	DEF					NA	NA	NA	N
J8600	MELPHALAN ORAL 2 MG	PRXOVR	DEF					NA	NA	NA	N
J8600	MELPHALAN ORAL 2 MG	MAXFEE	DEF					12	11/1/2018	12/31/2299	N
J8610	METHOTREXATE ORAL 2.5 MG	PRXOVR	DEF					NA	NA	NA	N
J8610	METHOTREXATE ORAL 2.5 MG	MAXFEE	DEF					0.23	7/1/2023	12/31/2299	N
J8650	NABILONE ORAL	PRXOVR	DEF					NA	NA	NA	N
J8650	NABILONE ORAL	MAXFEE	DEF					87.32	9/1/2013	12/31/2299	N
J8655	ORAL NETUPITANT; PALONOSETRO	PRXOVR	DEF					NA	NA	NA	N
J8655	ORAL NETUPITANT; PALONOSETRO	MAXFEE	DEF					461.26	7/1/2023	12/31/2299	N
J8670	ROLAPITANT; ORAL; 1MG	PRXOVR	DEF					NA	NA	NA	N
J8670	ROLAPITANT; ORAL; 1MG	MAXFEE	DEF					1.63	7/1/2023	12/31/2299	N
J8700	TEMOZOLOMIDE	PRXOVR	DEF					NA	NA	NA	N
J8700	TEMOZOLOMIDE	MAXFEE	DEF					0.19	7/1/2023	12/31/2299	N
J8705	TOPOTECAN ORAL	PRXOVR	DEF					NA	NA	NA	N
J8705	TOPOTECAN ORAL	MAXFEE	DEF					112.30	7/1/2023	12/31/2299	N
J8999	ORAL PRESCRIPTION DRUG CHEMO	PRXOVR	DEF					NA	NA	NA	N
J8999	ORAL PRESCRIPTION DRUG CHEMO	MANUAL	DEF					NA	NA	NA	N
J9000	DOXORUBICIN HCL INJECTION	PRXOVR	DEF					NA	NA	NA	N
J9000	DOXORUBICIN HCL INJECTION	MAXFEE	DEF					2.50	7/1/2023	12/31/2299	N
J9015	ALDESLEUKIN INJECTION	PRXOVR	DEF					NA	NA	NA	N
J9015	ALDESLEUKIN INJECTION	MAXFEE	DEF					2110.63	11/1/2014	12/31/2299	N
J9017	ARSENIC TRIOXIDE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J9017	ARSENIC TRIOXIDE INJECTION	MAXFEE	DEF					12.97	7/1/2023	12/31/2299	N
J9019	ERWINAZE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J9019	ERWINAZE INJECTION	MAXFEE	DEF					427.27	10/1/2020	12/31/2299	N
J9020	ASPARAGINASE; NOS	PRXOVR	DEF					NA	NA	NA	N
J9020	ASPARAGINASE; NOS	MAXFEE	DEF					64.56	5/1/2015	12/31/2299	N
J9021	INJ; ASPARA; RYLAZE; 0.1 MG	PRXOVR	DEF					NA	NA	NA	N
J9021	INJ; ASPARA; RYLAZE; 0.1 MG	MAXFEE	DEF					49.53	7/1/2023	12/31/2299	N
J9022	INJ; ATEZOLIZUMAB;10 MG	PRXOVR	DEF					NA	NA	NA	N
J9022	INJ; ATEZOLIZUMAB;10 MG	MAXFEE	DEF					82.68	7/1/2023	12/31/2299	N
J9023	INJECTION; AVELUMAB; 10 MG	PRXOVR	DEF					NA	NA	NA	N
J9023	INJECTION; AVELUMAB; 10 MG	MAXFEE	DEF					90.57	7/1/2023	12/31/2299	N
J9025	AZACITIDINE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J9025	AZACITIDINE INJECTION	MAXFEE	DEF					0.40	7/1/2023	12/31/2299	N
J9027	CLOFARABINE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J9027	CLOFARABINE INJECTION	MAXFEE	DEF					29.42	7/1/2023	12/31/2299	N
J9029	Inj; adstiladrin; per tx dos	PRXOVR	DEF					NA	NA	NA	N
J9029	Inj; adstiladrin; per tx dos	MAXFEE	DEF					0	7/1/2023	12/31/2299	N
J9030	BCG LIVE INTRAVESICAL 1MG	PRXOVR	DEF					NA	NA	NA	N
J9030	BCG LIVE INTRAVESICAL 1MG	MAXFEE	DEF					2.89	7/1/2023	12/31/2299	N
J9032	INJECTION; BELINOSTAT; 10MG	PRXOVR	DEF					NA	NA	NA	N
J9032	INJECTION; BELINOSTAT; 10MG	MAXFEE	DEF					47.62	7/1/2023	12/31/2299	N
J9033	INJ.; TREANDA 1 MG	PRXOVR	DEF					NA	NA	NA	N
J9033	INJ.; TREANDA 1 MG	MAXFEE	DEF					12.28	7/1/2023	12/31/2299	N
J9034	INJ.; BENDEKA 1 MG	PRXOVR	DEF					NA	NA	NA	N
J9034	INJ.; BENDEKA 1 MG	MAXFEE	DEF					16.51	7/1/2023	12/31/2299	N
J9035	BEVACIZUMAB INJECTION	PRXOVR	DEF					NA	NA	NA	N
J9035	BEVACIZUMAB INJECTION	MAXFEE	DEF					73.58	7/1/2023	12/31/2299	N
J9036	INJ. BELRAPZO/BENDAMUSTINE	PRXOVR	DEF					NA	NA	NA	N
J9036	INJ. BELRAPZO/BENDAMUSTINE	MAXFEE	DEF					16.72	7/1/2023	12/31/2299	N
J9037	INJ BELANTAMAB MAFODOT BLMF	PRXOVR	DEF					NA	NA	NA	N
J9037	INJ BELANTAMAB MAFODOT BLMF	MAXFEE	DEF					45.28	1/1/2023	12/31/2299	N
J9039	INJECTION; BLINATUMOMAB	PRXOVR	DEF					NA	NA	NA	N
J9039	INJECTION; BLINATUMOMAB	MAXFEE	DEF					144.68	7/1/2023	12/31/2299	N
J9040	BLEOMYCIN SULFATE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J9040	BLEOMYCIN SULFATE INJECTION	MAXFEE	DEF					24.53	7/1/2023	12/31/2299	N
J9041	INJECTION; BORTEZOMIB; 0.1MG	PRXOVR	DEF					NA	NA	NA	N
J9041	INJECTION; BORTEZOMIB; 0.1MG	MAXFEE	DEF					3.03	7/1/2023	12/31/2299	N
J9042	BRENTUXIMAB VEDOTIN INJ	PRXOVR	DEF					NA	NA	NA	N
J9042	BRENTUXIMAB VEDOTIN INJ	MAXFEE	DEF					221.96	7/1/2023	12/31/2299	N
J9043	CABAZITAXEL INJECTION	PRXOVR	DEF					NA	NA	NA	N
J9043	CABAZITAXEL INJECTION	MAXFEE	DEF					206.03	7/1/2023	12/31/2299	N
J9044	INJ; BORTEZOMIB; NOS; 0.1 MG	PRXOVR	DEF					NA	NA	NA	N
J9044	INJ; BORTEZOMIB; NOS; 0.1 MG	MAXFEE	DEF					NA			N
J9045	CARBOPLATIN INJECTION	PRXOVR	DEF					NA	NA	NA	N
J9045	CARBOPLATIN INJECTION	MAXFEE	DEF					2.41	7/1/2023	12/31/2299	N
J9046	INJ; BORTEZOMIB; DR. REDDY'S	PRXOVR	DEF					NA	NA	NA	N
J9046	INJ; BORTEZOMIB; DR. REDDY'S	MAXFEE	DEF					48.55	7/1/2023	12/31/2299	N
J9047	INJECTION; CARFILZOMIB; 1 MG	PRXOVR	DEF					NA	NA	NA	N
J9047	INJECTION; CARFILZOMIB; 1 MG	MAXFEE	DEF					47.04	7/1/2023	12/31/2299	N
J9048	INJ; BORTEZOMIB FRESENIUSKAB	PRXOVR	DEF					NA	NA	NA	N
J9048	INJ; BORTEZOMIB FRESENIUSKAB	MAXFEE	DEF					2.68	1/1/2023	12/31/2299	N
J9049	INJ; BORTEZOMIB; HOSPIRA	PRXOVR	DEF					NA	NA	NA	N
J9049	INJ; BORTEZOMIB; HOSPIRA	MAXFEE	DEF					3.89	7/1/2023	12/31/2299	N
J9050	CARMUSTINE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J9050	CARMUSTINE INJECTION	MAXFEE	DEF					410.96	7/1/2023	12/31/2299	N
J9055	CETUXIMAB INJECTION	PRXOVR	DEF					NA	NA	NA	N
J9055	CETUXIMAB INJECTION	MAXFEE	DEF					72.08	7/1/2023	12/31/2299	N
J9056	Inj; bendamustine; 1 mg	PRXOVR	DEF					NA	NA	NA	N
J9056	Inj; bendamustine; 1 mg	MAXFEE	DEF					33.33	7/1/2023	12/31/2299	N
J9057	INJ.; COPANLISIB; 1 MG	PRXOVR	DEF					NA	NA	NA	N
J9057	INJ.; COPANLISIB; 1 MG	MAXFEE	DEF					81.57	1/1/2019	12/31/2299	N
J9058	Inj apotex/bendamustine 1 mg	PRXOVR	DEF					NA	NA	NA	N
J9058	Inj apotex/bendamustine 1 mg	MAXFEE	DEF					34.34	7/1/2023	12/31/2299	N
J9059	Inj bendamustine; baxter 1mg	PRXOVR	DEF					NA	NA	NA	N
J9059	Inj bendamustine; baxter 1mg	MAXFEE	DEF					23.96	7/1/2023	12/31/2299	N
J9060	CISPLATIN 10 MG INJECTION	PRXOVR	DEF					NA	NA	NA	N
J9060	CISPLATIN 10 MG INJECTION	MAXFEE	DEF					3.17	7/1/2023	12/31/2299	N
J9061	INJ; AMIVANTAMAB-VMJW	PRXOVR	DEF					NA	NA	NA	N
J9061	INJ; AMIVANTAMAB-VMJW	MAXFEE	DEF					19.63	7/1/2023	12/31/2299	N
J9063	Inj; elahere; 1 mg	PRXOVR	DEF					NA	NA	NA	N
J9063	Inj; elahere; 1 mg	MAXFEE	DEF					65.80	7/1/2023	12/31/2299	N
J9065	INJ CLADRIBINE PER 1 MG	PRXOVR	DEF					NA	NA	NA	N
J9065	INJ CLADRIBINE PER 1 MG	MAXFEE	DEF					18.30	7/1/2023	12/31/2299	N
J9070	CYCLOPHOSPHAMIDE 100 MG INJ	PRXOVR	DEF					NA	NA	NA	N
J9070	CYCLOPHOSPHAMIDE 100 MG INJ	MAXFEE	DEF					17.09	7/1/2023	12/31/2299	N
J9071	INJ CYCLOPHOSPHAMD AUROMEDIC	PRXOVR	DEF					NA	NA	NA	N
J9071	INJ CYCLOPHOSPHAMD AUROMEDIC	MAXFEE	DEF					3.87	4/1/2023	12/31/2299	N
J9098	CYTARABINE LIPOSOME INJ	PRXOVR	DEF					NA	NA	NA	N
J9098	CYTARABINE LIPOSOME INJ	MAXFEE	DEF					628.37	5/1/2018	12/31/2299	N
J9100	CYTARABINE HCL 100 MG INJ	PRXOVR	DEF					NA	NA	NA	N
J9100	CYTARABINE HCL 100 MG INJ	MAXFEE	DEF					0.92	7/1/2023	12/31/2299	N
J9118	INJ. CALASPARGASE PEGOL-MKNL	PRXOVR	DEF					NA	NA	NA	N
J9118	INJ. CALASPARGASE PEGOL-MKNL	MAXFEE	DEF					72.87	7/1/2023	12/31/2299	N
J9119	INJ.; CEMIPLIMAB-RWLC; 1 MG	PRXOVR	DEF					NA	NA	NA	N
J9119	INJ.; CEMIPLIMAB-RWLC; 1 MG	MAXFEE	DEF					26.92	7/1/2023	12/31/2299	N
J9120	DACTINOMYCIN INJECTION	PRXOVR	DEF					NA	NA	NA	N
J9120	DACTINOMYCIN INJECTION	MAXFEE	DEF					594.55	7/1/2023	12/31/2299	N
J9130	DACARBAZINE 100 MG INJ	PRXOVR	DEF					NA	NA	NA	N
J9130	DACARBAZINE 100 MG INJ	MAXFEE	DEF					4.05	7/1/2023	12/31/2299	N
J9144	DARATUMUMAB; HYALURONIDASE	PRXOVR	DEF					NA	NA	NA	N
J9144	DARATUMUMAB; HYALURONIDASE	MAXFEE	DEF					49.12	7/1/2023	12/31/2299	N
J9145	INJECTION; DARATUMUMAB 10 MG	PRXOVR	DEF					NA	NA	NA	N
J9145	INJECTION; DARATUMUMAB 10 MG	MAXFEE	DEF					61.78	7/1/2023	12/31/2299	N
J9150	DAUNORUBICIN INJECTION	PRXOVR	DEF					NA	NA	NA	N
J9150	DAUNORUBICIN INJECTION	MAXFEE	DEF					45.62	7/1/2023	12/31/2299	N
J9151	DAUNORUBICIN CITRATE INJ	PRXOVR	DEF					NA	NA	NA	N
J9151	DAUNORUBICIN CITRATE INJ	MAXFEE	DEF					246.10	9/1/2013	12/31/2299	N
J9153	INJ DAUNORUBICIN; CYTARABINE	PRXOVR	DEF					NA	NA	NA	N
J9153	INJ DAUNORUBICIN; CYTARABINE	MAXFEE	DEF					227.23	7/1/2023	12/31/2299	N
J9155	DEGARELIX INJECTION	PRXOVR	DEF					NA	NA	NA	N
J9155	DEGARELIX INJECTION	MAXFEE	DEF					4.19	7/1/2023	12/31/2299	N
J9160	DENILEUKIN DIFTITOX INJ	PRXOVR	DEF					NA	NA	NA	N
J9160	DENILEUKIN DIFTITOX INJ	MAXFEE	DEF					1646.18	9/1/2013	12/31/2299	N
J9171	DOCETAXEL INJECTION	PRXOVR	DEF					NA	NA	NA	N
J9171	DOCETAXEL INJECTION	MAXFEE	DEF					0.94	7/1/2023	12/31/2299	N
J9173	INJ.; DURVALUMAB; 10 MG	PRXOVR	DEF					NA	NA	NA	N
J9173	INJ.; DURVALUMAB; 10 MG	MAXFEE	DEF					79.76	7/1/2023	12/31/2299	N
J9175	ELLIOTTS B SOLUTION PER ML	PRXOVR	DEF					NA	NA	NA	N
J9175	ELLIOTTS B SOLUTION PER ML	MAXFEE	DEF					4.16	1/1/2014	12/31/2299	N
J9176	INJECTION; ELOTUZUMAB; 1MG	PRXOVR	DEF					NA	NA	NA	N
J9176	INJECTION; ELOTUZUMAB; 1MG	MAXFEE	DEF					7.19	7/1/2023	12/31/2299	N
J9177	INJ ENFORT VEDO-EJFV 0.25MG	PRXOVR	DEF					NA	NA	NA	N
J9177	INJ ENFORT VEDO-EJFV 0.25MG	MAXFEE	DEF					33.82	7/1/2023	12/31/2299	N
J9178	INJ; EPIRUBICIN HCL; 2 MG	PRXOVR	DEF					NA	NA	NA	N
J9178	INJ; EPIRUBICIN HCL; 2 MG	MAXFEE	DEF					1.34	7/1/2023	12/31/2299	N
J9179	ERIBULIN MESYLATE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J9179	ERIBULIN MESYLATE INJECTION	MAXFEE	DEF					128.78	7/1/2023	12/31/2299	N
J9181	ETOPOSIDE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J9181	ETOPOSIDE INJECTION	MAXFEE	DEF					0.70	7/1/2023	12/31/2299	N
J9185	FLUDARABINE PHOSPHATE INJ	PRXOVR	DEF					NA	NA	NA	N
J9185	FLUDARABINE PHOSPHATE INJ	MAXFEE	DEF					604.75	7/1/2023	12/31/2299	N
J9190	FLUOROURACIL INJECTION	PRXOVR	DEF					NA	NA	NA	N
J9190	FLUOROURACIL INJECTION	MAXFEE	DEF					1.83	7/1/2023	12/31/2299	N
J9196	INJ GEMCITABINE HCL (ACCORD)	PRXOVR	DEF					NA	NA	NA	N
J9196	INJ GEMCITABINE HCL (ACCORD)	MAXFEE	DEF					3.72	7/1/2023	12/31/2299	N
J9198	INJ. INFUGEM; 100 MG	PRXOVR	DEF					NA	NA	NA	N
J9198	INJ. INFUGEM; 100 MG	MAXFEE	DEF					40.28	7/1/2023	12/31/2299	N
J9199	INJECTION; INFUGEM; 200 MG	PRXOVR	DEF					NA	NA	NA	N
J9199	INJECTION; INFUGEM; 200 MG	MANUAL	DEF					NA	NA	NA	N
J9200	FLOXURIDINE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J9200	FLOXURIDINE INJECTION	MAXFEE	DEF					3551	7/1/2023	12/31/2299	N
J9201	IN GEMCITABINE HCL NOS 200MG	PRXOVR	DEF					NA	NA	NA	N
J9201	IN GEMCITABINE HCL NOS 200MG	MAXFEE	DEF					3.71	7/1/2023	12/31/2299	N
J9202	GOSERELIN ACETATE IMPLANT	PRXOVR	DEF					NA	NA	NA	N
J9202	GOSERELIN ACETATE IMPLANT	MAXFEE	DEF					613.57	7/1/2023	12/31/2299	N
J9203	GEMTUZUMAB OZOGAMICIN 0.1 MG	PRXOVR	DEF					NA	NA	NA	N
J9203	GEMTUZUMAB OZOGAMICIN 0.1 MG	MAXFEE	DEF					221.84	7/1/2023	12/31/2299	N
J9204	INJ MOGAMULIZUMAB-KPKC; 1 MG	PRXOVR	DEF					NA	NA	NA	N
J9204	INJ MOGAMULIZUMAB-KPKC; 1 MG	MAXFEE	DEF					226.71	7/1/2023	12/31/2299	N
J9205	INJ IRINOTECAN LIPOSOME 1 MG	PRXOVR	DEF					NA	NA	NA	N
J9205	INJ IRINOTECAN LIPOSOME 1 MG	MAXFEE	DEF					61.96	7/1/2023	12/31/2299	N
J9206	IRINOTECAN INJECTION	PRXOVR	DEF					NA	NA	NA	N
J9206	IRINOTECAN INJECTION	MAXFEE	DEF					3	7/1/2023	12/31/2299	N
J9207	IXABEPILONE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J9207	IXABEPILONE INJECTION	MAXFEE	DEF					122.55	7/1/2023	12/31/2299	N
J9208	IFOSFAMIDE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J9208	IFOSFAMIDE INJECTION	MAXFEE	DEF					25.38	7/1/2023	12/31/2299	N
J9209	MESNA INJECTION	PRXOVR	DEF					NA	NA	NA	N
J9209	MESNA INJECTION	MAXFEE	DEF					1.67	7/1/2023	12/31/2299	N
J9210	INJ.; EMAPALUMAB-LZSG; 1 MG	PRXOVR	DEF					NA	NA	NA	N
J9210	INJ.; EMAPALUMAB-LZSG; 1 MG	MAXFEE	DEF					393.72	7/1/2023	12/31/2299	N
J9211	IDARUBICIN HCL INJECTION	PRXOVR	DEF					NA	NA	NA	N
J9211	IDARUBICIN HCL INJECTION	MAXFEE	DEF					33.90	7/1/2023	12/31/2299	N
J9212	INTERFERON ALFACON-1 INJ	PRXOVR	DEF					NA	NA	NA	N
J9212	INTERFERON ALFACON-1 INJ	MAXFEE	DEF					13.77	9/1/2013	12/31/2299	N
J9213	INTERFERON ALFA-2A INJ	PRXOVR	DEF					NA	NA	NA	N
J9213	INTERFERON ALFA-2A INJ	MAXFEE	DEF					40.52	4/1/2009	12/31/2299	N
J9214	INTERFERON ALFA-2B INJ	PRXOVR	DEF					NA	NA	NA	N
J9214	INTERFERON ALFA-2B INJ	MAXFEE	DEF					32.57	10/1/2022	12/31/2299	N
J9215	INTERFERON ALFA-N3 INJ	PRXOVR	DEF					NA	NA	NA	N
J9215	INTERFERON ALFA-N3 INJ	MAXFEE	DEF					8.60	4/1/2006	12/31/2299	N
J9216	INTERFERON GAMMA 1-B INJ	PRXOVR	DEF					NA	NA	NA	N
J9216	INTERFERON GAMMA 1-B INJ	MAXFEE	DEF					2717.27	9/1/2013	12/31/2299	N
J9217	LEUPROLIDE ACETATE SUSPNSION	PRXOVR	DEF					NA	NA	NA	N
J9217	LEUPROLIDE ACETATE SUSPNSION	MAXFEE	DEF					165.86	7/1/2023	12/31/2299	N
J9218	LEUPROLIDE ACETATE INJECITON	PRXOVR	DEF					NA	NA	NA	N
J9218	LEUPROLIDE ACETATE INJECITON	MAXFEE	DEF					10.06	7/1/2023	12/31/2299	N
J9219	LEUPROLIDE ACETATE IMPLANT	PRXOVR	DEF					NA	NA	NA	N
J9219	LEUPROLIDE ACETATE IMPLANT	MAXFEE	DEF					4819.82	4/1/2009	12/31/2299	N
J9223	INJ. LURBINECTEDIN; 0.1 MG	PRXOVR	DEF					NA	NA	NA	N
J9223	INJ. LURBINECTEDIN; 0.1 MG	MAXFEE	DEF					197.18	7/1/2023	12/31/2299	N
J9225	VANTAS IMPLANT	PRXOVR	DEF					NA	NA	NA	N
J9225	VANTAS IMPLANT	MAXFEE	DEF					5166.29	7/1/2021	12/31/2299	N
J9226	SUPPRELIN LA IMPLANT	PRXOVR	DEF					NA	NA	NA	N
J9226	SUPPRELIN LA IMPLANT	MAXFEE	DEF					43270.02	7/1/2023	12/31/2299	N
J9227	INJ. ISATUXIMAB-IRFC 10 MG	PRXOVR	DEF					NA	NA	NA	N
J9227	INJ. ISATUXIMAB-IRFC 10 MG	MAXFEE	DEF					74.35	7/1/2023	12/31/2299	N
J9228	IPILIMUMAB INJECTION	PRXOVR	DEF					NA	NA	NA	N
J9228	IPILIMUMAB INJECTION	MAXFEE	DEF					167.93	7/1/2023	12/31/2299	N
J9229	INJ INOTUZUMAB OZOGAM 0.1 MG	PRXOVR	DEF					NA	NA	NA	N
J9229	INJ INOTUZUMAB OZOGAM 0.1 MG	MAXFEE	DEF					2529.55	7/1/2023	12/31/2299	N
J9230	MECHLORETHAMINE HCL INJ	PRXOVR	DEF					NA	NA	NA	N
J9230	MECHLORETHAMINE HCL INJ	MAXFEE	DEF					321.72	5/1/2019	12/31/2299	N
J9245	INJ MELPHA HYDROCH NOS 50 MG	PRXOVR	DEF					NA	NA	NA	N
J9245	INJ MELPHA HYDROCH NOS 50 MG	MAXFEE	DEF					154.19	7/1/2023	12/31/2299	N
J9246	INJ.; EVOMELA; 1 MG	PRXOVR	DEF					NA	NA	NA	N
J9246	INJ.; EVOMELA; 1 MG	MAXFEE	DEF					16.44	7/1/2023	12/31/2299	N
J9247	INJ; MELPHALAN FLUFENAMI 1MG	PRXOVR	DEF					NA	NA	NA	N
J9247	INJ; MELPHALAN FLUFENAMI 1MG	MAXFEE	DEF					503.50	7/1/2022	12/31/2299	N
J9250	METHOTREXATE SODIUM INJ	PRXOVR	DEF					NA	NA	NA	N
J9250	METHOTREXATE SODIUM INJ	MAXFEE	DEF					0.27	7/1/2023	12/31/2299	N
J9259	Paclitaxel (american regent)	PRXOVR	DEF					NA	NA	NA	N
J9259	Paclitaxel (american regent)	MAXFEE	DEF					16.86	7/1/2023	12/31/2299	N
J9260	METHOTREXATE SODIUM INJ	PRXOVR	DEF					NA	NA	NA	N
J9260	METHOTREXATE SODIUM INJ	MAXFEE	DEF					2.71	7/1/2023	12/31/2299	N
J9261	NELARABINE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J9261	NELARABINE INJECTION	MAXFEE	DEF					128.99	7/1/2023	12/31/2299	N
J9262	INJ; OMACETAXINE MEP; 0.01MG	PRXOVR	DEF					NA	NA	NA	N
J9262	INJ; OMACETAXINE MEP; 0.01MG	MAXFEE	DEF					4.01	7/1/2023	12/31/2299	N
J9263	OXALIPLATIN	PRXOVR	DEF					NA	NA	NA	N
J9263	OXALIPLATIN	MAXFEE	DEF					0.07	4/1/2023	12/31/2299	N
J9264	PACLITAXEL PROTEIN BOUND	PRXOVR	DEF					NA	NA	NA	N
J9264	PACLITAXEL PROTEIN BOUND	MAXFEE	DEF					12.06	7/1/2023	12/31/2299	N
J9266	PEGASPARGASE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J9266	PEGASPARGASE INJECTION	MAXFEE	DEF					25762.46	7/1/2023	12/31/2299	N
J9267	PACLITAXEL INJECTION	PRXOVR	DEF					NA	NA	NA	N
J9267	PACLITAXEL INJECTION	MAXFEE	DEF					0.12	7/1/2023	12/31/2299	N
J9268	PENTOSTATIN INJECTION	PRXOVR	DEF					NA	NA	NA	N
J9268	PENTOSTATIN INJECTION	MAXFEE	DEF					2387.73	7/1/2023	12/31/2299	N
J9269	INJ. TAGRAXOFUSP-ERZS 10 MCG	PRXOVR	DEF					NA	NA	NA	N
J9269	INJ. TAGRAXOFUSP-ERZS 10 MCG	MAXFEE	DEF					322.60	7/1/2023	12/31/2299	N
J9271	INJ PEMBROLIZUMAB	PRXOVR	DEF					NA	NA	NA	N
J9271	INJ PEMBROLIZUMAB	MAXFEE	DEF					54.81	7/1/2023	12/31/2299	N
J9272	INJ; DOSTARLIMAB-GXLY; 10 MG	PRXOVR	DEF					NA	NA	NA	N
J9272	INJ; DOSTARLIMAB-GXLY; 10 MG	MAXFEE	DEF					226.93	7/1/2023	12/31/2299	N
J9273	INJ TISOTU VEDOTIN-TFTV; 1MG	PRXOVR	DEF					NA	NA	NA	N
J9273	INJ TISOTU VEDOTIN-TFTV; 1MG	MAXFEE	DEF					162.05	7/1/2023	12/31/2299	N
J9274	INJ; TEBENTAFUSP-TEBN; 1 MCG	PRXOVR	DEF					NA	NA	NA	Y
J9274	INJ; TEBENTAFUSP-TEBN; 1 MCG	MAXFEE	DEF					203.83	7/1/2023	12/31/2299	Y
J9280	MITOMYCIN INJECTION	PRXOVR	DEF					NA	NA	NA	N
J9280	MITOMYCIN INJECTION	MAXFEE	DEF					79.02	7/1/2023	12/31/2299	N
J9281	MITOMYCIN INSTILLATION	PRXOVR	DEF					NA	NA	NA	N
J9281	MITOMYCIN INSTILLATION	MAXFEE	DEF					296.17	7/1/2023	12/31/2299	N
J9285	INJ; OLARATUMAB; 10 MG	PRXOVR	DEF					NA	NA	NA	N
J9285	INJ; OLARATUMAB; 10 MG	MAXFEE	DEF					52.07	4/1/2020	12/31/2299	N
J9293	MITOXANTRONE HYDROCHL / 5 MG	PRXOVR	DEF					NA	NA	NA	N
J9293	MITOXANTRONE HYDROCHL / 5 MG	MAXFEE	DEF					29.06	7/1/2023	12/31/2299	N
J9294	INJ PEMETREXED; HOSPIRA 10MG	PRXOVR	DEF					NA	NA	NA	N
J9294	INJ PEMETREXED; HOSPIRA 10MG	MAXFEE	DEF					10	7/1/2023	12/31/2299	N
J9295	INJECTION; NECITUMUMAB; 1 MG	PRXOVR	DEF					NA	NA	NA	N
J9295	INJECTION; NECITUMUMAB; 1 MG	MAXFEE	DEF					5.74	1/1/2021	12/31/2299	N
J9296	INJ PEMETREXED (ACCORD) 10MG	PRXOVR	DEF					NA	NA	NA	N
J9296	INJ PEMETREXED (ACCORD) 10MG	MAXFEE	DEF					9.66	7/1/2023	12/31/2299	N
J9297	INJ PEMETREXED (SANDOZ) 10MG	PRXOVR	DEF					NA	NA	NA	N
J9297	INJ PEMETREXED (SANDOZ) 10MG	MAXFEE	DEF					1.73	7/1/2023	12/31/2299	N
J9298	INJ NIVOL RELATLIMAB 3MG/1MG	PRXOVR	DEF					NA	NA	NA	N
J9298	INJ NIVOL RELATLIMAB 3MG/1MG	MAXFEE	DEF					183.63	7/1/2023	12/31/2299	N
J9299	INJECTION; NIVOLUMAB	PRXOVR	DEF					NA	NA	NA	N
J9299	INJECTION; NIVOLUMAB	MAXFEE	DEF					30.46	7/1/2023	12/31/2299	N
J9300	GEMTUZUMAB OZOGAMICIN INJ	PRXOVR	DEF					NA	NA	NA	N
J9300	GEMTUZUMAB OZOGAMICIN INJ	MAXFEE	DEF					NA			N
J9301	OBINUTUZUMAB INJ	PRXOVR	DEF					NA	NA	NA	N
J9301	OBINUTUZUMAB INJ	MAXFEE	DEF					70.55	7/1/2023	12/31/2299	N
J9302	OFATUMUMAB INJECTION	PRXOVR	DEF					NA	NA	NA	N
J9302	OFATUMUMAB INJECTION	MAXFEE	DEF					63.96	7/1/2021	12/31/2299	N
J9303	PANITUMUMAB INJECTION	PRXOVR	DEF					NA	NA	NA	N
J9303	PANITUMUMAB INJECTION	MAXFEE	DEF					149.71	7/1/2023	12/31/2299	N
J9304	INJ. PEMETREXED; 10 MG	PRXOVR	DEF					NA	NA	NA	N
J9304	INJ. PEMETREXED; 10 MG	MAXFEE	DEF					64.48	7/1/2023	12/31/2299	N
J9305	INJ. PEMETREXED NOS 10MG	PRXOVR	DEF					NA	NA	NA	N
J9305	INJ. PEMETREXED NOS 10MG	MAXFEE	DEF					7.93	7/1/2023	12/31/2299	N
J9306	INJECTION; PERTUZUMAB; 1 MG	PRXOVR	DEF					NA	NA	NA	N
J9306	INJECTION; PERTUZUMAB; 1 MG	MAXFEE	DEF					15.37	7/1/2023	12/31/2299	N
J9307	PRALATREXATE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J9307	PRALATREXATE INJECTION	MAXFEE	DEF					356.51	7/1/2023	12/31/2299	N
J9308	INJECTION; RAMUCIRUMAB	PRXOVR	DEF					NA	NA	NA	N
J9308	INJECTION; RAMUCIRUMAB	MAXFEE	DEF					68.87	7/1/2023	12/31/2299	N
J9309	INJ; POLATUZUMAB VEDOTIN 1MG	PRXOVR	DEF					NA	NA	NA	N
J9309	INJ; POLATUZUMAB VEDOTIN 1MG	MAXFEE	DEF					121.25	7/1/2023	12/31/2299	N
J9311	INJ RITUXIMAB; HYALURONIDASE	PRXOVR	DEF					NA	NA	NA	N
J9311	INJ RITUXIMAB; HYALURONIDASE	MAXFEE	DEF					37.46	7/1/2023	12/31/2299	N
J9312	INJ.; RITUXIMAB; 10 MG	PRXOVR	DEF					NA	NA	NA	N
J9312	INJ.; RITUXIMAB; 10 MG	MAXFEE	DEF					81.04	7/1/2023	12/31/2299	N
J9313	INJ.; LUMOXITI; 0.01 MG	PRXOVR	DEF					NA	NA	NA	N
J9313	INJ.; LUMOXITI; 0.01 MG	MAXFEE	DEF					23.39	4/1/2021	12/31/2299	N
J9314	INJ PEMETREXED (TEVA) 10MG	PRXOVR	DEF					NA	NA	NA	N
J9314	INJ PEMETREXED (TEVA) 10MG	MAXFEE	DEF					12.30	7/1/2023	12/31/2299	N
J9315	ROMIDEPSIN INJECTION	PRXOVR	DEF					NA	NA	NA	N
J9315	ROMIDEPSIN INJECTION	MAXFEE	DEF					336.84	7/1/2021	12/31/2299	N
J9316	PERTUZU; TRASTUZU; 10 MG	PRXOVR	DEF					NA	NA	NA	N
J9316	PERTUZU; TRASTUZU; 10 MG	MAXFEE	DEF					68.21	7/1/2023	12/31/2299	N
J9317	SACITUZUMAB GOVITECAN-HZIY	PRXOVR	DEF					NA	NA	NA	N
J9317	SACITUZUMAB GOVITECAN-HZIY	MAXFEE	DEF					33.32	7/1/2023	12/31/2299	N
J9318	INJ ROMIDEPSIN NON-LYO 0.1MG	PRXOVR	DEF					NA	NA	NA	N
J9318	INJ ROMIDEPSIN NON-LYO 0.1MG	MANUAL	DEF					NA	NA	NA	N
J9319	INJ ROMIDEPSIN LYOPHIL 0.1MG	PRXOVR	DEF					NA	NA	NA	N
J9319	INJ ROMIDEPSIN LYOPHIL 0.1MG	MAXFEE	DEF					30.37	7/1/2023	12/31/2299	N
J9320	STREPTOZOCIN INJECTION	PRXOVR	DEF					NA	NA	NA	N
J9320	STREPTOZOCIN INJECTION	MAXFEE	DEF					370.18	1/1/2023	12/31/2299	N
J9322	Inj pemetrexed (bluepoint)	PRXOVR	DEF					NA	NA	NA	N
J9322	Inj pemetrexed (bluepoint)	MAXFEE	DEF					17.12	7/1/2023	12/31/2299	N
J9323	INJ PEMETREXED DITROMETHAMIN	PRXOVR	DEF					NA	NA	NA	N
J9323	INJ PEMETREXED DITROMETHAMIN	MAXFEE	DEF					11.77	7/1/2023	12/31/2299	N
J9325	INJ TALIMOGENE LAHERPAREPVEC	PRXOVR	DEF					NA	NA	NA	N
J9325	INJ TALIMOGENE LAHERPAREPVEC	MAXFEE	DEF					66.05	7/1/2023	12/31/2299	N
J9328	TEMOZOLOMIDE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J9328	TEMOZOLOMIDE INJECTION	MAXFEE	DEF					10.41	7/1/2023	12/31/2299	N
J9330	TEMSIROLIMUS INJECTION	PRXOVR	DEF					NA	NA	NA	N
J9330	TEMSIROLIMUS INJECTION	MAXFEE	DEF					33.64	7/1/2023	12/31/2299	N
J9331	INJ SIROLIMUS PROT PART 1 MG	PRXOVR	DEF					NA	NA	NA	N
J9331	INJ SIROLIMUS PROT PART 1 MG	MAXFEE	DEF					107.61	7/1/2023	12/31/2299	N
J9332	INJ EFGARTIGIMOD 2MG	PRXOVR	DEF					NA	NA	NA	N
J9332	INJ EFGARTIGIMOD 2MG	MAXFEE	DEF					31.81	7/1/2023	12/31/2299	N
J9340	THIOTEPA INJECTION	PRXOVR	DEF					NA	NA	NA	N
J9340	THIOTEPA INJECTION	MAXFEE	DEF					259.56	7/1/2023	12/31/2299	N
J9347	Inj; tremelimumab-actl; 1 mg	PRXOVR	DEF					NA	NA	NA	N
J9347	Inj; tremelimumab-actl; 1 mg	MAXFEE	DEF					136.56	7/1/2023	12/31/2299	N
J9348	INJ. NAXITAMAB-GQGK; 1 MG	PRXOVR	DEF					NA	NA	NA	N
J9348	INJ. NAXITAMAB-GQGK; 1 MG	MAXFEE	DEF					579.65	7/1/2023	12/31/2299	N
J9349	INJ.; TAFASITAMAB-CXIX	PRXOVR	DEF					NA	NA	NA	N
J9349	INJ.; TAFASITAMAB-CXIX	MAXFEE	DEF					13.30	7/1/2023	12/31/2299	N
J9350	TOPOTECAN INJECTION	PRXOVR	DEF					NA	NA	NA	N
J9350	TOPOTECAN INJECTION	MAXFEE	DEF					635.64	7/1/2023	12/31/2299	N
J9351	TOPOTECAN INJECTION	PRXOVR	DEF					NA	NA	NA	N
J9351	TOPOTECAN INJECTION	MAXFEE	DEF					0.50	7/1/2023	12/31/2299	N
J9352	INJECTION TRABECTEDIN 0.1MG	PRXOVR	DEF					NA	NA	NA	N
J9352	INJECTION TRABECTEDIN 0.1MG	MAXFEE	DEF					337.28	7/1/2023	12/31/2299	N
J9353	INJ. MARGETUXIMAB-CMKB; 5 MG	PRXOVR	DEF					NA	NA	NA	N
J9353	INJ. MARGETUXIMAB-CMKB; 5 MG	MAXFEE	DEF					45.88	7/1/2023	12/31/2299	N
J9354	INJ; ADO-TRASTUZUMAB EMT 1MG	PRXOVR	DEF					NA	NA	NA	N
J9354	INJ; ADO-TRASTUZUMAB EMT 1MG	MAXFEE	DEF					38.33	7/1/2023	12/31/2299	N
J9355	INJ TRASTUZUMAB EXCL BIOSIMI	PRXOVR	DEF					NA	NA	NA	N
J9355	INJ TRASTUZUMAB EXCL BIOSIMI	MAXFEE	DEF					81.08	7/1/2023	12/31/2299	N
J9356	INJ. HERCEPTIN HYLECTA; 10MG	PRXOVR	DEF					NA	NA	NA	N
J9356	INJ. HERCEPTIN HYLECTA; 10MG	MAXFEE	DEF					65.58	7/1/2023	12/31/2299	N
J9357	VALRUBICIN INJECTION	PRXOVR	DEF					NA	NA	NA	N
J9357	VALRUBICIN INJECTION	MAXFEE	DEF					1391.80	7/1/2023	12/31/2299	N
J9358	INJ FAM-TRASTU DERU-NXKI 1MG	PRXOVR	DEF					NA	NA	NA	N
J9358	INJ FAM-TRASTU DERU-NXKI 1MG	MAXFEE	DEF					26.24	7/1/2023	12/31/2299	N
J9359	INJ LON TESIRIN-LPYL 0.075MG	PRXOVR	DEF					NA	NA	NA	N
J9359	INJ LON TESIRIN-LPYL 0.075MG	MAXFEE	DEF					196.45	7/1/2023	12/31/2299	N
J9360	VINBLASTINE SULFATE INJ	PRXOVR	DEF					NA	NA	NA	N
J9360	VINBLASTINE SULFATE INJ	MAXFEE	DEF					3.95	7/1/2023	12/31/2299	N
J9370	VINCRISTINE SULFATE 1 MG INJ	PRXOVR	DEF					NA	NA	NA	N
J9370	VINCRISTINE SULFATE 1 MG INJ	MAXFEE	DEF					7.49	7/1/2023	12/31/2299	N
J9371	INJ; VINCRISTINE SUL LIP 1MG	PRXOVR	DEF					NA	NA	NA	N
J9371	INJ; VINCRISTINE SUL LIP 1MG	MAXFEE	DEF					3420.78	1/1/2022	12/31/2299	N
J9380	VINCRISTINE SULFATE 5 MG INJ	PRXOVR	DEF					NA	NA	NA	N
J9380	VINCRISTINE SULFATE 5 MG INJ	MAXFEE	DEF					30.94	7/1/2023	12/31/2299	N
J9381	Inj teplizumab mzwv 5 mcg	PRXOVR	DEF					NA	NA	NA	N
J9381	Inj teplizumab mzwv 5 mcg	MAXFEE	DEF					36.27	7/1/2023	12/31/2299	N
J9390	VINORELBINE TARTRATE INJ	PRXOVR	DEF					NA	NA	NA	N
J9390	VINORELBINE TARTRATE INJ	MAXFEE	DEF					8.27	7/1/2023	12/31/2299	N
J9393	INJ; FULVESTRANT (TEVA)	PRXOVR	DEF					NA	NA	NA	N
J9393	INJ; FULVESTRANT (TEVA)	MAXFEE	DEF					21.20	7/1/2023	12/31/2299	N
J9394	INJ; FULVESTRANT (FRESENIUS)	PRXOVR	DEF					NA	NA	NA	N
J9394	INJ; FULVESTRANT (FRESENIUS)	MAXFEE	DEF					1.65	7/1/2023	12/31/2299	N
J9395	INJECTION; FULVESTRANT	PRXOVR	DEF					NA	NA	NA	N
J9395	INJECTION; FULVESTRANT	MAXFEE	DEF					9.47	7/1/2023	12/31/2299	N
J9400	INJ; ZIV-AFLIBERCEPT; 1MG	PRXOVR	DEF					NA	NA	NA	N
J9400	INJ; ZIV-AFLIBERCEPT; 1MG	MAXFEE	DEF					6.81	7/1/2023	12/31/2299	N
J9600	PORFIMER SODIUM INJECTION	PRXOVR	DEF					NA	NA	NA	N
J9600	PORFIMER SODIUM INJECTION	MAXFEE	DEF					19906.23	9/1/2013	12/31/2299	N
J9999	CHEMOTHERAPY DRUG	PRXOVR	DEF					NA	NA	NA	N
J9999	CHEMOTHERAPY DRUG	MANUAL	DEF					NA	NA	NA	N
K1034	COVID TEST SELF-ADMN/COLLECT	PRXOVR	DEF					NA	NA	NA	N
K1034	COVID TEST SELF-ADMN/COLLECT	MAXFEE	DEF					12	4/4/2022	12/31/2299	N
M0201	COVID-19 VACCINE HOME ADMIN	PRXOVR	DEF					NA	NA	NA	N
M0201	COVID-19 VACCINE HOME ADMIN	MAXFEE	OTH					64.55	7/1/2023	12/31/2299	N
M0201	COVID-19 VACCINE HOME ADMIN	MAXFEE	DEF					35.45	7/1/2023	12/31/2299	N
Q0138	FERUMOXYTOL; NON-ESRD	PRXOVR	DEF					NA	NA	NA	N
Q0138	FERUMOXYTOL; NON-ESRD	MAXFEE	DEF					0.50	7/1/2023	12/31/2299	N
Q0139	FERUMOXYTOL; ESRD USE	PRXOVR	DEF					NA	NA	NA	N
Q0139	FERUMOXYTOL; ESRD USE	MAXFEE	DEF					0.50	7/1/2023	12/31/2299	N
Q0161	CHLORPROMAZINE HCL 5MG ORAL	PRXOVR	DEF					NA	NA	NA	N
Q0161	CHLORPROMAZINE HCL 5MG ORAL	MANUAL	DEF					NA	NA	NA	N
Q0515	SERMORELIN ACETATE INJECTION	PRXOVR	DEF					NA	NA	NA	N
Q0515	SERMORELIN ACETATE INJECTION	MAXFEE	DEF					1.80	7/1/2009	12/31/2299	N
Q2009	FOSPHENYTOIN INJ PE	PRXOVR	DEF					NA	NA	NA	N
Q2009	FOSPHENYTOIN INJ PE	MAXFEE	DEF					1.41	4/1/2014	12/31/2299	N
Q2017	TENIPOSIDE; 50 MG	PRXOVR	DEF					NA	NA	NA	N
Q2017	TENIPOSIDE; 50 MG	MAXFEE	DEF					346.95	1/1/2014	12/31/2299	N
Q2026	RADIESSE INJECTION	PRXOVR	DEF					NA	NA	NA	N
Q2026	RADIESSE INJECTION	MANUAL	DEF					NA	NA	NA	N
Q2027	SCULPTRA INJECTION	PRXOVR	DEF					NA	NA	NA	N
Q2027	SCULPTRA INJECTION	MANUAL	DEF					NA	NA	NA	N
Q2033	INFLUENZA VACCINE; (FLUBLOK)	PRXOVR	DEF					NA	NA	NA	N
Q2033	INFLUENZA VACCINE; (FLUBLOK)	MANUAL	DEF					NA	NA	NA	N
Q2034	AGRIFLU VACCINE	PRXOVR	DEF					NA	NA	NA	N
Q2034	AGRIFLU VACCINE	MANUAL	DEF					NA	NA	NA	N
Q2035	AFLURIA VACC; 3 YRS & >; IM	PRXOVR	DEF					NA	NA	NA	N
Q2035	AFLURIA VACC; 3 YRS & >; IM	MAXFEE	DEF					20.97	1/1/2020	12/31/2299	N
Q2039	INFLUENZA VIRUS VACCINE; NOS	PRXOVR	DEF					NA	NA	NA	N
Q2039	INFLUENZA VIRUS VACCINE; NOS	MAXFEE	DEF					NA			N
Q2042	TISAGENLECLEUCEL CAR-POS T	PRXOVR	DEF					NA	NA	NA	N
Q2042	TISAGENLECLEUCEL CAR-POS T	MAXFEE	DEF					NA			N
Q2043	SIPULEUCEL-T AUTO CD54+	PRXOVR	DEF					NA	NA	NA	N
Q2043	SIPULEUCEL-T AUTO CD54+	MAXFEE	DEF					53062.44	7/1/2023	12/31/2299	N
Q2049	IMPORTED LIPODOX INJ	PRXOVR	DEF					NA	NA	NA	N
Q2049	IMPORTED LIPODOX INJ	MAXFEE	DEF					508.43	11/1/2014	12/31/2299	N
Q2050	DOXORUBICIN INJ 10MG	PRXOVR	DEF					NA	NA	NA	N
Q2050	DOXORUBICIN INJ 10MG	MAXFEE	DEF					87.98	7/1/2023	12/31/2299	N
Q2053	BREXUCABTAGENE CAR POS T	PRXOVR	DEF					NA	NA	NA	N
Q2053	BREXUCABTAGENE CAR POS T	MAXFEE	DEF					449440	7/1/2023	12/31/2299	N
Q3027	INJ BETA INTERFERON IM 1 MCG	PRXOVR	DEF					NA	NA	NA	N
Q3027	INJ BETA INTERFERON IM 1 MCG	MAXFEE	DEF					53.15	7/1/2023	12/31/2299	N
Q3028	INJ BETA INTERFERON SQ 1 MCG	PRXOVR	DEF					NA	NA	NA	N
Q3028	INJ BETA INTERFERON SQ 1 MCG	MANUAL	DEF					NA	NA	NA	N
Q4074	ILOPROST NON-COMP UNIT DOSE	PRXOVR	DEF					NA	NA	NA	N
Q4074	ILOPROST NON-COMP UNIT DOSE	MAXFEE	DEF					144.43	7/1/2023	12/31/2299	N
Q4081	EPOETIN ALFA; 100 UNITS ESRD	PRXOVR	DEF					NA	NA	NA	N
Q4081	EPOETIN ALFA; 100 UNITS ESRD	MAXFEE	DEF					0.69	7/1/2023	12/31/2299	N
Q4171	INTERFYL; 1 MG	PRXOVR	DEF					NA	NA	NA	N
Q4171	INTERFYL; 1 MG	MAXFEE	DEF					12.99	7/1/2023	12/31/2299	N
Q4272	Esano a; per sq cm	PRXOVR	DEF					NA	NA	NA	N
Q4272	Esano a; per sq cm	MAXFEE	DEF					0	7/1/2023	12/31/2299	N
Q4273	Esano aaa; per sq cm	PRXOVR	DEF					NA	NA	NA	N
Q4273	Esano aaa; per sq cm	MAXFEE	DEF					0	7/1/2023	12/31/2299	N
Q4274	Esano ac; per sq cm	PRXOVR	DEF					NA	NA	NA	N
Q4274	Esano ac; per sq cm	MAXFEE	DEF					0	7/1/2023	12/31/2299	N
Q4275	Esano aca; per sq cm	PRXOVR	DEF					NA	NA	NA	N
Q4275	Esano aca; per sq cm	MAXFEE	DEF					0	7/1/2023	12/31/2299	N
Q4276	Orion; per sq cm	PRXOVR	DEF					NA	NA	NA	N
Q4276	Orion; per sq cm	MAXFEE	DEF					0	7/1/2023	12/31/2299	N
Q4277	Woundplus e-grat; per sq cm	PRXOVR	DEF					NA	NA	NA	N
Q4277	Woundplus e-grat; per sq cm	MAXFEE	DEF					0	7/1/2023	12/31/2299	N
Q4278	Epieffect; per sq cm	PRXOVR	DEF					NA	NA	NA	N
Q4278	Epieffect; per sq cm	MAXFEE	DEF					0	7/1/2023	12/31/2299	N
Q4280	Xcell amnio matrix per sq cm	PRXOVR	DEF					NA	NA	NA	N
Q4280	Xcell amnio matrix per sq cm	MAXFEE	DEF					0	7/1/2023	12/31/2299	N
Q4281	Barrera slor dl per sq cm	PRXOVR	DEF					NA	NA	NA	N
Q4281	Barrera slor dl per sq cm	MAXFEE	DEF					0	7/1/2023	12/31/2299	N
Q4282	Cygnus dual per sq cm	PRXOVR	DEF					NA	NA	NA	N
Q4282	Cygnus dual per sq cm	MAXFEE	DEF					0	7/1/2023	12/31/2299	N
Q4283	Biovance tri or 3l; sq cm	PRXOVR	DEF					NA	NA	NA	N
Q4283	Biovance tri or 3l; sq cm	MAXFEE	DEF					0	7/1/2023	12/31/2299	N
Q4284	Dermabind sl; per sq cm	PRXOVR	DEF					NA	NA	NA	N
Q4284	Dermabind sl; per sq cm	MAXFEE	DEF					0	7/1/2023	12/31/2299	N
Q5101	INJECTION; ZARXIO	PRXOVR	DEF					NA	NA	NA	N
Q5101	INJECTION; ZARXIO	MAXFEE	DEF					0.18	7/1/2023	12/31/2299	N
Q5103	INJECTION; INFLECTRA	PRXOVR	DEF					NA	NA	NA	N
Q5103	INJECTION; INFLECTRA	MAXFEE	DEF					18.43	7/1/2023	12/31/2299	N
Q5104	INJECTION; RENFLEXIS	PRXOVR	DEF					NA	NA	NA	N
Q5104	INJECTION; RENFLEXIS	MAXFEE	DEF					35.55	7/1/2023	12/31/2299	N
Q5105	INJ RETACRIT ESRD ON DIALYSI	PRXOVR	DEF					NA	NA	NA	N
Q5105	INJ RETACRIT ESRD ON DIALYSI	MAXFEE	DEF					0.75	7/1/2023	12/31/2299	N
Q5106	INJ RETACRIT NON-ESRD USE	PRXOVR	DEF					NA	NA	NA	N
Q5106	INJ RETACRIT NON-ESRD USE	MAXFEE	DEF					7.50	7/1/2023	12/31/2299	N
Q5107	INJ MVASI 10 MG	PRXOVR	DEF					NA	NA	NA	N
Q5107	INJ MVASI 10 MG	MAXFEE	DEF					28.40	7/1/2023	12/31/2299	N
Q5108	INJECTION; FULPHILA	PRXOVR	DEF					NA	NA	NA	N
Q5108	INJECTION; FULPHILA	MAXFEE	DEF					111.15	7/1/2023	12/31/2299	N
Q5109	INJECTION; IXIFI; 10 MG	PRXOVR	DEF					NA	NA	NA	N
Q5109	INJECTION; IXIFI; 10 MG	MAXFEE	DEF					101.25	1/1/2019	12/31/2299	N
Q5110	NIVESTYM	PRXOVR	DEF					NA	NA	NA	N
Q5110	NIVESTYM	MAXFEE	DEF					0.33	4/1/2023	12/31/2299	N
Q5111	INJECTION; UDENYCA 0.5 MG	PRXOVR	DEF					NA	NA	NA	N
Q5111	INJECTION; UDENYCA 0.5 MG	MANUAL	DEF					NA	NA	NA	N
Q5112	INJ ONTRUZANT 10 MG	PRXOVR	DEF					NA	NA	NA	N
Q5112	INJ ONTRUZANT 10 MG	MAXFEE	DEF					46.93	7/1/2023	12/31/2299	N
Q5113	INJ HERZUMA 10 MG	PRXOVR	DEF					NA	NA	NA	N
Q5113	INJ HERZUMA 10 MG	MAXFEE	DEF					29.87	7/1/2023	12/31/2299	N
Q5114	INJ OGIVRI 10 MG	PRXOVR	DEF					NA	NA	NA	N
Q5114	INJ OGIVRI 10 MG	MAXFEE	DEF					40.41	7/1/2023	12/31/2299	N
Q5115	INJ TRUXIMA 10 MG	PRXOVR	DEF					NA	NA	NA	N
Q5115	INJ TRUXIMA 10 MG	MAXFEE	DEF					39.79	7/1/2023	12/31/2299	N
Q5116	INJ.; TRAZIMERA; 10 MG	PRXOVR	DEF					NA	NA	NA	N
Q5116	INJ.; TRAZIMERA; 10 MG	MAXFEE	DEF					23.15	7/1/2023	12/31/2299	N
Q5117	INJ.; KANJINTI; 10 MG	PRXOVR	DEF					NA	NA	NA	N
Q5117	INJ.; KANJINTI; 10 MG	MAXFEE	DEF					23.96	7/1/2023	12/31/2299	N
Q5118	INJ.; ZIRABEV; 10 MG	PRXOVR	DEF					NA	NA	NA	N
Q5118	INJ.; ZIRABEV; 10 MG	MAXFEE	DEF					28.19	7/1/2023	12/31/2299	N
Q5119	INJ RUXIENCE; 10 MG	PRXOVR	DEF					NA	NA	NA	N
Q5119	INJ RUXIENCE; 10 MG	MAXFEE	DEF					27.51	7/1/2023	12/31/2299	N
Q5120	INJ PEGFILGRASTIM-BMEZ 0.5MG	PRXOVR	DEF					NA	NA	NA	N
Q5120	INJ PEGFILGRASTIM-BMEZ 0.5MG	MAXFEE	DEF					30.05	7/1/2023	12/31/2299	N
Q5121	INJ. AVSOLA; 10 MG	PRXOVR	DEF					NA	NA	NA	N
Q5121	INJ. AVSOLA; 10 MG	MAXFEE	DEF					28.33	7/1/2023	12/31/2299	N
Q5122	INJ; NYVEPRIA	PRXOVR	DEF					NA	NA	NA	N
Q5122	INJ; NYVEPRIA	MAXFEE	DEF					101.89	7/1/2023	12/31/2299	N
Q5123	INJ. RIABNI; 10 MG	PRXOVR	DEF					NA	NA	NA	N
Q5123	INJ. RIABNI; 10 MG	MAXFEE	DEF					44.58	7/1/2023	12/31/2299	N
Q5124	INJ. BYOOVIZ; 0.1 MG	PRXOVR	DEF					NA	NA	NA	N
Q5124	INJ. BYOOVIZ; 0.1 MG	MAXFEE	DEF					220.83	7/1/2023	12/31/2299	N
Q5125	INJ; RELEUKO 1 MCG	PRXOVR	DEF					NA	NA	NA	N
Q5125	INJ; RELEUKO 1 MCG	MAXFEE	DEF					0.59	4/1/2023	12/31/2299	N
Q5126	INJ ALYMSYS 10 MG	PRXOVR	DEF					NA	NA	NA	N
Q5126	INJ ALYMSYS 10 MG	MAXFEE	DEF					72.52	7/1/2023	12/31/2299	N
Q5127	INJ; STIMUFEND; 0.5 MG	PRXOVR	DEF					NA	NA	NA	N
Q5127	INJ; STIMUFEND; 0.5 MG	MAXFEE	DEF					620.45	4/1/2023	12/31/2299	N
Q5128	INJ; CIMERLI; 0.1 MG	PRXOVR	DEF					NA	NA	NA	N
Q5128	INJ; CIMERLI; 0.1 MG	MAXFEE	DEF					279.50	7/1/2023	12/31/2299	N
Q5129	INJ; VEGZELMA; 10 MG	PRXOVR	DEF					NA	NA	NA	N
Q5129	INJ; VEGZELMA; 10 MG	MAXFEE	DEF					18.12	4/1/2023	12/31/2299	N
Q5130	INJ; FYLNETRA; 0.5 MG	PRXOVR	DEF					NA	NA	NA	N
Q5130	INJ; FYLNETRA; 0.5 MG	MAXFEE	DEF					354.16	4/1/2023	12/31/2299	N
Q5131	Inj; idacio; 20 mg	PRXOVR	DEF					NA	NA	NA	N
Q5131	Inj; idacio; 20 mg	MAXFEE	DEF					0	7/1/2023	12/31/2299	N
Q9950	INJ SULF HEXA LIPID MICROSPH	PRXOVR	DEF					NA	NA	NA	N
Q9950	INJ SULF HEXA LIPID MICROSPH	MAXFEE	DEF					19	7/1/2023	12/31/2299	N
Q9951	LOCM >= 400 MG/ML IODINE;1ML	PRXOVR	DEF					NA	NA	NA	N
Q9951	LOCM >= 400 MG/ML IODINE;1ML	MANUAL	DEF					NA	NA	NA	N
Q9954	ORAL MR CONTRAST; 100 ML	PRXOVR	DEF					NA	NA	NA	N
Q9954	ORAL MR CONTRAST; 100 ML	MAXFEE	DEF					11.66	9/1/2013	12/31/2299	N
Q9955	INJ PERFLEXANE LIP MICROS;ML	PRXOVR	DEF					NA	NA	NA	N
Q9955	INJ PERFLEXANE LIP MICROS;ML	MAXFEE	DEF					13.25	9/1/2005	12/31/2299	N
Q9957	INJ PERFLUTREN LIP MICROS;ML	PRXOVR	DEF					NA	NA	NA	N
Q9957	INJ PERFLUTREN LIP MICROS;ML	MAXFEE	DEF					49.06	4/1/2023	12/31/2299	N
Q9957	INJ PERFLUTREN LIP MICROS;ML	MAXFEE	DEF					42.72	7/1/2023	12/31/2299	N
Q9965	LOCM 100-199MG/ML IODINE;1ML	PRXOVR	DEF					NA	NA	NA	N
Q9965	LOCM 100-199MG/ML IODINE;1ML	MAXFEE	DEF					1.31	7/1/2023	12/31/2299	N
Q9966	LOCM 200-299MG/ML IODINE;1ML	PRXOVR	DEF					NA	NA	NA	N
Q9966	LOCM 200-299MG/ML IODINE;1ML	MAXFEE	DEF					0.37	7/1/2023	12/31/2299	N
Q9967	LOCM 300-399MG/ML IODINE;1ML	PRXOVR	DEF					NA	NA	NA	N
Q9967	LOCM 300-399MG/ML IODINE;1ML	MAXFEE	DEF					0.13	7/1/2023	12/31/2299	N
Q9978	NETUPITANT PALONOSETRON ORAL	PRXOVR	DEF					NA	NA	NA	N
Q9978	NETUPITANT PALONOSETRON ORAL	MANUAL	DEF					NA	NA	NA	N
Q9982	FLUTEMETAMOL F18 DIAGNOSTIC	PRXOVR	DEF					NA	NA	NA	N
Q9982	FLUTEMETAMOL F18 DIAGNOSTIC	MAXFEE	DEF					28248	7/1/2016	12/31/2299	N
Q9983	FLORBETABEN F18 DIAGNOSTIC	PRXOVR	DEF					NA	NA	NA	N
Q9983	FLORBETABEN F18 DIAGNOSTIC	MANUAL	DEF					NA	NA	NA	N
Q9991	BUPRENORPH XR 100 MG OR LESS	PRXOVR	DEF					NA	NA	NA	N
Q9991	BUPRENORPH XR 100 MG OR LESS	MAXFEE	DEF					1886.37	7/1/2023	12/31/2299	N
Q9992	BUPRENORPHINE XR OVER 100 MG	PRXOVR	DEF					NA	NA	NA	N
Q9992	BUPRENORPHINE XR OVER 100 MG	MAXFEE	DEF					1886.37	7/1/2023	12/31/2299	N
S1091	STENT NON-CORONARY PROPEL	PRXOVR	DEF					NA	NA	NA	N
S1091	STENT NON-CORONARY PROPEL	MAXFEE	DEF					1444.50	4/1/2021	12/31/2299	N