To calculate a SCAN member's 2008 Drug Copay for an office administered injectable

Step 1: Select HCPCS or Long Description of Drug     HCPCS: -- None Selected --90396905869064790648907029071490715A9576 A9577 A9578 A9579 J0128J0129J0130J0132J0133J0135J0150J0152J0170J0180J0200J0205J0207J0210J0215J0220 J0256J0270J0275J0278J0280J0282J0285J0287J0288J0289J0290J0295J0300J0330J0348J0350J0360J0364J0365J0390J0400 J0456J0460J0470J0475J0476J0480J0500J0515J0520J0530J0540J0550J0560J0570J0580J0583J0585J0587J0592J0594J0595J0600J0610J0620J0630J0636J0637J0640J0670J0690J0692J0694J0696J0697J0698J0702J0704J0706J0713J0715J0720J0725J0735J0740J0743J0745J0760J0770J0780J0795J0800J0850J0878J0881J0882J0885J0886J0894J0895J0900J0945J0970J1000J1020J1030J1040J1051J1056J1060J1070J1080J1094J1100J1110J1120J1160J1162J1165J1170J1180J1190J1200J1205J1212J1230J1240J1245J1250J1260J1265J1270J1300 J1320J1325J1327J1335J1364J1380J1390J1410J1430J1435J1436J1438J1440J1441J1450J1451J1452J1455J1457J1458J1460J1470J1480J1490J1500J1510J1520J1530J1540J1550J1560J1561 J1562J1565J1566J1567J1568 J1569 J1570J1571 J1572 J1573 J1580J1590J1595J1600J1610J1620J1626J1630J1631J1640J1642J1644J1645J1650J1652J1655J1700J1710J1720J1730J1740J1742J1743 J1745J1751J1752J1756J1785J1790J1800J1810J1815J1817J1830J1835J1840J1850J1885J1890J1910J1931J1940J1945J1950J1955J1956J1960J1980J1990J2000J2001J2010J2020J2060J2150J2175J2180J2185J2210J2248J2250J2260J2270J2271J2275J2278J2280J2300J2310J2315J2320J2321J2322J2323 J2325J2352J2353J2354J2355J2357J2360J2370J2400J2405J2410J2425J2430J2440J2460J2469J2501J2503J2504J2505J2510J2513J2515J2540J2543J2545J2550J2560J2590J2597J2650J2675J2680J2690J2700J2710J2720J2724 J2725J2730J2760J2765J2770J2778 J2780J2783J2788J2790J2791 J2792J2794J2795J2800J2805J2810J2820J2850J2910J2912J2916J2920J2930J2941J2950J2993J2995J2997J3000J3010J3030J3070J3100J3105J3110J3120J3130J3140J3150J3230J3240J3243J3246J3250J3260J3265J3280J3285J3301J3302J3303J3305J3315J3320J3355J3360J3364J3365J3370J3395J3396J3410J3411J3415J3420J3430J3465J3470J3471J3472J3473J3475J3480J3485J3486J3487J3488 J3590J7030J7040J7042J7050J7060J7070J7100J7110J7120J7187J7188J7189J7190J7192J7193J7194J7195J7197J7198J7308J7310J7311J7317J7320J7321 J7322 J7323 J7324 J7330J7340J7341J7342J7343J7344J7345J7346J7347 J7348 J7349 J7350J7500J7501J7502J7504J7505J7506J7507J7509J7510J7511J7513J7515J7516J7517J7518J7520J7525J7605 J7608J7611J7612J7613J7614J7616J7620J7621J7626J7631J7635J7636J7637J7638J7639J7642J7643J7644J7669J7674J7682J8501J8510J8515J8520J8521J8530J8540J8560J8600J8610J8700J9000J9001J9010J9015J9017J9020J9025J9027J9031J9035J9040J9041J9045J9050J9055J9060J9062J9065J9070J9080J9090J9091J9092J9093J9094J9095J9096J9097J9098J9100J9110J9120J9130J9140J9150J9151J9160J9165J9170J9175J9178J9180J9181J9182J9185J9190J9200J9201J9202J9206J9208J9209J9211J9212J9213J9214J9215J9216J9217J9218J9219J9225J9226 J9230J9245J9250J9260J9261J9263J9264J9265J9266J9268J9270J9280J9290J9291J9293J9300J9303 J9305J9310J9320J9340J9350J9355J9357J9360J9370J9375J9380J9390J9395J9600P9041P9043P9045P9046P9047P9048Q0163Q0164Q0166Q0167Q0168Q0169Q0170Q0171Q0172Q0173Q0174Q0175Q0176Q0177Q0178Q0179Q0180Q0515Q2009Q2017Q3025Q4053Q4079Q4080Q4081Q4083Q4084Q4085Q4086Q4087 Q4087Q4088 Q4088Q4089 Q4089Q4090 Q4090Q4091 Q4091Q4092 Q4092Q4093 Q4093Q4094 Q4094Q4095 Q4095Q4096 Q4097 Q4098 Q4099 Q9920Q9921Q9922Q9923Q9924Q9925Q9926Q9927Q9928Q9929Q9930Q9931Q9932Q9933Q9934Q9935Q9936Q9937Q9938Q9939Q9940Q9945Q9946Q9947Q9948Q9949Q9950Q9952Q9953Q9954Q9956Q9957Q9958Q9960Q9961Q9962Q9963Q9964Q9965 Q9966 Q9967     Long Description:    -- None Selected --5% dextrose/normal saline5% dextrose/waterabarelix injectionabatacept, injabciximab injectionacetazolamid sodium injectioacetylcysteine inh sol u dacetylcysteine injectionacyclovir injectionadalimumab injectionadenosine injectionadrenalin epinephrin injectagalsidase beta injectionalbumin (human), 25%, 20 mlalbumin (human), 25%, 50mlalbumin (human), 5%, 250 mlalbumin (human),5%, 50mlalbuterol compound solutionalbuterol inh non-comp con albuterol inh non-comp conalbuterol inh non-comp u d albuterol inh non-comp u d albuterol ipratrop non-compalbuterol non-comp con1albuterol non-comp unit dose1albuterol, up to 5 mg (albuterol) or 2.5 mg (levoalbuterol), and ipratropium bromide, up to 1 mg, administered through dmealdesleukin/single use vialalefaceptalemtuzumab injectionalglucerase injectionalglucosidase alfa injalpha 1 proteinase inhibitoralprostadil for injectionalprostadil urethral supposalteplase recombinantamifostineamikacin sulfate injectionaminolevulinic acid hcl topaminophyllin 250 mg injamiodarone hclamobarbital 125 mg injampho b cholesteryl sulfateamphotericin bamphotericin b lipid complexamphotericin b liposome injampicillin 500 mg injampicillin sodium per 1.5 gmanadulafungin injectionanti-inhibitorantithrombin iii injectionantithymocyte globuln rabbitapomorphine hcl, injaprotonin, 10,000 kiuarformoterol non-comp unitaripiprazole im injarsenic trioxideasparaginase injectionatropine inhal sol conatropine inhal sol unit doseatropine sulfate injectionazacitidine injectionazathioprine oral 50mgazathioprine parenteralazithromycinbaclofen 10 mg injectionbaclofen intrathecal trialbasiliximabbcg live intravesical vacbcg vaccine, intravesicalbetamethasone acet&sod phospbetamethasone sod phosp/4 mgbevacizumab injectionbivalirudinbleomycin sulfate injectionbortezomib injectionbotulinum toxin a per unitbotulinum toxin type bbudesonide non-comp unit dosebuprenorphine hydrochloridebusulfan, injbutorphanol tartrate 1 mgcabergoline, oral 0.25mgcaffeine citrate injectioncalcitonin salmon injectioncalcium gluconate injectioncapecitabine, oral, 150 mgcapecitabine, oral, 500 mgcarboplatin injectioncarmus bischl nitro injcaspofungin acetatecefazolin sodium injectioncefepime hcl for injectioncefotaxime sodium injectioncefoxitin sodium injectionceftizoxime sodium / 500 mgceftriaxone sodium injectionceprotin injcetuximab injectionchloramphenicol sodium injecchlordiazepoxide injectionchloroprocaine hcl injectionchlorothiazide sodium injchlorpromazine hcl 10mg oralchlorpromazine hcl 25mg oralchlorpromazine hcl injectionchorionic gonadotropin/1000ucidofovir injectioncilastatin sodium injectioncisplatin 10 mg injectioncisplatin 50 mg injectionclofarabine injectionclonidine hydrochloridecolchicine injectioncolistimethate sodium injcorticorelin ovine triflutalcorticotropin injectioncromolyn sodium inh sol u dcultured chondrocytes implntcyclophosphamide 1.0 grm injcyclophosphamide 100 mg injcyclophosphamide 2.0 grm injcyclophosphamide 200 mg injcyclophosphamide 500 mg injcyclophosphamide lyophilizedcyclophosphamide lyophilizedcyclophosphamide lyophilizedcyclophosphamide lyophilizedcyclophosphamide lyophilizedcyclophosphamide oral 25 mgcyclosporin parenteral 250mgcyclosporine oral 100 mgcyclosporine oral 25 mgcytarabine hcl 100 mg injcytarabine hcl 500 mg injcytarabine liposomecytomegalovirus imm iv /viald5w infusiondacarbazine 100 mg injdacarbazine 200 mg injdaclizumab, parenteraldactinomycin actinomycin ddalteparin sodiumdaptomycin injectiondarbepoetin alfa, esrd usedarbepoetin alfa, non-esrddaunorubicindaunorubicin citrate liposomdecitabine, injdeferoxamine mesylate injdenileukin diftitox, 300 mcgdepo-estradiol cypionate injdexamethasone inhal sol condexamethasone inhal sol u ddexamethasone sodium phosdexrazoxane hcl injectiondextran 40 infusiondextran 75 infusiondiazepam injectiondicyclomine injectiondiethylstilbestrol diphosphate, 250 mgdigoxin immune fab (ovine)digoxin injectiondimecaprol injectiondimenhydrinate injectiondimethyl sulfoxide 50% 50 mldiphenhydramine hcl 50mgdiphenhydramine hcl injectiodipyridamole injectiondocetaxeldolasetron mesylatedolasetron mesylate oraldopamine injectiondornase alpha inhal sol u ddoxorubic hcl 10 mg vl chemodoxorubicin hcl liposome injdronabinol 2.5mg oraldronabinol 5mg oraldroperidol injectiondt vaccine < 7 yo, imdyphylline injeculizumab injedetate calcium disodium injelliotts b solution per mlepirubicin hydrochloride, 50 mgepoetin alfa, esrd on dialysisepoetin alfa, for esrd on dialysisepoetin alfa, non-esrdepoprostenol injectioneptifibatide injectionertapenem injectionerythro lactobionate /500 mgestradiol valerate 10 mg injestradiol valerate 20 mg injestradiol valerate injectionetanercept injectionethanolamine oleate 100 mgetoposide 10 mg injetoposide 100 mg injetoposide oral 50 mgeuflexxa, injeuflexxa, injfactor ix complexfactor ix non-recombinantfactor ix recombinantfactor viiafactor viiifactor viii recombinantfentanyl citrate injecitonfilgrastim 300 mcg injectionfilgrastim 480 mcg injectionflebogamma injection flebogamma injectionflebogamma injectionfloxuridine injectionfluconazolefludarabine phosphate injfluocinolone acetonide impltfluorouracil injectionfluphenazine decanoate 25 mgfomepizole, 15 mgfondaparinux sodiumformoterol fumarate, inhfoscarnet sodium injectionfosphenytoin, 50 mgfurosemide injectiongad-base mr contrast nosgallium nitrate injectiongalsulfase, injgamma globulin > 10 cc injgamma globulin 1 cc injgamma globulin 10 cc injgamma globulin 2 cc injgamma globulin 3 cc injgamma globulin 4 cc injgamma globulin 5 cc injgamma globulin 6 cc injgamma globulin 7 cc injgamma globulin 8 cc injgamma globulin 9 cc injgammagard liquid injection gammagard liquid injection gammagard liquid injection gamunex injection gamunex injectiongamunex injectionganciclovir long act implantganciclovir sodium injectiongaramycin gentamicin injgatifloxacin injectiongemcitabine hclgemtuzumab ozogamicinglucagon hydrochloride/1 mgglycopyrrolate inhal sol conglycopyrrolate inhal sol u dgold sodium thiomaleate injgonadorelin hydroch/ 100 mcggoserelin acetate implantgranisetron hcl 1 mg oralgranisetron hcl injectionhaloperidol decanoate injhaloperidol injectionhemin, 1 mghepagam b im injection hepagam b im injectionhepagam b im injectionhepagam b ivhib vaccine, prp-omp, imhib vaccine, prp-t, imhistrelin implanthocm <=149 mg/ml iodinehocm 200-249mg/ml iodinehocm 250-299mg/ml iodinehocm 300-349mg/ml iodinehocm 350-399mg/ml iodinehocm>= 400mg/ml iodinehyalgan or supartz, injhyalgan or supartz, injhyaluronidase injectionhyaluronidase, recombinant, injhydralazine hcl injectionhydrocortisone sodium succ ihydromorphone injectionhydroxyzine hcl injectionhydroxyzine pamoate 25mghydroxyzine pamoate 50mghylan g-f 20, 16 mg, for intra articular injectionhyoscyamine sulfate injibandronate sodium, injibutilide fumarate injectionidarubicin hcl injectionidursulfase injifosfamide injectioniloprost inhalation solutionim inj interferon beta 1-aimmune globulin, liquidimmune globulin, powderinfliximab injectioninj benztropine mesylateinj calcitriol per 0.1 mcginj ceftazidime per 500 mginj cladribine per 1 mginj codeine phosphate /30 mginj desmopressin acetateinj dexamethasone acetateinj dihydroergotamine mesyltinj dobutamine hcl/250 mginj enoxaparin sodiuminj estrogen conjugate 25 mginj fe-based mr contrast,1mlinj gad-base mr contrast,1mlinj heparin sodium per 10 uinj heparin sodium per 1000uinj levocarnitine per 1 gminj magnesium sulfateinj melphalan hydrochl 50 mginj mepivacaine hcl/10 mlinj midazolam hydrochlorideinj milrinone lactate / 5 mginj multihanceinj multihance multipackinj nalbuphine hydrochlorideinj naloxone hydrochlorideinj octafluoropropane mic,mlinj perflutren lip micros,mlinj potassium chlorideinj progesterone per 50 mginj prohance multipackinj protamine sulfate/10 mginj secretin synthetic humaninj streptokinase /250000 iuinj theophylline per 40 mginj vonwillebrand factor iuinj vonwillebrand factor iuinj, epirubicin hcl, 2 mginj, moxifloxacin 100 mginjectable human tissueinjectable human tissueinjection adenosine 6 mginjection anistreplase 30 uinjection glatiramer acetateinjection imiglucerase /unitinjection of epo, per 1000 units, at patient hct of 20 or lessinjection of epo, per 1000 units, at patient hct of 21injection of epo, per 1000 units, at patient hct of 22injection of epo, per 1000 units, at patient hct of 23injection of epo, per 1000 units, at patient hct of 24injection of epo, per 1000 units, at patient hct of 25injection of epo, per 1000 units, at patient hct of 26injection of epo, per 1000 units, at patient hct of 27injection of epo, per 1000 units, at patient hct of 28injection of epo, per 1000 units, at patient hct of 29injection of epo, per 1000 units, at patient hct of 30injection of epo, per 1000 units, at patient hct of 31injection of epo, per 1000 units, at patient hct of 32injection of epo, per 1000 units, at patient hct of 33injection of epo, per 1000 units, at patient hct of 34injection of epo, per 1000 units, at patient hct of 35injection of epo, per 1000 units, at patient hct of 36injection of epo, per 1000 units, at patient hct of 37injection of epo, per 1000 units, at patient hct of 38injection of epo, per 1000 units, at patient hct of 39injection of epo, per 1000 units, at patient hct of 40 or aboveinjection torsemide 10 mg/mlinjection, alatrofloxacin mesylate, 100 mginjection, amitriptyline hcl, up to 20 mginjection, aurothioglucose, up to 50 mginjection, bethanechol chloride, myotonachol or urecholine, up to 5 mginjection, brompheniramine maleate, per 10 mginjection, calcium glycerophosphate and calcium lactate, per 10 mlinjection, cephalothin sodium, up to 1 graminjection, chloroquine hydrochloride, up to 250 mginjection, diazoxide, up to 300 mginjection, doxercalciferolinjection, droperidol and fentanyl citrate, up to 2 ml ampuleinjection, estrone, per 1 mginjection, etidronate disodium, per 300 mginjection, fulvestrantinjection, hydrocortisone acetate, up to 25 mginjection, hydrocortisone sodium phosphate, up to 50 mginjection, kutapressin, up to 2 mlinjection, levorphanol tartrate, up to 2 mginjection, lidocaine hcl, 50 ccinjection, medroxyprogesterone acetate / estradiol cypionate, 5mg / 25mginjection, meperidine and promethazine hcl, up to 50 mginjection, octreotide acetate, 1 mginjection, oxytetracycline hcl, up to 50 mginjection, pegfilgrastim 6mginjection, pegfilgrastim, 1 mginjection, promazine hcl, up to 25 mginjection, protirelin, per 250 mcginjection, sodium chloride, 0.9%, per 2 mlinjection, spectinomycin dihydrochloride, up to 2 gminjection, testosterone enanthate and estradiol valerate, up to 1 ccinjection, testosterone propionate, up to 100 mginjection, testosterone suspension, up to 50 mginjection, thiethylperazine maleate, up to 10 mginjection, trimetrexate glucuronate, per 25 mginjection, verteporfin, 15mginjection, voriconazoleinsulin for insulin pump useinsulin injectioninterferon alfa-2a injinterferon alfa-2b injinterferon alfacon-1interferon beta-1b / .25 mginterferon gamma 1-b injinterferon, alfa-n3, (human leukocyte derived), 250,000 iuintraocular fomivirsen naipratropium bromide non-compirinotecan injectioniron dextran 165 injectioniron dextran 267 injectioniron dextran injectioniron sucrose injectionitraconazole injectionkanamycin sulfate 500 mg injkanamycin sulfate 75 mg injketorolac tromethamine injlaronidase injectionlepirudinleucovorin calcium injectionleuprolide acetate /3.75 mgleuprolide acetate implantleuprolide acetate injecitonleuprolide acetate suspnsionlevalbuterol non-comp con1levalbuterol non-comp unit dose1levofloxacin injectionlidocaine injectionlincomycin injectionlinezolid injectionlocm <=149 mg/ml iodine, 1mllocm 100-199mg/ml iodinelocm 150-199mg/ml iodine,1mllocm 200-249mg/ml iodine,1mllocm 200-299mg/ml iodine locm 250-299mg/ml iodine,1mllocm 300-349mg/ml iodine,1mllocm 300-399mg/ml iodine locm 350-399mg/ml iodine,1mllorazepam injectionlymphocyte immune globulinmannitol injectionmechlorethamine hcl injmedroxyprogesterone injmelphalan oral 2 mgmeperidine hydrochl /100 mgmeropenemmesna injectionmetabolic active d/e tissuemetabolically active tissuemetaproterenol non-comp unit dosemethacholine chloride, nebmethadone injectionmethocarbamol injectionmethotrexate oral 2.5 mgmethotrexate sodium injmethotrexate sodium injmethyldopate hcl injectionmethylergonovin maleate injmethylprednisolone 20 mg injmethylprednisolone 40 mg injmethylprednisolone 80 mg injmethylprednisolone injectionmethylprednisolone injectionmethylprednisolone oralmetoclopramide hcl injectionmicafungin sodium, injmitomycin 20 mg injmitomycin 40 mg injmitomycin 5 mg injmitoxantrone hydrochl / 5 mgmonoclonal antibodiesmorphine so4 injection 100mgmorphine sulfate injectionmorphine sulfate injectionmycophenolate mofetil oralmycophenolic acidna ferric gluconate complexnaltrexone, depot form injnandrolone decanoate 100 mgnandrolone decanoate 200 mgnandrolone decanoate 50 mgnatalizumab injectionnatalizumab injectionnelarabine injectionneostigmine methylslfte injnesiritide injectionnon-human, metabolic tissuenon-human, non-metab tissuenon-human, non-metab tissuenonmetabolic act d/e tissuenonmetabolic active tissuenormal saline solution infusnormal saline solution infusnormal saline solution infusoctagam injection octagam injectionoctagam injectionoctreotide inj, non-depotoctreotide injection, depotomalizumab injectionondansetron hcl 8mg oralondansetron hcl injectionoprelvekin injectionoral aprepitantoral busulfanoral dexamethasoneoral mr contrast, 100 mlorphenadrine injectionorthovisc, injorthovisc, injovine, 1000 usp unitsovine, up to 999 usp unitsoxacillin sodium injecitonoxaliplatinoxymorphone hcl injectionoxytocin injectionpaclitaxel injectionpaclitaxel protein boundpalifermin injectionpalonosetron hclpamidronate disodium /30 mgpanitumumab injpapaverin hcl injectionparicalcitolpegademase bovine, 25 iupegaptanib sodium injectionpegaspargase/singl dose vialpemetrexed injectionpenicillin g benzathine injpenicillin g benzathine injpenicillin g benzathine injpenicillin g benzathine injpenicillin g benzathine injpenicillin g benzathine injpenicillin g potassium injpenicillin g procaine injpentamidine isethionte/300mgpentastarch 10% solutionpentazocine injectionpentobarbital sodium injpentostatin injectionperphenazine 4mg oralperphenazine 8mg oralphenobarbital sodium injphentolaine mesylate injphenylephrine hcl injectionphenytoin sodium injectionpiperacillin/tazobactamplasma protein fract,5%,50mlplasmaprotein fract,5%,250mlplicamycin, 2.5 mgporfimer sodiumpralidoxime chloride injprednisolone acetate injprednisolone oral per 5 mgprednisone oralprimatrix tissueprivigen injectionprocainamide hcl injectionprochlorperazine injectionprochlorperazine maleate 5mgpromethazine hcl 25 mg oralpromethazine hcl injectionpromethazine hcl oralpropranolol injectionpyridoxine hcl 100 mgquinupristin/dalfopristinranibizumab injranitidine hydrochloride injrasburicasereclast injection reclast injectionreclast injectionreteplase injectionrho d immune globulin 50 mcgrho d immune globulin injrho(d) immune globulin h, sdrhophylac injection rhophylac injectionrhophylac injectionringers lactate infusionrisperidone, long actingrituximab cancer treatmentropivacaine hcl injectionrsv-ivigsargramostim injectionsermorelin acetate injectionsincalide injectionsirolimus, oralsodium hyaluronate, per 20 to 25 mg dose for intra-articular injectionsomatropin injectionsterile cefuroxime injectionstreptomycin injectionstreptozocin injectionsuccinycholine chloride injsumatriptan succinate / 6 mgsupprelin la implantsynvisc, injsynvisc, injtacrolimus injectiontacrolimus oral per 1 mgtd vaccine no prsrv >/= 7 yo, imtdap => 7 yo, imtemozolomidetenecteplase injectionteniposide, 50 mgterbutaline sulfate injteriparatide injectiontestosterone cypionat 100 mgtestosterone cypionat 200 mgtestosterone cypionate 1 mltestosterone enanthate injtestosterone enanthate injthiamine hcl 100 mgthiethylperazine maleate10mgthiotepa injectionthyrotropin injectiontigecycline, injtinzaparin sodium injectiontirofiban hcltissuemend tissuetobramycin non-comp unit dosetobramycin sulfate injectiontopotecantrastuzumabtreprostinil injectiontriamcinolone acetonide injtriamcinolone diacetate injtriamcinolone hexacetonl injtrimethobenzamide hcl 250mgtrimethobenzamide hcl injtriptorelin pamoateunclassified biologicsurofollitropin, 75 iuurokinase 250,000 iu injurokinase 5000 iu injectionvalrubicin, intravesical, 200 mgvancomycin hcl injectionvaricella-zoster ig, imverteporfin injectionvinblastine sulfate injvincristine sulfate 1 mg injvincristine sulfate 2 mg injvincristine sulfate 5 mg injvinorelbine tartrate/10 mgvitamin b12 injectionvitamin k phytonadione injvivaglobulin, injectionvwf complex, nosziconotide injectionzidovudineziprasidone mesylatezoledronic acid Step 2: Enter number of Units     Units:  Step 3: Calculate CoPay         CoPay: $