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Revised January 2025 1st Quarter ASC Drug File

Effective 01/01/2025 – Revised 10/01/2025

HCPCS Code Status Indicator Drug Price Coinsurance Payment Cap Indicator Payment Cap Price
A9506 A $328.60 0.000 N $0.00
A9513 A $296.25 20.000 N $0.00
A9515 A $2,062.94 20.000 N $0.00
A9517 A $23.13 20.000 N $0.00
A9521 A $5,388.99 20.000 N $0.00
A9530 A $20.88 20.000 N $0.00
A9542 A $798.02 20.000 N $0.00
A9543 A $56,824.55 20.000 N $0.00
A9547 A $772.64 20.000 N $0.00
A9548 A $715.29 20.000 N $0.00
A9557 A $683.80 20.000 N $0.00
A9563 A $179.12 20.000 N $0.00
A9568 A $809.51 20.000 N $0.00
A9569 A $1,040.32 20.000 N $0.00
A9570 A $1,031.39 20.000 N $0.00
A9572 A $1,914.61 20.000 N $0.00
A9582 A $4,380.79 20.000 N $0.00
A9584 A $1,920.51 20.000 N $0.00
A9586 A $3,028.84 20.000 N $0.00
A9587 A $3,180.00 20.000 N $0.00
A9588 A $5,017.78 20.000 N $0.00
A9591 A $693.74 20.000 N $0.00
A9592 A $959.37 20.000 N $0.00
A9593 A $886.76 20.000 N $0.00
A9594 A $868.23 20.000 N $0.00
A9595 A $615.12 20.000 N $0.00
A9596 A $1,006.81 20.000 N $0.00
A9600 A $4,146.34 20.000 N $0.00
A9601 A $3,710.00 0.000 N $0.00
A9602 A $498.62 20.000 N $0.00
A9604 A $4,314.91 20.000 N $0.00
A9606 A $168.71 20.000 N $0.00
A9607 A $241.21 20.000 N $0.00
A9608 A $651.67 0.000 N $0.00
A9615 A $37.51 0.000 N $0.00
A9697 A $1,137.96 0.000 N $0.00
A9800 A $873.44 20.000 N $0.00
C9067 A $4.05 20.000 N $0.00
C9088 A $0.77 20.000 N $0.00
C9089 A $0.86 20.000 Y $700.48
C9101 A $1.32 0.000 N $0.00
C9144 A $0.50 20.000 N $0.00
C9145 A $1.86 0.000 N $0.00
C9173 A $0.54 20.000 N $0.00
C9248 A $2.80 20.000 N $0.00
C9250 A $134.50 20.000 N $0.00
C9257 A $1.83 20.000 N $0.00
C9399 C $0.00 20.000 N $0.00
C9460 A $18.82 20.000 N $0.00
C9482 A $22.78 18.559 N $0.00
J0121 A $3.92 20.000 N $0.00
J0129 A $43.80 20.000 N $0.00
J0139 A $91.72 20.000 N $0.00
J0172 A $5.98 20.000 N $0.00
J0174 A $1.33 20.000 N $0.00
J0175 A $4.09 20.000 N $0.00
J0177 A $329.06 20.000 N $0.00
J0178 A $801.07 20.000 N $0.00
J0179 A $338.89 20.000 N $0.00
J0180 A $223.52 20.000 N $0.00
J0184 A $9.08 0.000 N $0.00
J0185 A $1.70 20.000 N $0.00
J0202 A $2,413.36 20.000 N $0.00
J0206 A $4.40 20.000 N $0.00
J0208 A $96.00 20.000 N $0.00
J0211 A $2.17 20.000 N $0.00
J0217 A $440.81 20.000 N $0.00
J0218 A $381.58 20.000 N $0.00
J0219 A $77.86 20.000 N $0.00
J0221 A $201.64 20.000 N $0.00
J0222 A $98.83 20.000 N $0.00
J0223 A $115.47 20.000 N $0.00
J0224 A $318.01 20.000 N $0.00
J0225 A $4,917.75 20.000 N $0.00
J0256 A $5.09 20.000 N $0.00
J0257 A $5.51 20.000 N $0.00
J0287 A $10.30 20.000 N $0.00
J0289 A $23.98 20.000 N $0.00
J0291 A $3.57 20.000 N $0.00
J0349 A $10.42 19.860 N $0.00
J0391 A $51.83 20.000 N $0.00
J0401 A $7.07 20.000 N $0.00
J0402 A $5.92 20.000 N $0.00
J0475 A $173.84 20.000 N $0.00
J0480 A $4,657.58 20.000 N $0.00
J0485 A $3.93 20.000 N $0.00
J0490 A $54.91 20.000 N $0.00
J0491 A $17.76 20.000 N $0.00
J0517 A $165.89 20.000 N $0.00
J0558 A $19.52 14.832 N $0.00
J0561 A $26.82 13.624 N $0.00
J0565 A $39.87 20.000 N $0.00
J0577 A $428.66 19.275 N $0.00
J0578 A $1,714.63 19.275 N $0.00
J0584 A $469.73 18.894 N $0.00
J0585 A $6.47 20.000 N $0.00
J0586 A $8.53 20.000 N $0.00
J0587 A $12.99 20.000 N $0.00
J0588 A $5.31 20.000 N $0.00
J0589 A $3.13 20.000 N $0.00
J0594 A $1.42 20.000 N $0.00
J0596 A $34.67 20.000 N $0.00
J0597 A $72.46 19.083 N $0.00
J0598 A $64.07 20.000 N $0.00
J0600 A $6,084.10 20.000 N $0.00
J0630 A $1,142.41 20.000 N $0.00
J0638 A $135.88 20.000 N $0.00
J0651 A $3.82 20.000 N $0.00
J0652 A $5.14 20.000 N $0.00
J0666 A $1.45 20.000 Y $2,368.14
J0687 A $1.11 20.000 N $0.00
J0688 A $1.00 20.000 N $0.00
J0695 A $8.15 19.587 N $0.00
J0699 A $2.28 20.000 N $0.00
J0712 A $3.95 20.000 N $0.00
J0714 A $100.73 20.000 N $0.00
J0716 A $4,799.10 20.000 N $0.00
J0717 A $3.90 20.000 N $0.00
J0739 C $0.00 20.000 N $0.00
J0740 A $301.10 20.000 N $0.00
J0741 A $23.17 20.000 N $0.00
J0742 A $2.50 20.000 N $0.00
J0750 C $0.00 20.000 N $0.00
J0751 C $0.00 20.000 N $0.00
J0775 A $70.89 18.456 N $0.00
J0791 A $128.68 20.000 N $0.00
J0840 A $1,779.64 20.000 N $0.00
J0841 A $1,027.17 20.000 N $0.00
J0850 A $1,814.11 20.000 N $0.00
J0870 A $55.47 20.000 N $0.00
J0872 A $0.04 20.000 N $0.00
J0873 A $0.04 20.000 N $0.00
J0875 A $15.60 20.000 N $0.00
J0881 A $2.97 20.000 N $0.00
J0882 A $2.97 20.000 N $0.00
J0883 A $0.80 20.000 N $0.00
J0885 A $6.46 20.000 N $0.00
J0888 A $1.21 20.000 N $0.00
J0891 A $1.82 20.000 N $0.00
J0896 A $41.28 20.000 N $0.00
J0897 A $27.66 18.237 N $0.00
J0898 A $1.42 20.000 N $0.00
J0911 A $8.66 20.000 N $0.00
J1010 A $0.12 20.000 N $0.00
J1096 A $112.95 20.000 Y $427.57
J1097 A $96.84 20.000 Y $425.89
J1105 A $0.65 20.000 N $0.00
J1162 A $5,069.98 19.582 N $0.00
J1171 A $0.09 20.000 N $0.00
J1190 A $80.88 20.000 N $0.00
J1201 A $15.73 20.000 N $0.00
J1203 A $89.38 20.000 N $0.00
J1212 A $715.39 20.000 N $0.00
J1290 A $563.10 20.000 N $0.00
J1300 A $224.16 20.000 N $0.00
J1301 A $21.68 20.000 N $0.00
J1302 A $18.13 20.000 N $0.00
J1303 A $220.59 20.000 N $0.00
J1304 A $155.34 19.983 N $0.00
J1305 A $186.31 20.000 N $0.00
J1306 A $12.28 20.000 N $0.00
J1307 A $535.90 20.000 N $0.00
J1322 A $293.92 20.000 N $0.00
J1323 A $177.65 20.000 N $0.00
J1410 A $382.91 20.000 N $0.00
J1430 A $491.65 20.000 N $0.00
J1434 A $3.12 20.000 N $0.00
J1437 A $20.77 20.000 N $0.00
J1438 A $790.78 20.000 N $0.00
J1439 A $1.11 20.000 N $0.00
J1440 A $63.60 20.000 N $0.00
J1442 A $0.98 20.000 N $0.00
J1447 A $0.40 20.000 N $0.00
J1448 A $5.37 20.000 N $0.00
J1449 A $22.14 20.000 N $0.00
J1451 A $6.16 20.000 N $0.00
J1454 A $658.10 20.000 N $0.00
J1455 A $38.28 20.000 N $0.00
J1456 A $0.44 18.105 N $0.00
J1459 A $49.28 20.000 N $0.00
J1460 A $49.42 20.000 N $0.00
J1552 A $146.89 20.000 N $0.00
J1554 A $494.97 20.000 N $0.00
J1555 A $16.61 20.000 N $0.00
J1557 A $56.77 20.000 N $0.00
J1558 A $14.26 20.000 N $0.00
J1559 A $13.64 19.810 N $0.00
J1560 A $494.16 20.000 N $0.00
J1561 A $49.01 20.000 N $0.00
J1566 A $81.43 20.000 N $0.00
J1568 A $49.30 20.000 N $0.00
J1569 A $46.46 20.000 N $0.00
J1571 A $65.94 20.000 N $0.00
J1572 A $44.54 20.000 N $0.00
J1573 A $65.94 20.000 N $0.00
J1575 A $17.69 20.000 N $0.00
J1576 A $69.10 20.000 N $0.00
J1595 A $171.57 20.000 N $0.00
J1596 A $0.58 20.000 N $0.00
J1598 A $2.02 20.000 N $0.00
J1602 A $10.54 20.000 N $0.00
J1610 A $184.18 20.000 N $0.00
J1611 A $111.91 20.000 N $0.00
J1627 A $5.51 20.000 N $0.00
J1628 A $73.52 20.000 N $0.00
J1640 A $33.12 19.200 N $0.00
J1670 A $572.07 20.000 N $0.00
J1726 A $13.82 20.000 N $0.00
J1742 A $186.97 20.000 N $0.00
J1743 A $542.22 20.000 N $0.00
J1744 A $135.06 20.000 N $0.00
J1745 A $30.53 20.000 N $0.00
J1746 A $77.13 20.000 N $0.00
J1747 A $61.43 20.000 N $0.00
J1750 A $17.40 20.000 N $0.00
J1786 A $43.38 20.000 N $0.00
J1811 A $7.90 20.000 N $0.00
J1823 A $484.40 20.000 N $0.00
J1826 A $2,203.14 20.000 N $0.00
J1833 A $0.99 19.850 N $0.00
J1885 A $0.75 20.000 Y $1,214.30
J1930 A $44.98 20.000 N $0.00
J1931 A $38.62 20.000 N $0.00
J1932 A $30.68 20.000 N $0.00
J1939 A $0.58 20.000 N $0.00
J1943 A $3.13 20.000 N $0.00
J1944 A $3.23 20.000 N $0.00
J1950 A $1,666.78 18.865 N $0.00
J1951 A $136.48 20.000 N $0.00
J1952 A $55.91 20.000 N $0.00
J1954 A $235.28 20.000 N $0.00
J1961 A $21.98 20.000 N $0.00
J2002 A $0.00 20.000 N $0.00
J2182 A $30.69 20.000 N $0.00
J2183 A $1.65 20.000 N $0.00
J2186 A $2.10 20.000 N $0.00
J2265 A $2.59 18.580 N $0.00
J2267 A $45.39 20.000 N $0.00
J2277 A $25.22 20.000 N $0.00
J2278 A $9.78 20.000 N $0.00
J2315 A $4.12 20.000 N $0.00
J2323 A $23.88 20.000 N $0.00
J2326 A $1,246.99 20.000 N $0.00
J2327 A $15.08 20.000 N $0.00
J2329 A $69.03 20.000 N $0.00
J2350 A $58.77 20.000 N $0.00
J2353 A $218.37 20.000 N $0.00
J2356 A $18.16 20.000 N $0.00
J2357 A $37.76 20.000 N $0.00
J2358 A $2.92 20.000 N $0.00
J2373 A $0.14 20.000 N $0.00
J2403 A $0.61 0.000 N $0.00
J2406 A $43.32 20.000 N $0.00
J2407 A $28.53 20.000 N $0.00
J2425 A $33.99 16.931 N $0.00
J2426 A $14.73 20.000 N $0.00
J2427 A $12.62 20.000 N $0.00
J2468 A $59.74 20.000 N $0.00
J2502 A $533.50 15.840 N $0.00
J2506 A $19.98 20.000 N $0.00
J2507 A $3,550.05 19.648 N $0.00
J2508 A $226.79 19.758 N $0.00
J2510 A $47.19 20.000 N $0.00
J2547 A $1.68 20.000 N $0.00
J2561 A $0.65 20.000 N $0.00
J2562 A $37.08 20.000 N $0.00
J2597 A $4.87 20.000 N $0.00
J2601 A $3.63 20.000 N $0.00
J2679 A $7.69 20.000 N $0.00
J2690 A $183.03 20.000 N $0.00
J2724 A $15.03 20.000 N $0.00
J2760 A $394.63 20.000 N $0.00
J2770 A $4.26 20.000 N $0.00
J2777 A $35.25 20.000 N $0.00
J2778 A $123.98 20.000 N $0.00
J2779 A $80.46 20.000 N $0.00
J2781 A $146.37 20.000 N $0.00
J2782 A $108.70 20.000 N $0.00
J2783 A $369.97 20.000 N $0.00
J2786 A $10.32 20.000 N $0.00
J2792 A $32.86 20.000 N $0.00
J2794 A $10.99 20.000 N $0.00
J2798 A $12.19 20.000 N $0.00
J2799 A $24.72 20.000 N $0.00
J2801 A $13.03 20.000 N $0.00
J2802 A $10.54 18.772 N $0.00
J2820 A $60.02 19.839 N $0.00
J2840 A $539.52 20.000 N $0.00
J2850 A $42.57 19.648 N $0.00
J2860 A $155.97 18.799 N $0.00
J2919 A $0.27 20.000 N $0.00
J2941 A $48.92 20.000 N $0.00
J2993 A $2,777.14 20.000 N $0.00
J2997 A $91.48 20.000 N $0.00
J2998 A $32.52 20.000 N $0.00
J3032 A $19.32 19.419 N $0.00
J3055 A $69.97 19.787 N $0.00
J3060 A $41.62 20.000 N $0.00
J3090 A $1.81 20.000 N $0.00
J3095 A $7.40 20.000 N $0.00
J3101 A $162.43 19.959 N $0.00
J3111 A $11.49 19.485 N $0.00
J3145 A $1.92 19.648 N $0.00
J3240 A $2,067.91 20.000 N $0.00
J3241 A $347.10 20.000 N $0.00
J3245 A $133.18 20.000 N $0.00
J3247 A $17.72 20.000 N $0.00
J3262 A $5.97 20.000 N $0.00
J3263 A $39.32 20.000 N $0.00
J3285 A $55.95 20.000 N $0.00
J3299 A $48.42 20.000 N $0.00
J3304 A $18.00 20.000 N $0.00
J3315 A $481.29 20.000 N $0.00
J3316 A $3,512.09 20.000 N $0.00
J3357 A $155.88 20.000 N $0.00
J3358 A $12.76 20.000 N $0.00
J3380 A $21.67 20.000 N $0.00
J3385 A $374.02 20.000 N $0.00
J3396 A $11.50 20.000 N $0.00
J3398 A $3,173.23 20.000 N $0.00
J3401 A $1,016.78 20.000 N $0.00
J3424 A $5.18 20.000 N $0.00
J3425 A $0.01 20.000 N $0.00
J7165 A $1.80 20.000 N $0.00
J7168 A $2.21 20.000 N $0.00
J7169 A $131.80 20.000 N $0.00
J7170 A $52.02 20.000 N $0.00
J7171 A $34.57 20.000 N $0.00
J7175 A $9.53 20.000 N $0.00
J7177 A $1.11 20.000 N $0.00
J7178 A $1.48 20.000 N $0.00
J7179 A $1.85 20.000 N $0.00
J7180 A $10.47 20.000 N $0.00
J7181 A $17.17 20.000 N $0.00
J7182 A $1.43 20.000 N $0.00
J7183 A $1.28 20.000 N $0.00
J7185 A $1.50 20.000 N $0.00
J7186 A $1.20 20.000 N $0.00
J7187 A $1.45 20.000 N $0.00
J7188 A $3.23 20.000 N $0.00
J7189 A $2.55 20.000 N $0.00
J7190 A $1.12 20.000 N $0.00
J7192 A $1.54 20.000 N $0.00
J7193 A $1.34 20.000 N $0.00
J7194 A $1.66 20.000 N $0.00
J7195 A $1.84 20.000 N $0.00
J7197 A $3.96 20.000 N $0.00
J7198 A $2.36 20.000 N $0.00
J7201 A $3.58 20.000 N $0.00
J7202 A $5.21 20.000 N $0.00
J7203 A $4.39 20.000 N $0.00
J7204 A $2.19 20.000 N $0.00
J7205 A $2.34 20.000 N $0.00
J7207 A $2.10 20.000 N $0.00
J7208 A $2.45 20.000 N $0.00
J7209 A $1.24 20.000 N $0.00
J7210 A $1.52 20.000 N $0.00
J7211 A $1.48 20.000 N $0.00
J7213 A $1.86 20.000 N $0.00
J7214 A $4.64 20.000 N $0.00
J7308 A $395.26 20.000 N $0.00
J7311 A $333.23 20.000 N $0.00
J7312 A $205.56 20.000 N $0.00
J7313 A $493.68 20.000 N $0.00
J7314 A $525.89 20.000 N $0.00
J7318 A $6.70 20.000 N $0.00
J7320 A $6.17 20.000 N $0.00
J7322 A $17.42 20.000 N $0.00
J7323 A $119.95 20.000 N $0.00
J7324 A $92.14 20.000 N $0.00
J7325 A $9.16 20.000 N $0.00
J7326 A $526.38 20.000 N $0.00
J7327 A $564.65 20.000 N $0.00
J7329 A $6.10 20.000 N $0.00
J7332 A $10.09 20.000 N $0.00
J7336 A $3.33 20.000 N $0.00
J7340 A $235.95 20.000 N $0.00
J7345 A $1.72 20.000 N $0.00
J7351 A $209.89 20.000 N $0.00
J7352 A $2,873.33 20.000 N $0.00
J7353 A $56.99 20.000 N $0.00
J7354 A $711.75 20.000 N $0.00
J7355 A $197.16 20.000 N $0.00
J7402 A $11.35 20.000 N $0.00
J7501 A $228.97 20.000 N $0.00
J7504 A $4,355.73 13.043 N $0.00
J7511 A $950.26 20.000 N $0.00
J7525 A $254.67 20.000 N $0.00
J8510 A $84.21 20.000 N $0.00
J8522 A $0.04 20.000 N $0.00
J8611 A $18.97 20.000 N $0.00
J8612 A $20.71 20.000 N $0.00
J8655 A $399.87 19.030 N $0.00
J8670 A $1.62 20.000 N $0.00
J9015 A $5,301.26 20.000 N $0.00
J9017 A $4.68 20.000 N $0.00
J9021 A $54.14 19.549 N $0.00
J9022 A $88.22 20.000 N $0.00
J9023 A $96.95 20.000 N $0.00
J9026 A $1,575.42 20.000 N $0.00
J9027 A $8.46 20.000 N $0.00
J9028 A $94.87 20.000 N $0.00
J9029 A $63,402.04 20.000 N $0.00
J9032 A $50.28 20.000 N $0.00
J9033 A $1.80 20.000 N $0.00
J9034 A $13.45 20.000 N $0.00
J9035 A $73.19 20.000 N $0.00
J9036 A $17.13 20.000 N $0.00
J9037 A $41.73 20.000 N $0.00
J9039 A $152.51 19.281 N $0.00
J9042 A $248.93 18.275 N $0.00
J9043 A $224.09 20.000 N $0.00
J9046 A $4.91 20.000 N $0.00
J9047 A $51.97 18.735 N $0.00
J9048 A $16.50 20.000 N $0.00
J9050 A $255.32 20.000 N $0.00
J9052 A $0.05 20.000 N $0.00
J9055 A $77.10 20.000 N $0.00
J9056 A $28.65 20.000 N $0.00
J9057 A $89.16 20.000 N $0.00
J9061 A $21.56 19.138 N $0.00
J9063 A $68.11 20.000 N $0.00
J9065 A $11.27 20.000 N $0.00
J9071 A $0.70 20.000 N $0.00
J9073 A $2.19 17.035 N $0.00
J9074 A $4.35 20.000 N $0.00
J9075 A $0.88 20.000 N $0.00
J9119 A $28.21 20.000 N $0.00
J9120 A $324.80 20.000 N $0.00
J9144 A $51.39 20.000 N $0.00
J9145 A $65.32 20.000 N $0.00
J9150 A $23.52 20.000 N $0.00
J9153 A $248.41 19.634 N $0.00
J9155 A $4.34 20.000 N $0.00
J9172 A $52.21 20.000 N $0.00
J9173 A $83.88 20.000 N $0.00
J9176 A $7.72 20.000 N $0.00
J9177 A $36.65 19.072 N $0.00
J9179 A $133.32 20.000 N $0.00
J9185 A $168.30 20.000 N $0.00
J9200 A $3,989.64 20.000 N $0.00
J9202 A $703.06 18.185 N $0.00
J9203 A $233.12 20.000 N $0.00
J9204 A $243.32 20.000 N $0.00
J9205 A $64.22 20.000 N $0.00
J9207 A $136.43 19.758 N $0.00
J9210 A $376.57 20.000 N $0.00
J9217 A $180.79 20.000 N $0.00
J9223 A $204.90 20.000 N $0.00
J9226 A $45,261.80 20.000 N $0.00
J9227 A $79.35 20.000 N $0.00
J9228 A $180.05 20.000 N $0.00
J9229 A $2,658.13 20.000 N $0.00
J9245 A $133.69 20.000 N $0.00
J9246 A $18.00 20.000 N $0.00
J9248 A $773.80 20.000 N $0.00
J9261 A $74.76 20.000 N $0.00
J9262 A $3.95 20.000 N $0.00
J9264 A $13.54 20.000 N $0.00
J9266 A $27,070.53 19.139 N $0.00
J9268 A $2,732.53 17.347 N $0.00
J9269 A $338.89 20.000 N $0.00
J9271 A $57.60 20.000 N $0.00
J9272 A $240.06 20.000 N $0.00
J9273 A $181.87 19.503 N $0.00
J9274 A $214.76 20.000 N $0.00
J9280 A $46.35 20.000 N $0.00
J9281 A $311.36 20.000 N $0.00
J9286 A $2,770.91 20.000 N $0.00
J9293 A $60.82 20.000 N $0.00
J9294 A $2.57 20.000 N $0.00
J9295 A $5.73 20.000 N $0.00
J9296 A $9.74 20.000 N $0.00
J9298 A $193.86 20.000 N $0.00
J9299 A $32.30 20.000 N $0.00
J9301 A $74.83 20.000 N $0.00
J9302 A $62.23 20.000 N $0.00
J9303 A $165.71 18.661 N $0.00
J9304 A $52.70 20.000 N $0.00
J9305 A $5.27 20.000 N $0.00
J9306 A $16.19 20.000 N $0.00
J9307 A $373.77 19.958 N $0.00
J9308 A $72.91 20.000 N $0.00
J9309 A $132.92 20.000 N $0.00
J9311 A $36.58 20.000 N $0.00
J9312 A $76.73 20.000 N $0.00
J9313 A $23.39 20.000 N $0.00
J9314 A $7.14 20.000 N $0.00
J9316 A $63.88 20.000 N $0.00
J9317 A $35.44 20.000 N $0.00
J9318 A $28.52 20.000 N $0.00
J9319 A $30.39 20.000 N $0.00
J9321 A $55.19 20.000 N $0.00
J9323 A $10.55 20.000 N $0.00
J9324 A $82.14 20.000 N $0.00
J9325 A $70.37 19.315 N $0.00
J9328 A $10.41 20.000 N $0.00
J9329 A $55.16 20.000 N $0.00
J9330 A $29.52 20.000 N $0.00
J9331 A $80.81 20.000 N $0.00
J9332 A $32.45 20.000 N $0.00
J9333 A $22.82 20.000 N $0.00
J9334 A $33.10 20.000 N $0.00
J9340 A $221.75 20.000 N $0.00
J9345 A $29.26 20.000 N $0.00
J9347 A $138.43 20.000 N $0.00
J9348 A $642.29 20.000 N $0.00
J9349 A $13.97 20.000 N $0.00
J9350 A $641.07 20.000 N $0.00
J9352 A $362.75 20.000 N $0.00
J9353 A $49.40 20.000 N $0.00
J9354 A $40.97 20.000 N $0.00
J9355 A $77.05 20.000 N $0.00
J9356 A $63.06 20.000 N $0.00
J9357 A $1,392.52 20.000 N $0.00
J9358 A $28.81 20.000 N $0.00
J9359 A $212.12 20.000 N $0.00
J9380 A $32.55 19.984 N $0.00
J9381 A $37.24 20.000 N $0.00
J9393 A $21.20 20.000 N $0.00
J9394 A $12.26 20.000 N $0.00
J9395 A $6.66 20.000 N $0.00
J9400 A $7.98 20.000 N $0.00
J9600 A $24,228.42 20.000 N $0.00
P9045 A $53.08 20.000 N $0.00
P9046 A $21.23 20.000 N $0.00
Q0138 A $0.38 20.000 N $0.00
Q0139 A $0.38 20.000 N $0.00
Q2026 A $333.42 20.000 N $0.00
Q2028 A $1.00 20.000 N $0.00
Q2043 A $55,536.50 20.000 N $0.00
Q2049 A $528.86 20.000 N $0.00
Q2050 A $136.05 20.000 N $0.00
Q3027 A $55.62 20.000 N $0.00
Q5101 A $0.36 20.000 N $0.00
Q5103 A $11.55 20.000 N $0.00
Q5104 A $26.26 20.000 N $0.00
Q5105 A $0.75 20.000 N $0.00
Q5106 A $7.47 20.000 N $0.00
Q5107 A $28.73 20.000 N $0.00
Q5108 A $125.30 20.000 N $0.00
Q5110 A $0.29 20.000 N $0.00
Q5111 A $135.55 20.000 N $0.00
Q5112 A $26.37 20.000 N $0.00
Q5113 A $71.98 20.000 N $0.00
Q5114 A $51.84 20.000 N $0.00
Q5115 A $31.83 20.000 N $0.00
Q5116 A $18.97 20.000 N $0.00
Q5117 A $34.69 20.000 N $0.00
Q5118 A $23.00 20.000 N $0.00
Q5119 A $23.59 20.000 N $0.00
Q5120 A $24.71 20.000 N $0.00
Q5121 A $19.83 20.000 N $0.00
Q5122 A $117.01 20.000 N $0.00
Q5123 A $36.78 20.000 N $0.00
Q5124 A $169.20 20.000 N $0.00
Q5125 A $0.45 20.000 N $0.00
Q5126 A $48.79 20.000 N $0.00
Q5127 A $298.31 20.000 N $0.00
Q5128 A $168.74 20.000 N $0.00
Q5129 A $52.00 20.000 N $0.00
Q5130 A $169.69 20.000 N $0.00
Q5133 A $6.00 20.000 N $0.00
Q5135 A $4.11 20.000 N $0.00
Q5140 A $13.18 20.000 N $0.00
Q5141 A $13.75 20.000 N $0.00
Q5142 A $10.54 20.000 N $0.00
Q5143 A $10.43 20.000 N $0.00
Q5144 A $15.02 20.000 N $0.00
Q5145 A $128.07 20.000 N $0.00
Q9968 A $8.90 20.000 N $0.00
Q9982 A $1,866.58 20.000 N $0.00
Q9983 A $1,273.76 20.000 N $0.00
Q9991 A $1,931.81 20.000 N $0.00
Q9992 A $1,931.81 20.000 N $0.00
90371 A $146.31 20.000 N $0.00
90375 A $280.37 20.000 N $0.00
90376 A $347.32 20.000 N $0.00
90377 A $250.52 20.000 N $0.00
90378 A $719.87 20.000 N $0.00
90396 A $2,252.28 20.000 N $0.00
90675 A $327.78 20.000 N $0.00
90676 A $264.47 20.000 N $0.00
90740 C $0.00 20.000 N $0.00
90743 C $0.00 20.000 N $0.00
90744 C $0.00 20.000 N $0.00
90746 C $0.00 20.000 N $0.00
90747 C $0.00 20.000 N $0.00

All CPT codes begin with a numeric character and all HCPCS codes begin with an alpha character.

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted 2025 by the American Medical Association.

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