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.

