January 2006 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing File - Revised 09-07-06


Inclusion or exclusion of a fee schedule amount for an item or service does not imply any health insurance coverage.

 

HCPCS Code

Dosage

Fee

G0333

dispensing fee

$57.000

J0133

5 mg

$0.470

J0285

50 mg

$10.280

J0287

10 mg

$21.850

J0288

10 mg

$15.200

J0289

10 mg

$35.800

J0895

500 mg

$15.630

J1170

4 mg

$1.490

J1250

250 mg

$4.740

J1265

40 mg

$0.620

J1325

0.5 mg

$12.640

J1455

1000 mg

$13.070

J1566

500 mg

$22.222

J1567

500 mg

$28.361

J1570

500 mg

$35.250

J1644AX

1000 units

$0.210

J1815

5 Units

$0.239

J1817

50 units

$2.800

J2175

100 mg

$0.560

J2260

5 ml

$51.580

J2270

10 mg

$0.710

J2271

100 mg

$11.070

J2275

10 mg

$4.390

J2545

300 mg

$43.565

J2920

40 mg

$1.917

J2930

125 mg

$2.503

J3010

0.1 mg

$0.700

J3285

1 mg

$61.750

J3370

500 mg

$7.030

J7500

50 mg

$0.133

J7501

100 mg

$49.306

J7502

100 mg

$3.475

J7506

5 mg

$0.217

J7507

1 mg

$3.452

J7509

4 mg

$0.085

J7510

5 mg

$0.073

J7513

25 mg

$357.775

J7515

25 mg

$0.942

J7517

250 mg

$2.531

J7518

180 mg

$2.167

J7520

1 mg

$6.922

J7525

5 mg

$136.920

J7608KO

1 gram

$2.596

J7608KP

1 gram

$2.596

J7608KQ

1 gram

$2.465

J7611

1 mg

$0.077

J7612

1 mg

$0.987

J7613KO

1 mg

$0.060

J7613KP

1 mg

$0.060

J7613KQ

1 mg

$0.077

J7614KO

0.5 mg

$1.338

J7614KP

0.5 mg

$1.338

J7614KQ

0.5 mg

$0.987

J7622KO

1 mg

IC

J7622KP

1 mg

IC

J7622KQ

1 mg

IC

J7624KO

1 mg

IC

J7624KP

1 mg

IC

J7624KQ

1 mg

IC

J7626KO

1 unit

$4.407

J7626KP

1 unit

$4.407

J7626KQ

1 unit

$4.355

J7627KO

0.5 MG

IC

J7627KP

0.5 MG

IC

J7627KQ

0.5 MG

IC

J7628

1 mg

IC

J7629KO

1 mg

IC

J7629KP

1 mg

IC

J7629KQ

1 mg

IC

J7631KO

10 mg

$0.063

J7631KP

10 mg

$0.063

J7631KQ

10 mg

$0.034

J7633

0.25 mg

IC

J7635

1 mg

$0.119

J7636KO

1 mg

$0.119

J7636KP

1 mg

$0.119

J7636KQ

1 mg

$0.119

J7637

1 mg

$0.121

J7638KO

1 mg

$0.121

J7638KP

1 mg

$0.121

J7638KQ

1 mg

$0.121

J7639KO

1 mg

$18.647

J7639KP

1 mg

$18.647

J7639KQ

1 mg

$18.626

J7641KO

1 mg

IC

J7641KP

1 mg

IC

J7641KQ

1 mg

IC

J7642

1 mg

$1.186

J7643KO

1 mg

$1.186

J7643KP

1 mg

$1.186

J7643KQ

1 mg

$1.186

J7644KO

1 mg

$0.227

J7644KP

1 mg

$0.227

J7644KQ

1 mg

$0.124

J7648

1 mg

IC

J7649KO

1 mg

IC

J7649KP

1 mg

IC

J7649KQ

1 mg

IC

J7658

1 mg

IC

J7659KO

1 mg

IC

J7659KP

1 mg

IC

J7659KQ

1 mg

IC

J7668

10 mg

$0.180

J7669KO

10 mg

$0.232

J7669KP

10 mg

$0.232

J7669KQ

10 mg

IC

J7680

1 mg

IC

J7681KO

1 mg

IC

J7681KP

1 mg

IC

J7681KQ

1 mg

IC

J7682KO

1 mg

$52.456

J7682KP

1 mg

$52.456

J7682KQ

1 mg