| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
3,482 |
3,366 |
$3.33M |
| 78815 |
Positron emission tomography (PET) for limited area imaging |
1,650 |
1,642 |
$2.42M |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
39,935 |
34,145 |
$2.24M |
| 0360 |
|
851 |
677 |
$1.80M |
| 70553 |
Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences |
1,331 |
1,305 |
$1.64M |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
4,237 |
4,052 |
$1.30M |
| 80053 |
Comprehensive metabolic panel |
14,403 |
11,116 |
$1.23M |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
1,371 |
1,359 |
$1.20M |
| 74178 |
|
627 |
611 |
$1.12M |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
3,274 |
2,307 |
$1.06M |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
881 |
845 |
$1.03M |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
1,897 |
1,877 |
$920K |
| 78452 |
Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress |
884 |
851 |
$885K |
| 0250 |
|
5,123 |
4,329 |
$695K |
| 0760 |
|
6,827 |
5,932 |
$674K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
1,736 |
1,424 |
$661K |
| 0202U |
Oncology (prostate), multianalyte, gene expression profiling |
171 |
162 |
$645K |
| 0710 |
|
1,604 |
1,522 |
$630K |
| 71250 |
|
1,450 |
1,425 |
$616K |
| 74183 |
|
524 |
516 |
$598K |
| 93017 |
|
1,254 |
1,206 |
$577K |
| 71046 |
Radiologic examination, chest; 2 views |
3,011 |
2,749 |
$570K |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
548 |
535 |
$559K |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
677 |
518 |
$529K |
| 82962 |
|
3,877 |
3,462 |
$502K |
| 72197 |
|
531 |
526 |
$495K |
| 0270 |
|
2,295 |
2,041 |
$482K |
| 99199 |
Unlisted special service, procedure or report |
2,816 |
2,462 |
$442K |
| 0272 |
|
3,233 |
2,807 |
$425K |
| 74174 |
|
673 |
660 |
$422K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
4,687 |
4,369 |
$383K |
| 80197 |
|
8,921 |
5,397 |
$382K |
| 0370 |
|
2,090 |
1,996 |
$378K |
| A9577 |
Injection, gadobenate dimeglumine (multihance), per ml |
2,631 |
2,517 |
$377K |
| U0003 |
Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high throughput technologies as described by cms-2020-01-r |
6,443 |
5,825 |
$327K |
| 93975 |
|
1,276 |
1,243 |
$318K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
2,940 |
2,524 |
$307K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
1,568 |
1,351 |
$303K |
| Q3014 |
Telehealth originating site facility fee |
15,272 |
13,848 |
$303K |
| 86850 |
|
3,833 |
3,485 |
$284K |
| 45380 |
Colonoscopy, flexible; with biopsy, single or multiple |
304 |
298 |
$281K |
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
799 |
772 |
$273K |
| 83735 |
|
11,135 |
6,947 |
$256K |
| Q9957 |
Injection, perflutren lipid microspheres, per ml |
471 |
460 |
$252K |
| 96413 |
Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance |
1,761 |
1,295 |
$242K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
2,524 |
2,424 |
$235K |
| 99070 |
|
409 |
343 |
$231K |
| 86900 |
|
4,551 |
4,132 |
$226K |
| J2785 |
Injection, regadenoson, 0.1 mg |
666 |
645 |
$217K |
| 85610 |
|
5,069 |
4,491 |
$207K |
| J0485 |
Injection, belatacept, 1 mg |
316 |
143 |
$205K |
| 94010 |
|
1,838 |
1,688 |
$204K |
| 36415 |
Collection of venous blood by venipuncture |
11,003 |
8,439 |
$192K |
| 86832 |
|
2,715 |
2,487 |
$185K |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
1,356 |
651 |
$178K |
| 0510 |
|
15,832 |
13,563 |
$178K |
| 86833 |
|
2,719 |
2,483 |
$171K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
18,094 |
12,995 |
$169K |
| A9552 |
Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries |
1,372 |
1,366 |
$165K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
1,699 |
1,084 |
$162K |
| 72148 |
Magnetic resonance imaging, lumbar spine; without contrast material |
322 |
318 |
$159K |
| 82565 |
|
1,444 |
1,405 |
$156K |
| A4217 |
Sterile water/saline, 500 ml |
668 |
638 |
$144K |
| A9502 |
Technetium tc-99m tetrofosmin, diagnostic, per study dose |
632 |
608 |
$143K |
| 87497 |
|
3,617 |
2,684 |
$142K |
| 94618 |
|
688 |
675 |
$139K |
| 93356 |
|
625 |
602 |
$136K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
370 |
339 |
$128K |
| 94726 |
|
741 |
729 |
$126K |
| 92134 |
|
2,448 |
2,364 |
$125K |
| 80069 |
|
3,024 |
1,672 |
$122K |
| 82040 |
|
408 |
384 |
$122K |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
210 |
208 |
$121K |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
1,769 |
622 |
$121K |
| 86481 |
|
952 |
894 |
$118K |
| 86920 |
|
465 |
446 |
$114K |
| 81001 |
|
6,691 |
4,741 |
$114K |
| 92083 |
|
1,364 |
1,340 |
$112K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
204 |
201 |
$109K |
| J0897 |
Injection, denosumab, 1 mg |
140 |
139 |
$109K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
398 |
373 |
$107K |
| J1569 |
Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg |
49 |
27 |
$101K |
| 72110 |
|
529 |
528 |
$97K |
| 73564 |
|
849 |
775 |
$92K |
| 86901 |
|
4,473 |
4,055 |
$92K |
| 93880 |
|
294 |
289 |
$90K |
| 93970 |
|
333 |
324 |
$90K |
| J7999 |
Compounded drug, not otherwise classified |
223 |
203 |
$90K |
| 93350 |
|
67 |
66 |
$89K |
| 73630 |
|
509 |
491 |
$89K |
| 94729 |
|
724 |
713 |
$87K |
| J7050 |
Infusion, normal saline solution, 250 cc |
3,609 |
2,689 |
$82K |
| 84100 |
|
6,840 |
4,425 |
$82K |
| 92557 |
|
785 |
776 |
$82K |
| 0361 |
|
297 |
268 |
$79K |
| 88342 |
|
400 |
386 |
$78K |
| 83880 |
|
2,291 |
1,982 |
$78K |
| 96415 |
|
873 |
728 |
$77K |
| J7040 |
Infusion, normal saline solution, sterile (500 ml = 1 unit) |
424 |
318 |
$76K |
| 71045 |
Radiologic examination, chest; single view |
809 |
756 |
$72K |
| 91200 |
|
418 |
415 |
$72K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
5,678 |
5,246 |
$71K |
| 73030 |
|
635 |
615 |
$69K |
| 96361 |
Intravenous infusion, hydration; each additional hour |
429 |
276 |
$68K |
| 94060 |
|
245 |
242 |
$66K |
| 72141 |
|
108 |
108 |
$64K |
| 92133 |
|
1,045 |
1,023 |
$64K |
| 31231 |
|
463 |
441 |
$63K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,828 |
1,719 |
$63K |
| 87799 |
|
2,420 |
1,807 |
$60K |
| C8929 |
Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiography |
96 |
96 |
$58K |
| J2704 |
Injection, propofol, 10 mg |
3,063 |
2,816 |
$55K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
734 |
411 |
$53K |
| J3490 |
Unclassified drugs |
943 |
681 |
$50K |
| 76776 |
|
262 |
248 |
$50K |
| A9270 |
Non-covered item or service |
2,771 |
1,868 |
$49K |
| 31237 |
|
43 |
38 |
$48K |
| 74230 |
|
272 |
266 |
$48K |
| 72100 |
|
354 |
351 |
$47K |
| 93325 |
|
229 |
220 |
$46K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
666 |
629 |
$45K |
| 73562 |
|
607 |
570 |
$45K |
| 84156 |
|
4,316 |
2,641 |
$44K |
| 70450 |
Computed tomography, head or brain; without contrast material |
101 |
98 |
$43K |
| 73502 |
|
510 |
493 |
$43K |
| C1760 |
Closure device, vascular (implantable/insertable) |
17 |
16 |
$41K |
| 76770 |
|
298 |
294 |
$40K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
1,646 |
1,218 |
$39K |
| 87070 |
|
834 |
772 |
$39K |
| 85730 |
|
2,658 |
2,473 |
$38K |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
3,419 |
3,226 |
$37K |
| 80061 |
Lipid panel |
1,908 |
1,862 |
$37K |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
1,100 |
1,035 |
$36K |
| 93296 |
|
836 |
836 |
$35K |
| J0585 |
Injection, onabotulinumtoxina, 1 unit |
68 |
51 |
$35K |
| 86828 |
|
524 |
484 |
$34K |
| Q9956 |
Injection, octafluoropropane microspheres, per ml |
46 |
45 |
$33K |
| U0005 |
Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2 |
4,755 |
4,281 |
$33K |
| J1610 |
Injection, glucagon hydrochloride, per 1 mg |
208 |
207 |
$32K |
| 81376 |
|
184 |
149 |
$32K |
| 82570 |
|
4,619 |
2,921 |
$32K |
| 99221 |
|
1,076 |
940 |
$31K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
1,501 |
1,478 |
$30K |
| 86803 |
|
1,231 |
1,162 |
$30K |
| 86592 |
|
1,167 |
1,108 |
$30K |
| 92504 |
|
1,032 |
990 |
$29K |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
1,544 |
1,278 |
$28K |
| 93922 |
|
228 |
224 |
$28K |
| 87150 |
|
895 |
746 |
$26K |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
1,883 |
1,526 |
$26K |
| 84443 |
Thyroid stimulating hormone (TSH) |
1,884 |
1,827 |
$26K |
| 86704 |
|
1,208 |
1,142 |
$26K |
| 87081 |
|
1,763 |
1,685 |
$23K |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
646 |
326 |
$23K |
| 73610 |
|
275 |
265 |
$22K |
| 86480 |
|
204 |
201 |
$21K |
| 87186 |
|
730 |
675 |
$21K |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
2,613 |
2,372 |
$21K |
| 77073 |
|
360 |
354 |
$21K |
| 87077 |
|
1,152 |
1,047 |
$20K |
| 85027 |
|
2,403 |
2,175 |
$20K |
| J1644 |
Injection, heparin sodium, per 1000 units |
887 |
744 |
$19K |
| 43235 |
|
12 |
12 |
$19K |
| 86140 |
|
1,041 |
986 |
$19K |
| 87517 |
|
456 |
433 |
$19K |
| 87205 |
|
790 |
728 |
$19K |
| 99231 |
Subsequent hospital care, per day, straightforward or low complexity |
683 |
628 |
$18K |
| 31575 |
|
193 |
182 |
$18K |
| 73560 |
|
253 |
240 |
$18K |
| 77080 |
|
213 |
211 |
$18K |
| J0690 |
Injection, cefazolin sodium, 500 mg |
983 |
806 |
$17K |
| J7060 |
5% dextrose/water (500 ml = 1 unit) |
789 |
536 |
$17K |
| J1170 |
Injection, hydromorphone, up to 4 mg |
664 |
551 |
$17K |
| 0255 |
|
246 |
232 |
$17K |
| 92250 |
|
435 |
432 |
$17K |
| 93454 |
|
15 |
15 |
$17K |
| Z7500 |
|
471 |
405 |
$16K |
| 87340 |
|
1,314 |
1,246 |
$16K |
| 83970 |
|
541 |
516 |
$16K |
| 97535 |
Self-care/home management training, each 15 minutes |
656 |
450 |
$15K |
| 84153 |
|
719 |
685 |
$15K |
| 81025 |
|
620 |
586 |
$15K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
524 |
468 |
$15K |
| 97597 |
|
456 |
112 |
$14K |
| 72050 |
|
136 |
135 |
$14K |
| J7030 |
Infusion, normal saline solution , 1000 cc |
680 |
544 |
$14K |
| 87536 |
|
137 |
126 |
$14K |
| 80076 |
|
221 |
180 |
$13K |
| 73552 |
|
179 |
171 |
$13K |
| 81373 |
|
153 |
129 |
$13K |
| 67028 |
Intravitreal injection of a pharmacologic agent |
90 |
86 |
$13K |
| 82550 |
|
457 |
367 |
$12K |
| 73522 |
|
131 |
130 |
$12K |
| 83540 |
|
1,088 |
1,051 |
$12K |
| 83550 |
|
1,061 |
1,026 |
$12K |
| 87522 |
Neg quan hep c or qual rna |
236 |
217 |
$12K |
| J0178 |
Injection, aflibercept, 1 mg |
13 |
13 |
$11K |
| 82728 |
|
767 |
747 |
$11K |
| 86635 |
|
977 |
919 |
$11K |
| 88307 |
|
52 |
49 |
$9K |
| 86317 |
|
1,276 |
1,170 |
$8K |
| 73700 |
|
13 |
12 |
$8K |
| 97112 |
Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination |
146 |
85 |
$8K |
| 93925 |
|
39 |
39 |
$7K |
| 84439 |
|
526 |
510 |
$7K |
| 82105 |
|
624 |
601 |
$7K |
| 93321 |
|
42 |
40 |
$7K |
| J3590 |
Unclassified biologics |
96 |
91 |
$7K |
| G2066 |
Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular physiologic monitor system, implantable loop recorder system, or subcutaneous cardiac rhythm monitor system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results |
189 |
189 |
$7K |
| 87210 |
|
206 |
192 |
$7K |
| 92025 |
|
167 |
167 |
$7K |
| 0761 |
|
312 |
298 |
$7K |
| 93308 |
|
17 |
16 |
$7K |
| 82107 |
|
319 |
305 |
$6K |
| 82803 |
|
27 |
27 |
$6K |
| 83615 |
|
530 |
433 |
$6K |
| 83951 |
|
219 |
211 |
$6K |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
107 |
104 |
$6K |
| 93246 |
|
103 |
100 |
$6K |
| 90677 |
|
26 |
26 |
$6K |
| 80180 |
|
862 |
538 |
$6K |
| 87102 |
|
205 |
193 |
$6K |
| 93280 |
|
146 |
145 |
$6K |
| 85652 |
|
1,007 |
972 |
$6K |
| 0300 |
|
151 |
137 |
$6K |
| 73590 |
|
68 |
66 |
$6K |
| J1642 |
Injection, heparin sodium, (heparin lock flush), per 10 units |
1,031 |
667 |
$6K |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
169 |
139 |
$5K |
| 90662 |
|
147 |
147 |
$5K |
| 70486 |
|
12 |
12 |
$5K |
| 76536 |
|
45 |
45 |
$5K |
| 0271 |
|
333 |
320 |
$5K |
| 72040 |
|
39 |
39 |
$4K |
| 73221 |
|
12 |
12 |
$4K |
| C1769 |
Guide wire |
98 |
96 |
$4K |
| 74240 |
|
27 |
27 |
$4K |
| 86665 |
|
946 |
886 |
$4K |
| 88304 |
|
75 |
73 |
$4K |
| 82607 |
|
392 |
388 |
$4K |
| 92567 |
|
108 |
106 |
$4K |
| 83605 |
|
134 |
124 |
$4K |
| 93283 |
|
37 |
37 |
$3K |
| 99215 |
Prolong outpt/office vis |
53 |
51 |
$3K |
| 84484 |
|
140 |
131 |
$3K |
| 82784 |
|
326 |
281 |
$3K |
| 88313 |
|
26 |
26 |
$3K |
| 31579 |
|
12 |
12 |
$3K |
| 72082 |
|
14 |
14 |
$3K |
| 82610 |
|
464 |
431 |
$3K |
| X3908 |
|
96 |
43 |
$3K |
| G0008 |
Administration of influenza virus vaccine |
179 |
178 |
$3K |
| 86644 |
|
948 |
891 |
$3K |
| 87040 |
|
40 |
38 |
$3K |
| 0420 |
|
15 |
12 |
$2K |
| 87015 |
|
134 |
124 |
$2K |
| 93971 |
|
13 |
13 |
$2K |
| 93976 |
|
14 |
13 |
$2K |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
198 |
158 |
$2K |
| 92588 |
|
13 |
13 |
$2K |
| A9500 |
Technetium tc-99m sestamibi, diagnostic, per study dose |
13 |
13 |
$2K |
| 86645 |
|
744 |
698 |
$2K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
12 |
12 |
$2K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
31 |
27 |
$2K |
| 96367 |
|
36 |
30 |
$2K |
| 86790 |
|
145 |
140 |
$2K |
| 73130 |
|
24 |
24 |
$1K |
| 82746 |
|
135 |
132 |
$1K |
| A4649 |
Surgical supply; miscellaneous |
138 |
96 |
$1K |
| 85018 |
|
28 |
27 |
$1K |
| 86141 |
|
281 |
271 |
$1K |
| 93926 |
|
14 |
14 |
$1K |
| 76512 |
|
39 |
39 |
$1K |
| 88341 |
|
13 |
13 |
$1K |
| 92526 |
|
44 |
24 |
$1K |
| 72170 |
|
14 |
13 |
$1K |
| 97162 |
|
12 |
12 |
$1K |
| 90686 |
|
75 |
72 |
$1K |
| 89051 |
|
43 |
38 |
$1K |
| 73110 |
|
25 |
25 |
$1K |
| 87116 |
|
170 |
157 |
$1K |
| 86787 |
|
407 |
374 |
$1K |
| 82043 |
|
357 |
351 |
$978.62 |
| 69210 |
|
30 |
29 |
$937.83 |
| 86235 |
|
34 |
26 |
$925.16 |
| 92550 |
|
25 |
25 |
$910.57 |
| 86849 |
|
86 |
86 |
$890.39 |
| 97161 |
|
14 |
13 |
$864.99 |
| 86352 |
|
53 |
39 |
$854.54 |
| 87075 |
|
13 |
13 |
$824.79 |
| 92235 |
|
12 |
12 |
$789.48 |
| X3910 |
|
64 |
29 |
$782.28 |
| 76514 |
|
13 |
13 |
$679.46 |
| 83690 |
|
42 |
40 |
$663.93 |
| C1894 |
Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser |
13 |
13 |
$651.61 |
| 90653 |
|
61 |
61 |
$649.48 |
| Z7610 |
|
64 |
31 |
$638.16 |
| Q9966 |
Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml |
15 |
15 |
$618.65 |
| 87899 |
|
27 |
26 |
$582.89 |
| 86039 |
|
273 |
266 |
$564.42 |
| 88300 |
|
12 |
12 |
$465.83 |
| J0171 |
Injection, adrenalin, epinephrine, 0.1 mg |
55 |
51 |
$458.70 |
| 0480 |
|
39 |
39 |
$456.42 |
| 87206 |
|
156 |
144 |
$410.31 |
| 84550 |
|
58 |
54 |
$374.87 |
| 80158 |
|
21 |
15 |
$373.51 |
| J1805 |
Injection, esmolol hydrochloride, 10 mg |
44 |
43 |
$314.10 |
| 86682 |
|
43 |
41 |
$263.48 |
| 20610 |
|
14 |
12 |
$260.93 |
| 82375 |
|
14 |
14 |
$257.72 |
| 87305 |
|
14 |
13 |
$242.43 |
| J2003 |
Injection, lidocaine hydrochloride, 1 mg |
33 |
29 |
$238.00 |
| 82785 |
|
15 |
15 |
$220.16 |
| 84132 |
|
20 |
15 |
$215.46 |
| 92285 |
|
13 |
13 |
$205.63 |
| 86225 |
|
27 |
27 |
$189.64 |
| J3420 |
Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg |
104 |
97 |
$184.07 |
| J0173 |
Injection, epinephrine (belcher), not therapeutically equivalent to j0171, 0.1 mg |
15 |
12 |
$183.33 |
| 82810 |
|
14 |
13 |
$154.17 |
| 82977 |
|
14 |
13 |
$153.59 |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
14 |
13 |
$134.31 |
| J0688 |
Injection, cefazolin sodium (hikma), not therapeutically equivalent to j0690, 500 mg |
42 |
40 |
$131.88 |
| 86038 |
|
12 |
12 |
$127.00 |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
28 |
24 |
$117.92 |
| 83520 |
|
15 |
13 |
$97.73 |
| 82248 |
|
15 |
12 |
$91.91 |
| 86431 |
|
12 |
12 |
$87.72 |
| 80321 |
|
64 |
55 |
$72.00 |
| 86200 |
|
14 |
14 |
$69.73 |
| 92136 |
|
14 |
14 |
$33.07 |
| 83921 |
|
12 |
12 |
$30.45 |