| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99284 |
Emergency department visit for the evaluation and management, high severity |
16,182 |
13,956 |
$725K |
| 96361 |
Intravenous infusion, hydration; each additional hour |
5,750 |
4,545 |
$657K |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
14,166 |
12,311 |
$651K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
18,541 |
15,953 |
$587K |
| 87637 |
Infectious agent detection by nucleic acid; SARS-CoV-2, influenza, and RSV |
3,650 |
3,269 |
$435K |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
5,688 |
5,009 |
$305K |
| 80053 |
Comprehensive metabolic panel |
16,106 |
13,149 |
$275K |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
6,268 |
5,253 |
$260K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
4,420 |
3,839 |
$234K |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
11,609 |
4,091 |
$220K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
4,031 |
3,388 |
$204K |
| G0381 |
Level 2 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment) |
3,438 |
3,121 |
$196K |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
4,190 |
3,739 |
$195K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
4,078 |
2,181 |
$188K |
| G0380 |
Level 1 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment) |
3,169 |
2,830 |
$188K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
2,292 |
1,806 |
$177K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,867 |
3,375 |
$176K |
| G0382 |
Level 3 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment) |
2,975 |
2,666 |
$166K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,646 |
2,336 |
$153K |
| 87636 |
Infectious agent detection by nucleic acid; SARS-CoV-2 and influenza virus types A and B |
1,385 |
1,250 |
$144K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
18,490 |
14,508 |
$126K |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
10,455 |
3,458 |
$124K |
| 80306 |
|
5,193 |
3,720 |
$120K |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
1,936 |
1,662 |
$119K |
| 70450 |
Computed tomography, head or brain; without contrast material |
2,341 |
2,013 |
$116K |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
1,683 |
1,469 |
$104K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
5,169 |
4,195 |
$96K |
| C9803 |
Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
3,164 |
2,755 |
$87K |
| 84443 |
Thyroid stimulating hormone (TSH) |
4,747 |
4,123 |
$83K |
| A0427 |
Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) |
1,251 |
842 |
$74K |
| 92507 |
Treatment of speech, language, voice, communication, and/or auditory processing disorder |
2,819 |
845 |
$73K |
| 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 |
1,201 |
916 |
$68K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
1,466 |
1,215 |
$66K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
1,691 |
1,311 |
$66K |
| G0480 |
Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed |
1,553 |
1,225 |
$65K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
4,067 |
3,403 |
$61K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
1,736 |
1,423 |
$59K |
| 81025 |
|
3,377 |
2,826 |
$59K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
616 |
517 |
$58K |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
5,382 |
1,953 |
$56K |
| 80061 |
Lipid panel |
3,431 |
3,024 |
$54K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
1,160 |
905 |
$54K |
| 84484 |
|
5,379 |
3,466 |
$47K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
3,238 |
2,871 |
$46K |
| A0390 |
Als mileage (per mile) |
1,061 |
563 |
$45K |
| 81001 |
|
10,305 |
8,485 |
$44K |
| 84702 |
|
1,130 |
751 |
$41K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
576 |
537 |
$32K |
| G0378 |
Hospital observation service, per hour |
1,152 |
764 |
$32K |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
435 |
393 |
$30K |
| 73630 |
|
2,055 |
1,672 |
$28K |
| 87480 |
|
1,127 |
910 |
$26K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
808 |
731 |
$25K |
| 83690 |
|
4,124 |
3,459 |
$25K |
| 82948 |
|
2,529 |
1,546 |
$23K |
| 59025 |
Fetal non-stress test |
367 |
193 |
$22K |
| 71046 |
Radiologic examination, chest; 2 views |
5,208 |
4,498 |
$21K |
| 73110 |
|
1,095 |
843 |
$21K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
441 |
393 |
$19K |
| 85610 |
|
2,510 |
1,951 |
$19K |
| 87660 |
|
1,124 |
906 |
$18K |
| 73030 |
|
1,334 |
1,131 |
$18K |
| 87510 |
|
1,143 |
921 |
$18K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
331 |
297 |
$18K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
405 |
373 |
$18K |
| 87624 |
Infectious agent detection by nucleic acid; human papillomavirus (HPV), high-risk types |
427 |
334 |
$18K |
| 84439 |
|
1,187 |
1,024 |
$15K |
| 83880 |
|
771 |
639 |
$15K |
| 97112 |
Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination |
1,112 |
461 |
$15K |
| 83735 |
|
2,949 |
2,346 |
$15K |
| 87077 |
|
1,791 |
1,424 |
$15K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
190 |
145 |
$14K |
| 83605 |
|
1,884 |
1,388 |
$14K |
| 73564 |
|
781 |
679 |
$14K |
| 73610 |
|
1,416 |
1,184 |
$13K |
| 88175 |
Cytopathology, cervical or vaginal, any reporting system; collected in preservative fluid, automated thin layer |
513 |
402 |
$13K |
| 87186 |
|
1,853 |
1,535 |
$13K |
| 87634 |
|
283 |
238 |
$13K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
721 |
608 |
$12K |
| 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 |
1,172 |
900 |
$12K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
497 |
464 |
$12K |
| 73130 |
|
884 |
711 |
$12K |
| A0429 |
Ambulance service, basic life support, emergency transport (bls-emergency) |
279 |
186 |
$12K |
| 99291 |
Critical care, evaluation and management of the critically ill patient, first 30-74 minutes |
267 |
217 |
$11K |
| 76830 |
Ultrasound, transvaginal |
327 |
289 |
$11K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
264 |
236 |
$10K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
8,213 |
6,584 |
$10K |
| 76801 |
|
191 |
136 |
$9K |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
484 |
383 |
$9K |
| 85027 |
|
1,879 |
1,632 |
$9K |
| 87507 |
|
27 |
24 |
$9K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
155 |
147 |
$9K |
| 80055 |
|
99 |
78 |
$8K |
| 93010 |
Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only |
1,399 |
1,219 |
$8K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
110 |
81 |
$8K |
| 87070 |
|
402 |
333 |
$7K |
| 97162 |
|
659 |
580 |
$7K |
| 86803 |
|
548 |
477 |
$6K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
7,047 |
5,577 |
$6K |
| 87088 |
|
1,023 |
912 |
$5K |
| 84703 |
|
779 |
676 |
$5K |
| 90686 |
|
563 |
547 |
$5K |
| 86618 |
|
216 |
151 |
$5K |
| 87798 |
Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism |
75 |
72 |
$4K |
| 86140 |
|
744 |
576 |
$4K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
259 |
234 |
$4K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
77 |
76 |
$4K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
66 |
62 |
$4K |
| 85379 |
|
598 |
534 |
$4K |
| 86850 |
|
485 |
400 |
$4K |
| G0483 |
Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 22 or more drug class(es), including metabolite(s) if performed |
30 |
27 |
$4K |
| 11721 |
|
479 |
451 |
$4K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
4,039 |
3,161 |
$4K |
| 99233 |
Prolong inpt eval add15 m |
273 |
93 |
$4K |
| 91322 |
|
27 |
27 |
$4K |
| 99239 |
Hospital discharge day management, more than 30 minutes |
168 |
134 |
$3K |
| 81003 |
|
267 |
246 |
$3K |
| 98926 |
|
198 |
145 |
$3K |
| 82570 |
|
183 |
140 |
$3K |
| 72125 |
Computed tomography, cervical spine; without contrast material |
178 |
145 |
$3K |
| 86900 |
|
681 |
537 |
$3K |
| 85007 |
|
861 |
736 |
$3K |
| 36415 |
Collection of venous blood by venipuncture |
17,151 |
12,995 |
$3K |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
45 |
36 |
$2K |
| 73502 |
|
190 |
164 |
$2K |
| 87040 |
|
303 |
166 |
$2K |
| 99232 |
Subsequent hospital care, per day, moderate complexity |
199 |
82 |
$2K |
| 92567 |
|
72 |
64 |
$2K |
| G0379 |
Direct admission of patient for hospital observation care |
209 |
134 |
$2K |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
143 |
133 |
$2K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
4,496 |
3,615 |
$2K |
| 99308 |
Subsequent nursing facility care, per day, straightforward |
319 |
198 |
$2K |
| 87150 |
|
30 |
26 |
$2K |
| 82805 |
|
90 |
78 |
$2K |
| 87081 |
|
87 |
80 |
$2K |
| 97113 |
|
137 |
41 |
$2K |
| Q3014 |
Telehealth originating site facility fee |
110 |
86 |
$1K |
| 97035 |
|
258 |
111 |
$1K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
126 |
92 |
$1K |
| 87641 |
|
31 |
26 |
$1K |
| 82607 |
|
111 |
99 |
$1K |
| 20610 |
|
48 |
36 |
$1K |
| 84145 |
|
46 |
37 |
$1K |
| 86901 |
|
681 |
537 |
$1K |
| 85652 |
|
549 |
433 |
$1K |
| A0426 |
Ambulance service, advanced life support, non-emergency transport, level 1 (als 1) |
97 |
71 |
$1K |
| 90715 |
|
134 |
108 |
$1K |
| 73562 |
|
115 |
89 |
$1K |
| 90670 |
|
329 |
317 |
$1K |
| G0383 |
Level 4 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment) |
32 |
29 |
$1K |
| 0011A |
|
40 |
39 |
$1K |
| 72100 |
|
58 |
52 |
$995.18 |
| 88720 |
|
48 |
40 |
$993.34 |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
91 |
79 |
$912.35 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
14 |
14 |
$853.72 |
| 93976 |
|
26 |
24 |
$817.63 |
| 90698 |
|
258 |
241 |
$804.33 |
| 71045 |
Radiologic examination, chest; single view |
1,640 |
1,392 |
$741.04 |
| 92557 |
|
16 |
12 |
$733.88 |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
3,792 |
2,926 |
$713.26 |
| 85018 |
|
184 |
150 |
$701.32 |
| A0425 |
Ground mileage, per statute mile |
1,352 |
956 |
$668.38 |
| 12001 |
|
12 |
12 |
$631.08 |
| 72148 |
Magnetic resonance imaging, lumbar spine; without contrast material |
14 |
14 |
$614.48 |
| A0380 |
Bls mileage (per mile) |
46 |
24 |
$572.70 |
| 87210 |
|
122 |
101 |
$558.41 |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
288 |
225 |
$513.86 |
| 82043 |
|
58 |
48 |
$510.45 |
| 93971 |
|
30 |
25 |
$508.21 |
| 85014 |
|
79 |
69 |
$495.34 |
| 82550 |
|
107 |
94 |
$446.85 |
| 99307 |
|
26 |
16 |
$436.64 |
| 82950 |
|
14 |
12 |
$396.04 |
| 80050 |
General health panel |
42 |
37 |
$388.44 |
| 73080 |
|
79 |
62 |
$373.72 |
| 85730 |
|
114 |
97 |
$354.86 |
| 73140 |
|
65 |
61 |
$353.80 |
| 82728 |
|
26 |
24 |
$325.84 |
| 97166 |
|
17 |
14 |
$316.43 |
| 99443 |
|
22 |
15 |
$310.30 |
| 11056 |
|
14 |
14 |
$291.48 |
| 74019 |
|
118 |
107 |
$288.04 |
| 86787 |
|
39 |
28 |
$245.92 |
| 74018 |
|
60 |
49 |
$242.55 |
| 83520 |
|
16 |
12 |
$198.87 |
| 90744 |
|
66 |
56 |
$191.98 |
| A0428 |
Ambulance service, basic life support, non-emergency transport, (bls) |
17 |
13 |
$189.80 |
| 97163 |
|
43 |
37 |
$186.98 |
| 84100 |
|
52 |
44 |
$171.30 |
| 90681 |
|
55 |
53 |
$168.81 |
| 90658 |
|
13 |
12 |
$145.48 |
| J0702 |
Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg |
15 |
15 |
$140.46 |
| 83540 |
|
30 |
25 |
$134.90 |
| J3301 |
Injection, triamcinolone acetonide, not otherwise specified, 10 mg |
37 |
28 |
$103.91 |
| J2795 |
Injection, ropivacaine hydrochloride, 1 mg |
18 |
14 |
$73.50 |
| 82565 |
|
35 |
25 |
$70.82 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
139 |
115 |
$57.66 |
| 90710 |
|
17 |
17 |
$56.27 |
| 90723 |
|
15 |
14 |
$49.65 |
| 90648 |
|
14 |
13 |
$46.34 |
| 36000 |
|
802 |
705 |
$44.34 |
| 90633 |
|
13 |
13 |
$43.03 |
| 96376 |
|
468 |
370 |
$37.18 |
| 86592 |
|
15 |
13 |
$35.90 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
3,377 |
2,547 |
$20.87 |
| J2704 |
Injection, propofol, 10 mg |
1,790 |
982 |
$19.74 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
1,534 |
974 |
$10.93 |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
455 |
377 |
$6.77 |
| J1170 |
Injection, hydromorphone, up to 4 mg |
217 |
142 |
$5.36 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
2,389 |
1,859 |
$5.32 |
| J2001 |
Injection, lidocaine hcl for intravenous infusion, 10 mg |
115 |
91 |
$5.20 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
1,338 |
971 |
$5.15 |
| J0690 |
Injection, cefazolin sodium, 500 mg |
331 |
233 |
$4.67 |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
46 |
38 |
$3.00 |
| J2060 |
Injection, lorazepam, 2 mg |
53 |
39 |
$1.42 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
893 |
650 |
$1.04 |
| Q9963 |
High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml |
92 |
77 |
$0.18 |
| 91301 |
|
40 |
39 |
$0.07 |
| G8978 |
Mobility: walking & moving around functional limitation, current status, at therapy episode outset and at reporting intervals |
331 |
276 |
$0.00 |
| G8979 |
Mobility: walking & moving around functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting |
337 |
280 |
$0.00 |
| J0665 |
Injection, bupivicaine, not otherwise specified, 0.5 mg |
31 |
24 |
$0.00 |
| Q9966 |
Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml |
26 |
12 |
$0.00 |
| 94664 |
|
17 |
13 |
$0.00 |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
17 |
15 |
$0.00 |
| J0780 |
Injection, prochlorperazine, up to 10 mg |
13 |
12 |
$0.00 |
| A9270 |
Non-covered item or service |
1,445 |
522 |
$0.00 |
| J2003 |
Injection, lidocaine hydrochloride, 1 mg |
58 |
39 |
$0.00 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
140 |
89 |
$0.00 |
| G8988 |
Self care functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting |
14 |
12 |
$0.00 |
| G8987 |
Self care functional limitation, current status, at therapy episode outset and at reporting intervals |
14 |
12 |
$0.00 |