| Code | Description | Claims | Beneficiaries | Total Paid |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
25,632 |
22,991 |
$3.04M |
| 96361 |
Intravenous infusion, hydration; each additional hour |
10,147 |
7,755 |
$2.84M |
| 90853 |
Group psychotherapy (other than of a multiple-family group) |
41,874 |
5,059 |
$2.84M |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
26,176 |
24,271 |
$2.78M |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
9,453 |
8,069 |
$1.22M |
| 90791 |
Psychiatric diagnostic evaluation |
3,617 |
3,243 |
$733K |
| 70450 |
Computed tomography, head or brain; without contrast material |
2,986 |
2,518 |
$648K |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
2,432 |
2,020 |
$644K |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
10,377 |
2,660 |
$513K |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
6,617 |
5,483 |
$454K |
| 80053 |
Comprehensive metabolic panel |
45,122 |
39,051 |
$445K |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
1,287 |
1,083 |
$404K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
1,544 |
1,284 |
$399K |
| G0378 |
Hospital observation service, per hour |
3,128 |
1,564 |
$318K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
1,569 |
1,246 |
$294K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
2,095 |
1,558 |
$267K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
14,622 |
7,757 |
$258K |
| 92507 |
Treatment of speech, language, voice, communication, and/or auditory processing disorder |
3,575 |
1,074 |
$234K |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
2,203 |
2,000 |
$201K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
833 |
490 |
$186K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
784 |
636 |
$185K |
| 45385 |
Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) |
320 |
267 |
$174K |
| 41899 |
Unlisted procedure, dentoalveolar structures |
142 |
137 |
$164K |
| 45380 |
Colonoscopy, flexible; with biopsy, single or multiple |
428 |
355 |
$159K |
| 59025 |
Fetal non-stress test |
913 |
490 |
$149K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
6,113 |
5,765 |
$146K |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
3,950 |
1,282 |
$142K |
| 84443 |
Thyroid stimulating hormone (TSH) |
10,049 |
9,135 |
$129K |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
4,199 |
1,180 |
$121K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
45,852 |
39,218 |
$116K |
| 97112 |
Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination |
2,941 |
1,017 |
$105K |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
408 |
357 |
$89K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
904 |
787 |
$81K |
| 80061 |
Lipid panel |
7,034 |
6,543 |
$80K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
770 |
601 |
$79K |
| 84439 |
|
6,419 |
5,811 |
$78K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
477 |
423 |
$78K |
| 36415 |
Collection of venous blood by venipuncture |
41,524 |
35,231 |
$71K |
| 86141 |
|
2,565 |
2,432 |
$69K |
| 82607 |
|
3,967 |
3,726 |
$69K |
| 87624 |
Infectious agent detection by nucleic acid; human papillomavirus (HPV), high-risk types |
1,431 |
1,315 |
$58K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
4,290 |
3,121 |
$54K |
| 71046 |
Radiologic examination, chest; 2 views |
3,103 |
2,797 |
$46K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
1,684 |
1,476 |
$42K |
| 88175 |
Cytopathology, cervical or vaginal, any reporting system; collected in preservative fluid, automated thin layer |
2,306 |
2,109 |
$41K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
3,634 |
3,362 |
$41K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
462 |
361 |
$38K |
| 76830 |
Ultrasound, transvaginal |
883 |
792 |
$36K |
| 84481 |
|
2,231 |
2,131 |
$36K |
| 72131 |
|
574 |
471 |
$35K |
| 97161 |
|
894 |
712 |
$34K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
5,527 |
4,674 |
$31K |
| 96413 |
Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance |
258 |
126 |
$31K |
| 97602 |
|
215 |
140 |
$30K |
| 82746 |
|
3,170 |
2,994 |
$29K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
1,666 |
1,458 |
$29K |
| 96367 |
|
359 |
253 |
$28K |
| 82728 |
|
1,948 |
1,781 |
$28K |
| 93975 |
|
211 |
178 |
$28K |
| 71250 |
|
398 |
347 |
$25K |
| 12001 |
|
182 |
147 |
$25K |
| 84484 |
|
9,215 |
6,824 |
$25K |
| 86850 |
|
1,289 |
1,031 |
$24K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
745 |
681 |
$24K |
| 93971 |
|
304 |
266 |
$24K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
15,557 |
13,408 |
$22K |
| 93970 |
|
198 |
157 |
$22K |
| 83735 |
|
5,253 |
4,173 |
$22K |
| 86803 |
|
849 |
773 |
$22K |
| 72125 |
Computed tomography, cervical spine; without contrast material |
981 |
829 |
$21K |
| 85027 |
|
3,730 |
2,808 |
$21K |
| 83550 |
|
2,180 |
1,980 |
$20K |
| 83540 |
|
2,220 |
2,018 |
$20K |
| 80349 |
|
1,191 |
472 |
$20K |
| 71045 |
Radiologic examination, chest; single view |
7,382 |
6,275 |
$19K |
| 86038 |
|
974 |
902 |
$19K |
| 76642 |
|
220 |
206 |
$18K |
| 97113 |
|
393 |
111 |
$18K |
| 76536 |
|
169 |
155 |
$17K |
| 84702 |
|
1,307 |
951 |
$16K |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
167 |
146 |
$16K |
| 72100 |
|
624 |
542 |
$16K |
| 97535 |
Self-care/home management training, each 15 minutes |
613 |
366 |
$16K |
| H0015 |
Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including assessment, counseling; crisis intervention, and activity therapies or education |
148 |
28 |
$16K |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
453 |
404 |
$16K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
8,116 |
7,089 |
$15K |
| 97162 |
|
469 |
361 |
$15K |
| 86900 |
|
1,444 |
1,062 |
$15K |
| 87653 |
|
406 |
362 |
$15K |
| 90837 |
Psychotherapy, 53 minutes with patient |
109 |
67 |
$14K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
3,312 |
2,582 |
$14K |
| 90832 |
Psychotherapy, 30 minutes with patient |
158 |
96 |
$14K |
| 86140 |
|
2,190 |
1,875 |
$14K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
104 |
93 |
$13K |
| 73562 |
|
836 |
646 |
$13K |
| 86592 |
|
623 |
562 |
$12K |
| 86376 |
|
585 |
555 |
$12K |
| 87070 |
|
2,684 |
2,343 |
$12K |
| 87340 |
|
494 |
450 |
$11K |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
330 |
304 |
$11K |
| 97116 |
|
415 |
206 |
$10K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
11,476 |
9,703 |
$10K |
| 80361 |
|
1,088 |
450 |
$10K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
3,544 |
2,461 |
$10K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
239 |
177 |
$9K |
| 73630 |
|
701 |
597 |
$9K |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
627 |
569 |
$9K |
| 70486 |
|
179 |
156 |
$8K |
| 84153 |
|
523 |
461 |
$8K |
| 73610 |
|
623 |
545 |
$8K |
| 73130 |
|
552 |
438 |
$8K |
| 73030 |
|
608 |
502 |
$8K |
| 81001 |
|
10,995 |
9,572 |
$8K |
| 82570 |
|
1,276 |
987 |
$8K |
| 85610 |
|
8,259 |
6,620 |
$7K |
| 90834 |
Psychotherapy, 45 minutes with patient |
53 |
35 |
$7K |
| 97165 |
|
110 |
86 |
$7K |
| G0279 |
Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066) |
266 |
241 |
$7K |
| 97533 |
|
181 |
81 |
$7K |
| 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 |
687 |
429 |
$6K |
| 80348 |
|
622 |
284 |
$6K |
| 80076 |
|
516 |
454 |
$6K |
| 88341 |
|
83 |
65 |
$6K |
| 85652 |
|
2,232 |
1,901 |
$6K |
| 82950 |
|
444 |
404 |
$6K |
| 81003 |
|
5,408 |
4,665 |
$6K |
| 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 |
34 |
33 |
$6K |
| 73110 |
|
453 |
384 |
$5K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
12,484 |
5,502 |
$5K |
| 86901 |
|
1,449 |
1,062 |
$5K |
| 74018 |
|
163 |
130 |
$5K |
| 81025 |
|
4,433 |
3,704 |
$5K |
| 93880 |
|
56 |
56 |
$5K |
| 90715 |
|
344 |
294 |
$5K |
| 88342 |
|
1,463 |
1,206 |
$5K |
| 70491 |
|
14 |
12 |
$5K |
| 82043 |
|
668 |
603 |
$4K |
| C9803 |
Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
112 |
106 |
$4K |
| 0011A |
|
171 |
155 |
$4K |
| 70553 |
Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences |
14 |
13 |
$4K |
| 87493 |
|
157 |
136 |
$4K |
| 84403 |
|
234 |
210 |
$4K |
| 86039 |
|
212 |
183 |
$4K |
| 87186 |
|
850 |
716 |
$4K |
| 0012A |
|
152 |
140 |
$4K |
| 83690 |
|
7,622 |
6,475 |
$4K |
| 84550 |
|
673 |
571 |
$3K |
| 80069 |
|
234 |
176 |
$3K |
| 72148 |
Magnetic resonance imaging, lumbar spine; without contrast material |
30 |
25 |
$3K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
8,149 |
6,158 |
$3K |
| 96376 |
|
1,942 |
1,089 |
$3K |
| 82784 |
|
282 |
221 |
$3K |
| 83970 |
|
132 |
122 |
$3K |
| 97597 |
|
37 |
26 |
$3K |
| 80081 |
|
121 |
116 |
$3K |
| 87088 |
|
645 |
546 |
$3K |
| 87338 |
|
114 |
109 |
$3K |
| 86430 |
|
170 |
142 |
$3K |
| 85379 |
|
2,063 |
1,736 |
$3K |
| 72128 |
|
144 |
117 |
$3K |
| H0005 |
Alcohol and/or drug services; group counseling by a clinician |
70 |
29 |
$3K |
| 73502 |
|
118 |
105 |
$2K |
| U0004 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc, making use of high throughput technologies as described by cms-2020-01-r |
14 |
14 |
$2K |
| 88307 |
|
16 |
12 |
$2K |
| 85007 |
|
744 |
570 |
$2K |
| 85730 |
|
6,754 |
5,640 |
$2K |
| 83880 |
|
1,081 |
879 |
$2K |
| 83605 |
|
2,190 |
1,696 |
$2K |
| 82150 |
|
2,095 |
1,898 |
$2K |
| 84146 |
|
130 |
121 |
$2K |
| 72050 |
|
55 |
52 |
$2K |
| 87077 |
|
475 |
396 |
$2K |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
17 |
16 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
263 |
204 |
$2K |
| 73080 |
|
154 |
129 |
$2K |
| 00731 |
|
686 |
539 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
18 |
15 |
$2K |
| 93017 |
|
25 |
25 |
$2K |
| 86762 |
|
70 |
67 |
$2K |
| 84425 |
|
121 |
113 |
$2K |
| 83615 |
|
768 |
641 |
$1K |
| 82550 |
|
576 |
438 |
$1K |
| 94010 |
|
167 |
119 |
$1K |
| 83001 |
|
76 |
68 |
$1K |
| 12011 |
|
13 |
12 |
$1K |
| 87040 |
|
1,763 |
1,257 |
$1K |
| 76775 |
|
18 |
12 |
$1K |
| 86308 |
|
327 |
258 |
$1K |
| J1756 |
Injection, iron sucrose, 1 mg |
114 |
52 |
$1K |
| 84482 |
|
228 |
219 |
$1K |
| 80074 |
|
68 |
61 |
$1K |
| 73140 |
|
97 |
78 |
$1K |
| 72072 |
|
28 |
27 |
$1K |
| U0002 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
34 |
31 |
$1K |
| 00170 |
Anesthesia for intraoral procedures, including biopsy |
165 |
156 |
$1K |
| 82553 |
|
71 |
58 |
$964.03 |
| 86480 |
|
25 |
25 |
$958.26 |
| 84480 |
|
1,272 |
1,236 |
$957.51 |
| 84703 |
|
2,039 |
1,702 |
$883.43 |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
2,131 |
1,489 |
$803.96 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
2,282 |
2,016 |
$787.53 |
| J7999 |
Compounded drug, not otherwise classified |
256 |
202 |
$760.69 |
| 73590 |
|
30 |
26 |
$759.36 |
| 87807 |
|
925 |
790 |
$706.59 |
| C9113 |
Injection, pantoprazole sodium, per vial |
831 |
534 |
$693.65 |
| 84402 |
|
26 |
25 |
$650.05 |
| 97166 |
|
16 |
12 |
$647.60 |
| 84630 |
|
28 |
26 |
$610.44 |
| 84156 |
|
181 |
148 |
$592.95 |
| 97129 |
|
16 |
12 |
$580.49 |
| 87015 |
|
45 |
40 |
$550.47 |
| 87427 |
|
90 |
40 |
$533.15 |
| J1170 |
Injection, hydromorphone, up to 4 mg |
1,493 |
951 |
$460.87 |
| 84450 |
|
71 |
56 |
$437.30 |
| 85014 |
|
67 |
52 |
$430.81 |
| 82565 |
|
95 |
80 |
$422.96 |
| J7030 |
Infusion, normal saline solution , 1000 cc |
9,591 |
7,793 |
$408.36 |
| 87046 |
|
58 |
52 |
$396.11 |
| 77066 |
Tomosynthesis, mammo |
46 |
42 |
$386.85 |
| 87449 |
|
64 |
55 |
$372.25 |
| 84460 |
|
92 |
70 |
$371.53 |
| 72170 |
|
95 |
81 |
$370.29 |
| 87045 |
|
58 |
52 |
$364.64 |
| J2543 |
Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams) |
91 |
61 |
$343.37 |
| Q0111 |
Wet mounts, including preparations of vaginal, cervical or skin specimens |
147 |
125 |
$337.91 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
414 |
394 |
$319.97 |
| J1650 |
Injection, enoxaparin sodium, 10 mg |
782 |
468 |
$297.52 |
| 82803 |
|
79 |
54 |
$290.45 |
| J1815 |
Injection, insulin, per 5 units |
715 |
212 |
$279.01 |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
5,043 |
4,022 |
$245.55 |
| 83520 |
|
18 |
14 |
$239.37 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
3,969 |
3,049 |
$237.22 |
| 84520 |
|
91 |
75 |
$231.13 |
| 82533 |
|
13 |
13 |
$228.76 |
| 84145 |
|
38 |
28 |
$226.96 |
| 88304 |
|
126 |
94 |
$225.65 |
| 77065 |
Tomosynthesis, mammo |
18 |
14 |
$218.39 |
| 88313 |
|
436 |
343 |
$212.31 |
| 80354 |
|
25 |
13 |
$208.32 |
| 74022 |
|
15 |
13 |
$205.04 |
| 80178 |
|
13 |
12 |
$202.66 |
| J3370 |
Injection, vancomycin hcl, 500 mg |
328 |
215 |
$185.31 |
| J2360 |
Injection, orphenadrine citrate, up to 60 mg |
526 |
427 |
$181.73 |
| J7040 |
Infusion, normal saline solution, sterile (500 ml = 1 unit) |
1,477 |
950 |
$166.79 |
| 85045 |
|
70 |
66 |
$162.16 |
| J2704 |
Injection, propofol, 10 mg |
6,215 |
4,333 |
$161.70 |
| 87329 |
|
15 |
13 |
$161.26 |
| 87328 |
|
14 |
12 |
$161.24 |
| J3535 |
Drug administered through a metered dose inhaler |
33 |
25 |
$143.69 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
2,420 |
1,856 |
$143.27 |
| 82140 |
|
76 |
56 |
$114.18 |
| 84100 |
|
64 |
38 |
$111.92 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
8,302 |
6,530 |
$92.38 |
| J2470 |
Injection, pantoprazole sodium, 40 mg |
155 |
108 |
$87.43 |
| J1642 |
Injection, heparin sodium, (heparin lock flush), per 10 units |
457 |
209 |
$83.71 |
| 84155 |
|
17 |
12 |
$72.10 |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
250 |
185 |
$70.29 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
787 |
560 |
$68.78 |
| 73090 |
|
13 |
12 |
$50.25 |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
1,176 |
873 |
$50.24 |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
878 |
660 |
$48.89 |
| J0690 |
Injection, cefazolin sodium, 500 mg |
807 |
590 |
$48.04 |
| J2919 |
Injection, methylprednisolone sodium succinate, 5 mg |
85 |
58 |
$47.40 |
| J7060 |
5% dextrose/water (500 ml = 1 unit) |
360 |
180 |
$45.65 |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
3,935 |
3,259 |
$44.56 |
| 85018 |
|
17 |
13 |
$25.55 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
1,815 |
1,401 |
$24.48 |
| J0689 |
Injection, cefazolin sodium (baxter), not therapeutically equivalent to j0690, 500 mg |
215 |
129 |
$24.11 |
| 87899 |
|
18 |
14 |
$15.87 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
1,462 |
1,139 |
$15.45 |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
396 |
270 |
$15.15 |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
571 |
437 |
$14.69 |
| J2060 |
Injection, lorazepam, 2 mg |
209 |
153 |
$13.07 |
| J7620 |
Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme |
467 |
344 |
$9.60 |
| J3301 |
Injection, triamcinolone acetonide, not otherwise specified, 10 mg |
154 |
120 |
$8.64 |
| J3360 |
Injection, diazepam, up to 5 mg |
22 |
14 |
$7.63 |
| J8540 |
Dexamethasone, oral, 0.25 mg |
58 |
26 |
$6.52 |
| J7050 |
Infusion, normal saline solution, 250 cc |
591 |
327 |
$5.93 |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
108 |
82 |
$5.58 |
| J1644 |
Injection, heparin sodium, per 1000 units |
57 |
27 |
$4.64 |
| Q0162 |
Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen |
739 |
578 |
$4.21 |
| J2370 |
Injection, phenylephrine hcl, up to 1 ml |
115 |
81 |
$3.23 |
| J1171 |
Injection, hydromorphone, 0.1 mg |
75 |
57 |
$2.75 |
| J2001 |
Injection, lidocaine hcl for intravenous infusion, 10 mg |
1,154 |
921 |
$1.35 |
| J0330 |
Injection, succinylcholine chloride, up to 20 mg |
535 |
392 |
$0.40 |
| Q0177 |
Hydroxyzine pamoate, 25 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen |
41 |
26 |
$0.22 |
| A9270 |
Non-covered item or service |
448 |
120 |
$0.20 |
| Q0163 |
Diphenhydramine hydrochloride, 50 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at time of chemotherapy treatment not to exceed a 48 hour dosage regimen |
73 |
57 |
$0.13 |
| J0665 |
Injection, bupivicaine, not otherwise specified, 0.5 mg |
346 |
272 |
$0.06 |
| J8597 |
Antiemetic drug, oral, not otherwise specified |
22 |
15 |
$0.05 |
| J2371 |
Injection, phenylephrine hydrochloride, 20 micrograms |
260 |
199 |
$0.00 |
| J1630 |
Injection, haloperidol, up to 5 mg |
13 |
12 |
$0.00 |
| J1790 |
Injection, droperidol, up to 5 mg |
83 |
66 |
$0.00 |
| J2920 |
Injection, methylprednisolone sodium succinate, up to 40 mg |
20 |
15 |
$0.00 |
| C1769 |
Guide wire |
41 |
28 |
$0.00 |
| J3480 |
Injection, potassium chloride, per 2 meq |
26 |
12 |
$0.00 |
| J2795 |
Injection, ropivacaine hydrochloride, 1 mg |
34 |
27 |
$0.00 |
| 88311 |
|
18 |
12 |
$0.00 |
| 00811 |
|
317 |
256 |
$0.00 |
| 99152 |
|
34 |
25 |
$0.00 |
| J1596 |
Injection, glycopyrrolate, 0.1 mg |
250 |
211 |
$0.00 |
| A9575 |
Injection, gadoterate meglumine, 0.1 ml |
235 |
208 |
$0.00 |
| 00812 |
|
91 |
79 |
$0.00 |
| J2710 |
Injection, neostigmine methylsulfate, up to 0.5 mg |
34 |
28 |
$0.00 |
| 82010 |
|
17 |
13 |
$0.00 |