| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
31,290 |
29,560 |
$5.77M |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
19,815 |
18,801 |
$4.07M |
| G0378 |
Hospital observation service, per hour |
3,677 |
2,375 |
$3.49M |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
10,370 |
10,038 |
$1.65M |
| 96361 |
Intravenous infusion, hydration; each additional hour |
7,271 |
6,857 |
$1.15M |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
5,034 |
4,914 |
$994K |
| 36415 |
Collection of venous blood by venipuncture |
106,602 |
41,116 |
$836K |
| 70450 |
Computed tomography, head or brain; without contrast material |
3,945 |
3,845 |
$770K |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
6,916 |
5,671 |
$711K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
16,892 |
15,684 |
$670K |
| C1713 |
Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable) |
327 |
246 |
$568K |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
2,994 |
2,938 |
$538K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
9,796 |
9,464 |
$534K |
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
1,873 |
1,851 |
$529K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
1,664 |
1,636 |
$524K |
| 93976 |
|
1,710 |
1,661 |
$444K |
| 80053 |
Comprehensive metabolic panel |
30,399 |
26,748 |
$418K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
2,055 |
2,012 |
$411K |
| 93458 |
|
250 |
247 |
$313K |
| 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 |
5,730 |
5,392 |
$289K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
1,452 |
1,438 |
$274K |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
7,795 |
2,653 |
$219K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
1,869 |
1,850 |
$201K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
7,520 |
6,061 |
$197K |
| 93010 |
Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only |
25,038 |
22,854 |
$184K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
12,635 |
10,896 |
$178K |
| 47562 |
|
52 |
52 |
$171K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
4,633 |
4,536 |
$158K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
5,168 |
5,015 |
$138K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
1,463 |
1,427 |
$128K |
| C1821 |
Interspinous process distraction device (implantable) |
25 |
25 |
$123K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
3,183 |
2,944 |
$112K |
| 76801 |
|
1,415 |
1,316 |
$91K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
3,769 |
3,294 |
$89K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
8,358 |
6,026 |
$88K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
4,796 |
4,665 |
$88K |
| 97161 |
|
1,531 |
1,501 |
$86K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
19,934 |
14,539 |
$80K |
| 87631 |
|
1,878 |
1,861 |
$76K |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
2,916 |
2,885 |
$76K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
4,228 |
4,142 |
$75K |
| 86850 |
|
4,537 |
4,367 |
$74K |
| 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 |
3,868 |
3,780 |
$69K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
2,147 |
1,800 |
$68K |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
3,372 |
1,280 |
$64K |
| 76819 |
Fetal biophysical profile; without non-stress testing |
1,950 |
1,322 |
$64K |
| 93970 |
|
230 |
223 |
$60K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
896 |
890 |
$60K |
| 87481 |
|
1,831 |
1,728 |
$59K |
| 12001 |
|
209 |
209 |
$59K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
872 |
862 |
$55K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
17,252 |
15,894 |
$55K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
814 |
809 |
$54K |
| 93971 |
|
1,256 |
1,236 |
$52K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
1,798 |
1,792 |
$49K |
| 93975 |
|
146 |
146 |
$48K |
| 10060 |
|
225 |
219 |
$45K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
1,120 |
1,060 |
$45K |
| 99460 |
|
703 |
703 |
$42K |
| 86900 |
|
4,681 |
4,386 |
$42K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,123 |
1,102 |
$42K |
| 83880 |
|
2,120 |
2,059 |
$40K |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
256 |
254 |
$36K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
506 |
506 |
$35K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
764 |
761 |
$34K |
| 97010 |
|
2,580 |
872 |
$33K |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
7,599 |
6,901 |
$32K |
| G2023 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
2,158 |
2,093 |
$30K |
| 71046 |
Radiologic examination, chest; 2 views |
7,091 |
6,972 |
$30K |
| 72125 |
Computed tomography, cervical spine; without contrast material |
917 |
906 |
$30K |
| 99238 |
Hospital discharge day management, 30 minutes or less |
588 |
586 |
$30K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
3,673 |
3,644 |
$29K |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
476 |
474 |
$29K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
556 |
554 |
$28K |
| 97112 |
Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination |
1,216 |
401 |
$28K |
| 84443 |
Thyroid stimulating hormone (TSH) |
3,945 |
3,898 |
$28K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
38,537 |
34,335 |
$25K |
| 76830 |
Ultrasound, transvaginal |
1,320 |
1,298 |
$23K |
| 81025 |
|
9,175 |
8,823 |
$23K |
| 80061 |
Lipid panel |
3,664 |
3,641 |
$20K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
276 |
275 |
$20K |
| 81513 |
|
1,992 |
1,951 |
$20K |
| 84702 |
|
6,676 |
6,267 |
$18K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
2,570 |
2,549 |
$18K |
| 88304 |
|
931 |
917 |
$16K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
286 |
284 |
$16K |
| 82607 |
|
1,729 |
1,708 |
$16K |
| 84439 |
|
2,097 |
2,073 |
$16K |
| 80076 |
|
1,976 |
1,948 |
$15K |
| 85027 |
|
5,829 |
5,214 |
$14K |
| 86901 |
|
1,183 |
1,014 |
$13K |
| 59426 |
|
109 |
62 |
$13K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
204 |
185 |
$13K |
| 59425 |
|
96 |
76 |
$12K |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
65 |
64 |
$12K |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
65 |
64 |
$12K |
| 76811 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, detailed |
161 |
159 |
$11K |
| 59025 |
Fetal non-stress test |
520 |
415 |
$11K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
6,533 |
6,225 |
$11K |
| 90715 |
|
507 |
507 |
$11K |
| 72131 |
|
86 |
85 |
$11K |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
1,624 |
1,614 |
$10K |
| 82746 |
|
1,178 |
1,163 |
$10K |
| 99000 |
|
755 |
715 |
$10K |
| 85610 |
|
10,988 |
10,301 |
$10K |
| C1781 |
Mesh (implantable) |
24 |
24 |
$10K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
123 |
122 |
$10K |
| 72110 |
|
1,020 |
1,012 |
$9K |
| 12002 |
|
37 |
37 |
$9K |
| 90714 |
|
396 |
396 |
$9K |
| 85730 |
|
9,533 |
9,090 |
$9K |
| 86701 |
|
987 |
974 |
$8K |
| 81001 |
|
13,131 |
12,413 |
$8K |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
620 |
605 |
$8K |
| 99462 |
|
280 |
244 |
$8K |
| 87563 |
|
477 |
468 |
$8K |
| 76813 |
|
212 |
212 |
$8K |
| 82803 |
|
618 |
521 |
$7K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
944 |
939 |
$7K |
| 97113 |
|
209 |
49 |
$7K |
| 87798 |
Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism |
283 |
282 |
$7K |
| 86803 |
|
1,134 |
1,128 |
$7K |
| 71045 |
Radiologic examination, chest; single view |
7,985 |
7,658 |
$6K |
| C1769 |
Guide wire |
957 |
926 |
$6K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
136 |
136 |
$6K |
| 22853 |
|
28 |
25 |
$6K |
| G9007 |
Coordinated care fee, scheduled team conference |
59 |
59 |
$6K |
| 87660 |
|
3,170 |
3,090 |
$6K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
104 |
88 |
$6K |
| 29125 |
|
36 |
36 |
$5K |
| 70553 |
Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences |
26 |
26 |
$5K |
| 87340 |
|
673 |
670 |
$4K |
| 81003 |
|
6,191 |
5,961 |
$4K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
2,209 |
1,972 |
$4K |
| 94727 |
|
267 |
264 |
$4K |
| A9579 |
Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (nos), per ml |
98 |
97 |
$4K |
| 83735 |
|
7,055 |
5,759 |
$4K |
| 81220 |
CFTR (cystic fibrosis transmembrane conductance regulator) gene analysis; common variants |
13 |
13 |
$4K |
| 97162 |
|
69 |
69 |
$4K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
8,754 |
7,890 |
$4K |
| 72100 |
|
439 |
431 |
$4K |
| 73630 |
|
1,607 |
1,572 |
$3K |
| 99201 |
|
34 |
34 |
$3K |
| 70486 |
|
76 |
76 |
$3K |
| 86780 |
|
328 |
324 |
$3K |
| 99406 |
|
340 |
318 |
$3K |
| 85652 |
|
2,009 |
1,939 |
$3K |
| 94729 |
|
160 |
159 |
$3K |
| 82948 |
|
4,593 |
2,328 |
$3K |
| 86762 |
|
236 |
234 |
$2K |
| 82728 |
|
213 |
210 |
$2K |
| 99385 |
|
27 |
27 |
$2K |
| 73030 |
|
1,118 |
1,088 |
$2K |
| 99441 |
|
78 |
74 |
$2K |
| 72040 |
|
373 |
367 |
$2K |
| 93041 |
|
185 |
184 |
$2K |
| 88312 |
|
215 |
212 |
$2K |
| J3370 |
Injection, vancomycin hcl, 500 mg |
38 |
25 |
$2K |
| 73610 |
|
1,430 |
1,410 |
$2K |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
211 |
211 |
$2K |
| 84484 |
|
13,082 |
7,494 |
$2K |
| 76818 |
|
51 |
28 |
$2K |
| 73564 |
|
621 |
612 |
$2K |
| 99223 |
Prolong inpt eval add15 m |
12 |
12 |
$2K |
| 99233 |
Prolong inpt eval add15 m |
21 |
13 |
$2K |
| 83655 |
|
110 |
110 |
$2K |
| 73130 |
|
1,250 |
1,234 |
$1K |
| 93017 |
|
43 |
43 |
$1K |
| 87077 |
|
2,193 |
1,951 |
$1K |
| 73562 |
|
422 |
409 |
$1K |
| 78452 |
Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress |
12 |
12 |
$1K |
| 97535 |
Self-care/home management training, each 15 minutes |
57 |
52 |
$1K |
| J3490 |
Unclassified drugs |
2,454 |
1,913 |
$1K |
| 90686 |
|
60 |
60 |
$1K |
| 99153 |
Mod sedat endo service >5yrs |
302 |
297 |
$1K |
| 83550 |
|
326 |
319 |
$1K |
| 88311 |
|
50 |
50 |
$1K |
| 76536 |
|
26 |
26 |
$1K |
| 74018 |
|
355 |
350 |
$1K |
| 83690 |
|
10,624 |
9,935 |
$1K |
| 81002 |
|
1,840 |
1,236 |
$1K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
12 |
12 |
$1K |
| 87186 |
|
1,941 |
1,795 |
$1K |
| 82043 |
|
233 |
232 |
$1K |
| 85379 |
|
2,592 |
2,533 |
$1K |
| 86140 |
|
402 |
367 |
$1K |
| 90688 |
|
60 |
60 |
$1K |
| 82150 |
|
6,650 |
6,285 |
$1K |
| 94060 |
|
32 |
32 |
$989.22 |
| J1170 |
Injection, hydromorphone, up to 4 mg |
4,829 |
3,509 |
$962.31 |
| 87070 |
|
1,708 |
1,641 |
$924.16 |
| 99383 |
|
12 |
12 |
$842.66 |
| 99442 |
|
15 |
15 |
$837.69 |
| 90670 |
|
112 |
112 |
$759.97 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
10,600 |
9,378 |
$754.89 |
| 87040 |
|
3,132 |
1,649 |
$712.54 |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
12 |
12 |
$671.56 |
| 76775 |
|
13 |
13 |
$651.57 |
| 84153 |
|
38 |
38 |
$630.83 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
132 |
132 |
$627.97 |
| 82550 |
|
1,472 |
1,384 |
$621.81 |
| 72050 |
|
54 |
54 |
$610.28 |
| 87081 |
|
1,491 |
1,467 |
$600.22 |
| J7030 |
Infusion, normal saline solution , 1000 cc |
8,687 |
7,970 |
$573.45 |
| 97597 |
|
19 |
12 |
$529.84 |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
3,512 |
3,048 |
$522.98 |
| 90648 |
|
100 |
96 |
$519.81 |
| 73502 |
|
144 |
143 |
$439.43 |
| J2704 |
Injection, propofol, 10 mg |
3,197 |
3,111 |
$389.97 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
3,755 |
3,663 |
$385.16 |
| 73110 |
|
436 |
430 |
$378.53 |
| J0690 |
Injection, cefazolin sodium, 500 mg |
1,927 |
1,672 |
$374.11 |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
391 |
382 |
$368.72 |
| 83605 |
|
2,130 |
1,887 |
$359.49 |
| 99152 |
|
847 |
826 |
$354.11 |
| 73100 |
|
207 |
206 |
$336.99 |
| 90658 |
|
268 |
268 |
$292.40 |
| 73590 |
|
209 |
208 |
$286.85 |
| 83021 |
|
13 |
13 |
$284.41 |
| 85007 |
|
1,267 |
1,159 |
$254.97 |
| 90710 |
|
26 |
26 |
$246.39 |
| 76641 |
|
12 |
12 |
$233.44 |
| 90696 |
|
29 |
29 |
$232.05 |
| 90633 |
|
24 |
24 |
$215.82 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
10,807 |
9,894 |
$209.17 |
| 83540 |
|
53 |
52 |
$199.37 |
| 90723 |
|
27 |
27 |
$198.51 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
3,800 |
3,699 |
$193.28 |
| 86787 |
|
22 |
22 |
$183.10 |
| 87205 |
|
779 |
740 |
$174.04 |
| 84146 |
|
12 |
12 |
$169.33 |
| 81015 |
|
982 |
937 |
$157.74 |
| 83001 |
|
12 |
12 |
$148.24 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
1,875 |
1,595 |
$144.37 |
| J1644 |
Injection, heparin sodium, per 1000 units |
1,633 |
1,133 |
$138.52 |
| 82947 |
|
57 |
56 |
$134.15 |
| A9270 |
Non-covered item or service |
14,523 |
11,899 |
$123.27 |
| J1650 |
Injection, enoxaparin sodium, 10 mg |
1,714 |
955 |
$122.34 |
| J3420 |
Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg |
54 |
37 |
$121.30 |
| C1894 |
Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser |
721 |
702 |
$121.15 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
3,231 |
3,137 |
$119.17 |
| 82570 |
|
45 |
41 |
$118.43 |
| 84156 |
|
56 |
50 |
$79.21 |
| Q9969 |
Tc-99m from non-highly enriched uranium source, full cost recovery add-on, per study dose |
41 |
39 |
$78.96 |
| J7050 |
Infusion, normal saline solution, 250 cc |
327 |
281 |
$76.72 |
| 82247 |
|
44 |
38 |
$75.90 |
| 73090 |
|
57 |
55 |
$69.07 |
| 86308 |
|
403 |
401 |
$61.98 |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
1,576 |
1,365 |
$56.68 |
| 73080 |
|
123 |
121 |
$55.95 |
| C9803 |
Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
584 |
481 |
$52.72 |
| 87480 |
|
96 |
95 |
$51.51 |
| 87510 |
|
96 |
95 |
$46.68 |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
2,064 |
1,902 |
$43.01 |
| 71101 |
|
66 |
66 |
$42.00 |
| J7040 |
Infusion, normal saline solution, sterile (500 ml = 1 unit) |
519 |
510 |
$41.82 |
| J2272 |
Injection, morphine sulfate (fresenius kabi), not therapeutically equivalent to j2270, up to 10 mg |
915 |
836 |
$36.25 |
| C9113 |
Injection, pantoprazole sodium, per vial |
691 |
505 |
$34.88 |
| 84550 |
|
14 |
14 |
$31.64 |
| 99173 |
|
73 |
73 |
$30.82 |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
1,995 |
1,891 |
$30.33 |
| 80348 |
|
65 |
64 |
$30.10 |
| 94760 |
|
249 |
175 |
$29.73 |
| 80320 |
|
725 |
696 |
$26.58 |
| J0134 |
Injection, acetaminophen (fresenius kabi), not therapeutically equivalent to j0131, 10 mg |
283 |
279 |
$24.80 |
| J2001 |
Injection, lidocaine hcl for intravenous infusion, 10 mg |
1,165 |
1,104 |
$23.79 |
| 84460 |
|
26 |
25 |
$20.32 |
| 87075 |
|
47 |
42 |
$18.94 |
| 86403 |
|
54 |
53 |
$17.83 |
| 73140 |
|
12 |
12 |
$17.29 |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
726 |
680 |
$15.90 |
| 80179 |
|
179 |
174 |
$15.58 |
| 82565 |
|
14 |
14 |
$15.34 |
| 84155 |
|
27 |
26 |
$14.68 |
| J2305 |
Injection, nitroglycerin, 5 mg |
42 |
42 |
$13.64 |
| 74019 |
|
14 |
14 |
$13.45 |
| 87590 |
|
201 |
199 |
$12.99 |
| J2060 |
Injection, lorazepam, 2 mg |
910 |
817 |
$11.95 |
| J0780 |
Injection, prochlorperazine, up to 10 mg |
220 |
208 |
$11.49 |
| 87285 |
|
25 |
25 |
$10.95 |
| J1580 |
Injection, garamycin, gentamicin, up to 80 mg |
77 |
75 |
$7.20 |
| 82040 |
|
15 |
15 |
$6.74 |
| 96376 |
|
2,037 |
1,531 |
$6.60 |
| J0330 |
Injection, succinylcholine chloride, up to 20 mg |
367 |
366 |
$6.24 |
| 73060 |
|
12 |
12 |
$6.00 |
| J2470 |
Injection, pantoprazole sodium, 40 mg |
57 |
51 |
$3.87 |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
865 |
768 |
$2.92 |
| J1643 |
Injection, heparin sodium (pfizer), not therapeutically equivalent to j1644, per 1000 units |
275 |
267 |
$2.80 |
| 87147 |
|
58 |
54 |
$2.58 |
| J0132 |
Injection, acetylcysteine, 100 mg |
229 |
204 |
$1.04 |
| 80329 |
|
149 |
135 |
$0.83 |
| J7620 |
Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme |
26 |
19 |
$0.36 |
| 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 |
144 |
142 |
$0.12 |
| J1171 |
Injection, hydromorphone, 0.1 mg |
81 |
63 |
$0.00 |
| 99080 |
|
1,452 |
1,384 |
$0.00 |
| C1887 |
Catheter, guiding (may include infusion/perfusion capability) |
80 |
77 |
$0.00 |
| 82010 |
|
144 |
116 |
$0.00 |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
150 |
144 |
$0.00 |
| J2919 |
Injection, methylprednisolone sodium succinate, 5 mg |
14 |
14 |
$0.00 |
| 90734 |
|
32 |
32 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
16 |
13 |
$0.00 |
| 71100 |
|
13 |
13 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
37 |
37 |
$0.00 |
| J2371 |
Injection, phenylephrine hydrochloride, 20 micrograms |
43 |
43 |
$0.00 |
| 84075 |
|
12 |
12 |
$0.00 |
| 74022 |
|
145 |
143 |
$0.00 |
| J2370 |
Injection, phenylephrine hcl, up to 1 ml |
94 |
89 |
$0.00 |
| J2920 |
Injection, methylprednisolone sodium succinate, up to 40 mg |
30 |
26 |
$0.00 |
| Q9965 |
Low osmolar contrast material, 100-199 mg/ml iodine concentration, per ml |
39 |
39 |
$0.00 |
| J1815 |
Injection, insulin, per 5 units |
23 |
12 |
$0.00 |
| 90651 |
|
19 |
19 |
$0.00 |