| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| G9005 |
Coordinated care fee, risk adjusted maintenance |
78,220 |
78,162 |
$20.27M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
106,619 |
90,040 |
$7.38M |
| 90834 |
Psychotherapy, 45 minutes with patient |
33,428 |
24,174 |
$3.71M |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
15,079 |
14,308 |
$2.13M |
| 96361 |
Intravenous infusion, hydration; each additional hour |
13,008 |
7,680 |
$1.88M |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
13,486 |
12,697 |
$1.66M |
| 90832 |
Psychotherapy, 30 minutes with patient |
17,361 |
14,092 |
$1.49M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
19,445 |
18,418 |
$1.45M |
| 70450 |
Computed tomography, head or brain; without contrast material |
3,918 |
3,806 |
$1.14M |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
8,216 |
7,656 |
$1.04M |
| G9001 |
Coordinated care fee, initial rate |
13,707 |
13,706 |
$1.02M |
| G0378 |
Hospital observation service, per hour |
809 |
373 |
$850K |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
6,358 |
5,999 |
$848K |
| 80053 |
Comprehensive metabolic panel |
38,146 |
33,965 |
$741K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
5,319 |
4,320 |
$707K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
7,876 |
7,813 |
$664K |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
8,248 |
2,564 |
$593K |
| 97602 |
|
1,315 |
661 |
$561K |
| T2022 |
Case management, per month |
1,831 |
1,831 |
$506K |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
1,933 |
1,906 |
$500K |
| 90791 |
Psychiatric diagnostic evaluation |
3,162 |
2,611 |
$493K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
8,142 |
7,594 |
$491K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
5,225 |
5,160 |
$488K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
1,760 |
1,733 |
$480K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
2,063 |
2,016 |
$361K |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
7,535 |
6,000 |
$361K |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
677 |
663 |
$358K |
| 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 |
4,394 |
4,270 |
$317K |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
2,601 |
2,502 |
$300K |
| G0444 |
Annual depression screening, 5 to 15 minutes |
7,641 |
7,458 |
$296K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
3,052 |
3,009 |
$280K |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
1,934 |
1,920 |
$271K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
8,571 |
8,517 |
$256K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
3,993 |
3,685 |
$249K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
6,661 |
6,504 |
$243K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
7,324 |
6,715 |
$222K |
| 90853 |
Group psychotherapy (other than of a multiple-family group) |
9,727 |
1,072 |
$202K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
618 |
612 |
$179K |
| 11042 |
Debridement, subcutaneous tissue (includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm |
489 |
279 |
$174K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
10,490 |
9,408 |
$167K |
| 45378 |
Colonoscopy, flexible; diagnostic, including collection of specimen(s) |
221 |
219 |
$158K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
3,349 |
3,287 |
$139K |
| 99232 |
Subsequent hospital care, per day, moderate complexity |
6,498 |
2,462 |
$132K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
6,626 |
6,470 |
$129K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
1,316 |
1,308 |
$126K |
| 80061 |
Lipid panel |
14,632 |
14,526 |
$122K |
| 97161 |
|
1,431 |
1,407 |
$119K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
2,074 |
2,072 |
$118K |
| 1159F |
|
5,149 |
1,361 |
$113K |
| 83880 |
|
4,083 |
3,791 |
$110K |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
5,667 |
5,546 |
$109K |
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
1,151 |
1,147 |
$108K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
1,629 |
1,376 |
$100K |
| 93975 |
|
489 |
485 |
$97K |
| G2023 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
3,561 |
3,481 |
$93K |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
677 |
562 |
$92K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
756 |
699 |
$86K |
| 84443 |
Thyroid stimulating hormone (TSH) |
13,025 |
12,864 |
$79K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
12,539 |
12,422 |
$77K |
| 90715 |
|
2,227 |
2,218 |
$75K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
4,026 |
3,687 |
$69K |
| 12001 |
|
177 |
177 |
$67K |
| 76830 |
Ultrasound, transvaginal |
1,640 |
1,581 |
$66K |
| 84439 |
|
10,851 |
10,755 |
$65K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
956 |
942 |
$61K |
| 82607 |
|
7,317 |
7,262 |
$61K |
| 99222 |
Initial hospital care, per day, moderate complexity |
1,266 |
1,247 |
$60K |
| 93976 |
|
699 |
695 |
$56K |
| 86850 |
|
2,249 |
2,167 |
$54K |
| 90686 |
|
2,121 |
2,120 |
$53K |
| 88175 |
Cytopathology, cervical or vaginal, any reporting system; collected in preservative fluid, automated thin layer |
1,818 |
1,817 |
$53K |
| 99291 |
Critical care, evaluation and management of the critically ill patient, first 30-74 minutes |
451 |
449 |
$52K |
| 99233 |
Prolong inpt eval add15 m |
1,538 |
514 |
$52K |
| 93015 |
|
876 |
865 |
$51K |
| 93970 |
|
210 |
207 |
$46K |
| 82746 |
|
5,761 |
5,719 |
$45K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
33,310 |
29,422 |
$44K |
| 85008 |
|
3,736 |
3,701 |
$43K |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
4,358 |
4,330 |
$42K |
| 87624 |
Infectious agent detection by nucleic acid; human papillomavirus (HPV), high-risk types |
1,140 |
1,139 |
$40K |
| 71271 |
|
556 |
555 |
$40K |
| 93000 |
|
3,059 |
3,015 |
$38K |
| 86901 |
|
2,485 |
2,381 |
$36K |
| 99385 |
|
321 |
319 |
$34K |
| 86900 |
|
2,489 |
2,386 |
$32K |
| 1160F |
|
694 |
472 |
$31K |
| 36415 |
Collection of venous blood by venipuncture |
14,105 |
13,156 |
$29K |
| 10060 |
|
97 |
93 |
$29K |
| 93971 |
|
411 |
406 |
$28K |
| 71046 |
Radiologic examination, chest; 2 views |
4,437 |
4,405 |
$28K |
| 81001 |
|
19,723 |
18,379 |
$27K |
| 76818 |
|
441 |
241 |
$27K |
| 82728 |
|
2,503 |
2,398 |
$27K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
5,102 |
4,917 |
$26K |
| 3074F |
|
1,088 |
451 |
$26K |
| 99406 |
|
1,076 |
1,047 |
$25K |
| 86803 |
|
4,892 |
4,857 |
$23K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
702 |
688 |
$23K |
| 99239 |
Hospital discharge day management, more than 30 minutes |
655 |
644 |
$22K |
| 82570 |
|
6,820 |
6,748 |
$21K |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
1,298 |
1,291 |
$20K |
| 82043 |
|
6,528 |
6,475 |
$20K |
| 59025 |
Fetal non-stress test |
1,263 |
882 |
$20K |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
923 |
359 |
$18K |
| 76801 |
|
236 |
231 |
$18K |
| 76819 |
Fetal biophysical profile; without non-stress testing |
319 |
174 |
$17K |
| 87070 |
|
5,581 |
5,374 |
$17K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
9,344 |
8,131 |
$17K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
7,315 |
7,029 |
$17K |
| 45380 |
Colonoscopy, flexible; with biopsy, single or multiple |
14 |
14 |
$16K |
| 45385 |
Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) |
24 |
24 |
$16K |
| 99386 |
|
133 |
132 |
$16K |
| 78452 |
Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress |
108 |
108 |
$15K |
| 76813 |
|
226 |
223 |
$15K |
| 83735 |
|
10,556 |
9,065 |
$13K |
| 90732 |
|
252 |
250 |
$12K |
| 86780 |
|
1,554 |
1,534 |
$11K |
| 72110 |
|
1,086 |
1,079 |
$11K |
| 85610 |
|
7,794 |
6,805 |
$10K |
| 84153 |
|
736 |
726 |
$10K |
| 86141 |
|
1,219 |
1,051 |
$10K |
| 70486 |
|
448 |
444 |
$10K |
| 72125 |
Computed tomography, cervical spine; without contrast material |
701 |
684 |
$9K |
| 87522 |
Neg quan hep c or qual rna |
222 |
218 |
$9K |
| 87340 |
|
1,350 |
1,342 |
$9K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
132 |
118 |
$9K |
| 83540 |
|
2,295 |
2,265 |
$9K |
| 73562 |
|
1,606 |
1,521 |
$8K |
| 83550 |
|
2,185 |
2,156 |
$8K |
| 83655 |
|
611 |
609 |
$8K |
| 86762 |
|
888 |
883 |
$8K |
| 97150 |
Therapeutic procedure(s), group (2 or more individuals) |
109 |
39 |
$8K |
| 71045 |
Radiologic examination, chest; single view |
8,248 |
7,792 |
$7K |
| 99051 |
|
626 |
575 |
$7K |
| 73030 |
|
1,506 |
1,437 |
$7K |
| 99231 |
Subsequent hospital care, per day, straightforward or low complexity |
481 |
242 |
$7K |
| 92228 |
|
81 |
81 |
$7K |
| 3079F |
|
190 |
176 |
$7K |
| 3075F |
|
153 |
83 |
$6K |
| A9500 |
Technetium tc-99m sestamibi, diagnostic, per study dose |
93 |
93 |
$6K |
| 87088 |
|
2,345 |
2,289 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
134 |
54 |
$5K |
| 84550 |
|
1,850 |
1,800 |
$5K |
| 0001A |
|
173 |
173 |
$5K |
| 85730 |
|
5,521 |
5,235 |
$5K |
| 73630 |
|
1,495 |
1,438 |
$5K |
| 0004A |
|
122 |
122 |
$5K |
| 59430 |
|
39 |
39 |
$5K |
| 82948 |
|
3,942 |
1,765 |
$5K |
| 97597 |
|
20 |
14 |
$4K |
| 84702 |
|
1,367 |
1,163 |
$4K |
| 1000F |
|
689 |
195 |
$4K |
| 73130 |
|
1,320 |
1,239 |
$4K |
| 87077 |
|
2,130 |
2,077 |
$4K |
| 90836 |
|
55 |
54 |
$4K |
| 72148 |
Magnetic resonance imaging, lumbar spine; without contrast material |
13 |
13 |
$4K |
| 99223 |
Prolong inpt eval add15 m |
58 |
57 |
$4K |
| 72141 |
|
13 |
13 |
$4K |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
1,873 |
1,844 |
$4K |
| 90661 |
|
115 |
115 |
$4K |
| 0071A |
|
97 |
97 |
$4K |
| 0002A |
|
145 |
145 |
$4K |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
3,721 |
3,315 |
$4K |
| 99080 |
|
2,064 |
1,788 |
$4K |
| 0012A |
|
189 |
189 |
$4K |
| 0072A |
|
91 |
91 |
$4K |
| 73610 |
|
1,164 |
1,108 |
$3K |
| 92250 |
|
56 |
56 |
$3K |
| 99221 |
|
146 |
144 |
$3K |
| J2785 |
Injection, regadenoson, 0.1 mg |
40 |
40 |
$3K |
| 85027 |
|
1,674 |
1,612 |
$3K |
| 76536 |
|
132 |
132 |
$3K |
| 87186 |
|
1,951 |
1,879 |
$3K |
| 86787 |
|
587 |
586 |
$3K |
| G0008 |
Administration of influenza virus vaccine |
241 |
241 |
$3K |
| 0011A |
|
201 |
201 |
$3K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
6,972 |
6,517 |
$3K |
| D1110 |
Prophylaxis - adult |
55 |
28 |
$2K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
37 |
37 |
$2K |
| 85651 |
|
1,524 |
1,409 |
$2K |
| 84703 |
|
8,246 |
7,858 |
$2K |
| 82550 |
|
4,872 |
4,552 |
$2K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
1,020 |
838 |
$2K |
| 86769 |
|
139 |
137 |
$2K |
| 72100 |
|
689 |
685 |
$2K |
| 86706 |
|
315 |
313 |
$2K |
| 99215 |
Prolong outpt/office vis |
27 |
27 |
$2K |
| 90670 |
|
37 |
37 |
$2K |
| 73502 |
|
525 |
510 |
$2K |
| J7040 |
Infusion, normal saline solution, sterile (500 ml = 1 unit) |
435 |
353 |
$2K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
7,632 |
6,939 |
$2K |
| 76641 |
|
118 |
117 |
$2K |
| 88313 |
|
695 |
681 |
$2K |
| 90750 |
|
13 |
12 |
$2K |
| 73110 |
|
452 |
420 |
$2K |
| G0103 |
Prostate cancer screening; prostate specific antigen test (psa) |
328 |
326 |
$2K |
| 82652 |
|
156 |
156 |
$2K |
| 84484 |
|
6,326 |
5,444 |
$2K |
| 73564 |
|
253 |
242 |
$2K |
| 83020 |
|
182 |
181 |
$2K |
| G0297 |
Low dose ct scan (ldct) for lung cancer screening |
13 |
13 |
$2K |
| 86580 |
|
93 |
85 |
$2K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
332 |
306 |
$2K |
| 81003 |
|
1,377 |
1,371 |
$2K |
| 72040 |
|
403 |
403 |
$2K |
| 0064A |
|
38 |
38 |
$2K |
| 83690 |
|
4,942 |
4,657 |
$2K |
| 99238 |
Hospital discharge day management, 30 minutes or less |
332 |
329 |
$1K |
| 94760 |
|
364 |
290 |
$1K |
| 86480 |
|
26 |
26 |
$1K |
| 3044F |
|
133 |
57 |
$1K |
| 88307 |
|
68 |
68 |
$1K |
| 99407 |
|
39 |
39 |
$1K |
| 86038 |
|
268 |
267 |
$1K |
| 0124A |
|
28 |
28 |
$1K |
| 0054A |
|
32 |
32 |
$1K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
1,997 |
1,996 |
$1K |
| J7050 |
Infusion, normal saline solution, 250 cc |
3,482 |
2,876 |
$1K |
| 86704 |
|
141 |
139 |
$1K |
| 90833 |
Psychotherapy, 30 minutes with patient when performed with an E&M service (add-on) |
19 |
19 |
$985.34 |
| 84480 |
|
209 |
208 |
$974.55 |
| 90671 |
|
13 |
13 |
$960.05 |
| 20605 |
|
25 |
14 |
$943.69 |
| 73090 |
|
13 |
13 |
$891.75 |
| 74018 |
|
287 |
281 |
$831.94 |
| 93010 |
Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only |
131 |
109 |
$818.85 |
| 83002 |
|
51 |
50 |
$745.88 |
| C9803 |
Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
717 |
689 |
$738.84 |
| 93224 |
|
12 |
12 |
$720.00 |
| 87040 |
|
1,112 |
1,071 |
$717.57 |
| 83001 |
|
51 |
50 |
$713.66 |
| 3077F |
|
13 |
13 |
$701.09 |
| 84100 |
|
199 |
185 |
$698.95 |
| 1111F |
|
160 |
95 |
$682.97 |
| 0031A |
|
17 |
17 |
$680.00 |
| 72050 |
|
67 |
67 |
$649.12 |
| 0052A |
|
20 |
20 |
$640.00 |
| 96376 |
|
1,467 |
1,338 |
$635.30 |
| 82150 |
|
858 |
836 |
$627.91 |
| 80076 |
|
88 |
86 |
$619.41 |
| J2001 |
Injection, lidocaine hcl for intravenous infusion, 10 mg |
635 |
630 |
$616.95 |
| 85007 |
|
937 |
808 |
$583.63 |
| 88141 |
|
67 |
67 |
$547.80 |
| 85379 |
|
1,225 |
1,214 |
$503.95 |
| G0009 |
Administration of pneumococcal vaccine |
43 |
43 |
$482.79 |
| 84403 |
|
25 |
24 |
$469.48 |
| 82950 |
|
265 |
263 |
$459.71 |
| 90662 |
|
33 |
33 |
$452.39 |
| 86696 |
|
40 |
40 |
$449.50 |
| 83605 |
|
1,655 |
1,552 |
$423.31 |
| 88342 |
|
14 |
14 |
$405.92 |
| J1170 |
Injection, hydromorphone, up to 4 mg |
3,756 |
3,090 |
$388.75 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
1,995 |
1,871 |
$364.34 |
| Q3014 |
Telehealth originating site facility fee |
27 |
27 |
$342.34 |
| 86765 |
|
39 |
38 |
$321.45 |
| 82565 |
|
65 |
65 |
$284.70 |
| 80320 |
|
4,641 |
4,292 |
$257.42 |
| 84154 |
|
15 |
15 |
$247.99 |
| 83921 |
|
12 |
12 |
$233.31 |
| 86709 |
|
27 |
26 |
$210.00 |
| 73590 |
|
42 |
40 |
$206.19 |
| 86735 |
|
37 |
36 |
$184.69 |
| 87147 |
|
2,088 |
2,053 |
$181.31 |
| 80329 |
|
2,657 |
2,486 |
$179.22 |
| 84520 |
|
51 |
51 |
$178.07 |
| J7030 |
Infusion, normal saline solution , 1000 cc |
7,366 |
6,733 |
$173.04 |
| 88300 |
|
36 |
36 |
$148.72 |
| 84436 |
|
39 |
39 |
$145.92 |
| 82248 |
|
34 |
25 |
$135.69 |
| 72072 |
|
13 |
13 |
$126.00 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
6,219 |
5,596 |
$106.73 |
| 84425 |
|
13 |
13 |
$106.05 |
| 87430 |
|
1,045 |
1,033 |
$100.27 |
| Q0144 |
Azithromycin dihydrate, oral, capsules/powder, 1 gram |
532 |
526 |
$87.39 |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
754 |
722 |
$81.68 |
| J3490 |
Unclassified drugs |
143 |
106 |
$75.77 |
| 73080 |
|
16 |
16 |
$65.89 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
18 |
18 |
$64.58 |
| J1644 |
Injection, heparin sodium, per 1000 units |
198 |
127 |
$60.89 |
| 84460 |
|
12 |
12 |
$55.88 |
| 86431 |
|
13 |
13 |
$52.00 |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
1,225 |
1,109 |
$51.59 |
| 83615 |
|
14 |
12 |
$45.27 |
| 99460 |
|
277 |
274 |
$39.08 |
| 93226 |
|
12 |
12 |
$35.00 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
2,886 |
2,742 |
$34.61 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
1,387 |
1,333 |
$32.99 |
| A9579 |
Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (nos), per ml |
18 |
18 |
$31.30 |
| 82270 |
|
28 |
13 |
$30.60 |
| J0690 |
Injection, cefazolin sodium, 500 mg |
679 |
604 |
$28.99 |
| 82947 |
|
14 |
14 |
$27.51 |
| J2704 |
Injection, propofol, 10 mg |
944 |
922 |
$25.27 |
| J2060 |
Injection, lorazepam, 2 mg |
1,966 |
1,734 |
$22.30 |
| J3411 |
Injection, thiamine hcl, 100 mg |
166 |
155 |
$15.90 |
| J7620 |
Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme |
1,518 |
1,333 |
$15.52 |
| J3370 |
Injection, vancomycin hcl, 500 mg |
235 |
136 |
$14.98 |
| C9113 |
Injection, pantoprazole sodium, per vial |
282 |
247 |
$14.32 |
| J3420 |
Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg |
744 |
704 |
$12.26 |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
317 |
261 |
$11.44 |
| 71101 |
|
24 |
24 |
$10.61 |
| 99462 |
|
96 |
69 |
$10.42 |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
878 |
811 |
$9.98 |
| 86308 |
|
13 |
13 |
$9.56 |
| J3480 |
Injection, potassium chloride, per 2 meq |
75 |
62 |
$9.22 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
1,593 |
1,574 |
$9.00 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
1,721 |
1,691 |
$7.76 |
| 73140 |
|
14 |
14 |
$4.55 |
| J1790 |
Injection, droperidol, up to 5 mg |
374 |
345 |
$2.74 |
| 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 |
396 |
391 |
$2.20 |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
215 |
191 |
$1.84 |
| J1630 |
Injection, haloperidol, up to 5 mg |
238 |
211 |
$1.48 |
| 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 |
378 |
370 |
$1.48 |
| J1815 |
Injection, insulin, per 5 units |
367 |
240 |
$1.12 |
| 82009 |
|
55 |
51 |
$1.02 |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
943 |
900 |
$0.50 |
| 96127 |
|
175 |
171 |
$0.00 |
| 87451 |
|
22 |
21 |
$0.00 |
| 86710 |
|
75 |
74 |
$0.00 |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
167 |
158 |
$0.00 |
| 91301 |
|
27 |
27 |
$0.00 |
| 87280 |
|
14 |
14 |
$0.00 |
| J8540 |
Dexamethasone, oral, 0.25 mg |
52 |
44 |
$0.00 |
| J3360 |
Injection, diazepam, up to 5 mg |
14 |
12 |
$0.00 |
| 87276 |
|
17 |
17 |
$0.00 |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
14 |
14 |
$0.00 |
| J2919 |
Injection, methylprednisolone sodium succinate, 5 mg |
50 |
49 |
$0.00 |
| J1171 |
Injection, hydromorphone, 0.1 mg |
65 |
57 |
$0.00 |
| 3078F |
|
138 |
133 |
$0.00 |
| 87279 |
|
12 |
12 |
$0.00 |
| 3016F |
|
68 |
67 |
$0.00 |
| 87260 |
|
12 |
12 |
$0.00 |
| 73565 |
|
13 |
13 |
$0.00 |
| G8427 |
Eligible clinician attests to documenting in the medical record they obtained, updated, or reviewed the patient's current medications |
12 |
12 |
$0.00 |
| 87275 |
|
17 |
17 |
$0.00 |