| Code | Description | Claims | Beneficiaries | Total Paid |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
69,829 |
62,631 |
$12.22M |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
41,673 |
38,557 |
$7.18M |
| 96361 |
Intravenous infusion, hydration; each additional hour |
16,628 |
14,538 |
$6.39M |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
29,314 |
26,631 |
$5.40M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
17,327 |
15,465 |
$3.05M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
13,877 |
12,635 |
$2.42M |
| 70450 |
Computed tomography, head or brain; without contrast material |
10,166 |
9,408 |
$1.47M |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
40,294 |
32,672 |
$1.32M |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
8,149 |
7,854 |
$1.30M |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
7,011 |
6,586 |
$1.12M |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
5,257 |
5,022 |
$934K |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
15,160 |
4,234 |
$916K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
21,716 |
18,646 |
$725K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
5,017 |
4,701 |
$719K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
3,777 |
3,068 |
$643K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
6,263 |
5,642 |
$595K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
5,413 |
4,950 |
$516K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
6,401 |
6,314 |
$437K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
2,162 |
2,080 |
$418K |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
2,099 |
1,973 |
$370K |
| 45378 |
Colonoscopy, flexible; diagnostic, including collection of specimen(s) |
445 |
433 |
$350K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
59,791 |
50,669 |
$288K |
| S9485 |
Crisis intervention mental health services, per diem |
439 |
419 |
$280K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
1,109 |
1,010 |
$268K |
| 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 |
4,506 |
4,275 |
$263K |
| 11042 |
Debridement, subcutaneous tissue (includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm |
1,503 |
687 |
$236K |
| 93976 |
|
1,394 |
1,328 |
$223K |
| G0378 |
Hospital observation service, per hour |
5,901 |
2,704 |
$198K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
7,433 |
7,105 |
$192K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
1,871 |
1,858 |
$190K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
6,897 |
6,588 |
$177K |
| 80053 |
Comprehensive metabolic panel |
52,088 |
46,804 |
$175K |
| 66984 |
Extracapsular cataract removal with insertion of intraocular lens prosthesis |
224 |
209 |
$174K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
3,937 |
3,606 |
$173K |
| 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 |
6,515 |
5,797 |
$170K |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
2,574 |
2,553 |
$169K |
| 76830 |
Ultrasound, transvaginal |
1,378 |
1,331 |
$169K |
| 71046 |
Radiologic examination, chest; 2 views |
17,371 |
16,432 |
$160K |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
236 |
228 |
$159K |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
6,495 |
6,291 |
$155K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
1,223 |
1,175 |
$155K |
| 99291 |
Critical care, evaluation and management of the critically ill patient, first 30-74 minutes |
1,169 |
1,112 |
$138K |
| 0241U |
Neonatal screening for hereditary disorders, genomic sequence analysis panel |
1,900 |
1,849 |
$133K |
| ATP14 |
|
14,987 |
12,394 |
$131K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
20,823 |
18,708 |
$121K |
| 97161 |
|
1,815 |
1,693 |
$108K |
| 20610 |
|
573 |
537 |
$107K |
| 84484 |
|
17,290 |
12,334 |
$105K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
307 |
286 |
$99K |
| 10060 |
|
527 |
502 |
$99K |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
3,615 |
3,465 |
$93K |
| 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 |
4,742 |
4,542 |
$92K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
1,354 |
1,321 |
$89K |
| 84702 |
|
7,504 |
6,841 |
$88K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
5,098 |
4,985 |
$86K |
| 90715 |
|
2,839 |
2,757 |
$83K |
| 81025 |
|
14,662 |
13,756 |
$82K |
| 12001 |
|
334 |
325 |
$81K |
| 93971 |
|
273 |
264 |
$80K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
8,486 |
4,206 |
$80K |
| 31231 |
|
351 |
339 |
$79K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
12,966 |
12,471 |
$63K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
2,243 |
2,165 |
$62K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
11,519 |
10,747 |
$61K |
| 45385 |
Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) |
67 |
64 |
$60K |
| 83690 |
|
11,830 |
10,792 |
$59K |
| 97010 |
|
682 |
262 |
$57K |
| 83735 |
|
13,764 |
10,962 |
$56K |
| 84443 |
Thyroid stimulating hormone (TSH) |
6,971 |
6,647 |
$51K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
27,043 |
23,775 |
$50K |
| 80050 |
General health panel |
3,149 |
2,991 |
$50K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
20,590 |
17,572 |
$47K |
| 73630 |
|
3,400 |
3,191 |
$46K |
| 82947 |
|
14,501 |
9,406 |
$46K |
| 81001 |
|
20,703 |
19,190 |
$45K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
423 |
420 |
$44K |
| 72125 |
Computed tomography, cervical spine; without contrast material |
2,927 |
2,744 |
$44K |
| 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 |
691 |
663 |
$40K |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
1,090 |
371 |
$40K |
| 70486 |
|
689 |
662 |
$38K |
| 76642 |
|
263 |
233 |
$37K |
| 83880 |
|
2,281 |
2,099 |
$36K |
| ATP08 |
|
5,610 |
4,519 |
$36K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
11,573 |
10,326 |
$35K |
| 93017 |
|
280 |
264 |
$34K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
3,204 |
2,970 |
$33K |
| 73030 |
|
3,073 |
2,837 |
$30K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
13,509 |
11,854 |
$28K |
| 82805 |
|
851 |
709 |
$27K |
| 71045 |
Radiologic examination, chest; single view |
6,163 |
5,714 |
$27K |
| 83605 |
|
4,158 |
3,177 |
$25K |
| 85610 |
|
10,099 |
7,938 |
$25K |
| 84600 |
|
2,305 |
2,085 |
$24K |
| ATP17 |
|
2,681 |
2,345 |
$23K |
| 36415 |
Collection of venous blood by venipuncture |
33,902 |
27,329 |
$23K |
| ATP15 |
|
2,726 |
2,374 |
$22K |
| 81003 |
|
13,646 |
12,867 |
$21K |
| 85027 |
|
5,452 |
4,903 |
$21K |
| 73130 |
|
3,065 |
2,833 |
$21K |
| 90686 |
|
1,175 |
1,145 |
$20K |
| 73610 |
|
3,328 |
3,131 |
$20K |
| 71250 |
|
160 |
151 |
$19K |
| 87070 |
|
3,126 |
2,864 |
$19K |
| 72100 |
|
1,239 |
1,205 |
$19K |
| 87186 |
|
3,295 |
3,085 |
$18K |
| 87798 |
Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism |
387 |
213 |
$17K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
5,280 |
5,025 |
$17K |
| Q3014 |
Telehealth originating site facility fee |
4,047 |
3,113 |
$17K |
| ATP18 |
|
2,031 |
1,880 |
$17K |
| 80061 |
Lipid panel |
14,467 |
14,098 |
$16K |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
1,038 |
1,026 |
$16K |
| 78452 |
Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress |
40 |
38 |
$16K |
| 82607 |
|
1,866 |
1,792 |
$15K |
| 81513 |
|
180 |
174 |
$15K |
| 84439 |
|
2,660 |
2,534 |
$14K |
| 73110 |
|
1,836 |
1,677 |
$14K |
| 87486 |
|
500 |
479 |
$14K |
| 86803 |
|
1,284 |
1,245 |
$13K |
| 88304 |
|
376 |
333 |
$13K |
| 85379 |
|
1,812 |
1,715 |
$13K |
| 82043 |
|
4,512 |
4,411 |
$13K |
| 82570 |
|
4,818 |
4,571 |
$13K |
| 87040 |
|
2,123 |
1,127 |
$12K |
| 90674 |
|
832 |
810 |
$12K |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
19 |
13 |
$12K |
| 87899 |
|
1,122 |
1,079 |
$12K |
| 99219 |
|
22 |
13 |
$11K |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
13,455 |
10,951 |
$11K |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
1,279 |
534 |
$10K |
| 86703 |
|
996 |
967 |
$10K |
| 73564 |
|
890 |
814 |
$10K |
| 73562 |
|
2,038 |
1,874 |
$10K |
| 99215 |
Prolong outpt/office vis |
46 |
42 |
$10K |
| 12002 |
|
40 |
40 |
$10K |
| 73560 |
|
295 |
246 |
$10K |
| 87205 |
|
3,051 |
2,793 |
$9K |
| 82728 |
|
1,082 |
1,017 |
$9K |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
5,372 |
4,472 |
$9K |
| 84153 |
|
811 |
789 |
$9K |
| 87077 |
|
1,506 |
1,453 |
$8K |
| 87340 |
|
1,040 |
1,013 |
$8K |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
14,013 |
12,079 |
$8K |
| J3490 |
Unclassified drugs |
275 |
242 |
$8K |
| 77080 |
|
183 |
175 |
$8K |
| 97014 |
|
78 |
25 |
$8K |
| 83721 |
|
1,137 |
1,109 |
$7K |
| ATP03 |
|
2,703 |
2,387 |
$7K |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
5,499 |
4,802 |
$7K |
| 62323 |
|
12 |
12 |
$7K |
| 12011 |
|
38 |
37 |
$7K |
| J0171 |
Injection, adrenalin, epinephrine, 0.1 mg |
326 |
290 |
$7K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
640 |
620 |
$7K |
| 77065 |
Tomosynthesis, mammo |
78 |
70 |
$7K |
| 82746 |
|
780 |
734 |
$6K |
| 73502 |
|
633 |
601 |
$6K |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
3,840 |
3,684 |
$6K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
46 |
38 |
$6K |
| 85730 |
|
1,533 |
1,393 |
$6K |
| 83540 |
|
1,465 |
1,405 |
$6K |
| J2704 |
Injection, propofol, 10 mg |
4,737 |
3,752 |
$6K |
| 90750 |
|
134 |
130 |
$5K |
| 87481 |
|
209 |
203 |
$5K |
| 80076 |
|
3,196 |
2,999 |
$5K |
| ATP04 |
|
741 |
684 |
$5K |
| 76536 |
|
25 |
25 |
$5K |
| G0008 |
Administration of influenza virus vaccine |
944 |
919 |
$4K |
| U0002 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
671 |
593 |
$4K |
| 85007 |
|
1,976 |
1,757 |
$4K |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
2,896 |
2,610 |
$4K |
| 86850 |
|
616 |
569 |
$4K |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
3,741 |
3,229 |
$4K |
| 86592 |
|
1,165 |
1,131 |
$4K |
| 94060 |
|
31 |
29 |
$4K |
| 86706 |
|
471 |
332 |
$3K |
| 82550 |
|
3,150 |
2,879 |
$3K |
| 87480 |
|
200 |
197 |
$3K |
| 84481 |
|
303 |
295 |
$3K |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
1,546 |
1,160 |
$3K |
| 82274 |
|
470 |
465 |
$3K |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
4,458 |
3,203 |
$3K |
| 82248 |
|
5,577 |
5,433 |
$3K |
| J1040 |
Injection, methylprednisolone acetate, 80 mg |
1,355 |
1,261 |
$3K |
| 73080 |
|
363 |
344 |
$3K |
| 84480 |
|
245 |
243 |
$3K |
| 90716 |
|
25 |
25 |
$2K |
| ATP11 |
|
359 |
328 |
$2K |
| 86900 |
|
984 |
912 |
$2K |
| J0690 |
Injection, cefazolin sodium, 500 mg |
1,818 |
1,517 |
$2K |
| 86901 |
|
983 |
911 |
$2K |
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
13 |
13 |
$2K |
| 72148 |
Magnetic resonance imaging, lumbar spine; without contrast material |
13 |
12 |
$2K |
| J7030 |
Infusion, normal saline solution , 1000 cc |
6,722 |
5,426 |
$2K |
| J1644 |
Injection, heparin sodium, per 1000 units |
1,617 |
773 |
$2K |
| 97112 |
Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination |
148 |
81 |
$2K |
| 88342 |
|
227 |
217 |
$2K |
| 84100 |
|
1,550 |
1,171 |
$2K |
| 84466 |
|
239 |
224 |
$2K |
| 86140 |
|
560 |
523 |
$2K |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
3,502 |
3,077 |
$2K |
| 85652 |
|
1,078 |
986 |
$2K |
| 76801 |
|
13 |
13 |
$2K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
91 |
85 |
$2K |
| J1630 |
Injection, haloperidol, up to 5 mg |
2,852 |
2,189 |
$2K |
| 87147 |
|
293 |
279 |
$2K |
| J1170 |
Injection, hydromorphone, up to 4 mg |
1,626 |
858 |
$1K |
| J2060 |
Injection, lorazepam, 2 mg |
6,087 |
4,302 |
$1K |
| 73140 |
|
433 |
405 |
$1K |
| 88313 |
|
255 |
244 |
$1K |
| 94729 |
|
59 |
55 |
$1K |
| J2001 |
Injection, lidocaine hcl for intravenous infusion, 10 mg |
2,825 |
2,463 |
$1K |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
4,935 |
4,073 |
$1K |
| 94727 |
|
18 |
16 |
$909.60 |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
54 |
51 |
$878.80 |
| J1030 |
Injection, methylprednisolone acetate, 40 mg |
425 |
382 |
$816.61 |
| J1650 |
Injection, enoxaparin sodium, 10 mg |
182 |
83 |
$754.71 |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
731 |
563 |
$745.00 |
| 71271 |
|
12 |
12 |
$609.00 |
| 86480 |
|
13 |
13 |
$601.37 |
| 82565 |
|
282 |
274 |
$546.63 |
| 86618 |
|
49 |
44 |
$442.41 |
| 87522 |
Neg quan hep c or qual rna |
13 |
13 |
$441.70 |
| G0108 |
Diabetes outpatient self-management training services, individual, per 30 minutes |
59 |
53 |
$436.61 |
| 74019 |
|
17 |
16 |
$434.98 |
| G0009 |
Administration of pneumococcal vaccine |
96 |
86 |
$430.83 |
| 76376 |
|
1,258 |
1,145 |
$409.99 |
| 72110 |
|
15 |
13 |
$289.42 |
| 90670 |
|
17 |
13 |
$288.92 |
| 86038 |
|
41 |
37 |
$276.50 |
| 86709 |
|
29 |
29 |
$272.95 |
| 85651 |
|
141 |
126 |
$272.83 |
| 96376 |
|
1,728 |
1,537 |
$262.89 |
| 73590 |
|
56 |
54 |
$252.75 |
| 74018 |
|
45 |
38 |
$244.95 |
| 90732 |
|
32 |
28 |
$206.20 |
| 80179 |
|
12 |
12 |
$197.28 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
252 |
248 |
$195.45 |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
2,446 |
2,102 |
$186.52 |
| G0328 |
Colorectal cancer screening; fecal occult blood test, immunoassay, 1-3 simultaneous |
34 |
34 |
$172.88 |
| 86593 |
|
43 |
40 |
$149.49 |
| J3370 |
Injection, vancomycin hcl, 500 mg |
30 |
13 |
$145.95 |
| ATP02 |
|
42 |
40 |
$128.88 |
| 86708 |
|
12 |
12 |
$113.00 |
| 84145 |
|
25 |
24 |
$112.45 |
| ATP09 |
|
32 |
15 |
$107.52 |
| 80164 |
|
31 |
25 |
$97.86 |
| 83550 |
|
15 |
14 |
$72.16 |
| 96368 |
|
27 |
25 |
$65.93 |
| J1010 |
Injection, methylprednisolone acetate, 1 mg |
220 |
198 |
$64.12 |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
323 |
288 |
$48.96 |
| 87081 |
|
14 |
13 |
$20.52 |
| 83615 |
|
16 |
13 |
$16.50 |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
665 |
436 |
$8.11 |
| 84550 |
|
16 |
13 |
$7.76 |
| J8540 |
Dexamethasone, oral, 0.25 mg |
189 |
182 |
$0.98 |
| 80329 |
|
15 |
14 |
$0.00 |
| V2632 |
Posterior chamber intraocular lens |
70 |
66 |
$0.00 |
| A9579 |
Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (nos), per ml |
29 |
28 |
$0.00 |
| 76377 |
|
14 |
14 |
$0.00 |
| 80320 |
|
54 |
48 |
$0.00 |
| J7050 |
Infusion, normal saline solution, 250 cc |
51 |
41 |
$0.00 |
| 71101 |
|
13 |
13 |
$0.00 |
| G1004 |
Clinical decision support mechanism national decision support company, as defined by the medicare appropriate use criteria program |
84 |
74 |
$0.00 |
| C9113 |
Injection, pantoprazole sodium, per vial |
173 |
113 |
$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 |
255 |
237 |
$0.00 |
| Q0144 |
Azithromycin dihydrate, oral, capsules/powder, 1 gram |
27 |
27 |
$0.00 |
| G8978 |
Mobility: walking & moving around functional limitation, current status, at therapy episode outset and at reporting intervals |
190 |
176 |
$0.00 |
| 84520 |
|
51 |
50 |
$0.00 |
| S0164 |
Injection, pantoprazole sodium, 40 mg |
18 |
14 |
$0.00 |
| A9502 |
Technetium tc-99m tetrofosmin, diagnostic, per study dose |
41 |
39 |
$0.00 |
| 96367 |
|
13 |
12 |
$0.00 |