| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A9150 |
Non-prescription drugs |
60,638 |
27,244 |
$14.42M |
| 0450 |
Emergency room services |
55,270 |
49,961 |
$14.08M |
| 36415 |
Collection of venous blood by venipuncture |
65,736 |
57,268 |
$7.81M |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
39,866 |
37,308 |
$7.13M |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
48,625 |
45,705 |
$7.10M |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
21,895 |
12,618 |
$5.89M |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
17,138 |
16,128 |
$4.64M |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
9,377 |
8,998 |
$1.86M |
| 80053 |
Comprehensive metabolic panel |
68,699 |
63,958 |
$1.42M |
| 0360 |
|
2,941 |
2,663 |
$1.39M |
| G0378 |
Hospital observation service, per hour |
790 |
713 |
$852K |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
6,095 |
5,957 |
$773K |
| 70450 |
Computed tomography, head or brain; without contrast material |
8,381 |
8,169 |
$728K |
| 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 |
5,111 |
4,868 |
$671K |
| 71046 |
Radiologic examination, chest; 2 views |
15,414 |
14,870 |
$589K |
| 99499 |
|
1,758 |
1,081 |
$575K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
22,121 |
20,035 |
$575K |
| Z7502 |
|
13,832 |
13,716 |
$514K |
| 0270 |
|
50,921 |
23,604 |
$508K |
| J3490 |
Unclassified drugs |
71,104 |
35,933 |
$495K |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
2,390 |
2,256 |
$432K |
| 71045 |
Radiologic examination, chest; single view |
17,849 |
17,124 |
$428K |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
1,703 |
1,609 |
$394K |
| 66984 |
Extracapsular cataract removal with insertion of intraocular lens prosthesis |
918 |
887 |
$381K |
| 0710 |
|
3,379 |
3,301 |
$363K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
72,411 |
65,585 |
$346K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
14,238 |
13,328 |
$343K |
| 0250 |
|
3,716 |
1,936 |
$339K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
3,958 |
3,878 |
$336K |
| 0241U |
Neonatal screening for hereditary disorders, genomic sequence analysis panel |
10,174 |
9,949 |
$329K |
| 0762 |
|
89 |
86 |
$324K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
29,952 |
28,043 |
$322K |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
510 |
393 |
$320K |
| 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 |
8,769 |
8,050 |
$315K |
| 99199 |
Unlisted special service, procedure or report |
3,365 |
2,183 |
$262K |
| 0750 |
|
1,106 |
798 |
$258K |
| U0002 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
1,015 |
977 |
$254K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
10,865 |
9,808 |
$249K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
16,520 |
14,908 |
$220K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
2,219 |
1,823 |
$218K |
| 59025 |
Fetal non-stress test |
6,895 |
2,834 |
$209K |
| 45378 |
Colonoscopy, flexible; diagnostic, including collection of specimen(s) |
291 |
287 |
$202K |
| 72125 |
Computed tomography, cervical spine; without contrast material |
1,884 |
1,851 |
$197K |
| 84484 |
|
20,281 |
18,171 |
$197K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
1,704 |
1,654 |
$189K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
9,752 |
9,202 |
$184K |
| 45380 |
Colonoscopy, flexible; with biopsy, single or multiple |
222 |
156 |
$166K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
4,687 |
4,513 |
$150K |
| 81001 |
|
27,504 |
26,258 |
$140K |
| 73610 |
|
2,191 |
2,164 |
$131K |
| T5999 |
Supply, not otherwise specified |
686 |
642 |
$130K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
12,639 |
12,126 |
$128K |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
6,756 |
3,229 |
$125K |
| V2632 |
Posterior chamber intraocular lens |
930 |
904 |
$124K |
| 83690 |
|
22,943 |
21,597 |
$120K |
| 81003 |
|
12,681 |
12,190 |
$119K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
7,774 |
6,737 |
$119K |
| 97750 |
|
4,793 |
2,885 |
$114K |
| 0160 |
|
231 |
210 |
$113K |
| 96361 |
Intravenous infusion, hydration; each additional hour |
5,472 |
4,842 |
$111K |
| 73630 |
|
2,393 |
2,342 |
$110K |
| 82962 |
|
7,476 |
5,363 |
$101K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
2,178 |
1,251 |
$99K |
| 73030 |
|
1,873 |
1,839 |
$94K |
| Z9725 |
|
3,000 |
2,959 |
$90K |
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
2,788 |
2,738 |
$90K |
| 73562 |
|
1,958 |
1,926 |
$89K |
| 87081 |
|
3,526 |
3,475 |
$87K |
| 73130 |
|
1,661 |
1,637 |
$87K |
| 93971 |
|
1,949 |
1,893 |
$86K |
| C1713 |
Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable) |
97 |
94 |
$83K |
| 84703 |
|
13,751 |
13,142 |
$82K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
2,530 |
2,473 |
$82K |
| 76830 |
Ultrasound, transvaginal |
2,044 |
1,998 |
$78K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
3,975 |
3,886 |
$77K |
| 73110 |
|
1,465 |
1,429 |
$76K |
| 78452 |
Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress |
282 |
266 |
$76K |
| 96376 |
|
2,314 |
1,925 |
$72K |
| 76801 |
|
2,509 |
2,262 |
$69K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
2,537 |
2,459 |
$67K |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
9,523 |
9,214 |
$65K |
| Q0111 |
Wet mounts, including preparations of vaginal, cervical or skin specimens |
2,668 |
2,604 |
$64K |
| 74018 |
|
1,699 |
1,658 |
$63K |
| 81025 |
|
8,062 |
7,854 |
$62K |
| 87040 |
|
6,494 |
5,839 |
$62K |
| 87077 |
|
3,529 |
3,426 |
$61K |
| A9270 |
Non-covered item or service |
11,102 |
4,137 |
$61K |
| J8540 |
Dexamethasone, oral, 0.25 mg |
1,072 |
1,049 |
$60K |
| 0324 |
|
416 |
404 |
$59K |
| 10060 |
|
579 |
565 |
$57K |
| 83605 |
|
8,437 |
7,912 |
$57K |
| 83880 |
|
5,312 |
5,036 |
$57K |
| Z7610 |
|
9,674 |
4,918 |
$57K |
| 97139 |
|
8,107 |
2,281 |
$57K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
1,948 |
1,761 |
$55K |
| 43235 |
|
101 |
97 |
$53K |
| 0760 |
|
1,048 |
884 |
$52K |
| 85027 |
|
15,594 |
14,873 |
$52K |
| J7040 |
Infusion, normal saline solution, sterile (500 ml = 1 unit) |
4,484 |
2,588 |
$51K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
1,865 |
1,836 |
$49K |
| 84702 |
|
5,261 |
4,735 |
$47K |
| J2704 |
Injection, propofol, 10 mg |
6,738 |
6,321 |
$46K |
| 72100 |
|
905 |
890 |
$44K |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
5,941 |
5,467 |
$43K |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
9,422 |
8,578 |
$42K |
| 73140 |
|
564 |
556 |
$40K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
1,884 |
1,802 |
$40K |
| 29848 |
|
127 |
126 |
$38K |
| 87631 |
|
1,196 |
1,172 |
$38K |
| 73080 |
|
596 |
587 |
$35K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
3,979 |
3,891 |
$34K |
| Q4051 |
Splint supplies, miscellaneous (includes thermoplastics, strapping, fasteners, padding and other supplies) |
29 |
16 |
$34K |
| J7030 |
Infusion, normal saline solution , 1000 cc |
15,642 |
13,079 |
$33K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
3,741 |
3,693 |
$31K |
| 97803 |
|
839 |
745 |
$29K |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
19,817 |
18,777 |
$28K |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
296 |
278 |
$28K |
| 0720 |
|
479 |
379 |
$27K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
565 |
563 |
$26K |
| 0949 |
|
623 |
515 |
$25K |
| 12001 |
|
421 |
415 |
$25K |
| 83735 |
|
5,134 |
4,530 |
$25K |
| 70496 |
|
216 |
208 |
$24K |
| J1815 |
Injection, insulin, per 5 units |
2,453 |
1,635 |
$24K |
| 70486 |
|
353 |
350 |
$24K |
| 74174 |
|
81 |
81 |
$23K |
| 72131 |
|
274 |
270 |
$23K |
| G0500 |
Moderate sedation services provided by the same physician or other qualified health care professional performing a gastrointestinal endoscopic service that sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; initial 15 minutes of intra-service time; patient age 5 years or older (additional time may be reported with 99153, as appropriate) |
211 |
207 |
$22K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
850 |
717 |
$22K |
| 0254 |
|
16 |
16 |
$22K |
| 70498 |
|
176 |
175 |
$21K |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
10,148 |
9,519 |
$21K |
| 80076 |
|
2,264 |
2,190 |
$20K |
| 73090 |
|
323 |
322 |
$19K |
| 29125 |
|
709 |
680 |
$19K |
| 85610 |
|
6,587 |
6,271 |
$18K |
| 73502 |
|
539 |
522 |
$18K |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
1,175 |
1,061 |
$18K |
| 85379 |
|
3,144 |
3,070 |
$17K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
1,370 |
1,324 |
$17K |
| 12011 |
|
254 |
247 |
$16K |
| 94644 |
|
976 |
907 |
$16K |
| 99291 |
Critical care, evaluation and management of the critically ill patient, first 30-74 minutes |
107 |
107 |
$16K |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
1,510 |
1,487 |
$15K |
| 45385 |
Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) |
18 |
17 |
$14K |
| 86141 |
|
2,368 |
2,282 |
$14K |
| 93017 |
|
291 |
274 |
$14K |
| J0690 |
Injection, cefazolin sodium, 500 mg |
2,301 |
2,159 |
$13K |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
6,268 |
6,070 |
$13K |
| 86901 |
|
3,803 |
3,662 |
$13K |
| 85730 |
|
3,184 |
3,088 |
$13K |
| 82803 |
|
930 |
898 |
$13K |
| 0301 |
|
123 |
62 |
$12K |
| 0370 |
|
216 |
211 |
$12K |
| 80061 |
Lipid panel |
1,172 |
1,128 |
$12K |
| 86885 |
|
1,437 |
1,380 |
$12K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,106 |
1,952 |
$12K |
| 73590 |
|
329 |
325 |
$11K |
| 93970 |
|
137 |
132 |
$11K |
| 90715 |
|
1,667 |
1,648 |
$11K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
314 |
308 |
$11K |
| 84145 |
|
1,634 |
1,579 |
$11K |
| 87186 |
|
2,876 |
2,793 |
$11K |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
3,449 |
2,986 |
$11K |
| 0761 |
|
152 |
126 |
$11K |
| J2785 |
Injection, regadenoson, 0.1 mg |
273 |
257 |
$10K |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
5,168 |
4,333 |
$10K |
| 92507 |
Treatment of speech, language, voice, communication, and/or auditory processing disorder |
435 |
254 |
$9K |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
4,166 |
3,945 |
$9K |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
1,251 |
825 |
$9K |
| 84443 |
Thyroid stimulating hormone (TSH) |
1,345 |
1,315 |
$8K |
| J7510 |
Prednisolone oral, per 5 mg |
29 |
29 |
$8K |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
37 |
37 |
$7K |
| 82010 |
|
802 |
758 |
$7K |
| 88304 |
|
93 |
91 |
$7K |
| 82550 |
|
902 |
813 |
$7K |
| 97165 |
|
276 |
219 |
$7K |
| 85007 |
|
2,326 |
2,219 |
$6K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
13 |
12 |
$6K |
| 87147 |
|
657 |
641 |
$6K |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
65 |
64 |
$6K |
| 85651 |
|
926 |
884 |
$6K |
| 97802 |
|
83 |
79 |
$6K |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
3,784 |
3,541 |
$5K |
| 97161 |
|
207 |
145 |
$5K |
| 87637 |
Infectious agent detection by nucleic acid; SARS-CoV-2, influenza, and RSV |
470 |
456 |
$5K |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
233 |
189 |
$5K |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
3,691 |
3,483 |
$5K |
| J0780 |
Injection, prochlorperazine, up to 10 mg |
1,881 |
1,789 |
$5K |
| L1830 |
Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf |
81 |
81 |
$5K |
| 86900 |
|
2,119 |
2,042 |
$5K |
| 97799 |
|
795 |
200 |
$5K |
| 87428 |
|
214 |
211 |
$5K |
| 70491 |
|
43 |
40 |
$4K |
| 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 |
2,671 |
2,584 |
$4K |
| J2060 |
Injection, lorazepam, 2 mg |
2,145 |
1,845 |
$4K |
| 80069 |
|
327 |
119 |
$4K |
| 99153 |
Mod sedat endo service >5yrs |
53 |
52 |
$4K |
| 76870 |
|
79 |
78 |
$4K |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
149 |
84 |
$4K |
| 73564 |
|
78 |
78 |
$3K |
| A9500 |
Technetium tc-99m sestamibi, diagnostic, per study dose |
162 |
146 |
$3K |
| L4386 |
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
46 |
46 |
$3K |
| C9399 |
Unclassified drugs or biologicals |
128 |
127 |
$3K |
| 86880 |
|
614 |
592 |
$3K |
| A9502 |
Technetium tc-99m tetrofosmin, diagnostic, per study dose |
127 |
125 |
$2K |
| 47563 |
|
12 |
12 |
$2K |
| 96367 |
|
248 |
237 |
$2K |
| J1644 |
Injection, heparin sodium, per 1000 units |
893 |
457 |
$2K |
| J0665 |
Injection, bupivicaine, not otherwise specified, 0.5 mg |
627 |
614 |
$2K |
| 71020 |
|
56 |
34 |
$2K |
| 72128 |
|
13 |
13 |
$2K |
| J0171 |
Injection, adrenalin, epinephrine, 0.1 mg |
452 |
440 |
$2K |
| 0272 |
|
153 |
146 |
$2K |
| 29105 |
|
45 |
42 |
$2K |
| 97162 |
|
84 |
84 |
$2K |
| X4110 |
|
54 |
12 |
$2K |
| 82553 |
|
116 |
107 |
$2K |
| J3486 |
Injection, ziprasidone mesylate, 10 mg |
120 |
92 |
$1K |
| 97010 |
|
99 |
25 |
$1K |
| J1650 |
Injection, enoxaparin sodium, 10 mg |
127 |
79 |
$1K |
| 70360 |
|
25 |
24 |
$1K |
| C1781 |
Mesh (implantable) |
12 |
12 |
$1K |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
493 |
458 |
$1K |
| 99070 |
|
162 |
57 |
$1K |
| S0020 |
Injection, bupivicaine hydrochloride, 30 ml |
224 |
220 |
$1K |
| G0121 |
Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk |
12 |
12 |
$1K |
| 86308 |
|
341 |
334 |
$994.08 |
| 29515 |
|
107 |
103 |
$966.52 |
| J7050 |
Infusion, normal saline solution, 250 cc |
485 |
409 |
$915.56 |
| 92610 |
|
38 |
36 |
$905.89 |
| Z7500 |
|
27 |
24 |
$903.65 |
| 12002 |
|
12 |
12 |
$845.34 |
| G8980 |
Mobility: walking & moving around functional limitation, discharge status, at discharge from therapy or to end reporting |
120 |
105 |
$801.79 |
| 92522 |
|
44 |
42 |
$794.24 |
| 82140 |
|
156 |
147 |
$789.07 |
| 84439 |
|
49 |
48 |
$777.39 |
| 84100 |
|
258 |
248 |
$700.54 |
| 76770 |
|
29 |
25 |
$684.84 |
| 74019 |
|
25 |
25 |
$671.58 |
| J1630 |
Injection, haloperidol, up to 5 mg |
408 |
354 |
$636.06 |
| 29530 |
|
38 |
37 |
$440.77 |
| G8978 |
Mobility: walking & moving around functional limitation, current status, at therapy episode outset and at reporting intervals |
347 |
322 |
$397.87 |
| 73560 |
|
12 |
12 |
$332.68 |
| J1170 |
Injection, hydromorphone, up to 4 mg |
173 |
157 |
$314.51 |
| 76775 |
|
12 |
12 |
$309.02 |
| 94664 |
|
32 |
31 |
$262.71 |
| 29130 |
|
50 |
50 |
$244.56 |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
26 |
26 |
$201.66 |
| 87634 |
|
15 |
15 |
$172.73 |
| 84132 |
|
19 |
14 |
$155.53 |
| 36600 |
|
31 |
28 |
$133.10 |
| J3370 |
Injection, vancomycin hcl, 500 mg |
146 |
120 |
$129.03 |
| J0360 |
Injection, hydralazine hcl, up to 20 mg |
41 |
38 |
$128.38 |
| 97166 |
|
110 |
95 |
$124.74 |
| G8979 |
Mobility: walking & moving around functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting |
413 |
383 |
$113.46 |
| 86780 |
|
27 |
24 |
$98.80 |
| S0028 |
Injection, famotidine, 20 mg |
50 |
48 |
$93.73 |
| 80164 |
|
43 |
39 |
$92.40 |
| S0164 |
Injection, pantoprazole sodium, 40 mg |
72 |
56 |
$78.97 |
| J2470 |
Injection, pantoprazole sodium, 40 mg |
32 |
25 |
$77.76 |
| 88720 |
|
14 |
14 |
$70.30 |
| 82570 |
|
12 |
12 |
$61.00 |
| M0243 |
Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring |
19 |
18 |
$50.28 |
| J0500 |
Injection, dicyclomine hcl, up to 20 mg |
55 |
55 |
$48.89 |
| J2919 |
Injection, methylprednisolone sodium succinate, 5 mg |
28 |
28 |
$48.57 |
| J1953 |
Injection, levetiracetam, 10 mg |
15 |
13 |
$33.28 |
| C9113 |
Injection, pantoprazole sodium, per vial |
45 |
41 |
$22.00 |
| Q9969 |
Tc-99m from non-highly enriched uranium source, full cost recovery add-on, per study dose |
408 |
397 |
$14.65 |
| J1940 |
Injection, furosemide, up to 20 mg |
23 |
14 |
$3.13 |
| 84550 |
|
14 |
14 |
$1.10 |
| G8987 |
Self care functional limitation, current status, at therapy episode outset and at reporting intervals |
40 |
40 |
$0.00 |
| 71101 |
|
14 |
14 |
$0.00 |
| G8988 |
Self care functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting |
46 |
43 |
$0.00 |