| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
37,339 |
33,772 |
$11.30M |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
52,992 |
48,843 |
$10.68M |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
61,471 |
56,993 |
$9.91M |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
7,018 |
6,620 |
$4.54M |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
6,880 |
6,426 |
$3.01M |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
15,416 |
14,376 |
$1.55M |
| 72125 |
Computed tomography, cervical spine; without contrast material |
3,755 |
3,567 |
$1.37M |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
2,712 |
2,521 |
$1.27M |
| 70450 |
Computed tomography, head or brain; without contrast material |
12,243 |
11,357 |
$1.14M |
| G0378 |
Hospital observation service, per hour |
18,159 |
8,185 |
$969K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
3,994 |
3,617 |
$899K |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
3,363 |
985 |
$544K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
2,494 |
2,373 |
$489K |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
1,713 |
1,615 |
$480K |
| 93971 |
|
2,346 |
2,185 |
$367K |
| 72131 |
|
920 |
879 |
$287K |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
336 |
309 |
$279K |
| 93975 |
|
1,186 |
1,143 |
$269K |
| 78452 |
Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress |
203 |
187 |
$253K |
| 93970 |
|
1,493 |
1,404 |
$225K |
| 11042 |
Debridement, subcutaneous tissue (includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm |
1,425 |
746 |
$208K |
| 45380 |
Colonoscopy, flexible; with biopsy, single or multiple |
600 |
558 |
$189K |
| 72100 |
|
1,494 |
1,445 |
$154K |
| 96361 |
Intravenous infusion, hydration; each additional hour |
30,675 |
24,604 |
$150K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
13,391 |
11,647 |
$133K |
| 47562 |
|
39 |
38 |
$123K |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
2,338 |
2,216 |
$122K |
| 73564 |
|
994 |
933 |
$120K |
| 95810 |
Polysomnography; sleep staging with 4 or more additional parameters |
172 |
164 |
$112K |
| 70486 |
|
1,596 |
1,516 |
$102K |
| 59025 |
Fetal non-stress test |
663 |
503 |
$98K |
| 95811 |
|
167 |
152 |
$95K |
| 99291 |
Critical care, evaluation and management of the critically ill patient, first 30-74 minutes |
70 |
68 |
$59K |
| G0121 |
Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk |
146 |
142 |
$56K |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
1,512 |
1,339 |
$49K |
| 70496 |
|
681 |
636 |
$47K |
| 47563 |
|
13 |
12 |
$44K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
26,685 |
22,262 |
$44K |
| 93458 |
|
31 |
28 |
$43K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
298 |
280 |
$36K |
| 12001 |
|
1,086 |
1,064 |
$28K |
| 45378 |
Colonoscopy, flexible; diagnostic, including collection of specimen(s) |
137 |
132 |
$27K |
| 97535 |
Self-care/home management training, each 15 minutes |
1,756 |
1,226 |
$27K |
| 45385 |
Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) |
95 |
91 |
$25K |
| 74174 |
|
39 |
38 |
$24K |
| 10060 |
|
1,320 |
1,257 |
$24K |
| 93976 |
|
3,099 |
2,926 |
$24K |
| 80053 |
Comprehensive metabolic panel |
55,554 |
48,140 |
$23K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
33,465 |
29,345 |
$21K |
| C1781 |
Mesh (implantable) |
181 |
174 |
$19K |
| 50590 |
|
13 |
12 |
$19K |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
12,402 |
11,296 |
$18K |
| 73130 |
|
2,563 |
2,440 |
$17K |
| 71250 |
|
232 |
214 |
$17K |
| 71046 |
Radiologic examination, chest; 2 views |
16,987 |
16,061 |
$16K |
| 73630 |
|
2,651 |
2,511 |
$16K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
3,993 |
3,766 |
$15K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,040 |
784 |
$14K |
| 73562 |
|
2,174 |
2,015 |
$14K |
| 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 |
9,534 |
8,982 |
$14K |
| 73030 |
|
2,533 |
2,388 |
$12K |
| 29580 |
|
326 |
127 |
$11K |
| C1887 |
Catheter, guiding (may include infusion/perfusion capability) |
2,273 |
2,115 |
$11K |
| 76801 |
|
3,105 |
2,837 |
$9K |
| 73110 |
|
1,660 |
1,581 |
$8K |
| 96376 |
|
7,529 |
4,835 |
$8K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
1,047 |
985 |
$8K |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
2,215 |
852 |
$8K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
31,670 |
28,585 |
$7K |
| S2900 |
Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure) |
85 |
81 |
$7K |
| 12002 |
|
659 |
643 |
$7K |
| 73140 |
|
513 |
496 |
$7K |
| 0042T |
|
12 |
12 |
$6K |
| 12011 |
|
562 |
539 |
$6K |
| 88304 |
|
1,344 |
1,272 |
$6K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
3,747 |
2,660 |
$5K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
23,770 |
20,393 |
$5K |
| 73610 |
|
2,436 |
2,319 |
$5K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
8,241 |
7,718 |
$5K |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
786 |
444 |
$5K |
| 11043 |
|
38 |
14 |
$5K |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
354 |
345 |
$5K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
7,569 |
6,941 |
$4K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
347 |
332 |
$4K |
| 87400 |
|
11,195 |
9,966 |
$4K |
| 76830 |
Ultrasound, transvaginal |
1,254 |
1,191 |
$3K |
| 81025 |
|
17,357 |
16,377 |
$3K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
18,149 |
15,043 |
$3K |
| 73090 |
|
645 |
609 |
$3K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
67,342 |
55,942 |
$3K |
| 73080 |
|
782 |
758 |
$3K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
247 |
240 |
$3K |
| 71045 |
Radiologic examination, chest; single view |
19,868 |
18,104 |
$3K |
| 43249 |
|
12 |
12 |
$2K |
| 76641 |
|
12 |
12 |
$2K |
| 76870 |
|
163 |
157 |
$2K |
| 99292 |
|
14 |
12 |
$2K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
4,076 |
3,941 |
$2K |
| 73590 |
|
1,000 |
942 |
$2K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
11,620 |
11,053 |
$2K |
| 84484 |
|
24,496 |
18,192 |
$2K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
4,076 |
3,942 |
$2K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
204 |
194 |
$1K |
| J3490 |
Unclassified drugs |
4,777 |
4,111 |
$1K |
| 74018 |
|
1,656 |
1,571 |
$1K |
| 81001 |
|
36,663 |
33,757 |
$1K |
| 87186 |
|
5,983 |
5,612 |
$1K |
| 73502 |
|
879 |
821 |
$1K |
| 70498 |
|
680 |
629 |
$1K |
| 72128 |
|
109 |
104 |
$1K |
| 93017 |
|
268 |
246 |
$1K |
| J8499 |
Prescription drug, oral, non chemotherapeutic, nos |
9,435 |
7,904 |
$1K |
| 93880 |
|
100 |
92 |
$989.43 |
| 83690 |
|
20,570 |
18,704 |
$923.14 |
| 80076 |
|
1,350 |
1,279 |
$909.74 |
| 83880 |
|
6,809 |
6,156 |
$741.50 |
| 84703 |
|
9,106 |
8,625 |
$726.10 |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
2,249 |
2,206 |
$713.09 |
| U0002 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
942 |
869 |
$694.89 |
| 71101 |
|
607 |
572 |
$688.87 |
| C1769 |
Guide wire |
1,002 |
887 |
$685.49 |
| 83735 |
|
18,591 |
14,889 |
$636.81 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
11,047 |
9,572 |
$613.27 |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
6,286 |
4,663 |
$604.17 |
| 84702 |
|
3,802 |
3,469 |
$599.07 |
| 87088 |
|
17,611 |
16,245 |
$562.88 |
| C8923 |
Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, without spectral or color doppler echocardiography |
59 |
55 |
$528.73 |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
443 |
401 |
$526.24 |
| 83605 |
|
9,341 |
7,907 |
$481.22 |
| 85730 |
|
6,746 |
6,113 |
$477.41 |
| J7030 |
Infusion, normal saline solution , 1000 cc |
6,796 |
5,342 |
$475.44 |
| 72040 |
|
419 |
409 |
$460.76 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
3,290 |
3,216 |
$437.99 |
| 85379 |
|
5,420 |
4,972 |
$435.27 |
| 87081 |
|
2,836 |
2,763 |
$419.38 |
| 90715 |
|
3,205 |
3,118 |
$393.66 |
| 81003 |
|
13,529 |
12,569 |
$392.83 |
| 74019 |
|
505 |
469 |
$390.58 |
| 82962 |
|
19,462 |
10,550 |
$373.08 |
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
25 |
25 |
$354.08 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
21,460 |
19,725 |
$349.02 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
25,562 |
22,117 |
$321.47 |
| 80061 |
Lipid panel |
1,891 |
1,740 |
$316.13 |
| 29125 |
|
1,231 |
1,183 |
$303.79 |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
14,811 |
10,621 |
$301.99 |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
5,470 |
5,149 |
$290.10 |
| 73120 |
|
98 |
94 |
$285.45 |
| 76775 |
|
27 |
26 |
$283.59 |
| 87040 |
|
5,719 |
3,723 |
$281.88 |
| 88342 |
|
765 |
702 |
$276.01 |
| 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 |
5,412 |
5,122 |
$272.79 |
| 97162 |
|
155 |
136 |
$268.80 |
| 82803 |
|
823 |
741 |
$220.12 |
| 36600 |
|
56 |
45 |
$219.98 |
| 84443 |
Thyroid stimulating hormone (TSH) |
3,057 |
2,831 |
$218.53 |
| J2785 |
Injection, regadenoson, 0.1 mg |
194 |
180 |
$208.25 |
| 87210 |
|
1,980 |
1,900 |
$206.28 |
| 29515 |
|
305 |
293 |
$205.09 |
| 82550 |
|
7,737 |
6,692 |
$204.38 |
| 97163 |
|
698 |
617 |
$193.39 |
| 85027 |
|
6,263 |
5,299 |
$187.46 |
| 85610 |
|
10,749 |
9,626 |
$186.27 |
| 87077 |
|
4,462 |
4,143 |
$167.87 |
| 97167 |
|
254 |
236 |
$150.41 |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
1,588 |
1,417 |
$133.18 |
| 84100 |
|
3,468 |
2,944 |
$110.43 |
| 84112 |
|
28 |
27 |
$109.38 |
| Q9957 |
Injection, perflutren lipid microspheres, per ml |
60 |
57 |
$96.54 |
| 72070 |
|
28 |
26 |
$92.98 |
| 86901 |
|
4,523 |
4,286 |
$92.92 |
| 29505 |
|
190 |
185 |
$87.89 |
| 84145 |
|
1,261 |
1,154 |
$84.26 |
| J2060 |
Injection, lorazepam, 2 mg |
4,492 |
3,810 |
$77.74 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,905 |
2,816 |
$74.85 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
1,560 |
1,443 |
$74.61 |
| 73560 |
|
15 |
13 |
$74.05 |
| 86900 |
|
4,521 |
4,286 |
$70.60 |
| 86850 |
|
2,170 |
2,033 |
$70.14 |
| 97168 |
|
12 |
12 |
$65.13 |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
5,748 |
5,214 |
$62.97 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
6,031 |
5,579 |
$59.06 |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
513 |
455 |
$56.94 |
| J0780 |
Injection, prochlorperazine, up to 10 mg |
2,722 |
2,462 |
$51.34 |
| J2274 |
Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg |
225 |
154 |
$50.58 |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
422 |
241 |
$40.54 |
| 73620 |
|
166 |
152 |
$40.46 |
| 87147 |
|
1,806 |
1,512 |
$37.72 |
| 87070 |
|
881 |
770 |
$36.14 |
| 87102 |
|
178 |
141 |
$33.93 |
| 87205 |
|
1,073 |
753 |
$31.44 |
| 96367 |
|
627 |
541 |
$31.05 |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
3,613 |
3,318 |
$23.65 |
| 96368 |
|
286 |
277 |
$22.78 |
| J1170 |
Injection, hydromorphone, up to 4 mg |
5,269 |
4,240 |
$21.71 |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
221 |
185 |
$20.88 |
| J1630 |
Injection, haloperidol, up to 5 mg |
1,499 |
1,335 |
$18.81 |
| J7050 |
Infusion, normal saline solution, 250 cc |
1,236 |
845 |
$18.20 |
| J0690 |
Injection, cefazolin sodium, 500 mg |
4,309 |
3,777 |
$17.17 |
| J2704 |
Injection, propofol, 10 mg |
9,883 |
8,965 |
$16.58 |
| 87420 |
|
1,144 |
1,131 |
$13.08 |
| J3371 |
Injection, vancomycin hcl (mylan), not therapeutically equivalent to j3370, 500 mg |
143 |
90 |
$12.50 |
| J3370 |
Injection, vancomycin hcl, 500 mg |
809 |
482 |
$10.42 |
| J3360 |
Injection, diazepam, up to 5 mg |
114 |
102 |
$10.32 |
| A9270 |
Non-covered item or service |
10,985 |
5,793 |
$8.84 |
| 94760 |
|
483 |
319 |
$8.02 |
| 36415 |
Collection of venous blood by venipuncture |
4,211 |
2,610 |
$7.64 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
8,665 |
7,601 |
$7.51 |
| 99001 |
|
401 |
378 |
$7.26 |
| 85651 |
|
612 |
570 |
$6.14 |
| 82270 |
|
207 |
192 |
$4.98 |
| 76770 |
|
27 |
26 |
$2.90 |
| 97016 |
|
3,071 |
948 |
$2.26 |
| J1815 |
Injection, insulin, per 5 units |
2,778 |
2,083 |
$1.90 |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
2,636 |
2,488 |
$0.60 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
5,920 |
5,435 |
$0.12 |
| J1596 |
Injection, glycopyrrolate, 0.1 mg |
186 |
177 |
$0.00 |
| C9113 |
Injection, pantoprazole sodium, per vial |
1,977 |
1,379 |
$0.00 |
| J7040 |
Infusion, normal saline solution, sterile (500 ml = 1 unit) |
141 |
113 |
$0.00 |
| J1644 |
Injection, heparin sodium, per 1000 units |
1,014 |
323 |
$0.00 |
| C1894 |
Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser |
399 |
355 |
$0.00 |
| S0028 |
Injection, famotidine, 20 mg |
50 |
49 |
$0.00 |
| 87899 |
|
16 |
12 |
$0.00 |
| J2550 |
Injection, promethazine hcl, up to 50 mg |
216 |
190 |
$0.00 |
| J0665 |
Injection, bupivicaine, not otherwise specified, 0.5 mg |
435 |
417 |
$0.00 |
| 97116 |
|
379 |
237 |
$0.00 |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
110 |
100 |
$0.00 |
| J1956 |
Injection, levofloxacin, 250 mg |
433 |
237 |
$0.00 |
| J2272 |
Injection, morphine sulfate (fresenius kabi), not therapeutically equivalent to j2270, up to 10 mg |
14 |
12 |
$0.00 |
| 85384 |
|
16 |
14 |
$0.00 |
| 84439 |
|
42 |
40 |
$0.00 |
| 87075 |
|
113 |
90 |
$0.00 |
| 82140 |
|
92 |
82 |
$0.00 |
| J2919 |
Injection, methylprednisolone sodium succinate, 5 mg |
207 |
185 |
$0.00 |
| A9502 |
Technetium tc-99m tetrofosmin, diagnostic, per study dose |
201 |
185 |
$0.00 |
| J1171 |
Injection, hydromorphone, 0.1 mg |
80 |
62 |
$0.00 |
| 74300 |
|
13 |
12 |
$0.00 |
| 70360 |
|
14 |
12 |
$0.00 |
| J1953 |
Injection, levetiracetam, 10 mg |
54 |
52 |
$0.00 |
| C1760 |
Closure device, vascular (implantable/insertable) |
30 |
29 |
$0.00 |
| J2004 |
Injection, lidocaine hcl with epinephrine, 1 mg |
24 |
24 |
$0.00 |
| 92610 |
|
14 |
12 |
$0.00 |
| J0737 |
Injection, clindamycin phosphate (baxter), not therapeutically equivalent to j0736, 300 mg |
18 |
15 |
$0.00 |
| S0030 |
Injection, metronidazole, 500 mg |
21 |
12 |
$0.00 |
| A9576 |
Injection, gadoteridol, (prohance multipack), per ml |
14 |
14 |
$0.00 |
| A9150 |
Non-prescription drugs |
368 |
340 |
$0.00 |
| 86140 |
|
685 |
652 |
$0.00 |
| J1940 |
Injection, furosemide, up to 20 mg |
306 |
182 |
$0.00 |
| J2175 |
Injection, meperidine hydrochloride, per 100 mg |
359 |
321 |
$0.00 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
221 |
210 |
$0.00 |
| J0561 |
Injection, penicillin g benzathine, 100,000 units |
92 |
90 |
$0.00 |
| J2003 |
Injection, lidocaine hydrochloride, 1 mg |
77 |
74 |
$0.00 |
| J0360 |
Injection, hydralazine hcl, up to 20 mg |
941 |
639 |
$0.00 |
| 87116 |
|
168 |
132 |
$0.00 |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
261 |
247 |
$0.00 |
| 74022 |
|
385 |
370 |
$0.00 |
| 83615 |
|
185 |
172 |
$0.00 |
| 84132 |
|
110 |
86 |
$0.00 |
| 90686 |
|
155 |
151 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
179 |
171 |
$0.00 |
| J3590 |
Unclassified biologics |
77 |
72 |
$0.00 |
| J2470 |
Injection, pantoprazole sodium, 40 mg |
128 |
101 |
$0.00 |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
12 |
12 |
$0.00 |
| 82728 |
|
35 |
33 |
$0.00 |
| 72170 |
|
12 |
12 |
$0.00 |
| 29130 |
|
39 |
39 |
$0.00 |
| 87206 |
|
168 |
132 |
$0.00 |
| 88307 |
|
17 |
12 |
$0.00 |
| 97166 |
|
29 |
29 |
$0.00 |
| 73060 |
|
39 |
39 |
$0.00 |
| J0610 |
Injection, calcium gluconate (fresenius kabi), per 10 ml |
43 |
29 |
$0.00 |
| J2371 |
Injection, phenylephrine hydrochloride, 20 micrograms |
16 |
14 |
$0.00 |
| J7999 |
Compounded drug, not otherwise classified |
69 |
59 |
$0.00 |
| J0687 |
Injection, cefazolin sodium (wg critical care), not therapeutically equivalent to j0690, 500 mg |
94 |
92 |
$0.00 |
| J1790 |
Injection, droperidol, up to 5 mg |
43 |
41 |
$0.00 |
| 73600 |
|
18 |
15 |
$0.00 |
| J2920 |
Injection, methylprednisolone sodium succinate, up to 40 mg |
171 |
64 |
$0.00 |
| 87449 |
|
15 |
12 |
$0.00 |
| 51798 |
|
13 |
12 |
$0.00 |
| C1726 |
Catheter, balloon dilatation, non-vascular |
14 |
14 |
$0.00 |
| 82746 |
|
14 |
14 |
$0.00 |
| 86592 |
|
33 |
30 |
$0.00 |
| J1920 |
Injection, labetalol hydrochloride, 5 mg |
12 |
12 |
$0.00 |
| 82607 |
|
14 |
14 |
$0.00 |