| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
41,606 |
36,397 |
$3.75M |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
37,454 |
32,223 |
$2.44M |
| H2019 |
Therapeutic behavioral services, per 15 minutes |
41,853 |
30,083 |
$1.93M |
| T1015 |
Clinic visit/encounter, all-inclusive |
39,718 |
31,708 |
$1.91M |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
21,363 |
17,118 |
$1.40M |
| 80053 |
Comprehensive metabolic panel |
55,409 |
41,923 |
$1.36M |
| H0032 |
Mental health service plan development by non-physician |
20,494 |
16,641 |
$858K |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
9,760 |
8,345 |
$832K |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
5,289 |
4,653 |
$718K |
| 76819 |
Fetal biophysical profile; without non-stress testing |
16,752 |
10,729 |
$670K |
| T1017 |
Targeted case management, each 15 minutes |
10,614 |
2,158 |
$595K |
| 59899 |
|
5,988 |
3,860 |
$536K |
| 70450 |
Computed tomography, head or brain; without contrast material |
7,524 |
6,021 |
$527K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
13,283 |
11,016 |
$508K |
| 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 |
7,850 |
6,596 |
$460K |
| G0257 |
Unscheduled or emergency dialysis treatment for an esrd patient in a hospital outpatient department that is not certified as an esrd facility |
2,123 |
446 |
$443K |
| 76811 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, detailed |
5,313 |
4,734 |
$387K |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
8,548 |
7,085 |
$385K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
2,935 |
2,543 |
$371K |
| H0031 |
Mental health assessment, by non-physician |
9,507 |
5,611 |
$363K |
| H2000 |
Comprehensive multidisciplinary evaluation |
2,206 |
1,785 |
$326K |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
3,447 |
3,089 |
$273K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
6,318 |
4,443 |
$260K |
| 0202U |
Oncology (prostate), multianalyte, gene expression profiling |
5,038 |
4,787 |
$251K |
| 59410 |
|
291 |
254 |
$235K |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
4,965 |
1,283 |
$210K |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
10,210 |
7,127 |
$204K |
| G0378 |
Hospital observation service, per hour |
19,790 |
8,079 |
$189K |
| 81003 |
|
36,700 |
30,983 |
$175K |
| 36415 |
Collection of venous blood by venipuncture |
64,339 |
42,354 |
$169K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
15,210 |
10,148 |
$160K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
1,384 |
1,162 |
$157K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
8,162 |
6,763 |
$150K |
| 99291 |
Critical care, evaluation and management of the critically ill patient, first 30-74 minutes |
791 |
631 |
$143K |
| 84112 |
|
643 |
494 |
$130K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
5,109 |
4,235 |
$118K |
| 81025 |
|
12,488 |
10,887 |
$117K |
| 87631 |
|
2,434 |
2,251 |
$113K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
2,051 |
1,774 |
$107K |
| 99215 |
Prolong outpt/office vis |
1,921 |
1,630 |
$100K |
| 82948 |
|
21,915 |
7,717 |
$97K |
| 81220 |
CFTR (cystic fibrosis transmembrane conductance regulator) gene analysis; common variants |
269 |
254 |
$75K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
7,069 |
5,904 |
$70K |
| 72125 |
Computed tomography, cervical spine; without contrast material |
2,164 |
1,648 |
$65K |
| 96367 |
|
999 |
496 |
$65K |
| 0241U |
Neonatal screening for hereditary disorders, genomic sequence analysis panel |
4,918 |
4,489 |
$62K |
| 71045 |
Radiologic examination, chest; single view |
23,445 |
19,576 |
$58K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
8,801 |
7,513 |
$55K |
| 96413 |
Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance |
1,577 |
804 |
$53K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,925 |
2,160 |
$53K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
4,020 |
3,683 |
$51K |
| 78452 |
Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress |
282 |
221 |
$51K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
66,331 |
48,177 |
$50K |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
927 |
766 |
$49K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
1,589 |
1,290 |
$49K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
3,726 |
2,751 |
$47K |
| 71046 |
Radiologic examination, chest; 2 views |
4,969 |
4,386 |
$44K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
660 |
452 |
$44K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
1,848 |
1,715 |
$44K |
| 59025 |
Fetal non-stress test |
1,549 |
1,187 |
$39K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
771 |
728 |
$38K |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
964 |
327 |
$38K |
| 96361 |
Intravenous infusion, hydration; each additional hour |
876 |
705 |
$35K |
| 99443 |
|
1,020 |
998 |
$35K |
| 87480 |
|
2,356 |
2,065 |
$34K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
1,934 |
1,758 |
$30K |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
4,442 |
4,208 |
$24K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
1,504 |
1,333 |
$23K |
| 84443 |
Thyroid stimulating hormone (TSH) |
7,430 |
6,384 |
$22K |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
15,121 |
11,164 |
$22K |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
615 |
199 |
$21K |
| A9270 |
Non-covered item or service |
4,787 |
1,667 |
$20K |
| 97161 |
|
522 |
445 |
$20K |
| 84702 |
|
4,296 |
3,336 |
$20K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
26,051 |
19,955 |
$19K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
197 |
163 |
$19K |
| 99442 |
|
1,065 |
1,004 |
$19K |
| 76821 |
|
3,491 |
2,032 |
$19K |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
3,751 |
2,696 |
$17K |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
2,887 |
2,130 |
$16K |
| 85610 |
|
12,889 |
9,358 |
$15K |
| 84484 |
|
22,685 |
12,027 |
$15K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
1,407 |
1,181 |
$15K |
| 73610 |
|
983 |
866 |
$14K |
| 76801 |
|
2,474 |
2,000 |
$14K |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
8,060 |
5,498 |
$14K |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
2,170 |
1,591 |
$14K |
| 93971 |
|
1,257 |
1,067 |
$14K |
| 73630 |
|
1,137 |
979 |
$13K |
| 73130 |
|
880 |
795 |
$13K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
3,190 |
2,093 |
$13K |
| 83735 |
|
10,987 |
7,330 |
$13K |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
180 |
138 |
$12K |
| 73030 |
|
1,411 |
1,100 |
$12K |
| 74022 |
|
782 |
751 |
$12K |
| 74018 |
|
834 |
755 |
$12K |
| C1769 |
Guide wire |
970 |
649 |
$11K |
| 76820 |
|
2,948 |
1,650 |
$11K |
| 80061 |
Lipid panel |
6,168 |
5,273 |
$11K |
| 86850 |
|
2,740 |
2,179 |
$11K |
| 90791 |
Psychiatric diagnostic evaluation |
1,203 |
969 |
$10K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
2,862 |
2,083 |
$10K |
| J1650 |
Injection, enoxaparin sodium, 10 mg |
4,743 |
2,018 |
$10K |
| 59515 |
|
14 |
13 |
$10K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
4,099 |
3,165 |
$9K |
| 83880 |
|
7,271 |
5,562 |
$9K |
| J1644 |
Injection, heparin sodium, per 1000 units |
1,599 |
752 |
$9K |
| G0123 |
Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision |
524 |
500 |
$9K |
| 72100 |
|
1,671 |
1,350 |
$9K |
| 93017 |
|
466 |
376 |
$8K |
| 36591 |
|
963 |
496 |
$8K |
| 87070 |
|
706 |
527 |
$8K |
| J7050 |
Infusion, normal saline solution, 250 cc |
1,943 |
1,122 |
$8K |
| 97162 |
|
115 |
110 |
$8K |
| 86900 |
|
4,385 |
3,611 |
$8K |
| 97035 |
|
1,501 |
471 |
$7K |
| 72131 |
|
126 |
101 |
$7K |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
4,240 |
3,281 |
$7K |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
2,338 |
1,896 |
$7K |
| J0690 |
Injection, cefazolin sodium, 500 mg |
1,134 |
757 |
$7K |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
4,475 |
3,480 |
$7K |
| U0002 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
351 |
313 |
$6K |
| 93970 |
|
460 |
377 |
$6K |
| Q4081 |
Injection, epoetin alfa, 100 units (for esrd on dialysis) |
266 |
49 |
$6K |
| 85027 |
|
7,785 |
5,671 |
$6K |
| 85730 |
|
6,059 |
4,815 |
$6K |
| J3490 |
Unclassified drugs |
1,019 |
777 |
$6K |
| 73562 |
|
455 |
372 |
$6K |
| J0360 |
Injection, hydralazine hcl, up to 20 mg |
1,323 |
829 |
$6K |
| M0243 |
Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring |
88 |
83 |
$5K |
| 84156 |
|
882 |
664 |
$5K |
| 76830 |
Ultrasound, transvaginal |
1,156 |
1,059 |
$5K |
| J2001 |
Injection, lidocaine hcl for intravenous infusion, 10 mg |
1,858 |
1,449 |
$5K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
4,044 |
3,707 |
$5K |
| 84481 |
|
264 |
255 |
$5K |
| 86780 |
|
1,041 |
961 |
$4K |
| 87633 |
Infectious agent detection by nucleic acid, respiratory virus, 12-25 targets |
122 |
110 |
$4K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
4,555 |
4,001 |
$4K |
| C1894 |
Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser |
295 |
179 |
$4K |
| 73110 |
|
459 |
410 |
$4K |
| 87340 |
|
1,669 |
1,417 |
$4K |
| 0100U |
|
115 |
109 |
$4K |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
11,174 |
9,151 |
$4K |
| 87077 |
|
3,547 |
2,964 |
$3K |
| 84100 |
|
1,824 |
1,093 |
$3K |
| 0352U |
|
136 |
130 |
$3K |
| 84703 |
|
4,290 |
3,830 |
$3K |
| J1170 |
Injection, hydromorphone, up to 4 mg |
1,946 |
1,332 |
$3K |
| 83690 |
|
11,351 |
9,758 |
$3K |
| 87040 |
|
1,719 |
1,429 |
$3K |
| 54150 |
|
45 |
39 |
$3K |
| 70486 |
|
77 |
67 |
$3K |
| 96156 |
|
1,030 |
707 |
$3K |
| 82550 |
|
3,732 |
2,970 |
$3K |
| 83605 |
|
3,015 |
2,380 |
$2K |
| 70491 |
|
15 |
13 |
$2K |
| 87186 |
|
2,862 |
2,341 |
$2K |
| 73502 |
|
364 |
286 |
$2K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
109 |
67 |
$2K |
| 12001 |
|
209 |
199 |
$2K |
| 96376 |
|
245 |
152 |
$2K |
| J1815 |
Injection, insulin, per 5 units |
3,557 |
1,746 |
$2K |
| 84145 |
|
2,178 |
1,688 |
$2K |
| 97602 |
|
18 |
12 |
$2K |
| 11043 |
|
68 |
24 |
$2K |
| 76770 |
|
64 |
56 |
$2K |
| 85380 |
|
2,606 |
2,261 |
$2K |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
920 |
609 |
$2K |
| 86901 |
|
4,339 |
3,570 |
$2K |
| 73564 |
|
140 |
102 |
$2K |
| C9113 |
Injection, pantoprazole sodium, per vial |
373 |
160 |
$2K |
| 81001 |
|
1,103 |
933 |
$2K |
| 82728 |
|
1,435 |
1,189 |
$2K |
| J2060 |
Injection, lorazepam, 2 mg |
2,206 |
1,589 |
$2K |
| 80074 |
|
150 |
114 |
$2K |
| 82607 |
|
1,051 |
859 |
$2K |
| 86803 |
|
632 |
596 |
$2K |
| 87641 |
|
292 |
219 |
$2K |
| 84550 |
|
297 |
248 |
$1K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
161 |
123 |
$1K |
| 36416 |
|
295 |
199 |
$1K |
| 87205 |
|
926 |
693 |
$1K |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
1,452 |
1,326 |
$974.06 |
| 85018 |
|
1,591 |
1,434 |
$955.69 |
| J0692 |
Injection, cefepime hydrochloride, 500 mg |
1,283 |
747 |
$952.83 |
| 73590 |
|
81 |
67 |
$889.18 |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
2,434 |
1,989 |
$814.87 |
| 93880 |
|
137 |
119 |
$804.56 |
| 82805 |
|
158 |
128 |
$784.87 |
| 82950 |
|
284 |
277 |
$774.94 |
| J0456 |
Injection, azithromycin, 500 mg |
82 |
49 |
$759.03 |
| 82247 |
|
406 |
243 |
$755.27 |
| H2010 |
Comprehensive medication services, per 15 minutes |
49 |
46 |
$750.13 |
| 84439 |
|
1,754 |
1,423 |
$739.66 |
| 94760 |
|
417 |
309 |
$729.65 |
| P9016 |
Red blood cells, leukocytes reduced, each unit |
21 |
12 |
$716.51 |
| 86592 |
|
343 |
297 |
$690.61 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
169 |
118 |
$682.33 |
| 83655 |
|
167 |
163 |
$617.92 |
| 73560 |
|
155 |
75 |
$604.02 |
| 90834 |
Psychotherapy, 45 minutes with patient |
284 |
185 |
$593.39 |
| 99205 |
Prolong outpt/office vis |
30 |
27 |
$590.54 |
| J2920 |
Injection, methylprednisolone sodium succinate, up to 40 mg |
743 |
395 |
$562.20 |
| 90714 |
|
661 |
549 |
$545.11 |
| 12011 |
|
71 |
64 |
$539.52 |
| 12002 |
|
69 |
63 |
$531.26 |
| 73090 |
|
46 |
40 |
$510.72 |
| 82140 |
|
186 |
129 |
$489.41 |
| T1023 |
Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter |
37 |
34 |
$467.00 |
| 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 |
2,322 |
2,003 |
$454.01 |
| 85652 |
|
1,592 |
1,324 |
$428.30 |
| 87660 |
|
2,416 |
2,123 |
$427.66 |
| 72040 |
|
89 |
60 |
$420.36 |
| 86140 |
|
2,138 |
1,732 |
$375.97 |
| 83540 |
|
945 |
815 |
$318.64 |
| 87510 |
|
2,354 |
2,064 |
$318.07 |
| 87081 |
|
201 |
197 |
$312.36 |
| A9502 |
Technetium tc-99m tetrofosmin, diagnostic, per study dose |
288 |
228 |
$290.27 |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
13 |
12 |
$288.72 |
| 86762 |
|
657 |
593 |
$255.98 |
| 29125 |
|
98 |
89 |
$226.18 |
| 82746 |
|
489 |
410 |
$224.73 |
| 97032 |
|
258 |
115 |
$201.09 |
| 83550 |
|
640 |
557 |
$194.18 |
| 93976 |
|
14 |
12 |
$191.29 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
16 |
14 |
$167.16 |
| 84436 |
|
219 |
210 |
$163.64 |
| J1940 |
Injection, furosemide, up to 20 mg |
37 |
24 |
$153.01 |
| 84144 |
|
34 |
33 |
$150.99 |
| 83020 |
|
247 |
237 |
$149.40 |
| 83021 |
|
247 |
237 |
$117.28 |
| 87075 |
|
106 |
80 |
$115.81 |
| J0744 |
Injection, ciprofloxacin for intravenous infusion, 200 mg |
22 |
12 |
$111.56 |
| 87798 |
Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism |
131 |
118 |
$104.09 |
| 82248 |
|
605 |
381 |
$101.53 |
| 87581 |
|
114 |
102 |
$90.05 |
| 87486 |
|
114 |
102 |
$90.05 |
| 82947 |
|
380 |
367 |
$84.56 |
| 84450 |
|
272 |
269 |
$80.20 |
| 80164 |
|
50 |
39 |
$79.57 |
| 83615 |
|
808 |
633 |
$78.44 |
| 0240U |
|
164 |
128 |
$74.46 |
| P9603 |
Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated miles actually travelled |
1,628 |
666 |
$69.27 |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
17 |
14 |
$69.00 |
| 86787 |
|
261 |
248 |
$67.36 |
| 84460 |
|
273 |
270 |
$65.63 |
| 85045 |
|
41 |
36 |
$63.32 |
| J3360 |
Injection, diazepam, up to 5 mg |
17 |
15 |
$56.05 |
| G0471 |
Collection of venous blood by venipuncture or urine sample by catheterization from an individual in a skilled nursing facility (snf) or by a laboratory on behalf of a home health agency (hha) |
1,377 |
477 |
$52.82 |
| J2360 |
Injection, orphenadrine citrate, up to 60 mg |
135 |
116 |
$46.18 |
| 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 |
368 |
248 |
$37.27 |
| 90686 |
|
58 |
43 |
$32.31 |
| 82570 |
|
853 |
674 |
$29.18 |
| 87640 |
|
44 |
37 |
$27.81 |
| 82043 |
|
252 |
239 |
$23.55 |
| 87430 |
|
69 |
60 |
$23.49 |
| 82150 |
|
91 |
77 |
$22.89 |
| J8540 |
Dexamethasone, oral, 0.25 mg |
933 |
819 |
$18.85 |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
738 |
534 |
$16.53 |
| J7510 |
Prednisolone oral, per 5 mg |
617 |
590 |
$11.02 |
| 82077 |
|
1,025 |
857 |
$7.78 |
| 85014 |
|
68 |
39 |
$5.68 |
| 84480 |
|
16 |
14 |
$4.57 |
| 84132 |
|
34 |
28 |
$3.10 |
| 72170 |
|
83 |
65 |
$0.00 |
| 71101 |
|
29 |
26 |
$0.00 |
| 96150 |
|
24 |
24 |
$0.00 |
| 0399T |
|
104 |
90 |
$0.00 |
| 96151 |
|
113 |
74 |
$0.00 |
| J2785 |
Injection, regadenoson, 0.1 mg |
102 |
82 |
$0.00 |
| J2543 |
Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams) |
194 |
105 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
17 |
16 |
$0.00 |
| 85379 |
|
70 |
53 |
$0.00 |
| J1630 |
Injection, haloperidol, up to 5 mg |
14 |
12 |
$0.00 |
| 96415 |
|
17 |
12 |
$0.00 |
| J0500 |
Injection, dicyclomine hcl, up to 20 mg |
46 |
40 |
$0.00 |
| 86376 |
|
31 |
27 |
$0.00 |
| J2370 |
Injection, phenylephrine hcl, up to 1 ml |
20 |
12 |
$0.00 |
| 73552 |
|
13 |
12 |
$0.00 |
| J2710 |
Injection, neostigmine methylsulfate, up to 0.5 mg |
96 |
82 |
$0.00 |
| J2272 |
Injection, morphine sulfate (fresenius kabi), not therapeutically equivalent to j2270, up to 10 mg |
33 |
25 |
$0.00 |
| 82010 |
|
423 |
328 |
$0.00 |
| Q0244 |
Injection, casirivimab and imdevimab, 1200 mg |
31 |
31 |
$0.00 |
| J0780 |
Injection, prochlorperazine, up to 10 mg |
227 |
193 |
$0.00 |
| J3370 |
Injection, vancomycin hcl, 500 mg |
108 |
73 |
$0.00 |
| J3105 |
Injection, terbutaline sulfate, up to 1 mg |
18 |
12 |
$0.00 |
| J0153 |
Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds) |
17 |
13 |
$0.00 |
| 86003 |
|
21 |
17 |
$0.00 |
| 76376 |
|
181 |
152 |
$0.00 |
| J1953 |
Injection, levetiracetam, 10 mg |
36 |
25 |
$0.00 |
| J3486 |
Injection, ziprasidone mesylate, 10 mg |
14 |
12 |
$0.00 |
| 0353U |
|
84 |
77 |
$0.00 |
| 93356 |
|
83 |
68 |
$0.00 |
| 82465 |
|
12 |
12 |
$0.00 |