| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
65,989 |
57,337 |
$19.03M |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
97,542 |
81,727 |
$17.19M |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
6,122 |
5,932 |
$4.37M |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
8,642 |
7,424 |
$3.21M |
| 70450 |
Computed tomography, head or brain; without contrast material |
6,461 |
6,260 |
$2.58M |
| A0427 |
Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) |
11,044 |
10,647 |
$2.45M |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
13,883 |
12,712 |
$2.36M |
| 99201 |
|
7,657 |
5,320 |
$2.03M |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
21,632 |
19,953 |
$1.70M |
| 96375 |
Therapeutic injection; each additional sequential IV push |
12,376 |
10,113 |
$1.56M |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
2,968 |
2,951 |
$1.54M |
| 72125 |
Computed tomography, cervical spine; without contrast material |
2,379 |
2,350 |
$1.51M |
| 93976 |
|
2,597 |
2,530 |
$1.49M |
| 0241U |
Neonatal screening for hereditary disorders, genomic sequence analysis panel |
9,739 |
9,358 |
$1.30M |
| J3490 |
Unclassified drugs |
91,709 |
48,019 |
$1.25M |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
5,446 |
4,420 |
$1.19M |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
13,723 |
12,326 |
$1.18M |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
14,506 |
12,433 |
$1.08M |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
1,601 |
1,569 |
$1.06M |
| 71046 |
Radiologic examination, chest; 2 views |
15,424 |
14,806 |
$948K |
| 96361 |
Intravenous infusion, hydration; each additional hour |
8,189 |
6,751 |
$889K |
| 0450 |
Emergency room services |
4,089 |
3,696 |
$829K |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
839 |
834 |
$685K |
| 80053 |
Comprehensive metabolic panel |
59,046 |
49,165 |
$660K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
3,830 |
3,077 |
$649K |
| 96413 |
Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance |
5,986 |
3,432 |
$599K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
1,693 |
1,663 |
$590K |
| Q5108 |
Injection, pegfilgrastim-jmdb (fulphila), biosimilar, 0.5 mg |
177 |
118 |
$552K |
| 93971 |
|
1,621 |
1,586 |
$537K |
| 93303 |
Transthoracic echocardiography for congenital cardiac anomalies, follow-up or limited study |
995 |
975 |
$482K |
| 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 |
7,646 |
6,942 |
$481K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
2,695 |
2,589 |
$477K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
58,956 |
48,557 |
$463K |
| J0185 |
Injection, aprepitant, 1 mg |
1,114 |
694 |
$424K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
2,031 |
1,985 |
$392K |
| Q5118 |
Injection, bevacizumab-bvzr, biosimilar, (zirabev), 10 mg |
122 |
55 |
$382K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
1,568 |
1,518 |
$380K |
| J2469 |
Injection, palonosetron hcl, 25 mcg |
2,239 |
1,420 |
$371K |
| 71045 |
Radiologic examination, chest; single view |
9,138 |
8,706 |
$319K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
4,254 |
3,631 |
$318K |
| 70498 |
|
471 |
470 |
$317K |
| 76801 |
|
1,825 |
1,719 |
$299K |
| 70486 |
|
477 |
472 |
$247K |
| 93320 |
|
1,063 |
1,043 |
$242K |
| 70496 |
|
356 |
356 |
$242K |
| 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 |
2,723 |
2,679 |
$238K |
| 96417 |
|
2,041 |
1,292 |
$235K |
| A0425 |
Ground mileage, per statute mile |
12,787 |
12,183 |
$221K |
| J9271 |
Injection, pembrolizumab, 1 mg |
19 |
13 |
$216K |
| J1453 |
Injection, fosaprepitant, 1 mg |
627 |
425 |
$216K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
1,327 |
1,303 |
$204K |
| 78452 |
Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress |
176 |
175 |
$187K |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
9,767 |
9,325 |
$183K |
| Z7502 |
|
4,541 |
4,480 |
$175K |
| 99070 |
|
9,938 |
8,318 |
$169K |
| J7030 |
Infusion, normal saline solution , 1000 cc |
14,037 |
11,860 |
$166K |
| 11042 |
Debridement, subcutaneous tissue (includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm |
5,998 |
3,042 |
$164K |
| 96367 |
|
1,417 |
1,053 |
$161K |
| 76830 |
Ultrasound, transvaginal |
845 |
829 |
$161K |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
1,038 |
985 |
$156K |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
1,218 |
1,170 |
$155K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
910 |
757 |
$154K |
| 94729 |
|
1,053 |
1,048 |
$154K |
| 84484 |
|
13,772 |
12,158 |
$154K |
| 73610 |
|
1,767 |
1,733 |
$150K |
| 96415 |
|
1,420 |
920 |
$148K |
| J2505 |
Injection, pegfilgrastim, 6 mg |
17 |
12 |
$146K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
2,886 |
2,834 |
$145K |
| Z9725 |
|
4,342 |
4,295 |
$144K |
| 94726 |
|
1,062 |
1,057 |
$142K |
| 87040 |
|
8,487 |
7,934 |
$140K |
| 36415 |
Collection of venous blood by venipuncture |
1,849 |
1,463 |
$135K |
| 84443 |
Thyroid stimulating hormone (TSH) |
7,715 |
7,228 |
$132K |
| 59025 |
Fetal non-stress test |
1,850 |
1,598 |
$132K |
| 73030 |
|
1,383 |
1,361 |
$129K |
| 73630 |
|
1,621 |
1,591 |
$128K |
| 83880 |
|
4,161 |
3,899 |
$127K |
| 73130 |
|
1,455 |
1,429 |
$127K |
| 87653 |
|
3,036 |
2,998 |
$125K |
| 81001 |
|
24,333 |
22,313 |
$124K |
| A9150 |
Non-prescription drugs |
1,143 |
490 |
$123K |
| 97750 |
|
727 |
465 |
$118K |
| 87631 |
|
1,011 |
964 |
$117K |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
13,455 |
12,219 |
$116K |
| 72131 |
|
174 |
172 |
$115K |
| 73110 |
|
1,348 |
1,324 |
$115K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
13,657 |
12,344 |
$112K |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
13,869 |
12,641 |
$111K |
| 83605 |
|
9,814 |
9,025 |
$109K |
| 83690 |
|
15,425 |
14,247 |
$103K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
610 |
536 |
$102K |
| 10060 |
|
1,296 |
1,266 |
$99K |
| 74018 |
|
1,649 |
1,587 |
$99K |
| J2704 |
Injection, propofol, 10 mg |
6,683 |
6,183 |
$95K |
| A9500 |
Technetium tc-99m sestamibi, diagnostic, per study dose |
262 |
260 |
$95K |
| 85027 |
|
11,544 |
10,132 |
$94K |
| 87637 |
Infectious agent detection by nucleic acid; SARS-CoV-2, influenza, and RSV |
618 |
598 |
$87K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
8,691 |
7,828 |
$86K |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
9,984 |
8,597 |
$85K |
| 90715 |
|
1,466 |
1,453 |
$79K |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
8,812 |
8,098 |
$77K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
2,346 |
2,299 |
$76K |
| 84145 |
|
4,273 |
3,942 |
$75K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
2,352 |
2,304 |
$74K |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
5,680 |
5,014 |
$74K |
| 99199 |
Unlisted special service, procedure or report |
1,175 |
997 |
$72K |
| 0250 |
|
2,489 |
1,122 |
$71K |
| J2785 |
Injection, regadenoson, 0.1 mg |
264 |
262 |
$71K |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
5,022 |
4,006 |
$71K |
| 93017 |
|
263 |
261 |
$70K |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
7,516 |
7,243 |
$68K |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
1,355 |
1,239 |
$65K |
| 73564 |
|
673 |
665 |
$64K |
| 97597 |
|
914 |
653 |
$64K |
| G0481 |
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; 8-14 drug class(es), including metabolite(s) if performed |
662 |
617 |
$63K |
| 76813 |
|
295 |
294 |
$62K |
| 76770 |
|
280 |
276 |
$57K |
| 12001 |
|
827 |
820 |
$54K |
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
234 |
227 |
$54K |
| 99152 |
|
407 |
391 |
$53K |
| J7050 |
Infusion, normal saline solution, 250 cc |
5,325 |
3,417 |
$53K |
| 87077 |
|
5,370 |
5,239 |
$52K |
| 93458 |
|
26 |
25 |
$51K |
| 87186 |
|
4,706 |
4,548 |
$49K |
| 11045 |
|
486 |
143 |
$48K |
| 83735 |
|
8,152 |
6,807 |
$47K |
| A0429 |
Ambulance service, basic life support, emergency transport (bls-emergency) |
251 |
237 |
$47K |
| J0780 |
Injection, prochlorperazine, up to 10 mg |
2,259 |
2,100 |
$46K |
| J1170 |
Injection, hydromorphone, up to 4 mg |
3,812 |
3,027 |
$46K |
| 73080 |
|
522 |
512 |
$45K |
| 94060 |
|
438 |
438 |
$44K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
300 |
198 |
$44K |
| 81003 |
|
14,452 |
13,637 |
$42K |
| S0020 |
Injection, bupivicaine hydrochloride, 30 ml |
2,375 |
2,280 |
$42K |
| J0690 |
Injection, cefazolin sodium, 500 mg |
3,523 |
2,851 |
$42K |
| 99153 |
Mod sedat endo service >5yrs |
1,073 |
1,044 |
$41K |
| 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) |
369 |
358 |
$41K |
| J3480 |
Injection, potassium chloride, per 2 meq |
944 |
640 |
$41K |
| 12011 |
|
422 |
418 |
$39K |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
3,341 |
2,896 |
$39K |
| 86141 |
|
3,422 |
3,008 |
$38K |
| 82805 |
|
1,264 |
1,179 |
$37K |
| 87503 |
|
642 |
630 |
$37K |
| 87070 |
|
3,924 |
3,818 |
$37K |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
237 |
232 |
$32K |
| J1642 |
Injection, heparin sodium, (heparin lock flush), per 10 units |
6,446 |
3,617 |
$32K |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
40 |
40 |
$32K |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
4,042 |
3,640 |
$30K |
| 96411 |
|
403 |
267 |
$30K |
| 85379 |
|
3,110 |
3,020 |
$30K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
2,841 |
2,785 |
$29K |
| 82962 |
|
5,275 |
3,660 |
$29K |
| 87798 |
Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism |
170 |
162 |
$28K |
| 85610 |
|
7,030 |
6,551 |
$27K |
| 85730 |
|
4,703 |
4,502 |
$27K |
| 73590 |
|
370 |
358 |
$27K |
| 84439 |
|
3,040 |
2,977 |
$25K |
| 86850 |
|
5,759 |
5,426 |
$25K |
| 96416 |
|
141 |
84 |
$24K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
1,969 |
1,954 |
$24K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
1,417 |
1,221 |
$24K |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
2,970 |
2,755 |
$24K |
| 96368 |
|
356 |
252 |
$24K |
| J1815 |
Injection, insulin, per 5 units |
403 |
331 |
$23K |
| 73502 |
|
205 |
202 |
$22K |
| 73562 |
|
253 |
251 |
$22K |
| 73140 |
|
370 |
361 |
$20K |
| J2060 |
Injection, lorazepam, 2 mg |
2,251 |
1,930 |
$19K |
| J7040 |
Infusion, normal saline solution, sterile (500 ml = 1 unit) |
2,085 |
1,520 |
$19K |
| 12002 |
|
236 |
234 |
$18K |
| 73090 |
|
234 |
229 |
$18K |
| 70491 |
|
20 |
16 |
$18K |
| 86901 |
|
6,250 |
5,872 |
$18K |
| 86900 |
|
6,252 |
5,873 |
$17K |
| 76870 |
|
94 |
93 |
$17K |
| 84702 |
|
1,335 |
1,104 |
$17K |
| J2370 |
Injection, phenylephrine hcl, up to 1 ml |
828 |
778 |
$17K |
| 80061 |
Lipid panel |
994 |
977 |
$16K |
| J2360 |
Injection, orphenadrine citrate, up to 60 mg |
740 |
710 |
$15K |
| 83615 |
|
2,538 |
1,886 |
$14K |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
421 |
419 |
$14K |
| 85007 |
|
3,501 |
2,862 |
$12K |
| 82247 |
|
2,203 |
1,277 |
$12K |
| J3370 |
Injection, vancomycin hcl, 500 mg |
1,084 |
847 |
$12K |
| 87205 |
|
2,809 |
2,728 |
$12K |
| 84703 |
|
1,829 |
1,756 |
$11K |
| 82951 |
|
389 |
388 |
$11K |
| 95819 |
|
96 |
96 |
$10K |
| 11043 |
|
190 |
123 |
$10K |
| 97165 |
|
62 |
41 |
$10K |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
1,008 |
755 |
$10K |
| 86762 |
|
311 |
311 |
$10K |
| 72100 |
|
96 |
95 |
$10K |
| 87641 |
|
114 |
111 |
$9K |
| 87340 |
|
475 |
471 |
$9K |
| 84100 |
|
2,101 |
1,947 |
$9K |
| 96523 |
|
252 |
216 |
$9K |
| J2710 |
Injection, neostigmine methylsulfate, up to 0.5 mg |
479 |
478 |
$8K |
| 86780 |
|
338 |
333 |
$8K |
| 87633 |
Infectious agent detection by nucleic acid, respiratory virus, 12-25 targets |
26 |
25 |
$8K |
| J2175 |
Injection, meperidine hydrochloride, per 100 mg |
493 |
483 |
$8K |
| 72128 |
|
12 |
12 |
$7K |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
82 |
79 |
$7K |
| 87210 |
|
1,437 |
1,405 |
$7K |
| 87081 |
|
1,039 |
1,018 |
$7K |
| J0640 |
Injection, leucovorin calcium, per 50 mg |
162 |
95 |
$7K |
| 76376 |
|
65 |
63 |
$7K |
| 87075 |
|
1,033 |
1,014 |
$7K |
| 85652 |
|
2,485 |
2,187 |
$7K |
| 71101 |
|
56 |
55 |
$7K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
189 |
183 |
$6K |
| 87506 |
|
28 |
28 |
$6K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
26 |
24 |
$6K |
| 93970 |
|
12 |
12 |
$6K |
| 82550 |
|
968 |
907 |
$5K |
| S0028 |
Injection, famotidine, 20 mg |
932 |
906 |
$5K |
| 73620 |
|
65 |
64 |
$5K |
| 29125 |
|
165 |
165 |
$4K |
| 49083 |
|
24 |
12 |
$4K |
| 84156 |
|
984 |
773 |
$4K |
| J0665 |
Injection, bupivicaine, not otherwise specified, 0.5 mg |
400 |
381 |
$4K |
| 82378 |
|
309 |
248 |
$4K |
| 72170 |
|
51 |
50 |
$4K |
| J9190 |
Injection, fluorouracil, 500 mg |
264 |
82 |
$3K |
| J0330 |
Injection, succinylcholine chloride, up to 20 mg |
141 |
139 |
$3K |
| 86592 |
|
631 |
623 |
$3K |
| J1596 |
Injection, glycopyrrolate, 0.1 mg |
189 |
189 |
$3K |
| 86803 |
|
79 |
79 |
$2K |
| J0171 |
Injection, adrenalin, epinephrine, 0.1 mg |
138 |
136 |
$2K |
| Z7610 |
|
374 |
226 |
$2K |
| 87147 |
|
235 |
227 |
$2K |
| J2795 |
Injection, ropivacaine hydrochloride, 1 mg |
138 |
136 |
$2K |
| 76536 |
|
12 |
12 |
$2K |
| 88304 |
|
207 |
201 |
$2K |
| 87428 |
|
36 |
35 |
$2K |
| 82570 |
|
421 |
346 |
$2K |
| J1644 |
Injection, heparin sodium, per 1000 units |
208 |
153 |
$2K |
| J7060 |
5% dextrose/water (500 ml = 1 unit) |
119 |
76 |
$2K |
| 29105 |
|
42 |
42 |
$2K |
| 81025 |
|
228 |
228 |
$2K |
| 88342 |
|
142 |
139 |
$2K |
| J1650 |
Injection, enoxaparin sodium, 10 mg |
226 |
163 |
$2K |
| 96402 |
|
39 |
37 |
$2K |
| Z7500 |
|
52 |
41 |
$2K |
| 45380 |
Colonoscopy, flexible; with biopsy, single or multiple |
12 |
12 |
$2K |
| J2916 |
Injection, sodium ferric gluconate complex in sucrose injection, 12.5 mg |
49 |
25 |
$2K |
| S0164 |
Injection, pantoprazole sodium, 40 mg |
113 |
98 |
$2K |
| 51701 |
|
26 |
25 |
$1K |
| U0002 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
27 |
27 |
$1K |
| J0694 |
Injection, cefoxitin sodium, 1 gm |
47 |
38 |
$1K |
| 88313 |
|
83 |
78 |
$1K |
| 72040 |
|
12 |
12 |
$1K |
| 36600 |
|
44 |
44 |
$1K |
| 73100 |
|
14 |
12 |
$1K |
| S0077 |
Injection, clindamycin phosphate, 300 mg |
63 |
55 |
$1K |
| 71020 |
|
15 |
12 |
$936.45 |
| J9263 |
Injection, oxaliplatin, 0.5 mg |
19 |
13 |
$915.82 |
| 29515 |
|
24 |
24 |
$786.15 |
| 84550 |
|
77 |
67 |
$778.61 |
| 73070 |
|
12 |
12 |
$763.20 |
| J0688 |
Injection, cefazolin sodium (hikma), not therapeutically equivalent to j0690, 500 mg |
74 |
43 |
$762.58 |
| 94010 |
|
12 |
12 |
$676.36 |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
39 |
38 |
$659.97 |
| 86308 |
|
167 |
166 |
$549.28 |
| 64450 |
|
13 |
12 |
$522.08 |
| 82009 |
|
187 |
174 |
$508.24 |
| 87045 |
|
25 |
25 |
$497.63 |
| 87046 |
|
33 |
25 |
$423.38 |
| 85384 |
|
70 |
60 |
$411.03 |
| J2371 |
Injection, phenylephrine hydrochloride, 20 micrograms |
51 |
50 |
$396.62 |
| J3301 |
Injection, triamcinolone acetonide, not otherwise specified, 10 mg |
43 |
42 |
$388.32 |
| J7042 |
5% dextrose/normal saline (500 ml = 1 unit) |
67 |
54 |
$377.67 |
| J1953 |
Injection, levetiracetam, 10 mg |
21 |
14 |
$314.36 |
| J0134 |
Injection, acetaminophen (fresenius kabi), not therapeutically equivalent to j0131, 10 mg |
35 |
31 |
$271.84 |
| 82140 |
|
26 |
24 |
$234.65 |
| 88307 |
|
13 |
13 |
$210.36 |
| 80076 |
|
31 |
25 |
$205.96 |
| J2543 |
Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams) |
23 |
13 |
$196.58 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
41 |
38 |
$178.40 |
| 83655 |
|
17 |
17 |
$170.08 |
| J0360 |
Injection, hydralazine hcl, up to 20 mg |
14 |
13 |
$148.71 |
| 82024 |
|
14 |
13 |
$120.00 |
| J2470 |
Injection, pantoprazole sodium, 40 mg |
27 |
27 |
$112.23 |
| 82272 |
|
16 |
15 |
$20.48 |