| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
3,809 |
3,232 |
$3.35M |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
3,575 |
3,073 |
$2.35M |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
2,094 |
1,801 |
$1.74M |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
12,433 |
10,791 |
$1.66M |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
28,582 |
25,669 |
$1.46M |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
7,682 |
6,354 |
$1.38M |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
6,143 |
4,309 |
$1.37M |
| 70450 |
Computed tomography, head or brain; without contrast material |
3,650 |
2,866 |
$1.04M |
| 87632 |
|
5,159 |
4,764 |
$927K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
11,027 |
6,729 |
$924K |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
16,452 |
4,516 |
$907K |
| 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 |
14,049 |
12,025 |
$846K |
| 78452 |
Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress |
1,011 |
852 |
$754K |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
6,960 |
6,210 |
$683K |
| 87633 |
Infectious agent detection by nucleic acid, respiratory virus, 12-25 targets |
1,634 |
1,453 |
$600K |
| G0378 |
Hospital observation service, per hour |
4,828 |
1,786 |
$580K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
8,884 |
7,482 |
$498K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
9,974 |
8,864 |
$487K |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
7,393 |
6,244 |
$458K |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
9,750 |
2,590 |
$437K |
| 93458 |
|
292 |
184 |
$412K |
| 80053 |
Comprehensive metabolic panel |
34,105 |
24,605 |
$397K |
| 93017 |
|
1,272 |
1,212 |
$369K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
8,136 |
6,974 |
$353K |
| 72125 |
Computed tomography, cervical spine; without contrast material |
1,026 |
917 |
$343K |
| 71046 |
Radiologic examination, chest; 2 views |
9,084 |
7,594 |
$335K |
| 97014 |
|
9,381 |
2,869 |
$305K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,677 |
3,425 |
$286K |
| 76830 |
Ultrasound, transvaginal |
1,243 |
1,175 |
$285K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
37,708 |
30,186 |
$278K |
| 87798 |
Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism |
5,203 |
4,835 |
$273K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
8,104 |
6,676 |
$238K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
7,115 |
5,697 |
$232K |
| 97163 |
|
3,249 |
2,604 |
$228K |
| 59025 |
Fetal non-stress test |
1,158 |
785 |
$222K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
13,980 |
12,854 |
$212K |
| 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 |
10,250 |
8,977 |
$199K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
1,130 |
987 |
$191K |
| 87636 |
Infectious agent detection by nucleic acid; SARS-CoV-2 and influenza virus types A and B |
1,799 |
1,628 |
$185K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
1,145 |
1,062 |
$175K |
| 87581 |
|
5,624 |
5,060 |
$171K |
| 71045 |
Radiologic examination, chest; single view |
5,758 |
4,045 |
$165K |
| 73630 |
|
4,276 |
3,151 |
$163K |
| 36415 |
Collection of venous blood by venipuncture |
41,973 |
21,941 |
$163K |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
3,879 |
1,253 |
$162K |
| 84443 |
Thyroid stimulating hormone (TSH) |
10,389 |
9,770 |
$150K |
| 72148 |
Magnetic resonance imaging, lumbar spine; without contrast material |
777 |
605 |
$141K |
| 84484 |
|
9,982 |
5,849 |
$137K |
| 80305 |
|
11,576 |
9,051 |
$136K |
| 71250 |
|
503 |
430 |
$133K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
2,796 |
2,545 |
$125K |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
2,310 |
2,093 |
$121K |
| 73610 |
|
3,135 |
2,386 |
$119K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
1,665 |
1,612 |
$119K |
| 92507 |
Treatment of speech, language, voice, communication, and/or auditory processing disorder |
2,381 |
593 |
$112K |
| 80061 |
Lipid panel |
8,602 |
8,024 |
$111K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
10,624 |
7,930 |
$108K |
| 94060 |
|
683 |
576 |
$106K |
| C1725 |
Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability) |
677 |
508 |
$97K |
| 97010 |
|
8,559 |
2,589 |
$95K |
| 87507 |
|
301 |
269 |
$91K |
| 73130 |
|
2,290 |
1,896 |
$90K |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
3,131 |
1,999 |
$88K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
6,575 |
5,938 |
$87K |
| 73502 |
|
1,435 |
1,043 |
$85K |
| 73562 |
|
2,363 |
1,845 |
$85K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
3,549 |
3,385 |
$76K |
| 73110 |
|
2,007 |
1,537 |
$76K |
| 99152 |
|
643 |
582 |
$74K |
| 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 |
1,260 |
918 |
$74K |
| 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 |
1,074 |
992 |
$74K |
| 73030 |
|
2,016 |
1,607 |
$71K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
9,670 |
7,623 |
$70K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
1,152 |
746 |
$70K |
| 82652 |
|
1,894 |
1,831 |
$69K |
| 96361 |
Intravenous infusion, hydration; each additional hour |
2,898 |
2,093 |
$67K |
| 99291 |
Critical care, evaluation and management of the critically ill patient, first 30-74 minutes |
259 |
169 |
$65K |
| C9803 |
Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
11,055 |
9,170 |
$62K |
| 87430 |
|
3,799 |
3,469 |
$60K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
295 |
267 |
$60K |
| 76811 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, detailed |
313 |
295 |
$59K |
| 97035 |
|
2,009 |
781 |
$58K |
| C1769 |
Guide wire |
587 |
525 |
$57K |
| 76536 |
|
392 |
352 |
$53K |
| 83690 |
|
6,160 |
5,341 |
$50K |
| 97164 |
|
2,213 |
1,333 |
$47K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
957 |
724 |
$47K |
| 87040 |
|
2,706 |
2,210 |
$47K |
| 81025 |
|
5,182 |
4,613 |
$46K |
| 76641 |
|
452 |
347 |
$44K |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
1,449 |
1,261 |
$42K |
| 83880 |
|
1,474 |
1,291 |
$42K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
5,119 |
4,851 |
$41K |
| 86328 |
|
1,313 |
1,104 |
$41K |
| 87486 |
|
1,149 |
1,080 |
$40K |
| 81001 |
|
13,244 |
11,376 |
$38K |
| 84702 |
|
2,741 |
1,982 |
$37K |
| J2785 |
Injection, regadenoson, 0.1 mg |
402 |
386 |
$37K |
| A9502 |
Technetium tc-99m tetrofosmin, diagnostic, per study dose |
836 |
798 |
$36K |
| 82607 |
|
2,747 |
2,253 |
$36K |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
918 |
824 |
$35K |
| 83605 |
|
3,155 |
2,725 |
$35K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
1,073 |
1,016 |
$35K |
| 96367 |
|
1,091 |
860 |
$34K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
1,074 |
1,022 |
$33K |
| 87186 |
|
3,896 |
3,504 |
$33K |
| 84145 |
|
1,556 |
1,403 |
$33K |
| 80050 |
General health panel |
814 |
689 |
$31K |
| Q9966 |
Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml |
525 |
456 |
$31K |
| 93225 |
|
115 |
102 |
$29K |
| 93880 |
|
114 |
110 |
$27K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
1,102 |
615 |
$27K |
| 82150 |
|
2,977 |
2,644 |
$27K |
| 76010 |
|
325 |
299 |
$27K |
| 84439 |
|
3,237 |
3,089 |
$27K |
| 87070 |
|
3,800 |
2,952 |
$26K |
| 76376 |
|
1,190 |
1,047 |
$26K |
| 80074 |
|
589 |
550 |
$25K |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
9,177 |
6,944 |
$25K |
| 86140 |
|
4,802 |
4,177 |
$24K |
| 76819 |
Fetal biophysical profile; without non-stress testing |
119 |
93 |
$24K |
| 73721 |
Magnetic resonance imaging, any joint of lower extremity; without contrast material |
135 |
99 |
$24K |
| 84436 |
|
3,728 |
3,498 |
$22K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
125 |
104 |
$22K |
| 70486 |
|
53 |
50 |
$22K |
| 86703 |
|
1,628 |
1,540 |
$21K |
| 97033 |
|
534 |
205 |
$21K |
| 93971 |
|
123 |
116 |
$20K |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
47 |
38 |
$20K |
| 75574 |
|
79 |
67 |
$20K |
| 84703 |
|
2,686 |
2,461 |
$20K |
| 85651 |
|
4,760 |
4,211 |
$20K |
| 87088 |
|
2,423 |
2,207 |
$20K |
| 62323 |
|
53 |
50 |
$20K |
| 83735 |
|
3,157 |
2,538 |
$19K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
431 |
341 |
$19K |
| 87276 |
|
1,369 |
1,276 |
$19K |
| 72110 |
|
105 |
91 |
$18K |
| 80076 |
|
2,088 |
1,888 |
$18K |
| 72170 |
|
334 |
303 |
$18K |
| A9576 |
Injection, gadoteridol, (prohance multipack), per ml |
268 |
235 |
$18K |
| 87275 |
|
1,466 |
1,307 |
$17K |
| 73564 |
|
272 |
194 |
$16K |
| 12001 |
|
188 |
173 |
$16K |
| 93270 |
|
222 |
219 |
$16K |
| 72131 |
|
41 |
38 |
$16K |
| 87380 |
|
959 |
916 |
$15K |
| 73590 |
|
406 |
341 |
$15K |
| 87077 |
|
1,538 |
1,372 |
$15K |
| J0561 |
Injection, penicillin g benzathine, 100,000 units |
117 |
103 |
$14K |
| 85610 |
|
3,299 |
2,422 |
$14K |
| 73090 |
|
368 |
315 |
$14K |
| 99201 |
|
586 |
560 |
$13K |
| 82803 |
|
609 |
511 |
$13K |
| 82962 |
|
3,218 |
1,925 |
$12K |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
1,056 |
700 |
$12K |
| J1644 |
Injection, heparin sodium, per 1000 units |
1,052 |
511 |
$12K |
| 86850 |
|
1,350 |
1,202 |
$12K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
428 |
415 |
$11K |
| 97112 |
Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination |
279 |
104 |
$11K |
| 45385 |
Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) |
13 |
12 |
$11K |
| J1040 |
Injection, methylprednisolone acetate, 80 mg |
956 |
885 |
$11K |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
3,301 |
794 |
$11K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
326 |
297 |
$10K |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
534 |
183 |
$10K |
| 94729 |
|
271 |
261 |
$10K |
| 87340 |
|
1,088 |
1,026 |
$10K |
| 82728 |
|
826 |
774 |
$10K |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
43 |
43 |
$10K |
| 85378 |
|
1,214 |
1,083 |
$10K |
| 74018 |
|
153 |
133 |
$9K |
| 73080 |
|
209 |
180 |
$9K |
| 29125 |
|
150 |
127 |
$8K |
| 96376 |
|
318 |
279 |
$8K |
| 86762 |
|
637 |
603 |
$8K |
| 87205 |
|
1,875 |
1,621 |
$8K |
| 72128 |
|
27 |
26 |
$8K |
| 74174 |
|
29 |
24 |
$8K |
| 90715 |
|
219 |
209 |
$7K |
| 76801 |
|
100 |
94 |
$7K |
| 95886 |
|
68 |
58 |
$7K |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
356 |
331 |
$7K |
| 86235 |
|
105 |
52 |
$6K |
| 84144 |
|
334 |
303 |
$6K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
43 |
41 |
$6K |
| 70498 |
|
32 |
28 |
$6K |
| 94726 |
|
47 |
43 |
$6K |
| G0482 |
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; 15-21 drug class(es), including metabolite(s) if performed |
46 |
43 |
$6K |
| G0399 |
Home sleep test (hst) with type iii portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ecg/heart rate and 1 oxygen saturation |
55 |
54 |
$6K |
| 71271 |
|
133 |
120 |
$6K |
| 70496 |
|
30 |
26 |
$6K |
| G0381 |
Level 2 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment) |
100 |
99 |
$5K |
| 82746 |
|
459 |
429 |
$5K |
| 93923 |
|
41 |
39 |
$5K |
| 95806 |
|
42 |
40 |
$5K |
| 85007 |
|
4,184 |
3,420 |
$5K |
| 94618 |
|
73 |
68 |
$5K |
| 87522 |
Neg quan hep c or qual rna |
118 |
105 |
$5K |
| G0103 |
Prostate cancer screening; prostate specific antigen test (psa) |
437 |
347 |
$5K |
| 70553 |
Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences |
12 |
12 |
$5K |
| 82553 |
|
459 |
392 |
$5K |
| 83550 |
|
661 |
632 |
$5K |
| 82951 |
|
369 |
302 |
$4K |
| 85018 |
|
666 |
573 |
$4K |
| 86803 |
|
328 |
311 |
$4K |
| 83540 |
|
742 |
702 |
$4K |
| 76770 |
|
42 |
26 |
$4K |
| 86592 |
|
807 |
764 |
$4K |
| 82043 |
|
761 |
691 |
$4K |
| 81003 |
|
2,318 |
2,134 |
$4K |
| 82550 |
|
587 |
503 |
$4K |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
698 |
586 |
$3K |
| 87902 |
|
14 |
12 |
$3K |
| 84479 |
|
573 |
544 |
$3K |
| 72100 |
|
44 |
33 |
$3K |
| 97165 |
|
63 |
49 |
$3K |
| 85730 |
|
500 |
441 |
$3K |
| 86403 |
|
276 |
267 |
$3K |
| 82570 |
|
772 |
726 |
$3K |
| 86003 |
|
14 |
13 |
$3K |
| 29515 |
|
55 |
52 |
$3K |
| J2710 |
Injection, neostigmine methylsulfate, up to 0.5 mg |
155 |
134 |
$2K |
| 87265 |
|
226 |
221 |
$2K |
| J7030 |
Infusion, normal saline solution , 1000 cc |
140 |
84 |
$2K |
| 93226 |
|
13 |
13 |
$2K |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
291 |
155 |
$2K |
| 80361 |
|
69 |
66 |
$2K |
| 72072 |
|
18 |
12 |
$2K |
| 73560 |
|
34 |
32 |
$2K |
| 86593 |
|
402 |
391 |
$2K |
| 71101 |
|
19 |
13 |
$1K |
| 85014 |
|
687 |
578 |
$1K |
| J1010 |
Injection, methylprednisolone acetate, 1 mg |
102 |
101 |
$1K |
| 85027 |
|
221 |
195 |
$1K |
| 84403 |
|
55 |
52 |
$1K |
| 97166 |
|
16 |
15 |
$1K |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
268 |
253 |
$1K |
| 73600 |
|
36 |
26 |
$1K |
| 82565 |
|
151 |
119 |
$995.58 |
| 85049 |
|
289 |
271 |
$995.07 |
| J2919 |
Injection, methylprednisolone sodium succinate, 5 mg |
182 |
86 |
$970.46 |
| 76820 |
|
15 |
12 |
$907.36 |
| 29505 |
|
15 |
14 |
$846.69 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
265 |
198 |
$834.27 |
| 80365 |
|
34 |
33 |
$825.08 |
| 77065 |
Tomosynthesis, mammo |
19 |
16 |
$795.99 |
| 94727 |
|
13 |
12 |
$786.65 |
| 93041 |
|
117 |
95 |
$771.80 |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
60 |
52 |
$718.12 |
| J2704 |
Injection, propofol, 10 mg |
25 |
25 |
$695.39 |
| 84550 |
|
152 |
125 |
$671.45 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
14 |
14 |
$645.60 |
| 73100 |
|
17 |
15 |
$634.30 |
| 85048 |
|
280 |
266 |
$598.94 |
| 73060 |
|
12 |
12 |
$550.24 |
| 80346 |
|
45 |
45 |
$549.70 |
| 86225 |
|
44 |
41 |
$483.63 |
| 83001 |
|
25 |
25 |
$466.27 |
| J1170 |
Injection, hydromorphone, up to 4 mg |
40 |
24 |
$450.64 |
| 84520 |
|
82 |
77 |
$421.87 |
| 86790 |
|
35 |
32 |
$357.49 |
| 86695 |
|
35 |
32 |
$352.89 |
| 84100 |
|
87 |
66 |
$341.30 |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
113 |
105 |
$255.11 |
| 90686 |
|
13 |
13 |
$243.37 |
| 86706 |
|
18 |
14 |
$216.94 |
| J1956 |
Injection, levofloxacin, 250 mg |
18 |
14 |
$215.27 |
| J2550 |
Injection, promethazine hcl, up to 50 mg |
102 |
27 |
$189.79 |
| 86431 |
|
41 |
36 |
$186.49 |
| S0077 |
Injection, clindamycin phosphate, 300 mg |
37 |
27 |
$137.19 |
| 86038 |
|
13 |
12 |
$129.35 |
| 84155 |
|
60 |
55 |
$123.10 |
| 86704 |
|
25 |
12 |
$115.77 |
| J1171 |
Injection, hydromorphone, 0.1 mg |
16 |
12 |
$112.09 |
| J0690 |
Injection, cefazolin sodium, 500 mg |
37 |
27 |
$103.76 |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
24 |
24 |
$88.05 |
| 86708 |
|
17 |
13 |
$86.73 |
| 87210 |
|
14 |
12 |
$64.02 |
| J2060 |
Injection, lorazepam, 2 mg |
33 |
12 |
$32.08 |
| Q0162 |
Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen |
95 |
93 |
$27.51 |
| 75571 |
|
14 |
14 |
$0.00 |
| 93010 |
Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only |
22 |
12 |
$0.00 |