| Code | Description | Claims | Beneficiaries | Total Paid |
| G0378 |
Hospital observation service, per hour |
3,227 |
3,099 |
$4.23M |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
11,978 |
11,258 |
$2.46M |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
12,582 |
11,943 |
$2.36M |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
12,191 |
11,556 |
$1.95M |
| 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 |
17,989 |
16,616 |
$1.49M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
12,948 |
11,974 |
$1.22M |
| 96361 |
Intravenous infusion, hydration; each additional hour |
5,987 |
5,557 |
$1.12M |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
5,397 |
4,903 |
$1.08M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
7,718 |
7,305 |
$957K |
| 80053 |
Comprehensive metabolic panel |
63,549 |
48,976 |
$929K |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
1,279 |
1,268 |
$826K |
| 70450 |
Computed tomography, head or brain; without contrast material |
3,907 |
3,776 |
$720K |
| 93458 |
|
424 |
418 |
$671K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
20,914 |
20,528 |
$582K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
20,705 |
20,376 |
$506K |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
2,028 |
1,991 |
$487K |
| 45380 |
Colonoscopy, flexible; with biopsy, single or multiple |
590 |
585 |
$467K |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
17,448 |
17,144 |
$369K |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
4,690 |
4,080 |
$366K |
| 88175 |
Cytopathology, cervical or vaginal, any reporting system; collected in preservative fluid, automated thin layer |
13,534 |
13,475 |
$351K |
| 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 |
13,186 |
12,574 |
$328K |
| 87631 |
|
6,212 |
6,077 |
$302K |
| 70553 |
Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences |
715 |
707 |
$270K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
1,752 |
1,744 |
$248K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
1,772 |
1,732 |
$247K |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
1,147 |
1,108 |
$233K |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
1,122 |
1,109 |
$226K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
4,964 |
4,625 |
$223K |
| 87481 |
|
3,277 |
3,241 |
$199K |
| 87624 |
Infectious agent detection by nucleic acid; human papillomavirus (HPV), high-risk types |
7,355 |
7,323 |
$188K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
903 |
892 |
$170K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
629 |
625 |
$162K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
1,104 |
1,098 |
$158K |
| 70496 |
|
869 |
864 |
$158K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
1,303 |
1,240 |
$149K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
906 |
891 |
$145K |
| 84443 |
Thyroid stimulating hormone (TSH) |
14,138 |
13,930 |
$140K |
| 99442 |
|
1,200 |
1,154 |
$136K |
| 80061 |
Lipid panel |
15,584 |
15,479 |
$132K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
12,237 |
9,667 |
$128K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
4,986 |
4,953 |
$128K |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
982 |
975 |
$127K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
47,800 |
41,686 |
$126K |
| 36415 |
Collection of venous blood by venipuncture |
24,748 |
17,488 |
$120K |
| 78452 |
Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress |
513 |
509 |
$106K |
| C9803 |
Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
6,631 |
6,468 |
$106K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
15,392 |
14,822 |
$102K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
6,024 |
5,499 |
$94K |
| 83880 |
|
3,833 |
3,658 |
$93K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
11,400 |
9,761 |
$90K |
| 84153 |
|
4,745 |
4,716 |
$82K |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
5,588 |
5,568 |
$79K |
| 45385 |
Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) |
119 |
118 |
$72K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
402 |
401 |
$69K |
| 87070 |
|
8,551 |
8,363 |
$61K |
| 86900 |
|
3,559 |
3,462 |
$58K |
| 81513 |
|
1,976 |
1,937 |
$56K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
17,398 |
16,094 |
$55K |
| 99443 |
|
488 |
466 |
$54K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
385 |
384 |
$51K |
| 93975 |
|
86 |
85 |
$47K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
413 |
391 |
$47K |
| 82803 |
|
2,300 |
2,082 |
$47K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
3,688 |
3,569 |
$45K |
| 97161 |
|
1,044 |
1,019 |
$43K |
| 82607 |
|
3,684 |
3,662 |
$43K |
| 84439 |
|
5,350 |
5,299 |
$43K |
| 81025 |
|
11,799 |
11,367 |
$43K |
| 97803 |
|
2,253 |
2,243 |
$43K |
| 96127 |
|
4,242 |
3,221 |
$39K |
| 87077 |
|
4,451 |
4,313 |
$37K |
| 71046 |
Radiologic examination, chest; 2 views |
9,084 |
8,828 |
$37K |
| 86850 |
|
3,540 |
3,473 |
$37K |
| 93017 |
|
802 |
798 |
$36K |
| 86901 |
|
3,529 |
3,432 |
$35K |
| 86780 |
|
3,575 |
3,516 |
$35K |
| G0121 |
Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk |
40 |
40 |
$34K |
| 88342 |
|
537 |
529 |
$31K |
| 86141 |
|
3,957 |
3,021 |
$31K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
1,259 |
1,213 |
$31K |
| 86003 |
|
476 |
452 |
$31K |
| 0042T |
|
587 |
578 |
$29K |
| 84403 |
|
1,167 |
1,139 |
$28K |
| 81001 |
|
16,515 |
15,964 |
$28K |
| 99406 |
|
956 |
949 |
$28K |
| 87186 |
|
4,068 |
3,928 |
$27K |
| 85610 |
|
11,359 |
9,770 |
$26K |
| 82728 |
|
2,178 |
2,154 |
$25K |
| A9577 |
Injection, gadobenate dimeglumine (multihance), per ml |
629 |
620 |
$25K |
| 83735 |
|
9,296 |
7,832 |
$25K |
| 87147 |
|
1,680 |
1,654 |
$24K |
| 86480 |
|
461 |
454 |
$24K |
| 82746 |
|
2,248 |
2,236 |
$24K |
| 83874 |
|
7,182 |
6,614 |
$22K |
| 85027 |
|
6,841 |
5,551 |
$22K |
| 87088 |
|
3,410 |
3,339 |
$22K |
| C1769 |
Guide wire |
1,348 |
1,326 |
$21K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
9,238 |
8,304 |
$21K |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
5,203 |
5,049 |
$18K |
| 86803 |
|
2,212 |
2,200 |
$17K |
| 82043 |
|
3,406 |
3,392 |
$16K |
| 76000 |
|
428 |
420 |
$16K |
| 72125 |
Computed tomography, cervical spine; without contrast material |
627 |
621 |
$16K |
| 82570 |
|
3,789 |
3,753 |
$16K |
| 85730 |
|
5,777 |
5,590 |
$16K |
| 87660 |
|
1,195 |
1,153 |
$16K |
| 90715 |
|
489 |
488 |
$15K |
| 87480 |
|
1,197 |
1,156 |
$14K |
| 87510 |
|
1,193 |
1,152 |
$14K |
| 97162 |
|
239 |
235 |
$14K |
| 83690 |
|
5,213 |
4,951 |
$14K |
| C1887 |
Catheter, guiding (may include infusion/perfusion capability) |
94 |
94 |
$14K |
| 83540 |
|
2,676 |
2,633 |
$13K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
5,227 |
4,764 |
$12K |
| 83970 |
|
270 |
245 |
$11K |
| 86762 |
|
772 |
771 |
$11K |
| A9500 |
Technetium tc-99m sestamibi, diagnostic, per study dose |
257 |
255 |
$11K |
| 74174 |
|
41 |
41 |
$11K |
| 82784 |
|
667 |
659 |
$10K |
| 3077F |
|
466 |
142 |
$10K |
| 83550 |
|
2,017 |
1,996 |
$10K |
| 94726 |
|
417 |
414 |
$10K |
| 83001 |
|
620 |
616 |
$10K |
| 70498 |
|
591 |
588 |
$10K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
427 |
421 |
$10K |
| 90686 |
|
315 |
312 |
$10K |
| 86769 |
|
529 |
520 |
$9K |
| 83655 |
|
729 |
721 |
$9K |
| 83605 |
|
3,551 |
3,263 |
$9K |
| 71045 |
Radiologic examination, chest; single view |
5,813 |
5,570 |
$9K |
| 85651 |
|
4,472 |
3,680 |
$9K |
| 94729 |
|
507 |
504 |
$8K |
| C1894 |
Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser |
1,043 |
1,030 |
$8K |
| 96376 |
|
1,626 |
1,430 |
$8K |
| 70486 |
|
84 |
84 |
$8K |
| 87522 |
Neg quan hep c or qual rna |
201 |
190 |
$8K |
| 83002 |
|
456 |
454 |
$7K |
| 84154 |
|
435 |
430 |
$7K |
| 84146 |
|
424 |
414 |
$7K |
| 84702 |
|
750 |
673 |
$7K |
| 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 |
643 |
619 |
$7K |
| 71250 |
|
65 |
65 |
$7K |
| 99291 |
Critical care, evaluation and management of the critically ill patient, first 30-74 minutes |
70 |
70 |
$7K |
| 86038 |
|
1,006 |
1,000 |
$7K |
| 93308 |
|
38 |
38 |
$6K |
| 3074F |
|
320 |
103 |
$6K |
| 84134 |
|
737 |
629 |
$6K |
| 73564 |
|
910 |
737 |
$6K |
| A9579 |
Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (nos), per ml |
220 |
218 |
$6K |
| 94010 |
|
432 |
413 |
$6K |
| 82785 |
|
401 |
401 |
$6K |
| 86706 |
|
608 |
600 |
$6K |
| 84703 |
|
1,913 |
1,882 |
$6K |
| 82948 |
|
4,310 |
2,961 |
$5K |
| 87340 |
|
637 |
631 |
$5K |
| 84484 |
|
9,900 |
8,881 |
$5K |
| 99215 |
Prolong outpt/office vis |
38 |
37 |
$5K |
| 72148 |
Magnetic resonance imaging, lumbar spine; without contrast material |
14 |
14 |
$5K |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
124 |
123 |
$4K |
| 11721 |
|
195 |
114 |
$4K |
| C9399 |
Unclassified drugs or biologicals |
345 |
344 |
$4K |
| 99205 |
Prolong outpt/office vis |
29 |
29 |
$4K |
| 97802 |
|
183 |
181 |
$4K |
| 87210 |
|
1,304 |
1,193 |
$4K |
| 20610 |
|
13 |
13 |
$4K |
| 86765 |
|
319 |
318 |
$4K |
| 84550 |
|
881 |
859 |
$4K |
| 84436 |
|
844 |
841 |
$3K |
| 86376 |
|
244 |
244 |
$3K |
| 88304 |
|
226 |
224 |
$3K |
| 84100 |
|
1,194 |
1,003 |
$3K |
| 72141 |
|
16 |
16 |
$3K |
| 84402 |
|
127 |
127 |
$3K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
1,521 |
1,149 |
$3K |
| J2704 |
Injection, propofol, 10 mg |
3,424 |
3,096 |
$3K |
| 86735 |
|
320 |
319 |
$3K |
| 84481 |
|
277 |
277 |
$3K |
| 85008 |
|
367 |
330 |
$3K |
| 73030 |
|
636 |
592 |
$3K |
| 81003 |
|
1,886 |
1,880 |
$3K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
271 |
270 |
$3K |
| 87184 |
|
496 |
484 |
$3K |
| J2785 |
Injection, regadenoson, 0.1 mg |
79 |
79 |
$3K |
| 88112 |
|
85 |
85 |
$3K |
| 80320 |
|
968 |
937 |
$3K |
| 76830 |
Ultrasound, transvaginal |
109 |
107 |
$3K |
| 86431 |
|
533 |
530 |
$3K |
| 73502 |
|
544 |
529 |
$2K |
| 73630 |
|
710 |
647 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
801 |
794 |
$2K |
| 82550 |
|
909 |
774 |
$2K |
| 80348 |
|
483 |
461 |
$2K |
| 85032 |
|
1,340 |
1,214 |
$2K |
| 97116 |
|
124 |
95 |
$2K |
| 86800 |
|
165 |
165 |
$2K |
| 97165 |
|
40 |
38 |
$2K |
| 94760 |
|
1,233 |
1,100 |
$2K |
| 80076 |
|
304 |
303 |
$2K |
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
40 |
40 |
$2K |
| P9604 |
Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated trip charge |
235 |
183 |
$2K |
| 72100 |
|
218 |
218 |
$2K |
| 88313 |
|
145 |
142 |
$2K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
26 |
26 |
$2K |
| 3075F |
|
55 |
16 |
$2K |
| 87040 |
|
790 |
760 |
$2K |
| 88341 |
|
27 |
27 |
$2K |
| 73562 |
|
243 |
204 |
$1K |
| 90688 |
|
86 |
86 |
$1K |
| 81002 |
|
1,023 |
1,005 |
$1K |
| 87625 |
|
464 |
462 |
$1K |
| 99441 |
|
32 |
32 |
$1K |
| 82565 |
|
867 |
856 |
$1K |
| 86039 |
|
165 |
162 |
$1K |
| 83721 |
|
389 |
385 |
$1K |
| 86787 |
|
102 |
102 |
$993.01 |
| 87181 |
|
130 |
126 |
$934.02 |
| 82150 |
|
201 |
199 |
$931.70 |
| 85018 |
|
649 |
627 |
$923.37 |
| 86618 |
|
57 |
57 |
$919.35 |
| 84480 |
|
168 |
168 |
$909.21 |
| 73610 |
|
328 |
308 |
$903.97 |
| 86696 |
|
49 |
49 |
$892.09 |
| 94060 |
|
26 |
26 |
$879.78 |
| 69210 |
|
21 |
12 |
$843.81 |
| 83993 |
|
66 |
66 |
$778.88 |
| 82670 |
|
26 |
26 |
$777.03 |
| 72110 |
|
128 |
128 |
$745.71 |
| 85379 |
|
605 |
600 |
$745.11 |
| J1644 |
Injection, heparin sodium, per 1000 units |
2,742 |
1,659 |
$641.43 |
| 73130 |
|
429 |
404 |
$594.80 |
| 86592 |
|
221 |
221 |
$565.12 |
| 86255 |
|
74 |
46 |
$526.01 |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
53 |
38 |
$515.95 |
| 82140 |
|
58 |
48 |
$504.67 |
| 84156 |
|
135 |
129 |
$489.43 |
| 86704 |
|
58 |
57 |
$480.03 |
| 90656 |
|
20 |
20 |
$421.34 |
| 82787 |
|
16 |
16 |
$357.83 |
| 88302 |
|
12 |
12 |
$327.80 |
| 73110 |
|
97 |
90 |
$322.87 |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
26 |
26 |
$306.71 |
| 86738 |
|
13 |
13 |
$294.70 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
2,869 |
2,768 |
$291.91 |
| 74018 |
|
31 |
28 |
$237.06 |
| 87075 |
|
50 |
50 |
$219.98 |
| 84460 |
|
41 |
40 |
$199.69 |
| 89190 |
|
37 |
37 |
$183.68 |
| 84450 |
|
38 |
37 |
$182.94 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
2,875 |
2,817 |
$167.88 |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
1,254 |
1,068 |
$157.62 |
| 87081 |
|
58 |
55 |
$151.82 |
| J0690 |
Injection, cefazolin sodium, 500 mg |
1,417 |
1,270 |
$140.13 |
| 82950 |
|
27 |
27 |
$133.65 |
| J1170 |
Injection, hydromorphone, up to 4 mg |
2,054 |
1,576 |
$132.10 |
| 85347 |
|
25 |
24 |
$125.29 |
| 82977 |
|
24 |
24 |
$121.95 |
| 87338 |
|
13 |
13 |
$116.35 |
| 87400 |
|
297 |
264 |
$113.60 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
4,365 |
3,841 |
$104.92 |
| 80361 |
|
21 |
21 |
$97.87 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
4,293 |
3,921 |
$89.20 |
| J0330 |
Injection, succinylcholine chloride, up to 20 mg |
219 |
217 |
$88.76 |
| 87101 |
|
25 |
25 |
$86.82 |
| 86710 |
|
255 |
252 |
$84.17 |
| 85045 |
|
31 |
27 |
$70.33 |
| 80177 |
|
12 |
12 |
$69.70 |
| 82248 |
|
13 |
12 |
$60.60 |
| 83615 |
|
15 |
12 |
$58.10 |
| J3370 |
Injection, vancomycin hcl, 500 mg |
96 |
83 |
$57.01 |
| 87430 |
|
246 |
245 |
$55.36 |
| 84520 |
|
12 |
12 |
$47.94 |
| 73590 |
|
31 |
29 |
$45.52 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
1,000 |
851 |
$44.75 |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
408 |
360 |
$44.22 |
| 87449 |
|
13 |
13 |
$43.86 |
| 73080 |
|
13 |
13 |
$41.80 |
| 82010 |
|
74 |
67 |
$40.14 |
| 89051 |
|
14 |
14 |
$37.46 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
1,741 |
1,703 |
$33.38 |
| 87324 |
|
12 |
12 |
$30.51 |
| 82945 |
|
12 |
12 |
$26.82 |
| 84157 |
|
12 |
12 |
$25.76 |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
199 |
197 |
$23.20 |
| J7040 |
Infusion, normal saline solution, sterile (500 ml = 1 unit) |
40 |
40 |
$21.79 |
| 74022 |
|
24 |
24 |
$16.07 |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
969 |
911 |
$12.62 |
| J3480 |
Injection, potassium chloride, per 2 meq |
60 |
50 |
$9.86 |
| J0780 |
Injection, prochlorperazine, up to 10 mg |
25 |
24 |
$8.00 |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
657 |
596 |
$6.74 |
| J2060 |
Injection, lorazepam, 2 mg |
215 |
206 |
$4.03 |
| Q9966 |
Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml |
85 |
83 |
$2.44 |
| J2305 |
Injection, nitroglycerin, 5 mg |
12 |
12 |
$0.26 |
| J2370 |
Injection, phenylephrine hcl, up to 1 ml |
218 |
214 |
$0.12 |
| J1171 |
Injection, hydromorphone, 0.1 mg |
75 |
59 |
$0.00 |
| C9113 |
Injection, pantoprazole sodium, per vial |
43 |
26 |
$0.00 |
| J2710 |
Injection, neostigmine methylsulfate, up to 0.5 mg |
27 |
26 |
$0.00 |
| J0744 |
Injection, ciprofloxacin for intravenous infusion, 200 mg |
13 |
13 |
$0.00 |
| Q9963 |
High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml |
112 |
110 |
$0.00 |
| J2371 |
Injection, phenylephrine hydrochloride, 20 micrograms |
86 |
84 |
$0.00 |
| 80329 |
|
14 |
13 |
$0.00 |
| C2617 |
Stent, non-coronary, temporary, without delivery system |
14 |
13 |
$0.00 |