| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
32,897 |
31,809 |
$39.85M |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
34,875 |
34,211 |
$20.92M |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
47,962 |
46,683 |
$17.21M |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
1,961 |
1,945 |
$2.17M |
| J1569 |
Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg |
649 |
489 |
$2.11M |
| Q5103 |
Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg |
289 |
271 |
$1.91M |
| 96413 |
Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance |
3,026 |
2,240 |
$1.52M |
| 70553 |
Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences |
753 |
747 |
$1.34M |
| 95810 |
Polysomnography; sleep staging with 4 or more additional parameters |
631 |
621 |
$1.22M |
| J3490 |
Unclassified drugs |
23,204 |
16,921 |
$1.14M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
6,981 |
6,526 |
$1.08M |
| 76825 |
|
924 |
915 |
$1.05M |
| 42820 |
Tonsillectomy and adenoidectomy; younger than age 12 |
695 |
693 |
$997K |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
789 |
783 |
$990K |
| 95782 |
|
473 |
466 |
$928K |
| J1745 |
Injection, infliximab, excludes biosimilar, 10 mg |
396 |
383 |
$868K |
| 74230 |
|
911 |
906 |
$833K |
| 99291 |
Critical care, evaluation and management of the critically ill patient, first 30-74 minutes |
312 |
311 |
$773K |
| 87799 |
|
2,150 |
1,526 |
$698K |
| 93325 |
|
3,068 |
2,919 |
$698K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
6,586 |
6,018 |
$696K |
| 87633 |
Infectious agent detection by nucleic acid, respiratory virus, 12-25 targets |
6,661 |
6,575 |
$559K |
| P9016 |
Red blood cells, leukocytes reduced, each unit |
498 |
454 |
$531K |
| 96361 |
Intravenous infusion, hydration; each additional hour |
6,866 |
6,294 |
$493K |
| 92611 |
|
920 |
916 |
$400K |
| 71046 |
Radiologic examination, chest; 2 views |
9,697 |
9,448 |
$397K |
| 76770 |
|
1,259 |
1,246 |
$370K |
| 70450 |
Computed tomography, head or brain; without contrast material |
2,188 |
2,147 |
$367K |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
255 |
251 |
$358K |
| 93975 |
|
1,510 |
1,475 |
$332K |
| J2704 |
Injection, propofol, 10 mg |
13,787 |
13,413 |
$310K |
| 70543 |
|
129 |
128 |
$309K |
| 74183 |
|
148 |
147 |
$304K |
| G0378 |
Hospital observation service, per hour |
1,351 |
948 |
$301K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,649 |
1,568 |
$300K |
| 96415 |
|
343 |
236 |
$292K |
| 80053 |
Comprehensive metabolic panel |
25,101 |
21,705 |
$288K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
34,378 |
29,379 |
$282K |
| 86920 |
|
718 |
629 |
$281K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
1,424 |
1,215 |
$266K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
3,641 |
3,407 |
$257K |
| 37241 |
|
26 |
26 |
$246K |
| 87637 |
Infectious agent detection by nucleic acid; SARS-CoV-2, influenza, and RSV |
6,061 |
6,030 |
$243K |
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
655 |
653 |
$238K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
5,906 |
5,814 |
$231K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
6,289 |
5,007 |
$227K |
| 36430 |
|
444 |
367 |
$226K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
2,065 |
2,018 |
$225K |
| 93321 |
|
1,034 |
994 |
$222K |
| 94776 |
|
402 |
402 |
$216K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
3,529 |
3,124 |
$212K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
4,221 |
4,060 |
$205K |
| 75561 |
|
81 |
81 |
$202K |
| 76827 |
|
942 |
933 |
$199K |
| 96367 |
|
1,203 |
1,043 |
$191K |
| 93303 |
Transthoracic echocardiography for congenital cardiac anomalies, follow-up or limited study |
253 |
242 |
$187K |
| 96409 |
|
686 |
405 |
$176K |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
150 |
147 |
$170K |
| 69436 |
Tympanostomy (requiring insertion of ventilating tube), general anesthesia |
298 |
297 |
$166K |
| 74240 |
|
271 |
271 |
$164K |
| 74019 |
|
3,761 |
3,667 |
$155K |
| 93308 |
|
302 |
293 |
$145K |
| 76536 |
|
715 |
696 |
$143K |
| 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 |
3,304 |
3,288 |
$137K |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
1,505 |
1,481 |
$135K |
| 76886 |
|
318 |
318 |
$135K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
944 |
932 |
$133K |
| 71555 |
|
50 |
50 |
$131K |
| J0665 |
Injection, bupivicaine, not otherwise specified, 0.5 mg |
1,332 |
1,310 |
$120K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
2,663 |
2,612 |
$118K |
| 72197 |
|
57 |
56 |
$117K |
| 93304 |
|
200 |
189 |
$114K |
| 87507 |
|
862 |
561 |
$106K |
| 93320 |
|
439 |
407 |
$105K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
4,566 |
4,468 |
$105K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
771 |
761 |
$101K |
| 49591 |
|
50 |
50 |
$100K |
| 99215 |
Prolong outpt/office vis |
456 |
429 |
$96K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
10,540 |
10,362 |
$90K |
| U0002 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
1,600 |
1,586 |
$87K |
| 95812 |
|
167 |
167 |
$81K |
| 74018 |
|
1,149 |
1,069 |
$81K |
| 76870 |
|
554 |
543 |
$76K |
| 70486 |
|
170 |
170 |
$76K |
| 87581 |
|
6,644 |
6,559 |
$71K |
| 44970 |
|
12 |
12 |
$71K |
| 87486 |
|
6,639 |
6,554 |
$71K |
| 92567 |
|
595 |
589 |
$70K |
| 82728 |
|
4,003 |
3,724 |
$70K |
| 71045 |
Radiologic examination, chest; single view |
1,501 |
1,452 |
$70K |
| 86850 |
|
2,168 |
1,959 |
$67K |
| 72170 |
|
1,293 |
1,280 |
$66K |
| 87497 |
|
1,207 |
875 |
$66K |
| 75565 |
|
206 |
206 |
$65K |
| 97162 |
|
465 |
461 |
$60K |
| 92587 |
|
634 |
628 |
$58K |
| 86833 |
|
441 |
404 |
$56K |
| 86832 |
|
441 |
404 |
$55K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
219 |
218 |
$54K |
| 87040 |
|
5,659 |
5,497 |
$53K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
2,383 |
2,305 |
$51K |
| 86828 |
|
471 |
433 |
$49K |
| 93017 |
|
40 |
40 |
$48K |
| 80197 |
|
2,500 |
1,577 |
$46K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
288 |
286 |
$45K |
| 70360 |
|
461 |
455 |
$45K |
| 86360 |
|
801 |
733 |
$44K |
| 83880 |
|
1,252 |
1,156 |
$44K |
| 73590 |
|
1,259 |
1,199 |
$43K |
| 86140 |
|
9,723 |
9,022 |
$41K |
| 73610 |
|
1,472 |
1,443 |
$41K |
| 51701 |
|
2,528 |
2,505 |
$41K |
| 94644 |
|
2,673 |
2,602 |
$40K |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
7,129 |
7,059 |
$39K |
| 73630 |
|
1,384 |
1,365 |
$39K |
| 86901 |
|
2,409 |
2,150 |
$38K |
| 75573 |
|
12 |
12 |
$38K |
| 73721 |
Magnetic resonance imaging, any joint of lower extremity; without contrast material |
24 |
24 |
$37K |
| 72040 |
|
1,029 |
1,014 |
$37K |
| 96411 |
|
98 |
64 |
$36K |
| 85045 |
|
7,647 |
6,629 |
$36K |
| 85246 |
|
1,187 |
1,148 |
$35K |
| 73552 |
|
637 |
615 |
$34K |
| 82784 |
|
1,621 |
1,462 |
$34K |
| 84443 |
Thyroid stimulating hormone (TSH) |
1,951 |
1,927 |
$33K |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
13,930 |
13,611 |
$33K |
| 73560 |
|
425 |
413 |
$32K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
4,783 |
4,417 |
$30K |
| 85576 |
|
474 |
376 |
$29K |
| 93886 |
|
39 |
39 |
$28K |
| 88185 |
|
80 |
78 |
$28K |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
9,894 |
9,352 |
$27K |
| 83970 |
|
479 |
459 |
$26K |
| 87077 |
|
2,933 |
2,867 |
$26K |
| 83550 |
|
2,287 |
2,216 |
$25K |
| 85027 |
|
3,390 |
3,242 |
$25K |
| 92018 |
|
31 |
29 |
$25K |
| 73070 |
|
959 |
915 |
$23K |
| 85397 |
|
833 |
812 |
$23K |
| 76881 |
|
506 |
484 |
$23K |
| 73130 |
|
939 |
916 |
$22K |
| 86357 |
|
802 |
734 |
$22K |
| 86355 |
|
800 |
732 |
$22K |
| 87186 |
|
2,429 |
2,373 |
$22K |
| 83020 |
|
1,743 |
1,534 |
$22K |
| 86359 |
|
1,299 |
760 |
$22K |
| 94668 |
|
148 |
90 |
$22K |
| 83735 |
|
2,588 |
1,846 |
$22K |
| 94775 |
|
187 |
187 |
$21K |
| 73090 |
|
1,545 |
1,501 |
$21K |
| 83540 |
|
2,477 |
2,377 |
$21K |
| 85240 |
|
883 |
866 |
$21K |
| 80069 |
|
1,912 |
1,500 |
$21K |
| 85730 |
|
2,987 |
2,795 |
$20K |
| 72100 |
|
375 |
369 |
$19K |
| 83690 |
|
4,236 |
4,131 |
$19K |
| 82570 |
|
2,772 |
2,416 |
$19K |
| J7030 |
Infusion, normal saline solution , 1000 cc |
10,020 |
9,159 |
$18K |
| 72148 |
Magnetic resonance imaging, lumbar spine; without contrast material |
25 |
24 |
$18K |
| 86160 |
|
649 |
555 |
$18K |
| 82330 |
|
3,179 |
2,957 |
$18K |
| 88342 |
|
561 |
549 |
$18K |
| 96450 |
|
44 |
37 |
$17K |
| 88307 |
|
283 |
281 |
$17K |
| 80061 |
Lipid panel |
963 |
933 |
$17K |
| 73110 |
|
709 |
704 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
12 |
12 |
$17K |
| 54161 |
|
26 |
26 |
$16K |
| 85652 |
|
6,002 |
5,571 |
$16K |
| 81001 |
|
8,065 |
7,734 |
$15K |
| 85245 |
|
499 |
494 |
$15K |
| 73562 |
|
852 |
827 |
$15K |
| 87798 |
Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism |
2,831 |
2,709 |
$15K |
| 42830 |
|
14 |
14 |
$14K |
| 82977 |
|
2,301 |
1,920 |
$14K |
| 83520 |
|
422 |
327 |
$14K |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
1,076 |
1,067 |
$14K |
| 72081 |
|
64 |
64 |
$14K |
| J1170 |
Injection, hydromorphone, up to 4 mg |
3,904 |
3,602 |
$13K |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
13,452 |
13,013 |
$13K |
| 87070 |
|
1,759 |
1,711 |
$13K |
| 85610 |
|
3,060 |
2,850 |
$13K |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
11,644 |
10,072 |
$13K |
| 84439 |
|
1,334 |
1,316 |
$13K |
| 83615 |
|
2,076 |
1,737 |
$13K |
| 92652 |
|
12 |
12 |
$13K |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
657 |
454 |
$13K |
| 82803 |
|
2,796 |
2,644 |
$12K |
| 88304 |
|
717 |
714 |
$12K |
| 85384 |
|
1,243 |
1,178 |
$12K |
| 81003 |
|
8,919 |
8,683 |
$12K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
1,170 |
1,149 |
$12K |
| J0690 |
Injection, cefazolin sodium, 500 mg |
4,436 |
3,794 |
$11K |
| 81025 |
|
3,629 |
3,536 |
$11K |
| 96376 |
|
252 |
243 |
$11K |
| J0561 |
Injection, penicillin g benzathine, 100,000 units |
198 |
198 |
$11K |
| 92579 |
|
159 |
159 |
$11K |
| 86356 |
|
124 |
116 |
$11K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
1,079 |
999 |
$11K |
| 76010 |
|
212 |
208 |
$10K |
| 86900 |
|
2,409 |
2,150 |
$10K |
| 86665 |
|
274 |
264 |
$10K |
| 12011 |
|
829 |
820 |
$10K |
| S0020 |
Injection, bupivicaine hydrochloride, 30 ml |
3,112 |
3,076 |
$10K |
| 86480 |
|
128 |
127 |
$10K |
| 67311 |
|
12 |
12 |
$10K |
| 84156 |
|
2,046 |
1,704 |
$10K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
335 |
333 |
$9K |
| J3473 |
Injection, hyaluronidase, recombinant, 1 usp unit |
37 |
37 |
$9K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
1,110 |
1,057 |
$9K |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
2,670 |
2,416 |
$9K |
| 84100 |
|
1,621 |
1,304 |
$9K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
1,049 |
999 |
$9K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,423 |
1,401 |
$9K |
| J9370 |
Vincristine sulfate, 1 mg |
614 |
392 |
$8K |
| 93296 |
|
57 |
57 |
$8K |
| 82248 |
|
1,493 |
1,184 |
$8K |
| 73140 |
|
450 |
443 |
$8K |
| 86003 |
|
45 |
45 |
$8K |
| J7999 |
Compounded drug, not otherwise classified |
1,057 |
964 |
$7K |
| J2710 |
Injection, neostigmine methylsulfate, up to 0.5 mg |
1,256 |
888 |
$7K |
| D9420 |
|
105 |
26 |
$7K |
| 70491 |
|
12 |
12 |
$7K |
| 80143 |
|
959 |
933 |
$7K |
| 94680 |
|
60 |
38 |
$7K |
| 73060 |
|
211 |
207 |
$7K |
| 84703 |
|
1,639 |
1,608 |
$7K |
| 73030 |
|
289 |
284 |
$6K |
| 88184 |
|
109 |
102 |
$6K |
| 85379 |
|
627 |
598 |
$6K |
| 94645 |
|
381 |
371 |
$6K |
| J1815 |
Injection, insulin, per 5 units |
250 |
230 |
$6K |
| 86902 |
|
370 |
329 |
$6K |
| 97161 |
|
40 |
40 |
$6K |
| J0330 |
Injection, succinylcholine chloride, up to 20 mg |
143 |
143 |
$6K |
| 80179 |
|
871 |
858 |
$6K |
| 86256 |
|
368 |
319 |
$5K |
| 86664 |
|
328 |
323 |
$5K |
| 69210 |
|
38 |
38 |
$5K |
| 90686 |
|
1,134 |
1,114 |
$5K |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
12,861 |
12,272 |
$5K |
| 82247 |
|
987 |
743 |
$5K |
| 87340 |
|
652 |
607 |
$5K |
| J2919 |
Injection, methylprednisolone sodium succinate, 5 mg |
158 |
122 |
$5K |
| 82948 |
|
1,601 |
968 |
$5K |
| 82550 |
|
1,093 |
1,012 |
$5K |
| 85999 |
|
528 |
519 |
$5K |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
492 |
490 |
$4K |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
1,694 |
1,320 |
$4K |
| 87205 |
|
1,685 |
1,635 |
$4K |
| 85660 |
|
618 |
357 |
$4K |
| 84145 |
|
252 |
239 |
$4K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
13 |
13 |
$4K |
| 86663 |
|
256 |
252 |
$4K |
| 12001 |
|
416 |
415 |
$3K |
| 82077 |
|
623 |
618 |
$3K |
| S5571 |
Insulin delivery device, disposable pen (including insulin); 3 ml size |
147 |
142 |
$3K |
| 76641 |
|
13 |
13 |
$3K |
| 86706 |
|
493 |
488 |
$3K |
| 85732 |
|
190 |
186 |
$3K |
| 70487 |
|
14 |
14 |
$3K |
| 84484 |
|
412 |
399 |
$3K |
| 94660 |
|
66 |
48 |
$3K |
| 82947 |
|
3,240 |
3,057 |
$3K |
| 85670 |
|
354 |
345 |
$3K |
| J7050 |
Infusion, normal saline solution, 250 cc |
2,464 |
2,253 |
$3K |
| J0295 |
Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm |
792 |
296 |
$3K |
| J9255 |
Injection, methotrexate (accord), not therapeutically equivalent to j9260, 50 mg |
68 |
39 |
$3K |
| 84132 |
|
2,695 |
2,551 |
$2K |
| 97166 |
|
13 |
13 |
$2K |
| J0290 |
Injection, ampicillin sodium, 500 mg |
1,180 |
735 |
$2K |
| 84295 |
|
2,693 |
2,507 |
$2K |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
643 |
629 |
$2K |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
3,260 |
3,169 |
$2K |
| D1120 |
Prophylaxis - child |
13 |
13 |
$2K |
| 86317 |
|
31 |
13 |
$2K |
| J1644 |
Injection, heparin sodium, per 1000 units |
1,053 |
862 |
$2K |
| 82043 |
|
280 |
275 |
$2K |
| 76942 |
|
47 |
47 |
$2K |
| 86039 |
|
170 |
164 |
$2K |
| J0171 |
Injection, adrenalin, epinephrine, 0.1 mg |
441 |
416 |
$2K |
| 82820 |
|
300 |
232 |
$2K |
| 86592 |
|
740 |
709 |
$2K |
| 83050 |
|
250 |
232 |
$2K |
| 72070 |
|
51 |
50 |
$2K |
| 85014 |
|
3,008 |
2,823 |
$2K |
| 82810 |
|
274 |
225 |
$2K |
| 73000 |
|
83 |
80 |
$2K |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
14 |
14 |
$2K |
| 77072 |
|
12 |
12 |
$2K |
| J7042 |
5% dextrose/normal saline (500 ml = 1 unit) |
629 |
484 |
$1K |
| 88313 |
|
24 |
24 |
$1K |
| 85018 |
|
1,170 |
644 |
$1K |
| 87075 |
|
103 |
102 |
$1K |
| 89051 |
|
370 |
308 |
$1K |
| 83516 |
|
65 |
62 |
$1K |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
1,099 |
920 |
$1K |
| 80195 |
|
63 |
52 |
$1K |
| 82785 |
|
48 |
47 |
$1K |
| J9260 |
Injection, methotrexate sodium, 50 mg |
118 |
77 |
$1K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
324 |
304 |
$1K |
| 29105 |
|
37 |
37 |
$1K |
| 95700 |
|
26 |
26 |
$1K |
| J0780 |
Injection, prochlorperazine, up to 10 mg |
562 |
514 |
$936.27 |
| S0030 |
Injection, metronidazole, 500 mg |
54 |
40 |
$879.21 |
| J1756 |
Injection, iron sucrose, 1 mg |
16 |
13 |
$840.59 |
| 82375 |
|
239 |
232 |
$795.30 |
| 82607 |
|
45 |
43 |
$784.74 |
| 86364 |
|
78 |
77 |
$763.60 |
| J2795 |
Injection, ropivacaine hydrochloride, 1 mg |
13 |
13 |
$762.03 |
| 96368 |
|
24 |
24 |
$723.63 |
| J7040 |
Infusion, normal saline solution, sterile (500 ml = 1 unit) |
453 |
406 |
$695.65 |
| S0077 |
Injection, clindamycin phosphate, 300 mg |
161 |
92 |
$695.20 |
| 85347 |
|
237 |
229 |
$685.61 |
| 83001 |
|
27 |
27 |
$679.90 |
| 25565 |
|
12 |
12 |
$593.36 |
| 82670 |
|
15 |
15 |
$589.80 |
| 82610 |
|
36 |
30 |
$573.90 |
| 90715 |
|
38 |
38 |
$556.91 |
| 82150 |
|
133 |
132 |
$542.85 |
| 87081 |
|
28 |
28 |
$512.60 |
| 84403 |
|
14 |
14 |
$508.62 |
| 84402 |
|
14 |
14 |
$501.48 |
| J2272 |
Injection, morphine sulfate (fresenius kabi), not therapeutically equivalent to j2270, up to 10 mg |
58 |
56 |
$451.68 |
| 87102 |
|
40 |
38 |
$450.23 |
| 86644 |
|
29 |
26 |
$409.25 |
| 88240 |
|
38 |
37 |
$368.50 |
| 83002 |
|
14 |
14 |
$364.84 |
| 86645 |
|
15 |
14 |
$355.65 |
| J1596 |
Injection, glycopyrrolate, 0.1 mg |
49 |
48 |
$340.50 |
| J1836 |
Injection, metronidazole, 10 mg |
21 |
14 |
$329.63 |
| 84146 |
|
12 |
12 |
$327.24 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
41 |
39 |
$287.59 |
| 86376 |
|
14 |
14 |
$286.72 |
| 82746 |
|
17 |
15 |
$268.97 |
| 86880 |
|
39 |
37 |
$249.16 |
| J2371 |
Injection, phenylephrine hydrochloride, 20 micrograms |
14 |
14 |
$246.47 |
| 87206 |
|
28 |
26 |
$234.64 |
| 88311 |
|
54 |
54 |
$234.56 |
| 84550 |
|
56 |
53 |
$229.18 |
| J3480 |
Injection, potassium chloride, per 2 meq |
115 |
82 |
$204.96 |
| 86704 |
|
14 |
12 |
$203.70 |
| J2920 |
Injection, methylprednisolone sodium succinate, up to 40 mg |
42 |
38 |
$179.94 |
| J0694 |
Injection, cefoxitin sodium, 1 gm |
29 |
25 |
$178.40 |
| J1171 |
Injection, hydromorphone, 0.1 mg |
22 |
22 |
$159.96 |
| J2060 |
Injection, lorazepam, 2 mg |
14 |
12 |
$155.38 |
| 86803 |
|
14 |
13 |
$145.59 |
| 86308 |
|
29 |
29 |
$80.12 |
| J0610 |
Injection, calcium gluconate (fresenius kabi), per 10 ml |
12 |
12 |
$57.73 |
| 82565 |
|
32 |
32 |
$35.55 |
| 82270 |
|
12 |
12 |
$31.65 |
| J1940 |
Injection, furosemide, up to 20 mg |
12 |
12 |
$2.94 |
| 90656 |
|
164 |
164 |
$0.00 |
| 12002 |
|
26 |
26 |
$0.00 |
| 10060 |
|
13 |
13 |
$0.00 |
| 94664 |
|
85 |
85 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
38 |
36 |
$0.00 |
| 94667 |
|
13 |
12 |
$0.00 |
| 24640 |
|
13 |
13 |
$0.00 |
| 29125 |
|
12 |
12 |
$0.00 |