| Code | Description | Claims | Beneficiaries | Total Paid |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
43,860 |
39,649 |
$6.16M |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
13,382 |
12,714 |
$3.12M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
21,590 |
19,533 |
$3.06M |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
7,038 |
6,816 |
$1.50M |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
11,715 |
3,349 |
$1.21M |
| 96361 |
Intravenous infusion, hydration; each additional hour |
3,231 |
2,932 |
$1.18M |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
5,628 |
5,386 |
$1.01M |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
4,918 |
4,882 |
$776K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
5,202 |
4,823 |
$733K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
4,863 |
4,858 |
$677K |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
3,814 |
3,653 |
$666K |
| 80053 |
Comprehensive metabolic panel |
19,814 |
18,348 |
$653K |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
2,980 |
2,900 |
$645K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
1,292 |
1,266 |
$600K |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
1,239 |
1,213 |
$519K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
3,701 |
3,701 |
$519K |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
6,053 |
5,872 |
$497K |
| 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 |
6,177 |
5,378 |
$473K |
| 70450 |
Computed tomography, head or brain; without contrast material |
1,154 |
1,131 |
$437K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
1,544 |
1,328 |
$315K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
2,080 |
2,059 |
$315K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,961 |
1,898 |
$278K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
679 |
668 |
$276K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
1,922 |
1,916 |
$267K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
4,703 |
4,281 |
$246K |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
482 |
481 |
$217K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
1,661 |
1,649 |
$217K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
4,200 |
4,074 |
$199K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
1,450 |
1,438 |
$196K |
| 80061 |
Lipid panel |
6,579 |
6,549 |
$181K |
| 97161 |
|
1,239 |
1,219 |
$148K |
| 81025 |
|
3,738 |
3,536 |
$145K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
732 |
728 |
$127K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
1,365 |
1,365 |
$113K |
| 20610 |
|
284 |
269 |
$102K |
| 86900 |
|
1,479 |
1,424 |
$95K |
| 90686 |
|
3,485 |
3,480 |
$93K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
2,670 |
2,660 |
$90K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
2,055 |
2,035 |
$81K |
| C9803 |
Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
3,479 |
3,231 |
$81K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
861 |
808 |
$80K |
| 71046 |
Radiologic examination, chest; 2 views |
2,791 |
2,749 |
$72K |
| 84443 |
Thyroid stimulating hormone (TSH) |
7,729 |
7,612 |
$71K |
| 90648 |
|
3,295 |
3,292 |
$66K |
| 90715 |
|
2,025 |
2,025 |
$62K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
19,220 |
17,265 |
$59K |
| 90723 |
|
2,629 |
2,627 |
$57K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
498 |
495 |
$57K |
| 90670 |
|
2,495 |
2,493 |
$52K |
| 87633 |
Infectious agent detection by nucleic acid, respiratory virus, 12-25 targets |
371 |
367 |
$50K |
| 90680 |
|
2,449 |
2,447 |
$49K |
| 83655 |
|
2,697 |
2,669 |
$48K |
| 36415 |
Collection of venous blood by venipuncture |
9,819 |
8,618 |
$48K |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
1,944 |
806 |
$48K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
376 |
376 |
$48K |
| 87798 |
Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism |
567 |
504 |
$47K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
296 |
296 |
$44K |
| 86850 |
|
1,464 |
1,403 |
$43K |
| 90633 |
|
1,939 |
1,939 |
$42K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
1,505 |
1,408 |
$39K |
| 88175 |
Cytopathology, cervical or vaginal, any reporting system; collected in preservative fluid, automated thin layer |
1,150 |
1,147 |
$39K |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
1,327 |
1,048 |
$38K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
2,055 |
2,035 |
$37K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
461 |
457 |
$37K |
| 72100 |
|
1,224 |
1,177 |
$34K |
| 87624 |
Infectious agent detection by nucleic acid; human papillomavirus (HPV), high-risk types |
526 |
523 |
$32K |
| 81003 |
|
16,016 |
12,600 |
$31K |
| 86703 |
|
1,757 |
1,750 |
$30K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
5,068 |
5,037 |
$29K |
| 90734 |
|
894 |
893 |
$28K |
| 76830 |
Ultrasound, transvaginal |
288 |
286 |
$27K |
| 73630 |
|
1,142 |
1,092 |
$27K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
211 |
199 |
$26K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
596 |
596 |
$26K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
250 |
249 |
$25K |
| 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 |
559 |
474 |
$25K |
| 99215 |
Prolong outpt/office vis |
191 |
184 |
$25K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
127 |
100 |
$24K |
| 90710 |
|
801 |
801 |
$22K |
| 86901 |
|
1,507 |
1,443 |
$21K |
| 87631 |
|
322 |
322 |
$21K |
| 90716 |
|
814 |
814 |
$20K |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
993 |
993 |
$20K |
| 90651 |
|
548 |
547 |
$19K |
| 90707 |
|
799 |
799 |
$18K |
| D1110 |
Prophylaxis - adult |
316 |
316 |
$18K |
| 87634 |
|
290 |
289 |
$18K |
| 90700 |
|
769 |
769 |
$17K |
| 90677 |
|
616 |
616 |
$17K |
| 95117 |
|
307 |
183 |
$16K |
| 96127 |
|
3,066 |
2,897 |
$15K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
3,202 |
3,001 |
$15K |
| 87486 |
|
355 |
350 |
$15K |
| 90696 |
|
694 |
694 |
$14K |
| 73030 |
|
832 |
816 |
$14K |
| 73610 |
|
902 |
851 |
$14K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
6,234 |
5,856 |
$14K |
| 59025 |
Fetal non-stress test |
80 |
50 |
$14K |
| 83880 |
|
366 |
329 |
$14K |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
403 |
397 |
$14K |
| 73130 |
|
910 |
851 |
$13K |
| 82607 |
|
1,407 |
1,400 |
$13K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
115 |
105 |
$13K |
| 72148 |
Magnetic resonance imaging, lumbar spine; without contrast material |
50 |
50 |
$13K |
| 85027 |
|
3,507 |
3,451 |
$12K |
| 90671 |
|
508 |
508 |
$12K |
| 84439 |
|
2,142 |
2,113 |
$12K |
| 84702 |
|
1,955 |
1,607 |
$12K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,516 |
2,487 |
$11K |
| 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 |
221 |
191 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
374 |
374 |
$11K |
| 80306 |
|
2,901 |
2,764 |
$9K |
| 85610 |
|
2,577 |
2,216 |
$9K |
| 90656 |
|
378 |
378 |
$9K |
| 73564 |
|
414 |
412 |
$8K |
| 86803 |
|
1,513 |
1,500 |
$8K |
| 87581 |
|
355 |
350 |
$8K |
| 76801 |
|
75 |
73 |
$8K |
| 99381 |
|
51 |
51 |
$8K |
| 12001 |
|
13 |
13 |
$7K |
| 93242 |
|
78 |
78 |
$7K |
| 29125 |
|
28 |
28 |
$7K |
| 76536 |
|
78 |
78 |
$7K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
5,392 |
5,067 |
$7K |
| 73110 |
|
449 |
412 |
$6K |
| 83735 |
|
3,306 |
3,010 |
$6K |
| 82570 |
|
1,578 |
1,553 |
$6K |
| 73721 |
Magnetic resonance imaging, any joint of lower extremity; without contrast material |
25 |
25 |
$6K |
| 82043 |
|
1,403 |
1,391 |
$6K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
277 |
257 |
$6K |
| 86618 |
|
784 |
778 |
$6K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
73 |
72 |
$6K |
| 36416 |
|
336 |
304 |
$5K |
| 80050 |
General health panel |
36 |
35 |
$5K |
| 72040 |
|
265 |
256 |
$5K |
| 0012A |
|
161 |
161 |
$5K |
| 86140 |
|
1,818 |
1,655 |
$5K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
2,139 |
1,941 |
$4K |
| 0241U |
Neonatal screening for hereditary disorders, genomic sequence analysis panel |
30 |
30 |
$4K |
| 86592 |
|
1,222 |
1,219 |
$4K |
| 0011A |
|
170 |
170 |
$4K |
| D1120 |
Prophylaxis - child |
97 |
97 |
$4K |
| 76641 |
|
49 |
49 |
$4K |
| 87340 |
|
1,056 |
1,048 |
$4K |
| 99441 |
|
95 |
94 |
$4K |
| 76770 |
|
28 |
28 |
$4K |
| 99442 |
|
72 |
71 |
$3K |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
389 |
384 |
$3K |
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
25 |
25 |
$3K |
| 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 |
396 |
378 |
$3K |
| 86039 |
|
433 |
430 |
$3K |
| 82728 |
|
285 |
283 |
$3K |
| 71045 |
Radiologic examination, chest; single view |
2,500 |
2,413 |
$3K |
| 84153 |
|
209 |
209 |
$3K |
| 83550 |
|
446 |
442 |
$3K |
| G0378 |
Hospital observation service, per hour |
183 |
136 |
$3K |
| 94060 |
|
12 |
12 |
$2K |
| 83540 |
|
541 |
537 |
$2K |
| 87081 |
|
804 |
758 |
$2K |
| 72141 |
|
12 |
12 |
$2K |
| 87400 |
|
1,952 |
1,932 |
$2K |
| 11721 |
|
170 |
164 |
$2K |
| 87070 |
|
1,546 |
1,528 |
$2K |
| 86762 |
|
560 |
555 |
$2K |
| 93017 |
|
13 |
13 |
$2K |
| 92552 |
|
33 |
33 |
$2K |
| 73502 |
|
113 |
110 |
$2K |
| 86787 |
|
638 |
632 |
$2K |
| 85652 |
|
1,357 |
1,300 |
$2K |
| 74018 |
|
92 |
89 |
$2K |
| 71250 |
|
12 |
12 |
$2K |
| 90682 |
|
87 |
87 |
$2K |
| 84436 |
|
284 |
283 |
$2K |
| D0274 |
Bitewings - four radiographic images |
55 |
55 |
$2K |
| 96367 |
|
14 |
13 |
$2K |
| 73562 |
|
121 |
120 |
$2K |
| 87077 |
|
1,370 |
1,295 |
$1K |
| 87186 |
|
1,351 |
1,256 |
$1K |
| 83970 |
|
37 |
37 |
$1K |
| 0064A |
|
35 |
35 |
$1K |
| 85730 |
|
1,330 |
1,287 |
$1K |
| 85014 |
|
297 |
290 |
$1K |
| 82950 |
|
209 |
207 |
$1K |
| 82150 |
|
1,442 |
1,392 |
$1K |
| 83690 |
|
2,040 |
1,948 |
$1K |
| 0001A |
|
25 |
25 |
$990.11 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
407 |
400 |
$971.72 |
| 97112 |
Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination |
28 |
12 |
$910.20 |
| G0283 |
Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care |
38 |
13 |
$814.58 |
| 83721 |
|
134 |
132 |
$807.03 |
| 93971 |
|
13 |
13 |
$787.94 |
| 85379 |
|
1,070 |
1,040 |
$749.02 |
| 84484 |
|
2,448 |
2,189 |
$716.46 |
| 85651 |
|
352 |
340 |
$664.76 |
| 84480 |
|
68 |
68 |
$657.53 |
| 80076 |
|
44 |
42 |
$567.55 |
| 82803 |
|
29 |
26 |
$541.62 |
| 87205 |
|
979 |
962 |
$522.50 |
| 86617 |
|
49 |
25 |
$469.55 |
| 87420 |
|
428 |
422 |
$459.66 |
| 85018 |
|
297 |
290 |
$422.24 |
| 0225U |
|
48 |
47 |
$416.78 |
| 82550 |
|
403 |
365 |
$401.99 |
| 72070 |
|
12 |
12 |
$341.46 |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
1,395 |
1,363 |
$340.21 |
| 84703 |
|
406 |
403 |
$316.43 |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
357 |
282 |
$286.09 |
| 73560 |
|
25 |
25 |
$249.54 |
| 80069 |
|
26 |
25 |
$243.64 |
| G0008 |
Administration of influenza virus vaccine |
12 |
12 |
$242.70 |
| 84156 |
|
73 |
71 |
$221.84 |
| 86666 |
|
32 |
32 |
$217.93 |
| 90647 |
|
12 |
12 |
$215.28 |
| 90744 |
|
12 |
12 |
$214.20 |
| 82784 |
|
28 |
26 |
$204.60 |
| 86376 |
|
14 |
14 |
$189.15 |
| 86431 |
|
78 |
78 |
$186.02 |
| 86706 |
|
24 |
24 |
$170.73 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
13 |
$168.00 |
| 86753 |
|
22 |
19 |
$151.21 |
| Q3014 |
Telehealth originating site facility fee |
23 |
15 |
$128.31 |
| 87147 |
|
166 |
153 |
$114.52 |
| 73590 |
|
12 |
12 |
$78.39 |
| 82962 |
|
837 |
633 |
$77.60 |
| A9579 |
Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (nos), per ml |
13 |
13 |
$75.68 |
| 82948 |
|
137 |
95 |
$55.81 |
| 86308 |
|
25 |
25 |
$51.54 |
| 86430 |
|
14 |
14 |
$48.10 |
| 87040 |
|
201 |
164 |
$39.52 |
| J7030 |
Infusion, normal saline solution , 1000 cc |
2,470 |
2,229 |
$38.83 |
| 84550 |
|
14 |
13 |
$31.78 |
| 83605 |
|
275 |
250 |
$21.15 |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
2,217 |
2,016 |
$16.24 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
3,889 |
3,595 |
$13.64 |
| C9113 |
Injection, pantoprazole sodium, per vial |
85 |
80 |
$11.37 |
| J2704 |
Injection, propofol, 10 mg |
1,242 |
1,223 |
$7.08 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
2,817 |
2,647 |
$5.71 |
| 91322 |
|
15 |
15 |
$4.70 |
| J3301 |
Injection, triamcinolone acetonide, not otherwise specified, 10 mg |
96 |
81 |
$4.04 |
| 90480 |
|
13 |
13 |
$2.73 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
1,977 |
1,911 |
$1.82 |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
114 |
105 |
$1.06 |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
15 |
13 |
$0.73 |
| S0119 |
Ondansetron, oral, 4 mg (for circumstances falling under the medicare statute, use hcpcs q code) |
85 |
82 |
$0.53 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
251 |
215 |
$0.50 |
| J2710 |
Injection, neostigmine methylsulfate, up to 0.5 mg |
75 |
75 |
$0.36 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
1,690 |
1,605 |
$0.16 |
| J0665 |
Injection, bupivicaine, not otherwise specified, 0.5 mg |
37 |
27 |
$0.14 |
| J0690 |
Injection, cefazolin sodium, 500 mg |
248 |
226 |
$0.12 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
1,304 |
1,289 |
$0.06 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
75 |
75 |
$0.00 |
| J7040 |
Infusion, normal saline solution, sterile (500 ml = 1 unit) |
12 |
12 |
$0.00 |
| A4649 |
Surgical supply; miscellaneous |
87 |
72 |
$0.00 |
| J7620 |
Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme |
465 |
438 |
$0.00 |
| J7050 |
Infusion, normal saline solution, 250 cc |
239 |
176 |
$0.00 |
| 96376 |
|
50 |
39 |
$0.00 |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
94 |
87 |
$0.00 |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
75 |
69 |
$0.00 |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
27 |
25 |
$0.00 |
| 94760 |
|
15 |
15 |
$0.00 |
| 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 |
18 |
18 |
$0.00 |
| J1170 |
Injection, hydromorphone, up to 4 mg |
14 |
14 |
$0.00 |