| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J7050 |
Infusion, normal saline solution, 250 cc |
18,833 |
8,850 |
$2.82M |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
48,438 |
30,072 |
$1.73M |
| J9271 |
Injection, pembrolizumab, 1 mg |
834 |
597 |
$1.71M |
| 77386 |
|
8,283 |
804 |
$1.66M |
| J2505 |
Injection, pegfilgrastim, 6 mg |
1,632 |
1,049 |
$972K |
| 96413 |
Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance |
20,891 |
10,598 |
$954K |
| J7030 |
Infusion, normal saline solution , 1000 cc |
7,823 |
4,481 |
$707K |
| J7040 |
Infusion, normal saline solution, sterile (500 ml = 1 unit) |
5,336 |
2,712 |
$696K |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
9,489 |
8,005 |
$529K |
| 80053 |
Comprehensive metabolic panel |
51,854 |
29,564 |
$509K |
| 36415 |
Collection of venous blood by venipuncture |
33,884 |
22,980 |
$502K |
| 77412 |
|
3,812 |
483 |
$500K |
| Q5116 |
Injection, trastuzumab-qyyp, biosimilar, (trazimera), 10 mg |
577 |
406 |
$492K |
| Q5107 |
Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg |
1,069 |
517 |
$438K |
| J9306 |
Injection, pertuzumab, 1 mg |
663 |
442 |
$415K |
| J9299 |
Injection, nivolumab, 1 mg |
559 |
353 |
$400K |
| 78815 |
Positron emission tomography (PET) for limited area imaging |
2,539 |
2,176 |
$399K |
| 96415 |
|
5,285 |
2,941 |
$385K |
| J9355 |
Injection, trastuzumab, excludes biosimilar, 10 mg |
986 |
661 |
$361K |
| 77336 |
|
3,735 |
1,766 |
$361K |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
7,882 |
6,708 |
$294K |
| 96361 |
Intravenous infusion, hydration; each additional hour |
3,830 |
1,881 |
$280K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
4,058 |
2,115 |
$244K |
| 36591 |
|
12,107 |
7,068 |
$238K |
| 96416 |
|
2,988 |
1,437 |
$236K |
| 70553 |
Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences |
2,703 |
2,365 |
$227K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
3,409 |
1,718 |
$213K |
| 96402 |
|
2,249 |
1,553 |
$203K |
| J2506 |
Injection, pegfilgrastim, excludes biosimilar, 0.5 mg |
413 |
283 |
$201K |
| 96367 |
|
4,741 |
2,879 |
$182K |
| 82948 |
|
4,221 |
3,169 |
$180K |
| A9576 |
Injection, gadoteridol, (prohance multipack), per ml |
3,439 |
2,916 |
$180K |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
6,294 |
5,339 |
$169K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
52,537 |
28,450 |
$168K |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
1,423 |
1,195 |
$154K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
12,434 |
6,337 |
$142K |
| 38222 |
|
1,103 |
924 |
$141K |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
24,470 |
14,192 |
$139K |
| Q5119 |
Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg |
80 |
36 |
$138K |
| J0897 |
Injection, denosumab, 1 mg |
635 |
545 |
$136K |
| 36592 |
|
2,382 |
1,252 |
$122K |
| J1453 |
Injection, fosaprepitant, 1 mg |
3,398 |
2,090 |
$120K |
| 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 |
2,847 |
2,240 |
$119K |
| J2469 |
Injection, palonosetron hcl, 25 mcg |
5,934 |
3,283 |
$117K |
| 77300 |
|
1,731 |
925 |
$115K |
| J9035 |
Injection, bevacizumab, 10 mg |
282 |
160 |
$111K |
| J1930 |
Injection, lanreotide, 1 mg |
74 |
65 |
$110K |
| 36430 |
|
2,848 |
1,314 |
$108K |
| P9040 |
Red blood cells, leukocytes reduced, irradiated, each unit |
1,585 |
997 |
$106K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
2,275 |
1,317 |
$103K |
| 88185 |
|
2,376 |
1,459 |
$83K |
| A9585 |
Injection, gadobutrol, 0.1 ml |
1,466 |
1,222 |
$79K |
| 78306 |
|
840 |
747 |
$79K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
1,007 |
649 |
$71K |
| 77334 |
|
1,770 |
1,106 |
$67K |
| 36561 |
|
172 |
134 |
$66K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
2,843 |
1,606 |
$65K |
| 77387 |
|
835 |
124 |
$64K |
| 70491 |
|
1,839 |
1,553 |
$60K |
| J3490 |
Unclassified drugs |
10,410 |
5,192 |
$59K |
| 77290 |
|
486 |
393 |
$56K |
| 96523 |
|
3,209 |
2,033 |
$55K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
4,672 |
3,808 |
$53K |
| 71250 |
|
1,566 |
1,305 |
$52K |
| 96401 |
|
2,009 |
1,086 |
$48K |
| J8540 |
Dexamethasone, oral, 0.25 mg |
8,599 |
4,419 |
$45K |
| 77301 |
|
344 |
250 |
$43K |
| 82565 |
|
6,423 |
5,516 |
$42K |
| 88321 |
|
3,773 |
3,052 |
$38K |
| J9202 |
Goserelin acetate implant, per 3.6 mg |
476 |
366 |
$38K |
| 76536 |
|
859 |
787 |
$37K |
| J2704 |
Injection, propofol, 10 mg |
3,855 |
3,072 |
$37K |
| J9395 |
Injection, fulvestrant, 25 mg |
154 |
126 |
$37K |
| 31575 |
|
1,012 |
845 |
$36K |
| 83735 |
|
13,690 |
6,727 |
$33K |
| 83615 |
|
15,034 |
8,850 |
$31K |
| 86900 |
|
3,883 |
2,820 |
$31K |
| J9070 |
Cyclophosphamide, 100 mg |
394 |
214 |
$29K |
| 76642 |
|
693 |
572 |
$28K |
| 81025 |
|
1,430 |
1,120 |
$28K |
| 82728 |
|
2,825 |
1,954 |
$27K |
| 96368 |
|
691 |
423 |
$27K |
| 86885 |
|
3,501 |
2,543 |
$26K |
| 84439 |
|
6,379 |
5,157 |
$26K |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
4,847 |
3,702 |
$26K |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
4,932 |
3,146 |
$26K |
| 88184 |
|
2,243 |
1,570 |
$25K |
| 88341 |
|
2,530 |
1,889 |
$25K |
| J2353 |
Injection, octreotide, depot form for intramuscular injection, 1 mg |
100 |
67 |
$24K |
| 0202U |
Oncology (prostate), multianalyte, gene expression profiling |
362 |
302 |
$24K |
| 85027 |
|
4,360 |
3,429 |
$24K |
| 96417 |
|
5,830 |
3,368 |
$23K |
| 84100 |
|
8,345 |
4,605 |
$23K |
| 84443 |
Thyroid stimulating hormone (TSH) |
7,343 |
5,934 |
$23K |
| J1170 |
Injection, hydromorphone, up to 4 mg |
3,061 |
1,623 |
$22K |
| J0690 |
Injection, cefazolin sodium, 500 mg |
2,556 |
1,781 |
$22K |
| 78816 |
|
78 |
69 |
$22K |
| 88271 |
|
594 |
422 |
$21K |
| 94760 |
|
3,114 |
2,230 |
$21K |
| J2997 |
Injection, alteplase recombinant, 1 mg |
639 |
525 |
$20K |
| J7060 |
5% dextrose/water (500 ml = 1 unit) |
1,866 |
993 |
$20K |
| J9263 |
Injection, oxaliplatin, 0.5 mg |
503 |
266 |
$20K |
| 86300 |
|
2,571 |
1,912 |
$19K |
| J9312 |
Injection, rituximab, 10 mg |
41 |
31 |
$19K |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
2,897 |
1,896 |
$19K |
| 85610 |
|
6,942 |
5,213 |
$18K |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
4,001 |
2,916 |
$18K |
| 85730 |
|
6,838 |
5,149 |
$18K |
| 74183 |
|
228 |
188 |
$17K |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
4,188 |
2,040 |
$17K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
2,464 |
1,968 |
$17K |
| 88342 |
|
3,169 |
2,523 |
$16K |
| 88307 |
|
497 |
414 |
$16K |
| 77049 |
|
81 |
78 |
$16K |
| 84481 |
|
3,539 |
2,730 |
$15K |
| 81455 |
|
16 |
13 |
$15K |
| J8501 |
Aprepitant, oral, 5 mg |
522 |
454 |
$14K |
| 85097 |
|
1,064 |
878 |
$14K |
| 71046 |
Radiologic examination, chest; 2 views |
1,418 |
1,158 |
$14K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
2,958 |
2,412 |
$14K |
| C1769 |
Guide wire |
1,279 |
982 |
$13K |
| 82378 |
|
4,609 |
3,577 |
$13K |
| A9579 |
Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (nos), per ml |
84 |
69 |
$13K |
| J9171 |
Injection, docetaxel, 1 mg |
172 |
113 |
$12K |
| 77062 |
|
428 |
382 |
$12K |
| J9045 |
Injection, carboplatin, 50 mg |
1,959 |
1,157 |
$11K |
| 77001 |
|
893 |
729 |
$11K |
| Q9966 |
Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml |
83 |
66 |
$10K |
| 88264 |
|
678 |
564 |
$10K |
| 77065 |
Tomosynthesis, mammo |
1,046 |
845 |
$10K |
| 96409 |
|
778 |
475 |
$10K |
| 74160 |
|
504 |
406 |
$10K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
437 |
227 |
$10K |
| 96376 |
|
1,115 |
482 |
$10K |
| 80197 |
|
1,720 |
796 |
$10K |
| G1004 |
Clinical decision support mechanism national decision support company, as defined by the medicare appropriate use criteria program |
1,421 |
1,042 |
$10K |
| 77066 |
Tomosynthesis, mammo |
988 |
820 |
$10K |
| 77338 |
|
392 |
282 |
$9K |
| 86920 |
|
2,283 |
1,503 |
$9K |
| 86901 |
|
3,837 |
2,786 |
$9K |
| J9190 |
Injection, fluorouracil, 500 mg |
2,697 |
1,277 |
$9K |
| J9267 |
Injection, paclitaxel, 1 mg |
1,821 |
885 |
$8K |
| P9037 |
Platelets, pheresis, leukocytes reduced, irradiated, each unit |
52 |
25 |
$8K |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
1,233 |
597 |
$8K |
| 81001 |
|
2,232 |
1,709 |
$8K |
| 96411 |
|
2,128 |
1,274 |
$8K |
| 87641 |
|
426 |
384 |
$7K |
| 77061 |
|
189 |
176 |
$7K |
| 82784 |
|
3,601 |
2,615 |
$7K |
| Q5101 |
Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram |
84 |
12 |
$7K |
| 85046 |
|
1,757 |
1,328 |
$7K |
| A9552 |
Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries |
2,844 |
2,439 |
$7K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
1,334 |
1,179 |
$6K |
| J2370 |
Injection, phenylephrine hcl, up to 1 ml |
1,268 |
1,028 |
$6K |
| 72197 |
|
46 |
37 |
$6K |
| 77295 |
|
29 |
26 |
$6K |
| G0378 |
Hospital observation service, per hour |
423 |
205 |
$6K |
| 86334 |
|
2,600 |
1,972 |
$6K |
| Q9969 |
Tc-99m from non-highly enriched uranium source, full cost recovery add-on, per study dose |
1,002 |
887 |
$5K |
| 99152 |
|
1,121 |
872 |
$5K |
| 88311 |
|
1,072 |
871 |
$5K |
| 84165 |
|
2,596 |
1,967 |
$5K |
| 0399T |
|
44 |
40 |
$5K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
859 |
685 |
$5K |
| 80061 |
Lipid panel |
1,035 |
851 |
$5K |
| 88237 |
|
753 |
624 |
$5K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
29 |
25 |
$5K |
| 88313 |
|
1,193 |
970 |
$5K |
| 76937 |
|
602 |
465 |
$5K |
| 99153 |
Mod sedat endo service >5yrs |
1,014 |
789 |
$5K |
| 86304 |
|
1,016 |
805 |
$5K |
| 96377 |
|
1,764 |
1,146 |
$4K |
| 36593 |
|
396 |
328 |
$4K |
| 87633 |
Infectious agent detection by nucleic acid, respiratory virus, 12-25 targets |
210 |
159 |
$4K |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
85 |
27 |
$4K |
| 94761 |
|
1,067 |
826 |
$4K |
| 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 |
144 |
131 |
$4K |
| 74178 |
|
85 |
71 |
$4K |
| 84156 |
|
722 |
596 |
$4K |
| 83521 |
|
798 |
463 |
$4K |
| A6258 |
Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
395 |
248 |
$4K |
| J9201 |
Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg |
612 |
268 |
$4K |
| 88275 |
|
613 |
400 |
$4K |
| 83883 |
|
1,556 |
1,105 |
$4K |
| J9206 |
Injection, irinotecan, 20 mg |
664 |
374 |
$4K |
| J3480 |
Injection, potassium chloride, per 2 meq |
492 |
220 |
$3K |
| 88360 |
|
357 |
285 |
$3K |
| 77280 |
|
21 |
16 |
$3K |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
43 |
15 |
$3K |
| 80195 |
|
1,370 |
590 |
$3K |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
14 |
12 |
$3K |
| 81206 |
|
29 |
26 |
$3K |
| 84550 |
|
1,726 |
1,013 |
$3K |
| 72156 |
|
24 |
24 |
$3K |
| 85049 |
|
656 |
461 |
$3K |
| 82232 |
|
1,024 |
802 |
$3K |
| 94729 |
|
249 |
225 |
$3K |
| C9399 |
Unclassified drugs or biologicals |
291 |
217 |
$3K |
| 72158 |
|
69 |
64 |
$3K |
| 94010 |
|
119 |
97 |
$2K |
| 71045 |
Radiologic examination, chest; single view |
124 |
88 |
$2K |
| J0461 |
Injection, atropine sulfate, 0.01 mg |
184 |
119 |
$2K |
| 88112 |
|
49 |
39 |
$2K |
| J9144 |
Injection, daratumumab, 10 mg and hyaluronidase-fihj |
125 |
50 |
$2K |
| 87070 |
|
252 |
183 |
$2K |
| 81003 |
|
640 |
529 |
$2K |
| 86141 |
|
568 |
310 |
$2K |
| 84432 |
|
211 |
186 |
$2K |
| 87040 |
|
268 |
153 |
$2K |
| 87497 |
|
471 |
234 |
$2K |
| 97161 |
|
45 |
40 |
$2K |
| 93356 |
|
668 |
557 |
$2K |
| 36590 |
|
14 |
12 |
$2K |
| 0002A |
|
273 |
244 |
$2K |
| 86301 |
|
1,409 |
1,038 |
$2K |
| 82803 |
|
17 |
13 |
$2K |
| 88172 |
|
133 |
115 |
$2K |
| 94726 |
|
248 |
223 |
$2K |
| 93971 |
|
62 |
51 |
$2K |
| 87340 |
|
620 |
514 |
$2K |
| 81450 |
|
25 |
24 |
$2K |
| 86355 |
|
242 |
182 |
$1K |
| 77370 |
|
44 |
39 |
$1K |
| 84153 |
|
727 |
567 |
$1K |
| 0241U |
Neonatal screening for hereditary disorders, genomic sequence analysis panel |
124 |
106 |
$1K |
| 82607 |
|
870 |
741 |
$1K |
| 0099U |
|
100 |
85 |
$1K |
| 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 |
780 |
436 |
$1K |
| 83540 |
|
1,214 |
1,001 |
$1K |
| 86803 |
|
567 |
477 |
$1K |
| Q0164 |
Prochlorperazine maleate, 5 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 |
42 |
25 |
$1K |
| J7999 |
Compounded drug, not otherwise classified |
232 |
180 |
$1K |
| 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 |
1,588 |
1,260 |
$1K |
| 84166 |
|
395 |
321 |
$1K |
| G0279 |
Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066) |
288 |
230 |
$1K |
| 82533 |
|
463 |
358 |
$1K |
| 83550 |
|
988 |
830 |
$1K |
| 86704 |
|
221 |
183 |
$1K |
| 0001A |
|
255 |
223 |
$1K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
767 |
621 |
$1K |
| 87798 |
Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism |
222 |
166 |
$986.91 |
| 74170 |
|
47 |
42 |
$982.79 |
| 86335 |
|
334 |
268 |
$956.21 |
| 77085 |
|
28 |
24 |
$929.12 |
| 84484 |
|
273 |
204 |
$922.77 |
| 83970 |
|
154 |
132 |
$912.05 |
| 94642 |
|
27 |
24 |
$894.02 |
| 87486 |
|
194 |
145 |
$869.15 |
| J3489 |
Injection, zoledronic acid, 1 mg |
275 |
204 |
$842.97 |
| 87581 |
|
194 |
145 |
$838.52 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
61 |
48 |
$835.82 |
| 86357 |
|
242 |
182 |
$770.20 |
| 86356 |
|
240 |
181 |
$770.20 |
| 86800 |
|
212 |
190 |
$762.51 |
| 86359 |
|
206 |
154 |
$759.68 |
| 97802 |
|
50 |
44 |
$758.75 |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
122 |
95 |
$749.48 |
| 86360 |
|
206 |
154 |
$721.57 |
| 82746 |
|
475 |
406 |
$695.70 |
| 88173 |
|
258 |
208 |
$669.29 |
| 81378 |
|
16 |
12 |
$616.59 |
| J2001 |
Injection, lidocaine hcl for intravenous infusion, 10 mg |
158 |
130 |
$616.19 |
| 86140 |
|
354 |
191 |
$599.74 |
| 83690 |
|
542 |
448 |
$588.78 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
92 |
61 |
$568.91 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
106 |
81 |
$511.52 |
| 88300 |
|
12 |
12 |
$494.00 |
| 85651 |
|
512 |
401 |
$468.95 |
| 84403 |
|
364 |
303 |
$460.11 |
| 88108 |
|
44 |
27 |
$451.90 |
| 87205 |
|
37 |
27 |
$434.56 |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
98 |
84 |
$415.51 |
| 82105 |
|
207 |
166 |
$396.65 |
| 86644 |
|
87 |
75 |
$391.58 |
| A9561 |
Technetium tc-99m oxidronate, diagnostic, per study dose, up to 30 millicuries |
746 |
671 |
$378.76 |
| 0011A |
|
304 |
231 |
$364.83 |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
152 |
84 |
$363.41 |
| 77470 |
|
19 |
15 |
$300.42 |
| 82024 |
|
126 |
104 |
$299.16 |
| 81268 |
|
26 |
24 |
$263.67 |
| 88161 |
|
52 |
38 |
$254.99 |
| J0330 |
Injection, succinylcholine chloride, up to 20 mg |
118 |
93 |
$235.66 |
| 83520 |
|
558 |
288 |
$228.50 |
| 73552 |
|
17 |
13 |
$225.63 |
| 83880 |
|
50 |
42 |
$189.60 |
| 93702 |
|
13 |
12 |
$162.20 |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
103 |
78 |
$154.68 |
| 82248 |
|
20 |
16 |
$139.39 |
| 82977 |
|
40 |
14 |
$132.14 |
| C1788 |
Port, indwelling (implantable) |
103 |
68 |
$105.51 |
| J9060 |
Injection, cisplatin, powder or solution, 10 mg |
100 |
39 |
$102.47 |
| C1729 |
Catheter, drainage |
16 |
12 |
$100.34 |
| 86592 |
|
27 |
25 |
$91.37 |
| 96040 |
|
12 |
12 |
$87.89 |
| 83010 |
|
88 |
70 |
$87.14 |
| 0012A |
|
219 |
197 |
$46.54 |
| 82570 |
|
18 |
12 |
$43.28 |
| 0013A |
|
38 |
28 |
$40.00 |
| J0780 |
Injection, prochlorperazine, up to 10 mg |
46 |
36 |
$38.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
174 |
128 |
$35.88 |
| 88177 |
|
37 |
27 |
$35.40 |
| J1720 |
Injection, hydrocortisone sodium succinate, up to 100 mg |
108 |
69 |
$34.00 |
| 83605 |
|
110 |
87 |
$32.25 |
| J0640 |
Injection, leucovorin calcium, per 50 mg |
234 |
131 |
$29.58 |
| 84702 |
|
12 |
12 |
$18.14 |
| 87799 |
|
16 |
14 |
$16.49 |
| 90686 |
|
179 |
150 |
$14.32 |
| 84145 |
|
34 |
27 |
$11.63 |
| 85652 |
|
35 |
28 |
$10.56 |
| 89051 |
|
18 |
12 |
$10.08 |
| 87077 |
|
30 |
26 |
$9.28 |
| 36600 |
|
17 |
13 |
$4.34 |
| 83001 |
|
15 |
13 |
$4.05 |
| 82150 |
|
16 |
12 |
$3.13 |
| G0008 |
Administration of influenza virus vaccine |
18 |
12 |
$0.00 |
| 0064A |
|
17 |
15 |
$0.00 |
| J2060 |
Injection, lorazepam, 2 mg |
27 |
16 |
$0.00 |
| 72157 |
|
18 |
14 |
$0.00 |
| 87186 |
|
16 |
13 |
$0.00 |
| J9000 |
Injection, doxorubicin hydrochloride, 10 mg |
98 |
63 |
$0.00 |
| 90670 |
|
87 |
73 |
$0.00 |
| 0003A |
|
96 |
83 |
$0.00 |
| 90746 |
|
13 |
12 |
$0.00 |
| A6403 |
Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing |
16 |
13 |
$0.00 |
| J9370 |
Vincristine sulfate, 1 mg |
38 |
25 |
$0.00 |
| J1644 |
Injection, heparin sodium, per 1000 units |
42 |
24 |
$0.00 |
| 90648 |
|
13 |
12 |
$0.00 |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
18 |
13 |
$0.00 |
| 76942 |
|
19 |
13 |
$0.00 |