| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
41,813 |
38,492 |
$18.28M |
| G0378 |
Hospital observation service, per hour |
7,563 |
4,670 |
$9.04M |
| 93458 |
|
1,055 |
1,050 |
$5.34M |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
5,272 |
5,110 |
$4.26M |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
5,413 |
5,306 |
$1.68M |
| 0450 |
Emergency room services |
36,870 |
32,245 |
$1.65M |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
6,533 |
6,314 |
$1.26M |
| 66984 |
Extracapsular cataract removal with insertion of intraocular lens prosthesis |
359 |
355 |
$811K |
| 87636 |
Infectious agent detection by nucleic acid; SARS-CoV-2 and influenza virus types A and B |
17,184 |
16,580 |
$790K |
| 82565 |
|
148,830 |
130,838 |
$714K |
| 70450 |
Computed tomography, head or brain; without contrast material |
6,611 |
6,455 |
$678K |
| 80051 |
|
121,542 |
105,202 |
$673K |
| 70553 |
Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences |
1,580 |
1,548 |
$619K |
| 80061 |
Lipid panel |
40,045 |
39,885 |
$565K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
56,207 |
55,723 |
$558K |
| 84443 |
Thyroid stimulating hormone (TSH) |
32,784 |
32,379 |
$550K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
3,125 |
3,072 |
$544K |
| 86900 |
|
9,085 |
8,265 |
$533K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
91,953 |
78,563 |
$524K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
15,953 |
15,897 |
$523K |
| 84460 |
|
93,315 |
87,080 |
$488K |
| 86885 |
|
6,356 |
5,829 |
$470K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
12,899 |
11,036 |
$460K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
12,895 |
11,034 |
$460K |
| 71045 |
Radiologic examination, chest; single view |
9,634 |
9,146 |
$456K |
| 85027 |
|
74,299 |
72,434 |
$437K |
| 78815 |
Positron emission tomography (PET) for limited area imaging |
226 |
226 |
$421K |
| 83880 |
|
13,969 |
12,108 |
$389K |
| 85097 |
|
543 |
541 |
$383K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
2,117 |
2,116 |
$323K |
| 71046 |
Radiologic examination, chest; 2 views |
5,862 |
5,733 |
$269K |
| 72197 |
|
623 |
615 |
$266K |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
1,144 |
1,127 |
$266K |
| 87536 |
|
3,094 |
3,078 |
$265K |
| 83970 |
|
5,735 |
5,673 |
$265K |
| 99291 |
Critical care, evaluation and management of the critically ill patient, first 30-74 minutes |
204 |
203 |
$262K |
| 74183 |
|
605 |
603 |
$252K |
| 82247 |
|
50,387 |
44,928 |
$227K |
| 84075 |
|
47,695 |
43,075 |
$225K |
| 84450 |
|
46,528 |
42,795 |
$218K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
2,818 |
2,674 |
$214K |
| 62323 |
|
396 |
393 |
$212K |
| 93971 |
|
1,041 |
1,003 |
$209K |
| 76830 |
Ultrasound, transvaginal |
2,721 |
2,584 |
$208K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
2,425 |
2,371 |
$204K |
| 84520 |
|
76,131 |
63,747 |
$204K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
4,614 |
4,114 |
$189K |
| 88184 |
|
692 |
687 |
$185K |
| 82728 |
|
12,780 |
12,601 |
$181K |
| 86923 |
|
857 |
717 |
$180K |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
8,034 |
8,000 |
$178K |
| 86141 |
|
13,024 |
12,482 |
$170K |
| 86901 |
|
9,095 |
8,272 |
$164K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
3,933 |
3,822 |
$162K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
8,849 |
8,144 |
$162K |
| 82310 |
|
31,864 |
28,722 |
$156K |
| 82947 |
|
61,066 |
55,279 |
$149K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
625 |
621 |
$139K |
| 86780 |
|
10,296 |
10,210 |
$136K |
| 86480 |
|
1,924 |
1,922 |
$123K |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
4,158 |
3,834 |
$122K |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
531 |
526 |
$121K |
| 82607 |
|
7,654 |
7,620 |
$121K |
| 86803 |
|
8,696 |
8,640 |
$120K |
| 87505 |
|
1,118 |
1,107 |
$118K |
| 83550 |
|
13,007 |
12,868 |
$114K |
| 82043 |
|
17,320 |
17,194 |
$114K |
| A9585 |
Injection, gadobutrol, 0.1 ml |
1,221 |
1,206 |
$114K |
| 84702 |
|
10,913 |
9,873 |
$113K |
| 83735 |
|
22,167 |
17,855 |
$110K |
| 72148 |
Magnetic resonance imaging, lumbar spine; without contrast material |
424 |
424 |
$105K |
| 85610 |
|
31,022 |
24,115 |
$102K |
| 73562 |
|
1,922 |
1,805 |
$102K |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
8,604 |
8,184 |
$100K |
| 77080 |
|
615 |
614 |
$100K |
| 82040 |
|
19,872 |
18,910 |
$97K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
2,328 |
1,707 |
$95K |
| 81003 |
|
52,176 |
49,388 |
$94K |
| 73630 |
|
1,756 |
1,686 |
$90K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
2,326 |
2,194 |
$89K |
| 73030 |
|
1,487 |
1,419 |
$88K |
| 0637 |
|
76,752 |
25,574 |
$82K |
| 83540 |
|
12,946 |
12,806 |
$81K |
| 83520 |
|
4,294 |
2,492 |
$78K |
| 78451 |
|
55 |
53 |
$76K |
| 99199 |
Unlisted special service, procedure or report |
2,080 |
1,914 |
$76K |
| 84153 |
|
3,984 |
3,940 |
$75K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
5,585 |
5,187 |
$75K |
| 84484 |
|
17,334 |
14,463 |
$71K |
| 72100 |
|
859 |
855 |
$70K |
| 83721 |
|
6,250 |
6,238 |
$69K |
| J7030 |
Infusion, normal saline solution , 1000 cc |
23,801 |
19,753 |
$69K |
| 83690 |
|
18,088 |
17,160 |
$68K |
| 73610 |
|
1,469 |
1,400 |
$64K |
| 87088 |
|
12,431 |
12,084 |
$63K |
| 87340 |
|
6,489 |
6,435 |
$62K |
| 81220 |
CFTR (cystic fibrosis transmembrane conductance regulator) gene analysis; common variants |
309 |
309 |
$61K |
| 74018 |
|
1,148 |
1,047 |
$61K |
| 0250 |
|
12,413 |
8,236 |
$58K |
| 87633 |
Infectious agent detection by nucleic acid, respiratory virus, 12-25 targets |
628 |
623 |
$58K |
| 82570 |
|
9,501 |
8,731 |
$57K |
| 90686 |
|
3,838 |
3,795 |
$57K |
| 84100 |
|
15,503 |
13,509 |
$54K |
| 83655 |
|
5,059 |
5,054 |
$53K |
| 82746 |
|
3,426 |
3,406 |
$51K |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
1,589 |
1,441 |
$50K |
| 84403 |
|
1,828 |
1,813 |
$47K |
| 93970 |
|
141 |
140 |
$45K |
| 71250 |
|
340 |
339 |
$43K |
| 81513 |
|
579 |
575 |
$43K |
| 76770 |
|
332 |
329 |
$42K |
| Z7502 |
|
1,291 |
1,249 |
$41K |
| 85652 |
|
15,072 |
14,518 |
$40K |
| 73130 |
|
920 |
868 |
$40K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
370 |
365 |
$39K |
| 72141 |
|
165 |
165 |
$39K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
215 |
107 |
$39K |
| 70496 |
|
161 |
159 |
$37K |
| 84156 |
|
8,738 |
8,177 |
$37K |
| 86762 |
|
2,606 |
2,600 |
$36K |
| 80076 |
|
4,669 |
4,163 |
$35K |
| 82378 |
|
1,629 |
1,371 |
$35K |
| 84165 |
|
2,827 |
2,685 |
$35K |
| 73564 |
|
250 |
234 |
$35K |
| 86787 |
|
2,813 |
2,807 |
$33K |
| 82248 |
|
9,047 |
8,595 |
$31K |
| 84439 |
|
3,565 |
3,326 |
$31K |
| 80197 |
|
2,011 |
1,724 |
$30K |
| 82105 |
|
1,694 |
1,666 |
$30K |
| 73110 |
|
545 |
504 |
$30K |
| 83718 |
|
3,763 |
3,759 |
$29K |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
8,735 |
7,052 |
$29K |
| 88342 |
|
189 |
187 |
$29K |
| A9575 |
Injection, gadoterate meglumine, 0.1 ml |
2,108 |
1,375 |
$27K |
| 73502 |
|
382 |
366 |
$27K |
| 82784 |
|
1,306 |
1,237 |
$27K |
| 70498 |
|
113 |
112 |
$27K |
| 96361 |
Intravenous infusion, hydration; each additional hour |
2,010 |
1,955 |
$26K |
| 76536 |
|
193 |
190 |
$26K |
| 86317 |
|
1,833 |
1,819 |
$25K |
| 76641 |
|
215 |
211 |
$25K |
| 80306 |
|
2,497 |
2,366 |
$25K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
2,974 |
2,823 |
$25K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
1,190 |
1,166 |
$24K |
| 87497 |
|
469 |
399 |
$24K |
| J3490 |
Unclassified drugs |
5,386 |
4,330 |
$24K |
| 86038 |
|
2,050 |
2,041 |
$24K |
| 86704 |
|
1,996 |
1,976 |
$24K |
| 83021 |
|
1,450 |
1,448 |
$24K |
| 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 |
784 |
759 |
$23K |
| 87040 |
|
6,942 |
3,638 |
$22K |
| 84550 |
|
5,369 |
5,088 |
$22K |
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
175 |
175 |
$22K |
| 87481 |
|
605 |
600 |
$21K |
| 83615 |
|
3,689 |
3,284 |
$21K |
| 83605 |
|
5,575 |
4,729 |
$21K |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
575 |
571 |
$21K |
| 82550 |
|
4,384 |
4,026 |
$20K |
| 86360 |
|
1,787 |
1,759 |
$20K |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
8,049 |
7,182 |
$20K |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
4,226 |
3,633 |
$19K |
| 70486 |
|
157 |
157 |
$18K |
| 82077 |
|
2,322 |
2,159 |
$18K |
| 85014 |
|
7,230 |
7,070 |
$17K |
| 84132 |
|
3,853 |
3,603 |
$17K |
| 84146 |
|
892 |
887 |
$17K |
| 72125 |
Computed tomography, cervical spine; without contrast material |
148 |
146 |
$17K |
| 82465 |
|
4,047 |
4,038 |
$16K |
| 85730 |
|
3,956 |
3,680 |
$16K |
| 87637 |
Infectious agent detection by nucleic acid; SARS-CoV-2, influenza, and RSV |
740 |
728 |
$16K |
| 86359 |
|
1,787 |
1,759 |
$16K |
| 73721 |
Magnetic resonance imaging, any joint of lower extremity; without contrast material |
58 |
54 |
$16K |
| 82670 |
|
499 |
482 |
$15K |
| 84134 |
|
1,065 |
1,039 |
$15K |
| 87210 |
|
3,822 |
3,711 |
$15K |
| 85379 |
|
2,847 |
2,771 |
$14K |
| 93880 |
|
12 |
12 |
$14K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
546 |
539 |
$14K |
| 85018 |
|
5,038 |
4,920 |
$13K |
| 86765 |
|
1,024 |
1,021 |
$13K |
| 87449 |
|
1,066 |
925 |
$13K |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
4,820 |
4,243 |
$13K |
| 83001 |
|
687 |
678 |
$12K |
| 82950 |
|
3,016 |
3,008 |
$12K |
| 86225 |
|
831 |
826 |
$12K |
| 86160 |
|
497 |
483 |
$12K |
| 88185 |
|
584 |
580 |
$11K |
| 97161 |
|
758 |
747 |
$11K |
| 72170 |
|
82 |
79 |
$10K |
| 73140 |
|
173 |
168 |
$10K |
| 71101 |
|
92 |
90 |
$10K |
| 0258 |
|
3,638 |
3,105 |
$10K |
| 90791 |
Psychiatric diagnostic evaluation |
107 |
102 |
$10K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
345 |
329 |
$9K |
| 86003 |
|
298 |
246 |
$9K |
| 88341 |
|
48 |
47 |
$8K |
| C1769 |
Guide wire |
305 |
294 |
$8K |
| P9021 |
Red blood cells, each unit |
147 |
116 |
$8K |
| G0008 |
Administration of influenza virus vaccine |
1,613 |
1,603 |
$8K |
| C1887 |
Catheter, guiding (may include infusion/perfusion capability) |
130 |
130 |
$8K |
| 81015 |
|
2,067 |
2,037 |
$7K |
| J1644 |
Injection, heparin sodium, per 1000 units |
2,524 |
1,602 |
$7K |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
1,641 |
1,451 |
$7K |
| 74022 |
|
165 |
161 |
$7K |
| 0370 |
|
1,428 |
1,407 |
$7K |
| 86431 |
|
1,100 |
1,098 |
$7K |
| 0710 |
|
771 |
762 |
$7K |
| 82977 |
|
980 |
951 |
$6K |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
3,031 |
2,763 |
$6K |
| 90656 |
|
463 |
463 |
$6K |
| 73080 |
|
103 |
94 |
$6K |
| 85046 |
|
1,045 |
999 |
$6K |
| J2060 |
Injection, lorazepam, 2 mg |
1,772 |
1,496 |
$6K |
| 80179 |
|
709 |
684 |
$6K |
| 76870 |
|
70 |
69 |
$6K |
| 90662 |
|
486 |
485 |
$5K |
| 87205 |
|
2,023 |
1,779 |
$5K |
| 84295 |
|
1,116 |
1,050 |
$5K |
| 87324 |
|
474 |
469 |
$5K |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
2,695 |
2,446 |
$5K |
| 87186 |
|
1,255 |
1,237 |
$5K |
| 70491 |
|
15 |
15 |
$5K |
| J2274 |
Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg |
268 |
199 |
$5K |
| J1815 |
Injection, insulin, per 5 units |
3,363 |
1,438 |
$5K |
| 74170 |
|
14 |
14 |
$5K |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
3,948 |
3,833 |
$4K |
| 82962 |
|
2,222 |
1,611 |
$4K |
| 86364 |
|
337 |
335 |
$4K |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
1,161 |
932 |
$4K |
| J1170 |
Injection, hydromorphone, up to 4 mg |
1,451 |
1,223 |
$4K |
| 86300 |
|
190 |
156 |
$4K |
| 86769 |
|
173 |
172 |
$4K |
| 87522 |
Neg quan hep c or qual rna |
102 |
99 |
$4K |
| J2001 |
Injection, lidocaine hcl for intravenous infusion, 10 mg |
2,418 |
2,392 |
$4K |
| 73590 |
|
78 |
76 |
$4K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
822 |
417 |
$3K |
| 73090 |
|
58 |
50 |
$3K |
| 82951 |
|
246 |
245 |
$3K |
| 86665 |
|
196 |
98 |
$3K |
| 85049 |
|
736 |
725 |
$3K |
| 86880 |
|
70 |
69 |
$3K |
| 76000 |
|
144 |
139 |
$3K |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
1,657 |
1,463 |
$3K |
| 84155 |
|
817 |
764 |
$3K |
| 86677 |
|
246 |
245 |
$3K |
| 82627 |
|
104 |
102 |
$3K |
| Q0144 |
Azithromycin dihydrate, oral, capsules/powder, 1 gram |
231 |
221 |
$3K |
| 77066 |
Tomosynthesis, mammo |
14 |
14 |
$2K |
| 72040 |
|
57 |
55 |
$2K |
| 90715 |
|
88 |
88 |
$2K |
| 74230 |
|
14 |
14 |
$2K |
| C1713 |
Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable) |
64 |
64 |
$2K |
| 0272 |
|
207 |
205 |
$2K |
| 86708 |
|
167 |
167 |
$2K |
| 72050 |
|
15 |
15 |
$2K |
| 73560 |
|
35 |
29 |
$2K |
| 73660 |
|
31 |
29 |
$2K |
| 84270 |
|
111 |
110 |
$2K |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
193 |
144 |
$2K |
| 96367 |
|
89 |
87 |
$2K |
| C1894 |
Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser |
205 |
202 |
$2K |
| 97116 |
|
241 |
217 |
$2K |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
3,750 |
3,703 |
$2K |
| J2785 |
Injection, regadenoson, 0.1 mg |
12 |
12 |
$2K |
| 86304 |
|
69 |
63 |
$2K |
| 86256 |
|
66 |
65 |
$2K |
| 86664 |
|
98 |
98 |
$1K |
| 86355 |
|
245 |
242 |
$1K |
| 83993 |
|
68 |
68 |
$1K |
| 86357 |
|
245 |
242 |
$1K |
| A9500 |
Technetium tc-99m sestamibi, diagnostic, per study dose |
20 |
16 |
$1K |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
12 |
12 |
$1K |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
461 |
431 |
$1K |
| 83002 |
|
85 |
85 |
$1K |
| 87081 |
|
420 |
416 |
$1K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
12 |
12 |
$1K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
599 |
596 |
$1K |
| 87517 |
|
40 |
40 |
$1K |
| 80162 |
|
50 |
47 |
$1K |
| 82952 |
|
245 |
244 |
$1K |
| 80324 |
|
664 |
635 |
$1K |
| 80359 |
|
736 |
701 |
$997.38 |
| 73100 |
|
15 |
13 |
$968.38 |
| 83930 |
|
187 |
176 |
$951.72 |
| J0690 |
Injection, cefazolin sodium, 500 mg |
649 |
581 |
$890.68 |
| J0360 |
Injection, hydralazine hcl, up to 20 mg |
402 |
338 |
$883.15 |
| J1940 |
Injection, furosemide, up to 20 mg |
747 |
457 |
$881.43 |
| 83935 |
|
168 |
155 |
$845.38 |
| J2919 |
Injection, methylprednisolone sodium succinate, 5 mg |
88 |
62 |
$782.75 |
| J3480 |
Injection, potassium chloride, per 2 meq |
576 |
398 |
$776.96 |
| J1650 |
Injection, enoxaparin sodium, 10 mg |
572 |
278 |
$771.94 |
| 86735 |
|
52 |
52 |
$760.27 |
| 87070 |
|
278 |
266 |
$756.78 |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
64 |
64 |
$756.70 |
| 87631 |
|
34 |
34 |
$746.79 |
| 90688 |
|
79 |
78 |
$741.30 |
| 86335 |
|
12 |
12 |
$693.70 |
| 82150 |
|
138 |
136 |
$690.43 |
| C1751 |
Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis) |
413 |
406 |
$679.72 |
| 88304 |
|
125 |
116 |
$576.83 |
| 86334 |
|
27 |
25 |
$547.86 |
| C1729 |
Catheter, drainage |
144 |
117 |
$537.59 |
| 85045 |
|
139 |
139 |
$483.04 |
| C1725 |
Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability) |
30 |
30 |
$456.77 |
| 86140 |
|
1,707 |
1,619 |
$451.07 |
| 80048 |
Basic metabolic panel (calcium, ionized) |
332 |
326 |
$445.14 |
| 86308 |
|
90 |
90 |
$429.53 |
| 86709 |
|
39 |
39 |
$420.65 |
| 80164 |
|
39 |
36 |
$391.10 |
| 84480 |
|
26 |
26 |
$391.00 |
| J7060 |
5% dextrose/water (500 ml = 1 unit) |
227 |
152 |
$368.18 |
| 87624 |
Infectious agent detection by nucleic acid; human papillomavirus (HPV), high-risk types |
12 |
12 |
$360.00 |
| 84145 |
|
90 |
85 |
$338.29 |
| 83010 |
|
29 |
27 |
$338.00 |
| 86039 |
|
40 |
40 |
$307.00 |
| 80320 |
|
655 |
554 |
$278.40 |
| 89051 |
|
94 |
78 |
$251.69 |
| 82140 |
|
36 |
36 |
$251.65 |
| J2003 |
Injection, lidocaine hydrochloride, 1 mg |
89 |
82 |
$248.76 |
| 85384 |
|
37 |
26 |
$214.63 |
| 82985 |
|
12 |
12 |
$196.00 |
| 82533 |
|
12 |
12 |
$183.97 |
| 82274 |
|
12 |
12 |
$175.00 |
| C9113 |
Injection, pantoprazole sodium, per vial |
474 |
313 |
$174.07 |
| 82330 |
|
13 |
12 |
$159.00 |
| J1836 |
Injection, metronidazole, 10 mg |
46 |
38 |
$124.88 |
| 82390 |
|
12 |
12 |
$122.00 |
| 88307 |
|
13 |
12 |
$110.00 |
| J3371 |
Injection, vancomycin hcl (mylan), not therapeutically equivalent to j3370, 500 mg |
21 |
13 |
$105.13 |
| 80178 |
|
13 |
12 |
$92.00 |
| J1630 |
Injection, haloperidol, up to 5 mg |
26 |
25 |
$88.17 |
| J3370 |
Injection, vancomycin hcl, 500 mg |
14 |
12 |
$88.15 |
| J2543 |
Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams) |
15 |
12 |
$76.29 |
| 82705 |
|
13 |
13 |
$72.00 |
| J7040 |
Infusion, normal saline solution, sterile (500 ml = 1 unit) |
39 |
39 |
$62.71 |
| J2470 |
Injection, pantoprazole sodium, 40 mg |
128 |
94 |
$54.18 |
| J2305 |
Injection, nitroglycerin, 5 mg |
12 |
12 |
$46.15 |
| J1920 |
Injection, labetalol hydrochloride, 5 mg |
22 |
13 |
$39.98 |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
220 |
153 |
$24.50 |
| V2632 |
Posterior chamber intraocular lens |
195 |
193 |
$15.82 |
| J1171 |
Injection, hydromorphone, 0.1 mg |
12 |
12 |
$11.15 |
| 3052F |
|
178 |
178 |
$0.01 |
| 3051F |
|
320 |
320 |
$0.01 |
| 3074F |
|
45 |
45 |
$0.00 |
| 80329 |
|
424 |
208 |
$0.00 |
| 3044F |
|
3,303 |
3,295 |
$0.00 |
| 3046F |
|
284 |
283 |
$0.00 |
| A9577 |
Injection, gadobenate dimeglumine (multihance), per ml |
49 |
47 |
$0.00 |
| C1760 |
Closure device, vascular (implantable/insertable) |
13 |
13 |
$0.00 |
| 3078F |
|
40 |
40 |
$0.00 |
| J0694 |
Injection, cefoxitin sodium, 1 gm |
13 |
12 |
$0.00 |
| C1757 |
Catheter, thrombectomy/embolectomy |
12 |
12 |
$0.00 |