| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
124,975 |
96,682 |
$9.93M |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
93,764 |
77,067 |
$9.86M |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
8,886 |
8,514 |
$3.67M |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
25,817 |
22,916 |
$2.58M |
| 70450 |
Computed tomography, head or brain; without contrast material |
10,014 |
9,555 |
$2.32M |
| J3490 |
Unclassified drugs |
196,699 |
84,882 |
$2.29M |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
15,664 |
10,937 |
$1.81M |
| 96375 |
Therapeutic injection; each additional sequential IV push |
23,308 |
19,500 |
$1.75M |
| 87633 |
Infectious agent detection by nucleic acid, respiratory virus, 12-25 targets |
4,414 |
3,968 |
$1.57M |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
31,681 |
27,285 |
$1.49M |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
10,505 |
9,242 |
$1.34M |
| 99201 |
|
10,592 |
7,082 |
$1.14M |
| 99070 |
|
47,692 |
34,415 |
$1.11M |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
16,121 |
11,609 |
$996K |
| 72125 |
Computed tomography, cervical spine; without contrast material |
2,499 |
2,443 |
$906K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
1,975 |
1,940 |
$767K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
18,476 |
16,564 |
$704K |
| 80053 |
Comprehensive metabolic panel |
91,860 |
55,783 |
$676K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
12,325 |
11,375 |
$631K |
| 99291 |
Critical care, evaluation and management of the critically ill patient, first 30-74 minutes |
1,576 |
1,508 |
$617K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
111,851 |
66,001 |
$602K |
| 87428 |
|
9,153 |
8,223 |
$572K |
| 96361 |
Intravenous infusion, hydration; each additional hour |
14,354 |
12,527 |
$558K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
2,648 |
2,549 |
$553K |
| 71045 |
Radiologic examination, chest; single view |
25,665 |
23,385 |
$512K |
| 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 |
7,439 |
6,554 |
$472K |
| 71046 |
Radiologic examination, chest; 2 views |
12,332 |
11,836 |
$446K |
| 93971 |
|
2,218 |
2,153 |
$433K |
| 0450 |
Emergency room services |
6,421 |
5,608 |
$432K |
| Z7502 |
|
11,368 |
11,092 |
$429K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
4,071 |
3,870 |
$419K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
3,628 |
3,304 |
$388K |
| 70486 |
|
1,302 |
1,281 |
$372K |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
1,059 |
1,035 |
$367K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
3,311 |
2,182 |
$363K |
| 87637 |
Infectious agent detection by nucleic acid; SARS-CoV-2, influenza, and RSV |
2,232 |
2,207 |
$317K |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
3,901 |
3,632 |
$299K |
| 84484 |
|
30,902 |
18,368 |
$286K |
| 59025 |
Fetal non-stress test |
6,401 |
2,774 |
$248K |
| 96413 |
Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance |
3,475 |
2,034 |
$246K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
6,079 |
5,313 |
$239K |
| 76830 |
Ultrasound, transvaginal |
2,104 |
2,034 |
$233K |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
508 |
495 |
$226K |
| 76801 |
|
2,219 |
1,993 |
$218K |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
20,324 |
17,673 |
$205K |
| 83880 |
|
8,306 |
5,370 |
$199K |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
1,559 |
1,400 |
$182K |
| 87798 |
Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism |
3,051 |
2,733 |
$180K |
| 78452 |
Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress |
324 |
321 |
$176K |
| J7030 |
Infusion, normal saline solution , 1000 cc |
12,226 |
10,552 |
$176K |
| J1642 |
Injection, heparin sodium, (heparin lock flush), per 10 units |
5,867 |
2,811 |
$169K |
| 83690 |
|
34,094 |
21,730 |
$167K |
| Z9725 |
|
3,838 |
3,643 |
$162K |
| 93970 |
|
475 |
467 |
$154K |
| U0002 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
3,016 |
2,901 |
$154K |
| 73630 |
|
3,455 |
3,178 |
$150K |
| 73562 |
|
3,505 |
3,151 |
$147K |
| 70498 |
|
353 |
343 |
$147K |
| 70496 |
|
352 |
342 |
$146K |
| 73610 |
|
3,114 |
2,933 |
$145K |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
20,225 |
18,101 |
$142K |
| 76770 |
|
1,019 |
983 |
$141K |
| 83605 |
|
17,244 |
11,146 |
$138K |
| 73130 |
|
2,957 |
2,747 |
$136K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
4,890 |
3,425 |
$136K |
| 87486 |
|
4,412 |
3,969 |
$133K |
| 87581 |
|
4,412 |
3,969 |
$133K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
5,236 |
3,661 |
$127K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
5,220 |
3,647 |
$127K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
2,130 |
1,889 |
$126K |
| J2785 |
Injection, regadenoson, 0.1 mg |
395 |
392 |
$124K |
| 0270 |
|
1,372 |
781 |
$121K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
20,148 |
12,998 |
$121K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
21,020 |
13,965 |
$119K |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
3,529 |
3,317 |
$118K |
| 72100 |
|
2,046 |
2,021 |
$112K |
| 73030 |
|
2,304 |
2,214 |
$111K |
| J1815 |
Injection, insulin, per 5 units |
2,251 |
1,773 |
$110K |
| 85730 |
|
25,454 |
16,742 |
$108K |
| 87040 |
|
8,909 |
5,848 |
$103K |
| 85610 |
|
35,712 |
22,910 |
$99K |
| 94799 |
|
1,238 |
1,124 |
$99K |
| J1170 |
Injection, hydromorphone, up to 4 mg |
10,437 |
7,620 |
$99K |
| A9500 |
Technetium tc-99m sestamibi, diagnostic, per study dose |
453 |
450 |
$98K |
| 90715 |
|
2,315 |
2,297 |
$97K |
| 73110 |
|
2,040 |
1,924 |
$95K |
| 94644 |
|
2,665 |
2,420 |
$93K |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
8,879 |
7,339 |
$90K |
| 97750 |
|
856 |
827 |
$86K |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
151 |
147 |
$85K |
| 87400 |
|
11,915 |
6,055 |
$84K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
2,366 |
903 |
$84K |
| 84443 |
Thyroid stimulating hormone (TSH) |
6,951 |
4,841 |
$82K |
| 96367 |
|
1,180 |
1,071 |
$76K |
| 81001 |
|
13,436 |
12,175 |
$73K |
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
538 |
520 |
$73K |
| 74018 |
|
2,159 |
1,996 |
$73K |
| 83735 |
|
14,216 |
9,520 |
$69K |
| 80306 |
|
3,156 |
2,972 |
$67K |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
5,992 |
5,497 |
$61K |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
13,474 |
12,815 |
$60K |
| 81015 |
|
25,177 |
12,208 |
$57K |
| 99292 |
|
255 |
249 |
$55K |
| J2370 |
Injection, phenylephrine hcl, up to 1 ml |
555 |
528 |
$54K |
| 99152 |
|
529 |
473 |
$54K |
| 87077 |
|
8,529 |
5,797 |
$52K |
| 93017 |
|
378 |
374 |
$51K |
| J0500 |
Injection, dicyclomine hcl, up to 20 mg |
695 |
656 |
$50K |
| 71250 |
|
127 |
126 |
$49K |
| 76819 |
Fetal biophysical profile; without non-stress testing |
213 |
177 |
$49K |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
6,842 |
6,161 |
$48K |
| J1756 |
Injection, iron sucrose, 1 mg |
772 |
506 |
$48K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
8,005 |
5,579 |
$47K |
| 87186 |
|
6,825 |
4,652 |
$46K |
| 93798 |
|
273 |
37 |
$46K |
| Q0144 |
Azithromycin dihydrate, oral, capsules/powder, 1 gram |
643 |
621 |
$44K |
| J7040 |
Infusion, normal saline solution, sterile (500 ml = 1 unit) |
4,140 |
3,011 |
$43K |
| J3480 |
Injection, potassium chloride, per 2 meq |
913 |
747 |
$42K |
| 73502 |
|
737 |
713 |
$42K |
| 10060 |
|
934 |
894 |
$41K |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
6,692 |
6,113 |
$41K |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
3,994 |
3,701 |
$40K |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
6,872 |
5,878 |
$40K |
| 81025 |
|
12,025 |
11,498 |
$40K |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
5,566 |
5,253 |
$39K |
| 95812 |
|
438 |
438 |
$38K |
| J0690 |
Injection, cefazolin sodium, 500 mg |
4,237 |
3,406 |
$38K |
| 73080 |
|
732 |
701 |
$37K |
| 81002 |
|
18,993 |
10,006 |
$37K |
| 73590 |
|
927 |
867 |
$35K |
| 87081 |
|
7,514 |
5,234 |
$35K |
| 73140 |
|
1,181 |
1,131 |
$34K |
| J7050 |
Infusion, normal saline solution, 250 cc |
4,393 |
3,188 |
$34K |
| 84145 |
|
1,547 |
1,432 |
$34K |
| 72040 |
|
673 |
664 |
$33K |
| 73090 |
|
855 |
798 |
$32K |
| 99199 |
Unlisted special service, procedure or report |
647 |
548 |
$32K |
| 12001 |
|
852 |
811 |
$31K |
| J2704 |
Injection, propofol, 10 mg |
4,925 |
4,588 |
$31K |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
27 |
26 |
$31K |
| 76870 |
|
282 |
275 |
$30K |
| 85378 |
|
5,255 |
3,559 |
$29K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
566 |
357 |
$29K |
| J2060 |
Injection, lorazepam, 2 mg |
4,670 |
4,041 |
$28K |
| J7060 |
5% dextrose/water (500 ml = 1 unit) |
2,605 |
1,502 |
$27K |
| S0077 |
Injection, clindamycin phosphate, 300 mg |
555 |
503 |
$26K |
| 80076 |
|
4,840 |
3,392 |
$25K |
| 84702 |
|
2,338 |
1,496 |
$25K |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
1,739 |
1,565 |
$25K |
| J1644 |
Injection, heparin sodium, per 1000 units |
3,820 |
2,039 |
$24K |
| 72170 |
|
649 |
636 |
$24K |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
1,566 |
1,392 |
$24K |
| 96415 |
|
394 |
293 |
$23K |
| C9290 |
Injection, bupivacaine liposome, 1 mg |
63 |
60 |
$23K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
159 |
157 |
$23K |
| J3370 |
Injection, vancomycin hcl, 500 mg |
941 |
746 |
$23K |
| J2550 |
Injection, promethazine hcl, up to 50 mg |
2,709 |
2,361 |
$21K |
| Z7610 |
|
2,655 |
1,570 |
$21K |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
1,551 |
1,258 |
$18K |
| 11042 |
Debridement, subcutaneous tissue (includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm |
975 |
673 |
$17K |
| 96417 |
|
286 |
194 |
$17K |
| J0330 |
Injection, succinylcholine chloride, up to 20 mg |
664 |
645 |
$17K |
| 82803 |
|
1,395 |
1,323 |
$17K |
| 84439 |
|
2,636 |
1,715 |
$16K |
| Z7514 |
|
277 |
160 |
$16K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
135 |
128 |
$16K |
| 59425 |
|
332 |
204 |
$16K |
| 93458 |
|
12 |
12 |
$15K |
| 12011 |
|
277 |
258 |
$15K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
2,443 |
1,699 |
$15K |
| 86141 |
|
1,809 |
911 |
$14K |
| 82010 |
|
2,347 |
1,434 |
$13K |
| 87070 |
|
2,059 |
1,338 |
$13K |
| 86901 |
|
5,566 |
3,693 |
$12K |
| 86140 |
|
3,083 |
2,446 |
$12K |
| 85018 |
|
4,415 |
2,927 |
$12K |
| J1650 |
Injection, enoxaparin sodium, 10 mg |
504 |
304 |
$11K |
| 81003 |
|
5,306 |
4,840 |
$11K |
| 87899 |
|
1,034 |
511 |
$11K |
| S4005 |
Interim labor facility global (labor occurring but not resulting in delivery) |
183 |
168 |
$11K |
| 82550 |
|
2,058 |
1,474 |
$11K |
| 94760 |
|
749 |
602 |
$10K |
| 74022 |
|
140 |
131 |
$10K |
| S0020 |
Injection, bupivicaine hydrochloride, 30 ml |
761 |
735 |
$10K |
| 99000 |
|
1,617 |
1,587 |
$9K |
| 29125 |
|
621 |
597 |
$9K |
| Z1034 |
|
166 |
110 |
$9K |
| 80061 |
Lipid panel |
921 |
579 |
$9K |
| 84703 |
|
1,512 |
1,189 |
$8K |
| Q9966 |
Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml |
313 |
309 |
$8K |
| 86900 |
|
3,541 |
2,322 |
$8K |
| 78226 |
|
12 |
12 |
$8K |
| Q5106 |
Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use), 1000 units |
27 |
12 |
$7K |
| L0172 |
Cervical, collar, semi-rigid thermoplastic foam, two-piece, prefabricated, off-the-shelf |
29 |
29 |
$6K |
| 87210 |
|
2,117 |
1,387 |
$6K |
| 85652 |
|
3,204 |
2,257 |
$6K |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
97 |
95 |
$6K |
| 86850 |
|
2,592 |
1,717 |
$6K |
| 70491 |
|
12 |
12 |
$6K |
| 0250 |
|
397 |
240 |
$6K |
| 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 |
5,612 |
5,183 |
$6K |
| 87420 |
|
2,566 |
1,314 |
$5K |
| 82140 |
|
546 |
349 |
$5K |
| J0360 |
Injection, hydralazine hcl, up to 20 mg |
492 |
426 |
$5K |
| 72131 |
|
13 |
13 |
$5K |
| J1940 |
Injection, furosemide, up to 20 mg |
546 |
399 |
$5K |
| A4217 |
Sterile water/saline, 500 ml |
421 |
408 |
$5K |
| 87075 |
|
709 |
495 |
$5K |
| 70487 |
|
13 |
13 |
$5K |
| 93351 |
|
14 |
12 |
$5K |
| P9016 |
Red blood cells, leukocytes reduced, each unit |
16 |
14 |
$5K |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
108 |
90 |
$5K |
| C9113 |
Injection, pantoprazole sodium, per vial |
393 |
332 |
$4K |
| J7611 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg |
2,574 |
2,302 |
$4K |
| 82947 |
|
830 |
682 |
$4K |
| 84100 |
|
1,045 |
921 |
$4K |
| J2543 |
Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams) |
172 |
132 |
$4K |
| 36415 |
Collection of venous blood by venipuncture |
2,813 |
2,357 |
$3K |
| 12002 |
|
88 |
86 |
$3K |
| 94645 |
|
108 |
100 |
$3K |
| 96523 |
|
180 |
147 |
$3K |
| J0665 |
Injection, bupivicaine, not otherwise specified, 0.5 mg |
484 |
470 |
$3K |
| 81000 |
|
1,121 |
1,032 |
$3K |
| 99153 |
Mod sedat endo service >5yrs |
57 |
48 |
$3K |
| J0171 |
Injection, adrenalin, epinephrine, 0.1 mg |
67 |
64 |
$3K |
| 86920 |
|
52 |
37 |
$3K |
| S0164 |
Injection, pantoprazole sodium, 40 mg |
173 |
147 |
$3K |
| 82248 |
|
557 |
521 |
$2K |
| 85027 |
|
457 |
291 |
$2K |
| 73552 |
|
54 |
49 |
$2K |
| 45380 |
Colonoscopy, flexible; with biopsy, single or multiple |
27 |
25 |
$2K |
| 90686 |
|
74 |
72 |
$2K |
| J2920 |
Injection, methylprednisolone sodium succinate, up to 40 mg |
196 |
173 |
$2K |
| 97116 |
|
48 |
43 |
$2K |
| 71020 |
|
69 |
43 |
$2K |
| 74019 |
|
48 |
48 |
$2K |
| 29515 |
|
79 |
77 |
$2K |
| 84550 |
|
449 |
358 |
$2K |
| 86703 |
|
146 |
144 |
$2K |
| 97803 |
|
31 |
27 |
$2K |
| 73060 |
|
40 |
37 |
$1K |
| J0780 |
Injection, prochlorperazine, up to 10 mg |
151 |
145 |
$1K |
| 45385 |
Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) |
14 |
14 |
$1K |
| 97165 |
|
14 |
13 |
$1K |
| A9537 |
Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries |
12 |
12 |
$1K |
| 74230 |
|
27 |
27 |
$1K |
| 36600 |
|
38 |
36 |
$1K |
| 82570 |
|
261 |
223 |
$1K |
| J3411 |
Injection, thiamine hcl, 100 mg |
109 |
94 |
$1K |
| J3360 |
Injection, diazepam, up to 5 mg |
51 |
48 |
$1K |
| 96368 |
|
32 |
29 |
$1K |
| 90744 |
|
62 |
62 |
$1K |
| 86308 |
|
282 |
164 |
$1K |
| J2919 |
Injection, methylprednisolone sodium succinate, 5 mg |
183 |
146 |
$1K |
| 10061 |
|
16 |
16 |
$1K |
| 45378 |
Colonoscopy, flexible; diagnostic, including collection of specimen(s) |
14 |
14 |
$989.67 |
| J1953 |
Injection, levetiracetam, 10 mg |
47 |
39 |
$972.33 |
| 93000 |
|
13 |
12 |
$949.21 |
| 84156 |
|
291 |
221 |
$921.88 |
| J1750 |
Injection, iron dextran, 50 mg |
12 |
12 |
$848.01 |
| 59430 |
|
17 |
17 |
$822.46 |
| 96376 |
|
16 |
12 |
$701.25 |
| 72070 |
|
14 |
14 |
$648.18 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
130 |
126 |
$561.98 |
| 86592 |
|
147 |
139 |
$514.17 |
| 74000 |
|
18 |
14 |
$478.80 |
| J1171 |
Injection, hydromorphone, 0.1 mg |
41 |
34 |
$470.95 |
| 71010 |
|
22 |
17 |
$449.60 |
| J7070 |
Infusion, d5w, 1000 cc |
15 |
13 |
$406.52 |
| J8540 |
Dexamethasone, oral, 0.25 mg |
887 |
846 |
$396.92 |
| 82270 |
|
158 |
100 |
$386.09 |
| 70360 |
|
13 |
13 |
$345.49 |
| 80164 |
|
52 |
25 |
$345.25 |
| 73660 |
|
12 |
12 |
$332.76 |
| J7620 |
Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme |
2,051 |
1,818 |
$283.69 |
| 85007 |
|
192 |
93 |
$263.41 |
| 83615 |
|
47 |
42 |
$257.76 |
| J2471 |
Injection, pantoprazole (hikma), not therapeutically equivalent to j2470, 40 mg |
72 |
59 |
$251.52 |
| J2795 |
Injection, ropivacaine hydrochloride, 1 mg |
13 |
12 |
$236.48 |
| 87205 |
|
49 |
47 |
$186.84 |
| 90585 |
|
40 |
40 |
$168.96 |
| 84132 |
|
45 |
41 |
$166.44 |
| 86580 |
|
19 |
19 |
$159.00 |
| J7644 |
Ipratropium bromide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram |
744 |
693 |
$148.08 |
| A6213 |
Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
15 |
13 |
$148.01 |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
1,508 |
1,419 |
$142.16 |
| 87449 |
|
16 |
16 |
$137.98 |
| J1836 |
Injection, metronidazole, 10 mg |
44 |
39 |
$135.44 |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
910 |
808 |
$106.64 |
| 82247 |
|
18 |
12 |
$88.67 |
| J2001 |
Injection, lidocaine hcl for intravenous infusion, 10 mg |
393 |
382 |
$39.51 |
| Q0177 |
Hydroxyzine pamoate, 25 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 |
69 |
55 |
$22.88 |
| Q0163 |
Diphenhydramine hydrochloride, 50 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at time of chemotherapy treatment not to exceed a 48 hour dosage regimen |
200 |
188 |
$0.00 |
| 0300 |
|
12 |
12 |
$0.00 |
| J1630 |
Injection, haloperidol, up to 5 mg |
37 |
33 |
$0.00 |
| J3535 |
Drug administered through a metered dose inhaler |
51 |
50 |
$0.00 |