| Code | Description | Claims | Beneficiaries | Total Paid |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
28,540 |
26,046 |
$3.55M |
| 96361 |
Intravenous infusion, hydration; each additional hour |
9,216 |
8,107 |
$2.93M |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
20,958 |
19,125 |
$2.16M |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
6,964 |
6,441 |
$1.34M |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
14,383 |
13,020 |
$1.13M |
| 70450 |
Computed tomography, head or brain; without contrast material |
3,954 |
3,657 |
$606K |
| 11042 |
Debridement, subcutaneous tissue (includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm |
4,261 |
1,845 |
$553K |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
3,235 |
3,039 |
$420K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
1,892 |
1,769 |
$365K |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
3,045 |
2,888 |
$340K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
1,917 |
1,792 |
$261K |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
6,656 |
4,028 |
$257K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
2,732 |
2,561 |
$234K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
1,037 |
979 |
$194K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
742 |
618 |
$163K |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
5,451 |
2,055 |
$158K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
3,977 |
3,658 |
$151K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
3,083 |
2,891 |
$146K |
| 59025 |
Fetal non-stress test |
971 |
758 |
$142K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
1,493 |
1,417 |
$126K |
| 80053 |
Comprehensive metabolic panel |
26,410 |
22,554 |
$107K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
1,107 |
1,063 |
$104K |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
3,036 |
1,149 |
$78K |
| 76830 |
Ultrasound, transvaginal |
938 |
893 |
$78K |
| G0378 |
Hospital observation service, per hour |
3,363 |
2,097 |
$77K |
| 70498 |
|
392 |
373 |
$77K |
| 10060 |
|
343 |
313 |
$62K |
| 71046 |
Radiologic examination, chest; 2 views |
9,005 |
8,315 |
$61K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
7,605 |
6,315 |
$48K |
| 29581 |
|
312 |
149 |
$46K |
| G0382 |
Level 3 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment) |
337 |
273 |
$45K |
| 93971 |
|
576 |
551 |
$44K |
| 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 |
837 |
744 |
$40K |
| 70553 |
Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences |
159 |
153 |
$39K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
1,101 |
1,092 |
$39K |
| 84484 |
|
10,128 |
8,200 |
$37K |
| 70491 |
|
170 |
163 |
$32K |
| 12001 |
|
171 |
170 |
$31K |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
1,173 |
585 |
$28K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
33,237 |
27,694 |
$25K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
13,869 |
11,828 |
$24K |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
854 |
846 |
$24K |
| 42820 |
Tonsillectomy and adenoidectomy; younger than age 12 |
13 |
13 |
$22K |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
180 |
177 |
$22K |
| 72125 |
Computed tomography, cervical spine; without contrast material |
1,078 |
1,025 |
$21K |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
567 |
548 |
$18K |
| 74018 |
|
957 |
834 |
$18K |
| 73721 |
Magnetic resonance imaging, any joint of lower extremity; without contrast material |
78 |
75 |
$17K |
| 87040 |
|
2,500 |
1,764 |
$16K |
| 78815 |
Positron emission tomography (PET) for limited area imaging |
38 |
38 |
$16K |
| 97161 |
|
389 |
350 |
$15K |
| 83605 |
|
3,670 |
3,284 |
$15K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
12,909 |
11,549 |
$15K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
8,945 |
7,812 |
$15K |
| 83880 |
|
3,534 |
3,174 |
$15K |
| 90715 |
|
720 |
709 |
$14K |
| 76770 |
|
122 |
122 |
$13K |
| 76801 |
|
329 |
300 |
$13K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
7,026 |
6,219 |
$12K |
| 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 |
1,320 |
1,129 |
$11K |
| 76870 |
|
132 |
131 |
$11K |
| 70486 |
|
234 |
227 |
$10K |
| 72100 |
|
624 |
595 |
$10K |
| 85379 |
|
2,521 |
2,364 |
$10K |
| 76536 |
|
121 |
120 |
$9K |
| 73630 |
|
1,280 |
1,186 |
$9K |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
39 |
38 |
$8K |
| 74174 |
|
41 |
41 |
$8K |
| 99291 |
Critical care, evaluation and management of the critically ill patient, first 30-74 minutes |
180 |
179 |
$8K |
| 36415 |
Collection of venous blood by venipuncture |
12,385 |
9,902 |
$8K |
| 73030 |
|
883 |
812 |
$7K |
| 71250 |
|
150 |
149 |
$7K |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
10,669 |
9,888 |
$7K |
| 71045 |
Radiologic examination, chest; single view |
4,966 |
4,517 |
$7K |
| 73130 |
|
1,164 |
1,085 |
$7K |
| 76642 |
|
82 |
77 |
$6K |
| 80076 |
|
1,050 |
946 |
$6K |
| 70496 |
|
410 |
390 |
$6K |
| 74178 |
|
43 |
40 |
$5K |
| 73562 |
|
718 |
665 |
$5K |
| 97597 |
|
61 |
41 |
$5K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
6,931 |
6,375 |
$5K |
| 83690 |
|
7,946 |
7,135 |
$5K |
| 72131 |
|
135 |
127 |
$5K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
242 |
217 |
$5K |
| 87420 |
|
362 |
349 |
$5K |
| 76641 |
|
43 |
41 |
$5K |
| 73610 |
|
1,006 |
933 |
$5K |
| 96376 |
|
2,604 |
2,064 |
$4K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
57 |
52 |
$4K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
1,398 |
1,112 |
$4K |
| 81001 |
|
10,258 |
9,442 |
$4K |
| 96368 |
|
89 |
81 |
$4K |
| 87400 |
|
648 |
632 |
$4K |
| 83735 |
|
4,227 |
3,372 |
$4K |
| 81025 |
|
7,139 |
6,711 |
$3K |
| 73502 |
|
339 |
319 |
$3K |
| 73110 |
|
473 |
452 |
$3K |
| 12002 |
|
27 |
27 |
$3K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
19 |
12 |
$3K |
| 72148 |
Magnetic resonance imaging, lumbar spine; without contrast material |
27 |
26 |
$3K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
482 |
435 |
$2K |
| 81003 |
|
8,342 |
7,699 |
$2K |
| 12011 |
|
15 |
12 |
$2K |
| 85027 |
|
2,593 |
2,152 |
$2K |
| 11045 |
|
247 |
78 |
$2K |
| 87081 |
|
861 |
782 |
$2K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
39 |
38 |
$2K |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
11,585 |
10,185 |
$2K |
| 97162 |
|
50 |
45 |
$2K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
27 |
27 |
$2K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
741 |
720 |
$2K |
| 84703 |
|
3,967 |
3,749 |
$2K |
| J7030 |
Infusion, normal saline solution , 1000 cc |
4,688 |
3,826 |
$2K |
| 80143 |
|
1,353 |
1,265 |
$2K |
| 86140 |
|
2,811 |
2,564 |
$2K |
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
13 |
13 |
$2K |
| G0279 |
Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066) |
92 |
92 |
$2K |
| 85610 |
|
6,198 |
4,647 |
$2K |
| 87636 |
Infectious agent detection by nucleic acid; SARS-CoV-2 and influenza virus types A and B |
3,339 |
3,174 |
$1K |
| 87186 |
|
2,067 |
1,870 |
$1K |
| 84702 |
|
1,400 |
1,248 |
$1K |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
10,916 |
9,849 |
$1K |
| 87077 |
|
2,152 |
1,988 |
$1K |
| 84443 |
Thyroid stimulating hormone (TSH) |
801 |
737 |
$1K |
| C9803 |
Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
457 |
388 |
$1K |
| 85014 |
|
447 |
374 |
$1K |
| 96367 |
|
105 |
92 |
$975.04 |
| 82948 |
|
2,493 |
1,277 |
$974.36 |
| J1170 |
Injection, hydromorphone, up to 4 mg |
4,082 |
3,231 |
$971.46 |
| 77080 |
|
16 |
16 |
$946.24 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
5,900 |
5,521 |
$857.69 |
| 86900 |
|
1,401 |
1,295 |
$768.35 |
| 80179 |
|
1,316 |
1,231 |
$744.20 |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
1,971 |
1,846 |
$740.00 |
| 87070 |
|
1,565 |
1,482 |
$703.10 |
| 71101 |
|
126 |
122 |
$696.76 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
874 |
826 |
$680.42 |
| 85018 |
|
407 |
342 |
$661.63 |
| 87428 |
|
942 |
848 |
$655.52 |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
2,464 |
2,100 |
$644.64 |
| 85730 |
|
2,150 |
1,913 |
$630.66 |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
6,710 |
5,046 |
$630.18 |
| 36592 |
|
7,216 |
6,274 |
$629.38 |
| 94760 |
|
3,109 |
2,745 |
$625.30 |
| 72040 |
|
26 |
25 |
$602.15 |
| A9577 |
Injection, gadobenate dimeglumine (multihance), per ml |
745 |
725 |
$601.54 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
968 |
931 |
$553.17 |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
1,514 |
1,399 |
$544.15 |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
526 |
475 |
$537.60 |
| 86901 |
|
1,395 |
1,290 |
$536.19 |
| 97116 |
|
26 |
25 |
$523.17 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
2,856 |
2,480 |
$461.67 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
92 |
82 |
$400.34 |
| 87205 |
|
1,065 |
986 |
$400.23 |
| 77066 |
Tomosynthesis, mammo |
12 |
12 |
$378.23 |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
577 |
492 |
$373.66 |
| 73560 |
|
42 |
40 |
$348.47 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
759 |
736 |
$324.67 |
| 77065 |
Tomosynthesis, mammo |
12 |
12 |
$322.80 |
| G1004 |
Clinical decision support mechanism national decision support company, as defined by the medicare appropriate use criteria program |
2,389 |
2,028 |
$295.49 |
| 82077 |
|
1,857 |
1,689 |
$271.07 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
5,944 |
5,481 |
$267.83 |
| 82565 |
|
1,290 |
1,174 |
$261.68 |
| 73590 |
|
160 |
153 |
$245.64 |
| J3490 |
Unclassified drugs |
626 |
563 |
$237.07 |
| 82150 |
|
1,030 |
959 |
$213.41 |
| 82550 |
|
1,498 |
1,412 |
$208.28 |
| J2710 |
Injection, neostigmine methylsulfate, up to 0.5 mg |
1,046 |
994 |
$200.18 |
| A4649 |
Surgical supply; miscellaneous |
1,303 |
1,127 |
$185.69 |
| J2060 |
Injection, lorazepam, 2 mg |
1,037 |
932 |
$182.27 |
| 88304 |
|
146 |
137 |
$181.85 |
| J1630 |
Injection, haloperidol, up to 5 mg |
196 |
180 |
$154.20 |
| 84112 |
|
13 |
12 |
$145.64 |
| J0330 |
Injection, succinylcholine chloride, up to 20 mg |
880 |
843 |
$139.21 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
4,732 |
4,371 |
$136.86 |
| 73140 |
|
86 |
81 |
$135.05 |
| 99152 |
|
300 |
248 |
$118.82 |
| J2704 |
Injection, propofol, 10 mg |
3,451 |
2,777 |
$108.11 |
| J0690 |
Injection, cefazolin sodium, 500 mg |
2,746 |
2,363 |
$107.62 |
| 85651 |
|
107 |
98 |
$89.90 |
| 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 |
810 |
719 |
$75.72 |
| 87637 |
Infectious agent detection by nucleic acid; SARS-CoV-2, influenza, and RSV |
328 |
321 |
$72.68 |
| 86850 |
|
511 |
485 |
$54.72 |
| 82248 |
|
19 |
13 |
$53.74 |
| 85652 |
|
586 |
560 |
$51.35 |
| 82803 |
|
812 |
666 |
$49.37 |
| 82805 |
|
347 |
318 |
$49.34 |
| 87184 |
|
181 |
175 |
$42.63 |
| 80051 |
|
967 |
915 |
$37.41 |
| 82247 |
|
830 |
779 |
$35.54 |
| 73080 |
|
69 |
68 |
$32.36 |
| 84145 |
|
221 |
210 |
$28.16 |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
178 |
165 |
$27.83 |
| 85007 |
|
147 |
143 |
$25.45 |
| 84520 |
|
962 |
907 |
$21.65 |
| J8540 |
Dexamethasone, oral, 0.25 mg |
424 |
386 |
$20.90 |
| 80305 |
|
806 |
738 |
$18.32 |
| 99153 |
Mod sedat endo service >5yrs |
62 |
50 |
$17.75 |
| 87801 |
Infectious agent detection by nucleic acid; amplified probe, multiple organisms |
58 |
57 |
$17.22 |
| 82947 |
|
963 |
912 |
$16.75 |
| 87430 |
|
230 |
227 |
$15.86 |
| 84450 |
|
819 |
763 |
$14.67 |
| 84460 |
|
818 |
762 |
$14.57 |
| 82977 |
|
906 |
842 |
$13.98 |
| 84075 |
|
811 |
762 |
$10.70 |
| 84155 |
|
731 |
687 |
$9.22 |
| 87481 |
|
64 |
55 |
$8.89 |
| 80050 |
General health panel |
32 |
32 |
$8.43 |
| 36416 |
|
377 |
355 |
$8.24 |
| 87210 |
|
153 |
148 |
$4.23 |
| 82040 |
|
819 |
763 |
$3.81 |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
55 |
54 |
$2.97 |
| J2919 |
Injection, methylprednisolone sodium succinate, 5 mg |
204 |
173 |
$2.57 |
| J2370 |
Injection, phenylephrine hcl, up to 1 ml |
260 |
248 |
$1.78 |
| J0665 |
Injection, bupivicaine, not otherwise specified, 0.5 mg |
481 |
448 |
$1.00 |
| J1790 |
Injection, droperidol, up to 5 mg |
147 |
136 |
$0.75 |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
675 |
600 |
$0.64 |
| 82270 |
|
85 |
84 |
$0.14 |
| J1815 |
Injection, insulin, per 5 units |
468 |
313 |
$0.04 |
| J1940 |
Injection, furosemide, up to 20 mg |
66 |
47 |
$0.00 |
| A9270 |
Non-covered item or service |
1,530 |
980 |
$0.00 |
| J7050 |
Infusion, normal saline solution, 250 cc |
451 |
340 |
$0.00 |
| J2001 |
Injection, lidocaine hcl for intravenous infusion, 10 mg |
990 |
930 |
$0.00 |
| C1769 |
Guide wire |
474 |
427 |
$0.00 |
| J3480 |
Injection, potassium chloride, per 2 meq |
126 |
80 |
$0.00 |
| J2371 |
Injection, phenylephrine hydrochloride, 20 micrograms |
217 |
213 |
$0.00 |
| Q9969 |
Tc-99m from non-highly enriched uranium source, full cost recovery add-on, per study dose |
13 |
12 |
$0.00 |
| J3360 |
Injection, diazepam, up to 5 mg |
28 |
26 |
$0.00 |
| J1920 |
Injection, labetalol hydrochloride, 5 mg |
30 |
28 |
$0.00 |
| J2543 |
Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams) |
53 |
36 |
$0.00 |
| 73564 |
|
13 |
12 |
$0.00 |
| J7060 |
5% dextrose/water (500 ml = 1 unit) |
23 |
16 |
$0.00 |
| J2003 |
Injection, lidocaine hydrochloride, 1 mg |
243 |
219 |
$0.00 |
| J0360 |
Injection, hydralazine hcl, up to 20 mg |
14 |
14 |
$0.00 |
| 81015 |
|
14 |
12 |
$0.00 |
| 73090 |
|
32 |
29 |
$0.00 |
| J0780 |
Injection, prochlorperazine, up to 10 mg |
489 |
456 |
$0.00 |
| C9113 |
Injection, pantoprazole sodium, per vial |
48 |
37 |
$0.00 |
| C1894 |
Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser |
338 |
267 |
$0.00 |
| J7040 |
Infusion, normal saline solution, sterile (500 ml = 1 unit) |
230 |
192 |
$0.00 |
| J1171 |
Injection, hydromorphone, 0.1 mg |
134 |
113 |
$0.00 |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
294 |
257 |
$0.00 |
| J1596 |
Injection, glycopyrrolate, 0.1 mg |
152 |
147 |
$0.00 |
| J3370 |
Injection, vancomycin hcl, 500 mg |
413 |
259 |
$0.00 |
| J1650 |
Injection, enoxaparin sodium, 10 mg |
365 |
197 |
$0.00 |
| A9552 |
Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries |
48 |
38 |
$0.00 |
| C1776 |
Joint device (implantable) |
13 |
12 |
$0.00 |
| C1713 |
Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable) |
151 |
137 |
$0.00 |
| J2004 |
Injection, lidocaine hcl with epinephrine, 1 mg |
34 |
34 |
$0.00 |
| J1644 |
Injection, heparin sodium, per 1000 units |
162 |
97 |
$0.00 |
| 86756 |
|
106 |
104 |
$0.00 |
| 82010 |
|
69 |
59 |
$0.00 |
| 80061 |
Lipid panel |
14 |
13 |
$0.00 |
| J0171 |
Injection, adrenalin, epinephrine, 0.1 mg |
14 |
12 |
$0.00 |
| 51702 |
|
27 |
26 |
$0.00 |
| J2550 |
Injection, promethazine hcl, up to 50 mg |
12 |
12 |
$0.00 |
| C1760 |
Closure device, vascular (implantable/insertable) |
14 |
14 |
$0.00 |
| 87075 |
|
15 |
12 |
$0.00 |
| C1758 |
Catheter, ureteral |
21 |
16 |
$0.00 |