| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99284 |
Emergency department visit for the evaluation and management, high severity |
46,956 |
37,824 |
$2.81M |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
35,816 |
30,146 |
$2.48M |
| 96361 |
Intravenous infusion, hydration; each additional hour |
19,686 |
15,090 |
$1.50M |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
30,419 |
23,148 |
$1.50M |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
6,216 |
4,855 |
$680K |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
8,181 |
7,177 |
$640K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
4,856 |
3,731 |
$445K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
6,167 |
4,798 |
$405K |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
11,990 |
8,705 |
$389K |
| 70450 |
Computed tomography, head or brain; without contrast material |
6,064 |
4,486 |
$358K |
| 80053 |
Comprehensive metabolic panel |
38,021 |
23,800 |
$303K |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
14,778 |
7,887 |
$264K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
29,324 |
22,940 |
$230K |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
2,875 |
2,584 |
$214K |
| 96413 |
Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance |
5,531 |
2,125 |
$211K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
78,437 |
50,107 |
$209K |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
1,700 |
1,190 |
$204K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
34,763 |
24,537 |
$196K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
19,154 |
13,114 |
$189K |
| G0378 |
Hospital observation service, per hour |
11,492 |
5,167 |
$182K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
26,925 |
20,532 |
$162K |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
4,921 |
3,383 |
$159K |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
16,940 |
11,224 |
$158K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
13,642 |
9,538 |
$158K |
| 36415 |
Collection of venous blood by venipuncture |
20,188 |
11,087 |
$149K |
| J7040 |
Infusion, normal saline solution, sterile (500 ml = 1 unit) |
6,365 |
2,266 |
$145K |
| 45380 |
Colonoscopy, flexible; with biopsy, single or multiple |
648 |
487 |
$138K |
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
2,864 |
2,287 |
$133K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
1,137 |
915 |
$125K |
| 87631 |
|
6,690 |
5,934 |
$117K |
| J1642 |
Injection, heparin sodium, (heparin lock flush), per 10 units |
4,391 |
1,497 |
$116K |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
7,345 |
4,749 |
$113K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
2,453 |
2,127 |
$109K |
| J7050 |
Infusion, normal saline solution, 250 cc |
4,486 |
1,910 |
$99K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
4,087 |
2,770 |
$97K |
| 76641 |
|
5,396 |
2,471 |
$87K |
| 45385 |
Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) |
454 |
331 |
$87K |
| 70498 |
|
1,076 |
811 |
$86K |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
6,843 |
4,501 |
$82K |
| 76770 |
|
1,712 |
1,260 |
$78K |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
1,603 |
1,150 |
$75K |
| J7620 |
Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme |
1,156 |
956 |
$74K |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
5,649 |
928 |
$73K |
| G0121 |
Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk |
166 |
155 |
$73K |
| 71046 |
Radiologic examination, chest; 2 views |
14,755 |
11,257 |
$70K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
5,281 |
2,759 |
$63K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
5,321 |
4,641 |
$61K |
| 87088 |
|
22,414 |
17,786 |
$56K |
| 80076 |
|
10,005 |
7,855 |
$53K |
| J7060 |
5% dextrose/water (500 ml = 1 unit) |
1,144 |
424 |
$52K |
| 72125 |
Computed tomography, cervical spine; without contrast material |
1,979 |
1,450 |
$51K |
| J2001 |
Injection, lidocaine hcl for intravenous infusion, 10 mg |
8,834 |
5,642 |
$46K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
2,989 |
2,288 |
$45K |
| 10060 |
|
681 |
586 |
$43K |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
5,742 |
3,923 |
$43K |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
5,987 |
4,082 |
$42K |
| 71045 |
Radiologic examination, chest; single view |
11,939 |
8,860 |
$38K |
| J2704 |
Injection, propofol, 10 mg |
8,550 |
5,645 |
$37K |
| 77066 |
Tomosynthesis, mammo |
1,756 |
1,213 |
$36K |
| 81025 |
|
11,992 |
10,551 |
$35K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
23,746 |
16,548 |
$34K |
| 73610 |
|
1,609 |
1,294 |
$32K |
| 41899 |
Unlisted procedure, dentoalveolar structures |
104 |
68 |
$31K |
| 76830 |
Ultrasound, transvaginal |
2,048 |
1,726 |
$31K |
| 85610 |
|
17,855 |
12,756 |
$31K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
3,978 |
2,691 |
$31K |
| 85730 |
|
16,466 |
11,802 |
$28K |
| C1769 |
Guide wire |
2,700 |
1,826 |
$28K |
| J0690 |
Injection, cefazolin sodium, 500 mg |
2,262 |
1,369 |
$26K |
| 86850 |
|
2,299 |
1,508 |
$26K |
| 11042 |
Debridement, subcutaneous tissue (includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm |
1,133 |
422 |
$26K |
| 72131 |
|
1,134 |
839 |
$26K |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
687 |
458 |
$25K |
| 86900 |
|
3,109 |
2,193 |
$25K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
2,165 |
1,722 |
$25K |
| 83615 |
|
2,270 |
1,214 |
$25K |
| J1644 |
Injection, heparin sodium, per 1000 units |
4,566 |
2,277 |
$25K |
| 71250 |
|
2,057 |
1,333 |
$24K |
| 85027 |
|
2,531 |
1,687 |
$24K |
| J3490 |
Unclassified drugs |
12,923 |
7,928 |
$23K |
| A9579 |
Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (nos), per ml |
1,532 |
1,030 |
$22K |
| C1894 |
Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser |
1,790 |
1,217 |
$22K |
| 93970 |
|
1,213 |
879 |
$21K |
| 93971 |
|
1,938 |
1,393 |
$20K |
| 83735 |
|
3,522 |
2,304 |
$19K |
| 73130 |
|
1,526 |
1,101 |
$19K |
| 73630 |
|
1,936 |
1,507 |
$18K |
| 73562 |
|
2,542 |
1,806 |
$18K |
| 84443 |
Thyroid stimulating hormone (TSH) |
4,970 |
3,419 |
$17K |
| 12001 |
|
315 |
280 |
$17K |
| J1170 |
Injection, hydromorphone, up to 4 mg |
1,483 |
972 |
$17K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
1,402 |
1,182 |
$16K |
| 81001 |
|
15,891 |
12,493 |
$16K |
| 84439 |
|
1,881 |
1,122 |
$16K |
| 87077 |
|
4,422 |
3,440 |
$16K |
| 77065 |
Tomosynthesis, mammo |
956 |
632 |
$16K |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
877 |
547 |
$15K |
| 80061 |
Lipid panel |
3,458 |
2,449 |
$15K |
| 76819 |
Fetal biophysical profile; without non-stress testing |
493 |
377 |
$15K |
| 74178 |
|
220 |
151 |
$15K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
977 |
641 |
$14K |
| 96417 |
|
873 |
310 |
$14K |
| 76801 |
|
1,823 |
1,480 |
$14K |
| 84484 |
|
16,607 |
11,200 |
$14K |
| 73110 |
|
1,139 |
833 |
$13K |
| 84702 |
|
3,155 |
2,504 |
$13K |
| 73030 |
|
2,169 |
1,494 |
$13K |
| J9271 |
Injection, pembrolizumab, 1 mg |
86 |
38 |
$12K |
| 76536 |
|
379 |
290 |
$12K |
| J0330 |
Injection, succinylcholine chloride, up to 20 mg |
2,457 |
1,626 |
$11K |
| J3370 |
Injection, vancomycin hcl, 500 mg |
1,676 |
950 |
$11K |
| 87081 |
|
593 |
547 |
$11K |
| 81003 |
|
11,894 |
9,677 |
$10K |
| C9803 |
Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
2,330 |
1,574 |
$10K |
| 83690 |
|
13,156 |
10,319 |
$10K |
| J2370 |
Injection, phenylephrine hcl, up to 1 ml |
2,095 |
1,408 |
$10K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
3,196 |
2,357 |
$9K |
| 86901 |
|
3,055 |
2,142 |
$8K |
| 88304 |
|
539 |
410 |
$8K |
| 12011 |
|
118 |
107 |
$8K |
| 87070 |
|
836 |
624 |
$8K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
1,265 |
1,042 |
$8K |
| 82728 |
|
3,030 |
1,852 |
$8K |
| 70486 |
|
201 |
157 |
$8K |
| 77080 |
|
572 |
433 |
$7K |
| 70496 |
|
999 |
754 |
$7K |
| C1887 |
Catheter, guiding (may include infusion/perfusion capability) |
409 |
263 |
$7K |
| 83540 |
|
2,548 |
1,590 |
$7K |
| 83550 |
|
2,520 |
1,566 |
$7K |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
2,012 |
1,140 |
$7K |
| 87040 |
|
4,380 |
3,251 |
$6K |
| 93458 |
|
99 |
69 |
$6K |
| 74174 |
|
76 |
57 |
$6K |
| 96415 |
|
310 |
156 |
$6K |
| 82607 |
|
2,239 |
1,388 |
$6K |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
13,291 |
10,498 |
$6K |
| 82746 |
|
1,876 |
1,154 |
$6K |
| Q9966 |
Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml |
95 |
67 |
$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 |
2,137 |
1,684 |
$5K |
| 74018 |
|
437 |
331 |
$5K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
1,926 |
1,745 |
$5K |
| 83605 |
|
6,100 |
4,488 |
$5K |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
2,912 |
2,664 |
$5K |
| 97161 |
|
439 |
320 |
$4K |
| 74183 |
|
52 |
40 |
$4K |
| 73080 |
|
453 |
355 |
$4K |
| 96367 |
|
360 |
190 |
$4K |
| 78815 |
Positron emission tomography (PET) for limited area imaging |
308 |
206 |
$4K |
| 83880 |
|
3,945 |
2,748 |
$4K |
| J2710 |
Injection, neostigmine methylsulfate, up to 0.5 mg |
719 |
441 |
$4K |
| 87205 |
|
1,412 |
1,064 |
$4K |
| J2060 |
Injection, lorazepam, 2 mg |
1,451 |
1,024 |
$3K |
| G1004 |
Clinical decision support mechanism national decision support company, as defined by the medicare appropriate use criteria program |
2,198 |
1,398 |
$3K |
| 72148 |
Magnetic resonance imaging, lumbar spine; without contrast material |
322 |
204 |
$3K |
| 70553 |
Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences |
40 |
24 |
$3K |
| C1725 |
Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability) |
17 |
13 |
$3K |
| 84481 |
|
453 |
247 |
$3K |
| 87186 |
|
3,788 |
2,926 |
$3K |
| 73502 |
|
892 |
654 |
$3K |
| J0360 |
Injection, hydralazine hcl, up to 20 mg |
793 |
505 |
$3K |
| C1760 |
Closure device, vascular (implantable/insertable) |
186 |
123 |
$3K |
| 88300 |
|
552 |
387 |
$3K |
| 72197 |
|
18 |
12 |
$3K |
| 93017 |
|
164 |
124 |
$3K |
| 96376 |
|
1,826 |
1,430 |
$3K |
| J1815 |
Injection, insulin, per 5 units |
2,532 |
939 |
$3K |
| 72100 |
|
347 |
265 |
$3K |
| M0243 |
Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring |
468 |
373 |
$3K |
| 76775 |
|
142 |
107 |
$2K |
| 87075 |
|
455 |
319 |
$2K |
| 85379 |
|
2,071 |
1,683 |
$2K |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
570 |
462 |
$2K |
| 72110 |
|
417 |
326 |
$2K |
| 76870 |
|
110 |
98 |
$2K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
2,599 |
1,898 |
$2K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
216 |
192 |
$2K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
1,944 |
1,763 |
$2K |
| 84153 |
|
532 |
323 |
$2K |
| 90715 |
|
1,461 |
1,166 |
$2K |
| 88342 |
|
1,203 |
743 |
$2K |
| 73140 |
|
127 |
108 |
$2K |
| 82565 |
|
759 |
511 |
$2K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
80 |
71 |
$2K |
| 12002 |
|
59 |
51 |
$2K |
| 85045 |
|
132 |
77 |
$2K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
1,692 |
1,141 |
$2K |
| J3420 |
Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg |
324 |
147 |
$1K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,406 |
1,063 |
$1K |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
3,824 |
2,763 |
$1K |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
754 |
598 |
$1K |
| 82378 |
|
86 |
50 |
$1K |
| 84520 |
|
467 |
311 |
$1K |
| 83970 |
|
426 |
268 |
$1K |
| 72040 |
|
84 |
65 |
$1K |
| 71101 |
|
60 |
50 |
$1K |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
2,615 |
2,149 |
$1K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
569 |
522 |
$1K |
| Q5106 |
Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use), 1000 units |
302 |
102 |
$1K |
| J0885 |
Injection, epoetin alfa, (for non-esrd use), 1000 units |
88 |
25 |
$976.72 |
| 82550 |
|
1,801 |
1,354 |
$881.58 |
| 84100 |
|
1,325 |
860 |
$851.43 |
| 96368 |
|
41 |
29 |
$822.39 |
| 72141 |
|
20 |
13 |
$792.37 |
| 94726 |
|
63 |
51 |
$762.56 |
| P9016 |
Red blood cells, leukocytes reduced, each unit |
73 |
36 |
$666.30 |
| 84550 |
|
1,102 |
739 |
$660.21 |
| 86140 |
|
1,089 |
798 |
$639.01 |
| C1893 |
Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, other than peel-away |
98 |
57 |
$610.22 |
| J0561 |
Injection, penicillin g benzathine, 100,000 units |
105 |
103 |
$590.40 |
| 82272 |
|
250 |
185 |
$563.65 |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
117 |
27 |
$560.25 |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
64 |
57 |
$559.03 |
| G8979 |
Mobility: walking & moving around functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting |
72 |
56 |
$546.08 |
| J1650 |
Injection, enoxaparin sodium, 10 mg |
1,773 |
893 |
$542.18 |
| J2360 |
Injection, orphenadrine citrate, up to 60 mg |
2,042 |
1,680 |
$532.87 |
| 74221 |
|
17 |
12 |
$505.80 |
| 84165 |
|
183 |
108 |
$500.41 |
| 96401 |
|
36 |
12 |
$498.70 |
| 97116 |
|
234 |
83 |
$453.44 |
| 51702 |
|
21 |
13 |
$444.36 |
| 93925 |
|
17 |
12 |
$362.57 |
| 85652 |
|
568 |
391 |
$353.74 |
| 73660 |
|
17 |
12 |
$340.33 |
| G8978 |
Mobility: walking & moving around functional limitation, current status, at therapy episode outset and at reporting intervals |
48 |
42 |
$317.26 |
| 82570 |
|
581 |
403 |
$316.44 |
| 82784 |
|
92 |
46 |
$313.81 |
| 77336 |
|
51 |
13 |
$276.73 |
| J1940 |
Injection, furosemide, up to 20 mg |
265 |
132 |
$230.16 |
| 87045 |
|
36 |
30 |
$227.74 |
| M0239 |
Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring |
50 |
38 |
$207.81 |
| 74019 |
|
35 |
29 |
$196.47 |
| 84156 |
|
270 |
171 |
$173.47 |
| J1756 |
Injection, iron sucrose, 1 mg |
133 |
50 |
$143.60 |
| G0279 |
Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066) |
359 |
262 |
$141.61 |
| C1758 |
Catheter, ureteral |
148 |
106 |
$129.42 |
| J1956 |
Injection, levofloxacin, 250 mg |
67 |
38 |
$129.42 |
| 00813 |
|
238 |
198 |
$106.54 |
| 94729 |
|
66 |
53 |
$86.97 |
| J1630 |
Injection, haloperidol, up to 5 mg |
180 |
140 |
$79.05 |
| J8540 |
Dexamethasone, oral, 0.25 mg |
1,131 |
829 |
$77.06 |
| 00812 |
|
100 |
92 |
$74.45 |
| M0222 |
Intravenous injection, bebtelovimab, includes injection and post administration monitoring |
279 |
193 |
$63.54 |
| 86592 |
|
46 |
29 |
$54.28 |
| 00731 |
|
42 |
37 |
$51.53 |
| 87340 |
|
204 |
124 |
$46.08 |
| 86300 |
|
55 |
25 |
$41.39 |
| 73090 |
|
30 |
29 |
$39.57 |
| 80069 |
|
114 |
70 |
$34.02 |
| 94010 |
|
21 |
16 |
$33.43 |
| 82248 |
|
819 |
512 |
$28.10 |
| J2543 |
Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams) |
476 |
229 |
$21.59 |
| 00170 |
Anesthesia for intraoral procedures, including biopsy |
67 |
51 |
$15.44 |
| 86704 |
|
46 |
27 |
$9.31 |
| 86706 |
|
50 |
29 |
$9.31 |
| 73060 |
|
16 |
12 |
$5.81 |
| 82043 |
|
31 |
24 |
$0.06 |
| J0500 |
Injection, dicyclomine hcl, up to 20 mg |
457 |
371 |
$0.00 |
| 87147 |
|
151 |
112 |
$0.00 |
| 87449 |
|
52 |
41 |
$0.00 |
| 78452 |
Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress |
14 |
13 |
$0.00 |
| 83883 |
|
20 |
12 |
$0.00 |
| 85651 |
|
36 |
26 |
$0.00 |
| 97165 |
|
17 |
12 |
$0.00 |
| C2617 |
Stent, non-coronary, temporary, without delivery system |
19 |
12 |
$0.00 |
| J7799 |
Noc drugs, other than inhalation drugs, administered through dme |
17 |
13 |
$0.00 |
| A9552 |
Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries |
369 |
255 |
$0.00 |
| 84145 |
|
19 |
12 |
$0.00 |
| 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 |
68 |
58 |
$0.00 |
| C9113 |
Injection, pantoprazole sodium, per vial |
15 |
13 |
$0.00 |
| 87324 |
|
35 |
28 |
$0.00 |
| J2720 |
Injection, protamine sulfate, per 10 mg |
19 |
13 |
$0.00 |
| A9502 |
Technetium tc-99m tetrofosmin, diagnostic, per study dose |
13 |
12 |
$0.00 |
| 29125 |
|
14 |
12 |
$0.00 |
| 73590 |
|
45 |
37 |
$0.00 |
| J3486 |
Injection, ziprasidone mesylate, 10 mg |
18 |
12 |
$0.00 |
| 87177 |
|
18 |
15 |
$0.00 |