NPI: 1932123247 · DALLAS, TX 75235 · Ambulatory Surgical Clinic/Center · NPI assigned 07/27/2006
Authorized official CERISE, FREDERICK controls 20+ related entities in our dataset. Read more
| Authorized Official | CERISE, FREDERICK (PRESIDENT/CHIEF EXECUTIVE OFFICER) |
| Parent Organization | DALLAS COUNTY HOSPITAL DISTRICT |
| NPI Enumeration Date | 07/27/2006 |
Other providers sharing the same authorized official: CERISE, FREDERICK
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 1,854 | $18K |
| 2019 | 17,111 | $611K |
| 2020 | 216,258 | $7.79M |
| 2021 | 888,880 | $38.03M |
| 2022 | 860,511 | $40.44M |
| 2023 | 763,611 | $38.64M |
| 2024 | 540,599 | $27.07M |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| 99213 | Office or other outpatient visit for the evaluation and management of an established patient, low complexity | 202,096 | 177,785 | $21.73M |
| 99212 | Office or other outpatient visit for the evaluation and management of an established patient, straightforward | 205,236 | 173,075 | $14.92M |
| J9271 | Injection, pembrolizumab, 1 mg | 853 | 703 | $11.66M |
| 99284 | Emergency department visit for the evaluation and management, high severity | 35,558 | 31,864 | $11.55M |
| 87801 | Infectious agent detection by nucleic acid; amplified probe, multiple organisms | 97,090 | 88,958 | $7.28M |
| 76805 | Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation | 33,404 | 32,654 | $4.85M |
| 81420 | Fetal chromosomal aneuploidy genomic sequence analysis panel | 7,579 | 6,793 | $4.39M |
| 99285 | Emergency department visit for the evaluation and management, high severity with immediate threat to life | 15,332 | 13,998 | $4.11M |
| 99214 | Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity | 30,475 | 27,837 | $3.32M |
| 86850 | 56,985 | 50,076 | $2.66M | |
| 87389 | Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies | 94,967 | 87,472 | $2.60M |
| 74177 | Computed tomography, abdomen and pelvis; with contrast material | 6,141 | 5,864 | $1.97M |
| 93005 | Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report | 28,380 | 23,199 | $1.91M |
| 99283 | Emergency department visit for the evaluation and management, moderate severity | 33,380 | 29,469 | $1.80M |
| 76816 | Ultrasound, pregnant uterus, real time with image documentation, follow-up | 12,706 | 11,408 | $1.64M |
| 90471 | Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine | 57,068 | 54,422 | $1.52M |
| 99211 | Office or other outpatient visit for the evaluation and management of an established patient, minimal severity | 29,222 | 26,529 | $1.48M |
| 86780 | 92,067 | 84,079 | $1.44M | |
| 93306 | Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete | 3,754 | 3,676 | $1.44M |
| 99204 | Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity | 12,036 | 10,799 | $1.18M |
| 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 | 15,551 | 14,501 | $1.14M |
| J9035 | Injection, bevacizumab, 10 mg | 278 | 129 | $996K |
| 87084 | 42,125 | 36,792 | $950K | |
| 96413 | Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance | 6,007 | 4,103 | $922K |
| 96365 | Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour | 6,643 | 6,032 | $796K |
| 96361 | Intravenous infusion, hydration; each additional hour | 7,377 | 5,738 | $783K |
| 90715 | 23,124 | 22,547 | $769K | |
| 80053 | Comprehensive metabolic panel | 63,172 | 51,077 | $764K |
| 84702 | 32,286 | 27,759 | $750K | |
| 97110 | Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion | 9,264 | 4,719 | $744K |
| J9312 | Injection, rituximab, 10 mg | 132 | 105 | $718K |
| J2505 | Injection, pegfilgrastim, 6 mg | 114 | 82 | $694K |
| J0585 | Injection, onabotulinumtoxina, 1 unit | 427 | 324 | $683K |
| 86762 | 42,187 | 37,005 | $663K | |
| G0463 | Hospital outpatient clinic visit for assessment and management of a patient | 51,595 | 41,265 | $649K |
| 87340 | 52,376 | 46,533 | $632K | |
| 88175 | Cytopathology, cervical or vaginal, any reporting system; collected in preservative fluid, automated thin layer | 23,265 | 21,830 | $627K |
| 76817 | Ultrasound, pregnant uterus, real time with image documentation, transvaginal | 6,536 | 6,003 | $616K |
| 70553 | Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences | 1,325 | 1,306 | $606K |
| 87536 | 5,891 | 5,734 | $596K | |
| 70450 | Computed tomography, head or brain; without contrast material | 4,919 | 4,617 | $567K |
| 85025 | Blood count; complete (CBC), automated, and automated differential WBC count | 70,605 | 57,348 | $565K |
| 90677 | 1,470 | 1,440 | $561K | |
| 81003 | 126,545 | 106,312 | $530K | |
| 76811 | Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, detailed | 2,788 | 2,695 | $526K |
| 71260 | Computed tomography, thorax, diagnostic; with contrast material | 2,588 | 2,553 | $521K |
| 77067 | Screening mammography, bilateral, including computer-aided detection | 4,813 | 4,783 | $507K |
| 96366 | Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour | 3,956 | 2,822 | $466K |
| 71275 | Computed tomographic angiography, chest, with contrast material | 1,897 | 1,802 | $452K |
| 74183 | 950 | 938 | $428K | |
| J9144 | Injection, daratumumab, 10 mg and hyaluronidase-fihj | 73 | 40 | $425K |
| 84703 | 43,049 | 38,209 | $424K | |
| 99281 | Emergency department visit for the evaluation and management, self-limited or minor | 10,632 | 7,797 | $416K |
| 99215 | Prolong outpt/office vis | 4,114 | 3,659 | $415K |
| 99203 | Office or other outpatient visit for the evaluation and management of a new patient, low complexity | 4,991 | 4,649 | $414K |
| 90688 | 23,589 | 22,618 | $403K | |
| 80307 | Drug test(s), presumptive, any number of drug classes; immunoassay | 6,218 | 5,782 | $398K |
| 88305 | Level IV - Surgical pathology, gross and microscopic examination | 4,495 | 4,285 | $385K |
| 81025 | 27,338 | 23,624 | $384K | |
| 83880 | 10,456 | 9,410 | $364K | |
| 80061 | Lipid panel | 21,090 | 20,555 | $362K |
| 99205 | Prolong outpt/office vis | 3,730 | 3,242 | $352K |
| J0185 | Injection, aprepitant, 1 mg | 902 | 615 | $347K |
| 86900 | 59,323 | 52,043 | $343K | |
| 84443 | Thyroid stimulating hormone (TSH) | 20,939 | 19,785 | $341K |
| 83036 | Hemoglobin; glycosylated (A1C) | 32,938 | 31,839 | $338K |
| 82677 | 12,230 | 11,569 | $335K | |
| 82105 | 14,175 | 13,378 | $333K | |
| 76801 | 2,939 | 2,876 | $331K | |
| 86901 | 59,324 | 52,042 | $327K | |
| 96360 | Intravenous infusion, hydration; initial, 31 minutes to 1 hour | 3,485 | 3,289 | $326K |
| 0002A | 10,009 | 9,914 | $319K | |
| 74176 | Computed tomography, abdomen and pelvis; without contrast material | 1,606 | 1,532 | $318K |
| 71046 | Radiologic examination, chest; 2 views | 8,641 | 8,089 | $312K |
| 76705 | Ultrasound, abdominal, real time with image documentation; limited | 3,221 | 3,086 | $312K |
| 82565 | 49,646 | 44,537 | $308K | |
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg | 42 | 36 | $295K |
| 85049 | 39,428 | 34,445 | $294K | |
| 82306 | Vitamin D; 25 hydroxy, includes fraction(s), if performed | 9,437 | 9,160 | $293K |
| 85013 | 37,119 | 34,857 | $289K | |
| 86336 | 12,320 | 11,654 | $268K | |
| 80048 | Basic metabolic panel (calcium, ionized) | 34,397 | 26,134 | $267K |
| 77063 | Screening digital breast tomosynthesis, bilateral | 4,242 | 4,212 | $263K |
| 82950 | 30,585 | 29,696 | $259K | |
| 85027 | 36,806 | 28,718 | $257K | |
| 84484 | 19,466 | 10,550 | $256K | |
| 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 | 12,083 | 11,251 | $255K |
| 82947 | 42,473 | 37,512 | $244K | |
| 0001A | 10,988 | 10,706 | $242K | |
| 71045 | Radiologic examination, chest; single view | 9,883 | 8,771 | $237K |
| 99282 | Emergency department visit for the evaluation and management, low to moderate severity | 5,198 | 4,371 | $234K |
| 87086 | Culture, bacterial; quantitative colony count, urine | 23,254 | 21,638 | $234K |
| 71250 | 2,050 | 2,012 | $229K | |
| 20610 | 1,394 | 1,293 | $226K | |
| 93970 | 1,077 | 1,035 | $225K | |
| 85014 | 50,494 | 44,907 | $212K | |
| 87636 | Infectious agent detection by nucleic acid; SARS-CoV-2 and influenza virus types A and B | 1,547 | 1,467 | $205K |
| 86923 | 1,153 | 942 | $204K | |
| 87428 | 3,692 | 3,553 | $199K | |
| 11042 | Debridement, subcutaneous tissue (includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm | 1,049 | 766 | $198K |
| 45380 | Colonoscopy, flexible; with biopsy, single or multiple | 442 | 425 | $198K |
| 96375 | Therapeutic injection; each additional sequential IV push | 10,432 | 7,867 | $188K |
| Q5107 | Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg | 65 | 26 | $182K |
| 93971 | 1,437 | 1,361 | $181K | |
| 78815 | Positron emission tomography (PET) for limited area imaging | 110 | 110 | $180K |
| 99391 | Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) | 10,956 | 9,165 | $175K |
| 86361 | 5,523 | 5,384 | $175K | |
| 86481 | 1,868 | 1,809 | $170K | |
| P9016 | Red blood cells, leukocytes reduced, each unit | 1,033 | 829 | $170K |
| J2506 | Injection, pegfilgrastim, excludes biosimilar, 0.5 mg | 39 | 28 | $169K |
| 96416 | 921 | 569 | $168K | |
| 76830 | Ultrasound, transvaginal | 1,038 | 1,017 | $164K |
| 96367 | 2,237 | 1,849 | $163K | |
| 76770 | 1,304 | 1,257 | $157K | |
| 85018 | 18,142 | 16,920 | $155K | |
| 83655 | 14,683 | 14,350 | $153K | |
| 87624 | Infectious agent detection by nucleic acid; human papillomavirus (HPV), high-risk types | 4,157 | 4,009 | $152K |
| 96374 | Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance | 7,304 | 6,641 | $149K |
| 72148 | Magnetic resonance imaging, lumbar spine; without contrast material | 565 | 553 | $144K |
| 72125 | Computed tomography, cervical spine; without contrast material | 1,234 | 1,184 | $142K |
| 43239 | Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple | 455 | 441 | $141K |
| 86803 | 13,121 | 12,093 | $140K | |
| 83970 | 3,879 | 3,765 | $137K | |
| 96417 | 1,698 | 1,216 | $134K | |
| 83735 | 22,621 | 15,117 | $132K | |
| 70551 | Magnetic resonance imaging, brain; without contrast material | 515 | 496 | $132K |
| 80050 | General health panel | 747 | 711 | $126K |
| 82728 | 7,629 | 7,347 | $117K | |
| 16020 | 925 | 789 | $116K | |
| 76642 | 1,275 | 1,200 | $114K | |
| 73630 | 2,966 | 2,706 | $114K | |
| 96415 | 1,969 | 1,471 | $111K | |
| J0561 | Injection, penicillin g benzathine, 100,000 units | 241 | 167 | $103K |
| 31575 | 960 | 919 | $103K | |
| 90670 | 1,618 | 1,523 | $99K | |
| 94640 | Pressurized or nonpressurized inhalation treatment for acute airway obstruction | 2,592 | 2,200 | $99K |
| 73560 | 2,541 | 2,335 | $95K | |
| 94060 | 508 | 502 | $94K | |
| 94729 | 1,032 | 1,017 | $93K | |
| 93308 | 756 | 725 | $92K | |
| 91320 | 1,040 | 927 | $92K | |
| 49083 | 182 | 122 | $91K | |
| 97162 | 1,572 | 1,469 | $91K | |
| 76857 | 1,222 | 1,184 | $91K | |
| 76825 | 303 | 274 | $89K | |
| 93017 | 341 | 338 | $88K | |
| 87210 | 13,505 | 12,552 | $88K | |
| 81220 | CFTR (cystic fibrosis transmembrane conductance regulator) gene analysis; common variants | 178 | 167 | $87K |
| 84460 | 15,511 | 14,881 | $87K | |
| 84450 | 16,441 | 15,622 | $87K | |
| 97161 | 2,062 | 1,893 | $85K | |
| 96372 | Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular | 11,893 | 8,618 | $80K |
| 87522 | Neg quan hep c or qual rna | 1,609 | 1,537 | $80K |
| 82951 | 4,236 | 4,172 | $79K | |
| 95811 | 119 | 118 | $77K | |
| 90732 | 1,136 | 1,099 | $77K | |
| 73030 | 2,087 | 1,964 | $77K | |
| 92134 | 2,506 | 2,433 | $74K | |
| 90472 | Immunization administration, each additional vaccine (list separately) | 5,444 | 3,853 | $74K |
| 73502 | 1,476 | 1,395 | $72K | |
| 92083 | 1,590 | 1,558 | $72K | |
| 83690 | 11,204 | 10,148 | $70K | |
| 81001 | 22,898 | 20,664 | $70K | |
| 72131 | 582 | 562 | $69K | |
| 73610 | 1,740 | 1,613 | $67K | |
| 97530 | Therapeutic activities, direct patient contact, each 15 minutes | 1,623 | 1,087 | $67K |
| 76536 | 566 | 557 | $66K | |
| 92014 | Ophthalmological services: medical examination and evaluation, comprehensive, established patient | 1,024 | 1,016 | $65K |
| 96376 | 3,949 | 2,607 | $65K | |
| 97165 | 987 | 957 | $64K | |
| 77066 | Tomosynthesis, mammo | 448 | 447 | $64K |
| J0881 | Injection, darbepoetin alfa, 1 microgram (non-esrd use) | 121 | 89 | $64K |
| 84439 | 6,190 | 5,880 | $63K | |
| 92557 | 822 | 808 | $62K | |
| 86870 | 553 | 516 | $62K | |
| 85610 | 15,847 | 12,127 | $61K | |
| 72100 | 1,343 | 1,318 | $61K | |
| 87040 | 5,595 | 2,961 | $60K | |
| 90678 | 299 | 286 | $59K | |
| 51702 | 671 | 611 | $59K | |
| 84100 | 17,028 | 12,385 | $59K | |
| 82274 | 3,609 | 3,547 | $58K | |
| 73130 | 1,381 | 1,237 | $58K | |
| 83605 | 5,644 | 4,190 | $56K | |
| J0640 | Injection, leucovorin calcium, per 50 mg | 568 | 237 | $55K |
| 93923 | 336 | 332 | $55K | |
| 88720 | 11,200 | 10,649 | $55K | |
| 97166 | 631 | 612 | $53K | |
| 82803 | 2,302 | 1,904 | $53K | |
| 94010 | 547 | 532 | $52K | |
| 85660 | 6,589 | 5,804 | $51K | |
| J0696 | Injection, ceftriaxone sodium, per 250 mg | 4,216 | 3,060 | $51K |
| 94726 | 656 | 644 | $51K | |
| 67028 | Intravitreal injection of a pharmacologic agent | 986 | 959 | $51K |
| 70496 | 253 | 242 | $50K | |
| 82607 | 3,975 | 3,862 | $50K | |
| 70498 | 254 | 242 | $49K | |
| 76815 | Ultrasound, pregnant uterus, real time with image documentation, limited | 595 | 538 | $49K |
| G0257 | Unscheduled or emergency dialysis treatment for an esrd patient in a hospital outpatient department that is not certified as an esrd facility | 368 | 181 | $48K |
| J3370 | Injection, vancomycin hcl, 500 mg | 1,541 | 869 | $48K |
| 87902 | 161 | 158 | $47K | |
| P9047 | Infusion, albumin (human), 25%, 50 ml | 210 | 134 | $47K |
| 70491 | 232 | 225 | $47K | |
| 73110 | 1,019 | 915 | $47K | |
| 82247 | 10,464 | 8,603 | $46K | |
| 87635 | Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe | 637 | 593 | $46K |
| 82570 | 8,738 | 7,964 | $45K | |
| J1050 | Injection, medroxyprogesterone acetate, 1 mg | 762 | 740 | $45K |
| 88342 | 703 | 661 | $44K | |
| 72158 | 111 | 107 | $42K | |
| 90656 | 2,328 | 2,278 | $42K | |
| 90832 | Psychotherapy, 30 minutes with patient | 1,006 | 776 | $42K |
| 59025 | Fetal non-stress test | 832 | 801 | $42K |
| 66984 | Extracapsular cataract removal with insertion of intraocular lens prosthesis | 67 | 67 | $41K |
| 92227 | 1,709 | 1,672 | $39K | |
| 73590 | 1,125 | 1,048 | $37K | |
| 83550 | 4,704 | 4,574 | $37K | |
| 87186 | 4,545 | 4,282 | $36K | |
| 58100 | 177 | 170 | $36K | |
| 84156 | 8,949 | 7,663 | $36K | |
| 92133 | 1,248 | 1,236 | $36K | |
| 51798 | 642 | 634 | $36K | |
| J2469 | Injection, palonosetron hcl, 25 mcg | 413 | 263 | $35K |
| 85379 | 1,668 | 1,574 | $35K | |
| 86140 | 6,852 | 6,339 | $35K | |
| 86704 | 2,678 | 2,571 | $34K | |
| 88341 | 232 | 213 | $34K | |
| 93922 | 230 | 227 | $34K | |
| 80051 | 5,203 | 4,999 | $33K | |
| J9190 | Injection, fluorouracil, 500 mg | 1,331 | 578 | $33K |
| 90756 | 1,773 | 1,714 | $33K | |
| J1644 | Injection, heparin sodium, per 1000 units | 5,692 | 2,646 | $33K |
| 78452 | Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress | 97 | 96 | $32K |
| 72141 | 125 | 125 | $32K | |
| 78306 | 115 | 115 | $31K | |
| 87426 | Infectious agent antigen detection, SARS-CoV-2 (COVID-19) | 603 | 583 | $31K |
| 85007 | 8,377 | 6,541 | $31K | |
| 0241U | Neonatal screening for hereditary disorders, genomic sequence analysis panel | 6,127 | 5,859 | $31K |
| 88142 | 1,581 | 1,488 | $30K | |
| 97140 | Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) | 710 | 426 | $30K |
| 71271 | 179 | 178 | $30K | |
| J1453 | Injection, fosaprepitant, 1 mg | 354 | 237 | $30K |
| J1100 | Injection, dexamethasone sodium phosphate, 1 mg | 6,691 | 4,935 | $30K |
| 96401 | 460 | 253 | $29K | |
| J9263 | Injection, oxaliplatin, 0.5 mg | 238 | 110 | $28K |
| 73552 | 742 | 693 | $28K | |
| 97116 | 871 | 619 | $28K | |
| 86706 | 2,303 | 2,241 | $27K | |
| J1650 | Injection, enoxaparin sodium, 10 mg | 4,687 | 2,588 | $27K |
| 82378 | 1,329 | 1,060 | $27K | |
| 87077 | 3,745 | 3,512 | $27K | |
| 84153 | 1,825 | 1,707 | $27K | |
| 82040 | 5,611 | 5,388 | $27K | |
| 84403 | 1,132 | 1,058 | $26K | |
| 74174 | 67 | 67 | $26K | |
| 0004A | 1,318 | 1,303 | $26K | |
| J2543 | Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams) | 1,079 | 557 | $26K |
| 84520 | 7,300 | 6,956 | $26K | |
| J1940 | Injection, furosemide, up to 20 mg | 4,072 | 2,012 | $25K |
| 82952 | 4,206 | 4,144 | $24K | |
| 95810 | Polysomnography; sleep staging with 4 or more additional parameters | 42 | 42 | $24K |
| 84075 | 5,218 | 4,905 | $24K | |
| J9045 | Injection, carboplatin, 50 mg | 471 | 312 | $24K |
| 0003A | 1,241 | 1,230 | $24K | |
| 86160 | 977 | 917 | $23K | |
| J2916 | Injection, sodium ferric gluconate complex in sucrose injection, 12.5 mg | 334 | 203 | $23K |
| 96411 | 270 | 196 | $23K | |
| 82248 | 5,199 | 3,809 | $23K | |
| J9267 | Injection, paclitaxel, 1 mg | 459 | 244 | $23K |
| 87661 | Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe | 636 | 614 | $23K |
| J0290 | Injection, ampicillin sodium, 500 mg | 2,303 | 1,033 | $22K |
| 96368 | 560 | 399 | $22K | |
| 45378 | Colonoscopy, flexible; diagnostic, including collection of specimen(s) | 70 | 67 | $22K |
| 90480 | 860 | 808 | $22K | |
| 82043 | 3,836 | 3,756 | $21K | |
| 72040 | 487 | 479 | $21K | |
| 0072A | 963 | 957 | $21K | |
| J3489 | Injection, zoledronic acid, 1 mg | 120 | 118 | $21K |
| J1170 | Injection, hydromorphone, up to 4 mg | 5,051 | 3,172 | $21K |
| 99202 | Office or other outpatient visit for the evaluation and management of a new patient, straightforward | 583 | 561 | $21K |
| 11721 | 291 | 285 | $21K | |
| 86708 | 1,507 | 1,463 | $21K | |
| 85730 | 4,033 | 3,443 | $20K | |
| 86592 | 4,332 | 4,151 | $20K | |
| 92025 | 303 | 300 | $20K | |
| 0071A | 949 | 936 | $20K | |
| 90746 | 224 | 214 | $20K | |
| 77065 | Tomosynthesis, mammo | 266 | 260 | $20K |
| Q9967 | Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml | 11,906 | 11,057 | $19K |
| 86922 | 62 | 55 | $19K | |
| 0124A | 917 | 908 | $18K | |
| 93296 | 599 | 592 | $18K | |
| 51705 | 110 | 103 | $18K | |
| 80069 | 2,356 | 2,125 | $18K | |
| 45385 | Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) | 126 | 122 | $18K |
| J2785 | Injection, regadenoson, 0.1 mg | 103 | 102 | $18K |
| 90697 | 230 | 218 | $17K | |
| 84481 | 1,011 | 980 | $17K | |
| J2405 | Injection, ondansetron hydrochloride, per 1 mg | 11,949 | 8,770 | $17K |
| 80197 | 1,591 | 946 | $16K | |
| 0054A | 690 | 681 | $16K | |
| 99392 | Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) | 1,008 | 983 | $16K |
| J3475 | Injection, magnesium sulfate, per 500 mg | 1,616 | 1,137 | $16K |
| 80320 | 1,201 | 1,124 | $16K | |
| 73070 | 529 | 487 | $16K | |
| 86787 | 1,351 | 1,318 | $15K | |
| 74018 | 553 | 490 | $15K | |
| 83721 | 1,679 | 1,632 | $15K | |
| 73562 | 387 | 371 | $14K | |
| 97535 | Self-care/home management training, each 15 minutes | 610 | 492 | $14K |
| 0012A | 548 | 544 | $14K | |
| 82550 | 2,258 | 1,923 | $14K | |
| 77080 | 494 | 477 | $14K | |
| 36561 | 12 | 12 | $14K | |
| 83615 | 2,184 | 1,842 | $14K | |
| 87081 | 1,465 | 1,422 | $14K | |
| 11720 | 637 | 627 | $13K | |
| J3301 | Injection, triamcinolone acetonide, not otherwise specified, 10 mg | 1,329 | 1,284 | $13K |
| 72128 | 108 | 107 | $13K | |
| 77091 | 616 | 582 | $13K | |
| 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) | 828 | 786 | $13K |
| 88112 | 247 | 220 | $13K | |
| 85045 | 2,675 | 2,238 | $13K | |
| 96402 | 485 | 455 | $13K | |
| 52000 | 25 | 25 | $12K | |
| C1769 | Guide wire | 958 | 900 | $12K |
| 82977 | 1,635 | 1,587 | $12K | |
| 83540 | 1,782 | 1,729 | $12K | |
| 87880 | Infectious agent antigen detection by immunoassay; Streptococcus, group A | 407 | 398 | $12K |
| 83020 | 860 | 684 | $11K | |
| 70486 | 92 | 90 | $11K | |
| 73060 | 376 | 316 | $11K | |
| 73521 | 276 | 268 | $11K | |
| 86696 | 587 | 559 | $11K | |
| A9500 | Technetium tc-99m sestamibi, diagnostic, per study dose | 150 | 148 | $11K |
| 85384 | 1,315 | 1,176 | $11K | |
| 87205 | 2,444 | 2,146 | $11K | |
| 93289 | 354 | 349 | $10K | |
| 86038 | 852 | 831 | $10K | |
| 92567 | 483 | 472 | $10K | |
| 99381 | 589 | 584 | $10K | |
| 87633 | Infectious agent detection by nucleic acid, respiratory virus, 12-25 targets | 26 | 25 | $10K |
| 94660 | 35 | 25 | $10K | |
| J1885 | Injection, ketorolac tromethamine, per 15 mg | 3,270 | 2,960 | $10K |
| 64643 | 13 | 12 | $10K | |
| 87631 | 82 | 79 | $10K | |
| J0780 | Injection, prochlorperazine, up to 10 mg | 615 | 550 | $10K |
| 0011A | 519 | 514 | $10K | |
| 74178 | 38 | 38 | $9K | |
| J3480 | Injection, potassium chloride, per 2 meq | 668 | 448 | $9K |
| 73565 | 235 | 231 | $9K | |
| 85651 | 2,299 | 2,165 | $9K | |
| 99152 | 358 | 345 | $9K | |
| 73090 | 296 | 281 | $9K | |
| J2270 | Injection, morphine sulfate, up to 10 mg | 3,348 | 2,770 | $9K |
| 87070 | 1,166 | 1,012 | $9K | |
| 80177 | 521 | 506 | $8K | |
| 84165 | 924 | 867 | $8K | |
| 97803 | 262 | 256 | $8K | |
| 84132 | 2,285 | 2,173 | $8K | |
| 86705 | 714 | 687 | $8K | |
| 92136 | 214 | 211 | $8K | |
| 97163 | 84 | 75 | $8K | |
| 90680 | 299 | 278 | $7K | |
| 84155 | 2,183 | 2,064 | $7K | |
| G0378 | Hospital observation service, per hour | 1,506 | 1,189 | $7K |
| G0383 | Level 4 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) | 399 | 372 | $7K |
| J2930 | Injection, methylprednisolone sodium succinate, up to 125 mg | 468 | 423 | $7K |
| 84550 | 1,673 | 1,585 | $7K | |
| J0131 | Injection, acetaminophen, not otherwise specified,10 mg | 733 | 667 | $7K |
| J3411 | Injection, thiamine hcl, 100 mg | 979 | 768 | $7K |
| 97760 | 97 | 93 | $6K | |
| 90686 | 397 | 392 | $6K | |
| 80164 | 467 | 430 | $6K | |
| J1815 | Injection, insulin, per 5 units | 1,979 | 390 | $6K |
| 86593 | 1,142 | 1,084 | $6K | |
| 86304 | 367 | 312 | $6K | |
| 10060 | 27 | 27 | $6K | |
| J0690 | Injection, cefazolin sodium, 500 mg | 1,406 | 1,180 | $6K |
| 72156 | 13 | 12 | $6K | |
| 84300 | 1,307 | 1,197 | $6K | |
| 97802 | 100 | 99 | $6K | |
| 82310 | 1,361 | 1,310 | $6K | |
| 87493 | 158 | 152 | $6K | |
| 72157 | 14 | 13 | $6K | |
| 72197 | 12 | 12 | $6K | |
| 86695 | 438 | 417 | $5K | |
| 90687 | 1,370 | 1,337 | $5K | |
| 90662 | 648 | 640 | $5K | |
| 93325 | 24 | 24 | $5K | |
| 0064A | 236 | 236 | $5K | |
| 86225 | 353 | 340 | $5K | |
| 86301 | 283 | 233 | $5K | |
| Q0091 | Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory | 850 | 773 | $5K |
| 80143 | 290 | 274 | $5K | |
| 87075 | 639 | 542 | $5K | |
| 92550 | 104 | 104 | $5K | |
| J0692 | Injection, cefepime hydrochloride, 500 mg | 163 | 81 | $5K |
| 49082 | 21 | 12 | $5K | |
| 82239 | 303 | 270 | $5K | |
| 41899 | Unlisted procedure, dentoalveolar structures | 49 | 42 | $5K |
| 72170 | 171 | 163 | $5K | |
| 84295 | 1,258 | 1,191 | $5K | |
| 76882 | 135 | 126 | $5K | |
| 87517 | 98 | 88 | $4K | |
| 83520 | 252 | 225 | $4K | |
| 86902 | 26 | 25 | $4K | |
| 90716 | 159 | 145 | $4K | |
| 0052A | 130 | 128 | $4K | |
| J1630 | Injection, haloperidol, up to 5 mg | 899 | 658 | $4K |
| 78451 | 15 | 15 | $4K | |
| 82140 | 363 | 326 | $4K | |
| 83010 | 366 | 318 | $4K | |
| 82533 | 260 | 220 | $4K | |
| 99153 | Mod sedat endo service >5yrs | 118 | 116 | $4K |
| 95819 | 12 | 12 | $4K | |
| C1894 | Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser | 665 | 645 | $4K |
| 87634 | 43 | 42 | $4K | |
| 76376 | 13 | 12 | $4K | |
| 36430 | 1,233 | 881 | $4K | |
| G0475 | Hiv antigen/antibody, combination assay, screening | 2,647 | 2,585 | $4K |
| J2791 | Injection, rho(d) immune globulin (human), (rhophylac), intramuscular or intravenous, 100 iu | 166 | 162 | $3K |
| 0053A | 116 | 113 | $3K | |
| 93990 | 90 | 87 | $3K | |
| 80361 | 126 | 122 | $3K | |
| 87430 | 146 | 140 | $3K | |
| 80179 | 177 | 169 | $3K | |
| 0051A | 107 | 105 | $3K | |
| Q3014 | Telehealth originating site facility fee | 148 | 141 | $3K |
| C9257 | Injection, bevacizumab, 0.25 mg | 605 | 588 | $3K |
| 85652 | 1,221 | 1,158 | $3K | |
| 92610 | 50 | 50 | $3K | |
| 80047 | 235 | 228 | $3K | |
| 80365 | 138 | 134 | $3K | |
| 90791 | Psychiatric diagnostic evaluation | 45 | 40 | $3K |
| 90633 | 470 | 426 | $3K | |
| A9585 | Injection, gadobutrol, 0.1 ml | 3,424 | 3,311 | $3K |
| J3010 | Injection, fentanyl citrate, 0.1 mg | 4,290 | 3,741 | $3K |
| J2060 | Injection, lorazepam, 2 mg | 1,302 | 979 | $3K |
| 82374 | 668 | 645 | $3K | |
| 90651 | 30 | 28 | $3K | |
| 29125 | 38 | 36 | $3K | |
| J1200 | Injection, diphenhydramine hcl, up to 50 mg | 1,547 | 1,120 | $3K |
| 83935 | 431 | 400 | $3K | |
| 88304 | 26 | 24 | $2K | |
| 87338 | 217 | 216 | $2K | |
| 82435 | 663 | 646 | $2K | |
| 89051 | 585 | 447 | $2K | |
| 93321 | 26 | 26 | $2K | |
| 76870 | 27 | 25 | $2K | |
| 86431 | 431 | 418 | $2K | |
| J2800 | Injection, methocarbamol, up to 10 ml | 170 | 146 | $2K |
| 83521 | 320 | 291 | $2K | |
| 87491 | Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe | 98 | 95 | $2K |
| 84540 | 490 | 452 | $2K | |
| 92250 | 70 | 68 | $2K | |
| C2629 | Introducer/sheath, other than guiding, other than intracardiac electrophysiological, laser | 231 | 219 | $2K |
| 98967 | 278 | 269 | $2K | |
| 96377 | 51 | 40 | $2K | |
| 90714 | 78 | 75 | $2K | |
| J2175 | Injection, meperidine hydrochloride, per 100 mg | 493 | 402 | $2K |
| J2250 | Injection, midazolam hydrochloride, per 1 mg | 2,947 | 2,715 | $2K |
| 11102 | 24 | 24 | $2K | |
| J3420 | Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg | 379 | 321 | $2K |
| 86200 | 137 | 132 | $2K | |
| 76512 | 46 | 37 | $2K | |
| 90739 | 13 | 13 | $2K | |
| 72070 | 42 | 40 | $2K | |
| J2704 | Injection, propofol, 10 mg | 4,644 | 3,364 | $2K |
| 0134A | 67 | 65 | $1K | |
| 82784 | 135 | 127 | $1K | |
| 87045 | 148 | 141 | $1K | |
| 88307 | 39 | 39 | $1K | |
| 86256 | 89 | 83 | $1K | |
| 69210 | 26 | 26 | $1K | |
| 80202 | 124 | 100 | $1K | |
| 87529 | 12 | 12 | $1K | |
| 82088 | 37 | 37 | $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 | 3,843 | 3,109 | $1K |
| A9270 | Non-covered item or service | 35,019 | 10,226 | $1K |
| J0689 | Injection, cefazolin sodium (baxter), not therapeutically equivalent to j0690, 500 mg | 193 | 150 | $1K |
| 87209 | 71 | 68 | $1K | |
| J0171 | Injection, adrenalin, epinephrine, 0.1 mg | 296 | 216 | $1K |
| 87581 | 26 | 25 | $1K | |
| 87486 | 26 | 25 | $1K | |
| 82664 | 16 | 16 | $1K | |
| 82024 | 28 | 25 | $1K | |
| 85460 | 145 | 135 | $1K | |
| 57454 | 12 | 12 | $1K | |
| 84133 | 235 | 218 | $989.21 | |
| 82436 | 205 | 190 | $982.21 | |
| 76000 | 28 | 24 | $950.70 | |
| J1642 | Injection, heparin sodium, (heparin lock flush), per 10 units | 1,103 | 752 | $895.91 |
| 82077 | 89 | 87 | $887.16 | |
| 91200 | 102 | 101 | $858.26 | |
| C1887 | Catheter, guiding (may include infusion/perfusion capability) | 60 | 56 | $851.18 |
| 83001 | 39 | 39 | $835.50 | |
| 97763 | 18 | 14 | $823.93 | |
| 73620 | 30 | 26 | $804.03 | |
| J2765 | Injection, metoclopramide hcl, up to 10 mg | 549 | 457 | $788.20 |
| Q0169 | Promethazine hydrochloride, 12.5 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 | 1,487 | 1,389 | $733.83 |
| 90734 | 42 | 39 | $729.06 | |
| 0081A | 13 | 13 | $718.80 | |
| J0330 | Injection, succinylcholine chloride, up to 20 mg | 81 | 79 | $711.97 |
| 90853 | Group psychotherapy (other than of a multiple-family group) | 18 | 12 | $676.96 |
| U0002 | 2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc | 113 | 107 | $674.87 |
| 86709 | 118 | 116 | $671.10 | |
| 90707 | 86 | 79 | $661.70 | |
| 87177 | 83 | 80 | $647.95 | |
| 86039 | 68 | 67 | $635.79 | |
| 90834 | Psychotherapy, 45 minutes with patient | 14 | 12 | $627.33 |
| 82330 | 155 | 141 | $626.21 | |
| 83883 | 34 | 33 | $612.04 | |
| 73140 | 12 | 12 | $598.68 | |
| J0360 | Injection, hydralazine hcl, up to 20 mg | 74 | 65 | $567.51 |
| 84146 | 26 | 26 | $548.63 | |
| J0610 | Injection, calcium gluconate (fresenius kabi), per 10 ml | 47 | 37 | $510.21 |
| 80156 | 13 | 13 | $463.43 | |
| 76937 | 12 | 12 | $447.80 | |
| 82746 | 27 | 27 | $446.00 | |
| J0595 | Injection, butorphanol tartrate, 1 mg | 75 | 57 | $445.37 |
| 84157 | 148 | 121 | $443.00 | |
| 97597 | 36 | 24 | $436.86 | |
| 88185 | 16 | 16 | $432.56 | |
| 88184 | 16 | 16 | $432.56 | |
| 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 | 280 | 265 | $427.30 |
| 90647 | 528 | 512 | $424.96 | |
| 11900 | 12 | 12 | $424.55 | |
| 87116 | 44 | 24 | $400.19 | |
| 90673 | 91 | 90 | $397.86 | |
| J3490 | Unclassified drugs | 89 | 72 | $395.63 |
| 80329 | 28 | 27 | $387.90 | |
| 96379 | 28 | 24 | $362.72 | |
| A9503 | Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries | 16 | 16 | $357.41 |
| 93288 | 24 | 24 | $308.11 | |
| 90474 | 132 | 132 | $298.22 | |
| 84466 | 25 | 25 | $279.90 | |
| 80354 | 14 | 13 | $279.34 | |
| J2370 | Injection, phenylephrine hcl, up to 1 ml | 669 | 596 | $273.05 |
| 86300 | 13 | 12 | $272.84 | |
| J2710 | Injection, neostigmine methylsulfate, up to 0.5 mg | 291 | 278 | $265.02 |
| 86886 | 57 | 54 | $242.52 | |
| 86235 | 21 | 17 | $238.65 | |
| 80325 | 13 | 12 | $228.44 | |
| J0665 | Injection, bupivicaine, not otherwise specified, 0.5 mg | 170 | 162 | $193.76 |
| 86702 | 14 | 14 | $184.58 | |
| 86701 | 28 | 27 | $171.34 | |
| 80359 | 13 | 12 | $169.30 | |
| 84134 | 13 | 13 | $156.73 | |
| 86880 | 26 | 26 | $147.06 | |
| G0380 | Level 1 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) | 14 | 14 | $140.56 |
| 87799 | 16 | 12 | $137.70 | |
| 92004 | Ophthalmological services: medical examination and evaluation, comprehensive, new patient | 16 | 15 | $122.75 |
| A6258 | Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing | 17 | 12 | $115.78 |
| 82042 | 15 | 13 | $114.88 | |
| J2919 | Injection, methylprednisolone sodium succinate, 5 mg | 28 | 24 | $113.29 |
| 83930 | 16 | 14 | $111.83 | |
| J1596 | Injection, glycopyrrolate, 0.1 mg | 142 | 137 | $101.41 |
| 82010 | 17 | 12 | $97.79 | |
| G0279 | Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066) | 29 | 29 | $77.30 |
| J1836 | Injection, metronidazole, 10 mg | 33 | 16 | $70.62 |
| G0476 | Infectious agent detection by nucleic acid (dna or rna); human papillomavirus (hpv), high-risk types (e.g., 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) for cervical cancer screening, must be performed in addition to pap test | 14 | 14 | $61.03 |
| 83525 | 15 | 14 | $60.84 | |
| J2795 | Injection, ropivacaine hydrochloride, 1 mg | 14 | 13 | $48.35 |
| G0008 | Administration of influenza virus vaccine | 3,249 | 3,213 | $46.71 |
| 90700 | 88 | 75 | $42.70 | |
| 82465 | 13 | 12 | $30.63 | |
| S0030 | Injection, metronidazole, 500 mg | 40 | 24 | $14.27 |
| G0009 | Administration of pneumococcal vaccine | 980 | 967 | $6.80 |
| J7611 | Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg | 16 | 12 | $4.96 |
| J7613 | Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg | 30 | 26 | $2.08 |
| 91300 | 18,253 | 15,990 | $0.01 | |
| 3078F | 5,389 | 5,016 | $0.00 | |
| G1004 | Clinical decision support mechanism national decision support company, as defined by the medicare appropriate use criteria program | 731 | 588 | $0.00 |
| A9552 | Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries | 108 | 108 | $0.00 |
| 90681 | 211 | 210 | $0.00 | |
| 77062 | 163 | 163 | $0.00 | |
| 91313 | 68 | 66 | $0.00 | |
| 91312 | 931 | 922 | $0.00 | |
| 91308 | 60 | 60 | $0.00 | |
| 90611 | 29 | 28 | $0.00 | |
| 98966 | 311 | 306 | $0.00 | |
| 99051 | 13 | 13 | $0.00 | |
| 77061 | 44 | 44 | $0.00 | |
| 90685 | 12 | 12 | $0.00 | |
| 98968 | 115 | 113 | $0.00 | |
| Q9957 | Injection, perflutren lipid microspheres, per ml | 15 | 15 | $0.00 |
| 3074F | 5,295 | 4,936 | $0.00 | |
| C1889 | Implantable/insertable device, not otherwise classified | 29 | 28 | $0.00 |
| G0103 | Prostate cancer screening; prostate specific antigen test (psa) | 568 | 555 | $0.00 |
| 3044F | 98 | 83 | $0.00 | |
| 91307 | 2,013 | 1,849 | $0.00 | |
| A9561 | Technetium tc-99m oxidronate, diagnostic, per study dose, up to 30 millicuries | 126 | 126 | $0.00 |
| 91305 | 928 | 898 | $0.00 | |
| 90723 | 252 | 251 | $0.00 | |
| 91306 | 114 | 114 | $0.00 | |
| 91301 | 713 | 691 | $0.00 | |
| 90674 | 38 | 38 | $0.00 | |
| J7999 | Compounded drug, not otherwise classified | 317 | 299 | $0.00 |
| G0108 | Diabetes outpatient self-management training services, individual, per 30 minutes | 15 | 14 | $0.00 |
| G0145 | Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system and manual rescreening under physician supervision | 56 | 55 | $0.00 |
| 96110 | Developmental screening, with scoring and documentation, per standardized instrument | 129 | 107 | $0.00 |
| J7512 | Prednisone, immediate release or delayed release, oral, 1 mg | 15 | 12 | $0.00 |
| J2003 | Injection, lidocaine hydrochloride, 1 mg | 99 | 85 | $0.00 |
| J3471 | Injection, hyaluronidase, ovine, preservative free, per 1 usp unit (up to 999 usp units) | 39 | 39 | $0.00 |
| V2632 | Posterior chamber intraocular lens | 15 | 15 | $0.00 |
| 3075F | 13 | 12 | $0.00 | |
| 91318 | 28 | 27 | $0.00 | |
| J7644 | Ipratropium bromide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram | 20 | 14 | $0.00 |
| 3079F | 15 | 14 | $0.00 |