| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
27,736 |
24,074 |
$9.21M |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
9,082 |
8,362 |
$4.98M |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
26,735 |
24,257 |
$4.34M |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
15,824 |
14,707 |
$2.82M |
| 70450 |
Computed tomography, head or brain; without contrast material |
11,696 |
10,469 |
$1.02M |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
4,200 |
3,766 |
$746K |
| G0378 |
Hospital observation service, per hour |
22,585 |
11,475 |
$635K |
| 72125 |
Computed tomography, cervical spine; without contrast material |
3,341 |
3,008 |
$473K |
| 49083 |
|
887 |
385 |
$375K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
3,744 |
3,499 |
$367K |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
3,623 |
3,408 |
$348K |
| 99291 |
Critical care, evaluation and management of the critically ill patient, first 30-74 minutes |
220 |
211 |
$199K |
| C1713 |
Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable) |
121 |
106 |
$172K |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
697 |
657 |
$143K |
| 11042 |
Debridement, subcutaneous tissue (includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm |
918 |
620 |
$128K |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
1,345 |
1,221 |
$123K |
| C1769 |
Guide wire |
2,260 |
1,933 |
$86K |
| 80053 |
Comprehensive metabolic panel |
57,232 |
45,184 |
$80K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
4,760 |
2,933 |
$73K |
| 93971 |
|
1,914 |
1,748 |
$69K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
9,012 |
7,301 |
$46K |
| 93970 |
|
214 |
197 |
$40K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
31,195 |
25,393 |
$34K |
| 71250 |
|
784 |
709 |
$34K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
3,125 |
2,141 |
$33K |
| 36430 |
|
176 |
121 |
$32K |
| 96361 |
Intravenous infusion, hydration; each additional hour |
5,875 |
4,897 |
$30K |
| 93458 |
|
26 |
19 |
$28K |
| 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 |
2,017 |
1,868 |
$28K |
| 74174 |
|
43 |
41 |
$27K |
| 45380 |
Colonoscopy, flexible; with biopsy, single or multiple |
70 |
66 |
$26K |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
505 |
463 |
$24K |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
573 |
155 |
$24K |
| 71046 |
Radiologic examination, chest; 2 views |
3,212 |
2,948 |
$22K |
| 70496 |
|
48 |
45 |
$22K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
22,870 |
17,521 |
$19K |
| 78452 |
Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress |
15 |
15 |
$16K |
| 70486 |
|
622 |
574 |
$15K |
| 80320 |
|
5,055 |
4,656 |
$14K |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
1,718 |
1,255 |
$12K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
25,538 |
22,227 |
$12K |
| 96376 |
|
11,166 |
6,478 |
$11K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
1,731 |
1,583 |
$10K |
| 88341 |
|
125 |
79 |
$10K |
| 96413 |
Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance |
374 |
189 |
$10K |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
181 |
164 |
$8K |
| 72131 |
|
29 |
25 |
$7K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
12,776 |
9,348 |
$7K |
| C1887 |
Catheter, guiding (may include infusion/perfusion capability) |
185 |
149 |
$6K |
| 71045 |
Radiologic examination, chest; single view |
25,140 |
21,887 |
$5K |
| 75574 |
|
44 |
41 |
$5K |
| 70491 |
|
12 |
12 |
$5K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
60,494 |
47,038 |
$5K |
| J8597 |
Antiemetic drug, oral, not otherwise specified |
2,255 |
1,868 |
$4K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
6,849 |
6,248 |
$4K |
| 86850 |
|
3,321 |
2,949 |
$3K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
9,747 |
6,452 |
$3K |
| J3490 |
Unclassified drugs |
29,588 |
12,895 |
$3K |
| C1894 |
Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser |
696 |
594 |
$3K |
| 87631 |
|
2,572 |
2,476 |
$3K |
| J1756 |
Injection, iron sucrose, 1 mg |
30 |
12 |
$3K |
| 82728 |
|
363 |
315 |
$3K |
| 72100 |
|
2,067 |
1,939 |
$3K |
| 87636 |
Infectious agent detection by nucleic acid; SARS-CoV-2 and influenza virus types A and B |
5,750 |
5,355 |
$3K |
| 84484 |
|
29,248 |
15,529 |
$2K |
| 86920 |
|
19 |
12 |
$2K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
1,792 |
1,572 |
$2K |
| 83690 |
|
18,130 |
15,911 |
$2K |
| 84443 |
Thyroid stimulating hormone (TSH) |
5,030 |
4,462 |
$1K |
| 73630 |
|
1,702 |
1,512 |
$1K |
| 73562 |
|
2,133 |
1,838 |
$1K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
474 |
371 |
$1K |
| 83880 |
|
6,640 |
5,932 |
$1K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
98 |
78 |
$1K |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
16,611 |
14,789 |
$1K |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
1,997 |
1,317 |
$1K |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
22,997 |
18,183 |
$1K |
| 86923 |
|
111 |
56 |
$1K |
| 81025 |
|
7,734 |
7,089 |
$977.63 |
| 85610 |
|
27,794 |
23,688 |
$958.70 |
| 73610 |
|
1,214 |
1,098 |
$947.82 |
| 83735 |
|
25,397 |
19,793 |
$905.52 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
1,865 |
1,800 |
$850.69 |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
8,112 |
7,313 |
$834.24 |
| 74018 |
|
414 |
376 |
$824.00 |
| 73030 |
|
1,845 |
1,625 |
$808.36 |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
610 |
589 |
$797.70 |
| 73130 |
|
1,040 |
935 |
$787.99 |
| 87040 |
|
7,173 |
3,413 |
$709.67 |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
134 |
44 |
$706.20 |
| 81001 |
|
16,109 |
14,327 |
$684.32 |
| 83605 |
|
11,217 |
8,786 |
$669.47 |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
4,326 |
2,258 |
$661.55 |
| 73502 |
|
1,024 |
910 |
$626.72 |
| 97535 |
Self-care/home management training, each 15 minutes |
377 |
234 |
$618.46 |
| 84703 |
|
6,443 |
6,115 |
$607.78 |
| 76830 |
Ultrasound, transvaginal |
512 |
492 |
$545.20 |
| 84702 |
|
1,629 |
1,503 |
$507.17 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
854 |
830 |
$462.48 |
| 36591 |
|
780 |
465 |
$460.23 |
| M0245 |
Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring |
139 |
136 |
$450.01 |
| 97116 |
|
1,535 |
1,056 |
$444.64 |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
12,260 |
8,642 |
$442.75 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
855 |
831 |
$442.07 |
| 90715 |
|
1,333 |
1,258 |
$440.79 |
| 93880 |
|
32 |
26 |
$429.65 |
| 82947 |
|
22,808 |
10,000 |
$420.61 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
1,016 |
983 |
$364.50 |
| 85730 |
|
931 |
780 |
$351.44 |
| J7030 |
Infusion, normal saline solution , 1000 cc |
13,628 |
11,067 |
$318.35 |
| 85379 |
|
1,253 |
1,138 |
$311.17 |
| 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 |
412 |
359 |
$298.51 |
| 70498 |
|
47 |
44 |
$294.43 |
| 97161 |
|
2,765 |
2,324 |
$288.65 |
| 93976 |
|
208 |
202 |
$281.76 |
| 82550 |
|
8,296 |
6,885 |
$267.33 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
11,823 |
10,404 |
$259.11 |
| 87088 |
|
6,142 |
5,280 |
$258.36 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
5,724 |
4,161 |
$252.79 |
| 88342 |
|
700 |
568 |
$241.88 |
| 85027 |
|
9,050 |
6,384 |
$226.59 |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
16 |
14 |
$225.74 |
| 73110 |
|
619 |
563 |
$211.24 |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
14 |
14 |
$200.04 |
| 82803 |
|
146 |
118 |
$185.07 |
| C9113 |
Injection, pantoprazole sodium, per vial |
2,696 |
1,621 |
$172.50 |
| 82565 |
|
2,392 |
2,196 |
$158.51 |
| 81003 |
|
8,884 |
8,141 |
$149.31 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
5,687 |
4,702 |
$147.67 |
| 85055 |
|
1,613 |
1,040 |
$146.18 |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
378 |
372 |
$131.57 |
| J0690 |
Injection, cefazolin sodium, 500 mg |
4,051 |
3,070 |
$128.47 |
| 96367 |
|
848 |
552 |
$126.88 |
| 86901 |
|
3,660 |
3,298 |
$120.00 |
| 86900 |
|
3,458 |
3,119 |
$115.04 |
| 73080 |
|
143 |
134 |
$113.31 |
| J2704 |
Injection, propofol, 10 mg |
8,753 |
7,437 |
$110.49 |
| 80061 |
Lipid panel |
1,858 |
1,629 |
$108.93 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
1,497 |
739 |
$105.14 |
| 73590 |
|
128 |
113 |
$97.98 |
| 87186 |
|
2,736 |
2,362 |
$94.50 |
| G0257 |
Unscheduled or emergency dialysis treatment for an esrd patient in a hospital outpatient department that is not certified as an esrd facility |
16 |
13 |
$94.04 |
| J8499 |
Prescription drug, oral, non chemotherapeutic, nos |
33,725 |
11,706 |
$91.66 |
| J0330 |
Injection, succinylcholine chloride, up to 20 mg |
1,687 |
1,519 |
$89.04 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
11,920 |
9,888 |
$87.89 |
| 84145 |
|
690 |
643 |
$84.96 |
| 87077 |
|
3,205 |
2,629 |
$75.71 |
| J0360 |
Injection, hydralazine hcl, up to 20 mg |
1,331 |
1,055 |
$67.37 |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
1,715 |
1,304 |
$59.73 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
2,066 |
1,856 |
$54.22 |
| 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 |
1,225 |
1,123 |
$53.39 |
| U0002 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
17 |
15 |
$51.31 |
| 93017 |
|
30 |
28 |
$49.97 |
| J2060 |
Injection, lorazepam, 2 mg |
3,066 |
2,545 |
$49.47 |
| J1170 |
Injection, hydromorphone, up to 4 mg |
3,265 |
2,441 |
$48.72 |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
1,553 |
1,283 |
$46.07 |
| 84439 |
|
492 |
437 |
$45.40 |
| 86140 |
|
1,613 |
1,461 |
$45.24 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,372 |
1,289 |
$44.90 |
| J1815 |
Injection, insulin, per 5 units |
6,526 |
2,894 |
$44.56 |
| 51702 |
|
33 |
28 |
$44.54 |
| J7040 |
Infusion, normal saline solution, sterile (500 ml = 1 unit) |
2,892 |
2,634 |
$43.99 |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
3,496 |
3,109 |
$42.35 |
| 84100 |
|
1,696 |
1,303 |
$42.03 |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
2,287 |
1,870 |
$39.66 |
| 82553 |
|
895 |
781 |
$39.59 |
| A9270 |
Non-covered item or service |
92,438 |
10,700 |
$38.46 |
| 76937 |
|
106 |
89 |
$38.25 |
| J1956 |
Injection, levofloxacin, 250 mg |
1,264 |
887 |
$29.65 |
| J1642 |
Injection, heparin sodium, (heparin lock flush), per 10 units |
2,317 |
1,032 |
$28.68 |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
2,532 |
2,286 |
$26.13 |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
5,181 |
4,234 |
$26.00 |
| J2550 |
Injection, promethazine hcl, up to 50 mg |
607 |
436 |
$24.46 |
| 82010 |
|
509 |
453 |
$23.27 |
| J2795 |
Injection, ropivacaine hydrochloride, 1 mg |
59 |
52 |
$22.05 |
| 84466 |
|
357 |
318 |
$19.71 |
| J1790 |
Injection, droperidol, up to 5 mg |
193 |
184 |
$19.56 |
| J1644 |
Injection, heparin sodium, per 1000 units |
3,436 |
1,851 |
$16.54 |
| 83540 |
|
359 |
318 |
$13.21 |
| 87210 |
|
291 |
283 |
$13.16 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
5,947 |
5,322 |
$12.29 |
| 85018 |
|
887 |
620 |
$12.23 |
| J2370 |
Injection, phenylephrine hcl, up to 1 ml |
505 |
449 |
$12.16 |
| 84132 |
|
2,401 |
1,931 |
$11.79 |
| 85652 |
|
947 |
834 |
$9.58 |
| 87081 |
|
185 |
175 |
$7.60 |
| J3370 |
Injection, vancomycin hcl, 500 mg |
959 |
566 |
$7.48 |
| 85014 |
|
385 |
268 |
$5.68 |
| J2710 |
Injection, neostigmine methylsulfate, up to 0.5 mg |
601 |
514 |
$2.33 |
| J2001 |
Injection, lidocaine hcl for intravenous infusion, 10 mg |
1,185 |
1,050 |
$0.00 |
| 80329 |
|
656 |
594 |
$0.00 |
| J2920 |
Injection, methylprednisolone sodium succinate, up to 40 mg |
312 |
146 |
$0.00 |
| 87205 |
|
2,016 |
1,397 |
$0.00 |
| J7999 |
Compounded drug, not otherwise classified |
754 |
534 |
$0.00 |
| J1630 |
Injection, haloperidol, up to 5 mg |
202 |
162 |
$0.00 |
| 72040 |
|
12 |
12 |
$0.00 |
| 87147 |
|
47 |
38 |
$0.00 |
| J7050 |
Infusion, normal saline solution, 250 cc |
522 |
210 |
$0.00 |
| 96368 |
|
218 |
156 |
$0.00 |
| J2543 |
Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams) |
226 |
111 |
$0.00 |
| 87070 |
|
1,659 |
1,155 |
$0.00 |
| 88304 |
|
261 |
238 |
$0.00 |
| J2470 |
Injection, pantoprazole sodium, 40 mg |
193 |
121 |
$0.00 |
| 12001 |
|
53 |
50 |
$0.00 |
| 86769 |
|
47 |
45 |
$0.00 |
| J2371 |
Injection, phenylephrine hydrochloride, 20 micrograms |
137 |
134 |
$0.00 |
| J3480 |
Injection, potassium chloride, per 2 meq |
621 |
425 |
$0.00 |
| 82607 |
|
209 |
187 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
537 |
459 |
$0.00 |
| J2785 |
Injection, regadenoson, 0.1 mg |
14 |
14 |
$0.00 |
| 76801 |
|
77 |
69 |
$0.00 |
| J0456 |
Injection, azithromycin, 500 mg |
52 |
40 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
58 |
52 |
$0.00 |
| J1940 |
Injection, furosemide, up to 20 mg |
555 |
342 |
$0.00 |
| 72170 |
|
16 |
14 |
$0.00 |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
16 |
14 |
$0.00 |
| 97165 |
|
245 |
211 |
$0.00 |
| 87116 |
|
26 |
12 |
$0.00 |
| A9585 |
Injection, gadobutrol, 0.1 ml |
100 |
85 |
$0.00 |
| 87206 |
|
56 |
24 |
$0.00 |
| 73090 |
|
15 |
14 |
$0.00 |
| 87807 |
|
13 |
13 |
$0.00 |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
41 |
37 |
$0.00 |
| 90686 |
|
68 |
62 |
$0.00 |
| 83615 |
|
48 |
41 |
$0.00 |
| 86635 |
|
105 |
52 |
$0.00 |
| J2003 |
Injection, lidocaine hydrochloride, 1 mg |
117 |
106 |
$0.00 |
| 82330 |
|
28 |
24 |
$0.00 |
| 72072 |
|
13 |
13 |
$0.00 |
| G0379 |
Direct admission of patient for hospital observation care |
13 |
13 |
$0.00 |
| M0243 |
Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring |
47 |
46 |
$0.00 |
| 71101 |
|
15 |
13 |
$0.00 |
| J1650 |
Injection, enoxaparin sodium, 10 mg |
3,554 |
1,810 |
$0.00 |
| 87075 |
|
114 |
95 |
$0.00 |
| S0028 |
Injection, famotidine, 20 mg |
712 |
679 |
$0.00 |
| 93041 |
|
17 |
17 |
$0.00 |
| C1760 |
Closure device, vascular (implantable/insertable) |
51 |
37 |
$0.00 |
| 84295 |
|
101 |
76 |
$0.00 |
| 99152 |
|
169 |
146 |
$0.00 |
| 82140 |
|
217 |
167 |
$0.00 |
| C1729 |
Catheter, drainage |
937 |
513 |
$0.00 |
| Q0245 |
Injection, bamlanivimab and etesevimab, 2100 mg |
148 |
139 |
$0.00 |
| J2919 |
Injection, methylprednisolone sodium succinate, 5 mg |
209 |
168 |
$0.00 |
| G8978 |
Mobility: walking & moving around functional limitation, current status, at therapy episode outset and at reporting intervals |
131 |
107 |
$0.00 |
| 94664 |
|
218 |
171 |
$0.00 |
| A9502 |
Technetium tc-99m tetrofosmin, diagnostic, per study dose |
16 |
16 |
$0.00 |
| J0665 |
Injection, bupivicaine, not otherwise specified, 0.5 mg |
493 |
349 |
$0.00 |
| J0692 |
Injection, cefepime hydrochloride, 500 mg |
26 |
16 |
$0.00 |
| 89051 |
|
308 |
176 |
$0.00 |
| C1758 |
Catheter, ureteral |
168 |
143 |
$0.00 |
| J1171 |
Injection, hydromorphone, 0.1 mg |
20 |
16 |
$0.00 |
| J1596 |
Injection, glycopyrrolate, 0.1 mg |
129 |
128 |
$0.00 |
| G8979 |
Mobility: walking & moving around functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting |
135 |
110 |
$0.00 |
| J0780 |
Injection, prochlorperazine, up to 10 mg |
96 |
64 |
$0.00 |
| J1953 |
Injection, levetiracetam, 10 mg |
65 |
50 |
$0.00 |
| 36600 |
|
46 |
33 |
$0.00 |
| P9016 |
Red blood cells, leukocytes reduced, each unit |
68 |
52 |
$0.00 |
| Q0244 |
Injection, casirivimab and imdevimab, 1200 mg |
44 |
43 |
$0.00 |
| 87102 |
|
32 |
25 |
$0.00 |
| J0744 |
Injection, ciprofloxacin for intravenous infusion, 200 mg |
24 |
18 |
$0.00 |
| J0295 |
Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm |
54 |
38 |
$0.00 |
| 88112 |
|
29 |
12 |
$0.00 |
| 72141 |
|
12 |
12 |
$0.00 |
| 73140 |
|
13 |
12 |
$0.00 |