| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
46,027 |
40,888 |
$1.43M |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
22,282 |
19,536 |
$1.11M |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
14,438 |
13,013 |
$246K |
| 99232 |
Subsequent hospital care, per day, moderate complexity |
9,927 |
3,996 |
$227K |
| 99233 |
Prolong inpt eval add15 m |
4,435 |
2,091 |
$197K |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
2,871 |
2,553 |
$153K |
| 0002A |
|
4,684 |
4,299 |
$107K |
| 99239 |
Hospital discharge day management, more than 30 minutes |
2,379 |
2,234 |
$104K |
| 0001A |
|
4,712 |
4,276 |
$101K |
| 99223 |
Prolong inpt eval add15 m |
1,194 |
1,136 |
$82K |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
4,609 |
4,214 |
$69K |
| 90832 |
Psychotherapy, 30 minutes with patient |
861 |
691 |
$61K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
21,068 |
19,391 |
$61K |
| 99460 |
|
743 |
732 |
$47K |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
4,534 |
3,534 |
$39K |
| 80053 |
Comprehensive metabolic panel |
92,810 |
82,683 |
$36K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
96,939 |
84,737 |
$33K |
| 96361 |
Intravenous infusion, hydration; each additional hour |
5,009 |
4,466 |
$28K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
5,538 |
4,931 |
$26K |
| 0012A |
|
902 |
824 |
$20K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,231 |
2,958 |
$19K |
| 0011A |
|
986 |
885 |
$18K |
| 87637 |
Infectious agent detection by nucleic acid; SARS-CoV-2, influenza, and RSV |
1,375 |
1,322 |
$16K |
| 36415 |
Collection of venous blood by venipuncture |
81,413 |
72,312 |
$13K |
| 99291 |
Critical care, evaluation and management of the critically ill patient, first 30-74 minutes |
125 |
63 |
$12K |
| C9803 |
Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
5,561 |
4,951 |
$11K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
13,094 |
11,716 |
$11K |
| 41899 |
Unlisted procedure, dentoalveolar structures |
185 |
177 |
$9K |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
8,300 |
7,354 |
$9K |
| 99479 |
Subsequent intensive care, per day, very low birth weight infant |
70 |
12 |
$8K |
| 99222 |
Initial hospital care, per day, moderate complexity |
153 |
143 |
$8K |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
655 |
613 |
$8K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,228 |
1,142 |
$8K |
| 84443 |
Thyroid stimulating hormone (TSH) |
11,892 |
11,258 |
$7K |
| 99231 |
Subsequent hospital care, per day, straightforward or low complexity |
574 |
247 |
$7K |
| 99220 |
|
112 |
104 |
$7K |
| 80061 |
Lipid panel |
11,114 |
10,582 |
$7K |
| 90791 |
Psychiatric diagnostic evaluation |
93 |
92 |
$7K |
| 81513 |
|
535 |
515 |
$6K |
| 71046 |
Radiologic examination, chest; 2 views |
1,546 |
1,411 |
$6K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
3,477 |
3,036 |
$5K |
| J7030 |
Infusion, normal saline solution , 1000 cc |
9,523 |
7,879 |
$5K |
| 96413 |
Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance |
466 |
245 |
$4K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
3,764 |
3,535 |
$4K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
3,769 |
3,540 |
$4K |
| 90834 |
Psychotherapy, 45 minutes with patient |
37 |
28 |
$4K |
| 59025 |
Fetal non-stress test |
645 |
491 |
$4K |
| 99238 |
Hospital discharge day management, 30 minutes or less |
76 |
76 |
$3K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
6,413 |
6,147 |
$3K |
| 90686 |
|
181 |
175 |
$3K |
| 0031A |
|
99 |
95 |
$3K |
| 81001 |
|
19,527 |
17,631 |
$2K |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
103 |
98 |
$2K |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
612 |
580 |
$2K |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
692 |
669 |
$2K |
| 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 |
846 |
761 |
$2K |
| 86780 |
|
1,215 |
1,154 |
$2K |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
1,955 |
1,831 |
$2K |
| 87481 |
|
535 |
515 |
$2K |
| 71045 |
Radiologic examination, chest; single view |
347 |
321 |
$2K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
771 |
531 |
$2K |
| 86900 |
|
289 |
268 |
$1K |
| J2704 |
Injection, propofol, 10 mg |
6,989 |
4,461 |
$1K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
7,120 |
6,339 |
$1K |
| 70450 |
Computed tomography, head or brain; without contrast material |
466 |
439 |
$1K |
| 87430 |
|
1,273 |
1,225 |
$1K |
| 87798 |
Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism |
1,759 |
1,640 |
$1K |
| M0243 |
Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring |
24 |
23 |
$1K |
| 90682 |
|
25 |
25 |
$1K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
118 |
82 |
$1K |
| 94060 |
|
25 |
24 |
$1K |
| 0202U |
Oncology (prostate), multianalyte, gene expression profiling |
64 |
63 |
$1K |
| 86803 |
|
1,769 |
1,694 |
$970.35 |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
524 |
483 |
$953.54 |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
1,951 |
1,860 |
$917.96 |
| 87633 |
Infectious agent detection by nucleic acid, respiratory virus, 12-25 targets |
172 |
169 |
$880.83 |
| 80074 |
|
296 |
281 |
$860.85 |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
440 |
406 |
$688.65 |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
123 |
118 |
$687.84 |
| 87631 |
|
857 |
801 |
$637.16 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
499 |
224 |
$636.30 |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
96 |
91 |
$620.28 |
| 83690 |
|
4,860 |
4,395 |
$617.26 |
| 93010 |
Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only |
219 |
172 |
$611.59 |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
293 |
281 |
$569.82 |
| 86140 |
|
3,046 |
2,695 |
$513.74 |
| 83605 |
|
1,222 |
1,092 |
$453.30 |
| 72125 |
Computed tomography, cervical spine; without contrast material |
16 |
15 |
$443.03 |
| 80048 |
Basic metabolic panel (calcium, ionized) |
2,791 |
2,512 |
$412.36 |
| 87507 |
|
157 |
153 |
$411.63 |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
2,806 |
2,343 |
$379.25 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
3,471 |
2,888 |
$342.14 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
25 |
25 |
$323.63 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
657 |
543 |
$282.05 |
| 84484 |
|
2,757 |
2,398 |
$262.41 |
| 85652 |
|
3,176 |
2,842 |
$253.86 |
| 82565 |
|
2,134 |
1,901 |
$235.96 |
| 87480 |
|
754 |
718 |
$227.76 |
| 87510 |
|
754 |
718 |
$227.76 |
| 87660 |
|
758 |
721 |
$227.76 |
| 87486 |
|
1,031 |
971 |
$222.39 |
| 87581 |
|
1,030 |
970 |
$201.54 |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
84 |
79 |
$188.98 |
| 85027 |
|
1,891 |
1,751 |
$186.56 |
| 82728 |
|
1,218 |
1,137 |
$172.97 |
| 87081 |
|
2,007 |
1,909 |
$172.97 |
| G0378 |
Hospital observation service, per hour |
350 |
217 |
$172.78 |
| 84439 |
|
1,411 |
1,317 |
$170.30 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
1,318 |
1,066 |
$169.23 |
| 80076 |
|
716 |
614 |
$167.52 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
90 |
71 |
$164.44 |
| 84466 |
|
1,076 |
1,009 |
$152.69 |
| J7050 |
Infusion, normal saline solution, 250 cc |
545 |
252 |
$149.44 |
| 84703 |
|
1,834 |
1,694 |
$139.48 |
| 81003 |
|
976 |
939 |
$138.94 |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
267 |
201 |
$133.32 |
| G2012 |
Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion |
17 |
16 |
$132.30 |
| 87070 |
|
1,613 |
1,510 |
$127.27 |
| 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 |
429 |
284 |
$111.00 |
| 84460 |
|
476 |
434 |
$106.05 |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
12 |
12 |
$103.50 |
| 84450 |
|
422 |
383 |
$99.09 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
979 |
855 |
$95.60 |
| 99152 |
|
145 |
137 |
$93.30 |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
1,536 |
624 |
$89.99 |
| 83880 |
|
295 |
272 |
$88.63 |
| 81025 |
|
508 |
474 |
$86.41 |
| 93971 |
|
15 |
14 |
$84.96 |
| 83540 |
|
1,100 |
1,030 |
$78.37 |
| 87077 |
|
1,953 |
1,810 |
$71.85 |
| 87088 |
|
1,930 |
1,774 |
$71.49 |
| 87276 |
|
357 |
347 |
$68.18 |
| J1170 |
Injection, hydromorphone, up to 4 mg |
728 |
574 |
$65.75 |
| 82962 |
|
635 |
511 |
$63.56 |
| 85379 |
|
332 |
314 |
$58.24 |
| 82607 |
|
600 |
564 |
$56.78 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
2,091 |
1,627 |
$54.55 |
| 83735 |
|
559 |
474 |
$54.02 |
| 87205 |
|
1,153 |
1,067 |
$53.53 |
| 87186 |
|
1,566 |
1,375 |
$52.61 |
| 85610 |
|
1,094 |
946 |
$48.30 |
| 87147 |
|
965 |
888 |
$45.78 |
| 92507 |
Treatment of speech, language, voice, communication, and/or auditory processing disorder |
937 |
355 |
$45.60 |
| 87275 |
|
357 |
347 |
$43.69 |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
591 |
478 |
$42.78 |
| 82950 |
|
590 |
556 |
$40.23 |
| 87040 |
|
262 |
247 |
$40.02 |
| 85007 |
|
870 |
802 |
$36.61 |
| 87075 |
|
174 |
160 |
$36.00 |
| 86762 |
|
106 |
101 |
$31.36 |
| 96376 |
|
587 |
477 |
$30.18 |
| 84702 |
|
512 |
379 |
$29.16 |
| 87340 |
|
294 |
282 |
$25.76 |
| 81002 |
|
277 |
237 |
$25.00 |
| 82784 |
|
206 |
192 |
$24.12 |
| 87046 |
|
250 |
235 |
$23.79 |
| J2060 |
Injection, lorazepam, 2 mg |
304 |
273 |
$22.43 |
| 87899 |
|
333 |
240 |
$21.86 |
| J0690 |
Injection, cefazolin sodium, 500 mg |
311 |
245 |
$21.16 |
| 99153 |
Mod sedat endo service >5yrs |
69 |
66 |
$20.18 |
| G0475 |
Hiv antigen/antibody, combination assay, screening |
460 |
458 |
$19.62 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
701 |
658 |
$19.39 |
| 84481 |
|
176 |
167 |
$17.64 |
| 86901 |
|
322 |
301 |
$17.51 |
| 86592 |
|
582 |
552 |
$16.51 |
| J0780 |
Injection, prochlorperazine, up to 10 mg |
230 |
196 |
$14.23 |
| 86850 |
|
411 |
385 |
$13.32 |
| 97602 |
|
93 |
40 |
$12.62 |
| 86704 |
|
54 |
54 |
$12.43 |
| 82746 |
|
393 |
369 |
$11.98 |
| 87338 |
|
78 |
77 |
$11.34 |
| 86038 |
|
189 |
179 |
$10.44 |
| 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 |
366 |
255 |
$10.08 |
| 87807 |
|
18 |
18 |
$10.06 |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
360 |
297 |
$8.61 |
| 87045 |
|
250 |
235 |
$7.93 |
| 82977 |
|
55 |
48 |
$6.46 |
| J0134 |
Injection, acetaminophen (fresenius kabi), not therapeutically equivalent to j0131, 10 mg |
14 |
14 |
$6.37 |
| 82043 |
|
474 |
456 |
$4.86 |
| J1644 |
Injection, heparin sodium, per 1000 units |
47 |
43 |
$4.66 |
| 82247 |
|
177 |
122 |
$4.09 |
| 85014 |
|
80 |
72 |
$3.03 |
| 89051 |
|
14 |
13 |
$1.94 |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
13 |
12 |
$0.54 |
| 88720 |
|
53 |
51 |
$0.00 |
| 83615 |
|
188 |
172 |
$0.00 |
| 83001 |
|
195 |
181 |
$0.00 |
| 87529 |
|
49 |
46 |
$0.00 |
| 80055 |
|
201 |
200 |
$0.00 |
| 85730 |
|
254 |
238 |
$0.00 |
| 84402 |
|
168 |
158 |
$0.00 |
| 80349 |
|
67 |
55 |
$0.00 |
| 84132 |
|
43 |
41 |
$0.00 |
| 85018 |
|
38 |
32 |
$0.00 |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
141 |
139 |
$0.00 |
| 89190 |
|
92 |
83 |
$0.00 |
| 87522 |
Neg quan hep c or qual rna |
93 |
85 |
$0.00 |
| 82550 |
|
134 |
106 |
$0.00 |
| 80081 |
|
262 |
244 |
$0.00 |
| 36591 |
|
374 |
224 |
$0.00 |
| 86376 |
|
67 |
62 |
$0.00 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
120 |
100 |
$0.00 |
| 82952 |
|
12 |
12 |
$0.00 |
| 86706 |
|
143 |
138 |
$0.00 |
| 76830 |
Ultrasound, transvaginal |
154 |
145 |
$0.00 |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
37 |
26 |
$0.00 |
| 97112 |
Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination |
357 |
159 |
$0.00 |
| 45380 |
Colonoscopy, flexible; with biopsy, single or multiple |
39 |
38 |
$0.00 |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
215 |
104 |
$0.00 |
| 80178 |
|
188 |
161 |
$0.00 |
| 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 |
41 |
33 |
$0.00 |
| 82670 |
|
66 |
65 |
$0.00 |
| 84153 |
|
371 |
355 |
$0.00 |
| 86430 |
|
146 |
140 |
$0.00 |
| J1630 |
Injection, haloperidol, up to 5 mg |
17 |
12 |
$0.00 |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
13 |
12 |
$0.00 |
| 82105 |
|
137 |
136 |
$0.00 |
| 86664 |
|
27 |
24 |
$0.00 |
| 93351 |
|
25 |
25 |
$0.00 |
| 86800 |
|
29 |
29 |
$0.00 |
| 76819 |
Fetal biophysical profile; without non-stress testing |
16 |
15 |
$0.00 |
| 87255 |
|
17 |
17 |
$0.00 |
| 86141 |
|
18 |
18 |
$0.00 |
| 82803 |
|
15 |
13 |
$0.00 |
| 97162 |
|
29 |
27 |
$0.00 |
| 97802 |
|
76 |
61 |
$0.00 |
| 96415 |
|
17 |
12 |
$0.00 |
| 86701 |
|
19 |
19 |
$0.00 |
| 82951 |
|
24 |
24 |
$0.00 |
| 86702 |
|
19 |
19 |
$0.00 |
| 84154 |
|
20 |
18 |
$0.00 |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
16 |
15 |
$0.00 |
| 45378 |
Colonoscopy, flexible; diagnostic, including collection of specimen(s) |
12 |
12 |
$0.00 |
| 84480 |
|
12 |
12 |
$0.00 |
| 83002 |
|
40 |
37 |
$0.00 |
| 87177 |
|
125 |
113 |
$0.00 |
| J7040 |
Infusion, normal saline solution, sterile (500 ml = 1 unit) |
275 |
188 |
$0.00 |
| 83516 |
|
191 |
143 |
$0.00 |
| 87209 |
|
125 |
113 |
$0.00 |
| 86480 |
|
27 |
26 |
$0.00 |
| 84146 |
|
117 |
111 |
$0.00 |
| 84100 |
|
94 |
76 |
$0.00 |
| 84520 |
|
155 |
107 |
$0.00 |
| 84403 |
|
241 |
229 |
$0.00 |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
1,090 |
377 |
$0.00 |
| 86665 |
|
76 |
61 |
$0.00 |
| 87329 |
|
125 |
116 |
$0.00 |
| 97163 |
|
13 |
12 |
$0.00 |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
175 |
163 |
$0.00 |
| 97803 |
|
192 |
139 |
$0.00 |
| 80356 |
|
31 |
28 |
$0.00 |
| 97116 |
|
300 |
91 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
691 |
527 |
$0.00 |
| 84156 |
|
58 |
36 |
$0.00 |
| 87210 |
|
232 |
226 |
$0.00 |
| 83970 |
|
59 |
56 |
$0.00 |
| 96367 |
|
324 |
163 |
$0.00 |
| 84550 |
|
284 |
242 |
$0.00 |
| 80164 |
|
33 |
31 |
$0.00 |
| 99001 |
|
20 |
17 |
$0.00 |
| 80365 |
|
31 |
28 |
$0.00 |
| 82570 |
|
39 |
31 |
$0.00 |
| 86787 |
|
13 |
13 |
$0.00 |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
19 |
12 |
$0.00 |
| 82274 |
|
14 |
13 |
$0.00 |
| 82947 |
|
57 |
52 |
$0.00 |
| 86703 |
|
86 |
85 |
$0.00 |
| Q9957 |
Injection, perflutren lipid microspheres, per ml |
54 |
54 |
$0.00 |
| 86003 |
|
73 |
44 |
$0.00 |
| 87324 |
|
16 |
16 |
$0.00 |
| 97167 |
|
28 |
27 |
$0.00 |
| P9604 |
Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated trip charge |
16 |
13 |
$0.00 |
| 99442 |
|
12 |
12 |
$0.00 |
| M0245 |
Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring |
15 |
13 |
$0.00 |
| 93017 |
|
17 |
14 |
$0.00 |
| 76000 |
|
12 |
12 |
$0.00 |
| 82248 |
|
26 |
17 |
$0.00 |