| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
69,971 |
65,499 |
$42.20M |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
24,659 |
22,980 |
$17.51M |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
20,293 |
19,521 |
$9.85M |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
8,167 |
7,758 |
$7.47M |
| G0378 |
Hospital observation service, per hour |
17,803 |
12,885 |
$5.15M |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
4,422 |
4,246 |
$2.00M |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
1,660 |
1,582 |
$1.80M |
| A0424 |
Extra ambulance attendant, ground (als or bls) or air (fixed or rotary winged); (requires medical review) |
1,173 |
817 |
$1.31M |
| 76811 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, detailed |
6,745 |
6,571 |
$1.23M |
| 70553 |
Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences |
956 |
926 |
$1.20M |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
10,617 |
4,843 |
$837K |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
10,242 |
5,382 |
$702K |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
1,342 |
1,314 |
$656K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
766 |
722 |
$652K |
| 96361 |
Intravenous infusion, hydration; each additional hour |
7,811 |
6,504 |
$635K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
5,288 |
5,146 |
$618K |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
1,675 |
1,641 |
$462K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
4,622 |
4,573 |
$455K |
| 87633 |
Infectious agent detection by nucleic acid, respiratory virus, 12-25 targets |
328 |
324 |
$441K |
| 92507 |
Treatment of speech, language, voice, communication, and/or auditory processing disorder |
7,894 |
3,953 |
$419K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
6,101 |
5,124 |
$364K |
| 76813 |
|
4,904 |
4,740 |
$320K |
| 92523 |
|
1,606 |
1,579 |
$300K |
| 76770 |
|
3,683 |
3,606 |
$288K |
| 92579 |
|
2,154 |
2,100 |
$262K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
3,568 |
3,445 |
$253K |
| 76827 |
|
857 |
789 |
$241K |
| 92557 |
|
1,378 |
1,337 |
$199K |
| 92526 |
|
2,971 |
2,260 |
$187K |
| 93976 |
|
1,073 |
1,035 |
$179K |
| L8699 |
Prosthetic implant, not otherwise specified |
828 |
800 |
$174K |
| 76801 |
|
2,650 |
2,442 |
$172K |
| 36430 |
|
1,522 |
1,034 |
$152K |
| A4649 |
Surgical supply; miscellaneous |
61,908 |
46,611 |
$147K |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
3,691 |
1,698 |
$141K |
| 58558 |
|
111 |
105 |
$140K |
| 77065 |
Tomosynthesis, mammo |
1,495 |
1,373 |
$126K |
| 70450 |
Computed tomography, head or brain; without contrast material |
1,843 |
1,780 |
$123K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
3,661 |
2,235 |
$112K |
| 81513 |
|
498 |
479 |
$107K |
| 92582 |
|
733 |
713 |
$103K |
| 71046 |
Radiologic examination, chest; 2 views |
17,070 |
16,315 |
$95K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
14,500 |
9,700 |
$95K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
1,388 |
1,281 |
$93K |
| G0379 |
Direct admission of patient for hospital observation care |
10,736 |
9,079 |
$92K |
| 97161 |
|
1,226 |
1,185 |
$91K |
| 77066 |
Tomosynthesis, mammo |
640 |
620 |
$81K |
| 96413 |
Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance |
3,044 |
1,678 |
$80K |
| 42820 |
Tonsillectomy and adenoidectomy; younger than age 12 |
38 |
37 |
$77K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
3,260 |
2,591 |
$75K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
7,717 |
6,108 |
$66K |
| 76642 |
|
2,899 |
2,455 |
$66K |
| 92587 |
|
5,500 |
5,325 |
$63K |
| 96409 |
|
1,341 |
823 |
$60K |
| 95819 |
|
372 |
365 |
$60K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
3,259 |
3,110 |
$59K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
10,128 |
7,363 |
$53K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
3,351 |
3,220 |
$51K |
| P9040 |
Red blood cells, leukocytes reduced, irradiated, each unit |
209 |
154 |
$51K |
| C9803 |
Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
4,367 |
4,034 |
$50K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
10,495 |
9,816 |
$48K |
| 0241U |
Neonatal screening for hereditary disorders, genomic sequence analysis panel |
4,729 |
4,582 |
$48K |
| 36591 |
|
4,743 |
2,171 |
$44K |
| 54161 |
|
40 |
40 |
$44K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
8,979 |
7,961 |
$43K |
| 54360 |
|
26 |
26 |
$43K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
3,664 |
3,433 |
$41K |
| 95810 |
Polysomnography; sleep staging with 4 or more additional parameters |
53 |
53 |
$41K |
| 69436 |
Tympanostomy (requiring insertion of ventilating tube), general anesthesia |
31 |
31 |
$40K |
| 73521 |
|
778 |
746 |
$40K |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
718 |
316 |
$39K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
4,455 |
4,305 |
$38K |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
285 |
268 |
$37K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
2,748 |
2,510 |
$35K |
| J0585 |
Injection, onabotulinumtoxina, 1 unit |
17 |
16 |
$35K |
| 92567 |
|
6,496 |
6,304 |
$35K |
| 92556 |
|
300 |
291 |
$35K |
| 76536 |
|
713 |
697 |
$31K |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
305 |
261 |
$30K |
| 77072 |
|
1,163 |
1,136 |
$28K |
| 95816 |
|
173 |
170 |
$27K |
| 92610 |
|
239 |
232 |
$26K |
| 92555 |
|
3,717 |
3,612 |
$24K |
| 76885 |
|
304 |
300 |
$23K |
| J0561 |
Injection, penicillin g benzathine, 100,000 units |
335 |
325 |
$21K |
| 73610 |
|
1,610 |
1,521 |
$21K |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
25 |
24 |
$20K |
| 76870 |
|
477 |
462 |
$20K |
| 73090 |
|
1,314 |
1,128 |
$18K |
| 87186 |
|
3,889 |
3,734 |
$16K |
| 96415 |
|
528 |
353 |
$15K |
| 73630 |
|
1,710 |
1,616 |
$15K |
| J3490 |
Unclassified drugs |
20,977 |
10,850 |
$15K |
| 97165 |
|
242 |
236 |
$14K |
| 41899 |
Unlisted procedure, dentoalveolar structures |
13 |
13 |
$13K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
8,531 |
7,676 |
$12K |
| 73070 |
|
644 |
541 |
$12K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
4,796 |
4,019 |
$11K |
| 76831 |
|
37 |
37 |
$10K |
| 93303 |
Transthoracic echocardiography for congenital cardiac anomalies, follow-up or limited study |
14 |
14 |
$10K |
| 36592 |
|
2,257 |
1,546 |
$10K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
11,410 |
10,799 |
$10K |
| 73590 |
|
699 |
602 |
$10K |
| P9016 |
Red blood cells, leukocytes reduced, each unit |
64 |
56 |
$9K |
| 86920 |
|
1,797 |
1,463 |
$9K |
| 92522 |
|
104 |
104 |
$9K |
| 93308 |
|
87 |
83 |
$9K |
| 19083 |
|
13 |
13 |
$9K |
| V5264 |
Ear mold/insert, not disposable, any type |
422 |
402 |
$8K |
| 86850 |
|
4,116 |
3,558 |
$7K |
| 73140 |
|
756 |
711 |
$7K |
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
110 |
106 |
$7K |
| 73560 |
|
485 |
419 |
$7K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
6,514 |
6,247 |
$6K |
| 80053 |
Comprehensive metabolic panel |
20,710 |
18,036 |
$6K |
| 73110 |
|
665 |
627 |
$6K |
| 73130 |
|
532 |
492 |
$6K |
| 74019 |
|
1,332 |
1,298 |
$5K |
| 73100 |
|
158 |
135 |
$5K |
| 73562 |
|
369 |
349 |
$5K |
| 71045 |
Radiologic examination, chest; single view |
2,497 |
2,335 |
$5K |
| 73080 |
|
305 |
281 |
$4K |
| 72082 |
|
42 |
41 |
$4K |
| 72081 |
|
95 |
93 |
$4K |
| 97112 |
Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination |
50 |
15 |
$4K |
| 92593 |
|
99 |
93 |
$4K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
35,841 |
28,504 |
$3K |
| 82803 |
|
835 |
774 |
$3K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
3,352 |
3,221 |
$3K |
| 93325 |
|
1,770 |
1,654 |
$3K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
76 |
71 |
$3K |
| 86592 |
|
195 |
187 |
$3K |
| 87077 |
|
5,297 |
4,454 |
$3K |
| 92553 |
|
26 |
26 |
$3K |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
3,162 |
3,069 |
$3K |
| 59025 |
Fetal non-stress test |
9,709 |
2,944 |
$3K |
| 36415 |
Collection of venous blood by venipuncture |
18,095 |
15,756 |
$3K |
| 62270 |
|
278 |
271 |
$2K |
| 29125 |
|
392 |
375 |
$2K |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
49 |
49 |
$2K |
| 73030 |
|
161 |
150 |
$2K |
| 97162 |
|
39 |
37 |
$2K |
| 92585 |
|
15 |
14 |
$2K |
| 87798 |
Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism |
396 |
379 |
$2K |
| 87210 |
|
88 |
81 |
$2K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
12,502 |
6,412 |
$2K |
| 87081 |
|
2,906 |
2,857 |
$2K |
| 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 |
601 |
575 |
$1K |
| 74022 |
|
1,104 |
1,082 |
$1K |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
2,618 |
2,463 |
$1K |
| 87480 |
|
2,197 |
2,100 |
$1K |
| Q9965 |
Low osmolar contrast material, 100-199 mg/ml iodine concentration, per ml |
1,299 |
1,225 |
$1K |
| 96376 |
|
3,013 |
2,047 |
$1K |
| 82948 |
|
2,816 |
2,505 |
$1K |
| 96367 |
|
2,102 |
1,581 |
$1K |
| 74018 |
|
85 |
77 |
$1K |
| 73552 |
|
51 |
49 |
$1K |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
7,628 |
6,652 |
$1K |
| 90715 |
|
375 |
368 |
$996.00 |
| 81025 |
|
16,296 |
15,176 |
$994.23 |
| 12011 |
|
453 |
445 |
$921.44 |
| 76830 |
Ultrasound, transvaginal |
3,404 |
3,281 |
$916.39 |
| 87510 |
|
2,197 |
2,100 |
$897.32 |
| 81003 |
|
14,599 |
13,913 |
$873.56 |
| 69210 |
|
66 |
60 |
$842.63 |
| 94375 |
|
12 |
12 |
$816.73 |
| 83880 |
|
537 |
490 |
$708.25 |
| 10060 |
|
135 |
132 |
$688.95 |
| 73000 |
|
54 |
52 |
$639.98 |
| 74021 |
|
296 |
289 |
$636.97 |
| Q9966 |
Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml |
270 |
255 |
$602.96 |
| 80048 |
Basic metabolic panel (calcium, ionized) |
6,637 |
6,041 |
$602.87 |
| 76820 |
|
41 |
26 |
$580.82 |
| A9270 |
Non-covered item or service |
8,498 |
4,994 |
$578.25 |
| 29515 |
|
212 |
211 |
$573.73 |
| 84702 |
|
2,060 |
1,788 |
$571.56 |
| 83690 |
|
7,343 |
6,833 |
$569.08 |
| 84484 |
|
2,752 |
2,542 |
$480.17 |
| V5275 |
Ear impression, each |
491 |
461 |
$478.48 |
| 87636 |
Infectious agent detection by nucleic acid; SARS-CoV-2 and influenza virus types A and B |
13 |
13 |
$457.69 |
| 87040 |
|
5,306 |
4,885 |
$445.69 |
| 73502 |
|
13 |
12 |
$442.52 |
| 12001 |
|
258 |
254 |
$428.03 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
17,164 |
15,492 |
$420.26 |
| 96040 |
|
162 |
135 |
$371.96 |
| 87481 |
|
647 |
488 |
$339.02 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
13,682 |
10,975 |
$336.84 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
9,306 |
7,648 |
$309.33 |
| 72100 |
|
12 |
12 |
$305.11 |
| 76819 |
Fetal biophysical profile; without non-stress testing |
19 |
12 |
$302.34 |
| A4300 |
Implantable access catheter, (e.g., venous, arterial, epidural subarachnoid, or peritoneal, etc.) external access |
18,232 |
15,651 |
$285.52 |
| 70360 |
|
36 |
36 |
$264.87 |
| 87660 |
|
2,196 |
2,099 |
$261.17 |
| 86140 |
|
6,620 |
6,210 |
$252.73 |
| 92552 |
|
311 |
299 |
$250.39 |
| 81001 |
|
12,733 |
11,746 |
$233.77 |
| 84145 |
|
1,499 |
1,431 |
$231.74 |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
3,345 |
2,908 |
$231.17 |
| 73660 |
|
13 |
13 |
$224.13 |
| 94664 |
|
2,479 |
2,400 |
$204.82 |
| 96450 |
|
149 |
120 |
$203.93 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
5,484 |
4,662 |
$201.23 |
| 87899 |
|
1,042 |
823 |
$200.74 |
| 86901 |
|
5,030 |
4,274 |
$193.75 |
| 94799 |
|
880 |
841 |
$182.40 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
2,423 |
2,387 |
$172.33 |
| 76825 |
|
776 |
711 |
$164.01 |
| 83605 |
|
1,933 |
1,753 |
$156.91 |
| 82330 |
|
453 |
403 |
$122.09 |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
1,156 |
1,128 |
$121.75 |
| V5011 |
Fitting/orientation/checking of hearing aid |
30 |
26 |
$120.00 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
9,894 |
8,257 |
$119.98 |
| A4570 |
Splint |
2,404 |
2,290 |
$119.44 |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
3,432 |
2,991 |
$102.28 |
| 85610 |
|
1,699 |
1,547 |
$98.71 |
| 87420 |
|
1,333 |
1,316 |
$96.77 |
| 84443 |
Thyroid stimulating hormone (TSH) |
983 |
913 |
$94.11 |
| V5266 |
Battery for use in hearing device |
41 |
37 |
$90.00 |
| 87070 |
|
1,736 |
1,672 |
$87.80 |
| J1170 |
Injection, hydromorphone, up to 4 mg |
1,008 |
845 |
$78.30 |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
508 |
490 |
$78.25 |
| 87075 |
|
503 |
489 |
$76.47 |
| J2704 |
Injection, propofol, 10 mg |
10,482 |
9,364 |
$72.13 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
3,750 |
3,503 |
$66.09 |
| J0136 |
Injection, acetaminophen (b braun), not therapeutically equivalent to j0131, 10 mg |
335 |
242 |
$61.78 |
| 88304 |
|
1,133 |
1,036 |
$54.51 |
| 83735 |
|
2,941 |
1,914 |
$50.04 |
| 87045 |
|
859 |
827 |
$47.41 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,030 |
995 |
$45.84 |
| A9585 |
Injection, gadobutrol, 0.1 ml |
1,970 |
1,884 |
$42.60 |
| U0002 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
1,305 |
1,220 |
$42.00 |
| J0688 |
Injection, cefazolin sodium (hikma), not therapeutically equivalent to j0690, 500 mg |
309 |
278 |
$41.20 |
| 86900 |
|
4,431 |
3,723 |
$37.05 |
| 82728 |
|
1,298 |
1,092 |
$36.75 |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
3,152 |
2,300 |
$36.42 |
| 87015 |
|
887 |
853 |
$32.43 |
| 85730 |
|
830 |
737 |
$32.06 |
| 84703 |
|
467 |
426 |
$30.14 |
| 76376 |
|
1,683 |
1,634 |
$29.58 |
| 81015 |
|
896 |
859 |
$28.53 |
| J0137 |
Injection, acetaminophen (hikma), not therapeutically equivalent to j0131, 10 mg |
1,136 |
771 |
$27.86 |
| 81002 |
|
1,468 |
1,377 |
$27.63 |
| 87088 |
|
444 |
414 |
$25.50 |
| 87046 |
|
859 |
827 |
$24.97 |
| J0690 |
Injection, cefazolin sodium, 500 mg |
3,404 |
2,568 |
$18.00 |
| 85651 |
|
2,095 |
1,948 |
$16.34 |
| 84100 |
|
2,394 |
1,753 |
$14.85 |
| 82570 |
|
1,248 |
1,077 |
$13.23 |
| A4467 |
Belt, strap, sleeve, garment, or covering, any type |
1,079 |
967 |
$13.20 |
| A4215 |
Needle, sterile, any size, each |
4,282 |
2,533 |
$10.56 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
4,602 |
4,242 |
$9.66 |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
112 |
70 |
$9.00 |
| J1642 |
Injection, heparin sodium, (heparin lock flush), per 10 units |
7,787 |
3,087 |
$8.94 |
| 80069 |
|
239 |
147 |
$8.68 |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
2,221 |
2,059 |
$8.05 |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
4,484 |
3,743 |
$7.86 |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
124 |
123 |
$7.80 |
| A4620 |
Variable concentration mask |
5,914 |
5,497 |
$7.21 |
| A4550 |
Surgical trays |
4,107 |
3,809 |
$7.14 |
| A6258 |
Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
934 |
606 |
$4.00 |
| 85027 |
|
87 |
76 |
$2.62 |
| A7002 |
Tubing, used with suction pump, each |
2,542 |
2,388 |
$0.60 |
| 36416 |
|
1,720 |
1,393 |
$0.50 |
| A4209 |
Syringe with needle, sterile 5 cc or greater, each |
484 |
447 |
$0.26 |
| A4617 |
Mouth piece |
2,465 |
2,357 |
$0.21 |
| 84157 |
|
294 |
289 |
$0.00 |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
1,842 |
1,825 |
$0.00 |
| A4335 |
Incontinence supply; miscellaneous |
2,646 |
2,302 |
$0.00 |
| P9612 |
Catheterization for collection of specimen, single patient, all places of service |
1,612 |
1,585 |
$0.00 |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
222 |
213 |
$0.00 |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
281 |
273 |
$0.00 |
| 88307 |
|
311 |
284 |
$0.00 |
| 82550 |
|
198 |
181 |
$0.00 |
| 87205 |
|
1,023 |
978 |
$0.00 |
| 83615 |
|
2,067 |
1,624 |
$0.00 |
| B4083 |
Stomach tube - levine type |
471 |
433 |
$0.00 |
| J7050 |
Infusion, normal saline solution, 250 cc |
1,479 |
819 |
$0.00 |
| 82945 |
|
296 |
291 |
$0.00 |
| A6448 |
Light compression bandage, elastic, knitted/woven, width less than three inches, per yard |
64 |
62 |
$0.00 |
| J2795 |
Injection, ropivacaine hydrochloride, 1 mg |
601 |
569 |
$0.00 |
| 84478 |
|
398 |
268 |
$0.00 |
| A6449 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
264 |
259 |
$0.00 |
| 87486 |
|
329 |
325 |
$0.00 |
| 88342 |
|
210 |
184 |
$0.00 |
| A4580 |
Cast supplies (e.g., plaster) |
1,314 |
1,245 |
$0.00 |
| A4322 |
Irrigation syringe, bulb or piston, each |
396 |
381 |
$0.00 |
| A9579 |
Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (nos), per ml |
12 |
12 |
$0.00 |
| 87581 |
|
330 |
325 |
$0.00 |
| 51600 |
|
31 |
24 |
$0.00 |
| J7042 |
5% dextrose/normal saline (500 ml = 1 unit) |
103 |
88 |
$0.00 |
| J2780 |
Injection, ranitidine hydrochloride, 25 mg |
27 |
24 |
$0.00 |
| 88108 |
|
156 |
122 |
$0.00 |
| J2371 |
Injection, phenylephrine hydrochloride, 20 micrograms |
13 |
13 |
$0.00 |
| J9250 |
Methotrexate sodium, 5 mg |
171 |
111 |
$0.00 |
| 85379 |
|
32 |
27 |
$0.00 |
| Q9968 |
Injection, non-radioactive, non-contrast, visualization adjunct (e.g., methylene blue, isosulfan blue), 1 mg |
15 |
12 |
$0.00 |
| 88341 |
|
12 |
12 |
$0.00 |
| J2003 |
Injection, lidocaine hydrochloride, 1 mg |
171 |
134 |
$0.00 |
| 93320 |
|
27 |
26 |
$0.00 |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
77 |
63 |
$0.00 |
| J2543 |
Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams) |
71 |
24 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
91 |
91 |
$0.00 |
| 87340 |
|
13 |
13 |
$0.00 |
| 82150 |
|
13 |
13 |
$0.00 |
| A4750 |
Blood tubing, arterial or venous, for hemodialysis, each |
38 |
26 |
$0.00 |
| J2370 |
Injection, phenylephrine hcl, up to 1 ml |
45 |
40 |
$0.00 |
| 76010 |
|
13 |
13 |
$0.00 |
| 86905 |
|
16 |
12 |
$0.00 |
| J7030 |
Infusion, normal saline solution , 1000 cc |
2,851 |
1,284 |
$0.00 |
| J9370 |
Vincristine sulfate, 1 mg |
988 |
674 |
$0.00 |
| 85045 |
|
1,775 |
1,450 |
$0.00 |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
37 |
26 |
$0.00 |
| J0171 |
Injection, adrenalin, epinephrine, 0.1 mg |
166 |
156 |
$0.00 |
| 82247 |
|
1,391 |
986 |
$0.00 |
| C1751 |
Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis) |
1,274 |
1,190 |
$0.00 |
| 82565 |
|
232 |
166 |
$0.00 |
| 89050 |
|
668 |
594 |
$0.00 |
| 84156 |
|
1,214 |
1,045 |
$0.00 |
| 84550 |
|
886 |
666 |
$0.00 |
| 77061 |
|
15 |
15 |
$0.00 |
| Q9958 |
High osmolar contrast material, up to 149 mg/ml iodine concentration, per ml |
30 |
25 |
$0.00 |
| A4565 |
Slings |
455 |
444 |
$0.00 |
| 84460 |
|
214 |
160 |
$0.00 |
| 85007 |
|
67 |
61 |
$0.00 |
| J8499 |
Prescription drug, oral, non chemotherapeutic, nos |
13 |
13 |
$0.00 |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
24 |
24 |
$0.00 |
| J0290 |
Injection, ampicillin sodium, 500 mg |
58 |
24 |
$0.00 |
| 82465 |
|
395 |
265 |
$0.00 |
| A6266 |
Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard |
43 |
42 |
$0.00 |
| 88302 |
|
81 |
77 |
$0.00 |
| 82977 |
|
407 |
276 |
$0.00 |
| 96417 |
|
179 |
118 |
$0.00 |
| 58340 |
|
51 |
49 |
$0.00 |
| 96160 |
|
36 |
32 |
$0.00 |
| J0780 |
Injection, prochlorperazine, up to 10 mg |
13 |
13 |
$0.00 |
| J1171 |
Injection, hydromorphone, 0.1 mg |
21 |
15 |
$0.00 |
| J0134 |
Injection, acetaminophen (fresenius kabi), not therapeutically equivalent to j0131, 10 mg |
68 |
50 |
$0.00 |
| A6403 |
Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing |
27 |
26 |
$0.00 |
| 87634 |
|
186 |
160 |
$0.00 |
| J2550 |
Injection, promethazine hcl, up to 50 mg |
25 |
24 |
$0.00 |
| 84439 |
|
26 |
25 |
$0.00 |
| J2004 |
Injection, lidocaine hcl with epinephrine, 1 mg |
33 |
33 |
$0.00 |
| 77062 |
|
25 |
25 |
$0.00 |
| 80076 |
|
16 |
15 |
$0.00 |
| 64642 |
|
13 |
13 |
$0.00 |
| A4246 |
Betadine or phisohex solution, per pint |
13 |
12 |
$0.00 |
| 29105 |
|
13 |
13 |
$0.00 |