| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99284 |
Emergency department visit for the evaluation and management, high severity |
175,059 |
149,104 |
$22.41M |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
176,460 |
156,332 |
$20.45M |
| 96361 |
Intravenous infusion, hydration; each additional hour |
64,729 |
43,626 |
$18.74M |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
75,674 |
62,483 |
$10.91M |
| J2350 |
Injection, ocrelizumab, 1 mg |
498 |
325 |
$10.61M |
| 70450 |
Computed tomography, head or brain; without contrast material |
23,106 |
16,881 |
$5.27M |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
43,148 |
33,038 |
$4.03M |
| J9271 |
Injection, pembrolizumab, 1 mg |
531 |
289 |
$3.94M |
| 0241U |
Neonatal screening for hereditary disorders, genomic sequence analysis panel |
32,990 |
25,889 |
$3.74M |
| G0378 |
Hospital observation service, per hour |
60,569 |
20,872 |
$3.67M |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
17,360 |
12,152 |
$3.32M |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
48,389 |
15,907 |
$3.26M |
| A0431 |
Ambulance service, conventional air services, transport, one way (rotary wing) |
2,190 |
2,004 |
$3.19M |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
32,518 |
27,336 |
$3.07M |
| 59025 |
Fetal non-stress test |
17,687 |
7,681 |
$2.56M |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
17,192 |
9,792 |
$1.85M |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
20,714 |
8,026 |
$1.76M |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
8,894 |
4,238 |
$1.60M |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
6,866 |
4,690 |
$1.47M |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
8,730 |
6,073 |
$1.43M |
| A0434 |
Specialty care transport (sct) |
8,099 |
7,444 |
$1.25M |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
9,546 |
7,526 |
$1.13M |
| 80048 |
Basic metabolic panel (calcium, ionized) |
175,347 |
130,272 |
$1.11M |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
7,403 |
5,315 |
$1.02M |
| 67311 |
|
562 |
374 |
$965K |
| 78452 |
Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress |
2,720 |
1,895 |
$913K |
| 47562 |
|
450 |
335 |
$806K |
| 90791 |
Psychiatric diagnostic evaluation |
4,352 |
3,190 |
$758K |
| J2323 |
Injection, natalizumab, 1 mg |
144 |
88 |
$742K |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
3,335 |
2,444 |
$648K |
| 70496 |
|
2,937 |
2,062 |
$603K |
| 70553 |
Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences |
2,800 |
2,111 |
$601K |
| 76811 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, detailed |
4,263 |
3,893 |
$600K |
| 76801 |
|
3,683 |
3,306 |
$493K |
| 95810 |
Polysomnography; sleep staging with 4 or more additional parameters |
787 |
701 |
$485K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
5,303 |
4,985 |
$450K |
| 58661 |
|
247 |
158 |
$439K |
| 76830 |
Ultrasound, transvaginal |
5,266 |
4,192 |
$437K |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
16,031 |
6,324 |
$426K |
| A0436 |
Rotary wing air mileage, per statute mile |
2,125 |
1,946 |
$402K |
| A0425 |
Ground mileage, per statute mile |
8,170 |
7,507 |
$392K |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
16,859 |
8,047 |
$372K |
| 66984 |
Extracapsular cataract removal with insertion of intraocular lens prosthesis |
753 |
438 |
$341K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
4,612 |
3,423 |
$322K |
| 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 |
1,877 |
1,800 |
$317K |
| 93970 |
|
2,831 |
2,080 |
$316K |
| 70491 |
|
1,313 |
929 |
$315K |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
1,021 |
709 |
$291K |
| 78815 |
Positron emission tomography (PET) for limited area imaging |
605 |
464 |
$280K |
| 41899 |
Unlisted procedure, dentoalveolar structures |
442 |
376 |
$278K |
| 96367 |
|
3,963 |
1,885 |
$245K |
| C8929 |
Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiography |
1,317 |
932 |
$243K |
| 93971 |
|
4,127 |
3,009 |
$237K |
| 96413 |
Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance |
3,792 |
1,507 |
$233K |
| 84484 |
|
89,660 |
45,304 |
$229K |
| P9016 |
Red blood cells, leukocytes reduced, each unit |
1,121 |
648 |
$221K |
| 71046 |
Radiologic examination, chest; 2 views |
24,119 |
21,059 |
$221K |
| 93017 |
|
3,071 |
2,169 |
$209K |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
4,989 |
4,000 |
$203K |
| 11042 |
Debridement, subcutaneous tissue (includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm |
2,601 |
1,186 |
$203K |
| 71250 |
|
2,820 |
2,082 |
$203K |
| 96415 |
|
1,169 |
531 |
$198K |
| 76642 |
|
1,941 |
1,411 |
$198K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
4,717 |
3,706 |
$195K |
| 72131 |
|
4,326 |
3,019 |
$195K |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
1,445 |
1,033 |
$192K |
| 12001 |
|
1,419 |
1,086 |
$191K |
| 73721 |
Magnetic resonance imaging, any joint of lower extremity; without contrast material |
922 |
744 |
$190K |
| 97112 |
Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination |
6,018 |
2,490 |
$184K |
| 64400 |
|
693 |
487 |
$183K |
| 90853 |
Group psychotherapy (other than of a multiple-family group) |
2,416 |
541 |
$182K |
| J1745 |
Injection, infliximab, excludes biosimilar, 10 mg |
259 |
186 |
$182K |
| 72148 |
Magnetic resonance imaging, lumbar spine; without contrast material |
1,337 |
1,017 |
$173K |
| 64721 |
|
378 |
244 |
$172K |
| 97162 |
|
6,747 |
4,694 |
$169K |
| 36430 |
|
1,354 |
733 |
$167K |
| 71270 |
|
787 |
519 |
$158K |
| 76813 |
|
2,348 |
2,149 |
$155K |
| 93458 |
|
196 |
133 |
$150K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
958 |
799 |
$148K |
| 30520 |
|
160 |
104 |
$147K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
110,896 |
84,466 |
$146K |
| 70487 |
|
564 |
369 |
$141K |
| 97116 |
|
6,300 |
2,763 |
$139K |
| 10060 |
|
952 |
749 |
$138K |
| J0561 |
Injection, penicillin g benzathine, 100,000 units |
593 |
392 |
$137K |
| 97166 |
|
4,695 |
2,979 |
$136K |
| G0257 |
Unscheduled or emergency dialysis treatment for an esrd patient in a hospital outpatient department that is not certified as an esrd facility |
1,019 |
274 |
$136K |
| 97602 |
|
1,070 |
813 |
$129K |
| 72125 |
Computed tomography, cervical spine; without contrast material |
10,059 |
7,114 |
$122K |
| 72141 |
|
876 |
659 |
$121K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
5,215 |
3,264 |
$120K |
| 95811 |
|
205 |
180 |
$120K |
| 86850 |
|
7,301 |
4,919 |
$116K |
| 97535 |
Self-care/home management training, each 15 minutes |
6,428 |
3,026 |
$112K |
| 97161 |
|
3,160 |
2,479 |
$110K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
10,194 |
7,117 |
$110K |
| 76536 |
|
1,100 |
914 |
$110K |
| 95819 |
|
845 |
631 |
$108K |
| 95886 |
|
467 |
365 |
$105K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
85,939 |
67,673 |
$104K |
| 71271 |
|
748 |
590 |
$101K |
| 71045 |
Radiologic examination, chest; single view |
68,582 |
54,194 |
$100K |
| 80053 |
Comprehensive metabolic panel |
58,076 |
38,677 |
$97K |
| 94060 |
|
759 |
604 |
$95K |
| 74178 |
|
1,237 |
838 |
$94K |
| 70486 |
|
3,282 |
2,428 |
$94K |
| 73221 |
|
511 |
393 |
$92K |
| 12002 |
|
661 |
503 |
$84K |
| 76775 |
|
1,331 |
1,008 |
$83K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
215,196 |
166,535 |
$83K |
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
536 |
420 |
$81K |
| 27130 |
|
17 |
12 |
$78K |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
927 |
770 |
$78K |
| 72100 |
|
2,093 |
1,677 |
$77K |
| 19083 |
|
116 |
82 |
$76K |
| 93308 |
|
381 |
280 |
$76K |
| 80320 |
|
9,844 |
6,893 |
$75K |
| 30140 |
|
180 |
121 |
$75K |
| 86900 |
|
8,076 |
5,542 |
$75K |
| 88307 |
|
1,168 |
740 |
$73K |
| 74183 |
|
385 |
276 |
$72K |
| 12011 |
|
583 |
451 |
$71K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
91,832 |
63,667 |
$71K |
| 93976 |
|
505 |
384 |
$65K |
| J0897 |
Injection, denosumab, 1 mg |
51 |
42 |
$64K |
| 93925 |
|
741 |
521 |
$64K |
| 74018 |
|
2,330 |
1,752 |
$63K |
| 85027 |
|
22,902 |
11,011 |
$62K |
| 97035 |
|
1,250 |
553 |
$61K |
| 88341 |
|
2,580 |
1,095 |
$60K |
| 73700 |
|
573 |
432 |
$60K |
| J3490 |
Unclassified drugs |
32,547 |
14,742 |
$57K |
| 73630 |
|
6,237 |
4,676 |
$57K |
| 72156 |
|
520 |
389 |
$57K |
| 73030 |
|
5,012 |
3,618 |
$57K |
| J3032 |
Injection, eptinezumab-jjmr, 1 mg |
36 |
28 |
$57K |
| 78264 |
|
295 |
221 |
$55K |
| 73560 |
|
3,756 |
2,543 |
$53K |
| 72128 |
|
2,533 |
1,768 |
$52K |
| 75635 |
|
276 |
181 |
$51K |
| 90715 |
|
3,619 |
2,617 |
$51K |
| 80076 |
|
8,009 |
7,266 |
$51K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
5,009 |
4,045 |
$50K |
| 72040 |
|
1,137 |
871 |
$49K |
| 58558 |
|
34 |
24 |
$49K |
| 15271 |
|
64 |
29 |
$48K |
| 70544 |
|
358 |
246 |
$48K |
| J1756 |
Injection, iron sucrose, 1 mg |
2,810 |
899 |
$48K |
| 10061 |
|
315 |
251 |
$47K |
| 76870 |
|
889 |
651 |
$45K |
| 94729 |
|
792 |
623 |
$45K |
| 97163 |
|
2,700 |
1,744 |
$45K |
| 72158 |
|
379 |
266 |
$44K |
| 73130 |
|
5,931 |
4,339 |
$44K |
| 97167 |
|
1,683 |
1,038 |
$43K |
| 94726 |
|
684 |
542 |
$43K |
| 72110 |
|
745 |
620 |
$42K |
| 92507 |
Treatment of speech, language, voice, communication, and/or auditory processing disorder |
936 |
368 |
$42K |
| G0279 |
Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066) |
1,307 |
1,081 |
$41K |
| 93880 |
|
644 |
466 |
$41K |
| 0001A |
|
1,293 |
1,242 |
$40K |
| 49083 |
|
174 |
75 |
$39K |
| 36415 |
Collection of venous blood by venipuncture |
155,669 |
123,658 |
$38K |
| 73562 |
|
3,941 |
2,854 |
$37K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
65,504 |
42,874 |
$37K |
| 76770 |
|
291 |
240 |
$36K |
| 58571 |
|
31 |
14 |
$36K |
| 96376 |
|
22,121 |
8,383 |
$36K |
| 97165 |
|
689 |
489 |
$35K |
| 93325 |
|
600 |
398 |
$35K |
| 77080 |
|
688 |
523 |
$35K |
| 0002A |
|
1,006 |
984 |
$35K |
| 64483 |
|
168 |
124 |
$34K |
| 94660 |
|
358 |
121 |
$34K |
| 76882 |
|
396 |
308 |
$34K |
| 73610 |
|
4,990 |
3,688 |
$33K |
| 73502 |
|
2,607 |
1,840 |
$31K |
| 76641 |
|
184 |
164 |
$30K |
| D1351 |
Sealant - per tooth |
1,422 |
403 |
$30K |
| 77065 |
Tomosynthesis, mammo |
1,130 |
814 |
$29K |
| 52356 |
|
27 |
13 |
$28K |
| 97113 |
|
458 |
171 |
$27K |
| 36561 |
|
44 |
26 |
$26K |
| 78227 |
|
102 |
58 |
$26K |
| 74420 |
|
334 |
213 |
$26K |
| 70498 |
|
2,812 |
1,957 |
$26K |
| S9472 |
Cardiac rehabilitation program, non-physician provider, per diem |
734 |
96 |
$26K |
| 76820 |
|
822 |
361 |
$25K |
| 44970 |
|
18 |
14 |
$25K |
| 73110 |
|
3,314 |
2,389 |
$23K |
| 77066 |
Tomosynthesis, mammo |
1,129 |
924 |
$23K |
| 20680 |
|
35 |
24 |
$22K |
| 97802 |
|
257 |
231 |
$22K |
| 97597 |
|
294 |
207 |
$21K |
| 86923 |
|
1,248 |
588 |
$21K |
| 69436 |
Tympanostomy (requiring insertion of ventilating tube), general anesthesia |
18 |
14 |
$21K |
| 78582 |
|
59 |
40 |
$20K |
| J0500 |
Injection, dicyclomine hcl, up to 20 mg |
1,683 |
1,166 |
$20K |
| 83735 |
|
15,468 |
8,110 |
$20K |
| 80069 |
|
3,502 |
1,204 |
$20K |
| 72192 |
|
737 |
501 |
$20K |
| J1650 |
Injection, enoxaparin sodium, 10 mg |
25,282 |
8,988 |
$18K |
| 88360 |
|
627 |
355 |
$18K |
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
14 |
13 |
$18K |
| J2800 |
Injection, methocarbamol, up to 10 ml |
5,928 |
3,675 |
$18K |
| 0240U |
|
185 |
148 |
$18K |
| 81003 |
|
74,965 |
67,217 |
$18K |
| 85610 |
|
16,036 |
9,780 |
$17K |
| 97012 |
|
747 |
269 |
$17K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
8,960 |
6,898 |
$17K |
| J1453 |
Injection, fosaprepitant, 1 mg |
1,511 |
641 |
$17K |
| 72050 |
|
265 |
213 |
$16K |
| J1459 |
Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg |
40 |
12 |
$16K |
| 80061 |
Lipid panel |
3,418 |
2,270 |
$16K |
| 81001 |
|
38,585 |
28,783 |
$15K |
| 36569 |
|
63 |
37 |
$15K |
| 82248 |
|
46,525 |
33,169 |
$14K |
| J2805 |
Injection, sincalide, 5 micrograms |
119 |
68 |
$14K |
| 84443 |
Thyroid stimulating hormone (TSH) |
5,227 |
3,553 |
$14K |
| 82565 |
|
2,237 |
1,589 |
$13K |
| 01922 |
|
134 |
87 |
$13K |
| 86920 |
|
798 |
328 |
$13K |
| 72146 |
|
156 |
107 |
$12K |
| J1439 |
Injection, ferric carboxymaltose, 1 mg |
18 |
12 |
$12K |
| 87070 |
|
3,999 |
2,828 |
$12K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
15,735 |
12,398 |
$12K |
| 72072 |
|
331 |
265 |
$12K |
| 73590 |
|
2,277 |
1,642 |
$12K |
| 81025 |
|
64,291 |
55,357 |
$11K |
| J1170 |
Injection, hydromorphone, up to 4 mg |
15,824 |
6,490 |
$11K |
| 72070 |
|
267 |
204 |
$11K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
4,333 |
3,025 |
$11K |
| 74230 |
|
133 |
92 |
$10K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
8,915 |
6,856 |
$10K |
| G0260 |
Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography |
55 |
43 |
$10K |
| 36591 |
|
972 |
520 |
$10K |
| 92610 |
|
600 |
373 |
$9K |
| 45378 |
Colonoscopy, flexible; diagnostic, including collection of specimen(s) |
42 |
32 |
$9K |
| 45380 |
Colonoscopy, flexible; with biopsy, single or multiple |
47 |
25 |
$9K |
| P9047 |
Infusion, albumin (human), 25%, 50 ml |
75 |
28 |
$9K |
| J2997 |
Injection, alteplase recombinant, 1 mg |
21 |
13 |
$8K |
| U0002 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
6,786 |
6,134 |
$8K |
| 93225 |
|
64 |
52 |
$8K |
| 97803 |
|
102 |
76 |
$8K |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
18,186 |
9,928 |
$8K |
| 72197 |
|
49 |
28 |
$8K |
| C5271 |
Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area |
21 |
12 |
$8K |
| 72157 |
|
103 |
69 |
$8K |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
2,743 |
1,596 |
$8K |
| 87040 |
|
6,542 |
2,443 |
$7K |
| 45385 |
Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) |
21 |
13 |
$7K |
| 76819 |
Fetal biophysical profile; without non-stress testing |
118 |
83 |
$7K |
| 86901 |
|
8,088 |
5,544 |
$7K |
| J1815 |
Injection, insulin, per 5 units |
9,529 |
1,897 |
$7K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
4,065 |
2,877 |
$7K |
| 83880 |
|
7,616 |
5,126 |
$7K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
56 |
39 |
$7K |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
5,495 |
4,342 |
$7K |
| 96368 |
|
1,086 |
574 |
$7K |
| 84439 |
|
2,427 |
1,661 |
$7K |
| J1953 |
Injection, levetiracetam, 10 mg |
889 |
504 |
$6K |
| 73552 |
|
1,308 |
923 |
$6K |
| 90686 |
|
367 |
239 |
$6K |
| 75574 |
|
16 |
13 |
$6K |
| 92526 |
|
155 |
77 |
$6K |
| 73070 |
|
1,490 |
1,079 |
$6K |
| 85379 |
|
9,247 |
6,793 |
$6K |
| 85730 |
|
11,021 |
7,004 |
$6K |
| J2469 |
Injection, palonosetron hcl, 25 mcg |
1,511 |
578 |
$6K |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
66,284 |
52,200 |
$6K |
| G0008 |
Administration of influenza virus vaccine |
542 |
367 |
$6K |
| 85014 |
|
3,056 |
1,068 |
$6K |
| J7030 |
Infusion, normal saline solution , 1000 cc |
48,055 |
28,376 |
$5K |
| J2543 |
Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams) |
1,693 |
647 |
$5K |
| 84702 |
|
5,191 |
3,694 |
$5K |
| 84100 |
|
5,360 |
2,734 |
$5K |
| 71100 |
|
422 |
325 |
$5K |
| 83605 |
|
9,929 |
5,665 |
$5K |
| 83690 |
|
41,202 |
30,728 |
$5K |
| 72170 |
|
2,206 |
1,578 |
$5K |
| 72114 |
|
82 |
71 |
$5K |
| 76937 |
|
416 |
284 |
$5K |
| J9045 |
Injection, carboplatin, 50 mg |
377 |
115 |
$5K |
| 93922 |
|
74 |
56 |
$5K |
| 95806 |
|
33 |
27 |
$4K |
| 94667 |
|
230 |
166 |
$4K |
| 73060 |
|
942 |
668 |
$4K |
| 87088 |
|
10,418 |
7,663 |
$4K |
| 73140 |
|
801 |
600 |
$4K |
| J2310 |
Injection, naloxone hydrochloride, per 1 mg |
384 |
191 |
$4K |
| 00731 |
|
1,462 |
1,086 |
$4K |
| 97014 |
|
115 |
58 |
$4K |
| 86140 |
|
1,770 |
1,182 |
$4K |
| C9113 |
Injection, pantoprazole sodium, per vial |
3,615 |
1,260 |
$4K |
| J0702 |
Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg |
406 |
176 |
$4K |
| 73620 |
|
155 |
114 |
$4K |
| 82803 |
|
8,205 |
5,232 |
$4K |
| 82728 |
|
1,092 |
776 |
$4K |
| 87077 |
|
4,890 |
3,136 |
$4K |
| 73080 |
|
411 |
323 |
$3K |
| 87430 |
|
6,479 |
5,102 |
$3K |
| 82607 |
|
1,084 |
701 |
$3K |
| 73090 |
|
1,428 |
1,045 |
$3K |
| 78306 |
|
19 |
14 |
$3K |
| 87641 |
|
344 |
235 |
$3K |
| 93923 |
|
34 |
29 |
$3K |
| 82550 |
|
4,679 |
2,741 |
$3K |
| 84145 |
|
1,422 |
911 |
$3K |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
484 |
316 |
$3K |
| 82140 |
|
1,661 |
959 |
$3K |
| J3471 |
Injection, hyaluronidase, ovine, preservative free, per 1 usp unit (up to 999 usp units) |
211 |
109 |
$3K |
| J8501 |
Aprepitant, oral, 5 mg |
157 |
98 |
$3K |
| 85018 |
|
3,100 |
1,090 |
$3K |
| 93312 |
|
19 |
12 |
$3K |
| 88365 |
|
186 |
133 |
$3K |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
9,374 |
5,020 |
$3K |
| 83540 |
|
1,403 |
895 |
$3K |
| 74160 |
|
15 |
12 |
$3K |
| 95700 |
|
28 |
14 |
$3K |
| J3370 |
Injection, vancomycin hcl, 500 mg |
2,641 |
1,130 |
$2K |
| J3486 |
Injection, ziprasidone mesylate, 10 mg |
220 |
121 |
$2K |
| 00170 |
Anesthesia for intraoral procedures, including biopsy |
966 |
726 |
$2K |
| 94668 |
|
32 |
12 |
$2K |
| J2790 |
Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.) |
28 |
27 |
$2K |
| 83550 |
|
1,308 |
878 |
$2K |
| 86592 |
|
676 |
512 |
$2K |
| 74019 |
|
79 |
60 |
$2K |
| 87186 |
|
4,573 |
2,965 |
$2K |
| J3411 |
Injection, thiamine hcl, 100 mg |
1,932 |
787 |
$2K |
| 82746 |
|
934 |
588 |
$2K |
| 73522 |
|
65 |
49 |
$2K |
| 73600 |
|
126 |
92 |
$2K |
| 86870 |
|
82 |
49 |
$2K |
| 87147 |
|
1,749 |
1,202 |
$2K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
5,254 |
3,361 |
$2K |
| 29581 |
|
23 |
12 |
$2K |
| 76604 |
|
30 |
25 |
$2K |
| 92523 |
|
52 |
42 |
$2K |
| J2550 |
Injection, promethazine hcl, up to 50 mg |
7,808 |
3,892 |
$2K |
| J0360 |
Injection, hydralazine hcl, up to 20 mg |
2,391 |
1,197 |
$2K |
| C1713 |
Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable) |
1,396 |
962 |
$2K |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
20,911 |
12,987 |
$2K |
| 00140 |
|
1,012 |
705 |
$2K |
| J0295 |
Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm |
1,167 |
433 |
$2K |
| 20553 |
|
21 |
13 |
$2K |
| 00300 |
|
728 |
503 |
$2K |
| 93321 |
|
104 |
70 |
$2K |
| 29125 |
|
784 |
604 |
$2K |
| 86922 |
|
116 |
42 |
$1K |
| 87633 |
Infectious agent detection by nucleic acid, respiratory virus, 12-25 targets |
19 |
14 |
$1K |
| J1644 |
Injection, heparin sodium, per 1000 units |
7,744 |
2,284 |
$1K |
| G0475 |
Hiv antigen/antibody, combination assay, screening |
477 |
360 |
$1K |
| 80164 |
|
652 |
400 |
$1K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
271 |
137 |
$1K |
| J2704 |
Injection, propofol, 10 mg |
24,722 |
14,018 |
$1K |
| 97750 |
|
55 |
48 |
$1K |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
30,975 |
17,628 |
$1K |
| 00160 |
|
314 |
216 |
$1K |
| 99404 |
|
15 |
12 |
$1K |
| 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 |
1,272 |
685 |
$1K |
| 0012A |
|
40 |
39 |
$1K |
| 0011A |
|
68 |
58 |
$1K |
| 20552 |
|
38 |
26 |
$1K |
| 74174 |
|
21 |
12 |
$1K |
| 82330 |
|
1,018 |
456 |
$1K |
| 92611 |
|
38 |
24 |
$1K |
| 90714 |
|
41 |
27 |
$1K |
| 00537 |
|
18 |
12 |
$1K |
| 80143 |
|
2,600 |
1,801 |
$1K |
| J0737 |
Injection, clindamycin phosphate (baxter), not therapeutically equivalent to j0736, 300 mg |
734 |
449 |
$1K |
| J0690 |
Injection, cefazolin sodium, 500 mg |
9,582 |
5,630 |
$1K |
| 36600 |
|
126 |
62 |
$1K |
| 85652 |
|
2,027 |
1,395 |
$1K |
| 82977 |
|
852 |
560 |
$943.75 |
| J3535 |
Drug administered through a metered dose inhaler |
2,158 |
577 |
$915.72 |
| 88331 |
|
33 |
13 |
$904.46 |
| 87563 |
|
1,172 |
1,088 |
$888.62 |
| 85049 |
|
1,292 |
769 |
$879.60 |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
197 |
141 |
$859.70 |
| J1642 |
Injection, heparin sodium, (heparin lock flush), per 10 units |
5,496 |
2,344 |
$838.69 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
52,436 |
32,617 |
$831.86 |
| 84132 |
|
834 |
445 |
$831.23 |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
12,836 |
6,748 |
$807.78 |
| 76857 |
|
34 |
26 |
$803.09 |
| 82570 |
|
914 |
659 |
$798.50 |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
3,428 |
1,817 |
$780.95 |
| 82010 |
|
1,734 |
1,149 |
$778.15 |
| 83615 |
|
494 |
305 |
$758.31 |
| J0780 |
Injection, prochlorperazine, up to 10 mg |
4,788 |
3,148 |
$737.46 |
| 72220 |
|
47 |
38 |
$730.29 |
| 73000 |
|
79 |
56 |
$725.60 |
| 84134 |
|
66 |
51 |
$718.92 |
| 70250 |
|
52 |
26 |
$708.30 |
| 87905 |
|
1,293 |
1,190 |
$700.67 |
| J1790 |
Injection, droperidol, up to 5 mg |
3,669 |
2,453 |
$626.52 |
| 0003A |
|
15 |
15 |
$613.40 |
| 84703 |
|
1,400 |
1,017 |
$612.58 |
| 73100 |
|
40 |
24 |
$603.06 |
| 87449 |
|
612 |
261 |
$601.88 |
| 97022 |
|
21 |
13 |
$596.18 |
| 86308 |
|
439 |
326 |
$591.94 |
| 71101 |
|
162 |
108 |
$586.97 |
| 86803 |
|
330 |
241 |
$586.78 |
| J2060 |
Injection, lorazepam, 2 mg |
4,115 |
2,454 |
$572.28 |
| 73120 |
|
20 |
12 |
$565.12 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
4,065 |
2,057 |
$559.38 |
| J1940 |
Injection, furosemide, up to 20 mg |
2,268 |
920 |
$553.23 |
| J3360 |
Injection, diazepam, up to 5 mg |
1,689 |
1,149 |
$549.12 |
| J7040 |
Infusion, normal saline solution, sterile (500 ml = 1 unit) |
10,408 |
5,251 |
$518.53 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
20,494 |
13,345 |
$513.37 |
| 84156 |
|
900 |
632 |
$506.00 |
| 00400 |
|
951 |
607 |
$499.41 |
| 72082 |
|
12 |
12 |
$490.48 |
| 77002 |
|
12 |
12 |
$486.72 |
| J2920 |
Injection, methylprednisolone sodium succinate, up to 40 mg |
686 |
281 |
$475.76 |
| 80074 |
|
117 |
69 |
$469.90 |
| 87340 |
|
254 |
175 |
$468.36 |
| 29515 |
|
50 |
39 |
$441.46 |
| 77001 |
|
75 |
50 |
$439.82 |
| 85347 |
|
481 |
232 |
$432.58 |
| 80179 |
|
2,490 |
1,762 |
$417.82 |
| 36416 |
|
3,435 |
2,117 |
$397.38 |
| 87081 |
|
344 |
250 |
$394.45 |
| 87205 |
|
867 |
560 |
$393.17 |
| 00940 |
|
157 |
85 |
$378.44 |
| 85045 |
|
1,176 |
374 |
$351.54 |
| 80177 |
|
319 |
213 |
$342.29 |
| 76000 |
|
19 |
15 |
$327.78 |
| J0171 |
Injection, adrenalin, epinephrine, 0.1 mg |
2,478 |
1,471 |
$309.17 |
| 88342 |
|
2,937 |
1,687 |
$302.73 |
| J7999 |
Compounded drug, not otherwise classified |
520 |
295 |
$286.57 |
| 90656 |
|
43 |
43 |
$280.90 |
| 82040 |
|
81 |
41 |
$263.30 |
| 81015 |
|
709 |
537 |
$257.27 |
| J3480 |
Injection, potassium chloride, per 2 meq |
3,260 |
1,402 |
$257.13 |
| 87481 |
|
133 |
81 |
$256.54 |
| 51702 |
|
166 |
97 |
$251.67 |
| J2919 |
Injection, methylprednisolone sodium succinate, 5 mg |
956 |
702 |
$247.40 |
| 87529 |
|
342 |
134 |
$239.96 |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
2,959 |
1,666 |
$238.29 |
| C1889 |
Implantable/insertable device, not otherwise classified |
605 |
393 |
$231.46 |
| 00840 |
|
1,288 |
878 |
$230.51 |
| 70360 |
|
20 |
15 |
$218.72 |
| 88304 |
|
1,708 |
1,208 |
$168.03 |
| 87075 |
|
473 |
269 |
$165.67 |
| J2371 |
Injection, phenylephrine hydrochloride, 20 micrograms |
816 |
500 |
$157.82 |
| J8499 |
Prescription drug, oral, non chemotherapeutic, nos |
1,592 |
612 |
$153.79 |
| 87486 |
|
20 |
15 |
$146.15 |
| 84295 |
|
83 |
12 |
$143.19 |
| 97763 |
|
127 |
68 |
$136.58 |
| J3410 |
Injection, hydroxyzine hcl, up to 25 mg |
265 |
195 |
$134.19 |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
33,524 |
23,548 |
$123.46 |
| J0280 |
Injection, aminophyllin, up to 250 mg |
18 |
12 |
$115.25 |
| 87798 |
Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism |
122 |
67 |
$106.42 |
| J1630 |
Injection, haloperidol, up to 5 mg |
1,064 |
709 |
$105.38 |
| 82784 |
|
44 |
26 |
$102.26 |
| J2370 |
Injection, phenylephrine hcl, up to 1 ml |
718 |
393 |
$97.76 |
| J0330 |
Injection, succinylcholine chloride, up to 20 mg |
1,815 |
1,189 |
$95.79 |
| A9575 |
Injection, gadoterate meglumine, 0.1 ml |
4,088 |
3,023 |
$87.75 |
| J2175 |
Injection, meperidine hydrochloride, per 100 mg |
993 |
632 |
$87.46 |
| 87324 |
|
46 |
25 |
$87.02 |
| J2360 |
Injection, orphenadrine citrate, up to 60 mg |
846 |
546 |
$80.91 |
| 0031A |
|
26 |
23 |
$79.19 |
| 87653 |
|
31 |
26 |
$78.87 |
| J7042 |
5% dextrose/normal saline (500 ml = 1 unit) |
1,742 |
630 |
$78.83 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
15,552 |
10,457 |
$76.13 |
| 87581 |
|
20 |
15 |
$73.06 |
| J0456 |
Injection, azithromycin, 500 mg |
749 |
344 |
$72.98 |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
2,371 |
931 |
$72.30 |
| 86304 |
|
29 |
12 |
$69.04 |
| J0137 |
Injection, acetaminophen (hikma), not therapeutically equivalent to j0131, 10 mg |
256 |
187 |
$54.94 |
| J7060 |
5% dextrose/water (500 ml = 1 unit) |
1,794 |
463 |
$53.21 |
| 90694 |
|
23 |
13 |
$52.92 |
| 84550 |
|
115 |
83 |
$48.11 |
| J1956 |
Injection, levofloxacin, 250 mg |
243 |
110 |
$47.44 |
| J0665 |
Injection, bupivicaine, not otherwise specified, 0.5 mg |
5,398 |
3,330 |
$40.19 |
| J1171 |
Injection, hydromorphone, 0.1 mg |
611 |
415 |
$36.39 |
| J1805 |
Injection, esmolol hydrochloride, 10 mg |
376 |
195 |
$36.11 |
| 80305 |
|
134 |
118 |
$34.44 |
| 89051 |
|
306 |
188 |
$34.04 |
| 84436 |
|
36 |
24 |
$30.87 |
| J0613 |
Injection, calcium gluconate (wg critical care), not therapeutically equivalent to j0612, 10 mg |
71 |
41 |
$29.88 |
| 83930 |
|
56 |
27 |
$27.30 |
| J1836 |
Injection, metronidazole, 10 mg |
106 |
41 |
$27.11 |
| J1040 |
Injection, methylprednisolone acetate, 80 mg |
985 |
837 |
$26.75 |
| 85651 |
|
42 |
27 |
$24.78 |
| J1596 |
Injection, glycopyrrolate, 0.1 mg |
1,750 |
1,419 |
$24.38 |
| J9267 |
Injection, paclitaxel, 1 mg |
265 |
94 |
$23.79 |
| J8540 |
Dexamethasone, oral, 0.25 mg |
179 |
83 |
$23.28 |
| J1920 |
Injection, labetalol hydrochloride, 5 mg |
1,271 |
644 |
$22.53 |
| 91300 |
|
2,164 |
2,000 |
$19.36 |
| J3301 |
Injection, triamcinolone acetonide, not otherwise specified, 10 mg |
668 |
470 |
$18.47 |
| C1762 |
Connective tissue, human (includes fascia lata) |
15 |
12 |
$17.74 |
| Q4102 |
Oasis wound matrix, per square centimeter (add-on, list separately in addition to primary procedure) |
106 |
53 |
$17.00 |
| 95909 |
|
15 |
13 |
$13.23 |
| J2470 |
Injection, pantoprazole sodium, 40 mg |
335 |
212 |
$12.93 |
| Q9969 |
Tc-99m from non-highly enriched uranium source, full cost recovery add-on, per study dose |
3,097 |
2,157 |
$12.60 |
| J0692 |
Injection, cefepime hydrochloride, 500 mg |
49 |
13 |
$10.26 |
| J7050 |
Infusion, normal saline solution, 250 cc |
11,478 |
4,843 |
$5.20 |
| J8597 |
Antiemetic drug, oral, not otherwise specified |
337 |
138 |
$2.12 |
| J3420 |
Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg |
18 |
14 |
$1.20 |
| J2003 |
Injection, lidocaine hydrochloride, 1 mg |
193 |
187 |
$0.80 |
| 91301 |
|
95 |
85 |
$0.74 |
| 91303 |
|
26 |
23 |
$0.02 |
| J2785 |
Injection, regadenoson, 0.1 mg |
2,299 |
1,557 |
$0.00 |
| J2001 |
Injection, lidocaine hcl for intravenous infusion, 10 mg |
70 |
58 |
$0.00 |
| 00790 |
|
691 |
499 |
$0.00 |
| C1726 |
Catheter, balloon dilatation, non-vascular |
233 |
149 |
$0.00 |
| C1781 |
Mesh (implantable) |
451 |
312 |
$0.00 |
| C1893 |
Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, other than peel-away |
248 |
143 |
$0.00 |
| A9270 |
Non-covered item or service |
1,091 |
167 |
$0.00 |
| C1725 |
Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability) |
155 |
99 |
$0.00 |
| 00813 |
|
169 |
112 |
$0.00 |
| 88377 |
|
99 |
52 |
$0.00 |
| 85576 |
|
53 |
26 |
$0.00 |
| C1769 |
Guide wire |
2,128 |
1,366 |
$0.00 |
| 00952 |
|
192 |
132 |
$0.00 |
| 94761 |
|
259 |
147 |
$0.00 |
| A4648 |
Tissue marker, implantable, any type, each |
461 |
296 |
$0.00 |
| 00142 |
|
918 |
534 |
$0.00 |
| 01480 |
|
287 |
190 |
$0.00 |
| 00902 |
|
41 |
28 |
$0.00 |
| J0697 |
Injection, sterile cefuroxime sodium, per 750 mg |
303 |
201 |
$0.00 |
| 88364 |
|
21 |
12 |
$0.00 |
| 80178 |
|
24 |
14 |
$0.00 |
| J2795 |
Injection, ropivacaine hydrochloride, 1 mg |
62 |
48 |
$0.00 |
| 94760 |
|
16 |
12 |
$0.00 |
| 00320 |
|
36 |
25 |
$0.00 |
| 0051A |
|
40 |
40 |
$0.00 |
| J1010 |
Injection, methylprednisolone acetate, 1 mg |
90 |
74 |
$0.00 |
| 01214 |
|
17 |
12 |
$0.00 |
| C2617 |
Stent, non-coronary, temporary, without delivery system |
162 |
88 |
$0.00 |
| J1030 |
Injection, methylprednisolone acetate, 40 mg |
17 |
12 |
$0.00 |
| 84157 |
|
19 |
12 |
$0.00 |
| 96411 |
|
114 |
43 |
$0.00 |
| 94762 |
|
68 |
38 |
$0.00 |
| 91305 |
|
37 |
37 |
$0.00 |
| 82945 |
|
19 |
12 |
$0.00 |
| 93356 |
|
1,073 |
839 |
$0.00 |
| 15853 |
|
242 |
207 |
$0.00 |
| C1776 |
Joint device (implantable) |
657 |
455 |
$0.00 |
| 00918 |
|
138 |
78 |
$0.00 |
| 01810 |
|
809 |
568 |
$0.00 |
| C1894 |
Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser |
343 |
210 |
$0.00 |
| C1887 |
Catheter, guiding (may include infusion/perfusion capability) |
770 |
476 |
$0.00 |
| A9552 |
Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries |
628 |
481 |
$0.00 |
| 01965 |
|
43 |
25 |
$0.00 |
| J1580 |
Injection, garamycin, gentamicin, up to 80 mg |
177 |
112 |
$0.00 |
| 96417 |
|
1,508 |
657 |
$0.00 |
| 01830 |
|
175 |
126 |
$0.00 |
| Q9956 |
Injection, octafluoropropane microspheres, per ml |
951 |
648 |
$0.00 |
| 88302 |
|
239 |
159 |
$0.00 |
| A9502 |
Technetium tc-99m tetrofosmin, diagnostic, per study dose |
29 |
14 |
$0.00 |
| Q9966 |
Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml |
738 |
495 |
$0.00 |
| 82365 |
|
48 |
25 |
$0.00 |
| C1760 |
Closure device, vascular (implantable/insertable) |
170 |
104 |
$0.00 |
| S0596 |
Phakic intraocular lens for correction of refractive error |
525 |
335 |
$0.00 |
| 99408 |
|
230 |
151 |
$0.00 |
| 00910 |
|
180 |
119 |
$0.00 |
| Q9957 |
Injection, perflutren lipid microspheres, per ml |
50 |
47 |
$0.00 |
| C1875 |
Stent, coated/covered, without delivery system |
12 |
12 |
$0.00 |
| Q0144 |
Azithromycin dihydrate, oral, capsules/powder, 1 gram |
326 |
180 |
$0.00 |
| 00811 |
|
116 |
65 |
$0.00 |
| 88112 |
|
30 |
13 |
$0.00 |
| 94150 |
|
37 |
24 |
$0.00 |
| J2710 |
Injection, neostigmine methylsulfate, up to 0.5 mg |
73 |
71 |
$0.00 |
| C1729 |
Catheter, drainage |
25 |
17 |
$0.00 |
| 88173 |
|
29 |
16 |
$0.00 |
| C1758 |
Catheter, ureteral |
13 |
12 |
$0.00 |
| C1751 |
Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis) |
45 |
26 |
$0.00 |
| 69209 |
|
43 |
32 |
$0.00 |
| 88313 |
|
18 |
13 |
$0.00 |
| C1788 |
Port, indwelling (implantable) |
45 |
26 |
$0.00 |
| 77012 |
|
17 |
12 |
$0.00 |