| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99284 |
Emergency department visit for the evaluation and management, high severity |
31,421 |
24,113 |
$10.66M |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
34,253 |
28,159 |
$6.21M |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
12,561 |
7,349 |
$5.58M |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
8,038 |
6,036 |
$2.75M |
| 70450 |
Computed tomography, head or brain; without contrast material |
6,820 |
5,190 |
$1.06M |
| 92507 |
Treatment of speech, language, voice, communication, and/or auditory processing disorder |
11,989 |
3,254 |
$886K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
3,422 |
2,604 |
$795K |
| 87637 |
Infectious agent detection by nucleic acid; SARS-CoV-2, influenza, and RSV |
6,418 |
5,692 |
$759K |
| G0378 |
Hospital observation service, per hour |
11,186 |
5,385 |
$754K |
| 71045 |
Radiologic examination, chest; single view |
16,123 |
10,956 |
$679K |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
5,941 |
5,376 |
$658K |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
2,053 |
1,801 |
$602K |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
7,162 |
5,492 |
$594K |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
1,531 |
1,040 |
$588K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
5,809 |
2,558 |
$583K |
| 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 |
8,357 |
6,873 |
$570K |
| 96361 |
Intravenous infusion, hydration; each additional hour |
8,084 |
3,653 |
$538K |
| 11042 |
Debridement, subcutaneous tissue (includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm |
3,396 |
1,336 |
$533K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
16,591 |
13,414 |
$515K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
12,723 |
10,207 |
$485K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
8,221 |
4,282 |
$460K |
| 36415 |
Collection of venous blood by venipuncture |
132,923 |
70,401 |
$439K |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
9,971 |
2,909 |
$425K |
| G0379 |
Direct admission of patient for hospital observation care |
1,372 |
1,046 |
$412K |
| 71046 |
Radiologic examination, chest; 2 views |
7,664 |
6,119 |
$399K |
| 41899 |
Unlisted procedure, dentoalveolar structures |
205 |
198 |
$387K |
| 72148 |
Magnetic resonance imaging, lumbar spine; without contrast material |
1,182 |
1,058 |
$366K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
2,711 |
2,405 |
$346K |
| 80053 |
Comprehensive metabolic panel |
47,018 |
36,236 |
$334K |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
11,146 |
9,114 |
$320K |
| 72125 |
Computed tomography, cervical spine; without contrast material |
2,138 |
1,808 |
$312K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
57,377 |
43,505 |
$310K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
3,165 |
2,255 |
$306K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
5,350 |
3,079 |
$283K |
| 70553 |
Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences |
645 |
515 |
$264K |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
1,173 |
880 |
$260K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
11,044 |
5,032 |
$254K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
914 |
769 |
$225K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
2,826 |
2,621 |
$217K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
4,823 |
3,660 |
$214K |
| 78452 |
Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress |
377 |
242 |
$196K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
3,767 |
3,267 |
$191K |
| 97112 |
Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination |
3,419 |
997 |
$184K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
5,259 |
4,855 |
$178K |
| 45380 |
Colonoscopy, flexible; with biopsy, single or multiple |
374 |
284 |
$172K |
| 0202U |
Oncology (prostate), multianalyte, gene expression profiling |
515 |
411 |
$168K |
| 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 |
3,347 |
2,571 |
$168K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
5,112 |
4,811 |
$162K |
| 84443 |
Thyroid stimulating hormone (TSH) |
10,586 |
9,593 |
$159K |
| 80061 |
Lipid panel |
12,488 |
11,010 |
$154K |
| 71250 |
|
1,018 |
823 |
$147K |
| 73630 |
|
2,916 |
2,414 |
$146K |
| 80050 |
General health panel |
6,824 |
6,180 |
$143K |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
3,300 |
1,185 |
$142K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
2,873 |
2,458 |
$133K |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
425 |
388 |
$126K |
| 76801 |
|
757 |
642 |
$117K |
| 74018 |
|
2,222 |
1,863 |
$114K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
4,582 |
4,212 |
$109K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
1,300 |
640 |
$108K |
| 73562 |
|
1,918 |
1,531 |
$105K |
| 73610 |
|
2,138 |
1,740 |
$102K |
| 72100 |
|
1,704 |
1,394 |
$97K |
| C9803 |
Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
6,930 |
5,505 |
$96K |
| 73130 |
|
1,929 |
1,590 |
$96K |
| 95810 |
Polysomnography; sleep staging with 4 or more additional parameters |
151 |
131 |
$95K |
| 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 |
4,518 |
3,795 |
$93K |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
2,945 |
2,789 |
$92K |
| 73030 |
|
2,085 |
1,613 |
$89K |
| 59025 |
Fetal non-stress test |
777 |
410 |
$89K |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
2,932 |
1,100 |
$89K |
| 99291 |
Critical care, evaluation and management of the critically ill patient, first 30-74 minutes |
160 |
87 |
$87K |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
3,276 |
2,813 |
$85K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
4,048 |
3,354 |
$83K |
| 73721 |
Magnetic resonance imaging, any joint of lower extremity; without contrast material |
237 |
220 |
$83K |
| U0004 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc, making use of high throughput technologies as described by cms-2020-01-r |
1,096 |
919 |
$82K |
| 96376 |
|
1,731 |
931 |
$79K |
| 81001 |
|
28,708 |
23,579 |
$73K |
| 84439 |
|
8,900 |
8,137 |
$72K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
12,962 |
9,709 |
$70K |
| 93017 |
|
434 |
366 |
$68K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
11,224 |
9,286 |
$67K |
| 76536 |
|
454 |
415 |
$66K |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
17,217 |
12,605 |
$65K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
542 |
499 |
$64K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
578 |
486 |
$64K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,504 |
2,217 |
$64K |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
2,978 |
2,779 |
$64K |
| 72131 |
|
534 |
385 |
$63K |
| 84484 |
|
7,694 |
5,137 |
$60K |
| 73110 |
|
967 |
802 |
$57K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,006 |
1,725 |
$57K |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
10,620 |
8,695 |
$56K |
| 76642 |
|
608 |
555 |
$55K |
| 82947 |
|
7,932 |
3,434 |
$54K |
| 97161 |
|
1,077 |
704 |
$53K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
6,995 |
6,367 |
$53K |
| 84702 |
|
4,343 |
3,109 |
$52K |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
11,202 |
9,478 |
$52K |
| 80074 |
|
1,307 |
1,187 |
$52K |
| 76819 |
Fetal biophysical profile; without non-stress testing |
436 |
239 |
$50K |
| 93971 |
|
393 |
362 |
$50K |
| A9500 |
Technetium tc-99m sestamibi, diagnostic, per study dose |
241 |
195 |
$48K |
| 76830 |
Ultrasound, transvaginal |
274 |
249 |
$47K |
| 76770 |
|
374 |
323 |
$47K |
| 72110 |
|
438 |
375 |
$47K |
| 82607 |
|
3,460 |
3,136 |
$46K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,163 |
1,863 |
$45K |
| 45385 |
Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) |
66 |
58 |
$44K |
| 81513 |
|
657 |
528 |
$43K |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
2,118 |
1,952 |
$43K |
| 96413 |
Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance |
236 |
99 |
$40K |
| 88342 |
|
863 |
766 |
$40K |
| A9579 |
Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (nos), per ml |
1,146 |
1,028 |
$40K |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
5,540 |
3,835 |
$39K |
| 83690 |
|
9,059 |
7,743 |
$39K |
| 83735 |
|
9,298 |
6,371 |
$38K |
| 86803 |
|
3,023 |
2,827 |
$38K |
| 84703 |
|
7,994 |
7,090 |
$38K |
| 83874 |
|
4,167 |
2,283 |
$38K |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
7,632 |
6,153 |
$37K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
368 |
303 |
$37K |
| J2704 |
Injection, propofol, 10 mg |
4,898 |
4,075 |
$37K |
| 70486 |
|
250 |
232 |
$37K |
| 87040 |
|
3,778 |
2,939 |
$35K |
| 99218 |
|
822 |
325 |
$35K |
| 87077 |
|
6,466 |
4,759 |
$35K |
| 87186 |
|
6,025 |
4,409 |
$34K |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
7,764 |
5,125 |
$34K |
| 83880 |
|
1,768 |
1,460 |
$33K |
| 82728 |
|
2,444 |
2,210 |
$28K |
| 96367 |
|
614 |
340 |
$28K |
| 86900 |
|
1,739 |
1,425 |
$26K |
| 94060 |
|
213 |
163 |
$26K |
| 73560 |
|
502 |
386 |
$25K |
| 83605 |
|
3,863 |
3,073 |
$25K |
| 74022 |
|
359 |
331 |
$25K |
| 80081 |
|
381 |
364 |
$24K |
| 87070 |
|
3,641 |
2,424 |
$23K |
| 73502 |
|
534 |
424 |
$23K |
| J1650 |
Injection, enoxaparin sodium, 10 mg |
1,828 |
946 |
$22K |
| J1815 |
Injection, insulin, per 5 units |
1,556 |
741 |
$22K |
| 81025 |
|
4,540 |
4,038 |
$21K |
| 87801 |
Infectious agent detection by nucleic acid; amplified probe, multiple organisms |
485 |
434 |
$21K |
| 85610 |
|
6,951 |
5,105 |
$21K |
| 76818 |
|
165 |
107 |
$21K |
| 87522 |
Neg quan hep c or qual rna |
483 |
422 |
$20K |
| J1170 |
Injection, hydromorphone, up to 4 mg |
3,459 |
2,157 |
$20K |
| 82553 |
|
3,018 |
1,786 |
$20K |
| 82550 |
|
5,174 |
3,482 |
$20K |
| 83550 |
|
2,700 |
2,485 |
$20K |
| 84145 |
|
1,515 |
1,357 |
$19K |
| 69436 |
Tympanostomy (requiring insertion of ventilating tube), general anesthesia |
29 |
28 |
$19K |
| Q0162 |
Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen |
3,698 |
3,105 |
$19K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
1,325 |
628 |
$18K |
| 83540 |
|
3,146 |
2,890 |
$18K |
| 76820 |
|
238 |
133 |
$17K |
| 80055 |
|
337 |
316 |
$17K |
| 87641 |
|
693 |
637 |
$17K |
| J2550 |
Injection, promethazine hcl, up to 50 mg |
4,952 |
3,418 |
$17K |
| 72141 |
|
29 |
29 |
$17K |
| 96523 |
|
1,073 |
548 |
$16K |
| 94760 |
|
1,301 |
1,061 |
$16K |
| J2785 |
Injection, regadenoson, 0.1 mg |
140 |
107 |
$16K |
| 82803 |
|
1,220 |
987 |
$16K |
| 82077 |
|
1,452 |
1,289 |
$16K |
| 82746 |
|
1,306 |
1,204 |
$16K |
| 85730 |
|
3,258 |
2,773 |
$15K |
| 73590 |
|
360 |
287 |
$15K |
| 76775 |
|
150 |
128 |
$15K |
| 87636 |
Infectious agent detection by nucleic acid; SARS-CoV-2 and influenza virus types A and B |
94 |
92 |
$14K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
119 |
101 |
$14K |
| 87481 |
|
460 |
421 |
$14K |
| 95806 |
|
92 |
89 |
$14K |
| 85379 |
|
2,296 |
2,040 |
$13K |
| 85027 |
|
2,281 |
1,846 |
$13K |
| A9577 |
Injection, gadobenate dimeglumine (multihance), per ml |
311 |
263 |
$13K |
| 87653 |
|
362 |
342 |
$12K |
| C1729 |
Catheter, drainage |
901 |
748 |
$12K |
| 58558 |
|
14 |
12 |
$12K |
| 88304 |
|
423 |
383 |
$12K |
| 86140 |
|
3,400 |
2,934 |
$12K |
| 87430 |
|
1,229 |
1,098 |
$12K |
| 77066 |
Tomosynthesis, mammo |
89 |
74 |
$11K |
| J1642 |
Injection, heparin sodium, (heparin lock flush), per 10 units |
4,303 |
1,798 |
$11K |
| 87081 |
|
1,605 |
1,451 |
$11K |
| 86787 |
|
888 |
845 |
$11K |
| 81003 |
|
2,695 |
2,273 |
$11K |
| J2360 |
Injection, orphenadrine citrate, up to 60 mg |
1,077 |
919 |
$10K |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
2,883 |
2,334 |
$10K |
| 97162 |
|
159 |
143 |
$10K |
| 80076 |
|
1,379 |
1,200 |
$10K |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
2,618 |
1,971 |
$9K |
| 73221 |
|
14 |
13 |
$9K |
| J0690 |
Injection, cefazolin sodium, 500 mg |
1,553 |
1,190 |
$9K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
191 |
177 |
$9K |
| 85652 |
|
4,048 |
3,593 |
$9K |
| 84403 |
|
365 |
311 |
$9K |
| J0330 |
Injection, succinylcholine chloride, up to 20 mg |
932 |
741 |
$9K |
| 73090 |
|
196 |
173 |
$9K |
| L4387 |
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf |
102 |
81 |
$8K |
| J0780 |
Injection, prochlorperazine, up to 10 mg |
993 |
766 |
$8K |
| J3490 |
Unclassified drugs |
984 |
638 |
$8K |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
1,086 |
797 |
$8K |
| 87205 |
|
2,186 |
1,845 |
$8K |
| U0002 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
182 |
160 |
$8K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
777 |
649 |
$8K |
| 94729 |
|
220 |
203 |
$8K |
| M0243 |
Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring |
23 |
22 |
$8K |
| 90715 |
|
425 |
348 |
$8K |
| 84100 |
|
2,347 |
1,260 |
$8K |
| 93975 |
|
27 |
26 |
$8K |
| 80069 |
|
857 |
666 |
$7K |
| 77065 |
Tomosynthesis, mammo |
92 |
82 |
$7K |
| 82248 |
|
1,992 |
1,585 |
$7K |
| G0103 |
Prostate cancer screening; prostate specific antigen test (psa) |
566 |
466 |
$7K |
| 86038 |
|
643 |
576 |
$7K |
| 72072 |
|
109 |
89 |
$7K |
| 84146 |
|
316 |
286 |
$7K |
| 94727 |
|
134 |
123 |
$7K |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
661 |
504 |
$7K |
| 97802 |
|
108 |
99 |
$6K |
| 77080 |
|
82 |
63 |
$6K |
| 82150 |
|
1,377 |
1,159 |
$6K |
| C1713 |
Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable) |
132 |
121 |
$6K |
| 72040 |
|
123 |
96 |
$6K |
| 86901 |
|
1,808 |
1,563 |
$6K |
| 36592 |
|
495 |
214 |
$6K |
| 80143 |
|
498 |
444 |
$6K |
| 99215 |
Prolong outpt/office vis |
307 |
251 |
$6K |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
120 |
109 |
$6K |
| 45378 |
Colonoscopy, flexible; diagnostic, including collection of specimen(s) |
26 |
13 |
$6K |
| 82043 |
|
1,158 |
1,035 |
$6K |
| J0561 |
Injection, penicillin g benzathine, 100,000 units |
48 |
43 |
$6K |
| 80179 |
|
485 |
441 |
$6K |
| 84481 |
|
359 |
338 |
$6K |
| 82570 |
|
1,301 |
1,072 |
$6K |
| 74019 |
|
127 |
117 |
$6K |
| 29515 |
|
52 |
51 |
$6K |
| 74021 |
|
90 |
73 |
$6K |
| C1889 |
Implantable/insertable device, not otherwise classified |
111 |
104 |
$6K |
| 82950 |
|
1,067 |
998 |
$5K |
| 86850 |
|
858 |
723 |
$5K |
| 85007 |
|
1,959 |
1,567 |
$5K |
| J2175 |
Injection, meperidine hydrochloride, per 100 mg |
1,809 |
1,354 |
$5K |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
1,386 |
1,153 |
$5K |
| 84550 |
|
1,301 |
1,132 |
$5K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
27 |
25 |
$5K |
| 84156 |
|
1,386 |
1,072 |
$4K |
| 83525 |
|
410 |
383 |
$4K |
| 87210 |
|
868 |
779 |
$4K |
| 29125 |
|
120 |
112 |
$4K |
| 86317 |
|
259 |
170 |
$4K |
| 83655 |
|
313 |
277 |
$4K |
| 87420 |
|
247 |
235 |
$3K |
| 87902 |
|
13 |
12 |
$3K |
| 12001 |
|
47 |
43 |
$3K |
| 73080 |
|
65 |
57 |
$3K |
| 82247 |
|
587 |
341 |
$3K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
403 |
337 |
$3K |
| 87493 |
|
124 |
111 |
$3K |
| J2060 |
Injection, lorazepam, 2 mg |
1,080 |
802 |
$3K |
| 94726 |
|
43 |
41 |
$3K |
| J0500 |
Injection, dicyclomine hcl, up to 20 mg |
143 |
133 |
$3K |
| 82948 |
|
827 |
304 |
$3K |
| A9573 |
Injection, gadopiclenol, 1 ml |
59 |
56 |
$3K |
| 71101 |
|
63 |
52 |
$3K |
| J3480 |
Injection, potassium chloride, per 2 meq |
359 |
228 |
$2K |
| 77061 |
|
74 |
58 |
$2K |
| 83001 |
|
123 |
120 |
$2K |
| 76641 |
|
17 |
13 |
$2K |
| G0279 |
Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066) |
85 |
67 |
$2K |
| J2710 |
Injection, neostigmine methylsulfate, up to 0.5 mg |
237 |
199 |
$2K |
| 92523 |
|
13 |
12 |
$2K |
| 88307 |
|
31 |
24 |
$2K |
| 83615 |
|
395 |
328 |
$2K |
| J2274 |
Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg |
378 |
242 |
$2K |
| 51701 |
|
59 |
54 |
$2K |
| 73070 |
|
48 |
43 |
$2K |
| 86592 |
|
409 |
367 |
$2K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
244 |
225 |
$2K |
| 87340 |
|
198 |
186 |
$2K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
165 |
131 |
$2K |
| 93325 |
|
13 |
12 |
$2K |
| 36600 |
|
123 |
97 |
$2K |
| J2543 |
Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams) |
110 |
63 |
$2K |
| J1790 |
Injection, droperidol, up to 5 mg |
156 |
137 |
$2K |
| 84112 |
|
29 |
26 |
$2K |
| J0694 |
Injection, cefoxitin sodium, 1 gm |
48 |
29 |
$2K |
| 82784 |
|
171 |
148 |
$1K |
| 90686 |
|
124 |
72 |
$1K |
| J3486 |
Injection, ziprasidone mesylate, 10 mg |
61 |
50 |
$1K |
| 93320 |
|
13 |
12 |
$1K |
| 72050 |
|
13 |
12 |
$1K |
| J0171 |
Injection, adrenalin, epinephrine, 0.1 mg |
96 |
78 |
$1K |
| 97166 |
|
19 |
13 |
$1K |
| 87807 |
|
136 |
132 |
$1K |
| J0360 |
Injection, hydralazine hcl, up to 20 mg |
153 |
110 |
$1K |
| J1956 |
Injection, levofloxacin, 250 mg |
190 |
122 |
$1K |
| 86431 |
|
174 |
126 |
$1K |
| 82330 |
|
175 |
90 |
$987.57 |
| 83516 |
|
62 |
55 |
$947.83 |
| 88341 |
|
15 |
13 |
$932.84 |
| J2001 |
Injection, lidocaine hcl for intravenous infusion, 10 mg |
254 |
209 |
$925.50 |
| 36416 |
|
618 |
404 |
$895.59 |
| 88313 |
|
36 |
33 |
$834.39 |
| J3301 |
Injection, triamcinolone acetonide, not otherwise specified, 10 mg |
78 |
69 |
$805.11 |
| Q3014 |
Telehealth originating site facility fee |
61 |
52 |
$801.28 |
| 87899 |
|
76 |
40 |
$780.04 |
| G0008 |
Administration of influenza virus vaccine |
20 |
19 |
$765.74 |
| 83520 |
|
16 |
14 |
$744.03 |
| 87045 |
|
83 |
65 |
$738.32 |
| 82565 |
|
117 |
108 |
$731.14 |
| Q9957 |
Injection, perflutren lipid microspheres, per ml |
13 |
12 |
$730.00 |
| 86706 |
|
96 |
89 |
$708.03 |
| 12011 |
|
19 |
14 |
$654.48 |
| 86308 |
|
128 |
120 |
$610.10 |
| 85018 |
|
312 |
229 |
$574.02 |
| 82105 |
|
28 |
28 |
$537.13 |
| 83970 |
|
12 |
12 |
$458.48 |
| 87427 |
|
55 |
41 |
$457.82 |
| 87075 |
|
44 |
40 |
$407.53 |
| 85014 |
|
247 |
170 |
$404.16 |
| 0011A |
|
16 |
14 |
$394.90 |
| 85384 |
|
56 |
49 |
$383.44 |
| J3590 |
Unclassified biologics |
16 |
12 |
$382.21 |
| C9113 |
Injection, pantoprazole sodium, per vial |
171 |
53 |
$369.08 |
| 87046 |
|
26 |
25 |
$364.82 |
| 82397 |
|
14 |
13 |
$361.44 |
| 86430 |
|
56 |
54 |
$345.48 |
| J3411 |
Injection, thiamine hcl, 100 mg |
66 |
53 |
$317.69 |
| J1171 |
Injection, hydromorphone, 0.1 mg |
20 |
16 |
$317.52 |
| J0595 |
Injection, butorphanol tartrate, 1 mg |
248 |
167 |
$311.23 |
| J1644 |
Injection, heparin sodium, per 1000 units |
71 |
24 |
$280.46 |
| 86708 |
|
26 |
25 |
$272.93 |
| 82533 |
|
23 |
16 |
$241.33 |
| 83993 |
|
12 |
12 |
$233.37 |
| 83002 |
|
15 |
14 |
$226.88 |
| J1940 |
Injection, furosemide, up to 20 mg |
57 |
24 |
$217.76 |
| 84460 |
|
63 |
52 |
$196.16 |
| 84132 |
|
68 |
54 |
$164.73 |
| 87073 |
|
18 |
15 |
$155.86 |
| 87071 |
|
18 |
15 |
$155.86 |
| 86762 |
|
24 |
24 |
$154.54 |
| 84450 |
|
59 |
53 |
$152.48 |
| 86200 |
|
16 |
14 |
$150.72 |
| 86778 |
|
15 |
13 |
$146.82 |
| 83883 |
|
12 |
12 |
$145.76 |
| 80320 |
|
18 |
15 |
$120.04 |
| 82390 |
|
13 |
12 |
$92.26 |
| 80349 |
|
22 |
14 |
$90.81 |
| A4315 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way, all silicone |
14 |
12 |
$87.68 |
| J8540 |
Dexamethasone, oral, 0.25 mg |
81 |
72 |
$81.10 |
| A4615 |
Cannula, nasal |
109 |
79 |
$79.16 |
| 85045 |
|
26 |
24 |
$77.89 |
| 85046 |
|
13 |
12 |
$55.58 |
| A9270 |
Non-covered item or service |
85 |
16 |
$49.63 |
| 82272 |
|
15 |
12 |
$28.15 |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
12 |
12 |
$20.08 |
| 85041 |
|
19 |
15 |
$16.57 |
| J7510 |
Prednisolone oral, per 5 mg |
14 |
14 |
$15.38 |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
52 |
34 |
$9.73 |