| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
10,456 |
8,878 |
$675K |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
11,623 |
10,016 |
$660K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
10,109 |
8,525 |
$652K |
| 96361 |
Intravenous infusion, hydration; each additional hour |
6,462 |
4,353 |
$594K |
| A0427 |
Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) |
4,275 |
3,379 |
$557K |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
7,881 |
6,757 |
$325K |
| A0390 |
Als mileage (per mile) |
1,808 |
1,424 |
$299K |
| 80053 |
Comprehensive metabolic panel |
17,591 |
13,139 |
$251K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
4,748 |
2,955 |
$246K |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
3,146 |
2,820 |
$205K |
| 87637 |
Infectious agent detection by nucleic acid; SARS-CoV-2, influenza, and RSV |
1,667 |
1,479 |
$192K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
2,344 |
1,772 |
$176K |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
5,413 |
4,606 |
$158K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
25,123 |
18,501 |
$152K |
| 99215 |
Prolong outpt/office vis |
3,551 |
2,029 |
$149K |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
2,999 |
2,575 |
$145K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
1,289 |
1,174 |
$142K |
| 90999 |
Unlisted dialysis procedure, inpatient or outpatient |
5,296 |
361 |
$136K |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
2,234 |
2,004 |
$133K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
8,862 |
7,283 |
$129K |
| 70450 |
Computed tomography, head or brain; without contrast material |
2,765 |
2,416 |
$125K |
| 96413 |
Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance |
5,038 |
2,314 |
$116K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
2,089 |
1,758 |
$113K |
| 80061 |
Lipid panel |
4,581 |
4,099 |
$112K |
| 84443 |
Thyroid stimulating hormone (TSH) |
4,865 |
4,152 |
$109K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
1,865 |
1,137 |
$109K |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
18,129 |
13,226 |
$103K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
2,227 |
1,940 |
$100K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,508 |
1,340 |
$89K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,290 |
1,204 |
$88K |
| 81001 |
|
13,357 |
10,963 |
$84K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
1,171 |
1,048 |
$83K |
| 81025 |
|
3,949 |
3,344 |
$80K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
825 |
773 |
$73K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,423 |
1,273 |
$72K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
1,294 |
1,115 |
$71K |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
1,060 |
948 |
$67K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
4,627 |
3,935 |
$66K |
| 87081 |
|
1,776 |
1,558 |
$63K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
4,387 |
3,951 |
$60K |
| 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 |
725 |
652 |
$59K |
| 20610 |
|
964 |
777 |
$59K |
| A0425 |
Ground mileage, per statute mile |
3,077 |
2,320 |
$57K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
1,992 |
1,671 |
$52K |
| 73630 |
|
3,071 |
2,228 |
$50K |
| 83880 |
|
2,011 |
1,704 |
$48K |
| 41899 |
Unlisted procedure, dentoalveolar structures |
105 |
93 |
$48K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
1,206 |
1,097 |
$46K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
524 |
468 |
$45K |
| 85610 |
|
5,297 |
3,839 |
$43K |
| 81514 |
|
385 |
300 |
$40K |
| 87634 |
|
728 |
670 |
$40K |
| 80050 |
General health panel |
2,662 |
2,014 |
$39K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
925 |
830 |
$39K |
| 84484 |
|
6,740 |
4,381 |
$36K |
| 96367 |
|
1,080 |
661 |
$36K |
| 82962 |
|
3,803 |
2,071 |
$36K |
| 85027 |
|
2,426 |
1,913 |
$33K |
| 83735 |
|
8,598 |
5,493 |
$33K |
| 90670 |
|
1,272 |
1,155 |
$33K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
438 |
375 |
$32K |
| 71046 |
Radiologic examination, chest; 2 views |
3,944 |
3,470 |
$32K |
| 96415 |
|
692 |
405 |
$31K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
1,329 |
1,194 |
$30K |
| 78452 |
Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress |
260 |
230 |
$29K |
| 84145 |
|
1,741 |
1,514 |
$29K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
416 |
375 |
$29K |
| 87186 |
|
1,457 |
1,232 |
$29K |
| 99243 |
|
439 |
393 |
$29K |
| 93296 |
|
967 |
902 |
$28K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
488 |
415 |
$28K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
389 |
337 |
$26K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
402 |
363 |
$26K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
568 |
497 |
$24K |
| 73030 |
|
1,677 |
1,379 |
$23K |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
808 |
673 |
$23K |
| 80306 |
|
631 |
544 |
$23K |
| 73562 |
|
1,668 |
1,268 |
$22K |
| 90756 |
|
1,130 |
1,014 |
$22K |
| 82728 |
|
1,271 |
1,133 |
$22K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
11,517 |
9,312 |
$22K |
| 87624 |
Infectious agent detection by nucleic acid; human papillomavirus (HPV), high-risk types |
499 |
412 |
$21K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,125 |
958 |
$20K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
563 |
499 |
$19K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
5,296 |
3,598 |
$19K |
| 73610 |
|
1,222 |
1,008 |
$19K |
| 90674 |
|
967 |
886 |
$18K |
| 87481 |
|
701 |
411 |
$18K |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
2,993 |
1,320 |
$18K |
| 72148 |
Magnetic resonance imaging, lumbar spine; without contrast material |
344 |
318 |
$17K |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
198 |
176 |
$17K |
| 85379 |
|
1,644 |
1,482 |
$17K |
| 83605 |
|
3,068 |
2,453 |
$16K |
| 81513 |
|
231 |
198 |
$16K |
| 90715 |
|
930 |
813 |
$16K |
| 84702 |
|
417 |
291 |
$16K |
| 83690 |
|
3,652 |
3,054 |
$15K |
| 87801 |
Infectious agent detection by nucleic acid; amplified probe, multiple organisms |
297 |
271 |
$15K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
346 |
322 |
$14K |
| 76801 |
|
250 |
200 |
$14K |
| 88142 |
|
681 |
561 |
$14K |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
454 |
387 |
$13K |
| 87040 |
|
2,100 |
1,045 |
$13K |
| 72100 |
|
819 |
742 |
$12K |
| 86140 |
|
2,934 |
2,495 |
$11K |
| 90651 |
|
244 |
221 |
$10K |
| G2066 |
Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular physiologic monitor system, implantable loop recorder system, or subcutaneous cardiac rhythm monitor system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results |
146 |
135 |
$10K |
| G0378 |
Hospital observation service, per hour |
1,622 |
1,236 |
$10K |
| 76830 |
Ultrasound, transvaginal |
212 |
195 |
$10K |
| 86803 |
|
884 |
723 |
$10K |
| 85018 |
|
1,710 |
1,390 |
$9K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
6,503 |
5,137 |
$9K |
| 90680 |
|
746 |
672 |
$9K |
| 82565 |
|
1,567 |
1,326 |
$9K |
| 97597 |
|
485 |
258 |
$8K |
| 93976 |
|
297 |
276 |
$8K |
| 86762 |
|
286 |
230 |
$8K |
| 73502 |
|
594 |
517 |
$8K |
| 0241U |
Neonatal screening for hereditary disorders, genomic sequence analysis panel |
262 |
246 |
$7K |
| 87077 |
|
729 |
605 |
$7K |
| J0882 |
Injection, darbepoetin alfa, 1 microgram (for esrd on dialysis) |
148 |
37 |
$7K |
| 86780 |
|
857 |
719 |
$7K |
| 90688 |
|
316 |
295 |
$7K |
| 85730 |
|
2,478 |
2,131 |
$7K |
| 11721 |
|
170 |
159 |
$7K |
| 86850 |
|
1,639 |
1,315 |
$7K |
| 90686 |
|
432 |
406 |
$6K |
| 36591 |
|
1,992 |
960 |
$6K |
| 90744 |
|
653 |
596 |
$6K |
| 87070 |
|
331 |
294 |
$6K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
113 |
81 |
$6K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
122 |
108 |
$6K |
| 87340 |
|
927 |
750 |
$6K |
| 72125 |
Computed tomography, cervical spine; without contrast material |
327 |
301 |
$6K |
| 93017 |
|
270 |
237 |
$6K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
2,105 |
1,662 |
$5K |
| 87798 |
Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism |
156 |
119 |
$5K |
| 90734 |
|
240 |
211 |
$5K |
| 83970 |
|
217 |
188 |
$5K |
| 86703 |
|
521 |
420 |
$5K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
128 |
106 |
$4K |
| 83550 |
|
908 |
816 |
$4K |
| 90633 |
|
524 |
483 |
$4K |
| 73110 |
|
270 |
230 |
$4K |
| 73130 |
|
607 |
450 |
$4K |
| 0002A |
|
323 |
221 |
$4K |
| 0001A |
|
355 |
260 |
$4K |
| 82607 |
|
291 |
260 |
$3K |
| 90698 |
|
923 |
840 |
$3K |
| 92002 |
|
75 |
70 |
$3K |
| 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 |
359 |
318 |
$3K |
| 96417 |
|
92 |
52 |
$3K |
| 84439 |
|
541 |
472 |
$3K |
| 83540 |
|
964 |
863 |
$3K |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
1,137 |
1,032 |
$3K |
| 99242 |
|
44 |
39 |
$3K |
| 86900 |
|
1,768 |
1,427 |
$3K |
| 86901 |
|
1,736 |
1,398 |
$3K |
| 82043 |
|
468 |
427 |
$3K |
| 36415 |
Collection of venous blood by venipuncture |
30,755 |
23,476 |
$3K |
| 99244 |
Office or other outpatient consultation, moderate to high complexity |
32 |
29 |
$3K |
| G0008 |
Administration of influenza virus vaccine |
1,854 |
1,665 |
$3K |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
160 |
136 |
$3K |
| 84153 |
|
92 |
83 |
$3K |
| 70553 |
Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences |
36 |
26 |
$3K |
| 87088 |
|
274 |
242 |
$3K |
| 71045 |
Radiologic examination, chest; single view |
4,307 |
3,731 |
$3K |
| G0481 |
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; 8-14 drug class(es), including metabolite(s) if performed |
40 |
32 |
$2K |
| 93971 |
|
107 |
92 |
$2K |
| 85652 |
|
1,250 |
1,066 |
$2K |
| 93297 |
|
27 |
26 |
$2K |
| 84460 |
|
1,071 |
920 |
$2K |
| 81003 |
|
289 |
256 |
$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 |
51 |
47 |
$2K |
| 82570 |
|
328 |
291 |
$2K |
| 74018 |
|
173 |
156 |
$2K |
| 82803 |
|
108 |
87 |
$2K |
| 82105 |
|
102 |
81 |
$2K |
| 86618 |
|
110 |
97 |
$2K |
| 99245 |
|
28 |
24 |
$2K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
6,968 |
4,549 |
$2K |
| 82077 |
|
202 |
158 |
$2K |
| Q3014 |
Telehealth originating site facility fee |
920 |
745 |
$2K |
| 82950 |
|
259 |
235 |
$2K |
| 82947 |
|
654 |
489 |
$1K |
| 76770 |
|
40 |
37 |
$1K |
| 87480 |
|
44 |
33 |
$1K |
| 76536 |
|
42 |
38 |
$1K |
| 45380 |
Colonoscopy, flexible; with biopsy, single or multiple |
15 |
14 |
$1K |
| 87653 |
|
26 |
24 |
$1K |
| 87510 |
|
45 |
34 |
$1K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
60 |
52 |
$1K |
| 90716 |
|
55 |
51 |
$1K |
| 86580 |
|
15 |
13 |
$1K |
| 83655 |
|
60 |
55 |
$911.03 |
| 72141 |
|
13 |
13 |
$902.34 |
| 80069 |
|
95 |
89 |
$867.37 |
| 82784 |
|
37 |
25 |
$852.85 |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
207 |
116 |
$850.19 |
| 83615 |
|
386 |
290 |
$836.72 |
| 85380 |
|
107 |
90 |
$833.42 |
| 36592 |
|
5,011 |
4,290 |
$819.81 |
| 87660 |
|
44 |
33 |
$814.56 |
| 90707 |
|
126 |
113 |
$793.49 |
| 87468 |
|
19 |
13 |
$710.93 |
| 73721 |
Magnetic resonance imaging, any joint of lower extremity; without contrast material |
13 |
12 |
$677.58 |
| 87205 |
|
253 |
224 |
$578.42 |
| 84132 |
|
818 |
516 |
$553.91 |
| 94060 |
|
28 |
26 |
$534.79 |
| 90710 |
|
48 |
44 |
$478.28 |
| J2469 |
Injection, palonosetron hcl, 25 mcg |
62 |
27 |
$468.55 |
| 87469 |
|
19 |
13 |
$462.93 |
| 87484 |
|
19 |
13 |
$462.93 |
| 90696 |
|
18 |
17 |
$428.24 |
| 84703 |
|
82 |
75 |
$427.35 |
| 92134 |
|
124 |
108 |
$412.53 |
| 84520 |
|
888 |
408 |
$396.18 |
| 84550 |
|
37 |
27 |
$395.32 |
| 73560 |
|
57 |
40 |
$367.00 |
| G0476 |
Infectious agent detection by nucleic acid (dna or rna); human papillomavirus (hpv), high-risk types (e.g., 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) for cervical cancer screening, must be performed in addition to pap test |
94 |
76 |
$361.00 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
56 |
55 |
$358.88 |
| 72170 |
|
14 |
13 |
$343.00 |
| 82150 |
|
90 |
80 |
$319.89 |
| 90662 |
|
43 |
43 |
$302.45 |
| 82310 |
|
548 |
429 |
$255.53 |
| 82248 |
|
84 |
65 |
$253.80 |
| 84100 |
|
594 |
424 |
$240.52 |
| 90700 |
|
45 |
45 |
$222.33 |
| 82040 |
|
493 |
405 |
$192.28 |
| 84481 |
|
15 |
12 |
$182.82 |
| 80076 |
|
28 |
24 |
$181.48 |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
19 |
12 |
$167.90 |
| 96368 |
|
16 |
12 |
$145.38 |
| 84075 |
|
465 |
380 |
$114.59 |
| 96376 |
|
2,187 |
1,601 |
$103.87 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
829 |
545 |
$94.69 |
| 82374 |
|
456 |
373 |
$89.13 |
| 90648 |
|
27 |
26 |
$84.95 |
| 94729 |
|
24 |
24 |
$78.11 |
| 87147 |
|
19 |
14 |
$77.96 |
| 90750 |
|
49 |
39 |
$64.20 |
| J1270 |
Injection, doxercalciferol, 1 mcg |
3,906 |
298 |
$27.28 |
| 84450 |
|
15 |
13 |
$22.95 |
| 97161 |
|
28 |
28 |
$12.72 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
3,847 |
3,213 |
$12.69 |
| G0009 |
Administration of pneumococcal vaccine |
13 |
12 |
$6.34 |
| J7030 |
Infusion, normal saline solution , 1000 cc |
1,568 |
1,218 |
$5.44 |
| Q2039 |
Influenza virus vaccine, not otherwise specified |
20 |
19 |
$5.00 |
| J2704 |
Injection, propofol, 10 mg |
3,581 |
3,153 |
$4.55 |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
123 |
107 |
$4.25 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
5,257 |
4,324 |
$2.62 |
| U0002 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
822 |
746 |
$0.51 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
5,164 |
3,393 |
$0.49 |
| J8499 |
Prescription drug, oral, non chemotherapeutic, nos |
1,732 |
1,226 |
$0.47 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
6,099 |
5,206 |
$0.47 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
4,227 |
3,574 |
$0.47 |
| J7620 |
Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme |
212 |
181 |
$0.11 |
| J2001 |
Injection, lidocaine hcl for intravenous infusion, 10 mg |
3,979 |
2,884 |
$0.01 |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
5,270 |
4,073 |
$0.00 |
| A9577 |
Injection, gadobenate dimeglumine (multihance), per ml |
1,256 |
605 |
$0.00 |
| J7040 |
Infusion, normal saline solution, sterile (500 ml = 1 unit) |
805 |
513 |
$0.00 |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
371 |
291 |
$0.00 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
391 |
362 |
$0.00 |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
1,038 |
631 |
$0.00 |
| J3301 |
Injection, triamcinolone acetonide, not otherwise specified, 10 mg |
1,067 |
739 |
$0.00 |
| 51702 |
|
52 |
41 |
$0.00 |
| V5266 |
Battery for use in hearing device |
493 |
482 |
$0.00 |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
108 |
96 |
$0.00 |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
286 |
136 |
$0.00 |
| J0171 |
Injection, adrenalin, epinephrine, 0.1 mg |
82 |
67 |
$0.00 |
| Q9957 |
Injection, perflutren lipid microspheres, per ml |
38 |
27 |
$0.00 |
| J2060 |
Injection, lorazepam, 2 mg |
341 |
260 |
$0.00 |
| A9270 |
Non-covered item or service |
4,327 |
3,111 |
$0.00 |
| 97162 |
|
26 |
25 |
$0.00 |
| J0690 |
Injection, cefazolin sodium, 500 mg |
1,209 |
1,034 |
$0.00 |
| J1170 |
Injection, hydromorphone, up to 4 mg |
984 |
776 |
$0.00 |
| A9500 |
Technetium tc-99m sestamibi, diagnostic, per study dose |
284 |
254 |
$0.00 |
| Q9969 |
Tc-99m from non-highly enriched uranium source, full cost recovery add-on, per study dose |
629 |
567 |
$0.00 |
| J1642 |
Injection, heparin sodium, (heparin lock flush), per 10 units |
2,540 |
191 |
$0.00 |
| J1010 |
Injection, methylprednisolone acetate, 1 mg |
35 |
30 |
$0.00 |
| J3490 |
Unclassified drugs |
1,853 |
1,174 |
$0.00 |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
229 |
200 |
$0.00 |
| J2785 |
Injection, regadenoson, 0.1 mg |
109 |
95 |
$0.00 |
| J7050 |
Infusion, normal saline solution, 250 cc |
61 |
43 |
$0.00 |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
29 |
25 |
$0.00 |
| J2370 |
Injection, phenylephrine hcl, up to 1 ml |
27 |
24 |
$0.00 |
| J2470 |
Injection, pantoprazole sodium, 40 mg |
38 |
26 |
$0.00 |
| J2003 |
Injection, lidocaine hydrochloride, 1 mg |
52 |
45 |
$0.00 |
| J1815 |
Injection, insulin, per 5 units |
20 |
12 |
$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 |
12 |
12 |
$0.00 |
| J1040 |
Injection, methylprednisolone acetate, 80 mg |
18 |
15 |
$0.00 |
| 94760 |
|
32 |
15 |
$0.00 |