| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 0450 |
Emergency room services |
180,921 |
157,485 |
$2.16M |
| 99199 |
Unlisted special service, procedure or report |
29,252 |
24,184 |
$1.57M |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
14,149 |
13,872 |
$793K |
| Z7502 |
|
17,538 |
17,215 |
$642K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
36,081 |
33,273 |
$533K |
| Z9725 |
|
12,122 |
12,073 |
$521K |
| 0202U |
Oncology (prostate), multianalyte, gene expression profiling |
6,259 |
6,184 |
$484K |
| 70450 |
Computed tomography, head or brain; without contrast material |
10,326 |
10,089 |
$477K |
| 93000 |
|
33,824 |
29,180 |
$334K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
116,277 |
105,836 |
$297K |
| 87633 |
Infectious agent detection by nucleic acid, respiratory virus, 12-25 targets |
2,150 |
2,125 |
$253K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
25,933 |
23,112 |
$232K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
28,929 |
25,727 |
$208K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
75,023 |
68,732 |
$207K |
| 71046 |
Radiologic examination, chest; 2 views |
29,396 |
28,576 |
$204K |
| 0360 |
|
10,604 |
9,671 |
$194K |
| 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 |
13,493 |
13,065 |
$188K |
| 96361 |
Intravenous infusion, hydration; each additional hour |
19,141 |
17,387 |
$156K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
22,695 |
19,969 |
$140K |
| 80053 |
Comprehensive metabolic panel |
42,343 |
38,639 |
$138K |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
2,316 |
2,137 |
$138K |
| 72125 |
Computed tomography, cervical spine; without contrast material |
2,572 |
2,534 |
$137K |
| C9803 |
Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
25,710 |
24,817 |
$133K |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
1,108 |
1,099 |
$130K |
| 84484 |
|
37,890 |
30,433 |
$125K |
| V2632 |
Posterior chamber intraocular lens |
1,873 |
1,638 |
$124K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
3,987 |
3,921 |
$119K |
| 80076 |
|
44,503 |
41,966 |
$109K |
| 71045 |
Radiologic examination, chest; single view |
13,574 |
13,008 |
$107K |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
3,155 |
3,000 |
$103K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
6,254 |
6,117 |
$96K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
1,996 |
1,942 |
$96K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
5,844 |
5,684 |
$90K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
5,708 |
5,004 |
$90K |
| 66984 |
Extracapsular cataract removal with insertion of intraocular lens prosthesis |
1,813 |
1,589 |
$86K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
6,239 |
6,147 |
$84K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
8,609 |
8,365 |
$81K |
| 76801 |
|
6,792 |
6,196 |
$75K |
| 93971 |
|
2,805 |
2,742 |
$75K |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
6,323 |
5,977 |
$74K |
| 81001 |
|
69,232 |
65,448 |
$74K |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
3,933 |
3,663 |
$74K |
| 83880 |
|
9,677 |
9,089 |
$72K |
| 76830 |
Ultrasound, transvaginal |
5,182 |
5,115 |
$70K |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
19,068 |
18,591 |
$68K |
| P9016 |
Red blood cells, leukocytes reduced, each unit |
1,382 |
1,240 |
$67K |
| 83690 |
|
28,706 |
27,104 |
$65K |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
1,819 |
1,592 |
$63K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
4,811 |
4,384 |
$59K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
3,410 |
3,117 |
$57K |
| 80306 |
|
10,067 |
9,472 |
$57K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
10,501 |
6,239 |
$56K |
| 83605 |
|
14,833 |
13,109 |
$51K |
| 83520 |
|
7,533 |
6,143 |
$51K |
| 0241U |
Neonatal screening for hereditary disorders, genomic sequence analysis panel |
2,765 |
2,740 |
$50K |
| 70553 |
Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences |
410 |
406 |
$48K |
| 0160 |
|
4,248 |
3,734 |
$47K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
27,970 |
26,772 |
$44K |
| 93975 |
|
791 |
781 |
$37K |
| 0710 |
|
10,452 |
10,096 |
$36K |
| 78452 |
Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress |
972 |
965 |
$35K |
| 80047 |
|
16,157 |
15,474 |
$35K |
| 93010 |
Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only |
22,354 |
20,169 |
$34K |
| 0250 |
|
29,857 |
21,875 |
$34K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
6,510 |
5,570 |
$34K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
2,214 |
2,152 |
$33K |
| 87040 |
|
9,238 |
5,531 |
$33K |
| 84443 |
Thyroid stimulating hormone (TSH) |
10,829 |
10,631 |
$32K |
| 70486 |
|
753 |
750 |
$32K |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
24,083 |
21,864 |
$32K |
| 72148 |
Magnetic resonance imaging, lumbar spine; without contrast material |
532 |
526 |
$31K |
| 90715 |
|
3,659 |
3,647 |
$31K |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
19,142 |
18,226 |
$30K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
5,500 |
5,321 |
$29K |
| 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 |
7,619 |
7,374 |
$29K |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
3,673 |
3,647 |
$29K |
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
2,813 |
2,782 |
$28K |
| 85027 |
|
19,072 |
17,459 |
$28K |
| 70496 |
|
586 |
581 |
$28K |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
12,131 |
10,543 |
$27K |
| J2704 |
Injection, propofol, 10 mg |
11,510 |
10,673 |
$24K |
| 84702 |
|
11,443 |
10,354 |
$24K |
| 83735 |
|
11,589 |
9,588 |
$24K |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
411 |
410 |
$24K |
| J7030 |
Infusion, normal saline solution , 1000 cc |
12,683 |
12,110 |
$24K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
2,422 |
2,134 |
$24K |
| 0750 |
|
439 |
399 |
$23K |
| A9500 |
Technetium tc-99m sestamibi, diagnostic, per study dose |
941 |
923 |
$23K |
| 88342 |
|
2,694 |
2,649 |
$23K |
| 81025 |
|
14,968 |
14,395 |
$22K |
| J2785 |
Injection, regadenoson, 0.1 mg |
698 |
697 |
$22K |
| 76770 |
|
1,301 |
1,265 |
$22K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
2,281 |
2,031 |
$21K |
| 84703 |
|
17,738 |
17,211 |
$21K |
| 86850 |
|
7,541 |
7,163 |
$19K |
| 0270 |
|
57,916 |
40,397 |
$18K |
| 73562 |
|
3,043 |
3,010 |
$18K |
| 73630 |
|
3,024 |
2,990 |
$18K |
| 85379 |
|
5,695 |
5,535 |
$17K |
| 73030 |
|
2,709 |
2,632 |
$17K |
| 93970 |
|
533 |
528 |
$17K |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
1,367 |
1,269 |
$17K |
| 36430 |
|
1,641 |
1,383 |
$17K |
| U0002 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
1,672 |
1,642 |
$16K |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
10,313 |
9,629 |
$16K |
| 73610 |
|
2,402 |
2,369 |
$16K |
| 82805 |
|
1,923 |
1,789 |
$15K |
| 72100 |
|
2,053 |
2,041 |
$15K |
| J1170 |
Injection, hydromorphone, up to 4 mg |
7,239 |
5,730 |
$15K |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
10,960 |
10,163 |
$14K |
| 86901 |
|
12,661 |
11,667 |
$14K |
| 85610 |
|
14,066 |
13,035 |
$14K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
4,813 |
4,734 |
$13K |
| 72131 |
|
339 |
336 |
$13K |
| 73130 |
|
2,332 |
2,304 |
$13K |
| J0780 |
Injection, prochlorperazine, up to 10 mg |
3,832 |
3,678 |
$13K |
| 70498 |
|
539 |
534 |
$13K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
4,776 |
4,696 |
$13K |
| 70491 |
|
211 |
211 |
$12K |
| 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 |
509 |
501 |
$12K |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
9,353 |
8,813 |
$12K |
| A9575 |
Injection, gadoterate meglumine, 0.1 ml |
1,148 |
1,129 |
$12K |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
6,869 |
6,404 |
$11K |
| 76870 |
|
715 |
697 |
$11K |
| 11042 |
Debridement, subcutaneous tissue (includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm |
6,573 |
3,119 |
$10K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
2,443 |
2,437 |
$10K |
| 11043 |
|
2,488 |
1,296 |
$10K |
| 86900 |
|
12,692 |
11,690 |
$10K |
| 73502 |
|
712 |
705 |
$10K |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
2,413 |
1,476 |
$10K |
| 36415 |
Collection of venous blood by venipuncture |
10,455 |
8,985 |
$9K |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
7,472 |
6,841 |
$9K |
| 99291 |
Critical care, evaluation and management of the critically ill patient, first 30-74 minutes |
245 |
241 |
$9K |
| 82150 |
|
4,050 |
3,869 |
$9K |
| 59025 |
Fetal non-stress test |
14,730 |
5,090 |
$9K |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
5,178 |
4,839 |
$8K |
| 74246 |
|
805 |
802 |
$8K |
| J2060 |
Injection, lorazepam, 2 mg |
4,606 |
4,001 |
$8K |
| 45378 |
Colonoscopy, flexible; diagnostic, including collection of specimen(s) |
593 |
589 |
$8K |
| 73110 |
|
1,430 |
1,416 |
$7K |
| 82248 |
|
4,651 |
4,491 |
$7K |
| 0324 |
|
442 |
432 |
$7K |
| 87210 |
|
5,512 |
5,351 |
$7K |
| 71250 |
|
190 |
188 |
$7K |
| 87088 |
|
5,804 |
5,691 |
$7K |
| 85018 |
|
11,492 |
10,952 |
$7K |
| J1815 |
Injection, insulin, per 5 units |
3,186 |
1,621 |
$6K |
| J0561 |
Injection, penicillin g benzathine, 100,000 units |
71 |
67 |
$6K |
| 93017 |
|
809 |
807 |
$6K |
| 84439 |
|
4,554 |
4,492 |
$6K |
| 85014 |
|
11,068 |
10,610 |
$6K |
| 87186 |
|
7,624 |
7,477 |
$6K |
| 85730 |
|
4,483 |
4,267 |
$6K |
| Z7610 |
|
2,175 |
1,496 |
$6K |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
1,871 |
1,682 |
$6K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
6,914 |
6,839 |
$6K |
| 82731 |
|
1,273 |
1,238 |
$6K |
| 0762 |
|
103 |
59 |
$6K |
| 82803 |
|
804 |
785 |
$6K |
| 86923 |
|
1,726 |
1,502 |
$5K |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
1,291 |
878 |
$5K |
| Q3014 |
Telehealth originating site facility fee |
544 |
448 |
$5K |
| 73590 |
|
1,037 |
1,024 |
$5K |
| 74174 |
|
113 |
113 |
$5K |
| 80061 |
Lipid panel |
6,127 |
6,046 |
$5K |
| 82140 |
|
1,344 |
1,249 |
$5K |
| 84100 |
|
3,961 |
3,187 |
$5K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
859 |
830 |
$5K |
| 73700 |
|
220 |
217 |
$5K |
| 81003 |
|
6,085 |
5,932 |
$5K |
| J1750 |
Injection, iron dextran, 50 mg |
277 |
266 |
$5K |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
2,604 |
2,474 |
$5K |
| 0121 |
|
20 |
18 |
$5K |
| 82550 |
|
2,037 |
1,919 |
$4K |
| 45380 |
Colonoscopy, flexible; with biopsy, single or multiple |
742 |
734 |
$4K |
| C1776 |
Joint device (implantable) |
26 |
26 |
$4K |
| 86703 |
|
2,519 |
2,510 |
$4K |
| 87081 |
|
4,256 |
4,220 |
$4K |
| J2359 |
Injection, olanzapine, 0.5 mg |
268 |
213 |
$4K |
| 73080 |
|
633 |
628 |
$4K |
| 0761 |
|
1,216 |
691 |
$4K |
| 94760 |
|
1,912 |
1,707 |
$4K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
1,487 |
1,457 |
$3K |
| 76642 |
|
869 |
854 |
$3K |
| 87070 |
|
3,174 |
3,008 |
$3K |
| 85007 |
|
3,440 |
3,249 |
$3K |
| 0403 |
|
31 |
31 |
$3K |
| 72040 |
|
337 |
334 |
$3K |
| 87147 |
|
2,387 |
2,338 |
$3K |
| 0760 |
|
2,081 |
1,433 |
$3K |
| Q9966 |
Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml |
220 |
218 |
$2K |
| 93458 |
|
44 |
44 |
$2K |
| 87400 |
|
1,030 |
397 |
$2K |
| M0243 |
Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring |
121 |
120 |
$2K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
2,734 |
2,712 |
$2K |
| 45385 |
Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) |
262 |
261 |
$2K |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
1,105 |
1,020 |
$2K |
| J2560 |
Injection, phenobarbital sodium, up to 120 mg |
93 |
83 |
$2K |
| J1630 |
Injection, haloperidol, up to 5 mg |
2,252 |
1,989 |
$2K |
| J0360 |
Injection, hydralazine hcl, up to 20 mg |
724 |
612 |
$2K |
| 72141 |
|
39 |
39 |
$2K |
| 74018 |
|
436 |
422 |
$2K |
| 73090 |
|
394 |
388 |
$2K |
| 82607 |
|
2,521 |
2,486 |
$2K |
| 80074 |
|
235 |
230 |
$2K |
| J1644 |
Injection, heparin sodium, per 1000 units |
1,062 |
622 |
$2K |
| 86140 |
|
1,843 |
1,660 |
$2K |
| 87641 |
|
241 |
235 |
$2K |
| 84550 |
|
1,908 |
1,768 |
$2K |
| 82746 |
|
1,378 |
1,350 |
$2K |
| 88304 |
|
729 |
725 |
$2K |
| J3370 |
Injection, vancomycin hcl, 500 mg |
355 |
267 |
$2K |
| 88360 |
|
344 |
336 |
$2K |
| 77066 |
Tomosynthesis, mammo |
393 |
389 |
$2K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
494 |
491 |
$2K |
| 82728 |
|
2,186 |
2,118 |
$2K |
| 87077 |
|
2,257 |
2,223 |
$2K |
| G0378 |
Hospital observation service, per hour |
36 |
30 |
$2K |
| 94644 |
|
347 |
284 |
$2K |
| 85652 |
|
3,011 |
2,824 |
$2K |
| 80055 |
|
511 |
507 |
$1K |
| 86780 |
|
629 |
613 |
$1K |
| J0690 |
Injection, cefazolin sodium, 500 mg |
572 |
543 |
$1K |
| 71020 |
|
613 |
306 |
$1K |
| 82010 |
|
476 |
462 |
$1K |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
54 |
49 |
$1K |
| 84466 |
|
1,854 |
1,808 |
$1K |
| 81223 |
|
42 |
42 |
$1K |
| 72072 |
|
169 |
169 |
$1K |
| 86480 |
|
840 |
836 |
$1K |
| 71101 |
|
113 |
112 |
$1K |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
1,346 |
1,343 |
$1K |
| J3105 |
Injection, terbutaline sulfate, up to 1 mg |
656 |
612 |
$1K |
| 72050 |
|
123 |
120 |
$1K |
| J1040 |
Injection, methylprednisolone acetate, 80 mg |
159 |
159 |
$1K |
| 84156 |
|
1,427 |
1,214 |
$1K |
| 11046 |
|
25 |
12 |
$1K |
| 84132 |
|
1,371 |
1,270 |
$1K |
| J1953 |
Injection, levetiracetam, 10 mg |
289 |
263 |
$1K |
| J2710 |
Injection, neostigmine methylsulfate, up to 0.5 mg |
26 |
15 |
$1K |
| 76536 |
|
264 |
261 |
$995.12 |
| 86592 |
|
1,787 |
1,756 |
$949.13 |
| J1650 |
Injection, enoxaparin sodium, 10 mg |
597 |
368 |
$945.70 |
| 74183 |
|
66 |
65 |
$938.70 |
| J1940 |
Injection, furosemide, up to 20 mg |
554 |
420 |
$910.15 |
| 86803 |
|
1,536 |
1,526 |
$907.84 |
| 84295 |
|
1,162 |
1,093 |
$904.80 |
| C1729 |
Catheter, drainage |
72 |
52 |
$847.76 |
| 86308 |
|
522 |
518 |
$830.34 |
| J3490 |
Unclassified drugs |
6,115 |
5,234 |
$809.41 |
| 80051 |
|
530 |
513 |
$806.20 |
| 83540 |
|
1,936 |
1,879 |
$762.66 |
| 73552 |
|
132 |
131 |
$755.06 |
| 97116 |
|
270 |
223 |
$750.25 |
| 97161 |
|
2,033 |
1,997 |
$738.47 |
| 82565 |
|
751 |
707 |
$732.68 |
| 96376 |
|
1,784 |
1,495 |
$722.27 |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
77 |
68 |
$682.81 |
| J7050 |
Infusion, normal saline solution, 250 cc |
850 |
760 |
$673.75 |
| 82310 |
|
568 |
552 |
$641.39 |
| 12001 |
|
226 |
225 |
$622.48 |
| C1769 |
Guide wire |
127 |
122 |
$606.90 |
| 92610 |
|
63 |
63 |
$602.91 |
| 82570 |
|
630 |
584 |
$551.98 |
| A9579 |
Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (nos), per ml |
223 |
222 |
$548.90 |
| 72170 |
|
192 |
191 |
$535.46 |
| 87205 |
|
596 |
547 |
$498.76 |
| 96367 |
|
66 |
62 |
$496.80 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
580 |
521 |
$492.79 |
| 92650 |
|
19 |
19 |
$487.92 |
| J7040 |
Infusion, normal saline solution, sterile (500 ml = 1 unit) |
406 |
375 |
$474.17 |
| 72128 |
|
27 |
26 |
$467.32 |
| 73560 |
|
91 |
91 |
$464.54 |
| J2919 |
Injection, methylprednisolone sodium succinate, 5 mg |
222 |
199 |
$456.60 |
| 0301 |
|
164 |
161 |
$443.21 |
| 0320 |
|
19 |
18 |
$439.69 |
| 47563 |
|
12 |
12 |
$385.08 |
| 77062 |
|
283 |
283 |
$354.53 |
| J0697 |
Injection, sterile cefuroxime sodium, per 750 mg |
391 |
343 |
$318.85 |
| 84480 |
|
58 |
58 |
$316.15 |
| 86403 |
|
183 |
100 |
$316.04 |
| 73564 |
|
40 |
39 |
$309.60 |
| J2175 |
Injection, meperidine hydrochloride, per 100 mg |
76 |
72 |
$306.46 |
| 73140 |
|
68 |
66 |
$296.81 |
| 99232 |
Subsequent hospital care, per day, moderate complexity |
29 |
29 |
$290.88 |
| 87340 |
|
166 |
166 |
$289.22 |
| 86376 |
|
134 |
133 |
$278.09 |
| 10060 |
|
505 |
489 |
$265.03 |
| J1171 |
Injection, hydromorphone, 0.1 mg |
120 |
99 |
$255.85 |
| A9270 |
Non-covered item or service |
567 |
267 |
$248.98 |
| G0475 |
Hiv antigen/antibody, combination assay, screening |
278 |
278 |
$234.06 |
| 73060 |
|
60 |
59 |
$231.08 |
| 87045 |
|
128 |
126 |
$226.71 |
| 85460 |
|
88 |
86 |
$225.40 |
| 12011 |
|
12 |
12 |
$216.81 |
| J3480 |
Injection, potassium chloride, per 2 meq |
215 |
168 |
$214.33 |
| 0258 |
|
948 |
900 |
$208.18 |
| 86696 |
|
776 |
704 |
$187.12 |
| 86695 |
|
776 |
704 |
$187.12 |
| J0665 |
Injection, bupivicaine, not otherwise specified, 0.5 mg |
294 |
280 |
$186.23 |
| 93798 |
|
341 |
99 |
$182.47 |
| 74300 |
|
25 |
25 |
$170.53 |
| 77080 |
|
108 |
107 |
$166.67 |
| 86141 |
|
64 |
64 |
$162.81 |
| J2795 |
Injection, ropivacaine hydrochloride, 1 mg |
28 |
26 |
$159.10 |
| G0472 |
Hepatitis c antibody screening, for individual at high risk and other covered indication(s) |
211 |
211 |
$155.73 |
| 87493 |
|
24 |
24 |
$154.65 |
| 84481 |
|
200 |
199 |
$137.81 |
| 86800 |
|
50 |
50 |
$136.99 |
| 82950 |
|
508 |
507 |
$121.84 |
| J2470 |
Injection, pantoprazole sodium, 40 mg |
74 |
69 |
$119.22 |
| 71010 |
|
80 |
34 |
$119.16 |
| 83970 |
|
50 |
50 |
$117.25 |
| 87015 |
|
123 |
119 |
$111.05 |
| 74240 |
|
14 |
14 |
$104.30 |
| 97165 |
|
192 |
190 |
$99.94 |
| 87046 |
|
241 |
138 |
$99.36 |
| C1894 |
Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser |
87 |
86 |
$94.80 |
| 84153 |
|
25 |
25 |
$94.36 |
| J3301 |
Injection, triamcinolone acetonide, not otherwise specified, 10 mg |
48 |
43 |
$92.90 |
| 76937 |
|
15 |
13 |
$87.82 |
| J1836 |
Injection, metronidazole, 10 mg |
37 |
30 |
$87.14 |
| 82043 |
|
387 |
387 |
$85.76 |
| 77065 |
Tomosynthesis, mammo |
28 |
28 |
$84.30 |
| 86870 |
|
12 |
12 |
$81.75 |
| 93880 |
|
43 |
38 |
$70.48 |
| 80069 |
|
16 |
13 |
$68.16 |
| 82947 |
|
227 |
225 |
$64.49 |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
684 |
485 |
$64.47 |
| 87185 |
|
419 |
415 |
$57.58 |
| 74241 |
|
12 |
12 |
$56.58 |
| 82330 |
|
15 |
12 |
$54.72 |
| 73620 |
|
13 |
13 |
$48.39 |
| A9537 |
Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries |
12 |
12 |
$47.63 |
| 94729 |
|
65 |
65 |
$46.42 |
| 94060 |
|
101 |
100 |
$43.40 |
| 94726 |
|
61 |
61 |
$42.55 |
| 82247 |
|
159 |
127 |
$34.36 |
| 86038 |
|
140 |
136 |
$32.96 |
| 86762 |
|
20 |
20 |
$30.72 |
| 43235 |
|
12 |
12 |
$30.24 |
| J1920 |
Injection, labetalol hydrochloride, 5 mg |
19 |
13 |
$27.53 |
| J0295 |
Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm |
117 |
97 |
$26.55 |
| 12002 |
|
58 |
58 |
$24.00 |
| 90686 |
|
13 |
13 |
$23.49 |
| J0171 |
Injection, adrenalin, epinephrine, 0.1 mg |
41 |
39 |
$23.02 |
| J8597 |
Antiemetic drug, oral, not otherwise specified |
648 |
548 |
$21.93 |
| J0456 |
Injection, azithromycin, 500 mg |
15 |
13 |
$21.00 |
| 82375 |
|
105 |
105 |
$18.37 |
| J0702 |
Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg |
20 |
13 |
$18.24 |
| 86235 |
|
13 |
13 |
$14.40 |
| 82810 |
|
46 |
46 |
$12.80 |
| 86431 |
|
37 |
37 |
$12.00 |
| 82977 |
|
12 |
12 |
$10.10 |
| 99070 |
|
21 |
13 |
$8.79 |
| 85046 |
|
13 |
13 |
$7.94 |
| 77061 |
|
25 |
25 |
$7.86 |
| 81050 |
|
15 |
12 |
$4.14 |
| C9113 |
Injection, pantoprazole sodium, per vial |
120 |
84 |
$0.00 |
| 0730 |
|
17 |
17 |
$0.00 |
| 93308 |
|
28 |
26 |
$0.00 |
| 0370R |
|
42 |
40 |
$0.00 |
| 29125 |
|
28 |
27 |
$0.00 |
| 0272 |
|
39 |
39 |
$0.00 |
| 93325 |
|
97 |
80 |
$0.00 |
| C1887 |
Catheter, guiding (may include infusion/perfusion capability) |
26 |
25 |
$0.00 |
| 0302 |
|
18 |
18 |
$0.00 |
| 83721 |
|
97 |
96 |
$0.00 |
| 0272R |
|
29 |
27 |
$0.00 |
| 0424 |
|
13 |
13 |
$0.00 |
| 84425 |
|
12 |
12 |
$0.00 |
| 0300 |
|
37 |
37 |
$0.00 |
| 99001 |
|
72 |
72 |
$0.00 |
| 29515 |
|
14 |
14 |
$0.00 |
| 0710R |
|
29 |
27 |
$0.00 |
| 84146 |
|
26 |
26 |
$0.00 |
| 83655 |
|
24 |
24 |
$0.00 |
| J1245 |
Injection, dipyridamole, per 10 mg |
17 |
17 |
$0.00 |
| 93321 |
|
13 |
12 |
$0.00 |
| 83695 |
|
12 |
12 |
$0.00 |
| A4649 |
Surgical supply; miscellaneous |
17 |
15 |
$0.00 |
| 27447 |
|
27 |
27 |
$0.00 |
| 36600 |
|
17 |
17 |
$0.00 |
| 0260 |
|
22 |
22 |
$0.00 |
| 0122 |
|
13 |
12 |
$0.00 |
| 84207 |
|
12 |
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 |
200 |
191 |
$0.00 |
| 11045 |
|
95 |
65 |
$0.00 |
| 15275 |
|
60 |
27 |
$0.00 |
| 0250R |
|
42 |
40 |
$0.00 |
| 0352 |
|
12 |
12 |
$0.00 |
| 0306 |
|
22 |
22 |
$0.00 |
| 0255 |
|
13 |
13 |
$0.00 |
| 0305 |
|
37 |
37 |
$0.00 |
| 0420 |
|
13 |
13 |
$0.00 |
| 0307 |
|
18 |
18 |
$0.00 |
| J3411 |
Injection, thiamine hcl, 100 mg |
15 |
12 |
$0.00 |