| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99284 |
Emergency department visit for the evaluation and management, high severity |
52,999 |
48,015 |
$9.31M |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
45,800 |
41,871 |
$4.68M |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
17,524 |
15,687 |
$4.47M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
137,055 |
116,777 |
$4.47M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
65,402 |
58,465 |
$3.13M |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
78,737 |
68,627 |
$2.21M |
| J9271 |
Injection, pembrolizumab, 1 mg |
595 |
406 |
$1.87M |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
59,386 |
47,317 |
$1.82M |
| 99215 |
Prolong outpt/office vis |
35,594 |
31,966 |
$1.63M |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
4,773 |
4,406 |
$1.38M |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
32,966 |
29,451 |
$1.34M |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
22,235 |
20,399 |
$1.28M |
| 96413 |
Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance |
9,358 |
5,497 |
$1.22M |
| 80053 |
Comprehensive metabolic panel |
120,187 |
96,467 |
$880K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
15,264 |
12,525 |
$741K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
15,489 |
13,270 |
$683K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
22,947 |
19,607 |
$662K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
22,981 |
19,606 |
$657K |
| 71045 |
Radiologic examination, chest; single view |
11,594 |
10,410 |
$631K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
112,803 |
91,146 |
$597K |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
1,931 |
1,701 |
$586K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
7,252 |
6,564 |
$572K |
| 59025 |
Fetal non-stress test |
6,177 |
4,724 |
$502K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
14,121 |
10,166 |
$477K |
| 76819 |
Fetal biophysical profile; without non-stress testing |
6,496 |
3,285 |
$420K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
26,727 |
23,219 |
$409K |
| 70450 |
Computed tomography, head or brain; without contrast material |
3,951 |
3,567 |
$387K |
| 71046 |
Radiologic examination, chest; 2 views |
7,841 |
7,142 |
$372K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
4,931 |
4,199 |
$366K |
| 36415 |
Collection of venous blood by venipuncture |
153,723 |
122,736 |
$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 |
3,366 |
2,776 |
$256K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
3,653 |
3,361 |
$252K |
| 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 |
5,817 |
4,695 |
$244K |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
4,435 |
4,067 |
$239K |
| 45378 |
Colonoscopy, flexible; diagnostic, including collection of specimen(s) |
737 |
647 |
$239K |
| G0378 |
Hospital observation service, per hour |
1,105 |
438 |
$228K |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
12,794 |
10,803 |
$228K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
8,923 |
6,980 |
$219K |
| 96361 |
Intravenous infusion, hydration; each additional hour |
10,108 |
7,582 |
$212K |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
4,663 |
4,111 |
$199K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
2,735 |
2,209 |
$192K |
| 80050 |
General health panel |
5,360 |
4,705 |
$191K |
| 81025 |
|
29,518 |
26,373 |
$182K |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
6,985 |
5,649 |
$181K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
2,908 |
2,468 |
$178K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
2,387 |
1,943 |
$174K |
| 80061 |
Lipid panel |
17,520 |
15,836 |
$170K |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
5,373 |
4,956 |
$161K |
| M0243 |
Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring |
705 |
433 |
$160K |
| J2469 |
Injection, palonosetron hcl, 25 mcg |
2,376 |
1,398 |
$155K |
| 83880 |
|
5,488 |
4,955 |
$136K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
9,591 |
4,878 |
$131K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
19,162 |
17,159 |
$130K |
| 67028 |
Intravitreal injection of a pharmacologic agent |
840 |
580 |
$129K |
| 20610 |
|
1,084 |
806 |
$113K |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
392 |
362 |
$111K |
| 87624 |
Infectious agent detection by nucleic acid; human papillomavirus (HPV), high-risk types |
3,794 |
3,246 |
$99K |
| 88175 |
Cytopathology, cervical or vaginal, any reporting system; collected in preservative fluid, automated thin layer |
5,092 |
4,382 |
$98K |
| 92250 |
|
3,798 |
3,390 |
$97K |
| 96367 |
|
3,521 |
2,075 |
$93K |
| J9202 |
Goserelin acetate implant, per 3.6 mg |
184 |
157 |
$90K |
| 84484 |
|
11,159 |
8,482 |
$83K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
12,725 |
10,519 |
$82K |
| 80074 |
|
2,540 |
2,010 |
$75K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
1,223 |
1,011 |
$73K |
| 81002 |
|
25,778 |
19,257 |
$73K |
| 92083 |
|
2,430 |
2,209 |
$67K |
| 84443 |
Thyroid stimulating hormone (TSH) |
5,491 |
4,793 |
$64K |
| 86703 |
|
6,534 |
5,678 |
$64K |
| 92133 |
|
2,603 |
2,346 |
$61K |
| 87536 |
|
1,294 |
1,120 |
$61K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
1,273 |
989 |
$60K |
| 81000 |
|
21,381 |
18,592 |
$58K |
| 87430 |
|
4,170 |
3,960 |
$58K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
4,671 |
3,962 |
$57K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
995 |
885 |
$55K |
| 73110 |
|
787 |
618 |
$55K |
| 87634 |
|
885 |
823 |
$54K |
| J0185 |
Injection, aprepitant, 1 mg |
356 |
191 |
$50K |
| 92134 |
|
1,901 |
1,672 |
$49K |
| 73564 |
|
906 |
708 |
$49K |
| 81003 |
|
26,437 |
20,836 |
$49K |
| J7030 |
Infusion, normal saline solution , 1000 cc |
5,796 |
4,534 |
$48K |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
21,974 |
19,428 |
$46K |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
2,667 |
898 |
$45K |
| 86803 |
|
4,457 |
3,805 |
$44K |
| 78452 |
Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress |
103 |
92 |
$42K |
| 83690 |
|
7,852 |
7,118 |
$41K |
| 73610 |
|
634 |
529 |
$40K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
444 |
410 |
$39K |
| 80055 |
|
2,263 |
1,785 |
$39K |
| 73130 |
|
572 |
454 |
$38K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
147 |
136 |
$38K |
| 45385 |
Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) |
274 |
232 |
$38K |
| 45380 |
Colonoscopy, flexible; with biopsy, single or multiple |
152 |
137 |
$37K |
| 87070 |
|
3,967 |
3,743 |
$34K |
| 87400 |
|
5,154 |
2,096 |
$34K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
1,794 |
1,479 |
$34K |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
2,713 |
2,482 |
$34K |
| 74019 |
|
564 |
536 |
$34K |
| 90686 |
|
5,071 |
4,345 |
$30K |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
720 |
704 |
$28K |
| 96401 |
|
454 |
189 |
$28K |
| J2505 |
Injection, pegfilgrastim, 6 mg |
36 |
12 |
$28K |
| 73562 |
|
394 |
337 |
$27K |
| 96417 |
|
623 |
394 |
$26K |
| 0002A |
|
760 |
639 |
$25K |
| 87210 |
|
5,486 |
4,970 |
$25K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
804 |
724 |
$24K |
| 87081 |
|
4,324 |
3,784 |
$24K |
| J3301 |
Injection, triamcinolone acetonide, not otherwise specified, 10 mg |
3,812 |
3,534 |
$23K |
| 0001A |
|
684 |
625 |
$23K |
| 90715 |
|
1,288 |
1,081 |
$22K |
| 66984 |
Extracapsular cataract removal with insertion of intraocular lens prosthesis |
62 |
51 |
$22K |
| 94761 |
|
9,039 |
6,765 |
$21K |
| 96402 |
|
720 |
622 |
$21K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
653 |
590 |
$20K |
| 81001 |
|
8,191 |
7,215 |
$20K |
| 86593 |
|
6,020 |
4,646 |
$20K |
| 83735 |
|
4,352 |
3,866 |
$20K |
| 88142 |
|
1,497 |
1,396 |
$19K |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
6,675 |
6,136 |
$18K |
| 86592 |
|
5,171 |
4,532 |
$18K |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
1,117 |
341 |
$18K |
| 93010 |
Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only |
2,970 |
2,396 |
$17K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
636 |
615 |
$17K |
| 88184 |
|
847 |
733 |
$17K |
| 82728 |
|
1,797 |
1,458 |
$16K |
| 73030 |
|
261 |
230 |
$16K |
| 87807 |
|
1,261 |
1,070 |
$16K |
| 80143 |
|
1,553 |
1,264 |
$16K |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
10,408 |
7,987 |
$16K |
| 86850 |
|
3,775 |
2,963 |
$14K |
| J1756 |
Injection, iron sucrose, 1 mg |
255 |
106 |
$14K |
| 85027 |
|
2,939 |
2,172 |
$13K |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
92 |
85 |
$13K |
| 93017 |
|
102 |
92 |
$13K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
2,518 |
1,772 |
$13K |
| 83605 |
|
1,552 |
1,293 |
$12K |
| 82607 |
|
1,055 |
923 |
$12K |
| J0702 |
Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg |
1,522 |
1,416 |
$12K |
| 86140 |
|
3,546 |
3,145 |
$12K |
| 86762 |
|
1,161 |
856 |
$11K |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
10,555 |
8,510 |
$11K |
| J3489 |
Injection, zoledronic acid, 1 mg |
107 |
92 |
$11K |
| 87340 |
|
1,491 |
1,170 |
$11K |
| 83655 |
|
895 |
859 |
$11K |
| J7297 |
Levonorgestrel-releasing intrauterine contraceptive system (liletta), 52 mg |
13 |
13 |
$11K |
| 72125 |
Computed tomography, cervical spine; without contrast material |
74 |
65 |
$11K |
| 82746 |
|
969 |
843 |
$11K |
| 80320 |
|
1,159 |
941 |
$10K |
| 94729 |
|
146 |
136 |
$10K |
| 85610 |
|
3,829 |
3,225 |
$9K |
| 92020 |
|
376 |
341 |
$9K |
| 76801 |
|
151 |
115 |
$9K |
| 82950 |
|
2,241 |
1,995 |
$9K |
| 94060 |
|
166 |
139 |
$9K |
| 94727 |
|
166 |
153 |
$9K |
| 86038 |
|
845 |
753 |
$8K |
| 86900 |
|
4,277 |
3,404 |
$8K |
| 83550 |
|
1,426 |
1,150 |
$8K |
| 86200 |
|
769 |
686 |
$8K |
| J2785 |
Injection, regadenoson, 0.1 mg |
79 |
75 |
$8K |
| 82550 |
|
1,584 |
1,329 |
$8K |
| 83615 |
|
1,887 |
1,483 |
$8K |
| 84702 |
|
611 |
534 |
$8K |
| 86901 |
|
4,290 |
3,419 |
$8K |
| J0897 |
Injection, denosumab, 1 mg |
36 |
26 |
$8K |
| 87040 |
|
1,067 |
522 |
$7K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
365 |
319 |
$7K |
| J1453 |
Injection, fosaprepitant, 1 mg |
33 |
24 |
$7K |
| 82570 |
|
1,859 |
1,632 |
$7K |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
2,437 |
2,053 |
$6K |
| J1642 |
Injection, heparin sodium, (heparin lock flush), per 10 units |
4,363 |
2,731 |
$6K |
| 83540 |
|
1,505 |
1,219 |
$6K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
140 |
124 |
$6K |
| 94664 |
|
102 |
96 |
$6K |
| 85660 |
|
1,298 |
1,072 |
$6K |
| 0004A |
|
160 |
140 |
$6K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
963 |
769 |
$6K |
| 82043 |
|
1,373 |
1,245 |
$6K |
| 83021 |
|
489 |
288 |
$5K |
| J1030 |
Injection, methylprednisolone acetate, 40 mg |
406 |
383 |
$5K |
| 82962 |
|
1,887 |
1,540 |
$5K |
| 86361 |
|
294 |
264 |
$5K |
| 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 |
351 |
257 |
$5K |
| 93246 |
|
132 |
129 |
$5K |
| 92507 |
Treatment of speech, language, voice, communication, and/or auditory processing disorder |
228 |
90 |
$4K |
| 11721 |
|
344 |
297 |
$4K |
| 73721 |
Magnetic resonance imaging, any joint of lower extremity; without contrast material |
19 |
19 |
$4K |
| 57454 |
|
16 |
13 |
$4K |
| 96161 |
|
293 |
269 |
$4K |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
795 |
702 |
$4K |
| 83020 |
|
727 |
288 |
$4K |
| 72100 |
|
83 |
75 |
$4K |
| 84439 |
|
644 |
539 |
$4K |
| 76818 |
|
48 |
38 |
$4K |
| 88720 |
|
1,194 |
1,049 |
$4K |
| 86431 |
|
865 |
765 |
$4K |
| A9502 |
Technetium tc-99m tetrofosmin, diagnostic, per study dose |
102 |
92 |
$4K |
| 76811 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, detailed |
21 |
12 |
$4K |
| 20611 |
|
19 |
13 |
$4K |
| 82784 |
|
552 |
234 |
$4K |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
2,096 |
1,580 |
$4K |
| 11719 |
|
275 |
238 |
$4K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
87 |
80 |
$4K |
| 0071A |
|
102 |
83 |
$3K |
| 85007 |
|
1,700 |
1,139 |
$3K |
| J9263 |
Injection, oxaliplatin, 0.5 mg |
44 |
24 |
$3K |
| 0072A |
|
90 |
67 |
$3K |
| J0561 |
Injection, penicillin g benzathine, 100,000 units |
31 |
26 |
$3K |
| 84156 |
|
1,112 |
753 |
$3K |
| 85045 |
|
1,160 |
942 |
$3K |
| 94760 |
|
2,702 |
2,209 |
$3K |
| 96415 |
|
104 |
66 |
$3K |
| 80081 |
|
49 |
43 |
$3K |
| 84550 |
|
743 |
583 |
$3K |
| 73630 |
|
56 |
50 |
$3K |
| J1170 |
Injection, hydromorphone, up to 4 mg |
2,196 |
1,530 |
$3K |
| 11056 |
|
111 |
98 |
$3K |
| 96409 |
|
22 |
12 |
$3K |
| 76830 |
Ultrasound, transvaginal |
33 |
33 |
$2K |
| 71270 |
|
14 |
12 |
$2K |
| J2704 |
Injection, propofol, 10 mg |
7,035 |
5,634 |
$2K |
| J7050 |
Infusion, normal saline solution, 250 cc |
506 |
232 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
285 |
224 |
$2K |
| 82378 |
|
212 |
163 |
$2K |
| 86235 |
|
324 |
78 |
$2K |
| 90656 |
|
369 |
255 |
$2K |
| 85651 |
|
848 |
755 |
$2K |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
1,335 |
1,146 |
$2K |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
1,084 |
919 |
$2K |
| U0002 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
51 |
46 |
$2K |
| 0064A |
|
81 |
59 |
$2K |
| 96376 |
|
87 |
73 |
$2K |
| 85018 |
|
753 |
721 |
$2K |
| J9206 |
Injection, irinotecan, 20 mg |
66 |
38 |
$2K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
75 |
66 |
$2K |
| J0780 |
Injection, prochlorperazine, up to 10 mg |
271 |
239 |
$2K |
| 90732 |
|
29 |
26 |
$2K |
| C1713 |
Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable) |
31 |
25 |
$2K |
| 85652 |
|
1,304 |
1,137 |
$2K |
| 82105 |
|
110 |
98 |
$2K |
| 90677 |
|
37 |
14 |
$2K |
| 93922 |
|
32 |
27 |
$2K |
| C1760 |
Closure device, vascular (implantable/insertable) |
12 |
12 |
$1K |
| 97164 |
|
60 |
53 |
$1K |
| 86039 |
|
139 |
126 |
$1K |
| 76511 |
|
12 |
12 |
$1K |
| 86704 |
|
131 |
106 |
$1K |
| 96523 |
|
112 |
94 |
$1K |
| 85379 |
|
173 |
145 |
$1K |
| 84153 |
|
111 |
90 |
$1K |
| 84165 |
|
212 |
183 |
$1K |
| 0003A |
|
40 |
31 |
$1K |
| J3490 |
Unclassified drugs |
607 |
350 |
$1K |
| J0690 |
Injection, cefazolin sodium, 500 mg |
1,730 |
1,155 |
$971.05 |
| 94618 |
|
18 |
15 |
$951.39 |
| J9045 |
Injection, carboplatin, 50 mg |
31 |
24 |
$930.91 |
| 82553 |
|
110 |
105 |
$913.57 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
92 |
57 |
$858.22 |
| 83521 |
|
115 |
39 |
$820.37 |
| 74018 |
|
13 |
13 |
$779.94 |
| 86706 |
|
119 |
46 |
$770.52 |
| 85730 |
|
364 |
296 |
$754.05 |
| 92132 |
|
13 |
12 |
$739.30 |
| 99238 |
Hospital discharge day management, 30 minutes or less |
17 |
12 |
$736.58 |
| 99464 |
|
14 |
12 |
$730.80 |
| 86225 |
|
76 |
65 |
$728.22 |
| 84100 |
|
215 |
163 |
$712.26 |
| 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 |
1,284 |
786 |
$704.63 |
| 82150 |
|
146 |
134 |
$699.44 |
| 80179 |
|
62 |
55 |
$685.02 |
| A9575 |
Injection, gadoterate meglumine, 0.1 ml |
32 |
24 |
$681.89 |
| 87186 |
|
121 |
95 |
$674.96 |
| J2919 |
Injection, methylprednisolone sodium succinate, 5 mg |
245 |
155 |
$639.38 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
3,882 |
3,271 |
$577.01 |
| A9698 |
Non-radioactive contrast imaging material, not otherwise classified, per study |
305 |
272 |
$559.32 |
| 83516 |
|
90 |
55 |
$542.85 |
| 11055 |
|
29 |
25 |
$518.68 |
| 87077 |
|
95 |
72 |
$509.04 |
| C1894 |
Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser |
54 |
51 |
$499.18 |
| J8540 |
Dexamethasone, oral, 0.25 mg |
186 |
53 |
$496.34 |
| 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 |
35 |
33 |
$491.02 |
| 81511 |
|
383 |
249 |
$490.70 |
| J1644 |
Injection, heparin sodium, per 1000 units |
60 |
51 |
$489.00 |
| 84163 |
|
41 |
32 |
$466.55 |
| 73560 |
|
14 |
12 |
$442.10 |
| 87147 |
|
141 |
83 |
$434.80 |
| 84630 |
|
51 |
45 |
$434.30 |
| 93270 |
|
16 |
16 |
$411.32 |
| 84466 |
|
40 |
34 |
$407.94 |
| J2360 |
Injection, orphenadrine citrate, up to 60 mg |
82 |
74 |
$401.34 |
| 76514 |
|
52 |
50 |
$382.29 |
| J1630 |
Injection, haloperidol, up to 5 mg |
80 |
70 |
$369.96 |
| 94762 |
|
17 |
12 |
$355.95 |
| 82247 |
|
93 |
65 |
$353.70 |
| 99462 |
|
14 |
12 |
$349.72 |
| 80323 |
|
24 |
17 |
$337.96 |
| J0665 |
Injection, bupivicaine, not otherwise specified, 0.5 mg |
682 |
561 |
$305.31 |
| J0461 |
Injection, atropine sulfate, 0.01 mg |
81 |
50 |
$301.94 |
| 84154 |
|
31 |
26 |
$294.24 |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
131 |
125 |
$292.64 |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
25,318 |
21,642 |
$287.66 |
| 86780 |
|
36 |
27 |
$278.04 |
| J2272 |
Injection, morphine sulfate (fresenius kabi), not therapeutically equivalent to j2270, up to 10 mg |
242 |
135 |
$277.96 |
| 83883 |
|
60 |
29 |
$261.28 |
| 84145 |
|
14 |
13 |
$255.70 |
| J2003 |
Injection, lidocaine hydrochloride, 1 mg |
309 |
267 |
$218.94 |
| 84146 |
|
12 |
12 |
$216.80 |
| 82810 |
|
49 |
45 |
$206.46 |
| 83921 |
|
16 |
12 |
$190.89 |
| C1769 |
Guide wire |
25 |
25 |
$184.66 |
| 96377 |
|
22 |
12 |
$182.03 |
| 82077 |
|
19 |
17 |
$181.30 |
| 82270 |
|
60 |
59 |
$170.66 |
| 93296 |
|
31 |
29 |
$157.31 |
| 90714 |
|
12 |
12 |
$149.04 |
| Q0111 |
Wet mounts, including preparations of vaginal, cervical or skin specimens |
523 |
296 |
$143.47 |
| J2060 |
Injection, lorazepam, 2 mg |
77 |
63 |
$143.11 |
| 85046 |
|
27 |
25 |
$116.97 |
| 80076 |
|
12 |
12 |
$108.68 |
| J2175 |
Injection, meperidine hydrochloride, per 100 mg |
77 |
37 |
$108.03 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
667 |
552 |
$102.00 |
| Q9969 |
Tc-99m from non-highly enriched uranium source, full cost recovery add-on, per study dose |
16 |
14 |
$99.81 |
| J1650 |
Injection, enoxaparin sodium, 10 mg |
19 |
13 |
$97.29 |
| J7510 |
Prednisolone oral, per 5 mg |
54 |
53 |
$83.36 |
| 99459 |
|
251 |
191 |
$77.02 |
| 96380 |
|
55 |
47 |
$76.48 |
| 99152 |
|
44 |
37 |
$72.63 |
| 84155 |
|
49 |
38 |
$64.33 |
| 90698 |
|
2,478 |
2,215 |
$62.22 |
| J0360 |
Injection, hydralazine hcl, up to 20 mg |
13 |
12 |
$58.26 |
| 82803 |
|
12 |
12 |
$57.15 |
| J2001 |
Injection, lidocaine hcl for intravenous infusion, 10 mg |
256 |
198 |
$52.66 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
42 |
31 |
$43.96 |
| 00811 |
|
656 |
628 |
$39.33 |
| 90633 |
|
594 |
496 |
$33.48 |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
31 |
14 |
$33.12 |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
82 |
63 |
$29.70 |
| J7040 |
Infusion, normal saline solution, sterile (500 ml = 1 unit) |
20 |
12 |
$28.65 |
| 36416 |
|
17 |
12 |
$26.50 |
| J2550 |
Injection, promethazine hcl, up to 50 mg |
13 |
13 |
$25.04 |
| 00813 |
|
91 |
87 |
$22.47 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
15 |
12 |
$21.98 |
| J3370 |
Injection, vancomycin hcl, 500 mg |
40 |
13 |
$21.46 |
| 90662 |
|
22 |
13 |
$13.74 |
| J1171 |
Injection, hydromorphone, 0.1 mg |
28 |
15 |
$1.81 |
| G0008 |
Administration of influenza virus vaccine |
281 |
278 |
$0.65 |
| 3078F |
|
97 |
94 |
$0.29 |
| 3074F |
|
46 |
45 |
$0.07 |
| 3077F |
|
14 |
14 |
$0.02 |
| 90670 |
|
2,687 |
2,394 |
$0.00 |
| 90685 |
|
68 |
51 |
$0.00 |
| 91300 |
|
1,484 |
1,263 |
$0.00 |
| Q0243 |
Injection, casirivimab and imdevimab, 2400 mg |
93 |
88 |
$0.00 |
| 88312 |
|
193 |
139 |
$0.00 |
| J0171 |
Injection, adrenalin, epinephrine, 0.1 mg |
47 |
38 |
$0.00 |
| 00731 |
|
26 |
26 |
$0.00 |
| Q0244 |
Injection, casirivimab and imdevimab, 1200 mg |
355 |
294 |
$0.00 |
| 90710 |
|
167 |
155 |
$0.00 |
| J0689 |
Injection, cefazolin sodium (baxter), not therapeutically equivalent to j0690, 500 mg |
30 |
16 |
$0.00 |
| C9257 |
Injection, bevacizumab, 0.25 mg |
52 |
36 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
27 |
26 |
$0.00 |
| 90707 |
|
19 |
15 |
$0.00 |
| 90744 |
|
1,548 |
1,335 |
$0.00 |
| 91303 |
|
35 |
26 |
$0.00 |
| J0178 |
Injection, aflibercept, 1 mg |
45 |
26 |
$0.00 |
| 90694 |
|
15 |
15 |
$0.00 |
| 90680 |
|
1,393 |
1,274 |
$0.00 |
| 88304 |
|
147 |
125 |
$0.00 |
| A9270 |
Non-covered item or service |
137 |
111 |
$0.00 |
| 90696 |
|
50 |
43 |
$0.00 |
| 88307 |
|
18 |
12 |
$0.00 |
| 91306 |
|
48 |
41 |
$0.00 |
| J1097 |
Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml |
31 |
27 |
$0.00 |
| J0330 |
Injection, succinylcholine chloride, up to 20 mg |
42 |
36 |
$0.00 |
| 91307 |
|
166 |
109 |
$0.00 |
| 90647 |
|
14 |
12 |
$0.00 |
| V2632 |
Posterior chamber intraocular lens |
18 |
12 |
$0.00 |
| 90716 |
|
20 |
16 |
$0.00 |