| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
54,056 |
48,698 |
$13.17M |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
52,536 |
45,803 |
$12.14M |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
25,881 |
24,190 |
$9.50M |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
18,716 |
15,955 |
$3.74M |
| 78452 |
Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress |
2,595 |
2,338 |
$2.60M |
| 70450 |
Computed tomography, head or brain; without contrast material |
21,671 |
19,797 |
$2.30M |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
11,514 |
10,763 |
$1.74M |
| 72125 |
Computed tomography, cervical spine; without contrast material |
6,407 |
5,881 |
$1.52M |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
13,843 |
12,826 |
$1.50M |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
48,464 |
18,558 |
$1.46M |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
1,640 |
1,562 |
$1.32M |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
3,591 |
3,242 |
$1.29M |
| G0378 |
Hospital observation service, per hour |
21,505 |
9,502 |
$1.19M |
| 0202U |
Oncology (prostate), multianalyte, gene expression profiling |
6,436 |
6,140 |
$1.18M |
| 95810 |
Polysomnography; sleep staging with 4 or more additional parameters |
2,207 |
2,162 |
$1.10M |
| 94060 |
|
3,998 |
3,850 |
$991K |
| 95811 |
|
1,946 |
1,882 |
$963K |
| 70553 |
Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences |
2,000 |
1,877 |
$762K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
21,437 |
19,799 |
$744K |
| 70498 |
|
1,123 |
1,021 |
$736K |
| 93971 |
|
4,171 |
3,793 |
$702K |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
4,339 |
4,017 |
$695K |
| 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 |
10,513 |
9,753 |
$684K |
| 74174 |
|
1,077 |
970 |
$647K |
| 80050 |
General health panel |
15,719 |
15,069 |
$603K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
18,262 |
17,273 |
$600K |
| 99232 |
Subsequent hospital care, per day, moderate complexity |
14,707 |
5,902 |
$589K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
17,895 |
13,073 |
$583K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
12,875 |
12,609 |
$555K |
| 72131 |
|
2,252 |
2,055 |
$554K |
| 93458 |
|
299 |
270 |
$515K |
| 93970 |
|
1,873 |
1,722 |
$488K |
| 59025 |
Fetal non-stress test |
3,370 |
2,390 |
$473K |
| 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 |
3,039 |
2,935 |
$434K |
| 71046 |
Radiologic examination, chest; 2 views |
35,818 |
33,151 |
$432K |
| 93010 |
Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only |
63,627 |
50,065 |
$431K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
2,079 |
1,945 |
$419K |
| 87637 |
Infectious agent detection by nucleic acid; SARS-CoV-2, influenza, and RSV |
9,579 |
9,146 |
$410K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
17,554 |
14,980 |
$389K |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
23,336 |
10,579 |
$387K |
| 88307 |
|
4,503 |
4,358 |
$363K |
| 78815 |
Positron emission tomography (PET) for limited area imaging |
697 |
659 |
$300K |
| 71045 |
Radiologic examination, chest; single view |
63,079 |
54,253 |
$279K |
| 45380 |
Colonoscopy, flexible; with biopsy, single or multiple |
484 |
456 |
$270K |
| 72148 |
Magnetic resonance imaging, lumbar spine; without contrast material |
2,110 |
2,012 |
$263K |
| 80053 |
Comprehensive metabolic panel |
98,399 |
77,823 |
$251K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
12,531 |
11,765 |
$239K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
5,593 |
5,321 |
$238K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
8,391 |
7,950 |
$223K |
| 72110 |
|
1,860 |
1,803 |
$222K |
| 73110 |
|
6,183 |
5,213 |
$220K |
| 97113 |
|
2,724 |
1,335 |
$220K |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
4,608 |
4,254 |
$217K |
| 99222 |
Initial hospital care, per day, moderate complexity |
2,705 |
2,625 |
$217K |
| 87636 |
Infectious agent detection by nucleic acid; SARS-CoV-2 and influenza virus types A and B |
2,672 |
2,573 |
$217K |
| 73030 |
|
8,412 |
7,622 |
$202K |
| 76642 |
|
3,528 |
3,408 |
$201K |
| 71250 |
|
2,920 |
2,735 |
$199K |
| 92588 |
|
532 |
521 |
$197K |
| 96413 |
Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance |
3,731 |
2,217 |
$196K |
| 70491 |
|
454 |
429 |
$195K |
| 73564 |
|
2,248 |
2,062 |
$191K |
| 97112 |
Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination |
7,087 |
3,909 |
$190K |
| 93798 |
|
2,903 |
457 |
$189K |
| 72100 |
|
4,652 |
4,508 |
$187K |
| 73610 |
|
5,512 |
5,020 |
$186K |
| 97162 |
|
4,046 |
3,742 |
$184K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
58,252 |
45,849 |
$174K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
15,163 |
9,481 |
$172K |
| G0483 |
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; 22 or more drug class(es), including metabolite(s) if performed |
800 |
766 |
$169K |
| C1713 |
Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable) |
280 |
256 |
$161K |
| 73562 |
|
6,228 |
5,726 |
$157K |
| 72072 |
|
1,638 |
1,586 |
$154K |
| 73130 |
|
5,965 |
5,283 |
$153K |
| C8929 |
Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiography |
686 |
608 |
$150K |
| 87624 |
Infectious agent detection by nucleic acid; human papillomavirus (HPV), high-risk types |
2,911 |
2,845 |
$150K |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
9,216 |
7,666 |
$146K |
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
2,104 |
2,032 |
$141K |
| 77080 |
|
1,889 |
1,832 |
$141K |
| 77066 |
Tomosynthesis, mammo |
1,759 |
1,687 |
$141K |
| 72040 |
|
2,142 |
2,068 |
$137K |
| 73502 |
|
4,154 |
3,819 |
$136K |
| 88342 |
|
4,673 |
4,341 |
$131K |
| 45378 |
Colonoscopy, flexible; diagnostic, including collection of specimen(s) |
257 |
247 |
$131K |
| J0690 |
Injection, cefazolin sodium, 500 mg |
5,690 |
3,997 |
$127K |
| 87340 |
|
1,662 |
1,620 |
$127K |
| 64493 |
|
166 |
148 |
$124K |
| 99233 |
Prolong inpt eval add15 m |
2,294 |
969 |
$117K |
| 92550 |
|
1,101 |
1,085 |
$116K |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
11,361 |
11,161 |
$114K |
| 73630 |
|
6,128 |
5,444 |
$114K |
| 97597 |
|
1,716 |
940 |
$113K |
| 72141 |
|
1,013 |
963 |
$111K |
| 73721 |
Magnetic resonance imaging, any joint of lower extremity; without contrast material |
1,097 |
1,011 |
$108K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
8,096 |
7,822 |
$106K |
| 84443 |
Thyroid stimulating hormone (TSH) |
13,252 |
12,316 |
$104K |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
4,607 |
2,665 |
$104K |
| 95816 |
|
1,241 |
1,180 |
$104K |
| 72128 |
|
1,340 |
1,228 |
$102K |
| 92557 |
|
2,905 |
2,849 |
$102K |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
4,279 |
4,185 |
$101K |
| 76536 |
|
2,170 |
2,081 |
$99K |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
6,318 |
3,676 |
$98K |
| 87536 |
|
621 |
600 |
$97K |
| 97161 |
|
5,525 |
5,283 |
$95K |
| 45385 |
Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) |
140 |
136 |
$93K |
| 82652 |
|
1,916 |
1,847 |
$92K |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
898 |
833 |
$90K |
| 93880 |
|
1,016 |
930 |
$90K |
| 72050 |
|
952 |
921 |
$90K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
17,041 |
12,032 |
$89K |
| 74178 |
|
363 |
337 |
$88K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
16,185 |
14,578 |
$82K |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
10,447 |
8,104 |
$81K |
| 99239 |
Hospital discharge day management, more than 30 minutes |
1,284 |
1,244 |
$80K |
| 80061 |
Lipid panel |
22,441 |
21,409 |
$76K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
6,615 |
3,410 |
$73K |
| 12001 |
|
917 |
883 |
$72K |
| 84154 |
|
905 |
883 |
$68K |
| 99223 |
Prolong inpt eval add15 m |
623 |
603 |
$68K |
| 20553 |
|
452 |
423 |
$68K |
| 73221 |
|
641 |
609 |
$65K |
| 73080 |
|
2,241 |
2,003 |
$64K |
| 70486 |
|
1,403 |
1,313 |
$62K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
4,545 |
3,739 |
$61K |
| 70496 |
|
1,000 |
906 |
$60K |
| Q4132 |
Grafix core and grafixpl core, per square centimeter (add-on, list separately in addition to primary procedure) |
71 |
30 |
$58K |
| 80055 |
|
369 |
362 |
$58K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
5,017 |
3,472 |
$54K |
| 76775 |
|
2,487 |
2,337 |
$54K |
| 99217 |
|
1,359 |
1,304 |
$53K |
| 73120 |
|
1,090 |
768 |
$53K |
| 99291 |
Critical care, evaluation and management of the critically ill patient, first 30-74 minutes |
454 |
155 |
$53K |
| 99243 |
|
1,153 |
1,143 |
$51K |
| 83970 |
|
1,390 |
1,304 |
$50K |
| 87150 |
|
1,548 |
1,530 |
$48K |
| 86703 |
|
3,132 |
3,055 |
$48K |
| 71271 |
|
1,235 |
1,164 |
$48K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,797 |
2,675 |
$47K |
| 86803 |
|
2,447 |
2,386 |
$47K |
| 87641 |
|
1,537 |
1,376 |
$47K |
| 81513 |
|
350 |
344 |
$46K |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
1,158 |
1,110 |
$43K |
| 73522 |
|
576 |
545 |
$42K |
| 74183 |
|
188 |
175 |
$41K |
| 76770 |
|
1,387 |
1,322 |
$39K |
| 84702 |
|
3,856 |
2,970 |
$38K |
| 84100 |
|
9,984 |
5,723 |
$37K |
| 93017 |
|
2,690 |
2,452 |
$36K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
101,732 |
77,799 |
$36K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
34,589 |
29,467 |
$35K |
| 87070 |
|
6,006 |
5,596 |
$35K |
| 92587 |
|
160 |
156 |
$34K |
| 20610 |
|
167 |
155 |
$34K |
| 97535 |
Self-care/home management training, each 15 minutes |
2,948 |
2,485 |
$34K |
| 82043 |
|
4,167 |
4,020 |
$33K |
| M0243 |
Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring |
133 |
130 |
$33K |
| 82951 |
|
1,300 |
1,173 |
$32K |
| 99221 |
|
535 |
518 |
$32K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
549 |
531 |
$32K |
| 87522 |
Neg quan hep c or qual rna |
838 |
800 |
$30K |
| 87081 |
|
5,299 |
5,006 |
$29K |
| 74018 |
|
2,021 |
1,892 |
$29K |
| 83880 |
|
8,789 |
7,245 |
$28K |
| 87186 |
|
6,494 |
5,935 |
$28K |
| 88142 |
|
1,197 |
1,174 |
$27K |
| 36415 |
Collection of venous blood by venipuncture |
158,924 |
116,240 |
$26K |
| 73590 |
|
1,320 |
1,155 |
$26K |
| 62323 |
|
85 |
78 |
$26K |
| 83721 |
|
850 |
819 |
$26K |
| 99219 |
|
362 |
351 |
$25K |
| 94729 |
|
4,045 |
3,903 |
$25K |
| 87507 |
|
171 |
162 |
$25K |
| 99238 |
Hospital discharge day management, 30 minutes or less |
563 |
553 |
$25K |
| 73140 |
|
961 |
868 |
$25K |
| 87480 |
|
2,377 |
2,280 |
$24K |
| 73560 |
|
959 |
864 |
$24K |
| 99215 |
Prolong outpt/office vis |
725 |
653 |
$23K |
| 86003 |
|
228 |
160 |
$23K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
27,968 |
21,154 |
$23K |
| 77065 |
Tomosynthesis, mammo |
1,822 |
1,666 |
$22K |
| 73090 |
|
1,123 |
956 |
$22K |
| 99231 |
Subsequent hospital care, per day, straightforward or low complexity |
1,022 |
357 |
$21K |
| 99220 |
|
217 |
208 |
$19K |
| 86920 |
|
307 |
266 |
$19K |
| 80074 |
|
1,468 |
1,385 |
$18K |
| 72114 |
|
349 |
343 |
$18K |
| 99225 |
|
538 |
402 |
$18K |
| 74019 |
|
301 |
283 |
$18K |
| 76870 |
|
981 |
906 |
$18K |
| 84484 |
|
40,843 |
25,873 |
$17K |
| 73620 |
|
651 |
570 |
$17K |
| 74220 |
|
129 |
125 |
$17K |
| 64483 |
|
59 |
38 |
$16K |
| 88304 |
|
1,388 |
1,320 |
$16K |
| 76830 |
Ultrasound, transvaginal |
4,815 |
4,574 |
$16K |
| 87653 |
|
385 |
379 |
$16K |
| 82728 |
|
3,672 |
3,419 |
$16K |
| G0279 |
Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066) |
3,468 |
3,370 |
$16K |
| 96361 |
Intravenous infusion, hydration; each additional hour |
13,373 |
11,182 |
$15K |
| 12002 |
|
395 |
382 |
$14K |
| 84481 |
|
1,624 |
1,575 |
$14K |
| 88112 |
|
809 |
717 |
$14K |
| 86039 |
|
464 |
453 |
$14K |
| 97166 |
|
363 |
317 |
$14K |
| 95812 |
|
200 |
183 |
$13K |
| 93925 |
|
70 |
64 |
$13K |
| 85610 |
|
16,559 |
12,149 |
$13K |
| 12011 |
|
189 |
183 |
$12K |
| 83690 |
|
21,268 |
18,094 |
$12K |
| 87075 |
|
1,195 |
1,089 |
$12K |
| 88175 |
Cytopathology, cervical or vaginal, any reporting system; collected in preservative fluid, automated thin layer |
2,139 |
2,114 |
$12K |
| 84425 |
|
153 |
148 |
$12K |
| 87077 |
|
1,962 |
1,756 |
$12K |
| 84703 |
|
16,490 |
14,794 |
$12K |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
35,779 |
20,141 |
$12K |
| 81025 |
|
5,660 |
5,195 |
$12K |
| 99205 |
Prolong outpt/office vis |
150 |
145 |
$12K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
17,905 |
17,008 |
$12K |
| 0450 |
Emergency room services |
300 |
259 |
$11K |
| 76882 |
|
474 |
441 |
$11K |
| J1453 |
Injection, fosaprepitant, 1 mg |
40 |
27 |
$11K |
| 19083 |
|
12 |
12 |
$11K |
| J0561 |
Injection, penicillin g benzathine, 100,000 units |
135 |
114 |
$11K |
| 81001 |
|
42,444 |
36,876 |
$11K |
| 10060 |
|
336 |
310 |
$10K |
| 84156 |
|
865 |
780 |
$10K |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
28,688 |
24,569 |
$10K |
| 0352U |
|
314 |
288 |
$10K |
| 94726 |
|
3,656 |
3,532 |
$10K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
732 |
708 |
$9K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
18,739 |
13,377 |
$9K |
| 84153 |
|
1,700 |
1,616 |
$9K |
| G0103 |
Prostate cancer screening; prostate specific antigen test (psa) |
786 |
759 |
$9K |
| 82024 |
|
29 |
29 |
$9K |
| 77012 |
|
67 |
59 |
$9K |
| 95806 |
|
145 |
141 |
$9K |
| 77334 |
|
30 |
24 |
$8K |
| 83001 |
|
172 |
167 |
$8K |
| 82607 |
|
6,218 |
5,906 |
$8K |
| 84030 |
|
728 |
717 |
$8K |
| 99218 |
|
165 |
158 |
$8K |
| 84439 |
|
16,779 |
15,670 |
$8K |
| J1815 |
Injection, insulin, per 5 units |
6,317 |
2,015 |
$7K |
| 29580 |
|
225 |
76 |
$7K |
| J3370 |
Injection, vancomycin hcl, 500 mg |
1,039 |
678 |
$7K |
| J1642 |
Injection, heparin sodium, (heparin lock flush), per 10 units |
11,952 |
3,275 |
$7K |
| 86592 |
|
3,259 |
3,145 |
$7K |
| 82803 |
|
2,075 |
1,746 |
$7K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
8,391 |
7,943 |
$7K |
| 85027 |
|
12,616 |
10,721 |
$7K |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
6,350 |
4,984 |
$7K |
| G0297 |
Low dose ct scan (ldct) for lung cancer screening |
271 |
262 |
$7K |
| 75574 |
|
122 |
118 |
$6K |
| 84403 |
|
779 |
737 |
$6K |
| 87040 |
|
6,377 |
3,610 |
$6K |
| 97116 |
|
1,945 |
1,136 |
$6K |
| J7030 |
Infusion, normal saline solution , 1000 cc |
13,588 |
9,764 |
$5K |
| 20611 |
|
34 |
27 |
$5K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
800 |
765 |
$5K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
9,560 |
5,387 |
$5K |
| 87045 |
|
227 |
205 |
$5K |
| 62321 |
|
15 |
12 |
$5K |
| 96523 |
|
160 |
133 |
$4K |
| 83605 |
|
15,261 |
11,536 |
$4K |
| J3490 |
Unclassified drugs |
13,787 |
9,091 |
$4K |
| 77427 |
|
43 |
13 |
$4K |
| 93926 |
|
13 |
12 |
$4K |
| 88341 |
|
322 |
278 |
$4K |
| 73700 |
|
12 |
12 |
$4K |
| 85060 |
|
225 |
214 |
$4K |
| 76376 |
|
5,523 |
5,104 |
$4K |
| 87205 |
|
2,923 |
2,645 |
$4K |
| 86900 |
|
5,670 |
4,992 |
$4K |
| 97165 |
|
387 |
346 |
$4K |
| J0688 |
Injection, cefazolin sodium (hikma), not therapeutically equivalent to j0690, 500 mg |
47 |
13 |
$4K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
3,437 |
3,139 |
$4K |
| 82950 |
|
222 |
221 |
$4K |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
6,640 |
4,287 |
$4K |
| 86787 |
|
1,651 |
1,610 |
$4K |
| 84480 |
|
215 |
209 |
$3K |
| 86235 |
|
259 |
253 |
$3K |
| 90715 |
|
3,306 |
3,142 |
$3K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
8,941 |
8,537 |
$3K |
| 86850 |
|
5,188 |
4,606 |
$3K |
| P9016 |
Red blood cells, leukocytes reduced, each unit |
84 |
65 |
$3K |
| 93922 |
|
107 |
104 |
$3K |
| 88300 |
|
519 |
492 |
$3K |
| 71101 |
|
366 |
336 |
$3K |
| 72202 |
|
68 |
64 |
$3K |
| 76942 |
|
29 |
26 |
$3K |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
12,411 |
9,841 |
$2K |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
25,012 |
18,782 |
$2K |
| 82670 |
|
158 |
150 |
$2K |
| 86480 |
|
26 |
24 |
$2K |
| C1769 |
Guide wire |
3,033 |
2,605 |
$2K |
| 82247 |
|
1,023 |
666 |
$2K |
| A9502 |
Technetium tc-99m tetrofosmin, diagnostic, per study dose |
2,582 |
2,324 |
$2K |
| 83615 |
|
396 |
339 |
$2K |
| 84132 |
|
1,739 |
1,506 |
$2K |
| 82746 |
|
3,972 |
3,765 |
$2K |
| 99226 |
|
46 |
38 |
$2K |
| 36591 |
|
467 |
284 |
$2K |
| 83735 |
|
16,959 |
10,136 |
$2K |
| 85378 |
|
4,116 |
3,749 |
$2K |
| 99152 |
|
811 |
731 |
$2K |
| A9585 |
Injection, gadobutrol, 0.1 ml |
4,157 |
3,812 |
$2K |
| 84146 |
|
25 |
24 |
$2K |
| 36430 |
|
91 |
68 |
$2K |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
2,978 |
2,301 |
$2K |
| 82105 |
|
153 |
149 |
$2K |
| 76801 |
|
1,476 |
1,261 |
$2K |
| 86038 |
|
1,170 |
1,128 |
$2K |
| 80076 |
|
779 |
741 |
$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 |
1,001 |
860 |
$2K |
| J2785 |
Injection, regadenoson, 0.1 mg |
2,488 |
2,232 |
$2K |
| 82948 |
|
19,521 |
9,763 |
$2K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
531 |
466 |
$2K |
| 86701 |
|
575 |
558 |
$2K |
| 83516 |
|
185 |
168 |
$1K |
| 73000 |
|
35 |
29 |
$1K |
| 85730 |
|
5,875 |
5,129 |
$1K |
| 86141 |
|
114 |
98 |
$1K |
| 82140 |
|
1,728 |
1,452 |
$1K |
| 86769 |
|
80 |
78 |
$1K |
| 85379 |
|
1,263 |
1,098 |
$1K |
| 96415 |
|
731 |
520 |
$1K |
| 87493 |
|
578 |
314 |
$1K |
| 29125 |
|
520 |
492 |
$1K |
| 82784 |
|
356 |
329 |
$1K |
| 86762 |
|
1,053 |
1,025 |
$1K |
| 84145 |
|
3,497 |
2,992 |
$1K |
| 82550 |
|
3,200 |
2,333 |
$1K |
| 83540 |
|
3,761 |
3,498 |
$1K |
| 96367 |
|
3,607 |
2,410 |
$1K |
| 84112 |
|
489 |
417 |
$993.21 |
| J1630 |
Injection, haloperidol, up to 5 mg |
315 |
260 |
$987.47 |
| 82533 |
|
66 |
59 |
$973.21 |
| 76937 |
|
316 |
280 |
$969.10 |
| 85014 |
|
205 |
158 |
$913.95 |
| 73060 |
|
71 |
67 |
$905.13 |
| 80164 |
|
74 |
53 |
$871.75 |
| 73565 |
|
33 |
31 |
$816.59 |
| 88141 |
|
40 |
39 |
$815.13 |
| 86901 |
|
5,899 |
5,181 |
$811.98 |
| 82947 |
|
2,394 |
1,745 |
$789.57 |
| 87510 |
|
2,376 |
2,279 |
$767.23 |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
2,712 |
1,250 |
$711.61 |
| 86376 |
|
298 |
291 |
$689.61 |
| 99242 |
|
43 |
42 |
$687.52 |
| P9047 |
Infusion, albumin (human), 25%, 50 ml |
21 |
12 |
$661.08 |
| 86756 |
|
472 |
458 |
$655.36 |
| 84436 |
|
4,094 |
3,936 |
$638.15 |
| 97032 |
|
90 |
56 |
$620.03 |
| 97802 |
|
15 |
15 |
$602.19 |
| J2274 |
Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg |
1,913 |
1,483 |
$580.46 |
| 73552 |
|
46 |
41 |
$563.24 |
| J1650 |
Injection, enoxaparin sodium, 10 mg |
4,427 |
2,006 |
$560.38 |
| 73100 |
|
15 |
13 |
$557.60 |
| J7040 |
Infusion, normal saline solution, sterile (500 ml = 1 unit) |
1,500 |
1,076 |
$523.19 |
| 81003 |
|
4,917 |
4,501 |
$506.03 |
| 87660 |
|
2,374 |
2,277 |
$490.83 |
| 86706 |
|
111 |
106 |
$465.82 |
| 82270 |
|
690 |
599 |
$446.67 |
| J1644 |
Injection, heparin sodium, per 1000 units |
5,725 |
2,394 |
$446.54 |
| 82627 |
|
86 |
85 |
$442.16 |
| J1953 |
Injection, levetiracetam, 10 mg |
83 |
67 |
$435.23 |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
132 |
121 |
$401.33 |
| 72170 |
|
74 |
71 |
$393.24 |
| 76881 |
|
43 |
32 |
$389.31 |
| 84295 |
|
1,502 |
1,329 |
$387.93 |
| 83655 |
|
54 |
54 |
$374.82 |
| 92579 |
|
12 |
12 |
$350.90 |
| 86200 |
|
135 |
133 |
$344.22 |
| J8540 |
Dexamethasone, oral, 0.25 mg |
5,350 |
2,765 |
$343.64 |
| J2060 |
Injection, lorazepam, 2 mg |
4,004 |
2,836 |
$336.90 |
| 86160 |
|
13 |
13 |
$328.08 |
| Q9950 |
Injection, sulfur hexafluoride lipid microspheres, per ml |
1,735 |
969 |
$302.25 |
| 86635 |
|
12 |
12 |
$295.12 |
| 97010 |
|
3,014 |
1,812 |
$285.99 |
| 86140 |
|
5,765 |
5,132 |
$283.88 |
| J0171 |
Injection, adrenalin, epinephrine, 0.1 mg |
320 |
201 |
$277.90 |
| J1170 |
Injection, hydromorphone, up to 4 mg |
6,821 |
4,140 |
$258.14 |
| 83550 |
|
3,383 |
3,139 |
$250.60 |
| 96417 |
|
203 |
111 |
$244.39 |
| 82330 |
|
104 |
77 |
$236.48 |
| 86403 |
|
28 |
27 |
$236.26 |
| 99442 |
|
45 |
45 |
$235.48 |
| 97164 |
|
19 |
19 |
$229.87 |
| 86800 |
|
15 |
14 |
$223.63 |
| J0456 |
Injection, azithromycin, 500 mg |
330 |
185 |
$213.85 |
| 96376 |
|
11,010 |
6,233 |
$196.45 |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
8,186 |
5,326 |
$195.73 |
| 82009 |
|
1,881 |
1,598 |
$194.37 |
| C1776 |
Joint device (implantable) |
1,682 |
1,522 |
$180.09 |
| L1906 |
Ankle foot orthosis, multiligamentous ankle support, prefabricated, off-the-shelf |
98 |
96 |
$175.33 |
| A6213 |
Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
762 |
405 |
$161.46 |
| G0283 |
Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care |
196 |
105 |
$158.84 |
| 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 |
6,743 |
6,262 |
$157.66 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
3,440 |
3,214 |
$154.11 |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
6,149 |
4,697 |
$148.34 |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
3,251 |
2,744 |
$146.35 |
| 88313 |
|
17 |
13 |
$145.34 |
| 97035 |
|
245 |
161 |
$141.77 |
| J2360 |
Injection, orphenadrine citrate, up to 60 mg |
3,646 |
3,312 |
$140.87 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
17,251 |
12,903 |
$140.09 |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
2,155 |
1,762 |
$138.07 |
| Q3014 |
Telehealth originating site facility fee |
473 |
433 |
$137.66 |
| 94762 |
|
1,971 |
972 |
$130.74 |
| 86780 |
|
28 |
28 |
$127.68 |
| 92567 |
|
690 |
672 |
$126.56 |
| A9270 |
Non-covered item or service |
4,300 |
1,794 |
$118.71 |
| J2919 |
Injection, methylprednisolone sodium succinate, 5 mg |
222 |
151 |
$116.81 |
| 82565 |
|
276 |
253 |
$109.46 |
| C1729 |
Catheter, drainage |
852 |
441 |
$107.64 |
| 82570 |
|
3,860 |
3,632 |
$104.68 |
| 85652 |
|
6,009 |
5,377 |
$101.79 |
| 77001 |
|
104 |
90 |
$99.21 |
| A9576 |
Injection, gadoteridol, (prohance multipack), per ml |
110 |
101 |
$98.39 |
| 76377 |
|
237 |
221 |
$93.93 |
| J2704 |
Injection, propofol, 10 mg |
11,443 |
8,470 |
$92.80 |
| J7050 |
Infusion, normal saline solution, 250 cc |
10,872 |
7,575 |
$91.21 |
| 86308 |
|
28 |
28 |
$80.62 |
| J2543 |
Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams) |
858 |
511 |
$78.72 |
| J0702 |
Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg |
202 |
166 |
$76.30 |
| 80177 |
|
27 |
25 |
$70.71 |
| 96368 |
|
800 |
490 |
$63.52 |
| 88311 |
|
15 |
12 |
$61.20 |
| 82785 |
|
68 |
58 |
$56.56 |
| 82010 |
|
492 |
398 |
$55.86 |
| 77002 |
|
34 |
29 |
$53.08 |
| 85007 |
|
3,020 |
2,612 |
$52.27 |
| 82435 |
|
1,491 |
1,311 |
$50.83 |
| 87899 |
|
396 |
243 |
$49.62 |
| J2550 |
Injection, promethazine hcl, up to 50 mg |
1,919 |
1,433 |
$43.00 |
| C9803 |
Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
214 |
195 |
$42.95 |
| 94760 |
|
850 |
560 |
$42.18 |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
495 |
476 |
$37.75 |
| 88302 |
|
59 |
56 |
$36.27 |
| 84520 |
|
126 |
115 |
$35.99 |
| J1940 |
Injection, furosemide, up to 20 mg |
1,537 |
779 |
$33.06 |
| 95012 |
|
93 |
93 |
$32.61 |
| J0330 |
Injection, succinylcholine chloride, up to 20 mg |
2,059 |
1,812 |
$31.41 |
| 84550 |
|
1,183 |
1,124 |
$30.02 |
| J0280 |
Injection, aminophyllin, up to 250 mg |
384 |
358 |
$27.84 |
| C9113 |
Injection, pantoprazole sodium, per vial |
3,355 |
1,721 |
$27.31 |
| J1790 |
Injection, droperidol, up to 5 mg |
832 |
727 |
$26.07 |
| 86431 |
|
1,106 |
1,078 |
$25.56 |
| C1894 |
Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser |
2,165 |
1,945 |
$23.70 |
| 84479 |
|
2,284 |
2,228 |
$22.27 |
| 94668 |
|
14 |
12 |
$20.84 |
| A6021 |
Collagen dressing, sterile, size 16 sq. in. or less, each |
700 |
349 |
$19.99 |
| 86702 |
|
576 |
559 |
$18.15 |
| 51702 |
|
372 |
304 |
$10.00 |
| J2710 |
Injection, neostigmine methylsulfate, up to 0.5 mg |
648 |
572 |
$9.10 |
| 81005 |
|
244 |
231 |
$7.19 |
| J0360 |
Injection, hydralazine hcl, up to 20 mg |
730 |
505 |
$6.49 |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
1,453 |
968 |
$6.38 |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
3,624 |
3,231 |
$5.59 |
| J2470 |
Injection, pantoprazole sodium, 40 mg |
81 |
61 |
$4.78 |
| 85018 |
|
262 |
198 |
$2.07 |
| S0028 |
Injection, famotidine, 20 mg |
1,768 |
1,380 |
$1.90 |
| A4215 |
Needle, sterile, any size, each |
3,191 |
2,822 |
$1.65 |
| J7620 |
Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme |
2,315 |
1,687 |
$0.90 |
| J3411 |
Injection, thiamine hcl, 100 mg |
993 |
415 |
$0.24 |
| J8597 |
Antiemetic drug, oral, not otherwise specified |
323 |
265 |
$0.00 |
| 88738 |
|
2,051 |
1,965 |
$0.00 |
| J2001 |
Injection, lidocaine hcl for intravenous infusion, 10 mg |
5,609 |
3,333 |
$0.00 |
| J1920 |
Injection, labetalol hydrochloride, 5 mg |
370 |
253 |
$0.00 |
| 87640 |
|
1,181 |
1,061 |
$0.00 |
| 94761 |
|
1,355 |
535 |
$0.00 |
| 86593 |
|
277 |
267 |
$0.00 |
| J7611 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg |
441 |
437 |
$0.00 |
| 83002 |
|
41 |
40 |
$0.00 |
| C1726 |
Catheter, balloon dilatation, non-vascular |
61 |
61 |
$0.00 |
| 84402 |
|
442 |
424 |
$0.00 |
| J0610 |
Injection, calcium gluconate (fresenius kabi), per 10 ml |
65 |
29 |
$0.00 |
| 84144 |
|
14 |
14 |
$0.00 |
| 64494 |
|
134 |
121 |
$0.00 |
| J3535 |
Drug administered through a metered dose inhaler |
298 |
295 |
$0.00 |
| 97014 |
|
38 |
26 |
$0.00 |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
408 |
387 |
$0.00 |
| C9399 |
Unclassified drugs or biologicals |
197 |
145 |
$0.00 |
| J2795 |
Injection, ropivacaine hydrochloride, 1 mg |
531 |
493 |
$0.00 |
| A4648 |
Tissue marker, implantable, any type, each |
203 |
169 |
$0.00 |
| J2370 |
Injection, phenylephrine hcl, up to 1 ml |
703 |
448 |
$0.00 |
| C9290 |
Injection, bupivacaine liposome, 1 mg |
474 |
448 |
$0.00 |
| 87015 |
|
73 |
68 |
$0.00 |
| G8980 |
Mobility: walking & moving around functional limitation, discharge status, at discharge from therapy or to end reporting |
259 |
208 |
$0.00 |
| J0500 |
Injection, dicyclomine hcl, up to 20 mg |
167 |
155 |
$0.00 |
| J2003 |
Injection, lidocaine hydrochloride, 1 mg |
470 |
387 |
$0.00 |
| 97018 |
|
29 |
14 |
$0.00 |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
57 |
51 |
$0.00 |
| J1836 |
Injection, metronidazole, 10 mg |
140 |
100 |
$0.00 |
| 97610 |
|
42 |
12 |
$0.00 |
| 87807 |
|
43 |
42 |
$0.00 |
| J2175 |
Injection, meperidine hydrochloride, per 100 mg |
20 |
12 |
$0.00 |
| 86704 |
|
21 |
19 |
$0.00 |
| U0002 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
78 |
64 |
$0.00 |
| J2371 |
Injection, phenylephrine hydrochloride, 20 micrograms |
140 |
122 |
$0.00 |
| 86225 |
|
13 |
13 |
$0.00 |
| J7060 |
5% dextrose/water (500 ml = 1 unit) |
33 |
17 |
$0.00 |
| J3480 |
Injection, potassium chloride, per 2 meq |
26 |
13 |
$0.00 |
| C1725 |
Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability) |
42 |
36 |
$0.00 |
| 36471 |
|
21 |
12 |
$0.00 |
| A6260 |
Wound cleansers, any type, any size |
28 |
26 |
$0.00 |
| 74022 |
|
13 |
13 |
$0.00 |
| C1781 |
Mesh (implantable) |
13 |
13 |
$0.00 |
| J0583 |
Injection, bivalirudin, 1 mg |
12 |
12 |
$0.00 |
| C1766 |
Introducer/sheath, guiding, intracardiac electrophysiological, steerable, other than peel-away |
14 |
12 |
$0.00 |
| J3360 |
Injection, diazepam, up to 5 mg |
78 |
42 |
$0.00 |
| L4350 |
Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf |
13 |
13 |
$0.00 |
| J2920 |
Injection, methylprednisolone sodium succinate, up to 40 mg |
64 |
24 |
$0.00 |
| 87503 |
|
18 |
18 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
14 |
13 |
$0.00 |
| J1626 |
Injection, granisetron hydrochloride, 100 mcg |
22 |
14 |
$0.00 |
| A9552 |
Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries |
737 |
702 |
$0.00 |
| C1760 |
Closure device, vascular (implantable/insertable) |
563 |
506 |
$0.00 |
| J3301 |
Injection, triamcinolone acetonide, not otherwise specified, 10 mg |
1,325 |
1,170 |
$0.00 |
| S0077 |
Injection, clindamycin phosphate, 300 mg |
359 |
227 |
$0.00 |
| 87535 |
|
15 |
14 |
$0.00 |
| G8985 |
Carrying, moving and handling objects, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting |
70 |
57 |
$0.00 |
| 82248 |
|
182 |
126 |
$0.00 |
| J2800 |
Injection, methocarbamol, up to 10 ml |
65 |
65 |
$0.00 |
| J0134 |
Injection, acetaminophen (fresenius kabi), not therapeutically equivalent to j0131, 10 mg |
844 |
696 |
$0.00 |
| A6254 |
Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
183 |
164 |
$0.00 |
| 76000 |
|
89 |
82 |
$0.00 |
| 83525 |
|
26 |
26 |
$0.00 |
| J1596 |
Injection, glycopyrrolate, 0.1 mg |
282 |
224 |
$0.00 |
| 51701 |
|
24 |
24 |
$0.00 |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
45 |
41 |
$0.00 |
| C1887 |
Catheter, guiding (may include infusion/perfusion capability) |
525 |
472 |
$0.00 |
| 91040 |
|
31 |
31 |
$0.00 |
| G8979 |
Mobility: walking & moving around functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting |
613 |
465 |
$0.00 |
| C1751 |
Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis) |
54 |
50 |
$0.00 |
| J0780 |
Injection, prochlorperazine, up to 10 mg |
347 |
309 |
$0.00 |
| J2004 |
Injection, lidocaine hcl with epinephrine, 1 mg |
43 |
41 |
$0.00 |
| G8978 |
Mobility: walking & moving around functional limitation, current status, at therapy episode outset and at reporting intervals |
470 |
370 |
$0.00 |
| G8984 |
Carrying, moving & handling objects functional limitation, current status, at therapy episode outset and at reporting intervals |
15 |
13 |
$0.00 |
| J1171 |
Injection, hydromorphone, 0.1 mg |
305 |
134 |
$0.00 |
| A6457 |
Tubular dressing with or without elastic, any width, per linear yard |
83 |
52 |
$0.00 |
| A4565 |
Slings |
243 |
223 |
$0.00 |
| 36600 |
|
50 |
43 |
$0.00 |
| J8499 |
Prescription drug, oral, non chemotherapeutic, nos |
94 |
55 |
$0.00 |
| C1758 |
Catheter, ureteral |
172 |
153 |
$0.00 |
| J3372 |
Injection, vancomycin hcl (xellia), not therapeutically equivalent to j3370, 500 mg |
145 |
107 |
$0.00 |
| L1830 |
Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf |
98 |
92 |
$0.00 |
| Q0177 |
Hydroxyzine pamoate, 25 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 |
20 |
12 |
$0.00 |
| 77336 |
|
132 |
49 |
$0.00 |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
151 |
77 |
$0.00 |
| Q0244 |
Injection, casirivimab and imdevimab, 1200 mg |
131 |
130 |
$0.00 |
| 94669 |
|
31 |
12 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
57 |
41 |
$0.00 |
| Q9966 |
Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml |
15 |
14 |
$0.00 |
| 87538 |
|
15 |
14 |
$0.00 |
| J0737 |
Injection, clindamycin phosphate (baxter), not therapeutically equivalent to j0736, 300 mg |
34 |
26 |
$0.00 |
| J1956 |
Injection, levofloxacin, 250 mg |
17 |
12 |
$0.00 |
| L0140 |
Cervical, semi-rigid, adjustable (plastic collar) |
12 |
12 |
$0.00 |