| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
46,747 |
37,230 |
$5.71M |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
26,242 |
20,488 |
$4.23M |
| G0378 |
Hospital observation service, per hour |
11,103 |
7,561 |
$1.95M |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
11,523 |
8,413 |
$1.84M |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
36,512 |
24,443 |
$1.32M |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
16,308 |
11,513 |
$1.30M |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
17,884 |
14,074 |
$1.27M |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
30,746 |
5,441 |
$1.12M |
| J0897 |
Injection, denosumab, 1 mg |
1,690 |
915 |
$782K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
9,637 |
5,470 |
$754K |
| 11042 |
Debridement, subcutaneous tissue (includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm |
7,340 |
3,534 |
$661K |
| 81514 |
|
5,019 |
3,833 |
$589K |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
4,651 |
3,548 |
$578K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
8,566 |
6,782 |
$496K |
| 71046 |
Radiologic examination, chest; 2 views |
13,235 |
10,848 |
$492K |
| 71045 |
Radiologic examination, chest; single view |
18,870 |
14,008 |
$492K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
19,816 |
9,828 |
$480K |
| 96413 |
Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance |
6,513 |
2,011 |
$477K |
| 86850 |
|
13,506 |
5,072 |
$454K |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
3,590 |
2,687 |
$427K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
25,316 |
17,590 |
$399K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
4,785 |
3,296 |
$370K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
85,454 |
56,919 |
$366K |
| 86900 |
|
7,170 |
5,357 |
$349K |
| 70450 |
Computed tomography, head or brain; without contrast material |
8,130 |
6,266 |
$338K |
| 92507 |
Treatment of speech, language, voice, communication, and/or auditory processing disorder |
7,674 |
1,812 |
$321K |
| 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 |
4,672 |
3,396 |
$320K |
| 87801 |
Infectious agent detection by nucleic acid; amplified probe, multiple organisms |
7,945 |
6,136 |
$309K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
4,687 |
3,962 |
$304K |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
7,399 |
1,808 |
$293K |
| 80053 |
Comprehensive metabolic panel |
50,617 |
34,953 |
$285K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
8,725 |
7,029 |
$279K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
2,842 |
2,542 |
$225K |
| 93458 |
|
380 |
229 |
$222K |
| 96361 |
Intravenous infusion, hydration; each additional hour |
5,694 |
3,675 |
$212K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
7,425 |
6,479 |
$207K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
7,255 |
6,334 |
$204K |
| 96367 |
|
8,029 |
2,487 |
$204K |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
5,679 |
4,473 |
$202K |
| 36415 |
Collection of venous blood by venipuncture |
109,754 |
70,991 |
$195K |
| 76801 |
|
2,722 |
2,214 |
$193K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
6,117 |
2,251 |
$182K |
| C9803 |
Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
12,947 |
10,399 |
$173K |
| 87400 |
|
7,964 |
6,933 |
$167K |
| 83880 |
|
10,818 |
7,558 |
$165K |
| 74018 |
|
2,571 |
2,112 |
$159K |
| G0379 |
Direct admission of patient for hospital observation care |
3,320 |
2,234 |
$159K |
| 78452 |
Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress |
599 |
462 |
$153K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
2,027 |
1,596 |
$145K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
1,939 |
1,631 |
$132K |
| 74019 |
|
1,618 |
1,350 |
$124K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
1,264 |
1,016 |
$123K |
| 72100 |
|
2,862 |
2,256 |
$120K |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
7,569 |
6,253 |
$119K |
| 76641 |
|
2,064 |
1,500 |
$118K |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
1,695 |
1,219 |
$117K |
| 88175 |
Cytopathology, cervical or vaginal, any reporting system; collected in preservative fluid, automated thin layer |
6,110 |
4,983 |
$115K |
| 84484 |
|
19,332 |
12,403 |
$113K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
1,737 |
1,513 |
$113K |
| 84443 |
Thyroid stimulating hormone (TSH) |
11,306 |
9,062 |
$111K |
| 87634 |
|
2,074 |
1,788 |
$109K |
| 36430 |
|
1,465 |
835 |
$109K |
| 73560 |
|
3,786 |
2,776 |
$107K |
| 86901 |
|
7,172 |
5,359 |
$107K |
| 86780 |
|
10,838 |
9,004 |
$104K |
| 80061 |
Lipid panel |
12,054 |
9,973 |
$104K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
20,905 |
14,898 |
$99K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
3,162 |
2,449 |
$98K |
| J9299 |
Injection, nivolumab, 1 mg |
83 |
42 |
$97K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
5,190 |
4,172 |
$92K |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
3,909 |
3,258 |
$92K |
| 72148 |
Magnetic resonance imaging, lumbar spine; without contrast material |
2,187 |
1,438 |
$91K |
| 87800 |
|
3,041 |
2,667 |
$91K |
| 72125 |
Computed tomography, cervical spine; without contrast material |
2,326 |
1,840 |
$90K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,179 |
1,520 |
$90K |
| U0001 |
Cdc 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel |
3,096 |
2,650 |
$90K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
2,796 |
2,112 |
$89K |
| P9016 |
Red blood cells, leukocytes reduced, each unit |
1,344 |
783 |
$88K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
16,807 |
13,219 |
$87K |
| 97161 |
|
2,246 |
1,822 |
$86K |
| 81025 |
|
13,667 |
11,357 |
$83K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
2,953 |
2,507 |
$83K |
| 93017 |
|
1,658 |
1,206 |
$80K |
| 82553 |
|
16,402 |
10,627 |
$79K |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
8,529 |
5,737 |
$75K |
| 87536 |
|
1,155 |
980 |
$74K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
1,076 |
827 |
$70K |
| 73030 |
|
2,573 |
1,886 |
$70K |
| 87430 |
|
5,257 |
4,773 |
$66K |
| 80305 |
|
8,571 |
6,833 |
$65K |
| 82550 |
|
17,262 |
11,129 |
$60K |
| 73630 |
|
1,790 |
1,407 |
$59K |
| 87653 |
|
2,242 |
1,932 |
$59K |
| 96415 |
|
2,611 |
893 |
$57K |
| 78815 |
Positron emission tomography (PET) for limited area imaging |
202 |
131 |
$56K |
| 73610 |
|
1,522 |
1,171 |
$52K |
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
976 |
809 |
$49K |
| 45385 |
Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) |
223 |
186 |
$47K |
| 71250 |
|
1,609 |
1,211 |
$47K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
8,100 |
6,556 |
$45K |
| 76818 |
|
816 |
328 |
$44K |
| 36600 |
|
1,669 |
1,206 |
$43K |
| 87040 |
|
5,759 |
4,332 |
$42K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,221 |
1,789 |
$42K |
| 84702 |
|
3,944 |
2,760 |
$41K |
| M0243 |
Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring |
287 |
257 |
$41K |
| 73502 |
|
1,854 |
1,301 |
$41K |
| 73130 |
|
1,130 |
903 |
$40K |
| 88342 |
|
766 |
545 |
$38K |
| 81001 |
|
19,963 |
15,613 |
$38K |
| 87624 |
Infectious agent detection by nucleic acid; human papillomavirus (HPV), high-risk types |
1,947 |
1,527 |
$38K |
| 86762 |
|
3,609 |
2,899 |
$36K |
| 93350 |
|
395 |
253 |
$36K |
| 86360 |
|
1,207 |
957 |
$34K |
| 87186 |
|
5,706 |
4,580 |
$33K |
| 85730 |
|
13,325 |
9,496 |
$32K |
| 83690 |
|
8,076 |
6,061 |
$31K |
| 86359 |
|
1,106 |
945 |
$30K |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
1,070 |
333 |
$29K |
| 85610 |
|
14,986 |
10,674 |
$28K |
| 87340 |
|
4,144 |
3,341 |
$28K |
| 86923 |
|
670 |
393 |
$27K |
| 94060 |
|
307 |
277 |
$27K |
| G0390 |
Trauma response team associated with hospital critical care service |
59 |
43 |
$27K |
| 96401 |
|
1,617 |
688 |
$26K |
| 72040 |
|
870 |
684 |
$26K |
| 87088 |
|
4,912 |
3,922 |
$25K |
| 96402 |
|
1,142 |
683 |
$24K |
| J9271 |
Injection, pembrolizumab, 1 mg |
31 |
12 |
$24K |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
125 |
80 |
$23K |
| 45378 |
Colonoscopy, flexible; diagnostic, including collection of specimen(s) |
82 |
78 |
$23K |
| 73110 |
|
654 |
492 |
$22K |
| 86703 |
|
1,869 |
1,595 |
$22K |
| 97597 |
|
658 |
460 |
$22K |
| 93225 |
|
824 |
607 |
$21K |
| 82150 |
|
5,233 |
4,120 |
$21K |
| 82962 |
|
13,628 |
5,283 |
$20K |
| 87481 |
|
362 |
335 |
$20K |
| D2999 |
|
36 |
36 |
$20K |
| 82728 |
|
3,273 |
2,352 |
$20K |
| 81003 |
|
14,950 |
12,023 |
$19K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
354 |
151 |
$19K |
| 86787 |
|
2,027 |
1,413 |
$19K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
343 |
296 |
$17K |
| 83605 |
|
3,882 |
2,596 |
$16K |
| 82803 |
|
1,856 |
1,318 |
$15K |
| 82565 |
|
5,459 |
4,102 |
$15K |
| 70486 |
|
259 |
222 |
$15K |
| 82105 |
|
1,296 |
1,070 |
$15K |
| 85379 |
|
3,286 |
2,525 |
$15K |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
228 |
174 |
$15K |
| 97016 |
|
2,360 |
586 |
$14K |
| 86756 |
|
1,101 |
1,006 |
$14K |
| 99291 |
Critical care, evaluation and management of the critically ill patient, first 30-74 minutes |
57 |
29 |
$14K |
| 86141 |
|
2,241 |
1,578 |
$14K |
| 85660 |
|
3,684 |
2,899 |
$14K |
| 93226 |
|
391 |
342 |
$14K |
| 82607 |
|
1,863 |
1,413 |
$13K |
| J0881 |
Injection, darbepoetin alfa, 1 microgram (non-esrd use) |
770 |
344 |
$13K |
| 88142 |
|
702 |
595 |
$13K |
| 83735 |
|
4,217 |
2,987 |
$13K |
| 72141 |
|
315 |
198 |
$13K |
| 96411 |
|
816 |
184 |
$12K |
| 87660 |
|
1,072 |
896 |
$12K |
| 87510 |
|
1,072 |
896 |
$12K |
| 87480 |
|
1,054 |
887 |
$12K |
| 96417 |
|
975 |
304 |
$11K |
| 87070 |
|
2,100 |
1,632 |
$11K |
| 86677 |
|
1,268 |
1,111 |
$10K |
| 97162 |
|
297 |
217 |
$10K |
| 82950 |
|
2,914 |
2,488 |
$10K |
| 80074 |
|
316 |
265 |
$9K |
| 88307 |
|
94 |
56 |
$9K |
| 86480 |
|
213 |
183 |
$9K |
| 72070 |
|
170 |
136 |
$9K |
| 86738 |
|
1,173 |
966 |
$9K |
| U0002 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
1,175 |
984 |
$8K |
| 76000 |
|
67 |
61 |
$8K |
| 85027 |
|
1,806 |
1,486 |
$8K |
| 11043 |
|
99 |
29 |
$7K |
| 82947 |
|
3,089 |
2,554 |
$7K |
| 97167 |
|
180 |
148 |
$7K |
| 97116 |
|
874 |
195 |
$7K |
| 73590 |
|
226 |
156 |
$7K |
| 95810 |
Polysomnography; sleep staging with 4 or more additional parameters |
19 |
18 |
$7K |
| 84520 |
|
2,767 |
2,119 |
$7K |
| 85049 |
|
2,026 |
1,721 |
$7K |
| J1750 |
Injection, iron dextran, 50 mg |
469 |
180 |
$6K |
| 96416 |
|
87 |
27 |
$6K |
| 45381 |
|
21 |
15 |
$6K |
| 84439 |
|
1,041 |
865 |
$6K |
| 80185 |
|
686 |
521 |
$6K |
| 83615 |
|
1,929 |
1,354 |
$6K |
| 93925 |
|
140 |
102 |
$6K |
| G0330 |
Facility services for dental rehabilitation procedure(s) performed on a patient who requires monitored anesthesia (e.g., general, intravenous sedation (monitored anesthesia care) and use of an operating room |
26 |
14 |
$6K |
| 87077 |
|
957 |
784 |
$6K |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
375 |
347 |
$6K |
| 81220 |
CFTR (cystic fibrosis transmembrane conductance regulator) gene analysis; common variants |
35 |
27 |
$6K |
| 82378 |
|
1,049 |
637 |
$5K |
| 85014 |
|
3,779 |
3,005 |
$5K |
| 84550 |
|
2,139 |
1,662 |
$5K |
| 93971 |
|
147 |
131 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
262 |
123 |
$5K |
| C9113 |
Injection, pantoprazole sodium, per vial |
610 |
304 |
$5K |
| 87205 |
|
1,915 |
1,476 |
$5K |
| 97112 |
Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination |
223 |
68 |
$5K |
| 72131 |
|
135 |
106 |
$5K |
| 97032 |
|
596 |
145 |
$5K |
| J1815 |
Injection, insulin, per 5 units |
718 |
432 |
$5K |
| 84460 |
|
1,236 |
894 |
$5K |
| 74022 |
|
81 |
74 |
$5K |
| 84100 |
|
1,581 |
1,156 |
$4K |
| 83540 |
|
1,338 |
990 |
$4K |
| 83550 |
|
981 |
722 |
$4K |
| 85651 |
|
1,765 |
1,261 |
$4K |
| J9202 |
Goserelin acetate implant, per 3.6 mg |
30 |
24 |
$4K |
| J9217 |
Leuprolide acetate (for depot suspension), 7.5 mg |
57 |
27 |
$4K |
| 76830 |
Ultrasound, transvaginal |
55 |
52 |
$4K |
| 84450 |
|
1,060 |
848 |
$4K |
| 85045 |
|
1,984 |
1,281 |
$4K |
| 77065 |
Tomosynthesis, mammo |
87 |
82 |
$4K |
| 86803 |
|
402 |
314 |
$4K |
| Q0138 |
Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (non-esrd use) |
66 |
29 |
$3K |
| 76770 |
|
79 |
63 |
$3K |
| 82270 |
|
1,820 |
1,168 |
$3K |
| 82570 |
|
1,057 |
850 |
$3K |
| 73070 |
|
106 |
94 |
$3K |
| 82248 |
|
1,018 |
797 |
$3K |
| 86592 |
|
1,048 |
875 |
$3K |
| 82746 |
|
482 |
328 |
$3K |
| 93970 |
|
44 |
42 |
$3K |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
1,815 |
1,360 |
$2K |
| J3489 |
Injection, zoledronic acid, 1 mg |
592 |
382 |
$2K |
| 85018 |
|
2,153 |
1,577 |
$2K |
| Q5105 |
Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for esrd on dialysis), 100 units |
40 |
24 |
$2K |
| 72110 |
|
62 |
49 |
$2K |
| 29580 |
|
83 |
40 |
$2K |
| M0222 |
Intravenous injection, bebtelovimab, includes injection and post administration monitoring |
18 |
16 |
$2K |
| D1120 |
Prophylaxis - child |
327 |
270 |
$2K |
| 96376 |
|
6,992 |
3,097 |
$2K |
| 86769 |
|
45 |
43 |
$2K |
| G0103 |
Prostate cancer screening; prostate specific antigen test (psa) |
175 |
153 |
$2K |
| 86706 |
|
308 |
252 |
$2K |
| 73090 |
|
77 |
37 |
$2K |
| 77066 |
Tomosynthesis, mammo |
28 |
25 |
$2K |
| M0239 |
Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring |
15 |
15 |
$2K |
| 82043 |
|
409 |
347 |
$2K |
| 73721 |
Magnetic resonance imaging, any joint of lower extremity; without contrast material |
38 |
27 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
76 |
27 |
$1K |
| M0247 |
Intravenous infusion, sotrovimab, includes infusion and post administration monitoring |
12 |
12 |
$1K |
| 80051 |
|
286 |
242 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
85 |
25 |
$1K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
45 |
39 |
$1K |
| 86038 |
|
201 |
156 |
$1K |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
9,082 |
5,706 |
$1K |
| 51702 |
|
45 |
37 |
$1K |
| 97165 |
|
44 |
26 |
$1K |
| 95816 |
|
19 |
12 |
$1K |
| 73140 |
|
31 |
27 |
$1K |
| 75574 |
|
14 |
14 |
$1K |
| 72170 |
|
28 |
24 |
$1K |
| 10060 |
|
13 |
12 |
$1K |
| 86696 |
|
70 |
64 |
$1K |
| 92523 |
|
17 |
12 |
$1K |
| 96523 |
|
107 |
37 |
$1K |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
10,460 |
5,767 |
$999.81 |
| 86920 |
|
16 |
12 |
$932.64 |
| J0640 |
Injection, leucovorin calcium, per 50 mg |
313 |
50 |
$928.20 |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
3,441 |
1,875 |
$898.69 |
| D2330 |
|
69 |
26 |
$856.47 |
| 86695 |
|
70 |
64 |
$752.75 |
| 87147 |
|
279 |
176 |
$750.43 |
| J7050 |
Infusion, normal saline solution, 250 cc |
2,601 |
1,020 |
$730.61 |
| J7060 |
5% dextrose/water (500 ml = 1 unit) |
1,111 |
413 |
$710.38 |
| 84436 |
|
116 |
100 |
$692.67 |
| Q0163 |
Diphenhydramine hydrochloride, 50 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at time of chemotherapy treatment not to exceed a 48 hour dosage regimen |
815 |
673 |
$668.09 |
| 87210 |
|
173 |
152 |
$631.12 |
| 76536 |
|
13 |
13 |
$630.12 |
| 96521 |
|
88 |
24 |
$573.20 |
| 73060 |
|
18 |
13 |
$542.87 |
| J7030 |
Infusion, normal saline solution , 1000 cc |
7,299 |
2,909 |
$503.97 |
| 82247 |
|
142 |
78 |
$501.88 |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
5,486 |
3,343 |
$449.44 |
| 71101 |
|
12 |
12 |
$447.89 |
| Q9969 |
Tc-99m from non-highly enriched uranium source, full cost recovery add-on, per study dose |
660 |
405 |
$422.40 |
| J0360 |
Injection, hydralazine hcl, up to 20 mg |
183 |
138 |
$386.26 |
| 84155 |
|
169 |
137 |
$378.60 |
| 81511 |
|
576 |
485 |
$377.70 |
| 86694 |
|
30 |
27 |
$365.73 |
| 88300 |
|
33 |
24 |
$364.37 |
| 73620 |
|
20 |
12 |
$363.54 |
| 82784 |
|
43 |
27 |
$351.54 |
| 73562 |
|
39 |
13 |
$342.51 |
| 80164 |
|
26 |
24 |
$285.72 |
| 90715 |
|
1,303 |
1,145 |
$279.84 |
| S0028 |
Injection, famotidine, 20 mg |
883 |
343 |
$203.81 |
| 83630 |
|
14 |
12 |
$193.38 |
| 86430 |
|
48 |
41 |
$182.84 |
| 86039 |
|
34 |
24 |
$152.83 |
| 82010 |
|
38 |
26 |
$152.78 |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
313 |
169 |
$106.02 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
7,999 |
6,214 |
$61.49 |
| 84145 |
|
188 |
136 |
$58.58 |
| 82232 |
|
21 |
12 |
$46.92 |
| 96368 |
|
1,168 |
389 |
$43.34 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
6,014 |
5,174 |
$34.83 |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
5,321 |
3,439 |
$21.45 |
| J2001 |
Injection, lidocaine hcl for intravenous infusion, 10 mg |
6,726 |
5,831 |
$19.12 |
| J2060 |
Injection, lorazepam, 2 mg |
744 |
571 |
$12.84 |
| 83521 |
|
22 |
12 |
$6.91 |
| J2550 |
Injection, promethazine hcl, up to 50 mg |
2,073 |
1,424 |
$1.76 |
| J2704 |
Injection, propofol, 10 mg |
4,673 |
3,631 |
$0.00 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
2,743 |
2,156 |
$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 |
403 |
378 |
$0.00 |
| 11045 |
|
2,116 |
1,090 |
$0.00 |
| J0690 |
Injection, cefazolin sodium, 500 mg |
1,127 |
718 |
$0.00 |
| G0257 |
Unscheduled or emergency dialysis treatment for an esrd patient in a hospital outpatient department that is not certified as an esrd facility |
20 |
12 |
$0.00 |
| J1940 |
Injection, furosemide, up to 20 mg |
1,000 |
612 |
$0.00 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
3,014 |
2,346 |
$0.00 |
| J7620 |
Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme |
148 |
99 |
$0.00 |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
1,188 |
867 |
$0.00 |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
3,405 |
1,784 |
$0.00 |
| J2175 |
Injection, meperidine hydrochloride, per 100 mg |
3,203 |
1,925 |
$0.00 |
| J1030 |
Injection, methylprednisolone acetate, 40 mg |
506 |
470 |
$0.00 |
| J2785 |
Injection, regadenoson, 0.1 mg |
399 |
346 |
$0.00 |
| C1769 |
Guide wire |
265 |
194 |
$0.00 |
| J2360 |
Injection, orphenadrine citrate, up to 60 mg |
86 |
80 |
$0.00 |
| J0330 |
Injection, succinylcholine chloride, up to 20 mg |
152 |
106 |
$0.00 |
| G0136 |
Administration of a standardized, evidence-based assessment of physical activity and nutrition, 5-15 minutes, not more often than every 6 months |
31 |
30 |
$0.00 |
| J1170 |
Injection, hydromorphone, up to 4 mg |
326 |
163 |
$0.00 |
| 88141 |
|
21 |
19 |
$0.00 |
| J2920 |
Injection, methylprednisolone sodium succinate, up to 40 mg |
168 |
113 |
$0.00 |
| J1250 |
Injection, dobutamine hydrochloride, per 250 mg |
108 |
96 |
$0.00 |
| 99292 |
|
19 |
13 |
$0.00 |
| G9035 |
Oseltamivir phosphate, oral, brand, per 75 mg (for use in a medicare-approved demonstration project) |
15 |
15 |
$0.00 |
| 88341 |
|
70 |
42 |
$0.00 |
| G0283 |
Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care |
102 |
26 |
$0.00 |
| J1644 |
Injection, heparin sodium, per 1000 units |
1,557 |
924 |
$0.00 |
| C1751 |
Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis) |
1,144 |
958 |
$0.00 |
| A9502 |
Technetium tc-99m tetrofosmin, diagnostic, per study dose |
602 |
464 |
$0.00 |
| C1760 |
Closure device, vascular (implantable/insertable) |
1,329 |
918 |
$0.00 |
| C1887 |
Catheter, guiding (may include infusion/perfusion capability) |
1,379 |
924 |
$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 |
387 |
273 |
$0.00 |
| J7510 |
Prednisolone oral, per 5 mg |
757 |
626 |
$0.00 |
| G8978 |
Mobility: walking & moving around functional limitation, current status, at therapy episode outset and at reporting intervals |
316 |
244 |
$0.00 |
| A9552 |
Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries |
229 |
155 |
$0.00 |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
1,159 |
514 |
$0.00 |
| J7642 |
Glycopyrrolate, inhalation solution, compounded product, administered through dme, concentrated form, per milligram |
13 |
12 |
$0.00 |
| J0702 |
Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg |
17 |
13 |
$0.00 |
| J7040 |
Infusion, normal saline solution, sterile (500 ml = 1 unit) |
20 |
12 |
$0.00 |