| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| G0378 |
Hospital observation service, per hour |
27,652 |
22,740 |
$25.31M |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
38,084 |
33,963 |
$15.20M |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
38,932 |
35,987 |
$14.86M |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
57,378 |
52,667 |
$14.36M |
| 96413 |
Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance |
22,369 |
12,837 |
$8.45M |
| OP250 |
|
177,652 |
104,119 |
$7.79M |
| J1745 |
Injection, infliximab, excludes biosimilar, 10 mg |
1,755 |
1,601 |
$7.00M |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
34,958 |
33,044 |
$6.73M |
| J9271 |
Injection, pembrolizumab, 1 mg |
888 |
600 |
$5.39M |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
3,299 |
3,160 |
$4.16M |
| J2505 |
Injection, pegfilgrastim, 6 mg |
766 |
596 |
$3.75M |
| 41899 |
Unlisted procedure, dentoalveolar structures |
1,458 |
1,430 |
$2.75M |
| OP710 |
|
26,544 |
25,129 |
$2.58M |
| 96375 |
Therapeutic injection; each additional sequential IV push |
29,083 |
21,095 |
$2.34M |
| 80053 |
Comprehensive metabolic panel |
113,216 |
85,411 |
$2.23M |
| 42820 |
Tonsillectomy and adenoidectomy; younger than age 12 |
1,165 |
1,154 |
$2.06M |
| 77386 |
|
4,695 |
413 |
$1.82M |
| 45380 |
Colonoscopy, flexible; with biopsy, single or multiple |
2,239 |
2,141 |
$1.77M |
| 77334 |
|
2,018 |
1,432 |
$1.72M |
| 96415 |
|
7,577 |
5,351 |
$1.64M |
| OP370 |
|
35,010 |
32,967 |
$1.61M |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
14,899 |
9,636 |
$1.58M |
| 36430 |
|
5,946 |
3,072 |
$1.44M |
| J1561 |
Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mg |
991 |
372 |
$1.31M |
| 69436 |
Tympanostomy (requiring insertion of ventilating tube), general anesthesia |
1,357 |
1,345 |
$1.28M |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
2,593 |
2,468 |
$1.23M |
| J2506 |
Injection, pegfilgrastim, excludes biosimilar, 0.5 mg |
820 |
501 |
$1.16M |
| OP272 |
|
18,633 |
16,799 |
$1.09M |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
9,017 |
8,531 |
$1.08M |
| OP270 |
|
16,932 |
16,324 |
$1.02M |
| Q5119 |
Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg |
668 |
292 |
$986K |
| 96361 |
Intravenous infusion, hydration; each additional hour |
17,706 |
12,993 |
$971K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
123,431 |
98,194 |
$954K |
| U0004 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc, making use of high throughput technologies as described by cms-2020-01-r |
15,362 |
14,032 |
$952K |
| J9355 |
Injection, trastuzumab, excludes biosimilar, 10 mg |
231 |
139 |
$906K |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
26,664 |
7,719 |
$903K |
| 96417 |
|
6,203 |
3,652 |
$882K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
24,063 |
21,483 |
$868K |
| 54161 |
|
535 |
522 |
$852K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
13,032 |
12,089 |
$810K |
| 99291 |
Critical care, evaluation and management of the critically ill patient, first 30-74 minutes |
4,123 |
3,965 |
$805K |
| OP278 |
|
3,277 |
3,081 |
$795K |
| 96411 |
|
3,003 |
1,878 |
$793K |
| 45378 |
Colonoscopy, flexible; diagnostic, including collection of specimen(s) |
786 |
763 |
$770K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
32,128 |
28,004 |
$728K |
| 77336 |
|
4,775 |
2,175 |
$717K |
| 70450 |
Computed tomography, head or brain; without contrast material |
11,356 |
10,533 |
$687K |
| 77412 |
|
3,079 |
340 |
$679K |
| 92587 |
|
5,617 |
5,528 |
$666K |
| 59025 |
Fetal non-stress test |
2,683 |
1,865 |
$664K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
16,409 |
12,565 |
$647K |
| 87636 |
Infectious agent detection by nucleic acid; SARS-CoV-2 and influenza virus types A and B |
7,328 |
6,626 |
$626K |
| 11042 |
Debridement, subcutaneous tissue (includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm |
3,901 |
1,903 |
$577K |
| J9045 |
Injection, carboplatin, 50 mg |
1,415 |
878 |
$560K |
| 77300 |
|
1,274 |
1,149 |
$537K |
| 96409 |
|
2,554 |
1,556 |
$522K |
| Q5116 |
Injection, trastuzumab-qyyp, biosimilar, (trazimera), 10 mg |
257 |
158 |
$504K |
| Q5117 |
Injection, trastuzumab-anns, biosimilar, (kanjinti), 10 mg |
221 |
145 |
$495K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
27,981 |
23,841 |
$485K |
| 93975 |
|
6,285 |
5,864 |
$438K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
51,195 |
41,496 |
$423K |
| 92567 |
|
7,123 |
6,983 |
$421K |
| J9306 |
Injection, pertuzumab, 1 mg |
123 |
78 |
$421K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
7,068 |
3,742 |
$417K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
5,627 |
4,756 |
$411K |
| 92557 |
|
3,326 |
3,262 |
$404K |
| 88185 |
|
1,582 |
1,190 |
$401K |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
32,731 |
25,216 |
$399K |
| 96367 |
|
6,390 |
3,814 |
$399K |
| 85027 |
|
44,621 |
33,045 |
$396K |
| 83735 |
|
51,503 |
32,687 |
$383K |
| P9040 |
Red blood cells, leukocytes reduced, irradiated, each unit |
2,797 |
1,597 |
$380K |
| 93970 |
|
2,076 |
1,980 |
$367K |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
10,984 |
3,413 |
$354K |
| C1713 |
Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable) |
468 |
449 |
$352K |
| 77295 |
|
353 |
328 |
$348K |
| 86850 |
|
25,393 |
17,613 |
$332K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
2,985 |
2,858 |
$327K |
| J9312 |
Injection, rituximab, 10 mg |
72 |
39 |
$325K |
| OP258 |
|
92,657 |
53,414 |
$324K |
| 70553 |
Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences |
700 |
667 |
$324K |
| J2469 |
Injection, palonosetron hcl, 25 mcg |
6,108 |
3,198 |
$319K |
| P9016 |
Red blood cells, leukocytes reduced, each unit |
1,923 |
1,505 |
$319K |
| 93017 |
|
1,647 |
1,563 |
$311K |
| J0897 |
Injection, denosumab, 1 mg |
187 |
177 |
$307K |
| 71046 |
Radiologic examination, chest; 2 views |
17,215 |
16,322 |
$306K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
6,278 |
5,309 |
$294K |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
2,408 |
2,282 |
$286K |
| 93458 |
|
232 |
206 |
$283K |
| 92579 |
|
2,069 |
2,035 |
$282K |
| 64483 |
|
296 |
285 |
$278K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
2,703 |
2,568 |
$267K |
| 94729 |
|
2,043 |
1,967 |
$264K |
| 72125 |
Computed tomography, cervical spine; without contrast material |
4,518 |
4,150 |
$260K |
| J9299 |
Injection, nivolumab, 1 mg |
53 |
27 |
$256K |
| 84443 |
Thyroid stimulating hormone (TSH) |
12,456 |
10,966 |
$255K |
| 71045 |
Radiologic examination, chest; single view |
15,734 |
13,899 |
$247K |
| 96416 |
|
1,069 |
588 |
$237K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
11,938 |
10,370 |
$237K |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
2,421 |
2,265 |
$236K |
| 90791 |
Psychiatric diagnostic evaluation |
8,177 |
7,131 |
$235K |
| A0427 |
Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) |
496 |
481 |
$231K |
| 78452 |
Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress |
1,146 |
1,081 |
$228K |
| 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 |
550 |
531 |
$225K |
| J9144 |
Injection, daratumumab, 10 mg and hyaluronidase-fihj |
87 |
50 |
$223K |
| 42830 |
|
151 |
147 |
$211K |
| 94060 |
|
711 |
696 |
$208K |
| 82784 |
|
6,557 |
4,618 |
$206K |
| C1874 |
Stent, coated/covered, with delivery system |
454 |
402 |
$203K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
4,505 |
3,331 |
$200K |
| 77290 |
|
446 |
350 |
$199K |
| 36415 |
Collection of venous blood by venipuncture |
95,499 |
70,257 |
$197K |
| Q5107 |
Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg |
165 |
52 |
$197K |
| 86900 |
|
26,488 |
18,890 |
$195K |
| 0002A |
|
6,365 |
6,361 |
$194K |
| Q5111 |
Injection, pegfilgrastim-cbqv (udenyca), biosimilar, 0.5 mg |
53 |
41 |
$190K |
| 77387 |
|
2,503 |
297 |
$188K |
| C9600 |
Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch |
56 |
53 |
$182K |
| 87081 |
|
8,615 |
8,429 |
$178K |
| 96401 |
|
2,393 |
1,317 |
$177K |
| 83883 |
|
1,834 |
1,446 |
$176K |
| 80061 |
Lipid panel |
8,167 |
7,737 |
$175K |
| 92507 |
Treatment of speech, language, voice, communication, and/or auditory processing disorder |
3,167 |
1,125 |
$174K |
| 82248 |
|
20,492 |
12,745 |
$171K |
| 81001 |
|
52,884 |
47,341 |
$170K |
| 0001A |
|
6,424 |
6,420 |
$168K |
| 87806 |
|
6,336 |
6,160 |
$167K |
| Q5118 |
Injection, bevacizumab-bvzr, biosimilar, (zirabev), 10 mg |
302 |
95 |
$166K |
| 82378 |
|
6,069 |
4,560 |
$164K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
7,488 |
5,925 |
$163K |
| 97112 |
Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination |
4,483 |
1,672 |
$159K |
| 92582 |
|
1,013 |
1,005 |
$156K |
| 83615 |
|
20,656 |
11,608 |
$152K |
| A9270 |
Non-covered item or service |
31,191 |
16,109 |
$151K |
| 62323 |
|
154 |
148 |
$150K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
4,005 |
3,817 |
$148K |
| 94726 |
|
1,320 |
1,270 |
$145K |
| 95812 |
|
431 |
428 |
$144K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
1,811 |
1,601 |
$144K |
| 96402 |
|
1,894 |
1,683 |
$142K |
| 82962 |
|
25,606 |
18,703 |
$142K |
| 87497 |
|
5,728 |
3,119 |
$140K |
| 84100 |
|
25,107 |
14,769 |
$139K |
| 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 |
7,035 |
6,162 |
$138K |
| 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 |
10,647 |
9,594 |
$137K |
| 54640 |
|
99 |
95 |
$133K |
| J9263 |
Injection, oxaliplatin, 0.5 mg |
401 |
151 |
$133K |
| OP720 |
|
901 |
759 |
$131K |
| C9290 |
Injection, bupivacaine liposome, 1 mg |
2,272 |
2,172 |
$130K |
| 86901 |
|
27,148 |
18,983 |
$129K |
| 36591 |
|
1,688 |
1,306 |
$126K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
2,979 |
2,876 |
$126K |
| 88341 |
|
2,219 |
1,900 |
$125K |
| 96376 |
|
4,674 |
3,508 |
$120K |
| 85610 |
|
25,185 |
20,474 |
$118K |
| 70496 |
|
1,217 |
1,138 |
$115K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
4,764 |
4,397 |
$115K |
| 87633 |
Infectious agent detection by nucleic acid, respiratory virus, 12-25 targets |
1,248 |
1,125 |
$115K |
| 85730 |
|
21,066 |
17,946 |
$112K |
| 20610 |
|
152 |
111 |
$111K |
| 70498 |
|
1,331 |
1,243 |
$110K |
| 85007 |
|
20,312 |
14,289 |
$109K |
| 73610 |
|
4,017 |
3,689 |
$106K |
| 93971 |
|
1,234 |
1,152 |
$105K |
| 82728 |
|
7,231 |
6,070 |
$105K |
| 76830 |
Ultrasound, transvaginal |
2,391 |
2,302 |
$104K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
3,379 |
3,210 |
$103K |
| 31231 |
|
518 |
503 |
$102K |
| 73110 |
|
3,166 |
2,813 |
$99K |
| 70486 |
|
1,502 |
1,441 |
$99K |
| 97162 |
|
2,590 |
2,510 |
$99K |
| 73130 |
|
3,480 |
3,156 |
$98K |
| C1769 |
Guide wire |
4,331 |
3,906 |
$97K |
| 86481 |
|
1,601 |
1,503 |
$96K |
| 88342 |
|
4,027 |
3,541 |
$95K |
| 80076 |
|
16,151 |
13,740 |
$94K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
15,824 |
14,308 |
$94K |
| 77280 |
|
301 |
236 |
$92K |
| 84439 |
|
8,196 |
6,928 |
$92K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
8,596 |
8,039 |
$91K |
| 73630 |
|
3,349 |
3,136 |
$90K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
2,681 |
2,389 |
$89K |
| J1453 |
Injection, fosaprepitant, 1 mg |
2,636 |
1,319 |
$88K |
| 67311 |
|
52 |
52 |
$87K |
| 86923 |
|
3,572 |
2,342 |
$86K |
| 45385 |
Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) |
213 |
195 |
$85K |
| 86334 |
|
4,004 |
3,027 |
$84K |
| 88307 |
|
1,962 |
1,805 |
$83K |
| 73590 |
|
2,901 |
2,652 |
$83K |
| G0379 |
Direct admission of patient for hospital observation care |
2,132 |
1,812 |
$80K |
| 87798 |
Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism |
2,142 |
2,082 |
$80K |
| 76770 |
|
1,136 |
1,090 |
$79K |
| 84702 |
|
5,956 |
4,921 |
$77K |
| J1756 |
Injection, iron sucrose, 1 mg |
1,819 |
766 |
$76K |
| 97164 |
|
1,584 |
1,521 |
$75K |
| 97161 |
|
1,887 |
1,827 |
$74K |
| 69210 |
|
605 |
585 |
$73K |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
2,346 |
1,248 |
$73K |
| 87536 |
|
745 |
710 |
$72K |
| 84484 |
|
15,024 |
12,546 |
$69K |
| 73080 |
|
2,428 |
2,219 |
$67K |
| 0225U |
|
619 |
595 |
$66K |
| 73090 |
|
2,503 |
2,308 |
$66K |
| 94010 |
|
458 |
442 |
$65K |
| 87490 |
|
3,773 |
3,699 |
$64K |
| 97113 |
|
881 |
345 |
$59K |
| 86803 |
|
2,833 |
2,567 |
$58K |
| C1887 |
Catheter, guiding (may include infusion/perfusion capability) |
1,940 |
1,710 |
$58K |
| 88304 |
|
3,370 |
3,279 |
$57K |
| 81002 |
|
6,136 |
3,935 |
$57K |
| 76801 |
|
1,592 |
1,418 |
$56K |
| 88313 |
|
1,221 |
957 |
$55K |
| U0002 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
996 |
887 |
$53K |
| C9803 |
Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
4,498 |
3,915 |
$53K |
| 73030 |
|
2,451 |
2,263 |
$53K |
| 83550 |
|
6,547 |
5,792 |
$52K |
| 83880 |
|
5,511 |
4,918 |
$52K |
| 92526 |
|
798 |
339 |
$52K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
3,284 |
3,052 |
$51K |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
5,902 |
4,432 |
$50K |
| 80197 |
|
7,122 |
3,092 |
$50K |
| 73562 |
|
2,036 |
1,886 |
$50K |
| 82607 |
|
2,454 |
2,264 |
$48K |
| 94727 |
|
453 |
452 |
$47K |
| 82232 |
|
3,234 |
2,363 |
$47K |
| 99292 |
|
230 |
216 |
$46K |
| 71250 |
|
541 |
519 |
$45K |
| 74174 |
|
242 |
226 |
$45K |
| 83540 |
|
6,826 |
5,954 |
$45K |
| 76937 |
|
1,231 |
1,181 |
$45K |
| 85045 |
|
7,275 |
5,938 |
$44K |
| 83690 |
|
16,150 |
13,772 |
$43K |
| 96377 |
|
972 |
694 |
$43K |
| 96450 |
|
124 |
79 |
$42K |
| 84481 |
|
1,862 |
1,487 |
$42K |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
165 |
154 |
$42K |
| A9502 |
Technetium tc-99m tetrofosmin, diagnostic, per study dose |
1,070 |
974 |
$42K |
| J1439 |
Injection, ferric carboxymaltose, 1 mg |
53 |
37 |
$41K |
| C1894 |
Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser |
3,251 |
2,942 |
$40K |
| 87340 |
|
3,367 |
2,934 |
$40K |
| 88184 |
|
1,687 |
1,286 |
$40K |
| 73552 |
|
1,475 |
1,328 |
$39K |
| 83605 |
|
5,200 |
4,683 |
$38K |
| 54150 |
|
22 |
22 |
$38K |
| 86360 |
|
618 |
593 |
$38K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
3,849 |
3,643 |
$37K |
| G0390 |
Trauma response team associated with hospital critical care service |
136 |
126 |
$37K |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
3,929 |
3,158 |
$37K |
| 82746 |
|
1,786 |
1,645 |
$37K |
| 87799 |
|
4,259 |
2,165 |
$36K |
| 88173 |
|
854 |
794 |
$35K |
| 88142 |
|
682 |
673 |
$35K |
| 86152 |
|
587 |
350 |
$35K |
| 87040 |
|
4,207 |
3,892 |
$34K |
| 84165 |
|
3,127 |
2,410 |
$34K |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
8,685 |
7,470 |
$34K |
| 86140 |
|
7,927 |
7,108 |
$34K |
| 81268 |
|
579 |
315 |
$34K |
| 73564 |
|
1,297 |
1,235 |
$33K |
| 88312 |
|
1,462 |
1,459 |
$33K |
| C1725 |
Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability) |
573 |
495 |
$31K |
| 81025 |
|
18,710 |
15,113 |
$31K |
| 86769 |
|
1,104 |
968 |
$31K |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
8,589 |
7,720 |
$31K |
| 87070 |
|
3,331 |
2,960 |
$30K |
| 74018 |
|
2,277 |
2,114 |
$30K |
| 83970 |
|
855 |
753 |
$29K |
| 31575 |
|
402 |
386 |
$29K |
| 38222 |
|
92 |
74 |
$29K |
| 73060 |
|
1,174 |
1,071 |
$29K |
| 73502 |
|
1,535 |
1,402 |
$29K |
| 90715 |
|
3,828 |
3,689 |
$29K |
| 86301 |
|
1,533 |
1,101 |
$28K |
| 12001 |
|
451 |
423 |
$28K |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
14,903 |
11,743 |
$28K |
| Q9957 |
Injection, perflutren lipid microspheres, per ml |
739 |
589 |
$28K |
| 86902 |
|
592 |
383 |
$27K |
| 86160 |
|
321 |
287 |
$27K |
| 86706 |
|
2,238 |
1,968 |
$27K |
| 74019 |
|
1,907 |
1,852 |
$26K |
| J0640 |
Injection, leucovorin calcium, per 50 mg |
1,167 |
499 |
$26K |
| 86922 |
|
997 |
583 |
$26K |
| 83020 |
|
2,336 |
2,095 |
$26K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
4,113 |
3,840 |
$25K |
| 96368 |
|
1,163 |
705 |
$25K |
| P9073 |
Platelets, pheresis, pathogen-reduced, each unit |
192 |
52 |
$25K |
| 88271 |
|
513 |
343 |
$24K |
| 84153 |
|
1,458 |
1,289 |
$24K |
| 82150 |
|
3,693 |
2,450 |
$23K |
| 88360 |
|
530 |
405 |
$23K |
| 88275 |
|
424 |
303 |
$22K |
| 84156 |
|
7,184 |
5,185 |
$22K |
| 84703 |
|
3,614 |
3,327 |
$21K |
| 76377 |
|
496 |
472 |
$21K |
| 97802 |
|
287 |
275 |
$21K |
| J9267 |
Injection, paclitaxel, 1 mg |
854 |
379 |
$21K |
| 36561 |
|
16 |
16 |
$21K |
| 77338 |
|
78 |
62 |
$21K |
| 86780 |
|
3,286 |
2,888 |
$20K |
| C1889 |
Implantable/insertable device, not otherwise classified |
173 |
165 |
$20K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
823 |
774 |
$20K |
| C9399 |
Unclassified drugs or biologicals |
17 |
12 |
$19K |
| 86038 |
|
674 |
669 |
$19K |
| J0690 |
Injection, cefazolin sodium, 500 mg |
4,877 |
4,016 |
$18K |
| 81003 |
|
4,795 |
3,974 |
$18K |
| 86300 |
|
1,376 |
1,022 |
$18K |
| 97116 |
|
1,207 |
869 |
$18K |
| 92583 |
|
299 |
298 |
$18K |
| J9070 |
Cyclophosphamide, 100 mg |
58 |
25 |
$18K |
| C2617 |
Stent, non-coronary, temporary, without delivery system |
331 |
300 |
$18K |
| 83655 |
|
686 |
683 |
$18K |
| 76870 |
|
485 |
461 |
$18K |
| 64493 |
|
15 |
13 |
$18K |
| 82803 |
|
1,312 |
1,207 |
$18K |
| 44970 |
|
15 |
12 |
$17K |
| 85652 |
|
6,471 |
5,949 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
1,272 |
1,160 |
$17K |
| 86304 |
|
1,585 |
1,086 |
$17K |
| 73140 |
|
961 |
904 |
$17K |
| 84480 |
|
1,340 |
995 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
565 |
304 |
$16K |
| 95713 |
|
34 |
31 |
$16K |
| 76857 |
|
447 |
438 |
$16K |
| D1110 |
Prophylaxis - adult |
938 |
925 |
$16K |
| 86704 |
|
1,812 |
1,482 |
$16K |
| 82550 |
|
3,032 |
2,634 |
$15K |
| A0425 |
Ground mileage, per statute mile |
356 |
347 |
$15K |
| 77301 |
|
13 |
12 |
$15K |
| 85384 |
|
2,413 |
1,346 |
$14K |
| 12011 |
|
388 |
353 |
$14K |
| 85379 |
|
3,782 |
3,129 |
$14K |
| 82105 |
|
859 |
717 |
$13K |
| 84550 |
|
3,256 |
2,117 |
$13K |
| 82947 |
|
927 |
918 |
$13K |
| 88300 |
|
1,557 |
1,484 |
$13K |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
5,768 |
2,892 |
$13K |
| 81265 |
|
584 |
315 |
$12K |
| OP259 |
|
2,824 |
2,487 |
$12K |
| 72131 |
|
279 |
254 |
$12K |
| G0108 |
Diabetes outpatient self-management training services, individual, per 30 minutes |
135 |
126 |
$12K |
| 87637 |
Infectious agent detection by nucleic acid; SARS-CoV-2, influenza, and RSV |
497 |
462 |
$12K |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
18,605 |
15,923 |
$11K |
| 31579 |
|
84 |
75 |
$11K |
| J9217 |
Leuprolide acetate (for depot suspension), 7.5 mg |
38 |
33 |
$11K |
| C1781 |
Mesh (implantable) |
60 |
57 |
$11K |
| 82805 |
|
641 |
573 |
$11K |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
17,319 |
14,896 |
$11K |
| 82043 |
|
1,190 |
1,178 |
$11K |
| 87205 |
|
2,574 |
2,347 |
$10K |
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
113 |
109 |
$10K |
| 86905 |
|
134 |
111 |
$10K |
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
12 |
12 |
$10K |
| J2704 |
Injection, propofol, 10 mg |
12,954 |
11,506 |
$10K |
| 94618 |
|
105 |
100 |
$10K |
| 81220 |
CFTR (cystic fibrosis transmembrane conductance regulator) gene analysis; common variants |
62 |
59 |
$9K |
| M0222 |
Intravenous injection, bebtelovimab, includes injection and post administration monitoring |
128 |
118 |
$9K |
| 97535 |
Self-care/home management training, each 15 minutes |
322 |
238 |
$9K |
| G0008 |
Administration of influenza virus vaccine |
946 |
926 |
$9K |
| 87624 |
Infectious agent detection by nucleic acid; human papillomavirus (HPV), high-risk types |
474 |
435 |
$9K |
| 88172 |
|
313 |
296 |
$9K |
| J3489 |
Injection, zoledronic acid, 1 mg |
194 |
169 |
$8K |
| J1170 |
Injection, hydromorphone, up to 4 mg |
4,797 |
3,609 |
$8K |
| 82977 |
|
598 |
332 |
$8K |
| OP637 |
|
4,866 |
2,095 |
$7K |
| 83521 |
|
1,526 |
1,038 |
$7K |
| 0241U |
Neonatal screening for hereditary disorders, genomic sequence analysis panel |
124 |
123 |
$7K |
| 82565 |
|
1,045 |
1,012 |
$7K |
| 29125 |
|
172 |
162 |
$7K |
| J2543 |
Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams) |
524 |
304 |
$7K |
| J1644 |
Injection, heparin sodium, per 1000 units |
1,784 |
1,096 |
$7K |
| 36592 |
|
146 |
117 |
$7K |
| 80055 |
|
47 |
47 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
442 |
433 |
$7K |
| 93923 |
|
41 |
40 |
$7K |
| 70491 |
|
70 |
66 |
$7K |
| 86708 |
|
697 |
517 |
$7K |
| C1760 |
Closure device, vascular (implantable/insertable) |
160 |
138 |
$7K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
103 |
102 |
$7K |
| 85097 |
|
252 |
156 |
$7K |
| J9370 |
Vincristine sulfate, 1 mg |
661 |
503 |
$6K |
| 43264 |
|
14 |
14 |
$6K |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
4,310 |
3,300 |
$6K |
| 84520 |
|
823 |
808 |
$6K |
| 76882 |
|
283 |
263 |
$6K |
| 92504 |
|
476 |
447 |
$6K |
| 74230 |
|
42 |
42 |
$6K |
| 97168 |
|
101 |
99 |
$6K |
| 88237 |
|
172 |
122 |
$6K |
| 87522 |
Neg quan hep c or qual rna |
128 |
105 |
$6K |
| 96523 |
|
68 |
67 |
$5K |
| C1726 |
Catheter, balloon dilatation, non-vascular |
87 |
81 |
$5K |
| 75561 |
|
13 |
12 |
$5K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
195 |
180 |
$5K |
| 88112 |
|
290 |
277 |
$5K |
| 12002 |
|
83 |
76 |
$5K |
| J9202 |
Goserelin acetate implant, per 3.6 mg |
12 |
12 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
1,403 |
1,311 |
$5K |
| A9575 |
Injection, gadoterate meglumine, 0.1 ml |
731 |
675 |
$5K |
| 86665 |
|
629 |
454 |
$5K |
| A9581 |
Injection, gadoxetate disodium, 1 ml |
94 |
94 |
$5K |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
1,572 |
1,287 |
$5K |
| 86335 |
|
754 |
561 |
$5K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
153 |
141 |
$5K |
| Q3014 |
Telehealth originating site facility fee |
1,286 |
1,065 |
$5K |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
103 |
97 |
$5K |
| 76642 |
|
58 |
56 |
$5K |
| 80143 |
|
1,263 |
1,177 |
$5K |
| 87449 |
|
992 |
409 |
$4K |
| 86235 |
|
16 |
15 |
$4K |
| 92611 |
|
15 |
15 |
$4K |
| 87186 |
|
1,692 |
1,484 |
$4K |
| 86870 |
|
196 |
155 |
$4K |
| 77001 |
|
49 |
49 |
$4K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
1,527 |
1,474 |
$4K |
| 80179 |
|
1,189 |
1,108 |
$4K |
| 97165 |
|
99 |
99 |
$4K |
| 92626 |
|
67 |
65 |
$4K |
| 10060 |
|
42 |
40 |
$4K |
| M0220 |
Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), includes injection and post administration monitoring |
33 |
18 |
$4K |
| 77370 |
|
40 |
38 |
$4K |
| 83516 |
|
91 |
91 |
$4K |
| 88302 |
|
403 |
384 |
$4K |
| 77066 |
Tomosynthesis, mammo |
40 |
39 |
$4K |
| 84166 |
|
887 |
634 |
$4K |
| 52000 |
|
13 |
12 |
$4K |
| 80164 |
|
511 |
448 |
$4K |
| 80329 |
|
964 |
917 |
$4K |
| 86592 |
|
257 |
256 |
$4K |
| 76536 |
|
39 |
39 |
$4K |
| 88264 |
|
121 |
79 |
$3K |
| 84466 |
|
319 |
234 |
$3K |
| 84145 |
|
428 |
396 |
$3K |
| 82950 |
|
290 |
274 |
$3K |
| 81267 |
|
556 |
301 |
$3K |
| 86762 |
|
202 |
182 |
$3K |
| J3480 |
Injection, potassium chloride, per 2 meq |
1,869 |
762 |
$3K |
| 86664 |
|
550 |
396 |
$3K |
| 84460 |
|
286 |
280 |
$3K |
| 81329 |
|
84 |
63 |
$3K |
| 80320 |
|
966 |
897 |
$3K |
| 76376 |
|
199 |
179 |
$3K |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
4,504 |
4,109 |
$3K |
| 88311 |
|
646 |
488 |
$3K |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
102 |
101 |
$3K |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
8,454 |
7,604 |
$3K |
| 0031A |
|
130 |
128 |
$3K |
| 94642 |
|
13 |
12 |
$3K |
| G0279 |
Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066) |
61 |
60 |
$3K |
| 93356 |
|
27 |
26 |
$3K |
| 93320 |
|
28 |
26 |
$3K |
| 25605 |
|
39 |
36 |
$3K |
| 85018 |
|
1,018 |
751 |
$3K |
| Q9963 |
High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml |
972 |
887 |
$3K |
| J0134 |
Injection, acetaminophen (fresenius kabi), not therapeutically equivalent to j0131, 10 mg |
3,067 |
2,895 |
$3K |
| 82570 |
|
3,531 |
2,552 |
$3K |
| J2060 |
Injection, lorazepam, 2 mg |
2,010 |
1,391 |
$3K |
| 86430 |
|
228 |
224 |
$3K |
| 89230 |
|
67 |
65 |
$3K |
| G0009 |
Administration of pneumococcal vaccine |
272 |
267 |
$3K |
| OP279 |
|
6,340 |
5,070 |
$2K |
| M0239 |
Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring |
20 |
20 |
$2K |
| 87533 |
|
415 |
119 |
$2K |
| Q0222 |
Injection, bebtelovimab, 175 mg |
128 |
117 |
$2K |
| Q0247 |
Injection, sotrovimab, 500 mg |
13 |
13 |
$2K |
| 84450 |
|
236 |
230 |
$2K |
| OP229 |
|
47 |
45 |
$2K |
| 88346 |
|
24 |
13 |
$2K |
| 86225 |
|
41 |
41 |
$2K |
| 84403 |
|
280 |
248 |
$2K |
| 87088 |
|
1,614 |
1,428 |
$2K |
| 93325 |
|
30 |
28 |
$2K |
| J2272 |
Injection, morphine sulfate (fresenius kabi), not therapeutically equivalent to j2270, up to 10 mg |
4,317 |
3,389 |
$2K |
| 90686 |
|
281 |
271 |
$2K |
| M0247 |
Intravenous infusion, sotrovimab, includes infusion and post administration monitoring |
33 |
30 |
$2K |
| 73560 |
|
57 |
53 |
$2K |
| 77065 |
Tomosynthesis, mammo |
26 |
25 |
$2K |
| 81206 |
|
81 |
55 |
$2K |
| 89051 |
|
799 |
692 |
$2K |
| 87077 |
|
725 |
660 |
$2K |
| C1753 |
Catheter, intravascular ultrasound |
42 |
37 |
$2K |
| 72082 |
|
27 |
26 |
$2K |
| G8978 |
Mobility: walking & moving around functional limitation, current status, at therapy episode outset and at reporting intervals |
755 |
606 |
$2K |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
7,179 |
6,479 |
$2K |
| J9201 |
Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg |
146 |
50 |
$2K |
| 88108 |
|
82 |
67 |
$2K |
| 72170 |
|
51 |
50 |
$2K |
| 92978 |
|
49 |
39 |
$2K |
| 92523 |
|
44 |
40 |
$2K |
| 73000 |
|
65 |
57 |
$2K |
| 77080 |
|
24 |
24 |
$2K |
| J0330 |
Injection, succinylcholine chloride, up to 20 mg |
1,149 |
1,022 |
$2K |
| 86644 |
|
635 |
432 |
$2K |
| J9206 |
Injection, irinotecan, 20 mg |
158 |
48 |
$2K |
| C1751 |
Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis) |
122 |
112 |
$2K |
| A9577 |
Injection, gadobenate dimeglumine (multihance), per ml |
394 |
383 |
$2K |
| 81243 |
|
102 |
76 |
$2K |
| 11045 |
|
37 |
24 |
$2K |
| 0012A |
|
60 |
58 |
$2K |
| 86645 |
|
635 |
432 |
$2K |
| C1788 |
Port, indwelling (implantable) |
15 |
15 |
$2K |
| 92604 |
|
15 |
12 |
$1K |
| J1650 |
Injection, enoxaparin sodium, 10 mg |
845 |
448 |
$1K |
| 0011A |
|
61 |
59 |
$1K |
| 83520 |
|
310 |
198 |
$1K |
| 90677 |
|
13 |
12 |
$1K |
| 90674 |
|
139 |
139 |
$1K |
| OP255 |
|
755 |
444 |
$1K |
| 87305 |
|
715 |
223 |
$1K |
| 97166 |
|
42 |
42 |
$1K |
| 75574 |
|
15 |
13 |
$1K |
| J0665 |
Injection, bupivicaine, not otherwise specified, 0.5 mg |
2,123 |
2,000 |
$1K |
| 88280 |
|
121 |
80 |
$1K |
| 86618 |
|
37 |
36 |
$1K |
| 80074 |
|
88 |
79 |
$1K |
| J0500 |
Injection, dicyclomine hcl, up to 20 mg |
409 |
380 |
$1K |
| 86828 |
|
53 |
39 |
$1K |
| 87075 |
|
202 |
186 |
$1K |
| J2919 |
Injection, methylprednisolone sodium succinate, 5 mg |
347 |
270 |
$1K |
| 86787 |
|
182 |
147 |
$1K |
| 64494 |
|
19 |
13 |
$1K |
| J1790 |
Injection, droperidol, up to 5 mg |
1,042 |
846 |
$1K |
| 86696 |
|
340 |
225 |
$1K |
| 86376 |
|
24 |
24 |
$1K |
| 0054A |
|
28 |
27 |
$1K |
| 83001 |
|
12 |
12 |
$997.48 |
| J1642 |
Injection, heparin sodium, (heparin lock flush), per 10 units |
572 |
333 |
$941.04 |
| J9000 |
Injection, doxorubicin hydrochloride, 10 mg |
68 |
36 |
$915.09 |
| 85014 |
|
567 |
389 |
$912.52 |
| J7298 |
Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg |
15 |
12 |
$911.28 |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
668 |
588 |
$910.25 |
| 80069 |
|
417 |
203 |
$871.53 |
| G8979 |
Mobility: walking & moving around functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting |
739 |
594 |
$858.52 |
| 86695 |
|
322 |
212 |
$856.90 |
| J3370 |
Injection, vancomycin hcl, 500 mg |
177 |
128 |
$855.28 |
| 82785 |
|
12 |
12 |
$848.09 |
| 81380 |
|
15 |
12 |
$834.74 |
| 95886 |
|
17 |
15 |
$833.11 |
| 83010 |
|
179 |
102 |
$826.62 |
| C9113 |
Injection, pantoprazole sodium, per vial |
54 |
31 |
$802.88 |
| 72110 |
|
12 |
12 |
$787.32 |
| 90662 |
|
54 |
49 |
$736.16 |
| 81401 |
|
15 |
14 |
$715.95 |
| 64484 |
|
58 |
55 |
$679.64 |
| 86800 |
|
13 |
13 |
$653.57 |
| J2785 |
Injection, regadenoson, 0.1 mg |
28 |
26 |
$639.84 |
| 58300 |
|
14 |
14 |
$623.08 |
| 86359 |
|
53 |
44 |
$619.43 |
| 84436 |
|
66 |
62 |
$610.91 |
| P9604 |
Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated trip charge |
924 |
416 |
$602.34 |
| G0103 |
Prostate cancer screening; prostate specific antigen test (psa) |
90 |
79 |
$579.80 |
| 90834 |
Psychotherapy, 45 minutes with patient |
39 |
15 |
$550.06 |
| 86039 |
|
106 |
90 |
$502.68 |
| 90670 |
|
13 |
12 |
$499.92 |
| J0136 |
Injection, acetaminophen (b braun), not therapeutically equivalent to j0131, 10 mg |
425 |
384 |
$494.01 |
| 0064A |
|
15 |
15 |
$454.36 |
| 87184 |
|
84 |
77 |
$443.83 |
| 82657 |
|
78 |
53 |
$427.54 |
| 86663 |
|
58 |
52 |
$424.31 |
| J1630 |
Injection, haloperidol, up to 5 mg |
1,529 |
1,019 |
$423.48 |
| 87045 |
|
58 |
53 |
$406.79 |
| 85240 |
|
56 |
40 |
$405.17 |
| 93308 |
|
12 |
12 |
$381.99 |
| 0004A |
|
13 |
13 |
$373.52 |
| 90732 |
|
78 |
78 |
$372.17 |
| 82247 |
|
117 |
109 |
$370.11 |
| J0171 |
Injection, adrenalin, epinephrine, 0.1 mg |
416 |
365 |
$348.38 |
| A9585 |
Injection, gadobutrol, 0.1 ml |
14 |
13 |
$337.48 |
| J0461 |
Injection, atropine sulfate, 0.01 mg |
272 |
180 |
$323.59 |
| J8540 |
Dexamethasone, oral, 0.25 mg |
514 |
243 |
$323.41 |
| J2003 |
Injection, lidocaine hydrochloride, 1 mg |
509 |
460 |
$321.90 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$312.00 |
| 84146 |
|
27 |
25 |
$295.81 |
| 80195 |
|
101 |
66 |
$295.35 |
| 85660 |
|
121 |
90 |
$257.83 |
| 87177 |
|
109 |
88 |
$255.90 |
| 82272 |
|
53 |
52 |
$254.82 |
| 74328 |
|
13 |
13 |
$253.86 |
| 86682 |
|
56 |
53 |
$252.00 |
| J2920 |
Injection, methylprednisolone sodium succinate, up to 40 mg |
187 |
119 |
$241.93 |
| 82330 |
|
51 |
49 |
$176.02 |
| J9250 |
Methotrexate sodium, 5 mg |
134 |
65 |
$171.58 |
| J1643 |
Injection, heparin sodium (pfizer), not therapeutically equivalent to j1644, per 1000 units |
603 |
427 |
$169.15 |
| 81257 |
|
15 |
13 |
$168.52 |
| 82010 |
|
53 |
42 |
$163.86 |
| J1596 |
Injection, glycopyrrolate, 0.1 mg |
635 |
603 |
$161.34 |
| 83050 |
|
80 |
79 |
$157.31 |
| J0295 |
Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm |
256 |
144 |
$152.58 |
| J1010 |
Injection, methylprednisolone acetate, 1 mg |
106 |
102 |
$150.03 |
| 88365 |
|
13 |
12 |
$149.06 |
| 86141 |
|
71 |
45 |
$139.31 |
| J0780 |
Injection, prochlorperazine, up to 10 mg |
45 |
41 |
$129.52 |
| 82375 |
|
31 |
30 |
$114.01 |
| 82533 |
|
18 |
14 |
$113.91 |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
254 |
201 |
$111.54 |
| 84132 |
|
185 |
152 |
$106.14 |
| 83525 |
|
12 |
12 |
$106.12 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
18 |
16 |
$100.00 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$99.00 |
| 85362 |
|
139 |
75 |
$94.30 |
| J1171 |
Injection, hydromorphone, 0.1 mg |
125 |
102 |
$93.78 |
| J0737 |
Injection, clindamycin phosphate (baxter), not therapeutically equivalent to j0736, 300 mg |
99 |
81 |
$92.88 |
| 80051 |
|
77 |
76 |
$92.18 |
| C1729 |
Catheter, drainage |
15 |
12 |
$90.69 |
| 82553 |
|
34 |
30 |
$89.72 |
| 85220 |
|
14 |
12 |
$74.16 |
| 84154 |
|
22 |
14 |
$73.50 |
| 85230 |
|
14 |
12 |
$70.26 |
| 85270 |
|
14 |
12 |
$69.87 |
| 87102 |
|
14 |
13 |
$69.74 |
| 85260 |
|
14 |
12 |
$68.88 |
| 84478 |
|
19 |
13 |
$67.78 |
| 87493 |
|
14 |
12 |
$67.47 |
| J1940 |
Injection, furosemide, up to 20 mg |
117 |
79 |
$67.24 |
| 82955 |
|
29 |
13 |
$67.09 |
| 86317 |
|
14 |
13 |
$65.20 |
| 85250 |
|
14 |
12 |
$64.40 |
| 82310 |
|
54 |
51 |
$61.84 |
| 84155 |
|
380 |
268 |
$61.02 |
| 84681 |
|
28 |
12 |
$59.34 |
| J2795 |
Injection, ropivacaine hydrochloride, 1 mg |
91 |
90 |
$59.02 |
| 85210 |
|
14 |
12 |
$52.99 |
| 82652 |
|
13 |
12 |
$47.87 |
| J1040 |
Injection, methylprednisolone acetate, 80 mg |
21 |
21 |
$46.96 |
| 82438 |
|
68 |
65 |
$44.74 |
| J1836 |
Injection, metronidazole, 10 mg |
61 |
46 |
$44.45 |
| D9310 |
|
27 |
25 |
$41.67 |
| J9190 |
Injection, fluorouracil, 500 mg |
100 |
45 |
$40.18 |
| 84075 |
|
39 |
38 |
$37.77 |
| 81000 |
|
166 |
85 |
$36.32 |
| 86200 |
|
15 |
13 |
$32.92 |
| J2370 |
Injection, phenylephrine hcl, up to 1 ml |
721 |
586 |
$29.94 |
| J2371 |
Injection, phenylephrine hydrochloride, 20 micrograms |
870 |
696 |
$29.81 |
| J2004 |
Injection, lidocaine hcl with epinephrine, 1 mg |
87 |
85 |
$28.76 |
| J3535 |
Drug administered through a metered dose inhaler |
146 |
121 |
$20.29 |
| 90656 |
|
12 |
12 |
$19.78 |
| 87324 |
|
13 |
12 |
$14.79 |
| J0360 |
Injection, hydralazine hcl, up to 20 mg |
39 |
31 |
$12.06 |
| 91303 |
|
98 |
97 |
$10.00 |
| J1956 |
Injection, levofloxacin, 250 mg |
43 |
38 |
$8.68 |
| J0687 |
Injection, cefazolin sodium (wg critical care), not therapeutically equivalent to j0690, 500 mg |
497 |
452 |
$6.47 |
| J2470 |
Injection, pantoprazole sodium, 40 mg |
20 |
16 |
$5.90 |
| J3301 |
Injection, triamcinolone acetonide, not otherwise specified, 10 mg |
15 |
14 |
$4.50 |
| 91300 |
|
6,033 |
5,235 |
$3.02 |
| Q0220 |
Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), 300 mg |
32 |
18 |
$3.00 |
| J2372 |
Injection, phenylephrine hydrochloride (biorphen), 20 micrograms |
102 |
89 |
$2.00 |
| 91306 |
|
12 |
12 |
$1.00 |
| 91305 |
|
28 |
27 |
$1.00 |
| J7620 |
Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme |
17 |
14 |
$0.05 |
| 81269 |
|
42 |
28 |
$0.00 |
| Q9966 |
Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml |
13 |
12 |
$0.00 |
| Q0239 |
Injection, bamlanivimab-xxxx, 700 mg |
12 |
12 |
$0.00 |
| G8987 |
Self care functional limitation, current status, at therapy episode outset and at reporting intervals |
31 |
25 |
$0.00 |
| G8988 |
Self care functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting |
59 |
49 |
$0.00 |
| J1815 |
Injection, insulin, per 5 units |
155 |
73 |
$0.00 |
| 91301 |
|
98 |
95 |
$0.00 |
| G8980 |
Mobility: walking & moving around functional limitation, discharge status, at discharge from therapy or to end reporting |
24 |
24 |
$0.00 |
| 84402 |
|
13 |
12 |
$0.00 |
| 82040 |
|
37 |
36 |
$0.00 |