| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
44,134 |
35,694 |
$22.44M |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
42,617 |
35,573 |
$12.66M |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
49,375 |
42,939 |
$10.44M |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
143,066 |
35,403 |
$8.61M |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
81,590 |
66,081 |
$7.97M |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
32,143 |
25,997 |
$4.34M |
| 99291 |
Critical care, evaluation and management of the critically ill patient, first 30-74 minutes |
3,331 |
2,825 |
$4.17M |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
15,111 |
12,637 |
$2.78M |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
11,863 |
8,991 |
$2.35M |
| 45380 |
Colonoscopy, flexible; with biopsy, single or multiple |
3,257 |
2,835 |
$2.32M |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
18,983 |
17,301 |
$1.86M |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
17,671 |
8,394 |
$1.83M |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
57,929 |
40,427 |
$1.79M |
| 70450 |
Computed tomography, head or brain; without contrast material |
14,712 |
11,629 |
$1.76M |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
13,258 |
11,941 |
$1.69M |
| 92507 |
Treatment of speech, language, voice, communication, and/or auditory processing disorder |
19,375 |
4,909 |
$1.61M |
| 93975 |
|
6,964 |
5,963 |
$1.38M |
| J1459 |
Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg |
2,186 |
737 |
$1.31M |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
3,177 |
2,643 |
$1.30M |
| 64493 |
|
1,955 |
1,568 |
$1.21M |
| 71046 |
Radiologic examination, chest; 2 views |
22,332 |
18,631 |
$1.20M |
| 96413 |
Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance |
5,863 |
2,955 |
$1.17M |
| 71045 |
Radiologic examination, chest; single view |
22,551 |
17,728 |
$1.06M |
| 45385 |
Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) |
1,873 |
1,635 |
$1.04M |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
9,019 |
7,660 |
$936K |
| 78452 |
Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress |
1,906 |
1,453 |
$930K |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
103,640 |
26,664 |
$884K |
| 76641 |
|
16,360 |
8,660 |
$848K |
| 45378 |
Colonoscopy, flexible; diagnostic, including collection of specimen(s) |
1,358 |
1,201 |
$842K |
| 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 |
14,082 |
12,018 |
$823K |
| 76830 |
Ultrasound, transvaginal |
8,757 |
7,527 |
$817K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
9,190 |
7,945 |
$807K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
36,591 |
33,772 |
$796K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
29,653 |
27,164 |
$794K |
| 84443 |
Thyroid stimulating hormone (TSH) |
65,721 |
60,302 |
$793K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
29,603 |
27,144 |
$792K |
| 80053 |
Comprehensive metabolic panel |
121,297 |
102,329 |
$719K |
| 11042 |
Debridement, subcutaneous tissue (includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm |
5,352 |
1,895 |
$708K |
| 80061 |
Lipid panel |
64,518 |
59,877 |
$667K |
| 97161 |
|
11,780 |
10,308 |
$648K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
24,737 |
17,476 |
$648K |
| 86900 |
|
16,636 |
13,355 |
$632K |
| 95810 |
Polysomnography; sleep staging with 4 or more additional parameters |
808 |
701 |
$606K |
| 76811 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, detailed |
2,779 |
2,514 |
$591K |
| 70553 |
Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences |
2,357 |
1,939 |
$585K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
183,888 |
138,819 |
$543K |
| 76818 |
|
4,948 |
2,002 |
$524K |
| 59025 |
Fetal non-stress test |
3,101 |
2,495 |
$515K |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
8,988 |
3,241 |
$490K |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
3,690 |
2,989 |
$487K |
| G0260 |
Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography |
1,570 |
1,170 |
$465K |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
3,070 |
2,538 |
$453K |
| 77065 |
Tomosynthesis, mammo |
4,307 |
3,398 |
$449K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
3,686 |
3,068 |
$442K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
3,587 |
2,872 |
$428K |
| 97112 |
Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination |
13,059 |
4,066 |
$405K |
| 88342 |
|
8,213 |
5,480 |
$400K |
| 70496 |
|
2,007 |
1,674 |
$380K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
54,449 |
50,239 |
$375K |
| 11043 |
|
2,475 |
751 |
$368K |
| 87624 |
Infectious agent detection by nucleic acid; human papillomavirus (HPV), high-risk types |
12,606 |
12,127 |
$347K |
| 76536 |
|
4,601 |
3,859 |
$308K |
| 76801 |
|
3,139 |
2,618 |
$300K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
5,409 |
4,200 |
$298K |
| 76642 |
|
5,518 |
4,288 |
$291K |
| 19083 |
|
259 |
227 |
$289K |
| 72148 |
Magnetic resonance imaging, lumbar spine; without contrast material |
2,206 |
1,866 |
$286K |
| 93798 |
|
6,366 |
775 |
$285K |
| 93351 |
|
945 |
768 |
$284K |
| 36415 |
Collection of venous blood by venipuncture |
271,035 |
198,194 |
$283K |
| 96367 |
|
4,701 |
2,396 |
$275K |
| 97162 |
|
6,180 |
5,110 |
$268K |
| 82607 |
|
24,680 |
22,629 |
$264K |
| 77066 |
Tomosynthesis, mammo |
2,277 |
2,028 |
$262K |
| 93971 |
|
3,978 |
3,220 |
$256K |
| 94726 |
|
3,009 |
2,296 |
$253K |
| 87637 |
Infectious agent detection by nucleic acid; SARS-CoV-2, influenza, and RSV |
1,924 |
1,821 |
$247K |
| 93970 |
|
2,178 |
1,763 |
$242K |
| 93458 |
|
175 |
132 |
$240K |
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
2,559 |
2,199 |
$236K |
| 76770 |
|
3,054 |
2,515 |
$230K |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
18,972 |
17,293 |
$221K |
| 73721 |
Magnetic resonance imaging, any joint of lower extremity; without contrast material |
1,235 |
1,051 |
$218K |
| 77080 |
|
2,619 |
2,332 |
$217K |
| 47562 |
|
47 |
40 |
$204K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
5,752 |
3,098 |
$199K |
| 73630 |
|
8,188 |
6,467 |
$198K |
| C9803 |
Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
60,316 |
42,337 |
$190K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
27,523 |
16,357 |
$184K |
| 84439 |
|
27,608 |
25,588 |
$183K |
| 93017 |
|
3,985 |
3,118 |
$177K |
| 86003 |
|
4,073 |
1,854 |
$176K |
| 82728 |
|
17,889 |
16,325 |
$170K |
| 73562 |
|
9,738 |
6,984 |
$168K |
| 96361 |
Intravenous infusion, hydration; each additional hour |
5,857 |
4,555 |
$166K |
| 74183 |
|
998 |
830 |
$165K |
| 73030 |
|
7,414 |
5,743 |
$163K |
| 87088 |
|
45,828 |
39,725 |
$157K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
1,325 |
978 |
$156K |
| 86480 |
|
3,782 |
3,558 |
$155K |
| J2505 |
Injection, pegfilgrastim, 6 mg |
63 |
38 |
$151K |
| 76819 |
Fetal biophysical profile; without non-stress testing |
1,463 |
1,203 |
$149K |
| 87510 |
|
9,196 |
8,575 |
$148K |
| 87480 |
|
9,197 |
8,576 |
$148K |
| 87660 |
|
9,196 |
8,575 |
$148K |
| 71250 |
|
2,976 |
2,339 |
$146K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
19,586 |
11,629 |
$145K |
| 82746 |
|
14,079 |
12,892 |
$143K |
| 86803 |
|
14,103 |
13,234 |
$140K |
| 93976 |
|
1,410 |
1,287 |
$137K |
| 72110 |
|
3,064 |
2,665 |
$131K |
| 72141 |
|
861 |
746 |
$131K |
| 97165 |
|
1,695 |
1,512 |
$122K |
| 92523 |
|
538 |
488 |
$117K |
| 88142 |
|
8,989 |
8,584 |
$116K |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
7,870 |
7,422 |
$115K |
| 62323 |
|
292 |
242 |
$114K |
| 97116 |
|
5,278 |
2,533 |
$110K |
| 88175 |
Cytopathology, cervical or vaginal, any reporting system; collected in preservative fluid, automated thin layer |
8,681 |
8,308 |
$108K |
| 73221 |
|
617 |
527 |
$106K |
| 83540 |
|
21,754 |
19,979 |
$103K |
| 84403 |
|
5,664 |
4,767 |
$102K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
45,642 |
33,302 |
$102K |
| 86703 |
|
8,830 |
8,304 |
$97K |
| 72197 |
|
337 |
301 |
$96K |
| 94060 |
|
536 |
450 |
$91K |
| 78815 |
Positron emission tomography (PET) for limited area imaging |
172 |
130 |
$91K |
| 96132 |
|
1,924 |
1,505 |
$91K |
| 84481 |
|
7,099 |
6,568 |
$88K |
| 83550 |
|
14,367 |
13,111 |
$86K |
| 86618 |
|
7,276 |
4,521 |
$85K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
75,459 |
54,650 |
$84K |
| 72100 |
|
2,443 |
2,103 |
$84K |
| 86780 |
|
7,485 |
6,866 |
$83K |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
1,312 |
1,059 |
$83K |
| 82670 |
|
3,578 |
3,349 |
$82K |
| 86696 |
|
5,172 |
4,875 |
$82K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
812 |
730 |
$81K |
| 94010 |
|
2,680 |
2,176 |
$80K |
| 74174 |
|
483 |
388 |
$80K |
| 83970 |
|
3,301 |
2,853 |
$79K |
| 87340 |
|
11,531 |
10,788 |
$77K |
| 96415 |
|
971 |
547 |
$75K |
| 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 |
3,589 |
3,280 |
$74K |
| 85027 |
|
27,770 |
22,794 |
$73K |
| 86769 |
|
1,957 |
1,411 |
$71K |
| 83525 |
|
6,732 |
6,087 |
$70K |
| 73130 |
|
5,039 |
3,525 |
$69K |
| 87070 |
|
23,638 |
20,256 |
$66K |
| 83001 |
|
4,272 |
4,012 |
$65K |
| 81003 |
|
99,598 |
81,207 |
$64K |
| 44970 |
|
13 |
12 |
$63K |
| 96417 |
|
1,222 |
656 |
$62K |
| 95816 |
|
484 |
353 |
$62K |
| 36430 |
|
999 |
601 |
$61K |
| 83655 |
|
5,404 |
5,239 |
$59K |
| 86695 |
|
5,172 |
4,875 |
$56K |
| 83002 |
|
3,560 |
3,346 |
$55K |
| Q0138 |
Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (non-esrd use) |
230 |
129 |
$54K |
| 88307 |
|
1,565 |
1,050 |
$54K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
10,476 |
8,867 |
$54K |
| 84152 |
|
3,409 |
3,283 |
$53K |
| 73110 |
|
3,514 |
2,829 |
$52K |
| 87633 |
Infectious agent detection by nucleic acid, respiratory virus, 12-25 targets |
1,513 |
1,314 |
$52K |
| 83013 |
|
965 |
909 |
$51K |
| 84702 |
|
11,184 |
8,465 |
$51K |
| P9016 |
Red blood cells, leukocytes reduced, each unit |
608 |
398 |
$50K |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
1,702 |
1,579 |
$50K |
| 73610 |
|
5,015 |
4,266 |
$49K |
| G0379 |
Direct admission of patient for hospital observation care |
173 |
112 |
$49K |
| 72050 |
|
802 |
703 |
$48K |
| 87798 |
Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism |
5,808 |
4,424 |
$48K |
| 82570 |
|
13,253 |
11,574 |
$46K |
| 88313 |
|
8,120 |
5,519 |
$45K |
| 84146 |
|
3,709 |
3,331 |
$45K |
| 95806 |
|
421 |
330 |
$45K |
| 84270 |
|
2,487 |
2,271 |
$45K |
| 72070 |
|
1,265 |
1,100 |
$44K |
| 87631 |
|
3,328 |
3,005 |
$43K |
| C8908 |
Magnetic resonance imaging without contrast followed by with contrast, breast; bilateral |
189 |
160 |
$43K |
| 87625 |
|
1,583 |
1,540 |
$43K |
| 87536 |
|
684 |
635 |
$42K |
| 87186 |
|
13,728 |
10,745 |
$42K |
| 86141 |
|
3,990 |
3,716 |
$41K |
| 82105 |
|
3,144 |
2,932 |
$40K |
| 87077 |
|
13,777 |
10,771 |
$40K |
| 19081 |
|
28 |
26 |
$40K |
| 82652 |
|
1,453 |
1,332 |
$39K |
| 86038 |
|
4,345 |
4,020 |
$39K |
| 87081 |
|
9,910 |
8,008 |
$39K |
| 70486 |
|
2,057 |
1,706 |
$38K |
| 84153 |
|
3,816 |
3,367 |
$38K |
| 82043 |
|
9,207 |
8,513 |
$38K |
| 72125 |
Computed tomography, cervical spine; without contrast material |
5,641 |
4,523 |
$38K |
| 29505 |
|
703 |
639 |
$37K |
| 97535 |
Self-care/home management training, each 15 minutes |
1,458 |
1,023 |
$35K |
| 84144 |
|
2,299 |
1,892 |
$35K |
| 86706 |
|
4,483 |
4,173 |
$35K |
| 73502 |
|
2,701 |
2,183 |
$34K |
| 95811 |
|
47 |
41 |
$34K |
| 73140 |
|
2,874 |
2,464 |
$33K |
| 85651 |
|
17,981 |
15,408 |
$33K |
| 96402 |
|
1,024 |
791 |
$32K |
| 82784 |
|
5,553 |
3,175 |
$32K |
| 80076 |
|
33,949 |
27,775 |
$32K |
| 83516 |
|
3,226 |
2,202 |
$31K |
| 83880 |
|
16,503 |
13,254 |
$31K |
| 84425 |
|
1,981 |
1,824 |
$31K |
| 73080 |
|
2,485 |
1,981 |
$31K |
| 83735 |
|
26,210 |
16,008 |
$30K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
2,550 |
2,070 |
$29K |
| 83520 |
|
2,695 |
2,389 |
$29K |
| 86140 |
|
14,288 |
12,053 |
$29K |
| 97113 |
|
812 |
215 |
$28K |
| 95700 |
|
209 |
185 |
$26K |
| 85730 |
|
23,041 |
17,876 |
$26K |
| 77061 |
|
3,846 |
3,084 |
$26K |
| 85610 |
|
37,723 |
24,714 |
$26K |
| 86709 |
|
3,027 |
2,815 |
$25K |
| 84466 |
|
2,501 |
2,344 |
$25K |
| 84402 |
|
1,851 |
1,625 |
$25K |
| 86787 |
|
3,431 |
3,134 |
$25K |
| 95250 |
|
568 |
324 |
$24K |
| 82378 |
|
2,705 |
2,248 |
$24K |
| 86592 |
|
6,717 |
6,288 |
$24K |
| 86762 |
|
3,812 |
3,567 |
$24K |
| 77090 |
|
692 |
547 |
$23K |
| 83020 |
|
3,840 |
3,579 |
$23K |
| 86406 |
|
2,869 |
2,690 |
$23K |
| 77091 |
|
692 |
547 |
$23K |
| 82627 |
|
1,248 |
1,164 |
$23K |
| 58558 |
|
15 |
13 |
$23K |
| 76882 |
|
410 |
339 |
$23K |
| 86850 |
|
15,593 |
12,722 |
$22K |
| 10060 |
|
167 |
152 |
$20K |
| 73560 |
|
1,447 |
831 |
$20K |
| 82533 |
|
1,741 |
1,463 |
$20K |
| 87147 |
|
9,838 |
7,530 |
$20K |
| 72131 |
|
474 |
395 |
$20K |
| 83615 |
|
9,428 |
7,716 |
$19K |
| 86235 |
|
879 |
430 |
$19K |
| 85007 |
|
15,632 |
13,305 |
$19K |
| 86255 |
|
1,797 |
1,154 |
$19K |
| 86800 |
|
1,667 |
1,389 |
$19K |
| 87501 |
|
5,902 |
3,858 |
$18K |
| 88312 |
|
4,000 |
3,154 |
$18K |
| 86376 |
|
1,836 |
1,695 |
$18K |
| 96118 |
|
306 |
252 |
$17K |
| 88112 |
|
1,140 |
873 |
$17K |
| 77062 |
|
2,160 |
1,931 |
$17K |
| 82985 |
|
1,634 |
1,502 |
$17K |
| 86360 |
|
538 |
485 |
$17K |
| 70491 |
|
155 |
121 |
$17K |
| 86694 |
|
1,420 |
1,325 |
$17K |
| 86920 |
|
689 |
422 |
$17K |
| J2469 |
Injection, palonosetron hcl, 25 mcg |
1,581 |
834 |
$16K |
| 86765 |
|
1,586 |
1,480 |
$16K |
| 10005 |
|
61 |
43 |
$16K |
| 88304 |
|
3,270 |
2,647 |
$16K |
| 80055 |
|
1,121 |
1,041 |
$15K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
9,949 |
9,077 |
$15K |
| 82950 |
|
3,599 |
3,423 |
$15K |
| 87899 |
|
3,525 |
1,704 |
$15K |
| 86735 |
|
1,283 |
1,202 |
$14K |
| 86160 |
|
1,561 |
798 |
$14K |
| 84165 |
|
2,821 |
2,414 |
$13K |
| 86747 |
|
1,874 |
877 |
$13K |
| 86300 |
|
1,469 |
1,232 |
$13K |
| 86665 |
|
1,179 |
556 |
$13K |
| 87046 |
|
3,953 |
1,777 |
$13K |
| 71271 |
|
134 |
131 |
$13K |
| 82951 |
|
1,154 |
1,097 |
$13K |
| 86430 |
|
2,944 |
2,758 |
$13K |
| J9217 |
Leuprolide acetate (for depot suspension), 7.5 mg |
134 |
112 |
$12K |
| 87522 |
Neg quan hep c or qual rna |
435 |
380 |
$12K |
| 74019 |
|
484 |
373 |
$12K |
| 83690 |
|
36,893 |
29,731 |
$12K |
| 82550 |
|
6,017 |
4,855 |
$12K |
| 97166 |
|
277 |
207 |
$11K |
| 74018 |
|
2,917 |
2,564 |
$11K |
| 88300 |
|
1,824 |
1,442 |
$11K |
| 86413 |
|
228 |
130 |
$11K |
| 73590 |
|
1,803 |
1,423 |
$11K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
968 |
700 |
$10K |
| 70498 |
|
1,852 |
1,536 |
$10K |
| 11044 |
|
41 |
12 |
$10K |
| 64635 |
|
21 |
13 |
$10K |
| 85044 |
|
4,005 |
3,527 |
$10K |
| 70544 |
|
210 |
157 |
$10K |
| 96133 |
|
226 |
164 |
$10K |
| 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 |
8,544 |
7,051 |
$10K |
| 86617 |
|
966 |
451 |
$10K |
| 71101 |
|
666 |
578 |
$9K |
| 86225 |
|
912 |
842 |
$9K |
| 87478 |
|
514 |
466 |
$9K |
| 87484 |
|
514 |
466 |
$9K |
| 87469 |
|
514 |
466 |
$9K |
| 87468 |
|
514 |
466 |
$9K |
| 86334 |
|
1,223 |
1,026 |
$9K |
| 83498 |
|
396 |
379 |
$9K |
| 76870 |
|
1,148 |
1,011 |
$8K |
| 84550 |
|
5,584 |
4,861 |
$8K |
| 82024 |
|
340 |
292 |
$8K |
| 12001 |
|
1,385 |
1,245 |
$8K |
| 84156 |
|
3,967 |
3,242 |
$8K |
| 87338 |
|
808 |
770 |
$8K |
| 84100 |
|
21,288 |
13,284 |
$8K |
| 83883 |
|
1,684 |
707 |
$8K |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
14,696 |
13,423 |
$8K |
| 86256 |
|
712 |
534 |
$7K |
| G0378 |
Hospital observation service, per hour |
12,854 |
10,062 |
$7K |
| 87075 |
|
2,580 |
1,928 |
$7K |
| 80069 |
|
1,299 |
1,131 |
$7K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
3,979 |
3,212 |
$7K |
| 87640 |
|
2,583 |
1,963 |
$7K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
9,752 |
7,022 |
$7K |
| 86364 |
|
773 |
640 |
$7K |
| 29125 |
|
1,861 |
1,688 |
$7K |
| 87045 |
|
2,002 |
1,776 |
$7K |
| 12011 |
|
820 |
728 |
$7K |
| 81025 |
|
39,471 |
33,348 |
$6K |
| 84480 |
|
1,056 |
972 |
$6K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
243 |
187 |
$6K |
| 76825 |
|
20 |
12 |
$6K |
| 86258 |
|
725 |
356 |
$6K |
| 81001 |
|
7,529 |
6,391 |
$6K |
| 93303 |
Transthoracic echocardiography for congenital cardiac anomalies, follow-up or limited study |
12 |
12 |
$6K |
| 84207 |
|
352 |
315 |
$6K |
| 83521 |
|
1,438 |
609 |
$6K |
| 86664 |
|
596 |
556 |
$6K |
| 93880 |
|
88 |
53 |
$6K |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
22,116 |
18,437 |
$5K |
| 87177 |
|
1,587 |
1,343 |
$5K |
| 85018 |
|
3,062 |
2,825 |
$5K |
| 86359 |
|
544 |
496 |
$5K |
| 87185 |
|
13,749 |
12,334 |
$5K |
| 85014 |
|
3,019 |
2,784 |
$5K |
| 83721 |
|
806 |
749 |
$5K |
| 82150 |
|
1,348 |
1,229 |
$5K |
| 80164 |
|
942 |
691 |
$5K |
| 73090 |
|
987 |
791 |
$5K |
| 85379 |
|
5,455 |
4,629 |
$5K |
| 82248 |
|
2,781 |
2,094 |
$5K |
| 90686 |
|
374 |
340 |
$5K |
| 84703 |
|
2,107 |
1,912 |
$5K |
| 86663 |
|
596 |
556 |
$5K |
| 82947 |
|
1,589 |
1,441 |
$5K |
| 87493 |
|
485 |
399 |
$4K |
| 76813 |
|
2,775 |
2,384 |
$4K |
| 86901 |
|
16,545 |
13,247 |
$4K |
| 82247 |
|
1,126 |
688 |
$4K |
| 83090 |
|
356 |
318 |
$4K |
| 84436 |
|
948 |
893 |
$4K |
| 86231 |
|
408 |
268 |
$4K |
| 82952 |
|
1,197 |
1,127 |
$4K |
| 77336 |
|
87 |
26 |
$4K |
| 80177 |
|
864 |
672 |
$4K |
| 84154 |
|
307 |
282 |
$4K |
| 74220 |
|
31 |
25 |
$4K |
| 82977 |
|
900 |
830 |
$4K |
| 72114 |
|
63 |
53 |
$3K |
| 86708 |
|
333 |
318 |
$3K |
| 82565 |
|
1,250 |
1,084 |
$3K |
| 87641 |
|
1,079 |
884 |
$3K |
| 36416 |
|
38,692 |
19,965 |
$3K |
| 84484 |
|
36,950 |
22,752 |
$3K |
| 78306 |
|
16 |
13 |
$3K |
| 82677 |
|
161 |
145 |
$3K |
| 82785 |
|
260 |
234 |
$3K |
| 86304 |
|
253 |
202 |
$3K |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
82 |
74 |
$3K |
| 86677 |
|
176 |
96 |
$3K |
| 29105 |
|
47 |
41 |
$3K |
| 86200 |
|
303 |
280 |
$3K |
| 72040 |
|
127 |
114 |
$3K |
| 96376 |
|
8,184 |
4,549 |
$3K |
| 29130 |
|
824 |
756 |
$3K |
| 87040 |
|
10,462 |
5,822 |
$3K |
| U0002 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
92 |
79 |
$3K |
| 84305 |
|
142 |
136 |
$3K |
| 97597 |
|
37 |
12 |
$2K |
| 12002 |
|
187 |
160 |
$2K |
| 81050 |
|
1,358 |
714 |
$2K |
| 86336 |
|
176 |
160 |
$2K |
| 94618 |
|
363 |
261 |
$2K |
| 84450 |
|
1,419 |
1,298 |
$2K |
| 73660 |
|
348 |
304 |
$2K |
| 72170 |
|
97 |
80 |
$2K |
| 86704 |
|
167 |
155 |
$2K |
| 82465 |
|
397 |
384 |
$2K |
| 73700 |
|
16 |
15 |
$1K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
12 |
12 |
$1K |
| 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 |
26 |
14 |
$1K |
| 83993 |
|
119 |
111 |
$1K |
| 86039 |
|
158 |
146 |
$1K |
| 84181 |
|
106 |
48 |
$1K |
| 84145 |
|
3,184 |
2,576 |
$1K |
| 92610 |
|
30 |
25 |
$1K |
| 90715 |
|
2,715 |
2,292 |
$1K |
| 29515 |
|
13 |
12 |
$1K |
| 86146 |
|
71 |
25 |
$1K |
| 87205 |
|
1,959 |
1,292 |
$1K |
| 72052 |
|
15 |
12 |
$1K |
| 87254 |
|
69 |
64 |
$1K |
| 86301 |
|
119 |
102 |
$1K |
| J2543 |
Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams) |
1,442 |
428 |
$1K |
| 76857 |
|
16 |
14 |
$1K |
| 86147 |
|
63 |
25 |
$1K |
| 83010 |
|
199 |
169 |
$984.82 |
| 82166 |
|
39 |
38 |
$891.99 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
5,678 |
5,213 |
$859.48 |
| 73060 |
|
264 |
226 |
$843.74 |
| 82232 |
|
182 |
146 |
$821.62 |
| G0279 |
Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066) |
278 |
200 |
$774.08 |
| 94762 |
|
34 |
13 |
$757.85 |
| 86308 |
|
476 |
439 |
$725.44 |
| 86645 |
|
55 |
51 |
$659.69 |
| 82948 |
|
39,282 |
15,895 |
$641.81 |
| 97163 |
|
14 |
12 |
$615.00 |
| G2024 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]) from an individual in a snf or by a laboratory on behalf of a hha, any specimen source |
2,338 |
2,016 |
$614.55 |
| 73521 |
|
21 |
15 |
$613.80 |
| 86666 |
|
76 |
33 |
$583.20 |
| 96401 |
|
20 |
12 |
$578.67 |
| 86644 |
|
55 |
51 |
$563.75 |
| 88302 |
|
671 |
539 |
$538.73 |
| 84132 |
|
2,147 |
1,716 |
$512.73 |
| 83605 |
|
8,671 |
6,265 |
$482.32 |
| 82274 |
|
40 |
40 |
$471.24 |
| 87269 |
|
58 |
32 |
$469.45 |
| 86705 |
|
54 |
51 |
$461.25 |
| 87272 |
|
57 |
31 |
$458.00 |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
13,620 |
9,979 |
$449.68 |
| 83695 |
|
49 |
49 |
$444.96 |
| 82805 |
|
1,333 |
949 |
$438.22 |
| 87102 |
|
118 |
95 |
$425.06 |
| 87425 |
|
87 |
71 |
$412.20 |
| 85397 |
|
29 |
26 |
$394.38 |
| 82397 |
|
36 |
33 |
$377.72 |
| 80175 |
|
66 |
56 |
$367.14 |
| J3490 |
Unclassified drugs |
50,481 |
22,376 |
$357.34 |
| Q9969 |
Tc-99m from non-highly enriched uranium source, full cost recovery add-on, per study dose |
662 |
539 |
$351.45 |
| 90656 |
|
22 |
22 |
$312.90 |
| 87563 |
|
14 |
13 |
$294.72 |
| J7040 |
Infusion, normal saline solution, sterile (500 ml = 1 unit) |
9,177 |
3,273 |
$284.41 |
| 86812 |
|
13 |
13 |
$271.15 |
| 84460 |
|
1,112 |
1,040 |
$261.71 |
| 84681 |
|
12 |
12 |
$238.44 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
17,967 |
13,547 |
$217.95 |
| 90732 |
|
19 |
12 |
$215.50 |
| 85613 |
|
35 |
24 |
$201.08 |
| 76376 |
|
752 |
634 |
$200.00 |
| 71100 |
|
17 |
14 |
$170.23 |
| 82172 |
|
13 |
12 |
$162.80 |
| 84432 |
|
15 |
12 |
$153.40 |
| 85246 |
|
13 |
12 |
$153.37 |
| 85240 |
|
15 |
13 |
$136.80 |
| J7030 |
Infusion, normal saline solution , 1000 cc |
7,959 |
6,344 |
$133.50 |
| J1650 |
Injection, enoxaparin sodium, 10 mg |
4,119 |
1,682 |
$131.63 |
| 80156 |
|
16 |
13 |
$125.19 |
| A9270 |
Non-covered item or service |
92,168 |
68,094 |
$115.14 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
19,526 |
14,964 |
$110.76 |
| J7060 |
5% dextrose/water (500 ml = 1 unit) |
5,864 |
2,111 |
$110.00 |
| G0108 |
Diabetes outpatient self-management training services, individual, per 30 minutes |
1,205 |
647 |
$100.00 |
| 83519 |
|
15 |
12 |
$90.00 |
| 70360 |
|
47 |
39 |
$88.86 |
| 73600 |
|
61 |
52 |
$87.89 |
| J0295 |
Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm |
3,364 |
1,387 |
$87.70 |
| 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 |
98 |
69 |
$87.15 |
| 82010 |
|
830 |
641 |
$84.86 |
| 85384 |
|
31 |
28 |
$81.10 |
| 81015 |
|
26,875 |
22,616 |
$79.14 |
| 89051 |
|
232 |
150 |
$78.90 |
| 82610 |
|
15 |
14 |
$77.88 |
| 82085 |
|
12 |
12 |
$75.90 |
| 82803 |
|
67 |
54 |
$67.44 |
| 88311 |
|
401 |
318 |
$67.21 |
| J3480 |
Injection, potassium chloride, per 2 meq |
592 |
345 |
$66.24 |
| 69209 |
|
243 |
220 |
$60.59 |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
8,026 |
5,825 |
$60.29 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
63 |
48 |
$60.00 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
6,314 |
3,263 |
$56.88 |
| P9612 |
Catheterization for collection of specimen, single patient, all places of service |
56 |
40 |
$54.60 |
| 82523 |
|
13 |
12 |
$53.55 |
| Q0144 |
Azithromycin dihydrate, oral, capsules/powder, 1 gram |
472 |
420 |
$49.52 |
| 87184 |
|
30 |
26 |
$46.13 |
| A9585 |
Injection, gadobutrol, 0.1 ml |
6,709 |
5,371 |
$44.36 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
37 |
37 |
$34.35 |
| J8597 |
Antiemetic drug, oral, not otherwise specified |
4,214 |
3,632 |
$30.41 |
| J3535 |
Drug administered through a metered dose inhaler |
2,980 |
2,407 |
$30.36 |
| J0780 |
Injection, prochlorperazine, up to 10 mg |
755 |
607 |
$28.19 |
| 94664 |
|
1,123 |
468 |
$27.19 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
23,990 |
17,762 |
$21.62 |
| C9399 |
Unclassified drugs or biologicals |
833 |
581 |
$15.64 |
| J2704 |
Injection, propofol, 10 mg |
23,980 |
16,675 |
$13.45 |
| S0028 |
Injection, famotidine, 20 mg |
7,485 |
5,331 |
$13.19 |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
2,641 |
2,050 |
$13.15 |
| J1170 |
Injection, hydromorphone, up to 4 mg |
4,605 |
2,816 |
$11.25 |
| J2001 |
Injection, lidocaine hcl for intravenous infusion, 10 mg |
22,652 |
16,043 |
$11.21 |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
9,405 |
6,540 |
$10.27 |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
18,301 |
14,548 |
$10.19 |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
7,315 |
5,859 |
$9.38 |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
1,635 |
1,294 |
$9.02 |
| 94760 |
|
3,508 |
1,782 |
$8.65 |
| 82009 |
|
132 |
93 |
$8.62 |
| J0665 |
Injection, bupivicaine, not otherwise specified, 0.5 mg |
630 |
494 |
$8.61 |
| J0690 |
Injection, cefazolin sodium, 500 mg |
9,245 |
5,927 |
$8.48 |
| J2060 |
Injection, lorazepam, 2 mg |
3,327 |
2,348 |
$8.16 |
| C9113 |
Injection, pantoprazole sodium, per vial |
1,097 |
497 |
$7.94 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
15,134 |
11,775 |
$7.24 |
| 84520 |
|
53 |
43 |
$6.94 |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
3,011 |
1,961 |
$6.81 |
| G8979 |
Mobility: walking & moving around functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting |
1,131 |
607 |
$4.86 |
| J1836 |
Injection, metronidazole, 10 mg |
167 |
72 |
$4.50 |
| G8978 |
Mobility: walking & moving around functional limitation, current status, at therapy episode outset and at reporting intervals |
926 |
524 |
$3.87 |
| 85008 |
|
285 |
235 |
$3.02 |
| G0103 |
Prostate cancer screening; prostate specific antigen test (psa) |
49 |
43 |
$2.42 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
19,398 |
13,416 |
$2.18 |
| G8980 |
Mobility: walking & moving around functional limitation, discharge status, at discharge from therapy or to end reporting |
482 |
291 |
$1.88 |
| G8985 |
Carrying, moving and handling objects, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting |
259 |
140 |
$1.13 |
| J1630 |
Injection, haloperidol, up to 5 mg |
686 |
528 |
$0.91 |
| Q0162 |
Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen |
1,628 |
1,452 |
$0.80 |
| G8984 |
Carrying, moving & handling objects functional limitation, current status, at therapy episode outset and at reporting intervals |
120 |
74 |
$0.55 |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
1,703 |
1,177 |
$0.28 |
| J2370 |
Injection, phenylephrine hcl, up to 1 ml |
1,630 |
1,129 |
$0.24 |
| J7050 |
Infusion, normal saline solution, 250 cc |
8,739 |
3,994 |
$0.00 |
| J1815 |
Injection, insulin, per 5 units |
4,126 |
1,562 |
$0.00 |
| J2785 |
Injection, regadenoson, 0.1 mg |
939 |
669 |
$0.00 |
| J2795 |
Injection, ropivacaine hydrochloride, 1 mg |
691 |
501 |
$0.00 |
| 64494 |
|
2,156 |
1,518 |
$0.00 |
| J3420 |
Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg |
1,288 |
761 |
$0.00 |
| A9500 |
Technetium tc-99m sestamibi, diagnostic, per study dose |
2,006 |
1,521 |
$0.00 |
| 88341 |
|
937 |
629 |
$0.00 |
| A4648 |
Tissue marker, implantable, any type, each |
1,188 |
923 |
$0.00 |
| C1769 |
Guide wire |
1,577 |
995 |
$0.00 |
| 99153 |
Mod sedat endo service >5yrs |
226 |
178 |
$0.00 |
| J1940 |
Injection, furosemide, up to 20 mg |
341 |
192 |
$0.00 |
| 88172 |
|
96 |
75 |
$0.00 |
| J2371 |
Injection, phenylephrine hydrochloride, 20 micrograms |
639 |
451 |
$0.00 |
| J1030 |
Injection, methylprednisolone acetate, 40 mg |
309 |
254 |
$0.00 |
| G9035 |
Oseltamivir phosphate, oral, brand, per 75 mg (for use in a medicare-approved demonstration project) |
48 |
45 |
$0.00 |
| G0472 |
Hepatitis c antibody screening, for individual at high risk and other covered indication(s) |
453 |
440 |
$0.00 |
| J0330 |
Injection, succinylcholine chloride, up to 20 mg |
110 |
81 |
$0.00 |
| J1642 |
Injection, heparin sodium, (heparin lock flush), per 10 units |
175 |
78 |
$0.00 |
| J2470 |
Injection, pantoprazole sodium, 40 mg |
176 |
91 |
$0.00 |
| C1781 |
Mesh (implantable) |
58 |
49 |
$0.00 |
| 80050 |
General health panel |
89 |
82 |
$0.00 |
| 70547 |
|
15 |
12 |
$0.00 |
| 76820 |
|
199 |
52 |
$0.00 |
| J0360 |
Injection, hydralazine hcl, up to 20 mg |
71 |
37 |
$0.00 |
| C1773 |
Retrieval device, insertable (used to retrieve fractured medical devices) |
22 |
12 |
$0.00 |
| A9503 |
Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries |
32 |
25 |
$0.00 |
| S0020 |
Injection, bupivicaine hydrochloride, 30 ml |
53 |
42 |
$0.00 |
| J2003 |
Injection, lidocaine hydrochloride, 1 mg |
578 |
489 |
$0.00 |
| J0280 |
Injection, aminophyllin, up to 250 mg |
20 |
12 |
$0.00 |
| J2920 |
Injection, methylprednisolone sodium succinate, up to 40 mg |
38 |
15 |
$0.00 |
| 76377 |
|
14 |
12 |
$0.00 |
| J0706 |
Injection, caffeine citrate, 5 mg |
54 |
41 |
$0.00 |
| 94660 |
|
19 |
12 |
$0.00 |
| J0697 |
Injection, sterile cefuroxime sodium, per 750 mg |
25 |
17 |
$0.00 |
| J3411 |
Injection, thiamine hcl, 100 mg |
116 |
52 |
$0.00 |
| J9045 |
Injection, carboplatin, 50 mg |
24 |
12 |
$0.00 |
| 87449 |
|
22 |
12 |
$0.00 |
| 96368 |
|
22 |
14 |
$0.00 |
| 64495 |
|
1,422 |
1,059 |
$0.00 |
| 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 |
3,189 |
2,240 |
$0.00 |
| C1713 |
Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable) |
1,304 |
1,009 |
$0.00 |
| J3301 |
Injection, triamcinolone acetonide, not otherwise specified, 10 mg |
4,715 |
3,226 |
$0.00 |
| J0171 |
Injection, adrenalin, epinephrine, 0.1 mg |
463 |
330 |
$0.00 |
| 94729 |
|
2,884 |
2,233 |
$0.00 |
| 76827 |
|
12 |
12 |
$0.00 |
| C1894 |
Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser |
418 |
265 |
$0.00 |
| J3489 |
Injection, zoledronic acid, 1 mg |
318 |
240 |
$0.00 |
| C1887 |
Catheter, guiding (may include infusion/perfusion capability) |
161 |
98 |
$0.00 |
| 93325 |
|
606 |
480 |
$0.00 |
| J2710 |
Injection, neostigmine methylsulfate, up to 0.5 mg |
85 |
66 |
$0.00 |
| 99152 |
|
1,131 |
860 |
$0.00 |
| J1644 |
Injection, heparin sodium, per 1000 units |
9,665 |
3,812 |
$0.00 |
| 27096 |
|
848 |
760 |
$0.00 |
| C1776 |
Joint device (implantable) |
15 |
12 |
$0.00 |
| J2919 |
Injection, methylprednisolone sodium succinate, 5 mg |
244 |
192 |
$0.00 |
| 0042T |
|
20 |
12 |
$0.00 |
| A9552 |
Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries |
191 |
137 |
$0.00 |
| 88173 |
|
243 |
142 |
$0.00 |
| C1758 |
Catheter, ureteral |
38 |
25 |
$0.00 |
| J7510 |
Prednisolone oral, per 5 mg |
181 |
153 |
$0.00 |
| J2916 |
Injection, sodium ferric gluconate complex in sucrose injection, 12.5 mg |
58 |
40 |
$0.00 |
| J0744 |
Injection, ciprofloxacin for intravenous infusion, 200 mg |
15 |
12 |
$0.00 |
| C1788 |
Port, indwelling (implantable) |
53 |
39 |
$0.00 |
| 76942 |
|
82 |
55 |
$0.00 |
| 88360 |
|
24 |
13 |
$0.00 |
| 73551 |
|
16 |
13 |
$0.00 |
| C1760 |
Closure device, vascular (implantable/insertable) |
18 |
14 |
$0.00 |
| 77012 |
|
13 |
12 |
$0.00 |
| 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 |
21 |
12 |
$0.00 |
| Q9966 |
Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml |
22 |
15 |
$0.00 |
| J1171 |
Injection, hydromorphone, 0.1 mg |
113 |
56 |
$0.00 |
| Q2038 |
Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluzone) |
24 |
12 |
$0.00 |
| 73100 |
|
17 |
15 |
$0.00 |