| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J9271 |
Injection, pembrolizumab, 1 mg |
955 |
763 |
$10.94M |
| 0450 |
Emergency room services |
133,327 |
116,580 |
$6.33M |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
102,044 |
91,085 |
$4.87M |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
154,251 |
119,515 |
$3.60M |
| 93975 |
|
18,734 |
18,271 |
$3.15M |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
15,221 |
14,911 |
$2.68M |
| 80053 |
Comprehensive metabolic panel |
138,528 |
122,174 |
$2.48M |
| 70450 |
Computed tomography, head or brain; without contrast material |
15,906 |
15,410 |
$2.38M |
| 0510 |
|
206,231 |
155,549 |
$2.27M |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
83,787 |
18,972 |
$2.26M |
| J1568 |
Injection, immune globulin, (octagam), intravenous, non-lyophilized (e.g., liquid), 500 mg |
1,085 |
207 |
$2.16M |
| 70553 |
Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences |
2,379 |
2,354 |
$2.01M |
| Z7502 |
|
54,071 |
53,475 |
$2.00M |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
33,847 |
32,013 |
$1.93M |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
146,378 |
128,475 |
$1.85M |
| 0360 |
|
18,867 |
9,575 |
$1.79M |
| 78815 |
Positron emission tomography (PET) for limited area imaging |
1,103 |
1,099 |
$1.74M |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
59,437 |
54,896 |
$1.62M |
| J9312 |
Injection, rituximab, 10 mg |
275 |
150 |
$1.36M |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
8,734 |
8,591 |
$1.34M |
| J0490 |
Injection, belimumab, 10 mg |
685 |
321 |
$1.33M |
| 99221 |
|
9,112 |
7,597 |
$1.32M |
| 87798 |
Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism |
22,270 |
21,635 |
$1.31M |
| 0121 |
|
235 |
209 |
$1.28M |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
26,812 |
24,961 |
$1.23M |
| J3490 |
Unclassified drugs |
159,326 |
71,372 |
$1.21M |
| 72148 |
Magnetic resonance imaging, lumbar spine; without contrast material |
2,204 |
2,174 |
$1.07M |
| 72125 |
Computed tomography, cervical spine; without contrast material |
5,206 |
5,108 |
$977K |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
3,897 |
3,837 |
$960K |
| J9035 |
Injection, bevacizumab, 10 mg |
1,501 |
1,232 |
$937K |
| 99499 |
|
15,327 |
12,110 |
$929K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
10,481 |
10,412 |
$928K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
16,829 |
16,066 |
$900K |
| 97763 |
|
10,054 |
2,831 |
$874K |
| 86803 |
|
33,213 |
33,015 |
$842K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
12,144 |
9,819 |
$776K |
| 73721 |
Magnetic resonance imaging, any joint of lower extremity; without contrast material |
2,017 |
1,958 |
$774K |
| 99070 |
|
246,285 |
108,413 |
$768K |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
1,707 |
1,674 |
$724K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
21,156 |
18,453 |
$705K |
| 84443 |
Thyroid stimulating hormone (TSH) |
23,175 |
22,062 |
$698K |
| 99231 |
Subsequent hospital care, per day, straightforward or low complexity |
14,072 |
11,909 |
$695K |
| J2505 |
Injection, pegfilgrastim, 6 mg |
219 |
160 |
$659K |
| 72141 |
|
1,242 |
1,233 |
$647K |
| A4649 |
Surgical supply; miscellaneous |
20,441 |
14,278 |
$646K |
| Z7500 |
|
17,540 |
15,424 |
$594K |
| 70498 |
|
3,201 |
3,155 |
$583K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
33,600 |
30,321 |
$574K |
| 71046 |
Radiologic examination, chest; 2 views |
32,581 |
31,504 |
$565K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
33,938 |
33,326 |
$558K |
| Q5120 |
Injection, pegfilgrastim-bmez (ziextenzo), biosimilar, 0.5 mg |
332 |
238 |
$554K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
11,177 |
10,881 |
$552K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
5,784 |
5,687 |
$552K |
| A4306 |
Disposable drug delivery system, flow rate of less than 50 ml per hour |
22,781 |
22,143 |
$549K |
| 0762 |
|
6,141 |
3,045 |
$541K |
| J1745 |
Injection, infliximab, excludes biosimilar, 10 mg |
424 |
275 |
$538K |
| Q5111 |
Injection, pegfilgrastim-cbqv (udenyca), biosimilar, 0.5 mg |
373 |
270 |
$529K |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
27,203 |
26,690 |
$528K |
| 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 |
8,497 |
7,691 |
$528K |
| J0897 |
Injection, denosumab, 1 mg |
256 |
243 |
$499K |
| 72131 |
|
2,831 |
2,791 |
$493K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
34,298 |
32,193 |
$490K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
8,440 |
8,289 |
$484K |
| 97750 |
|
12,060 |
10,723 |
$481K |
| 71250 |
|
2,466 |
2,418 |
$459K |
| 0241U |
Neonatal screening for hereditary disorders, genomic sequence analysis panel |
3,812 |
3,735 |
$454K |
| 70486 |
|
2,671 |
2,636 |
$438K |
| L1990 |
Ankle foot orthosis, double upright free plantar dorsiflexion, solid stirrup, calf band/cuff (double bar 'bk' orthosis), custom fabricated |
1,188 |
1,173 |
$429K |
| 80061 |
Lipid panel |
22,907 |
22,619 |
$421K |
| J0178 |
Injection, aflibercept, 1 mg |
210 |
195 |
$420K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
7,736 |
7,228 |
$416K |
| 84484 |
|
22,934 |
20,110 |
$411K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
23,043 |
20,791 |
$410K |
| 72128 |
|
2,271 |
2,239 |
$360K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,145 |
2,976 |
$358K |
| 99291 |
Critical care, evaluation and management of the critically ill patient, first 30-74 minutes |
1,601 |
1,574 |
$345K |
| A4663 |
Blood pressure cuff only |
16,273 |
14,633 |
$341K |
| 96413 |
Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance |
10,040 |
6,196 |
$338K |
| 73221 |
|
934 |
912 |
$336K |
| 93971 |
|
3,652 |
3,534 |
$331K |
| 93970 |
|
2,179 |
2,142 |
$329K |
| 0700 |
|
7,630 |
6,498 |
$328K |
| 76770 |
|
4,845 |
4,740 |
$327K |
| Z7610 |
|
33,780 |
19,961 |
$319K |
| 0202U |
Oncology (prostate), multianalyte, gene expression profiling |
1,054 |
1,040 |
$317K |
| 76830 |
Ultrasound, transvaginal |
5,401 |
5,313 |
$309K |
| 85027 |
|
28,188 |
26,510 |
$306K |
| 83690 |
|
26,181 |
24,491 |
$303K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
12,637 |
12,320 |
$303K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
1,911 |
1,876 |
$302K |
| 77066 |
Tomosynthesis, mammo |
2,840 |
2,811 |
$299K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
29,459 |
27,721 |
$298K |
| 73610 |
|
11,552 |
10,268 |
$276K |
| 73630 |
|
12,134 |
11,156 |
$275K |
| 97799 |
|
3,857 |
1,901 |
$270K |
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
3,760 |
3,710 |
$253K |
| 0761 |
|
6,828 |
6,209 |
$249K |
| 93976 |
|
1,444 |
1,400 |
$248K |
| 73130 |
|
9,902 |
8,859 |
$248K |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
2,709 |
2,507 |
$246K |
| 71045 |
Radiologic examination, chest; single view |
25,737 |
24,539 |
$240K |
| 81003 |
|
63,408 |
57,967 |
$239K |
| J3111 |
Injection, romosozumab-aqqg, 1 mg |
156 |
146 |
$237K |
| 99218 |
|
1,589 |
1,334 |
$228K |
| 59425 |
|
2,879 |
1,754 |
$224K |
| Q5119 |
Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg |
164 |
78 |
$222K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
4,263 |
3,013 |
$218K |
| 73030 |
|
8,636 |
8,192 |
$216K |
| 73110 |
|
9,038 |
7,793 |
$216K |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
9,503 |
8,531 |
$208K |
| 70496 |
|
1,400 |
1,378 |
$207K |
| 73562 |
|
8,272 |
7,884 |
$196K |
| 74178 |
|
1,012 |
997 |
$194K |
| G0378 |
Hospital observation service, per hour |
3,654 |
2,042 |
$194K |
| 83605 |
|
9,993 |
9,234 |
$193K |
| 90837 |
Psychotherapy, 53 minutes with patient |
1,697 |
1,364 |
$192K |
| 76642 |
|
3,687 |
3,624 |
$188K |
| 96415 |
|
4,966 |
3,501 |
$188K |
| P9047 |
Infusion, albumin (human), 25%, 50 ml |
982 |
475 |
$187K |
| 76801 |
|
3,827 |
3,446 |
$187K |
| 99232 |
Subsequent hospital care, per day, moderate complexity |
3,084 |
3,058 |
$179K |
| 92507 |
Treatment of speech, language, voice, communication, and/or auditory processing disorder |
2,960 |
1,338 |
$178K |
| J1453 |
Injection, fosaprepitant, 1 mg |
3,052 |
1,982 |
$177K |
| J2506 |
Injection, pegfilgrastim, excludes biosimilar, 0.5 mg |
246 |
179 |
$166K |
| 82803 |
|
4,644 |
4,477 |
$163K |
| 0206 |
|
18 |
12 |
$163K |
| 72100 |
|
6,117 |
6,012 |
$161K |
| 67028 |
Intravitreal injection of a pharmacologic agent |
2,968 |
2,700 |
$159K |
| 70491 |
|
797 |
786 |
$159K |
| 84702 |
|
7,649 |
6,421 |
$158K |
| 77065 |
Tomosynthesis, mammo |
1,931 |
1,872 |
$157K |
| Z9725 |
|
4,422 |
3,869 |
$155K |
| 74183 |
|
649 |
642 |
$154K |
| A9585 |
Injection, gadobutrol, 0.1 ml |
5,787 |
5,019 |
$153K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
7,399 |
6,260 |
$152K |
| 96417 |
|
3,754 |
2,382 |
$152K |
| 87040 |
|
4,798 |
4,561 |
$148K |
| 96367 |
|
4,742 |
3,122 |
$146K |
| 99152 |
|
3,387 |
3,369 |
$146K |
| 86850 |
|
12,451 |
11,928 |
$145K |
| 93325 |
|
1,460 |
1,445 |
$144K |
| 83735 |
|
12,646 |
10,007 |
$142K |
| 87340 |
|
7,490 |
7,418 |
$140K |
| 82947 |
|
15,705 |
12,261 |
$139K |
| J9355 |
Injection, trastuzumab, excludes biosimilar, 10 mg |
40 |
24 |
$138K |
| 99238 |
Hospital discharge day management, 30 minutes or less |
5,150 |
5,110 |
$138K |
| 83880 |
|
5,148 |
4,874 |
$132K |
| A9552 |
Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries |
630 |
628 |
$131K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
1,652 |
1,578 |
$130K |
| 76536 |
|
2,652 |
2,625 |
$128K |
| P9016 |
Red blood cells, leukocytes reduced, each unit |
554 |
495 |
$127K |
| 85610 |
|
21,199 |
18,969 |
$127K |
| 90715 |
|
4,460 |
4,291 |
$127K |
| 84439 |
|
7,752 |
7,483 |
$123K |
| 94060 |
|
3,240 |
3,162 |
$123K |
| 82948 |
|
18,764 |
15,094 |
$123K |
| 87186 |
|
8,012 |
7,683 |
$122K |
| 0710 |
|
4,736 |
4,508 |
$122K |
| 85730 |
|
12,678 |
12,205 |
$119K |
| 82728 |
|
5,608 |
5,384 |
$117K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
3,251 |
2,338 |
$115K |
| 66984 |
Extracapsular cataract removal with insertion of intraocular lens prosthesis |
572 |
559 |
$113K |
| 93308 |
|
1,192 |
1,165 |
$112K |
| 86901 |
|
15,233 |
14,408 |
$110K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
1,511 |
1,496 |
$107K |
| 92134 |
|
9,212 |
8,652 |
$106K |
| 73560 |
|
5,995 |
5,555 |
$106K |
| 77062 |
|
778 |
778 |
$105K |
| 97802 |
|
3,395 |
3,237 |
$103K |
| 97803 |
|
4,361 |
4,098 |
$102K |
| 86140 |
|
11,938 |
11,364 |
$101K |
| 99215 |
Prolong outpt/office vis |
623 |
593 |
$99K |
| 49083 |
|
1,845 |
918 |
$98K |
| Z7504 |
|
1,983 |
1,778 |
$98K |
| 59025 |
Fetal non-stress test |
5,155 |
3,650 |
$95K |
| 73590 |
|
4,783 |
4,367 |
$93K |
| 45385 |
Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) |
2,881 |
2,865 |
$91K |
| 73080 |
|
3,463 |
3,249 |
$91K |
| 76870 |
|
1,697 |
1,639 |
$90K |
| 86920 |
|
1,314 |
1,183 |
$88K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
1,676 |
1,533 |
$86K |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
26,206 |
23,054 |
$86K |
| 80047 |
|
11,090 |
10,474 |
$85K |
| 82607 |
|
3,293 |
3,197 |
$85K |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
2,919 |
2,908 |
$85K |
| 97597 |
|
2,094 |
707 |
$84K |
| 93320 |
|
1,369 |
1,358 |
$82K |
| J1439 |
Injection, ferric carboxymaltose, 1 mg |
103 |
80 |
$79K |
| 72040 |
|
3,303 |
3,235 |
$77K |
| 97039 |
|
3,075 |
1,666 |
$77K |
| J7050 |
Infusion, normal saline solution, 250 cc |
57,213 |
28,703 |
$76K |
| 86900 |
|
15,245 |
14,422 |
$74K |
| 77061 |
|
567 |
567 |
$73K |
| 80076 |
|
5,290 |
5,173 |
$73K |
| 72170 |
|
3,429 |
3,358 |
$73K |
| 73090 |
|
3,754 |
3,335 |
$73K |
| 81025 |
|
10,411 |
9,903 |
$71K |
| 84100 |
|
9,900 |
8,271 |
$70K |
| 93351 |
|
607 |
600 |
$69K |
| 45378 |
Colonoscopy, flexible; diagnostic, including collection of specimen(s) |
2,050 |
2,039 |
$69K |
| 93226 |
|
1,322 |
1,320 |
$68K |
| 90686 |
|
4,543 |
4,509 |
$67K |
| 92235 |
|
987 |
982 |
$66K |
| 73700 |
|
344 |
342 |
$66K |
| 20610 |
|
2,797 |
2,724 |
$63K |
| J2469 |
Injection, palonosetron hcl, 25 mcg |
3,061 |
1,960 |
$63K |
| 82746 |
|
2,423 |
2,334 |
$61K |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
1,239 |
1,193 |
$61K |
| 82550 |
|
5,629 |
5,118 |
$61K |
| 74018 |
|
3,622 |
3,529 |
$59K |
| 82378 |
|
1,701 |
1,438 |
$58K |
| 86923 |
|
296 |
273 |
$58K |
| 85651 |
|
10,310 |
9,782 |
$57K |
| 72197 |
|
247 |
246 |
$56K |
| 76811 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, detailed |
730 |
635 |
$56K |
| 93303 |
Transthoracic echocardiography for congenital cardiac anomalies, follow-up or limited study |
419 |
417 |
$56K |
| 73552 |
|
2,633 |
2,494 |
$55K |
| 97165 |
|
1,170 |
1,072 |
$55K |
| 86160 |
|
1,469 |
1,194 |
$53K |
| 73565 |
|
3,410 |
3,363 |
$53K |
| 93225 |
|
1,322 |
1,318 |
$52K |
| 95813 |
|
919 |
911 |
$52K |
| 73502 |
|
2,136 |
2,092 |
$52K |
| 86592 |
|
8,487 |
8,356 |
$52K |
| 80074 |
|
661 |
649 |
$52K |
| J7318 |
Hyaluronan or derivative, durolane, for intra-articular injection, 1 mg |
110 |
106 |
$51K |
| 94625 |
|
1,159 |
253 |
$50K |
| 94729 |
|
1,461 |
1,429 |
$50K |
| G0499 |
Hepatitis b screening in non-pregnant, high risk individual includes hepatitis b surface antigen (hbsag), antibodies to hbsag (anti-hbs) and antibodies to hepatitis b core antigen (anti-hbc), and is followed by a neutralizing confirmatory test, when performed, only for an initially reactive hbsag result |
1,815 |
1,798 |
$50K |
| 72070 |
|
1,834 |
1,804 |
$50K |
| J0640 |
Injection, leucovorin calcium, per 50 mg |
1,714 |
515 |
$49K |
| 67228 |
|
817 |
767 |
$49K |
| 84153 |
|
1,516 |
1,480 |
$48K |
| 96523 |
|
1,798 |
1,468 |
$47K |
| 82570 |
|
6,450 |
6,188 |
$47K |
| 76000 |
|
2,220 |
2,177 |
$45K |
| 45380 |
Colonoscopy, flexible; with biopsy, single or multiple |
1,829 |
1,822 |
$44K |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
26,442 |
22,006 |
$44K |
| 93798 |
|
2,157 |
410 |
$43K |
| 87210 |
|
5,845 |
5,406 |
$43K |
| 73060 |
|
2,136 |
1,949 |
$42K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
1,274 |
1,270 |
$42K |
| 77080 |
|
1,649 |
1,639 |
$42K |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
34,021 |
31,238 |
$42K |
| 84703 |
|
3,381 |
3,298 |
$42K |
| 77075 |
|
810 |
803 |
$42K |
| 83550 |
|
3,421 |
3,341 |
$40K |
| 94760 |
|
5,603 |
4,509 |
$39K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
578 |
568 |
$38K |
| 86703 |
|
2,370 |
2,316 |
$38K |
| 92250 |
|
2,716 |
2,482 |
$37K |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
1,743 |
1,740 |
$36K |
| Z1034 |
|
513 |
423 |
$36K |
| 76604 |
|
1,029 |
1,004 |
$35K |
| 99234 |
|
1,036 |
919 |
$35K |
| Q9957 |
Injection, perflutren lipid microspheres, per ml |
541 |
529 |
$35K |
| 84145 |
|
1,785 |
1,637 |
$34K |
| 83540 |
|
3,427 |
3,335 |
$34K |
| J1170 |
Injection, hydromorphone, up to 4 mg |
9,155 |
7,605 |
$34K |
| T1024 |
Evaluation and treatment by an integrated, specialty team contracted to provide coordinated care to multiple or severely handicapped children, per encounter |
885 |
833 |
$34K |
| 73070 |
|
1,824 |
1,593 |
$33K |
| A4217 |
Sterile water/saline, 500 ml |
8,557 |
8,286 |
$32K |
| 92523 |
|
354 |
354 |
$32K |
| 87070 |
|
2,121 |
2,051 |
$32K |
| 97139 |
|
1,389 |
574 |
$32K |
| A9541 |
Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries |
170 |
170 |
$32K |
| 99224 |
|
550 |
549 |
$31K |
| J0585 |
Injection, onabotulinumtoxina, 1 unit |
30 |
28 |
$31K |
| 87511 |
|
550 |
541 |
$31K |
| 73140 |
|
2,060 |
1,947 |
$31K |
| 87081 |
|
2,887 |
2,856 |
$30K |
| 82044 |
|
3,694 |
3,644 |
$30K |
| 86706 |
|
2,234 |
2,221 |
$30K |
| 85048 |
|
7,799 |
7,522 |
$29K |
| 93017 |
|
510 |
502 |
$29K |
| A4670 |
Automatic blood pressure monitor |
746 |
738 |
$28K |
| A9270 |
Non-covered item or service |
6,272 |
1,940 |
$28K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
762 |
753 |
$28K |
| 83615 |
|
2,892 |
2,560 |
$28K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
8,426 |
8,144 |
$28K |
| 73521 |
|
1,167 |
1,155 |
$27K |
| 78452 |
Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress |
98 |
97 |
$27K |
| J0780 |
Injection, prochlorperazine, up to 10 mg |
4,636 |
4,460 |
$26K |
| 73000 |
|
1,351 |
1,195 |
$26K |
| 72158 |
|
25 |
25 |
$26K |
| 83930 |
|
2,356 |
2,328 |
$25K |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
6,747 |
5,851 |
$25K |
| 85384 |
|
1,662 |
1,639 |
$25K |
| 87428 |
|
415 |
415 |
$25K |
| J2710 |
Injection, neostigmine methylsulfate, up to 0.5 mg |
1,356 |
1,318 |
$25K |
| 85379 |
|
1,414 |
1,369 |
$25K |
| 92133 |
|
2,283 |
2,248 |
$25K |
| 82010 |
|
1,818 |
1,720 |
$25K |
| J3301 |
Injection, triamcinolone acetonide, not otherwise specified, 10 mg |
4,891 |
4,719 |
$25K |
| 82553 |
|
1,041 |
733 |
$24K |
| 88312 |
|
2,500 |
2,482 |
$24K |
| 76641 |
|
338 |
289 |
$23K |
| 96416 |
|
521 |
335 |
$23K |
| 93880 |
|
172 |
168 |
$23K |
| 0760 |
|
980 |
848 |
$23K |
| 0515 |
|
767 |
756 |
$23K |
| 96361 |
Intravenous infusion, hydration; each additional hour |
831 |
607 |
$23K |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
18,822 |
16,168 |
$23K |
| 82105 |
|
1,346 |
1,313 |
$22K |
| 72110 |
|
511 |
508 |
$22K |
| 12001 |
|
1,286 |
1,272 |
$22K |
| 84132 |
|
3,110 |
2,914 |
$22K |
| 73200 |
|
115 |
111 |
$21K |
| 86318 |
|
870 |
835 |
$21K |
| G0423 |
Intensive cardiac rehabilitation; with or without continuous ecg monitoring; without exercise, per session |
257 |
48 |
$20K |
| J9267 |
Injection, paclitaxel, 1 mg |
875 |
421 |
$20K |
| J2704 |
Injection, propofol, 10 mg |
18,621 |
12,732 |
$20K |
| 90791 |
Psychiatric diagnostic evaluation |
140 |
134 |
$20K |
| 90670 |
|
1,656 |
1,592 |
$20K |
| 87653 |
|
628 |
619 |
$20K |
| 51701 |
|
1,435 |
1,406 |
$19K |
| 84550 |
|
2,700 |
2,472 |
$19K |
| 99225 |
|
328 |
327 |
$19K |
| 87563 |
|
567 |
558 |
$19K |
| 73501 |
|
1,094 |
1,060 |
$18K |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
27,316 |
24,314 |
$18K |
| 94726 |
|
575 |
568 |
$18K |
| 0001A |
|
956 |
956 |
$18K |
| 82950 |
|
2,397 |
2,360 |
$18K |
| J7060 |
5% dextrose/water (500 ml = 1 unit) |
9,193 |
4,835 |
$17K |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
569 |
560 |
$17K |
| 76813 |
|
313 |
269 |
$17K |
| J2785 |
Injection, regadenoson, 0.1 mg |
92 |
91 |
$16K |
| J1642 |
Injection, heparin sodium, (heparin lock flush), per 10 units |
3,185 |
2,027 |
$16K |
| 90834 |
Psychotherapy, 45 minutes with patient |
203 |
174 |
$16K |
| J9263 |
Injection, oxaliplatin, 0.5 mg |
1,086 |
386 |
$16K |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
8,053 |
7,563 |
$16K |
| 99153 |
Mod sedat endo service >5yrs |
1,516 |
1,507 |
$16K |
| 88304 |
|
1,277 |
1,266 |
$15K |
| 88307 |
|
532 |
531 |
$15K |
| S0020 |
Injection, bupivicaine hydrochloride, 30 ml |
2,370 |
2,311 |
$15K |
| 92526 |
|
349 |
192 |
$15K |
| 93271 |
|
216 |
216 |
$15K |
| 71020 |
|
733 |
568 |
$15K |
| 73564 |
|
566 |
526 |
$15K |
| 99217 |
|
579 |
579 |
$15K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
252 |
229 |
$15K |
| 12011 |
|
639 |
627 |
$14K |
| 74220 |
|
427 |
424 |
$14K |
| 93270 |
|
386 |
386 |
$14K |
| 82247 |
|
1,782 |
1,231 |
$14K |
| V5008 |
Hearing screening |
312 |
295 |
$14K |
| 36000 |
|
3,020 |
2,799 |
$13K |
| 84156 |
|
4,239 |
3,964 |
$13K |
| S0077 |
Injection, clindamycin phosphate, 300 mg |
767 |
681 |
$13K |
| 87088 |
|
1,637 |
1,598 |
$13K |
| 90656 |
|
646 |
645 |
$13K |
| A9502 |
Technetium tc-99m tetrofosmin, diagnostic, per study dose |
82 |
81 |
$13K |
| 95860 |
|
733 |
721 |
$13K |
| 52000 |
|
184 |
184 |
$12K |
| 67113 |
|
48 |
48 |
$12K |
| L3807 |
Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
97 |
97 |
$12K |
| J2370 |
Injection, phenylephrine hcl, up to 1 ml |
1,560 |
1,501 |
$12K |
| J1790 |
Injection, droperidol, up to 5 mg |
1,339 |
1,218 |
$12K |
| J9045 |
Injection, carboplatin, 50 mg |
494 |
308 |
$12K |
| 83970 |
|
272 |
258 |
$12K |
| J0690 |
Injection, cefazolin sodium, 500 mg |
7,967 |
7,408 |
$12K |
| 92551 |
|
898 |
865 |
$12K |
| 0002A |
|
384 |
384 |
$12K |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
20,570 |
19,373 |
$11K |
| E0197 |
Air pressure pad for mattress, standard mattress length and width |
84 |
78 |
$11K |
| 93925 |
|
129 |
128 |
$11K |
| 90723 |
|
1,263 |
1,206 |
$10K |
| 76001 |
|
129 |
117 |
$10K |
| 85060 |
|
559 |
514 |
$10K |
| 43235 |
|
342 |
340 |
$10K |
| 82140 |
|
606 |
589 |
$10K |
| A4209 |
Syringe with needle, sterile 5 cc or greater, each |
283 |
283 |
$10K |
| 73100 |
|
525 |
467 |
$10K |
| J9217 |
Leuprolide acetate (for depot suspension), 7.5 mg |
25 |
25 |
$10K |
| 90662 |
|
325 |
320 |
$10K |
| 0270 |
|
2,213 |
1,168 |
$10K |
| 92653 |
|
129 |
111 |
$10K |
| 78215 |
|
113 |
113 |
$9K |
| J0171 |
Injection, adrenalin, epinephrine, 0.1 mg |
2,957 |
2,660 |
$9K |
| 29125 |
|
806 |
768 |
$9K |
| 73660 |
|
612 |
596 |
$9K |
| 12002 |
|
530 |
525 |
$9K |
| 94618 |
|
614 |
603 |
$9K |
| L1810 |
Knee orthosis, elastic with joints, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
91 |
90 |
$9K |
| 47563 |
|
48 |
48 |
$9K |
| J0561 |
Injection, penicillin g benzathine, 100,000 units |
34 |
28 |
$9K |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
1,516 |
1,095 |
$9K |
| 72146 |
|
27 |
27 |
$9K |
| 99443 |
|
94 |
65 |
$9K |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
6,025 |
5,920 |
$8K |
| 74174 |
|
44 |
44 |
$8K |
| A4355 |
Irrigation tubing set for continuous bladder irrigation through a three-way indwelling foley catheter, each |
892 |
879 |
$8K |
| 83655 |
|
368 |
363 |
$8K |
| 90647 |
|
913 |
882 |
$8K |
| 76882 |
|
812 |
806 |
$8K |
| 85652 |
|
1,831 |
1,756 |
$8K |
| 29085 |
|
798 |
755 |
$8K |
| 51702 |
|
460 |
397 |
$7K |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
7,522 |
6,888 |
$7K |
| 87205 |
|
1,111 |
1,085 |
$7K |
| 87147 |
|
1,150 |
1,105 |
$7K |
| J9206 |
Injection, irinotecan, 20 mg |
277 |
112 |
$7K |
| J2916 |
Injection, sodium ferric gluconate complex in sucrose injection, 12.5 mg |
364 |
204 |
$7K |
| 0361 |
|
65 |
63 |
$7K |
| 81000 |
|
1,679 |
1,214 |
$7K |
| 90633 |
|
837 |
800 |
$7K |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
844 |
376 |
$7K |
| 74181 |
|
12 |
12 |
$7K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
562 |
212 |
$7K |
| 86705 |
|
296 |
293 |
$6K |
| J1650 |
Injection, enoxaparin sodium, 10 mg |
2,172 |
1,301 |
$6K |
| 86304 |
|
357 |
308 |
$6K |
| 99401 |
|
406 |
257 |
$6K |
| 36415 |
Collection of venous blood by venipuncture |
6,897 |
6,327 |
$6K |
| 73650 |
|
342 |
323 |
$6K |
| 87641 |
|
268 |
266 |
$6K |
| 74170 |
|
26 |
25 |
$6K |
| A4222 |
Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) |
202 |
147 |
$6K |
| 70487 |
|
29 |
29 |
$6K |
| 97161 |
|
281 |
279 |
$6K |
| 92083 |
|
1,295 |
1,280 |
$6K |
| 85045 |
|
991 |
899 |
$6K |
| 96402 |
|
513 |
473 |
$6K |
| 74240 |
|
119 |
119 |
$6K |
| 78264 |
|
58 |
58 |
$6K |
| 88341 |
|
25 |
25 |
$6K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
91 |
91 |
$6K |
| 85018 |
|
1,662 |
1,522 |
$6K |
| 29515 |
|
479 |
434 |
$6K |
| 72192 |
|
38 |
38 |
$5K |
| L1906 |
Ankle foot orthosis, multiligamentous ankle support, prefabricated, off-the-shelf |
38 |
38 |
$5K |
| 95819 |
|
151 |
140 |
$5K |
| J0330 |
Injection, succinylcholine chloride, up to 20 mg |
1,981 |
1,749 |
$5K |
| J9070 |
Cyclophosphamide, 100 mg |
28 |
12 |
$5K |
| A4301 |
Implantable access total catheter, port/reservoir (e.g., venous, arterial, epidural, subarachnoid, peritoneal, etc.) |
2,229 |
1,632 |
$5K |
| 72072 |
|
145 |
145 |
$5K |
| J1953 |
Injection, levetiracetam, 10 mg |
466 |
432 |
$5K |
| 92019 |
|
59 |
58 |
$5K |
| A4364 |
Adhesive, liquid or equal, any type, per oz |
1,994 |
1,957 |
$4K |
| 87077 |
|
682 |
636 |
$4K |
| A4215 |
Needle, sterile, any size, each |
4,495 |
3,078 |
$4K |
| 57288 |
|
38 |
38 |
$4K |
| 94727 |
|
184 |
175 |
$4K |
| J1644 |
Injection, heparin sodium, per 1000 units |
3,594 |
2,070 |
$4K |
| 11750 |
|
139 |
135 |
$4K |
| 10060 |
|
202 |
197 |
$4K |
| 90707 |
|
426 |
406 |
$4K |
| 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 |
53 |
53 |
$4K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
409 |
404 |
$4K |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
1,543 |
1,198 |
$4K |
| Q3014 |
Telehealth originating site facility fee |
193 |
179 |
$4K |
| 86431 |
|
412 |
410 |
$4K |
| 80069 |
|
273 |
269 |
$4K |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
3,192 |
3,061 |
$4K |
| J2920 |
Injection, methylprednisolone sodium succinate, up to 40 mg |
797 |
578 |
$4K |
| Q9968 |
Injection, non-radioactive, non-contrast, visualization adjunct (e.g., methylene blue, isosulfan blue), 1 mg |
177 |
148 |
$4K |
| 82310 |
|
478 |
461 |
$4K |
| J2543 |
Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams) |
814 |
691 |
$4K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
82 |
68 |
$4K |
| J2795 |
Injection, ropivacaine hydrochloride, 1 mg |
3,739 |
2,573 |
$4K |
| L3260 |
Surgical boot/shoe, each |
40 |
40 |
$4K |
| Z1032 |
|
25 |
25 |
$4K |
| 95251 |
|
137 |
137 |
$4K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
404 |
370 |
$4K |
| 90681 |
|
403 |
395 |
$3K |
| 90716 |
|
398 |
385 |
$3K |
| 88720 |
|
750 |
568 |
$3K |
| A4344 |
Indwelling catheter, foley type, two-way, all silicone or polyurethane, each |
254 |
246 |
$3K |
| 74160 |
|
14 |
14 |
$3K |
| J8540 |
Dexamethasone, oral, 0.25 mg |
960 |
754 |
$3K |
| 90732 |
|
76 |
72 |
$3K |
| 81005 |
|
832 |
646 |
$3K |
| 71270 |
|
13 |
13 |
$3K |
| 70481 |
|
14 |
14 |
$3K |
| 44970 |
|
18 |
17 |
$3K |
| 0259 |
|
1,546 |
1,129 |
$3K |
| 58558 |
|
25 |
25 |
$3K |
| Q0144 |
Azithromycin dihydrate, oral, capsules/powder, 1 gram |
479 |
457 |
$3K |
| 90700 |
|
354 |
344 |
$3K |
| J3370 |
Injection, vancomycin hcl, 500 mg |
523 |
450 |
$3K |
| 76706 |
|
70 |
68 |
$3K |
| J1580 |
Injection, garamycin, gentamicin, up to 80 mg |
712 |
648 |
$3K |
| C9257 |
Injection, bevacizumab, 0.25 mg |
12 |
12 |
$3K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
390 |
377 |
$3K |
| G0008 |
Administration of influenza virus vaccine |
555 |
553 |
$3K |
| 90710 |
|
313 |
296 |
$3K |
| 90649 |
|
308 |
292 |
$2K |
| J0360 |
Injection, hydralazine hcl, up to 20 mg |
557 |
518 |
$2K |
| 19083 |
|
106 |
105 |
$2K |
| 94664 |
|
218 |
218 |
$2K |
| 82270 |
|
419 |
414 |
$2K |
| A4356 |
External urethral clamp or compression device (not to be used for catheter clamp), each |
39 |
39 |
$2K |
| J2997 |
Injection, alteplase recombinant, 1 mg |
12 |
12 |
$2K |
| J3489 |
Injection, zoledronic acid, 1 mg |
90 |
85 |
$2K |
| J7030 |
Infusion, normal saline solution , 1000 cc |
162 |
150 |
$2K |
| 90696 |
|
275 |
258 |
$2K |
| J3480 |
Injection, potassium chloride, per 2 meq |
822 |
554 |
$2K |
| 90734 |
|
263 |
251 |
$2K |
| 96411 |
|
90 |
70 |
$2K |
| J1940 |
Injection, furosemide, up to 20 mg |
1,378 |
1,141 |
$2K |
| 97012 |
|
150 |
78 |
$2K |
| J2060 |
Injection, lorazepam, 2 mg |
2,294 |
2,074 |
$2K |
| 99490 |
Ccm add 20min |
52 |
52 |
$2K |
| 90657 |
|
299 |
299 |
$2K |
| 86593 |
|
260 |
259 |
$2K |
| 45390 |
|
72 |
72 |
$2K |
| 82951 |
|
90 |
90 |
$2K |
| 86301 |
|
108 |
92 |
$2K |
| 90739 |
|
12 |
12 |
$2K |
| J2560 |
Injection, phenobarbital sodium, up to 120 mg |
18 |
16 |
$2K |
| P9041 |
Infusion, albumin (human), 5%, 50 ml |
42 |
41 |
$2K |
| L1830 |
Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf |
25 |
24 |
$2K |
| 72052 |
|
39 |
38 |
$2K |
| 11721 |
|
180 |
177 |
$2K |
| A4212 |
Non-coring needle or stylet with or without catheter |
37 |
37 |
$2K |
| J0461 |
Injection, atropine sulfate, 0.01 mg |
533 |
337 |
$2K |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
95 |
93 |
$2K |
| 81001 |
|
300 |
243 |
$2K |
| 88173 |
|
52 |
52 |
$2K |
| 74230 |
|
37 |
37 |
$2K |
| J2800 |
Injection, methocarbamol, up to 10 ml |
234 |
183 |
$2K |
| J0697 |
Injection, sterile cefuroxime sodium, per 750 mg |
601 |
588 |
$2K |
| 96376 |
|
47 |
46 |
$2K |
| 66030 |
|
31 |
30 |
$1K |
| 95861 |
|
48 |
48 |
$1K |
| 86780 |
|
123 |
121 |
$1K |
| A4620 |
Variable concentration mask |
2,204 |
2,125 |
$1K |
| H1003 |
Prenatal care, at-risk enhanced service; education |
111 |
94 |
$1K |
| 92610 |
|
39 |
39 |
$1K |
| 73120 |
|
83 |
82 |
$1K |
| A4461 |
Surgical dressing holder, non-reusable, each |
734 |
726 |
$1K |
| 85007 |
|
254 |
234 |
$1K |
| G0202 |
Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (cad) when performed |
22 |
12 |
$1K |
| A4615 |
Cannula, nasal |
1,894 |
1,830 |
$1K |
| 85576 |
|
128 |
126 |
$1K |
| J2919 |
Injection, methylprednisolone sodium succinate, 5 mg |
367 |
269 |
$1K |
| 97116 |
|
76 |
40 |
$1K |
| A6403 |
Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing |
1,701 |
637 |
$1K |
| 78306 |
|
12 |
12 |
$1K |
| L4396 |
Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
12 |
12 |
$1K |
| 0451 |
|
25 |
25 |
$1K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
91 |
88 |
$1K |
| 71111 |
|
25 |
25 |
$1K |
| 81002 |
|
239 |
237 |
$1K |
| A4311 |
Insertion tray without drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
67 |
66 |
$1K |
| 90651 |
|
15 |
15 |
$1K |
| 97804 |
|
55 |
55 |
$1K |
| 43237 |
|
12 |
12 |
$1K |
| 20553 |
|
65 |
65 |
$1K |
| 92611 |
|
36 |
36 |
$1K |
| 94799 |
|
14 |
14 |
$1K |
| 72220 |
|
43 |
42 |
$1K |
| J0694 |
Injection, cefoxitin sodium, 1 gm |
86 |
85 |
$988.78 |
| 80164 |
|
56 |
50 |
$984.14 |
| A4556 |
Electrodes, (e.g., apnea monitor), per pair |
85 |
85 |
$969.39 |
| 25605 |
|
15 |
14 |
$948.78 |
| 82565 |
|
134 |
131 |
$930.86 |
| 73620 |
|
57 |
54 |
$915.10 |
| 71010 |
|
64 |
60 |
$908.29 |
| 10005 |
|
24 |
24 |
$891.38 |
| 90688 |
|
97 |
96 |
$873.00 |
| 93926 |
|
14 |
12 |
$872.48 |
| 95910 |
|
12 |
12 |
$869.16 |
| 82533 |
|
25 |
25 |
$848.09 |
| J9190 |
Injection, fluorouracil, 500 mg |
175 |
102 |
$817.32 |
| J9000 |
Injection, doxorubicin hydrochloride, 10 mg |
34 |
24 |
$752.50 |
| 43244 |
|
16 |
16 |
$740.49 |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
944 |
636 |
$711.55 |
| 29505 |
|
13 |
12 |
$710.86 |
| 11730 |
|
58 |
57 |
$698.79 |
| 76872 |
|
12 |
12 |
$698.64 |
| 74022 |
|
18 |
17 |
$685.73 |
| 82952 |
|
112 |
112 |
$658.88 |
| 87075 |
|
39 |
39 |
$650.36 |
| 71100 |
|
26 |
25 |
$638.54 |
| 84155 |
|
114 |
108 |
$634.73 |
| 76942 |
|
12 |
12 |
$633.61 |
| 85014 |
|
194 |
192 |
$631.17 |
| 90685 |
|
73 |
73 |
$621.00 |
| J2550 |
Injection, promethazine hcl, up to 50 mg |
309 |
276 |
$617.95 |
| J1120 |
Injection, acetazolamide sodium, up to 500 mg |
25 |
24 |
$603.24 |
| 82150 |
|
55 |
52 |
$602.03 |
| 88342 |
|
25 |
25 |
$596.38 |
| 84436 |
|
48 |
48 |
$585.12 |
| 51798 |
|
30 |
30 |
$580.19 |
| 29405 |
|
48 |
42 |
$578.06 |
| 88108 |
|
39 |
39 |
$576.47 |
| 11102 |
|
45 |
45 |
$568.48 |
| 74000 |
|
35 |
29 |
$564.55 |
| 58100 |
|
27 |
27 |
$560.86 |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
116 |
116 |
$541.72 |
| 97162 |
|
27 |
27 |
$531.53 |
| 86580 |
|
64 |
56 |
$522.73 |
| 76937 |
|
38 |
38 |
$520.08 |
| A4246 |
Betadine or phisohex solution, per pint |
26 |
26 |
$510.69 |
| J7040 |
Infusion, normal saline solution, sterile (500 ml = 1 unit) |
373 |
240 |
$503.92 |
| 94010 |
|
25 |
25 |
$465.74 |
| 71101 |
|
12 |
12 |
$452.22 |
| 97003 |
|
12 |
12 |
$449.73 |
| 20552 |
|
30 |
28 |
$445.05 |
| J2371 |
Injection, phenylephrine hydrochloride, 20 micrograms |
2,739 |
1,399 |
$375.59 |
| A7002 |
Tubing, used with suction pump, each |
89 |
89 |
$365.79 |
| 90648 |
|
47 |
47 |
$360.00 |
| 72190 |
|
12 |
12 |
$352.08 |
| 86704 |
|
17 |
17 |
$336.60 |
| 90658 |
|
38 |
37 |
$330.18 |
| 83993 |
|
19 |
19 |
$298.30 |
| J0665 |
Injection, bupivicaine, not otherwise specified, 0.5 mg |
1,550 |
1,046 |
$287.91 |
| 80185 |
|
13 |
12 |
$270.73 |
| 99188 |
|
15 |
15 |
$270.00 |
| J1805 |
Injection, esmolol hydrochloride, 10 mg |
597 |
322 |
$260.65 |
| 84520 |
|
41 |
41 |
$255.67 |
| A4616 |
Tubing (oxygen), per foot |
111 |
96 |
$255.04 |
| D1206 |
Topical application of fluoride varnish |
14 |
14 |
$252.00 |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
640 |
526 |
$243.11 |
| A4346 |
Indwelling catheter; foley type, three way for continuous irrigation, each |
14 |
14 |
$239.85 |
| 91010 |
|
12 |
12 |
$228.91 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
316 |
299 |
$224.84 |
| 29105 |
|
27 |
24 |
$220.37 |
| 12013 |
|
12 |
12 |
$216.00 |
| A4331 |
Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each |
58 |
58 |
$215.64 |
| 92552 |
|
13 |
13 |
$210.65 |
| 84300 |
|
31 |
30 |
$209.04 |
| J1741 |
Injection, ibuprofen, 100 mg |
47 |
44 |
$203.10 |
| 89051 |
|
24 |
24 |
$201.42 |
| 86709 |
|
12 |
12 |
$190.35 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
931 |
911 |
$178.08 |
| 97112 |
Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination |
18 |
13 |
$158.61 |
| J1171 |
Injection, hydromorphone, 0.1 mg |
329 |
216 |
$148.50 |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
12 |
12 |
$144.47 |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
15 |
12 |
$138.00 |
| 87102 |
|
12 |
12 |
$130.80 |
| 51700 |
|
15 |
15 |
$130.00 |
| 87807 |
|
13 |
12 |
$122.57 |
| A6252 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
17 |
14 |
$113.63 |
| 90621 |
|
12 |
12 |
$108.00 |
| J2470 |
Injection, pantoprazole sodium, 40 mg |
17 |
12 |
$100.38 |
| 85390 |
|
96 |
94 |
$89.28 |
| 69209 |
|
14 |
14 |
$81.00 |
| J0736 |
Injection, clindamycin phosphate, 300 mg |
26 |
25 |
$79.45 |
| 84460 |
|
13 |
12 |
$78.48 |
| 0271 |
|
13 |
12 |
$70.56 |
| A6407 |
Packing strips, non-impregnated, sterile, up to 2 inches in width, per linear yard |
15 |
12 |
$70.11 |
| 29130 |
|
15 |
12 |
$66.00 |
| J1250 |
Injection, dobutamine hydrochloride, per 250 mg |
13 |
13 |
$63.50 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
45 |
45 |
$57.25 |
| 88300 |
|
12 |
12 |
$44.40 |
| Q9966 |
Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml |
58 |
29 |
$42.60 |
| J0295 |
Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm |
13 |
13 |
$42.56 |
| J3411 |
Injection, thiamine hcl, 100 mg |
12 |
12 |
$33.50 |
| J7510 |
Prednisolone oral, per 5 mg |
16 |
12 |
$33.00 |
| J1630 |
Injection, haloperidol, up to 5 mg |
42 |
35 |
$26.78 |
| A4760 |
Dialysate solution test kit, for peritoneal dialysis, any type, each |
94 |
49 |
$15.74 |
| J2252 |
Injection, midazolam in 0.8% sodium chloride, intravenous, not therapeutically equivalent to j2250, 1 mg |
22 |
12 |
$8.47 |
| 0258 |
|
160 |
152 |
$6.80 |
| J1836 |
Injection, metronidazole, 10 mg |
27 |
26 |
$3.63 |
| H0049 |
Alcohol and/or drug screening |
106 |
104 |
$0.00 |
| G8433 |
Screening for depression not completed, documented patient or medical reason |
449 |
429 |
$0.00 |
| 80320 |
|
216 |
187 |
$0.00 |
| 80329 |
|
120 |
99 |
$0.00 |
| 0636 |
|
17 |
14 |
$0.00 |
| 3052F |
|
24 |
24 |
$0.00 |
| 0250 |
|
19 |
14 |
$0.00 |
| A4550 |
Surgical trays |
276 |
237 |
$0.00 |
| G8511 |
Screening for depression documented as positive, follow-up plan not documented, reason not given |
220 |
206 |
$0.00 |
| 3051F |
|
25 |
25 |
$0.00 |
| G1010 |
Clinical decision support mechanism stanson, as defined by the medicare appropriate use criteria program |
128 |
111 |
$0.00 |
| 3046F |
|
27 |
27 |
$0.00 |
| 0272 |
|
19 |
15 |
$0.00 |