| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
73,638 |
61,822 |
$18.07M |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
41,982 |
31,752 |
$15.33M |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
16,628 |
11,639 |
$6.74M |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
7,293 |
6,314 |
$3.67M |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
5,608 |
4,902 |
$3.28M |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
21,408 |
18,846 |
$2.92M |
| 70450 |
Computed tomography, head or brain; without contrast material |
7,919 |
6,299 |
$1.76M |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
28,694 |
20,802 |
$1.47M |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
32,025 |
20,014 |
$1.29M |
| G0378 |
Hospital observation service, per hour |
5,048 |
2,860 |
$1.28M |
| 93458 |
|
1,426 |
628 |
$1.23M |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
3,062 |
2,275 |
$1.22M |
| 71045 |
Radiologic examination, chest; single view |
19,995 |
16,194 |
$1.05M |
| 71046 |
Radiologic examination, chest; 2 views |
13,796 |
11,889 |
$1.02M |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
2,177 |
1,620 |
$927K |
| 0241U |
Neonatal screening for hereditary disorders, genomic sequence analysis panel |
11,456 |
9,455 |
$845K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
13,305 |
6,756 |
$807K |
| 72125 |
Computed tomography, cervical spine; without contrast material |
2,246 |
1,928 |
$787K |
| 95714 |
|
911 |
373 |
$781K |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
13,434 |
4,521 |
$742K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
19,157 |
15,356 |
$727K |
| 78452 |
Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress |
2,315 |
822 |
$553K |
| 72131 |
|
1,597 |
1,344 |
$530K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
1,828 |
1,659 |
$491K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
1,348 |
1,166 |
$484K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
18,525 |
11,376 |
$457K |
| 36415 |
Collection of venous blood by venipuncture |
86,977 |
52,135 |
$454K |
| 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 |
5,758 |
4,167 |
$419K |
| 80053 |
Comprehensive metabolic panel |
42,486 |
35,058 |
$418K |
| C1713 |
Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable) |
328 |
254 |
$410K |
| 95700 |
|
937 |
471 |
$409K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
7,472 |
6,536 |
$382K |
| 73630 |
|
4,569 |
4,091 |
$375K |
| C1769 |
Guide wire |
3,241 |
2,112 |
$360K |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
13,065 |
10,694 |
$355K |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
8,334 |
5,997 |
$343K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
49,579 |
40,553 |
$335K |
| 0240U |
|
6,045 |
5,263 |
$320K |
| 96361 |
Intravenous infusion, hydration; each additional hour |
17,941 |
10,233 |
$319K |
| 73130 |
|
3,600 |
3,210 |
$311K |
| 73610 |
|
3,452 |
3,101 |
$305K |
| 93017 |
|
1,061 |
910 |
$305K |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
5,473 |
2,004 |
$300K |
| 72100 |
|
2,756 |
2,447 |
$283K |
| G0283 |
Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care |
8,505 |
2,674 |
$263K |
| 73030 |
|
2,935 |
2,450 |
$252K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
5,365 |
2,432 |
$250K |
| 45385 |
Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) |
411 |
320 |
$240K |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
7,827 |
7,362 |
$227K |
| 71250 |
|
971 |
741 |
$212K |
| 93971 |
|
1,341 |
1,163 |
$207K |
| C1725 |
Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability) |
2,206 |
1,056 |
$202K |
| 97161 |
|
3,256 |
2,919 |
$196K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
13,110 |
6,223 |
$196K |
| 93356 |
|
1,580 |
1,365 |
$188K |
| 84484 |
|
17,424 |
12,896 |
$183K |
| 73110 |
|
2,341 |
2,026 |
$178K |
| 12001 |
|
1,098 |
989 |
$173K |
| 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 |
3,812 |
2,892 |
$171K |
| 96376 |
|
5,157 |
3,630 |
$169K |
| C1887 |
Catheter, guiding (may include infusion/perfusion capability) |
1,752 |
1,356 |
$166K |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
484 |
426 |
$159K |
| 83880 |
|
5,676 |
4,596 |
$156K |
| 73564 |
|
2,046 |
1,738 |
$141K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
3,938 |
3,475 |
$140K |
| 99152 |
|
3,373 |
2,566 |
$139K |
| 73562 |
|
1,594 |
1,357 |
$138K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
16,635 |
13,150 |
$134K |
| 97012 |
|
2,914 |
966 |
$130K |
| 11042 |
Debridement, subcutaneous tissue (includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm |
673 |
327 |
$124K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
4,367 |
3,031 |
$123K |
| 74018 |
|
2,176 |
1,893 |
$122K |
| 10060 |
|
722 |
620 |
$117K |
| C1776 |
Joint device (implantable) |
1,124 |
802 |
$110K |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
1,292 |
1,162 |
$109K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
2,711 |
1,739 |
$109K |
| 97035 |
|
2,407 |
874 |
$106K |
| 0399T |
|
956 |
745 |
$105K |
| 94761 |
|
2,245 |
1,669 |
$100K |
| 45378 |
Colonoscopy, flexible; diagnostic, including collection of specimen(s) |
222 |
184 |
$96K |
| 83690 |
|
16,301 |
14,218 |
$95K |
| 73080 |
|
1,169 |
1,009 |
$94K |
| 76830 |
Ultrasound, transvaginal |
396 |
366 |
$93K |
| 84443 |
Thyroid stimulating hormone (TSH) |
5,421 |
4,905 |
$88K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
2,693 |
2,451 |
$87K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
2,655 |
2,459 |
$87K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
1,733 |
1,670 |
$85K |
| 81001 |
|
27,536 |
23,789 |
$85K |
| 84703 |
|
10,908 |
9,817 |
$85K |
| 83605 |
|
8,604 |
6,932 |
$84K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
5,434 |
5,107 |
$84K |
| 82947 |
|
13,068 |
5,421 |
$83K |
| J7030 |
Infusion, normal saline solution , 1000 cc |
18,529 |
15,246 |
$81K |
| J2704 |
Injection, propofol, 10 mg |
10,614 |
7,769 |
$79K |
| 45380 |
Colonoscopy, flexible; with biopsy, single or multiple |
235 |
158 |
$79K |
| 95711 |
|
406 |
355 |
$71K |
| 77014 |
|
550 |
40 |
$70K |
| 95951 |
|
140 |
41 |
$68K |
| 76937 |
|
1,034 |
742 |
$65K |
| 70486 |
|
270 |
246 |
$64K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
8,693 |
7,693 |
$62K |
| 72040 |
|
721 |
644 |
$61K |
| 73502 |
|
1,193 |
924 |
$61K |
| 99153 |
Mod sedat endo service >5yrs |
1,177 |
920 |
$60K |
| 97010 |
|
5,460 |
1,753 |
$59K |
| 90715 |
|
1,740 |
1,585 |
$57K |
| 73590 |
|
570 |
508 |
$56K |
| 47562 |
|
12 |
12 |
$56K |
| 83735 |
|
9,466 |
7,744 |
$55K |
| 85014 |
|
2,725 |
2,141 |
$54K |
| 85027 |
|
7,883 |
6,521 |
$53K |
| 80061 |
Lipid panel |
3,908 |
3,093 |
$53K |
| G0481 |
Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 8-14 drug class(es), including metabolite(s) if performed |
478 |
417 |
$52K |
| 87040 |
|
4,545 |
2,674 |
$50K |
| 85049 |
|
1,338 |
1,062 |
$50K |
| C1894 |
Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser |
1,584 |
1,064 |
$50K |
| A9502 |
Technetium tc-99m tetrofosmin, diagnostic, per study dose |
333 |
286 |
$49K |
| 93970 |
|
209 |
187 |
$47K |
| 80047 |
|
1,650 |
1,357 |
$45K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
454 |
402 |
$45K |
| 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 |
2,996 |
2,386 |
$44K |
| 73090 |
|
495 |
429 |
$42K |
| 84702 |
|
3,169 |
2,723 |
$41K |
| 85610 |
|
7,710 |
6,142 |
$41K |
| 29125 |
|
329 |
296 |
$41K |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
6,181 |
4,784 |
$40K |
| 97165 |
|
968 |
784 |
$39K |
| 71101 |
|
487 |
413 |
$38K |
| 45384 |
|
90 |
61 |
$37K |
| 87081 |
|
5,117 |
4,730 |
$35K |
| 74022 |
|
374 |
338 |
$34K |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
14,052 |
12,166 |
$33K |
| 81025 |
|
4,829 |
4,319 |
$33K |
| 97162 |
|
485 |
420 |
$33K |
| 97542 |
|
1,757 |
1,194 |
$32K |
| 0202U |
Oncology (prostate), multianalyte, gene expression profiling |
185 |
129 |
$31K |
| 87186 |
|
3,535 |
3,152 |
$31K |
| 85379 |
|
3,744 |
3,368 |
$31K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
1,254 |
1,131 |
$31K |
| 97033 |
|
773 |
292 |
$30K |
| 12011 |
|
215 |
204 |
$30K |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
11,969 |
7,830 |
$29K |
| 87077 |
|
2,559 |
2,254 |
$29K |
| 97166 |
|
494 |
410 |
$27K |
| 72148 |
Magnetic resonance imaging, lumbar spine; without contrast material |
65 |
62 |
$26K |
| 87070 |
|
3,231 |
2,049 |
$25K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,829 |
1,650 |
$25K |
| 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 |
49 |
40 |
$25K |
| 87633 |
Infectious agent detection by nucleic acid, respiratory virus, 12-25 targets |
61 |
59 |
$24K |
| J1644 |
Injection, heparin sodium, per 1000 units |
5,340 |
3,004 |
$23K |
| 72070 |
|
327 |
267 |
$23K |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
20,608 |
16,625 |
$23K |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
4,496 |
3,493 |
$23K |
| 70553 |
Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences |
45 |
40 |
$23K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
2,673 |
2,289 |
$23K |
| C1760 |
Closure device, vascular (implantable/insertable) |
185 |
145 |
$22K |
| J3370 |
Injection, vancomycin hcl, 500 mg |
1,337 |
959 |
$21K |
| 77336 |
|
279 |
56 |
$21K |
| C9803 |
Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
2,034 |
1,486 |
$20K |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
2,160 |
1,841 |
$20K |
| M0243 |
Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring |
167 |
157 |
$20K |
| 80320 |
|
307 |
256 |
$19K |
| 84132 |
|
2,880 |
2,117 |
$18K |
| 87507 |
|
62 |
56 |
$18K |
| J0690 |
Injection, cefazolin sodium, 500 mg |
3,599 |
2,566 |
$18K |
| 96367 |
|
807 |
482 |
$17K |
| 87088 |
|
2,148 |
1,888 |
$17K |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
6,975 |
5,391 |
$17K |
| 81003 |
|
7,446 |
6,614 |
$17K |
| 85730 |
|
3,883 |
3,056 |
$16K |
| 82565 |
|
1,742 |
1,044 |
$16K |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
6,538 |
5,376 |
$16K |
| 80074 |
|
430 |
319 |
$15K |
| J1170 |
Injection, hydromorphone, up to 4 mg |
4,828 |
3,469 |
$15K |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
414 |
393 |
$14K |
| 73140 |
|
197 |
178 |
$14K |
| J1815 |
Injection, insulin, per 5 units |
3,464 |
637 |
$14K |
| 94729 |
|
273 |
249 |
$14K |
| 12002 |
|
84 |
63 |
$14K |
| 97014 |
|
342 |
117 |
$14K |
| J2710 |
Injection, neostigmine methylsulfate, up to 0.5 mg |
2,132 |
1,731 |
$13K |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
2,257 |
1,804 |
$13K |
| 84145 |
|
652 |
535 |
$13K |
| 97113 |
|
240 |
63 |
$13K |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
404 |
350 |
$12K |
| 82607 |
|
896 |
789 |
$12K |
| 62323 |
|
81 |
53 |
$12K |
| 87807 |
|
870 |
819 |
$12K |
| J0878 |
Injection, daptomycin, 1 mg |
49 |
12 |
$12K |
| 77300 |
|
122 |
36 |
$11K |
| 72128 |
|
42 |
28 |
$11K |
| J2001 |
Injection, lidocaine hcl for intravenous infusion, 10 mg |
5,619 |
4,554 |
$11K |
| J2543 |
Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams) |
568 |
265 |
$11K |
| 80081 |
|
116 |
112 |
$10K |
| 80076 |
|
1,260 |
1,137 |
$10K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
112 |
93 |
$9K |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
4,319 |
2,689 |
$9K |
| 87205 |
|
2,068 |
1,795 |
$8K |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
224 |
94 |
$8K |
| M0247 |
Intravenous infusion, sotrovimab, includes infusion and post administration monitoring |
43 |
35 |
$8K |
| J7040 |
Infusion, normal saline solution, sterile (500 ml = 1 unit) |
4,196 |
2,621 |
$8K |
| 82803 |
|
453 |
305 |
$8K |
| J2550 |
Injection, promethazine hcl, up to 50 mg |
4,712 |
3,762 |
$8K |
| 97535 |
Self-care/home management training, each 15 minutes |
359 |
228 |
$8K |
| Q0247 |
Injection, sotrovimab, 500 mg |
18 |
16 |
$7K |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
6,174 |
4,846 |
$7K |
| 70498 |
|
16 |
15 |
$7K |
| 87147 |
|
423 |
392 |
$7K |
| 80305 |
|
731 |
624 |
$7K |
| 94760 |
|
298 |
148 |
$7K |
| 80050 |
General health panel |
194 |
167 |
$6K |
| 80179 |
|
565 |
493 |
$6K |
| 82550 |
|
1,127 |
810 |
$6K |
| 84439 |
|
633 |
574 |
$6K |
| 70496 |
|
15 |
13 |
$6K |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
251 |
230 |
$6K |
| 82150 |
|
1,022 |
921 |
$6K |
| 86140 |
|
1,289 |
1,056 |
$6K |
| 43249 |
|
12 |
12 |
$6K |
| 94060 |
|
169 |
109 |
$6K |
| J2060 |
Injection, lorazepam, 2 mg |
2,744 |
2,096 |
$6K |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
16 |
12 |
$6K |
| J0360 |
Injection, hydralazine hcl, up to 20 mg |
847 |
609 |
$6K |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
3,215 |
2,638 |
$6K |
| 97597 |
|
92 |
64 |
$6K |
| 82948 |
|
881 |
542 |
$5K |
| 87522 |
Neg quan hep c or qual rna |
106 |
99 |
$5K |
| C9113 |
Injection, pantoprazole sodium, per vial |
989 |
657 |
$5K |
| 64494 |
|
16 |
15 |
$5K |
| Q9956 |
Injection, octafluoropropane microspheres, per ml |
89 |
68 |
$5K |
| 77334 |
|
17 |
13 |
$5K |
| 76536 |
|
29 |
28 |
$5K |
| J0330 |
Injection, succinylcholine chloride, up to 20 mg |
582 |
467 |
$5K |
| J2785 |
Injection, regadenoson, 0.1 mg |
52 |
41 |
$5K |
| 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 |
54 |
47 |
$5K |
| J2272 |
Injection, morphine sulfate (fresenius kabi), not therapeutically equivalent to j2270, up to 10 mg |
1,579 |
1,334 |
$4K |
| 87210 |
|
869 |
518 |
$4K |
| J1040 |
Injection, methylprednisolone acetate, 80 mg |
460 |
381 |
$4K |
| 97112 |
Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination |
168 |
70 |
$4K |
| 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 |
1,388 |
1,079 |
$4K |
| G0483 |
Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 22 or more drug class(es), including metabolite(s) if performed |
44 |
31 |
$4K |
| 88304 |
|
81 |
68 |
$4K |
| 93925 |
|
24 |
19 |
$4K |
| 36416 |
|
509 |
363 |
$4K |
| 94726 |
|
65 |
60 |
$4K |
| 93922 |
|
56 |
47 |
$4K |
| J7050 |
Infusion, normal saline solution, 250 cc |
932 |
629 |
$3K |
| J0561 |
Injection, penicillin g benzathine, 100,000 units |
26 |
24 |
$3K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
275 |
244 |
$3K |
| J3490 |
Unclassified drugs |
620 |
261 |
$3K |
| 84100 |
|
806 |
662 |
$3K |
| J3300 |
Injection, triamcinolone acetonide, preservative free, 1 mg |
313 |
257 |
$3K |
| 82728 |
|
231 |
191 |
$3K |
| C1726 |
Catheter, balloon dilatation, non-vascular |
28 |
24 |
$3K |
| 80143 |
|
209 |
190 |
$3K |
| 96413 |
Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance |
26 |
12 |
$3K |
| J2370 |
Injection, phenylephrine hcl, up to 1 ml |
1,159 |
856 |
$3K |
| 86803 |
|
191 |
172 |
$3K |
| 84402 |
|
97 |
90 |
$3K |
| 84153 |
|
122 |
119 |
$3K |
| 64493 |
|
16 |
15 |
$3K |
| 84403 |
|
88 |
82 |
$3K |
| 82746 |
|
177 |
160 |
$3K |
| 86480 |
|
46 |
45 |
$3K |
| G8978 |
Mobility: walking & moving around functional limitation, current status, at therapy episode outset and at reporting intervals |
316 |
147 |
$2K |
| 96368 |
|
119 |
87 |
$2K |
| 87798 |
Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism |
67 |
65 |
$2K |
| 99406 |
|
142 |
124 |
$2K |
| M0245 |
Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring |
16 |
15 |
$2K |
| J3411 |
Injection, thiamine hcl, 100 mg |
280 |
223 |
$2K |
| 83516 |
|
120 |
68 |
$2K |
| 82330 |
|
211 |
161 |
$2K |
| 94664 |
|
365 |
309 |
$2K |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
1,375 |
1,230 |
$2K |
| 76870 |
|
12 |
12 |
$2K |
| 86787 |
|
139 |
134 |
$2K |
| 72170 |
|
37 |
30 |
$2K |
| 82570 |
|
375 |
340 |
$2K |
| 87486 |
|
59 |
57 |
$2K |
| 93880 |
|
16 |
12 |
$2K |
| 82105 |
|
100 |
92 |
$2K |
| 86900 |
|
588 |
479 |
$2K |
| 86901 |
|
573 |
477 |
$2K |
| 85651 |
|
424 |
382 |
$2K |
| 82677 |
|
65 |
58 |
$2K |
| 80361 |
|
106 |
98 |
$2K |
| 80365 |
|
106 |
98 |
$2K |
| 80356 |
|
106 |
98 |
$2K |
| 94618 |
|
40 |
37 |
$2K |
| 83550 |
|
187 |
160 |
$2K |
| J2919 |
Injection, methylprednisolone sodium succinate, 5 mg |
204 |
181 |
$2K |
| 85347 |
|
42 |
27 |
$1K |
| Q0169 |
Promethazine hydrochloride, 12.5 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 |
543 |
372 |
$1K |
| 83540 |
|
242 |
199 |
$1K |
| 86038 |
|
112 |
99 |
$1K |
| 86850 |
|
188 |
152 |
$1K |
| 83001 |
|
60 |
57 |
$1K |
| 73552 |
|
14 |
12 |
$1K |
| 87581 |
|
59 |
57 |
$1K |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
66 |
61 |
$1K |
| 82043 |
|
207 |
190 |
$1K |
| 76000 |
|
62 |
45 |
$1K |
| 87340 |
|
123 |
109 |
$1K |
| 82670 |
|
34 |
32 |
$1K |
| 84146 |
|
47 |
45 |
$1K |
| 86336 |
|
65 |
58 |
$1K |
| J0688 |
Injection, cefazolin sodium (hikma), not therapeutically equivalent to j0690, 500 mg |
309 |
200 |
$1K |
| 86376 |
|
59 |
58 |
$996.42 |
| J1956 |
Injection, levofloxacin, 250 mg |
114 |
88 |
$988.05 |
| 83970 |
|
38 |
29 |
$944.18 |
| 84480 |
|
65 |
58 |
$919.64 |
| J0171 |
Injection, adrenalin, epinephrine, 0.1 mg |
154 |
126 |
$896.37 |
| 86706 |
|
80 |
68 |
$850.33 |
| 84144 |
|
31 |
30 |
$826.39 |
| 86704 |
|
67 |
58 |
$816.09 |
| 84481 |
|
47 |
43 |
$814.63 |
| 86708 |
|
63 |
55 |
$791.81 |
| J2795 |
Injection, ropivacaine hydrochloride, 1 mg |
21 |
14 |
$791.19 |
| J1596 |
Injection, glycopyrrolate, 0.1 mg |
212 |
171 |
$787.36 |
| 84550 |
|
158 |
150 |
$727.27 |
| 86431 |
|
105 |
93 |
$685.87 |
| 80069 |
|
87 |
75 |
$678.26 |
| A9577 |
Injection, gadobenate dimeglumine (multihance), per ml |
14 |
14 |
$628.25 |
| J1650 |
Injection, enoxaparin sodium, 10 mg |
20 |
12 |
$618.46 |
| J0735 |
Injection, clonidine hydrochloride, 1 mg |
268 |
218 |
$597.63 |
| J7510 |
Prednisolone oral, per 5 mg |
236 |
226 |
$587.16 |
| J2003 |
Injection, lidocaine hydrochloride, 1 mg |
259 |
225 |
$586.71 |
| J0780 |
Injection, prochlorperazine, up to 10 mg |
114 |
109 |
$584.52 |
| 87075 |
|
71 |
65 |
$579.28 |
| 86200 |
|
38 |
35 |
$577.23 |
| 87420 |
|
48 |
46 |
$552.71 |
| 82140 |
|
34 |
27 |
$529.57 |
| 86800 |
|
28 |
26 |
$525.14 |
| G8987 |
Self care functional limitation, current status, at therapy episode outset and at reporting intervals |
61 |
44 |
$502.24 |
| 93799 |
|
16 |
13 |
$470.35 |
| J1642 |
Injection, heparin sodium, (heparin lock flush), per 10 units |
126 |
73 |
$454.75 |
| J3480 |
Injection, potassium chloride, per 2 meq |
90 |
53 |
$442.91 |
| J2310 |
Injection, naloxone hydrochloride, per 1 mg |
19 |
13 |
$438.34 |
| 87184 |
|
58 |
46 |
$435.32 |
| 87338 |
|
24 |
24 |
$428.88 |
| 84520 |
|
151 |
101 |
$385.77 |
| J7060 |
5% dextrose/water (500 ml = 1 unit) |
66 |
30 |
$368.79 |
| 82784 |
|
54 |
33 |
$364.69 |
| J3360 |
Injection, diazepam, up to 5 mg |
17 |
13 |
$357.91 |
| J2470 |
Injection, pantoprazole sodium, 40 mg |
97 |
75 |
$353.92 |
| 87046 |
|
28 |
12 |
$351.95 |
| C1889 |
Implantable/insertable device, not otherwise classified |
13 |
13 |
$347.42 |
| 85652 |
|
135 |
108 |
$326.28 |
| 85007 |
|
97 |
89 |
$325.91 |
| 83883 |
|
17 |
13 |
$314.19 |
| 84450 |
|
51 |
48 |
$312.88 |
| 36600 |
|
13 |
12 |
$285.35 |
| 85018 |
|
99 |
76 |
$282.22 |
| 84156 |
|
76 |
71 |
$280.55 |
| J1171 |
Injection, hydromorphone, 0.1 mg |
42 |
31 |
$274.03 |
| 82962 |
|
126 |
100 |
$273.16 |
| G8988 |
Self care functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting |
63 |
44 |
$267.37 |
| 82553 |
|
29 |
12 |
$261.68 |
| 82951 |
|
17 |
15 |
$252.17 |
| 86592 |
|
51 |
50 |
$251.58 |
| 86039 |
|
18 |
17 |
$250.16 |
| 86308 |
|
43 |
38 |
$243.70 |
| J1598 |
Injection, glycopyrrolate (fresenius kabi), not therapeutically equivalent to j1596, 0.1 mg |
79 |
71 |
$235.29 |
| 84295 |
|
162 |
129 |
$233.57 |
| 80164 |
|
13 |
13 |
$222.13 |
| 81015 |
|
721 |
602 |
$217.32 |
| 84165 |
|
16 |
15 |
$214.92 |
| G8979 |
Mobility: walking & moving around functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting |
181 |
122 |
$180.94 |
| Q9963 |
High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml |
15 |
12 |
$180.41 |
| J2371 |
Injection, phenylephrine hydrochloride, 20 micrograms |
363 |
214 |
$177.48 |
| 87045 |
|
19 |
13 |
$163.97 |
| Q0177 |
Hydroxyzine pamoate, 25 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen |
158 |
65 |
$163.55 |
| 86780 |
|
15 |
12 |
$162.82 |
| 82374 |
|
125 |
100 |
$159.72 |
| 82435 |
|
127 |
101 |
$150.53 |
| 82977 |
|
13 |
13 |
$145.55 |
| J1630 |
Injection, haloperidol, up to 5 mg |
26 |
24 |
$135.03 |
| J1030 |
Injection, methylprednisolone acetate, 40 mg |
33 |
25 |
$119.60 |
| J8540 |
Dexamethasone, oral, 0.25 mg |
63 |
63 |
$114.60 |
| 84460 |
|
19 |
16 |
$107.13 |
| A9270 |
Non-covered item or service |
1,389 |
208 |
$84.00 |
| J1953 |
Injection, levetiracetam, 10 mg |
16 |
12 |
$74.50 |
| 82952 |
|
16 |
14 |
$72.78 |
| J7070 |
Infusion, d5w, 1000 cc |
30 |
26 |
$48.42 |
| Q9966 |
Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml |
17 |
13 |
$45.59 |
| J0665 |
Injection, bupivicaine, not otherwise specified, 0.5 mg |
32 |
24 |
$36.41 |
| J2004 |
Injection, lidocaine hcl with epinephrine, 1 mg |
12 |
12 |
$11.57 |
| Q0244 |
Injection, casirivimab and imdevimab, 1200 mg |
38 |
35 |
$0.00 |
| G8980 |
Mobility: walking & moving around functional limitation, discharge status, at discharge from therapy or to end reporting |
18 |
14 |
$0.00 |
| J2305 |
Injection, nitroglycerin, 5 mg |
28 |
14 |
$0.00 |