| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
651,324 |
484,205 |
$120.56M |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
115,061 |
97,838 |
$28.32M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
160,141 |
126,648 |
$26.37M |
| 92507 |
Treatment of speech, language, voice, communication, and/or auditory processing disorder |
86,272 |
32,415 |
$24.24M |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
83,799 |
68,954 |
$19.42M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
116,764 |
97,934 |
$18.49M |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
66,291 |
54,864 |
$16.16M |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
25,809 |
24,105 |
$15.80M |
| 96361 |
Intravenous infusion, hydration; each additional hour |
34,999 |
24,947 |
$14.71M |
| J9271 |
Injection, pembrolizumab, 1 mg |
2,346 |
1,385 |
$14.11M |
| J1569 |
Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg |
5,152 |
2,168 |
$9.94M |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
154,465 |
57,444 |
$9.40M |
| G0378 |
Hospital observation service, per hour |
49,357 |
31,168 |
$9.24M |
| 41899 |
Unlisted procedure, dentoalveolar structures |
4,470 |
3,903 |
$8.76M |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
47,510 |
40,660 |
$7.22M |
| 77386 |
|
11,560 |
971 |
$6.65M |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
14,180 |
12,176 |
$6.32M |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
84,511 |
36,738 |
$6.29M |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
16,656 |
11,112 |
$6.20M |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
38,832 |
25,543 |
$6.17M |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
19,903 |
17,207 |
$5.42M |
| 96413 |
Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance |
27,229 |
15,027 |
$5.40M |
| 70450 |
Computed tomography, head or brain; without contrast material |
21,347 |
18,163 |
$5.40M |
| J1745 |
Injection, infliximab, excludes biosimilar, 10 mg |
3,543 |
2,486 |
$5.36M |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
6,377 |
5,081 |
$4.89M |
| 70553 |
Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences |
10,498 |
9,366 |
$4.77M |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
21,019 |
18,428 |
$4.76M |
| 20610 |
|
12,876 |
9,884 |
$3.59M |
| 77412 |
|
7,428 |
863 |
$3.26M |
| 96415 |
|
7,430 |
4,123 |
$3.09M |
| 78815 |
Positron emission tomography (PET) for limited area imaging |
2,581 |
2,261 |
$3.05M |
| 59899 |
|
4,135 |
3,259 |
$3.04M |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
21,721 |
19,247 |
$3.03M |
| J0178 |
Injection, aflibercept, 1 mg |
2,359 |
1,793 |
$2.87M |
| 90837 |
Psychotherapy, 53 minutes with patient |
15,372 |
9,185 |
$2.81M |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
15,292 |
14,000 |
$2.79M |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
19,309 |
16,873 |
$2.78M |
| 42820 |
Tonsillectomy and adenoidectomy; younger than age 12 |
1,123 |
955 |
$2.75M |
| 99215 |
Prolong outpt/office vis |
16,860 |
14,050 |
$2.71M |
| 45385 |
Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) |
3,482 |
2,799 |
$2.67M |
| 45378 |
Colonoscopy, flexible; diagnostic, including collection of specimen(s) |
2,937 |
2,564 |
$2.63M |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
15,412 |
10,435 |
$2.63M |
| 78452 |
Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress |
2,829 |
2,415 |
$2.55M |
| 97112 |
Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination |
53,181 |
22,750 |
$2.51M |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
10,066 |
8,844 |
$2.46M |
| 93303 |
Transthoracic echocardiography for congenital cardiac anomalies, follow-up or limited study |
4,298 |
3,588 |
$2.45M |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
21,101 |
17,762 |
$2.39M |
| J0585 |
Injection, onabotulinumtoxina, 1 unit |
8,426 |
4,744 |
$2.33M |
| J2505 |
Injection, pegfilgrastim, 6 mg |
1,172 |
531 |
$2.22M |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
8,825 |
7,700 |
$2.19M |
| 97161 |
|
15,736 |
13,787 |
$2.16M |
| 43235 |
|
2,809 |
2,417 |
$2.13M |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
36,174 |
29,183 |
$2.10M |
| 93308 |
|
4,504 |
3,866 |
$2.09M |
| 52000 |
|
1,929 |
1,652 |
$2.03M |
| 76770 |
|
8,911 |
8,158 |
$2.01M |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
15,159 |
14,223 |
$1.96M |
| 93458 |
|
872 |
748 |
$1.96M |
| Q5111 |
Injection, pegfilgrastim-cbqv (udenyca), biosimilar, 0.5 mg |
744 |
417 |
$1.96M |
| Q5121 |
Injection, infliximab-axxq, biosimilar, (avsola), 10 mg |
977 |
682 |
$1.96M |
| 69436 |
Tympanostomy (requiring insertion of ventilating tube), general anesthesia |
1,637 |
1,134 |
$1.95M |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
49,610 |
19,875 |
$1.84M |
| 36430 |
|
7,566 |
3,838 |
$1.81M |
| 92526 |
|
24,270 |
12,144 |
$1.77M |
| J0485 |
Injection, belatacept, 1 mg |
3,276 |
1,554 |
$1.73M |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
14,199 |
12,355 |
$1.72M |
| 90834 |
Psychotherapy, 45 minutes with patient |
10,846 |
7,456 |
$1.71M |
| 74183 |
|
3,835 |
3,401 |
$1.64M |
| 45380 |
Colonoscopy, flexible; with biopsy, single or multiple |
2,413 |
1,921 |
$1.64M |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
5,425 |
4,677 |
$1.63M |
| 97162 |
|
9,209 |
8,165 |
$1.58M |
| 67028 |
Intravitreal injection of a pharmacologic agent |
5,377 |
3,922 |
$1.54M |
| 80048 |
Basic metabolic panel (calcium, ionized) |
191,528 |
127,041 |
$1.53M |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
4,195 |
3,756 |
$1.50M |
| P9016 |
Red blood cells, leukocytes reduced, each unit |
4,202 |
2,997 |
$1.49M |
| 80053 |
Comprehensive metabolic panel |
191,489 |
141,609 |
$1.40M |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
13,175 |
7,181 |
$1.40M |
| G0330 |
Facility services for dental rehabilitation procedure(s) performed on a patient who requires monitored anesthesia (e.g., general, intravenous sedation (monitored anesthesia care) and use of an operating room |
775 |
692 |
$1.39M |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
8,868 |
8,330 |
$1.38M |
| 64615 |
|
2,846 |
2,422 |
$1.37M |
| 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 |
31,722 |
26,303 |
$1.34M |
| 95810 |
Polysomnography; sleep staging with 4 or more additional parameters |
1,376 |
1,291 |
$1.33M |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
11,236 |
9,630 |
$1.30M |
| 92551 |
|
8,751 |
8,206 |
$1.29M |
| 31575 |
|
4,108 |
3,612 |
$1.29M |
| J9035 |
Injection, bevacizumab, 10 mg |
887 |
519 |
$1.27M |
| 92523 |
|
4,258 |
4,061 |
$1.25M |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
11,293 |
8,759 |
$1.22M |
| 36561 |
|
625 |
518 |
$1.20M |
| 97535 |
Self-care/home management training, each 15 minutes |
23,104 |
14,947 |
$1.19M |
| 73721 |
Magnetic resonance imaging, any joint of lower extremity; without contrast material |
3,905 |
3,435 |
$1.19M |
| 72148 |
Magnetic resonance imaging, lumbar spine; without contrast material |
4,990 |
4,532 |
$1.17M |
| 97116 |
|
20,619 |
9,532 |
$1.16M |
| J2357 |
Injection, omalizumab, 5 mg |
1,330 |
702 |
$1.15M |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
8,444 |
7,572 |
$1.14M |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
8,709 |
8,062 |
$1.10M |
| 87536 |
|
15,172 |
12,522 |
$1.08M |
| 90791 |
Psychiatric diagnostic evaluation |
4,420 |
4,000 |
$1.06M |
| 49083 |
|
1,434 |
595 |
$1.06M |
| 70498 |
|
6,223 |
5,369 |
$1.05M |
| 76830 |
Ultrasound, transvaginal |
6,224 |
5,471 |
$1.01M |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
80,720 |
74,698 |
$1.00M |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
3,653 |
3,405 |
$993K |
| 87633 |
Infectious agent detection by nucleic acid, respiratory virus, 12-25 targets |
12,991 |
11,112 |
$977K |
| P9040 |
Red blood cells, leukocytes reduced, irradiated, each unit |
2,703 |
1,224 |
$963K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
13,146 |
12,160 |
$935K |
| 95816 |
|
2,532 |
2,327 |
$923K |
| 36512 |
|
459 |
371 |
$913K |
| 81420 |
Fetal chromosomal aneuploidy genomic sequence analysis panel |
1,361 |
1,241 |
$911K |
| 97163 |
|
2,932 |
2,782 |
$897K |
| 72141 |
|
3,591 |
3,268 |
$860K |
| 54161 |
|
519 |
478 |
$851K |
| 59025 |
Fetal non-stress test |
3,282 |
2,472 |
$846K |
| 93017 |
|
5,407 |
4,626 |
$830K |
| 64643 |
|
1,593 |
1,385 |
$822K |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
9,355 |
8,205 |
$801K |
| 38222 |
|
1,358 |
867 |
$794K |
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
1,129 |
1,023 |
$792K |
| 93971 |
|
5,731 |
4,859 |
$784K |
| 93325 |
|
6,919 |
5,671 |
$779K |
| J3380 |
Injection, vedolizumab, intravenous, 1 mg |
201 |
168 |
$778K |
| 71250 |
|
7,341 |
6,342 |
$772K |
| 81220 |
CFTR (cystic fibrosis transmembrane conductance regulator) gene analysis; common variants |
1,334 |
1,227 |
$739K |
| 92610 |
|
3,503 |
3,153 |
$728K |
| Q5119 |
Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg |
235 |
95 |
$715K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
4,920 |
4,621 |
$714K |
| 66984 |
Extracapsular cataract removal with insertion of intraocular lens prosthesis |
414 |
360 |
$708K |
| 76819 |
Fetal biophysical profile; without non-stress testing |
5,681 |
3,448 |
$708K |
| 97165 |
|
5,958 |
5,064 |
$706K |
| 64483 |
|
973 |
781 |
$705K |
| J2323 |
Injection, natalizumab, 1 mg |
254 |
189 |
$701K |
| 64642 |
|
2,226 |
1,938 |
$701K |
| 90853 |
Group psychotherapy (other than of a multiple-family group) |
4,578 |
1,766 |
$672K |
| 75561 |
|
1,418 |
1,295 |
$644K |
| 70491 |
|
3,111 |
2,742 |
$642K |
| P9045 |
Infusion, albumin (human), 5%, 250 ml |
2,632 |
1,640 |
$640K |
| 99177 |
|
5,000 |
4,715 |
$639K |
| 70496 |
|
2,632 |
2,306 |
$632K |
| 76642 |
|
3,910 |
3,420 |
$631K |
| 90832 |
Psychotherapy, 30 minutes with patient |
4,588 |
3,311 |
$630K |
| 90686 |
|
42,951 |
39,149 |
$621K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
38,305 |
32,959 |
$619K |
| 93970 |
|
3,531 |
3,032 |
$617K |
| 76801 |
|
4,453 |
3,748 |
$599K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
27,478 |
25,726 |
$599K |
| 97803 |
|
6,110 |
5,650 |
$596K |
| 77336 |
|
5,236 |
2,289 |
$588K |
| 90651 |
|
9,025 |
8,456 |
$587K |
| 93975 |
|
3,709 |
3,287 |
$570K |
| 96367 |
|
7,517 |
4,854 |
$565K |
| 95806 |
|
678 |
625 |
$559K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
3,769 |
3,409 |
$549K |
| 76536 |
|
3,622 |
3,274 |
$549K |
| C9257 |
Injection, bevacizumab, 0.25 mg |
955 |
763 |
$545K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
35,524 |
29,663 |
$535K |
| G0257 |
Unscheduled or emergency dialysis treatment for an esrd patient in a hospital outpatient department that is not certified as an esrd facility |
2,609 |
1,400 |
$535K |
| 42830 |
|
177 |
160 |
$525K |
| 90677 |
|
6,239 |
5,892 |
$519K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
264,397 |
182,646 |
$518K |
| 17250 |
|
1,255 |
1,072 |
$510K |
| 77334 |
|
2,356 |
1,639 |
$510K |
| 71046 |
Radiologic examination, chest; 2 views |
42,663 |
35,092 |
$509K |
| 77301 |
|
356 |
308 |
$507K |
| 72197 |
|
1,389 |
1,254 |
$503K |
| 97166 |
|
2,817 |
2,605 |
$495K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
10,921 |
9,021 |
$491K |
| 95819 |
|
1,340 |
1,249 |
$489K |
| 95708 |
|
691 |
615 |
$477K |
| 83880 |
|
29,479 |
23,023 |
$469K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
38,304 |
32,958 |
$465K |
| J1561 |
Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mg |
239 |
126 |
$462K |
| 20550 |
|
1,571 |
1,156 |
$459K |
| 90670 |
|
25,023 |
23,042 |
$452K |
| 73221 |
|
1,611 |
1,466 |
$449K |
| 74178 |
|
1,516 |
1,340 |
$438K |
| 94010 |
|
11,581 |
9,979 |
$435K |
| 77002 |
|
2,729 |
2,303 |
$418K |
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
2,101 |
1,874 |
$417K |
| 97167 |
|
1,673 |
1,575 |
$415K |
| 31231 |
|
1,790 |
1,621 |
$411K |
| 58300 |
|
1,587 |
1,410 |
$405K |
| 96161 |
|
13,186 |
10,684 |
$402K |
| 97755 |
|
1,697 |
1,503 |
$395K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
95,720 |
74,371 |
$392K |
| J9299 |
Injection, nivolumab, 1 mg |
146 |
66 |
$388K |
| J2350 |
Injection, ocrelizumab, 1 mg |
13 |
13 |
$387K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
23,875 |
18,847 |
$383K |
| 96409 |
|
4,001 |
2,054 |
$378K |
| 88185 |
|
7,063 |
1,759 |
$378K |
| 77295 |
|
382 |
337 |
$378K |
| 93451 |
|
158 |
128 |
$377K |
| 95886 |
|
2,235 |
2,019 |
$375K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
46,034 |
33,466 |
$373K |
| 85027 |
|
117,168 |
85,041 |
$364K |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
27,133 |
23,411 |
$362K |
| P9073 |
Platelets, pheresis, pathogen-reduced, each unit |
618 |
188 |
$361K |
| 99173 |
|
5,716 |
5,331 |
$352K |
| 76942 |
|
4,832 |
3,749 |
$351K |
| 95885 |
|
2,003 |
1,844 |
$347K |
| J2353 |
Injection, octreotide, depot form for intramuscular injection, 1 mg |
125 |
105 |
$346K |
| 76604 |
|
3,421 |
2,930 |
$340K |
| 90715 |
|
14,994 |
13,480 |
$338K |
| 80197 |
|
21,067 |
11,274 |
$334K |
| 76937 |
|
4,427 |
3,472 |
$332K |
| 80061 |
Lipid panel |
48,654 |
41,188 |
$330K |
| 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 |
1,787 |
1,524 |
$329K |
| 72158 |
|
1,529 |
1,358 |
$323K |
| 95700 |
|
1,572 |
1,237 |
$315K |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
22,680 |
19,022 |
$313K |
| 97016 |
|
8,407 |
2,905 |
$312K |
| 36415 |
Collection of venous blood by venipuncture |
260,919 |
200,183 |
$307K |
| 96133 |
|
1,280 |
1,045 |
$306K |
| J0475 |
Injection, baclofen, 10 mg |
695 |
607 |
$301K |
| Q5103 |
Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg |
191 |
115 |
$301K |
| 96160 |
|
2,572 |
2,140 |
$299K |
| 76811 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, detailed |
1,852 |
1,721 |
$298K |
| 93296 |
|
8,916 |
7,956 |
$292K |
| 96416 |
|
665 |
344 |
$291K |
| Q5104 |
Injection, infliximab-abda, biosimilar, (renflexis), 10 mg |
220 |
118 |
$290K |
| 83735 |
|
115,256 |
70,416 |
$290K |
| 80076 |
|
33,627 |
22,374 |
$290K |
| 87522 |
Neg quan hep c or qual rna |
9,455 |
7,584 |
$288K |
| 97602 |
|
850 |
471 |
$288K |
| 74174 |
|
770 |
691 |
$284K |
| 90648 |
|
24,846 |
23,067 |
$281K |
| 93922 |
|
3,020 |
2,525 |
$279K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
1,508 |
1,348 |
$278K |
| 97597 |
|
3,054 |
1,769 |
$277K |
| 96130 |
|
645 |
573 |
$274K |
| 77001 |
|
2,103 |
1,597 |
$273K |
| 95716 |
|
661 |
354 |
$272K |
| 97802 |
|
3,095 |
2,845 |
$271K |
| 76775 |
|
1,748 |
1,558 |
$270K |
| 76870 |
|
1,954 |
1,710 |
$270K |
| 11981 |
|
717 |
643 |
$270K |
| 20680 |
|
258 |
216 |
$268K |
| J9144 |
Injection, daratumumab, 10 mg and hyaluronidase-fihj |
122 |
64 |
$268K |
| 97032 |
|
5,032 |
2,594 |
$260K |
| 74230 |
|
1,730 |
1,581 |
$257K |
| 83970 |
|
11,557 |
9,041 |
$257K |
| 70486 |
|
2,970 |
2,579 |
$252K |
| 84443 |
Thyroid stimulating hormone (TSH) |
56,094 |
46,323 |
$249K |
| 87632 |
|
2,058 |
1,972 |
$247K |
| 62323 |
|
318 |
277 |
$242K |
| 95811 |
|
388 |
337 |
$241K |
| 72125 |
Computed tomography, cervical spine; without contrast material |
8,546 |
7,330 |
$241K |
| 11982 |
|
488 |
454 |
$241K |
| 73610 |
|
14,223 |
10,701 |
$239K |
| 97760 |
|
5,102 |
4,104 |
$238K |
| 86833 |
|
2,131 |
1,777 |
$238K |
| 36591 |
|
13,765 |
6,048 |
$235K |
| 11042 |
Debridement, subcutaneous tissue (includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm |
658 |
424 |
$233K |
| 12001 |
|
756 |
704 |
$232K |
| 87653 |
|
4,890 |
4,319 |
$231K |
| 10060 |
|
1,219 |
1,035 |
$229K |
| 76882 |
|
1,808 |
1,563 |
$227K |
| 72156 |
|
1,403 |
1,271 |
$225K |
| 99291 |
Critical care, evaluation and management of the critically ill patient, first 30-74 minutes |
946 |
779 |
$224K |
| 96137 |
|
1,264 |
1,089 |
$221K |
| 86832 |
|
2,125 |
1,771 |
$220K |
| J7298 |
Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg |
355 |
319 |
$217K |
| 86780 |
|
20,693 |
17,699 |
$217K |
| 43762 |
|
776 |
706 |
$217K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
2,127 |
1,742 |
$215K |
| 76813 |
|
2,221 |
1,957 |
$212K |
| 97035 |
|
4,825 |
2,351 |
$211K |
| 94726 |
|
4,317 |
3,712 |
$210K |
| 73700 |
|
1,646 |
1,321 |
$210K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
1,682 |
1,488 |
$209K |
| 94729 |
|
5,177 |
4,458 |
$204K |
| 77280 |
|
595 |
396 |
$202K |
| 74018 |
|
7,908 |
6,703 |
$200K |
| J1756 |
Injection, iron sucrose, 1 mg |
5,192 |
2,132 |
$199K |
| 83655 |
|
8,671 |
7,566 |
$198K |
| 93880 |
|
1,615 |
1,364 |
$197K |
| 58301 |
|
837 |
748 |
$196K |
| J2997 |
Injection, alteplase recombinant, 1 mg |
1,768 |
775 |
$195K |
| 51784 |
|
753 |
649 |
$194K |
| 76498 |
|
651 |
561 |
$193K |
| G0438 |
Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit |
1,562 |
1,458 |
$193K |
| 92015 |
Determination of refractive state |
20,903 |
19,454 |
$189K |
| 29405 |
|
634 |
272 |
$188K |
| 72146 |
|
959 |
873 |
$186K |
| 76820 |
|
1,562 |
786 |
$183K |
| 73630 |
|
17,501 |
12,382 |
$183K |
| 94060 |
|
2,475 |
2,223 |
$183K |
| 87637 |
Infectious agent detection by nucleic acid; SARS-CoV-2, influenza, and RSV |
15,110 |
14,157 |
$181K |
| 77066 |
Tomosynthesis, mammo |
2,966 |
2,688 |
$181K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
1,780 |
1,602 |
$181K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
61,687 |
52,675 |
$178K |
| 97018 |
|
6,805 |
2,651 |
$178K |
| 86830 |
|
2,198 |
1,593 |
$177K |
| 78264 |
|
382 |
321 |
$176K |
| 77300 |
|
1,842 |
1,551 |
$175K |
| 96450 |
|
379 |
209 |
$175K |
| 86803 |
|
19,820 |
16,778 |
$174K |
| 95782 |
|
154 |
146 |
$174K |
| J1459 |
Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg |
185 |
93 |
$170K |
| 62370 |
|
1,161 |
1,033 |
$164K |
| 73030 |
|
14,038 |
10,585 |
$162K |
| 57454 |
|
271 |
218 |
$161K |
| 93350 |
|
489 |
408 |
$160K |
| 96523 |
|
3,500 |
1,489 |
$160K |
| 96132 |
|
1,351 |
1,100 |
$157K |
| 96116 |
|
776 |
669 |
$156K |
| 90723 |
|
17,033 |
15,839 |
$155K |
| 20552 |
|
589 |
509 |
$155K |
| 88142 |
|
9,158 |
7,612 |
$155K |
| 90633 |
|
14,418 |
13,602 |
$152K |
| 90870 |
|
351 |
187 |
$151K |
| 93926 |
|
1,477 |
1,178 |
$151K |
| J9312 |
Injection, rituximab, 10 mg |
96 |
28 |
$151K |
| P9047 |
Infusion, albumin (human), 25%, 50 ml |
421 |
211 |
$149K |
| 72040 |
|
6,229 |
5,228 |
$149K |
| 87799 |
|
5,560 |
3,441 |
$146K |
| 86831 |
|
2,127 |
1,560 |
$146K |
| 90734 |
|
6,231 |
5,663 |
$146K |
| 52310 |
|
171 |
129 |
$145K |
| 72100 |
|
9,960 |
8,493 |
$145K |
| 92083 |
|
4,801 |
4,105 |
$145K |
| 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 |
18,918 |
15,811 |
$144K |
| 76818 |
|
1,058 |
738 |
$144K |
| 77080 |
|
1,350 |
1,273 |
$143K |
| 12011 |
|
536 |
478 |
$142K |
| 71045 |
Radiologic examination, chest; single view |
26,072 |
20,942 |
$140K |
| 87497 |
|
3,294 |
1,870 |
$140K |
| 77338 |
|
389 |
334 |
$139K |
| 86360 |
|
12,933 |
10,559 |
$139K |
| 87624 |
Infectious agent detection by nucleic acid; human papillomavirus (HPV), high-risk types |
5,780 |
4,728 |
$138K |
| 88307 |
|
3,846 |
2,913 |
$138K |
| 49452 |
|
209 |
177 |
$137K |
| J1453 |
Injection, fosaprepitant, 1 mg |
1,667 |
778 |
$135K |
| 20605 |
|
478 |
385 |
$133K |
| 86850 |
|
39,830 |
30,230 |
$133K |
| 85610 |
|
55,610 |
38,931 |
$133K |
| 51728 |
|
367 |
326 |
$133K |
| 86359 |
|
12,946 |
10,568 |
$132K |
| 90636 |
|
1,364 |
1,187 |
$132K |
| 84484 |
|
52,195 |
38,891 |
$131K |
| 73590 |
|
8,655 |
6,568 |
$131K |
| 73562 |
|
8,486 |
6,265 |
$129K |
| 73564 |
|
12,639 |
10,006 |
$128K |
| 93304 |
|
320 |
216 |
$128K |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
4,326 |
4,104 |
$127K |
| Q9992 |
Injection, buprenorphine extended-release (sublocade), greater than 100 mg |
240 |
184 |
$127K |
| 86787 |
|
6,452 |
5,324 |
$127K |
| 90833 |
Psychotherapy, 30 minutes with patient when performed with an E&M service (add-on) |
997 |
907 |
$125K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
49,450 |
39,296 |
$125K |
| 77065 |
Tomosynthesis, mammo |
2,077 |
1,791 |
$124K |
| 77290 |
|
316 |
232 |
$124K |
| 86762 |
|
6,195 |
5,432 |
$123K |
| 82728 |
|
27,164 |
22,058 |
$122K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
45,019 |
37,178 |
$121K |
| 96401 |
|
1,847 |
786 |
$120K |
| 71271 |
|
804 |
740 |
$120K |
| 86923 |
|
4,579 |
2,916 |
$120K |
| 73560 |
|
9,592 |
7,211 |
$119K |
| 69210 |
|
2,153 |
1,892 |
$119K |
| 87040 |
|
9,243 |
6,858 |
$119K |
| 73130 |
|
9,865 |
7,034 |
$118K |
| J1642 |
Injection, heparin sodium, (heparin lock flush), per 10 units |
12,594 |
4,783 |
$117K |
| 87641 |
|
4,517 |
3,847 |
$117K |
| 90681 |
|
13,867 |
12,692 |
$116K |
| 72157 |
|
693 |
627 |
$115K |
| 93925 |
|
856 |
706 |
$115K |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
71,177 |
55,536 |
$115K |
| 87798 |
Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism |
13,365 |
11,651 |
$113K |
| 58100 |
|
485 |
355 |
$113K |
| 86900 |
|
42,547 |
31,964 |
$112K |
| 97164 |
|
773 |
701 |
$112K |
| 91322 |
|
2,118 |
1,894 |
$112K |
| 70543 |
|
287 |
225 |
$110K |
| 11102 |
|
270 |
176 |
$109K |
| 73502 |
|
10,152 |
8,106 |
$108K |
| 43248 |
|
125 |
90 |
$106K |
| 90847 |
Family psychotherapy with the patient present, 50 minutes |
443 |
360 |
$105K |
| 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 |
248 |
209 |
$104K |
| 91200 |
|
960 |
786 |
$103K |
| 92134 |
|
14,545 |
11,669 |
$103K |
| 84702 |
|
24,307 |
19,763 |
$102K |
| 80305 |
|
24,364 |
15,682 |
$100K |
| 84439 |
|
20,742 |
17,309 |
$100K |
| 88237 |
|
1,385 |
849 |
$99K |
| 82105 |
|
9,777 |
8,056 |
$99K |
| 81370 |
|
274 |
200 |
$98K |
| 92020 |
|
317 |
288 |
$98K |
| 83605 |
|
33,031 |
25,711 |
$96K |
| 90710 |
|
5,420 |
5,177 |
$95K |
| 0001A |
|
4,207 |
3,918 |
$95K |
| 82607 |
|
16,353 |
13,680 |
$94K |
| 96139 |
|
570 |
486 |
$93K |
| 86829 |
|
631 |
449 |
$93K |
| 87486 |
|
13,125 |
11,481 |
$93K |
| 0042T |
|
552 |
492 |
$90K |
| 90716 |
|
6,343 |
5,935 |
$90K |
| 52356 |
|
16 |
12 |
$88K |
| 0002A |
|
2,792 |
2,667 |
$86K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
657 |
606 |
$85K |
| 43760 |
|
239 |
212 |
$85K |
| 91300 |
|
8,127 |
7,139 |
$84K |
| 73110 |
|
6,590 |
5,167 |
$84K |
| 31615 |
|
43 |
39 |
$81K |
| G0472 |
Hepatitis c antibody screening, for individual at high risk and other covered indication(s) |
3,719 |
3,483 |
$81K |
| 19083 |
|
48 |
37 |
$81K |
| 90474 |
|
5,587 |
5,162 |
$80K |
| U0002 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
5,124 |
4,281 |
$79K |
| 36590 |
|
82 |
65 |
$79K |
| 92607 |
|
275 |
260 |
$79K |
| 96402 |
|
1,984 |
1,568 |
$79K |
| 97010 |
|
2,085 |
1,162 |
$78K |
| J0882 |
Injection, darbepoetin alfa, 1 microgram (for esrd on dialysis) |
83 |
24 |
$78K |
| 82784 |
|
8,998 |
7,063 |
$77K |
| 57420 |
|
126 |
98 |
$76K |
| 90707 |
|
7,498 |
7,037 |
$76K |
| 97763 |
|
1,640 |
1,191 |
$75K |
| 66982 |
|
46 |
39 |
$75K |
| 87340 |
|
20,813 |
17,692 |
$74K |
| 74455 |
|
321 |
293 |
$74K |
| 77073 |
|
4,803 |
4,129 |
$73K |
| 87581 |
|
13,124 |
11,482 |
$73K |
| 87517 |
|
2,151 |
1,784 |
$73K |
| 86901 |
|
42,395 |
31,930 |
$73K |
| 95951 |
|
156 |
96 |
$71K |
| 64450 |
|
190 |
141 |
$70K |
| 90671 |
|
678 |
630 |
$69K |
| L8699 |
Prosthetic implant, not otherwise specified |
1,330 |
665 |
$69K |
| 88341 |
|
3,078 |
2,271 |
$69K |
| J7050 |
Infusion, normal saline solution, 250 cc |
23,469 |
12,704 |
$69K |
| 76881 |
|
429 |
357 |
$69K |
| 70487 |
|
170 |
146 |
$68K |
| 20553 |
|
311 |
260 |
$68K |
| 81001 |
|
77,848 |
62,806 |
$68K |
| J2795 |
Injection, ropivacaine hydrochloride, 1 mg |
9,455 |
5,855 |
$68K |
| 77470 |
|
78 |
68 |
$67K |
| 54150 |
|
28 |
26 |
$67K |
| 82248 |
|
45,623 |
32,528 |
$67K |
| 86003 |
|
3,588 |
3,037 |
$66K |
| 88262 |
|
1,296 |
879 |
$66K |
| J3490 |
Unclassified drugs |
73,521 |
36,467 |
$66K |
| 90698 |
|
6,493 |
6,034 |
$65K |
| J9070 |
Cyclophosphamide, 100 mg |
606 |
198 |
$65K |
| 73552 |
|
5,985 |
4,755 |
$65K |
| 29075 |
|
152 |
118 |
$64K |
| 73070 |
|
3,204 |
2,517 |
$64K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
518 |
475 |
$63K |
| 84100 |
|
42,985 |
25,198 |
$63K |
| 86480 |
|
3,842 |
3,236 |
$63K |
| 90700 |
|
6,771 |
6,371 |
$63K |
| 92504 |
|
407 |
381 |
$63K |
| 70355 |
|
1,287 |
1,088 |
$63K |
| 87507 |
|
439 |
402 |
$62K |
| 78451 |
|
106 |
92 |
$62K |
| 73090 |
|
5,226 |
3,969 |
$61K |
| 72170 |
|
4,429 |
3,840 |
$61K |
| 73080 |
|
4,355 |
3,557 |
$61K |
| 92611 |
|
1,502 |
1,367 |
$61K |
| 90656 |
|
3,789 |
3,628 |
$60K |
| J2704 |
Injection, propofol, 10 mg |
92,516 |
49,232 |
$60K |
| 93321 |
|
1,168 |
918 |
$59K |
| 90999 |
Unlisted dialysis procedure, inpatient or outpatient |
587 |
64 |
$59K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
43,993 |
30,794 |
$58K |
| 0064U |
|
6,258 |
5,253 |
$58K |
| 87902 |
|
767 |
640 |
$58K |
| 92133 |
|
6,500 |
5,594 |
$57K |
| 84466 |
|
20,157 |
16,432 |
$57K |
| 95004 |
Percutaneous tests with allergenic extracts, immediate type reaction |
2,067 |
1,882 |
$57K |
| 36224 |
|
12 |
12 |
$57K |
| 62322 |
|
144 |
133 |
$57K |
| 77049 |
|
80 |
73 |
$57K |
| 95911 |
|
329 |
291 |
$57K |
| 95117 |
|
1,619 |
952 |
$56K |
| 88342 |
|
6,188 |
4,658 |
$56K |
| 80321 |
|
1,636 |
1,287 |
$56K |
| 96411 |
|
3,003 |
1,596 |
$55K |
| 86140 |
|
27,801 |
22,451 |
$54K |
| 96127 |
|
1,058 |
953 |
$53K |
| 83021 |
|
7,605 |
5,862 |
$53K |
| 95910 |
|
424 |
388 |
$53K |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
36,764 |
28,520 |
$53K |
| 86255 |
|
2,413 |
1,959 |
$53K |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
50,191 |
35,998 |
$53K |
| 70544 |
|
210 |
182 |
$52K |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
62,240 |
45,048 |
$52K |
| 92002 |
|
404 |
361 |
$52K |
| 90732 |
|
2,408 |
2,054 |
$51K |
| 93798 |
|
341 |
84 |
$50K |
| 11100 |
|
133 |
92 |
$50K |
| 36592 |
|
3,735 |
2,327 |
$50K |
| 90480 |
|
2,524 |
2,278 |
$50K |
| 73100 |
|
3,070 |
2,325 |
$49K |
| 70320 |
|
1,255 |
1,060 |
$49K |
| 36558 |
|
34 |
24 |
$49K |
| 83540 |
|
22,694 |
18,741 |
$49K |
| 99354 |
|
1,074 |
829 |
$49K |
| J7030 |
Infusion, normal saline solution , 1000 cc |
49,709 |
32,100 |
$49K |
| 86235 |
|
2,559 |
2,065 |
$48K |
| 74240 |
|
302 |
279 |
$48K |
| 72131 |
|
572 |
501 |
$48K |
| 88184 |
|
2,899 |
1,836 |
$47K |
| 88275 |
|
1,034 |
637 |
$47K |
| 84153 |
|
6,341 |
5,151 |
$46K |
| J2001 |
Injection, lidocaine hcl for intravenous infusion, 10 mg |
32,985 |
24,183 |
$46K |
| 72110 |
|
2,007 |
1,691 |
$46K |
| 84403 |
|
4,249 |
3,602 |
$45K |
| 88360 |
|
1,787 |
1,213 |
$45K |
| 99188 |
|
2,223 |
2,092 |
$45K |
| 95913 |
|
239 |
221 |
$45K |
| 81003 |
|
31,774 |
26,606 |
$45K |
| 83615 |
|
12,276 |
7,180 |
$44K |
| 88271 |
|
1,106 |
716 |
$44K |
| 54300 |
|
14 |
12 |
$43K |
| 82565 |
|
16,831 |
13,974 |
$43K |
| 72190 |
|
1,074 |
926 |
$42K |
| 86706 |
|
10,136 |
8,406 |
$42K |
| 10005 |
|
87 |
69 |
$42K |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
21,764 |
13,209 |
$42K |
| 92609 |
|
683 |
564 |
$41K |
| J3262 |
Injection, tocilizumab, 1 mg |
59 |
24 |
$41K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
2,061 |
1,852 |
$41K |
| 84402 |
|
1,982 |
1,679 |
$41K |
| 73200 |
|
258 |
228 |
$40K |
| G0476 |
Infectious agent detection by nucleic acid (dna or rna); human papillomavirus (hpv), high-risk types (e.g., 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) for cervical cancer screening, must be performed in addition to pap test |
1,111 |
1,048 |
$40K |
| 76512 |
|
265 |
228 |
$40K |
| 64493 |
|
45 |
30 |
$40K |
| 85730 |
|
21,099 |
16,740 |
$39K |
| 80364 |
|
3,278 |
2,489 |
$39K |
| 72082 |
|
3,290 |
2,910 |
$39K |
| 73060 |
|
3,250 |
2,589 |
$38K |
| 76000 |
|
2,499 |
2,049 |
$38K |
| Q5107 |
Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg |
41 |
12 |
$38K |
| 96040 |
|
258 |
222 |
$38K |
| G0297 |
Low dose ct scan (ldct) for lung cancer screening |
265 |
250 |
$38K |
| C1713 |
Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable) |
5,747 |
4,004 |
$38K |
| 64416 |
|
123 |
93 |
$37K |
| 73140 |
|
2,896 |
2,405 |
$37K |
| 80164 |
|
2,939 |
2,384 |
$37K |
| 82948 |
|
39,552 |
25,813 |
$36K |
| 77072 |
|
1,102 |
970 |
$36K |
| 84146 |
|
2,570 |
2,239 |
$36K |
| 85018 |
|
12,957 |
10,872 |
$35K |
| 82247 |
|
22,850 |
17,160 |
$35K |
| 81025 |
|
26,730 |
22,343 |
$35K |
| G2066 |
Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular physiologic monitor system, implantable loop recorder system, or subcutaneous cardiac rhythm monitor system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results |
1,345 |
1,241 |
$35K |
| 82533 |
|
2,246 |
1,760 |
$35K |
| J0690 |
Injection, cefazolin sodium, 500 mg |
27,199 |
17,976 |
$35K |
| 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 |
4,847 |
3,388 |
$35K |
| J8540 |
Dexamethasone, oral, 0.25 mg |
7,591 |
2,978 |
$34K |
| 84425 |
|
2,758 |
2,431 |
$34K |
| G0123 |
Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision |
1,956 |
1,785 |
$34K |
| 73620 |
|
2,613 |
1,827 |
$34K |
| 84156 |
|
17,297 |
13,576 |
$34K |
| G0008 |
Administration of influenza virus vaccine |
7,064 |
6,175 |
$34K |
| A9552 |
Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries |
2,970 |
2,647 |
$34K |
| 82805 |
|
11,464 |
9,335 |
$34K |
| 81329 |
|
1,164 |
1,076 |
$33K |
| 77062 |
|
963 |
907 |
$33K |
| 86704 |
|
7,666 |
6,270 |
$33K |
| 36593 |
|
170 |
128 |
$33K |
| 43249 |
|
41 |
37 |
$33K |
| 90746 |
|
1,474 |
1,297 |
$33K |
| 54640 |
|
14 |
12 |
$32K |
| 76827 |
|
1,060 |
879 |
$32K |
| C1894 |
Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser |
9,581 |
7,449 |
$32K |
| 86644 |
|
2,132 |
1,584 |
$32K |
| C1769 |
Guide wire |
12,077 |
9,230 |
$32K |
| 86334 |
|
3,030 |
2,386 |
$30K |
| 90696 |
|
2,731 |
2,649 |
$30K |
| 74221 |
|
245 |
229 |
$30K |
| 95874 |
|
1,015 |
846 |
$30K |
| 12002 |
|
114 |
104 |
$30K |
| 86160 |
|
3,986 |
3,091 |
$30K |
| J1950 |
Injection, leuprolide acetate (for depot suspension), per 3.75 mg |
80 |
66 |
$30K |
| 95909 |
|
214 |
203 |
$30K |
| 93799 |
|
3,415 |
1,778 |
$30K |
| 96138 |
|
565 |
485 |
$29K |
| 82746 |
|
8,733 |
7,298 |
$29K |
| 82977 |
|
2,352 |
1,794 |
$29K |
| 64644 |
|
184 |
153 |
$29K |
| 73600 |
|
2,174 |
1,682 |
$29K |
| 90662 |
|
2,870 |
2,391 |
$29K |
| 88312 |
|
1,481 |
1,120 |
$29K |
| 72070 |
|
1,874 |
1,628 |
$28K |
| 0124A |
|
2,011 |
1,766 |
$28K |
| 82670 |
|
1,753 |
1,467 |
$28K |
| 97542 |
|
507 |
326 |
$28K |
| 87631 |
|
1,351 |
1,178 |
$28K |
| 91312 |
|
2,037 |
1,796 |
$28K |
| 86665 |
|
1,290 |
958 |
$28K |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
10,535 |
8,036 |
$27K |
| 92522 |
|
66 |
65 |
$27K |
| 49450 |
|
35 |
29 |
$27K |
| 96376 |
|
20,421 |
11,956 |
$27K |
| 87077 |
|
15,227 |
12,454 |
$26K |
| 95953 |
|
75 |
64 |
$26K |
| 86038 |
|
6,091 |
5,023 |
$26K |
| 83516 |
|
1,893 |
1,591 |
$26K |
| 85379 |
|
4,176 |
3,617 |
$26K |
| 29826 |
|
27 |
25 |
$26K |
| 86870 |
|
1,171 |
860 |
$26K |
| 88313 |
|
3,101 |
2,113 |
$25K |
| 94618 |
|
169 |
150 |
$25K |
| 83690 |
|
33,859 |
27,732 |
$25K |
| 87529 |
|
1,098 |
925 |
$25K |
| 88304 |
|
3,046 |
2,629 |
$25K |
| 86922 |
|
816 |
501 |
$25K |
| 80177 |
|
3,373 |
2,664 |
$25K |
| 86708 |
|
4,516 |
3,857 |
$25K |
| 95970 |
|
469 |
402 |
$25K |
| 87640 |
|
3,889 |
3,258 |
$25K |
| 81382 |
|
200 |
169 |
$25K |
| G0475 |
Hiv antigen/antibody, combination assay, screening |
3,766 |
3,525 |
$24K |
| 86825 |
|
198 |
158 |
$24K |
| 91321 |
|
472 |
441 |
$24K |
| 0100U |
|
1,069 |
913 |
$24K |
| 72050 |
|
1,391 |
1,221 |
$24K |
| 82785 |
|
4,167 |
3,081 |
$23K |
| 88143 |
|
1,257 |
1,011 |
$23K |
| 83001 |
|
2,250 |
1,918 |
$23K |
| 87081 |
|
7,281 |
6,413 |
$23K |
| 77012 |
|
414 |
290 |
$22K |
| 87070 |
|
8,571 |
6,709 |
$22K |
| 85652 |
|
24,785 |
19,953 |
$22K |
| J1650 |
Injection, enoxaparin sodium, 10 mg |
10,186 |
3,955 |
$22K |
| 94660 |
|
97 |
54 |
$21K |
| C1751 |
Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis) |
2,877 |
2,217 |
$21K |
| 80320 |
|
3,374 |
2,579 |
$21K |
| 87075 |
|
3,384 |
2,642 |
$21K |
| 74019 |
|
1,971 |
1,759 |
$21K |
| J2545 |
Pentamidine isethionate, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per 300 mg |
60 |
50 |
$21K |
| 70480 |
|
111 |
109 |
$21K |
| 94621 |
|
148 |
141 |
$21K |
| 99406 |
|
762 |
656 |
$21K |
| 87184 |
|
11,197 |
9,111 |
$21K |
| A9609 |
Fludeoxyglucose f18 up to 15 millicuries |
103 |
86 |
$21K |
| 97014 |
|
489 |
226 |
$20K |
| 87210 |
|
4,779 |
4,204 |
$20K |
| 82043 |
|
11,251 |
9,501 |
$20K |
| 99153 |
Mod sedat endo service >5yrs |
3,426 |
2,717 |
$20K |
| 82950 |
|
3,850 |
3,475 |
$20K |
| 96417 |
|
4,610 |
2,427 |
$19K |
| J3315 |
Injection, triptorelin pamoate, 3.75 mg |
50 |
44 |
$19K |
| 93225 |
|
461 |
391 |
$19K |
| G0009 |
Administration of pneumococcal vaccine |
2,294 |
2,055 |
$19K |
| 86902 |
|
2,072 |
1,480 |
$19K |
| J0561 |
Injection, penicillin g benzathine, 100,000 units |
491 |
397 |
$19K |
| 20611 |
|
58 |
50 |
$19K |
| P9037 |
Platelets, pheresis, leukocytes reduced, irradiated, each unit |
37 |
12 |
$18K |
| 93320 |
|
4,160 |
3,469 |
$18K |
| 73000 |
|
1,014 |
786 |
$18K |
| 51700 |
|
50 |
41 |
$18K |
| 96368 |
|
2,704 |
1,788 |
$18K |
| 80323 |
|
1,123 |
947 |
$18K |
| 88311 |
|
1,933 |
1,377 |
$18K |
| 83002 |
|
1,646 |
1,377 |
$17K |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
26,257 |
21,748 |
$17K |
| 96121 |
|
30 |
28 |
$17K |
| 73120 |
|
1,194 |
842 |
$17K |
| 82103 |
|
1,354 |
1,163 |
$17K |
| J7040 |
Infusion, normal saline solution, sterile (500 ml = 1 unit) |
17,309 |
11,630 |
$17K |
| 87900 |
|
390 |
317 |
$17K |
| 89051 |
|
4,469 |
2,693 |
$17K |
| 95076 |
|
27 |
25 |
$17K |
| 84450 |
|
26,462 |
21,384 |
$16K |
| 36581 |
|
20 |
12 |
$16K |
| 74220 |
|
394 |
324 |
$16K |
| 59841 |
|
71 |
47 |
$16K |
| 82947 |
|
5,784 |
4,713 |
$16K |
| 88173 |
|
732 |
546 |
$16K |
| 70250 |
|
1,310 |
1,120 |
$16K |
| 11900 |
|
52 |
47 |
$16K |
| 73718 |
|
62 |
49 |
$16K |
| 64494 |
|
38 |
25 |
$16K |
| J3489 |
Injection, zoledronic acid, 1 mg |
428 |
331 |
$16K |
| J1644 |
Injection, heparin sodium, per 1000 units |
16,777 |
7,714 |
$16K |
| 83520 |
|
3,826 |
2,766 |
$16K |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
39,811 |
28,985 |
$15K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
2,747 |
2,407 |
$15K |
| 10061 |
|
60 |
55 |
$15K |
| 99152 |
|
4,215 |
3,376 |
$15K |
| 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 |
287 |
232 |
$15K |
| 84520 |
|
3,739 |
2,740 |
$14K |
| 82378 |
|
2,245 |
1,630 |
$14K |
| 99496 |
|
107 |
95 |
$14K |
| Q9957 |
Injection, perflutren lipid microspheres, per ml |
895 |
771 |
$14K |
| 84480 |
|
3,588 |
2,956 |
$14K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
3,345 |
3,020 |
$14K |
| C1889 |
Implantable/insertable device, not otherwise classified |
3,392 |
2,924 |
$14K |
| C1725 |
Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability) |
1,647 |
1,257 |
$14K |
| 97039 |
|
280 |
161 |
$14K |
| 80348 |
|
1,844 |
1,411 |
$13K |
| 86805 |
|
151 |
104 |
$13K |
| 0004A |
|
709 |
614 |
$13K |
| 87901 |
|
196 |
160 |
$13K |
| 84460 |
|
24,026 |
19,399 |
$13K |
| C1781 |
Mesh (implantable) |
53 |
39 |
$13K |
| 84270 |
|
1,988 |
1,683 |
$13K |
| 84165 |
|
3,847 |
2,886 |
$13K |
| 84207 |
|
1,641 |
1,483 |
$13K |
| 73222 |
|
13 |
13 |
$13K |
| 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 |
17,144 |
11,441 |
$13K |
| 86355 |
|
1,177 |
882 |
$13K |
| 0012A |
|
470 |
460 |
$13K |
| 81479 |
Unlisted molecular pathology procedure |
72 |
42 |
$12K |
| 92608 |
|
76 |
72 |
$12K |
| 85049 |
|
1,568 |
1,150 |
$12K |
| 93290 |
|
97 |
86 |
$12K |
| C1887 |
Catheter, guiding (may include infusion/perfusion capability) |
5,067 |
3,867 |
$12K |
| 95974 |
|
53 |
47 |
$12K |
| 87205 |
|
11,388 |
9,393 |
$12K |
| C9399 |
Unclassified drugs or biologicals |
1,277 |
1,043 |
$12K |
| 91301 |
|
876 |
837 |
$12K |
| 95713 |
|
34 |
30 |
$12K |
| Q0138 |
Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (non-esrd use) |
83 |
54 |
$12K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
109 |
96 |
$12K |
| 86481 |
|
745 |
599 |
$12K |
| 86709 |
|
1,446 |
1,124 |
$12K |
| 84630 |
|
1,314 |
1,173 |
$12K |
| 92136 |
|
655 |
537 |
$12K |
| 86256 |
|
848 |
713 |
$12K |
| 74241 |
|
73 |
62 |
$12K |
| 36416 |
|
9,076 |
7,611 |
$11K |
| C1726 |
Catheter, balloon dilatation, non-vascular |
1,168 |
891 |
$11K |
| 91308 |
|
747 |
723 |
$11K |
| 83921 |
|
1,384 |
1,135 |
$11K |
| J2785 |
Injection, regadenoson, 0.1 mg |
2,694 |
2,315 |
$11K |
| 99495 |
|
223 |
198 |
$11K |
| 82525 |
|
1,628 |
1,404 |
$11K |
| 81243 |
|
286 |
248 |
$11K |
| 86304 |
|
544 |
430 |
$11K |
| 51600 |
|
40 |
40 |
$11K |
| 51798 |
|
3,373 |
2,910 |
$11K |
| 74170 |
|
49 |
43 |
$11K |
| Q0221 |
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), 600 mg |
284 |
237 |
$10K |
| 64721 |
|
16 |
12 |
$10K |
| J0881 |
Injection, darbepoetin alfa, 1 microgram (non-esrd use) |
49 |
38 |
$10K |
| 80050 |
General health panel |
740 |
636 |
$10K |
| 93242 |
|
366 |
338 |
$10K |
| 0011A |
|
438 |
428 |
$10K |
| 93226 |
|
394 |
330 |
$10K |
| 82040 |
|
5,236 |
4,037 |
$10K |
| 36000 |
|
1,174 |
884 |
$10K |
| 95912 |
|
77 |
69 |
$10K |
| 92250 |
|
1,241 |
1,060 |
$10K |
| 82550 |
|
7,909 |
6,201 |
$10K |
| 86592 |
|
3,554 |
2,989 |
$10K |
| 82390 |
|
1,148 |
999 |
$10K |
| 90750 |
|
61 |
59 |
$10K |
| 94642 |
|
420 |
313 |
$10K |
| 88344 |
|
400 |
296 |
$9K |
| 36589 |
|
63 |
54 |
$9K |
| J1750 |
Injection, iron dextran, 50 mg |
96 |
45 |
$9K |
| 81206 |
|
82 |
60 |
$9K |
| 84305 |
|
635 |
562 |
$9K |
| 93750 |
|
262 |
197 |
$9K |
| 82677 |
|
524 |
486 |
$9K |
| J9263 |
Injection, oxaliplatin, 0.5 mg |
339 |
67 |
$9K |
| 85046 |
|
8,600 |
5,648 |
$9K |
| 92310 |
|
109 |
97 |
$9K |
| 86352 |
|
684 |
596 |
$9K |
| J9045 |
Injection, carboplatin, 50 mg |
1,630 |
731 |
$9K |
| 82627 |
|
903 |
790 |
$9K |
| 93886 |
|
46 |
40 |
$9K |
| 88108 |
|
1,564 |
1,070 |
$9K |
| 51741 |
|
726 |
610 |
$9K |
| 84550 |
|
6,265 |
4,681 |
$8K |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
8,709 |
6,586 |
$8K |
| 83993 |
|
680 |
631 |
$8K |
| 95977 |
|
45 |
41 |
$8K |
| 80354 |
|
2,422 |
1,766 |
$8K |
| 92025 |
|
128 |
112 |
$8K |
| 82951 |
|
409 |
389 |
$8K |
| J2543 |
Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams) |
4,497 |
2,066 |
$8K |
| G0108 |
Diabetes outpatient self-management training services, individual, per 30 minutes |
302 |
282 |
$8K |
| 80183 |
|
809 |
685 |
$8K |
| 95812 |
|
13 |
13 |
$8K |
| 29581 |
|
31 |
12 |
$8K |
| 20526 |
|
17 |
14 |
$8K |
| 20206 |
|
15 |
12 |
$8K |
| 11104 |
|
19 |
13 |
$8K |
| 87116 |
|
707 |
497 |
$8K |
| 76825 |
|
118 |
98 |
$8K |
| 59425 |
|
58 |
40 |
$8K |
| 93270 |
|
345 |
316 |
$7K |
| 20600 |
|
29 |
26 |
$7K |
| 74022 |
|
860 |
722 |
$7K |
| 84075 |
|
18,418 |
14,823 |
$7K |
| 99195 |
|
172 |
138 |
$7K |
| 86777 |
|
499 |
396 |
$7K |
| 96136 |
|
1,417 |
1,225 |
$7K |
| 0003A |
|
380 |
320 |
$7K |
| 90744 |
|
861 |
783 |
$7K |
| 72072 |
|
504 |
436 |
$7K |
| 90682 |
|
218 |
198 |
$7K |
| 90381 |
|
192 |
187 |
$7K |
| 85045 |
|
5,673 |
4,319 |
$7K |
| 82610 |
|
1,933 |
1,636 |
$7K |
| 91320 |
|
120 |
102 |
$7K |
| 86147 |
|
344 |
285 |
$7K |
| 51797 |
|
491 |
436 |
$7K |
| 84163 |
|
737 |
622 |
$7K |
| J1170 |
Injection, hydromorphone, up to 4 mg |
21,583 |
11,159 |
$6K |
| 82150 |
|
3,028 |
2,431 |
$6K |
| 86336 |
|
1,681 |
1,465 |
$6K |
| 87102 |
|
2,075 |
1,607 |
$6K |
| 80203 |
|
476 |
413 |
$6K |
| 86376 |
|
574 |
514 |
$6K |
| 84134 |
|
1,680 |
1,278 |
$6K |
| 81002 |
|
5,866 |
5,302 |
$6K |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
5,385 |
3,374 |
$6K |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
10,185 |
6,975 |
$6K |
| 86317 |
|
268 |
231 |
$6K |
| 72081 |
|
494 |
441 |
$6K |
| 80377 |
|
269 |
220 |
$6K |
| 92060 |
|
2,332 |
2,199 |
$6K |
| 83498 |
|
710 |
632 |
$6K |
| 90694 |
|
233 |
214 |
$6K |
| 93246 |
|
410 |
380 |
$6K |
| 84132 |
|
7,740 |
6,110 |
$6K |
| 82962 |
|
6,782 |
5,394 |
$6K |
| J7297 |
Levonorgestrel-releasing intrauterine contraceptive system (liletta), 52 mg |
12 |
12 |
$5K |
| 90658 |
|
521 |
484 |
$5K |
| J7325 |
Hyaluronan or derivative, synvisc or synvisc-one, for intra-articular injection, 1 mg |
14 |
14 |
$5K |
| 82553 |
|
773 |
592 |
$5K |
| 96131 |
|
139 |
122 |
$5K |
| 27096 |
|
12 |
12 |
$5K |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
28,667 |
21,638 |
$5K |
| 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 |
1,033 |
955 |
$5K |
| 80362 |
|
2,092 |
1,544 |
$5K |
| 87088 |
|
5,558 |
4,398 |
$5K |
| 86431 |
|
3,387 |
2,786 |
$5K |
| 76514 |
|
275 |
241 |
$5K |
| 97168 |
|
67 |
57 |
$5K |
| J2791 |
Injection, rho(d) immune globulin (human), (rhophylac), intramuscular or intravenous, 100 iu |
43 |
37 |
$5K |
| 95908 |
|
47 |
44 |
$5K |
| 87493 |
|
455 |
402 |
$5K |
| 86200 |
|
2,368 |
1,922 |
$5K |
| 82570 |
|
2,467 |
2,034 |
$5K |
| 82075 |
|
1,123 |
738 |
$5K |
| 83521 |
|
1,468 |
1,148 |
$5K |
| 80069 |
|
1,316 |
1,113 |
$5K |
| 86039 |
|
1,666 |
1,327 |
$5K |
| 86335 |
|
270 |
215 |
$5K |
| 99205 |
Prolong outpt/office vis |
135 |
115 |
$5K |
| 93261 |
|
32 |
27 |
$5K |
| 90685 |
|
337 |
323 |
$5K |
| 82330 |
|
2,668 |
2,050 |
$5K |
| 75565 |
|
369 |
331 |
$5K |
| 0082A |
|
88 |
86 |
$5K |
| G0500 |
Moderate sedation services provided by the same physician or other qualified health care professional performing a gastrointestinal endoscopic service that sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; initial 15 minutes of intra-service time; patient age 5 years or older (additional time may be reported with 99153, as appropriate) |
2,045 |
1,508 |
$5K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
4,154 |
3,825 |
$5K |
| 87015 |
|
2,642 |
1,991 |
$4K |
| 81378 |
|
37 |
31 |
$4K |
| 86225 |
|
2,285 |
1,816 |
$4K |
| 76776 |
|
32 |
24 |
$4K |
| 95012 |
|
620 |
549 |
$4K |
| 73722 |
|
23 |
17 |
$4K |
| 88300 |
|
1,746 |
1,419 |
$4K |
| 72120 |
|
456 |
400 |
$4K |
| 82985 |
|
1,105 |
894 |
$4K |
| 88172 |
|
372 |
288 |
$4K |
| 87186 |
|
3,426 |
2,764 |
$4K |
| A9502 |
Technetium tc-99m tetrofosmin, diagnostic, per study dose |
3,881 |
3,008 |
$4K |
| 72114 |
|
284 |
252 |
$4K |
| J2370 |
Injection, phenylephrine hcl, up to 1 ml |
391 |
300 |
$4K |
| 86364 |
|
1,130 |
1,039 |
$4K |
| 90461 |
|
1,923 |
1,784 |
$4K |
| 73523 |
|
457 |
336 |
$4K |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
11,645 |
8,847 |
$4K |
| C1729 |
Catheter, drainage |
2,626 |
1,678 |
$4K |
| 85384 |
|
1,553 |
1,108 |
$4K |
| 74420 |
|
14 |
13 |
$4K |
| 78306 |
|
15 |
12 |
$4K |
| 74450 |
|
15 |
13 |
$4K |
| 93356 |
|
781 |
696 |
$4K |
| J3470 |
Injection, hyaluronidase, up to 150 units |
73 |
67 |
$4K |
| 77077 |
|
206 |
168 |
$4K |
| 90713 |
|
223 |
201 |
$4K |
| 86593 |
|
1,577 |
1,357 |
$4K |
| 86800 |
|
451 |
373 |
$4K |
| 82140 |
|
1,449 |
1,183 |
$4K |
| 82397 |
|
947 |
821 |
$4K |
| 83010 |
|
1,010 |
745 |
$3K |
| 86880 |
|
1,304 |
954 |
$3K |
| 86695 |
|
303 |
237 |
$3K |
| 74246 |
|
16 |
16 |
$3K |
| J0702 |
Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg |
2,278 |
1,834 |
$3K |
| 80175 |
|
487 |
411 |
$3K |
| 87535 |
|
92 |
82 |
$3K |
| 87147 |
|
3,070 |
2,650 |
$3K |
| Q0240 |
Injection, casirivimab and imdevimab, 600 mg |
32 |
19 |
$3K |
| J0574 |
Buprenorphine/naloxone, oral, greater than 6 mg, but less than or equal to 10 mg buprenorphine |
677 |
429 |
$3K |
| 74181 |
|
15 |
12 |
$3K |
| 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 |
8,246 |
5,433 |
$3K |
| 90846 |
Family psychotherapy without the patient present, 50 minutes |
15 |
12 |
$3K |
| 11056 |
|
14 |
13 |
$3K |
| J9217 |
Leuprolide acetate (for depot suspension), 7.5 mg |
14 |
12 |
$3K |
| 64447 |
|
14 |
12 |
$3K |
| 95115 |
|
82 |
51 |
$3K |
| 86696 |
|
303 |
237 |
$3K |
| J1953 |
Injection, levetiracetam, 10 mg |
1,589 |
1,107 |
$3K |
| J3370 |
Injection, vancomycin hcl, 500 mg |
4,910 |
2,689 |
$3K |
| 83883 |
|
459 |
311 |
$3K |
| 62270 |
|
15 |
12 |
$3K |
| J0780 |
Injection, prochlorperazine, up to 10 mg |
7,998 |
6,137 |
$3K |
| 87634 |
|
94 |
84 |
$3K |
| 51705 |
|
14 |
12 |
$3K |
| 82465 |
|
819 |
700 |
$3K |
| 59426 |
|
23 |
12 |
$3K |
| 83951 |
|
125 |
93 |
$3K |
| 64415 |
|
22 |
15 |
$3K |
| 84436 |
|
961 |
793 |
$3K |
| 0081A |
|
65 |
64 |
$3K |
| 90655 |
|
279 |
253 |
$2K |
| 84244 |
|
245 |
213 |
$2K |
| 82088 |
|
147 |
127 |
$2K |
| 87636 |
Infectious agent detection by nucleic acid; SARS-CoV-2 and influenza virus types A and B |
170 |
159 |
$2K |
| 83090 |
|
128 |
104 |
$2K |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
8,977 |
5,137 |
$2K |
| G0103 |
Prostate cancer screening; prostate specific antigen test (psa) |
345 |
314 |
$2K |
| 97129 |
|
94 |
55 |
$2K |
| J2060 |
Injection, lorazepam, 2 mg |
3,910 |
2,877 |
$2K |
| J3480 |
Injection, potassium chloride, per 2 meq |
5,068 |
2,867 |
$2K |
| 90611 |
|
79 |
70 |
$2K |
| A9577 |
Injection, gadobenate dimeglumine (multihance), per ml |
8,514 |
7,653 |
$2K |
| 11055 |
|
13 |
12 |
$2K |
| 51701 |
|
212 |
188 |
$2K |
| 85007 |
|
658 |
417 |
$2K |
| 0031A |
|
77 |
69 |
$2K |
| H0005 |
Alcohol and/or drug services; group counseling by a clinician |
318 |
212 |
$2K |
| 80201 |
|
204 |
164 |
$2K |
| 70360 |
|
132 |
123 |
$2K |
| J9370 |
Vincristine sulfate, 1 mg |
2,697 |
1,473 |
$2K |
| 86886 |
|
82 |
64 |
$2K |
| J1940 |
Injection, furosemide, up to 20 mg |
4,157 |
2,356 |
$2K |
| 96422 |
|
23 |
12 |
$2K |
| 90630 |
|
163 |
137 |
$2K |
| 85246 |
|
186 |
151 |
$2K |
| 36600 |
|
51 |
38 |
$2K |
| 82310 |
|
1,134 |
806 |
$2K |
| 93299 |
|
47 |
40 |
$2K |
| 72128 |
|
43 |
41 |
$2K |
| 89050 |
|
694 |
457 |
$2K |
| 82024 |
|
70 |
64 |
$2K |
| 88720 |
|
303 |
202 |
$2K |
| 90935 |
Hemodialysis procedure with single evaluation by a physician |
31 |
18 |
$2K |
| 51702 |
|
54 |
45 |
$2K |
| 83051 |
|
206 |
125 |
$2K |
| 73503 |
|
212 |
159 |
$2K |
| 11721 |
|
424 |
385 |
$2K |
| 85613 |
|
319 |
277 |
$2K |
| 80346 |
|
200 |
162 |
$2K |
| 73565 |
|
221 |
167 |
$2K |
| 86618 |
|
170 |
139 |
$2K |
| 88177 |
|
126 |
100 |
$2K |
| 87449 |
|
109 |
85 |
$1K |
| 90620 |
|
59 |
57 |
$1K |
| G0279 |
Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066) |
75 |
73 |
$1K |
| 87338 |
|
230 |
214 |
$1K |
| 84481 |
|
351 |
303 |
$1K |
| 87899 |
|
823 |
669 |
$1K |
| G0460 |
Autologous platelet rich plasma or other blood-derived product for non-diabetic chronic wounds/ulcers, including as applicable phlebotomy, centrifugation or mixing, and all other preparatory procedures, administration and dressings, per treatment |
40 |
31 |
$1K |
| 0083A |
|
23 |
23 |
$1K |
| 86301 |
|
216 |
169 |
$1K |
| 82375 |
|
1,523 |
1,237 |
$1K |
| 91313 |
|
196 |
166 |
$1K |
| 86705 |
|
310 |
264 |
$1K |
| 93923 |
|
14 |
12 |
$1K |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
6,891 |
4,312 |
$1K |
| J1030 |
Injection, methylprednisolone acetate, 40 mg |
6,041 |
5,094 |
$1K |
| 80299 |
|
272 |
245 |
$1K |
| 97130 |
|
51 |
34 |
$1K |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
1,673 |
1,284 |
$1K |
| 86308 |
|
631 |
580 |
$1K |
| 90632 |
|
42 |
40 |
$1K |
| 84155 |
|
1,169 |
880 |
$1K |
| 82274 |
|
202 |
166 |
$1K |
| 76857 |
|
18 |
12 |
$1K |
| 85240 |
|
189 |
146 |
$1K |
| J1815 |
Injection, insulin, per 5 units |
4,587 |
1,639 |
$1K |
| 88230 |
|
29 |
24 |
$1K |
| 73522 |
|
127 |
98 |
$1K |
| C1788 |
Port, indwelling (implantable) |
588 |
492 |
$1K |
| 91303 |
|
74 |
67 |
$1K |
| 87140 |
|
199 |
177 |
$972.46 |
| 72192 |
|
14 |
13 |
$961.87 |
| 99381 |
|
18 |
14 |
$954.80 |
| 95983 |
|
12 |
12 |
$947.50 |
| J7644 |
Ipratropium bromide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram |
3,074 |
1,791 |
$945.11 |
| 87101 |
|
257 |
201 |
$942.55 |
| 84445 |
|
61 |
59 |
$909.57 |
| Q3014 |
Telehealth originating site facility fee |
634 |
530 |
$896.78 |
| 84295 |
|
2,268 |
1,806 |
$878.13 |
| 82164 |
|
95 |
67 |
$867.97 |
| C2617 |
Stent, non-coronary, temporary, without delivery system |
190 |
153 |
$861.00 |
| 81267 |
|
17 |
12 |
$841.98 |
| J1720 |
Injection, hydrocortisone sodium succinate, up to 100 mg |
483 |
300 |
$841.06 |
| 80349 |
|
179 |
141 |
$832.76 |
| 82955 |
|
193 |
157 |
$815.63 |
| A4663 |
Blood pressure cuff only |
2,032 |
485 |
$791.29 |
| 92285 |
|
67 |
61 |
$779.28 |
| J0280 |
Injection, aminophyllin, up to 250 mg |
782 |
665 |
$765.66 |
| 76376 |
|
216 |
195 |
$751.07 |
| J7999 |
Compounded drug, not otherwise classified |
2,461 |
905 |
$731.61 |
| J9196 |
Injection, gemcitabine hydrochloride (accord), not therapeutically equivalent to j9201, 200 mg |
20 |
12 |
$729.72 |
| J0461 |
Injection, atropine sulfate, 0.01 mg |
344 |
202 |
$725.24 |
| J0330 |
Injection, succinylcholine chloride, up to 20 mg |
4,210 |
3,092 |
$716.84 |
| 80230 |
|
301 |
272 |
$710.97 |
| 83718 |
|
267 |
232 |
$689.79 |
| J0610 |
Injection, calcium gluconate (fresenius kabi), per 10 ml |
886 |
372 |
$688.91 |
| 90678 |
|
20 |
20 |
$683.10 |
| 23350 |
|
49 |
42 |
$679.89 |
| 88112 |
|
98 |
83 |
$675.18 |
| 90739 |
|
19 |
18 |
$673.34 |
| 0013A |
|
31 |
25 |
$667.93 |
| J1630 |
Injection, haloperidol, up to 5 mg |
1,809 |
1,379 |
$661.84 |
| 84166 |
|
107 |
93 |
$661.11 |
| 82435 |
|
1,974 |
1,584 |
$657.78 |
| 88299 |
|
24 |
13 |
$653.05 |
| 87506 |
|
12 |
12 |
$651.97 |
| 84300 |
|
477 |
383 |
$642.07 |
| 85347 |
|
285 |
226 |
$632.08 |
| 80195 |
|
18 |
12 |
$562.48 |
| J3301 |
Injection, triamcinolone acetonide, not otherwise specified, 10 mg |
3,272 |
2,756 |
$543.31 |
| 80158 |
|
82 |
25 |
$541.93 |
| 84157 |
|
610 |
458 |
$505.72 |
| 96118 |
|
46 |
37 |
$504.21 |
| 93289 |
|
12 |
12 |
$502.74 |
| 84681 |
|
112 |
94 |
$495.95 |
| 84478 |
|
384 |
309 |
$493.87 |
| J7060 |
5% dextrose/water (500 ml = 1 unit) |
2,446 |
922 |
$489.23 |
| 80339 |
|
32 |
26 |
$482.87 |
| G0010 |
Administration of hepatitis b vaccine |
87 |
77 |
$480.63 |
| G0101 |
Cervical or vaginal cancer screening; pelvic and clinical breast examination |
147 |
119 |
$477.65 |
| 86146 |
|
122 |
106 |
$474.60 |
| 70030 |
|
28 |
24 |
$473.74 |
| 84590 |
|
106 |
92 |
$467.64 |
| 93280 |
|
17 |
15 |
$466.18 |
| A9541 |
Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries |
641 |
513 |
$464.22 |
| 84446 |
|
120 |
102 |
$449.84 |
| 83930 |
|
416 |
319 |
$445.13 |
| 85732 |
|
315 |
278 |
$440.16 |
| A9579 |
Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (nos), per ml |
1,029 |
944 |
$439.70 |
| J0572 |
Buprenorphine/naloxone, oral, less than or equal to 3 mg buprenorphine |
46 |
37 |
$435.94 |
| C1760 |
Closure device, vascular (implantable/insertable) |
1,322 |
1,003 |
$433.01 |
| J0171 |
Injection, adrenalin, epinephrine, 0.1 mg |
1,729 |
1,450 |
$424.13 |
| Q2038 |
Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluzone) |
53 |
42 |
$422.81 |
| 82945 |
|
385 |
285 |
$400.40 |
| 90680 |
|
139 |
118 |
$397.60 |
| 87110 |
|
222 |
189 |
$387.19 |
| C1750 |
Catheter, hemodialysis/peritoneal, long-term |
95 |
70 |
$377.25 |
| 94761 |
|
2,631 |
1,953 |
$367.74 |
| J9000 |
Injection, doxorubicin hydrochloride, 10 mg |
108 |
41 |
$362.84 |
| H0004 |
Behavioral health counseling and therapy, per 15 minutes |
36 |
31 |
$338.50 |
| 73660 |
|
45 |
40 |
$336.00 |
| J1250 |
Injection, dobutamine hydrochloride, per 250 mg |
158 |
124 |
$332.93 |
| 94664 |
|
341 |
290 |
$326.13 |
| 87206 |
|
385 |
255 |
$326.03 |
| 83050 |
|
1,300 |
1,057 |
$323.46 |
| J0360 |
Injection, hydralazine hcl, up to 20 mg |
1,424 |
1,036 |
$312.77 |
| 86769 |
|
108 |
87 |
$309.17 |
| 83721 |
|
176 |
147 |
$303.52 |
| 72020 |
|
57 |
49 |
$299.65 |
| 80235 |
|
109 |
99 |
$299.41 |
| 82239 |
|
28 |
24 |
$295.37 |
| 73650 |
|
14 |
12 |
$288.61 |
| 80358 |
|
153 |
117 |
$284.96 |
| J7042 |
5% dextrose/normal saline (500 ml = 1 unit) |
2,689 |
2,009 |
$281.43 |
| 73501 |
|
67 |
55 |
$277.81 |
| 86341 |
|
29 |
28 |
$271.77 |
| 87255 |
|
18 |
13 |
$266.25 |
| J2003 |
Injection, lidocaine hydrochloride, 1 mg |
1,559 |
1,448 |
$265.24 |
| J1580 |
Injection, garamycin, gentamicin, up to 80 mg |
119 |
76 |
$263.34 |
| 88346 |
|
16 |
12 |
$262.26 |
| C9113 |
Injection, pantoprazole sodium, per vial |
1,915 |
994 |
$259.60 |
| 83695 |
|
61 |
59 |
$245.64 |
| 84479 |
|
58 |
49 |
$239.15 |
| 86765 |
|
17 |
15 |
$232.61 |
| 86735 |
|
17 |
15 |
$211.14 |
| 85014 |
|
181 |
113 |
$208.29 |
| 86920 |
|
163 |
96 |
$208.03 |
| J1836 |
Injection, metronidazole, 10 mg |
717 |
450 |
$186.50 |
| 87045 |
|
62 |
55 |
$185.34 |
| G0451 |
Development testing, with interpretation and report, per standardized instrument form |
12 |
12 |
$183.37 |
| 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 |
52 |
38 |
$179.47 |
| 69209 |
|
173 |
152 |
$177.58 |
| 72080 |
|
14 |
13 |
$173.94 |
| J0612 |
Injection, calcium gluconate, not otherwise specified, 10 mg |
348 |
234 |
$165.73 |
| 86008 |
|
78 |
70 |
$165.70 |
| 0134A |
|
20 |
16 |
$164.70 |
| A4215 |
Needle, sterile, any size, each |
356 |
256 |
$162.64 |
| 86645 |
|
14 |
12 |
$160.19 |
| 82107 |
|
70 |
57 |
$159.65 |
| 84255 |
|
29 |
26 |
$154.61 |
| 83835 |
|
31 |
26 |
$154.32 |
| 84145 |
|
214 |
188 |
$153.52 |
| 86580 |
|
15 |
13 |
$140.33 |
| 71100 |
|
32 |
28 |
$137.17 |
| G8985 |
Carrying, moving and handling objects, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting |
234 |
124 |
$131.22 |
| 87046 |
|
63 |
55 |
$127.91 |
| J0692 |
Injection, cefepime hydrochloride, 500 mg |
261 |
122 |
$125.86 |
| 89060 |
|
82 |
67 |
$123.14 |
| 80373 |
|
14 |
13 |
$121.42 |
| 88333 |
|
95 |
64 |
$119.82 |
| V2632 |
Posterior chamber intraocular lens |
930 |
782 |
$116.19 |
| J1920 |
Injection, labetalol hydrochloride, 5 mg |
422 |
310 |
$113.26 |
| 86258 |
|
69 |
62 |
$105.66 |
| J2371 |
Injection, phenylephrine hydrochloride, 20 micrograms |
2,788 |
1,994 |
$101.88 |
| 85660 |
|
1,259 |
884 |
$99.91 |
| 82340 |
|
28 |
26 |
$98.91 |
| 88334 |
|
103 |
64 |
$96.41 |
| 80165 |
|
13 |
12 |
$95.85 |
| 86361 |
|
47 |
29 |
$95.83 |
| 87350 |
|
27 |
26 |
$94.34 |
| 80156 |
|
23 |
16 |
$94.33 |
| J0134 |
Injection, acetaminophen (fresenius kabi), not therapeutically equivalent to j0131, 10 mg |
1,793 |
907 |
$90.48 |
| J3420 |
Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg |
663 |
505 |
$89.38 |
| 87324 |
|
54 |
44 |
$88.20 |
| C1819 |
Surgical tissue localization and excision device (implantable) |
2,693 |
2,448 |
$87.49 |
| C1755 |
Catheter, intraspinal |
209 |
148 |
$84.41 |
| J9260 |
Injection, methotrexate sodium, 50 mg |
356 |
217 |
$81.34 |
| 83519 |
|
18 |
15 |
$80.57 |
| 86707 |
|
15 |
12 |
$77.98 |
| J0665 |
Injection, bupivicaine, not otherwise specified, 0.5 mg |
3,978 |
2,863 |
$74.76 |
| 88331 |
|
14 |
12 |
$74.02 |
| 87181 |
|
14 |
13 |
$67.72 |
| 86037 |
|
49 |
45 |
$67.36 |
| 87176 |
|
517 |
226 |
$64.09 |
| 87106 |
|
37 |
27 |
$61.94 |
| Q0111 |
Wet mounts, including preparations of vaginal, cervical or skin specimens |
15 |
12 |
$60.45 |
| J9250 |
Methotrexate sodium, 5 mg |
71 |
37 |
$56.38 |
| 91311 |
|
13 |
13 |
$54.51 |
| 91317 |
|
17 |
16 |
$54.50 |
| J1020 |
Injection, methylprednisolone acetate, 20 mg |
630 |
503 |
$53.06 |
| G8979 |
Mobility: walking & moving around functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting |
961 |
656 |
$49.13 |
| 88240 |
|
19 |
13 |
$47.18 |
| 86677 |
|
14 |
13 |
$44.42 |
| 90380 |
|
14 |
12 |
$44.15 |
| J9267 |
Injection, paclitaxel, 1 mg |
358 |
155 |
$43.82 |
| 46600 |
|
14 |
13 |
$43.70 |
| 85306 |
|
18 |
14 |
$42.36 |
| S0077 |
Injection, clindamycin phosphate, 300 mg |
136 |
78 |
$40.18 |
| A4649 |
Surgical supply; miscellaneous |
122 |
77 |
$38.88 |
| A9585 |
Injection, gadobutrol, 0.1 ml |
1,610 |
1,486 |
$35.34 |
| 82374 |
|
35 |
35 |
$34.58 |
| J0153 |
Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds) |
13 |
13 |
$34.48 |
| 82077 |
|
30 |
29 |
$28.90 |
| S5010 |
5% dextrose and 0.45% normal saline, 1000 ml |
764 |
486 |
$27.31 |
| J2920 |
Injection, methylprednisolone sodium succinate, up to 40 mg |
483 |
315 |
$26.65 |
| 85303 |
|
13 |
12 |
$25.77 |
| 81000 |
|
168 |
129 |
$25.67 |
| J1040 |
Injection, methylprednisolone acetate, 80 mg |
1,097 |
943 |
$22.29 |
| J2272 |
Injection, morphine sulfate (fresenius kabi), not therapeutically equivalent to j2270, up to 10 mg |
1,711 |
1,357 |
$19.32 |
| 86403 |
|
13 |
13 |
$16.66 |
| 99070 |
|
1,575 |
766 |
$16.20 |
| 94760 |
|
599 |
510 |
$15.92 |
| 84560 |
|
19 |
17 |
$14.78 |
| G8978 |
Mobility: walking & moving around functional limitation, current status, at therapy episode outset and at reporting intervals |
886 |
606 |
$13.95 |
| 80047 |
|
31 |
27 |
$10.38 |
| J2710 |
Injection, neostigmine methylsulfate, up to 0.5 mg |
66 |
45 |
$9.87 |
| J0744 |
Injection, ciprofloxacin for intravenous infusion, 200 mg |
73 |
48 |
$8.64 |
| 82010 |
|
13 |
12 |
$8.49 |
| J7620 |
Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme |
65 |
42 |
$8.02 |
| J1171 |
Injection, hydromorphone, 0.1 mg |
526 |
329 |
$7.59 |
| J2919 |
Injection, methylprednisolone sodium succinate, 5 mg |
745 |
569 |
$7.41 |
| A4550 |
Surgical trays |
77 |
66 |
$4.62 |
| L8613 |
Ossicula implant |
437 |
390 |
$0.33 |
| J2310 |
Injection, naloxone hydrochloride, per 1 mg |
416 |
331 |
$0.32 |
| A9503 |
Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries |
129 |
115 |
$0.00 |
| C1733 |
Catheter, electrophysiology, diagnostic/ablation, other than 3d or vector mapping, other than cool-tip |
15 |
13 |
$0.00 |
| G8987 |
Self care functional limitation, current status, at therapy episode outset and at reporting intervals |
35 |
24 |
$0.00 |
| 99220 |
|
23 |
22 |
$0.00 |
| J2470 |
Injection, pantoprazole sodium, 40 mg |
206 |
148 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
67 |
55 |
$0.00 |
| A4648 |
Tissue marker, implantable, any type, each |
306 |
267 |
$0.00 |
| J1805 |
Injection, esmolol hydrochloride, 10 mg |
148 |
85 |
$0.00 |
| G8988 |
Self care functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting |
59 |
37 |
$0.00 |
| G8980 |
Mobility: walking & moving around functional limitation, discharge status, at discharge from therapy or to end reporting |
49 |
39 |
$0.00 |
| A6197 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
63 |
51 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
18 |
18 |
$0.00 |
| C1892 |
Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, peel-away |
44 |
29 |
$0.00 |
| J1010 |
Injection, methylprednisolone acetate, 1 mg |
909 |
837 |
$0.00 |
| C1766 |
Introducer/sheath, guiding, intracardiac electrophysiological, steerable, other than peel-away |
16 |
14 |
$0.00 |
| D1351 |
Sealant - per tooth |
16 |
15 |
$0.00 |
| 71101 |
|
13 |
12 |
$0.00 |
| A4300 |
Implantable access catheter, (e.g., venous, arterial, epidural subarachnoid, or peritoneal, etc.) external access |
28 |
21 |
$0.00 |
| J0611 |
Injection, calcium gluconate (wg critical care), per 10 ml |
16 |
13 |
$0.00 |
| C9290 |
Injection, bupivacaine liposome, 1 mg |
37 |
25 |
$0.00 |
| 99156 |
|
31 |
30 |
$0.00 |
| J0613 |
Injection, calcium gluconate (wg critical care), not therapeutically equivalent to j0612, 10 mg |
29 |
25 |
$0.00 |
| J7507 |
Tacrolimus, immediate release, oral, 1 mg |
32 |
12 |
$0.00 |
| C1730 |
Catheter, electrophysiology, diagnostic, other than 3d mapping (19 or fewer electrodes) |
15 |
12 |
$0.00 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
92 |
78 |
$0.00 |
| J0737 |
Injection, clindamycin phosphate (baxter), not therapeutically equivalent to j0736, 300 mg |
254 |
151 |
$0.00 |
| J1596 |
Injection, glycopyrrolate, 0.1 mg |
1,026 |
528 |
$0.00 |
| J1598 |
Injection, glycopyrrolate (fresenius kabi), not therapeutically equivalent to j1596, 0.1 mg |
106 |
76 |
$0.00 |
| Q9966 |
Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml |
84 |
67 |
$0.00 |
| C1776 |
Joint device (implantable) |
401 |
273 |
$0.00 |
| 99157 |
|
15 |
15 |
$0.00 |
| C1874 |
Stent, coated/covered, with delivery system |
63 |
49 |
$0.00 |
| Q9950 |
Injection, sulfur hexafluoride lipid microspheres, per ml |
498 |
412 |
$0.00 |
| J0295 |
Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm |
367 |
122 |
$0.00 |
| J7070 |
Infusion, d5w, 1000 cc |
390 |
230 |
$0.00 |
| J0670 |
Injection, mepivacaine hydrochloride, per 10 ml |
62 |
48 |
$0.00 |
| J7510 |
Prednisolone oral, per 5 mg |
65 |
52 |
$0.00 |
| J0136 |
Injection, acetaminophen (b braun), not therapeutically equivalent to j0131, 10 mg |
41 |
25 |
$0.00 |
| Q9958 |
High osmolar contrast material, up to 149 mg/ml iodine concentration, per ml |
105 |
89 |
$0.00 |
| J2004 |
Injection, lidocaine hcl with epinephrine, 1 mg |
310 |
300 |
$0.00 |
| J0640 |
Injection, leucovorin calcium, per 50 mg |
156 |
39 |
$0.00 |
| D1120 |
Prophylaxis - child |
29 |
27 |
$0.00 |
| C1758 |
Catheter, ureteral |
50 |
39 |
$0.00 |
| G8984 |
Carrying, moving & handling objects functional limitation, current status, at therapy episode outset and at reporting intervals |
152 |
88 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
14 |
12 |
$0.00 |
| S0028 |
Injection, famotidine, 20 mg |
90 |
61 |
$0.00 |
| J9190 |
Injection, fluorouracil, 500 mg |
40 |
15 |
$0.00 |
| Q9956 |
Injection, octafluoropropane microspheres, per ml |
15 |
14 |
$0.00 |
| C1757 |
Catheter, thrombectomy/embolectomy |
16 |
12 |
$0.00 |
| J2720 |
Injection, protamine sulfate, per 10 mg |
18 |
14 |
$0.00 |