| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| X4011 |
State-specific procedure code |
41,619 |
37,723 |
$39.38M |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
355,858 |
323,739 |
$31.84M |
| J3490 |
Unclassified drugs |
72,641 |
43,183 |
$17.16M |
| X4006 |
|
15,137 |
12,153 |
$15.28M |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
35,699 |
33,355 |
$11.18M |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
21,740 |
20,074 |
$9.27M |
| X4003 |
|
170,702 |
152,661 |
$9.17M |
| Y7507 |
|
27,217 |
20,532 |
$8.62M |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
34,068 |
31,620 |
$7.08M |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
143,645 |
116,909 |
$7.07M |
| 80048 |
Basic metabolic panel (calcium, ionized) |
95,594 |
79,616 |
$5.13M |
| Y7506 |
|
12,064 |
9,230 |
$4.71M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
45,871 |
40,845 |
$3.96M |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
39,387 |
34,727 |
$3.93M |
| 95811 |
|
1,251 |
1,196 |
$3.26M |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
17,995 |
16,042 |
$2.92M |
| 81025 |
|
17,162 |
16,209 |
$2.69M |
| 81003 |
|
56,186 |
47,636 |
$2.40M |
| 81001 |
|
18,767 |
17,320 |
$2.34M |
| G0378 |
Hospital observation service, per hour |
4,126 |
3,535 |
$2.31M |
| 95810 |
Polysomnography; sleep staging with 4 or more additional parameters |
1,538 |
1,471 |
$2.07M |
| 71046 |
Radiologic examination, chest; 2 views |
19,743 |
18,019 |
$1.87M |
| 80076 |
|
31,849 |
28,664 |
$1.83M |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
3,142 |
2,886 |
$1.52M |
| 0241U |
Neonatal screening for hereditary disorders, genomic sequence analysis panel |
10,095 |
9,459 |
$1.44M |
| 45385 |
Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) |
1,622 |
1,520 |
$1.31M |
| 84484 |
|
21,511 |
18,288 |
$1.21M |
| 82948 |
|
26,357 |
22,197 |
$1.11M |
| 83690 |
|
14,616 |
13,411 |
$1.09M |
| 96413 |
Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance |
4,961 |
2,853 |
$1.09M |
| 76819 |
Fetal biophysical profile; without non-stress testing |
10,412 |
6,387 |
$1.03M |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
10,701 |
9,876 |
$1.02M |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
8,846 |
8,259 |
$1.00M |
| 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 |
17,596 |
15,990 |
$905K |
| 87088 |
|
9,252 |
8,648 |
$858K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
9,294 |
8,301 |
$817K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
19,209 |
17,087 |
$803K |
| 59025 |
Fetal non-stress test |
4,635 |
4,265 |
$767K |
| 85610 |
|
15,578 |
12,240 |
$733K |
| 45380 |
Colonoscopy, flexible; with biopsy, single or multiple |
1,210 |
1,133 |
$718K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
7,114 |
6,552 |
$694K |
| 83880 |
|
10,920 |
9,895 |
$660K |
| 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 |
6,649 |
6,182 |
$648K |
| 20610 |
|
5,325 |
4,526 |
$631K |
| 83735 |
|
23,905 |
18,251 |
$621K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
5,895 |
5,619 |
$586K |
| 85730 |
|
4,593 |
4,101 |
$580K |
| 70355 |
|
12,070 |
11,513 |
$535K |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
3,810 |
3,584 |
$504K |
| 86850 |
|
4,882 |
4,532 |
$472K |
| 86780 |
|
7,739 |
7,396 |
$455K |
| J2426 |
Injection, paliperidone palmitate extended release (invega sustenna), 1 mg |
583 |
543 |
$441K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
9,267 |
7,835 |
$439K |
| 86900 |
|
4,587 |
4,255 |
$438K |
| 66984 |
Extracapsular cataract removal with insertion of intraocular lens prosthesis |
589 |
475 |
$431K |
| 20553 |
|
3,496 |
3,204 |
$417K |
| 80053 |
Comprehensive metabolic panel |
24,357 |
17,389 |
$405K |
| 86901 |
|
4,570 |
4,240 |
$404K |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
6,323 |
6,059 |
$403K |
| 94060 |
|
1,639 |
1,523 |
$402K |
| 45378 |
Colonoscopy, flexible; diagnostic, including collection of specimen(s) |
505 |
484 |
$398K |
| 87801 |
Infectious agent detection by nucleic acid; amplified probe, multiple organisms |
5,641 |
5,439 |
$376K |
| 76811 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, detailed |
2,029 |
1,937 |
$288K |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
1,118 |
1,009 |
$280K |
| 88342 |
|
2,740 |
2,509 |
$263K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
4,133 |
3,959 |
$255K |
| D7240 |
Removal of impacted tooth - completely bony |
415 |
413 |
$247K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
3,674 |
3,425 |
$240K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,612 |
2,516 |
$214K |
| 64555 |
|
50 |
37 |
$214K |
| 87631 |
|
582 |
540 |
$212K |
| 70450 |
Computed tomography, head or brain; without contrast material |
1,991 |
1,788 |
$212K |
| 90834 |
Psychotherapy, 45 minutes with patient |
1,944 |
1,105 |
$210K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
1,370 |
926 |
$208K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
22,763 |
21,256 |
$207K |
| 59050 |
|
857 |
718 |
$206K |
| D7140 |
Extraction, erupted tooth or exposed root |
538 |
506 |
$191K |
| C9803 |
Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
10,521 |
9,885 |
$182K |
| 92083 |
|
3,138 |
2,907 |
$175K |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
3,621 |
905 |
$169K |
| 67028 |
Intravitreal injection of a pharmacologic agent |
822 |
749 |
$166K |
| 94726 |
|
964 |
897 |
$161K |
| 11042 |
Debridement, subcutaneous tissue (includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm |
1,107 |
698 |
$160K |
| 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 |
12,310 |
11,229 |
$159K |
| 87536 |
|
1,981 |
1,831 |
$150K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
1,640 |
1,551 |
$143K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
1,648 |
1,562 |
$142K |
| 94729 |
|
1,297 |
1,207 |
$132K |
| 84443 |
Thyroid stimulating hormone (TSH) |
6,826 |
6,217 |
$128K |
| 80061 |
Lipid panel |
10,157 |
9,604 |
$127K |
| 64493 |
|
227 |
165 |
$109K |
| 62323 |
|
509 |
465 |
$107K |
| 96361 |
Intravenous infusion, hydration; each additional hour |
2,216 |
1,951 |
$106K |
| 0001A |
|
2,871 |
2,529 |
$105K |
| 86803 |
|
2,653 |
2,527 |
$104K |
| 64450 |
|
461 |
424 |
$97K |
| 96367 |
|
1,795 |
1,033 |
$94K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
191 |
187 |
$93K |
| 87340 |
|
2,556 |
2,428 |
$91K |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
166 |
164 |
$91K |
| 0002A |
|
2,320 |
2,121 |
$88K |
| 76820 |
|
654 |
437 |
$86K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
3,501 |
3,308 |
$84K |
| 92134 |
|
2,333 |
2,151 |
$81K |
| 84702 |
|
853 |
790 |
$81K |
| 86762 |
|
1,922 |
1,841 |
$81K |
| 71045 |
Radiologic examination, chest; single view |
1,291 |
1,175 |
$79K |
| 88142 |
|
2,022 |
1,934 |
$77K |
| 11900 |
|
1,003 |
924 |
$74K |
| 83655 |
|
1,400 |
1,330 |
$73K |
| 70553 |
Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences |
230 |
217 |
$72K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
1,522 |
1,367 |
$71K |
| 82950 |
|
1,408 |
1,348 |
$67K |
| 96900 |
|
4,125 |
736 |
$66K |
| 83605 |
|
373 |
325 |
$64K |
| 73630 |
|
1,078 |
895 |
$62K |
| 92133 |
|
2,091 |
1,934 |
$61K |
| 27096 |
|
204 |
191 |
$57K |
| G0260 |
Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography |
128 |
113 |
$55K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
648 |
555 |
$54K |
| 91200 |
|
812 |
776 |
$51K |
| 92557 |
|
455 |
423 |
$49K |
| 96415 |
|
801 |
590 |
$48K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
13,154 |
11,349 |
$47K |
| 73030 |
|
1,128 |
905 |
$47K |
| 76801 |
|
606 |
573 |
$46K |
| 73565 |
|
1,052 |
991 |
$45K |
| 95004 |
Percutaneous tests with allergenic extracts, immediate type reaction |
101 |
97 |
$43K |
| 17110 |
|
447 |
411 |
$42K |
| 11102 |
|
497 |
444 |
$41K |
| 96417 |
|
640 |
384 |
$40K |
| 73564 |
|
532 |
334 |
$39K |
| 64635 |
|
42 |
25 |
$39K |
| 86360 |
|
1,308 |
1,219 |
$37K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
826 |
813 |
$37K |
| 11721 |
|
7,554 |
6,580 |
$36K |
| 84439 |
|
3,736 |
3,469 |
$36K |
| 29581 |
|
622 |
224 |
$36K |
| X4014 |
|
51 |
38 |
$36K |
| 93458 |
|
12 |
12 |
$34K |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
333 |
296 |
$34K |
| 73502 |
|
867 |
764 |
$33K |
| 64405 |
|
311 |
283 |
$33K |
| 87210 |
|
891 |
845 |
$30K |
| 96416 |
|
109 |
65 |
$30K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
632 |
432 |
$29K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
388 |
355 |
$29K |
| 84481 |
|
1,784 |
1,687 |
$29K |
| 87624 |
Infectious agent detection by nucleic acid; human papillomavirus (HPV), high-risk types |
765 |
721 |
$28K |
| 93296 |
|
1,290 |
1,241 |
$28K |
| 36415 |
Collection of venous blood by venipuncture |
14,234 |
11,659 |
$27K |
| 83020 |
|
459 |
425 |
$27K |
| 31575 |
|
253 |
245 |
$26K |
| 51798 |
|
1,347 |
1,252 |
$24K |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
253 |
211 |
$24K |
| 73110 |
|
394 |
333 |
$24K |
| 73130 |
|
412 |
337 |
$24K |
| 85651 |
|
2,068 |
1,888 |
$23K |
| 87081 |
|
448 |
438 |
$23K |
| 86003 |
|
256 |
180 |
$23K |
| 73610 |
|
466 |
393 |
$23K |
| 96158 |
|
291 |
242 |
$22K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
13 |
12 |
$21K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
128 |
121 |
$21K |
| 86235 |
|
206 |
191 |
$20K |
| 17000 |
|
320 |
280 |
$19K |
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
248 |
245 |
$19K |
| 90832 |
Psychotherapy, 30 minutes with patient |
715 |
370 |
$19K |
| 86706 |
|
419 |
398 |
$18K |
| 99152 |
|
96 |
92 |
$18K |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
482 |
192 |
$18K |
| D7999 |
|
12 |
12 |
$17K |
| 72148 |
Magnetic resonance imaging, lumbar spine; without contrast material |
131 |
117 |
$17K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
417 |
363 |
$16K |
| 87637 |
Infectious agent detection by nucleic acid; SARS-CoV-2, influenza, and RSV |
184 |
131 |
$16K |
| 0011A |
|
464 |
444 |
$16K |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
429 |
412 |
$16K |
| 96523 |
|
361 |
285 |
$16K |
| 0004A |
|
463 |
344 |
$16K |
| 17311 |
|
31 |
26 |
$15K |
| 86481 |
|
164 |
153 |
$15K |
| 11720 |
|
2,455 |
2,127 |
$14K |
| 95886 |
|
515 |
476 |
$14K |
| 11100 |
|
201 |
184 |
$14K |
| 51702 |
|
182 |
167 |
$14K |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
160 |
151 |
$12K |
| 72125 |
Computed tomography, cervical spine; without contrast material |
131 |
125 |
$12K |
| 82570 |
|
1,687 |
1,567 |
$12K |
| 49083 |
|
65 |
37 |
$12K |
| 92567 |
|
457 |
423 |
$12K |
| 90837 |
Psychotherapy, 53 minutes with patient |
460 |
296 |
$11K |
| 0124A |
|
289 |
274 |
$10K |
| 83970 |
|
342 |
311 |
$10K |
| 0054A |
|
255 |
249 |
$10K |
| 72110 |
|
99 |
94 |
$10K |
| 85652 |
|
118 |
111 |
$9K |
| 73562 |
|
201 |
176 |
$9K |
| 86336 |
|
118 |
107 |
$9K |
| 82728 |
|
667 |
612 |
$8K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
52 |
51 |
$8K |
| 76830 |
Ultrasound, transvaginal |
37 |
37 |
$7K |
| 82607 |
|
543 |
510 |
$7K |
| 20552 |
|
34 |
29 |
$7K |
| 84466 |
|
580 |
528 |
$7K |
| 11056 |
|
61 |
55 |
$6K |
| 86140 |
|
1,334 |
1,219 |
$6K |
| 96156 |
|
84 |
82 |
$6K |
| 86361 |
|
239 |
214 |
$6K |
| 0012A |
|
187 |
182 |
$6K |
| 87522 |
Neg quan hep c or qual rna |
128 |
126 |
$6K |
| 80069 |
|
685 |
616 |
$6K |
| 64494 |
|
157 |
80 |
$6K |
| 0013A |
|
130 |
128 |
$6K |
| 87563 |
|
268 |
258 |
$5K |
| 83516 |
|
503 |
354 |
$5K |
| 71250 |
|
125 |
115 |
$5K |
| 0051A |
|
122 |
102 |
$5K |
| 84156 |
|
1,162 |
1,073 |
$5K |
| 95117 |
|
108 |
38 |
$5K |
| 90480 |
|
119 |
114 |
$5K |
| 76813 |
|
55 |
51 |
$5K |
| 91010 |
|
14 |
12 |
$4K |
| 73140 |
|
70 |
60 |
$4K |
| 85018 |
|
56 |
48 |
$4K |
| 51701 |
|
39 |
38 |
$4K |
| 76642 |
|
72 |
71 |
$4K |
| 82043 |
|
324 |
305 |
$4K |
| 36591 |
|
68 |
47 |
$4K |
| 83540 |
|
581 |
529 |
$4K |
| 64483 |
|
13 |
12 |
$4K |
| 95910 |
|
15 |
15 |
$4K |
| 96368 |
|
394 |
230 |
$4K |
| 72170 |
|
147 |
142 |
$4K |
| 97602 |
|
19 |
14 |
$3K |
| 76827 |
|
24 |
24 |
$3K |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
611 |
585 |
$3K |
| J0401 |
Injection, aripiprazole (abilify maintena), 1 mg |
12 |
12 |
$3K |
| M0243 |
Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring |
20 |
18 |
$3K |
| 64615 |
|
13 |
13 |
$3K |
| 0003A |
|
66 |
66 |
$3K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
24 |
24 |
$3K |
| 82565 |
|
885 |
751 |
$3K |
| 11101 |
|
36 |
33 |
$3K |
| 85045 |
|
824 |
667 |
$3K |
| V2630 |
Anterior chamber intraocular lens |
125 |
110 |
$2K |
| 83986 |
|
29 |
28 |
$2K |
| 84163 |
|
42 |
39 |
$2K |
| 97161 |
|
47 |
28 |
$2K |
| 97116 |
|
119 |
54 |
$2K |
| 17003 |
|
128 |
84 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
27 |
26 |
$2K |
| 91065 |
|
15 |
12 |
$2K |
| 82746 |
|
167 |
154 |
$2K |
| 86704 |
|
215 |
198 |
$2K |
| 90791 |
Psychiatric diagnostic evaluation |
12 |
12 |
$2K |
| 86225 |
|
179 |
166 |
$2K |
| 86160 |
|
155 |
116 |
$2K |
| 0134A |
|
59 |
57 |
$2K |
| 93017 |
|
13 |
12 |
$2K |
| 86038 |
|
179 |
166 |
$2K |
| 94760 |
|
70 |
36 |
$2K |
| 86708 |
|
75 |
73 |
$2K |
| 72050 |
|
14 |
13 |
$2K |
| U0002 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
32 |
29 |
$2K |
| 82550 |
|
361 |
315 |
$2K |
| 0064A |
|
46 |
44 |
$2K |
| 11055 |
|
14 |
13 |
$2K |
| 83615 |
|
422 |
354 |
$2K |
| 41874 |
|
15 |
12 |
$1K |
| 82784 |
|
159 |
153 |
$1K |
| 76519 |
|
15 |
14 |
$1K |
| 90853 |
Group psychotherapy (other than of a multiple-family group) |
23 |
12 |
$1K |
| 82985 |
|
53 |
51 |
$1K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
54 |
53 |
$1K |
| 83921 |
|
45 |
42 |
$962.67 |
| 82800 |
|
51 |
51 |
$957.92 |
| 93010 |
Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only |
119 |
113 |
$927.36 |
| 84153 |
|
62 |
54 |
$822.50 |
| 99232 |
Subsequent hospital care, per day, moderate complexity |
14 |
14 |
$759.08 |
| 82378 |
|
51 |
37 |
$716.12 |
| 86880 |
|
14 |
14 |
$709.97 |
| XXXXX |
|
582 |
290 |
$673.07 |
| 86200 |
|
55 |
48 |
$637.28 |
| 69210 |
|
16 |
12 |
$605.02 |
| 76514 |
|
57 |
50 |
$599.44 |
| 73080 |
|
13 |
12 |
$572.55 |
| 92082 |
|
14 |
13 |
$555.39 |
| 0071A |
|
30 |
21 |
$550.00 |
| 0031A |
|
13 |
12 |
$494.00 |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
12 |
12 |
$350.00 |
| 88175 |
Cytopathology, cervical or vaginal, any reporting system; collected in preservative fluid, automated thin layer |
14 |
14 |
$323.32 |
| 86592 |
|
53 |
53 |
$310.56 |
| 84100 |
|
87 |
51 |
$248.41 |
| J3301 |
Injection, triamcinolone acetonide, not otherwise specified, 10 mg |
1,075 |
1,030 |
$247.69 |
| 87040 |
|
13 |
12 |
$241.57 |
| Q3014 |
Telehealth originating site facility fee |
15 |
15 |
$240.82 |
| 84403 |
|
15 |
15 |
$235.16 |
| 86376 |
|
12 |
12 |
$205.38 |
| 87338 |
|
12 |
12 |
$190.90 |
| 86709 |
|
15 |
15 |
$174.74 |
| J2704 |
Injection, propofol, 10 mg |
536 |
492 |
$143.11 |
| 82103 |
|
12 |
12 |
$142.20 |
| 82105 |
|
12 |
12 |
$134.10 |
| 86255 |
|
13 |
13 |
$127.48 |
| 76937 |
|
14 |
12 |
$119.28 |
| 86256 |
|
23 |
12 |
$114.00 |
| 84460 |
|
25 |
25 |
$103.38 |
| 84450 |
|
25 |
25 |
$101.04 |
| 97162 |
|
15 |
14 |
$93.92 |
| 90686 |
|
45 |
37 |
$82.11 |
| 84550 |
|
33 |
28 |
$80.20 |
| 76825 |
|
12 |
12 |
$68.11 |
| 86431 |
|
13 |
12 |
$64.32 |
| 81015 |
|
12 |
12 |
$62.57 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
69 |
53 |
$53.22 |
| J1642 |
Injection, heparin sodium, (heparin lock flush), per 10 units |
284 |
193 |
$47.16 |
| 80329 |
|
660 |
627 |
$45.56 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
173 |
157 |
$35.53 |
| 96376 |
|
103 |
78 |
$31.20 |
| J0665 |
Injection, bupivicaine, not otherwise specified, 0.5 mg |
261 |
228 |
$24.67 |
| 95806 |
|
29 |
29 |
$20.79 |
| 90688 |
|
13 |
12 |
$19.98 |
| G0008 |
Administration of influenza virus vaccine |
621 |
567 |
$17.39 |
| 80320 |
|
693 |
661 |
$15.50 |
| G8978 |
Mobility: walking & moving around functional limitation, current status, at therapy episode outset and at reporting intervals |
49 |
36 |
$12.95 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
53 |
39 |
$3.23 |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
57 |
29 |
$0.00 |
| Q9966 |
Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml |
60 |
57 |
$0.00 |
| 93325 |
|
12 |
12 |
$0.00 |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
21 |
12 |
$0.00 |
| 64495 |
|
69 |
29 |
$0.00 |
| 11103 |
|
18 |
12 |
$0.00 |
| G8979 |
Mobility: walking & moving around functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting |
51 |
36 |
$0.00 |
| 64636 |
|
48 |
13 |
$0.00 |
| 93356 |
|
28 |
26 |
$0.00 |
| 0370 |
|
41 |
34 |
$0.00 |
| A9270 |
Non-covered item or service |
172 |
104 |
$0.00 |
| J1030 |
Injection, methylprednisolone acetate, 40 mg |
33 |
30 |
$0.00 |
| C9290 |
Injection, bupivacaine liposome, 1 mg |
187 |
180 |
$0.00 |
| 0270 |
|
76 |
61 |
$0.00 |
| J2003 |
Injection, lidocaine hydrochloride, 1 mg |
17 |
14 |
$0.00 |
| 0250 |
|
359 |
289 |
$0.00 |
| A9585 |
Injection, gadobutrol, 0.1 ml |
49 |
49 |
$0.00 |
| C1769 |
Guide wire |
26 |
15 |
$0.00 |
| J7050 |
Infusion, normal saline solution, 250 cc |
17 |
12 |
$0.00 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
13 |
13 |
$0.00 |