| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
18,153 |
15,480 |
$1.18M |
| G0381 |
Level 2 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment) |
13,997 |
12,890 |
$1.07M |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
24,370 |
22,665 |
$940K |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
11,064 |
8,997 |
$879K |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
7,756 |
6,369 |
$757K |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
9,332 |
8,214 |
$663K |
| G0382 |
Level 3 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment) |
8,762 |
8,203 |
$652K |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
13,637 |
4,171 |
$626K |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
4,226 |
3,686 |
$621K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
3,660 |
3,167 |
$383K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
18,016 |
15,010 |
$380K |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
7,711 |
6,215 |
$360K |
| 70450 |
Computed tomography, head or brain; without contrast material |
4,459 |
3,551 |
$323K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
3,873 |
3,237 |
$251K |
| 36415 |
Collection of venous blood by venipuncture |
22,058 |
17,415 |
$205K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
1,704 |
1,461 |
$180K |
| G0380 |
Level 1 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment) |
3,324 |
3,052 |
$171K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
6,878 |
3,931 |
$157K |
| 72125 |
Computed tomography, cervical spine; without contrast material |
1,175 |
917 |
$139K |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
1,289 |
1,020 |
$127K |
| 80053 |
Comprehensive metabolic panel |
47,979 |
37,835 |
$127K |
| C9803 |
Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
2,880 |
2,573 |
$120K |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
2,355 |
1,850 |
$119K |
| G0378 |
Hospital observation service, per hour |
7,449 |
4,093 |
$110K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
12,373 |
9,704 |
$109K |
| J7030 |
Infusion, normal saline solution , 1000 cc |
1,402 |
1,115 |
$106K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
878 |
732 |
$103K |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
490 |
444 |
$102K |
| 97162 |
|
2,314 |
1,888 |
$97K |
| G0383 |
Level 4 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment) |
1,509 |
1,429 |
$95K |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
5,191 |
1,674 |
$92K |
| 97161 |
|
855 |
764 |
$89K |
| 80305 |
|
2,594 |
2,288 |
$87K |
| 96361 |
Intravenous infusion, hydration; each additional hour |
2,317 |
1,915 |
$85K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
1,585 |
863 |
$82K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
1,371 |
1,175 |
$74K |
| 87088 |
|
15,651 |
13,229 |
$72K |
| 86850 |
|
3,538 |
2,928 |
$71K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
2,042 |
1,851 |
$63K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
4,140 |
3,604 |
$60K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
750 |
698 |
$57K |
| 84484 |
|
11,343 |
7,191 |
$53K |
| 73630 |
|
969 |
828 |
$52K |
| 93975 |
|
1,201 |
1,119 |
$48K |
| 71046 |
Radiologic examination, chest; 2 views |
4,804 |
4,163 |
$47K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
3,444 |
3,138 |
$46K |
| 73610 |
|
932 |
817 |
$46K |
| 81001 |
|
20,478 |
17,319 |
$44K |
| 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 |
935 |
805 |
$43K |
| 71045 |
Radiologic examination, chest; single view |
12,820 |
10,547 |
$43K |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
693 |
629 |
$43K |
| 73562 |
|
1,235 |
951 |
$42K |
| 87633 |
Infectious agent detection by nucleic acid, respiratory virus, 12-25 targets |
956 |
842 |
$42K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
1,178 |
1,128 |
$41K |
| 59025 |
Fetal non-stress test |
2,991 |
2,183 |
$41K |
| 73130 |
|
745 |
622 |
$39K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
3,548 |
3,290 |
$39K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
1,907 |
1,510 |
$38K |
| 82962 |
|
8,243 |
3,432 |
$36K |
| 81003 |
|
7,589 |
6,507 |
$35K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
46,196 |
36,987 |
$33K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
550 |
489 |
$32K |
| 97113 |
|
367 |
115 |
$31K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
6,525 |
4,741 |
$29K |
| 94060 |
|
467 |
399 |
$25K |
| 96376 |
|
4,355 |
2,555 |
$25K |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
1,117 |
503 |
$25K |
| 73030 |
|
1,028 |
810 |
$25K |
| 59050 |
|
2,565 |
1,963 |
$25K |
| 0241U |
Neonatal screening for hereditary disorders, genomic sequence analysis panel |
533 |
498 |
$24K |
| 93971 |
|
736 |
624 |
$23K |
| 81025 |
|
10,817 |
9,752 |
$23K |
| 84702 |
|
2,565 |
2,021 |
$22K |
| 78452 |
Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress |
261 |
194 |
$22K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
1,316 |
808 |
$22K |
| J2785 |
Injection, regadenoson, 0.1 mg |
159 |
115 |
$21K |
| 73110 |
|
362 |
320 |
$18K |
| 85027 |
|
12,057 |
9,263 |
$18K |
| 84443 |
Thyroid stimulating hormone (TSH) |
8,094 |
6,871 |
$18K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
15,033 |
11,629 |
$18K |
| 86900 |
|
3,391 |
2,869 |
$18K |
| 99291 |
Critical care, evaluation and management of the critically ill patient, first 30-74 minutes |
129 |
116 |
$17K |
| 72100 |
|
810 |
695 |
$17K |
| 85610 |
|
12,512 |
9,735 |
$16K |
| 74018 |
|
902 |
825 |
$14K |
| 93017 |
|
567 |
434 |
$12K |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
2,422 |
2,236 |
$12K |
| 45380 |
Colonoscopy, flexible; with biopsy, single or multiple |
45 |
39 |
$12K |
| 83880 |
|
2,631 |
1,985 |
$11K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
2,019 |
1,552 |
$11K |
| 12001 |
|
215 |
199 |
$10K |
| 76830 |
Ultrasound, transvaginal |
1,003 |
934 |
$10K |
| 80061 |
Lipid panel |
7,920 |
6,723 |
$10K |
| 81220 |
CFTR (cystic fibrosis transmembrane conductance regulator) gene analysis; common variants |
83 |
78 |
$8K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
3,419 |
3,120 |
$8K |
| U0002 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
2,177 |
1,951 |
$8K |
| 93798 |
|
348 |
51 |
$8K |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
10,938 |
8,642 |
$7K |
| 0202U |
Oncology (prostate), multianalyte, gene expression profiling |
710 |
678 |
$7K |
| 83735 |
|
5,472 |
3,825 |
$7K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
1,977 |
1,671 |
$7K |
| 86901 |
|
3,553 |
2,954 |
$7K |
| 87807 |
|
77 |
77 |
$6K |
| A9579 |
Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (nos), per ml |
524 |
423 |
$6K |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
2,451 |
2,075 |
$6K |
| G1004 |
Clinical decision support mechanism national decision support company, as defined by the medicare appropriate use criteria program |
2,455 |
1,419 |
$6K |
| 87186 |
|
5,168 |
4,055 |
$5K |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
3,438 |
2,680 |
$5K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
5,818 |
4,890 |
$5K |
| 87077 |
|
5,642 |
4,358 |
$5K |
| 87081 |
|
3,127 |
2,957 |
$5K |
| 87070 |
|
1,441 |
1,217 |
$5K |
| 85730 |
|
3,588 |
2,872 |
$5K |
| 70553 |
Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences |
44 |
40 |
$5K |
| 73080 |
|
125 |
109 |
$5K |
| 87481 |
|
583 |
516 |
$5K |
| 80320 |
|
1,627 |
1,405 |
$5K |
| 82565 |
|
362 |
292 |
$4K |
| 72040 |
|
167 |
147 |
$4K |
| 83690 |
|
10,001 |
8,512 |
$4K |
| 94760 |
|
2,408 |
1,853 |
$4K |
| 97010 |
|
551 |
196 |
$4K |
| 81513 |
|
205 |
197 |
$4K |
| J2704 |
Injection, propofol, 10 mg |
2,823 |
2,428 |
$4K |
| 84703 |
|
2,992 |
2,729 |
$4K |
| C1769 |
Guide wire |
170 |
130 |
$4K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
126 |
114 |
$4K |
| 97112 |
Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination |
106 |
39 |
$4K |
| 97535 |
Self-care/home management training, each 15 minutes |
73 |
39 |
$3K |
| 86762 |
|
1,350 |
1,228 |
$3K |
| 93970 |
|
81 |
65 |
$3K |
| G8978 |
Mobility: walking & moving around functional limitation, current status, at therapy episode outset and at reporting intervals |
247 |
210 |
$3K |
| G8979 |
Mobility: walking & moving around functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting |
252 |
214 |
$3K |
| 84112 |
|
145 |
120 |
$3K |
| J0690 |
Injection, cefazolin sodium, 500 mg |
1,309 |
970 |
$3K |
| 85379 |
|
2,519 |
2,142 |
$3K |
| 87210 |
|
1,000 |
938 |
$3K |
| 83605 |
|
2,885 |
2,128 |
$3K |
| J1650 |
Injection, enoxaparin sodium, 10 mg |
2,717 |
1,234 |
$3K |
| 87040 |
|
2,554 |
1,573 |
$2K |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
5,164 |
4,278 |
$2K |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
2,828 |
2,371 |
$2K |
| 86803 |
|
1,096 |
997 |
$2K |
| 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 |
369 |
276 |
$2K |
| 86140 |
|
3,400 |
2,690 |
$2K |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
3,025 |
2,322 |
$2K |
| 87340 |
|
2,074 |
1,891 |
$2K |
| 80074 |
|
59 |
50 |
$2K |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
2,281 |
1,890 |
$2K |
| 87799 |
|
311 |
215 |
$2K |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
664 |
604 |
$2K |
| 29515 |
|
201 |
184 |
$2K |
| 82728 |
|
1,294 |
1,084 |
$2K |
| 82607 |
|
2,341 |
1,946 |
$2K |
| 49083 |
|
20 |
12 |
$2K |
| 72131 |
|
31 |
27 |
$2K |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
1,979 |
1,649 |
$2K |
| 29125 |
|
251 |
225 |
$2K |
| 71101 |
|
50 |
45 |
$2K |
| 80164 |
|
641 |
513 |
$2K |
| 82950 |
|
973 |
929 |
$2K |
| 87116 |
|
191 |
166 |
$2K |
| 84481 |
|
339 |
301 |
$2K |
| 87637 |
Infectious agent detection by nucleic acid; SARS-CoV-2, influenza, and RSV |
482 |
458 |
$1K |
| 94618 |
|
116 |
96 |
$1K |
| 64493 |
|
17 |
12 |
$1K |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
29 |
24 |
$1K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
70 |
67 |
$1K |
| 84439 |
|
2,496 |
2,168 |
$1K |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
1,051 |
837 |
$1K |
| 87205 |
|
1,460 |
1,224 |
$1K |
| 76775 |
|
55 |
50 |
$1K |
| 12011 |
|
160 |
151 |
$1K |
| 85652 |
|
2,252 |
1,910 |
$1K |
| 87581 |
|
955 |
841 |
$1K |
| J1815 |
Injection, insulin, per 5 units |
2,204 |
758 |
$1K |
| 82550 |
|
1,851 |
1,430 |
$1K |
| 0100U |
|
40 |
35 |
$1K |
| 87798 |
Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism |
962 |
847 |
$1K |
| 87486 |
|
955 |
841 |
$1K |
| 86592 |
|
2,243 |
2,050 |
$1K |
| J1170 |
Injection, hydromorphone, up to 4 mg |
3,011 |
1,947 |
$1K |
| 84100 |
|
1,015 |
676 |
$1K |
| J0702 |
Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg |
278 |
224 |
$1K |
| 20610 |
|
37 |
28 |
$1K |
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
13 |
13 |
$954.39 |
| 73502 |
|
162 |
124 |
$940.12 |
| 83550 |
|
1,324 |
1,097 |
$906.66 |
| 87512 |
|
390 |
340 |
$901.02 |
| 83540 |
|
1,552 |
1,281 |
$863.60 |
| J2060 |
Injection, lorazepam, 2 mg |
1,176 |
833 |
$838.68 |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
535 |
434 |
$836.00 |
| J1644 |
Injection, heparin sodium, per 1000 units |
471 |
196 |
$784.62 |
| 96367 |
|
110 |
89 |
$777.20 |
| 83970 |
|
237 |
185 |
$754.75 |
| 85007 |
|
1,335 |
1,066 |
$669.64 |
| J0330 |
Injection, succinylcholine chloride, up to 20 mg |
817 |
705 |
$667.55 |
| 94644 |
|
146 |
117 |
$626.74 |
| 84153 |
|
472 |
402 |
$622.10 |
| 82043 |
|
1,731 |
1,458 |
$581.98 |
| 73620 |
|
12 |
12 |
$556.03 |
| 87507 |
|
46 |
43 |
$532.53 |
| M0243 |
Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring |
65 |
55 |
$430.34 |
| 87015 |
|
191 |
166 |
$404.39 |
| 87206 |
|
191 |
166 |
$404.39 |
| 88304 |
|
54 |
50 |
$399.18 |
| 82951 |
|
24 |
24 |
$375.78 |
| 51701 |
|
536 |
402 |
$360.91 |
| 94729 |
|
295 |
251 |
$360.27 |
| 85660 |
|
121 |
115 |
$351.59 |
| 87102 |
|
96 |
76 |
$342.39 |
| 77002 |
|
17 |
13 |
$324.44 |
| J1040 |
Injection, methylprednisolone acetate, 80 mg |
309 |
261 |
$308.42 |
| A9500 |
Technetium tc-99m sestamibi, diagnostic, per study dose |
359 |
227 |
$288.42 |
| 84156 |
|
877 |
690 |
$273.42 |
| 82746 |
|
700 |
576 |
$269.94 |
| 84550 |
|
1,151 |
909 |
$263.93 |
| 90715 |
|
246 |
220 |
$262.79 |
| J2370 |
Injection, phenylephrine hcl, up to 1 ml |
321 |
270 |
$260.12 |
| 74022 |
|
99 |
90 |
$229.78 |
| 99152 |
|
179 |
140 |
$228.56 |
| 87510 |
|
89 |
81 |
$199.06 |
| J2550 |
Injection, promethazine hcl, up to 50 mg |
436 |
345 |
$191.19 |
| 86038 |
|
253 |
211 |
$181.23 |
| 97116 |
|
53 |
24 |
$180.00 |
| 76819 |
Fetal biophysical profile; without non-stress testing |
17 |
14 |
$178.27 |
| 82947 |
|
74 |
71 |
$176.29 |
| J3301 |
Injection, triamcinolone acetonide, not otherwise specified, 10 mg |
106 |
87 |
$160.76 |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
806 |
773 |
$156.13 |
| J1030 |
Injection, methylprednisolone acetate, 40 mg |
187 |
148 |
$136.81 |
| J2543 |
Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams) |
312 |
158 |
$136.76 |
| 29530 |
|
39 |
29 |
$135.28 |
| 94727 |
|
281 |
237 |
$122.01 |
| 82670 |
|
14 |
13 |
$116.35 |
| 82805 |
|
28 |
25 |
$104.99 |
| 84403 |
|
102 |
83 |
$94.20 |
| P9612 |
Catheterization for collection of specimen, single patient, all places of service |
307 |
231 |
$92.32 |
| 88342 |
|
21 |
20 |
$83.51 |
| J2360 |
Injection, orphenadrine citrate, up to 60 mg |
169 |
147 |
$82.82 |
| 80329 |
|
191 |
177 |
$78.54 |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
299 |
218 |
$76.47 |
| 80069 |
|
108 |
70 |
$75.04 |
| 82248 |
|
258 |
196 |
$67.48 |
| 88312 |
|
320 |
271 |
$64.97 |
| 76801 |
|
46 |
41 |
$62.14 |
| 80197 |
|
38 |
26 |
$47.13 |
| 87480 |
|
89 |
81 |
$37.50 |
| 87660 |
|
91 |
82 |
$37.50 |
| 83615 |
|
402 |
316 |
$34.57 |
| 00811 |
|
27 |
25 |
$29.17 |
| J1940 |
Injection, furosemide, up to 20 mg |
25 |
13 |
$24.81 |
| 86376 |
|
28 |
25 |
$19.37 |
| 84145 |
|
31 |
24 |
$16.28 |
| 00731 |
|
77 |
65 |
$14.49 |
| J0780 |
Injection, prochlorperazine, up to 10 mg |
331 |
281 |
$12.39 |
| 87147 |
|
18 |
16 |
$10.44 |
| 86431 |
|
15 |
13 |
$9.48 |
| 82150 |
|
17 |
14 |
$8.85 |
| 82533 |
|
16 |
12 |
$8.10 |
| 84132 |
|
14 |
12 |
$3.13 |
| 85384 |
|
68 |
55 |
$2.38 |
| 64494 |
|
17 |
12 |
$0.00 |
| C1725 |
Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability) |
57 |
50 |
$0.00 |
| Q9969 |
Tc-99m from non-highly enriched uranium source, full cost recovery add-on, per study dose |
84 |
67 |
$0.00 |
| J1790 |
Injection, droperidol, up to 5 mg |
212 |
177 |
$0.00 |
| J0360 |
Injection, hydralazine hcl, up to 20 mg |
133 |
93 |
$0.00 |
| 00813 |
|
118 |
106 |
$0.00 |
| 86308 |
|
15 |
12 |
$0.00 |
| 80156 |
|
20 |
12 |
$0.00 |
| J3480 |
Injection, potassium chloride, per 2 meq |
48 |
28 |
$0.00 |
| 94762 |
|
43 |
25 |
$0.00 |
| J7510 |
Prednisolone oral, per 5 mg |
315 |
311 |
$0.00 |
| Q0163 |
Diphenhydramine hydrochloride, 50 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at time of chemotherapy treatment not to exceed a 48 hour dosage regimen |
25 |
25 |
$0.00 |
| C1713 |
Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable) |
18 |
12 |
$0.00 |
| 00840 |
|
67 |
62 |
$0.00 |
| 94664 |
|
17 |
12 |
$0.00 |
| 88313 |
|
105 |
90 |
$0.00 |
| C1776 |
Joint device (implantable) |
32 |
28 |
$0.00 |
| 83516 |
|
21 |
12 |
$0.00 |
| C1876 |
Stent, non-coated/non-covered, with delivery system |
19 |
12 |
$0.00 |
| 84460 |
|
13 |
12 |
$0.00 |
| 84450 |
|
13 |
12 |
$0.00 |