| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A0427 |
Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) |
12,188 |
11,208 |
$10.77M |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
25,380 |
22,922 |
$8.82M |
| A0429 |
Ambulance service, basic life support, emergency transport (bls-emergency) |
35,943 |
29,947 |
$7.66M |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
23,487 |
21,718 |
$6.61M |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
16,104 |
14,589 |
$6.47M |
| H0035 |
Mental health partial hospitalization, treatment, less than 24 hours |
33,399 |
3,832 |
$5.85M |
| 90834 |
Psychotherapy, 45 minutes with patient |
37,370 |
24,107 |
$4.18M |
| A0428 |
Ambulance service, basic life support, non-emergency transport, (bls) |
14,133 |
11,695 |
$3.92M |
| S9480 |
Intensive outpatient psychiatric services, per diem |
4,433 |
3,991 |
$3.47M |
| 90791 |
Psychiatric diagnostic evaluation |
19,150 |
16,453 |
$2.50M |
| G0378 |
Hospital observation service, per hour |
7,217 |
5,182 |
$2.24M |
| A0425 |
Ground mileage, per statute mile |
60,671 |
47,513 |
$1.71M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
21,379 |
18,501 |
$1.54M |
| OP272 |
|
21,590 |
17,586 |
$1.22M |
| 90837 |
Psychotherapy, 53 minutes with patient |
10,664 |
6,973 |
$1.16M |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
9,469 |
8,480 |
$1.11M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
14,224 |
13,213 |
$1.07M |
| T2034 |
Crisis intervention, waiver; per diem |
1,282 |
1,127 |
$1.02M |
| 99291 |
Critical care, evaluation and management of the critically ill patient, first 30-74 minutes |
1,974 |
1,773 |
$936K |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
6,410 |
5,609 |
$821K |
| 90832 |
Psychotherapy, 30 minutes with patient |
12,081 |
8,235 |
$775K |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
2,762 |
2,574 |
$614K |
| A0998 |
Ambulance response and treatment, no transport |
403 |
395 |
$611K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
11,785 |
9,222 |
$516K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
12,172 |
8,313 |
$513K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
12,761 |
11,346 |
$455K |
| A0434 |
Specialty care transport (sct) |
466 |
443 |
$446K |
| 90853 |
Group psychotherapy (other than of a multiple-family group) |
12,595 |
3,689 |
$445K |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
14,160 |
9,299 |
$442K |
| 71045 |
Radiologic examination, chest; single view |
9,507 |
8,559 |
$399K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
3,024 |
2,808 |
$397K |
| 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 |
6,236 |
5,697 |
$384K |
| 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 |
7,535 |
4,676 |
$377K |
| 96361 |
Intravenous infusion, hydration; each additional hour |
6,984 |
6,099 |
$363K |
| OP710 |
|
2,037 |
1,611 |
$361K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
2,825 |
2,279 |
$340K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
2,402 |
2,183 |
$339K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
3,178 |
3,127 |
$328K |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
2,416 |
2,339 |
$325K |
| 70450 |
Computed tomography, head or brain; without contrast material |
4,634 |
4,227 |
$302K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
2,459 |
1,918 |
$297K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
10,785 |
9,432 |
$279K |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
10,380 |
2,346 |
$273K |
| OP370 |
|
2,217 |
1,868 |
$249K |
| OP250 |
|
46,166 |
24,955 |
$230K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
2,435 |
2,118 |
$224K |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
4,780 |
3,786 |
$223K |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
1,204 |
1,170 |
$215K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
26,822 |
22,524 |
$215K |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
685 |
685 |
$209K |
| A0433 |
Advanced life support, level 2 (als 2) |
137 |
133 |
$193K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
5,327 |
4,667 |
$187K |
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
2,221 |
2,066 |
$171K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
2,160 |
1,936 |
$166K |
| 71046 |
Radiologic examination, chest; 2 views |
4,820 |
4,556 |
$165K |
| 97112 |
Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination |
6,649 |
1,674 |
$157K |
| 11042 |
Debridement, subcutaneous tissue (includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm |
850 |
335 |
$144K |
| 76641 |
|
1,510 |
1,484 |
$131K |
| 80320 |
|
4,262 |
3,753 |
$131K |
| C9803 |
Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
8,121 |
7,132 |
$128K |
| 76819 |
Fetal biophysical profile; without non-stress testing |
1,318 |
1,193 |
$128K |
| OP271 |
|
11,067 |
9,463 |
$120K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
14,909 |
13,023 |
$116K |
| 76811 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, detailed |
548 |
541 |
$106K |
| 80053 |
Comprehensive metabolic panel |
12,317 |
10,443 |
$105K |
| 36415 |
Collection of venous blood by venipuncture |
31,464 |
25,674 |
$105K |
| G0379 |
Direct admission of patient for hospital observation care |
199 |
177 |
$91K |
| 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 |
4,670 |
4,229 |
$88K |
| 90715 |
|
1,587 |
1,506 |
$88K |
| OP259 |
|
9,401 |
7,942 |
$88K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
6,202 |
4,233 |
$85K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
1,132 |
1,082 |
$82K |
| 80306 |
|
3,670 |
1,476 |
$80K |
| 73130 |
|
1,776 |
1,644 |
$77K |
| 73630 |
|
1,967 |
1,794 |
$76K |
| 99241 |
|
3,246 |
2,910 |
$75K |
| 90833 |
Psychotherapy, 30 minutes with patient when performed with an E&M service (add-on) |
1,434 |
829 |
$72K |
| 80305 |
|
3,422 |
3,030 |
$71K |
| J3490 |
Unclassified drugs |
6,619 |
3,426 |
$69K |
| 93975 |
|
545 |
527 |
$63K |
| 94664 |
|
754 |
677 |
$63K |
| 74018 |
|
1,389 |
1,260 |
$60K |
| 73610 |
|
1,521 |
1,409 |
$60K |
| 78452 |
Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress |
159 |
159 |
$58K |
| 93017 |
|
323 |
319 |
$55K |
| 84484 |
|
7,454 |
5,988 |
$55K |
| 93976 |
|
501 |
458 |
$52K |
| OP270 |
|
5,549 |
4,869 |
$51K |
| 73030 |
|
1,319 |
1,196 |
$51K |
| 86900 |
|
1,888 |
1,737 |
$51K |
| 72125 |
Computed tomography, cervical spine; without contrast material |
855 |
748 |
$50K |
| 84443 |
Thyroid stimulating hormone (TSH) |
3,030 |
2,860 |
$49K |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
1,978 |
1,926 |
$47K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,364 |
1,216 |
$46K |
| 81025 |
|
13,447 |
12,276 |
$45K |
| 73562 |
|
1,202 |
1,073 |
$45K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
1,347 |
1,314 |
$44K |
| 59025 |
Fetal non-stress test |
336 |
233 |
$44K |
| 76830 |
Ultrasound, transvaginal |
528 |
519 |
$43K |
| U0002 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
1,128 |
1,037 |
$42K |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
1,018 |
303 |
$41K |
| 72100 |
|
644 |
607 |
$39K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
1,334 |
1,301 |
$38K |
| 87633 |
Infectious agent detection by nucleic acid, respiratory virus, 12-25 targets |
117 |
116 |
$37K |
| J7030 |
Infusion, normal saline solution , 1000 cc |
9,640 |
7,912 |
$37K |
| 83690 |
|
7,712 |
6,913 |
$37K |
| 87070 |
|
4,733 |
4,554 |
$34K |
| 76801 |
|
418 |
367 |
$32K |
| 96376 |
|
700 |
577 |
$32K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
6,390 |
5,713 |
$31K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
1,027 |
1,022 |
$29K |
| 82962 |
|
6,234 |
4,206 |
$29K |
| 97161 |
|
448 |
442 |
$28K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
2,564 |
2,455 |
$28K |
| 82550 |
|
4,952 |
4,349 |
$28K |
| 93970 |
|
232 |
222 |
$27K |
| 83880 |
|
1,215 |
1,104 |
$27K |
| 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 |
1,888 |
1,625 |
$27K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
372 |
290 |
$26K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
187 |
180 |
$26K |
| 80076 |
|
4,455 |
4,065 |
$26K |
| 90847 |
Family psychotherapy with the patient present, 50 minutes |
461 |
369 |
$26K |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
6,182 |
5,207 |
$26K |
| 80061 |
Lipid panel |
2,004 |
1,899 |
$25K |
| 99215 |
Prolong outpt/office vis |
329 |
291 |
$24K |
| A9270 |
Non-covered item or service |
637 |
523 |
$24K |
| 82075 |
|
3,143 |
2,626 |
$24K |
| 99242 |
|
209 |
160 |
$23K |
| 73110 |
|
570 |
530 |
$23K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
461 |
389 |
$21K |
| 81001 |
|
10,256 |
9,185 |
$21K |
| 85730 |
|
5,296 |
4,828 |
$20K |
| 0202U |
Oncology (prostate), multianalyte, gene expression profiling |
193 |
165 |
$20K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
284 |
272 |
$20K |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
909 |
882 |
$20K |
| 85610 |
|
5,706 |
5,161 |
$19K |
| 86850 |
|
1,707 |
1,540 |
$19K |
| 87186 |
|
1,257 |
1,111 |
$18K |
| J2704 |
Injection, propofol, 10 mg |
2,534 |
1,882 |
$18K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
215 |
175 |
$18K |
| 87798 |
Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism |
446 |
428 |
$16K |
| 76813 |
|
159 |
157 |
$16K |
| 85027 |
|
3,710 |
3,305 |
$15K |
| 87088 |
|
3,033 |
2,890 |
$14K |
| 87275 |
|
1,478 |
1,466 |
$13K |
| 86901 |
|
1,757 |
1,574 |
$13K |
| 83735 |
|
2,734 |
2,243 |
$13K |
| 77080 |
|
251 |
231 |
$13K |
| 97010 |
|
2,303 |
635 |
$13K |
| 81003 |
|
6,868 |
6,358 |
$13K |
| 87040 |
|
1,432 |
1,093 |
$13K |
| 29125 |
|
84 |
80 |
$13K |
| 84439 |
|
1,443 |
1,388 |
$12K |
| 87077 |
|
1,603 |
1,463 |
$12K |
| 82553 |
|
1,528 |
1,401 |
$12K |
| 87806 |
|
501 |
481 |
$12K |
| 83605 |
|
1,393 |
1,180 |
$12K |
| 87081 |
|
1,660 |
1,645 |
$12K |
| J2060 |
Injection, lorazepam, 2 mg |
2,342 |
1,704 |
$11K |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
904 |
655 |
$11K |
| 87420 |
|
1,031 |
1,005 |
$11K |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
6,277 |
4,905 |
$11K |
| 74019 |
|
132 |
127 |
$11K |
| OP720 |
|
64 |
48 |
$10K |
| 87276 |
|
1,479 |
1,467 |
$10K |
| 12001 |
|
61 |
55 |
$9K |
| 73502 |
|
276 |
254 |
$9K |
| 84702 |
|
728 |
633 |
$9K |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
382 |
188 |
$9K |
| 80164 |
|
348 |
299 |
$9K |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
332 |
328 |
$8K |
| OP279 |
|
707 |
692 |
$8K |
| OP258 |
|
775 |
665 |
$8K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
1,591 |
1,512 |
$8K |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
1,648 |
1,265 |
$7K |
| 72110 |
|
120 |
116 |
$7K |
| 73560 |
|
235 |
203 |
$7K |
| 51798 |
|
146 |
137 |
$7K |
| 77065 |
Tomosynthesis, mammo |
68 |
64 |
$7K |
| J1170 |
Injection, hydromorphone, up to 4 mg |
1,546 |
1,076 |
$6K |
| 85379 |
|
1,405 |
1,283 |
$6K |
| 82150 |
|
1,132 |
1,094 |
$5K |
| 81220 |
CFTR (cystic fibrosis transmembrane conductance regulator) gene analysis; common variants |
12 |
12 |
$5K |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
1,741 |
1,402 |
$4K |
| 82947 |
|
1,175 |
929 |
$4K |
| 76770 |
|
67 |
66 |
$4K |
| 73080 |
|
114 |
105 |
$4K |
| 76536 |
|
53 |
53 |
$4K |
| J7060 |
5% dextrose/water (500 ml = 1 unit) |
1,929 |
915 |
$4K |
| J0690 |
Injection, cefazolin sodium, 500 mg |
567 |
395 |
$4K |
| J7040 |
Infusion, normal saline solution, sterile (500 ml = 1 unit) |
1,125 |
996 |
$3K |
| 85378 |
|
530 |
521 |
$3K |
| 97116 |
|
112 |
61 |
$3K |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
1,386 |
1,112 |
$3K |
| 87486 |
|
114 |
113 |
$3K |
| 87581 |
|
113 |
112 |
$3K |
| 80329 |
|
40 |
26 |
$3K |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
2,654 |
1,418 |
$3K |
| 10060 |
|
12 |
12 |
$3K |
| 85007 |
|
1,202 |
1,091 |
$3K |
| 83655 |
|
279 |
278 |
$3K |
| 84703 |
|
294 |
275 |
$2K |
| 80354 |
|
80 |
45 |
$2K |
| 93880 |
|
41 |
41 |
$2K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
236 |
209 |
$2K |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
393 |
280 |
$2K |
| 12011 |
|
12 |
12 |
$2K |
| M0222 |
Intravenous injection, bebtelovimab, includes injection and post administration monitoring |
19 |
17 |
$2K |
| 97597 |
|
25 |
12 |
$2K |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
882 |
689 |
$2K |
| 87205 |
|
363 |
354 |
$2K |
| 72050 |
|
42 |
42 |
$2K |
| J2543 |
Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams) |
86 |
26 |
$2K |
| 97162 |
|
27 |
24 |
$2K |
| 74021 |
|
26 |
25 |
$2K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
15 |
13 |
$1K |
| 72040 |
|
42 |
38 |
$1K |
| 80074 |
|
56 |
53 |
$1K |
| 87299 |
|
109 |
104 |
$1K |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
544 |
345 |
$1K |
| 86592 |
|
441 |
411 |
$1K |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
731 |
579 |
$955.27 |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
932 |
784 |
$855.17 |
| 87340 |
|
184 |
181 |
$844.45 |
| G0008 |
Administration of influenza virus vaccine |
41 |
40 |
$795.38 |
| 29130 |
|
14 |
12 |
$764.53 |
| J1630 |
Injection, haloperidol, up to 5 mg |
509 |
332 |
$760.17 |
| 82950 |
|
125 |
111 |
$724.37 |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
153 |
121 |
$681.71 |
| 83020 |
|
113 |
111 |
$679.39 |
| 93225 |
|
12 |
12 |
$671.73 |
| 76818 |
|
12 |
12 |
$647.80 |
| 71100 |
|
27 |
25 |
$622.61 |
| 82465 |
|
184 |
184 |
$618.84 |
| 36600 |
|
13 |
12 |
$600.59 |
| 80178 |
|
19 |
17 |
$550.97 |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
12 |
12 |
$543.53 |
| 86618 |
|
29 |
29 |
$531.74 |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
17 |
15 |
$502.88 |
| 88304 |
|
15 |
13 |
$484.38 |
| A9575 |
Injection, gadoterate meglumine, 0.1 ml |
17 |
12 |
$484.04 |
| 82248 |
|
95 |
76 |
$444.01 |
| 84480 |
|
30 |
30 |
$436.50 |
| 93296 |
|
13 |
12 |
$435.03 |
| 84100 |
|
152 |
111 |
$427.79 |
| J3411 |
Injection, thiamine hcl, 100 mg |
146 |
128 |
$417.34 |
| J0665 |
Injection, bupivicaine, not otherwise specified, 0.5 mg |
173 |
119 |
$400.19 |
| 90686 |
|
14 |
14 |
$383.28 |
| 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 |
682 |
515 |
$362.57 |
| A9500 |
Technetium tc-99m sestamibi, diagnostic, per study dose |
26 |
26 |
$361.81 |
| 83021 |
|
16 |
16 |
$344.00 |
| 82247 |
|
119 |
89 |
$337.30 |
| 82105 |
|
24 |
24 |
$272.90 |
| 86762 |
|
98 |
96 |
$272.42 |
| J2001 |
Injection, lidocaine hcl for intravenous infusion, 10 mg |
549 |
283 |
$263.43 |
| 87147 |
|
24 |
24 |
$252.30 |
| 36416 |
|
133 |
104 |
$220.80 |
| 94760 |
|
27 |
21 |
$159.18 |
| A6449 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
90 |
76 |
$137.86 |
| J1650 |
Injection, enoxaparin sodium, 10 mg |
40 |
13 |
$113.86 |
| 85652 |
|
79 |
78 |
$100.99 |
| J0780 |
Injection, prochlorperazine, up to 10 mg |
31 |
30 |
$95.85 |
| S0020 |
Injection, bupivicaine hydrochloride, 30 ml |
14 |
13 |
$81.65 |
| J2470 |
Injection, pantoprazole sodium, 40 mg |
19 |
14 |
$76.06 |
| A4930 |
Gloves, sterile, per pair |
22 |
20 |
$76.04 |
| 85660 |
|
16 |
16 |
$48.00 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
42 |
37 |
$46.11 |
| 82805 |
|
13 |
12 |
$43.38 |
| J1171 |
Injection, hydromorphone, 0.1 mg |
15 |
12 |
$39.27 |
| A4657 |
Syringe, with or without needle, each |
35 |
31 |
$39.14 |
| A4223 |
Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately) |
29 |
24 |
$38.35 |
| J7510 |
Prednisolone oral, per 5 mg |
18 |
15 |
$28.59 |
| 81002 |
|
41 |
41 |
$23.55 |
| P9603 |
Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated miles actually travelled |
66 |
55 |
$23.00 |
| OP255 |
|
13 |
13 |
$21.19 |
| J2003 |
Injection, lidocaine hydrochloride, 1 mg |
41 |
26 |
$16.67 |
| Q0245 |
Injection, bamlanivimab and etesevimab, 2100 mg |
12 |
12 |
$12.41 |
| J1815 |
Injection, insulin, per 5 units |
21 |
12 |
$5.69 |
| Q0222 |
Injection, bebtelovimab, 175 mg |
20 |
17 |
$5.47 |
| 84132 |
|
12 |
12 |
$1.00 |
| G8978 |
Mobility: walking & moving around functional limitation, current status, at therapy episode outset and at reporting intervals |
26 |
25 |
$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 |
27 |
26 |
$0.00 |