| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99284 |
Emergency department visit for the evaluation and management, high severity |
30,388 |
28,720 |
$6.65M |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
34,111 |
32,697 |
$5.44M |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
18,494 |
17,092 |
$5.31M |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
5,771 |
5,600 |
$2.37M |
| 87636 |
Infectious agent detection by nucleic acid; SARS-CoV-2 and influenza virus types A and B |
13,419 |
12,972 |
$1.72M |
| G0378 |
Hospital observation service, per hour |
2,815 |
2,675 |
$1.69M |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
21,461 |
18,951 |
$1.25M |
| 70450 |
Computed tomography, head or brain; without contrast material |
6,155 |
5,852 |
$1.03M |
| 80053 |
Comprehensive metabolic panel |
59,416 |
51,038 |
$1.02M |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
14,744 |
3,944 |
$975K |
| 71045 |
Radiologic examination, chest; single view |
16,296 |
15,261 |
$939K |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
21,250 |
17,284 |
$920K |
| 87631 |
|
5,798 |
5,642 |
$815K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
3,072 |
2,947 |
$788K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
18,437 |
17,073 |
$718K |
| 71046 |
Radiologic examination, chest; 2 views |
10,677 |
10,315 |
$685K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
6,813 |
5,197 |
$649K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
14,529 |
12,415 |
$645K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
4,559 |
3,405 |
$557K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
57,650 |
49,236 |
$552K |
| 0241U |
Neonatal screening for hereditary disorders, genomic sequence analysis panel |
3,893 |
3,775 |
$511K |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
1,164 |
1,153 |
$430K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
9,114 |
8,331 |
$416K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
1,084 |
1,063 |
$402K |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
4,012 |
3,895 |
$388K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
11,581 |
9,568 |
$305K |
| 73562 |
|
3,560 |
2,920 |
$305K |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
8,629 |
2,800 |
$296K |
| 72125 |
Computed tomography, cervical spine; without contrast material |
1,406 |
1,373 |
$289K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
2,851 |
2,791 |
$279K |
| 93976 |
|
2,401 |
2,265 |
$277K |
| 84484 |
|
15,503 |
11,778 |
$248K |
| 96361 |
Intravenous infusion, hydration; each additional hour |
7,219 |
6,694 |
$243K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
1,537 |
1,532 |
$239K |
| 73610 |
|
2,320 |
2,016 |
$226K |
| 59025 |
Fetal non-stress test |
2,075 |
1,611 |
$220K |
| 73030 |
|
2,585 |
2,258 |
$209K |
| 83690 |
|
15,758 |
14,686 |
$205K |
| 99215 |
Prolong outpt/office vis |
3,354 |
2,978 |
$180K |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
764 |
758 |
$175K |
| 96376 |
|
3,705 |
2,433 |
$166K |
| 84443 |
Thyroid stimulating hormone (TSH) |
8,537 |
8,239 |
$166K |
| 73130 |
|
2,364 |
2,064 |
$158K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
1,145 |
1,125 |
$156K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
1,956 |
1,795 |
$152K |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
8,604 |
8,260 |
$148K |
| 76830 |
Ultrasound, transvaginal |
1,055 |
1,036 |
$147K |
| 73630 |
|
2,254 |
2,026 |
$145K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
8,123 |
7,945 |
$141K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
2,383 |
2,324 |
$138K |
| 83605 |
|
10,012 |
8,759 |
$138K |
| 36415 |
Collection of venous blood by venipuncture |
30,084 |
27,394 |
$125K |
| 92507 |
Treatment of speech, language, voice, communication, and/or auditory processing disorder |
1,482 |
561 |
$121K |
| 87633 |
Infectious agent detection by nucleic acid, respiratory virus, 12-25 targets |
295 |
287 |
$119K |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
350 |
347 |
$114K |
| 73110 |
|
1,758 |
1,502 |
$113K |
| 87081 |
|
11,481 |
11,250 |
$113K |
| 81001 |
|
18,861 |
17,819 |
$110K |
| 74018 |
|
1,682 |
1,614 |
$108K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
1,863 |
1,246 |
$100K |
| 83735 |
|
13,977 |
12,123 |
$100K |
| 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 |
1,186 |
1,157 |
$100K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
1,157 |
1,088 |
$93K |
| 87040 |
|
4,899 |
3,328 |
$91K |
| 83880 |
|
4,691 |
4,283 |
$88K |
| 76801 |
|
614 |
608 |
$87K |
| 45380 |
Colonoscopy, flexible; with biopsy, single or multiple |
191 |
190 |
$84K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
10,716 |
10,105 |
$83K |
| 93971 |
|
1,117 |
1,077 |
$82K |
| 87637 |
Infectious agent detection by nucleic acid; SARS-CoV-2, influenza, and RSV |
631 |
623 |
$81K |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
1,189 |
616 |
$80K |
| 84702 |
|
2,686 |
2,398 |
$73K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
4,435 |
4,033 |
$73K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
2,675 |
2,652 |
$71K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
870 |
775 |
$71K |
| 85027 |
|
9,175 |
8,595 |
$70K |
| 73564 |
|
851 |
544 |
$70K |
| U0002 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
2,336 |
2,252 |
$66K |
| 96367 |
|
1,115 |
812 |
$64K |
| 72100 |
|
705 |
696 |
$62K |
| 81003 |
|
12,626 |
11,790 |
$59K |
| 84703 |
|
6,088 |
5,830 |
$58K |
| 71250 |
|
450 |
443 |
$58K |
| 74022 |
|
668 |
658 |
$56K |
| 73080 |
|
765 |
640 |
$53K |
| 36000 |
|
3,136 |
2,997 |
$53K |
| 82962 |
|
8,179 |
4,694 |
$50K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
5,819 |
5,705 |
$49K |
| 81025 |
|
4,914 |
4,759 |
$49K |
| J3490 |
Unclassified drugs |
16,271 |
6,513 |
$48K |
| 86140 |
|
12,625 |
11,560 |
$46K |
| 85379 |
|
3,110 |
2,968 |
$46K |
| 76770 |
|
523 |
518 |
$46K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
1,219 |
1,191 |
$45K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
1,218 |
1,191 |
$45K |
| 73721 |
Magnetic resonance imaging, any joint of lower extremity; without contrast material |
107 |
102 |
$42K |
| 84439 |
|
3,880 |
3,828 |
$41K |
| 73140 |
|
564 |
462 |
$41K |
| 99291 |
Critical care, evaluation and management of the critically ill patient, first 30-74 minutes |
103 |
99 |
$41K |
| 85610 |
|
7,158 |
6,587 |
$39K |
| 97112 |
Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination |
676 |
370 |
$38K |
| 74019 |
|
336 |
333 |
$38K |
| 73502 |
|
700 |
663 |
$38K |
| 0225U |
|
98 |
96 |
$37K |
| 87430 |
|
2,232 |
2,190 |
$37K |
| 96413 |
Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance |
254 |
159 |
$36K |
| 45378 |
Colonoscopy, flexible; diagnostic, including collection of specimen(s) |
67 |
66 |
$36K |
| J1439 |
Injection, ferric carboxymaltose, 1 mg |
38 |
24 |
$36K |
| 82077 |
|
3,150 |
2,863 |
$34K |
| 94761 |
|
2,496 |
1,616 |
$33K |
| 73100 |
|
442 |
347 |
$33K |
| 86850 |
|
2,232 |
2,142 |
$31K |
| 87077 |
|
4,131 |
3,919 |
$31K |
| 87186 |
|
2,718 |
2,594 |
$30K |
| 97162 |
|
609 |
594 |
$30K |
| 82728 |
|
2,289 |
2,208 |
$30K |
| 72110 |
|
310 |
305 |
$29K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
733 |
688 |
$28K |
| 76642 |
|
261 |
222 |
$27K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,244 |
1,225 |
$26K |
| 82570 |
|
4,581 |
3,917 |
$26K |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
450 |
437 |
$26K |
| 80061 |
Lipid panel |
1,967 |
1,940 |
$25K |
| 73090 |
|
391 |
343 |
$25K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
182 |
167 |
$25K |
| J7040 |
Infusion, normal saline solution, sterile (500 ml = 1 unit) |
9,584 |
6,951 |
$24K |
| 82803 |
|
1,049 |
925 |
$24K |
| 83970 |
|
522 |
513 |
$22K |
| 83550 |
|
2,095 |
2,043 |
$22K |
| 72131 |
|
108 |
106 |
$22K |
| 82043 |
|
3,768 |
3,713 |
$21K |
| 87632 |
|
89 |
84 |
$21K |
| 73590 |
|
316 |
281 |
$21K |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
544 |
542 |
$21K |
| 70486 |
|
99 |
96 |
$21K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
1,477 |
1,419 |
$20K |
| 86900 |
|
2,715 |
2,577 |
$20K |
| 94760 |
|
1,923 |
1,555 |
$20K |
| 97161 |
|
677 |
662 |
$19K |
| 29125 |
|
185 |
180 |
$19K |
| 82550 |
|
2,633 |
2,382 |
$19K |
| 90715 |
|
985 |
973 |
$19K |
| Q3014 |
Telehealth originating site facility fee |
679 |
659 |
$17K |
| 94060 |
|
182 |
180 |
$17K |
| J2704 |
Injection, propofol, 10 mg |
3,141 |
2,961 |
$17K |
| 99443 |
|
281 |
271 |
$17K |
| 12001 |
|
145 |
145 |
$16K |
| 51702 |
|
251 |
237 |
$16K |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
4,085 |
3,629 |
$16K |
| 86901 |
|
2,712 |
2,575 |
$16K |
| 72040 |
|
180 |
179 |
$16K |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
2,760 |
2,100 |
$16K |
| 80143 |
|
1,302 |
1,192 |
$15K |
| 76536 |
|
135 |
133 |
$15K |
| 80179 |
|
1,268 |
1,160 |
$15K |
| 83540 |
|
2,186 |
2,128 |
$14K |
| 85730 |
|
2,076 |
1,969 |
$14K |
| 70553 |
Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences |
26 |
26 |
$14K |
| 73522 |
|
169 |
165 |
$12K |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
497 |
494 |
$12K |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
5,434 |
4,904 |
$12K |
| 86803 |
|
821 |
816 |
$12K |
| M0245 |
Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring |
22 |
22 |
$11K |
| G0399 |
Home sleep test (hst) with type iii portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ecg/heart rate and 1 oxygen saturation |
48 |
48 |
$11K |
| 86780 |
|
667 |
651 |
$10K |
| 93017 |
|
57 |
56 |
$10K |
| 80076 |
|
947 |
917 |
$9K |
| 81002 |
|
3,337 |
2,854 |
$9K |
| 84100 |
|
1,466 |
1,160 |
$9K |
| 81513 |
|
69 |
68 |
$9K |
| 94726 |
|
108 |
106 |
$8K |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
6,623 |
5,900 |
$8K |
| J1642 |
Injection, heparin sodium, (heparin lock flush), per 10 units |
991 |
525 |
$8K |
| 36591 |
|
284 |
172 |
$8K |
| J0690 |
Injection, cefazolin sodium, 500 mg |
1,286 |
1,115 |
$8K |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
2,299 |
1,873 |
$8K |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
2,806 |
2,571 |
$8K |
| 88307 |
|
70 |
68 |
$8K |
| 70498 |
|
14 |
13 |
$7K |
| 85652 |
|
1,310 |
1,235 |
$7K |
| 87807 |
|
441 |
426 |
$7K |
| 78815 |
Positron emission tomography (PET) for limited area imaging |
12 |
12 |
$7K |
| 84550 |
|
1,174 |
1,129 |
$6K |
| 94729 |
|
120 |
118 |
$6K |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
3,623 |
3,230 |
$6K |
| 70496 |
|
13 |
12 |
$6K |
| 71101 |
|
67 |
64 |
$5K |
| 78452 |
Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress |
12 |
12 |
$5K |
| 73620 |
|
77 |
70 |
$5K |
| 93970 |
|
32 |
32 |
$5K |
| 36600 |
|
211 |
201 |
$5K |
| 82140 |
|
385 |
329 |
$5K |
| 87070 |
|
384 |
361 |
$5K |
| 99205 |
Prolong outpt/office vis |
48 |
46 |
$5K |
| 82248 |
|
572 |
515 |
$5K |
| 88342 |
|
90 |
89 |
$5K |
| 84156 |
|
1,067 |
1,016 |
$5K |
| 96523 |
|
173 |
157 |
$5K |
| 88304 |
|
181 |
176 |
$4K |
| J0561 |
Injection, penicillin g benzathine, 100,000 units |
38 |
37 |
$4K |
| 80074 |
|
93 |
93 |
$4K |
| J2001 |
Injection, lidocaine hcl for intravenous infusion, 10 mg |
1,595 |
1,486 |
$4K |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
14 |
14 |
$4K |
| A9577 |
Injection, gadobenate dimeglumine (multihance), per ml |
202 |
195 |
$4K |
| 84112 |
|
63 |
60 |
$4K |
| 82607 |
|
253 |
250 |
$4K |
| 86762 |
|
266 |
263 |
$4K |
| 87340 |
|
352 |
348 |
$4K |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
97 |
97 |
$4K |
| 80050 |
General health panel |
186 |
186 |
$3K |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
510 |
439 |
$3K |
| 78227 |
|
12 |
12 |
$3K |
| 77066 |
Tomosynthesis, mammo |
30 |
30 |
$3K |
| 11721 |
|
126 |
122 |
$3K |
| 70220 |
|
30 |
30 |
$3K |
| 86787 |
|
240 |
237 |
$3K |
| J1650 |
Injection, enoxaparin sodium, 10 mg |
663 |
461 |
$3K |
| J2360 |
Injection, orphenadrine citrate, up to 60 mg |
281 |
275 |
$3K |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
1,570 |
1,504 |
$3K |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
1,580 |
1,453 |
$2K |
| J1170 |
Injection, hydromorphone, up to 4 mg |
812 |
697 |
$2K |
| 87205 |
|
414 |
387 |
$2K |
| 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 |
132 |
130 |
$2K |
| 87486 |
|
48 |
45 |
$2K |
| 73560 |
|
29 |
25 |
$2K |
| 83655 |
|
119 |
119 |
$2K |
| 82010 |
|
248 |
228 |
$2K |
| 94727 |
|
12 |
12 |
$2K |
| 31720 |
|
14 |
13 |
$2K |
| 87581 |
|
48 |
45 |
$2K |
| 82805 |
|
73 |
64 |
$2K |
| 77065 |
Tomosynthesis, mammo |
17 |
15 |
$2K |
| 93242 |
|
39 |
38 |
$2K |
| 87481 |
|
55 |
55 |
$2K |
| 82247 |
|
149 |
111 |
$1K |
| 99407 |
|
122 |
110 |
$1K |
| 83615 |
|
130 |
113 |
$1K |
| 93243 |
|
18 |
17 |
$1K |
| 12011 |
|
14 |
14 |
$1K |
| 73120 |
|
14 |
12 |
$1K |
| 82375 |
|
74 |
65 |
$1K |
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
15 |
13 |
$1K |
| 97164 |
|
107 |
97 |
$1K |
| 83525 |
|
105 |
105 |
$1K |
| J1815 |
Injection, insulin, per 5 units |
734 |
340 |
$1K |
| 82784 |
|
96 |
92 |
$1K |
| 76010 |
|
13 |
13 |
$1K |
| 51701 |
|
13 |
12 |
$1K |
| J2919 |
Injection, methylprednisolone sodium succinate, 5 mg |
240 |
199 |
$1K |
| 96368 |
|
23 |
17 |
$1K |
| 86038 |
|
79 |
76 |
$1K |
| 51798 |
|
38 |
38 |
$1K |
| 72070 |
|
15 |
14 |
$949.01 |
| 10060 |
|
13 |
13 |
$881.26 |
| 80069 |
|
121 |
115 |
$853.54 |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
26 |
26 |
$824.70 |
| 82746 |
|
64 |
63 |
$761.17 |
| J2060 |
Injection, lorazepam, 2 mg |
420 |
364 |
$713.71 |
| 73552 |
|
12 |
12 |
$653.54 |
| 90686 |
|
62 |
61 |
$653.36 |
| 82150 |
|
64 |
64 |
$592.75 |
| J0780 |
Injection, prochlorperazine, up to 10 mg |
193 |
183 |
$573.90 |
| J3370 |
Injection, vancomycin hcl, 500 mg |
69 |
51 |
$564.99 |
| J2543 |
Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams) |
88 |
41 |
$561.22 |
| J2003 |
Injection, lidocaine hydrochloride, 1 mg |
87 |
82 |
$560.21 |
| 87210 |
|
87 |
86 |
$505.65 |
| J3480 |
Injection, potassium chloride, per 2 meq |
96 |
68 |
$489.81 |
| J0137 |
Injection, acetaminophen (hikma), not therapeutically equivalent to j0131, 10 mg |
68 |
66 |
$481.33 |
| J1756 |
Injection, iron sucrose, 1 mg |
26 |
14 |
$480.80 |
| J1630 |
Injection, haloperidol, up to 5 mg |
351 |
341 |
$461.88 |
| J2920 |
Injection, methylprednisolone sodium succinate, up to 40 mg |
23 |
13 |
$449.19 |
| 87505 |
|
46 |
46 |
$425.94 |
| 84132 |
|
79 |
72 |
$384.86 |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
261 |
244 |
$362.10 |
| 86300 |
|
14 |
12 |
$352.17 |
| 93270 |
|
12 |
12 |
$334.11 |
| S0028 |
Injection, famotidine, 20 mg |
115 |
104 |
$330.90 |
| 82330 |
|
46 |
39 |
$308.74 |
| J2550 |
Injection, promethazine hcl, up to 50 mg |
187 |
164 |
$297.17 |
| 87449 |
|
24 |
24 |
$291.69 |
| J1790 |
Injection, droperidol, up to 5 mg |
89 |
83 |
$285.25 |
| G8978 |
Mobility: walking & moving around functional limitation, current status, at therapy episode outset and at reporting intervals |
180 |
171 |
$274.82 |
| 87075 |
|
15 |
14 |
$273.53 |
| 86308 |
|
24 |
24 |
$240.44 |
| J7510 |
Prednisolone oral, per 5 mg |
92 |
88 |
$228.42 |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
45 |
33 |
$216.53 |
| 84295 |
|
51 |
40 |
$211.78 |
| J3301 |
Injection, triamcinolone acetonide, not otherwise specified, 10 mg |
17 |
17 |
$209.80 |
| 85014 |
|
80 |
68 |
$208.75 |
| 90670 |
|
122 |
121 |
$208.43 |
| 85018 |
|
65 |
64 |
$192.01 |
| Q9969 |
Tc-99m from non-highly enriched uranium source, full cost recovery add-on, per study dose |
26 |
25 |
$184.90 |
| J1953 |
Injection, levetiracetam, 10 mg |
28 |
26 |
$176.22 |
| J1171 |
Injection, hydromorphone, 0.1 mg |
29 |
27 |
$160.45 |
| J0665 |
Injection, bupivicaine, not otherwise specified, 0.5 mg |
72 |
67 |
$134.26 |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
202 |
145 |
$119.04 |
| J0456 |
Injection, azithromycin, 500 mg |
17 |
12 |
$117.15 |
| 82947 |
|
47 |
40 |
$114.91 |
| J1836 |
Injection, metronidazole, 10 mg |
44 |
27 |
$111.81 |
| 86431 |
|
12 |
12 |
$109.26 |
| 97116 |
|
20 |
13 |
$108.50 |
| 81015 |
|
24 |
24 |
$104.50 |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
29 |
27 |
$95.76 |
| 85045 |
|
13 |
12 |
$87.76 |
| G0008 |
Administration of influenza virus vaccine |
87 |
86 |
$85.21 |
| 87147 |
|
13 |
12 |
$75.91 |
| J7060 |
5% dextrose/water (500 ml = 1 unit) |
19 |
12 |
$74.22 |
| Q9966 |
Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml |
12 |
12 |
$37.41 |
| J0360 |
Injection, hydralazine hcl, up to 20 mg |
13 |
12 |
$27.58 |
| 36416 |
|
32 |
30 |
$20.61 |
| J8540 |
Dexamethasone, oral, 0.25 mg |
12 |
12 |
$20.40 |
| Q2039 |
Influenza virus vaccine, not otherwise specified |
42 |
41 |
$15.68 |
| J1940 |
Injection, furosemide, up to 20 mg |
17 |
12 |
$12.94 |
| G8979 |
Mobility: walking & moving around functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting |
237 |
216 |
$0.00 |
| A9552 |
Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries |
12 |
12 |
$0.00 |