| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
28,262 |
24,649 |
$3.18M |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
15,957 |
13,531 |
$2.43M |
| 41899 |
Unlisted procedure, dentoalveolar structures |
1,519 |
1,325 |
$1.61M |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
5,059 |
3,669 |
$1.08M |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
3,490 |
2,587 |
$1.03M |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
6,139 |
3,975 |
$895K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
25,685 |
22,197 |
$818K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
10,708 |
9,325 |
$812K |
| 42820 |
Tonsillectomy and adenoidectomy; younger than age 12 |
850 |
784 |
$752K |
| 69436 |
Tympanostomy (requiring insertion of ventilating tube), general anesthesia |
1,252 |
1,200 |
$706K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
10,328 |
5,362 |
$684K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
11,272 |
7,417 |
$661K |
| 96361 |
Intravenous infusion, hydration; each additional hour |
11,445 |
5,766 |
$622K |
| 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 |
9,096 |
7,932 |
$609K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
14,979 |
12,124 |
$554K |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
13,036 |
3,534 |
$544K |
| 36415 |
Collection of venous blood by venipuncture |
162,454 |
62,637 |
$526K |
| 76830 |
Ultrasound, transvaginal |
2,476 |
2,207 |
$497K |
| 70450 |
Computed tomography, head or brain; without contrast material |
4,701 |
3,321 |
$485K |
| 80053 |
Comprehensive metabolic panel |
49,471 |
35,835 |
$484K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
14,911 |
12,260 |
$447K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
9,327 |
7,734 |
$443K |
| 71046 |
Radiologic examination, chest; 2 views |
14,880 |
10,760 |
$414K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
2,028 |
1,853 |
$390K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
51,644 |
41,718 |
$373K |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
6,794 |
5,966 |
$371K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
6,945 |
5,921 |
$367K |
| 76801 |
|
2,339 |
1,931 |
$362K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
10,875 |
9,238 |
$344K |
| 72148 |
Magnetic resonance imaging, lumbar spine; without contrast material |
943 |
877 |
$339K |
| 95810 |
Polysomnography; sleep staging with 4 or more additional parameters |
374 |
343 |
$325K |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
4,781 |
4,339 |
$322K |
| 96413 |
Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance |
1,537 |
664 |
$309K |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
1,534 |
1,354 |
$300K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
11,524 |
7,909 |
$290K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
1,755 |
1,613 |
$288K |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
766 |
411 |
$279K |
| 81220 |
CFTR (cystic fibrosis transmembrane conductance regulator) gene analysis; common variants |
929 |
884 |
$274K |
| 92507 |
Treatment of speech, language, voice, communication, and/or auditory processing disorder |
5,218 |
1,992 |
$264K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
1,177 |
1,113 |
$262K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
2,008 |
1,943 |
$250K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
5,778 |
5,176 |
$240K |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
8,024 |
7,461 |
$233K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
2,271 |
2,161 |
$225K |
| 84443 |
Thyroid stimulating hormone (TSH) |
14,291 |
13,347 |
$216K |
| 74178 |
|
460 |
369 |
$200K |
| 73630 |
|
3,777 |
3,080 |
$199K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
4,021 |
2,367 |
$182K |
| 70553 |
Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences |
362 |
296 |
$180K |
| 87633 |
Infectious agent detection by nucleic acid, respiratory virus, 12-25 targets |
461 |
425 |
$176K |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
14,770 |
10,831 |
$174K |
| J7030 |
Infusion, normal saline solution , 1000 cc |
14,222 |
10,274 |
$168K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
886 |
720 |
$157K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
819 |
566 |
$153K |
| 71045 |
Radiologic examination, chest; single view |
9,793 |
5,187 |
$152K |
| 95811 |
|
206 |
193 |
$148K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
1,860 |
1,126 |
$146K |
| 73610 |
|
2,671 |
2,217 |
$144K |
| 87088 |
|
20,782 |
15,564 |
$138K |
| 83880 |
|
4,787 |
4,001 |
$136K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
6,502 |
5,501 |
$136K |
| 83735 |
|
21,804 |
17,593 |
$131K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
3,367 |
2,095 |
$121K |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
3,751 |
995 |
$121K |
| 80061 |
Lipid panel |
9,852 |
8,787 |
$118K |
| 73562 |
|
2,528 |
1,843 |
$115K |
| 87634 |
|
1,798 |
1,704 |
$109K |
| 73030 |
|
2,561 |
1,908 |
$109K |
| 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 |
5,930 |
5,178 |
$109K |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
4,255 |
3,796 |
$107K |
| 74018 |
|
2,293 |
1,872 |
$103K |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
12,129 |
8,458 |
$101K |
| 84484 |
|
8,772 |
6,463 |
$100K |
| 72100 |
|
1,713 |
1,412 |
$99K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
11,347 |
8,802 |
$98K |
| 97161 |
|
1,987 |
1,538 |
$97K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
5,882 |
4,649 |
$96K |
| 99217 |
|
1,761 |
1,568 |
$94K |
| 96376 |
|
1,912 |
981 |
$91K |
| 73130 |
|
1,674 |
1,415 |
$91K |
| 80349 |
|
1,544 |
1,399 |
$89K |
| 85730 |
|
18,371 |
15,967 |
$86K |
| 87430 |
|
5,877 |
5,384 |
$85K |
| 78452 |
Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress |
427 |
193 |
$83K |
| 86922 |
|
2,572 |
2,189 |
$82K |
| 45380 |
Colonoscopy, flexible; with biopsy, single or multiple |
173 |
111 |
$79K |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
222 |
192 |
$78K |
| 76775 |
|
1,003 |
951 |
$77K |
| C9803 |
Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
9,844 |
7,524 |
$76K |
| 85610 |
|
20,526 |
17,099 |
$76K |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
2,290 |
2,115 |
$74K |
| J0875 |
Injection, dalbavancin, 5 mg |
25 |
12 |
$74K |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
509 |
363 |
$72K |
| 82607 |
|
5,368 |
5,019 |
$70K |
| 20610 |
|
939 |
679 |
$66K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
8,990 |
8,342 |
$66K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
1,509 |
1,349 |
$64K |
| 76536 |
|
352 |
316 |
$61K |
| J7050 |
Infusion, normal saline solution, 250 cc |
3,651 |
1,919 |
$60K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
2,857 |
2,676 |
$59K |
| 81025 |
|
7,353 |
6,624 |
$59K |
| 84439 |
|
6,650 |
6,264 |
$56K |
| 72125 |
Computed tomography, cervical spine; without contrast material |
444 |
381 |
$54K |
| 92557 |
|
1,036 |
835 |
$54K |
| 52000 |
|
232 |
186 |
$54K |
| 59025 |
Fetal non-stress test |
650 |
346 |
$54K |
| A9577 |
Injection, gadobenate dimeglumine (multihance), per ml |
807 |
759 |
$53K |
| 81001 |
|
17,647 |
15,350 |
$52K |
| 93971 |
|
1,097 |
966 |
$52K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
1,421 |
1,365 |
$51K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
1,529 |
1,476 |
$51K |
| 73110 |
|
923 |
774 |
$50K |
| 87186 |
|
5,809 |
5,269 |
$50K |
| 80305 |
|
4,295 |
3,642 |
$49K |
| 36600 |
|
2,422 |
1,943 |
$49K |
| 87040 |
|
4,069 |
2,507 |
$47K |
| 87081 |
|
6,253 |
5,387 |
$47K |
| 84702 |
|
3,211 |
2,295 |
$45K |
| 73721 |
Magnetic resonance imaging, any joint of lower extremity; without contrast material |
97 |
92 |
$45K |
| 82550 |
|
7,383 |
6,077 |
$43K |
| 82803 |
|
2,065 |
1,770 |
$43K |
| 99221 |
|
390 |
335 |
$41K |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
1,621 |
661 |
$40K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
498 |
441 |
$40K |
| 83690 |
|
6,028 |
5,266 |
$39K |
| 86703 |
|
2,394 |
2,254 |
$39K |
| 76642 |
|
674 |
508 |
$38K |
| 97010 |
|
4,909 |
1,570 |
$36K |
| 87070 |
|
3,966 |
3,091 |
$34K |
| 92579 |
|
525 |
511 |
$33K |
| 88304 |
|
918 |
877 |
$33K |
| 83605 |
|
3,125 |
2,587 |
$33K |
| 80320 |
|
2,268 |
2,049 |
$33K |
| 80324 |
|
1,145 |
1,033 |
$33K |
| 72040 |
|
706 |
587 |
$32K |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
3,000 |
2,443 |
$31K |
| 81003 |
|
12,795 |
10,710 |
$30K |
| 92567 |
|
1,850 |
1,756 |
$30K |
| 96367 |
|
578 |
377 |
$30K |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
3,415 |
2,666 |
$28K |
| 73560 |
|
890 |
710 |
$28K |
| 86803 |
|
1,887 |
1,801 |
$28K |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
14,373 |
11,487 |
$26K |
| 82728 |
|
2,482 |
2,106 |
$26K |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
8,596 |
6,870 |
$25K |
| 82150 |
|
4,335 |
3,811 |
$25K |
| 69210 |
|
961 |
822 |
$25K |
| 82746 |
|
1,746 |
1,651 |
$22K |
| 85379 |
|
2,391 |
2,196 |
$22K |
| 51798 |
|
875 |
785 |
$22K |
| C2617 |
Stent, non-coronary, temporary, without delivery system |
187 |
143 |
$22K |
| G0103 |
Prostate cancer screening; prostate specific antigen test (psa) |
4,600 |
1,237 |
$21K |
| 80074 |
|
493 |
456 |
$21K |
| 85027 |
|
3,241 |
2,727 |
$20K |
| 80361 |
|
547 |
497 |
$20K |
| 73502 |
|
674 |
533 |
$20K |
| 82962 |
|
4,119 |
2,258 |
$19K |
| 86850 |
|
2,740 |
2,501 |
$19K |
| J0561 |
Injection, penicillin g benzathine, 100,000 units |
177 |
169 |
$19K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
856 |
812 |
$19K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
390 |
221 |
$18K |
| 93017 |
|
139 |
132 |
$18K |
| J7040 |
Infusion, normal saline solution, sterile (500 ml = 1 unit) |
1,473 |
998 |
$18K |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
8,478 |
6,205 |
$18K |
| 99215 |
Prolong outpt/office vis |
492 |
455 |
$17K |
| 87807 |
|
1,083 |
1,017 |
$17K |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
9,009 |
7,610 |
$17K |
| 84703 |
|
2,192 |
1,974 |
$17K |
| 87653 |
|
518 |
497 |
$16K |
| 47562 |
|
14 |
12 |
$16K |
| 93970 |
|
181 |
170 |
$16K |
| J0690 |
Injection, cefazolin sodium, 500 mg |
2,326 |
1,869 |
$16K |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
7,363 |
6,131 |
$15K |
| 82553 |
|
1,461 |
1,194 |
$15K |
| J1642 |
Injection, heparin sodium, (heparin lock flush), per 10 units |
2,780 |
1,549 |
$15K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
755 |
703 |
$15K |
| 83540 |
|
2,505 |
2,303 |
$14K |
| 90715 |
|
449 |
424 |
$13K |
| 64425 |
|
227 |
171 |
$13K |
| 86762 |
|
1,264 |
1,207 |
$13K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
811 |
743 |
$12K |
| 72131 |
|
91 |
82 |
$12K |
| 87340 |
|
1,625 |
1,555 |
$12K |
| 97113 |
|
383 |
110 |
$12K |
| 71250 |
|
116 |
83 |
$11K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
611 |
575 |
$11K |
| C9113 |
Injection, pantoprazole sodium, per vial |
1,756 |
1,390 |
$11K |
| 86140 |
|
2,250 |
1,998 |
$11K |
| M0243 |
Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring |
86 |
85 |
$11K |
| 87205 |
|
2,229 |
1,997 |
$10K |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
3,311 |
2,299 |
$10K |
| 84403 |
|
421 |
401 |
$10K |
| J3480 |
Injection, potassium chloride, per 2 meq |
746 |
453 |
$10K |
| 76870 |
|
52 |
48 |
$10K |
| C1769 |
Guide wire |
170 |
108 |
$10K |
| 11043 |
|
49 |
25 |
$10K |
| 82043 |
|
1,967 |
1,847 |
$10K |
| 72141 |
|
24 |
24 |
$9K |
| 77080 |
|
326 |
268 |
$9K |
| J3301 |
Injection, triamcinolone acetonide, not otherwise specified, 10 mg |
1,092 |
963 |
$9K |
| 70486 |
|
74 |
65 |
$9K |
| 73080 |
|
151 |
120 |
$8K |
| 84144 |
|
399 |
330 |
$8K |
| 82570 |
|
1,946 |
1,782 |
$8K |
| 86592 |
|
2,149 |
1,992 |
$8K |
| 84466 |
|
778 |
736 |
$8K |
| G0279 |
Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066) |
769 |
523 |
$8K |
| 52332 |
|
13 |
12 |
$8K |
| J0558 |
Injection, penicillin g benzathine and penicillin g procaine, 100,000 units |
66 |
65 |
$7K |
| 83970 |
|
233 |
221 |
$7K |
| 83001 |
|
361 |
342 |
$7K |
| Q3014 |
Telehealth originating site facility fee |
611 |
574 |
$7K |
| 73590 |
|
139 |
119 |
$7K |
| 86769 |
|
244 |
195 |
$7K |
| 97162 |
|
117 |
108 |
$7K |
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
24 |
22 |
$7K |
| 86900 |
|
2,146 |
1,960 |
$7K |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
1,611 |
1,236 |
$7K |
| C1713 |
Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable) |
16 |
13 |
$6K |
| 78815 |
Positron emission tomography (PET) for limited area imaging |
12 |
12 |
$6K |
| 86901 |
|
2,140 |
1,956 |
$6K |
| 84550 |
|
1,401 |
1,247 |
$6K |
| 80348 |
|
233 |
201 |
$6K |
| 80347 |
|
177 |
162 |
$6K |
| 73221 |
|
12 |
12 |
$5K |
| J1956 |
Injection, levofloxacin, 250 mg |
1,092 |
849 |
$5K |
| 96523 |
|
95 |
66 |
$5K |
| 80329 |
|
289 |
181 |
$5K |
| C1747 |
Endoscope, single-use (i.e. disposable), urinary tract, imaging/illumination device (insertable) |
34 |
29 |
$5K |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
687 |
485 |
$5K |
| 96401 |
|
52 |
27 |
$5K |
| J2710 |
Injection, neostigmine methylsulfate, up to 0.5 mg |
135 |
125 |
$4K |
| 93225 |
|
104 |
89 |
$4K |
| 77065 |
Tomosynthesis, mammo |
52 |
38 |
$4K |
| 94060 |
|
71 |
43 |
$4K |
| 73090 |
|
86 |
75 |
$4K |
| A9552 |
Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries |
66 |
49 |
$4K |
| 85018 |
|
938 |
839 |
$4K |
| 83550 |
|
1,308 |
1,231 |
$4K |
| 82950 |
|
774 |
741 |
$4K |
| 84436 |
|
745 |
697 |
$4K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
175 |
159 |
$4K |
| 0012A |
|
354 |
340 |
$4K |
| M0240 |
Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring, subsequent repeat doses |
14 |
14 |
$4K |
| 85652 |
|
1,534 |
1,380 |
$4K |
| 88312 |
|
151 |
146 |
$3K |
| 72072 |
|
71 |
55 |
$3K |
| 0011A |
|
323 |
298 |
$3K |
| 84153 |
|
229 |
196 |
$3K |
| 82565 |
|
268 |
141 |
$3K |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
790 |
627 |
$3K |
| 73140 |
|
115 |
101 |
$3K |
| G0378 |
Hospital observation service, per hour |
31 |
24 |
$3K |
| 83721 |
|
1,005 |
954 |
$3K |
| A9500 |
Technetium tc-99m sestamibi, diagnostic, per study dose |
62 |
58 |
$3K |
| 76819 |
Fetal biophysical profile; without non-stress testing |
19 |
15 |
$3K |
| 73100 |
|
102 |
82 |
$3K |
| 99291 |
Critical care, evaluation and management of the critically ill patient, first 30-74 minutes |
13 |
12 |
$3K |
| 83002 |
|
153 |
145 |
$3K |
| J2785 |
Injection, regadenoson, 0.1 mg |
26 |
25 |
$3K |
| Q9966 |
Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml |
41 |
40 |
$3K |
| 85660 |
|
451 |
426 |
$2K |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
81 |
79 |
$2K |
| 12001 |
|
25 |
24 |
$2K |
| 83615 |
|
450 |
416 |
$2K |
| 10060 |
|
48 |
39 |
$2K |
| J2360 |
Injection, orphenadrine citrate, up to 60 mg |
198 |
185 |
$2K |
| 96368 |
|
89 |
75 |
$2K |
| 86038 |
|
201 |
188 |
$2K |
| C9733 |
Non-ophthalmic fluorescent vascular angiography |
14 |
12 |
$2K |
| J3370 |
Injection, vancomycin hcl, 500 mg |
184 |
130 |
$2K |
| 86665 |
|
90 |
50 |
$2K |
| 92523 |
|
26 |
24 |
$2K |
| 93922 |
|
41 |
36 |
$2K |
| 84112 |
|
30 |
25 |
$2K |
| 85651 |
|
530 |
467 |
$2K |
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
16 |
12 |
$2K |
| 72110 |
|
33 |
30 |
$2K |
| 83525 |
|
189 |
182 |
$2K |
| 11721 |
|
168 |
129 |
$2K |
| 97165 |
|
50 |
43 |
$2K |
| J2175 |
Injection, meperidine hydrochloride, per 100 mg |
750 |
615 |
$2K |
| 84145 |
|
87 |
77 |
$2K |
| 82652 |
|
58 |
56 |
$2K |
| 77066 |
Tomosynthesis, mammo |
16 |
13 |
$2K |
| J1170 |
Injection, hydromorphone, up to 4 mg |
520 |
317 |
$2K |
| 93880 |
|
12 |
12 |
$2K |
| 84481 |
|
126 |
117 |
$2K |
| 74022 |
|
27 |
25 |
$2K |
| J2550 |
Injection, promethazine hcl, up to 50 mg |
794 |
632 |
$2K |
| 86593 |
|
219 |
211 |
$2K |
| 87427 |
|
127 |
60 |
$2K |
| 86308 |
|
226 |
218 |
$1K |
| 93226 |
|
26 |
26 |
$1K |
| 84146 |
|
70 |
68 |
$1K |
| 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 |
15 |
12 |
$1K |
| 80076 |
|
176 |
166 |
$1K |
| 88104 |
|
74 |
66 |
$1K |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
407 |
349 |
$1K |
| J2919 |
Injection, methylprednisolone sodium succinate, 5 mg |
145 |
106 |
$1K |
| J1071 |
Injection, testosterone cypionate, 1 mg |
597 |
441 |
$1K |
| 87045 |
|
111 |
76 |
$1K |
| 86664 |
|
50 |
50 |
$959.00 |
| 72170 |
|
35 |
25 |
$945.02 |
| 84156 |
|
352 |
299 |
$932.13 |
| 84479 |
|
165 |
157 |
$851.05 |
| 86663 |
|
50 |
50 |
$822.73 |
| J2470 |
Injection, pantoprazole sodium, 40 mg |
103 |
64 |
$819.55 |
| 83655 |
|
62 |
61 |
$742.55 |
| 82731 |
|
12 |
12 |
$725.00 |
| J3490 |
Unclassified drugs |
72 |
53 |
$697.74 |
| 82140 |
|
54 |
48 |
$671.17 |
| J1030 |
Injection, methylprednisolone acetate, 40 mg |
97 |
91 |
$667.02 |
| J2060 |
Injection, lorazepam, 2 mg |
387 |
301 |
$634.94 |
| 71101 |
|
14 |
13 |
$630.36 |
| 87324 |
|
61 |
50 |
$629.65 |
| 94729 |
|
15 |
12 |
$622.67 |
| 94727 |
|
15 |
12 |
$603.41 |
| 97597 |
|
22 |
12 |
$601.23 |
| 0013A |
|
61 |
60 |
$595.35 |
| 87046 |
|
67 |
60 |
$589.09 |
| 86757 |
|
28 |
14 |
$577.36 |
| 84207 |
|
27 |
25 |
$513.66 |
| 86618 |
|
29 |
27 |
$511.82 |
| 87449 |
|
40 |
36 |
$491.57 |
| 82670 |
|
12 |
12 |
$388.00 |
| 97014 |
|
34 |
12 |
$382.53 |
| 88342 |
|
13 |
13 |
$346.56 |
| 87522 |
Neg quan hep c or qual rna |
14 |
12 |
$327.93 |
| G2023 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
33 |
24 |
$311.28 |
| 97602 |
|
14 |
12 |
$289.52 |
| J1626 |
Injection, granisetron hydrochloride, 100 mcg |
28 |
23 |
$280.56 |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
26 |
25 |
$279.18 |
| J2370 |
Injection, phenylephrine hcl, up to 1 ml |
58 |
40 |
$272.99 |
| 85008 |
|
416 |
323 |
$262.11 |
| 97164 |
|
12 |
12 |
$246.00 |
| 90633 |
|
12 |
12 |
$243.11 |
| 93010 |
Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only |
5,266 |
4,145 |
$228.59 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
15 |
14 |
$225.74 |
| 86431 |
|
37 |
36 |
$180.56 |
| J1040 |
Injection, methylprednisolone acetate, 80 mg |
18 |
13 |
$155.27 |
| 84425 |
|
12 |
12 |
$151.99 |
| 87177 |
|
15 |
13 |
$151.00 |
| 84100 |
|
29 |
28 |
$106.71 |
| J1644 |
Injection, heparin sodium, per 1000 units |
20 |
12 |
$100.39 |
| 82272 |
|
43 |
26 |
$98.51 |
| 87075 |
|
14 |
12 |
$96.59 |
| 90686 |
|
16 |
16 |
$71.23 |
| 82247 |
|
15 |
13 |
$66.66 |
| 85046 |
|
13 |
12 |
$56.70 |
| 84132 |
|
12 |
12 |
$34.64 |
| A9270 |
Non-covered item or service |
107 |
67 |
$5.90 |