| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
44,233 |
38,565 |
$6.72M |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
36,332 |
31,217 |
$5.94M |
| 96361 |
Intravenous infusion, hydration; each additional hour |
18,752 |
15,302 |
$4.72M |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
17,366 |
15,199 |
$3.06M |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
16,208 |
14,045 |
$2.23M |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
14,562 |
12,614 |
$2.00M |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
7,728 |
6,858 |
$1.44M |
| 70450 |
Computed tomography, head or brain; without contrast material |
7,198 |
6,169 |
$1.07M |
| G0378 |
Hospital observation service, per hour |
9,596 |
7,985 |
$1.06M |
| 59025 |
Fetal non-stress test |
6,408 |
4,206 |
$1.04M |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
8,859 |
6,471 |
$999K |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
1,973 |
1,847 |
$893K |
| 45385 |
Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) |
1,318 |
1,230 |
$812K |
| 45380 |
Colonoscopy, flexible; with biopsy, single or multiple |
1,140 |
1,075 |
$691K |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
16,137 |
4,504 |
$643K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
5,525 |
4,786 |
$556K |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
1,884 |
1,692 |
$533K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
11,342 |
9,858 |
$532K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
3,601 |
2,277 |
$511K |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
3,272 |
3,017 |
$423K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
2,214 |
1,977 |
$387K |
| 45378 |
Colonoscopy, flexible; diagnostic, including collection of specimen(s) |
459 |
441 |
$331K |
| 11042 |
Debridement, subcutaneous tissue (includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm |
2,089 |
945 |
$329K |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
2,573 |
2,386 |
$309K |
| 70553 |
Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences |
948 |
887 |
$304K |
| 76642 |
|
2,824 |
2,233 |
$284K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
5,831 |
3,973 |
$261K |
| G0121 |
Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk |
298 |
296 |
$253K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
2,712 |
2,514 |
$248K |
| 78815 |
Positron emission tomography (PET) for limited area imaging |
209 |
199 |
$218K |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
4,400 |
4,232 |
$214K |
| 80053 |
Comprehensive metabolic panel |
47,949 |
40,619 |
$210K |
| 93971 |
|
2,207 |
1,950 |
$201K |
| 76830 |
Ultrasound, transvaginal |
2,468 |
2,295 |
$199K |
| 0241U |
Neonatal screening for hereditary disorders, genomic sequence analysis panel |
2,486 |
2,391 |
$192K |
| 78452 |
Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress |
366 |
315 |
$186K |
| 71046 |
Radiologic examination, chest; 2 views |
19,324 |
17,038 |
$185K |
| 93976 |
|
2,265 |
2,041 |
$173K |
| 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 |
6,232 |
5,674 |
$172K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
1,040 |
874 |
$171K |
| 76937 |
|
3,261 |
2,511 |
$154K |
| 58558 |
|
166 |
150 |
$145K |
| 93017 |
|
1,362 |
1,216 |
$139K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
5,644 |
5,323 |
$135K |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
660 |
602 |
$129K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
11,284 |
10,503 |
$121K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
28,403 |
22,755 |
$118K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
2,134 |
1,855 |
$115K |
| 97162 |
|
1,739 |
1,525 |
$107K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
9,960 |
8,831 |
$103K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
75,160 |
59,731 |
$101K |
| 58662 |
|
44 |
38 |
$99K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
27,865 |
23,559 |
$97K |
| 80061 |
Lipid panel |
15,453 |
14,404 |
$96K |
| 70496 |
|
378 |
347 |
$87K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
1,263 |
1,148 |
$84K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
3,334 |
2,986 |
$77K |
| 0240U |
|
1,233 |
1,186 |
$71K |
| 58661 |
|
27 |
24 |
$68K |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
2,429 |
1,044 |
$66K |
| 84443 |
Thyroid stimulating hormone (TSH) |
12,351 |
11,517 |
$66K |
| 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 |
5,189 |
4,448 |
$61K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
15,403 |
14,293 |
$61K |
| 72125 |
Computed tomography, cervical spine; without contrast material |
2,661 |
2,293 |
$61K |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
5,376 |
1,651 |
$60K |
| G0299 |
Direct skilled nursing services of a registered nurse (rn) in the home health or hospice setting, each 15 minutes |
1,486 |
349 |
$58K |
| 97161 |
|
394 |
377 |
$55K |
| 43235 |
|
96 |
89 |
$54K |
| 29125 |
|
417 |
370 |
$52K |
| 80050 |
General health panel |
5,351 |
4,923 |
$52K |
| 71250 |
|
676 |
621 |
$52K |
| 36430 |
|
245 |
185 |
$51K |
| 71045 |
Radiologic examination, chest; single view |
10,628 |
9,031 |
$47K |
| 87633 |
Infectious agent detection by nucleic acid, respiratory virus, 12-25 targets |
1,232 |
1,173 |
$45K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
398 |
391 |
$43K |
| 93970 |
|
397 |
355 |
$41K |
| 36415 |
Collection of venous blood by venipuncture |
39,562 |
34,069 |
$41K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
9,900 |
8,776 |
$38K |
| 77065 |
Tomosynthesis, mammo |
1,165 |
1,047 |
$36K |
| 84439 |
|
6,869 |
6,333 |
$36K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
24,833 |
20,489 |
$35K |
| 0223U |
|
344 |
323 |
$35K |
| 97112 |
Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination |
2,120 |
657 |
$34K |
| 77066 |
Tomosynthesis, mammo |
1,579 |
1,446 |
$34K |
| 76770 |
|
292 |
270 |
$32K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
19,908 |
15,305 |
$32K |
| 97116 |
|
1,923 |
935 |
$32K |
| 97163 |
|
483 |
441 |
$32K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
9,666 |
7,538 |
$32K |
| 76536 |
|
293 |
280 |
$31K |
| 88307 |
|
1,392 |
1,117 |
$31K |
| 77062 |
|
864 |
814 |
$31K |
| 83880 |
|
3,784 |
3,160 |
$31K |
| 81025 |
|
25,012 |
21,985 |
$30K |
| 86885 |
|
7,317 |
6,398 |
$27K |
| 97035 |
|
526 |
217 |
$26K |
| 87806 |
|
1,514 |
1,430 |
$26K |
| 90715 |
|
1,292 |
1,210 |
$25K |
| 12001 |
|
159 |
147 |
$25K |
| P9016 |
Red blood cells, leukocytes reduced, each unit |
117 |
95 |
$25K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
204 |
190 |
$24K |
| 71271 |
|
213 |
211 |
$24K |
| 82607 |
|
4,240 |
3,690 |
$24K |
| 84484 |
|
19,616 |
12,469 |
$23K |
| 80047 |
|
6,994 |
6,184 |
$22K |
| 97165 |
|
265 |
253 |
$22K |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
5,206 |
4,166 |
$21K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
15,548 |
9,509 |
$21K |
| J7050 |
Infusion, normal saline solution, 250 cc |
3,949 |
2,952 |
$20K |
| 82728 |
|
3,321 |
2,954 |
$19K |
| 97802 |
|
181 |
178 |
$18K |
| G0279 |
Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066) |
885 |
845 |
$17K |
| 83970 |
|
891 |
768 |
$17K |
| 85379 |
|
3,112 |
2,774 |
$17K |
| 81003 |
|
44,342 |
37,204 |
$17K |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
14,333 |
12,610 |
$17K |
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
134 |
123 |
$17K |
| 86900 |
|
10,280 |
7,167 |
$16K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
9,802 |
8,521 |
$16K |
| 73030 |
|
1,762 |
1,503 |
$16K |
| 76801 |
|
201 |
194 |
$16K |
| 85014 |
|
8,023 |
7,020 |
$16K |
| 94726 |
|
340 |
322 |
$15K |
| 86901 |
|
10,270 |
7,167 |
$15K |
| 85610 |
|
7,206 |
5,928 |
$15K |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
1,141 |
1,070 |
$15K |
| 83655 |
|
1,899 |
1,862 |
$15K |
| 72148 |
Magnetic resonance imaging, lumbar spine; without contrast material |
75 |
73 |
$15K |
| 72100 |
|
1,012 |
946 |
$15K |
| 72110 |
|
502 |
485 |
$15K |
| 82948 |
|
15,578 |
8,797 |
$15K |
| 93350 |
|
48 |
42 |
$14K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
1,232 |
1,083 |
$14K |
| 86803 |
|
1,333 |
1,233 |
$14K |
| 96376 |
|
9,241 |
5,097 |
$14K |
| 70491 |
|
68 |
64 |
$13K |
| 94060 |
|
216 |
207 |
$13K |
| 87040 |
|
2,358 |
1,436 |
$13K |
| 73630 |
|
1,894 |
1,617 |
$13K |
| 87650 |
|
3,759 |
3,503 |
$13K |
| U0002 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
1,750 |
1,536 |
$13K |
| 76819 |
Fetal biophysical profile; without non-stress testing |
293 |
236 |
$12K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,373 |
2,151 |
$12K |
| 80329 |
|
1,321 |
1,041 |
$12K |
| J7030 |
Infusion, normal saline solution , 1000 cc |
23,869 |
18,784 |
$12K |
| 94729 |
|
355 |
336 |
$12K |
| 85018 |
|
1,559 |
1,341 |
$12K |
| 95810 |
Polysomnography; sleep staging with 4 or more additional parameters |
26 |
25 |
$11K |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
16,846 |
13,224 |
$11K |
| M0243 |
Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring |
55 |
54 |
$11K |
| 10060 |
|
76 |
75 |
$11K |
| 73564 |
|
1,057 |
859 |
$10K |
| 80143 |
|
1,940 |
1,683 |
$10K |
| 88142 |
|
1,159 |
1,074 |
$10K |
| 87581 |
|
1,269 |
1,202 |
$10K |
| 83550 |
|
1,867 |
1,745 |
$10K |
| 83540 |
|
2,875 |
2,666 |
$10K |
| 86922 |
|
730 |
441 |
$9K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
180 |
167 |
$9K |
| 90674 |
|
433 |
385 |
$9K |
| 77061 |
|
204 |
202 |
$9K |
| 87798 |
Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism |
1,407 |
1,310 |
$9K |
| 84153 |
|
881 |
824 |
$9K |
| 73610 |
|
1,631 |
1,424 |
$9K |
| 10061 |
|
42 |
38 |
$8K |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
1,198 |
1,141 |
$8K |
| 80320 |
|
2,553 |
2,141 |
$8K |
| 80076 |
|
3,106 |
2,765 |
$8K |
| 83735 |
|
8,008 |
6,226 |
$8K |
| 85027 |
|
4,338 |
3,774 |
$8K |
| 82746 |
|
2,013 |
1,768 |
$8K |
| 83605 |
|
4,276 |
3,274 |
$8K |
| 84145 |
|
1,050 |
932 |
$8K |
| 87503 |
|
1,219 |
1,072 |
$7K |
| 86592 |
|
2,249 |
2,089 |
$7K |
| 70498 |
|
259 |
232 |
$7K |
| 99406 |
|
371 |
345 |
$7K |
| 87070 |
|
2,395 |
2,134 |
$7K |
| 97803 |
|
32 |
32 |
$7K |
| 82043 |
|
2,203 |
2,081 |
$7K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
77 |
73 |
$7K |
| 97597 |
|
63 |
40 |
$7K |
| 73130 |
|
978 |
842 |
$7K |
| 84702 |
|
3,705 |
3,107 |
$7K |
| 73502 |
|
1,082 |
948 |
$7K |
| 86923 |
|
216 |
126 |
$6K |
| 99291 |
Critical care, evaluation and management of the critically ill patient, first 30-74 minutes |
27 |
24 |
$6K |
| 80069 |
|
1,555 |
1,102 |
$6K |
| 85525 |
|
1,382 |
1,198 |
$6K |
| J2704 |
Injection, propofol, 10 mg |
17,536 |
12,344 |
$6K |
| 29505 |
|
57 |
52 |
$6K |
| 74240 |
|
41 |
41 |
$6K |
| 86140 |
|
1,455 |
1,109 |
$6K |
| 70486 |
|
117 |
108 |
$6K |
| 72197 |
|
13 |
13 |
$6K |
| 97535 |
Self-care/home management training, each 15 minutes |
404 |
314 |
$5K |
| 83690 |
|
16,893 |
14,178 |
$5K |
| 74018 |
|
429 |
367 |
$5K |
| 80179 |
|
1,751 |
1,536 |
$5K |
| 77080 |
|
96 |
92 |
$5K |
| 73562 |
|
515 |
445 |
$5K |
| G0297 |
Low dose ct scan (ldct) for lung cancer screening |
50 |
44 |
$5K |
| 88342 |
|
2,016 |
1,866 |
$5K |
| 93880 |
|
116 |
90 |
$4K |
| 77336 |
|
41 |
24 |
$4K |
| 90935 |
Hemodialysis procedure with single evaluation by a physician |
35 |
12 |
$4K |
| 90656 |
|
152 |
150 |
$4K |
| 82565 |
|
2,405 |
2,096 |
$4K |
| 95816 |
|
30 |
29 |
$4K |
| 72141 |
|
30 |
26 |
$4K |
| J3490 |
Unclassified drugs |
21,242 |
8,009 |
$4K |
| G0151 |
Services performed by a qualified physical therapist in the home health or hospice setting, each 15 minutes |
84 |
38 |
$4K |
| Q0244 |
Injection, casirivimab and imdevimab, 1200 mg |
59 |
29 |
$4K |
| 87624 |
Infectious agent detection by nucleic acid; human papillomavirus (HPV), high-risk types |
336 |
319 |
$4K |
| 96160 |
|
196 |
181 |
$4K |
| 96367 |
|
484 |
411 |
$4K |
| 95886 |
|
25 |
24 |
$4K |
| 88304 |
|
994 |
865 |
$4K |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
11,544 |
9,457 |
$4K |
| 87186 |
|
3,531 |
3,021 |
$3K |
| 80074 |
|
228 |
211 |
$3K |
| 85651 |
|
1,689 |
1,316 |
$3K |
| 84112 |
|
446 |
402 |
$3K |
| 86038 |
|
409 |
374 |
$3K |
| 95819 |
|
31 |
27 |
$3K |
| 84425 |
|
773 |
634 |
$3K |
| 72040 |
|
131 |
126 |
$3K |
| 99152 |
|
885 |
802 |
$3K |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
23,607 |
17,985 |
$3K |
| 87340 |
|
994 |
882 |
$3K |
| 82570 |
|
1,903 |
1,646 |
$2K |
| 87088 |
|
3,187 |
2,733 |
$2K |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
5,989 |
5,029 |
$2K |
| J1650 |
Injection, enoxaparin sodium, 10 mg |
2,919 |
1,171 |
$2K |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
11,653 |
8,049 |
$2K |
| 87631 |
|
104 |
86 |
$2K |
| 87210 |
|
5,697 |
5,032 |
$2K |
| 97166 |
|
27 |
26 |
$2K |
| 73110 |
|
315 |
292 |
$2K |
| 84550 |
|
1,459 |
1,279 |
$2K |
| 87205 |
|
1,245 |
1,051 |
$2K |
| J8540 |
Dexamethasone, oral, 0.25 mg |
915 |
773 |
$2K |
| 0042T |
|
13 |
12 |
$2K |
| 84481 |
|
252 |
231 |
$2K |
| 82731 |
|
92 |
80 |
$2K |
| 96413 |
Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance |
13 |
12 |
$2K |
| 80164 |
|
339 |
269 |
$2K |
| J0702 |
Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg |
472 |
341 |
$2K |
| 82977 |
|
310 |
301 |
$1K |
| 84703 |
|
560 |
527 |
$1K |
| 73560 |
|
307 |
278 |
$1K |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
9,079 |
6,425 |
$1K |
| 74220 |
|
27 |
26 |
$1K |
| 93975 |
|
22 |
20 |
$1K |
| 87077 |
|
1,124 |
955 |
$1K |
| 84156 |
|
1,536 |
1,262 |
$1K |
| 84403 |
|
99 |
96 |
$1K |
| 87653 |
|
42 |
41 |
$837.57 |
| 82550 |
|
712 |
505 |
$814.80 |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
2,241 |
1,680 |
$797.15 |
| 84630 |
|
88 |
80 |
$794.35 |
| J1170 |
Injection, hydromorphone, up to 4 mg |
7,355 |
4,766 |
$754.45 |
| 97014 |
|
38 |
12 |
$726.23 |
| 85730 |
|
665 |
598 |
$672.48 |
| 51798 |
|
66 |
52 |
$667.39 |
| J0500 |
Injection, dicyclomine hcl, up to 20 mg |
721 |
642 |
$653.55 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
8,281 |
7,079 |
$646.88 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
8,215 |
7,207 |
$619.28 |
| A9585 |
Injection, gadobutrol, 0.1 ml |
2,239 |
2,074 |
$537.28 |
| Q9957 |
Injection, perflutren lipid microspheres, per ml |
75 |
64 |
$515.32 |
| J7040 |
Infusion, normal saline solution, sterile (500 ml = 1 unit) |
2,280 |
1,773 |
$485.02 |
| J0690 |
Injection, cefazolin sodium, 500 mg |
4,718 |
3,152 |
$445.37 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
4,315 |
2,828 |
$423.20 |
| Q0111 |
Wet mounts, including preparations of vaginal, cervical or skin specimens |
637 |
603 |
$398.19 |
| J1815 |
Injection, insulin, per 5 units |
5,271 |
1,345 |
$362.31 |
| J1644 |
Injection, heparin sodium, per 1000 units |
5,877 |
2,225 |
$360.19 |
| 84402 |
|
30 |
28 |
$355.23 |
| 83615 |
|
479 |
403 |
$347.77 |
| 94010 |
|
16 |
13 |
$347.72 |
| 73140 |
|
106 |
100 |
$335.85 |
| 86677 |
|
145 |
82 |
$311.09 |
| 86762 |
|
70 |
62 |
$310.51 |
| 88341 |
|
17 |
13 |
$290.87 |
| Q9969 |
Tc-99m from non-highly enriched uranium source, full cost recovery add-on, per study dose |
1,446 |
1,332 |
$280.67 |
| J2060 |
Injection, lorazepam, 2 mg |
3,131 |
2,236 |
$273.24 |
| A9270 |
Non-covered item or service |
46,631 |
11,626 |
$270.75 |
| 87486 |
|
283 |
267 |
$270.03 |
| 82248 |
|
118 |
87 |
$260.67 |
| 87430 |
|
330 |
298 |
$259.85 |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
1,786 |
1,380 |
$258.49 |
| 86430 |
|
61 |
52 |
$257.92 |
| 90653 |
|
19 |
18 |
$236.53 |
| 73080 |
|
29 |
26 |
$236.14 |
| 94760 |
|
1,416 |
970 |
$226.51 |
| 82670 |
|
15 |
15 |
$217.78 |
| J2550 |
Injection, promethazine hcl, up to 50 mg |
2,408 |
1,833 |
$207.21 |
| 99153 |
Mod sedat endo service >5yrs |
251 |
225 |
$200.76 |
| J2370 |
Injection, phenylephrine hcl, up to 1 ml |
2,053 |
1,620 |
$193.50 |
| 86706 |
|
42 |
41 |
$186.48 |
| C1769 |
Guide wire |
896 |
794 |
$185.87 |
| 87081 |
|
100 |
93 |
$158.42 |
| 90662 |
|
13 |
12 |
$158.16 |
| 73590 |
|
101 |
82 |
$129.55 |
| J0780 |
Injection, prochlorperazine, up to 10 mg |
1,299 |
1,164 |
$126.14 |
| J2001 |
Injection, lidocaine hcl for intravenous infusion, 10 mg |
2,279 |
1,614 |
$122.05 |
| 87641 |
|
32 |
27 |
$121.25 |
| J0330 |
Injection, succinylcholine chloride, up to 20 mg |
1,518 |
1,360 |
$105.06 |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
1,705 |
1,442 |
$101.61 |
| C9113 |
Injection, pantoprazole sodium, per vial |
1,429 |
596 |
$98.47 |
| A9500 |
Technetium tc-99m sestamibi, diagnostic, per study dose |
403 |
340 |
$87.86 |
| 82947 |
|
634 |
214 |
$87.52 |
| 84590 |
|
13 |
12 |
$82.72 |
| J3480 |
Injection, potassium chloride, per 2 meq |
800 |
438 |
$81.47 |
| 82247 |
|
19 |
15 |
$77.41 |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
233 |
223 |
$73.09 |
| 88302 |
|
13 |
12 |
$68.58 |
| 87507 |
|
45 |
42 |
$54.92 |
| 84100 |
|
47 |
38 |
$46.38 |
| 94761 |
|
1,030 |
777 |
$38.89 |
| J1630 |
Injection, haloperidol, up to 5 mg |
593 |
459 |
$30.75 |
| 84132 |
|
14 |
13 |
$30.35 |
| 82951 |
|
15 |
13 |
$15.81 |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
311 |
238 |
$15.28 |
| J1642 |
Injection, heparin sodium, (heparin lock flush), per 10 units |
426 |
151 |
$13.32 |
| 82803 |
|
128 |
112 |
$12.02 |
| 36600 |
|
18 |
13 |
$10.96 |
| C1894 |
Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser |
600 |
535 |
$10.57 |
| J1940 |
Injection, furosemide, up to 20 mg |
129 |
61 |
$9.88 |
| A9579 |
Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (nos), per ml |
42 |
40 |
$6.20 |
| J3370 |
Injection, vancomycin hcl, 500 mg |
214 |
89 |
$5.94 |
| J2919 |
Injection, methylprednisolone sodium succinate, 5 mg |
133 |
116 |
$5.89 |
| 82270 |
|
14 |
13 |
$5.23 |
| J2272 |
Injection, morphine sulfate (fresenius kabi), not therapeutically equivalent to j2270, up to 10 mg |
140 |
123 |
$4.56 |
| J0360 |
Injection, hydralazine hcl, up to 20 mg |
137 |
111 |
$1.76 |
| 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 |
243 |
229 |
$1.68 |
| Q9961 |
High osmolar contrast material, 250-299 mg/ml iodine concentration, per ml |
99 |
80 |
$0.96 |
| J2300 |
Injection, nalbuphine hydrochloride, per 10 mg |
23 |
14 |
$0.22 |
| J1805 |
Injection, esmolol hydrochloride, 10 mg |
131 |
119 |
$0.00 |
| J2371 |
Injection, phenylephrine hydrochloride, 20 micrograms |
707 |
609 |
$0.00 |
| G8980 |
Mobility: walking & moving around functional limitation, discharge status, at discharge from therapy or to end reporting |
241 |
146 |
$0.00 |
| C1889 |
Implantable/insertable device, not otherwise classified |
30 |
27 |
$0.00 |
| J2785 |
Injection, regadenoson, 0.1 mg |
140 |
123 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
92 |
78 |
$0.00 |
| C9399 |
Unclassified drugs or biologicals |
114 |
99 |
$0.00 |
| C9290 |
Injection, bupivacaine liposome, 1 mg |
133 |
125 |
$0.00 |
| J2003 |
Injection, lidocaine hydrochloride, 1 mg |
352 |
235 |
$0.00 |
| J1920 |
Injection, labetalol hydrochloride, 5 mg |
33 |
30 |
$0.00 |
| 94762 |
|
15 |
14 |
$0.00 |
| Q9963 |
High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml |
13 |
12 |
$0.00 |
| J7611 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg |
38 |
30 |
$0.00 |
| J2543 |
Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams) |
52 |
25 |
$0.00 |
| A4648 |
Tissue marker, implantable, any type, each |
12 |
12 |
$0.00 |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
13 |
13 |
$0.00 |
| J1596 |
Injection, glycopyrrolate, 0.1 mg |
432 |
412 |
$0.00 |
| C1713 |
Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable) |
326 |
296 |
$0.00 |
| G8978 |
Mobility: walking & moving around functional limitation, current status, at therapy episode outset and at reporting intervals |
292 |
183 |
$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 |
312 |
199 |
$0.00 |
| A9552 |
Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries |
301 |
288 |
$0.00 |
| Q9966 |
Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml |
83 |
72 |
$0.00 |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
1,383 |
870 |
$0.00 |
| J3486 |
Injection, ziprasidone mesylate, 10 mg |
59 |
25 |
$0.00 |
| J1953 |
Injection, levetiracetam, 10 mg |
12 |
12 |
$0.00 |
| J0689 |
Injection, cefazolin sodium (baxter), not therapeutically equivalent to j0690, 500 mg |
721 |
562 |
$0.00 |
| J0665 |
Injection, bupivicaine, not otherwise specified, 0.5 mg |
661 |
558 |
$0.00 |
| J0137 |
Injection, acetaminophen (hikma), not therapeutically equivalent to j0131, 10 mg |
52 |
42 |
$0.00 |
| J0134 |
Injection, acetaminophen (fresenius kabi), not therapeutically equivalent to j0131, 10 mg |
121 |
99 |
$0.00 |
| C1887 |
Catheter, guiding (may include infusion/perfusion capability) |
135 |
125 |
$0.00 |
| 99218 |
|
127 |
114 |
$0.00 |
| C1776 |
Joint device (implantable) |
13 |
13 |
$0.00 |
| J0737 |
Injection, clindamycin phosphate (baxter), not therapeutically equivalent to j0736, 300 mg |
18 |
12 |
$0.00 |
| J1171 |
Injection, hydromorphone, 0.1 mg |
153 |
81 |
$0.00 |
| J1756 |
Injection, iron sucrose, 1 mg |
27 |
13 |
$0.00 |
| C1758 |
Catheter, ureteral |
15 |
12 |
$0.00 |