| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
112,355 |
87,121 |
$8.12M |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
7,019 |
6,291 |
$2.19M |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
11,248 |
9,941 |
$2.11M |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
11,446 |
10,337 |
$1.29M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
37,948 |
35,325 |
$1.09M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
26,669 |
24,988 |
$1.07M |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
7,166 |
6,222 |
$730K |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
12,579 |
4,543 |
$721K |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
2,827 |
2,631 |
$468K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
5,576 |
3,549 |
$447K |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
15,757 |
5,738 |
$347K |
| 92507 |
Treatment of speech, language, voice, communication, and/or auditory processing disorder |
7,214 |
1,952 |
$265K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
4,471 |
4,416 |
$251K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
4,415 |
4,371 |
$245K |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
2,922 |
2,764 |
$231K |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
2,474 |
2,329 |
$231K |
| 70450 |
Computed tomography, head or brain; without contrast material |
2,846 |
2,579 |
$226K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
10,621 |
10,414 |
$210K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
3,732 |
3,551 |
$208K |
| 87636 |
Infectious agent detection by nucleic acid; SARS-CoV-2 and influenza virus types A and B |
3,075 |
2,902 |
$203K |
| U0004 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc, making use of high throughput technologies as described by cms-2020-01-r |
3,301 |
3,087 |
$193K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
5,719 |
4,589 |
$186K |
| 96361 |
Intravenous infusion, hydration; each additional hour |
3,765 |
2,882 |
$152K |
| 71046 |
Radiologic examination, chest; 2 views |
3,743 |
3,526 |
$150K |
| 97602 |
|
3,366 |
1,129 |
$146K |
| 71045 |
Radiologic examination, chest; single view |
4,034 |
3,613 |
$137K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
2,352 |
2,325 |
$134K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
2,202 |
2,161 |
$106K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
911 |
858 |
$93K |
| 20610 |
|
868 |
812 |
$92K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
710 |
632 |
$70K |
| 84443 |
Thyroid stimulating hormone (TSH) |
10,285 |
9,757 |
$67K |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
3,590 |
1,579 |
$63K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
1,822 |
1,740 |
$62K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
6,255 |
4,328 |
$61K |
| 80053 |
Comprehensive metabolic panel |
29,181 |
24,843 |
$61K |
| 80061 |
Lipid panel |
8,148 |
7,851 |
$60K |
| 97535 |
Self-care/home management training, each 15 minutes |
2,859 |
1,604 |
$57K |
| G0008 |
Administration of influenza virus vaccine |
2,955 |
2,875 |
$56K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
850 |
796 |
$55K |
| 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 |
3,559 |
3,321 |
$52K |
| 76830 |
Ultrasound, transvaginal |
644 |
621 |
$51K |
| 99215 |
Prolong outpt/office vis |
1,027 |
952 |
$51K |
| 93010 |
Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only |
12,583 |
10,114 |
$49K |
| U0002 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
1,872 |
1,767 |
$47K |
| 45385 |
Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) |
84 |
79 |
$46K |
| 97112 |
Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination |
2,138 |
1,181 |
$44K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
781 |
760 |
$44K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
667 |
645 |
$43K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
3,466 |
3,342 |
$42K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
1,094 |
720 |
$41K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
29,234 |
23,887 |
$41K |
| 86900 |
|
1,100 |
959 |
$40K |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
1,943 |
1,909 |
$40K |
| 78452 |
Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress |
97 |
94 |
$39K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
2,624 |
2,520 |
$38K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
2,616 |
2,513 |
$38K |
| 97803 |
|
1,430 |
1,360 |
$37K |
| 97162 |
|
1,064 |
994 |
$34K |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
98 |
96 |
$34K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
1,285 |
1,262 |
$33K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
8,633 |
8,276 |
$31K |
| 36415 |
Collection of venous blood by venipuncture |
36,495 |
30,670 |
$30K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
2,518 |
2,301 |
$30K |
| 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 |
485 |
477 |
$30K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
4,542 |
4,474 |
$29K |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
700 |
642 |
$28K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
506 |
491 |
$28K |
| 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 |
2,729 |
2,449 |
$28K |
| C8929 |
Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiography |
87 |
87 |
$25K |
| Q3014 |
Telehealth originating site facility fee |
1,814 |
1,718 |
$23K |
| G0009 |
Administration of pneumococcal vaccine |
748 |
740 |
$23K |
| 11721 |
|
2,646 |
2,539 |
$23K |
| 97161 |
|
493 |
479 |
$21K |
| 87510 |
|
2,052 |
1,964 |
$21K |
| 87480 |
|
2,054 |
1,966 |
$20K |
| 73610 |
|
1,327 |
1,154 |
$20K |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
376 |
354 |
$20K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
9,907 |
8,615 |
$20K |
| 99309 |
Subsequent nursing facility care, per day, low to moderate complexity |
1,181 |
817 |
$20K |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
1,931 |
1,816 |
$19K |
| 87631 |
|
898 |
860 |
$19K |
| G0108 |
Diabetes outpatient self-management training services, individual, per 30 minutes |
1,145 |
1,066 |
$17K |
| 73721 |
Magnetic resonance imaging, any joint of lower extremity; without contrast material |
116 |
110 |
$17K |
| C9803 |
Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
1,157 |
1,074 |
$17K |
| 99308 |
Subsequent nursing facility care, per day, straightforward |
1,654 |
1,018 |
$16K |
| 80050 |
General health panel |
780 |
760 |
$16K |
| 73562 |
|
1,415 |
1,201 |
$16K |
| 90473 |
|
695 |
690 |
$16K |
| 97163 |
|
551 |
505 |
$15K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
837 |
791 |
$15K |
| 85027 |
|
7,161 |
6,372 |
$15K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
182 |
171 |
$15K |
| 87430 |
|
2,992 |
2,883 |
$14K |
| 73110 |
|
954 |
805 |
$14K |
| 82728 |
|
2,863 |
2,664 |
$14K |
| 82607 |
|
2,649 |
2,543 |
$14K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
7,551 |
6,797 |
$13K |
| 76819 |
Fetal biophysical profile; without non-stress testing |
141 |
67 |
$13K |
| 90686 |
|
4,140 |
4,085 |
$12K |
| 59025 |
Fetal non-stress test |
91 |
52 |
$12K |
| 83550 |
|
3,822 |
3,578 |
$12K |
| 73030 |
|
1,072 |
962 |
$12K |
| 94060 |
|
131 |
128 |
$12K |
| 52000 |
|
54 |
54 |
$12K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
7,922 |
6,356 |
$11K |
| 73630 |
|
812 |
746 |
$10K |
| 83540 |
|
4,134 |
3,873 |
$10K |
| 83655 |
|
1,053 |
1,033 |
$10K |
| 76642 |
|
176 |
174 |
$10K |
| 84439 |
|
2,434 |
2,315 |
$9K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
336 |
311 |
$9K |
| 45380 |
Colonoscopy, flexible; with biopsy, single or multiple |
14 |
13 |
$9K |
| 87798 |
Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism |
421 |
413 |
$8K |
| 87081 |
|
3,773 |
3,616 |
$8K |
| 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 |
71 |
71 |
$8K |
| 72100 |
|
270 |
262 |
$8K |
| 95810 |
Polysomnography; sleep staging with 4 or more additional parameters |
26 |
26 |
$8K |
| 73502 |
|
970 |
858 |
$7K |
| 96367 |
|
283 |
188 |
$6K |
| 92504 |
|
2,817 |
2,573 |
$6K |
| 93017 |
|
196 |
188 |
$6K |
| 87660 |
|
374 |
362 |
$6K |
| 85610 |
|
7,865 |
4,712 |
$6K |
| 31575 |
|
72 |
67 |
$6K |
| 97802 |
|
98 |
95 |
$6K |
| 98927 |
|
455 |
433 |
$6K |
| 83735 |
|
9,997 |
7,567 |
$6K |
| 86140 |
|
4,575 |
4,129 |
$6K |
| 81001 |
|
10,220 |
9,170 |
$6K |
| 72148 |
Magnetic resonance imaging, lumbar spine; without contrast material |
54 |
53 |
$6K |
| 84702 |
|
746 |
511 |
$6K |
| 93971 |
|
91 |
88 |
$6K |
| 86803 |
|
1,218 |
1,165 |
$5K |
| 0002A |
|
135 |
135 |
$5K |
| 0054A |
|
230 |
227 |
$5K |
| 71250 |
|
102 |
102 |
$5K |
| 97166 |
|
113 |
106 |
$4K |
| 73130 |
|
582 |
495 |
$4K |
| 87070 |
|
1,034 |
976 |
$4K |
| 0001A |
|
118 |
117 |
$4K |
| 82570 |
|
2,830 |
2,615 |
$4K |
| 87186 |
|
2,025 |
1,911 |
$4K |
| 96413 |
Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance |
41 |
27 |
$4K |
| 36591 |
|
565 |
301 |
$4K |
| G0279 |
Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066) |
209 |
200 |
$4K |
| 86618 |
|
827 |
802 |
$4K |
| 97116 |
|
379 |
177 |
$4K |
| 99335 |
|
65 |
50 |
$4K |
| 71271 |
|
58 |
57 |
$4K |
| 84703 |
|
2,899 |
2,639 |
$3K |
| 90620 |
|
85 |
80 |
$3K |
| 95251 |
|
263 |
253 |
$3K |
| 11042 |
Debridement, subcutaneous tissue (includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm |
70 |
51 |
$3K |
| 76775 |
|
174 |
158 |
$3K |
| 81003 |
|
6,827 |
6,013 |
$3K |
| G0433 |
Infectious agent antibody detection by enzyme-linked immunosorbent assay (elisa) technique, hiv-1 and/or hiv-2, screening |
322 |
317 |
$3K |
| 84153 |
|
510 |
477 |
$3K |
| 83880 |
|
2,045 |
1,836 |
$3K |
| 87077 |
|
2,360 |
2,244 |
$2K |
| 72125 |
Computed tomography, cervical spine; without contrast material |
506 |
475 |
$2K |
| 93271 |
|
40 |
40 |
$2K |
| 85018 |
|
1,993 |
1,797 |
$2K |
| 90480 |
|
299 |
294 |
$2K |
| 82043 |
|
1,261 |
1,211 |
$2K |
| 83970 |
|
191 |
188 |
$2K |
| 85651 |
|
1,797 |
1,623 |
$2K |
| 82746 |
|
418 |
406 |
$2K |
| 73564 |
|
132 |
119 |
$2K |
| 93225 |
|
38 |
37 |
$2K |
| 91320 |
|
148 |
146 |
$2K |
| 99442 |
|
82 |
78 |
$2K |
| 74018 |
|
90 |
81 |
$2K |
| 0134A |
|
186 |
184 |
$2K |
| 76801 |
|
17 |
14 |
$2K |
| 99443 |
|
55 |
53 |
$2K |
| 90677 |
|
15 |
13 |
$2K |
| 77066 |
Tomosynthesis, mammo |
30 |
28 |
$2K |
| 83690 |
|
4,089 |
3,688 |
$1K |
| 82950 |
|
344 |
329 |
$1K |
| 97035 |
|
258 |
114 |
$1K |
| 99307 |
|
123 |
93 |
$1K |
| 80076 |
|
481 |
443 |
$1K |
| 87280 |
|
1,638 |
1,559 |
$1K |
| 87390 |
|
249 |
245 |
$1K |
| 95806 |
|
59 |
58 |
$1K |
| 85730 |
|
1,844 |
1,617 |
$1K |
| 86038 |
|
226 |
217 |
$1K |
| 95250 |
|
24 |
24 |
$1K |
| 86592 |
|
310 |
304 |
$1K |
| 81025 |
|
2,219 |
2,100 |
$1K |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
13 |
13 |
$1K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
121 |
121 |
$1K |
| 90670 |
|
947 |
940 |
$1K |
| 87340 |
|
383 |
378 |
$989.52 |
| 85652 |
|
1,429 |
1,311 |
$979.17 |
| 96161 |
|
37 |
35 |
$930.50 |
| 87484 |
|
206 |
197 |
$921.04 |
| 87469 |
|
206 |
197 |
$921.02 |
| 96523 |
|
64 |
41 |
$912.80 |
| 76536 |
|
15 |
15 |
$911.23 |
| 90474 |
|
520 |
517 |
$887.04 |
| 84460 |
|
374 |
353 |
$858.25 |
| 99495 |
|
13 |
13 |
$857.83 |
| 99232 |
Subsequent hospital care, per day, moderate complexity |
90 |
16 |
$811.08 |
| 86702 |
|
249 |
245 |
$795.46 |
| 97167 |
|
29 |
26 |
$788.60 |
| 87205 |
|
617 |
576 |
$742.97 |
| 84450 |
|
369 |
348 |
$726.58 |
| 90651 |
|
357 |
354 |
$693.45 |
| 99188 |
|
37 |
37 |
$684.00 |
| 86850 |
|
1,098 |
953 |
$669.14 |
| 93016 |
|
72 |
68 |
$659.95 |
| 86701 |
|
249 |
245 |
$659.73 |
| 90619 |
|
310 |
306 |
$632.70 |
| 76770 |
|
12 |
12 |
$614.12 |
| 76376 |
|
143 |
138 |
$600.80 |
| 87468 |
|
124 |
116 |
$590.51 |
| 86617 |
|
53 |
38 |
$588.62 |
| 82247 |
|
269 |
237 |
$580.32 |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
12 |
12 |
$579.40 |
| 90662 |
|
417 |
399 |
$564.78 |
| 83516 |
|
75 |
72 |
$525.69 |
| 87040 |
|
1,172 |
1,041 |
$502.04 |
| G0378 |
Hospital observation service, per hour |
522 |
439 |
$500.00 |
| 99239 |
Hospital discharge day management, more than 30 minutes |
43 |
24 |
$493.22 |
| 91322 |
|
38 |
38 |
$484.95 |
| 87478 |
|
137 |
129 |
$467.71 |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
2,172 |
2,006 |
$453.84 |
| 93018 |
|
69 |
66 |
$420.95 |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
2,392 |
2,260 |
$418.09 |
| 0072A |
|
84 |
84 |
$411.26 |
| 00811 |
|
13 |
13 |
$402.75 |
| 84484 |
|
5,368 |
4,460 |
$391.42 |
| D1206 |
Topical application of fluoride varnish |
56 |
56 |
$384.00 |
| 82565 |
|
392 |
320 |
$382.99 |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
1,777 |
1,233 |
$353.45 |
| 0064A |
|
105 |
102 |
$341.99 |
| 00812 |
|
13 |
13 |
$334.83 |
| 76000 |
|
32 |
29 |
$329.73 |
| 0124A |
|
17 |
17 |
$308.79 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
435 |
426 |
$292.75 |
| 90680 |
|
677 |
673 |
$277.22 |
| 82040 |
|
355 |
333 |
$276.81 |
| 81002 |
|
1,240 |
992 |
$269.98 |
| 85379 |
|
824 |
769 |
$267.62 |
| 84100 |
|
264 |
243 |
$262.99 |
| 51798 |
|
152 |
143 |
$261.22 |
| 84075 |
|
173 |
161 |
$250.92 |
| 99406 |
|
18 |
13 |
$241.88 |
| 0004A |
|
186 |
184 |
$238.28 |
| 82550 |
|
318 |
287 |
$233.21 |
| 83605 |
|
2,041 |
1,810 |
$226.20 |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
1,733 |
1,366 |
$221.98 |
| 77080 |
|
12 |
12 |
$220.00 |
| 82784 |
|
63 |
59 |
$212.80 |
| 86706 |
|
24 |
24 |
$159.85 |
| 90656 |
|
20 |
20 |
$156.47 |
| 73080 |
|
30 |
26 |
$154.66 |
| 90756 |
|
159 |
133 |
$148.52 |
| 80305 |
|
797 |
749 |
$144.86 |
| 86762 |
|
71 |
69 |
$143.90 |
| 0154A |
|
14 |
14 |
$137.24 |
| 82947 |
|
43 |
40 |
$134.82 |
| 92551 |
|
13 |
13 |
$132.96 |
| 93272 |
|
12 |
12 |
$129.87 |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
301 |
269 |
$127.68 |
| J2704 |
Injection, propofol, 10 mg |
3,477 |
3,103 |
$122.64 |
| 86376 |
|
13 |
13 |
$116.40 |
| 84146 |
|
14 |
12 |
$116.28 |
| 82150 |
|
143 |
135 |
$109.90 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
3,961 |
3,292 |
$109.78 |
| 0074A |
|
16 |
16 |
$109.61 |
| 84156 |
|
98 |
84 |
$105.85 |
| 83525 |
|
13 |
12 |
$102.24 |
| 80299 |
|
14 |
12 |
$97.93 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
4,761 |
4,024 |
$94.24 |
| G0103 |
Prostate cancer screening; prostate specific antigen test (psa) |
15 |
14 |
$94.00 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
2,077 |
1,724 |
$91.32 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
1,922 |
1,706 |
$91.32 |
| 86431 |
|
28 |
27 |
$90.72 |
| 90715 |
|
851 |
833 |
$87.08 |
| 94727 |
|
39 |
37 |
$83.48 |
| 86901 |
|
1,121 |
975 |
$74.62 |
| 73140 |
|
14 |
13 |
$69.47 |
| 80178 |
|
28 |
24 |
$68.80 |
| 83721 |
|
26 |
26 |
$65.59 |
| 84466 |
|
12 |
12 |
$63.80 |
| 83615 |
|
38 |
25 |
$54.41 |
| 84550 |
|
66 |
64 |
$51.25 |
| 85378 |
|
255 |
243 |
$43.74 |
| 90648 |
|
182 |
180 |
$43.34 |
| 0071A |
|
84 |
84 |
$43.00 |
| 84481 |
|
12 |
12 |
$40.73 |
| 94729 |
|
63 |
62 |
$39.64 |
| 82948 |
|
922 |
631 |
$31.24 |
| 82962 |
|
887 |
521 |
$31.07 |
| 99173 |
|
14 |
14 |
$27.02 |
| J1030 |
Injection, methylprednisolone acetate, 40 mg |
303 |
283 |
$26.73 |
| 84520 |
|
22 |
15 |
$20.15 |
| 82248 |
|
18 |
16 |
$20.08 |
| 93270 |
|
42 |
42 |
$16.78 |
| 73620 |
|
57 |
51 |
$16.19 |
| J7030 |
Infusion, normal saline solution , 1000 cc |
4,696 |
3,806 |
$15.48 |
| J7050 |
Infusion, normal saline solution, 250 cc |
1,699 |
1,119 |
$12.18 |
| 96376 |
|
2,474 |
1,590 |
$8.14 |
| 82803 |
|
352 |
313 |
$8.06 |
| 85014 |
|
15 |
12 |
$4.74 |
| J0690 |
Injection, cefazolin sodium, 500 mg |
1,379 |
1,128 |
$3.62 |
| 82077 |
|
158 |
136 |
$3.45 |
| J0665 |
Injection, bupivicaine, not otherwise specified, 0.5 mg |
207 |
177 |
$3.25 |
| 90672 |
|
335 |
333 |
$1.52 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
1,479 |
1,361 |
$0.31 |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
18 |
13 |
$0.04 |
| 90710 |
|
122 |
121 |
$0.03 |
| 90716 |
|
43 |
43 |
$0.03 |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
992 |
575 |
$0.00 |
| Q9957 |
Injection, perflutren lipid microspheres, per ml |
148 |
146 |
$0.00 |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
150 |
112 |
$0.00 |
| 90707 |
|
55 |
55 |
$0.00 |
| 90633 |
|
492 |
486 |
$0.00 |
| 90700 |
|
54 |
54 |
$0.00 |
| J7040 |
Infusion, normal saline solution, sterile (500 ml = 1 unit) |
171 |
140 |
$0.00 |
| A9575 |
Injection, gadoterate meglumine, 0.1 ml |
126 |
123 |
$0.00 |
| 80179 |
|
103 |
98 |
$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 |
232 |
213 |
$0.00 |
| 90671 |
|
182 |
182 |
$0.00 |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
162 |
143 |
$0.00 |
| 93226 |
|
38 |
37 |
$0.00 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
460 |
456 |
$0.00 |
| G8978 |
Mobility: walking & moving around functional limitation, current status, at therapy episode outset and at reporting intervals |
150 |
143 |
$0.00 |
| J0171 |
Injection, adrenalin, epinephrine, 0.1 mg |
12 |
12 |
$0.00 |
| A9502 |
Technetium tc-99m tetrofosmin, diagnostic, per study dose |
71 |
70 |
$0.00 |
| 80143 |
|
159 |
152 |
$0.00 |
| J2919 |
Injection, methylprednisolone sodium succinate, 5 mg |
60 |
46 |
$0.00 |
| 80361 |
|
27 |
26 |
$0.00 |
| 91300 |
|
129 |
112 |
$0.00 |
| C9113 |
Injection, pantoprazole sodium, per vial |
36 |
27 |
$0.00 |
| 90734 |
|
145 |
145 |
$0.00 |
| J1650 |
Injection, enoxaparin sodium, 10 mg |
27 |
14 |
$0.00 |
| 80348 |
|
29 |
27 |
$0.00 |
| 94150 |
|
25 |
25 |
$0.00 |
| J1170 |
Injection, hydromorphone, up to 4 mg |
378 |
253 |
$0.00 |
| J1642 |
Injection, heparin sodium, (heparin lock flush), per 10 units |
2,103 |
1,126 |
$0.00 |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
126 |
98 |
$0.00 |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
2,010 |
1,738 |
$0.00 |
| 90723 |
|
456 |
454 |
$0.00 |
| 90696 |
|
102 |
101 |
$0.00 |
| A9270 |
Non-covered item or service |
1,146 |
285 |
$0.00 |
| 36416 |
|
2,923 |
1,708 |
$0.00 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
1,940 |
1,414 |
$0.00 |
| J7620 |
Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme |
83 |
70 |
$0.00 |
| J2060 |
Injection, lorazepam, 2 mg |
480 |
377 |
$0.00 |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
240 |
209 |
$0.00 |
| 90697 |
|
294 |
293 |
$0.00 |
| 91307 |
|
111 |
106 |
$0.00 |
| J1010 |
Injection, methylprednisolone acetate, 1 mg |
134 |
131 |
$0.00 |
| Q2036 |
Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (flulaval) |
23 |
23 |
$0.00 |
| 88342 |
|
50 |
50 |
$0.00 |
| 90647 |
|
272 |
270 |
$0.00 |
| 88304 |
|
52 |
52 |
$0.00 |
| 88300 |
|
64 |
64 |
$0.00 |
| C1773 |
Retrieval device, insertable (used to retrieve fractured medical devices) |
45 |
40 |
$0.00 |
| 91306 |
|
127 |
125 |
$0.00 |
| J2001 |
Injection, lidocaine hcl for intravenous infusion, 10 mg |
197 |
191 |
$0.00 |
| J2370 |
Injection, phenylephrine hcl, up to 1 ml |
48 |
44 |
$0.00 |
| S0320 |
Telephone calls by a registered nurse to a disease management program member for monitoring purposes; per month |
18 |
16 |
$0.00 |
| J2785 |
Injection, regadenoson, 0.1 mg |
12 |
12 |
$0.00 |
| 94760 |
|
23 |
13 |
$0.00 |
| J2003 |
Injection, lidocaine hydrochloride, 1 mg |
93 |
86 |
$0.00 |
| 94250 |
|
14 |
12 |
$0.00 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
40 |
39 |
$0.00 |