| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
77,325 |
69,648 |
$8.52M |
| 96361 |
Intravenous infusion, hydration; each additional hour |
13,062 |
10,820 |
$3.62M |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
22,760 |
20,431 |
$2.68M |
| 90837 |
Psychotherapy, 53 minutes with patient |
16,227 |
10,819 |
$1.94M |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
34,780 |
27,005 |
$1.89M |
| H2019 |
Therapeutic behavioral services, per 15 minutes |
18,720 |
10,666 |
$1.46M |
| 90834 |
Psychotherapy, 45 minutes with patient |
8,027 |
6,582 |
$992K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
6,982 |
6,293 |
$948K |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
9,636 |
9,041 |
$920K |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
13,314 |
3,233 |
$911K |
| 92507 |
Treatment of speech, language, voice, communication, and/or auditory processing disorder |
11,891 |
3,576 |
$740K |
| 70450 |
Computed tomography, head or brain; without contrast material |
2,773 |
2,338 |
$696K |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
2,583 |
2,067 |
$620K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
4,245 |
3,795 |
$565K |
| 0241U |
Neonatal screening for hereditary disorders, genomic sequence analysis panel |
4,879 |
4,150 |
$564K |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
7,006 |
2,043 |
$482K |
| 90791 |
Psychiatric diagnostic evaluation |
2,298 |
2,183 |
$479K |
| 90832 |
Psychotherapy, 30 minutes with patient |
4,982 |
4,040 |
$454K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
1,633 |
1,382 |
$421K |
| 80053 |
Comprehensive metabolic panel |
32,882 |
28,223 |
$393K |
| 90853 |
Group psychotherapy (other than of a multiple-family group) |
4,824 |
1,652 |
$390K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
3,773 |
1,969 |
$389K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
2,909 |
2,255 |
$381K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
1,799 |
1,351 |
$363K |
| H2020 |
Therapeutic behavioral services, per diem |
3,627 |
547 |
$359K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
1,429 |
697 |
$291K |
| 90839 |
|
1,913 |
1,622 |
$230K |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
656 |
526 |
$226K |
| 93010 |
Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only |
38,905 |
34,334 |
$225K |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
1,871 |
1,497 |
$222K |
| H0015 |
Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including assessment, counseling; crisis intervention, and activity therapies or education |
2,868 |
569 |
$217K |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
747 |
666 |
$187K |
| 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 |
960 |
901 |
$166K |
| 45380 |
Colonoscopy, flexible; with biopsy, single or multiple |
383 |
296 |
$161K |
| 0202U |
Oncology (prostate), multianalyte, gene expression profiling |
1,163 |
1,031 |
$159K |
| 59050 |
|
1,098 |
790 |
$150K |
| G0378 |
Hospital observation service, per hour |
1,759 |
860 |
$144K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
52,852 |
44,441 |
$131K |
| 84443 |
Thyroid stimulating hormone (TSH) |
7,562 |
6,857 |
$128K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
17,942 |
15,321 |
$117K |
| H0005 |
Alcohol and/or drug services; group counseling by a clinician |
1,351 |
480 |
$112K |
| C9803 |
Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
2,475 |
2,264 |
$102K |
| 45385 |
Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) |
179 |
142 |
$101K |
| 70553 |
Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences |
372 |
344 |
$95K |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
4,077 |
1,141 |
$90K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
377 |
300 |
$87K |
| 45378 |
Colonoscopy, flexible; diagnostic, including collection of specimen(s) |
181 |
146 |
$79K |
| H0036 |
Community psychiatric supportive treatment, face-to-face, per 15 minutes |
3,151 |
1,793 |
$77K |
| 80061 |
Lipid panel |
6,189 |
5,718 |
$77K |
| 96413 |
Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance |
952 |
514 |
$67K |
| 84439 |
|
3,147 |
2,853 |
$67K |
| 71046 |
Radiologic examination, chest; 2 views |
10,649 |
9,583 |
$65K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
731 |
656 |
$65K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
4,898 |
3,969 |
$62K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
2,487 |
2,284 |
$55K |
| 36415 |
Collection of venous blood by venipuncture |
60,315 |
50,000 |
$54K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,031 |
700 |
$52K |
| 93971 |
|
1,384 |
1,225 |
$48K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
374 |
338 |
$45K |
| 97161 |
|
842 |
735 |
$44K |
| S9470 |
Nutritional counseling, dietitian visit |
588 |
422 |
$43K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
6,200 |
5,864 |
$41K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
354 |
331 |
$40K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
10,501 |
9,227 |
$40K |
| 82607 |
|
1,996 |
1,808 |
$39K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
23,684 |
20,329 |
$38K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
2,096 |
1,857 |
$38K |
| 97162 |
|
651 |
609 |
$37K |
| 95810 |
Polysomnography; sleep staging with 4 or more additional parameters |
64 |
55 |
$35K |
| H0006 |
Alcohol and/or drug services; case management |
955 |
491 |
$34K |
| 96367 |
|
554 |
297 |
$33K |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
300 |
256 |
$32K |
| 94060 |
|
227 |
208 |
$31K |
| 82728 |
|
1,943 |
1,754 |
$31K |
| 12001 |
|
220 |
188 |
$30K |
| 97113 |
|
456 |
115 |
$29K |
| 73130 |
|
876 |
766 |
$29K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
2,092 |
1,856 |
$29K |
| 97116 |
|
919 |
280 |
$29K |
| 97112 |
Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination |
903 |
271 |
$28K |
| 76642 |
|
223 |
206 |
$27K |
| 72148 |
Magnetic resonance imaging, lumbar spine; without contrast material |
166 |
149 |
$26K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
952 |
859 |
$26K |
| 90840 |
|
1,396 |
1,226 |
$26K |
| 70496 |
|
137 |
109 |
$25K |
| 73030 |
|
917 |
814 |
$25K |
| 76775 |
|
298 |
263 |
$24K |
| 64635 |
|
123 |
97 |
$23K |
| 93970 |
|
555 |
487 |
$23K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
4,193 |
3,900 |
$23K |
| 83540 |
|
2,285 |
2,058 |
$22K |
| 73610 |
|
876 |
774 |
$21K |
| 66984 |
Extracapsular cataract removal with insertion of intraocular lens prosthesis |
17 |
17 |
$21K |
| 64493 |
|
80 |
61 |
$21K |
| 72110 |
|
581 |
526 |
$20K |
| 73564 |
|
894 |
798 |
$20K |
| 84484 |
|
10,117 |
7,823 |
$19K |
| 74018 |
|
714 |
607 |
$18K |
| J1756 |
Injection, iron sucrose, 1 mg |
383 |
136 |
$18K |
| 73560 |
|
473 |
409 |
$18K |
| 43235 |
|
49 |
42 |
$18K |
| 96415 |
|
74 |
50 |
$18K |
| 91200 |
|
174 |
160 |
$18K |
| 92523 |
|
264 |
259 |
$17K |
| 72050 |
|
381 |
350 |
$17K |
| 73630 |
|
940 |
828 |
$17K |
| 83550 |
|
2,061 |
1,840 |
$16K |
| 97165 |
|
292 |
249 |
$16K |
| 73110 |
|
475 |
418 |
$16K |
| 97016 |
|
532 |
121 |
$15K |
| 94729 |
|
248 |
227 |
$15K |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
468 |
419 |
$15K |
| 94726 |
|
228 |
208 |
$15K |
| 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 |
525 |
509 |
$14K |
| 73502 |
|
602 |
511 |
$14K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
17,802 |
14,697 |
$14K |
| 87798 |
Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism |
850 |
768 |
$13K |
| 86850 |
|
672 |
529 |
$13K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
15,256 |
12,978 |
$13K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
147 |
124 |
$13K |
| 86703 |
|
585 |
542 |
$13K |
| 80076 |
|
5,181 |
4,291 |
$12K |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
960 |
864 |
$12K |
| 81001 |
|
23,399 |
20,673 |
$12K |
| 72125 |
Computed tomography, cervical spine; without contrast material |
837 |
697 |
$12K |
| 90785 |
|
450 |
346 |
$12K |
| 71045 |
Radiologic examination, chest; single view |
6,548 |
5,818 |
$12K |
| 82746 |
|
1,299 |
1,163 |
$11K |
| 86038 |
|
462 |
418 |
$11K |
| J3490 |
Unclassified drugs |
3,278 |
1,827 |
$11K |
| 83970 |
|
450 |
411 |
$11K |
| 97535 |
Self-care/home management training, each 15 minutes |
299 |
127 |
$11K |
| 86140 |
|
1,146 |
924 |
$10K |
| 87081 |
|
1,383 |
1,220 |
$10K |
| 76830 |
Ultrasound, transvaginal |
215 |
193 |
$10K |
| 86900 |
|
844 |
605 |
$10K |
| 84702 |
|
711 |
479 |
$10K |
| 0002A |
|
260 |
256 |
$10K |
| 0001A |
|
285 |
269 |
$9K |
| 84153 |
|
513 |
466 |
$9K |
| 97597 |
|
628 |
199 |
$9K |
| 82805 |
|
241 |
175 |
$9K |
| 82553 |
|
1,371 |
1,224 |
$9K |
| 90870 |
|
25 |
12 |
$9K |
| 36591 |
|
870 |
401 |
$9K |
| 72100 |
|
267 |
234 |
$8K |
| H0048 |
Alcohol and/or other drug testing: collection and handling only, specimens other than blood |
1,628 |
1,107 |
$8K |
| 82570 |
|
1,035 |
949 |
$8K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
2,394 |
1,994 |
$8K |
| 86803 |
|
528 |
488 |
$8K |
| 83735 |
|
3,687 |
2,862 |
$8K |
| 97014 |
|
253 |
87 |
$7K |
| 87070 |
|
867 |
734 |
$7K |
| 85610 |
|
9,342 |
7,500 |
$7K |
| 88307 |
|
69 |
41 |
$7K |
| 87633 |
Infectious agent detection by nucleic acid, respiratory virus, 12-25 targets |
93 |
85 |
$7K |
| 70486 |
|
123 |
111 |
$6K |
| 87186 |
|
1,790 |
1,400 |
$6K |
| 85027 |
|
1,504 |
1,248 |
$6K |
| 71250 |
|
118 |
108 |
$6K |
| 90715 |
|
469 |
380 |
$6K |
| 83880 |
|
3,042 |
2,387 |
$6K |
| 76801 |
|
99 |
80 |
$6K |
| 78452 |
Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress |
12 |
12 |
$6K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
42 |
39 |
$6K |
| 12011 |
|
43 |
37 |
$6K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
11,319 |
8,993 |
$6K |
| 93017 |
|
60 |
56 |
$5K |
| 87340 |
|
291 |
255 |
$5K |
| 88175 |
Cytopathology, cervical or vaginal, any reporting system; collected in preservative fluid, automated thin layer |
343 |
332 |
$5K |
| 87088 |
|
1,611 |
1,330 |
$5K |
| 88304 |
|
346 |
287 |
$5K |
| 73721 |
Magnetic resonance imaging, any joint of lower extremity; without contrast material |
29 |
24 |
$5K |
| 85652 |
|
1,287 |
1,103 |
$5K |
| 73100 |
|
107 |
69 |
$5K |
| 76536 |
|
53 |
52 |
$5K |
| 82043 |
|
782 |
739 |
$5K |
| 80069 |
|
456 |
308 |
$4K |
| 97166 |
|
85 |
72 |
$4K |
| 92609 |
|
101 |
37 |
$4K |
| 87486 |
|
94 |
85 |
$4K |
| 84481 |
|
357 |
345 |
$4K |
| 72114 |
|
76 |
73 |
$4K |
| 87481 |
|
200 |
113 |
$4K |
| 87077 |
|
713 |
557 |
$4K |
| 86592 |
|
197 |
177 |
$4K |
| 73590 |
|
218 |
187 |
$4K |
| 84436 |
|
245 |
223 |
$4K |
| 81003 |
|
5,483 |
4,791 |
$4K |
| 82948 |
|
3,143 |
1,753 |
$3K |
| 87801 |
Infectious agent detection by nucleic acid; amplified probe, multiple organisms |
174 |
160 |
$3K |
| T1002 |
Rn services, up to 15 minutes |
332 |
197 |
$3K |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
28 |
25 |
$3K |
| 81025 |
|
13,369 |
11,622 |
$3K |
| 83690 |
|
10,730 |
9,050 |
$3K |
| G0476 |
Infectious agent detection by nucleic acid (dna or rna); human papillomavirus (hpv), high-risk types (e.g., 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) for cervical cancer screening, must be performed in addition to pap test |
86 |
70 |
$3K |
| 10061 |
|
24 |
24 |
$3K |
| 70498 |
|
132 |
108 |
$3K |
| 86901 |
|
845 |
605 |
$3K |
| 10060 |
|
17 |
13 |
$3K |
| 82550 |
|
4,632 |
3,799 |
$3K |
| 73090 |
|
116 |
83 |
$3K |
| 82565 |
|
778 |
627 |
$3K |
| 82731 |
|
112 |
90 |
$3K |
| 82784 |
|
246 |
207 |
$3K |
| 84550 |
|
510 |
465 |
$3K |
| 93880 |
|
100 |
88 |
$3K |
| 87522 |
Neg quan hep c or qual rna |
79 |
64 |
$3K |
| G0145 |
Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system and manual rescreening under physician supervision |
126 |
104 |
$3K |
| 85007 |
|
759 |
604 |
$3K |
| 84466 |
|
161 |
157 |
$3K |
| 73080 |
|
138 |
120 |
$3K |
| 82533 |
|
138 |
116 |
$2K |
| 83721 |
|
182 |
163 |
$2K |
| 84146 |
|
348 |
279 |
$2K |
| 88341 |
|
39 |
27 |
$2K |
| 86706 |
|
129 |
109 |
$2K |
| 85730 |
|
6,382 |
5,308 |
$2K |
| 87581 |
|
94 |
85 |
$2K |
| 00731 |
|
640 |
499 |
$2K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
2,803 |
2,461 |
$2K |
| 82150 |
|
1,903 |
1,694 |
$2K |
| 73562 |
|
40 |
40 |
$2K |
| G0008 |
Administration of influenza virus vaccine |
68 |
63 |
$2K |
| 72170 |
|
78 |
69 |
$2K |
| 80320 |
|
102 |
97 |
$2K |
| 93225 |
|
14 |
12 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
545 |
411 |
$2K |
| G0447 |
Face-to-face behavioral counseling for obesity, 15 minutes |
27 |
25 |
$2K |
| 88342 |
|
386 |
296 |
$2K |
| 82077 |
|
2,103 |
1,688 |
$1K |
| 84480 |
|
120 |
111 |
$1K |
| 87624 |
Infectious agent detection by nucleic acid; human papillomavirus (HPV), high-risk types |
67 |
66 |
$1K |
| J1170 |
Injection, hydromorphone, up to 4 mg |
5,212 |
2,969 |
$1K |
| 86376 |
|
68 |
62 |
$1K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
26 |
24 |
$1K |
| 96376 |
|
1,533 |
965 |
$1K |
| J2704 |
Injection, propofol, 10 mg |
6,563 |
4,799 |
$1K |
| 87205 |
|
744 |
615 |
$1K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
1,570 |
1,498 |
$1K |
| 72072 |
|
44 |
36 |
$1K |
| 72131 |
|
20 |
18 |
$1K |
| 84450 |
|
202 |
163 |
$1K |
| 86704 |
|
53 |
48 |
$1K |
| H2012 |
Behavioral health day treatment, per hour |
33 |
24 |
$1K |
| 82248 |
|
408 |
321 |
$990.83 |
| 83655 |
|
31 |
31 |
$979.49 |
| 36416 |
|
3,727 |
3,135 |
$939.14 |
| 87040 |
|
1,348 |
690 |
$917.18 |
| 90686 |
|
62 |
39 |
$858.69 |
| 87071 |
|
175 |
143 |
$855.31 |
| 73140 |
|
30 |
29 |
$851.87 |
| Q3014 |
Telehealth originating site facility fee |
67 |
56 |
$843.88 |
| 84100 |
|
257 |
221 |
$842.36 |
| 83605 |
|
955 |
723 |
$834.30 |
| 93226 |
|
14 |
12 |
$811.05 |
| 84156 |
|
280 |
251 |
$784.35 |
| 84403 |
|
79 |
71 |
$767.12 |
| 87109 |
|
30 |
29 |
$765.00 |
| 86431 |
|
60 |
53 |
$762.47 |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
1,753 |
1,092 |
$751.82 |
| 84703 |
|
411 |
363 |
$731.46 |
| 96523 |
|
23 |
14 |
$705.06 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
12,375 |
10,394 |
$651.58 |
| 87427 |
|
60 |
27 |
$645.88 |
| 94375 |
|
378 |
343 |
$632.62 |
| 87045 |
|
31 |
27 |
$630.20 |
| 93922 |
|
12 |
12 |
$624.18 |
| 87046 |
|
59 |
27 |
$614.48 |
| 85379 |
|
911 |
734 |
$613.32 |
| 86364 |
|
53 |
27 |
$608.38 |
| 87493 |
|
15 |
13 |
$583.91 |
| 73552 |
|
26 |
25 |
$570.56 |
| 94010 |
|
12 |
12 |
$567.17 |
| 84520 |
|
255 |
211 |
$556.45 |
| 86231 |
|
27 |
24 |
$543.34 |
| J7030 |
Infusion, normal saline solution , 1000 cc |
9,414 |
6,291 |
$531.14 |
| 93923 |
|
27 |
15 |
$521.36 |
| 84402 |
|
28 |
27 |
$510.60 |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
2,296 |
1,649 |
$493.75 |
| 85014 |
|
126 |
96 |
$475.44 |
| J1642 |
Injection, heparin sodium, (heparin lock flush), per 10 units |
2,159 |
694 |
$455.26 |
| 87210 |
|
376 |
309 |
$398.50 |
| 0031A |
|
23 |
16 |
$398.31 |
| C9113 |
Injection, pantoprazole sodium, per vial |
414 |
244 |
$388.73 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
5,511 |
3,339 |
$373.15 |
| 71101 |
|
48 |
41 |
$355.14 |
| 87807 |
|
122 |
117 |
$348.42 |
| 87075 |
|
120 |
96 |
$344.05 |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
3,884 |
3,055 |
$340.88 |
| 77065 |
Tomosynthesis, mammo |
38 |
33 |
$327.55 |
| J3420 |
Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg |
294 |
212 |
$292.40 |
| 85018 |
|
74 |
50 |
$272.95 |
| J2550 |
Injection, promethazine hcl, up to 50 mg |
2,535 |
1,935 |
$270.95 |
| 76377 |
|
1,293 |
1,020 |
$268.91 |
| 82653 |
|
13 |
13 |
$257.36 |
| 80051 |
|
44 |
38 |
$251.53 |
| 64636 |
|
98 |
39 |
$250.72 |
| 86480 |
|
12 |
12 |
$222.95 |
| 90656 |
|
29 |
29 |
$220.40 |
| 83615 |
|
27 |
14 |
$190.91 |
| 83993 |
|
14 |
14 |
$189.05 |
| 88720 |
|
14 |
12 |
$170.68 |
| 77066 |
Tomosynthesis, mammo |
14 |
13 |
$144.31 |
| 82962 |
|
2,426 |
2,231 |
$134.54 |
| 82075 |
|
21 |
13 |
$133.01 |
| 82272 |
|
28 |
24 |
$127.00 |
| A9270 |
Non-covered item or service |
8,441 |
2,590 |
$120.18 |
| 82247 |
|
22 |
14 |
$112.93 |
| A9579 |
Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (nos), per ml |
682 |
598 |
$110.16 |
| J0171 |
Injection, adrenalin, epinephrine, 0.1 mg |
461 |
300 |
$109.49 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
9,026 |
6,763 |
$105.88 |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
319 |
237 |
$92.96 |
| J1650 |
Injection, enoxaparin sodium, 10 mg |
188 |
96 |
$91.53 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
3,194 |
2,196 |
$90.78 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
1,375 |
949 |
$82.39 |
| 86800 |
|
12 |
12 |
$77.52 |
| 29125 |
|
19 |
14 |
$75.90 |
| J3301 |
Injection, triamcinolone acetonide, not otherwise specified, 10 mg |
860 |
648 |
$72.65 |
| 51701 |
|
19 |
16 |
$71.56 |
| 85045 |
|
17 |
12 |
$68.36 |
| J0690 |
Injection, cefazolin sodium, 500 mg |
1,139 |
702 |
$66.45 |
| J1644 |
Injection, heparin sodium, per 1000 units |
866 |
412 |
$62.90 |
| J0780 |
Injection, prochlorperazine, up to 10 mg |
433 |
331 |
$61.63 |
| J3370 |
Injection, vancomycin hcl, 500 mg |
250 |
147 |
$60.63 |
| J8540 |
Dexamethasone, oral, 0.25 mg |
378 |
228 |
$59.19 |
| 82140 |
|
16 |
12 |
$57.32 |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
858 |
544 |
$54.41 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
2,698 |
1,835 |
$49.62 |
| J7050 |
Infusion, normal saline solution, 250 cc |
2,034 |
691 |
$45.05 |
| J2060 |
Injection, lorazepam, 2 mg |
774 |
498 |
$37.32 |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
1,775 |
1,212 |
$35.87 |
| J7040 |
Infusion, normal saline solution, sterile (500 ml = 1 unit) |
549 |
353 |
$34.39 |
| 82947 |
|
14 |
12 |
$34.00 |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
609 |
438 |
$30.58 |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
913 |
726 |
$25.40 |
| 87270 |
|
25 |
25 |
$22.86 |
| J2795 |
Injection, ropivacaine hydrochloride, 1 mg |
358 |
253 |
$15.04 |
| J0330 |
Injection, succinylcholine chloride, up to 20 mg |
224 |
140 |
$9.83 |
| J2919 |
Injection, methylprednisolone sodium succinate, 5 mg |
189 |
136 |
$9.66 |
| J2470 |
Injection, pantoprazole sodium, 40 mg |
102 |
85 |
$8.46 |
| J3480 |
Injection, potassium chloride, per 2 meq |
89 |
43 |
$5.56 |
| 91300 |
|
567 |
486 |
$5.33 |
| J2371 |
Injection, phenylephrine hydrochloride, 20 micrograms |
86 |
55 |
$3.60 |
| J1171 |
Injection, hydromorphone, 0.1 mg |
178 |
119 |
$2.28 |
| 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 |
178 |
165 |
$1.77 |
| J1940 |
Injection, furosemide, up to 20 mg |
26 |
12 |
$1.02 |
| 82010 |
|
70 |
55 |
$0.00 |
| Q9966 |
Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml |
180 |
138 |
$0.00 |
| 00811 |
|
572 |
463 |
$0.00 |
| C1729 |
Catheter, drainage |
195 |
143 |
$0.00 |
| C1894 |
Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser |
72 |
56 |
$0.00 |
| C1780 |
Lens, intraocular (new technology) |
17 |
17 |
$0.00 |
| 64495 |
|
55 |
41 |
$0.00 |
| H2017 |
Psychosocial rehabilitation services, per 15 minutes |
37 |
30 |
$0.00 |
| Q9969 |
Tc-99m from non-highly enriched uranium source, full cost recovery add-on, per study dose |
187 |
141 |
$0.00 |
| 64494 |
|
74 |
57 |
$0.00 |
| J1030 |
Injection, methylprednisolone acetate, 40 mg |
44 |
38 |
$0.00 |
| J2360 |
Injection, orphenadrine citrate, up to 60 mg |
53 |
46 |
$0.00 |
| J2001 |
Injection, lidocaine hcl for intravenous infusion, 10 mg |
36 |
26 |
$0.00 |
| C1769 |
Guide wire |
119 |
86 |
$0.00 |
| G0103 |
Prostate cancer screening; prostate specific antigen test (psa) |
17 |
12 |
$0.00 |
| J1790 |
Injection, droperidol, up to 5 mg |
19 |
13 |
$0.00 |
| 00142 |
|
17 |
17 |
$0.00 |
| J2370 |
Injection, phenylephrine hcl, up to 1 ml |
60 |
37 |
$0.00 |
| C9290 |
Injection, bupivacaine liposome, 1 mg |
19 |
12 |
$0.00 |
| A9500 |
Technetium tc-99m sestamibi, diagnostic, per study dose |
12 |
12 |
$0.00 |