| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99284 |
Emergency department visit for the evaluation and management, high severity |
21,854 |
21,186 |
$2.60M |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
22,866 |
22,289 |
$1.87M |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
10,242 |
9,865 |
$1.66M |
| G0378 |
Hospital observation service, per hour |
1,969 |
1,253 |
$532K |
| 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 |
5,191 |
5,060 |
$479K |
| 80053 |
Comprehensive metabolic panel |
43,313 |
40,546 |
$441K |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
2,356 |
2,290 |
$426K |
| 87636 |
Infectious agent detection by nucleic acid; SARS-CoV-2 and influenza virus types A and B |
3,745 |
3,661 |
$371K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
12,022 |
11,425 |
$342K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
46,966 |
42,903 |
$246K |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
6,142 |
6,036 |
$236K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
6,538 |
6,231 |
$235K |
| 87633 |
Infectious agent detection by nucleic acid, respiratory virus, 12-25 targets |
483 |
457 |
$197K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
2,096 |
2,053 |
$186K |
| 70450 |
Computed tomography, head or brain; without contrast material |
2,740 |
2,648 |
$174K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
18,074 |
17,221 |
$163K |
| 80061 |
Lipid panel |
11,974 |
11,771 |
$161K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
2,194 |
2,040 |
$135K |
| 72148 |
Magnetic resonance imaging, lumbar spine; without contrast material |
720 |
716 |
$132K |
| 84443 |
Thyroid stimulating hormone (TSH) |
6,922 |
6,773 |
$127K |
| 80050 |
General health panel |
2,377 |
2,349 |
$123K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
6,394 |
5,946 |
$114K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
3,174 |
3,111 |
$111K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
545 |
535 |
$108K |
| 71045 |
Radiologic examination, chest; single view |
14,050 |
13,602 |
$106K |
| 84484 |
|
10,821 |
9,810 |
$98K |
| 83735 |
|
13,572 |
12,331 |
$85K |
| 73721 |
Magnetic resonance imaging, any joint of lower extremity; without contrast material |
299 |
294 |
$83K |
| 87637 |
Infectious agent detection by nucleic acid; SARS-CoV-2, influenza, and RSV |
1,069 |
1,038 |
$78K |
| 72141 |
|
304 |
296 |
$73K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
808 |
804 |
$68K |
| 70553 |
Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences |
251 |
249 |
$63K |
| 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 |
1,104 |
1,003 |
$61K |
| 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 |
3,778 |
3,664 |
$58K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
6,933 |
6,577 |
$54K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,827 |
1,473 |
$53K |
| 97597 |
|
2,231 |
1,579 |
$51K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
6,695 |
5,731 |
$50K |
| 85730 |
|
8,015 |
7,696 |
$48K |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
776 |
771 |
$48K |
| 83690 |
|
8,915 |
8,613 |
$43K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
1,539 |
1,493 |
$43K |
| 85027 |
|
6,733 |
5,983 |
$42K |
| 74178 |
|
203 |
200 |
$42K |
| 71046 |
Radiologic examination, chest; 2 views |
2,848 |
2,789 |
$41K |
| 81001 |
|
13,606 |
12,997 |
$39K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
5,500 |
5,405 |
$37K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
993 |
974 |
$36K |
| 12001 |
|
189 |
186 |
$34K |
| C9803 |
Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
2,350 |
2,286 |
$33K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
1,198 |
1,105 |
$33K |
| 47562 |
|
40 |
38 |
$33K |
| 85610 |
|
9,945 |
9,100 |
$32K |
| 78452 |
Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress |
198 |
195 |
$32K |
| 72125 |
Computed tomography, cervical spine; without contrast material |
496 |
476 |
$31K |
| 71250 |
|
512 |
498 |
$31K |
| 93971 |
|
456 |
448 |
$30K |
| 83880 |
|
1,080 |
1,021 |
$29K |
| 69436 |
Tympanostomy (requiring insertion of ventilating tube), general anesthesia |
81 |
73 |
$27K |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
362 |
357 |
$25K |
| 74183 |
|
55 |
55 |
$24K |
| 73221 |
|
93 |
92 |
$23K |
| 87798 |
Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism |
724 |
522 |
$23K |
| 96361 |
Intravenous infusion, hydration; each additional hour |
2,325 |
2,074 |
$23K |
| 82607 |
|
1,929 |
1,895 |
$23K |
| 76536 |
|
460 |
451 |
$22K |
| 82550 |
|
3,797 |
3,506 |
$22K |
| 78227 |
|
69 |
68 |
$22K |
| 76830 |
Ultrasound, transvaginal |
457 |
449 |
$22K |
| 87088 |
|
2,996 |
2,772 |
$22K |
| 86803 |
|
1,054 |
1,032 |
$21K |
| 77066 |
Tomosynthesis, mammo |
241 |
238 |
$20K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
2,435 |
1,722 |
$20K |
| 73562 |
|
1,255 |
1,207 |
$20K |
| 70486 |
|
261 |
257 |
$20K |
| 82248 |
|
2,740 |
2,657 |
$19K |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
81 |
79 |
$18K |
| 84703 |
|
1,665 |
1,626 |
$18K |
| 72110 |
|
866 |
853 |
$18K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
364 |
357 |
$18K |
| 76770 |
|
453 |
445 |
$18K |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
769 |
765 |
$17K |
| 87186 |
|
1,581 |
1,490 |
$17K |
| 93970 |
|
197 |
192 |
$16K |
| 87040 |
|
852 |
794 |
$16K |
| 83605 |
|
2,282 |
2,152 |
$16K |
| 12011 |
|
84 |
83 |
$16K |
| 82728 |
|
1,304 |
1,260 |
$16K |
| 36415 |
Collection of venous blood by venipuncture |
46,375 |
41,721 |
$15K |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
564 |
555 |
$15K |
| 93925 |
|
167 |
165 |
$15K |
| 81025 |
|
3,754 |
3,555 |
$14K |
| 84436 |
|
1,998 |
1,952 |
$14K |
| 84702 |
|
795 |
635 |
$14K |
| 20610 |
|
881 |
803 |
$14K |
| 73030 |
|
883 |
833 |
$14K |
| 83540 |
|
1,566 |
1,521 |
$14K |
| 80081 |
|
138 |
138 |
$13K |
| 52000 |
|
98 |
97 |
$13K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
555 |
545 |
$13K |
| 93880 |
|
185 |
182 |
$13K |
| 76642 |
|
297 |
293 |
$12K |
| 82553 |
|
1,618 |
1,432 |
$12K |
| 96413 |
Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance |
128 |
73 |
$12K |
| 93017 |
|
360 |
352 |
$12K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
296 |
293 |
$12K |
| 84153 |
|
493 |
480 |
$12K |
| 83970 |
|
289 |
278 |
$12K |
| 82043 |
|
1,417 |
1,389 |
$11K |
| 81003 |
|
3,900 |
3,747 |
$11K |
| 94729 |
|
396 |
390 |
$11K |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
221 |
215 |
$11K |
| 87077 |
|
1,588 |
1,511 |
$11K |
| 73564 |
|
498 |
484 |
$11K |
| 86704 |
|
639 |
626 |
$11K |
| 86787 |
|
362 |
357 |
$11K |
| 73610 |
|
564 |
534 |
$10K |
| 84402 |
|
329 |
325 |
$10K |
| 86708 |
|
623 |
612 |
$10K |
| 84403 |
|
325 |
320 |
$10K |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
2,892 |
2,666 |
$10K |
| 73560 |
|
651 |
584 |
$10K |
| 94726 |
|
378 |
373 |
$10K |
| 73502 |
|
536 |
515 |
$10K |
| 86706 |
|
657 |
645 |
$10K |
| 84439 |
|
1,161 |
1,139 |
$10K |
| 72131 |
|
152 |
147 |
$10K |
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
169 |
165 |
$9K |
| 80076 |
|
958 |
897 |
$9K |
| 36430 |
|
146 |
73 |
$9K |
| 85379 |
|
878 |
855 |
$9K |
| 87340 |
|
632 |
617 |
$8K |
| 51798 |
|
1,014 |
984 |
$8K |
| 73630 |
|
653 |
621 |
$8K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
364 |
326 |
$8K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
457 |
387 |
$8K |
| 82747 |
|
316 |
311 |
$8K |
| 84146 |
|
267 |
263 |
$8K |
| 78264 |
|
83 |
82 |
$7K |
| 82570 |
|
981 |
948 |
$7K |
| 72100 |
|
359 |
353 |
$7K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
1,008 |
990 |
$7K |
| 82805 |
|
259 |
245 |
$7K |
| 71271 |
|
81 |
81 |
$7K |
| 87522 |
Neg quan hep c or qual rna |
162 |
156 |
$7K |
| 10060 |
|
53 |
51 |
$7K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
298 |
292 |
$7K |
| 12002 |
|
39 |
39 |
$7K |
| 73130 |
|
553 |
510 |
$7K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
298 |
292 |
$7K |
| 87070 |
|
987 |
931 |
$6K |
| 90715 |
|
989 |
972 |
$6K |
| 83550 |
|
1,304 |
1,262 |
$6K |
| 72050 |
|
261 |
253 |
$6K |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
3,573 |
3,377 |
$6K |
| 84460 |
|
785 |
768 |
$6K |
| 82784 |
|
292 |
283 |
$6K |
| 83001 |
|
283 |
281 |
$6K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
234 |
232 |
$6K |
| 84479 |
|
615 |
605 |
$6K |
| 74018 |
|
407 |
400 |
$6K |
| 81596 |
|
109 |
104 |
$6K |
| 82803 |
|
221 |
207 |
$6K |
| T1015 |
Clinic visit/encounter, all-inclusive |
300 |
171 |
$6K |
| 82746 |
|
792 |
776 |
$5K |
| 86617 |
|
183 |
178 |
$5K |
| 84450 |
|
755 |
742 |
$5K |
| 87081 |
|
845 |
818 |
$5K |
| 72072 |
|
229 |
226 |
$5K |
| 86038 |
|
395 |
386 |
$5K |
| J2785 |
Injection, regadenoson, 0.1 mg |
153 |
148 |
$5K |
| 83002 |
|
230 |
228 |
$5K |
| 93226 |
|
121 |
120 |
$4K |
| 70498 |
|
26 |
26 |
$4K |
| 86762 |
|
203 |
199 |
$4K |
| 70496 |
|
25 |
25 |
$4K |
| 86850 |
|
600 |
568 |
$4K |
| 82565 |
|
643 |
605 |
$4K |
| 99291 |
Critical care, evaluation and management of the critically ill patient, first 30-74 minutes |
59 |
58 |
$4K |
| 73110 |
|
319 |
301 |
$4K |
| 76775 |
|
102 |
102 |
$4K |
| 77062 |
|
198 |
195 |
$4K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
495 |
345 |
$4K |
| 94060 |
|
340 |
336 |
$4K |
| 82150 |
|
751 |
728 |
$3K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
58 |
54 |
$3K |
| 86780 |
|
248 |
244 |
$3K |
| 84466 |
|
179 |
177 |
$3K |
| 70491 |
|
44 |
43 |
$3K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
627 |
607 |
$3K |
| 73590 |
|
182 |
166 |
$3K |
| 83655 |
|
247 |
245 |
$3K |
| 84550 |
|
444 |
435 |
$3K |
| Q9966 |
Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml |
884 |
853 |
$3K |
| 80164 |
|
151 |
135 |
$3K |
| 86003 |
|
14 |
14 |
$3K |
| 86900 |
|
681 |
634 |
$3K |
| 87807 |
|
173 |
170 |
$3K |
| 76870 |
|
52 |
51 |
$3K |
| 86901 |
|
679 |
632 |
$2K |
| 82105 |
|
121 |
119 |
$2K |
| 84145 |
|
160 |
149 |
$2K |
| 87581 |
|
521 |
499 |
$2K |
| 84520 |
|
476 |
441 |
$2K |
| 87205 |
|
492 |
443 |
$2K |
| 72146 |
|
13 |
13 |
$2K |
| 94760 |
|
1,425 |
1,396 |
$2K |
| 73080 |
|
191 |
179 |
$2K |
| 86140 |
|
726 |
667 |
$2K |
| 82670 |
|
87 |
86 |
$2K |
| 72040 |
|
145 |
142 |
$2K |
| 86431 |
|
247 |
242 |
$2K |
| 84481 |
|
86 |
86 |
$2K |
| P9016 |
Red blood cells, leukocytes reduced, each unit |
49 |
39 |
$2K |
| 82950 |
|
273 |
269 |
$2K |
| 85652 |
|
700 |
660 |
$2K |
| 84100 |
|
460 |
405 |
$2K |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
86 |
85 |
$2K |
| 93225 |
|
121 |
120 |
$2K |
| 88112 |
|
46 |
46 |
$2K |
| 77065 |
Tomosynthesis, mammo |
32 |
31 |
$2K |
| 20553 |
|
63 |
62 |
$2K |
| 82977 |
|
172 |
150 |
$2K |
| 96367 |
|
229 |
211 |
$2K |
| 97602 |
|
75 |
70 |
$2K |
| 85651 |
|
455 |
426 |
$2K |
| A9577 |
Injection, gadobenate dimeglumine (multihance), per ml |
239 |
238 |
$2K |
| 86618 |
|
54 |
53 |
$2K |
| 77080 |
|
30 |
30 |
$2K |
| 82627 |
|
60 |
59 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
449 |
417 |
$2K |
| 82172 |
|
67 |
66 |
$1K |
| 73090 |
|
117 |
112 |
$1K |
| 82140 |
|
323 |
282 |
$1K |
| 73600 |
|
113 |
106 |
$1K |
| 73552 |
|
75 |
70 |
$1K |
| 85018 |
|
356 |
341 |
$1K |
| 86592 |
|
315 |
312 |
$1K |
| 87430 |
|
175 |
172 |
$1K |
| 29581 |
|
130 |
68 |
$1K |
| 83010 |
|
72 |
71 |
$963.84 |
| 99215 |
Prolong outpt/office vis |
54 |
53 |
$953.79 |
| Q9957 |
Injection, perflutren lipid microspheres, per ml |
59 |
54 |
$945.87 |
| 80177 |
|
77 |
73 |
$912.82 |
| 84156 |
|
218 |
200 |
$910.87 |
| 73100 |
|
74 |
65 |
$903.04 |
| 73140 |
|
100 |
97 |
$901.98 |
| 83525 |
|
70 |
68 |
$899.91 |
| A9500 |
Technetium tc-99m sestamibi, diagnostic, per study dose |
200 |
197 |
$878.00 |
| 82947 |
|
183 |
182 |
$858.74 |
| U0002 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
24 |
24 |
$830.92 |
| 93976 |
|
12 |
12 |
$820.73 |
| J2805 |
Injection, sincalide, 5 micrograms |
26 |
25 |
$807.99 |
| 87147 |
|
154 |
151 |
$772.27 |
| 87209 |
|
44 |
44 |
$749.72 |
| 85014 |
|
228 |
213 |
$747.95 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
4,428 |
4,049 |
$728.24 |
| 87045 |
|
96 |
94 |
$726.26 |
| C1889 |
Implantable/insertable device, not otherwise classified |
57 |
49 |
$712.47 |
| 80179 |
|
181 |
171 |
$709.32 |
| 80143 |
|
183 |
174 |
$709.32 |
| 80069 |
|
60 |
53 |
$671.25 |
| 82247 |
|
102 |
90 |
$642.50 |
| 83516 |
|
209 |
201 |
$624.17 |
| 96376 |
|
848 |
537 |
$603.95 |
| 72170 |
|
71 |
71 |
$578.91 |
| A9578 |
Injection, gadobenate dimeglumine (multihance multipack), per ml |
174 |
172 |
$564.82 |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
1,485 |
1,174 |
$558.56 |
| 87046 |
|
51 |
49 |
$548.19 |
| 93296 |
|
93 |
93 |
$544.71 |
| 73120 |
|
53 |
53 |
$537.70 |
| 73522 |
|
27 |
27 |
$531.94 |
| 73620 |
|
47 |
44 |
$519.13 |
| 82785 |
|
27 |
27 |
$506.52 |
| 62323 |
|
12 |
12 |
$485.99 |
| 85045 |
|
120 |
114 |
$483.64 |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
389 |
361 |
$480.89 |
| J2704 |
Injection, propofol, 10 mg |
2,846 |
2,474 |
$468.01 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
3,859 |
3,561 |
$454.88 |
| 80051 |
|
94 |
90 |
$448.64 |
| 72202 |
|
26 |
26 |
$430.94 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
12,051 |
10,446 |
$414.76 |
| 82010 |
|
102 |
97 |
$409.10 |
| 86920 |
|
14 |
12 |
$382.83 |
| 74230 |
|
29 |
29 |
$380.36 |
| 86308 |
|
48 |
47 |
$372.73 |
| 87177 |
|
44 |
44 |
$370.41 |
| 83615 |
|
58 |
49 |
$368.34 |
| 73060 |
|
26 |
26 |
$363.48 |
| 74022 |
|
13 |
13 |
$359.04 |
| 86696 |
|
12 |
12 |
$356.31 |
| 20552 |
|
12 |
12 |
$310.64 |
| 82272 |
|
98 |
93 |
$304.49 |
| 29125 |
|
17 |
17 |
$297.37 |
| 86695 |
|
12 |
12 |
$285.10 |
| 77061 |
|
15 |
15 |
$283.20 |
| 86039 |
|
16 |
16 |
$278.40 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
1,035 |
873 |
$263.90 |
| 94761 |
|
104 |
102 |
$256.10 |
| A9541 |
Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries |
68 |
67 |
$232.00 |
| 93922 |
|
17 |
17 |
$227.10 |
| 73501 |
|
27 |
25 |
$223.07 |
| 94010 |
|
31 |
30 |
$220.22 |
| J0780 |
Injection, prochlorperazine, up to 10 mg |
156 |
146 |
$215.17 |
| 82951 |
|
14 |
14 |
$213.16 |
| 84480 |
|
28 |
28 |
$212.49 |
| 86200 |
|
13 |
13 |
$201.16 |
| 83883 |
|
88 |
86 |
$199.20 |
| 87808 |
|
15 |
15 |
$199.14 |
| 85046 |
|
32 |
30 |
$198.51 |
| 71101 |
|
12 |
12 |
$195.87 |
| 36600 |
|
45 |
43 |
$195.40 |
| J1170 |
Injection, hydromorphone, up to 4 mg |
440 |
379 |
$183.25 |
| A9537 |
Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries |
107 |
106 |
$181.20 |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
2,237 |
1,820 |
$174.23 |
| J3370 |
Injection, vancomycin hcl, 500 mg |
160 |
109 |
$170.88 |
| 92611 |
|
12 |
12 |
$158.26 |
| 83520 |
|
45 |
41 |
$139.04 |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
199 |
183 |
$135.15 |
| 97162 |
|
32 |
31 |
$121.60 |
| 90714 |
|
33 |
32 |
$119.80 |
| 88304 |
|
300 |
294 |
$112.29 |
| J1650 |
Injection, enoxaparin sodium, 10 mg |
458 |
246 |
$106.98 |
| 86376 |
|
13 |
13 |
$97.66 |
| 97165 |
|
97 |
89 |
$95.16 |
| J2060 |
Injection, lorazepam, 2 mg |
590 |
519 |
$94.99 |
| 97161 |
|
112 |
103 |
$92.51 |
| 84132 |
|
14 |
13 |
$90.63 |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
602 |
521 |
$81.10 |
| J0690 |
Injection, cefazolin sodium, 500 mg |
807 |
695 |
$79.19 |
| 95992 |
|
67 |
39 |
$78.10 |
| 87075 |
|
19 |
12 |
$74.41 |
| J2543 |
Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams) |
116 |
80 |
$73.64 |
| 87324 |
|
51 |
47 |
$70.16 |
| J1644 |
Injection, heparin sodium, per 1000 units |
580 |
361 |
$66.77 |
| 87015 |
|
23 |
12 |
$65.78 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
2,557 |
2,282 |
$63.98 |
| 82077 |
|
15 |
13 |
$53.15 |
| J1953 |
Injection, levetiracetam, 10 mg |
14 |
14 |
$52.56 |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
221 |
202 |
$51.50 |
| J2550 |
Injection, promethazine hcl, up to 50 mg |
63 |
56 |
$37.28 |
| 99152 |
|
13 |
13 |
$34.16 |
| 81015 |
|
13 |
13 |
$28.14 |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
1,438 |
1,167 |
$27.66 |
| J2795 |
Injection, ropivacaine hydrochloride, 1 mg |
68 |
64 |
$23.10 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
2,466 |
2,239 |
$22.34 |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
135 |
129 |
$16.53 |
| J2360 |
Injection, orphenadrine citrate, up to 60 mg |
12 |
12 |
$14.26 |
| 88300 |
|
51 |
48 |
$13.26 |
| J1580 |
Injection, garamycin, gentamicin, up to 80 mg |
15 |
14 |
$11.70 |
| J1940 |
Injection, furosemide, up to 20 mg |
143 |
103 |
$10.48 |
| 82962 |
|
29 |
28 |
$4.74 |
| 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 |
181 |
174 |
$3.81 |
| J1630 |
Injection, haloperidol, up to 5 mg |
13 |
12 |
$2.86 |
| J7510 |
Prednisolone oral, per 5 mg |
14 |
14 |
$2.13 |
| J7050 |
Infusion, normal saline solution, 250 cc |
12 |
12 |
$0.76 |
| J2001 |
Injection, lidocaine hcl for intravenous infusion, 10 mg |
507 |
452 |
$0.55 |
| J2710 |
Injection, neostigmine methylsulfate, up to 0.5 mg |
272 |
238 |
$0.00 |
| J0702 |
Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg |
210 |
201 |
$0.00 |
| 90675 |
|
31 |
12 |
$0.00 |
| J0888 |
Injection, epoetin beta, 1 microgram, (for non esrd use) |
15 |
12 |
$0.00 |
| J0688 |
Injection, cefazolin sodium (hikma), not therapeutically equivalent to j0690, 500 mg |
12 |
12 |
$0.00 |
| J3480 |
Injection, potassium chloride, per 2 meq |
89 |
67 |
$0.00 |
| G0475 |
Hiv antigen/antibody, combination assay, screening |
12 |
12 |
$0.00 |
| J1030 |
Injection, methylprednisolone acetate, 40 mg |
122 |
122 |
$0.00 |
| J1010 |
Injection, methylprednisolone acetate, 1 mg |
34 |
28 |
$0.00 |
| 74420 |
|
15 |
13 |
$0.00 |
| C2617 |
Stent, non-coronary, temporary, without delivery system |
15 |
13 |
$0.00 |