| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| G0378 |
Hospital observation service, per hour |
18,179 |
7,478 |
$434K |
| 92507 |
Treatment of speech, language, voice, communication, and/or auditory processing disorder |
19,771 |
7,871 |
$281K |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
26,649 |
11,331 |
$276K |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
27,217 |
23,464 |
$269K |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
16,992 |
14,710 |
$203K |
| 0202U |
Oncology (prostate), multianalyte, gene expression profiling |
2,594 |
2,177 |
$139K |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
8,475 |
7,392 |
$129K |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
18,617 |
16,942 |
$125K |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
39,260 |
13,829 |
$90K |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
5,255 |
4,591 |
$87K |
| 70450 |
Computed tomography, head or brain; without contrast material |
8,098 |
6,818 |
$79K |
| C1713 |
Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable) |
1,416 |
1,174 |
$79K |
| 87633 |
Infectious agent detection by nucleic acid, respiratory virus, 12-25 targets |
6,043 |
5,673 |
$71K |
| J3490 |
Unclassified drugs |
31,511 |
12,267 |
$54K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
22,786 |
16,805 |
$41K |
| 80053 |
Comprehensive metabolic panel |
82,461 |
66,487 |
$39K |
| 71046 |
Radiologic examination, chest; 2 views |
11,449 |
10,478 |
$37K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
7,732 |
6,806 |
$36K |
| 70553 |
Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences |
1,784 |
1,489 |
$35K |
| 97112 |
Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination |
6,865 |
2,988 |
$32K |
| 72125 |
Computed tomography, cervical spine; without contrast material |
2,772 |
2,391 |
$30K |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
1,714 |
1,474 |
$29K |
| 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 |
623 |
56 |
$28K |
| 97113 |
|
3,316 |
1,447 |
$27K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
99,212 |
76,457 |
$25K |
| 69436 |
Tympanostomy (requiring insertion of ventilating tube), general anesthesia |
136 |
115 |
$23K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
15,110 |
11,054 |
$23K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
26,585 |
21,771 |
$22K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
8,437 |
5,138 |
$21K |
| 42820 |
Tonsillectomy and adenoidectomy; younger than age 12 |
26 |
25 |
$20K |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
20,899 |
7,650 |
$20K |
| 74018 |
|
2,135 |
1,917 |
$18K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
6,840 |
4,044 |
$18K |
| 71045 |
Radiologic examination, chest; single view |
12,095 |
10,222 |
$16K |
| 86003 |
|
1,404 |
772 |
$16K |
| 73721 |
Magnetic resonance imaging, any joint of lower extremity; without contrast material |
1,423 |
1,366 |
$16K |
| G0108 |
Diabetes outpatient self-management training services, individual, per 30 minutes |
1,633 |
1,404 |
$15K |
| 97162 |
|
5,880 |
5,311 |
$15K |
| 96361 |
Intravenous infusion, hydration; each additional hour |
9,174 |
7,691 |
$14K |
| 92523 |
|
399 |
374 |
$14K |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
2,753 |
2,342 |
$14K |
| C9290 |
Injection, bupivacaine liposome, 1 mg |
722 |
626 |
$13K |
| 36415 |
Collection of venous blood by venipuncture |
102,550 |
77,177 |
$13K |
| 90791 |
Psychiatric diagnostic evaluation |
3,029 |
2,832 |
$13K |
| 97535 |
Self-care/home management training, each 15 minutes |
2,422 |
1,723 |
$12K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
2,790 |
2,414 |
$12K |
| 87641 |
|
8,815 |
7,777 |
$12K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
8,193 |
7,567 |
$12K |
| 70486 |
|
1,457 |
1,337 |
$12K |
| 80061 |
Lipid panel |
18,279 |
17,174 |
$11K |
| 76770 |
|
1,570 |
1,484 |
$11K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
3,880 |
3,362 |
$11K |
| 87798 |
Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism |
6,288 |
5,880 |
$10K |
| 73610 |
|
3,152 |
2,825 |
$10K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
13,372 |
11,812 |
$10K |
| 90837 |
Psychotherapy, 53 minutes with patient |
5,245 |
2,978 |
$10K |
| 92526 |
|
1,572 |
932 |
$10K |
| 84703 |
|
12,639 |
10,950 |
$10K |
| 72148 |
Magnetic resonance imaging, lumbar spine; without contrast material |
2,222 |
2,121 |
$10K |
| 73110 |
|
2,458 |
2,108 |
$10K |
| 81001 |
|
29,704 |
25,437 |
$9K |
| 73630 |
|
3,273 |
3,000 |
$9K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
12,913 |
12,260 |
$8K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
12,575 |
8,499 |
$8K |
| H2036 |
Alcohol and/or other drug treatment program, per diem |
206 |
37 |
$8K |
| 87581 |
|
6,071 |
5,695 |
$8K |
| 73130 |
|
2,713 |
2,415 |
$8K |
| 87486 |
|
6,064 |
5,689 |
$8K |
| 83690 |
|
13,954 |
11,767 |
$7K |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
3,493 |
3,172 |
$7K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
2,668 |
2,471 |
$7K |
| 96376 |
|
5,026 |
3,482 |
$7K |
| 0241U |
Neonatal screening for hereditary disorders, genomic sequence analysis panel |
887 |
849 |
$6K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
7,054 |
6,574 |
$6K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
7,057 |
6,577 |
$6K |
| 97166 |
|
1,271 |
1,120 |
$6K |
| 74019 |
|
780 |
730 |
$6K |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
2,708 |
2,503 |
$6K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
2,712 |
2,569 |
$6K |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
15,653 |
13,166 |
$6K |
| 62323 |
|
1,143 |
996 |
$6K |
| 88304 |
|
2,055 |
1,707 |
$5K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
2,078 |
1,913 |
$5K |
| 84443 |
Thyroid stimulating hormone (TSH) |
28,475 |
26,276 |
$5K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
479 |
462 |
$5K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
19,314 |
18,181 |
$5K |
| C1769 |
Guide wire |
1,436 |
1,122 |
$5K |
| 72141 |
|
1,034 |
962 |
$5K |
| D1206 |
Topical application of fluoride varnish |
161 |
138 |
$5K |
| 87081 |
|
3,086 |
2,869 |
$5K |
| 87040 |
|
3,548 |
1,941 |
$4K |
| 73030 |
|
3,087 |
2,761 |
$4K |
| 97116 |
|
3,799 |
1,947 |
$4K |
| 73562 |
|
2,095 |
1,965 |
$4K |
| 87186 |
|
7,603 |
6,209 |
$4K |
| 76536 |
|
1,472 |
1,390 |
$4K |
| 87077 |
|
6,735 |
5,716 |
$4K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
12,901 |
8,497 |
$4K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
19,753 |
15,885 |
$4K |
| J0690 |
Injection, cefazolin sodium, 500 mg |
6,129 |
4,323 |
$4K |
| J0694 |
Injection, cefoxitin sodium, 1 gm |
1,625 |
1,161 |
$4K |
| 73140 |
|
1,067 |
935 |
$4K |
| 12001 |
|
230 |
223 |
$4K |
| 83605 |
|
5,841 |
4,789 |
$4K |
| 84145 |
|
2,898 |
2,524 |
$4K |
| 84484 |
|
16,684 |
10,775 |
$3K |
| 93976 |
|
532 |
454 |
$3K |
| 73560 |
|
1,450 |
1,312 |
$3K |
| 88342 |
|
3,343 |
3,035 |
$3K |
| J2704 |
Injection, propofol, 10 mg |
12,788 |
10,810 |
$3K |
| 97161 |
|
329 |
286 |
$3K |
| 97163 |
|
1,504 |
1,379 |
$3K |
| 11042 |
Debridement, subcutaneous tissue (includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm |
2,194 |
1,113 |
$3K |
| 73090 |
|
325 |
276 |
$3K |
| 73590 |
|
803 |
704 |
$3K |
| 95819 |
|
111 |
105 |
$3K |
| 86140 |
|
9,070 |
7,919 |
$3K |
| 90715 |
|
1,129 |
1,079 |
$3K |
| 73564 |
|
840 |
816 |
$3K |
| 84439 |
|
6,289 |
5,842 |
$2K |
| 73221 |
|
766 |
715 |
$2K |
| J0171 |
Injection, adrenalin, epinephrine, 0.1 mg |
1,598 |
1,330 |
$2K |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
1,265 |
1,074 |
$2K |
| 82803 |
|
1,560 |
1,293 |
$2K |
| 73502 |
|
1,740 |
1,609 |
$2K |
| 82784 |
|
2,285 |
1,762 |
$2K |
| 86900 |
|
3,166 |
2,622 |
$2K |
| 85730 |
|
11,115 |
9,303 |
$2K |
| 86780 |
|
4,374 |
3,950 |
$2K |
| A9576 |
Injection, gadoteridol, (prohance multipack), per ml |
2,377 |
2,150 |
$2K |
| 83516 |
|
1,605 |
1,209 |
$2K |
| 82728 |
|
4,671 |
4,246 |
$2K |
| 76830 |
Ultrasound, transvaginal |
2,478 |
2,348 |
$2K |
| 87147 |
|
1,453 |
1,283 |
$2K |
| D1120 |
Prophylaxis - child |
110 |
100 |
$2K |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
3,081 |
2,077 |
$2K |
| 83735 |
|
9,744 |
7,700 |
$2K |
| 72100 |
|
2,217 |
2,088 |
$2K |
| M0243 |
Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring |
72 |
72 |
$2K |
| M0245 |
Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring |
215 |
207 |
$2K |
| 85379 |
|
3,653 |
3,343 |
$2K |
| 87205 |
|
3,923 |
3,452 |
$1K |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
439 |
379 |
$1K |
| 87070 |
|
3,838 |
3,384 |
$1K |
| 71250 |
|
1,631 |
1,535 |
$1K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,513 |
1,389 |
$1K |
| 83630 |
|
1,302 |
1,166 |
$1K |
| 85652 |
|
8,242 |
7,277 |
$1K |
| 83880 |
|
3,463 |
3,012 |
$1K |
| 97168 |
|
157 |
157 |
$1K |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
1,039 |
952 |
$1K |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
3,419 |
3,268 |
$1K |
| 86850 |
|
2,627 |
2,201 |
$1K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
866 |
533 |
$1K |
| 80074 |
|
1,773 |
1,668 |
$1K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
489 |
475 |
$1K |
| 84702 |
|
2,497 |
1,802 |
$1K |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
50,499 |
34,009 |
$1K |
| 85610 |
|
16,802 |
12,947 |
$1K |
| 92522 |
|
75 |
69 |
$1K |
| 84100 |
|
3,087 |
2,537 |
$1K |
| 93971 |
|
1,570 |
1,473 |
$1K |
| 82375 |
|
1,502 |
1,254 |
$1K |
| 73080 |
|
263 |
254 |
$1K |
| 97167 |
|
279 |
255 |
$1K |
| 84403 |
|
789 |
725 |
$1K |
| 82948 |
|
11,531 |
5,357 |
$1K |
| 90834 |
Psychotherapy, 45 minutes with patient |
2,526 |
1,761 |
$1K |
| 82607 |
|
6,396 |
6,021 |
$974.45 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
473 |
87 |
$952.30 |
| 86901 |
|
3,125 |
2,591 |
$939.14 |
| 76870 |
|
98 |
94 |
$897.11 |
| A9579 |
Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (nos), per ml |
262 |
172 |
$882.68 |
| 94729 |
|
584 |
523 |
$876.16 |
| 83550 |
|
4,813 |
4,425 |
$869.32 |
| J3480 |
Injection, potassium chloride, per 2 meq |
1,106 |
618 |
$842.12 |
| 94375 |
|
302 |
288 |
$835.55 |
| 80076 |
|
2,817 |
2,558 |
$822.61 |
| 94726 |
|
572 |
509 |
$818.51 |
| 85027 |
|
5,052 |
4,241 |
$803.75 |
| 83970 |
|
2,151 |
1,964 |
$799.84 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
10,789 |
8,717 |
$792.64 |
| J2710 |
Injection, neostigmine methylsulfate, up to 0.5 mg |
442 |
396 |
$741.44 |
| 72110 |
|
1,041 |
1,012 |
$732.73 |
| 73070 |
|
139 |
121 |
$712.50 |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
1,758 |
1,186 |
$706.78 |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
6,007 |
4,059 |
$705.67 |
| 78452 |
Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress |
689 |
542 |
$700.99 |
| 93350 |
|
658 |
636 |
$652.82 |
| 12011 |
|
13 |
12 |
$649.39 |
| 82746 |
|
4,958 |
4,672 |
$636.60 |
| 88300 |
|
111 |
101 |
$636.06 |
| 90832 |
Psychotherapy, 30 minutes with patient |
2,125 |
1,520 |
$635.14 |
| J2001 |
Injection, lidocaine hcl for intravenous infusion, 10 mg |
7,158 |
5,628 |
$609.30 |
| 93226 |
|
462 |
435 |
$600.57 |
| 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 |
15,556 |
12,694 |
$582.93 |
| 86891 |
|
12 |
12 |
$581.39 |
| 81025 |
|
1,273 |
1,214 |
$556.61 |
| J1040 |
Injection, methylprednisolone acetate, 80 mg |
1,460 |
1,275 |
$552.81 |
| 72040 |
|
704 |
657 |
$545.81 |
| 82150 |
|
1,254 |
1,176 |
$540.60 |
| 87210 |
|
2,647 |
2,450 |
$536.48 |
| 71101 |
|
152 |
139 |
$536.35 |
| 83655 |
|
437 |
396 |
$534.74 |
| 94760 |
|
5,273 |
3,487 |
$527.09 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
8,684 |
7,109 |
$526.13 |
| 86665 |
|
188 |
96 |
$514.72 |
| 72070 |
|
314 |
299 |
$509.61 |
| 82550 |
|
1,454 |
1,196 |
$497.20 |
| 86364 |
|
408 |
344 |
$485.94 |
| 97016 |
|
1,240 |
452 |
$482.25 |
| 97802 |
|
13 |
13 |
$479.40 |
| D7140 |
Extraction, erupted tooth or exposed root |
112 |
30 |
$474.30 |
| 97164 |
|
43 |
42 |
$473.68 |
| 83540 |
|
4,273 |
4,020 |
$471.02 |
| 88321 |
|
84 |
79 |
$461.04 |
| 86803 |
|
2,968 |
2,803 |
$457.67 |
| 83520 |
|
549 |
461 |
$450.42 |
| 97035 |
|
3,471 |
1,520 |
$437.80 |
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
116 |
111 |
$434.69 |
| 86038 |
|
1,688 |
1,593 |
$427.84 |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
967 |
838 |
$416.50 |
| 97760 |
|
27 |
25 |
$410.98 |
| 93225 |
|
443 |
417 |
$410.04 |
| 85007 |
|
584 |
425 |
$405.70 |
| 76801 |
|
546 |
497 |
$402.90 |
| J7030 |
Infusion, normal saline solution , 1000 cc |
1,457 |
828 |
$392.77 |
| 86592 |
|
918 |
851 |
$391.88 |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
3,395 |
2,752 |
$380.50 |
| 97803 |
|
41 |
39 |
$364.65 |
| 96413 |
Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance |
3,842 |
1,923 |
$358.80 |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
1,781 |
1,415 |
$340.62 |
| 93017 |
|
2,237 |
1,985 |
$339.76 |
| 88341 |
|
316 |
274 |
$335.48 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
17,469 |
12,198 |
$328.24 |
| J7050 |
Infusion, normal saline solution, 250 cc |
5,051 |
2,333 |
$315.64 |
| 74022 |
|
147 |
143 |
$312.63 |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
2,006 |
1,716 |
$285.52 |
| 87075 |
|
384 |
311 |
$280.90 |
| 90686 |
|
596 |
570 |
$272.34 |
| 95886 |
|
491 |
480 |
$272.10 |
| D0272 |
Bitewings - two radiographic images |
70 |
65 |
$265.79 |
| J1170 |
Injection, hydromorphone, up to 4 mg |
6,548 |
4,269 |
$264.60 |
| 90839 |
|
89 |
84 |
$254.15 |
| 86480 |
|
252 |
231 |
$248.27 |
| J1630 |
Injection, haloperidol, up to 5 mg |
400 |
318 |
$247.04 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
11,847 |
8,703 |
$245.09 |
| 82105 |
|
925 |
862 |
$236.41 |
| J8499 |
Prescription drug, oral, non chemotherapeutic, nos |
202 |
116 |
$229.61 |
| 84146 |
|
204 |
188 |
$226.02 |
| 72170 |
|
157 |
148 |
$223.15 |
| 80320 |
|
26 |
22 |
$217.95 |
| 87522 |
Neg quan hep c or qual rna |
1,334 |
1,257 |
$215.37 |
| 94060 |
|
1,379 |
1,129 |
$213.18 |
| G0008 |
Administration of influenza virus vaccine |
1,150 |
1,060 |
$204.00 |
| 83001 |
|
219 |
201 |
$189.63 |
| 76642 |
|
456 |
452 |
$188.99 |
| 80050 |
General health panel |
187 |
183 |
$184.95 |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
5,095 |
5,003 |
$182.56 |
| 87340 |
|
1,853 |
1,730 |
$178.15 |
| 86200 |
|
711 |
659 |
$175.60 |
| 84550 |
|
2,077 |
1,868 |
$175.44 |
| 82248 |
|
612 |
392 |
$170.45 |
| 82670 |
|
119 |
112 |
$162.65 |
| J1105 |
Dexmedetomidine, oral, 1 mcg |
371 |
174 |
$162.24 |
| Q2036 |
Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (flulaval) |
132 |
124 |
$161.18 |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
408 |
377 |
$153.46 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
19,863 |
13,927 |
$148.72 |
| 82140 |
|
661 |
550 |
$147.01 |
| 87634 |
|
15 |
15 |
$135.71 |
| 96367 |
|
3,036 |
1,499 |
$134.89 |
| 82043 |
|
1,358 |
1,291 |
$134.47 |
| J7060 |
5% dextrose/water (500 ml = 1 unit) |
1,354 |
775 |
$132.78 |
| 88312 |
|
28 |
25 |
$125.36 |
| 84480 |
|
127 |
123 |
$124.02 |
| 99152 |
|
346 |
285 |
$122.49 |
| 73660 |
|
18 |
13 |
$115.86 |
| 84402 |
|
73 |
68 |
$111.39 |
| 86376 |
|
209 |
189 |
$105.90 |
| 80305 |
|
3,858 |
2,682 |
$102.70 |
| 84460 |
|
155 |
148 |
$102.20 |
| 77066 |
Tomosynthesis, mammo |
64 |
63 |
$99.58 |
| 45385 |
Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) |
675 |
658 |
$97.98 |
| 82570 |
|
1,929 |
1,695 |
$94.19 |
| 87015 |
|
958 |
896 |
$93.74 |
| 83615 |
|
793 |
665 |
$92.43 |
| A9270 |
Non-covered item or service |
9,198 |
3,833 |
$92.30 |
| 82977 |
|
523 |
435 |
$90.29 |
| J3370 |
Injection, vancomycin hcl, 500 mg |
143 |
95 |
$84.48 |
| J1650 |
Injection, enoxaparin sodium, 10 mg |
2,663 |
1,232 |
$84.28 |
| 86431 |
|
1,025 |
971 |
$79.74 |
| 80069 |
|
2,137 |
1,811 |
$75.82 |
| 82565 |
|
1,162 |
1,045 |
$75.79 |
| 84481 |
|
234 |
205 |
$73.92 |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
4,690 |
3,770 |
$72.94 |
| 82785 |
|
154 |
140 |
$72.02 |
| 86762 |
|
451 |
434 |
$69.79 |
| 84156 |
|
2,168 |
1,785 |
$68.25 |
| J0780 |
Injection, prochlorperazine, up to 10 mg |
79 |
66 |
$63.81 |
| 87653 |
|
863 |
781 |
$61.04 |
| 80299 |
|
46 |
41 |
$60.89 |
| 86308 |
|
44 |
42 |
$58.35 |
| J2370 |
Injection, phenylephrine hcl, up to 1 ml |
463 |
378 |
$56.40 |
| 29581 |
|
2,346 |
553 |
$55.23 |
| 72050 |
|
203 |
200 |
$52.54 |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
52 |
52 |
$51.16 |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
86 |
57 |
$49.60 |
| 82533 |
|
192 |
129 |
$47.54 |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
5,060 |
4,968 |
$47.46 |
| 82274 |
|
13 |
13 |
$46.43 |
| G0144 |
Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system, under physician supervision |
3,295 |
3,203 |
$43.97 |
| J2371 |
Injection, phenylephrine hydrochloride, 20 micrograms |
296 |
169 |
$37.04 |
| 73620 |
|
14 |
12 |
$32.92 |
| 95012 |
|
243 |
189 |
$32.37 |
| 82077 |
|
307 |
282 |
$29.75 |
| 83993 |
|
13 |
13 |
$28.62 |
| 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 |
180 |
119 |
$26.98 |
| 85018 |
|
470 |
366 |
$25.44 |
| 85014 |
|
548 |
422 |
$23.57 |
| 86800 |
|
70 |
66 |
$23.20 |
| G0447 |
Face-to-face behavioral counseling for obesity, 15 minutes |
1,986 |
1,602 |
$22.26 |
| J1644 |
Injection, heparin sodium, per 1000 units |
3,944 |
1,911 |
$21.57 |
| G0279 |
Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066) |
489 |
471 |
$21.47 |
| 87338 |
|
66 |
65 |
$20.96 |
| 81003 |
|
646 |
572 |
$20.20 |
| J2060 |
Injection, lorazepam, 2 mg |
2,552 |
1,800 |
$18.59 |
| 84520 |
|
587 |
548 |
$17.88 |
| J1815 |
Injection, insulin, per 5 units |
1,046 |
395 |
$15.24 |
| 82247 |
|
334 |
219 |
$14.64 |
| 87046 |
|
12 |
12 |
$13.76 |
| 87045 |
|
12 |
12 |
$13.76 |
| 84436 |
|
25 |
25 |
$13.28 |
| 82947 |
|
1,098 |
543 |
$11.46 |
| J7040 |
Infusion, normal saline solution, sterile (500 ml = 1 unit) |
1,019 |
625 |
$7.91 |
| J2550 |
Injection, promethazine hcl, up to 50 mg |
1,430 |
1,188 |
$7.85 |
| J1596 |
Injection, glycopyrrolate, 0.1 mg |
51 |
34 |
$7.65 |
| J2003 |
Injection, lidocaine hydrochloride, 1 mg |
406 |
208 |
$6.49 |
| 82465 |
|
38 |
38 |
$6.30 |
| J0665 |
Injection, bupivicaine, not otherwise specified, 0.5 mg |
481 |
243 |
$6.24 |
| 84425 |
|
57 |
56 |
$2.87 |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
213 |
160 |
$0.22 |
| G0103 |
Prostate cancer screening; prostate specific antigen test (psa) |
2,126 |
2,069 |
$0.00 |
| 36591 |
|
2,575 |
1,386 |
$0.00 |
| G0396 |
Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes |
254 |
211 |
$0.00 |
| H0035 |
Mental health partial hospitalization, treatment, less than 24 hours |
2,184 |
304 |
$0.00 |
| 84153 |
|
1,278 |
1,142 |
$0.00 |
| 20610 |
|
1,421 |
1,178 |
$0.00 |
| 86160 |
|
20 |
12 |
$0.00 |
| 99153 |
Mod sedat endo service >5yrs |
1,399 |
1,265 |
$0.00 |
| 36416 |
|
1,664 |
975 |
$0.00 |
| 76811 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, detailed |
260 |
255 |
$0.00 |
| G8980 |
Mobility: walking & moving around functional limitation, discharge status, at discharge from therapy or to end reporting |
128 |
116 |
$0.00 |
| 72146 |
|
13 |
13 |
$0.00 |
| 96415 |
|
389 |
210 |
$0.00 |
| 82950 |
|
225 |
219 |
$0.00 |
| 87624 |
Infectious agent detection by nucleic acid; human papillomavirus (HPV), high-risk types |
2,518 |
2,425 |
$0.00 |
| 80349 |
|
74 |
72 |
$0.00 |
| 45380 |
Colonoscopy, flexible; with biopsy, single or multiple |
731 |
638 |
$0.00 |
| 93922 |
|
364 |
343 |
$0.00 |
| J0185 |
Injection, aprepitant, 1 mg |
43 |
25 |
$0.00 |
| 83883 |
|
83 |
64 |
$0.00 |
| J2175 |
Injection, meperidine hydrochloride, per 100 mg |
127 |
102 |
$0.00 |
| 82378 |
|
621 |
479 |
$0.00 |
| 86706 |
|
284 |
252 |
$0.00 |
| 96127 |
|
297 |
270 |
$0.00 |
| Q3014 |
Telehealth originating site facility fee |
88 |
58 |
$0.00 |
| 93246 |
|
25 |
24 |
$0.00 |
| 70491 |
|
84 |
81 |
$0.00 |
| J2785 |
Injection, regadenoson, 0.1 mg |
404 |
342 |
$0.00 |
| C1726 |
Catheter, balloon dilatation, non-vascular |
287 |
273 |
$0.00 |
| G8988 |
Self care functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting |
175 |
146 |
$0.00 |
| J0330 |
Injection, succinylcholine chloride, up to 20 mg |
46 |
44 |
$0.00 |
| 99495 |
|
12 |
12 |
$0.00 |
| 86704 |
|
68 |
62 |
$0.00 |
| 80359 |
|
73 |
71 |
$0.00 |
| J2360 |
Injection, orphenadrine citrate, up to 60 mg |
147 |
139 |
$0.00 |
| 80353 |
|
64 |
63 |
$0.00 |
| 82164 |
|
128 |
43 |
$0.00 |
| J1010 |
Injection, methylprednisolone acetate, 1 mg |
361 |
234 |
$0.00 |
| 80178 |
|
13 |
12 |
$0.00 |
| 87529 |
|
152 |
94 |
$0.00 |
| 17000 |
|
16 |
14 |
$0.00 |
| 36000 |
|
226 |
142 |
$0.00 |
| 80357 |
|
114 |
55 |
$0.00 |
| J2469 |
Injection, palonosetron hcl, 25 mcg |
469 |
239 |
$0.00 |
| 80345 |
|
175 |
58 |
$0.00 |
| 86255 |
|
28 |
25 |
$0.00 |
| 64494 |
|
24 |
24 |
$0.00 |
| 80197 |
|
20 |
12 |
$0.00 |
| 88307 |
|
194 |
130 |
$0.00 |
| 73060 |
|
14 |
13 |
$0.00 |
| 87640 |
|
672 |
494 |
$0.00 |
| 64493 |
|
24 |
24 |
$0.00 |
| D1351 |
Sealant - per tooth |
41 |
16 |
$0.00 |
| 76377 |
|
12 |
12 |
$0.00 |
| J2505 |
Injection, pegfilgrastim, 6 mg |
17 |
12 |
$0.00 |
| D0240 |
|
34 |
15 |
$0.00 |
| J3360 |
Injection, diazepam, up to 5 mg |
33 |
25 |
$0.00 |
| G8987 |
Self care functional limitation, current status, at therapy episode outset and at reporting intervals |
165 |
138 |
$0.00 |
| 80371 |
|
85 |
48 |
$0.00 |
| 83002 |
|
58 |
56 |
$0.00 |
| 45378 |
Colonoscopy, flexible; diagnostic, including collection of specimen(s) |
85 |
84 |
$0.00 |
| 88323 |
|
16 |
16 |
$0.00 |
| 81596 |
|
101 |
98 |
$0.00 |
| J1790 |
Injection, droperidol, up to 5 mg |
31 |
26 |
$0.00 |
| 94010 |
|
47 |
38 |
$0.00 |
| 95911 |
|
40 |
40 |
$0.00 |
| 93458 |
|
12 |
12 |
$0.00 |
| 87507 |
|
13 |
12 |
$0.00 |
| 80358 |
|
73 |
71 |
$0.00 |
| 76819 |
Fetal biophysical profile; without non-stress testing |
61 |
27 |
$0.00 |
| 86812 |
|
36 |
24 |
$0.00 |
| 80352 |
|
48 |
47 |
$0.00 |
| 80368 |
|
57 |
55 |
$0.00 |
| 90694 |
|
34 |
34 |
$0.00 |
| 97597 |
|
42 |
14 |
$0.00 |
| 82962 |
|
27 |
24 |
$0.00 |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
13 |
12 |
$0.00 |
| C1781 |
Mesh (implantable) |
55 |
46 |
$0.00 |
| J1642 |
Injection, heparin sodium, (heparin lock flush), per 10 units |
43 |
27 |
$0.00 |
| 83521 |
|
20 |
12 |
$0.00 |
| 73120 |
|
14 |
14 |
$0.00 |
| G0009 |
Administration of pneumococcal vaccine |
15 |
15 |
$0.00 |
| 94761 |
|
26 |
16 |
$0.00 |
| 97165 |
|
13 |
12 |
$0.00 |
| 86920 |
|
19 |
14 |
$0.00 |
| 80329 |
|
21 |
13 |
$0.00 |
| 73700 |
|
14 |
13 |
$0.00 |
| 99291 |
Critical care, evaluation and management of the critically ill patient, first 30-74 minutes |
40 |
16 |
$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 |
21 |
12 |
$0.00 |
| 17250 |
|
25 |
12 |
$0.00 |
| 74221 |
|
13 |
13 |
$0.00 |
| 51798 |
|
32 |
29 |
$0.00 |
| 64635 |
|
14 |
12 |
$0.00 |
| 83789 |
|
12 |
12 |
$0.00 |
| 90853 |
Group psychotherapy (other than of a multiple-family group) |
4,800 |
1,520 |
$0.00 |
| 80364 |
|
71 |
69 |
$0.00 |
| 86235 |
|
135 |
73 |
$0.00 |
| 81002 |
|
253 |
219 |
$0.00 |
| A9502 |
Technetium tc-99m tetrofosmin, diagnostic, per study dose |
358 |
314 |
$0.00 |
| 36592 |
|
140 |
67 |
$0.00 |
| 43249 |
|
63 |
63 |
$0.00 |
| 11721 |
|
809 |
744 |
$0.00 |
| J2919 |
Injection, methylprednisolone sodium succinate, 5 mg |
83 |
60 |
$0.00 |
| 77080 |
|
352 |
349 |
$0.00 |
| 77065 |
Tomosynthesis, mammo |
12 |
12 |
$0.00 |
| G0483 |
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; 22 or more drug class(es), including metabolite(s) if performed |
1,360 |
1,137 |
$0.00 |
| 29848 |
|
89 |
87 |
$0.00 |
| J1453 |
Injection, fosaprepitant, 1 mg |
118 |
57 |
$0.00 |
| 80365 |
|
146 |
71 |
$0.00 |
| G0500 |
Moderate sedation services provided by the same physician or other qualified health care professional performing a gastrointestinal endoscopic service that sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; initial 15 minutes of intra-service time; patient age 5 years or older (additional time may be reported with 99153, as appropriate) |
1,297 |
1,217 |
$0.00 |
| 90653 |
|
117 |
113 |
$0.00 |
| 99490 |
Ccm add 20min |
128 |
124 |
$0.00 |
| 74178 |
|
29 |
27 |
$0.00 |
| 80361 |
|
214 |
71 |
$0.00 |
| 86705 |
|
100 |
97 |
$0.00 |
| C9113 |
Injection, pantoprazole sodium, per vial |
567 |
340 |
$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 |
458 |
396 |
$0.00 |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
455 |
311 |
$0.00 |
| A9552 |
Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries |
122 |
115 |
$0.00 |
| G0141 |
Screening cytopathology smears, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physician |
102 |
78 |
$0.00 |
| G0260 |
Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography |
215 |
197 |
$0.00 |
| 92610 |
|
31 |
26 |
$0.00 |
| G0482 |
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; 15-21 drug class(es), including metabolite(s) if performed |
223 |
206 |
$0.00 |
| 80348 |
|
145 |
71 |
$0.00 |
| 84165 |
|
87 |
84 |
$0.00 |
| 80321 |
|
148 |
77 |
$0.00 |
| 71271 |
|
146 |
127 |
$0.00 |
| 80355 |
|
60 |
58 |
$0.00 |
| 89051 |
|
56 |
50 |
$0.00 |
| 80370 |
|
29 |
29 |
$0.00 |
| 83992 |
|
31 |
30 |
$0.00 |
| 80354 |
|
215 |
71 |
$0.00 |
| J1580 |
Injection, garamycin, gentamicin, up to 80 mg |
63 |
50 |
$0.00 |
| C1729 |
Catheter, drainage |
79 |
40 |
$0.00 |
| 86708 |
|
12 |
12 |
$0.00 |
| 80346 |
|
73 |
71 |
$0.00 |
| G8978 |
Mobility: walking & moving around functional limitation, current status, at therapy episode outset and at reporting intervals |
422 |
377 |
$0.00 |
| J0585 |
Injection, onabotulinumtoxina, 1 unit |
20 |
13 |
$0.00 |
| 77085 |
|
153 |
152 |
$0.00 |
| 36600 |
|
81 |
66 |
$0.00 |
| 43235 |
|
66 |
64 |
$0.00 |
| 93798 |
|
101 |
12 |
$0.00 |
| 77336 |
|
132 |
62 |
$0.00 |
| 96417 |
|
98 |
49 |
$0.00 |
| 80338 |
|
89 |
30 |
$0.00 |
| 95816 |
|
26 |
26 |
$0.00 |
| 84166 |
|
36 |
28 |
$0.00 |
| 97542 |
|
73 |
65 |
$0.00 |
| 78815 |
Positron emission tomography (PET) for limited area imaging |
228 |
201 |
$0.00 |
| 80366 |
|
58 |
57 |
$0.00 |
| 47562 |
|
32 |
27 |
$0.00 |
| 64636 |
|
14 |
12 |
$0.00 |
| 84155 |
|
32 |
32 |
$0.00 |
| 95913 |
|
87 |
79 |
$0.00 |
| 93296 |
|
121 |
112 |
$0.00 |
| 80323 |
|
133 |
67 |
$0.00 |
| 88112 |
|
13 |
12 |
$0.00 |
| Q9966 |
Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml |
205 |
131 |
$0.00 |
| 80339 |
|
30 |
30 |
$0.00 |
| J3301 |
Injection, triamcinolone acetonide, not otherwise specified, 10 mg |
31 |
30 |
$0.00 |
| C1894 |
Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser |
120 |
93 |
$0.00 |
| 99408 |
|
14 |
12 |
$0.00 |
| 82010 |
|
35 |
28 |
$0.00 |
| 93880 |
|
55 |
53 |
$0.00 |
| Q0244 |
Injection, casirivimab and imdevimab, 1200 mg |
17 |
17 |
$0.00 |
| 93356 |
|
70 |
63 |
$0.00 |
| 80360 |
|
120 |
58 |
$0.00 |
| 80344 |
|
30 |
30 |
$0.00 |
| 80356 |
|
73 |
71 |
$0.00 |
| 80373 |
|
75 |
34 |
$0.00 |
| 74220 |
|
15 |
15 |
$0.00 |
| Q0163 |
Diphenhydramine hydrochloride, 50 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at time of chemotherapy treatment not to exceed a 48 hour dosage regimen |
49 |
43 |
$0.00 |
| 80325 |
|
12 |
12 |
$0.00 |
| 80164 |
|
45 |
40 |
$0.00 |
| 86703 |
|
36 |
34 |
$0.00 |
| Q9957 |
Injection, perflutren lipid microspheres, per ml |
39 |
39 |
$0.00 |
| 76818 |
|
54 |
29 |
$0.00 |
| J9271 |
Injection, pembrolizumab, 1 mg |
14 |
12 |
$0.00 |
| 0077U |
|
13 |
13 |
$0.00 |
| 80372 |
|
12 |
12 |
$0.00 |
| 87220 |
|
14 |
14 |
$0.00 |
| A4649 |
Surgical supply; miscellaneous |
25 |
16 |
$0.00 |