| Code | Description | Claims | Beneficiaries | Total Paid |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
16,414 |
15,955 |
$1.04M |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
8,669 |
8,344 |
$770K |
| 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 |
9,555 |
9,202 |
$740K |
| G0378 |
Hospital observation service, per hour |
2,392 |
1,672 |
$629K |
| T1015 |
Clinic visit/encounter, all-inclusive |
13,815 |
4,190 |
$510K |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
14,243 |
13,775 |
$453K |
| 0202U |
Oncology (prostate), multianalyte, gene expression profiling |
1,724 |
1,686 |
$428K |
| 87633 |
Infectious agent detection by nucleic acid, respiratory virus, 12-25 targets |
1,081 |
1,066 |
$306K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
9,377 |
9,215 |
$270K |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
1,678 |
1,619 |
$266K |
| X0592 |
|
7,844 |
7,068 |
$216K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
8,959 |
8,540 |
$208K |
| 90837 |
Psychotherapy, 53 minutes with patient |
1,437 |
673 |
$205K |
| X0616 |
|
1,129 |
1,099 |
$200K |
| 80053 |
Comprehensive metabolic panel |
24,567 |
20,271 |
$196K |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
1,749 |
1,662 |
$161K |
| 87637 |
Infectious agent detection by nucleic acid; SARS-CoV-2, influenza, and RSV |
1,533 |
1,516 |
$153K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,609 |
3,178 |
$147K |
| X0621 |
|
660 |
386 |
$127K |
| 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 |
5,823 |
5,576 |
$115K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
27,438 |
22,208 |
$111K |
| 70450 |
Computed tomography, head or brain; without contrast material |
1,700 |
1,619 |
$93K |
| 80050 |
General health panel |
1,831 |
1,796 |
$84K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
4,361 |
4,029 |
$71K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
8,614 |
7,919 |
$65K |
| 64615 |
|
746 |
739 |
$61K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
1,481 |
1,405 |
$58K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
771 |
752 |
$57K |
| 0002A |
|
1,216 |
1,212 |
$49K |
| 71045 |
Radiologic examination, chest; single view |
6,754 |
6,424 |
$44K |
| 84484 |
|
5,726 |
5,063 |
$44K |
| 0001A |
|
1,198 |
1,192 |
$42K |
| 87486 |
|
1,083 |
1,068 |
$40K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
503 |
503 |
$39K |
| 83874 |
|
3,601 |
3,369 |
$38K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
3,140 |
2,886 |
$37K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
925 |
904 |
$34K |
| 81001 |
|
12,637 |
11,983 |
$32K |
| 80061 |
Lipid panel |
2,486 |
2,452 |
$31K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
173 |
163 |
$30K |
| 95811 |
|
82 |
80 |
$30K |
| 62323 |
|
500 |
491 |
$29K |
| 83880 |
|
1,130 |
1,058 |
$28K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
868 |
858 |
$27K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
784 |
775 |
$26K |
| 82553 |
|
3,597 |
3,365 |
$26K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
859 |
844 |
$26K |
| 72148 |
Magnetic resonance imaging, lumbar spine; without contrast material |
193 |
185 |
$25K |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
458 |
448 |
$24K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
1,315 |
1,272 |
$23K |
| M0243 |
Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring |
75 |
73 |
$22K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
3,165 |
2,988 |
$22K |
| 78452 |
Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress |
156 |
150 |
$22K |
| 96413 |
Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance |
362 |
230 |
$21K |
| 76830 |
Ultrasound, transvaginal |
484 |
473 |
$21K |
| 84443 |
Thyroid stimulating hormone (TSH) |
1,366 |
1,307 |
$20K |
| 73721 |
Magnetic resonance imaging, any joint of lower extremity; without contrast material |
97 |
92 |
$20K |
| 83690 |
|
4,810 |
4,607 |
$20K |
| 87428 |
|
593 |
589 |
$19K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
720 |
531 |
$19K |
| 87040 |
|
1,239 |
1,129 |
$19K |
| 72141 |
|
94 |
94 |
$19K |
| 72125 |
Computed tomography, cervical spine; without contrast material |
336 |
320 |
$19K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
702 |
692 |
$16K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
682 |
672 |
$16K |
| 97161 |
|
468 |
441 |
$16K |
| 92557 |
|
596 |
588 |
$15K |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
227 |
222 |
$15K |
| 93971 |
|
270 |
258 |
$15K |
| 84702 |
|
897 |
736 |
$15K |
| 92567 |
|
1,330 |
1,301 |
$15K |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
84 |
84 |
$14K |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
363 |
356 |
$14K |
| 73110 |
|
527 |
479 |
$14K |
| 87070 |
|
1,976 |
1,920 |
$13K |
| 97597 |
|
779 |
440 |
$13K |
| 83735 |
|
2,923 |
2,452 |
$13K |
| 29848 |
|
26 |
26 |
$13K |
| 71250 |
|
248 |
237 |
$12K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
1,886 |
1,852 |
$12K |
| 70553 |
Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences |
55 |
55 |
$11K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
197 |
194 |
$11K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
328 |
313 |
$10K |
| 85610 |
|
3,811 |
3,505 |
$10K |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
503 |
503 |
$10K |
| 73630 |
|
921 |
849 |
$10K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
199 |
180 |
$10K |
| 73564 |
|
566 |
525 |
$10K |
| U0002 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
431 |
411 |
$10K |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
990 |
904 |
$9K |
| 84145 |
|
676 |
551 |
$9K |
| 84703 |
|
975 |
942 |
$9K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
246 |
212 |
$9K |
| 73610 |
|
575 |
525 |
$9K |
| 71046 |
Radiologic examination, chest; 2 views |
754 |
728 |
$9K |
| 83605 |
|
1,282 |
1,091 |
$8K |
| 95810 |
Polysomnography; sleep staging with 4 or more additional parameters |
43 |
41 |
$8K |
| 72100 |
|
537 |
518 |
$8K |
| 73030 |
|
640 |
596 |
$8K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
1,178 |
1,170 |
$8K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
161 |
159 |
$7K |
| 80081 |
|
92 |
92 |
$7K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
183 |
175 |
$7K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
1,013 |
833 |
$7K |
| 86803 |
|
404 |
398 |
$7K |
| 11042 |
Debridement, subcutaneous tissue (includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm |
362 |
236 |
$7K |
| 87186 |
|
1,018 |
958 |
$7K |
| 84146 |
|
294 |
275 |
$7K |
| G0481 |
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; 8-14 drug class(es), including metabolite(s) if performed |
139 |
136 |
$6K |
| 82728 |
|
682 |
631 |
$6K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
128 |
127 |
$6K |
| 69436 |
Tympanostomy (requiring insertion of ventilating tube), general anesthesia |
14 |
14 |
$6K |
| 76642 |
|
156 |
150 |
$6K |
| 0003A |
|
144 |
144 |
$6K |
| 73130 |
|
555 |
498 |
$6K |
| C1713 |
Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable) |
43 |
40 |
$6K |
| 84439 |
|
830 |
804 |
$6K |
| 87150 |
|
132 |
131 |
$6K |
| 93017 |
|
221 |
214 |
$5K |
| 94729 |
|
228 |
222 |
$5K |
| 85730 |
|
1,052 |
997 |
$5K |
| 86618 |
|
230 |
227 |
$5K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
32 |
27 |
$5K |
| 90853 |
Group psychotherapy (other than of a multiple-family group) |
521 |
152 |
$5K |
| 96367 |
|
268 |
186 |
$5K |
| 76536 |
|
119 |
117 |
$5K |
| 82805 |
|
147 |
136 |
$5K |
| M0245 |
Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring |
19 |
18 |
$5K |
| 94726 |
|
216 |
210 |
$5K |
| 97165 |
|
179 |
174 |
$5K |
| 87077 |
|
744 |
706 |
$5K |
| 82607 |
|
396 |
392 |
$4K |
| 76770 |
|
144 |
134 |
$4K |
| 72110 |
|
270 |
259 |
$4K |
| 87641 |
|
230 |
217 |
$4K |
| 85379 |
|
503 |
465 |
$4K |
| 87806 |
|
157 |
155 |
$4K |
| 82550 |
|
761 |
687 |
$4K |
| 73502 |
|
300 |
280 |
$4K |
| 85027 |
|
519 |
489 |
$4K |
| 80349 |
|
305 |
289 |
$4K |
| 83540 |
|
490 |
477 |
$4K |
| 86140 |
|
1,370 |
1,228 |
$3K |
| 86038 |
|
246 |
242 |
$3K |
| 72131 |
|
58 |
58 |
$3K |
| 85652 |
|
1,336 |
1,196 |
$3K |
| 84153 |
|
164 |
160 |
$3K |
| 82150 |
|
799 |
769 |
$3K |
| 81025 |
|
1,007 |
951 |
$3K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
25 |
24 |
$3K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
132 |
129 |
$3K |
| 96361 |
Intravenous infusion, hydration; each additional hour |
365 |
303 |
$3K |
| 36415 |
Collection of venous blood by venipuncture |
19,471 |
15,888 |
$3K |
| 90715 |
|
379 |
373 |
$3K |
| 88342 |
|
113 |
107 |
$3K |
| 97168 |
|
91 |
86 |
$3K |
| 97162 |
|
68 |
67 |
$3K |
| 87430 |
|
416 |
404 |
$3K |
| Q3014 |
Telehealth originating site facility fee |
188 |
184 |
$2K |
| 74018 |
|
195 |
185 |
$2K |
| 72040 |
|
205 |
191 |
$2K |
| 95806 |
|
38 |
38 |
$2K |
| X0620 |
|
14 |
14 |
$2K |
| 73080 |
|
217 |
198 |
$2K |
| 93976 |
|
29 |
29 |
$2K |
| 84460 |
|
297 |
290 |
$2K |
| 84450 |
|
293 |
286 |
$2K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
91 |
63 |
$2K |
| 84100 |
|
507 |
417 |
$2K |
| 0071A |
|
47 |
47 |
$2K |
| 83550 |
|
481 |
468 |
$2K |
| 73221 |
|
12 |
12 |
$2K |
| A9500 |
Technetium tc-99m sestamibi, diagnostic, per study dose |
132 |
127 |
$2K |
| 87631 |
|
14 |
14 |
$2K |
| 82570 |
|
322 |
282 |
$2K |
| 70496 |
|
16 |
15 |
$2K |
| 94060 |
|
238 |
230 |
$2K |
| 70498 |
|
15 |
14 |
$2K |
| 86850 |
|
337 |
304 |
$2K |
| 73140 |
|
229 |
209 |
$2K |
| 80069 |
|
222 |
206 |
$2K |
| 82746 |
|
176 |
173 |
$2K |
| 94664 |
|
247 |
219 |
$2K |
| 83970 |
|
56 |
54 |
$2K |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
779 |
717 |
$2K |
| 62321 |
|
25 |
24 |
$2K |
| 0072A |
|
40 |
40 |
$2K |
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
43 |
42 |
$2K |
| 73560 |
|
143 |
130 |
$2K |
| 82962 |
|
1,091 |
695 |
$1K |
| 87205 |
|
404 |
373 |
$1K |
| 73100 |
|
129 |
105 |
$1K |
| 81003 |
|
455 |
446 |
$1K |
| 83001 |
|
75 |
74 |
$1K |
| 86900 |
|
406 |
358 |
$1K |
| 84550 |
|
244 |
227 |
$1K |
| 86592 |
|
326 |
315 |
$1K |
| 96523 |
|
91 |
72 |
$1K |
| 80320 |
|
142 |
131 |
$1K |
| 80324 |
|
79 |
72 |
$1K |
| 82043 |
|
152 |
152 |
$1K |
| 72070 |
|
86 |
84 |
$1K |
| 82565 |
|
179 |
172 |
$1K |
| 86901 |
|
406 |
358 |
$1K |
| 82950 |
|
176 |
174 |
$1K |
| 93226 |
|
42 |
41 |
$1K |
| 80076 |
|
123 |
112 |
$1K |
| C9803 |
Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
77 |
76 |
$1K |
| 73562 |
|
91 |
86 |
$1K |
| 84156 |
|
304 |
266 |
$1K |
| 17110 |
|
24 |
24 |
$1K |
| 71271 |
|
12 |
12 |
$1K |
| 86430 |
|
147 |
146 |
$1K |
| 73590 |
|
80 |
74 |
$990.66 |
| 96376 |
|
320 |
296 |
$985.48 |
| 86200 |
|
74 |
73 |
$965.00 |
| 80329 |
|
87 |
83 |
$957.51 |
| 87522 |
Neg quan hep c or qual rna |
25 |
25 |
$915.21 |
| 83615 |
|
198 |
182 |
$909.52 |
| 93970 |
|
12 |
12 |
$877.34 |
| Q9966 |
Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml |
544 |
538 |
$843.33 |
| 20553 |
|
52 |
50 |
$832.55 |
| 96415 |
|
41 |
29 |
$808.86 |
| 82784 |
|
42 |
39 |
$778.43 |
| 72050 |
|
36 |
36 |
$771.75 |
| 82375 |
|
163 |
152 |
$768.04 |
| 70486 |
|
14 |
12 |
$763.69 |
| 86617 |
|
19 |
19 |
$753.28 |
| J7030 |
Infusion, normal saline solution , 1000 cc |
5,687 |
5,195 |
$711.81 |
| 86235 |
|
12 |
12 |
$680.37 |
| 80074 |
|
12 |
12 |
$679.35 |
| 77080 |
|
13 |
12 |
$628.47 |
| J2704 |
Injection, propofol, 10 mg |
1,573 |
1,420 |
$627.43 |
| J3490 |
Unclassified drugs |
930 |
895 |
$608.48 |
| 76857 |
|
50 |
49 |
$585.20 |
| 76801 |
|
13 |
13 |
$498.85 |
| 93225 |
|
42 |
41 |
$495.52 |
| 73090 |
|
48 |
46 |
$477.71 |
| J2710 |
Injection, neostigmine methylsulfate, up to 0.5 mg |
193 |
183 |
$465.48 |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
26 |
26 |
$456.58 |
| 92587 |
|
16 |
16 |
$442.20 |
| 82378 |
|
51 |
43 |
$436.74 |
| 82140 |
|
96 |
87 |
$392.50 |
| 86160 |
|
13 |
13 |
$365.26 |
| 83050 |
|
148 |
137 |
$359.25 |
| 87340 |
|
24 |
24 |
$339.00 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
3,527 |
3,214 |
$338.95 |
| 80179 |
|
444 |
409 |
$338.22 |
| 82077 |
|
582 |
534 |
$335.28 |
| 69210 |
|
28 |
28 |
$328.00 |
| 36600 |
|
43 |
40 |
$327.60 |
| 80143 |
|
450 |
412 |
$326.34 |
| 84403 |
|
13 |
13 |
$324.00 |
| 99406 |
|
238 |
226 |
$321.27 |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
2,279 |
2,102 |
$293.64 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
165 |
155 |
$290.00 |
| J2360 |
Injection, orphenadrine citrate, up to 60 mg |
294 |
272 |
$274.23 |
| 11102 |
|
15 |
14 |
$273.72 |
| 12001 |
|
12 |
12 |
$269.50 |
| 87581 |
|
851 |
837 |
$249.54 |
| J2785 |
Injection, regadenoson, 0.1 mg |
47 |
47 |
$237.24 |
| C9290 |
Injection, bupivacaine liposome, 1 mg |
56 |
55 |
$227.70 |
| 80164 |
|
14 |
12 |
$226.49 |
| 72170 |
|
35 |
33 |
$197.09 |
| 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 |
13 |
13 |
$189.40 |
| 36591 |
|
227 |
153 |
$188.32 |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
70 |
59 |
$178.00 |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
649 |
506 |
$176.82 |
| 85007 |
|
39 |
38 |
$166.26 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
1,414 |
1,266 |
$156.23 |
| J3370 |
Injection, vancomycin hcl, 500 mg |
222 |
159 |
$152.34 |
| 83655 |
|
14 |
14 |
$152.00 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
1,180 |
942 |
$139.41 |
| 85520 |
|
30 |
25 |
$133.82 |
| J1170 |
Injection, hydromorphone, up to 4 mg |
369 |
286 |
$130.80 |
| 84436 |
|
12 |
12 |
$124.45 |
| E0113 |
Crutch underarm, wood, adjustable or fixed, each, with pad, tip and handgrip |
15 |
15 |
$119.00 |
| J0690 |
Injection, cefazolin sodium, 500 mg |
464 |
397 |
$116.42 |
| 51701 |
|
12 |
12 |
$112.00 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
3,206 |
2,792 |
$107.50 |
| 82947 |
|
26 |
26 |
$104.40 |
| 86376 |
|
12 |
12 |
$94.12 |
| 82310 |
|
12 |
12 |
$93.84 |
| Q9969 |
Tc-99m from non-highly enriched uranium source, full cost recovery add-on, per study dose |
293 |
281 |
$92.20 |
| 82248 |
|
12 |
12 |
$89.37 |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
180 |
161 |
$87.04 |
| 92555 |
|
13 |
13 |
$86.35 |
| 88304 |
|
28 |
26 |
$76.70 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
317 |
245 |
$74.93 |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
163 |
114 |
$74.56 |
| 36000 |
|
12 |
12 |
$70.71 |
| J7050 |
Infusion, normal saline solution, 250 cc |
1,046 |
867 |
$69.56 |
| A4311 |
Insertion tray without drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
56 |
54 |
$55.48 |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
596 |
520 |
$55.13 |
| J0780 |
Injection, prochlorperazine, up to 10 mg |
86 |
81 |
$44.02 |
| J7040 |
Infusion, normal saline solution, sterile (500 ml = 1 unit) |
288 |
250 |
$40.92 |
| J3301 |
Injection, triamcinolone acetonide, not otherwise specified, 10 mg |
74 |
73 |
$39.43 |
| A9585 |
Injection, gadobutrol, 0.1 ml |
13 |
12 |
$35.00 |
| J2795 |
Injection, ropivacaine hydrochloride, 1 mg |
26 |
25 |
$31.50 |
| A4570 |
Splint |
69 |
67 |
$28.62 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
664 |
595 |
$28.35 |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
323 |
282 |
$27.69 |
| J2550 |
Injection, promethazine hcl, up to 50 mg |
144 |
116 |
$26.81 |
| 3052F |
|
33 |
31 |
$24.57 |
| 3051F |
|
131 |
128 |
$20.00 |
| J2060 |
Injection, lorazepam, 2 mg |
121 |
98 |
$19.98 |
| J7060 |
5% dextrose/water (500 ml = 1 unit) |
183 |
135 |
$19.86 |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
92 |
76 |
$16.55 |
| J1650 |
Injection, enoxaparin sodium, 10 mg |
361 |
192 |
$9.16 |
| 81050 |
|
12 |
12 |
$8.10 |
| S0020 |
Injection, bupivicaine hydrochloride, 30 ml |
37 |
37 |
$7.73 |
| J0171 |
Injection, adrenalin, epinephrine, 0.1 mg |
30 |
27 |
$0.00 |
| J1171 |
Injection, hydromorphone, 0.1 mg |
46 |
31 |
$0.00 |
| J1644 |
Injection, heparin sodium, per 1000 units |
113 |
58 |
$0.00 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
46 |
46 |
$0.00 |
| J0665 |
Injection, bupivicaine, not otherwise specified, 0.5 mg |
68 |
62 |
$0.00 |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
47 |
12 |
$0.00 |
| 92579 |
|
12 |
12 |
$0.00 |
| 3044F |
|
33 |
31 |
$0.00 |