| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99284 |
Emergency department visit for the evaluation and management, high severity |
29,634 |
27,138 |
$20.71M |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
23,599 |
22,284 |
$10.20M |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
12,011 |
10,834 |
$8.14M |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
29,471 |
28,030 |
$7.66M |
| 0450 |
Emergency room services |
109,357 |
97,010 |
$5.41M |
| G0378 |
Hospital observation service, per hour |
5,528 |
4,384 |
$4.20M |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
31,490 |
29,786 |
$3.83M |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
11,122 |
10,743 |
$3.41M |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
23,788 |
23,272 |
$2.30M |
| 99199 |
Unlisted special service, procedure or report |
40,920 |
35,704 |
$2.08M |
| 70450 |
Computed tomography, head or brain; without contrast material |
15,599 |
14,954 |
$1.86M |
| 87637 |
Infectious agent detection by nucleic acid; SARS-CoV-2, influenza, and RSV |
17,588 |
17,058 |
$1.48M |
| 71046 |
Radiologic examination, chest; 2 views |
27,049 |
26,172 |
$1.43M |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
6,096 |
5,930 |
$1.09M |
| 71045 |
Radiologic examination, chest; single view |
22,634 |
21,023 |
$886K |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
4,164 |
4,067 |
$874K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
8,529 |
8,317 |
$840K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
31,124 |
28,120 |
$776K |
| 76830 |
Ultrasound, transvaginal |
6,596 |
6,445 |
$765K |
| 66984 |
Extracapsular cataract removal with insertion of intraocular lens prosthesis |
563 |
446 |
$751K |
| 99499 |
|
11,058 |
9,099 |
$743K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
15,585 |
13,684 |
$715K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
124,345 |
104,429 |
$713K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
6,346 |
6,189 |
$705K |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
2,615 |
2,583 |
$684K |
| 72148 |
Magnetic resonance imaging, lumbar spine; without contrast material |
2,413 |
2,393 |
$625K |
| 36415 |
Collection of venous blood by venipuncture |
140,987 |
114,388 |
$603K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
18,900 |
17,809 |
$585K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
43,971 |
39,468 |
$557K |
| 73630 |
|
8,474 |
7,449 |
$523K |
| 70553 |
Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences |
1,131 |
1,123 |
$510K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
3,975 |
3,760 |
$464K |
| 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 |
8,151 |
7,930 |
$464K |
| 80051 |
|
92,440 |
80,544 |
$458K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
11,790 |
10,588 |
$435K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
11,788 |
10,586 |
$434K |
| 72125 |
Computed tomography, cervical spine; without contrast material |
2,728 |
2,684 |
$411K |
| 73610 |
|
6,340 |
5,824 |
$390K |
| 70491 |
|
1,716 |
1,693 |
$389K |
| 82565 |
|
113,310 |
97,837 |
$384K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
21,671 |
19,709 |
$379K |
| 78451 |
|
493 |
474 |
$364K |
| 73130 |
|
5,605 |
5,025 |
$327K |
| 70486 |
|
2,036 |
2,018 |
$319K |
| 83880 |
|
16,390 |
14,998 |
$307K |
| 96361 |
Intravenous infusion, hydration; each additional hour |
18,794 |
17,400 |
$305K |
| 73110 |
|
4,896 |
4,473 |
$304K |
| 72141 |
|
1,130 |
1,114 |
$297K |
| 73560 |
|
5,746 |
5,178 |
$292K |
| 73721 |
Magnetic resonance imaging, any joint of lower extremity; without contrast material |
994 |
949 |
$288K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
1,259 |
1,249 |
$283K |
| 72100 |
|
3,406 |
3,371 |
$280K |
| 73030 |
|
4,578 |
4,244 |
$247K |
| 82947 |
|
93,528 |
81,711 |
$242K |
| 86900 |
|
6,370 |
6,072 |
$241K |
| 84520 |
|
93,082 |
80,969 |
$241K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
8,527 |
7,912 |
$235K |
| 0270 |
|
26,915 |
14,267 |
$235K |
| 93971 |
|
2,591 |
2,516 |
$229K |
| 84460 |
|
60,154 |
52,843 |
$228K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
1,381 |
1,380 |
$220K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
14,719 |
13,735 |
$208K |
| 84443 |
Thyroid stimulating hormone (TSH) |
12,448 |
12,171 |
$207K |
| J7030 |
Infusion, normal saline solution , 1000 cc |
47,024 |
39,832 |
$195K |
| 83690 |
|
38,884 |
35,585 |
$188K |
| 84484 |
|
27,938 |
24,235 |
$188K |
| 82247 |
|
52,479 |
44,880 |
$187K |
| 84702 |
|
19,326 |
16,805 |
$182K |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
6,413 |
6,354 |
$182K |
| 84450 |
|
50,494 |
44,671 |
$181K |
| 88304 |
|
3,233 |
3,199 |
$172K |
| 73080 |
|
2,821 |
2,597 |
$170K |
| 73140 |
|
2,781 |
2,651 |
$169K |
| 74018 |
|
3,235 |
3,054 |
$168K |
| 73564 |
|
1,550 |
1,211 |
$164K |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
8,973 |
8,469 |
$163K |
| 71250 |
|
1,362 |
1,351 |
$163K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
1,692 |
1,617 |
$162K |
| 84075 |
|
45,479 |
40,605 |
$160K |
| 93976 |
|
859 |
851 |
$156K |
| 74022 |
|
1,986 |
1,950 |
$154K |
| 81001 |
|
53,640 |
50,096 |
$153K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
5,628 |
5,482 |
$148K |
| 73590 |
|
2,794 |
2,507 |
$148K |
| 76857 |
|
1,186 |
1,178 |
$143K |
| 88307 |
|
518 |
511 |
$140K |
| 73502 |
|
2,483 |
2,347 |
$138K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
15,296 |
15,134 |
$138K |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
11,629 |
11,247 |
$136K |
| 73090 |
|
2,461 |
2,201 |
$129K |
| 87631 |
|
2,552 |
2,512 |
$122K |
| 0762 |
|
402 |
260 |
$119K |
| 72040 |
|
1,920 |
1,884 |
$119K |
| 87040 |
|
9,724 |
9,036 |
$115K |
| 80061 |
Lipid panel |
7,902 |
7,819 |
$110K |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
4,518 |
4,472 |
$108K |
| 76770 |
|
965 |
944 |
$105K |
| 83735 |
|
23,473 |
19,648 |
$104K |
| 80306 |
|
11,681 |
10,859 |
$100K |
| 86850 |
|
4,629 |
4,462 |
$99K |
| 87088 |
|
17,773 |
16,972 |
$93K |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
26,365 |
24,224 |
$92K |
| 87636 |
Infectious agent detection by nucleic acid; SARS-CoV-2 and influenza virus types A and B |
1,267 |
1,253 |
$92K |
| 86901 |
|
6,370 |
6,072 |
$91K |
| 76882 |
|
914 |
663 |
$90K |
| 83605 |
|
10,470 |
9,457 |
$82K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
15,091 |
13,849 |
$82K |
| J3490 |
Unclassified drugs |
20,190 |
11,791 |
$81K |
| 87506 |
|
461 |
456 |
$80K |
| 74019 |
|
1,102 |
1,083 |
$77K |
| 85027 |
|
12,766 |
12,080 |
$74K |
| 76870 |
|
838 |
817 |
$74K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
2,601 |
2,573 |
$74K |
| 82077 |
|
9,646 |
8,526 |
$71K |
| 86780 |
|
4,805 |
4,760 |
$69K |
| 82728 |
|
4,824 |
4,711 |
$69K |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
24,058 |
21,353 |
$68K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
2,511 |
2,378 |
$68K |
| 85610 |
|
23,092 |
19,023 |
$63K |
| 72070 |
|
779 |
771 |
$63K |
| 93970 |
|
358 |
350 |
$60K |
| 83970 |
|
1,642 |
1,589 |
$60K |
| 78452 |
Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress |
87 |
87 |
$58K |
| 84132 |
|
13,954 |
12,596 |
$57K |
| 70496 |
|
217 |
216 |
$57K |
| 96376 |
|
5,185 |
4,687 |
$56K |
| 81003 |
|
30,184 |
28,968 |
$56K |
| 86803 |
|
3,124 |
3,097 |
$49K |
| 73620 |
|
1,033 |
952 |
$47K |
| 76536 |
|
390 |
388 |
$46K |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
13,725 |
12,261 |
$45K |
| 73221 |
|
176 |
168 |
$45K |
| 85652 |
|
14,615 |
14,122 |
$45K |
| 73660 |
|
773 |
733 |
$44K |
| 73060 |
|
850 |
810 |
$44K |
| 0160 |
|
740 |
618 |
$44K |
| 70460 |
|
228 |
203 |
$42K |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
9,115 |
8,329 |
$41K |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
8,964 |
7,700 |
$40K |
| 84100 |
|
13,101 |
11,684 |
$40K |
| 80179 |
|
4,978 |
4,659 |
$39K |
| 73100 |
|
787 |
689 |
$39K |
| 73120 |
|
560 |
513 |
$39K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
763 |
758 |
$38K |
| 82607 |
|
2,630 |
2,602 |
$36K |
| 82248 |
|
7,615 |
5,955 |
$35K |
| 86923 |
|
281 |
267 |
$33K |
| 87536 |
|
378 |
371 |
$32K |
| 72170 |
|
597 |
583 |
$32K |
| 82962 |
|
12,472 |
9,072 |
$32K |
| 73552 |
|
639 |
598 |
$32K |
| 82803 |
|
2,945 |
2,728 |
$31K |
| 90715 |
|
932 |
920 |
$30K |
| 83550 |
|
3,388 |
3,324 |
$29K |
| 87340 |
|
2,536 |
2,505 |
$29K |
| A9585 |
Injection, gadobutrol, 0.1 ml |
827 |
810 |
$29K |
| J1170 |
Injection, hydromorphone, up to 4 mg |
6,922 |
5,774 |
$28K |
| 71101 |
|
377 |
369 |
$28K |
| 27502 |
|
43 |
37 |
$28K |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
8,068 |
7,206 |
$27K |
| 82310 |
|
6,361 |
5,375 |
$27K |
| 85379 |
|
4,551 |
4,437 |
$27K |
| 84295 |
|
6,057 |
5,457 |
$27K |
| 70498 |
|
126 |
125 |
$27K |
| 86235 |
|
204 |
204 |
$27K |
| 82040 |
|
6,099 |
5,400 |
$24K |
| 86140 |
|
6,053 |
5,743 |
$24K |
| 84439 |
|
2,559 |
2,424 |
$24K |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
6,478 |
6,175 |
$23K |
| Z7502 |
|
1,300 |
1,224 |
$22K |
| J2060 |
Injection, lorazepam, 2 mg |
5,534 |
4,617 |
$21K |
| 73600 |
|
511 |
487 |
$21K |
| 82105 |
|
1,393 |
1,348 |
$21K |
| 80349 |
|
4,526 |
4,225 |
$21K |
| 76801 |
|
229 |
220 |
$21K |
| 10060 |
|
1,332 |
1,302 |
$21K |
| 83540 |
|
3,406 |
3,342 |
$20K |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
6,191 |
5,654 |
$19K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
1,139 |
899 |
$19K |
| A9502 |
Technetium tc-99m tetrofosmin, diagnostic, per study dose |
373 |
370 |
$18K |
| 82043 |
|
3,641 |
3,601 |
$18K |
| 85378 |
|
3,071 |
2,917 |
$18K |
| 0637 |
|
110,063 |
32,258 |
$17K |
| 84153 |
|
1,198 |
1,167 |
$17K |
| 80164 |
|
1,427 |
1,299 |
$16K |
| J0780 |
Injection, prochlorperazine, up to 10 mg |
2,563 |
2,429 |
$16K |
| 73562 |
|
313 |
261 |
$16K |
| J1815 |
Injection, insulin, per 5 units |
5,183 |
2,590 |
$16K |
| 82550 |
|
2,718 |
2,260 |
$16K |
| 12001 |
|
1,180 |
1,165 |
$15K |
| 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 |
1,659 |
1,530 |
$15K |
| 86706 |
|
1,402 |
1,390 |
$15K |
| 72131 |
|
115 |
114 |
$14K |
| 82570 |
|
3,364 |
3,059 |
$14K |
| 86360 |
|
325 |
321 |
$14K |
| 85730 |
|
2,325 |
2,278 |
$14K |
| 0250 |
|
36,437 |
16,245 |
$13K |
| 86704 |
|
1,109 |
1,091 |
$13K |
| 88342 |
|
127 |
126 |
$13K |
| 70544 |
|
41 |
41 |
$13K |
| 80361 |
|
1,087 |
1,042 |
$12K |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
3,118 |
2,814 |
$12K |
| 87210 |
|
3,015 |
2,960 |
$12K |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
1,778 |
1,561 |
$12K |
| 73020 |
|
303 |
280 |
$12K |
| 12011 |
|
765 |
757 |
$11K |
| 0370 |
|
3,391 |
3,194 |
$11K |
| J1630 |
Injection, haloperidol, up to 5 mg |
3,440 |
2,782 |
$11K |
| 84550 |
|
2,265 |
2,114 |
$10K |
| 96367 |
|
657 |
644 |
$10K |
| 81025 |
|
1,096 |
1,084 |
$10K |
| P9016 |
Red blood cells, leukocytes reduced, each unit |
68 |
53 |
$10K |
| 97161 |
|
864 |
814 |
$10K |
| A9575 |
Injection, gadoterate meglumine, 0.1 ml |
662 |
653 |
$9K |
| S0164 |
Injection, pantoprazole sodium, 40 mg |
796 |
654 |
$8K |
| 87449 |
|
875 |
864 |
$8K |
| 87070 |
|
1,400 |
1,328 |
$8K |
| 80346 |
|
1,854 |
1,717 |
$8K |
| 84403 |
|
303 |
301 |
$8K |
| 29125 |
|
1,115 |
1,082 |
$8K |
| J1940 |
Injection, furosemide, up to 20 mg |
2,274 |
1,498 |
$8K |
| 87324 |
|
830 |
821 |
$7K |
| 83615 |
|
1,371 |
1,242 |
$7K |
| 83516 |
|
311 |
309 |
$7K |
| J1953 |
Injection, levetiracetam, 10 mg |
546 |
473 |
$7K |
| 0710 |
|
3,855 |
3,641 |
$7K |
| 84156 |
|
2,291 |
2,042 |
$6K |
| S0119 |
Ondansetron, oral, 4 mg (for circumstances falling under the medicare statute, use hcpcs q code) |
2,334 |
2,267 |
$6K |
| 12002 |
|
451 |
444 |
$5K |
| J2785 |
Injection, regadenoson, 0.1 mg |
83 |
79 |
$5K |
| 72082 |
|
45 |
45 |
$5K |
| 93017 |
|
102 |
96 |
$5K |
| 80325 |
|
2,841 |
2,628 |
$5K |
| 73000 |
|
53 |
52 |
$5K |
| 86480 |
|
97 |
97 |
$5K |
| 85014 |
|
2,509 |
2,262 |
$5K |
| J3370 |
Injection, vancomycin hcl, 500 mg |
686 |
422 |
$4K |
| 82140 |
|
488 |
411 |
$4K |
| Q0144 |
Azithromycin dihydrate, oral, capsules/powder, 1 gram |
1,310 |
1,246 |
$4K |
| 85018 |
|
2,402 |
2,164 |
$4K |
| 70360 |
|
102 |
101 |
$4K |
| J0690 |
Injection, cefazolin sodium, 500 mg |
1,949 |
1,751 |
$4K |
| 80197 |
|
408 |
261 |
$4K |
| 74178 |
|
13 |
12 |
$4K |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
2,639 |
2,489 |
$4K |
| 89051 |
|
819 |
510 |
$4K |
| 87517 |
|
183 |
172 |
$4K |
| 99070 |
|
557 |
208 |
$4K |
| 80178 |
|
602 |
536 |
$4K |
| J1644 |
Injection, heparin sodium, per 1000 units |
1,232 |
604 |
$3K |
| 86225 |
|
241 |
241 |
$3K |
| 73070 |
|
94 |
92 |
$3K |
| 73700 |
|
24 |
24 |
$3K |
| C1713 |
Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable) |
384 |
380 |
$3K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,064 |
1,016 |
$3K |
| 87205 |
|
773 |
648 |
$3K |
| J1650 |
Injection, enoxaparin sodium, 10 mg |
601 |
314 |
$3K |
| 80069 |
|
445 |
359 |
$3K |
| 93922 |
|
26 |
26 |
$2K |
| 82272 |
|
468 |
464 |
$2K |
| 93923 |
|
28 |
28 |
$2K |
| 86038 |
|
202 |
202 |
$2K |
| 87209 |
|
165 |
165 |
$2K |
| 87798 |
Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism |
33 |
33 |
$2K |
| J0360 |
Injection, hydralazine hcl, up to 20 mg |
520 |
469 |
$2K |
| 87522 |
Neg quan hep c or qual rna |
75 |
70 |
$2K |
| 85007 |
|
821 |
668 |
$2K |
| 80356 |
|
623 |
602 |
$2K |
| C1769 |
Guide wire |
294 |
283 |
$2K |
| 88300 |
|
100 |
99 |
$2K |
| 87633 |
Infectious agent detection by nucleic acid, respiratory virus, 12-25 targets |
13 |
13 |
$2K |
| Q9965 |
Low osmolar contrast material, 100-199 mg/ml iodine concentration, per ml |
21 |
21 |
$2K |
| 0301 |
|
22 |
22 |
$2K |
| 90749 |
|
766 |
751 |
$2K |
| 72128 |
|
15 |
15 |
$2K |
| J3480 |
Injection, potassium chloride, per 2 meq |
193 |
143 |
$2K |
| 70250 |
|
26 |
25 |
$2K |
| J2543 |
Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams) |
213 |
139 |
$2K |
| 72146 |
|
14 |
14 |
$2K |
| 73501 |
|
27 |
23 |
$2K |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
2,628 |
2,328 |
$2K |
| 84703 |
|
229 |
228 |
$2K |
| S0077 |
Injection, clindamycin phosphate, 300 mg |
88 |
78 |
$2K |
| 90686 |
|
119 |
111 |
$2K |
| 86593 |
|
323 |
317 |
$2K |
| 29515 |
|
241 |
228 |
$1K |
| 0272 |
|
489 |
472 |
$1K |
| 84146 |
|
76 |
75 |
$1K |
| 72050 |
|
13 |
12 |
$1K |
| C1894 |
Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser |
204 |
197 |
$1K |
| 82985 |
|
146 |
146 |
$1K |
| 88341 |
|
25 |
25 |
$1K |
| 87329 |
|
139 |
139 |
$1K |
| 0320 |
|
39 |
39 |
$1K |
| 85045 |
|
317 |
279 |
$1K |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
877 |
833 |
$1K |
| 80365 |
|
467 |
452 |
$1K |
| J2919 |
Injection, methylprednisolone sodium succinate, 5 mg |
249 |
221 |
$1K |
| 80348 |
|
412 |
339 |
$1K |
| J0171 |
Injection, adrenalin, epinephrine, 0.1 mg |
590 |
542 |
$1K |
| 80324 |
|
764 |
720 |
$962.18 |
| 85008 |
|
382 |
357 |
$909.91 |
| 84165 |
|
135 |
134 |
$886.00 |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
15 |
13 |
$832.74 |
| 80320 |
|
1,677 |
1,474 |
$832.54 |
| J7060 |
5% dextrose/water (500 ml = 1 unit) |
128 |
104 |
$776.01 |
| 83655 |
|
51 |
51 |
$764.00 |
| 82746 |
|
69 |
67 |
$748.69 |
| C9113 |
Injection, pantoprazole sodium, per vial |
639 |
539 |
$743.96 |
| 80354 |
|
149 |
140 |
$736.00 |
| 96368 |
|
144 |
142 |
$735.06 |
| 72072 |
|
12 |
12 |
$716.41 |
| 82435 |
|
219 |
209 |
$655.01 |
| 80329 |
|
851 |
801 |
$579.86 |
| 87081 |
|
236 |
226 |
$543.42 |
| 94660 |
|
15 |
12 |
$526.10 |
| 86665 |
|
26 |
26 |
$519.80 |
| 82784 |
|
38 |
37 |
$456.00 |
| J1171 |
Injection, hydromorphone, 0.1 mg |
143 |
117 |
$454.33 |
| 29105 |
|
54 |
53 |
$449.38 |
| J3360 |
Injection, diazepam, up to 5 mg |
68 |
60 |
$447.84 |
| 82670 |
|
12 |
12 |
$441.00 |
| 87338 |
|
56 |
56 |
$418.20 |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
13 |
12 |
$415.62 |
| 87529 |
|
13 |
13 |
$362.47 |
| 80353 |
|
207 |
198 |
$361.38 |
| 87799 |
|
14 |
12 |
$352.00 |
| 83001 |
|
13 |
13 |
$351.00 |
| 82150 |
|
56 |
52 |
$288.56 |
| J0295 |
Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm |
34 |
24 |
$252.72 |
| 82374 |
|
68 |
60 |
$252.00 |
| 89055 |
|
90 |
90 |
$249.35 |
| 86664 |
|
26 |
26 |
$228.78 |
| J8501 |
Aprepitant, oral, 5 mg |
479 |
476 |
$226.62 |
| J0737 |
Injection, clindamycin phosphate (baxter), not therapeutically equivalent to j0736, 300 mg |
76 |
62 |
$211.39 |
| 84155 |
|
82 |
77 |
$207.84 |
| 83721 |
|
29 |
29 |
$201.00 |
| J8540 |
Dexamethasone, oral, 0.25 mg |
211 |
199 |
$175.77 |
| J2550 |
Injection, promethazine hcl, up to 50 mg |
39 |
37 |
$174.78 |
| 85004 |
|
30 |
27 |
$162.00 |
| 0636 |
|
192 |
189 |
$160.95 |
| J2310 |
Injection, naloxone hydrochloride, per 1 mg |
14 |
13 |
$156.98 |
| J3371 |
Injection, vancomycin hcl (mylan), not therapeutically equivalent to j3370, 500 mg |
15 |
12 |
$154.55 |
| 29130 |
|
24 |
24 |
$139.05 |
| 84630 |
|
12 |
12 |
$136.00 |
| 82950 |
|
15 |
14 |
$126.00 |
| 86431 |
|
26 |
26 |
$116.22 |
| 86709 |
|
13 |
13 |
$115.36 |
| G0472 |
Hepatitis c antibody screening, for individual at high risk and other covered indication(s) |
35 |
33 |
$90.84 |
| J3411 |
Injection, thiamine hcl, 100 mg |
30 |
26 |
$51.92 |
| G0008 |
Administration of influenza virus vaccine |
46 |
45 |
$51.31 |
| 59025 |
Fetal non-stress test |
13 |
13 |
$45.60 |
| 0258 |
|
1,491 |
1,286 |
$36.56 |
| 29505 |
|
12 |
12 |
$36.00 |
| J2470 |
Injection, pantoprazole sodium, 40 mg |
87 |
76 |
$11.61 |
| Z7610 |
|
206 |
48 |
$7.75 |
| 76376 |
|
433 |
426 |
$0.00 |
| J2280 |
Injection, moxifloxacin, 100 mg |
416 |
288 |
$0.00 |
| C9290 |
Injection, bupivacaine liposome, 1 mg |
68 |
68 |
$0.00 |
| J2001 |
Injection, lidocaine hcl for intravenous infusion, 10 mg |
19 |
19 |
$0.00 |
| V2632 |
Posterior chamber intraocular lens |
453 |
334 |
$0.00 |
| 3044F |
|
72 |
72 |
$0.00 |