| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
69,654 |
64,287 |
$57.59M |
| 0450 |
Emergency room services |
13,216 |
12,335 |
$7.23M |
| Z4300 |
|
40,287 |
40,032 |
$4.15M |
| J1745 |
Injection, infliximab, excludes biosimilar, 10 mg |
1,756 |
1,134 |
$2.75M |
| Z7500 |
|
80,156 |
71,487 |
$2.72M |
| Z4306 |
|
39,498 |
39,251 |
$2.70M |
| Z4301 |
|
58,586 |
56,236 |
$1.43M |
| 93325 |
|
10,869 |
10,664 |
$1.41M |
| J0585 |
Injection, onabotulinumtoxina, 1 unit |
2,854 |
1,426 |
$1.37M |
| 0360 |
|
7,743 |
3,998 |
$1.29M |
| 93303 |
Transthoracic echocardiography for congenital cardiac anomalies, follow-up or limited study |
6,869 |
6,807 |
$1.23M |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
4,825 |
4,656 |
$1.12M |
| Z4304 |
|
13,432 |
13,428 |
$1.04M |
| Z4303 |
|
22,378 |
22,193 |
$961K |
| 99221 |
|
5,507 |
5,423 |
$756K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
11,607 |
5,070 |
$705K |
| Z4307 |
|
26,801 |
26,669 |
$674K |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
14,312 |
10,899 |
$636K |
| 80053 |
Comprehensive metabolic panel |
45,600 |
32,806 |
$610K |
| 76811 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, detailed |
5,311 |
5,276 |
$573K |
| 93320 |
|
6,936 |
6,867 |
$573K |
| 0510 |
|
13,756 |
9,719 |
$549K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
6,902 |
5,907 |
$535K |
| Z4308 |
|
18,792 |
18,667 |
$475K |
| J3490 |
Unclassified drugs |
35,975 |
15,764 |
$462K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
8,689 |
8,213 |
$454K |
| Z7610 |
|
41,033 |
12,918 |
$450K |
| 76770 |
|
5,514 |
5,468 |
$438K |
| 44970 |
|
695 |
681 |
$369K |
| Z4311 |
|
29,233 |
29,080 |
$352K |
| 59025 |
Fetal non-stress test |
13,689 |
5,369 |
$341K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
6,724 |
6,246 |
$331K |
| 0710 |
|
6,588 |
4,884 |
$321K |
| 96367 |
|
4,545 |
2,764 |
$294K |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
1,881 |
1,815 |
$276K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
29,522 |
23,451 |
$274K |
| 76825 |
|
2,701 |
2,596 |
$269K |
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
257 |
253 |
$267K |
| 87633 |
Infectious agent detection by nucleic acid, respiratory virus, 12-25 targets |
4,586 |
4,471 |
$254K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,103 |
3,091 |
$242K |
| V5008 |
Hearing screening |
4,666 |
4,598 |
$224K |
| Z7502 |
|
6,042 |
5,967 |
$222K |
| Z4312 |
|
18,228 |
18,096 |
$219K |
| 96450 |
|
840 |
739 |
$219K |
| Z4302 |
|
16,586 |
16,511 |
$216K |
| 42820 |
Tonsillectomy and adenoidectomy; younger than age 12 |
1,100 |
1,094 |
$211K |
| 96112 |
|
1,274 |
1,272 |
$194K |
| J2704 |
Injection, propofol, 10 mg |
9,349 |
7,597 |
$177K |
| 0720 |
|
4,358 |
3,452 |
$171K |
| J0586 |
Injection, abobotulinumtoxina, 5 units |
412 |
163 |
$161K |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
8,755 |
6,285 |
$154K |
| J3262 |
Injection, tocilizumab, 1 mg |
734 |
78 |
$154K |
| 76813 |
|
1,976 |
1,953 |
$154K |
| 99238 |
Hospital discharge day management, 30 minutes or less |
5,996 |
5,493 |
$152K |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
12,984 |
10,598 |
$148K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
2,076 |
2,016 |
$146K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
1,488 |
1,464 |
$146K |
| 99231 |
Subsequent hospital care, per day, straightforward or low complexity |
2,828 |
2,808 |
$144K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
2,585 |
2,250 |
$140K |
| 69436 |
Tympanostomy (requiring insertion of ventilating tube), general anesthesia |
1,189 |
702 |
$140K |
| J7050 |
Infusion, normal saline solution, 250 cc |
12,214 |
10,278 |
$139K |
| T1024 |
Evaluation and treatment by an integrated, specialty team contracted to provide coordinated care to multiple or severely handicapped children, per encounter |
4,168 |
2,665 |
$139K |
| 76827 |
|
2,696 |
2,589 |
$134K |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
605 |
577 |
$133K |
| 0750 |
|
1,357 |
646 |
$122K |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
11,548 |
11,347 |
$118K |
| 85027 |
|
15,491 |
12,300 |
$114K |
| 92588 |
|
2,277 |
2,197 |
$113K |
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
1,810 |
1,789 |
$110K |
| Z4309 |
|
4,415 |
4,322 |
$110K |
| X4303 |
|
1,624 |
710 |
$105K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
1,917 |
1,647 |
$102K |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
137 |
132 |
$100K |
| L8699 |
Prosthetic implant, not otherwise specified |
461 |
447 |
$98K |
| Z7506 |
|
653 |
649 |
$90K |
| 93976 |
|
1,280 |
1,239 |
$87K |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
1,733 |
1,680 |
$86K |
| 96361 |
Intravenous infusion, hydration; each additional hour |
5,064 |
4,248 |
$85K |
| 76801 |
|
1,674 |
1,555 |
$82K |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
6,118 |
4,252 |
$81K |
| J1642 |
Injection, heparin sodium, (heparin lock flush), per 10 units |
13,145 |
4,593 |
$79K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
1,396 |
705 |
$76K |
| 99218 |
|
508 |
506 |
$74K |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
2,861 |
2,748 |
$69K |
| 0762 |
|
1,621 |
883 |
$68K |
| 76819 |
Fetal biophysical profile; without non-stress testing |
893 |
829 |
$67K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
4,063 |
3,963 |
$62K |
| 99070 |
|
77,262 |
42,210 |
$60K |
| 97803 |
|
995 |
614 |
$58K |
| 93975 |
|
990 |
900 |
$57K |
| 97802 |
|
628 |
612 |
$56K |
| 83735 |
|
6,509 |
4,465 |
$55K |
| 81001 |
|
19,460 |
17,935 |
$51K |
| 81003 |
|
13,338 |
9,377 |
$51K |
| 70450 |
Computed tomography, head or brain; without contrast material |
1,586 |
1,573 |
$50K |
| G0378 |
Hospital observation service, per hour |
6,321 |
3,754 |
$50K |
| 36415 |
Collection of venous blood by venipuncture |
2,891 |
2,577 |
$49K |
| 99232 |
Subsequent hospital care, per day, moderate complexity |
934 |
929 |
$47K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
2,236 |
2,158 |
$47K |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
3,807 |
3,662 |
$46K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
6,306 |
5,631 |
$46K |
| 87088 |
|
7,868 |
7,521 |
$43K |
| X3920 |
|
848 |
844 |
$42K |
| J9370 |
Vincristine sulfate, 1 mg |
3,161 |
1,773 |
$42K |
| 96111 |
|
388 |
388 |
$42K |
| 76820 |
|
1,400 |
856 |
$41K |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
2,259 |
1,612 |
$40K |
| J0690 |
Injection, cefazolin sodium, 500 mg |
2,440 |
2,374 |
$37K |
| 92507 |
Treatment of speech, language, voice, communication, and/or auditory processing disorder |
845 |
329 |
$37K |
| 84100 |
|
6,351 |
4,384 |
$36K |
| 96413 |
Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance |
896 |
354 |
$36K |
| X4304 |
|
1,093 |
466 |
$35K |
| 96409 |
|
1,393 |
1,108 |
$35K |
| 87210 |
|
6,900 |
6,093 |
$35K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
3,009 |
2,930 |
$34K |
| 41899 |
Unlisted procedure, dentoalveolar structures |
224 |
219 |
$34K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
990 |
972 |
$33K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
993 |
972 |
$33K |
| 71046 |
Radiologic examination, chest; 2 views |
3,603 |
3,561 |
$32K |
| X4100 |
|
612 |
612 |
$31K |
| 86140 |
|
5,030 |
4,763 |
$28K |
| 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 |
383 |
372 |
$28K |
| 42999 |
|
246 |
244 |
$28K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
3,865 |
3,580 |
$26K |
| 85007 |
|
6,468 |
4,728 |
$26K |
| 86850 |
|
3,831 |
3,334 |
$25K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
1,217 |
1,190 |
$24K |
| 24538 |
|
14 |
14 |
$23K |
| Z9725 |
|
535 |
532 |
$23K |
| 88304 |
|
1,668 |
1,646 |
$22K |
| 99217 |
|
851 |
520 |
$21K |
| 86900 |
|
5,295 |
3,778 |
$20K |
| 85046 |
|
2,630 |
2,410 |
$20K |
| 74018 |
|
4,059 |
3,957 |
$18K |
| 0761 |
|
437 |
416 |
$18K |
| J2710 |
Injection, neostigmine methylsulfate, up to 0.5 mg |
1,598 |
1,570 |
$18K |
| P9016 |
Red blood cells, leukocytes reduced, each unit |
70 |
53 |
$18K |
| 86901 |
|
4,975 |
3,677 |
$18K |
| 87070 |
|
2,427 |
2,333 |
$17K |
| 76870 |
|
700 |
686 |
$17K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
2,208 |
2,154 |
$17K |
| S0020 |
Injection, bupivicaine hydrochloride, 30 ml |
945 |
939 |
$17K |
| 76536 |
|
388 |
386 |
$16K |
| 83615 |
|
2,014 |
1,829 |
$16K |
| Z7512 |
|
553 |
552 |
$14K |
| 77075 |
|
391 |
384 |
$14K |
| J7030 |
Infusion, normal saline solution , 1000 cc |
1,470 |
1,381 |
$14K |
| 71045 |
Radiologic examination, chest; single view |
1,803 |
1,759 |
$13K |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
2,393 |
2,300 |
$13K |
| 0272 |
|
695 |
657 |
$13K |
| 99367 |
|
253 |
250 |
$13K |
| 87077 |
|
4,007 |
2,376 |
$12K |
| 84702 |
|
1,530 |
1,216 |
$12K |
| 43762 |
|
357 |
342 |
$12K |
| 99224 |
|
236 |
236 |
$12K |
| 82570 |
|
2,084 |
1,715 |
$12K |
| 84550 |
|
2,069 |
1,896 |
$12K |
| Z4314 |
|
181 |
136 |
$11K |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
560 |
556 |
$10K |
| J9260 |
Injection, methotrexate sodium, 50 mg |
1,227 |
761 |
$10K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
1,543 |
1,317 |
$10K |
| J0665 |
Injection, bupivicaine, not otherwise specified, 0.5 mg |
694 |
579 |
$9K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
1,778 |
1,672 |
$9K |
| 76857 |
|
349 |
346 |
$9K |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
1,725 |
1,160 |
$9K |
| 94010 |
|
538 |
518 |
$9K |
| 83690 |
|
3,273 |
3,162 |
$9K |
| C1713 |
Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable) |
12 |
12 |
$8K |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
1,863 |
1,623 |
$8K |
| Z7514 |
|
136 |
65 |
$8K |
| 45380 |
Colonoscopy, flexible; with biopsy, single or multiple |
166 |
154 |
$8K |
| 0270 |
|
1,200 |
844 |
$8K |
| 93321 |
|
165 |
165 |
$8K |
| 73080 |
|
1,656 |
1,431 |
$8K |
| 0370 |
|
451 |
434 |
$7K |
| 93304 |
|
73 |
73 |
$7K |
| 86945 |
|
207 |
126 |
$7K |
| 87636 |
Infectious agent detection by nucleic acid; SARS-CoV-2 and influenza virus types A and B |
43 |
43 |
$7K |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
87 |
87 |
$7K |
| 76885 |
|
69 |
68 |
$6K |
| J2916 |
Injection, sodium ferric gluconate complex in sucrose injection, 12.5 mg |
386 |
170 |
$6K |
| 94770 |
|
309 |
309 |
$6K |
| 82962 |
|
2,946 |
2,563 |
$6K |
| 0259 |
|
1,660 |
1,122 |
$6K |
| 73130 |
|
1,131 |
1,057 |
$6K |
| 84156 |
|
2,036 |
1,688 |
$6K |
| 82728 |
|
462 |
453 |
$6K |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
534 |
499 |
$5K |
| 74455 |
|
78 |
73 |
$5K |
| J0694 |
Injection, cefoxitin sodium, 1 gm |
606 |
600 |
$5K |
| 85730 |
|
1,787 |
1,704 |
$5K |
| 90839 |
|
1,506 |
1,445 |
$5K |
| 85018 |
|
1,885 |
1,805 |
$5K |
| X4300 |
|
51 |
51 |
$5K |
| 73630 |
|
993 |
929 |
$5K |
| 73610 |
|
1,153 |
1,054 |
$5K |
| 99225 |
|
83 |
83 |
$5K |
| Z5406 |
|
174 |
143 |
$5K |
| G0109 |
Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes |
241 |
117 |
$4K |
| G0383 |
Level 4 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment) |
29 |
24 |
$4K |
| 73564 |
|
636 |
599 |
$4K |
| 96411 |
|
137 |
81 |
$3K |
| J0330 |
Injection, succinylcholine chloride, up to 20 mg |
983 |
969 |
$3K |
| 43760 |
|
66 |
66 |
$3K |
| 84443 |
Thyroid stimulating hormone (TSH) |
518 |
502 |
$3K |
| 73590 |
|
1,162 |
1,030 |
$3K |
| 93247 |
|
26 |
26 |
$3K |
| J2370 |
Injection, phenylephrine hcl, up to 1 ml |
337 |
316 |
$3K |
| 73090 |
|
1,875 |
1,726 |
$3K |
| J7042 |
5% dextrose/normal saline (500 ml = 1 unit) |
2,121 |
1,960 |
$3K |
| 85610 |
|
1,779 |
1,715 |
$3K |
| 83880 |
|
192 |
183 |
$3K |
| 88342 |
|
98 |
97 |
$3K |
| 84703 |
|
4,620 |
4,381 |
$3K |
| J1756 |
Injection, iron sucrose, 1 mg |
237 |
105 |
$3K |
| J0137 |
Injection, acetaminophen (hikma), not therapeutically equivalent to j0131, 10 mg |
405 |
233 |
$2K |
| 87390 |
|
109 |
108 |
$2K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
418 |
414 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
441 |
440 |
$2K |
| 73070 |
|
441 |
382 |
$2K |
| 87637 |
Infectious agent detection by nucleic acid; SARS-CoV-2, influenza, and RSV |
13 |
13 |
$2K |
| 73060 |
|
1,031 |
988 |
$2K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
1,397 |
1,359 |
$2K |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
877 |
846 |
$2K |
| 99366 |
|
121 |
78 |
$2K |
| 85240 |
|
80 |
65 |
$2K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
94 |
92 |
$2K |
| 74019 |
|
373 |
370 |
$2K |
| 74240 |
|
13 |
13 |
$2K |
| 74022 |
|
476 |
472 |
$2K |
| 73110 |
|
1,069 |
1,002 |
$2K |
| 83605 |
|
624 |
580 |
$1K |
| 86702 |
|
109 |
108 |
$1K |
| 87497 |
|
23 |
12 |
$1K |
| 85384 |
|
278 |
263 |
$1K |
| J2252 |
Injection, midazolam in 0.8% sodium chloride, intravenous, not therapeutically equivalent to j2250, 1 mg |
95 |
95 |
$1K |
| J0780 |
Injection, prochlorperazine, up to 10 mg |
299 |
282 |
$1K |
| 87147 |
|
245 |
73 |
$1K |
| J1170 |
Injection, hydromorphone, up to 4 mg |
112 |
100 |
$1K |
| 92552 |
|
41 |
41 |
$1K |
| 73552 |
|
486 |
434 |
$1K |
| 99368 |
|
102 |
71 |
$1K |
| 86701 |
|
109 |
108 |
$1K |
| 93308 |
|
13 |
13 |
$1K |
| 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 |
409 |
290 |
$1K |
| 51600 |
|
50 |
49 |
$1K |
| 86762 |
|
70 |
65 |
$1K |
| 42821 |
|
12 |
12 |
$972.00 |
| 85652 |
|
948 |
928 |
$965.36 |
| 76826 |
|
14 |
13 |
$928.11 |
| 70486 |
|
26 |
24 |
$897.93 |
| 86787 |
|
43 |
39 |
$874.88 |
| 83550 |
|
80 |
79 |
$857.56 |
| 86735 |
|
38 |
38 |
$814.53 |
| 86765 |
|
38 |
38 |
$805.19 |
| 99499 |
|
373 |
278 |
$802.58 |
| 87040 |
|
448 |
413 |
$738.88 |
| 82150 |
|
650 |
637 |
$738.14 |
| J3480 |
Injection, potassium chloride, per 2 meq |
35 |
25 |
$683.90 |
| 86593 |
|
169 |
166 |
$648.68 |
| J2371 |
Injection, phenylephrine hydrochloride, 20 micrograms |
461 |
239 |
$639.56 |
| 82248 |
|
129 |
118 |
$571.96 |
| J7060 |
5% dextrose/water (500 ml = 1 unit) |
273 |
177 |
$564.83 |
| 93246 |
|
26 |
26 |
$527.89 |
| J7040 |
Infusion, normal saline solution, sterile (500 ml = 1 unit) |
279 |
273 |
$500.48 |
| 84484 |
|
138 |
124 |
$480.07 |
| 73030 |
|
245 |
224 |
$452.65 |
| 86160 |
|
25 |
24 |
$425.25 |
| 76010 |
|
49 |
48 |
$407.04 |
| 87430 |
|
818 |
814 |
$358.36 |
| 76828 |
|
14 |
13 |
$314.33 |
| 86803 |
|
13 |
12 |
$307.37 |
| 94799 |
|
94 |
92 |
$295.93 |
| 87186 |
|
184 |
173 |
$275.15 |
| 86780 |
|
21 |
19 |
$225.95 |
| 73100 |
|
235 |
208 |
$213.94 |
| 90840 |
|
102 |
99 |
$207.94 |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
137 |
128 |
$207.50 |
| 76937 |
|
13 |
13 |
$204.88 |
| 82247 |
|
141 |
126 |
$196.84 |
| 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 |
13 |
13 |
$189.00 |
| 82330 |
|
81 |
77 |
$159.56 |
| 87340 |
|
37 |
36 |
$158.38 |
| 82805 |
|
41 |
41 |
$152.51 |
| 82550 |
|
141 |
138 |
$151.93 |
| 12011 |
|
138 |
137 |
$138.87 |
| J0171 |
Injection, adrenalin, epinephrine, 0.1 mg |
30 |
30 |
$137.26 |
| 76882 |
|
28 |
24 |
$119.13 |
| 0250 |
|
213 |
104 |
$104.57 |
| 84439 |
|
27 |
25 |
$98.63 |
| 86592 |
|
14 |
14 |
$87.18 |
| 94664 |
|
65 |
65 |
$82.83 |
| 84132 |
|
79 |
77 |
$80.55 |
| 12001 |
|
130 |
130 |
$80.31 |
| 94760 |
|
33 |
33 |
$73.68 |
| 82947 |
|
39 |
39 |
$67.08 |
| 82565 |
|
39 |
39 |
$65.40 |
| 84295 |
|
43 |
43 |
$64.01 |
| 87205 |
|
68 |
63 |
$63.51 |
| 82435 |
|
41 |
41 |
$63.11 |
| 82375 |
|
42 |
41 |
$51.04 |
| 87184 |
|
27 |
25 |
$42.48 |
| 83050 |
|
41 |
41 |
$33.93 |
| 84145 |
|
14 |
14 |
$27.76 |
| 73000 |
|
17 |
16 |
$23.90 |
| J1836 |
Injection, metronidazole, 10 mg |
121 |
88 |
$20.90 |
| 31720 |
|
15 |
15 |
$20.00 |
| 86308 |
|
106 |
102 |
$12.52 |
| A4217 |
Sterile water/saline, 500 ml |
40 |
40 |
$1.00 |
| 25605 |
|
16 |
16 |
$0.00 |
| 0637 |
|
27 |
16 |
$0.00 |
| 80143 |
|
56 |
52 |
$0.00 |
| 73562 |
|
15 |
13 |
$0.00 |
| 73502 |
|
25 |
24 |
$0.00 |
| 0271 |
|
12 |
12 |
$0.00 |
| A9270 |
Non-covered item or service |
72 |
48 |
$0.00 |
| 0636 |
|
57 |
38 |
$0.00 |