| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| G9005 |
Mccd, risk adj, maintenance |
131,014 |
131,014 |
$43.35M |
| 99283 |
|
52,531 |
48,786 |
$6.63M |
| 99284 |
|
40,245 |
37,866 |
$5.02M |
| 99214 |
|
58,838 |
52,017 |
$4.54M |
| G0463 |
Hospital outpt clinic visit |
46,888 |
39,615 |
$3.95M |
| 99213 |
|
41,365 |
38,206 |
$3.15M |
| 96361 |
|
15,159 |
12,828 |
$3.14M |
| 99285 |
|
26,081 |
24,648 |
$3.14M |
| 99282 |
|
22,795 |
21,763 |
$2.88M |
| 74177 |
|
10,818 |
10,595 |
$2.65M |
| 11042 |
|
9,786 |
4,000 |
$2.57M |
| 97110 |
|
44,015 |
14,290 |
$2.44M |
| 70450 |
|
8,918 |
8,656 |
$2.25M |
| 76856 |
|
5,971 |
5,867 |
$1.97M |
| 90834 |
|
20,314 |
13,918 |
$1.81M |
| 43239 |
|
3,070 |
3,058 |
$1.69M |
| H2019 |
Ther behav svc, per 15 min |
2,979 |
2,893 |
$1.60M |
| 80053 |
|
79,646 |
71,589 |
$1.57M |
| 93975 |
|
5,270 |
5,129 |
$1.53M |
| 90832 |
|
18,368 |
13,337 |
$1.27M |
| 99281 |
|
8,797 |
8,263 |
$1.10M |
| 45380 |
|
1,656 |
1,648 |
$1.09M |
| 71275 |
|
3,677 |
3,628 |
$1.08M |
| U0003 |
Cov-19 amp prb hgh thruput |
14,320 |
13,993 |
$1.07M |
| 96365 |
|
7,118 |
6,180 |
$950K |
| 74176 |
|
3,589 |
3,516 |
$866K |
| 97140 |
|
25,625 |
9,346 |
$753K |
| 36415 |
|
133,842 |
101,214 |
$736K |
| 11045 |
|
987 |
434 |
$727K |
| 87636 |
|
8,540 |
8,206 |
$627K |
| 80307 |
|
15,301 |
13,482 |
$618K |
| 87635 |
|
14,572 |
13,909 |
$594K |
| 12001 |
|
1,475 |
1,470 |
$579K |
| 77067 |
|
6,740 |
6,730 |
$577K |
| 45378 |
|
872 |
864 |
$566K |
| J2323 |
Natalizumab injection |
107 |
102 |
$546K |
| 76770 |
|
1,744 |
1,730 |
$527K |
| 87491 |
|
15,499 |
15,186 |
$485K |
| 87502 |
|
10,120 |
9,928 |
$484K |
| H2018 |
Psysoc rehab svc, per diem |
1,240 |
1,059 |
$472K |
| G0378 |
Hospital observation per hr |
4,717 |
2,986 |
$458K |
| 96360 |
|
3,261 |
3,041 |
$456K |
| 93970 |
|
1,121 |
1,106 |
$451K |
| Q3014 |
Telehealth facility fee |
14,462 |
12,801 |
$438K |
| 70553 |
|
875 |
869 |
$379K |
| T1015 |
Clinic service |
1,318 |
1,312 |
$355K |
| 90791 |
|
2,926 |
2,678 |
$354K |
| 96366 |
|
2,863 |
2,286 |
$351K |
| 99395 |
|
3,763 |
3,729 |
$350K |
| 97161 |
|
4,075 |
4,054 |
$339K |
| 12011 |
|
840 |
838 |
$328K |
| 71260 |
|
1,829 |
1,816 |
$325K |
| 87651 |
|
9,652 |
9,475 |
$324K |
| 87591 |
|
15,502 |
15,186 |
$311K |
| 96372 |
|
17,872 |
15,285 |
$310K |
| 76801 |
|
3,268 |
3,005 |
$309K |
| 99391 |
|
3,996 |
3,516 |
$305K |
| 70496 |
|
1,180 |
1,171 |
$300K |
| 10060 |
|
1,070 |
1,053 |
$300K |
| 99392 |
|
3,816 |
3,718 |
$291K |
| 99396 |
|
3,272 |
3,242 |
$282K |
| 99215 |
Prolong outpt/office vis |
5,497 |
3,308 |
$275K |
| 76705 |
|
5,648 |
5,565 |
$273K |
| 99393 |
|
3,388 |
3,368 |
$268K |
| 76830 |
|
5,732 |
5,637 |
$250K |
| 99291 |
|
1,930 |
1,902 |
$223K |
| 29125 |
|
1,159 |
1,147 |
$223K |
| 99204 |
|
2,335 |
2,315 |
$219K |
| 99394 |
|
2,601 |
2,584 |
$217K |
| 82306 |
|
9,204 |
9,091 |
$215K |
| 97162 |
|
2,076 |
2,061 |
$204K |
| 99212 |
|
2,544 |
2,432 |
$199K |
| C9803 |
Hopd covid-19 spec collect |
25,020 |
23,806 |
$198K |
| 64400 |
|
502 |
472 |
$197K |
| 0223U |
|
843 |
834 |
$191K |
| 70491 |
|
704 |
693 |
$187K |
| 90853 |
|
2,753 |
929 |
$184K |
| C1713 |
Anchor/screw bn/bn,tis/bn |
260 |
258 |
$183K |
| 76641 |
|
3,757 |
3,747 |
$182K |
| 45385 |
|
415 |
415 |
$181K |
| 86900 |
|
5,859 |
5,613 |
$180K |
| 88305 |
|
5,714 |
5,648 |
$178K |
| 71250 |
|
1,488 |
1,479 |
$161K |
| 93971 |
|
2,798 |
2,749 |
$159K |
| 96413 |
|
1,627 |
1,066 |
$158K |
| 88342 |
|
3,266 |
3,247 |
$158K |
| 80061 |
|
15,193 |
14,980 |
$157K |
| 97112 |
|
4,878 |
1,849 |
$157K |
| 29515 |
|
824 |
818 |
$155K |
| 76817 |
|
2,573 |
2,349 |
$152K |
| 86850 |
|
5,367 |
5,164 |
$146K |
| 76805 |
|
1,810 |
1,781 |
$143K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
18,554 |
16,280 |
$136K |
| 76700 |
|
1,047 |
1,046 |
$132K |
| 12002 |
|
326 |
324 |
$131K |
| 99203 |
|
1,578 |
1,568 |
$131K |
| 70551 |
|
403 |
401 |
$130K |
| 84443 |
|
16,994 |
16,527 |
$129K |
| 71046 |
|
22,007 |
21,368 |
$127K |
| 90460 |
|
8,784 |
8,381 |
$127K |
| 99211 |
|
3,453 |
2,301 |
$122K |
| 77063 |
|
6,723 |
6,714 |
$122K |
| 96374 |
|
28,623 |
25,648 |
$121K |
| 83880 |
|
4,288 |
4,073 |
$115K |
| 90715 |
|
4,541 |
4,522 |
$113K |
| 87634 |
|
2,432 |
2,365 |
$112K |
| G9001 |
Mccd, initial rate |
1,489 |
1,489 |
$112K |
| 99385 |
|
1,113 |
1,101 |
$109K |
| 86901 |
|
5,868 |
5,618 |
$106K |
| 93306 |
|
572 |
568 |
$102K |
| 70498 |
|
1,170 |
1,162 |
$102K |
| 97530 |
|
3,757 |
1,977 |
$100K |
| G0480 |
Drug test def 1-7 classes |
3,132 |
2,846 |
$100K |
| 80048 |
|
7,009 |
6,184 |
$99K |
| 97035 |
|
5,572 |
2,284 |
$97K |
| 77065 |
Tomosynthesis, mammo |
1,088 |
1,007 |
$96K |
| 90837 |
|
1,118 |
879 |
$94K |
| 70486 |
|
1,437 |
1,425 |
$93K |
| 97165 |
|
1,223 |
1,219 |
$90K |
| 77066 |
Tomosynthesis, mammo |
956 |
946 |
$89K |
| 59025 |
|
563 |
429 |
$89K |
| U0005 |
Infec agen detec ampli probe |
3,468 |
3,388 |
$83K |
| 76536 |
|
1,755 |
1,750 |
$78K |
| 85025 |
|
71,878 |
64,098 |
$78K |
| 99232 |
|
1,746 |
634 |
$78K |
| 72125 |
|
2,360 |
2,311 |
$75K |
| 83036 |
|
13,073 |
12,826 |
$73K |
| M0243 |
Casirivi and imdevi inj |
239 |
237 |
$73K |
| 90686 |
|
4,057 |
4,040 |
$71K |
| 90471 |
|
10,992 |
10,861 |
$70K |
| 87624 |
|
2,441 |
2,425 |
$70K |
| Q0138 |
Ferumoxytol, non-esrd |
223 |
161 |
$70K |
| 76815 |
|
845 |
810 |
$69K |
| 76775 |
|
1,199 |
1,191 |
$64K |
| 77080 |
|
856 |
856 |
$63K |
| 88142 |
|
2,648 |
2,643 |
$63K |
| 0241U |
|
767 |
750 |
$63K |
| 72148 |
|
164 |
164 |
$62K |
| 85610 |
|
13,543 |
8,778 |
$61K |
| 71271 |
|
1,053 |
1,052 |
$60K |
| 36416 |
|
4,406 |
1,928 |
$56K |
| 87637 |
|
482 |
474 |
$54K |
| 76816 |
|
654 |
627 |
$47K |
| H2010 |
Comprehensive med svc 15 min |
824 |
545 |
$46K |
| 99223 |
Prolong inpt eval add15 m |
487 |
484 |
$45K |
| 87428 |
|
1,285 |
1,224 |
$42K |
| 84439 |
|
7,504 |
7,367 |
$41K |
| 96367 |
|
814 |
687 |
$41K |
| 82607 |
|
4,435 |
4,366 |
$39K |
| 96375 |
|
20,554 |
17,981 |
$39K |
| 90461 |
|
2,745 |
2,740 |
$39K |
| 29505 |
|
202 |
201 |
$39K |
| U0002 |
Covid-19 lab test non-cdc |
955 |
938 |
$38K |
| 74183 |
|
96 |
96 |
$37K |
| 77062 |
|
358 |
358 |
$35K |
| 90651 |
|
1,190 |
1,190 |
$34K |
| 99406 |
|
1,930 |
1,867 |
$34K |
| 86780 |
|
4,379 |
4,299 |
$34K |
| 87389 |
|
2,840 |
2,794 |
$33K |
| 93976 |
|
84 |
81 |
$32K |
| M0222 |
Bebtelovimab injection |
170 |
168 |
$32K |
| 81220 |
|
106 |
104 |
$32K |
| 87798 |
|
748 |
739 |
$31K |
| 72131 |
|
314 |
301 |
$31K |
| 99386 |
|
318 |
315 |
$30K |
| 97116 |
|
1,004 |
614 |
$30K |
| 47562 |
|
12 |
12 |
$30K |
| Q0222 |
Bebtelovimab 175 mg |
44 |
43 |
$29K |
| 82805 |
|
2,713 |
2,457 |
$29K |
| 93005 |
|
33,790 |
28,922 |
$28K |
| 95806 |
|
468 |
463 |
$27K |
| 81420 |
|
53 |
53 |
$25K |
| G0472 |
Hep c screen high risk/other |
598 |
595 |
$24K |
| 69436 |
|
15 |
15 |
$24K |
| 99222 |
|
334 |
330 |
$24K |
| 86703 |
|
1,634 |
1,631 |
$24K |
| H0002 |
Alcohol and/or drug screenin |
223 |
213 |
$23K |
| 90670 |
|
1,432 |
1,427 |
$23K |
| 87660 |
|
6,665 |
6,531 |
$23K |
| 82728 |
|
3,820 |
3,600 |
$22K |
| 72100 |
|
1,605 |
1,600 |
$22K |
| 90677 |
|
773 |
768 |
$22K |
| 76870 |
|
873 |
855 |
$22K |
| 90633 |
|
1,181 |
1,178 |
$21K |
| 87480 |
|
6,509 |
6,377 |
$20K |
| 87086 |
|
10,527 |
10,137 |
$20K |
| 80047 |
|
929 |
909 |
$20K |
| 85027 |
|
10,234 |
9,635 |
$19K |
| 99233 |
Prolong inpt eval add15 m |
357 |
188 |
$19K |
| 83655 |
|
1,616 |
1,596 |
$19K |
| 90648 |
|
1,193 |
1,189 |
$19K |
| 0352U |
|
994 |
966 |
$19K |
| 88304 |
|
572 |
568 |
$19K |
| 87510 |
|
6,474 |
6,345 |
$19K |
| 81025 |
|
6,311 |
6,104 |
$18K |
| G0475 |
Hiv combination assay |
1,020 |
1,014 |
$17K |
| 76811 |
|
167 |
167 |
$17K |
| 90734 |
|
881 |
881 |
$16K |
| 86803 |
|
2,372 |
2,351 |
$16K |
| G0123 |
Screen cerv/vag thin layer |
801 |
791 |
$16K |
| G0283 |
Elec stim other than wound |
896 |
364 |
$16K |
| 82746 |
|
1,822 |
1,787 |
$16K |
| 77061 |
|
194 |
194 |
$15K |
| 73630 |
|
3,054 |
2,946 |
$15K |
| 87653 |
|
609 |
606 |
$15K |
| U0001 |
2019-ncov diagnostic p |
592 |
572 |
$15K |
| 74018 |
|
1,387 |
1,337 |
$15K |
| 82043 |
|
3,651 |
3,507 |
$14K |
| 90723 |
|
770 |
767 |
$14K |
| 83970 |
|
514 |
502 |
$14K |
| 73564 |
|
1,973 |
1,937 |
$14K |
| 90472 |
|
2,058 |
2,045 |
$14K |
| 81001 |
|
26,632 |
25,205 |
$13K |
| 87563 |
|
683 |
676 |
$13K |
| 99239 |
|
210 |
208 |
$13K |
| 84153 |
|
870 |
846 |
$13K |
| 99460 |
|
283 |
283 |
$13K |
| 86480 |
|
313 |
310 |
$13K |
| 90698 |
|
763 |
761 |
$12K |
| 84702 |
|
6,228 |
5,518 |
$12K |
| M0247 |
Sotrovimab infusion |
40 |
40 |
$12K |
| 74178 |
|
64 |
64 |
$11K |
| T1017 |
Targeted case management |
68 |
57 |
$11K |
| 36430 |
|
43 |
38 |
$11K |
| H0031 |
Mh health assess by non-md |
60 |
51 |
$11K |
| 90674 |
|
410 |
409 |
$11K |
| 73030 |
|
2,371 |
2,293 |
$11K |
| 83735 |
|
13,095 |
11,671 |
$11K |
| 97014 |
|
594 |
293 |
$11K |
| 97535 |
|
630 |
521 |
$10K |
| 83540 |
|
3,119 |
3,052 |
$10K |
| 87426 |
|
436 |
427 |
$10K |
| 29130 |
|
53 |
53 |
$10K |
| P9016 |
Rbc leukocytes reduced |
28 |
25 |
$10K |
| 87661 |
|
510 |
505 |
$10K |
| 87340 |
|
1,999 |
1,955 |
$10K |
| 96415 |
|
146 |
129 |
$9K |
| 99238 |
|
238 |
235 |
$9K |
| 86618 |
|
1,516 |
1,276 |
$9K |
| 82570 |
|
2,862 |
2,721 |
$9K |
| 90681 |
|
388 |
386 |
$9K |
| 84481 |
|
974 |
956 |
$8K |
| 90833 |
|
97 |
90 |
$8K |
| 90680 |
|
479 |
478 |
$8K |
| 87150 |
|
264 |
261 |
$8K |
| 99205 |
Prolong outpt/office vis |
78 |
77 |
$8K |
| 83550 |
|
2,096 |
2,072 |
$8K |
| 86580 |
|
598 |
551 |
$8K |
| 73502 |
|
1,039 |
1,015 |
$7K |
| 81003 |
|
14,071 |
13,542 |
$7K |
| 90682 |
|
302 |
299 |
$7K |
| 87880 |
|
2,554 |
2,489 |
$7K |
| 86762 |
|
1,217 |
1,185 |
$7K |
| 73610 |
|
2,716 |
2,652 |
$7K |
| 54150 |
|
101 |
101 |
$7K |
| 78815 |
|
16 |
16 |
$7K |
| 80074 |
|
366 |
362 |
$7K |
| 88307 |
|
103 |
103 |
$7K |
| 80076 |
|
839 |
822 |
$7K |
| 90656 |
|
518 |
516 |
$7K |
| 73130 |
|
2,558 |
2,474 |
$7K |
| 94060 |
|
77 |
77 |
$6K |
| 86038 |
|
874 |
855 |
$6K |
| 71045 |
|
8,144 |
7,859 |
$6K |
| 90744 |
|
369 |
368 |
$6K |
| 74174 |
|
53 |
53 |
$6K |
| G0297 |
Ldct for lung ca screen |
47 |
47 |
$6K |
| 93010 |
|
966 |
879 |
$6K |
| 73562 |
|
877 |
861 |
$5K |
| 84403 |
|
236 |
231 |
$5K |
| 90707 |
|
277 |
277 |
$5K |
| 90710 |
|
260 |
258 |
$5K |
| 86140 |
|
2,568 |
2,487 |
$5K |
| 0002A |
|
136 |
136 |
$5K |
| 86765 |
|
892 |
878 |
$5K |
| 99442 |
|
89 |
83 |
$4K |
| 87186 |
|
3,432 |
3,353 |
$4K |
| 94760 |
|
37,185 |
32,450 |
$4K |
| 90620 |
|
205 |
205 |
$4K |
| J3490 |
Drugs unclassified injection |
279 |
264 |
$4K |
| 72141 |
|
12 |
12 |
$4K |
| 97166 |
|
54 |
53 |
$4K |
| 86769 |
|
119 |
119 |
$4K |
| 86696 |
|
455 |
415 |
$4K |
| 86235 |
|
88 |
78 |
$4K |
| 90716 |
|
195 |
195 |
$4K |
| G0399 |
Home sleep test/type 3 porta |
223 |
223 |
$4K |
| 87077 |
|
3,808 |
3,740 |
$4K |
| 99404 |
|
43 |
42 |
$4K |
| 86617 |
|
405 |
335 |
$4K |
| 73110 |
|
1,581 |
1,537 |
$4K |
| 83690 |
|
19,012 |
17,714 |
$4K |
| 99401 |
|
81 |
81 |
$4K |
| 86787 |
|
848 |
823 |
$4K |
| 87507 |
|
27 |
27 |
$3K |
| 92551 |
|
52 |
52 |
$3K |
| 0011A |
|
142 |
142 |
$3K |
| 99231 |
|
128 |
63 |
$3K |
| 82550 |
|
1,962 |
1,851 |
$3K |
| 96127 |
|
1,773 |
1,727 |
$3K |
| 84550 |
|
1,175 |
1,136 |
$3K |
| 90661 |
|
117 |
117 |
$3K |
| 90696 |
|
157 |
155 |
$3K |
| 97150 |
|
53 |
24 |
$3K |
| 87468 |
|
88 |
87 |
$3K |
| 82784 |
|
367 |
352 |
$3K |
| 86701 |
|
317 |
316 |
$3K |
| 90700 |
|
118 |
118 |
$3K |
| 84484 |
|
21,611 |
18,424 |
$3K |
| J1631 |
Haloperidol decanoate inj |
477 |
215 |
$3K |
| 84703 |
|
22,404 |
21,140 |
$3K |
| 0001A |
|
157 |
156 |
$3K |
| 0012A |
|
97 |
97 |
$3K |
| 73140 |
|
1,202 |
1,181 |
$3K |
| G0103 |
Psa screening |
211 |
206 |
$3K |
| 93000 |
|
732 |
698 |
$3K |
| 86431 |
|
570 |
488 |
$3K |
| 97760 |
|
172 |
132 |
$3K |
| 85018 |
|
1,500 |
1,398 |
$3K |
| 84100 |
|
2,266 |
2,089 |
$3K |
| 86706 |
|
435 |
425 |
$2K |
| J2405 |
Ondansetron hcl injection |
17,325 |
15,814 |
$2K |
| 97010 |
|
199 |
102 |
$2K |
| 0071A |
|
80 |
80 |
$2K |
| 83520 |
|
181 |
172 |
$2K |
| 93798 |
|
81 |
13 |
$2K |
| 85651 |
|
1,004 |
960 |
$2K |
| 97163 |
|
16 |
16 |
$2K |
| 74019 |
|
143 |
142 |
$2K |
| 76819 |
|
44 |
26 |
$2K |
| 84146 |
|
148 |
142 |
$2K |
| 72040 |
|
106 |
106 |
$2K |
| 87088 |
|
927 |
908 |
$2K |
| 85652 |
|
2,424 |
2,282 |
$2K |
| 85379 |
|
3,850 |
3,789 |
$2K |
| 87522 |
Neg quan hep c or qual rna |
51 |
51 |
$2K |
| 82947 |
|
1,849 |
1,435 |
$2K |
| 87070 |
|
1,713 |
1,632 |
$2K |
| 83001 |
|
115 |
115 |
$2K |
| J2930 |
Methylprednisolone injection |
1,589 |
1,443 |
$2K |
| 0124A |
|
116 |
115 |
$2K |
| 86695 |
|
261 |
253 |
$2K |
| 73560 |
|
173 |
170 |
$2K |
| 83002 |
|
98 |
98 |
$2K |
| 94640 |
|
2,783 |
2,550 |
$2K |
| 99221 |
|
27 |
26 |
$1K |
| 81329 |
|
13 |
13 |
$1K |
| 86200 |
|
142 |
138 |
$1K |
| 96110 |
|
12 |
12 |
$1K |
| H0014 |
Alcohol and/or drug services |
12 |
12 |
$1K |
| 84425 |
|
78 |
74 |
$1K |
| 99381 |
|
12 |
12 |
$1K |
| 99001 |
|
195 |
123 |
$1K |
| 85730 |
|
3,273 |
3,153 |
$1K |
| 73590 |
|
639 |
621 |
$1K |
| 81002 |
|
3,188 |
2,508 |
$1K |
| 99383 |
|
12 |
12 |
$1K |
| 86141 |
|
199 |
197 |
$1K |
| 90480 |
|
133 |
133 |
$1K |
| J2680 |
Fluphenazine decanoate 25 mg |
91 |
24 |
$1K |
| 82950 |
|
289 |
285 |
$1K |
| 84402 |
|
44 |
44 |
$1K |
| 90673 |
|
40 |
40 |
$1K |
| J2310 |
Inj naloxone hydrochloride |
57 |
51 |
$1K |
| 0072A |
|
41 |
41 |
$1K |
| 96368 |
|
35 |
34 |
$1K |
| A9575 |
Inj gadoterate meglumi 0.1ml |
1,708 |
1,680 |
$1K |
| 82248 |
|
355 |
331 |
$1K |
| 83615 |
|
980 |
848 |
$1K |
| 76642 |
|
26 |
26 |
$1K |
| 96376 |
|
4,975 |
3,984 |
$981.71 |
| G0432 |
Eia hiv-1/hiv-2 screen |
61 |
61 |
$975.96 |
| 73080 |
|
728 |
719 |
$953.80 |
| 0064A |
|
47 |
47 |
$934.13 |
| J7030 |
Normal saline solution infus |
15,697 |
14,253 |
$926.55 |
| 82150 |
|
388 |
372 |
$897.82 |
| 97032 |
|
51 |
28 |
$884.37 |
| 94729 |
|
78 |
78 |
$858.80 |
| 83525 |
|
85 |
82 |
$837.16 |
| 94726 |
|
52 |
52 |
$835.39 |
| 83516 |
|
76 |
70 |
$823.29 |
| 91320 |
|
69 |
69 |
$769.65 |
| 0004A |
|
52 |
52 |
$752.35 |
| J1100 |
Dexamethasone sodium phos |
5,091 |
4,644 |
$726.26 |
| 86920 |
|
31 |
26 |
$717.08 |
| 90662 |
|
76 |
76 |
$699.05 |
| 90685 |
|
39 |
39 |
$678.30 |
| 82105 |
|
88 |
86 |
$625.35 |
| 71101 |
|
144 |
143 |
$612.80 |
| J7050 |
Normal saline solution infus |
2,063 |
1,583 |
$595.54 |
| 83605 |
|
6,496 |
5,851 |
$592.31 |
| 87633 |
|
13 |
13 |
$592.13 |
| 87040 |
|
3,884 |
3,012 |
$577.48 |
| 92250 |
|
14 |
14 |
$576.30 |
| 87147 |
|
301 |
295 |
$558.06 |
| 0054A |
|
30 |
30 |
$554.95 |
| 94010 |
|
14 |
14 |
$540.76 |
| G0008 |
Admin influenza virus vac |
126 |
126 |
$539.78 |
| 87205 |
|
778 |
722 |
$502.99 |
| 94664 |
|
856 |
827 |
$473.87 |
| 86225 |
|
73 |
69 |
$464.33 |
| 90619 |
|
28 |
28 |
$453.34 |
| 84156 |
|
243 |
221 |
$445.63 |
| 87210 |
|
393 |
376 |
$420.60 |
| 72070 |
|
24 |
24 |
$420.03 |
| 70360 |
|
25 |
25 |
$416.21 |
| 73090 |
|
342 |
330 |
$400.42 |
| 85014 |
|
1,228 |
1,178 |
$390.02 |
| 36591 |
|
103 |
66 |
$389.58 |
| 88341 |
|
25 |
25 |
$365.05 |
| 85007 |
|
1,718 |
1,569 |
$357.32 |
| G2211 |
Complex e/m visit add on |
41 |
41 |
$343.47 |
| J0736 |
Inj, clindamycin phosp 300mg |
160 |
151 |
$313.12 |
| S0077 |
Injection, clindamycin phosp |
132 |
124 |
$294.79 |
| J2919 |
Inj, methylpred sod succ 5mg |
266 |
227 |
$293.25 |
| 86665 |
|
13 |
13 |
$290.24 |
| 99441 |
|
14 |
13 |
$279.22 |
| 90621 |
|
12 |
12 |
$263.59 |
| 87804 |
|
792 |
640 |
$263.24 |
| J1200 |
Diphenhydramine hcl injectio |
7,939 |
7,368 |
$251.31 |
| P9604 |
One-way allow prorated trip |
68 |
29 |
$237.12 |
| 87581 |
|
13 |
13 |
$236.52 |
| J7120 |
Ringers lactate infusion |
9,016 |
8,381 |
$230.05 |
| 71100 |
|
26 |
26 |
$219.23 |
| S0028 |
Injection, famotidine, 20 mg |
548 |
515 |
$218.72 |
| J3475 |
Inj magnesium sulfate |
1,645 |
1,483 |
$214.23 |
| C1769 |
Guide wire |
387 |
381 |
$205.04 |
| 86376 |
|
13 |
13 |
$198.82 |
| J2543 |
Piperacillin/tazobactam |
933 |
739 |
$193.28 |
| J7040 |
Normal saline solution infus |
626 |
597 |
$186.78 |
| 86308 |
|
717 |
708 |
$184.55 |
| 86800 |
|
12 |
12 |
$182.28 |
| J0696 |
Ceftriaxone sodium injection |
4,252 |
4,051 |
$177.32 |
| 73660 |
|
50 |
50 |
$166.44 |
| J3480 |
Inj potassium chloride |
478 |
338 |
$160.90 |
| 80348 |
|
196 |
188 |
$160.50 |
| J2270 |
Morphine sulfate injection |
6,462 |
5,545 |
$145.31 |
| 82247 |
|
266 |
251 |
$139.23 |
| S0020 |
Injection, bupivicaine hydro |
277 |
277 |
$138.54 |
| 86300 |
|
14 |
13 |
$126.21 |
| 80362 |
|
488 |
470 |
$124.45 |
| 82270 |
|
139 |
130 |
$124.07 |
| 84436 |
|
108 |
102 |
$122.82 |
| 86664 |
|
12 |
12 |
$122.32 |
| 99358 |
Prolong nursin fac eval 15m |
546 |
540 |
$112.58 |
| 84480 |
|
14 |
14 |
$111.28 |
| A9552 |
F18 fdg |
15 |
15 |
$106.10 |
| J2704 |
Inj, propofol, 10 mg |
5,044 |
4,986 |
$101.94 |
| 87641 |
|
12 |
12 |
$98.59 |
| 82040 |
|
273 |
265 |
$96.45 |
| 72170 |
|
92 |
91 |
$95.08 |
| 86364 |
|
16 |
16 |
$94.55 |
| 86334 |
|
21 |
12 |
$90.70 |
| 87185 |
|
36 |
35 |
$88.99 |
| 80164 |
|
24 |
24 |
$85.23 |
| 84132 |
|
767 |
744 |
$82.81 |
| 80354 |
|
410 |
395 |
$79.74 |
| 80177 |
|
37 |
37 |
$79.72 |
| 87207 |
|
465 |
464 |
$78.43 |
| 84460 |
|
81 |
81 |
$77.34 |
| 86735 |
|
12 |
12 |
$77.25 |
| 86666 |
|
33 |
18 |
$66.16 |
| J1170 |
Hydromorphone injection |
3,265 |
2,831 |
$60.11 |
| 84450 |
|
43 |
43 |
$55.48 |
| 86704 |
|
13 |
13 |
$54.09 |
| J1885 |
Ketorolac tromethamine inj |
14,730 |
13,920 |
$52.09 |
| 84165 |
|
24 |
14 |
$48.70 |
| J0690 |
Cefazolin sodium injection |
3,122 |
2,855 |
$46.00 |
| 82140 |
|
13 |
13 |
$43.71 |
| 87075 |
|
55 |
55 |
$42.23 |
| J3010 |
Fentanyl citrate injection |
9,515 |
9,341 |
$40.77 |
| J0171 |
Adrenalin epinephrine inject |
195 |
189 |
$34.32 |
| J2765 |
Metoclopramide hcl injection |
4,850 |
4,509 |
$31.87 |
| 82565 |
|
26 |
26 |
$31.86 |
| J3301 |
Triamcinolone acet inj nos |
56 |
53 |
$30.47 |
| 73620 |
|
14 |
12 |
$30.00 |
| C1894 |
Intro/sheath, non-laser |
226 |
224 |
$29.69 |
| J1790 |
Droperidol injection |
1,014 |
905 |
$29.20 |
| 80320 |
|
988 |
920 |
$28.75 |
| 82803 |
|
332 |
325 |
$28.35 |
| 84155 |
|
185 |
178 |
$26.76 |
| 87073 |
|
97 |
96 |
$26.08 |
| J2250 |
Inj midazolam hydrochloride |
9,878 |
9,664 |
$25.71 |
| J1644 |
Inj heparin sodium per 1000u |
416 |
305 |
$24.31 |
| J0574 |
Bupren/nal 6.1 to 10mg bupre |
14 |
12 |
$23.03 |
| 82272 |
|
26 |
26 |
$15.69 |
| J3370 |
Vancomycin hcl injection |
535 |
442 |
$15.50 |
| 84075 |
|
90 |
89 |
$14.59 |
| 81015 |
|
829 |
792 |
$13.04 |
| J7620 |
Albuterol ipratrop non-comp |
387 |
334 |
$12.91 |
| J2710 |
Neostigmine methylslfte inj |
543 |
540 |
$12.48 |
| 82310 |
|
80 |
79 |
$11.42 |
| 83721 |
|
42 |
42 |
$10.50 |
| J0780 |
Prochlorperazine injection |
833 |
794 |
$8.97 |
| 81000 |
|
81 |
69 |
$8.14 |
| 80329 |
|
205 |
197 |
$8.02 |
| 82962 |
|
274 |
265 |
$7.47 |
| J1650 |
Inj enoxaparin sodium |
1,015 |
565 |
$6.72 |
| J2060 |
Lorazepam injection |
2,733 |
2,426 |
$6.54 |
| A9270 |
Non-covered item or service |
192 |
152 |
$6.36 |
| J1815 |
Insulin injection |
633 |
436 |
$5.21 |
| J1630 |
Haloperidol injection |
831 |
784 |
$4.83 |
| J0330 |
Succinycholine chloride inj |
469 |
466 |
$2.30 |
| J7512 |
Prednisone ir or dr oral 1mg |
1,817 |
1,737 |
$2.19 |
| 73060 |
|
42 |
39 |
$0.14 |
| J2371 |
Inj phenylephrine hcl 20 mcg |
13 |
13 |
$0.13 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
268 |
246 |
$0.09 |
| C9113 |
Inj pantoprazole sodium, via |
140 |
93 |
$0.00 |
| J1596 |
Inj, glycopyrrolate, 0.1 mg |
126 |
126 |
$0.00 |
| G9920 |
Scrning perf and negative |
431 |
427 |
$0.00 |
| 3078F |
|
6,234 |
6,061 |
$0.00 |
| 99354 |
|
12 |
12 |
$0.00 |
| 99359 |
Prolong nursin fac eval 15m |
206 |
204 |
$0.00 |
| J1953 |
Levetiracetam injection |
70 |
52 |
$0.00 |
| 87400 |
|
32 |
16 |
$0.00 |
| J0670 |
Inj mepivacaine hcl/10 ml |
58 |
58 |
$0.00 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
75 |
63 |
$0.00 |
| 97012 |
|
28 |
12 |
$0.00 |
| 91300 |
|
90 |
88 |
$0.00 |
| S9401 |
Anticoag clinic per session |
241 |
166 |
$0.00 |
| 3077F |
|
27 |
27 |
$0.00 |
| J7510 |
Prednisolone oral per 5 mg |
26 |
26 |
$0.00 |
| C1758 |
Catheter, ureteral |
12 |
12 |
$0.00 |
| J0295 |
Ampicillin sulbactam 1.5 gm |
16 |
15 |
$0.00 |
| A4312 |
Cath w/o bag 2-way silicone |
12 |
12 |
$0.00 |
| J0692 |
Cefepime hcl for injection |
21 |
13 |
$0.00 |
| 3074F |
|
8,287 |
8,033 |
$0.00 |
| 3008F |
|
3,923 |
3,875 |
$0.00 |
| 3079F |
|
1,434 |
1,400 |
$0.00 |
| 3075F |
|
145 |
143 |
$0.00 |
| 90474 |
|
43 |
43 |
$0.00 |
| J2795 |
Ropivacaine hcl injection |
160 |
160 |
$0.00 |
| 3044F |
|
698 |
662 |
$0.00 |
| J7613 |
Albuterol non-comp unit |
181 |
168 |
$0.00 |
| J1940 |
Furosemide injection |
14 |
13 |
$0.00 |
| 3080F |
|
14 |
14 |
$0.00 |
| J3360 |
Diazepam injection |
14 |
14 |
$0.00 |
| 1220F |
|
56 |
56 |
$0.00 |
| 91301 |
|
87 |
85 |
$0.00 |
| A4344 |
Cath indw foley 2 way silicn |
12 |
12 |
$0.00 |
| 87807 |
|
19 |
19 |
$0.00 |
| J0456 |
Azithromycin |
12 |
12 |
$0.00 |