| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 87633 |
|
15,068 |
14,032 |
$7.16M |
| 41899 |
|
3,943 |
3,863 |
$3.84M |
| 99284 |
|
9,783 |
9,075 |
$3.38M |
| 99213 |
|
38,769 |
33,601 |
$2.28M |
| 82306 |
|
74,786 |
73,166 |
$1.81M |
| U0003 |
Cov-19 amp prb hgh thruput |
16,354 |
15,688 |
$1.76M |
| 80050 |
|
27,776 |
27,165 |
$1.69M |
| 99285 |
|
5,414 |
4,776 |
$1.51M |
| 76816 |
|
10,728 |
8,438 |
$1.49M |
| U0002 |
Covid-19 lab test non-cdc |
20,607 |
19,217 |
$1.35M |
| 80061 |
|
116,723 |
114,199 |
$1.34M |
| 99214 |
|
18,168 |
16,578 |
$1.28M |
| 84443 |
|
92,326 |
89,838 |
$1.27M |
| 87491 |
|
30,758 |
29,962 |
$1.21M |
| 87591 |
|
30,610 |
29,822 |
$1.20M |
| 43239 |
|
2,822 |
2,741 |
$1.20M |
| 76819 |
|
11,365 |
8,090 |
$1.17M |
| 80053 |
|
138,601 |
129,221 |
$1.12M |
| 97110 |
|
25,105 |
5,482 |
$1.09M |
| 87581 |
|
21,347 |
19,828 |
$944K |
| 87486 |
|
21,330 |
19,817 |
$943K |
| 87798 |
|
35,558 |
19,437 |
$818K |
| 86850 |
|
25,369 |
24,245 |
$762K |
| 87631 |
|
4,072 |
3,676 |
$744K |
| 76811 |
|
5,466 |
4,925 |
$721K |
| 83036 |
|
77,539 |
75,552 |
$610K |
| 85025 |
|
102,735 |
92,952 |
$597K |
| 76820 |
|
10,517 |
6,893 |
$591K |
| 86703 |
|
37,147 |
36,006 |
$568K |
| 86780 |
|
38,238 |
36,778 |
$562K |
| 80307 |
|
9,413 |
8,912 |
$530K |
| 84439 |
|
58,923 |
57,442 |
$522K |
| 88175 |
|
17,929 |
17,708 |
$521K |
| 97140 |
|
15,966 |
4,029 |
$473K |
| 97112 |
|
16,934 |
4,263 |
$457K |
| 87502 |
|
4,013 |
3,616 |
$430K |
| 99283 |
|
7,384 |
6,844 |
$415K |
| U0005 |
Infec agen detec ampli probe |
12,018 |
11,569 |
$394K |
| 87088 |
|
49,940 |
47,263 |
$391K |
| 83525 |
|
28,427 |
27,681 |
$386K |
| G0378 |
Hospital observation per hr |
2,432 |
2,085 |
$363K |
| 87340 |
|
33,199 |
32,256 |
$348K |
| 87804 |
|
15,031 |
7,448 |
$329K |
| 86003 |
|
4,338 |
1,987 |
$313K |
| 74177 |
|
1,500 |
1,422 |
$298K |
| 85027 |
|
50,231 |
47,545 |
$287K |
| 86762 |
|
18,145 |
17,742 |
$282K |
| 87624 |
|
8,162 |
8,070 |
$279K |
| 99204 |
|
3,430 |
3,336 |
$262K |
| 93306 |
|
2,774 |
2,717 |
$259K |
| 96413 |
|
2,969 |
1,681 |
$258K |
| 76770 |
|
2,352 |
2,304 |
$258K |
| 76817 |
|
3,103 |
2,570 |
$256K |
| 87507 |
|
693 |
667 |
$245K |
| 87070 |
|
23,089 |
20,775 |
$239K |
| 84480 |
|
15,227 |
14,883 |
$225K |
| 76700 |
|
2,170 |
2,142 |
$215K |
| 92588 |
|
2,384 |
2,286 |
$208K |
| 87880 |
|
9,235 |
9,050 |
$205K |
| G0463 |
Hospital outpt clinic visit |
35,214 |
29,031 |
$194K |
| 82105 |
|
10,557 |
10,247 |
$185K |
| 87498 |
|
4,058 |
3,665 |
$183K |
| 84481 |
|
11,249 |
10,997 |
$180K |
| 45380 |
|
504 |
472 |
$167K |
| 82607 |
|
18,252 |
17,844 |
$161K |
| 90834 |
|
2,285 |
1,766 |
$159K |
| 86738 |
|
9,352 |
6,068 |
$156K |
| 87635 |
|
5,563 |
5,110 |
$153K |
| 0002A |
|
4,218 |
4,051 |
$151K |
| 99203 |
|
2,329 |
2,251 |
$144K |
| 92567 |
|
4,562 |
4,416 |
$140K |
| 74270 |
|
587 |
580 |
$136K |
| 84702 |
|
8,319 |
6,576 |
$132K |
| 87503 |
|
4,013 |
3,616 |
$131K |
| 76818 |
|
1,025 |
763 |
$130K |
| 69436 |
|
232 |
206 |
$122K |
| 87800 |
|
2,649 |
2,576 |
$118K |
| 0001A |
|
3,253 |
3,052 |
$114K |
| 70450 |
|
1,988 |
1,900 |
$110K |
| 77067 |
|
2,825 |
2,798 |
$110K |
| 83516 |
|
5,042 |
3,403 |
$110K |
| 74246 |
|
526 |
523 |
$109K |
| 76801 |
|
1,064 |
941 |
$108K |
| 51702 |
|
932 |
810 |
$108K |
| 90832 |
|
2,834 |
2,016 |
$108K |
| 76641 |
|
1,109 |
1,039 |
$105K |
| 97530 |
|
5,605 |
1,518 |
$103K |
| 97162 |
|
1,513 |
1,452 |
$103K |
| 84436 |
|
25,765 |
25,209 |
$101K |
| 88142 |
|
4,525 |
4,460 |
$100K |
| Q3014 |
Telehealth facility fee |
4,359 |
4,178 |
$97K |
| 74018 |
|
2,471 |
2,425 |
$96K |
| 87081 |
|
12,123 |
11,864 |
$93K |
| 74176 |
|
860 |
834 |
$93K |
| 93005 |
|
7,579 |
6,604 |
$92K |
| 77063 |
|
2,819 |
2,792 |
$91K |
| 84403 |
|
4,047 |
3,958 |
$91K |
| 82728 |
|
9,803 |
9,419 |
$91K |
| 83970 |
|
3,794 |
3,652 |
$87K |
| 71045 |
|
4,829 |
4,424 |
$85K |
| 66984 |
|
492 |
411 |
$83K |
| 87807 |
|
4,883 |
4,434 |
$83K |
| 80048 |
|
18,980 |
16,854 |
$80K |
| 86900 |
|
24,947 |
23,807 |
$78K |
| 70553 |
|
265 |
260 |
$78K |
| 30901 |
|
118 |
116 |
$77K |
| 86901 |
|
24,927 |
23,792 |
$77K |
| 86318 |
|
2,908 |
2,872 |
$74K |
| 86787 |
|
5,313 |
5,064 |
$73K |
| 71046 |
|
3,052 |
2,888 |
$73K |
| 76536 |
|
764 |
749 |
$73K |
| 82746 |
|
8,691 |
8,505 |
$73K |
| 76705 |
|
829 |
780 |
$72K |
| 81001 |
|
37,487 |
35,012 |
$72K |
| 86803 |
|
6,526 |
6,377 |
$72K |
| 83013 |
|
1,229 |
1,183 |
$71K |
| 92557 |
|
1,276 |
1,259 |
$68K |
| 76856 |
|
637 |
620 |
$68K |
| 52000 |
|
403 |
395 |
$68K |
| 0071A |
|
1,465 |
1,407 |
$63K |
| 83001 |
|
3,464 |
3,375 |
$62K |
| 84146 |
|
3,060 |
2,989 |
$56K |
| 78815 |
|
87 |
83 |
$56K |
| 78452 |
|
681 |
651 |
$55K |
| 87077 |
|
10,124 |
8,799 |
$53K |
| 83655 |
|
3,412 |
3,293 |
$52K |
| 90792 |
|
490 |
484 |
$49K |
| 86376 |
|
3,289 |
3,222 |
$49K |
| A9500 |
Tc99m sestamibi |
722 |
692 |
$48K |
| 83002 |
|
2,539 |
2,462 |
$48K |
| 69210 |
|
1,100 |
937 |
$48K |
| 80076 |
|
8,317 |
8,077 |
$48K |
| 0072A |
|
1,042 |
1,010 |
$48K |
| 70551 |
|
279 |
271 |
$47K |
| 99212 |
|
984 |
852 |
$45K |
| 96450 |
|
219 |
193 |
$45K |
| 93925 |
|
559 |
541 |
$44K |
| 93970 |
|
667 |
637 |
$44K |
| 71260 |
|
459 |
430 |
$44K |
| 99282 |
|
1,052 |
998 |
$44K |
| 82670 |
|
1,678 |
1,644 |
$43K |
| 42820 |
|
13 |
13 |
$42K |
| 82627 |
|
2,256 |
2,214 |
$42K |
| 82677 |
|
1,485 |
1,446 |
$41K |
| 86696 |
|
2,235 |
1,641 |
$40K |
| 87186 |
|
8,202 |
7,048 |
$39K |
| 82785 |
|
2,127 |
1,995 |
$39K |
| 84270 |
|
1,896 |
1,858 |
$37K |
| 83735 |
|
12,382 |
11,039 |
$37K |
| 82570 |
|
14,486 |
12,979 |
$36K |
| 86140 |
|
8,053 |
7,725 |
$36K |
| 76815 |
|
424 |
383 |
$35K |
| 90791 |
|
262 |
258 |
$34K |
| 82950 |
|
6,035 |
5,903 |
$33K |
| 0003A |
|
1,720 |
1,671 |
$33K |
| 82947 |
|
7,709 |
7,406 |
$33K |
| 93880 |
|
642 |
623 |
$32K |
| 82784 |
|
3,190 |
2,861 |
$31K |
| G0480 |
Drug test def 1-7 classes |
709 |
582 |
$30K |
| 87625 |
|
884 |
868 |
$30K |
| 93017 |
|
1,184 |
1,134 |
$30K |
| 93458 |
|
89 |
76 |
$30K |
| 85730 |
|
11,438 |
9,946 |
$29K |
| 90833 |
|
828 |
795 |
$29K |
| 86800 |
|
1,491 |
1,433 |
$29K |
| 86695 |
|
2,238 |
1,640 |
$29K |
| 84460 |
|
4,440 |
4,332 |
$29K |
| 71250 |
|
649 |
637 |
$27K |
| 73560 |
|
1,214 |
1,032 |
$27K |
| 86336 |
|
1,527 |
1,488 |
$27K |
| 82140 |
|
2,307 |
2,186 |
$27K |
| 85610 |
|
13,515 |
11,832 |
$27K |
| 83880 |
|
2,731 |
2,594 |
$27K |
| 88313 |
|
705 |
568 |
$27K |
| 84153 |
|
4,400 |
4,317 |
$26K |
| 88305 |
|
2,375 |
1,926 |
$26K |
| 83540 |
|
7,616 |
7,380 |
$26K |
| 86225 |
|
2,747 |
2,665 |
$26K |
| 87480 |
|
1,333 |
1,274 |
$25K |
| 84450 |
|
3,896 |
3,799 |
$25K |
| 84484 |
|
3,861 |
3,166 |
$25K |
| 87510 |
|
1,333 |
1,274 |
$24K |
| 87660 |
|
1,333 |
1,274 |
$24K |
| 83498 |
|
714 |
694 |
$24K |
| 73721 |
|
69 |
69 |
$24K |
| 77066 |
Tomosynthesis, mammo |
488 |
482 |
$24K |
| 80069 |
|
5,207 |
4,995 |
$23K |
| 83550 |
|
5,993 |
5,790 |
$23K |
| 86038 |
|
2,845 |
2,666 |
$23K |
| 86769 |
|
418 |
230 |
$23K |
| J0696 |
Ceftriaxone sodium injection |
1,580 |
1,185 |
$23K |
| 82043 |
|
10,701 |
10,059 |
$23K |
| 82310 |
|
6,057 |
5,793 |
$22K |
| 76825 |
|
82 |
66 |
$22K |
| 82274 |
|
1,888 |
1,532 |
$22K |
| 85652 |
|
10,877 |
10,532 |
$22K |
| 77072 |
|
614 |
609 |
$22K |
| 84550 |
|
10,181 |
9,792 |
$21K |
| 96417 |
|
467 |
301 |
$20K |
| 87426 |
|
930 |
873 |
$20K |
| 87653 |
|
558 |
534 |
$20K |
| 84156 |
|
7,992 |
7,465 |
$19K |
| 49083 |
|
218 |
121 |
$19K |
| 84482 |
|
924 |
900 |
$19K |
| 80051 |
|
2,841 |
2,722 |
$19K |
| 72148 |
|
192 |
190 |
$19K |
| 99215 |
Prolong outpt/office vis |
209 |
170 |
$18K |
| 72125 |
|
301 |
293 |
$18K |
| 72100 |
|
675 |
648 |
$18K |
| 82247 |
|
3,295 |
2,879 |
$18K |
| 82951 |
|
1,362 |
1,314 |
$18K |
| 82565 |
|
5,114 |
4,553 |
$18K |
| 73562 |
|
772 |
714 |
$18K |
| 97803 |
|
1,597 |
1,561 |
$17K |
| 84479 |
|
4,758 |
4,673 |
$17K |
| 83690 |
|
3,512 |
3,316 |
$17K |
| 87040 |
|
1,731 |
1,290 |
$16K |
| 96409 |
|
119 |
110 |
$16K |
| 93975 |
|
68 |
67 |
$16K |
| 0054A |
|
417 |
404 |
$16K |
| 77080 |
|
937 |
929 |
$15K |
| 73030 |
|
808 |
743 |
$14K |
| 83605 |
|
2,201 |
1,887 |
$14K |
| 84703 |
|
2,062 |
1,902 |
$14K |
| 51798 |
|
1,214 |
1,106 |
$14K |
| 84144 |
|
761 |
648 |
$14K |
| J1756 |
Iron sucrose injection |
189 |
103 |
$13K |
| 86704 |
|
1,723 |
1,693 |
$13K |
| 76821 |
|
151 |
80 |
$13K |
| 84075 |
|
1,953 |
1,899 |
$13K |
| 96415 |
|
294 |
194 |
$13K |
| 82040 |
|
1,937 |
1,876 |
$12K |
| 86008 |
|
141 |
135 |
$12K |
| 82248 |
|
3,107 |
2,689 |
$12K |
| J2785 |
Regadenoson injection |
810 |
780 |
$11K |
| 84466 |
|
865 |
844 |
$11K |
| 87899 |
|
758 |
359 |
$11K |
| 73100 |
|
429 |
296 |
$11K |
| 93971 |
|
191 |
183 |
$11K |
| 20610 |
|
607 |
464 |
$11K |
| 82397 |
|
634 |
630 |
$11K |
| 96365 |
|
2,270 |
1,189 |
$10K |
| 86141 |
|
1,152 |
1,130 |
$10K |
| 84520 |
|
2,174 |
2,115 |
$10K |
| 72170 |
|
635 |
605 |
$10K |
| 0202U |
|
5,021 |
4,718 |
$9K |
| 84155 |
|
2,016 |
1,960 |
$9K |
| 86794 |
|
445 |
439 |
$9K |
| 81025 |
|
1,231 |
1,145 |
$9K |
| 36430 |
|
189 |
132 |
$9K |
| 86592 |
|
2,083 |
2,038 |
$9K |
| 72110 |
|
326 |
316 |
$9K |
| 83090 |
|
1,228 |
1,204 |
$8K |
| 86709 |
|
1,137 |
1,121 |
$8K |
| 97116 |
|
1,236 |
415 |
$8K |
| 87102 |
|
787 |
774 |
$8K |
| 73610 |
|
269 |
257 |
$8K |
| 99281 |
|
282 |
269 |
$8K |
| 82977 |
|
997 |
981 |
$8K |
| 73502 |
|
321 |
296 |
$8K |
| 95886 |
|
36 |
36 |
$7K |
| 82626 |
|
237 |
231 |
$7K |
| 86304 |
|
422 |
370 |
$7K |
| 84305 |
|
298 |
293 |
$7K |
| 73630 |
|
293 |
280 |
$7K |
| 73130 |
|
319 |
284 |
$7K |
| 76827 |
|
97 |
80 |
$7K |
| J1642 |
Inj heparin sodium per 10 u |
2,644 |
1,572 |
$7K |
| 76830 |
|
73 |
65 |
$7K |
| 31231 |
|
25 |
25 |
$7K |
| 74178 |
|
55 |
55 |
$7K |
| 81003 |
|
3,993 |
3,384 |
$7K |
| 82150 |
|
1,440 |
1,392 |
$6K |
| J0885 |
Epoetin alfa, non-esrd |
164 |
77 |
$6K |
| 82533 |
|
424 |
379 |
$6K |
| 85014 |
|
3,192 |
2,621 |
$6K |
| 97597 |
|
119 |
113 |
$6K |
| 88108 |
|
124 |
112 |
$6K |
| 85018 |
|
2,446 |
2,313 |
$6K |
| 87662 |
|
88 |
86 |
$6K |
| 72082 |
|
63 |
62 |
$6K |
| 86431 |
|
1,693 |
1,654 |
$6K |
| 83615 |
|
1,207 |
1,066 |
$5K |
| 86160 |
|
638 |
321 |
$5K |
| J1100 |
Dexamethasone sodium phos |
2,363 |
1,604 |
$5K |
| 0081A |
|
132 |
129 |
$5K |
| 87147 |
|
983 |
930 |
$5K |
| 99291 |
|
18 |
17 |
$5K |
| 84100 |
|
3,122 |
2,525 |
$5K |
| 85007 |
|
5,877 |
4,945 |
$5K |
| 87073 |
|
1,029 |
795 |
$5K |
| 45385 |
|
53 |
49 |
$4K |
| 82952 |
|
1,131 |
1,076 |
$4K |
| 73110 |
|
218 |
188 |
$4K |
| 90471 |
|
193 |
183 |
$4K |
| 86480 |
|
167 |
165 |
$4K |
| 84154 |
|
701 |
695 |
$4K |
| 87205 |
|
1,687 |
1,551 |
$4K |
| J2405 |
Ondansetron hcl injection |
5,762 |
4,404 |
$4K |
| J7050 |
Normal saline solution infus |
2,128 |
1,445 |
$4K |
| 0074A |
|
98 |
98 |
$4K |
| 87045 |
|
446 |
407 |
$4K |
| 86706 |
|
435 |
423 |
$3K |
| 97163 |
|
113 |
109 |
$3K |
| 86200 |
|
765 |
756 |
$3K |
| 83519 |
|
154 |
151 |
$3K |
| 94640 |
|
149 |
94 |
$3K |
| J7030 |
Normal saline solution infus |
2,226 |
1,835 |
$3K |
| G0279 |
Tomosynthesis, mammo |
254 |
252 |
$3K |
| 0124A |
|
150 |
145 |
$3K |
| P9016 |
Rbc leukocytes reduced |
29 |
24 |
$3K |
| J0690 |
Cefazolin sodium injection |
2,034 |
1,566 |
$3K |
| G0257 |
Unsched dialysis esrd pt hos |
50 |
12 |
$3K |
| 82550 |
|
815 |
744 |
$3K |
| J1644 |
Inj heparin sodium per 1000u |
2,253 |
1,330 |
$3K |
| J2270 |
Morphine sulfate injection |
2,466 |
2,003 |
$3K |
| J0702 |
Betamethasone acet&sod phosp |
169 |
105 |
$2K |
| 11042 |
|
39 |
34 |
$2K |
| 86923 |
|
61 |
50 |
$2K |
| 93923 |
|
78 |
78 |
$2K |
| 97161 |
|
113 |
93 |
$2K |
| 31575 |
|
12 |
12 |
$2K |
| 0082A |
|
59 |
58 |
$2K |
| 82378 |
|
318 |
275 |
$2K |
| 96361 |
|
395 |
335 |
$2K |
| J7120 |
Ringers lactate infusion |
513 |
400 |
$2K |
| 80197 |
|
1,603 |
1,068 |
$2K |
| 89051 |
|
341 |
306 |
$2K |
| J1453 |
Fosaprepitant injection |
24 |
15 |
$2K |
| 86235 |
|
229 |
75 |
$2K |
| 87220 |
|
428 |
422 |
$2K |
| 85378 |
|
514 |
479 |
$2K |
| J9370 |
Vincristine sulfate 1 mg inj |
86 |
84 |
$2K |
| 90837 |
|
26 |
25 |
$2K |
| 83520 |
|
182 |
178 |
$2K |
| J3010 |
Fentanyl citrate injection |
3,540 |
3,034 |
$2K |
| 95816 |
|
15 |
15 |
$2K |
| J1885 |
Ketorolac tromethamine inj |
1,628 |
1,346 |
$2K |
| 85045 |
|
938 |
915 |
$2K |
| 87493 |
|
46 |
44 |
$2K |
| 96523 |
|
65 |
53 |
$2K |
| 87177 |
|
245 |
197 |
$2K |
| 96375 |
|
816 |
678 |
$2K |
| 78306 |
|
12 |
12 |
$1K |
| 96374 |
|
2,338 |
2,025 |
$1K |
| P9046 |
Albumin (human), 25%, 20 ml |
53 |
29 |
$1K |
| 85384 |
|
131 |
116 |
$1K |
| 94761 |
|
94 |
86 |
$1K |
| 96367 |
|
554 |
286 |
$1K |
| J0360 |
Hydralazine hcl injection |
406 |
329 |
$1K |
| J2250 |
Inj midazolam hydrochloride |
3,860 |
3,253 |
$1K |
| 77065 |
Tomosynthesis, mammo |
52 |
52 |
$1K |
| 0052A |
|
35 |
34 |
$1K |
| 87338 |
|
143 |
143 |
$1K |
| 72070 |
|
68 |
66 |
$1K |
| 86317 |
|
128 |
124 |
$1K |
| 87799 |
|
299 |
225 |
$1K |
| 76813 |
|
13 |
12 |
$1K |
| 88312 |
|
578 |
482 |
$1K |
| J3475 |
Inj magnesium sulfate |
160 |
107 |
$1K |
| 86308 |
|
226 |
198 |
$1K |
| 73090 |
|
27 |
26 |
$1K |
| 96366 |
|
277 |
185 |
$1K |
| 76937 |
|
105 |
91 |
$1K |
| 72080 |
|
45 |
43 |
$1K |
| 82542 |
|
39 |
25 |
$968.86 |
| Q5105 |
Inj retacrit esrd on dialysi |
297 |
106 |
$946.26 |
| 87350 |
|
61 |
61 |
$905.69 |
| J1200 |
Diphenhydramine hcl injectio |
1,043 |
708 |
$870.88 |
| 85055 |
|
43 |
24 |
$864.41 |
| 76000 |
|
57 |
54 |
$848.48 |
| 88304 |
|
65 |
55 |
$807.63 |
| 84145 |
|
26 |
25 |
$792.97 |
| 87184 |
|
135 |
83 |
$744.14 |
| 86060 |
|
90 |
88 |
$724.90 |
| 96360 |
|
40 |
38 |
$711.71 |
| 70220 |
|
13 |
12 |
$657.32 |
| 82330 |
|
44 |
40 |
$647.47 |
| 82962 |
|
12,538 |
6,867 |
$621.00 |
| J2710 |
Neostigmine methylslfte inj |
400 |
343 |
$601.38 |
| 96372 |
|
1,864 |
1,172 |
$591.31 |
| 0154A |
|
16 |
15 |
$583.85 |
| 97802 |
|
80 |
76 |
$570.09 |
| 94760 |
|
57 |
42 |
$561.22 |
| J7040 |
Normal saline solution infus |
2,433 |
2,167 |
$551.87 |
| 87107 |
|
41 |
39 |
$522.10 |
| 75716 |
|
14 |
13 |
$497.06 |
| 80185 |
|
105 |
96 |
$457.80 |
| 51797 |
|
13 |
12 |
$455.01 |
| 72040 |
|
24 |
24 |
$450.48 |
| 84425 |
|
37 |
37 |
$447.87 |
| 88341 |
|
82 |
31 |
$413.37 |
| J2543 |
Piperacillin/tazobactam |
58 |
39 |
$412.69 |
| 86665 |
|
26 |
13 |
$402.24 |
| 72050 |
|
13 |
12 |
$383.13 |
| 77336 |
|
28 |
12 |
$379.65 |
| 76805 |
|
14 |
12 |
$361.56 |
| 73140 |
|
22 |
15 |
$355.74 |
| 82575 |
|
39 |
39 |
$345.83 |
| 88342 |
|
93 |
77 |
$312.98 |
| 51705 |
|
14 |
12 |
$308.36 |
| 87209 |
|
20 |
15 |
$300.00 |
| 87185 |
|
56 |
53 |
$299.11 |
| 87425 |
|
17 |
17 |
$269.73 |
| 73080 |
|
14 |
13 |
$269.34 |
| 36600 |
|
22 |
12 |
$267.75 |
| 85049 |
|
38 |
38 |
$256.98 |
| A9270 |
Non-covered item or service |
15,161 |
10,949 |
$244.14 |
| 86708 |
|
26 |
26 |
$229.35 |
| J1030 |
Methylprednisolone 40 mg inj |
148 |
129 |
$217.75 |
| 36415 |
|
23,990 |
20,813 |
$210.84 |
| 73552 |
|
15 |
12 |
$200.79 |
| 83921 |
|
76 |
75 |
$173.94 |
| 90686 |
|
12 |
12 |
$170.98 |
| 86664 |
|
13 |
13 |
$169.52 |
| J1815 |
Insulin injection |
915 |
469 |
$146.64 |
| J0171 |
Adrenalin epinephrine inject |
234 |
194 |
$145.38 |
| 86334 |
|
12 |
12 |
$140.19 |
| A9503 |
Tc99m medronate |
12 |
12 |
$136.56 |
| 87075 |
|
57 |
52 |
$136.18 |
| 81015 |
|
49 |
43 |
$130.87 |
| 90715 |
|
14 |
12 |
$108.42 |
| 87497 |
|
128 |
97 |
$93.99 |
| J2765 |
Metoclopramide hcl injection |
48 |
42 |
$93.18 |
| J9260 |
Inj methotrexate sodium 50mg |
20 |
19 |
$89.25 |
| 82103 |
|
12 |
12 |
$85.24 |
| J9250 |
Methotrexate sodium inj |
209 |
183 |
$71.33 |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
2,851 |
2,631 |
$68.37 |
| 91200 |
|
12 |
12 |
$68.26 |
| 83014 |
|
14 |
14 |
$66.90 |
| 81002 |
|
38 |
37 |
$62.36 |
| C1725 |
Cath, translumin non-laser |
85 |
75 |
$55.88 |
| J1170 |
Hydromorphone injection |
38 |
25 |
$46.20 |
| Q9963 |
Hocm 350-399mg/ml iodine,1ml |
400 |
395 |
$42.08 |
| C1894 |
Intro/sheath, non-laser |
1,432 |
1,173 |
$31.48 |
| 84165 |
|
12 |
12 |
$29.08 |
| J1580 |
Garamycin gentamicin inj |
91 |
79 |
$12.77 |
| 84132 |
|
13 |
12 |
$10.76 |
| J2704 |
Inj, propofol, 10 mg |
2,477 |
2,178 |
$6.92 |
| A9575 |
Inj gadoterate meglumi 0.1ml |
753 |
723 |
$0.00 |
| C1887 |
Catheter, guiding |
44 |
38 |
$0.00 |
| 91312 |
|
150 |
145 |
$0.00 |
| A9552 |
F18 fdg |
73 |
72 |
$0.00 |
| 77062 |
|
87 |
85 |
$0.00 |
| Q9966 |
Locm 200-299mg/ml iodine,1ml |
385 |
371 |
$0.00 |
| 91300 |
|
2,532 |
2,403 |
$0.00 |
| J3473 |
Hyaluronidase recombinant |
42 |
39 |
$0.00 |
| C1760 |
Closure dev, vasc |
49 |
40 |
$0.00 |
| 91308 |
|
234 |
220 |
$0.00 |
| 93356 |
|
12 |
12 |
$0.00 |
| J2001 |
Lidocaine injection |
1,874 |
1,629 |
$0.00 |
| G0328 |
Fecal blood scrn immunoassay |
230 |
188 |
$0.00 |
| C1769 |
Guide wire |
1,250 |
1,024 |
$0.00 |
| G0103 |
Psa screening |
1,224 |
1,223 |
$0.00 |
| 91307 |
|
2,710 |
2,266 |
$0.00 |
| C1773 |
Ret dev, insertable |
44 |
39 |
$0.00 |
| 91305 |
|
533 |
516 |
$0.00 |
| 78492 |
|
27 |
26 |
$0.00 |
| 91315 |
|
16 |
15 |
$0.00 |
| J7042 |
5% dextrose/normal saline |
50 |
40 |
$0.00 |
| G0145 |
Scr c/v cyto,thinlayer,rescr |
52 |
52 |
$0.00 |
| J2003 |
Inj, lidocaine hcl, 1 mg |
71 |
60 |
$0.00 |
| A9555 |
Rb82 rubidium |
27 |
26 |
$0.00 |
| 86381 |
|
12 |
12 |
$0.00 |
| J2175 |
Meperidine hydrochl /100 mg |
13 |
13 |
$0.00 |
| J2370 |
Phenylephrine hcl injection |
15 |
12 |
$0.00 |