| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99283 |
|
127,778 |
117,510 |
$14.65M |
| G0463 |
Hospital outpt clinic visit |
165,317 |
134,825 |
$12.96M |
| 96361 |
|
30,694 |
24,625 |
$8.74M |
| 99284 |
|
89,812 |
80,495 |
$7.89M |
| 99282 |
|
28,678 |
27,536 |
$2.89M |
| 99285 |
|
38,854 |
35,222 |
$2.77M |
| 74177 |
|
14,615 |
14,009 |
$2.28M |
| 96365 |
|
21,345 |
12,569 |
$2.09M |
| 97530 |
|
34,891 |
21,070 |
$2.02M |
| G0382 |
Lev 3 hosp type b ed visit |
15,561 |
15,124 |
$1.88M |
| 47562 |
|
810 |
780 |
$1.74M |
| 59025 |
|
11,517 |
8,542 |
$1.71M |
| 42820 |
|
948 |
945 |
$1.61M |
| 96366 |
|
7,426 |
4,121 |
$1.61M |
| 70450 |
|
11,871 |
11,177 |
$1.49M |
| J2357 |
Omalizumab injection |
2,987 |
1,203 |
$1.43M |
| 95810 |
|
2,603 |
2,565 |
$1.39M |
| 96360 |
|
11,731 |
9,204 |
$1.38M |
| 52000 |
|
2,720 |
2,670 |
$1.33M |
| 92507 |
|
21,620 |
12,198 |
$999K |
| 93306 |
|
5,192 |
5,067 |
$895K |
| 76705 |
|
9,624 |
9,159 |
$866K |
| 74176 |
|
5,288 |
5,097 |
$847K |
| 95811 |
|
1,766 |
1,722 |
$701K |
| 44970 |
|
217 |
206 |
$682K |
| 96415 |
|
3,343 |
2,430 |
$677K |
| 69436 |
|
431 |
430 |
$614K |
| G0378 |
Hospital observation per hr |
17,671 |
11,013 |
$611K |
| 12001 |
|
2,881 |
2,837 |
$589K |
| 96367 |
|
7,334 |
4,583 |
$588K |
| 76830 |
|
7,031 |
6,903 |
$579K |
| 43239 |
|
2,075 |
1,954 |
$567K |
| 96413 |
|
10,467 |
6,304 |
$565K |
| 76700 |
|
6,005 |
5,935 |
$559K |
| 77412 |
|
1,652 |
169 |
$543K |
| G0381 |
Lev 2 hosp type b ed visit |
5,138 |
5,041 |
$530K |
| 64483 |
|
1,443 |
1,416 |
$497K |
| 70551 |
|
2,747 |
2,684 |
$480K |
| 76642 |
|
5,228 |
4,991 |
$460K |
| 12011 |
|
1,845 |
1,815 |
$429K |
| 76856 |
|
8,291 |
8,144 |
$398K |
| 70553 |
|
1,780 |
1,749 |
$369K |
| 72148 |
|
3,193 |
3,146 |
$366K |
| 10060 |
|
1,794 |
1,715 |
$360K |
| 80047 |
|
90,318 |
78,246 |
$357K |
| 77063 |
|
8,292 |
8,236 |
$345K |
| 71275 |
|
2,290 |
2,206 |
$337K |
| 97110 |
|
11,812 |
4,753 |
$331K |
| 76805 |
|
4,609 |
4,557 |
$309K |
| 78452 |
|
1,197 |
1,177 |
$303K |
| 76770 |
|
2,714 |
2,667 |
$291K |
| 12002 |
|
1,533 |
1,506 |
$274K |
| 93017 |
|
2,760 |
2,689 |
$260K |
| 92523 |
|
1,941 |
1,927 |
$255K |
| C9803 |
Hopd covid-19 spec collect |
28,042 |
25,782 |
$255K |
| G0383 |
Lev 4 hosp type b ed visit |
2,130 |
2,094 |
$253K |
| 73721 |
|
1,666 |
1,637 |
$247K |
| 29581 |
|
2,490 |
714 |
$247K |
| 76816 |
|
3,729 |
3,553 |
$243K |
| 76815 |
|
5,130 |
4,647 |
$233K |
| J2469 |
Palonosetron hcl |
4,048 |
2,392 |
$231K |
| 76536 |
|
2,691 |
2,648 |
$231K |
| 76801 |
|
4,063 |
3,769 |
$213K |
| J1453 |
Fosaprepitant injection |
2,488 |
1,570 |
$209K |
| 83605 |
|
50,351 |
42,354 |
$209K |
| P9016 |
Rbc leukocytes reduced |
1,038 |
687 |
$203K |
| 45380 |
|
812 |
764 |
$199K |
| 62323 |
|
956 |
938 |
$199K |
| J1745 |
Infliximab not biosimil 10mg |
188 |
180 |
$195K |
| 97140 |
|
9,533 |
4,180 |
$194K |
| 11042 |
|
1,497 |
1,122 |
$187K |
| 92526 |
|
3,594 |
2,599 |
$184K |
| 29125 |
|
1,029 |
991 |
$177K |
| 80053 |
|
36,092 |
29,059 |
$176K |
| 80307 |
|
12,635 |
10,656 |
$174K |
| 99281 |
|
1,546 |
1,493 |
$174K |
| 71046 |
|
17,383 |
16,715 |
$169K |
| 95886 |
|
1,307 |
1,191 |
$167K |
| C8929 |
Tte w or wo fol wcon,doppler |
947 |
927 |
$165K |
| 76870 |
|
1,683 |
1,632 |
$164K |
| 31575 |
|
1,048 |
1,016 |
$161K |
| 93971 |
|
1,844 |
1,788 |
$149K |
| 36430 |
|
1,679 |
1,234 |
$144K |
| 76882 |
|
1,650 |
1,587 |
$139K |
| J0585 |
Injection,onabotulinumtoxina |
828 |
791 |
$135K |
| 78815 |
|
326 |
323 |
$130K |
| 70496 |
|
1,152 |
1,111 |
$130K |
| 72141 |
|
1,183 |
1,167 |
$129K |
| 19083 |
|
212 |
194 |
$126K |
| 71260 |
|
3,598 |
3,512 |
$126K |
| 87633 |
|
1,574 |
1,524 |
$112K |
| 87635 |
|
6,674 |
6,061 |
$111K |
| J9271 |
Inj pembrolizumab |
33 |
26 |
$107K |
| T1002 |
Rn services up to 15 minutes |
1,148 |
894 |
$106K |
| 77336 |
|
2,172 |
924 |
$105K |
| 96523 |
|
2,781 |
1,978 |
$104K |
| 93005 |
|
61,794 |
53,732 |
$104K |
| 20610 |
|
859 |
772 |
$100K |
| 77386 |
|
258 |
25 |
$99K |
| 84484 |
|
30,602 |
25,291 |
$98K |
| 36415 |
|
92,847 |
79,397 |
$97K |
| 70491 |
|
907 |
879 |
$97K |
| 71250 |
|
2,156 |
2,120 |
$97K |
| 90471 |
|
7,702 |
7,528 |
$95K |
| 96416 |
|
1,010 |
561 |
$94K |
| 85025 |
|
116,751 |
94,575 |
$92K |
| 31231 |
|
437 |
432 |
$89K |
| 99291 |
|
2,541 |
2,425 |
$86K |
| 73221 |
|
640 |
627 |
$85K |
| 76817 |
|
3,016 |
2,680 |
$84K |
| 97162 |
|
2,158 |
2,091 |
$83K |
| 45378 |
|
199 |
193 |
$81K |
| 45385 |
|
267 |
244 |
$80K |
| 92552 |
|
1,594 |
1,575 |
$79K |
| 76942 |
|
1,353 |
1,286 |
$79K |
| 96417 |
|
3,151 |
1,911 |
$77K |
| 94640 |
|
9,898 |
8,993 |
$75K |
| 77067 |
|
8,299 |
8,243 |
$72K |
| 80048 |
|
16,929 |
12,886 |
$69K |
| 74181 |
|
324 |
310 |
$68K |
| 87400 |
|
11,183 |
10,867 |
$68K |
| 93458 |
|
82 |
81 |
$67K |
| 96372 |
|
42,823 |
32,132 |
$67K |
| 97535 |
|
4,281 |
2,467 |
$65K |
| 80076 |
|
27,954 |
25,409 |
$64K |
| 70486 |
|
1,240 |
1,217 |
$64K |
| 77066 |
Tomosynthesis, mammo |
2,361 |
2,331 |
$62K |
| 97161 |
|
1,730 |
1,639 |
$62K |
| 93271 |
|
1,043 |
1,029 |
$61K |
| 96368 |
|
2,316 |
1,416 |
$61K |
| 72100 |
|
4,152 |
4,063 |
$60K |
| 94060 |
|
1,321 |
1,303 |
$59K |
| 74420 |
|
536 |
506 |
$57K |
| 87591 |
|
6,448 |
6,201 |
$57K |
| 96125 |
|
985 |
981 |
$56K |
| 74178 |
|
430 |
423 |
$54K |
| 93320 |
|
320 |
315 |
$51K |
| 73700 |
|
788 |
743 |
$50K |
| 73030 |
|
4,795 |
4,602 |
$47K |
| 87040 |
|
7,171 |
4,714 |
$47K |
| 80050 |
|
8,402 |
7,788 |
$46K |
| 74230 |
|
579 |
564 |
$44K |
| 92609 |
|
754 |
307 |
$44K |
| 73562 |
|
3,129 |
2,996 |
$43K |
| 96152 |
|
574 |
410 |
$43K |
| Q3014 |
Telehealth facility fee |
2,457 |
2,310 |
$42K |
| 77334 |
|
557 |
409 |
$42K |
| 93225 |
|
1,555 |
1,535 |
$42K |
| 73630 |
|
5,054 |
4,885 |
$41K |
| 29105 |
|
184 |
179 |
$41K |
| 87510 |
|
4,846 |
4,648 |
$41K |
| 76775 |
|
592 |
574 |
$40K |
| 87641 |
|
3,528 |
3,339 |
$40K |
| 73610 |
|
5,437 |
5,254 |
$40K |
| 74018 |
|
4,280 |
4,114 |
$40K |
| 87505 |
|
1,370 |
1,252 |
$40K |
| 52310 |
|
75 |
73 |
$39K |
| J9263 |
Oxaliplatin |
40 |
14 |
$39K |
| 87420 |
|
3,870 |
3,748 |
$37K |
| 90714 |
|
2,087 |
2,048 |
$37K |
| 70498 |
|
1,140 |
1,101 |
$37K |
| 95912 |
|
431 |
413 |
$36K |
| 73560 |
|
3,725 |
3,601 |
$36K |
| 97163 |
|
945 |
908 |
$36K |
| 96521 |
|
732 |
123 |
$36K |
| Q5104 |
Injection, renflexis |
38 |
37 |
$35K |
| 96112 |
|
450 |
448 |
$35K |
| 92557 |
|
903 |
882 |
$35K |
| 93976 |
|
492 |
477 |
$35K |
| 10061 |
|
331 |
320 |
$32K |
| 84443 |
|
9,951 |
9,519 |
$32K |
| 90715 |
|
2,402 |
2,347 |
$32K |
| 58661 |
|
12 |
12 |
$32K |
| 93296 |
|
3,673 |
3,632 |
$32K |
| 72125 |
|
2,801 |
2,710 |
$32K |
| 73130 |
|
4,205 |
4,060 |
$31K |
| 90472 |
|
1,760 |
1,728 |
$31K |
| 92567 |
|
3,377 |
3,316 |
$31K |
| 36591 |
|
7,603 |
4,608 |
$31K |
| 83036 |
|
9,526 |
9,214 |
$29K |
| 72110 |
|
1,480 |
1,449 |
$29K |
| 93270 |
|
1,043 |
1,029 |
$29K |
| 97803 |
|
586 |
521 |
$28K |
| 72040 |
|
1,768 |
1,734 |
$28K |
| 94726 |
|
1,233 |
1,213 |
$28K |
| 83880 |
|
8,815 |
7,882 |
$26K |
| 73110 |
|
3,155 |
3,040 |
$26K |
| 71045 |
|
26,719 |
24,383 |
$26K |
| 69210 |
|
704 |
666 |
$26K |
| 20680 |
|
13 |
12 |
$25K |
| 95910 |
|
339 |
318 |
$25K |
| 73502 |
|
2,729 |
2,637 |
$25K |
| 96158 |
|
406 |
308 |
$23K |
| 52356 |
|
15 |
15 |
$23K |
| J1750 |
Inj iron dextran |
555 |
364 |
$23K |
| 92555 |
|
1,593 |
1,579 |
$22K |
| 94729 |
|
1,348 |
1,327 |
$22K |
| 87491 |
|
6,449 |
6,202 |
$22K |
| 72070 |
|
1,512 |
1,479 |
$22K |
| 73140 |
|
1,983 |
1,914 |
$22K |
| 84702 |
|
23,717 |
21,018 |
$22K |
| 77080 |
|
416 |
413 |
$22K |
| 93226 |
|
1,554 |
1,534 |
$22K |
| G0108 |
Diab manage trn per indiv |
678 |
603 |
$21K |
| 80061 |
|
6,712 |
6,536 |
$20K |
| Q5107 |
Inj mvasi 10 mg |
62 |
24 |
$20K |
| 97166 |
|
398 |
395 |
$20K |
| 97763 |
|
265 |
246 |
$20K |
| 87660 |
|
4,846 |
4,648 |
$19K |
| 88307 |
|
1,274 |
1,150 |
$19K |
| J0561 |
Penicillin g benzathine inj |
596 |
562 |
$19K |
| 85379 |
|
4,087 |
3,895 |
$18K |
| 54161 |
|
14 |
12 |
$18K |
| 74019 |
|
1,343 |
1,305 |
$18K |
| 52332 |
|
52 |
50 |
$17K |
| 93970 |
|
217 |
213 |
$17K |
| 93242 |
|
399 |
392 |
$15K |
| 82728 |
|
4,093 |
3,862 |
$15K |
| 90686 |
|
1,877 |
1,836 |
$14K |
| 49083 |
|
60 |
37 |
$14K |
| 83735 |
|
13,595 |
9,922 |
$14K |
| 84439 |
|
2,575 |
2,477 |
$14K |
| 73590 |
|
1,657 |
1,584 |
$13K |
| 64450 |
|
147 |
142 |
$13K |
| 86780 |
|
1,819 |
1,738 |
$13K |
| 73522 |
|
515 |
507 |
$13K |
| G0279 |
Tomosynthesis, mammo |
2,684 |
2,650 |
$13K |
| J1439 |
Inj ferric carboxymaltos 1mg |
179 |
121 |
$13K |
| 96374 |
|
39,536 |
34,485 |
$13K |
| 25600 |
|
25 |
25 |
$12K |
| 82607 |
|
2,488 |
2,383 |
$12K |
| 93880 |
|
386 |
378 |
$12K |
| 97112 |
|
470 |
298 |
$12K |
| 97165 |
|
407 |
393 |
$12K |
| 78227 |
|
51 |
51 |
$12K |
| 84112 |
|
1,508 |
1,420 |
$12K |
| 87086 |
|
18,155 |
17,036 |
$12K |
| 73080 |
|
2,197 |
2,111 |
$11K |
| 73620 |
|
649 |
632 |
$11K |
| 52287 |
|
27 |
26 |
$11K |
| 93308 |
|
40 |
40 |
$11K |
| 82247 |
|
1,576 |
1,081 |
$11K |
| 76857 |
|
136 |
125 |
$11K |
| 86140 |
|
10,366 |
9,414 |
$11K |
| 85027 |
|
12,741 |
11,045 |
$10K |
| 78264 |
|
47 |
47 |
$10K |
| 73120 |
|
623 |
596 |
$9K |
| 87661 |
|
1,897 |
1,850 |
$9K |
| 73090 |
|
1,310 |
1,251 |
$9K |
| 81001 |
|
58,651 |
53,481 |
$9K |
| 82306 |
|
1,944 |
1,875 |
$9K |
| 97802 |
|
124 |
122 |
$8K |
| 86870 |
|
1,057 |
983 |
$8K |
| G0480 |
Drug test def 1-7 classes |
1,182 |
1,077 |
$8K |
| 93243 |
|
399 |
392 |
$8K |
| 87480 |
|
4,794 |
4,596 |
$8K |
| 95911 |
|
200 |
195 |
$7K |
| 93978 |
|
338 |
308 |
$7K |
| 83540 |
|
3,898 |
3,716 |
$7K |
| 20553 |
|
71 |
70 |
$7K |
| 86850 |
|
6,725 |
5,776 |
$7K |
| 77300 |
|
157 |
148 |
$7K |
| 93922 |
|
225 |
213 |
$7K |
| J3489 |
Zoledronic acid 1mg |
248 |
236 |
$7K |
| 97150 |
|
559 |
324 |
$6K |
| T1017 |
Targeted case management |
125 |
107 |
$6K |
| 97116 |
|
762 |
522 |
$6K |
| 87077 |
|
12,878 |
11,067 |
$6K |
| 71271 |
|
83 |
83 |
$6K |
| 82570 |
|
2,333 |
2,134 |
$6K |
| 64415 |
|
66 |
65 |
$6K |
| J0475 |
Baclofen 10 mg injection |
26 |
25 |
$6K |
| 86803 |
|
1,565 |
1,499 |
$6K |
| 96376 |
|
12,142 |
8,783 |
$6K |
| 87389 |
|
2,831 |
2,708 |
$6K |
| 36592 |
|
1,778 |
1,509 |
$6K |
| 72050 |
|
293 |
285 |
$6K |
| 92610 |
|
107 |
106 |
$6K |
| 74183 |
|
29 |
29 |
$6K |
| 73100 |
|
501 |
484 |
$5K |
| 87081 |
|
2,191 |
2,145 |
$5K |
| 85610 |
|
13,739 |
11,240 |
$5K |
| 82105 |
|
787 |
727 |
$5K |
| 97597 |
|
154 |
128 |
$5K |
| 82565 |
|
3,708 |
3,538 |
$5K |
| 82803 |
|
48,664 |
42,231 |
$5K |
| 62321 |
|
13 |
13 |
$5K |
| C1776 |
Joint device (implantable) |
143 |
129 |
$5K |
| 94010 |
|
209 |
208 |
$5K |
| 95990 |
|
218 |
214 |
$5K |
| 17110 |
|
13 |
13 |
$5K |
| 87522 |
Neg quan hep c or qual rna |
464 |
408 |
$5K |
| 74220 |
|
169 |
164 |
$5K |
| 20550 |
|
27 |
27 |
$5K |
| 86753 |
|
765 |
748 |
$5K |
| 87340 |
|
1,767 |
1,681 |
$5K |
| 92504 |
|
149 |
137 |
$5K |
| 85652 |
|
5,278 |
4,722 |
$5K |
| G0384 |
Lev 5 hosp type b ed visit |
44 |
43 |
$5K |
| 82378 |
|
2,039 |
1,766 |
$5K |
| 76981 |
|
350 |
343 |
$5K |
| 72170 |
|
824 |
793 |
$4K |
| 97032 |
|
655 |
260 |
$4K |
| C1713 |
Anchor/screw bn/bn,tis/bn |
2,720 |
2,597 |
$4K |
| 0124A |
|
165 |
162 |
$4K |
| 87426 |
|
24,433 |
23,022 |
$4K |
| G0008 |
Admin influenza virus vac |
1,852 |
1,801 |
$4K |
| J2805 |
Sincalide injection |
39 |
39 |
$4K |
| 86901 |
|
7,903 |
6,865 |
$4K |
| 86762 |
|
1,054 |
1,012 |
$4K |
| 77295 |
|
15 |
13 |
$4K |
| 95909 |
|
89 |
88 |
$4K |
| 77065 |
Tomosynthesis, mammo |
137 |
132 |
$4K |
| 31500 |
|
14 |
13 |
$4K |
| 90674 |
|
301 |
300 |
$4K |
| 97035 |
|
471 |
233 |
$3K |
| 70360 |
|
266 |
259 |
$3K |
| 80074 |
|
1,082 |
1,049 |
$3K |
| 0001A |
|
86 |
85 |
$3K |
| 86900 |
|
7,012 |
6,034 |
$3K |
| 83615 |
|
3,827 |
3,245 |
$3K |
| 72131 |
|
80 |
78 |
$3K |
| 94618 |
|
38 |
37 |
$3K |
| 93925 |
|
72 |
68 |
$3K |
| 72114 |
|
106 |
105 |
$3K |
| 83690 |
|
21,409 |
19,257 |
$3K |
| 87070 |
|
3,470 |
3,262 |
$3K |
| G0380 |
Lev 1 hosp type b ed visit |
25 |
24 |
$3K |
| 84153 |
|
513 |
491 |
$3K |
| 74174 |
|
26 |
25 |
$3K |
| 93288 |
|
372 |
367 |
$3K |
| 96156 |
|
25 |
25 |
$3K |
| 77290 |
|
15 |
13 |
$3K |
| 73600 |
|
89 |
86 |
$2K |
| 95165 |
|
126 |
122 |
$2K |
| 90378 |
|
16 |
12 |
$2K |
| J0897 |
Denosumab injection |
16 |
13 |
$2K |
| 0004A |
|
73 |
72 |
$2K |
| 12013 |
|
15 |
15 |
$2K |
| 97760 |
|
73 |
57 |
$2K |
| 87046 |
|
981 |
954 |
$2K |
| 96150 |
|
25 |
25 |
$2K |
| J3370 |
Vancomycin hcl injection |
3,871 |
1,363 |
$2K |
| 87186 |
|
8,925 |
8,085 |
$2K |
| 95117 |
|
138 |
49 |
$2K |
| 43762 |
|
12 |
12 |
$2K |
| 71101 |
|
998 |
983 |
$2K |
| D0220 |
|
12 |
12 |
$2K |
| 96375 |
|
34,414 |
27,330 |
$2K |
| 20552 |
|
14 |
13 |
$2K |
| 88305 |
|
6,910 |
5,990 |
$2K |
| J2997 |
Alteplase recombinant |
63 |
52 |
$2K |
| 82731 |
|
182 |
177 |
$2K |
| J2704 |
Inj, propofol, 10 mg |
22,184 |
19,915 |
$2K |
| 87430 |
|
8,322 |
8,120 |
$2K |
| 90670 |
|
666 |
662 |
$2K |
| 84100 |
|
1,776 |
1,316 |
$2K |
| 92553 |
|
18 |
17 |
$2K |
| 82043 |
|
940 |
903 |
$2K |
| 73200 |
|
28 |
27 |
$2K |
| 30901 |
|
41 |
39 |
$2K |
| 85007 |
|
4,998 |
4,413 |
$2K |
| 86592 |
|
1,434 |
1,382 |
$2K |
| 85014 |
|
24,745 |
21,318 |
$2K |
| 84156 |
|
1,389 |
1,220 |
$2K |
| 85730 |
|
4,608 |
4,278 |
$2K |
| 73552 |
|
175 |
165 |
$1K |
| 51701 |
|
668 |
656 |
$1K |
| 82950 |
|
469 |
459 |
$1K |
| 69200 |
|
15 |
13 |
$1K |
| 88304 |
|
3,303 |
3,184 |
$1K |
| 82746 |
|
815 |
767 |
$1K |
| G0297 |
Ldct for lung ca screen |
12 |
12 |
$1K |
| 82947 |
|
702 |
666 |
$1K |
| 73660 |
|
127 |
127 |
$1K |
| 82248 |
|
544 |
428 |
$1K |
| Q2038 |
Fluzone vacc, 3 yrs & >, im |
163 |
148 |
$1K |
| 81025 |
|
11,517 |
11,009 |
$1K |
| 0002A |
|
26 |
26 |
$1K |
| 80306 |
|
6,199 |
5,709 |
$1K |
| 86304 |
|
222 |
176 |
$1K |
| 84145 |
|
111 |
99 |
$1K |
| 86480 |
|
104 |
103 |
$1K |
| 82077 |
|
4,803 |
4,261 |
$1K |
| J7030 |
Normal saline solution infus |
26,454 |
20,201 |
$1K |
| 84703 |
|
2,358 |
2,237 |
$1K |
| 82550 |
|
1,441 |
1,242 |
$1K |
| 83001 |
|
125 |
122 |
$1K |
| 92611 |
|
69 |
67 |
$1K |
| 99490 |
Ccm add 20min |
54 |
53 |
$1K |
| M0243 |
Casirivi and imdevi inj |
14 |
13 |
$1K |
| 76000 |
|
272 |
266 |
$963.31 |
| 97167 |
|
16 |
16 |
$945.37 |
| 87205 |
|
4,098 |
3,762 |
$927.91 |
| 85384 |
|
692 |
658 |
$919.59 |
| 94770 |
|
12 |
12 |
$900.58 |
| 86706 |
|
413 |
391 |
$878.53 |
| 73060 |
|
140 |
132 |
$858.51 |
| 82784 |
|
244 |
181 |
$856.94 |
| 85018 |
|
20,104 |
17,046 |
$856.88 |
| S9436 |
Lamaze class |
14 |
14 |
$840.00 |
| 92579 |
|
44 |
43 |
$827.88 |
| 81003 |
|
4,978 |
4,805 |
$812.73 |
| 73070 |
|
58 |
55 |
$805.18 |
| 72081 |
|
15 |
15 |
$797.54 |
| 85045 |
|
660 |
607 |
$793.56 |
| G2066 |
Inter devc remote 30d |
51 |
51 |
$788.60 |
| 97014 |
|
102 |
59 |
$779.93 |
| G0379 |
Direct refer hospital observ |
27 |
27 |
$675.22 |
| 90677 |
|
232 |
231 |
$666.35 |
| 92522 |
|
13 |
13 |
$659.64 |
| J3010 |
Fentanyl citrate injection |
15,749 |
13,684 |
$636.70 |
| J2791 |
Rhophylac injection |
12 |
12 |
$626.29 |
| J1100 |
Dexamethasone sodium phos |
29,110 |
24,250 |
$625.35 |
| 97016 |
|
133 |
51 |
$619.54 |
| 98967 |
|
15 |
12 |
$615.73 |
| 36593 |
|
30 |
24 |
$614.51 |
| 97542 |
|
13 |
12 |
$609.18 |
| 0072A |
|
13 |
13 |
$592.00 |
| 96040 |
|
13 |
13 |
$590.70 |
| 90651 |
|
326 |
323 |
$573.40 |
| 83883 |
|
67 |
43 |
$552.33 |
| 86300 |
|
132 |
101 |
$552.03 |
| 51741 |
|
345 |
342 |
$545.76 |
| J3490 |
Drugs unclassified injection |
725 |
666 |
$530.86 |
| J2930 |
Methylprednisolone injection |
1,627 |
1,232 |
$527.20 |
| 90636 |
|
24 |
24 |
$503.71 |
| 83550 |
|
234 |
225 |
$486.32 |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
28,381 |
26,995 |
$478.81 |
| 83516 |
|
109 |
67 |
$474.20 |
| 11721 |
|
30 |
30 |
$472.72 |
| 97550 |
|
15 |
12 |
$457.93 |
| 90480 |
|
68 |
67 |
$441.54 |
| 93975 |
|
46 |
45 |
$428.91 |
| 90656 |
|
156 |
154 |
$421.96 |
| 84146 |
|
59 |
56 |
$413.46 |
| 82670 |
|
61 |
59 |
$403.27 |
| 73000 |
|
39 |
37 |
$401.36 |
| 90662 |
|
426 |
416 |
$399.80 |
| 84550 |
|
552 |
466 |
$396.68 |
| 84403 |
|
55 |
53 |
$392.96 |
| 86920 |
|
1,791 |
993 |
$377.80 |
| 82652 |
|
69 |
66 |
$376.46 |
| J2310 |
Inj naloxone hydrochloride |
14 |
13 |
$357.43 |
| 86038 |
|
168 |
151 |
$352.42 |
| J0330 |
Succinycholine chloride inj |
7,029 |
6,688 |
$329.49 |
| 91322 |
|
48 |
47 |
$318.36 |
| 72220 |
|
40 |
40 |
$317.56 |
| 87075 |
|
561 |
507 |
$317.37 |
| 84132 |
|
772 |
547 |
$301.41 |
| 92556 |
|
282 |
280 |
$260.38 |
| 80051 |
|
27 |
27 |
$257.88 |
| 86923 |
|
101 |
74 |
$254.37 |
| 93325 |
|
321 |
316 |
$226.84 |
| 82140 |
|
410 |
350 |
$225.46 |
| J2710 |
Neostigmine methylslfte inj |
2,628 |
2,504 |
$209.32 |
| J0696 |
Ceftriaxone sodium injection |
8,565 |
5,389 |
$205.02 |
| 87209 |
|
37 |
35 |
$196.59 |
| 86703 |
|
59 |
58 |
$188.41 |
| 83970 |
|
14 |
12 |
$187.42 |
| 84460 |
|
96 |
84 |
$182.94 |
| J0360 |
Hydralazine hcl injection |
636 |
542 |
$180.38 |
| 99152 |
|
669 |
647 |
$175.69 |
| 76937 |
|
127 |
121 |
$168.57 |
| 94664 |
|
38 |
37 |
$145.34 |
| J1050 |
Medroxyprogesterone acetate |
69 |
69 |
$128.15 |
| 82977 |
|
87 |
76 |
$127.40 |
| 80202 |
|
14 |
12 |
$126.02 |
| 51702 |
|
633 |
601 |
$123.19 |
| Q9957 |
Inj perflutren lip micros,ml |
1,267 |
1,242 |
$120.99 |
| 82677 |
|
14 |
13 |
$119.88 |
| 84450 |
|
44 |
40 |
$119.57 |
| 88342 |
|
1,528 |
1,415 |
$118.90 |
| 86787 |
|
29 |
29 |
$117.40 |
| 96159 |
|
153 |
117 |
$116.13 |
| J0500 |
Dicyclomine injection |
1,290 |
1,245 |
$113.76 |
| 94660 |
|
12 |
12 |
$110.62 |
| 51798 |
|
746 |
731 |
$109.63 |
| 82533 |
|
31 |
27 |
$107.82 |
| 86336 |
|
15 |
14 |
$107.27 |
| J1885 |
Ketorolac tromethamine inj |
19,569 |
18,109 |
$106.62 |
| J1650 |
Inj enoxaparin sodium |
6,025 |
2,772 |
$105.48 |
| J2405 |
Ondansetron hcl injection |
35,559 |
30,624 |
$105.47 |
| 87177 |
|
37 |
35 |
$104.61 |
| J2250 |
Inj midazolam hydrochloride |
16,761 |
15,749 |
$102.97 |
| 90632 |
|
14 |
13 |
$94.67 |
| 80164 |
|
14 |
13 |
$87.66 |
| 89050 |
|
90 |
77 |
$79.33 |
| U0002 |
Covid-19 lab test non-cdc |
24 |
18 |
$68.55 |
| J1200 |
Diphenhydramine hcl injectio |
9,203 |
7,897 |
$68.06 |
| 85046 |
|
69 |
54 |
$63.54 |
| 88360 |
|
16 |
12 |
$61.88 |
| J1040 |
Methylprednisolone 80 mg inj |
2,165 |
2,108 |
$59.94 |
| 86308 |
|
198 |
193 |
$54.11 |
| 74022 |
|
12 |
12 |
$53.78 |
| J1170 |
Hydromorphone injection |
15,691 |
12,093 |
$53.09 |
| J2060 |
Lorazepam injection |
4,362 |
3,702 |
$50.17 |
| C1769 |
Guide wire |
1,307 |
1,210 |
$48.70 |
| 85004 |
|
126 |
117 |
$47.23 |
| 84134 |
|
99 |
96 |
$46.30 |
| J1630 |
Haloperidol injection |
1,252 |
1,089 |
$41.50 |
| 86200 |
|
13 |
13 |
$37.84 |
| 99153 |
Mod sedat endo service >5yrs |
221 |
213 |
$36.08 |
| 82274 |
|
14 |
12 |
$31.88 |
| 86160 |
|
15 |
14 |
$25.66 |
| 90648 |
|
78 |
77 |
$24.87 |
| 84520 |
|
16 |
14 |
$22.85 |
| 88341 |
|
143 |
89 |
$21.73 |
| 94760 |
|
5,666 |
4,441 |
$20.72 |
| 87529 |
|
16 |
15 |
$20.54 |
| 90694 |
|
70 |
68 |
$19.84 |
| 82310 |
|
15 |
13 |
$18.98 |
| J0690 |
Cefazolin sodium injection |
11,031 |
9,407 |
$15.96 |
| 80305 |
|
35 |
32 |
$15.48 |
| 82330 |
|
183 |
165 |
$14.79 |
| 87449 |
|
12 |
12 |
$13.88 |
| J1790 |
Droperidol injection |
250 |
222 |
$13.41 |
| J0131 |
Inj, acetaminophen (nos) |
1,085 |
1,053 |
$13.02 |
| 88720 |
|
50 |
41 |
$11.00 |
| J7512 |
Prednisone ir or dr oral 1mg |
4,410 |
3,767 |
$10.58 |
| 95012 |
|
40 |
39 |
$8.77 |
| 84478 |
|
13 |
12 |
$7.44 |
| J7120 |
Ringers lactate infusion |
1,880 |
1,609 |
$7.05 |
| 85049 |
|
12 |
12 |
$6.10 |
| 36416 |
|
1,259 |
928 |
$6.06 |
| 84295 |
|
166 |
152 |
$5.04 |
| J0780 |
Prochlorperazine injection |
2,676 |
2,513 |
$5.00 |
| J1836 |
Inj, metronidazole, 10 mg |
304 |
210 |
$4.44 |
| J1644 |
Inj heparin sodium per 1000u |
4,348 |
1,911 |
$3.77 |
| 81002 |
|
978 |
961 |
$3.15 |
| 85347 |
|
155 |
114 |
$2.68 |
| J2175 |
Meperidine hydrochl /100 mg |
1,348 |
1,302 |
$1.67 |
| J1940 |
Furosemide injection |
1,002 |
632 |
$1.32 |
| A9585 |
Gadobutrol injection |
2,770 |
2,697 |
$0.01 |
| J2919 |
Inj, methylpred sod succ 5mg |
263 |
209 |
$0.00 |
| A9502 |
Tc99m tetrofosmin |
880 |
865 |
$0.00 |
| C9113 |
Inj pantoprazole sodium, via |
1,173 |
690 |
$0.00 |
| 99394 |
|
799 |
786 |
$0.00 |
| J9190 |
Fluorouracil injection |
1,664 |
681 |
$0.00 |
| 99393 |
|
1,066 |
1,052 |
$0.00 |
| 99391 |
|
998 |
963 |
$0.00 |
| 99396 |
|
505 |
500 |
$0.00 |
| 99392 |
|
1,028 |
1,011 |
$0.00 |
| J3301 |
Triamcinolone acet inj nos |
1,138 |
1,081 |
$0.00 |
| Q9966 |
Locm 200-299mg/ml iodine,1ml |
634 |
607 |
$0.00 |
| Q0163 |
Diphenhydramine hcl 50mg |
284 |
275 |
$0.00 |
| J1953 |
Levetiracetam injection |
271 |
229 |
$0.00 |
| J3475 |
Inj magnesium sulfate |
2,773 |
1,622 |
$0.00 |
| 80143 |
|
339 |
313 |
$0.00 |
| G1004 |
Cdsm ndsc |
793 |
765 |
$0.00 |
| J0295 |
Ampicillin sulbactam 1.5 gm |
492 |
288 |
$0.00 |
| 90633 |
|
381 |
378 |
$0.00 |
| A9537 |
Tc99m mebrofenin |
63 |
63 |
$0.00 |
| J0694 |
Cefoxitin sodium injection |
559 |
395 |
$0.00 |
| G8990 |
Other pt/ot current status |
149 |
114 |
$0.00 |
| J1596 |
Inj, glycopyrrolate, 0.1 mg |
535 |
529 |
$0.00 |
| J0640 |
Leucovorin calcium injection |
1,536 |
566 |
$0.00 |
| 99395 |
|
361 |
354 |
$0.00 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
360 |
281 |
$0.00 |
| 90710 |
|
171 |
169 |
$0.00 |
| A9552 |
F18 fdg |
320 |
309 |
$0.00 |
| 80179 |
|
298 |
276 |
$0.00 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
1,923 |
1,872 |
$0.00 |
| 90473 |
|
13 |
13 |
$0.00 |
| J0688 |
Inj cefazolin sodium, hikma |
608 |
581 |
$0.00 |
| 90700 |
|
85 |
85 |
$0.00 |
| A4649 |
Surgical supplies |
598 |
520 |
$0.00 |
| C1894 |
Intro/sheath, non-laser |
107 |
90 |
$0.00 |
| J1580 |
Garamycin gentamicin inj |
148 |
136 |
$0.00 |
| G0390 |
Trauma respons w/hosp criti |
39 |
39 |
$0.00 |
| J2270 |
Morphine sulfate injection |
701 |
644 |
$0.00 |
| C1887 |
Catheter, guiding |
57 |
30 |
$0.00 |
| G0500 |
Mod sedat endo service >5yrs |
70 |
68 |
$0.00 |
| 87324 |
|
12 |
12 |
$0.00 |
| Q9950 |
Inj sulf hexa lipid microsph |
77 |
77 |
$0.00 |
| J2272 |
Inj, morphine (fresenius) |
123 |
109 |
$0.00 |
| 90734 |
|
101 |
101 |
$0.00 |
| 96402 |
|
43 |
30 |
$0.00 |
| 95874 |
|
40 |
37 |
$0.00 |
| J3105 |
Terbutaline sulfate inj |
61 |
52 |
$0.00 |
| 51610 |
|
15 |
12 |
$0.00 |
| A9541 |
Tc99m sulfur colloid |
47 |
47 |
$0.00 |
| J0735 |
Clonidine hydrochloride |
16 |
14 |
$0.00 |
| A9577 |
Inj multihance |
20 |
20 |
$0.00 |
| J1756 |
Iron sucrose injection |
41 |
13 |
$0.00 |
| J1642 |
Inj heparin sodium per 10 u |
8,671 |
4,330 |
$0.00 |
| J8540 |
Oral dexamethasone |
3,336 |
3,181 |
$0.00 |
| J2001 |
Lidocaine injection |
2,582 |
2,479 |
$0.00 |
| J3480 |
Inj potassium chloride |
1,885 |
1,152 |
$0.00 |
| 90680 |
|
531 |
528 |
$0.00 |
| J2795 |
Ropivacaine hcl injection |
1,261 |
1,221 |
$0.00 |
| 90474 |
|
118 |
116 |
$0.00 |
| 96411 |
|
1,789 |
1,116 |
$0.00 |
| J1626 |
Granisetron hcl injection |
2,076 |
1,000 |
$0.00 |
| J0461 |
Atropine sulfate injection |
421 |
303 |
$0.00 |
| J1815 |
Insulin injection |
7,650 |
2,869 |
$0.00 |
| 99406 |
|
563 |
552 |
$0.00 |
| J2785 |
Regadenoson injection |
1,061 |
1,045 |
$0.00 |
| A9270 |
Non-covered item or service |
10,855 |
7,691 |
$0.00 |
| J1010 |
Inj, methylpred acetate 1 mg |
335 |
328 |
$0.00 |
| J8501 |
Oral aprepitant |
1,578 |
1,506 |
$0.00 |
| A9500 |
Tc99m sestamibi |
359 |
346 |
$0.00 |
| J3411 |
Thiamine hcl 100 mg |
155 |
133 |
$0.00 |
| J0574 |
Bupren/nal 6.1 to 10mg bupre |
285 |
259 |
$0.00 |
| J0571 |
Buprenorphine oral 1mg |
135 |
110 |
$0.00 |
| C2617 |
Stent, non-cor, tem w/o del |
489 |
455 |
$0.00 |
| J3420 |
Vitamin b12 injection |
347 |
270 |
$0.00 |
| J9045 |
Carboplatin injection |
157 |
100 |
$0.00 |
| J1920 |
Inj, labetalol hcl, 5mg |
28 |
26 |
$0.00 |
| 90697 |
|
307 |
303 |
$0.00 |
| J2371 |
Inj phenylephrine hcl 20 mcg |
703 |
668 |
$0.00 |
| J0687 |
Inj cefazolin (wg crit care) |
12 |
12 |
$0.00 |
| A9579 |
Gad-base mr contrast nos,1ml |
274 |
266 |
$0.00 |
| 90619 |
|
114 |
113 |
$0.00 |
| J2543 |
Piperacillin/tazobactam |
630 |
208 |
$0.00 |
| Q9965 |
Locm 100-199mg/ml iodine,1ml |
122 |
117 |
$0.00 |
| J9267 |
Paclitaxel injection |
138 |
61 |
$0.00 |
| J2765 |
Metoclopramide hcl injection |
477 |
450 |
$0.00 |
| J2920 |
Methylprednisolone injection |
127 |
92 |
$0.00 |
| J3360 |
Diazepam injection |
73 |
69 |
$0.00 |
| A4648 |
Implantable tissue marker |
156 |
150 |
$0.00 |
| J2305 |
Inj, nitroglycerin, 5 mg |
45 |
44 |
$0.00 |
| J7060 |
5% dextrose/water |
182 |
87 |
$0.00 |
| A9503 |
Tc99m medronate |
25 |
25 |
$0.00 |
| 90696 |
|
26 |
26 |
$0.00 |
| C1889 |
Implant/insert device, noc |
30 |
30 |
$0.00 |
| J1805 |
Inj, esmolol hcl, 10mg |
31 |
31 |
$0.00 |
| J2003 |
Inj, lidocaine hcl, 1 mg |
596 |
514 |
$0.00 |
| G8991 |
Other pt/ot goal status |
154 |
118 |
$0.00 |
| J7613 |
Albuterol non-comp unit |
66 |
65 |
$0.00 |
| J2470 |
Inj pantoprazole sodium 40mg |
39 |
27 |
$0.00 |
| G0283 |
Elec stim other than wound |
30 |
12 |
$0.00 |
| Q9969 |
Non-heu tc-99m add-on/dose |
17 |
15 |
$0.00 |
| 94761 |
|
28 |
26 |
$0.00 |
| J7050 |
Normal saline solution infus |
324 |
207 |
$0.00 |
| 74450 |
|
15 |
12 |
$0.00 |
| Q0162 |
Ondansetron oral |
30 |
29 |
$0.00 |