| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99283 |
|
81,085 |
75,055 |
$10.73M |
| 96361 |
|
29,513 |
26,406 |
$9.33M |
| 99284 |
|
62,205 |
57,989 |
$5.84M |
| 99285 |
|
54,547 |
50,444 |
$4.32M |
| G0463 |
Hospital outpt clinic visit |
37,564 |
25,772 |
$3.77M |
| 93306 |
|
13,145 |
12,890 |
$3.35M |
| 96365 |
|
19,236 |
15,090 |
$2.10M |
| 43239 |
|
4,526 |
4,459 |
$1.90M |
| 70450 |
|
12,807 |
12,159 |
$1.88M |
| U0003 |
Cov-19 amp prb hgh thruput |
23,475 |
21,739 |
$1.86M |
| 74177 |
|
10,177 |
9,872 |
$1.68M |
| S9480 |
Intensive outpatient psychia |
3,393 |
600 |
$1.58M |
| 96366 |
|
6,745 |
5,050 |
$1.56M |
| 44970 |
|
450 |
449 |
$1.54M |
| 93303 |
|
4,095 |
4,040 |
$1.53M |
| 96360 |
|
10,272 |
9,897 |
$1.38M |
| 99281 |
|
6,668 |
6,217 |
$982K |
| 99282 |
|
9,597 |
9,234 |
$928K |
| 54161 |
|
530 |
527 |
$699K |
| 74176 |
|
4,300 |
4,148 |
$695K |
| 67311 |
|
339 |
334 |
$669K |
| 70553 |
|
2,347 |
2,188 |
$655K |
| H2012 |
Behav hlth day treat, per hr |
1,882 |
276 |
$652K |
| 45380 |
|
1,391 |
1,372 |
$646K |
| 93304 |
|
1,564 |
1,533 |
$622K |
| 93458 |
|
671 |
648 |
$588K |
| 76705 |
|
6,092 |
5,748 |
$585K |
| 93308 |
|
2,003 |
1,944 |
$584K |
| 78452 |
|
1,630 |
1,591 |
$574K |
| 93325 |
|
9,113 |
8,798 |
$548K |
| 70551 |
|
2,740 |
2,672 |
$543K |
| 80053 |
|
105,893 |
89,208 |
$542K |
| 43235 |
|
1,404 |
1,372 |
$504K |
| C8929 |
Tte w or wo fol wcon,doppler |
2,356 |
2,304 |
$485K |
| 95819 |
|
2,182 |
2,162 |
$473K |
| G0378 |
Hospital observation per hr |
25,892 |
11,995 |
$470K |
| 71275 |
|
3,219 |
3,124 |
$465K |
| 87631 |
|
9,149 |
8,707 |
$456K |
| 80307 |
|
15,473 |
14,220 |
$447K |
| 12011 |
|
1,761 |
1,740 |
$396K |
| 12001 |
|
1,698 |
1,682 |
$363K |
| 58571 |
|
148 |
145 |
$362K |
| 96415 |
|
1,280 |
965 |
$337K |
| 95816 |
|
1,278 |
1,260 |
$293K |
| 36430 |
|
1,700 |
1,176 |
$289K |
| 93017 |
|
2,707 |
2,650 |
$277K |
| 76770 |
|
2,253 |
2,213 |
$266K |
| 96413 |
|
3,106 |
1,971 |
$259K |
| 93971 |
|
2,355 |
2,252 |
$198K |
| 45385 |
|
472 |
460 |
$186K |
| 80048 |
|
36,255 |
30,373 |
$164K |
| 70498 |
|
1,510 |
1,482 |
$160K |
| 88305 |
|
14,996 |
14,627 |
$158K |
| J1561 |
Gamunex-c/gammaked |
96 |
77 |
$142K |
| 12002 |
|
768 |
757 |
$137K |
| 95700 |
|
741 |
727 |
$137K |
| 36415 |
|
72,723 |
59,455 |
$131K |
| 85025 |
|
122,466 |
102,184 |
$128K |
| 99291 |
|
2,975 |
2,892 |
$128K |
| 96367 |
|
2,695 |
2,344 |
$127K |
| 70496 |
|
1,566 |
1,528 |
$117K |
| 76830 |
|
1,516 |
1,479 |
$115K |
| 93975 |
|
1,880 |
1,829 |
$111K |
| 76856 |
|
1,935 |
1,887 |
$111K |
| 94640 |
|
13,890 |
10,066 |
$108K |
| 84484 |
|
25,999 |
18,306 |
$105K |
| 78264 |
|
284 |
280 |
$105K |
| 84443 |
|
18,049 |
17,495 |
$101K |
| 87633 |
|
3,335 |
3,241 |
$97K |
| 83880 |
|
11,453 |
9,998 |
$97K |
| 96450 |
|
232 |
196 |
$93K |
| 43244 |
|
186 |
182 |
$91K |
| 87040 |
|
12,250 |
7,226 |
$85K |
| 20680 |
|
67 |
63 |
$83K |
| 87086 |
|
26,505 |
25,211 |
$78K |
| 90870 |
|
420 |
171 |
$77K |
| 74230 |
|
915 |
886 |
$77K |
| 77072 |
|
1,554 |
1,547 |
$75K |
| 87636 |
|
12,732 |
12,131 |
$72K |
| 95714 |
|
213 |
176 |
$69K |
| J1745 |
Infliximab not biosimil 10mg |
57 |
48 |
$69K |
| 87591 |
|
5,063 |
4,944 |
$68K |
| 71046 |
|
21,513 |
20,568 |
$67K |
| 76937 |
|
1,306 |
1,222 |
$67K |
| 70491 |
|
338 |
326 |
$64K |
| 83735 |
|
29,403 |
21,320 |
$63K |
| 93321 |
|
3,988 |
3,878 |
$59K |
| 82306 |
|
8,324 |
8,146 |
$59K |
| 76870 |
|
617 |
589 |
$59K |
| 83605 |
|
12,764 |
10,130 |
$58K |
| 70486 |
|
1,608 |
1,558 |
$58K |
| 47562 |
|
24 |
24 |
$53K |
| 88307 |
|
2,605 |
2,484 |
$53K |
| J3490 |
Drugs unclassified injection |
4,346 |
3,873 |
$52K |
| 83970 |
|
2,646 |
2,418 |
$51K |
| 88142 |
|
3,766 |
3,752 |
$51K |
| 82784 |
|
6,307 |
5,329 |
$50K |
| 76801 |
|
772 |
734 |
$49K |
| 86140 |
|
20,660 |
18,631 |
$47K |
| 74240 |
|
461 |
456 |
$46K |
| G0249 |
Provide inr test mater/equip |
1,951 |
1,746 |
$46K |
| 84145 |
|
5,505 |
5,046 |
$45K |
| 87624 |
|
2,941 |
2,920 |
$45K |
| 90715 |
|
2,650 |
2,599 |
$44K |
| 93005 |
|
41,390 |
37,465 |
$44K |
| 97161 |
|
1,290 |
1,245 |
$43K |
| 80050 |
|
6,540 |
6,426 |
$43K |
| 87635 |
|
988 |
961 |
$42K |
| 93320 |
|
4,121 |
4,059 |
$42K |
| 72125 |
|
4,241 |
4,084 |
$42K |
| 97530 |
|
2,421 |
1,276 |
$40K |
| 87798 |
|
3,853 |
3,586 |
$40K |
| 29125 |
|
223 |
217 |
$39K |
| 97162 |
|
1,375 |
1,306 |
$39K |
| 96374 |
|
39,106 |
35,817 |
$37K |
| 87641 |
|
3,176 |
3,110 |
$36K |
| 87651 |
|
3,639 |
3,592 |
$36K |
| 87186 |
|
12,353 |
11,943 |
$36K |
| 74018 |
|
6,495 |
6,133 |
$36K |
| 49083 |
|
74 |
36 |
$36K |
| 80069 |
|
6,227 |
4,532 |
$36K |
| 85027 |
|
26,916 |
21,891 |
$34K |
| 87486 |
|
3,363 |
3,266 |
$34K |
| 87581 |
|
3,362 |
3,265 |
$34K |
| 87077 |
|
10,116 |
9,763 |
$34K |
| 97166 |
|
1,222 |
1,156 |
$33K |
| 96375 |
|
34,404 |
28,512 |
$33K |
| 87661 |
|
4,286 |
4,190 |
$31K |
| 80061 |
|
5,260 |
5,174 |
$30K |
| 71260 |
|
2,027 |
1,979 |
$29K |
| 43237 |
|
123 |
120 |
$29K |
| 96409 |
|
2,108 |
1,132 |
$28K |
| 94729 |
|
778 |
761 |
$28K |
| 82570 |
|
7,780 |
7,020 |
$28K |
| 42820 |
|
14 |
14 |
$28K |
| 87502 |
|
1,739 |
1,703 |
$27K |
| 85379 |
|
5,575 |
5,330 |
$27K |
| 10060 |
|
147 |
142 |
$26K |
| 36561 |
|
27 |
27 |
$25K |
| 72148 |
|
172 |
168 |
$25K |
| 84439 |
|
6,090 |
5,919 |
$25K |
| 71045 |
|
19,728 |
18,167 |
$24K |
| 85652 |
|
12,325 |
11,604 |
$22K |
| J9312 |
Inj., rituximab, 10 mg |
17 |
12 |
$22K |
| 81001 |
|
55,454 |
50,924 |
$22K |
| 85610 |
|
34,205 |
23,977 |
$21K |
| 87491 |
|
5,062 |
4,945 |
$21K |
| 45378 |
|
55 |
55 |
$20K |
| 76700 |
|
183 |
182 |
$20K |
| 80143 |
|
4,947 |
4,687 |
$20K |
| 82728 |
|
5,487 |
5,209 |
$20K |
| 87505 |
|
261 |
251 |
$19K |
| 83036 |
|
5,548 |
5,434 |
$19K |
| 10061 |
|
93 |
93 |
$19K |
| 76882 |
|
217 |
202 |
$18K |
| 88342 |
|
3,651 |
3,533 |
$18K |
| 97165 |
|
576 |
545 |
$18K |
| 76825 |
|
249 |
231 |
$18K |
| 59025 |
|
100 |
96 |
$17K |
| 76817 |
|
658 |
629 |
$17K |
| 84305 |
|
1,298 |
1,287 |
$17K |
| 85007 |
|
4,653 |
3,557 |
$17K |
| 80306 |
|
15,832 |
14,881 |
$16K |
| 84156 |
|
6,448 |
5,649 |
$16K |
| 84146 |
|
1,199 |
1,174 |
$16K |
| 83550 |
|
3,671 |
3,532 |
$16K |
| P9040 |
Rbc leukoreduced irradiated |
58 |
52 |
$16K |
| 86803 |
|
2,705 |
2,668 |
$15K |
| 87088 |
|
6,683 |
6,415 |
$15K |
| P9047 |
Albumin (human), 25%, 50ml |
75 |
38 |
$15K |
| 87081 |
|
3,441 |
3,394 |
$15K |
| 86780 |
|
1,497 |
1,469 |
$15K |
| 29848 |
|
14 |
13 |
$15K |
| 86850 |
|
9,863 |
8,838 |
$15K |
| 83516 |
|
2,445 |
2,080 |
$15K |
| 82533 |
|
1,324 |
1,102 |
$15K |
| 84100 |
|
10,162 |
6,878 |
$14K |
| 80197 |
|
2,317 |
1,379 |
$14K |
| 93531 |
|
12 |
12 |
$14K |
| 87070 |
|
7,268 |
6,742 |
$14K |
| 86923 |
|
1,277 |
1,064 |
$14K |
| 80164 |
|
1,961 |
1,732 |
$13K |
| 31624 |
|
40 |
38 |
$13K |
| 86364 |
|
1,978 |
1,961 |
$13K |
| 94060 |
|
345 |
334 |
$12K |
| 96372 |
|
12,501 |
9,480 |
$12K |
| 43259 |
|
44 |
44 |
$12K |
| 82962 |
|
45,174 |
25,150 |
$12K |
| 84403 |
|
1,101 |
1,073 |
$12K |
| 87205 |
|
8,230 |
7,578 |
$12K |
| 80076 |
|
2,444 |
2,270 |
$11K |
| 83690 |
|
26,005 |
24,023 |
$11K |
| G0379 |
Direct refer hospital observ |
524 |
514 |
$11K |
| 95812 |
|
29 |
29 |
$11K |
| 87075 |
|
4,937 |
4,589 |
$11K |
| 84702 |
|
7,042 |
6,518 |
$11K |
| 29105 |
|
92 |
92 |
$10K |
| 87340 |
|
3,283 |
3,213 |
$10K |
| 83540 |
|
4,077 |
3,916 |
$10K |
| 86900 |
|
9,978 |
8,820 |
$10K |
| 80179 |
|
4,688 |
4,476 |
$10K |
| 92960 |
|
42 |
38 |
$10K |
| 88185 |
|
288 |
154 |
$10K |
| 83001 |
|
1,083 |
1,051 |
$9K |
| 86901 |
|
10,539 |
9,345 |
$9K |
| 43752 |
|
21 |
13 |
$9K |
| 83002 |
|
1,019 |
983 |
$9K |
| 82607 |
|
1,580 |
1,558 |
$9K |
| 70487 |
|
74 |
73 |
$9K |
| 36573 |
|
15 |
13 |
$9K |
| 71250 |
|
225 |
218 |
$9K |
| 81025 |
|
21,976 |
20,929 |
$9K |
| 94660 |
|
63 |
37 |
$9K |
| 83874 |
|
1,958 |
1,891 |
$9K |
| 76827 |
|
263 |
242 |
$8K |
| 94726 |
|
268 |
260 |
$8K |
| 85014 |
|
5,178 |
4,449 |
$8K |
| 82105 |
|
810 |
775 |
$8K |
| 86480 |
|
548 |
538 |
$8K |
| 51600 |
|
24 |
24 |
$7K |
| 74019 |
|
2,860 |
2,765 |
$7K |
| 82670 |
|
563 |
552 |
$7K |
| P9016 |
Rbc leukocytes reduced |
56 |
50 |
$7K |
| 95951 |
|
37 |
26 |
$7K |
| 92611 |
|
742 |
718 |
$7K |
| 82043 |
|
3,334 |
3,228 |
$7K |
| 82785 |
|
685 |
656 |
$6K |
| 86160 |
|
1,063 |
1,010 |
$6K |
| 82550 |
|
4,158 |
3,406 |
$6K |
| 25605 |
|
13 |
13 |
$6K |
| 87389 |
|
1,406 |
1,387 |
$6K |
| 83520 |
|
1,113 |
968 |
$6K |
| 49452 |
|
12 |
12 |
$6K |
| J1439 |
Inj ferric carboxymaltos 1mg |
16 |
12 |
$6K |
| 43242 |
|
14 |
14 |
$5K |
| 90686 |
|
648 |
638 |
$5K |
| 82565 |
|
2,285 |
2,091 |
$5K |
| 85576 |
|
550 |
442 |
$5K |
| 74174 |
|
38 |
38 |
$5K |
| 72141 |
|
38 |
38 |
$5K |
| 80178 |
|
670 |
597 |
$5K |
| 82077 |
|
12,685 |
11,777 |
$5K |
| 86762 |
|
1,281 |
1,270 |
$5K |
| 90471 |
|
4,187 |
4,019 |
$5K |
| 88304 |
|
2,283 |
2,255 |
$5K |
| 85730 |
|
7,665 |
6,938 |
$5K |
| 73130 |
|
2,508 |
2,354 |
$5K |
| 84436 |
|
457 |
450 |
$5K |
| 96376 |
|
14,102 |
10,571 |
$5K |
| 94770 |
|
78 |
53 |
$5K |
| 73562 |
|
1,473 |
1,434 |
$5K |
| J2405 |
Ondansetron hcl injection |
55,970 |
45,203 |
$5K |
| 88313 |
|
903 |
841 |
$4K |
| J2704 |
Inj, propofol, 10 mg |
34,911 |
31,622 |
$4K |
| 86376 |
|
359 |
355 |
$4K |
| 84112 |
|
616 |
571 |
$4K |
| 82248 |
|
1,947 |
1,585 |
$4K |
| 88175 |
|
332 |
329 |
$4K |
| 97535 |
|
373 |
253 |
$4K |
| 99152 |
|
3,451 |
3,248 |
$4K |
| 88341 |
|
1,051 |
993 |
$4K |
| 87147 |
|
2,071 |
2,025 |
$4K |
| J3010 |
Fentanyl citrate injection |
33,442 |
26,978 |
$4K |
| 43762 |
|
39 |
36 |
$4K |
| 86592 |
|
1,078 |
1,069 |
$4K |
| J2250 |
Inj midazolam hydrochloride |
20,034 |
18,696 |
$4K |
| M0243 |
Casirivi and imdevi inj |
33 |
33 |
$4K |
| 43247 |
|
12 |
12 |
$4K |
| 85018 |
|
4,167 |
3,459 |
$4K |
| 72100 |
|
1,752 |
1,645 |
$4K |
| 84550 |
|
2,118 |
1,960 |
$4K |
| 86704 |
|
1,190 |
1,168 |
$4K |
| 86361 |
|
282 |
276 |
$4K |
| 72040 |
|
1,194 |
1,096 |
$4K |
| 87511 |
|
399 |
396 |
$4K |
| C1874 |
Stent, coated/cov w/del sys |
43 |
40 |
$4K |
| 85049 |
|
1,286 |
1,271 |
$3K |
| 99153 |
Mod sedat endo service >5yrs |
3,269 |
3,105 |
$3K |
| 86706 |
|
1,055 |
1,028 |
$3K |
| 10120 |
|
12 |
12 |
$3K |
| 93880 |
|
74 |
74 |
$3K |
| 73630 |
|
2,352 |
2,201 |
$3K |
| 74328 |
|
126 |
121 |
$3K |
| 86038 |
|
885 |
867 |
$3K |
| 87799 |
|
399 |
271 |
$3K |
| 86003 |
|
413 |
346 |
$3K |
| 73610 |
|
2,592 |
2,348 |
$3K |
| 82805 |
|
757 |
661 |
$3K |
| 84460 |
|
1,359 |
1,212 |
$3K |
| 88184 |
|
581 |
527 |
$3K |
| 73030 |
|
2,287 |
2,069 |
$3K |
| J2001 |
Lidocaine injection |
25,157 |
21,791 |
$3K |
| 82746 |
|
744 |
734 |
$3K |
| 92585 |
|
13 |
13 |
$3K |
| 81003 |
|
10,412 |
9,360 |
$3K |
| J7120 |
Ringers lactate infusion |
21,804 |
19,472 |
$3K |
| J1170 |
Hydromorphone injection |
25,645 |
18,230 |
$3K |
| 84703 |
|
7,372 |
7,096 |
$3K |
| 85046 |
|
2,709 |
2,072 |
$3K |
| J1100 |
Dexamethasone sodium phos |
26,557 |
24,867 |
$2K |
| 89230 |
|
91 |
89 |
$2K |
| 83615 |
|
2,450 |
1,881 |
$2K |
| 95957 |
|
34 |
24 |
$2K |
| 82247 |
|
525 |
395 |
$2K |
| 73090 |
|
2,076 |
1,725 |
$2K |
| 82950 |
|
707 |
706 |
$2K |
| 86800 |
|
138 |
137 |
$2K |
| 87184 |
|
1,033 |
1,005 |
$2K |
| C8930 |
Tte w or w/o contr, cont ecg |
50 |
49 |
$2K |
| 82610 |
|
260 |
253 |
$2K |
| 82977 |
|
852 |
684 |
$2K |
| 87497 |
|
179 |
128 |
$2K |
| 93312 |
|
13 |
13 |
$2K |
| M0247 |
Sotrovimab infusion |
16 |
16 |
$2K |
| 73502 |
|
1,389 |
1,268 |
$2K |
| 82803 |
|
4,227 |
3,821 |
$2K |
| 74455 |
|
12 |
12 |
$2K |
| J1885 |
Ketorolac tromethamine inj |
27,164 |
23,065 |
$2K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
23,404 |
21,852 |
$2K |
| 73700 |
|
42 |
38 |
$2K |
| 87899 |
|
1,188 |
615 |
$2K |
| J1815 |
Insulin injection |
10,124 |
4,014 |
$2K |
| 87481 |
|
418 |
365 |
$2K |
| 87046 |
|
632 |
614 |
$2K |
| 87210 |
|
2,192 |
2,115 |
$2K |
| J7030 |
Normal saline solution infus |
24,024 |
20,657 |
$2K |
| 73110 |
|
1,586 |
1,464 |
$2K |
| 97110 |
|
220 |
146 |
$2K |
| 0202U |
|
2,781 |
2,690 |
$2K |
| 73552 |
|
765 |
688 |
$2K |
| 82150 |
|
1,085 |
948 |
$2K |
| 73590 |
|
1,999 |
1,757 |
$2K |
| A9541 |
Tc99m sulfur colloid |
648 |
640 |
$2K |
| J1642 |
Inj heparin sodium per 10 u |
8,351 |
3,876 |
$2K |
| 87209 |
|
202 |
200 |
$2K |
| 87493 |
|
399 |
384 |
$2K |
| 73560 |
|
1,170 |
1,098 |
$2K |
| J0131 |
Inj, acetaminophen (nos) |
2,713 |
2,370 |
$2K |
| 89051 |
|
1,801 |
1,500 |
$2K |
| 82626 |
|
107 |
103 |
$1K |
| 82947 |
|
1,995 |
1,810 |
$1K |
| 83519 |
|
167 |
162 |
$1K |
| Q0247 |
Sotrovimab |
16 |
16 |
$1K |
| J0690 |
Cefazolin sodium injection |
15,083 |
11,552 |
$1K |
| 82140 |
|
836 |
753 |
$1K |
| 73140 |
|
697 |
675 |
$1K |
| 87522 |
Neg quan hep c or qual rna |
75 |
75 |
$1K |
| 84295 |
|
1,731 |
1,593 |
$1K |
| 86231 |
|
253 |
252 |
$1K |
| 81015 |
|
396 |
387 |
$1K |
| J7050 |
Normal saline solution infus |
30,204 |
18,348 |
$1K |
| J2370 |
Phenylephrine hcl injection |
7,000 |
6,675 |
$1K |
| 99157 |
|
89 |
86 |
$1K |
| 87116 |
|
178 |
148 |
$1K |
| 96368 |
|
240 |
134 |
$1K |
| 87045 |
|
617 |
605 |
$1K |
| J0696 |
Ceftriaxone sodium injection |
8,336 |
6,286 |
$1K |
| 88112 |
|
240 |
221 |
$1K |
| J2270 |
Morphine sulfate injection |
10,796 |
8,546 |
$1K |
| 97802 |
|
27 |
27 |
$1K |
| G0500 |
Mod sedat endo service >5yrs |
892 |
867 |
$1K |
| 73080 |
|
949 |
889 |
$993.48 |
| 86360 |
|
70 |
68 |
$964.69 |
| C1769 |
Guide wire |
6,798 |
6,369 |
$956.74 |
| 82951 |
|
117 |
117 |
$948.05 |
| C1713 |
Anchor/screw bn/bn,tis/bn |
2,267 |
2,205 |
$932.31 |
| J9370 |
Vincristine sulfate 1 mg inj |
1,271 |
885 |
$917.77 |
| 93970 |
|
13 |
12 |
$883.35 |
| Q9957 |
Inj perflutren lip micros,ml |
3,249 |
3,166 |
$862.45 |
| 87177 |
|
201 |
199 |
$855.76 |
| 72126 |
|
233 |
223 |
$852.95 |
| A9585 |
Gadobutrol injection |
3,220 |
3,148 |
$796.79 |
| 87634 |
|
828 |
808 |
$779.96 |
| 85384 |
|
1,299 |
1,163 |
$753.23 |
| C1894 |
Intro/sheath, non-laser |
4,108 |
3,841 |
$752.39 |
| 99155 |
|
46 |
45 |
$739.73 |
| 82024 |
|
41 |
40 |
$715.73 |
| A9500 |
Tc99m sestamibi |
1,740 |
1,617 |
$699.27 |
| 82330 |
|
529 |
440 |
$686.74 |
| 87804 |
|
1,248 |
622 |
$658.23 |
| 96417 |
|
15 |
12 |
$642.00 |
| 80175 |
|
98 |
88 |
$639.55 |
| 81002 |
|
2,297 |
1,911 |
$637.41 |
| 84450 |
|
394 |
369 |
$625.87 |
| C1889 |
Implant/insert device, noc |
579 |
544 |
$614.89 |
| 86147 |
|
53 |
40 |
$604.47 |
| C2617 |
Stent, non-cor, tem w/o del |
238 |
227 |
$571.87 |
| 87338 |
|
106 |
106 |
$570.25 |
| 84402 |
|
105 |
104 |
$567.32 |
| 87176 |
|
337 |
317 |
$563.38 |
| 86200 |
|
121 |
120 |
$562.42 |
| 88275 |
|
18 |
12 |
$562.07 |
| 0399T |
|
121 |
119 |
$558.29 |
| 85670 |
|
429 |
349 |
$557.56 |
| 84132 |
|
2,459 |
2,136 |
$549.09 |
| 84478 |
|
281 |
172 |
$541.02 |
| 86225 |
|
184 |
174 |
$534.12 |
| 84480 |
|
94 |
94 |
$528.68 |
| 89060 |
|
233 |
221 |
$526.65 |
| 86708 |
|
199 |
195 |
$525.46 |
| 82438 |
|
67 |
65 |
$514.34 |
| J1756 |
Iron sucrose injection |
65 |
39 |
$497.23 |
| J3370 |
Vancomycin hcl injection |
5,857 |
3,673 |
$492.45 |
| D0220 |
|
70 |
68 |
$489.14 |
| 99156 |
|
13 |
13 |
$470.72 |
| J0330 |
Succinycholine chloride inj |
5,663 |
4,604 |
$466.40 |
| D1206 |
|
93 |
90 |
$457.78 |
| 82310 |
|
173 |
146 |
$454.74 |
| 85240 |
|
92 |
82 |
$453.54 |
| 36591 |
|
105 |
90 |
$450.62 |
| 86317 |
|
72 |
41 |
$440.73 |
| J1644 |
Inj heparin sodium per 1000u |
10,109 |
5,404 |
$432.13 |
| 82627 |
|
62 |
62 |
$428.04 |
| 82553 |
|
57 |
55 |
$423.72 |
| 84445 |
|
15 |
15 |
$419.48 |
| 86431 |
|
142 |
129 |
$412.66 |
| 88271 |
|
12 |
12 |
$399.80 |
| A9270 |
Non-covered item or service |
34,314 |
5,630 |
$394.42 |
| 94668 |
|
19 |
12 |
$390.72 |
| 87206 |
|
619 |
406 |
$381.32 |
| J1200 |
Diphenhydramine hcl injectio |
8,231 |
7,025 |
$372.87 |
| 86039 |
|
62 |
62 |
$363.79 |
| C1751 |
Cath, inf, per/cent/midline |
1,218 |
1,125 |
$354.85 |
| 94010 |
|
14 |
14 |
$345.65 |
| 82010 |
|
680 |
587 |
$342.20 |
| 72170 |
|
339 |
327 |
$341.25 |
| J7060 |
5% dextrose/water |
1,616 |
1,092 |
$340.28 |
| J2795 |
Ropivacaine hcl injection |
719 |
578 |
$336.79 |
| 94727 |
|
15 |
14 |
$335.19 |
| 73070 |
|
461 |
389 |
$330.57 |
| 86235 |
|
45 |
36 |
$328.41 |
| 73564 |
|
124 |
118 |
$325.73 |
| J2310 |
Inj naloxone hydrochloride |
41 |
27 |
$321.89 |
| 83655 |
|
26 |
26 |
$312.78 |
| 84446 |
|
28 |
28 |
$302.91 |
| 88237 |
|
12 |
12 |
$292.94 |
| D0150 |
|
69 |
67 |
$279.68 |
| J7040 |
Normal saline solution infus |
3,846 |
3,512 |
$276.02 |
| J2710 |
Neostigmine methylslfte inj |
2,238 |
2,180 |
$268.10 |
| C1887 |
Catheter, guiding |
2,657 |
2,323 |
$264.71 |
| J0280 |
Aminophyllin 250 mg inj |
730 |
712 |
$262.91 |
| 83993 |
|
30 |
30 |
$236.45 |
| J9045 |
Carboplatin injection |
16 |
13 |
$236.13 |
| G1004 |
Cdsm ndsc |
23,027 |
17,958 |
$233.97 |
| J1650 |
Inj enoxaparin sodium |
7,176 |
2,982 |
$233.15 |
| 90670 |
|
12 |
12 |
$224.33 |
| D0230 |
|
59 |
56 |
$217.17 |
| 80177 |
|
42 |
38 |
$215.29 |
| 84520 |
|
976 |
911 |
$200.08 |
| 80074 |
|
39 |
38 |
$194.93 |
| 87015 |
|
230 |
192 |
$184.54 |
| J1580 |
Garamycin gentamicin inj |
975 |
880 |
$180.87 |
| 84481 |
|
16 |
16 |
$177.66 |
| 84144 |
|
25 |
25 |
$175.17 |
| 73060 |
|
211 |
196 |
$174.36 |
| 83010 |
|
13 |
12 |
$172.01 |
| 88311 |
|
137 |
120 |
$170.05 |
| 88264 |
|
12 |
12 |
$166.80 |
| J2930 |
Methylprednisolone injection |
3,174 |
2,572 |
$165.37 |
| 84466 |
|
41 |
41 |
$153.22 |
| 80202 |
|
16 |
12 |
$141.30 |
| J3475 |
Inj magnesium sulfate |
4,682 |
3,237 |
$140.28 |
| J0780 |
Prochlorperazine injection |
1,673 |
1,502 |
$138.72 |
| 89055 |
|
45 |
43 |
$131.15 |
| 90656 |
|
17 |
17 |
$124.34 |
| J2765 |
Metoclopramide hcl injection |
3,093 |
2,640 |
$118.61 |
| 87806 |
|
1,391 |
1,373 |
$111.63 |
| 87880 |
|
218 |
215 |
$111.32 |
| 51798 |
|
25 |
25 |
$109.37 |
| J2550 |
Promethazine hcl injection |
2,952 |
2,367 |
$104.36 |
| 84590 |
|
13 |
13 |
$103.08 |
| 70250 |
|
12 |
12 |
$98.01 |
| C9113 |
Inj pantoprazole sodium, via |
2,938 |
1,873 |
$95.63 |
| U0005 |
Infec agen detec ampli probe |
9,899 |
8,967 |
$91.25 |
| 86334 |
|
13 |
13 |
$77.53 |
| 73000 |
|
58 |
54 |
$70.98 |
| J1245 |
Dipyridamole injection |
775 |
749 |
$67.58 |
| 84165 |
|
14 |
14 |
$66.24 |
| 82435 |
|
794 |
756 |
$65.92 |
| 88300 |
|
62 |
62 |
$63.19 |
| 86258 |
|
15 |
15 |
$62.86 |
| 72072 |
|
63 |
63 |
$61.02 |
| J9260 |
Inj methotrexate sodium 50mg |
419 |
292 |
$58.06 |
| 86015 |
|
12 |
12 |
$52.80 |
| 87807 |
|
107 |
107 |
$51.97 |
| 84075 |
|
14 |
13 |
$50.93 |
| 87426 |
|
272 |
175 |
$49.26 |
| J2060 |
Lorazepam injection |
6,268 |
5,162 |
$47.68 |
| 86665 |
|
25 |
13 |
$43.87 |
| J0295 |
Ampicillin sulbactam 1.5 gm |
3,861 |
1,723 |
$43.78 |
| J2360 |
Orphenadrine injection |
281 |
280 |
$43.09 |
| U0002 |
Covid-19 lab test non-cdc |
17 |
17 |
$41.03 |
| 87430 |
|
29 |
29 |
$39.60 |
| 86037 |
|
13 |
12 |
$38.56 |
| 88108 |
|
49 |
48 |
$38.27 |
| J1940 |
Furosemide injection |
1,669 |
1,212 |
$37.33 |
| Q0162 |
Ondansetron oral |
973 |
802 |
$37.23 |
| 87102 |
|
52 |
43 |
$36.89 |
| J0694 |
Cefoxitin sodium injection |
146 |
86 |
$36.80 |
| 36416 |
|
308 |
293 |
$36.00 |
| J1953 |
Levetiracetam injection |
419 |
340 |
$35.42 |
| 86308 |
|
67 |
66 |
$34.48 |
| 87181 |
|
13 |
13 |
$26.68 |
| 81050 |
|
15 |
15 |
$26.46 |
| Q0177 |
Hydroxyzine pamoate 25mg |
2,635 |
1,977 |
$25.97 |
| 87637 |
|
52 |
52 |
$25.80 |
| J8540 |
Oral dexamethasone |
1,945 |
1,669 |
$25.04 |
| J2543 |
Piperacillin/tazobactam |
1,043 |
404 |
$25.00 |
| 76010 |
|
36 |
36 |
$23.34 |
| 88312 |
|
13 |
13 |
$20.77 |
| 86664 |
|
13 |
13 |
$19.53 |
| J7512 |
Prednisone ir or dr oral 1mg |
3,378 |
2,133 |
$18.93 |
| J1630 |
Haloperidol injection |
881 |
745 |
$16.44 |
| J3480 |
Inj potassium chloride |
2,142 |
1,441 |
$13.02 |
| J0702 |
Betamethasone acet&sod phosp |
15 |
12 |
$13.02 |
| 85246 |
|
13 |
12 |
$11.96 |
| J3411 |
Thiamine hcl 100 mg |
1,804 |
1,232 |
$11.75 |
| 84157 |
|
28 |
28 |
$8.26 |
| 82945 |
|
38 |
38 |
$8.10 |
| J0500 |
Dicyclomine injection |
391 |
317 |
$3.44 |
| C1725 |
Cath, translumin non-laser |
1,044 |
861 |
$3.28 |
| C1766 |
Intro/sheath,strble,non-peel |
229 |
215 |
$3.25 |
| J0171 |
Adrenalin epinephrine inject |
766 |
706 |
$2.91 |
| J2920 |
Methylprednisolone injection |
23 |
13 |
$2.20 |
| J0744 |
Ciprofloxacin iv |
87 |
65 |
$1.87 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
1,257 |
1,206 |
$1.00 |
| J2175 |
Meperidine hydrochl /100 mg |
25 |
24 |
$0.90 |
| Q0244 |
Casirivi and imdevi 1200 mg |
13 |
13 |
$0.03 |
| J1920 |
Inj, labetalol hcl, 5mg |
190 |
160 |
$0.00 |
| G8987 |
Self care current status |
238 |
223 |
$0.00 |
| J1790 |
Droperidol injection |
915 |
856 |
$0.00 |
| J2371 |
Inj phenylephrine hcl 20 mcg |
1,722 |
1,655 |
$0.00 |
| C1726 |
Cath, bal dil, non-vascular |
151 |
146 |
$0.00 |
| S2900 |
Robotic surgical system |
99 |
96 |
$0.00 |
| 73600 |
|
14 |
13 |
$0.00 |
| J2470 |
Inj pantoprazole sodium 40mg |
88 |
66 |
$0.00 |
| J1836 |
Inj, metronidazole, 10 mg |
353 |
253 |
$0.00 |
| S9981 |
Med record copy admin |
17 |
16 |
$0.00 |
| J0456 |
Azithromycin |
74 |
58 |
$0.00 |
| J2305 |
Inj, nitroglycerin, 5 mg |
129 |
113 |
$0.00 |
| J7999 |
Compounded drug, noc |
166 |
135 |
$0.00 |
| 96411 |
|
39 |
25 |
$0.00 |
| G8988 |
Self care goal status |
216 |
203 |
$0.00 |
| 43264 |
|
12 |
12 |
$0.00 |
| J0360 |
Hydralazine hcl injection |
106 |
86 |
$0.00 |
| J2785 |
Regadenoson injection |
15 |
15 |
$0.00 |
| 76815 |
|
13 |
13 |
$0.00 |
| S9982 |
Med record copy per page |
28 |
27 |
$0.00 |
| 72020 |
|
61 |
44 |
$0.00 |
| J1805 |
Inj, esmolol hcl, 10mg |
12 |
12 |
$0.00 |
| J2919 |
Inj, methylpred sod succ 5mg |
218 |
180 |
$0.00 |
| J1596 |
Inj, glycopyrrolate, 0.1 mg |
367 |
342 |
$0.00 |
| 0100U |
|
33 |
32 |
$0.00 |
| J2359 |
Inj. olanzapine, 0.5mg |
123 |
106 |
$0.00 |
| G8979 |
Mobility goal status |
310 |
295 |
$0.00 |
| J0134 |
Inj acetaminophen -fresenius |
457 |
425 |
$0.00 |
| 93356 |
|
671 |
655 |
$0.00 |
| G8978 |
Mobility current status |
329 |
308 |
$0.00 |
| J0692 |
Cefepime hcl for injection |
264 |
121 |
$0.00 |
| S0080 |
Injection, pentamidine iseth |
157 |
140 |
$0.00 |
| J3415 |
Pyridoxine hcl 100 mg |
208 |
176 |
$0.00 |
| J0688 |
Inj cefazolin sodium, hikma |
568 |
490 |
$0.00 |
| 71100 |
|
12 |
12 |
$0.00 |
| G8989 |
Self care d/c status |
28 |
27 |
$0.00 |
| J2004 |
Inj, lidocaine w epinephrine |
101 |
100 |
$0.00 |
| C1758 |
Catheter, ureteral |
12 |
12 |
$0.00 |
| J1956 |
Levofloxacin injection |
55 |
42 |
$0.00 |
| J2720 |
Inj protamine sulfate/10 mg |
24 |
24 |
$0.00 |
| J0137 |
Inj, acetaminophen (hikma) |
13 |
12 |
$0.00 |
| G2215 |
Home supply nasal naloxone |
16 |
16 |
$0.00 |
| J3371 |
Inj, vancomycin hcl (mylan) |
38 |
24 |
$0.00 |
| C1760 |
Closure dev, vasc |
12 |
12 |
$0.00 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
299 |
228 |
$0.00 |
| Q9958 |
Hocm <=149 mg/ml iodine, 1ml |
13 |
13 |
$0.00 |
| J0736 |
Inj, clindamycin phosp 300mg |
16 |
12 |
$0.00 |
| 51702 |
|
16 |
15 |
$0.00 |
| C2625 |
Stent, non-cor, tem w/del sy |
13 |
13 |
$0.00 |
| C1776 |
Joint device (implantable) |
14 |
12 |
$0.00 |