MONROE SURGICAL HOSPITAL, LLC

$797K

Total Medicaid Paid

20,107

Total Claims

16,973

Beneficiaries

50

Codes Billed

2018-01

First Month

2024-12

Last Month

Code	Description	Claims	Beneficiaries	Total Paid
43239		592	530	$216K
66984		269	206	$155K
93306		1,053	960	$79K
V2632	Post chmbr intraocular lens	573	457	$68K
69436		92	86	$43K
93017		789	720	$39K
87635		1,117	1,005	$38K
78452		240	216	$32K
80050		554	504	$21K
85025		2,904	2,444	$20K
76856		160	139	$10K
87804		686	597	$10K
A9500	Tc99m sestamibi	358	216	$9K
80061		603	547	$7K
76830		115	94	$7K
87880		420	372	$6K
93270		123	118	$5K
45385		13	12	$5K
87811		170	145	$4K
73564		233	215	$4K
73630		79	65	$4K
73130		81	67	$4K
J2785	Regadenoson injection	114	103	$3K
70220		203	194	$2K
74018		151	133	$1K
73562		49	40	$1K
J2704	Inj, propofol, 10 mg	2,538	2,130	$507.92
93246		23	14	$464.20
72100		17	17	$399.36
87807		26	24	$314.40
82962		100	81	$291.78
70360		14	13	$240.89
C9803	Hopd covid-19 spec collect	1,178	982	$155.62
81003		72	65	$137.35
85027		202	181	$61.27
85730		171	152	$42.07
36415		250	206	$31.33
85610		171	152	$30.03
93005		33	25	$29.70
81025		194	157	$24.45
80048		61	53	$16.92
82948		12	12	$4.07
J3010	Fentanyl citrate injection	588	434	$0.75
J2250	Inj midazolam hydrochloride	175	168	$0.38
J2001	Lidocaine injection	2,034	1,530	$0.37
J0690	Cefazolin sodium injection	131	88	$0.00
J3490	Drugs unclassified injection	270	208	$0.00
J1100	Dexamethasone sodium phos	14	14	$0.00
J2780	Ranitidine hydrochloride inj	16	13	$0.00
J2405	Ondansetron hcl injection	76	69	$0.00

Medicaid Provider Spending