| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| U0004 |
Cov-19 test non-cdc hgh thru |
28,583 |
26,780 |
$2.36M |
| 0202U |
|
10,336 |
10,060 |
$2.26M |
| 99285 |
|
14,682 |
14,009 |
$1.67M |
| 87631 |
|
7,286 |
7,035 |
$1.00M |
| 99284 |
|
10,712 |
10,297 |
$950K |
| G0378 |
Hospital observation per hr |
1,191 |
828 |
$913K |
| 99283 |
|
12,440 |
11,973 |
$826K |
| J3380 |
Inj vedolizumab iv 1 mg |
568 |
538 |
$821K |
| U0003 |
Cov-19 amp prb hgh thruput |
9,133 |
8,535 |
$725K |
| 80307 |
|
11,125 |
9,416 |
$655K |
| 80053 |
|
65,851 |
60,699 |
$650K |
| 84443 |
|
29,809 |
29,001 |
$618K |
| J9271 |
Inj pembrolizumab |
659 |
528 |
$570K |
| J0585 |
Injection,onabotulinumtoxina |
2,828 |
2,572 |
$473K |
| 80061 |
|
33,119 |
32,594 |
$425K |
| 300 |
Patient transfer system <300 |
6,229 |
1,396 |
$398K |
| 76811 |
|
3,307 |
3,247 |
$393K |
| 87637 |
|
2,982 |
2,821 |
$360K |
| J1745 |
Infliximab not biosimil 10mg |
238 |
212 |
$356K |
| 87481 |
|
5,013 |
4,755 |
$339K |
| 96413 |
|
3,746 |
2,589 |
$329K |
| G0480 |
Drug test def 1-7 classes |
5,709 |
5,187 |
$319K |
| 85025 |
|
67,262 |
61,249 |
$317K |
| T1015 |
Clinic service |
8,858 |
6,148 |
$311K |
| 76816 |
|
5,860 |
5,529 |
$302K |
| U0005 |
Infec agen detec ampli probe |
22,469 |
21,442 |
$301K |
| 87491 |
|
10,544 |
10,321 |
$255K |
| Q3014 |
Telehealth facility fee |
18,463 |
17,690 |
$248K |
| 82306 |
|
6,777 |
6,648 |
$232K |
| 87591 |
|
9,183 |
8,983 |
$211K |
| 87661 |
|
5,565 |
5,404 |
$205K |
| 83036 |
|
31,131 |
30,615 |
$195K |
| 0100U |
|
483 |
464 |
$195K |
| 78815 |
|
233 |
230 |
$188K |
| C1713 |
Anchor/screw bn/bn,tis/bn |
190 |
173 |
$185K |
| 74177 |
|
1,321 |
1,282 |
$176K |
| 70553 |
|
744 |
722 |
$161K |
| 87389 |
|
6,413 |
6,331 |
$160K |
| 70551 |
|
505 |
489 |
$130K |
| 80048 |
|
19,273 |
16,914 |
$129K |
| 87430 |
|
18,647 |
18,166 |
$120K |
| 95165 |
|
455 |
294 |
$118K |
| 36415 |
|
66,946 |
59,101 |
$112K |
| 87086 |
|
15,264 |
14,642 |
$111K |
| 64615 |
|
1,409 |
1,369 |
$111K |
| 82607 |
|
9,188 |
9,050 |
$105K |
| 99282 |
|
2,937 |
2,842 |
$105K |
| 96365 |
|
3,338 |
2,208 |
$99K |
| 88175 |
|
3,348 |
3,339 |
$98K |
| 80050 |
|
2,195 |
2,179 |
$97K |
| X0621 |
|
501 |
267 |
$97K |
| X0616 |
|
547 |
541 |
$97K |
| 87624 |
|
2,512 |
2,499 |
$96K |
| 86803 |
|
5,241 |
5,151 |
$91K |
| 0002A |
|
2,510 |
2,507 |
$89K |
| 76819 |
|
1,240 |
899 |
$88K |
| 82728 |
|
8,096 |
7,814 |
$84K |
| 85027 |
|
14,829 |
13,428 |
$83K |
| 96374 |
|
3,170 |
2,988 |
$77K |
| 84702 |
|
5,247 |
4,677 |
$76K |
| 0001A |
|
2,595 |
2,587 |
$76K |
| 93306 |
|
970 |
955 |
$73K |
| 76770 |
|
1,228 |
1,210 |
$73K |
| 87506 |
|
513 |
507 |
$72K |
| 71275 |
|
345 |
335 |
$66K |
| 83970 |
|
1,798 |
1,746 |
$60K |
| 83540 |
|
8,247 |
8,007 |
$60K |
| Q5121 |
Inj. avsola, 10 mg |
741 |
695 |
$58K |
| 70450 |
|
1,028 |
984 |
$57K |
| 77386 |
|
222 |
26 |
$57K |
| 94010 |
|
1,727 |
1,693 |
$55K |
| 88305 |
|
5,198 |
4,334 |
$55K |
| 83655 |
|
4,960 |
4,823 |
$54K |
| X0592 |
|
1,518 |
1,354 |
$53K |
| G0463 |
Hospital outpt clinic visit |
6,180 |
4,937 |
$53K |
| 87511 |
|
2,661 |
2,611 |
$52K |
| X0620 |
|
366 |
325 |
$52K |
| 93005 |
|
7,028 |
6,612 |
$51K |
| G0108 |
Diab manage trn per indiv |
2,450 |
2,376 |
$50K |
| 86003 |
|
542 |
530 |
$50K |
| 43239 |
|
418 |
409 |
$49K |
| 92557 |
|
1,784 |
1,735 |
$48K |
| 82570 |
|
7,580 |
7,212 |
$48K |
| 84439 |
|
5,586 |
5,416 |
$42K |
| 87522 |
Neg quan hep c or qual rna |
1,055 |
1,045 |
$41K |
| 71046 |
|
3,059 |
2,919 |
$41K |
| 86480 |
|
645 |
642 |
$41K |
| 87150 |
|
942 |
933 |
$41K |
| 82043 |
|
5,798 |
5,644 |
$41K |
| 92579 |
|
636 |
626 |
$40K |
| 96372 |
|
3,912 |
3,393 |
$40K |
| 87651 |
|
309 |
270 |
$38K |
| 72148 |
|
243 |
240 |
$37K |
| 93325 |
|
1,514 |
1,469 |
$34K |
| 83550 |
|
7,892 |
7,664 |
$34K |
| 86618 |
|
1,451 |
1,437 |
$33K |
| 76830 |
|
582 |
533 |
$32K |
| 76705 |
|
733 |
713 |
$30K |
| 92567 |
|
3,142 |
3,070 |
$30K |
| 87536 |
|
301 |
294 |
$29K |
| 88342 |
|
981 |
916 |
$28K |
| 36561 |
|
30 |
29 |
$28K |
| 86317 |
|
1,214 |
1,195 |
$28K |
| 72141 |
|
140 |
137 |
$28K |
| 71260 |
|
405 |
396 |
$27K |
| 87340 |
|
2,398 |
2,368 |
$27K |
| 83735 |
|
4,815 |
4,135 |
$26K |
| 45380 |
|
119 |
114 |
$26K |
| 84484 |
|
3,441 |
2,931 |
$26K |
| 93296 |
|
2,108 |
2,066 |
$26K |
| 82784 |
|
1,432 |
1,339 |
$25K |
| 82746 |
|
2,572 |
2,541 |
$25K |
| 93971 |
|
390 |
362 |
$25K |
| 80074 |
|
530 |
529 |
$25K |
| 84146 |
|
1,075 |
1,050 |
$25K |
| 83880 |
|
946 |
908 |
$25K |
| X0615 |
|
151 |
150 |
$24K |
| 87186 |
|
3,247 |
3,029 |
$23K |
| 74183 |
|
84 |
84 |
$23K |
| J1459 |
Inj ivig privigen 500 mg |
1,140 |
359 |
$23K |
| 96361 |
|
2,203 |
1,919 |
$23K |
| 29581 |
|
1,330 |
476 |
$23K |
| 96375 |
|
1,421 |
1,259 |
$23K |
| 72100 |
|
1,168 |
1,144 |
$22K |
| 84403 |
|
872 |
862 |
$22K |
| J2357 |
Omalizumab injection |
20 |
12 |
$22K |
| 76885 |
|
209 |
208 |
$22K |
| 74176 |
|
300 |
284 |
$21K |
| 90686 |
|
2,688 |
2,641 |
$21K |
| 84153 |
|
934 |
923 |
$20K |
| 80076 |
|
2,640 |
2,407 |
$20K |
| 72125 |
|
366 |
352 |
$19K |
| 78264 |
|
188 |
186 |
$19K |
| 92507 |
|
670 |
284 |
$19K |
| 73721 |
|
98 |
92 |
$19K |
| 85610 |
|
7,197 |
5,383 |
$19K |
| 96415 |
|
565 |
474 |
$18K |
| 95910 |
|
318 |
314 |
$17K |
| 96417 |
|
321 |
228 |
$17K |
| 76817 |
|
372 |
335 |
$17K |
| 71250 |
|
285 |
275 |
$17K |
| U0002 |
Covid-19 lab test non-cdc |
487 |
477 |
$17K |
| 83525 |
|
1,509 |
1,483 |
$16K |
| 81003 |
|
6,652 |
6,286 |
$16K |
| 81001 |
|
6,939 |
6,612 |
$16K |
| 96360 |
|
642 |
547 |
$16K |
| 88341 |
|
479 |
381 |
$15K |
| 86780 |
|
1,035 |
1,024 |
$15K |
| 83520 |
|
1,312 |
1,292 |
$15K |
| 93304 |
|
599 |
582 |
$15K |
| 87077 |
|
2,299 |
1,996 |
$15K |
| 86762 |
|
1,081 |
1,066 |
$15K |
| 83690 |
|
3,655 |
3,454 |
$15K |
| 86360 |
|
279 |
274 |
$15K |
| 0012A |
|
515 |
514 |
$15K |
| 86850 |
|
3,257 |
3,045 |
$15K |
| 70496 |
|
70 |
70 |
$14K |
| 87529 |
|
234 |
233 |
$14K |
| 0004A |
|
344 |
344 |
$14K |
| 83605 |
|
2,556 |
2,328 |
$14K |
| 43235 |
|
106 |
103 |
$14K |
| 70498 |
|
103 |
102 |
$13K |
| J0185 |
Inj., aprepitant, 1 mg |
226 |
139 |
$13K |
| 86140 |
|
4,983 |
4,663 |
$13K |
| 77067 |
|
175 |
174 |
$13K |
| 86038 |
|
907 |
894 |
$13K |
| 97161 |
|
308 |
301 |
$12K |
| 83001 |
|
761 |
758 |
$12K |
| 93880 |
|
186 |
178 |
$12K |
| 87641 |
|
559 |
540 |
$12K |
| J0897 |
Denosumab injection |
68 |
66 |
$12K |
| 86900 |
|
3,773 |
3,173 |
$12K |
| 85652 |
|
4,470 |
4,279 |
$12K |
| 97165 |
|
335 |
321 |
$11K |
| 70486 |
|
175 |
169 |
$11K |
| 90715 |
|
1,465 |
1,441 |
$11K |
| 86359 |
|
279 |
274 |
$11K |
| 95886 |
|
824 |
814 |
$11K |
| 71045 |
|
1,625 |
1,515 |
$11K |
| 93303 |
|
118 |
118 |
$11K |
| 94640 |
|
291 |
238 |
$11K |
| 82248 |
|
1,966 |
1,880 |
$11K |
| J1756 |
Iron sucrose injection |
3,632 |
1,630 |
$11K |
| C9803 |
Hopd covid-19 spec collect |
916 |
895 |
$11K |
| 84481 |
|
490 |
477 |
$11K |
| 86147 |
|
147 |
144 |
$11K |
| 86235 |
|
285 |
282 |
$11K |
| 82805 |
|
481 |
444 |
$10K |
| 85046 |
|
1,929 |
1,853 |
$10K |
| 84100 |
|
2,511 |
2,027 |
$10K |
| 96040 |
|
352 |
349 |
$10K |
| 76815 |
|
261 |
197 |
$10K |
| G0008 |
Admin influenza virus vac |
1,113 |
1,101 |
$10K |
| 88312 |
|
278 |
239 |
$10K |
| 84270 |
|
384 |
363 |
$9K |
| 86592 |
|
2,345 |
2,312 |
$9K |
| 93970 |
|
91 |
89 |
$9K |
| 45385 |
|
36 |
34 |
$9K |
| 82565 |
|
1,943 |
1,869 |
$9K |
| 74018 |
|
761 |
724 |
$9K |
| 93321 |
|
792 |
770 |
$9K |
| 86787 |
|
595 |
587 |
$9K |
| 87070 |
|
1,583 |
1,527 |
$9K |
| 87798 |
|
350 |
345 |
$9K |
| 0071A |
|
208 |
208 |
$9K |
| 86901 |
|
3,758 |
3,159 |
$9K |
| 83002 |
|
546 |
546 |
$9K |
| 92610 |
|
244 |
241 |
$8K |
| C1769 |
Guide wire |
481 |
444 |
$8K |
| 93350 |
|
197 |
195 |
$8K |
| 87088 |
|
1,195 |
1,134 |
$8K |
| 73610 |
|
587 |
516 |
$8K |
| 87902 |
|
50 |
49 |
$8K |
| 84630 |
|
727 |
719 |
$8K |
| 82670 |
|
423 |
410 |
$8K |
| 64405 |
|
227 |
216 |
$8K |
| 88313 |
|
187 |
135 |
$8K |
| 95004 |
|
104 |
103 |
$8K |
| 0072A |
|
186 |
185 |
$8K |
| 72156 |
|
54 |
53 |
$8K |
| 69436 |
|
24 |
13 |
$8K |
| 95909 |
|
180 |
180 |
$8K |
| 87635 |
|
207 |
205 |
$8K |
| 80326 |
|
480 |
335 |
$8K |
| 86160 |
|
289 |
285 |
$8K |
| 97162 |
|
232 |
224 |
$7K |
| 76536 |
|
149 |
147 |
$7K |
| 93922 |
|
420 |
408 |
$7K |
| 82105 |
|
418 |
415 |
$7K |
| 74240 |
|
149 |
149 |
$7K |
| 80081 |
|
91 |
91 |
$7K |
| 86039 |
|
536 |
523 |
$7K |
| 82950 |
|
1,087 |
1,071 |
$7K |
| 85379 |
|
771 |
741 |
$7K |
| 80354 |
|
194 |
144 |
$7K |
| 80346 |
|
403 |
292 |
$7K |
| 82785 |
|
436 |
431 |
$7K |
| C1887 |
Catheter, guiding |
33 |
33 |
$7K |
| 80164 |
|
428 |
408 |
$7K |
| 83615 |
|
1,242 |
1,058 |
$7K |
| 87493 |
|
201 |
200 |
$7K |
| 31231 |
|
129 |
128 |
$7K |
| 73564 |
|
486 |
402 |
$7K |
| 0011A |
|
403 |
399 |
$7K |
| 76700 |
|
92 |
91 |
$7K |
| 80069 |
|
920 |
857 |
$7K |
| 81025 |
|
2,124 |
2,066 |
$7K |
| 76805 |
|
111 |
111 |
$7K |
| 36591 |
|
308 |
237 |
$7K |
| 86665 |
|
176 |
174 |
$6K |
| 86800 |
|
373 |
368 |
$6K |
| 84305 |
|
287 |
285 |
$6K |
| 93320 |
|
437 |
435 |
$6K |
| 77336 |
|
165 |
88 |
$6K |
| 73630 |
|
819 |
653 |
$6K |
| 0241U |
|
172 |
156 |
$6K |
| 92587 |
|
195 |
194 |
$6K |
| 87040 |
|
447 |
391 |
$6K |
| 88185 |
|
138 |
85 |
$6K |
| 59899 |
|
62 |
55 |
$6K |
| 86704 |
|
442 |
440 |
$6K |
| 84460 |
|
975 |
944 |
$6K |
| 72040 |
|
420 |
409 |
$6K |
| 73502 |
|
352 |
339 |
$5K |
| 83721 |
|
518 |
516 |
$5K |
| 86431 |
|
743 |
741 |
$5K |
| 96366 |
|
359 |
254 |
$5K |
| 36430 |
|
221 |
136 |
$5K |
| 95819 |
|
388 |
383 |
$5K |
| 75561 |
|
14 |
14 |
$5K |
| 78452 |
|
39 |
36 |
$5K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
6,795 |
6,386 |
$5K |
| 0064A |
|
126 |
126 |
$5K |
| 72082 |
|
144 |
144 |
$5K |
| 450 |
Pov group 1 hd 301-450 lbs |
20 |
12 |
$5K |
| 84590 |
|
504 |
501 |
$5K |
| 84156 |
|
1,473 |
1,368 |
$5K |
| 73030 |
|
450 |
401 |
$5K |
| 86334 |
|
220 |
215 |
$5K |
| 95816 |
|
390 |
389 |
$5K |
| 82533 |
|
492 |
425 |
$5K |
| 82627 |
|
252 |
247 |
$5K |
| 92014 |
|
154 |
152 |
$5K |
| 80047 |
|
587 |
428 |
$5K |
| 86225 |
|
371 |
366 |
$5K |
| 80365 |
|
138 |
111 |
$5K |
| 91200 |
|
235 |
233 |
$5K |
| 49083 |
|
76 |
36 |
$4K |
| Q9966 |
Locm 200-299mg/ml iodine,1ml |
173 |
167 |
$4K |
| 90471 |
|
528 |
510 |
$4K |
| 92133 |
|
501 |
498 |
$4K |
| 0003A |
|
102 |
102 |
$4K |
| 84165 |
|
382 |
374 |
$4K |
| 82024 |
|
115 |
111 |
$4K |
| 82550 |
|
767 |
714 |
$4K |
| 83921 |
|
273 |
272 |
$4K |
| 73130 |
|
564 |
442 |
$4K |
| C1894 |
Intro/sheath, non-laser |
379 |
352 |
$4K |
| 84450 |
|
680 |
671 |
$4K |
| 82657 |
|
113 |
94 |
$4K |
| 86617 |
|
105 |
104 |
$4K |
| 94729 |
|
411 |
400 |
$4K |
| 76825 |
|
147 |
144 |
$4K |
| 73590 |
|
348 |
314 |
$4K |
| 82525 |
|
401 |
392 |
$4K |
| 82962 |
|
3,442 |
2,368 |
$4K |
| 96376 |
|
185 |
147 |
$4K |
| 73562 |
|
361 |
295 |
$4K |
| 78227 |
|
14 |
14 |
$4K |
| 92134 |
|
506 |
495 |
$4K |
| 94060 |
|
396 |
386 |
$4K |
| A4220 |
Infusion pump refill kit |
515 |
378 |
$4K |
| 84550 |
|
708 |
678 |
$4K |
| 96411 |
|
66 |
51 |
$4K |
| 85730 |
|
738 |
710 |
$4K |
| 85018 |
|
1,314 |
1,246 |
$4K |
| 85007 |
|
1,343 |
1,033 |
$4K |
| 76820 |
|
252 |
126 |
$4K |
| 94726 |
|
334 |
327 |
$4K |
| 86708 |
|
236 |
235 |
$3K |
| 77072 |
|
267 |
266 |
$3K |
| 84112 |
|
62 |
60 |
$3K |
| A9585 |
Gadobutrol injection |
3,325 |
3,056 |
$3K |
| 86200 |
|
263 |
263 |
$3K |
| 84425 |
|
539 |
535 |
$3K |
| 82977 |
|
512 |
486 |
$3K |
| 95810 |
|
12 |
12 |
$3K |
| 73221 |
|
13 |
12 |
$3K |
| 87338 |
|
214 |
212 |
$3K |
| 88142 |
|
192 |
192 |
$3K |
| 74230 |
|
110 |
109 |
$3K |
| 93293 |
|
320 |
313 |
$3K |
| 74174 |
|
13 |
13 |
$3K |
| 80197 |
|
327 |
241 |
$3K |
| 70491 |
|
29 |
29 |
$3K |
| 76881 |
|
33 |
32 |
$3K |
| 80361 |
|
138 |
111 |
$3K |
| 83516 |
|
236 |
233 |
$3K |
| 73552 |
|
248 |
218 |
$3K |
| 81513 |
|
46 |
46 |
$3K |
| 88307 |
|
220 |
175 |
$3K |
| 84681 |
|
106 |
106 |
$3K |
| 97166 |
|
164 |
156 |
$3K |
| 76942 |
|
126 |
122 |
$3K |
| 86376 |
|
380 |
375 |
$3K |
| 97597 |
|
113 |
60 |
$3K |
| 73560 |
|
289 |
245 |
$3K |
| 80175 |
|
227 |
216 |
$3K |
| 87075 |
|
380 |
349 |
$3K |
| 80177 |
|
237 |
233 |
$3K |
| 82951 |
|
214 |
210 |
$3K |
| 73110 |
|
318 |
292 |
$3K |
| 94664 |
|
209 |
195 |
$2K |
| 95885 |
|
152 |
152 |
$2K |
| 76642 |
|
68 |
55 |
$2K |
| G0328 |
Fecal blood scrn immunoassay |
139 |
139 |
$2K |
| 77334 |
|
43 |
30 |
$2K |
| 88304 |
|
376 |
347 |
$2K |
| 82947 |
|
606 |
589 |
$2K |
| 20610 |
|
137 |
111 |
$2K |
| 83498 |
|
111 |
108 |
$2K |
| 93246 |
|
85 |
84 |
$2K |
| G0009 |
Admin pneumococcal vaccine |
206 |
205 |
$2K |
| 87328 |
|
239 |
237 |
$2K |
| 82040 |
|
876 |
847 |
$2K |
| 93926 |
|
41 |
38 |
$2K |
| 72170 |
|
248 |
240 |
$2K |
| 88184 |
|
94 |
86 |
$2K |
| 82247 |
|
377 |
320 |
$2K |
| 20611 |
|
51 |
43 |
$2K |
| 88173 |
|
125 |
116 |
$2K |
| 83090 |
|
124 |
121 |
$2K |
| 86923 |
|
195 |
143 |
$2K |
| 86765 |
|
162 |
160 |
$2K |
| 82375 |
|
589 |
550 |
$2K |
| 72158 |
|
14 |
13 |
$2K |
| 86735 |
|
149 |
148 |
$2K |
| 84520 |
|
512 |
482 |
$2K |
| 87205 |
|
616 |
568 |
$2K |
| 82378 |
|
170 |
156 |
$2K |
| 92523 |
|
14 |
14 |
$2K |
| 92083 |
|
37 |
37 |
$2K |
| 76827 |
|
124 |
120 |
$2K |
| 43762 |
|
107 |
103 |
$2K |
| 86664 |
|
89 |
87 |
$2K |
| 82330 |
|
265 |
239 |
$2K |
| 82310 |
|
433 |
371 |
$2K |
| 97168 |
|
40 |
40 |
$2K |
| 80178 |
|
225 |
216 |
$2K |
| 76801 |
|
46 |
41 |
$2K |
| 83021 |
|
83 |
77 |
$2K |
| J2469 |
Palonosetron hcl |
278 |
179 |
$2K |
| 73080 |
|
175 |
161 |
$2K |
| 95700 |
|
13 |
12 |
$2K |
| 11720 |
|
204 |
203 |
$1K |
| 320 |
|
17 |
12 |
$1K |
| 36416 |
|
1,340 |
1,287 |
$1K |
| 90670 |
|
227 |
227 |
$1K |
| 95117 |
|
63 |
36 |
$1K |
| 86255 |
|
73 |
72 |
$1K |
| 87046 |
|
558 |
551 |
$1K |
| 74455 |
|
38 |
38 |
$1K |
| 11056 |
|
64 |
63 |
$1K |
| 86146 |
|
24 |
24 |
$1K |
| 84446 |
|
167 |
167 |
$1K |
| J1170 |
Hydromorphone injection |
2,175 |
1,699 |
$1K |
| 73090 |
|
174 |
154 |
$1K |
| 84478 |
|
168 |
164 |
$1K |
| A4627 |
Spacer bag/reservoir |
68 |
68 |
$1K |
| 71271 |
|
13 |
13 |
$1K |
| 84145 |
|
92 |
83 |
$1K |
| 84132 |
|
344 |
259 |
$1K |
| G0101 |
Ca screen;pelvic/breast exam |
31 |
31 |
$1K |
| 84207 |
|
29 |
29 |
$1K |
| 77001 |
|
91 |
90 |
$1K |
| 49452 |
|
14 |
14 |
$1K |
| 77063 |
|
51 |
51 |
$1K |
| 90791 |
|
48 |
47 |
$1K |
| 76882 |
|
123 |
109 |
$1K |
| 82103 |
|
66 |
66 |
$980.07 |
| 99152 |
|
247 |
240 |
$922.78 |
| 76377 |
|
26 |
26 |
$907.72 |
| 77065 |
Tomosynthesis, mammo |
13 |
13 |
$903.43 |
| J2270 |
Morphine sulfate injection |
1,211 |
971 |
$871.92 |
| J2704 |
Inj, propofol, 10 mg |
7,389 |
5,951 |
$859.67 |
| J0330 |
Succinycholine chloride inj |
1,219 |
1,155 |
$841.35 |
| 99281 |
|
43 |
43 |
$821.05 |
| 97167 |
|
15 |
15 |
$820.39 |
| 76856 |
|
14 |
14 |
$816.16 |
| C1788 |
Port, indwelling, imp |
29 |
26 |
$798.16 |
| 10005 |
|
13 |
13 |
$784.28 |
| 83050 |
|
467 |
431 |
$782.13 |
| P9021 |
Red blood cells unit |
20 |
16 |
$771.66 |
| 89051 |
|
255 |
235 |
$745.78 |
| 84075 |
|
201 |
195 |
$744.73 |
| 84300 |
|
113 |
112 |
$743.59 |
| J3301 |
Triamcinolone acet inj nos |
2,296 |
2,241 |
$741.90 |
| J1650 |
Inj enoxaparin sodium |
1,867 |
770 |
$725.05 |
| 93017 |
|
39 |
39 |
$719.60 |
| 89343 |
|
112 |
73 |
$717.80 |
| 11721 |
|
73 |
72 |
$710.90 |
| 87102 |
|
115 |
109 |
$710.74 |
| 85520 |
|
126 |
85 |
$704.35 |
| J1020 |
Methylprednisolone 20 mg inj |
250 |
233 |
$701.85 |
| 76870 |
|
17 |
15 |
$680.06 |
| J1885 |
Ketorolac tromethamine inj |
8,746 |
7,701 |
$674.34 |
| 86777 |
|
49 |
49 |
$658.47 |
| 82140 |
|
154 |
148 |
$653.08 |
| 82553 |
|
122 |
104 |
$652.36 |
| 86769 |
|
61 |
57 |
$649.28 |
| 72070 |
|
37 |
37 |
$645.35 |
| 73060 |
|
71 |
64 |
$624.95 |
| 99153 |
Mod sedat endo service >5yrs |
262 |
252 |
$624.57 |
| 46600 |
|
38 |
38 |
$619.00 |
| J3010 |
Fentanyl citrate injection |
9,600 |
8,399 |
$614.48 |
| C1729 |
Cath, drainage |
69 |
49 |
$610.72 |
| 86696 |
|
29 |
28 |
$608.38 |
| 83883 |
|
41 |
40 |
$597.24 |
| 0296T |
|
13 |
12 |
$593.73 |
| 82077 |
|
70 |
60 |
$570.70 |
| 82952 |
|
182 |
182 |
$564.54 |
| 87206 |
|
246 |
222 |
$558.26 |
| 82088 |
|
25 |
25 |
$554.32 |
| 90834 |
|
43 |
35 |
$528.25 |
| 95908 |
|
13 |
13 |
$517.24 |
| 51700 |
|
21 |
13 |
$512.87 |
| 0013A |
|
12 |
12 |
$508.80 |
| V5264 |
Ear mold/insert |
12 |
12 |
$508.80 |
| 80325 |
|
35 |
34 |
$503.90 |
| 86695 |
|
28 |
27 |
$497.04 |
| 82668 |
|
41 |
40 |
$495.64 |
| 92611 |
|
14 |
14 |
$489.65 |
| 82157 |
|
21 |
20 |
$481.50 |
| 84432 |
|
17 |
15 |
$465.12 |
| J7050 |
Normal saline solution infus |
13,835 |
8,754 |
$462.95 |
| J7040 |
Normal saline solution infus |
8,673 |
5,661 |
$458.17 |
| 80299 |
|
43 |
41 |
$456.00 |
| 83010 |
|
55 |
53 |
$450.17 |
| J0690 |
Cefazolin sodium injection |
3,180 |
2,580 |
$444.51 |
| 80321 |
|
36 |
34 |
$442.89 |
| 97803 |
|
12 |
12 |
$441.29 |
| 87181 |
|
47 |
28 |
$430.76 |
| 82465 |
|
70 |
70 |
$428.33 |
| 82390 |
|
44 |
44 |
$423.85 |
| 59025 |
|
99 |
87 |
$409.91 |
| 87497 |
|
23 |
14 |
$406.64 |
| 82340 |
|
53 |
52 |
$402.89 |
| 73523 |
|
12 |
12 |
$394.57 |
| 84480 |
|
54 |
54 |
$392.57 |
| 86644 |
|
26 |
26 |
$390.58 |
| J2405 |
Ondansetron hcl injection |
12,782 |
10,692 |
$387.01 |
| G0279 |
Tomosynthesis, mammo |
17 |
17 |
$376.26 |
| 86308 |
|
60 |
59 |
$371.45 |
| 85014 |
|
123 |
116 |
$366.76 |
| J1100 |
Dexamethasone sodium phos |
7,802 |
6,800 |
$362.78 |
| 90723 |
|
80 |
80 |
$340.00 |
| J7060 |
5% dextrose/water |
2,427 |
1,473 |
$332.85 |
| 90680 |
|
58 |
58 |
$330.00 |
| 73140 |
|
45 |
43 |
$328.06 |
| 85246 |
|
12 |
12 |
$315.85 |
| 76000 |
|
81 |
81 |
$314.22 |
| 72110 |
|
15 |
15 |
$313.20 |
| 0054A |
|
12 |
12 |
$313.00 |
| A9541 |
Tc99m sulfur colloid |
13 |
13 |
$312.18 |
| 84133 |
|
53 |
53 |
$311.99 |
| 70360 |
|
24 |
24 |
$308.36 |
| J0780 |
Prochlorperazine injection |
796 |
733 |
$306.61 |
| 83993 |
|
13 |
13 |
$301.69 |
| J7030 |
Normal saline solution infus |
1,493 |
853 |
$298.56 |
| 96402 |
|
15 |
12 |
$294.66 |
| 84597 |
|
15 |
14 |
$281.75 |
| 3052F |
|
77 |
73 |
$280.75 |
| 90935 |
|
325 |
39 |
$268.15 |
| J1644 |
Inj heparin sodium per 1000u |
2,609 |
1,442 |
$267.72 |
| 87147 |
|
93 |
88 |
$253.94 |
| 90647 |
|
51 |
51 |
$250.00 |
| 90633 |
|
14 |
14 |
$244.70 |
| J1790 |
Droperidol injection |
496 |
405 |
$242.75 |
| 84295 |
|
68 |
63 |
$242.35 |
| 96523 |
|
16 |
16 |
$230.36 |
| 67028 |
|
43 |
43 |
$218.41 |
| 84134 |
|
13 |
13 |
$217.28 |
| 84144 |
|
14 |
13 |
$216.24 |
| J0696 |
Ceftriaxone sodium injection |
1,200 |
1,003 |
$214.90 |
| 82435 |
|
64 |
57 |
$209.99 |
| 84155 |
|
72 |
70 |
$200.53 |
| 11719 |
|
13 |
13 |
$196.44 |
| 86304 |
|
12 |
12 |
$193.17 |
| J3370 |
Vancomycin hcl injection |
613 |
448 |
$181.95 |
| 87015 |
|
60 |
54 |
$171.78 |
| G0416 |
Prostate biopsy, any mthd |
32 |
31 |
$166.10 |
| 12001 |
|
15 |
15 |
$165.40 |
| 10060 |
|
13 |
12 |
$163.53 |
| 82150 |
|
47 |
42 |
$159.45 |
| 80179 |
|
13 |
12 |
$157.08 |
| 76857 |
|
13 |
13 |
$149.10 |
| J1200 |
Diphenhydramine hcl injectio |
1,823 |
1,553 |
$147.88 |
| 82374 |
|
46 |
43 |
$146.23 |
| G0127 |
Trim nail(s) |
14 |
12 |
$139.15 |
| 83020 |
|
14 |
13 |
$138.60 |
| 88104 |
|
16 |
13 |
$138.00 |
| 51701 |
|
12 |
12 |
$136.17 |
| 87880 |
|
26 |
26 |
$130.15 |
| 70355 |
|
12 |
12 |
$129.36 |
| 86812 |
|
14 |
13 |
$126.12 |
| 84244 |
|
12 |
12 |
$114.12 |
| 76937 |
|
74 |
71 |
$113.27 |
| 73100 |
|
13 |
12 |
$109.99 |
| J1580 |
Garamycin gentamicin inj |
282 |
257 |
$107.39 |
| J2930 |
Methylprednisolone injection |
283 |
233 |
$106.21 |
| 87116 |
|
15 |
13 |
$105.89 |
| 89342 |
|
33 |
33 |
$100.45 |
| 81015 |
|
34 |
33 |
$95.55 |
| 82397 |
|
12 |
12 |
$93.17 |
| Q9957 |
Inj perflutren lip micros,ml |
777 |
764 |
$92.72 |
| 86364 |
|
16 |
16 |
$91.67 |
| J3475 |
Inj magnesium sulfate |
976 |
716 |
$88.45 |
| J2250 |
Inj midazolam hydrochloride |
7,657 |
7,237 |
$88.12 |
| 94618 |
|
27 |
27 |
$87.60 |
| 3044F |
|
92 |
90 |
$80.00 |
| J1815 |
Insulin injection |
1,374 |
498 |
$79.96 |
| 88108 |
|
29 |
27 |
$78.54 |
| J1940 |
Furosemide injection |
191 |
141 |
$66.04 |
| J7512 |
Prednisone ir or dr oral 1mg |
1,226 |
961 |
$59.83 |
| 88311 |
|
42 |
37 |
$56.54 |
| 87184 |
|
12 |
12 |
$55.23 |
| J3420 |
Vitamin b12 injection |
1,421 |
1,327 |
$54.14 |
| J2370 |
Phenylephrine hcl injection |
633 |
552 |
$52.93 |
| 82274 |
|
15 |
15 |
$43.38 |
| J9370 |
Vincristine sulfate 1 mg inj |
441 |
309 |
$40.22 |
| J2060 |
Lorazepam injection |
345 |
292 |
$38.48 |
| J0461 |
Atropine sulfate injection |
19 |
15 |
$20.35 |
| J9250 |
Methotrexate sodium inj |
82 |
53 |
$15.54 |
| S0119 |
Ondansetron 4 mg |
123 |
66 |
$9.08 |
| J2765 |
Metoclopramide hcl injection |
62 |
59 |
$6.48 |
| S0028 |
Injection, famotidine, 20 mg |
37 |
37 |
$2.11 |
| J3490 |
Drugs unclassified injection |
305 |
298 |
$2.07 |
| S0020 |
Injection, bupivicaine hydro |
62 |
57 |
$1.38 |
| J3480 |
Inj potassium chloride |
70 |
52 |
$0.70 |
| Q0162 |
Ondansetron oral |
74 |
27 |
$0.06 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
1,264 |
1,207 |
$0.00 |
| J0295 |
Ampicillin sulbactam 1.5 gm |
109 |
79 |
$0.00 |
| J0688 |
Inj cefazolin sodium, hikma |
81 |
69 |
$0.00 |
| J1050 |
Medroxyprogesterone acetate |
301 |
301 |
$0.00 |
| J0134 |
Inj acetaminophen -fresenius |
385 |
369 |
$0.00 |
| J1596 |
Inj, glycopyrrolate, 0.1 mg |
139 |
137 |
$0.00 |
| J1453 |
Fosaprepitant injection |
40 |
31 |
$0.00 |
| J0744 |
Ciprofloxacin iv |
13 |
12 |
$0.00 |
| Q0163 |
Diphenhydramine hcl 50mg |
92 |
53 |
$0.00 |
| J0171 |
Adrenalin epinephrine inject |
13 |
12 |
$0.00 |
| J1750 |
Inj iron dextran |
19 |
15 |
$0.00 |
| J2004 |
Inj, lidocaine w epinephrine |
38 |
38 |
$0.00 |
| 90746 |
|
12 |
12 |
$0.00 |
| J2919 |
Inj, methylpred sod succ 5mg |
254 |
187 |
$0.00 |
| J0137 |
Inj, acetaminophen (hikma) |
131 |
129 |
$0.00 |
| J0689 |
Inj cefazolin sodium, baxter |
41 |
41 |
$0.00 |
| J0136 |
Inj, acetaminophen (b braun) |
17 |
17 |
$0.00 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
106 |
99 |
$0.00 |
| P9045 |
Albumin (human), 5%, 250 ml |
19 |
17 |
$0.00 |
| 90832 |
|
13 |
12 |
$0.00 |
| J0702 |
Betamethasone acet&sod phosp |
16 |
15 |
$0.00 |
| 90662 |
|
29 |
29 |
$0.00 |
| C9290 |
Inj, bupivacaine liposome |
124 |
119 |
$0.00 |
| J1642 |
Inj heparin sodium per 10 u |
785 |
523 |
$0.00 |
| J2795 |
Ropivacaine hcl injection |
158 |
147 |
$0.00 |
| J0131 |
Inj, acetaminophen (nos) |
251 |
229 |
$0.00 |
| C9399 |
Unclassified drugs or biolog |
284 |
282 |
$0.00 |
| J2785 |
Regadenoson injection |
84 |
84 |
$0.00 |
| J1597 |
Inj glycopyrrolate, glyrx-pf |
83 |
82 |
$0.00 |
| 90677 |
|
94 |
92 |
$0.00 |
| 90656 |
|
423 |
416 |
$0.00 |
| J2371 |
Inj phenylephrine hcl 20 mcg |
228 |
219 |
$0.00 |
| J2920 |
Methylprednisolone injection |
234 |
183 |
$0.00 |
| J8501 |
Oral aprepitant |
14 |
14 |
$0.00 |
| J8540 |
Oral dexamethasone |
17 |
14 |
$0.00 |
| J2805 |
Sincalide injection |
12 |
12 |
$0.00 |
| J2543 |
Piperacillin/tazobactam |
21 |
14 |
$0.00 |
| J1720 |
Hydrocortisone sodium succ i |
29 |
25 |
$0.00 |
| Q9965 |
Locm 100-199mg/ml iodine,1ml |
12 |
12 |
$0.00 |
| Q5122 |
Inj, nyvepria |
22 |
13 |
$0.00 |
| J1250 |
Inj dobutamine hcl/250 mg |
13 |
13 |
$0.00 |
| J2003 |
Inj, lidocaine hcl, 1 mg |
144 |
133 |
$0.00 |