| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| G0384 |
Lev 5 hosp type b ed visit |
17,694 |
15,740 |
$10.17M |
| 99285 |
|
19,599 |
16,960 |
$6.67M |
| 99284 |
|
17,616 |
15,448 |
$4.02M |
| G0383 |
Lev 4 hosp type b ed visit |
16,689 |
15,504 |
$3.75M |
| 96374 |
|
23,540 |
20,245 |
$3.40M |
| 99283 |
|
18,924 |
16,808 |
$3.23M |
| G0382 |
Lev 3 hosp type b ed visit |
16,818 |
15,603 |
$2.84M |
| 45380 |
|
2,952 |
2,815 |
$2.09M |
| 74177 |
|
8,427 |
7,801 |
$1.93M |
| 43239 |
|
4,427 |
4,196 |
$1.89M |
| G0379 |
Direct refer hospital observ |
2,766 |
2,207 |
$1.44M |
| S9480 |
Intensive outpatient psychia |
10,546 |
1,784 |
$1.36M |
| 97110 |
|
34,757 |
10,775 |
$1.24M |
| 90834 |
|
23,539 |
14,590 |
$991K |
| 99213 |
|
16,240 |
15,226 |
$977K |
| 95810 |
|
1,246 |
1,209 |
$957K |
| 70450 |
|
9,295 |
8,431 |
$933K |
| 96365 |
|
7,348 |
4,435 |
$816K |
| 78452 |
|
1,638 |
1,541 |
$776K |
| 96375 |
|
16,941 |
13,789 |
$756K |
| 11042 |
|
4,833 |
2,213 |
$754K |
| 71046 |
|
13,902 |
12,392 |
$741K |
| 96361 |
|
13,657 |
10,550 |
$699K |
| 97140 |
|
18,998 |
6,643 |
$692K |
| 45385 |
|
1,578 |
1,449 |
$672K |
| 99291 |
|
824 |
753 |
$661K |
| H0035 |
Mh partial hosp tx under 24h |
2,941 |
517 |
$574K |
| 74176 |
|
3,483 |
3,251 |
$510K |
| 97597 |
|
6,382 |
3,096 |
$504K |
| 96360 |
|
3,788 |
3,323 |
$474K |
| G0463 |
Hospital outpt clinic visit |
7,878 |
6,071 |
$471K |
| 71045 |
|
8,891 |
7,895 |
$429K |
| 87637 |
|
4,332 |
4,050 |
$421K |
| 87635 |
|
10,816 |
9,766 |
$413K |
| 93306 |
|
2,040 |
1,911 |
$413K |
| H0015 |
Alcohol and/or drug services |
2,962 |
548 |
$386K |
| 97010 |
|
20,537 |
6,661 |
$367K |
| 99282 |
|
2,783 |
2,565 |
$306K |
| 84443 |
|
29,213 |
27,595 |
$287K |
| 80053 |
|
41,213 |
36,868 |
$271K |
| 85025 |
|
103,510 |
84,703 |
$266K |
| 97161 |
|
4,578 |
4,219 |
$254K |
| 82306 |
|
12,808 |
12,326 |
$253K |
| 90832 |
|
8,839 |
6,303 |
$242K |
| 80061 |
|
26,805 |
25,741 |
$238K |
| 80307 |
|
14,251 |
10,964 |
$228K |
| 71275 |
|
1,861 |
1,711 |
$213K |
| G0381 |
Lev 2 hosp type b ed visit |
2,205 |
2,108 |
$211K |
| 90792 |
|
1,768 |
1,680 |
$206K |
| 76856 |
|
2,170 |
2,030 |
$206K |
| 87591 |
|
7,996 |
7,557 |
$199K |
| 87491 |
|
7,995 |
7,556 |
$199K |
| 59025 |
|
1,790 |
1,404 |
$193K |
| 76705 |
|
2,205 |
2,057 |
$185K |
| 97035 |
|
10,248 |
3,830 |
$184K |
| 90853 |
|
12,037 |
3,473 |
$171K |
| J3380 |
Inj vedolizumab iv 1 mg |
39 |
36 |
$170K |
| 77067 |
|
1,424 |
1,401 |
$162K |
| 93971 |
|
2,206 |
2,065 |
$149K |
| 36415 |
|
161,638 |
113,447 |
$142K |
| 88175 |
|
10,529 |
10,323 |
$139K |
| 86900 |
|
5,978 |
5,196 |
$136K |
| 83036 |
|
21,662 |
20,783 |
$129K |
| 76830 |
|
1,444 |
1,344 |
$129K |
| G0380 |
Lev 1 hosp type b ed visit |
1,699 |
1,596 |
$128K |
| 93798 |
|
1,968 |
291 |
$127K |
| 76700 |
|
1,311 |
1,268 |
$124K |
| U0003 |
Cov-19 amp prb hgh thruput |
2,100 |
1,818 |
$118K |
| 76801 |
|
1,127 |
1,002 |
$114K |
| 82947 |
|
45,946 |
39,030 |
$112K |
| 45378 |
|
188 |
173 |
$110K |
| 71260 |
|
1,288 |
1,230 |
$108K |
| 71250 |
|
2,070 |
1,979 |
$107K |
| 87624 |
|
3,850 |
3,705 |
$104K |
| 97162 |
|
2,229 |
2,076 |
$103K |
| 96413 |
|
349 |
318 |
$96K |
| 97012 |
|
1,861 |
676 |
$95K |
| 97112 |
|
2,316 |
1,043 |
$94K |
| U0002 |
Covid-19 lab test non-cdc |
2,899 |
2,488 |
$93K |
| 82728 |
|
9,732 |
9,191 |
$86K |
| 97014 |
|
3,280 |
1,406 |
$83K |
| 97113 |
|
1,931 |
576 |
$82K |
| 80048 |
|
15,428 |
11,991 |
$70K |
| 87389 |
|
4,866 |
4,633 |
$68K |
| G0480 |
Drug test def 1-7 classes |
9,296 |
6,867 |
$65K |
| 93970 |
|
499 |
467 |
$61K |
| 82607 |
|
6,405 |
6,120 |
$60K |
| 95811 |
|
94 |
90 |
$56K |
| 90791 |
|
534 |
488 |
$56K |
| 87086 |
|
17,372 |
15,589 |
$51K |
| 83550 |
|
8,101 |
7,777 |
$47K |
| 86780 |
|
4,238 |
4,036 |
$46K |
| 72125 |
|
2,919 |
2,661 |
$45K |
| 96366 |
|
1,509 |
1,037 |
$40K |
| 84153 |
|
3,363 |
3,239 |
$40K |
| 83540 |
|
8,962 |
8,567 |
$39K |
| 86803 |
|
3,806 |
3,654 |
$38K |
| 82746 |
|
4,004 |
3,815 |
$37K |
| 84439 |
|
6,338 |
6,027 |
$36K |
| 86885 |
|
3,108 |
2,701 |
$35K |
| 78815 |
|
73 |
72 |
$33K |
| 97530 |
|
1,087 |
702 |
$31K |
| 73630 |
|
3,051 |
2,656 |
$30K |
| 96372 |
|
6,614 |
3,848 |
$30K |
| 97165 |
|
448 |
423 |
$30K |
| 83615 |
|
8,781 |
6,716 |
$29K |
| 93017 |
|
1,869 |
1,738 |
$28K |
| 43450 |
|
110 |
106 |
$27K |
| 86617 |
|
1,348 |
1,255 |
$27K |
| 70486 |
|
800 |
753 |
$27K |
| C9803 |
Hopd covid-19 spec collect |
11,257 |
10,031 |
$26K |
| 83735 |
|
18,283 |
15,197 |
$25K |
| 72100 |
|
2,139 |
2,000 |
$25K |
| 70553 |
|
99 |
92 |
$24K |
| 73564 |
|
2,144 |
1,849 |
$24K |
| 82784 |
|
2,002 |
1,881 |
$24K |
| 97535 |
|
1,204 |
769 |
$23K |
| G0378 |
Hospital observation per hr |
9,785 |
7,970 |
$23K |
| 85027 |
|
9,418 |
7,920 |
$23K |
| 87070 |
|
7,353 |
6,701 |
$21K |
| 72110 |
|
366 |
351 |
$21K |
| 99214 |
|
244 |
233 |
$21K |
| 10060 |
|
133 |
118 |
$21K |
| 82570 |
|
8,377 |
7,092 |
$20K |
| 73030 |
|
2,708 |
2,424 |
$20K |
| 70496 |
|
124 |
121 |
$19K |
| 85610 |
|
16,448 |
12,246 |
$19K |
| 99215 |
Prolong outpt/office vis |
174 |
152 |
$19K |
| 87340 |
|
3,369 |
3,189 |
$18K |
| 93005 |
|
23,588 |
20,622 |
$18K |
| 76642 |
|
317 |
264 |
$18K |
| 98968 |
|
372 |
219 |
$17K |
| 82043 |
|
4,885 |
4,741 |
$17K |
| 62323 |
|
65 |
64 |
$17K |
| 87186 |
|
5,933 |
5,463 |
$16K |
| 11043 |
|
57 |
28 |
$16K |
| 84403 |
|
789 |
753 |
$16K |
| 83970 |
|
887 |
856 |
$16K |
| 72148 |
|
105 |
99 |
$16K |
| 99281 |
|
271 |
234 |
$15K |
| 80076 |
|
3,367 |
2,722 |
$15K |
| 86038 |
|
1,635 |
1,562 |
$14K |
| 70551 |
|
181 |
168 |
$14K |
| 98967 |
|
326 |
204 |
$13K |
| 76536 |
|
186 |
177 |
$13K |
| 87493 |
|
706 |
663 |
$12K |
| 87502 |
|
626 |
558 |
$12K |
| M0243 |
Casirivi and imdevi inj |
45 |
41 |
$12K |
| 94060 |
|
59 |
58 |
$12K |
| 74018 |
|
602 |
543 |
$11K |
| 73610 |
|
2,287 |
2,095 |
$11K |
| 84702 |
|
3,595 |
2,953 |
$11K |
| 83883 |
|
744 |
694 |
$11K |
| 86140 |
|
4,380 |
3,965 |
$10K |
| 73130 |
|
1,880 |
1,660 |
$10K |
| 86666 |
|
642 |
597 |
$10K |
| 85007 |
|
7,466 |
6,146 |
$10K |
| 86704 |
|
1,036 |
990 |
$10K |
| 76775 |
|
242 |
232 |
$10K |
| Q9969 |
Non-heu tc-99m add-on/dose |
2,178 |
2,043 |
$9K |
| 81001 |
|
19,373 |
17,430 |
$9K |
| 83690 |
|
22,286 |
19,436 |
$9K |
| 73502 |
|
1,271 |
1,183 |
$9K |
| 87625 |
|
903 |
879 |
$8K |
| 86403 |
|
2,371 |
2,201 |
$8K |
| 73562 |
|
1,340 |
1,129 |
$8K |
| 86334 |
|
720 |
675 |
$8K |
| 83880 |
|
5,713 |
5,151 |
$8K |
| 87077 |
|
3,170 |
2,907 |
$8K |
| 73110 |
|
1,275 |
1,153 |
$8K |
| P9604 |
One-way allow prorated trip |
6,904 |
4,988 |
$8K |
| 85652 |
|
5,570 |
4,968 |
$8K |
| 84146 |
|
685 |
652 |
$7K |
| 97116 |
|
358 |
259 |
$7K |
| 87660 |
|
619 |
582 |
$7K |
| 87480 |
|
619 |
582 |
$7K |
| 87510 |
|
619 |
582 |
$7K |
| 82652 |
|
244 |
236 |
$7K |
| 84165 |
|
1,169 |
1,099 |
$7K |
| 83516 |
|
422 |
394 |
$6K |
| 86618 |
|
1,057 |
991 |
$6K |
| 86753 |
|
542 |
504 |
$6K |
| 86480 |
|
142 |
137 |
$6K |
| 84402 |
|
299 |
281 |
$6K |
| 80051 |
|
46,388 |
39,286 |
$6K |
| 87205 |
|
3,833 |
3,453 |
$6K |
| 82565 |
|
48,010 |
40,664 |
$5K |
| 80069 |
|
1,294 |
1,141 |
$5K |
| 86696 |
|
328 |
317 |
$5K |
| 86787 |
|
1,313 |
1,229 |
$5K |
| 86762 |
|
1,509 |
1,418 |
$5K |
| 71271 |
|
44 |
44 |
$5K |
| 88342 |
|
5,655 |
4,406 |
$5K |
| 84100 |
|
3,685 |
2,918 |
$5K |
| 80164 |
|
783 |
685 |
$5K |
| 82378 |
|
426 |
369 |
$5K |
| 85730 |
|
4,232 |
3,729 |
$5K |
| 88142 |
|
354 |
345 |
$5K |
| 82150 |
|
887 |
727 |
$4K |
| 90837 |
|
51 |
41 |
$4K |
| 82105 |
|
335 |
322 |
$4K |
| 82247 |
|
38,030 |
32,581 |
$4K |
| 87522 |
Neg quan hep c or qual rna |
149 |
138 |
$4K |
| 72072 |
|
182 |
169 |
$4K |
| 82950 |
|
1,000 |
963 |
$4K |
| 86431 |
|
994 |
959 |
$4K |
| 70491 |
|
26 |
26 |
$4K |
| 83013 |
|
77 |
71 |
$4K |
| 94640 |
|
6,113 |
3,832 |
$4K |
| 84450 |
|
39,283 |
33,896 |
$4K |
| 87427 |
|
586 |
548 |
$4K |
| 86695 |
|
328 |
317 |
$4K |
| 90847 |
|
49 |
38 |
$3K |
| 84550 |
|
2,451 |
2,212 |
$3K |
| 84160 |
|
1,168 |
1,099 |
$3K |
| 83655 |
|
303 |
295 |
$3K |
| 87081 |
|
691 |
650 |
$3K |
| 82550 |
|
2,168 |
1,912 |
$3K |
| J3490 |
Drugs unclassified injection |
100,885 |
41,308 |
$3K |
| 83001 |
|
204 |
195 |
$3K |
| 87045 |
|
586 |
548 |
$3K |
| 87046 |
|
586 |
548 |
$3K |
| 82248 |
|
2,024 |
1,598 |
$3K |
| 85045 |
|
1,246 |
1,126 |
$2K |
| 86376 |
|
257 |
246 |
$2K |
| 84703 |
|
1,303 |
1,222 |
$2K |
| 84630 |
|
230 |
202 |
$2K |
| P9016 |
Rbc leukocytes reduced |
17 |
12 |
$2K |
| 73700 |
|
45 |
40 |
$2K |
| 87177 |
|
360 |
334 |
$2K |
| 82977 |
|
501 |
476 |
$2K |
| 85379 |
|
4,513 |
4,153 |
$2K |
| 73140 |
|
392 |
362 |
$2K |
| 83721 |
|
333 |
320 |
$2K |
| 73721 |
|
13 |
12 |
$2K |
| 82310 |
|
7,341 |
6,624 |
$2K |
| 82172 |
|
242 |
236 |
$2K |
| 84156 |
|
1,289 |
1,075 |
$2K |
| 82140 |
|
602 |
480 |
$2K |
| 70498 |
|
131 |
128 |
$2K |
| 72131 |
|
62 |
57 |
$2K |
| 84484 |
|
16,149 |
13,359 |
$2K |
| 73080 |
|
382 |
348 |
$2K |
| 77065 |
Tomosynthesis, mammo |
12 |
12 |
$2K |
| 88305 |
|
11,537 |
7,228 |
$1K |
| 87040 |
|
2,846 |
2,504 |
$1K |
| 81003 |
|
986 |
890 |
$1K |
| 29515 |
|
16 |
12 |
$1K |
| 86328 |
|
52 |
51 |
$1K |
| 91065 |
|
12 |
12 |
$1K |
| 84520 |
|
47,207 |
39,960 |
$1K |
| 85014 |
|
1,243 |
1,024 |
$1K |
| 85018 |
|
1,243 |
1,024 |
$1K |
| 82040 |
|
37,274 |
32,119 |
$1K |
| 86316 |
|
84 |
74 |
$1K |
| G0283 |
Elec stim other than wound |
80 |
26 |
$1K |
| 83002 |
|
67 |
63 |
$990.08 |
| 81025 |
|
16,194 |
14,524 |
$975.36 |
| 72050 |
|
13 |
13 |
$956.24 |
| 82670 |
|
43 |
39 |
$933.80 |
| 86706 |
|
119 |
114 |
$933.66 |
| 84075 |
|
37,236 |
32,128 |
$922.15 |
| 87536 |
|
13 |
12 |
$893.86 |
| 93880 |
|
13 |
12 |
$865.32 |
| 81002 |
|
19,899 |
17,871 |
$822.42 |
| 87328 |
|
99 |
93 |
$778.60 |
| 87329 |
|
99 |
93 |
$778.60 |
| 88112 |
|
65 |
55 |
$777.88 |
| 84481 |
|
56 |
56 |
$725.16 |
| 71101 |
|
305 |
286 |
$723.49 |
| 72040 |
|
66 |
63 |
$677.32 |
| 84145 |
|
1,897 |
1,603 |
$648.08 |
| 97163 |
|
12 |
12 |
$641.34 |
| 86003 |
|
12 |
12 |
$632.46 |
| 87430 |
|
123 |
114 |
$584.92 |
| 80178 |
|
178 |
143 |
$523.73 |
| 96376 |
|
6,016 |
4,121 |
$523.63 |
| 87804 |
|
1,107 |
986 |
$516.81 |
| 84207 |
|
27 |
26 |
$515.90 |
| 83605 |
|
4,869 |
4,236 |
$515.82 |
| 82553 |
|
1,597 |
1,224 |
$510.30 |
| 82270 |
|
256 |
231 |
$508.64 |
| 83525 |
|
55 |
54 |
$501.86 |
| 84460 |
|
39,344 |
33,953 |
$479.42 |
| 83014 |
|
77 |
71 |
$458.11 |
| 86800 |
|
39 |
39 |
$429.66 |
| 82785 |
|
43 |
39 |
$427.40 |
| 97124 |
|
107 |
65 |
$401.19 |
| 86200 |
|
40 |
37 |
$395.52 |
| U0001 |
2019-ncov diagnostic p |
13 |
12 |
$395.01 |
| 86747 |
|
540 |
496 |
$373.36 |
| 84436 |
|
136 |
131 |
$355.91 |
| 76870 |
|
26 |
25 |
$348.63 |
| 86765 |
|
34 |
31 |
$337.51 |
| 12011 |
|
68 |
66 |
$325.50 |
| 12001 |
|
688 |
653 |
$299.03 |
| 90471 |
|
1,883 |
1,662 |
$284.65 |
| 82533 |
|
24 |
24 |
$280.26 |
| 86308 |
|
113 |
109 |
$266.76 |
| 97032 |
|
61 |
28 |
$254.96 |
| 84425 |
|
12 |
12 |
$243.24 |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
13,920 |
12,742 |
$241.02 |
| 84155 |
|
36,930 |
31,805 |
$239.66 |
| J7030 |
Normal saline solution infus |
19,751 |
15,748 |
$227.46 |
| 73090 |
|
51 |
51 |
$227.04 |
| 90714 |
|
1,674 |
1,566 |
$224.10 |
| J2405 |
Ondansetron hcl injection |
18,395 |
14,330 |
$215.01 |
| 87420 |
|
209 |
197 |
$206.10 |
| 87880 |
|
2,337 |
2,148 |
$184.90 |
| 86735 |
|
16 |
14 |
$161.98 |
| 73590 |
|
123 |
108 |
$160.47 |
| J1885 |
Ketorolac tromethamine inj |
16,814 |
14,064 |
$125.48 |
| 83021 |
|
26 |
24 |
$120.68 |
| 94761 |
|
4,215 |
3,749 |
$113.48 |
| 88304 |
|
784 |
713 |
$111.05 |
| 83921 |
|
13 |
13 |
$110.04 |
| 96367 |
|
15 |
12 |
$104.84 |
| 73560 |
|
21 |
12 |
$98.72 |
| 76817 |
|
216 |
195 |
$81.42 |
| 86901 |
|
5,978 |
5,196 |
$80.80 |
| 85049 |
|
173 |
141 |
$74.80 |
| 82948 |
|
4,498 |
3,443 |
$69.76 |
| 88313 |
|
6,290 |
4,239 |
$64.65 |
| 84132 |
|
36 |
36 |
$64.09 |
| 94760 |
|
2,851 |
2,555 |
$63.25 |
| J1170 |
Hydromorphone injection |
7,863 |
4,160 |
$52.35 |
| J0696 |
Ceftriaxone sodium injection |
5,256 |
2,659 |
$47.10 |
| 87207 |
|
59 |
59 |
$43.23 |
| Q0162 |
Ondansetron oral |
2,168 |
1,897 |
$41.78 |
| 36416 |
|
5,319 |
4,057 |
$36.75 |
| 86850 |
|
2,033 |
1,862 |
$34.40 |
| J1650 |
Inj enoxaparin sodium |
931 |
532 |
$25.23 |
| J1100 |
Dexamethasone sodium phos |
5,420 |
4,823 |
$15.76 |
| 87210 |
|
499 |
470 |
$13.83 |
| J7120 |
Ringers lactate infusion |
3,043 |
2,198 |
$11.00 |
| J2060 |
Lorazepam injection |
3,716 |
2,671 |
$9.17 |
| 81015 |
|
43 |
39 |
$8.27 |
| J2270 |
Morphine sulfate injection |
7,344 |
4,821 |
$7.96 |
| J2930 |
Methylprednisolone injection |
1,213 |
1,019 |
$2.69 |
| G8979 |
Mobility goal status |
528 |
425 |
$2.53 |
| G0103 |
Psa screening |
12 |
12 |
$2.16 |
| J7050 |
Normal saline solution infus |
5,749 |
3,859 |
$2.15 |
| G8978 |
Mobility current status |
435 |
359 |
$2.08 |
| A9150 |
Misc/exper non-prescript dru |
2,324 |
1,810 |
$1.97 |
| J1200 |
Diphenhydramine hcl injectio |
4,073 |
2,895 |
$1.74 |
| J2765 |
Metoclopramide hcl injection |
3,043 |
2,617 |
$1.48 |
| J2550 |
Promethazine hcl injection |
2,353 |
1,567 |
$0.82 |
| J3010 |
Fentanyl citrate injection |
7,747 |
5,812 |
$0.73 |
| J8499 |
Oral prescrip drug non chemo |
2,936 |
2,135 |
$0.58 |
| G8980 |
Mobility d/c status |
147 |
121 |
$0.50 |
| C9113 |
Inj pantoprazole sodium, via |
1,407 |
851 |
$0.46 |
| J3475 |
Inj magnesium sulfate |
772 |
447 |
$0.09 |
| J1644 |
Inj heparin sodium per 1000u |
3,084 |
1,392 |
$0.00 |
| A9575 |
Inj gadoterate meglumi 0.1ml |
913 |
854 |
$0.00 |
| A9552 |
F18 fdg |
86 |
85 |
$0.00 |
| C1713 |
Anchor/screw bn/bn,tis/bn |
102 |
91 |
$0.00 |
| 94729 |
|
29 |
28 |
$0.00 |
| 29125 |
|
102 |
94 |
$0.00 |
| J0171 |
Adrenalin epinephrine inject |
458 |
341 |
$0.00 |
| 97598 |
|
2,126 |
642 |
$0.00 |
| J1956 |
Levofloxacin injection |
59 |
26 |
$0.00 |
| J2919 |
Inj, methylpred sod succ 5mg |
229 |
161 |
$0.00 |
| 82075 |
|
323 |
277 |
$0.00 |
| 93356 |
|
224 |
214 |
$0.00 |
| 93041 |
|
246 |
221 |
$0.00 |
| J0295 |
Ampicillin sulbactam 1.5 gm |
135 |
78 |
$0.00 |
| 99442 |
|
227 |
186 |
$0.00 |
| 82800 |
|
15 |
13 |
$0.00 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
223 |
89 |
$0.00 |
| J3370 |
Vancomycin hcl injection |
73 |
36 |
$0.00 |
| S0164 |
Injection pantroprazole |
26 |
15 |
$0.00 |
| 99203 |
|
26 |
25 |
$0.00 |
| J3301 |
Triamcinolone acet inj nos |
95 |
71 |
$0.00 |
| Q0243 |
Casirivimab and imdevimab |
85 |
81 |
$0.00 |
| 82009 |
|
14 |
12 |
$0.00 |
| 94727 |
|
29 |
28 |
$0.00 |
| 88312 |
|
16 |
16 |
$0.00 |
| J2250 |
Inj midazolam hydrochloride |
2,994 |
2,581 |
$0.00 |
| J2785 |
Regadenoson injection |
947 |
881 |
$0.00 |
| A9500 |
Tc99m sestamibi |
1,637 |
1,531 |
$0.00 |
| J1630 |
Haloperidol injection |
818 |
645 |
$0.00 |
| J1642 |
Inj heparin sodium per 10 u |
1,789 |
498 |
$0.00 |
| 97802 |
|
591 |
517 |
$0.00 |
| J0690 |
Cefazolin sodium injection |
3,402 |
2,785 |
$0.00 |
| J1815 |
Insulin injection |
1,450 |
660 |
$0.00 |
| J2704 |
Inj, propofol, 10 mg |
13,516 |
10,864 |
$0.00 |
| J7512 |
Prednisone ir or dr oral 1mg |
1,982 |
1,671 |
$0.00 |
| J7611 |
Albuterol non-comp con |
856 |
739 |
$0.00 |
| J7620 |
Albuterol ipratrop non-comp |
1,847 |
1,529 |
$0.00 |
| A9270 |
Non-covered item or service |
2,573 |
1,001 |
$0.00 |
| J3535 |
Metered dose inhaler drug |
154 |
143 |
$0.00 |
| J0500 |
Dicyclomine injection |
202 |
180 |
$0.00 |
| 96368 |
|
119 |
68 |
$0.00 |
| 88307 |
|
66 |
53 |
$0.00 |
| J0131 |
Inj, acetaminophen (nos) |
132 |
106 |
$0.00 |
| J7042 |
5% dextrose/normal saline |
23 |
13 |
$0.00 |
| J2470 |
Inj pantoprazole sodium 40mg |
234 |
146 |
$0.00 |
| A9585 |
Gadobutrol injection |
138 |
132 |
$0.00 |
| J7060 |
5% dextrose/water |
140 |
93 |
$0.00 |
| J8540 |
Oral dexamethasone |
160 |
143 |
$0.00 |
| 12002 |
|
88 |
80 |
$0.00 |
| 88341 |
|
14 |
12 |
$0.00 |
| C1781 |
Mesh (implantable) |
52 |
50 |
$0.00 |
| J1790 |
Droperidol injection |
148 |
127 |
$0.00 |
| 11045 |
|
168 |
38 |
$0.00 |
| 99070 |
|
46 |
29 |
$0.00 |
| 77001 |
|
20 |
13 |
$0.00 |
| 74019 |
|
13 |
12 |
$0.00 |
| J0330 |
Succinycholine chloride inj |
12 |
12 |
$0.00 |
| 86920 |
|
17 |
12 |
$0.00 |