NPI: 1366479099 · WEST HILLS, CA 91304 · Clinical Medical Laboratory · NPI assigned 06/27/2006
Authorized official TIMMERMAN, LEAH controls 20+ related entities in our dataset. Read more
| Authorized Official | TIMMERMAN, LEAH (VICE PRESIDENT) |
| Parent Organization | QUEST DIAGNOSTICS INCORPORATED |
| NPI Enumeration Date | 06/27/2006 |
Other providers sharing the same authorized official: TIMMERMAN, LEAH
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 10,922,838 | $80.00M |
| 2019 | 13,266,254 | $79.32M |
| 2020 | 12,373,965 | $93.81M |
| 2021 | 16,264,901 | $121.88M |
| 2022 | 17,151,409 | $118.56M |
| 2023 | 19,794,120 | $83.73M |
| 2024 | 21,864,115 | $91.20M |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| U0003 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high throughput technologies as described by cms-2020-01-r | 1,017,350 | 936,414 | $57.23M |
| 87491 | Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe | 3,367,029 | 3,247,147 | $36.80M |
| 87591 | Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe | 3,348,753 | 3,229,158 | $35.89M |
| 80061 | Lipid panel | 6,916,945 | 6,846,533 | $34.47M |
| 84443 | Thyroid stimulating hormone (TSH) | 5,406,712 | 5,321,986 | $30.19M |
| 80053 | Comprehensive metabolic panel | 8,400,110 | 8,081,273 | $28.98M |
| 82306 | Vitamin D; 25 hydroxy, includes fraction(s), if performed | 2,991,534 | 2,956,942 | $27.77M |
| 83036 | Hemoglobin; glycosylated (A1C) | 6,224,992 | 6,149,922 | $19.77M |
| 85025 | Blood count; complete (CBC), automated, and automated differential WBC count | 7,100,438 | 6,789,510 | $16.25M |
| 88175 | Cytopathology, cervical or vaginal, any reporting system; collected in preservative fluid, automated thin layer | 1,381,638 | 1,358,545 | $14.25M |
| 80307 | Drug test(s), presumptive, any number of drug classes; immunoassay | 630,793 | 574,807 | $13.84M |
| 87624 | Infectious agent detection by nucleic acid; human papillomavirus (HPV), high-risk types | 1,047,749 | 1,023,691 | $12.97M |
| 87389 | Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies | 2,124,278 | 2,098,927 | $12.89M |
| 86480 | 714,970 | 704,224 | $12.37M | |
| 86003 | 260,661 | 257,042 | $12.10M | |
| 80081 | 320,884 | 304,557 | $11.57M | |
| 81220 | CFTR (cystic fibrosis transmembrane conductance regulator) gene analysis; common variants | 114,285 | 113,650 | $10.38M |
| 88305 | Level IV - Surgical pathology, gross and microscopic examination | 340,929 | 318,898 | $8.46M |
| G0480 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed | 249,868 | 224,761 | $6.96M |
| 87661 | Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe | 549,993 | 534,841 | $6.94M |
| 84439 | 1,483,913 | 1,459,831 | $6.56M | |
| 86803 | 1,462,724 | 1,445,617 | $6.42M | |
| 81513 | 168,786 | 165,698 | $6.39M | |
| 81420 | Fetal chromosomal aneuploidy genomic sequence analysis panel | 20,523 | 20,383 | $6.29M |
| 80074 | 376,616 | 372,965 | $6.01M | |
| 87799 | 270,116 | 145,823 | $5.90M | |
| 87086 | Culture, bacterial; quantitative colony count, urine | 1,946,322 | 1,854,565 | $5.66M |
| 87801 | Infectious agent detection by nucleic acid; amplified probe, multiple organisms | 274,102 | 268,369 | $5.60M |
| 86592 | 2,775,854 | 2,709,693 | $5.08M | |
| 82607 | 1,042,557 | 1,028,176 | $4.06M | |
| 87536 | 171,767 | 169,113 | $3.97M | |
| 87088 | 1,473,352 | 1,422,312 | $3.90M | |
| 84153 | 650,905 | 642,959 | $3.81M | |
| 82728 | 883,433 | 863,030 | $3.70M | |
| 82652 | 304,811 | 302,422 | $3.68M | |
| 81162 | 4,254 | 4,221 | $3.61M | |
| 82746 | 775,873 | 767,976 | $3.60M | |
| 36415 | Collection of venous blood by venipuncture | 4,595,759 | 4,321,683 | $3.58M |
| 81001 | 3,116,843 | 3,028,590 | $3.33M | |
| 85027 | 1,637,348 | 1,609,299 | $3.31M | |
| 83013 | 207,990 | 206,359 | $3.27M | |
| 82043 | 1,546,453 | 1,528,207 | $3.24M | |
| 82570 | 1,728,305 | 1,692,772 | $3.13M | |
| 87522 | Neg quan hep c or qual rna | 155,306 | 151,445 | $3.09M |
| 86235 | 149,300 | 146,772 | $2.96M | |
| 82274 | 606,079 | 594,952 | $2.85M | |
| 84403 | 347,657 | 342,791 | $2.85M | |
| 87636 | Infectious agent detection by nucleic acid; SARS-CoV-2 and influenza virus types A and B | 31,799 | 30,987 | $2.72M |
| 84481 | 356,599 | 351,571 | $2.65M | |
| 83970 | 225,030 | 221,165 | $2.56M | |
| 87340 | 835,805 | 826,874 | $2.51M | |
| U0005 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2 | 177,074 | 161,273 | $2.42M |
| 83655 | 559,638 | 552,251 | $2.32M | |
| 86038 | 488,155 | 481,619 | $2.19M | |
| 81329 | 50,157 | 49,867 | $2.16M | |
| 87902 | 24,739 | 24,006 | $2.02M | |
| 84702 | 340,201 | 264,152 | $2.02M | |
| 82670 | 197,492 | 194,662 | $1.90M | |
| 87512 | 130,166 | 126,777 | $1.84M | |
| G0482 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 15-21 drug class(es), including metabolite(s) if performed | 40,426 | 38,796 | $1.80M |
| 83550 | 806,217 | 794,488 | $1.80M | |
| 86769 | 58,883 | 55,780 | $1.71M | |
| 87186 | 508,380 | 488,283 | $1.60M | |
| 83540 | 924,293 | 908,344 | $1.58M | |
| 86704 | 499,017 | 494,064 | $1.57M | |
| 84480 | 235,316 | 232,460 | $1.56M | |
| 88142 | 203,031 | 199,932 | $1.55M | |
| 80048 | Basic metabolic panel (calcium, ionized) | 607,672 | 581,147 | $1.52M |
| 83001 | 266,166 | 262,234 | $1.50M | |
| 87635 | Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe | 42,528 | 39,939 | $1.50M |
| 81003 | 361,104 | 356,718 | $1.46M | |
| 86696 | 171,398 | 169,432 | $1.34M | |
| 80050 | General health panel | 311,321 | 309,572 | $1.32M |
| 86708 | 397,683 | 393,298 | $1.32M | |
| 84402 | 157,617 | 155,425 | $1.28M | |
| 86706 | 456,767 | 452,769 | $1.27M | |
| 87077 | 502,851 | 484,700 | $1.24M | |
| 87070 | 355,304 | 347,394 | $1.21M | |
| 86376 | 220,425 | 218,224 | $1.19M | |
| 82105 | 109,559 | 107,113 | $1.19M | |
| 86140 | 628,990 | 604,589 | $1.18M | |
| 86787 | 224,079 | 219,520 | $1.16M | |
| 83880 | 112,853 | 109,476 | $1.16M | |
| 83002 | 209,833 | 207,574 | $1.16M | |
| 87481 | 109,029 | 38,245 | $1.15M | |
| 84146 | 204,196 | 200,037 | $1.14M | |
| 82785 | 213,572 | 211,672 | $1.13M | |
| 84436 | 523,384 | 517,923 | $1.13M | |
| 84550 | 648,664 | 634,906 | $1.11M | |
| 87081 | 342,473 | 334,846 | $1.08M | |
| 85652 | 833,339 | 808,952 | $1.07M | |
| 86317 | 275,803 | 267,855 | $1.07M | |
| 83735 | 427,739 | 383,899 | $1.01M | |
| 86300 | 80,427 | 71,926 | $971K | |
| 88141 | 197,012 | 196,154 | $969K | |
| 86780 | 219,772 | 212,232 | $933K | |
| 86160 | 126,056 | 124,010 | $916K | |
| 87209 | 108,227 | 98,359 | $909K | |
| 86695 | 161,334 | 159,503 | $872K | |
| 88185 | 10,452 | 10,240 | $857K | |
| 87901 | 9,399 | 9,174 | $843K | |
| 83520 | 133,662 | 105,460 | $838K | |
| 85730 | 438,203 | 425,732 | $828K | |
| 86762 | 165,472 | 161,061 | $825K | |
| 87255 | 49,109 | 47,944 | $812K | |
| 85610 | 598,980 | 549,793 | $804K | |
| 82627 | 94,986 | 93,930 | $786K | |
| 87517 | 53,985 | 53,306 | $762K | |
| 86800 | 119,436 | 117,879 | $757K | |
| 87338 | 178,631 | 177,267 | $730K | |
| 83516 | 112,926 | 95,303 | $729K | |
| 84479 | 328,340 | 325,322 | $725K | |
| 82378 | 120,512 | 109,558 | $724K | |
| 82951 | 135,149 | 131,899 | $681K | |
| 86431 | 356,466 | 352,859 | $668K | |
| 84144 | 83,598 | 80,866 | $666K | |
| 82784 | 146,250 | 142,591 | $661K | |
| G0481 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 8-14 drug class(es), including metabolite(s) if performed | 19,428 | 19,006 | $661K |
| 82950 | 314,802 | 306,754 | $630K | |
| 86200 | 187,053 | 185,644 | $617K | |
| 80076 | 261,933 | 258,275 | $610K | |
| G0483 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 22 or more drug class(es), including metabolite(s) if performed | 13,682 | 13,270 | $596K |
| 86225 | 148,562 | 146,549 | $590K | |
| 87660 | 95,000 | 93,298 | $579K | |
| 84445 | 36,108 | 35,559 | $570K | |
| 86360 | 42,692 | 42,038 | $567K | |
| 86361 | 91,509 | 90,584 | $556K | |
| 99001 | 120,866 | 104,703 | $552K | |
| 80197 | 88,281 | 65,456 | $547K | |
| 81229 | 3,408 | 3,397 | $541K | |
| 87510 | 95,456 | 93,747 | $541K | |
| 86147 | 42,664 | 37,448 | $536K | |
| 87480 | 95,441 | 93,731 | $536K | |
| 86364 | 48,399 | 48,095 | $534K | |
| 86008 | 24,385 | 23,334 | $503K | |
| 86765 | 112,778 | 111,620 | $501K | |
| 87631 | 9,813 | 9,548 | $498K | |
| 86146 | 30,674 | 26,070 | $496K | |
| 81596 | 32,126 | 31,925 | $487K | |
| 84154 | 103,429 | 102,486 | $479K | |
| 86039 | 165,409 | 163,046 | $464K | |
| 80055 | 27,937 | 27,812 | $463K | |
| 82248 | 355,273 | 339,218 | $457K | |
| 87177 | 108,616 | 98,727 | $450K | |
| 83525 | 122,308 | 121,249 | $448K | |
| 86735 | 104,382 | 103,428 | $437K | |
| 87900 | 9,396 | 9,168 | $432K | |
| 84100 | 291,605 | 259,534 | $428K | |
| 82533 | 58,976 | 56,591 | $401K | |
| 83690 | 166,122 | 162,680 | $392K | |
| 88341 | 9,923 | 9,729 | $391K | |
| 86304 | 54,709 | 51,002 | $384K | |
| 87633 | Infectious agent detection by nucleic acid, respiratory virus, 12-25 targets | 4,161 | 4,112 | $381K |
| 88112 | 26,016 | 23,030 | $379K | |
| 84681 | 46,609 | 46,146 | $362K | |
| 83615 | 165,983 | 151,980 | $361K | |
| 82947 | 218,510 | 214,166 | $360K | |
| 86255 | 60,851 | 45,378 | $359K | |
| 84156 | 239,415 | 227,044 | $349K | |
| 84270 | 54,894 | 54,229 | $349K | |
| 88342 | 17,800 | 16,393 | $348K | |
| 87497 | 18,300 | 14,085 | $345K | |
| 87529 | 17,353 | 14,226 | $339K | |
| 88230 | 7,174 | 7,073 | $335K | |
| 87147 | 193,658 | 190,384 | $331K | |
| 86334 | 43,343 | 41,862 | $325K | |
| 88262 | 6,892 | 6,797 | $323K | |
| 82550 | 172,173 | 165,377 | $321K | |
| 83993 | 36,249 | 35,739 | $319K | |
| 88304 | 27,606 | 27,266 | $317K | |
| 83498 | 37,992 | 37,622 | $309K | |
| 88312 | 19,500 | 19,310 | $308K | |
| 86665 | 25,639 | 25,383 | $307K | |
| 84425 | 51,834 | 51,379 | $297K | |
| 80164 | 51,006 | 49,083 | $297K | |
| 81243 | 22,072 | 21,938 | $289K | |
| 87535 | 16,526 | 15,991 | $289K | |
| 88307 | 4,219 | 4,200 | $287K | |
| 86635 | 22,983 | 22,058 | $282K | |
| 82977 | 143,269 | 137,023 | $279K | |
| 81432 | 1,253 | 1,245 | $275K | |
| 80069 | 111,177 | 106,603 | $271K | |
| 87427 | 62,935 | 62,228 | $270K | |
| 87906 | 5,293 | 5,176 | $265K | |
| 82024 | 20,876 | 20,352 | $263K | |
| 83521 | 18,538 | 17,629 | $262K | |
| 84165 | 74,094 | 71,786 | $257K | |
| 86141 | 70,056 | 69,300 | $254K | |
| 0241U | Neonatal screening for hereditary disorders, genomic sequence analysis panel | 2,908 | 2,848 | $252K |
| 82107 | 23,768 | 23,382 | $252K | |
| 82150 | 99,450 | 97,301 | $251K | |
| 83090 | 50,615 | 50,106 | $249K | |
| 81206 | 6,659 | 6,573 | $247K | |
| 84460 | 214,297 | 210,654 | $233K | |
| 84305 | 24,557 | 24,194 | $233K | |
| 83020 | 69,424 | 67,811 | $233K | |
| 86301 | 40,349 | 36,817 | $228K | |
| 86593 | 155,791 | 148,305 | $222K | |
| 82672 | 26,557 | 26,299 | $220K | |
| 83021 | 39,205 | 38,862 | $219K | |
| 81257 | 6,162 | 6,107 | $218K | |
| 87798 | Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism | 22,275 | 12,322 | $218K |
| 84207 | 32,828 | 32,526 | $213K | |
| 86709 | 47,773 | 46,867 | $212K | |
| 87045 | 67,090 | 66,106 | $210K | |
| 87449 | 49,627 | 46,273 | $210K | |
| 81270 | 7,026 | 6,967 | $209K | |
| 83921 | 39,824 | 39,497 | $207K | |
| 86341 | 16,036 | 11,989 | $197K | |
| 86021 | 31,644 | 27,573 | $196K | |
| 86812 | 31,099 | 30,814 | $193K | |
| 84450 | 168,246 | 164,848 | $191K | |
| 87625 | 26,967 | 26,807 | $191K | |
| 87075 | 50,257 | 48,654 | $190K | |
| 83014 | 82,313 | 81,579 | $184K | |
| 82542 | 25,956 | 24,168 | $181K | |
| 86359 | 14,308 | 14,007 | $178K | |
| 84432 | 26,936 | 26,365 | $178K | |
| 86162 | 16,418 | 16,321 | $174K | |
| 82247 | 80,083 | 67,569 | $170K | |
| 87637 | Infectious agent detection by nucleic acid; SARS-CoV-2, influenza, and RSV | 1,910 | 1,882 | $166K |
| 85045 | 102,699 | 99,606 | $162K | |
| 81381 | 4,030 | 4,010 | $161K | |
| 82565 | 115,448 | 111,700 | $159K | |
| 86705 | 35,549 | 35,034 | $156K | |
| 85379 | 27,496 | 26,598 | $154K | |
| 86901 | 118,316 | 115,840 | $154K | |
| 82088 | 11,920 | 11,614 | $152K | |
| 82465 | 88,779 | 84,783 | $149K | |
| 84134 | 21,143 | 18,295 | $148K | |
| 84703 | 68,563 | 67,348 | $147K | |
| 86900 | 113,456 | 112,194 | $144K | |
| 84478 | 54,797 | 45,762 | $142K | |
| 83718 | 36,232 | 35,141 | $140K | |
| 82140 | 23,332 | 22,485 | $136K | |
| 85060 | 38,546 | 38,110 | $132K | |
| 86850 | 81,367 | 80,215 | $130K | |
| 88189 | 9,119 | 8,918 | $130K | |
| 86381 | 18,470 | 18,345 | $129K | |
| 82668 | 16,981 | 16,714 | $124K | |
| 85613 | 34,276 | 33,763 | $121K | |
| 82330 | 32,115 | 31,377 | $121K | |
| 82157 | 9,821 | 9,682 | $118K | |
| 85018 | 168,616 | 166,420 | $117K | |
| 83883 | 19,700 | 13,077 | $116K | |
| 83721 | 72,785 | 72,438 | $116K | |
| 87205 | 62,486 | 60,162 | $115K | |
| 81025 | 35,500 | 34,761 | $115K | |
| 86015 | 21,491 | 21,328 | $114K | |
| 82952 | 70,686 | 68,833 | $114K | |
| 84630 | 30,161 | 29,818 | $113K | |
| 86664 | 19,650 | 19,511 | $112K | |
| 88360 | 2,510 | 2,477 | $112K | |
| 87563 | 10,650 | 10,540 | $112K | |
| 88184 | 10,422 | 10,234 | $111K | |
| 86870 | 10,837 | 10,467 | $110K | |
| 81219 | 3,581 | 3,549 | $110K | |
| 88173 | 4,517 | 4,452 | $109K | |
| 80177 | 19,978 | 19,525 | $109K | |
| 87506 | 1,121 | 1,114 | $107K | |
| 85246 | 11,290 | 11,114 | $107K | |
| 87329 | 30,828 | 30,511 | $106K | |
| 85240 | 11,840 | 11,644 | $103K | |
| 87324 | 21,000 | 20,689 | $103K | |
| 84244 | 12,232 | 11,984 | $102K | |
| 83519 | 12,097 | 10,306 | $102K | |
| 80361 | 27,065 | 25,780 | $101K | |
| 86481 | 4,198 | 4,159 | $100K | |
| 82653 | 5,179 | 5,162 | $99K | |
| 83010 | 17,668 | 16,994 | $98K | |
| 87046 | 36,932 | 36,337 | $98K | |
| 82626 | 9,852 | 9,768 | $96K | |
| 81207 | 3,862 | 3,828 | $96K | |
| 86682 | 13,346 | 12,831 | $93K | |
| 84482 | 6,524 | 6,457 | $93K | |
| 81279 | 2,966 | 2,942 | $92K | |
| 80178 | 31,824 | 30,357 | $92K | |
| 82390 | 23,867 | 23,644 | $90K | |
| 84166 | 15,811 | 15,516 | $88K | |
| 81401 | 1,766 | 1,717 | $88K | |
| 84182 | 4,135 | 4,095 | $88K | |
| 85245 | 9,582 | 9,452 | $87K | |
| 81479 | Unlisted molecular pathology procedure | 3,849 | 3,640 | $86K |
| 82172 | 21,485 | 21,354 | $85K | |
| 84466 | 25,799 | 25,378 | $85K | |
| 80159 | 14,112 | 11,653 | $84K | |
| 86702 | 16,198 | 15,467 | $84K | |
| 82310 | 68,594 | 67,421 | $82K | |
| 83835 | 8,395 | 7,774 | $82K | |
| 85014 | 103,553 | 101,866 | $82K | |
| 80349 | 20,068 | 18,161 | $82K | |
| 99199 | Unlisted special service, procedure or report | 94,333 | 78,596 | $79K |
| 86036 | 15,408 | 15,276 | $78K | |
| 82232 | 11,883 | 11,120 | $77K | |
| 87350 | 22,593 | 22,429 | $77K | |
| 86644 | 12,814 | 12,561 | $76K | |
| 81241 | 5,038 | 4,976 | $74K | |
| 87999 | 1,829 | 1,807 | $74K | |
| 86258 | 5,271 | 5,242 | $74K | |
| 86355 | 6,140 | 5,923 | $74K | |
| 82397 | 7,382 | 7,217 | $73K | |
| 82103 | 14,036 | 13,923 | $73K | |
| 82530 | 9,087 | 8,470 | $72K | |
| 86337 | 7,534 | 7,397 | $71K | |
| 81339 | 2,721 | 2,699 | $71K | |
| 83951 | 5,027 | 4,950 | $71K | |
| 85007 | 78,142 | 76,646 | $70K | |
| 85247 | 6,101 | 6,021 | $68K | |
| 82525 | 18,912 | 18,654 | $67K | |
| 86645 | 9,621 | 9,424 | $67K | |
| 81403 | 1,251 | 1,211 | $67K | |
| 82787 | 5,920 | 5,844 | $66K | |
| 86777 | 11,515 | 11,246 | $65K | |
| 87493 | 6,124 | 6,060 | $65K | |
| 80202 | 10,131 | 4,607 | $63K | |
| 81433 | 746 | 738 | $63K | |
| 84520 | 63,472 | 61,576 | $63K | |
| 86701 | 17,068 | 16,318 | $62K | |
| 83704 | 8,542 | 8,475 | $62K | |
| 82040 | 45,518 | 44,674 | $61K | |
| 86618 | 8,179 | 8,083 | $58K | |
| 80299 | 8,629 | 8,030 | $57K | |
| 81364 | 709 | 703 | $56K | |
| 81382 | 1,080 | 1,066 | $55K | |
| 81256 | 2,357 | 2,327 | $54K | |
| 84590 | 16,991 | 16,868 | $52K | |
| 82085 | 23,917 | 23,679 | $52K | |
| 80158 | 4,347 | 3,658 | $52K | |
| 80156 | 8,937 | 8,783 | $52K | |
| 80175 | 7,541 | 7,352 | $52K | |
| 87101 | 16,813 | 16,691 | $52K | |
| 86335 | 6,688 | 6,568 | $51K | |
| 86357 | 4,101 | 3,904 | $51K | |
| 83695 | 16,149 | 16,017 | $51K | |
| 86707 | 19,604 | 19,481 | $50K | |
| 84155 | 48,101 | 47,239 | $50K | |
| G0328 | Colorectal cancer screening; fecal occult blood test, immunoassay, 1-3 simultaneous | 12,840 | 12,733 | $49K |
| 82610 | 8,788 | 8,572 | $48K | |
| 84484 | 8,240 | 7,832 | $48K | |
| 82239 | 6,490 | 5,814 | $47K | |
| 86790 | 3,917 | 3,376 | $47K | |
| 87210 | 61,689 | 60,917 | $47K | |
| 85306 | 6,592 | 6,437 | $47K | |
| 80185 | 8,067 | 7,700 | $46K | |
| 81240 | 3,789 | 3,749 | $46K | |
| 87076 | 15,044 | 14,785 | $45K | |
| 0001M | 1,138 | 1,113 | $45K | |
| 80373 | 17,118 | 16,091 | $45K | |
| 88271 | 1,231 | 1,218 | $44K | |
| 82985 | 6,353 | 6,270 | $44K | |
| 86060 | 15,898 | 15,807 | $43K | |
| 86001 | 4,188 | 4,149 | $43K | |
| 86617 | 3,488 | 3,441 | $42K | |
| 86671 | 8,683 | 5,705 | $42K | |
| 86778 | 6,893 | 6,713 | $41K | |
| 85041 | 50,764 | 50,004 | $40K | |
| 84075 | 30,952 | 30,308 | $40K | |
| 81015 | 70,101 | 68,821 | $39K | |
| 82384 | 3,703 | 3,477 | $39K | |
| 85303 | 6,592 | 6,446 | $39K | |
| 87150 | 4,717 | 4,663 | $39K | |
| 86148 | 4,368 | 3,545 | $38K | |
| 82507 | 4,853 | 4,776 | $38K | |
| 85300 | 5,286 | 5,186 | $38K | |
| 80051 | 23,304 | 22,847 | $38K | |
| 80346 | 12,041 | 11,198 | $37K | |
| 87102 | 10,169 | 9,908 | $37K | |
| 85384 | 8,623 | 8,285 | $37K | |
| 83698 | 3,906 | 3,887 | $36K | |
| 80365 | 22,553 | 21,488 | $35K | |
| 82681 | 3,483 | 3,461 | $35K | |
| 82747 | 9,157 | 9,082 | $34K | |
| 87040 | 6,588 | 6,154 | $34K | |
| 84255 | 3,350 | 3,263 | $33K | |
| 87521 | Neg quan hep c or qual rna | 1,689 | 1,656 | $33K |
| 87502 | Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets | 1,379 | 1,367 | $33K |
| 84132 | 23,352 | 22,727 | $33K | |
| 87467 | 2,794 | 2,784 | $30K | |
| 80321 | 10,680 | 9,872 | $30K | |
| 82164 | 7,617 | 7,511 | $29K | |
| 80195 | 4,119 | 3,377 | $29K | |
| 86382 | 2,187 | 2,146 | $29K | |
| 87206 | 14,209 | 11,687 | $28K | |
| 84446 | 10,469 | 10,398 | $28K | |
| 81376 | 1,035 | 1,020 | $27K | |
| 86308 | 13,487 | 13,413 | $27K | |
| 82552 | 3,474 | 3,431 | $27K | |
| 89055 | 14,515 | 14,382 | $27K | |
| 86774 | 5,433 | 5,360 | $26K | |
| 87662 | 635 | 631 | $26K | |
| 85598 | 4,421 | 4,355 | $26K | |
| 85597 | 4,709 | 4,623 | $26K | |
| 83825 | 3,941 | 3,899 | $25K | |
| 80348 | 15,460 | 12,254 | $25K | |
| 81402 | 668 | 660 | $24K | |
| G0472 | Hepatitis c antibody screening, for individual at high risk and other covered indication(s) | 4,558 | 4,530 | $24K |
| 82104 | 6,539 | 6,444 | $24K | |
| G0103 | Prostate cancer screening; prostate specific antigen test (psa) | 6,551 | 6,486 | $24K |
| 83935 | 7,438 | 7,246 | $24K | |
| 82175 | 3,104 | 3,062 | $23K | |
| 88275 | 687 | 681 | $23K | |
| 86231 | 3,355 | 3,333 | $23K | |
| 84080 | 4,310 | 4,221 | $23K | |
| 86316 | 3,553 | 3,355 | $23K | |
| 87220 | 12,205 | 12,107 | $23K | |
| 80323 | 8,700 | 8,394 | $22K | |
| 83874 | 910 | 875 | $22K | |
| 82166 | 3,748 | 3,710 | $22K | |
| 86747 | 2,500 | 2,386 | $22K | |
| 82705 | 6,873 | 6,802 | $22K | |
| 82308 | 1,420 | 1,401 | $21K | |
| 84300 | 13,207 | 12,939 | $21K | |
| G0145 | Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system and manual rescreening under physician supervision | 4,594 | 4,536 | $20K |
| 82523 | 2,592 | 2,522 | $20K | |
| 87116 | 6,162 | 4,069 | $19K | |
| 86256 | 4,812 | 4,709 | $19K | |
| 83003 | 3,327 | 3,284 | $19K | |
| 87632 | 155 | 155 | $19K | |
| 81374 | 1,618 | 1,611 | $19K | |
| 80368 | 9,573 | 8,783 | $19K | |
| 88313 | 1,167 | 1,160 | $18K | |
| 82955 | 5,690 | 5,629 | $18K | |
| 86648 | 4,179 | 4,131 | $18K | |
| 80183 | 2,503 | 2,461 | $18K | |
| 84597 | 4,549 | 4,515 | $18K | |
| 80184 | 3,127 | 2,902 | $18K | |
| 83945 | 4,958 | 4,880 | $18K | |
| 80162 | 3,908 | 3,770 | $18K | |
| 82679 | 1,835 | 1,823 | $17K | |
| 87230 | 2,712 | 2,662 | $17K | |
| 82379 | 1,375 | 1,357 | $17K | |
| 84295 | 15,079 | 14,626 | $17K | |
| 84252 | 3,685 | 3,582 | $17K | |
| 83930 | 6,013 | 5,840 | $17K | |
| 81517 | 489 | 489 | $16K | |
| 82642 | 1,813 | 1,791 | $16K | |
| 82340 | 9,125 | 9,014 | $16K | |
| 84140 | 2,343 | 2,324 | $16K | |
| 85660 | 15,703 | 15,453 | $16K | |
| 82139 | 588 | 550 | $16K | |
| 87107 | 4,338 | 4,305 | $16K | |
| 88302 | 559 | 556 | $16K | |
| 86037 | 2,638 | 2,603 | $16K | |
| 87912 | 1,186 | 1,175 | $15K | |
| 82575 | 4,396 | 4,341 | $15K | |
| 87634 | 1,054 | 1,047 | $15K | |
| 87140 | 5,398 | 5,343 | $15K | |
| 80324 | 7,432 | 6,549 | $15K | |
| 85048 | 20,305 | 19,757 | $15K | |
| 85305 | 2,792 | 2,747 | $15K | |
| 82671 | 588 | 583 | $15K | |
| 83630 | 1,158 | 1,144 | $15K | |
| 36416 | 3,557 | 3,019 | $14K | |
| 80369 | 5,411 | 5,213 | $14K | |
| 87106 | 4,573 | 4,494 | $14K | |
| 84376 | 2,423 | 2,387 | $14K | |
| 80165 | 2,233 | 2,197 | $14K | |
| 80372 | 10,915 | 10,287 | $14K | |
| 82656 | 827 | 823 | $14K | |
| 80354 | 20,137 | 17,029 | $14K | |
| 82365 | 3,073 | 3,030 | $13K | |
| 87880 | Infectious agent antigen detection by immunoassay; Streptococcus, group A | 2,158 | 2,134 | $13K |
| 86340 | 2,322 | 2,309 | $13K | |
| U0002 | 2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc | 315 | 313 | $13K |
| 86403 | 3,128 | 3,062 | $12K | |
| 87015 | 6,605 | 4,641 | $12K | |
| 88237 | 279 | 276 | $12K | |
| 84591 | 2,469 | 2,427 | $12K | |
| 85004 | 8,270 | 8,007 | $12K | |
| 80320 | 7,176 | 7,013 | $12K | |
| 80358 | 9,174 | 8,790 | $12K | |
| 86606 | 1,127 | 1,109 | $11K | |
| 80362 | 5,651 | 5,283 | $11K | |
| 86663 | 1,865 | 1,851 | $11K | |
| 80201 | 2,176 | 2,123 | $11K | |
| 81291 | 2,256 | 2,238 | $11K | |
| 82435 | 10,972 | 10,854 | $11K | |
| 87425 | 318 | 315 | $11K | |
| 82180 | 5,195 | 5,166 | $11K | |
| 82553 | 2,817 | 2,761 | $11K | |
| 86880 | 6,014 | 5,851 | $11K | |
| 87254 | 1,585 | 1,575 | $11K | |
| 84238 | 489 | 481 | $10K | |
| 88264 | 278 | 275 | $10K | |
| 80353 | 4,342 | 4,152 | $10K | |
| 88377 | 228 | 228 | $10K | |
| 86615 | 1,561 | 1,544 | $10K | |
| 83992 | 7,202 | 7,042 | $10K | |
| 80337 | 6,373 | 6,253 | $10K | |
| 81332 | 923 | 917 | $9K | |
| 87850 | 1,508 | 1,505 | $9K | |
| 80370 | 6,353 | 6,230 | $9K | |
| 85302 | 2,097 | 2,069 | $9K | |
| 80360 | 4,770 | 4,638 | $9K | |
| 80326 | 6,351 | 6,231 | $9K | |
| 80355 | 6,030 | 5,626 | $9K | |
| 85301 | 2,099 | 2,072 | $9K | |
| 87804 | Infectious agent antigen detection by immunoassay; Influenza, each type | 868 | 857 | $9K |
| 83605 | 2,018 | 1,952 | $9K | |
| 80338 | 6,497 | 6,347 | $8K | |
| 80503 | 1,997 | 1,975 | $8K | |
| 86692 | 2,024 | 2,012 | $8K | |
| 84560 | 6,016 | 5,916 | $8K | |
| 84133 | 6,375 | 6,262 | $8K | |
| 84145 | 750 | 704 | $8K | |
| 87328 | 2,298 | 2,283 | $7K | |
| 83527 | 724 | 721 | $7K | |
| G0475 | Hiv antigen/antibody, combination assay, screening | 2,081 | 2,061 | $7K |
| 80366 | 5,020 | 4,903 | $7K | |
| 80377 | 6,348 | 6,226 | $7K | |
| 84105 | 4,943 | 4,875 | $7K | |
| 80345 | 7,638 | 7,465 | $7K | |
| 80359 | 3,129 | 3,041 | $7K | |
| 82595 | 3,815 | 3,783 | $7K | |
| 80356 | 5,604 | 5,212 | $7K | |
| 82657 | 566 | 565 | $6K | |
| 87185 | 5,490 | 5,440 | $6K | |
| 86343 | 1,839 | 1,829 | $6K | |
| 88344 | 82 | 76 | $6K | |
| 80364 | 2,994 | 2,919 | $6K | |
| 84378 | 1,608 | 1,594 | $6K | |
| 86041 | 410 | 407 | $6K | |
| 86905 | 3,487 | 3,321 | $6K | |
| 86886 | 3,414 | 3,245 | $6K | |
| 86611 | 1,000 | 606 | $6K | |
| 80367 | 3,493 | 3,258 | $5K | |
| 86161 | 917 | 906 | $5K | |
| 84392 | 4,021 | 3,990 | $5K | |
| 83986 | 4,799 | 4,759 | $5K | |
| 80235 | 1,063 | 1,038 | $5K | |
| 82941 | 709 | 691 | $5K | |
| 86794 | 528 | 524 | $5K | |
| 80344 | 2,082 | 2,034 | $5K | |
| 81335 | 127 | 125 | $5K | |
| 99058 | 12,294 | 10,232 | $5K | |
| 80340 | 2,095 | 2,046 | $5K | |
| 85049 | 4,729 | 4,653 | $4K | |
| 87272 | 1,439 | 1,422 | $4K | |
| 80333 | 2,095 | 2,046 | $4K | |
| 80342 | 4,279 | 4,160 | $4K | |
| 99000 | 574 | 504 | $4K | |
| 86631 | 513 | 492 | $4K | |
| P9011 | Blood, split unit | 1,521 | 1,504 | $4K |
| 80363 | 4,097 | 4,033 | $3K | |
| 80357 | 2,257 | 2,193 | $3K | |
| 84433 | 156 | 156 | $3K | |
| 87650 | 663 | 660 | $3K | |
| 80339 | 4,030 | 3,969 | $3K | |
| 89060 | 2,272 | 2,143 | $3K | |
| 82731 | 195 | 195 | $3K | |
| 85670 | 1,308 | 1,275 | $3K | |
| 86043 | 184 | 183 | $3K | |
| 80167 | 137 | 126 | $3K | |
| 87341 | 1,381 | 1,356 | $3K | |
| 82374 | 6,141 | 6,059 | $3K | |
| 86698 | 391 | 385 | $3K | |
| 80332 | 4,245 | 4,140 | $3K | |
| 87593 | 612 | 557 | $3K | |
| 84311 | 247 | 243 | $3K | |
| 87110 | 153 | 153 | $3K | |
| 86738 | 376 | 367 | $3K | |
| 82540 | 2,405 | 2,383 | $3K | |
| 81443 | 127 | 120 | $3K | |
| 84143 | 578 | 572 | $3K | |
| 86632 | 540 | 520 | $2K | |
| 86042 | 189 | 188 | $2K | |
| 80371 | 2,272 | 2,217 | $2K | |
| 83625 | 923 | 914 | $2K | |
| 80330 | 2,092 | 2,042 | $2K | |
| 89051 | 2,428 | 2,295 | $2K | |
| 80329 | 4,310 | 4,243 | $2K | |
| 80335 | 944 | 906 | $2K | |
| 81301 | 53 | 53 | $2K | |
| 89321 | 573 | 556 | $2K | |
| 80203 | 203 | 193 | $2K | |
| 83497 | 321 | 313 | $2K | |
| 0346U | 159 | 158 | $2K | |
| 84585 | 311 | 307 | $2K | |
| 81327 | 2,209 | 2,209 | $2K | |
| 83631 | 396 | 396 | $1K | |
| 86703 | 272 | 271 | $1K | |
| 88289 | 168 | 167 | $1K | |
| 80180 | 118 | 103 | $1K | |
| 83018 | 141 | 138 | $1K | |
| 85999 | 316 | 309 | $1K | |
| 80325 | 119 | 119 | $1K | |
| 86305 | 433 | 428 | $1K | |
| 87207 | 425 | 393 | $1K | |
| 87149 | 31 | 24 | $1K | |
| 80169 | 211 | 143 | $1K | |
| 86609 | 275 | 80 | $1K | |
| 84206 | 96 | 91 | $1K | |
| 86710 | 143 | 143 | $972.22 | |
| 81225 | 145 | 145 | $955.29 | |
| 85307 | 179 | 177 | $935.47 | |
| 87276 | 415 | 385 | $915.28 | |
| 87275 | 415 | 385 | $910.58 | |
| 87807 | 478 | 474 | $857.86 | |
| 0014M | 26 | 26 | $817.52 | |
| 88187 | 138 | 138 | $787.67 | |
| 86336 | 243 | 237 | $753.57 | |
| 88300 | 295 | 294 | $734.16 | |
| 84442 | 298 | 298 | $635.47 | |
| 87280 | 275 | 275 | $635.12 | |
| 82978 | 55 | 55 | $621.46 | |
| 85810 | 227 | 215 | $572.05 | |
| 87109 | 309 | 307 | $543.93 | |
| 88321 | 53 | 53 | $532.04 | |
| 84260 | 72 | 69 | $467.55 | |
| 85385 | 80 | 79 | $417.79 | |
| 83937 | 91 | 91 | $413.30 | |
| 80374 | 3,453 | 3,115 | $391.16 | |
| 82608 | 100 | 99 | $385.33 | |
| 86596 | 13 | 13 | $381.84 | |
| 80375 | 992 | 938 | $376.04 | |
| 86023 | 121 | 102 | $360.30 | |
| 87172 | 174 | 170 | $351.13 | |
| 80500 | 820 | 813 | $326.33 | |
| 86628 | 39 | 39 | $319.54 | |
| 86332 | 607 | 603 | $311.20 | |
| G0123 | Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision | 164 | 164 | $304.30 |
| 87530 | 190 | 190 | $292.78 | |
| 82436 | 135 | 133 | $278.75 | |
| 84588 | 14 | 14 | $278.10 | |
| 87118 | 153 | 114 | $264.97 | |
| 87556 | 55 | 51 | $256.40 | |
| 87305 | 119 | 117 | $237.97 | |
| 87279 | 27 | 27 | $233.22 | |
| 85651 | 235 | 226 | $216.80 | |
| 82710 | 38 | 38 | $211.48 | |
| 86215 | 29 | 29 | $209.86 | |
| G0476 | Infectious agent detection by nucleic acid (dna or rna); human papillomavirus (hpv), high-risk types (e.g., 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) for cervical cancer screening, must be performed in addition to pap test | 77 | 74 | $185.42 |
| 80352 | 860 | 834 | $184.61 | |
| 86753 | 30 | 26 | $176.16 | |
| 87300 | 187 | 186 | $170.08 | |
| 89320 | 116 | 113 | $166.19 | |
| 86788 | 24 | 24 | $141.90 | |
| 82300 | 38 | 38 | $137.11 | |
| 80204 | 18 | 18 | $108.00 | |
| 86052 | 53 | 53 | $107.13 | |
| 84181 | 25 | 25 | $102.18 | |
| 85362 | 70 | 65 | $97.93 | |
| 87260 | 27 | 27 | $91.82 | |
| 86022 | 12 | 12 | $87.26 | |
| 82677 | 26 | 26 | $86.78 | |
| 80186 | 25 | 25 | $86.42 | |
| 87496 | 12 | 12 | $82.93 | |
| 83918 | 12 | 12 | $82.72 | |
| 80168 | 12 | 12 | $78.71 | |
| 87385 | 18 | 18 | $68.69 | |
| 87503 | 31 | 25 | $67.14 | |
| 88311 | 13 | 12 | $64.04 | |
| 85250 | 16 | 16 | $50.30 | |
| 86789 | 12 | 12 | $38.11 | |
| 84540 | 25 | 25 | $32.20 | |
| 85420 | 14 | 14 | $30.80 | |
| 86331 | 14 | 13 | $23.96 | |
| 80171 | 64 | 64 | $23.17 | |
| 87184 | 26 | 26 | $21.15 | |
| 85244 | 18 | 14 | $18.98 | |
| 88164 | 25 | 25 | $16.59 | |
| G0306 | Complete cbc, automated (hgb, hct, rbc, wbc, without platelet count) and automated wbc differential count | 76 | 75 | $4.62 |
| 99283 | Emergency department visit for the evaluation and management, moderate severity | 120 | 117 | $0.00 |
| 99213 | Office or other outpatient visit for the evaluation and management of an established patient, low complexity | 1,270 | 1,184 | $0.00 |
| 3044F | 63,707 | 63,362 | $0.00 | |
| 3048F | 9,508 | 9,451 | $0.00 | |
| 3049F | 5,905 | 5,878 | $0.00 | |
| 84431 | 397 | 396 | $0.00 | |
| 3052F | 3,623 | 3,592 | $0.00 | |
| H0049 | Alcohol and/or drug screening | 61 | 59 | $0.00 |
| 81255 | 56 | 54 | $0.00 | |
| 81200 | 39 | 39 | $0.00 | |
| 92004 | Ophthalmological services: medical examination and evaluation, comprehensive, new patient | 13 | 13 | $0.00 |
| 89322 | 12 | 12 | $0.00 | |
| 3351F | 84 | 74 | $0.00 | |
| 90471 | Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine | 13 | 13 | $0.00 |
| E0431 | Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing | 12 | 12 | $0.00 |
| 99214 | Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity | 86 | 86 | $0.00 |
| 83789 | 703 | 650 | $0.00 | |
| H2019 | Therapeutic behavioral services, per 15 minutes | 100 | 31 | $0.00 |
| 95117 | 23 | 15 | $0.00 | |
| 99285 | Emergency department visit for the evaluation and management, high severity with immediate threat to life | 14 | 14 | $0.00 |
| 81000 | 13 | 13 | $0.00 | |
| T4535 | Disposable liner/shield/guard/pad/undergarment, for incontinence, each | 13 | 13 | $0.00 |
| 3008F | 25 | 25 | $0.00 | |
| 92014 | Ophthalmological services: medical examination and evaluation, comprehensive, established patient | 40 | 40 | $0.00 |
| 3050F | 4,251 | 4,226 | $0.00 | |
| 88120 | 12 | 12 | $0.00 | |
| 3051F | 5,763 | 5,724 | $0.00 | |
| 92015 | Determination of refractive state | 113 | 113 | $0.00 |
| 99284 | Emergency department visit for the evaluation and management, high severity | 19 | 19 | $0.00 |
| 3046F | 5,560 | 5,523 | $0.00 | |
| 92340 | Fitting of spectacles, except for aphakia; monofocal | 30 | 30 | $0.00 |
| T4541 | Incontinence product, disposable underpad, large, each | 51 | 50 | $0.00 |
| T1015 | Clinic visit/encounter, all-inclusive | 112 | 110 | $0.00 |
| V2020 | Frames, purchases | 30 | 30 | $0.00 |
| P9604 | Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated trip charge | 94 | 88 | $0.00 |
| 97039 | 32 | 15 | $0.00 | |
| T4526 | Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each | 14 | 14 | $0.00 |
| S5111 | Home care training, family; per session | 65 | 27 | $0.00 |
| 3725F | 62 | 60 | $0.00 | |
| 88147 | 15 | 15 | $0.00 | |
| H0046 | Mental health services, not otherwise specified | 57 | 27 | $0.00 |
| 81260 | 40 | 40 | $0.00 | |
| 99212 | Office or other outpatient visit for the evaluation and management of an established patient, straightforward | 41 | 40 | $0.00 |
| S9999 | Sales tax | 30 | 29 | $0.00 |
| T4527 | Adult sized disposable incontinence product, protective underwear/pull-on, large size, each | 15 | 15 | $0.00 |
| A0425 | Ground mileage, per statute mile | 15 | 13 | $0.00 |