| Code | Description | Claims | Beneficiaries | Total Paid |
| U0003 |
Cov-19 amp prb hgh thruput |
281,657 |
258,045 |
$18.31M |
| 87491 |
|
296,520 |
288,764 |
$5.07M |
| 87591 |
|
295,192 |
287,483 |
$4.80M |
| 82306 |
|
301,122 |
296,507 |
$4.02M |
| U0005 |
Infec agen detec ampli probe |
189,979 |
174,986 |
$3.97M |
| 80050 |
|
228,729 |
225,736 |
$3.43M |
| 87661 |
|
158,000 |
151,581 |
$2.42M |
| 80053 |
|
426,164 |
413,566 |
$2.18M |
| 80061 |
|
472,187 |
464,818 |
$2.17M |
| 88175 |
|
135,195 |
134,262 |
$2.08M |
| 86480 |
|
72,873 |
71,682 |
$2.07M |
| 87798 |
|
47,207 |
44,976 |
$2.04M |
| 86769 |
|
65,971 |
65,359 |
$2.00M |
| 87389 |
|
182,304 |
178,265 |
$1.93M |
| 87624 |
|
109,025 |
108,371 |
$1.92M |
| 83036 |
|
377,694 |
371,498 |
$1.38M |
| 82607 |
|
191,632 |
188,538 |
$1.33M |
| 85025 |
|
445,921 |
432,020 |
$1.24M |
| 84443 |
|
241,135 |
236,486 |
$1.23M |
| 86803 |
|
140,530 |
138,075 |
$987K |
| 87801 |
|
31,722 |
30,404 |
$974K |
| 80307 |
|
53,787 |
48,810 |
$970K |
| 82746 |
|
131,131 |
129,201 |
$896K |
| 84439 |
|
201,047 |
197,577 |
$842K |
| 88305 |
|
17,959 |
16,942 |
$821K |
| 87086 |
|
214,366 |
201,012 |
$819K |
| 87481 |
|
38,572 |
37,438 |
$809K |
| 86003 |
|
17,021 |
15,138 |
$755K |
| 87635 |
|
25,141 |
24,404 |
$738K |
| 87633 |
|
7,953 |
7,827 |
$736K |
| 81220 |
|
3,581 |
3,568 |
$696K |
| 82728 |
|
99,626 |
97,002 |
$598K |
| 83013 |
|
17,095 |
16,760 |
$580K |
| 81001 |
|
344,698 |
334,483 |
$575K |
| 84403 |
|
40,041 |
39,290 |
$546K |
| 87340 |
|
93,824 |
93,017 |
$543K |
| 86706 |
|
95,631 |
94,190 |
$534K |
| 84153 |
|
66,224 |
63,213 |
$527K |
| 84481 |
|
73,314 |
72,267 |
$521K |
| 87636 |
|
5,443 |
5,127 |
$512K |
| 86696 |
|
57,624 |
55,888 |
$503K |
| 87070 |
|
121,854 |
113,032 |
$501K |
| 87077 |
|
96,533 |
88,328 |
$484K |
| 80074 |
|
33,040 |
31,859 |
$456K |
| 87502 |
|
8,770 |
8,671 |
$405K |
| 86762 |
|
46,914 |
46,233 |
$362K |
| 87186 |
|
80,633 |
76,331 |
$360K |
| 82670 |
|
23,918 |
23,564 |
$355K |
| 83001 |
|
34,565 |
34,198 |
$354K |
| 83655 |
|
51,315 |
51,103 |
$349K |
| 87511 |
|
23,813 |
23,562 |
$339K |
| 81514 |
|
4,846 |
4,705 |
$339K |
| 86235 |
|
17,058 |
16,669 |
$321K |
| 83970 |
|
15,778 |
15,492 |
$317K |
| 86592 |
|
150,204 |
145,976 |
$316K |
| 83002 |
|
31,262 |
30,897 |
$315K |
| 81513 |
|
12,368 |
11,546 |
$313K |
| 86765 |
|
44,207 |
43,641 |
$310K |
| 88141 |
|
27,015 |
26,809 |
$306K |
| 84702 |
|
42,079 |
38,525 |
$301K |
| 83550 |
|
93,807 |
91,633 |
$295K |
| 84146 |
|
27,663 |
27,266 |
$290K |
| 86708 |
|
44,510 |
43,841 |
$283K |
| 86695 |
|
53,636 |
52,288 |
$282K |
| 86787 |
|
42,011 |
41,442 |
$282K |
| 83540 |
|
108,059 |
105,434 |
$280K |
| 86704 |
|
46,153 |
45,418 |
$271K |
| 87480 |
|
25,245 |
24,708 |
$261K |
| 87510 |
|
24,122 |
23,604 |
$252K |
| 86735 |
|
39,274 |
38,737 |
$239K |
| 87536 |
|
4,050 |
3,930 |
$238K |
| 86780 |
|
36,438 |
35,769 |
$229K |
| 87522 |
Neg quan hep c or qual rna |
8,910 |
8,661 |
$222K |
| 86694 |
|
34,326 |
33,280 |
$209K |
| 86038 |
|
42,263 |
41,306 |
$201K |
| 87634 |
|
9,639 |
9,183 |
$200K |
| 86376 |
|
26,492 |
26,145 |
$199K |
| 87081 |
|
55,535 |
54,697 |
$189K |
| 80081 |
|
5,805 |
5,739 |
$189K |
| 82570 |
|
74,098 |
72,125 |
$180K |
| 82043 |
|
69,343 |
68,433 |
$180K |
| 87660 |
|
17,299 |
16,928 |
$178K |
| G0480 |
Drug test def 1-7 classes |
7,544 |
7,047 |
$178K |
| 84550 |
|
74,652 |
73,130 |
$173K |
| 84144 |
|
15,449 |
14,461 |
$170K |
| 85027 |
|
56,524 |
55,683 |
$167K |
| 83021 |
|
17,103 |
17,000 |
$166K |
| 88112 |
|
5,880 |
5,702 |
$166K |
| 84270 |
|
22,010 |
21,165 |
$163K |
| 87529 |
|
5,692 |
5,571 |
$161K |
| 82627 |
|
13,036 |
12,930 |
$152K |
| 86800 |
|
19,596 |
19,255 |
$152K |
| 84480 |
|
28,556 |
28,128 |
$150K |
| 86618 |
|
14,969 |
14,335 |
$150K |
| 81511 |
|
2,672 |
2,669 |
$149K |
| 84154 |
|
15,344 |
15,139 |
$142K |
| 80048 |
|
39,605 |
38,290 |
$137K |
| 82784 |
|
19,758 |
17,490 |
$135K |
| 83735 |
|
47,279 |
45,521 |
$135K |
| 81420 |
|
874 |
873 |
$126K |
| 86140 |
|
54,650 |
53,044 |
$125K |
| 82652 |
|
13,580 |
13,473 |
$122K |
| 87517 |
|
9,263 |
9,199 |
$122K |
| 86364 |
|
8,601 |
8,155 |
$116K |
| 82248 |
|
47,351 |
46,167 |
$116K |
| 88142 |
|
10,132 |
10,095 |
$116K |
| 82785 |
|
14,173 |
13,852 |
$115K |
| 86147 |
|
5,365 |
4,752 |
$111K |
| 86617 |
|
9,065 |
7,708 |
$110K |
| 84436 |
|
39,369 |
38,682 |
$110K |
| 87563 |
|
8,099 |
7,928 |
$108K |
| 88342 |
|
2,697 |
2,208 |
$107K |
| 83521 |
|
2,988 |
2,901 |
$100K |
| 86709 |
|
17,796 |
17,365 |
$99K |
| 86160 |
|
12,313 |
9,735 |
$99K |
| 83525 |
|
16,472 |
16,187 |
$97K |
| 86665 |
|
5,411 |
4,818 |
$96K |
| 86360 |
|
3,136 |
3,080 |
$94K |
| 87467 |
|
14,028 |
13,580 |
$89K |
| 87350 |
|
15,702 |
15,404 |
$89K |
| 85652 |
|
73,101 |
71,299 |
$88K |
| 86707 |
|
15,528 |
15,222 |
$88K |
| 84402 |
|
6,315 |
6,269 |
$87K |
| 83498 |
|
5,771 |
5,734 |
$86K |
| 82105 |
|
14,113 |
13,996 |
$83K |
| 87147 |
|
37,905 |
36,556 |
$77K |
| 86430 |
|
25,258 |
25,058 |
$76K |
| 36415 |
|
281,171 |
260,292 |
$72K |
| 86225 |
|
14,531 |
14,174 |
$72K |
| 83516 |
|
10,668 |
10,045 |
$71K |
| 80076 |
|
18,434 |
18,070 |
$71K |
| 86255 |
|
12,032 |
11,753 |
$69K |
| 82626 |
|
4,937 |
4,914 |
$67K |
| 86200 |
|
16,567 |
16,380 |
$65K |
| 82533 |
|
7,745 |
7,552 |
$64K |
| 86334 |
|
6,516 |
6,395 |
$63K |
| 82550 |
|
22,422 |
21,657 |
$63K |
| 83520 |
|
11,046 |
10,868 |
$61K |
| 83690 |
|
17,739 |
17,276 |
$57K |
| 86008 |
|
2,159 |
2,064 |
$57K |
| 83090 |
|
6,018 |
5,983 |
$57K |
| 86705 |
|
10,338 |
10,058 |
$56K |
| 83880 |
|
4,170 |
3,964 |
$56K |
| 84100 |
|
23,639 |
22,562 |
$55K |
| 86258 |
|
3,893 |
3,300 |
$54K |
| 86141 |
|
9,184 |
8,958 |
$54K |
| 86747 |
|
4,662 |
3,942 |
$53K |
| 88361 |
|
799 |
790 |
$52K |
| 86015 |
|
3,135 |
2,552 |
$51K |
| 85610 |
|
28,667 |
26,077 |
$51K |
| 81329 |
|
1,676 |
1,667 |
$50K |
| 82274 |
|
9,374 |
9,292 |
$50K |
| 87653 |
|
3,232 |
3,198 |
$50K |
| 82977 |
|
17,632 |
16,680 |
$49K |
| 84445 |
|
3,139 |
3,090 |
$48K |
| 84425 |
|
5,093 |
5,013 |
$48K |
| 84165 |
|
10,623 |
10,444 |
$48K |
| 86317 |
|
4,850 |
4,825 |
$48K |
| 84479 |
|
20,225 |
20,043 |
$47K |
| 82378 |
|
5,545 |
5,171 |
$47K |
| 87631 |
|
1,117 |
1,080 |
$46K |
| 82465 |
|
21,935 |
21,359 |
$46K |
| 82150 |
|
14,839 |
14,430 |
$45K |
| 84681 |
|
4,150 |
4,115 |
$43K |
| 85730 |
|
19,453 |
18,728 |
$42K |
| 87255 |
|
2,997 |
2,957 |
$41K |
| 86757 |
|
2,418 |
2,319 |
$41K |
| 86146 |
|
2,014 |
1,725 |
$38K |
| 86357 |
|
2,200 |
2,183 |
$37K |
| 82951 |
|
6,787 |
6,576 |
$37K |
| 82157 |
|
2,411 |
2,402 |
$37K |
| 87338 |
|
6,298 |
6,260 |
$36K |
| 86850 |
|
9,947 |
9,738 |
$36K |
| 86359 |
|
2,203 |
2,148 |
$36K |
| 82950 |
|
14,392 |
14,279 |
$34K |
| 82024 |
|
1,795 |
1,753 |
$33K |
| 87045 |
|
4,839 |
4,373 |
$33K |
| 83615 |
|
12,409 |
11,804 |
$33K |
| 81243 |
|
2,771 |
2,757 |
$33K |
| 82677 |
|
2,511 |
2,498 |
$32K |
| 84163 |
|
3,978 |
3,976 |
$32K |
| 87902 |
|
182 |
180 |
$31K |
| 87106 |
|
5,392 |
5,203 |
$30K |
| 86664 |
|
3,581 |
3,452 |
$29K |
| 86666 |
|
3,175 |
2,842 |
$29K |
| 87177 |
|
5,540 |
5,217 |
$29K |
| 81596 |
|
1,289 |
1,281 |
$28K |
| 84460 |
|
10,592 |
10,327 |
$28K |
| 82671 |
|
2,974 |
2,958 |
$27K |
| 86812 |
|
2,998 |
2,893 |
$27K |
| 86901 |
|
15,507 |
15,255 |
$27K |
| 81401 |
|
665 |
658 |
$27K |
| 81507 |
|
230 |
227 |
$27K |
| 84156 |
|
15,521 |
14,762 |
$26K |
| 83921 |
|
2,520 |
2,498 |
$26K |
| 86900 |
|
15,721 |
15,468 |
$25K |
| 88173 |
|
536 |
451 |
$25K |
| 80069 |
|
3,848 |
3,752 |
$25K |
| 86663 |
|
3,437 |
3,311 |
$24K |
| 83721 |
|
11,565 |
11,287 |
$24K |
| 87329 |
|
3,716 |
3,484 |
$23K |
| 86777 |
|
2,902 |
2,863 |
$23K |
| 86304 |
|
2,844 |
2,762 |
$23K |
| 87102 |
|
4,553 |
4,527 |
$22K |
| 84207 |
|
1,638 |
1,602 |
$22K |
| 86231 |
|
3,212 |
3,133 |
$22K |
| 84305 |
|
2,041 |
2,012 |
$22K |
| 80349 |
|
6,718 |
6,280 |
$21K |
| 86039 |
|
4,783 |
4,655 |
$21K |
| 84466 |
|
3,836 |
3,705 |
$21K |
| 85045 |
|
11,217 |
11,040 |
$20K |
| 86021 |
|
3,909 |
3,810 |
$20K |
| 81376 |
|
521 |
520 |
$20K |
| 86300 |
|
2,448 |
2,244 |
$20K |
| 83010 |
|
3,428 |
3,388 |
$20K |
| 82672 |
|
1,753 |
1,727 |
$20K |
| 87799 |
|
457 |
444 |
$20K |
| 86738 |
|
1,699 |
1,690 |
$20K |
| 80348 |
|
3,283 |
2,896 |
$19K |
| 80055 |
|
813 |
809 |
$19K |
| 84590 |
|
2,948 |
2,931 |
$19K |
| 87581 |
|
1,174 |
1,163 |
$19K |
| 87486 |
|
1,163 |
1,152 |
$19K |
| 84703 |
|
6,501 |
6,333 |
$19K |
| 87046 |
|
4,233 |
4,121 |
$19K |
| 86355 |
|
1,251 |
1,236 |
$19K |
| 82172 |
|
1,786 |
1,769 |
$18K |
| 82985 |
|
2,609 |
2,588 |
$17K |
| 87209 |
|
2,757 |
2,502 |
$17K |
| 86671 |
|
1,785 |
1,744 |
$17K |
| 86778 |
|
2,250 |
2,223 |
$17K |
| 84432 |
|
3,184 |
3,104 |
$17K |
| 88120 |
|
74 |
74 |
$17K |
| 86431 |
|
7,082 |
6,926 |
$16K |
| 84075 |
|
6,613 |
6,417 |
$16K |
| 80365 |
|
5,939 |
5,277 |
$16K |
| 82088 |
|
957 |
857 |
$16K |
| 86336 |
|
2,184 |
2,177 |
$16K |
| 85379 |
|
3,015 |
2,899 |
$15K |
| 86256 |
|
1,944 |
1,932 |
$15K |
| 82668 |
|
2,144 |
2,094 |
$15K |
| 86710 |
|
1,029 |
956 |
$15K |
| 84478 |
|
7,375 |
7,200 |
$15K |
| 82397 |
|
3,235 |
3,200 |
$14K |
| 84630 |
|
2,665 |
2,651 |
$14K |
| 80164 |
|
2,532 |
2,363 |
$14K |
| 83883 |
|
1,792 |
1,724 |
$14K |
| 86644 |
|
1,791 |
1,737 |
$14K |
| 82653 |
|
641 |
631 |
$13K |
| 82164 |
|
2,755 |
2,715 |
$13K |
| 81002 |
|
9,004 |
8,899 |
$13K |
| 87075 |
|
2,955 |
2,448 |
$13K |
| 87637 |
|
223 |
217 |
$13K |
| 86036 |
|
890 |
885 |
$12K |
| 86645 |
|
1,582 |
1,531 |
$12K |
| 82330 |
|
2,190 |
2,118 |
$12K |
| 84181 |
|
909 |
857 |
$12K |
| 82390 |
|
2,415 |
2,401 |
$12K |
| 82947 |
|
6,104 |
6,001 |
$12K |
| 84450 |
|
9,806 |
9,543 |
$12K |
| 86356 |
|
1,492 |
1,486 |
$12K |
| 82525 |
|
1,713 |
1,695 |
$12K |
| 87625 |
|
1,250 |
1,229 |
$12K |
| 83993 |
|
1,565 |
1,551 |
$12K |
| 82103 |
|
1,776 |
1,721 |
$12K |
| 87324 |
|
2,069 |
2,030 |
$12K |
| 88184 |
|
733 |
726 |
$12K |
| 87469 |
|
752 |
635 |
$11K |
| 87449 |
|
2,533 |
2,480 |
$11K |
| 87341 |
|
2,015 |
1,984 |
$11K |
| 88189 |
|
530 |
524 |
$10K |
| 85613 |
|
2,324 |
2,175 |
$10K |
| 84446 |
|
1,339 |
1,330 |
$10K |
| 83789 |
|
1,141 |
1,097 |
$9K |
| 86611 |
|
701 |
699 |
$9K |
| 87468 |
|
704 |
602 |
$9K |
| 87507 |
|
138 |
137 |
$9K |
| 86677 |
|
679 |
655 |
$9K |
| 82565 |
|
4,377 |
4,179 |
$9K |
| 87272 |
|
1,350 |
1,234 |
$9K |
| 82166 |
|
657 |
645 |
$9K |
| 86593 |
|
3,910 |
3,761 |
$9K |
| 87328 |
|
1,517 |
1,390 |
$9K |
| 87109 |
|
1,261 |
1,236 |
$9K |
| 84166 |
|
1,079 |
1,058 |
$8K |
| 86631 |
|
796 |
794 |
$8K |
| 84080 |
|
1,333 |
1,310 |
$8K |
| 81003 |
|
8,486 |
7,929 |
$8K |
| 87185 |
|
3,478 |
3,256 |
$8K |
| 87484 |
|
622 |
552 |
$8K |
| 88262 |
|
141 |
139 |
$8K |
| 84155 |
|
8,903 |
8,684 |
$8K |
| 82787 |
|
663 |
650 |
$8K |
| 84255 |
|
773 |
768 |
$8K |
| 86301 |
|
1,276 |
1,181 |
$8K |
| 82955 |
|
1,505 |
1,481 |
$7K |
| 82232 |
|
1,242 |
1,211 |
$7K |
| 87101 |
|
1,743 |
1,669 |
$7K |
| 83695 |
|
1,937 |
1,931 |
$7K |
| 82642 |
|
755 |
642 |
$7K |
| 80346 |
|
2,555 |
2,416 |
$7K |
| 82310 |
|
3,326 |
3,158 |
$7K |
| 81256 |
|
455 |
455 |
$7K |
| 84520 |
|
4,040 |
3,866 |
$7K |
| 86341 |
|
798 |
747 |
$6K |
| 87912 |
|
67 |
67 |
$6K |
| 82085 |
|
1,920 |
1,877 |
$6K |
| 84484 |
|
1,408 |
1,337 |
$6K |
| 81241 |
|
330 |
328 |
$6K |
| 80324 |
|
2,027 |
1,894 |
$6K |
| 84482 |
|
1,289 |
1,274 |
$6K |
| 80178 |
|
1,791 |
1,606 |
$6K |
| 80177 |
|
1,144 |
1,122 |
$6K |
| 86753 |
|
911 |
760 |
$6K |
| 86335 |
|
490 |
484 |
$6K |
| 82308 |
|
468 |
466 |
$6K |
| 86632 |
|
794 |
791 |
$6K |
| 87478 |
|
415 |
413 |
$6K |
| 86063 |
|
2,159 |
2,129 |
$6K |
| 84378 |
|
915 |
908 |
$6K |
| 87471 |
|
470 |
464 |
$6K |
| 86308 |
|
2,072 |
2,039 |
$6K |
| 87512 |
|
355 |
354 |
$6K |
| 85660 |
|
2,458 |
2,420 |
$6K |
| 80159 |
|
771 |
571 |
$6K |
| 83718 |
|
3,037 |
3,007 |
$5K |
| 87623 |
|
1,151 |
1,151 |
$5K |
| 88185 |
|
132 |
131 |
$5K |
| 80361 |
|
1,823 |
1,714 |
$5K |
| 83835 |
|
627 |
594 |
$5K |
| 80359 |
|
2,310 |
1,840 |
$5K |
| 82180 |
|
976 |
967 |
$5K |
| 81291 |
|
567 |
555 |
$5K |
| 88280 |
|
434 |
429 |
$5K |
| 82679 |
|
259 |
258 |
$4K |
| 83519 |
|
803 |
779 |
$4K |
| 82552 |
|
719 |
699 |
$4K |
| 85240 |
|
639 |
626 |
$4K |
| 84244 |
|
782 |
749 |
$4K |
| 86702 |
|
961 |
915 |
$4K |
| 82247 |
|
6,209 |
5,983 |
$4K |
| 86692 |
|
400 |
392 |
$4K |
| 82610 |
|
705 |
668 |
$4K |
| 86885 |
|
1,799 |
1,760 |
$4K |
| 87040 |
|
462 |
372 |
$4K |
| 83630 |
|
536 |
526 |
$4K |
| 85384 |
|
808 |
788 |
$4K |
| 82270 |
|
1,828 |
1,804 |
$3K |
| 85007 |
|
2,576 |
2,241 |
$3K |
| 82107 |
|
140 |
139 |
$3K |
| G0103 |
Psa screening |
823 |
816 |
$3K |
| 87205 |
|
1,704 |
1,567 |
$3K |
| 84134 |
|
511 |
507 |
$3K |
| 81015 |
|
2,244 |
2,122 |
$3K |
| 85246 |
|
333 |
329 |
$3K |
| 82040 |
|
5,553 |
5,392 |
$3K |
| 86701 |
|
982 |
936 |
$3K |
| 84442 |
|
446 |
443 |
$3K |
| 87641 |
|
168 |
165 |
$3K |
| 86340 |
|
406 |
404 |
$3K |
| 81240 |
|
156 |
154 |
$3K |
| 80362 |
|
830 |
636 |
$3K |
| 82952 |
|
948 |
936 |
$2K |
| 86148 |
|
229 |
228 |
$2K |
| 86622 |
|
527 |
526 |
$2K |
| 83704 |
|
365 |
362 |
$2K |
| 86886 |
|
816 |
809 |
$2K |
| 80320 |
|
383 |
369 |
$2K |
| 80353 |
|
1,085 |
987 |
$2K |
| 83014 |
|
775 |
769 |
$2K |
| 86337 |
|
294 |
292 |
$2K |
| 87593 |
|
49 |
49 |
$2K |
| 84132 |
|
1,066 |
1,008 |
$2K |
| 86331 |
|
293 |
286 |
$2K |
| 82239 |
|
292 |
257 |
$2K |
| 88304 |
|
83 |
82 |
$2K |
| 82747 |
|
191 |
190 |
$2K |
| 84300 |
|
872 |
854 |
$2K |
| 80051 |
|
618 |
527 |
$2K |
| G0145 |
Scr c/v cyto,thinlayer,rescr |
417 |
416 |
$2K |
| 83003 |
|
197 |
195 |
$2K |
| 82530 |
|
214 |
201 |
$2K |
| 85245 |
|
211 |
211 |
$2K |
| 85306 |
|
192 |
188 |
$1K |
| 80175 |
|
225 |
212 |
$1K |
| 81050 |
|
1,229 |
1,208 |
$1K |
| 88341 |
|
54 |
40 |
$1K |
| 84597 |
|
183 |
181 |
$1K |
| 80197 |
|
243 |
175 |
$1K |
| 83020 |
|
189 |
185 |
$1K |
| 85014 |
|
1,270 |
1,245 |
$1K |
| 86361 |
|
74 |
74 |
$1K |
| 86215 |
|
181 |
181 |
$1K |
| 82542 |
|
143 |
141 |
$1K |
| 85018 |
|
1,222 |
1,195 |
$1K |
| 87476 |
|
50 |
49 |
$1K |
| 80358 |
|
585 |
526 |
$1K |
| 87273 |
|
137 |
137 |
$1K |
| 86162 |
|
94 |
94 |
$1K |
| 82608 |
|
119 |
119 |
$1K |
| 82710 |
|
86 |
86 |
$999.08 |
| 86658 |
|
94 |
93 |
$989.45 |
| 82495 |
|
70 |
70 |
$980.94 |
| 83698 |
|
53 |
53 |
$979.82 |
| 82272 |
|
570 |
558 |
$861.78 |
| 84238 |
|
165 |
163 |
$848.39 |
| 85303 |
|
118 |
117 |
$844.82 |
| 85300 |
|
148 |
148 |
$819.33 |
| 87493 |
|
64 |
64 |
$803.51 |
| 81257 |
|
330 |
329 |
$776.77 |
| 82140 |
|
106 |
100 |
$770.78 |
| 87274 |
|
90 |
90 |
$711.81 |
| 81361 |
|
25 |
25 |
$699.28 |
| 87015 |
|
280 |
243 |
$654.09 |
| 82595 |
|
235 |
231 |
$618.99 |
| 85247 |
|
86 |
86 |
$568.94 |
| 82731 |
|
13 |
12 |
$560.68 |
| 88235 |
|
12 |
12 |
$558.55 |
| 82365 |
|
82 |
79 |
$533.56 |
| 85049 |
|
730 |
685 |
$487.50 |
| 82384 |
|
55 |
55 |
$485.86 |
| 0107U |
|
215 |
210 |
$475.24 |
| 86870 |
|
41 |
40 |
$422.92 |
| 83527 |
|
60 |
59 |
$422.12 |
| 82374 |
|
358 |
348 |
$397.45 |
| 84295 |
|
513 |
491 |
$386.08 |
| 84704 |
|
60 |
59 |
$382.31 |
| 88108 |
|
85 |
85 |
$371.44 |
| 80414 |
|
12 |
12 |
$369.23 |
| 86880 |
|
187 |
181 |
$346.53 |
| 87280 |
|
54 |
54 |
$339.60 |
| 87535 |
|
43 |
38 |
$339.50 |
| 84588 |
|
13 |
13 |
$334.65 |
| 84586 |
|
13 |
13 |
$296.91 |
| 83825 |
|
24 |
24 |
$295.44 |
| 87168 |
|
201 |
189 |
$286.95 |
| 81270 |
|
25 |
25 |
$274.98 |
| 89060 |
|
83 |
73 |
$273.62 |
| 87400 |
|
28 |
28 |
$272.67 |
| 87252 |
|
13 |
13 |
$233.28 |
| 85305 |
|
26 |
26 |
$229.74 |
| P9603 |
One-way allow prorated miles |
227 |
175 |
$229.27 |
| 87497 |
|
21 |
12 |
$227.68 |
| 80306 |
|
31 |
29 |
$220.22 |
| 82435 |
|
424 |
403 |
$215.03 |
| 80325 |
|
265 |
226 |
$206.28 |
| 87116 |
|
36 |
27 |
$200.88 |
| 80373 |
|
13 |
13 |
$171.12 |
| G0476 |
Hpv combo assay ca screen |
66 |
66 |
$143.31 |
| 85302 |
|
12 |
12 |
$141.63 |
| 80354 |
|
317 |
271 |
$140.10 |
| G0472 |
Hep c screen high risk/other |
89 |
89 |
$139.05 |
| 82575 |
|
28 |
28 |
$129.93 |
| 82104 |
|
13 |
12 |
$123.76 |
| 85046 |
|
44 |
43 |
$117.78 |
| 80183 |
|
12 |
12 |
$103.98 |
| 85307 |
|
12 |
12 |
$98.18 |
| 82681 |
|
13 |
13 |
$97.79 |
| 83935 |
|
40 |
38 |
$74.98 |
| 87210 |
|
26 |
26 |
$64.64 |
| 86682 |
|
12 |
12 |
$62.49 |
| 84133 |
|
31 |
30 |
$54.68 |
| 83930 |
|
15 |
15 |
$54.21 |
| 82436 |
|
27 |
26 |
$49.80 |
| 85597 |
|
14 |
14 |
$46.75 |
| 85041 |
|
29 |
28 |
$45.36 |
| 85598 |
|
13 |
13 |
$44.95 |
| 87206 |
|
17 |
13 |
$41.03 |
| 87140 |
|
14 |
14 |
$40.10 |
| 82340 |
|
12 |
12 |
$39.82 |
| 89320 |
|
291 |
288 |
$38.78 |
| 89051 |
|
13 |
12 |
$38.39 |
| 85670 |
|
12 |
12 |
$25.73 |
| 89050 |
|
15 |
14 |
$24.32 |
| 87181 |
|
13 |
12 |
$20.14 |
| 80047 |
|
27 |
27 |
$0.00 |
| 99080 |
|
362 |
155 |
$0.00 |
| P9604 |
One-way allow prorated trip |
18 |
14 |
$0.00 |