| Code | Description | Claims | Beneficiaries | Total Paid |
| G0463 |
Hospital outpt clinic visit |
529,039 |
475,605 |
$39.69M |
| 99283 |
|
88,578 |
86,354 |
$13.98M |
| 99285 |
|
33,100 |
28,967 |
$12.85M |
| 42820 |
|
4,255 |
4,093 |
$12.78M |
| 99284 |
|
23,741 |
22,304 |
$6.12M |
| 69436 |
|
3,775 |
3,512 |
$4.35M |
| J0475 |
Baclofen 10 mg injection |
5,178 |
3,641 |
$3.75M |
| U0004 |
Cov-19 test non-cdc hgh thru |
23,678 |
22,967 |
$1.76M |
| G0378 |
Hospital observation per hr |
3,500 |
3,008 |
$1.61M |
| 70553 |
|
2,108 |
2,003 |
$1.59M |
| 93303 |
|
5,196 |
4,800 |
$1.55M |
| 70551 |
|
3,272 |
3,114 |
$1.49M |
| 93306 |
|
3,780 |
3,165 |
$1.38M |
| 95810 |
|
2,493 |
2,445 |
$1.26M |
| 95782 |
|
1,666 |
1,521 |
$1.23M |
| 43239 |
|
2,003 |
1,705 |
$1.16M |
| 87636 |
|
8,588 |
8,466 |
$1.13M |
| 41899 |
|
1,306 |
1,259 |
$1.13M |
| 90471 |
|
40,242 |
38,361 |
$976K |
| 85025 |
|
120,220 |
99,336 |
$822K |
| J0585 |
Injection,onabotulinumtoxina |
1,082 |
653 |
$816K |
| 74177 |
|
696 |
583 |
$695K |
| 96413 |
|
4,068 |
2,391 |
$690K |
| 97530 |
|
8,453 |
3,744 |
$674K |
| 87637 |
|
5,697 |
5,637 |
$614K |
| 80053 |
|
60,687 |
45,251 |
$612K |
| A0425 |
Ground mileage |
4,799 |
3,896 |
$611K |
| 41010 |
|
471 |
451 |
$529K |
| 99282 |
|
5,758 |
5,648 |
$495K |
| 87491 |
|
26,562 |
24,201 |
$474K |
| J2323 |
Natalizumab injection |
144 |
97 |
$471K |
| 93005 |
|
24,768 |
22,075 |
$470K |
| 87591 |
|
26,537 |
24,185 |
$468K |
| 90677 |
|
4,972 |
4,819 |
$463K |
| 93325 |
|
11,784 |
10,762 |
$458K |
| 92587 |
|
3,057 |
2,929 |
$438K |
| 94010 |
|
7,740 |
7,022 |
$420K |
| 95004 |
|
7,013 |
6,596 |
$357K |
| 96110 |
|
39,326 |
36,161 |
$353K |
| C9803 |
Hopd covid-19 spec collect |
22,307 |
21,047 |
$349K |
| 80048 |
|
42,664 |
30,882 |
$346K |
| U0002 |
Covid-19 lab test non-cdc |
7,778 |
7,258 |
$337K |
| 84443 |
|
25,707 |
23,924 |
$332K |
| 54161 |
|
362 |
354 |
$322K |
| 90670 |
|
5,322 |
4,898 |
$318K |
| 96365 |
|
3,030 |
1,583 |
$306K |
| 96375 |
|
3,426 |
2,403 |
$305K |
| 36415 |
|
85,378 |
64,280 |
$302K |
| 88305 |
|
3,450 |
2,827 |
$292K |
| J2405 |
Ondansetron hcl injection |
27,275 |
23,911 |
$292K |
| 92579 |
|
5,911 |
5,675 |
$273K |
| 93320 |
|
5,164 |
4,836 |
$262K |
| 71046 |
|
6,472 |
5,134 |
$261K |
| 96374 |
|
3,820 |
3,297 |
$257K |
| 70450 |
|
783 |
680 |
$248K |
| 92567 |
|
18,232 |
17,609 |
$247K |
| J2704 |
Inj, propofol, 10 mg |
23,104 |
19,415 |
$240K |
| 74018 |
|
5,880 |
5,386 |
$240K |
| 76819 |
|
3,508 |
2,555 |
$237K |
| 86900 |
|
10,766 |
9,099 |
$230K |
| 95816 |
|
1,651 |
1,576 |
$228K |
| J3490 |
Drugs unclassified injection |
17,970 |
10,848 |
$227K |
| 87635 |
|
4,875 |
4,679 |
$209K |
| 80061 |
|
14,236 |
12,778 |
$205K |
| 76816 |
|
5,967 |
5,276 |
$196K |
| 87389 |
|
24,763 |
22,599 |
$195K |
| 87633 |
|
2,591 |
2,452 |
$193K |
| 76770 |
|
2,048 |
1,894 |
$189K |
| J3010 |
Fentanyl citrate injection |
27,087 |
22,227 |
$178K |
| 83655 |
|
13,447 |
12,817 |
$174K |
| 76805 |
|
2,216 |
2,028 |
$172K |
| 83036 |
|
30,045 |
28,003 |
$169K |
| G0108 |
Diab manage trn per indiv |
1,806 |
1,671 |
$165K |
| 92551 |
|
12,341 |
11,795 |
$158K |
| 82306 |
|
10,286 |
9,131 |
$143K |
| 84439 |
|
16,117 |
15,286 |
$138K |
| 87536 |
|
3,154 |
2,639 |
$132K |
| J1170 |
Hydromorphone injection |
11,184 |
8,191 |
$129K |
| 86780 |
|
12,761 |
11,553 |
$128K |
| 81416 |
|
13 |
12 |
$126K |
| 92004 |
|
1,392 |
1,311 |
$124K |
| 80307 |
|
4,599 |
3,723 |
$122K |
| 95117 |
|
4,345 |
2,354 |
$121K |
| 59025 |
|
1,696 |
1,302 |
$117K |
| 90472 |
|
19,205 |
18,233 |
$116K |
| J1100 |
Dexamethasone sodium phos |
18,692 |
16,295 |
$113K |
| 92014 |
|
1,444 |
1,315 |
$109K |
| 96161 |
|
10,483 |
9,495 |
$107K |
| 96127 |
|
14,574 |
13,857 |
$101K |
| 42830 |
|
56 |
53 |
$99K |
| 86850 |
|
10,438 |
8,853 |
$95K |
| 82728 |
|
8,877 |
7,553 |
$95K |
| 72082 |
|
3,554 |
3,474 |
$95K |
| 81025 |
|
15,640 |
12,122 |
$94K |
| 80305 |
|
10,812 |
7,793 |
$91K |
| 85027 |
|
24,769 |
22,094 |
$88K |
| 83516 |
|
3,233 |
2,606 |
$86K |
| 87661 |
|
5,716 |
5,206 |
$82K |
| 93296 |
|
7,166 |
6,257 |
$80K |
| 76700 |
|
1,014 |
877 |
$78K |
| 83735 |
|
12,567 |
9,217 |
$78K |
| J1745 |
Infliximab not biosimil 10mg |
13 |
12 |
$77K |
| 83880 |
|
2,630 |
2,004 |
$77K |
| 92012 |
|
1,209 |
1,081 |
$77K |
| 76775 |
|
1,898 |
1,847 |
$76K |
| 90837 |
|
2,372 |
1,360 |
$76K |
| J1885 |
Ketorolac tromethamine inj |
2,942 |
2,193 |
$76K |
| 62370 |
|
1,387 |
1,123 |
$75K |
| J0690 |
Cefazolin sodium injection |
3,481 |
2,752 |
$75K |
| 87081 |
|
11,469 |
11,260 |
$72K |
| 90686 |
|
14,501 |
13,529 |
$72K |
| 82570 |
|
7,998 |
7,017 |
$72K |
| 71260 |
|
153 |
129 |
$71K |
| 90847 |
|
1,104 |
817 |
$70K |
| 87086 |
|
19,031 |
16,843 |
$68K |
| G0480 |
Drug test def 1-7 classes |
2,855 |
2,025 |
$68K |
| 86360 |
|
3,072 |
2,421 |
$68K |
| 86140 |
|
14,019 |
12,706 |
$66K |
| 49452 |
|
94 |
89 |
$64K |
| J2250 |
Inj midazolam hydrochloride |
2,347 |
2,044 |
$64K |
| 87631 |
|
876 |
871 |
$63K |
| 80076 |
|
9,884 |
8,283 |
$63K |
| 90834 |
|
2,154 |
1,504 |
$63K |
| 72170 |
|
1,558 |
1,476 |
$62K |
| A0427 |
Als1-emergency |
151 |
129 |
$62K |
| 96372 |
|
2,187 |
1,565 |
$61K |
| G0008 |
Admin influenza virus vac |
4,953 |
4,443 |
$59K |
| 86359 |
|
3,203 |
2,580 |
$59K |
| G0330 |
Facility svs dental rehab |
76 |
73 |
$59K |
| 87804 |
|
10,343 |
7,924 |
$59K |
| 82784 |
|
7,969 |
7,390 |
$58K |
| 95715 |
|
151 |
97 |
$55K |
| 87653 |
|
2,768 |
2,618 |
$54K |
| 80197 |
|
11,277 |
8,193 |
$54K |
| A0426 |
Als 1 |
1,371 |
1,192 |
$53K |
| 72148 |
|
220 |
214 |
$51K |
| 86901 |
|
10,673 |
9,087 |
$49K |
| 72141 |
|
137 |
136 |
$48K |
| 36591 |
|
1,797 |
1,100 |
$47K |
| 92507 |
|
898 |
442 |
$46K |
| 83970 |
|
2,088 |
1,656 |
$46K |
| J0131 |
Inj, acetaminophen (nos) |
11,258 |
10,584 |
$46K |
| 92582 |
|
700 |
678 |
$45K |
| 87880 |
|
9,209 |
9,051 |
$43K |
| 85651 |
|
14,488 |
13,324 |
$43K |
| 90460 |
|
3,274 |
3,182 |
$43K |
| C1769 |
Guide wire |
1,213 |
942 |
$40K |
| 81002 |
|
12,517 |
11,619 |
$39K |
| 90791 |
|
420 |
412 |
$39K |
| 82977 |
|
8,724 |
7,479 |
$39K |
| 81415 |
|
15 |
13 |
$38K |
| 76830 |
|
554 |
497 |
$38K |
| J7999 |
Compounded drug, noc |
2,340 |
1,714 |
$37K |
| 87799 |
|
1,203 |
942 |
$37K |
| 97803 |
|
998 |
951 |
$36K |
| 76817 |
|
759 |
673 |
$36K |
| 90715 |
|
1,275 |
1,170 |
$36K |
| 85610 |
|
6,813 |
5,942 |
$34K |
| 0001A |
|
1,036 |
959 |
$33K |
| 76825 |
|
148 |
136 |
$33K |
| 86803 |
|
6,286 |
5,806 |
$33K |
| 85018 |
|
15,302 |
14,561 |
$33K |
| 0002A |
|
957 |
903 |
$33K |
| C1713 |
Anchor/screw bn/bn,tis/bn |
108 |
87 |
$33K |
| 90656 |
|
3,018 |
2,946 |
$33K |
| 14040 |
|
85 |
84 |
$33K |
| 45380 |
|
70 |
40 |
$31K |
| 95819 |
|
227 |
220 |
$30K |
| 85045 |
|
11,727 |
10,004 |
$30K |
| 71045 |
|
415 |
348 |
$30K |
| 84100 |
|
10,629 |
8,154 |
$30K |
| 81001 |
|
16,943 |
15,209 |
$30K |
| 96415 |
|
298 |
239 |
$30K |
| 86364 |
|
2,712 |
2,639 |
$29K |
| 76705 |
|
268 |
245 |
$28K |
| 0071A |
|
700 |
698 |
$28K |
| 82248 |
|
3,987 |
3,041 |
$28K |
| 82950 |
|
3,423 |
3,227 |
$27K |
| 96900 |
|
1,151 |
210 |
$27K |
| 86832 |
|
323 |
260 |
$26K |
| A9585 |
Gadobutrol injection |
1,285 |
1,222 |
$26K |
| 87340 |
|
9,823 |
8,814 |
$26K |
| J2795 |
Ropivacaine hcl injection |
1,506 |
1,423 |
$26K |
| 95700 |
|
179 |
155 |
$26K |
| 95991 |
|
516 |
387 |
$25K |
| 76820 |
|
1,239 |
886 |
$24K |
| 92556 |
|
535 |
516 |
$24K |
| 0072A |
|
586 |
586 |
$24K |
| 86833 |
|
289 |
232 |
$23K |
| 92060 |
|
3,975 |
3,836 |
$23K |
| 92552 |
|
814 |
790 |
$23K |
| 82962 |
|
2,093 |
1,102 |
$22K |
| 83550 |
|
2,926 |
2,669 |
$22K |
| 72146 |
|
107 |
107 |
$21K |
| 97110 |
|
627 |
232 |
$21K |
| 72125 |
|
39 |
37 |
$20K |
| 90620 |
|
546 |
486 |
$19K |
| 86258 |
|
1,956 |
1,904 |
$19K |
| 96366 |
|
173 |
103 |
$19K |
| 36416 |
|
11,862 |
11,203 |
$19K |
| 90480 |
|
756 |
738 |
$18K |
| 83690 |
|
2,094 |
1,858 |
$18K |
| 92555 |
|
1,224 |
1,184 |
$18K |
| 83021 |
|
2,743 |
1,980 |
$18K |
| 83540 |
|
3,330 |
3,004 |
$18K |
| 84702 |
|
1,388 |
1,169 |
$17K |
| 99173 |
|
12,013 |
11,564 |
$17K |
| 83605 |
|
1,136 |
769 |
$17K |
| G0383 |
Lev 4 hosp type b ed visit |
198 |
163 |
$17K |
| 93304 |
|
75 |
75 |
$16K |
| 84156 |
|
5,602 |
4,854 |
$16K |
| 85730 |
|
1,982 |
1,742 |
$16K |
| 82565 |
|
2,155 |
1,893 |
$16K |
| 92611 |
|
240 |
234 |
$15K |
| 87070 |
|
1,404 |
1,209 |
$15K |
| 73590 |
|
256 |
223 |
$15K |
| 76811 |
|
106 |
94 |
$14K |
| 82261 |
|
14 |
13 |
$14K |
| 97802 |
|
268 |
258 |
$14K |
| M0243 |
Casirivi and imdevi inj |
39 |
32 |
$14K |
| J2001 |
Lidocaine injection |
2,260 |
1,906 |
$14K |
| 74230 |
|
223 |
216 |
$13K |
| 73552 |
|
262 |
236 |
$13K |
| 47000 |
|
13 |
13 |
$13K |
| 93308 |
|
140 |
106 |
$13K |
| U0001 |
2019-ncov diagnostic p |
422 |
402 |
$12K |
| 93975 |
|
67 |
67 |
$12K |
| 76981 |
|
196 |
194 |
$12K |
| 36430 |
|
83 |
61 |
$11K |
| A0428 |
Bls |
814 |
678 |
$11K |
| 95076 |
|
37 |
26 |
$11K |
| 81229 |
|
43 |
37 |
$11K |
| 96376 |
|
324 |
159 |
$10K |
| 86003 |
|
249 |
237 |
$10K |
| 72081 |
|
746 |
719 |
$10K |
| 76815 |
|
168 |
153 |
$9K |
| 54360 |
|
12 |
12 |
$9K |
| 93321 |
|
327 |
278 |
$9K |
| 87624 |
|
374 |
339 |
$9K |
| 73560 |
|
440 |
432 |
$9K |
| 90461 |
|
877 |
854 |
$8K |
| 93226 |
|
116 |
110 |
$8K |
| 82803 |
|
417 |
304 |
$8K |
| 77072 |
|
545 |
514 |
$8K |
| 73610 |
|
138 |
127 |
$8K |
| 88342 |
|
104 |
100 |
$8K |
| 82610 |
|
1,555 |
1,398 |
$8K |
| 70480 |
|
54 |
52 |
$8K |
| 86762 |
|
5,174 |
4,512 |
$8K |
| 82550 |
|
898 |
810 |
$8K |
| 87497 |
|
448 |
356 |
$7K |
| 87077 |
|
922 |
789 |
$7K |
| J1200 |
Diphenhydramine hcl injectio |
288 |
220 |
$7K |
| 88175 |
|
388 |
339 |
$7K |
| 43762 |
|
37 |
36 |
$7K |
| 87801 |
|
204 |
191 |
$7K |
| J2370 |
Phenylephrine hcl injection |
240 |
186 |
$6K |
| 93270 |
|
173 |
171 |
$6K |
| 86255 |
|
510 |
447 |
$6K |
| 84460 |
|
1,225 |
1,128 |
$6K |
| 90792 |
|
79 |
70 |
$6K |
| 82139 |
|
983 |
801 |
$6K |
| 97161 |
|
79 |
72 |
$6K |
| 84484 |
|
544 |
393 |
$5K |
| 97162 |
|
72 |
62 |
$5K |
| C1894 |
Intro/sheath, non-laser |
260 |
200 |
$5K |
| 31622 |
|
26 |
24 |
$5K |
| 84450 |
|
1,159 |
1,066 |
$5K |
| 88720 |
|
1,415 |
1,297 |
$5K |
| 96910 |
|
527 |
99 |
$5K |
| 90723 |
|
7,124 |
6,674 |
$5K |
| 84144 |
|
593 |
528 |
$5K |
| 86038 |
|
1,155 |
1,053 |
$5K |
| 82105 |
|
1,206 |
1,097 |
$5K |
| 82607 |
|
464 |
379 |
$5K |
| 73090 |
|
234 |
197 |
$5K |
| 86706 |
|
990 |
905 |
$4K |
| 96112 |
|
45 |
43 |
$4K |
| 83520 |
|
280 |
246 |
$4K |
| C1889 |
Implant/insert device, noc |
2,067 |
1,936 |
$4K |
| 78452 |
|
15 |
14 |
$4K |
| 90846 |
|
56 |
41 |
$4K |
| 90661 |
|
641 |
634 |
$4K |
| 90380 |
|
121 |
103 |
$4K |
| 92553 |
|
21 |
17 |
$4K |
| 87186 |
|
425 |
378 |
$4K |
| 87481 |
|
142 |
137 |
$4K |
| J1596 |
Inj, glycopyrrolate, 0.1 mg |
799 |
778 |
$4K |
| 90688 |
|
373 |
332 |
$3K |
| 93356 |
|
163 |
144 |
$3K |
| 84520 |
|
712 |
664 |
$3K |
| 82042 |
|
732 |
677 |
$3K |
| J1644 |
Inj heparin sodium per 1000u |
711 |
361 |
$3K |
| 83615 |
|
841 |
705 |
$3K |
| 86704 |
|
868 |
805 |
$3K |
| 96160 |
|
378 |
334 |
$3K |
| 52287 |
|
14 |
12 |
$3K |
| 76827 |
|
148 |
136 |
$3K |
| 81407 |
|
30 |
24 |
$3K |
| 74019 |
|
62 |
55 |
$3K |
| 90832 |
|
61 |
53 |
$3K |
| 96380 |
|
121 |
112 |
$3K |
| 92557 |
|
54 |
51 |
$3K |
| 80195 |
|
256 |
220 |
$3K |
| 73070 |
|
85 |
80 |
$3K |
| 86902 |
|
50 |
39 |
$3K |
| 92083 |
|
482 |
442 |
$3K |
| 96361 |
|
72 |
38 |
$2K |
| 0124A |
|
71 |
67 |
$2K |
| G0009 |
Admin pneumococcal vaccine |
135 |
125 |
$2K |
| 76813 |
|
79 |
68 |
$2K |
| 84403 |
|
110 |
102 |
$2K |
| 81408 |
|
15 |
12 |
$2K |
| 99195 |
|
51 |
48 |
$2K |
| 73630 |
|
138 |
128 |
$2K |
| G2066 |
Inter devc remote 30d |
63 |
60 |
$2K |
| 77073 |
|
62 |
60 |
$2K |
| 82043 |
|
164 |
146 |
$2K |
| A9552 |
F18 fdg |
132 |
111 |
$2K |
| 82330 |
|
273 |
227 |
$2K |
| 73100 |
|
145 |
130 |
$2K |
| 82040 |
|
1,004 |
927 |
$2K |
| 90685 |
|
164 |
158 |
$2K |
| Q3014 |
Telehealth facility fee |
749 |
690 |
$2K |
| J1171 |
Inj, hydromorphone, 0.1 mg |
273 |
221 |
$2K |
| 90648 |
|
10,124 |
9,556 |
$2K |
| 86376 |
|
414 |
385 |
$2K |
| 76857 |
|
24 |
24 |
$2K |
| 82104 |
|
387 |
365 |
$2K |
| 83993 |
|
111 |
109 |
$2K |
| 90678 |
|
18 |
15 |
$2K |
| 84305 |
|
98 |
92 |
$2K |
| 82390 |
|
576 |
523 |
$2K |
| 90716 |
|
2,543 |
2,443 |
$2K |
| 87205 |
|
290 |
252 |
$2K |
| 88313 |
|
41 |
37 |
$2K |
| 86481 |
|
24 |
24 |
$2K |
| 92133 |
|
288 |
259 |
$2K |
| 96138 |
|
64 |
63 |
$2K |
| 76885 |
|
32 |
29 |
$2K |
| 96450 |
|
16 |
12 |
$2K |
| 0081A |
|
40 |
39 |
$1K |
| 81513 |
|
13 |
13 |
$1K |
| 96136 |
|
151 |
150 |
$1K |
| 96111 |
|
14 |
14 |
$1K |
| 96113 |
|
17 |
16 |
$1K |
| 94729 |
|
72 |
62 |
$1K |
| 87522 |
Neg quan hep c or qual rna |
266 |
239 |
$1K |
| 64615 |
|
15 |
12 |
$1K |
| 87102 |
|
42 |
37 |
$1K |
| 77080 |
|
34 |
27 |
$1K |
| 97763 |
|
15 |
12 |
$1K |
| Q9969 |
Non-heu tc-99m add-on/dose |
407 |
366 |
$1K |
| 92526 |
|
15 |
12 |
$1K |
| 93017 |
|
15 |
14 |
$1K |
| 62369 |
|
27 |
22 |
$1K |
| 0054A |
|
27 |
25 |
$1K |
| 93567 |
|
13 |
12 |
$998.24 |
| 84402 |
|
33 |
30 |
$963.06 |
| 94726 |
|
31 |
26 |
$948.19 |
| 76376 |
|
14 |
14 |
$940.66 |
| 92002 |
|
14 |
14 |
$925.56 |
| 76942 |
|
32 |
29 |
$867.62 |
| 86800 |
|
47 |
40 |
$864.10 |
| 90707 |
|
2,534 |
2,434 |
$850.70 |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
31 |
16 |
$816.17 |
| 96116 |
|
15 |
14 |
$814.66 |
| J1642 |
Inj heparin sodium per 10 u |
58 |
37 |
$809.10 |
| 90381 |
|
192 |
175 |
$795.87 |
| 86015 |
|
366 |
357 |
$766.23 |
| 99281 |
|
13 |
13 |
$762.24 |
| G0101 |
Ca screen;pelvic/breast exam |
13 |
13 |
$758.20 |
| 90633 |
|
2,842 |
2,763 |
$733.97 |
| 81321 |
|
15 |
12 |
$720.00 |
| 86480 |
|
13 |
13 |
$713.85 |
| 90474 |
|
579 |
567 |
$671.61 |
| 81220 |
|
14 |
13 |
$667.92 |
| 81302 |
|
15 |
12 |
$633.44 |
| 99391 |
|
8,337 |
7,846 |
$600.20 |
| 73080 |
|
29 |
27 |
$582.22 |
| J2270 |
Morphine sulfate injection |
26 |
15 |
$575.85 |
| A9502 |
Tc99m tetrofosmin |
15 |
14 |
$573.50 |
| 99393 |
|
4,330 |
4,189 |
$572.76 |
| 87040 |
|
32 |
27 |
$560.79 |
| 0082A |
|
14 |
14 |
$560.00 |
| 87147 |
|
86 |
84 |
$557.32 |
| 75565 |
|
15 |
14 |
$527.80 |
| 84270 |
|
33 |
30 |
$523.85 |
| 99392 |
|
6,473 |
6,283 |
$501.78 |
| 0004A |
|
13 |
12 |
$480.80 |
| 0154A |
|
12 |
12 |
$480.00 |
| 90651 |
|
1,037 |
1,015 |
$479.40 |
| 62367 |
|
18 |
13 |
$462.91 |
| 86709 |
|
176 |
169 |
$446.40 |
| 84550 |
|
181 |
150 |
$444.55 |
| 40806 |
|
81 |
72 |
$438.15 |
| 81243 |
|
21 |
12 |
$416.00 |
| 87015 |
|
119 |
86 |
$388.70 |
| 86696 |
|
291 |
281 |
$379.20 |
| 82746 |
|
42 |
39 |
$376.70 |
| 96381 |
|
87 |
68 |
$373.50 |
| 73562 |
|
36 |
36 |
$363.94 |
| 90734 |
|
372 |
355 |
$363.83 |
| 94664 |
|
27 |
26 |
$358.18 |
| 86160 |
|
110 |
103 |
$353.73 |
| 86708 |
|
189 |
183 |
$353.08 |
| 83001 |
|
15 |
12 |
$319.63 |
| 85055 |
|
12 |
12 |
$318.69 |
| 99394 |
|
829 |
812 |
$318.01 |
| 51798 |
|
84 |
74 |
$309.83 |
| 70355 |
|
15 |
12 |
$304.78 |
| A9575 |
Inj gadoterate meglumi 0.1ml |
21 |
20 |
$302.60 |
| 90674 |
|
4,330 |
4,273 |
$292.17 |
| 84590 |
|
25 |
24 |
$280.96 |
| J9370 |
Vincristine sulfate 1 mg inj |
34 |
24 |
$276.21 |
| 85384 |
|
45 |
38 |
$271.23 |
| J7030 |
Normal saline solution infus |
52 |
22 |
$269.23 |
| 86695 |
|
291 |
281 |
$259.11 |
| 82435 |
|
133 |
103 |
$252.51 |
| 82627 |
|
12 |
12 |
$235.85 |
| 96130 |
|
96 |
96 |
$227.34 |
| 92134 |
|
18 |
16 |
$217.79 |
| 77067 |
|
12 |
12 |
$209.70 |
| 84446 |
|
14 |
13 |
$206.27 |
| 99381 |
|
76 |
71 |
$206.00 |
| 69210 |
|
41 |
39 |
$196.03 |
| 95885 |
|
31 |
25 |
$196.02 |
| 94640 |
|
132 |
88 |
$191.90 |
| C1887 |
Catheter, guiding |
168 |
150 |
$184.38 |
| J1756 |
Iron sucrose injection |
25 |
12 |
$180.44 |
| 82077 |
|
13 |
13 |
$177.78 |
| 87807 |
|
12 |
12 |
$176.30 |
| G0381 |
Lev 2 hosp type b ed visit |
12 |
12 |
$169.30 |
| 85014 |
|
41 |
39 |
$140.74 |
| 87210 |
|
47 |
41 |
$125.84 |
| J7040 |
Normal saline solution infus |
63 |
36 |
$120.84 |
| J0561 |
Penicillin g benzathine inj |
15 |
15 |
$104.42 |
| 82274 |
|
14 |
14 |
$99.96 |
| 82525 |
|
17 |
17 |
$89.98 |
| V5266 |
Battery for hearing device |
17 |
13 |
$84.60 |
| 85049 |
|
15 |
14 |
$77.20 |
| 90700 |
|
150 |
147 |
$73.27 |
| 92015 |
|
142 |
137 |
$72.80 |
| 87088 |
|
15 |
13 |
$72.10 |
| 83525 |
|
14 |
12 |
$69.17 |
| 85245 |
|
17 |
13 |
$65.22 |
| 85246 |
|
17 |
13 |
$65.22 |
| 83010 |
|
70 |
69 |
$63.90 |
| 92250 |
|
14 |
14 |
$63.63 |
| 89051 |
|
13 |
12 |
$59.74 |
| 85240 |
|
17 |
13 |
$50.90 |
| 82787 |
|
46 |
43 |
$22.44 |
| J1720 |
Hydrocortisone sodium succ i |
12 |
12 |
$17.60 |
| 80354 |
|
818 |
617 |
$12.08 |
| 80047 |
|
31 |
30 |
$11.91 |
| Q0162 |
Ondansetron oral |
1,408 |
1,304 |
$10.42 |
| 97140 |
|
69 |
25 |
$9.96 |
| 91300 |
|
591 |
462 |
$4.69 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
61 |
38 |
$2.82 |
| 91307 |
|
286 |
281 |
$2.33 |
| Q0244 |
Casirivi and imdevi 1200 mg |
30 |
25 |
$0.04 |
| 90680 |
|
5,890 |
5,503 |
$0.00 |
| 88300 |
|
381 |
369 |
$0.00 |
| A9270 |
Non-covered item or service |
528 |
315 |
$0.00 |
| 87116 |
|
103 |
74 |
$0.00 |
| 96131 |
|
80 |
79 |
$0.00 |
| 90696 |
|
110 |
106 |
$0.00 |
| 96139 |
|
64 |
63 |
$0.00 |
| 87206 |
|
103 |
74 |
$0.00 |
| 88307 |
|
13 |
12 |
$0.00 |
| 92650 |
|
13 |
12 |
$0.00 |
| 83498 |
|
14 |
13 |
$0.00 |
| J2785 |
Regadenoson injection |
15 |
14 |
$0.00 |
| J3430 |
Vitamin k phytonadione inj |
13 |
12 |
$0.00 |
| 83789 |
|
14 |
13 |
$0.00 |
| 80348 |
|
4,477 |
3,422 |
$0.00 |
| 92025 |
|
26 |
24 |
$0.00 |
| A0100 |
Nonemergency transport taxi |
106 |
102 |
$0.00 |
| 76000 |
|
14 |
13 |
$0.00 |
| 81479 |
|
14 |
13 |
$0.00 |
| 99395 |
|
131 |
127 |
$0.00 |
| 96137 |
|
95 |
94 |
$0.00 |
| 82760 |
|
14 |
13 |
$0.00 |
| J1050 |
Medroxyprogesterone acetate |
250 |
246 |
$0.00 |
| 80175 |
|
25 |
24 |
$0.00 |
| 90833 |
|
12 |
12 |
$0.00 |
| G1004 |
Cdsm ndsc |
25 |
15 |
$0.00 |