| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 0450 |
|
106,171 |
92,674 |
$5.88M |
| 0510 |
|
98,685 |
80,787 |
$3.96M |
| 99202 |
|
38,167 |
30,019 |
$2.09M |
| 74177 |
|
9,242 |
9,064 |
$1.92M |
| J9271 |
Inj pembrolizumab |
248 |
206 |
$1.89M |
| A0427 |
Als1-emergency |
10,117 |
9,601 |
$1.84M |
| G0378 |
Hospital observation per hr |
49,935 |
40,938 |
$1.78M |
| 97110 |
|
42,785 |
12,470 |
$1.62M |
| 99281 |
|
23,823 |
20,756 |
$1.48M |
| 0250 |
|
99,774 |
46,589 |
$1.19M |
| 80053 |
|
100,281 |
84,196 |
$1.19M |
| A0429 |
Bls-emergency |
6,289 |
5,828 |
$1.13M |
| 70450 |
|
9,129 |
8,882 |
$1.11M |
| 93005 |
|
35,866 |
32,944 |
$980K |
| 99199 |
|
17,701 |
14,933 |
$897K |
| 85025 |
|
104,833 |
87,392 |
$890K |
| A0431 |
Rotary wing air transport |
581 |
576 |
$882K |
| A0436 |
Rotary wing air mileage |
566 |
561 |
$680K |
| 0762 |
|
9,656 |
5,148 |
$650K |
| 96374 |
|
11,353 |
10,158 |
$637K |
| 93306 |
|
3,720 |
3,705 |
$634K |
| 74176 |
|
5,913 |
5,806 |
$611K |
| 96375 |
|
12,531 |
9,795 |
$598K |
| 87428 |
|
12,354 |
12,041 |
$595K |
| 0750 |
|
3,470 |
3,424 |
$581K |
| 87633 |
|
1,462 |
1,450 |
$578K |
| 96361 |
|
15,117 |
13,033 |
$537K |
| 96365 |
|
7,470 |
5,901 |
$525K |
| 72125 |
|
2,956 |
2,923 |
$523K |
| A0425 |
Ground mileage |
19,900 |
18,248 |
$504K |
| 99283 |
|
12,389 |
9,997 |
$496K |
| 78815 |
|
332 |
331 |
$476K |
| 97139 |
|
10,493 |
3,189 |
$459K |
| 0761 |
|
3,580 |
2,920 |
$421K |
| 71260 |
|
2,286 |
2,277 |
$384K |
| 96372 |
|
11,273 |
8,789 |
$324K |
| G0463 |
Hospital outpt clinic visit |
27,327 |
22,408 |
$311K |
| 70553 |
|
641 |
641 |
$302K |
| 87635 |
|
5,614 |
5,468 |
$301K |
| 71275 |
|
1,441 |
1,423 |
$267K |
| 87491 |
|
6,381 |
6,265 |
$266K |
| 87591 |
|
6,382 |
6,266 |
$264K |
| 93971 |
|
2,256 |
2,196 |
$263K |
| 59025 |
|
9,387 |
3,192 |
$253K |
| 76705 |
|
4,240 |
4,110 |
$251K |
| 76856 |
|
3,666 |
3,611 |
$249K |
| 96360 |
|
4,233 |
3,634 |
$244K |
| 82077 |
|
6,168 |
5,585 |
$238K |
| J7030 |
Normal saline solution infus |
19,609 |
15,462 |
$237K |
| 71045 |
|
19,626 |
18,355 |
$235K |
| 97161 |
|
4,044 |
3,990 |
$234K |
| 76815 |
|
3,471 |
2,235 |
$232K |
| 84443 |
|
11,780 |
10,973 |
$232K |
| 97010 |
|
5,513 |
1,914 |
$227K |
| 76830 |
|
3,155 |
3,113 |
$217K |
| 84484 |
|
19,618 |
17,377 |
$210K |
| 83880 |
|
6,845 |
6,480 |
$203K |
| 71046 |
|
10,492 |
10,225 |
$200K |
| 76801 |
|
3,480 |
3,242 |
$196K |
| 96413 |
|
5,161 |
3,293 |
$195K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
18,351 |
13,965 |
$195K |
| 83690 |
|
23,209 |
21,398 |
$191K |
| Z7502 |
|
5,070 |
4,967 |
$187K |
| 96367 |
|
3,017 |
2,040 |
$182K |
| 73610 |
|
6,384 |
5,523 |
$180K |
| 78452 |
|
651 |
644 |
$171K |
| 90715 |
|
4,129 |
4,117 |
$166K |
| J3490 |
Drugs unclassified injection |
34,810 |
16,692 |
$161K |
| 0361 |
|
961 |
867 |
$158K |
| 87426 |
|
3,919 |
3,853 |
$152K |
| 99284 |
|
3,913 |
3,607 |
$144K |
| 93976 |
|
685 |
675 |
$143K |
| 73630 |
|
5,383 |
4,796 |
$139K |
| 87086 |
|
16,225 |
15,464 |
$138K |
| 73110 |
|
4,845 |
3,929 |
$136K |
| 87880 |
|
12,192 |
11,943 |
$133K |
| 81001 |
|
34,055 |
31,857 |
$133K |
| 71250 |
|
1,001 |
998 |
$132K |
| 96366 |
|
1,910 |
1,229 |
$126K |
| 76817 |
|
2,059 |
1,940 |
$124K |
| 76811 |
|
1,414 |
1,413 |
$123K |
| 87811 |
|
2,629 |
2,573 |
$123K |
| G0472 |
Hep c screen high risk/other |
2,494 |
2,482 |
$121K |
| 73130 |
|
4,333 |
3,573 |
$121K |
| 94640 |
|
5,053 |
4,241 |
$113K |
| 80305 |
|
9,162 |
8,650 |
$112K |
| 73030 |
|
4,136 |
3,747 |
$108K |
| 0710 |
|
3,617 |
3,580 |
$107K |
| 83605 |
|
8,338 |
7,917 |
$103K |
| 87637 |
|
779 |
768 |
$99K |
| 72148 |
|
416 |
415 |
$99K |
| 70496 |
|
544 |
541 |
$97K |
| J7120 |
Ringers lactate infusion |
13,282 |
11,440 |
$96K |
| 85610 |
|
23,103 |
19,032 |
$93K |
| 73562 |
|
3,807 |
3,533 |
$92K |
| 70486 |
|
586 |
579 |
$91K |
| 80055 |
|
1,847 |
1,837 |
$88K |
| 83036 |
|
7,846 |
7,782 |
$88K |
| 86140 |
|
14,248 |
13,023 |
$87K |
| T1999 |
Noc retail items andsupplies |
6,337 |
3,593 |
$86K |
| Z7500 |
|
2,415 |
2,258 |
$81K |
| C9803 |
Hopd covid-19 spec collect |
3,472 |
3,410 |
$80K |
| 82306 |
|
2,615 |
2,604 |
$79K |
| 87077 |
|
9,976 |
9,374 |
$75K |
| 73080 |
|
2,610 |
2,153 |
$74K |
| 81003 |
|
26,974 |
21,098 |
$73K |
| J1885 |
Ketorolac tromethamine inj |
14,633 |
13,610 |
$73K |
| J2405 |
Ondansetron hcl injection |
16,073 |
13,627 |
$72K |
| 87040 |
|
4,039 |
3,394 |
$71K |
| J9202 |
Goserelin acetate implant |
119 |
111 |
$71K |
| 76770 |
|
880 |
870 |
$70K |
| 70551 |
|
274 |
273 |
$70K |
| 93017 |
|
1,224 |
1,213 |
$70K |
| 87186 |
|
7,340 |
7,114 |
$70K |
| 81025 |
|
8,852 |
8,649 |
$68K |
| 93970 |
|
347 |
343 |
$64K |
| 83735 |
|
8,594 |
6,636 |
$64K |
| 99201 |
|
1,265 |
989 |
$63K |
| 97799 |
|
1,570 |
628 |
$63K |
| 72100 |
|
2,103 |
2,089 |
$63K |
| 92507 |
|
1,001 |
423 |
$63K |
| 43239 |
|
1,351 |
1,350 |
$63K |
| 80048 |
|
6,821 |
6,169 |
$62K |
| 80143 |
|
1,555 |
1,450 |
$60K |
| 85027 |
|
8,305 |
7,516 |
$59K |
| 96415 |
|
1,827 |
1,358 |
$59K |
| A9577 |
Inj multihance |
1,728 |
1,576 |
$58K |
| 76816 |
|
1,079 |
1,040 |
$57K |
| 97750 |
|
938 |
785 |
$56K |
| 70491 |
|
246 |
243 |
$56K |
| J2469 |
Palonosetron hcl |
1,708 |
1,035 |
$56K |
| J1453 |
Fosaprepitant injection |
658 |
409 |
$55K |
| 0260 |
|
408 |
229 |
$54K |
| 73502 |
|
1,847 |
1,758 |
$54K |
| 80179 |
|
1,419 |
1,324 |
$54K |
| 85730 |
|
7,717 |
7,452 |
$53K |
| 93041 |
|
3,741 |
3,560 |
$52K |
| 70498 |
|
404 |
402 |
$52K |
| 92557 |
|
974 |
972 |
$50K |
| 97165 |
|
609 |
503 |
$50K |
| 80307 |
|
764 |
704 |
$50K |
| 87389 |
|
2,197 |
2,193 |
$50K |
| J8499 |
Oral prescrip drug non chemo |
5,672 |
3,064 |
$49K |
| A9552 |
F18 fdg |
352 |
347 |
$49K |
| J0696 |
Ceftriaxone sodium injection |
7,251 |
6,161 |
$48K |
| J7298 |
Mirena, 52 mg |
39 |
39 |
$47K |
| 87400 |
|
7,540 |
7,425 |
$47K |
| 73590 |
|
2,074 |
1,799 |
$46K |
| 72141 |
|
193 |
193 |
$46K |
| J1170 |
Hydromorphone injection |
6,365 |
5,372 |
$46K |
| J2704 |
Inj, propofol, 10 mg |
7,108 |
6,153 |
$45K |
| 85379 |
|
3,745 |
3,678 |
$45K |
| 87807 |
|
4,740 |
4,615 |
$44K |
| 45378 |
|
446 |
444 |
$44K |
| 72040 |
|
1,618 |
1,590 |
$43K |
| 99213 |
|
1,972 |
1,959 |
$43K |
| 73140 |
|
2,416 |
2,054 |
$43K |
| 80061 |
|
3,373 |
3,333 |
$41K |
| 45380 |
|
673 |
665 |
$39K |
| J1100 |
Dexamethasone sodium phos |
7,527 |
4,956 |
$37K |
| 77067 |
|
408 |
408 |
$37K |
| 74018 |
|
2,068 |
1,976 |
$37K |
| 87075 |
|
3,433 |
3,253 |
$37K |
| 73090 |
|
1,548 |
1,244 |
$36K |
| 73721 |
|
125 |
120 |
$36K |
| 97140 |
|
3,424 |
1,273 |
$35K |
| J7040 |
Normal saline solution infus |
3,994 |
3,029 |
$35K |
| 73564 |
|
1,118 |
1,028 |
$34K |
| 82728 |
|
2,609 |
2,479 |
$34K |
| 76870 |
|
610 |
592 |
$33K |
| A0428 |
Bls |
356 |
351 |
$32K |
| J2785 |
Regadenoson injection |
262 |
259 |
$31K |
| 76700 |
|
405 |
402 |
$31K |
| 87150 |
|
1,430 |
1,388 |
$31K |
| 0360 |
|
158 |
131 |
$30K |
| J1200 |
Diphenhydramine hcl injectio |
6,354 |
5,358 |
$30K |
| 99282 |
|
1,941 |
1,708 |
$29K |
| J1815 |
Insulin injection |
1,605 |
934 |
$29K |
| G0480 |
Drug test def 1-7 classes |
581 |
535 |
$28K |
| 73100 |
|
1,493 |
1,190 |
$28K |
| 96417 |
|
834 |
554 |
$28K |
| J1642 |
Inj heparin sodium per 10 u |
5,059 |
3,047 |
$28K |
| 84439 |
|
2,647 |
2,547 |
$27K |
| 90651 |
|
109 |
109 |
$26K |
| J3010 |
Fentanyl citrate injection |
5,739 |
5,554 |
$25K |
| 73560 |
|
1,206 |
1,101 |
$25K |
| 72131 |
|
152 |
147 |
$24K |
| 0700 |
|
483 |
413 |
$24K |
| 86703 |
|
1,384 |
1,374 |
$23K |
| 45385 |
|
419 |
416 |
$23K |
| 87340 |
|
1,834 |
1,811 |
$22K |
| 87081 |
|
2,864 |
2,857 |
$22K |
| 82951 |
|
1,390 |
1,377 |
$21K |
| J2270 |
Morphine sulfate injection |
2,436 |
2,178 |
$21K |
| 82746 |
|
1,261 |
1,247 |
$21K |
| J7050 |
Normal saline solution infus |
4,188 |
2,701 |
$20K |
| J0780 |
Prochlorperazine injection |
1,892 |
1,801 |
$20K |
| 86901 |
|
5,426 |
5,030 |
$20K |
| 76805 |
|
194 |
192 |
$20K |
| 83540 |
|
3,041 |
2,943 |
$19K |
| 83550 |
|
2,672 |
2,596 |
$19K |
| 73221 |
|
58 |
57 |
$18K |
| 87507 |
|
49 |
49 |
$18K |
| A9502 |
Tc99m tetrofosmin |
207 |
189 |
$18K |
| 47562 |
|
62 |
61 |
$18K |
| 76813 |
|
286 |
286 |
$17K |
| 82378 |
|
853 |
661 |
$17K |
| 85651 |
|
6,158 |
5,388 |
$17K |
| 77336 |
|
179 |
90 |
$17K |
| 76536 |
|
316 |
315 |
$17K |
| J2060 |
Lorazepam injection |
3,411 |
2,945 |
$17K |
| 74178 |
|
80 |
80 |
$17K |
| J0897 |
Denosumab injection |
30 |
30 |
$17K |
| P9016 |
Rbc leukocytes reduced |
62 |
50 |
$16K |
| 86900 |
|
5,149 |
4,850 |
$16K |
| 87205 |
|
3,595 |
3,412 |
$16K |
| 87070 |
|
1,487 |
1,472 |
$16K |
| 82803 |
|
1,005 |
944 |
$16K |
| 73552 |
|
742 |
689 |
$15K |
| 97803 |
|
568 |
500 |
$15K |
| J1439 |
Inj ferric carboxymaltos 1mg |
38 |
24 |
$15K |
| J2550 |
Promethazine hcl injection |
2,389 |
2,011 |
$15K |
| 82550 |
|
1,904 |
1,760 |
$15K |
| 93226 |
|
232 |
232 |
$15K |
| 94664 |
|
1,532 |
1,447 |
$14K |
| 86850 |
|
3,412 |
3,198 |
$14K |
| J2250 |
Inj midazolam hydrochloride |
3,721 |
3,018 |
$14K |
| 83615 |
|
2,301 |
2,026 |
$13K |
| 92550 |
|
629 |
627 |
$13K |
| 86922 |
|
179 |
134 |
$13K |
| 86592 |
|
2,845 |
2,727 |
$13K |
| 92588 |
|
155 |
155 |
$12K |
| J1756 |
Iron sucrose injection |
238 |
115 |
$12K |
| 82247 |
|
2,081 |
1,411 |
$12K |
| 0258 |
|
865 |
545 |
$11K |
| 74183 |
|
49 |
49 |
$11K |
| 96523 |
|
247 |
241 |
$11K |
| J1650 |
Inj enoxaparin sodium |
1,688 |
915 |
$11K |
| 85007 |
|
3,517 |
3,184 |
$11K |
| 96402 |
|
967 |
910 |
$11K |
| J0131 |
Inj, acetaminophen (nos) |
1,505 |
1,283 |
$11K |
| 72170 |
|
556 |
546 |
$10K |
| 93225 |
|
246 |
246 |
$10K |
| 73000 |
|
431 |
373 |
$10K |
| 74175 |
|
41 |
41 |
$10K |
| 82607 |
|
593 |
588 |
$9K |
| J1644 |
Inj heparin sodium per 1000u |
1,752 |
970 |
$9K |
| J2272 |
Inj, morphine (fresenius) |
1,325 |
1,185 |
$9K |
| 93880 |
|
78 |
77 |
$9K |
| 77063 |
|
381 |
381 |
$9K |
| 11042 |
|
730 |
421 |
$9K |
| 90674 |
|
258 |
258 |
$9K |
| 82950 |
|
1,534 |
1,528 |
$8K |
| 74019 |
|
355 |
351 |
$8K |
| J7070 |
D5w infusion |
1,001 |
539 |
$8K |
| J3475 |
Inj magnesium sulfate |
1,308 |
758 |
$8K |
| J2765 |
Metoclopramide hcl injection |
1,643 |
1,439 |
$8K |
| 80069 |
|
836 |
678 |
$7K |
| 87209 |
|
478 |
327 |
$7K |
| 73700 |
|
44 |
42 |
$7K |
| 82570 |
|
1,276 |
1,143 |
$7K |
| 82948 |
|
1,584 |
1,061 |
$7K |
| 73660 |
|
394 |
366 |
$7K |
| 76642 |
|
130 |
128 |
$7K |
| 0255 |
|
703 |
632 |
$7K |
| 93247 |
|
85 |
85 |
$7K |
| 84153 |
|
411 |
399 |
$6K |
| 82784 |
|
946 |
560 |
$6K |
| 99070 |
|
502 |
447 |
$6K |
| 82670 |
|
210 |
203 |
$6K |
| 77049 |
|
24 |
24 |
$6K |
| 0391 |
|
33 |
24 |
$6K |
| 77066 |
Tomosynthesis, mammo |
59 |
59 |
$6K |
| 74170 |
|
29 |
29 |
$6K |
| S0164 |
Injection pantroprazole |
635 |
428 |
$6K |
| 86403 |
|
453 |
451 |
$6K |
| 86705 |
|
420 |
419 |
$6K |
| J2930 |
Methylprednisolone injection |
550 |
493 |
$6K |
| 76000 |
|
336 |
317 |
$6K |
| 82731 |
|
92 |
87 |
$5K |
| 84145 |
|
228 |
220 |
$5K |
| 92504 |
|
252 |
218 |
$5K |
| 72110 |
|
100 |
100 |
$5K |
| J0690 |
Cefazolin sodium injection |
1,184 |
1,057 |
$5K |
| 96368 |
|
230 |
165 |
$5K |
| 82248 |
|
874 |
599 |
$5K |
| 84550 |
|
993 |
785 |
$5K |
| Q9966 |
Locm 200-299mg/ml iodine,1ml |
991 |
882 |
$5K |
| 87430 |
|
306 |
305 |
$5K |
| 90630 |
|
185 |
185 |
$4K |
| 86709 |
|
338 |
337 |
$4K |
| 0402 |
|
28 |
28 |
$4K |
| A0422 |
Ambulance 02 life sustaining |
491 |
447 |
$4K |
| 36415 |
|
3,395 |
2,957 |
$4K |
| J3480 |
Inj potassium chloride |
246 |
146 |
$4K |
| A0426 |
Als 1 |
55 |
55 |
$4K |
| 92553 |
|
140 |
139 |
$4K |
| 84403 |
|
269 |
262 |
$4K |
| 78264 |
|
36 |
36 |
$3K |
| 86762 |
|
205 |
205 |
$3K |
| 80076 |
|
413 |
374 |
$3K |
| 86706 |
|
289 |
283 |
$3K |
| 86704 |
|
253 |
247 |
$3K |
| 87045 |
|
289 |
287 |
$3K |
| 95913 |
|
13 |
13 |
$3K |
| J3301 |
Triamcinolone acet inj nos |
275 |
261 |
$3K |
| 83516 |
|
383 |
260 |
$3K |
| 97802 |
|
92 |
92 |
$3K |
| 93325 |
|
25 |
25 |
$3K |
| 93010 |
|
225 |
171 |
$3K |
| 76882 |
|
333 |
330 |
$3K |
| A9500 |
Tc99m sestamibi |
25 |
25 |
$3K |
| 77300 |
|
17 |
17 |
$3K |
| A9541 |
Tc99m sulfur colloid |
67 |
67 |
$3K |
| 72070 |
|
82 |
82 |
$3K |
| 82010 |
|
303 |
286 |
$3K |
| 84155 |
|
847 |
718 |
$2K |
| 84702 |
|
169 |
140 |
$2K |
| 77334 |
|
16 |
13 |
$2K |
| 87641 |
|
91 |
91 |
$2K |
| 82105 |
|
153 |
150 |
$2K |
| 82040 |
|
546 |
475 |
$2K |
| 41899 |
|
45 |
44 |
$2K |
| J3372 |
Inj, vancomycin hcl (xellia) |
126 |
77 |
$2K |
| U0002 |
Covid-19 lab test non-cdc |
533 |
518 |
$2K |
| 94644 |
|
106 |
101 |
$2K |
| J7611 |
Albuterol non-comp con |
1,412 |
1,340 |
$2K |
| 0481 |
|
12 |
12 |
$2K |
| 87803 |
|
193 |
192 |
$2K |
| 12002 |
|
88 |
86 |
$2K |
| 80047 |
|
254 |
243 |
$2K |
| 73060 |
|
104 |
92 |
$2K |
| 74174 |
|
12 |
12 |
$2K |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
500 |
389 |
$2K |
| 72081 |
|
77 |
77 |
$2K |
| J3360 |
Diazepam injection |
189 |
124 |
$2K |
| 10061 |
|
54 |
51 |
$2K |
| 72120 |
|
45 |
45 |
$2K |
| 0160 |
|
34 |
15 |
$2K |
| 77061 |
|
14 |
14 |
$2K |
| 31575 |
|
30 |
30 |
$2K |
| 97112 |
|
514 |
215 |
$2K |
| Z9725 |
|
39 |
39 |
$2K |
| J3420 |
Vitamin b12 injection |
379 |
316 |
$2K |
| 12001 |
|
70 |
70 |
$2K |
| J3370 |
Vancomycin hcl injection |
170 |
114 |
$2K |
| J1050 |
Medroxyprogesterone acetate |
62 |
62 |
$2K |
| 83001 |
|
79 |
78 |
$2K |
| 87449 |
|
179 |
178 |
$2K |
| 96411 |
|
78 |
47 |
$2K |
| 82375 |
|
127 |
123 |
$2K |
| 84100 |
|
366 |
298 |
$2K |
| 83655 |
|
116 |
115 |
$1K |
| 84165 |
|
251 |
230 |
$1K |
| 93702 |
|
15 |
14 |
$1K |
| 71271 |
|
35 |
35 |
$1K |
| 12011 |
|
39 |
39 |
$1K |
| 86334 |
|
219 |
200 |
$1K |
| 96156 |
|
13 |
13 |
$1K |
| 97530 |
|
832 |
386 |
$1K |
| 86920 |
|
14 |
12 |
$1K |
| 71101 |
|
43 |
43 |
$1K |
| 84703 |
|
768 |
739 |
$1K |
| 0636 |
|
131 |
123 |
$1K |
| 87899 |
|
159 |
110 |
$1K |
| 85045 |
|
323 |
300 |
$1K |
| 77065 |
Tomosynthesis, mammo |
14 |
14 |
$1K |
| Q3014 |
Telehealth facility fee |
34 |
33 |
$1K |
| 87634 |
|
16 |
16 |
$1K |
| 83520 |
|
102 |
79 |
$1K |
| 92587 |
|
15 |
15 |
$1K |
| 20610 |
|
90 |
75 |
$1K |
| 51798 |
|
122 |
122 |
$1K |
| 82810 |
|
127 |
123 |
$1K |
| 93246 |
|
85 |
85 |
$1K |
| 84425 |
|
64 |
64 |
$1K |
| 73620 |
|
55 |
50 |
$1K |
| 10060 |
|
38 |
38 |
$1K |
| Z7610 |
|
100 |
73 |
$1K |
| J7060 |
5% dextrose/water |
163 |
124 |
$938.64 |
| 90686 |
|
51 |
51 |
$911.29 |
| 84207 |
|
38 |
38 |
$898.90 |
| 83050 |
|
127 |
123 |
$892.61 |
| 0760 |
|
46 |
37 |
$880.86 |
| 0270 |
|
146 |
94 |
$872.59 |
| 76819 |
|
19 |
12 |
$847.40 |
| 87177 |
|
70 |
66 |
$790.29 |
| 84144 |
|
32 |
25 |
$776.55 |
| 73070 |
|
30 |
25 |
$744.00 |
| J9190 |
Fluorouracil injection |
35 |
14 |
$724.70 |
| 83521 |
|
205 |
126 |
$699.02 |
| 95886 |
|
15 |
15 |
$695.82 |
| 29515 |
|
54 |
51 |
$690.34 |
| 97016 |
|
302 |
94 |
$675.63 |
| 29105 |
|
60 |
59 |
$671.40 |
| 0335 |
|
17 |
13 |
$668.80 |
| 83883 |
|
92 |
52 |
$661.47 |
| J2920 |
Methylprednisolone injection |
71 |
63 |
$659.18 |
| 84478 |
|
106 |
101 |
$657.26 |
| J2795 |
Ropivacaine hcl injection |
197 |
136 |
$654.46 |
| J1010 |
Inj, methylpred acetate 1 mg |
77 |
75 |
$654.26 |
| 0271 |
|
66 |
50 |
$621.30 |
| 29125 |
|
55 |
53 |
$609.91 |
| J1630 |
Haloperidol injection |
123 |
103 |
$604.27 |
| A4217 |
Sterile water/saline, 500 ml |
33 |
33 |
$600.00 |
| 77338 |
|
12 |
12 |
$589.00 |
| 86317 |
|
65 |
65 |
$580.50 |
| Q0162 |
Ondansetron oral |
968 |
883 |
$575.52 |
| 93922 |
|
25 |
25 |
$562.34 |
| J1836 |
Inj, metronidazole, 10 mg |
341 |
228 |
$550.92 |
| J1920 |
Inj, labetalol hcl, 5mg |
109 |
100 |
$505.59 |
| 88305 |
|
63 |
42 |
$475.67 |
| 99212 |
|
30 |
30 |
$475.49 |
| 73120 |
|
31 |
18 |
$471.33 |
| 83970 |
|
15 |
15 |
$463.66 |
| 83090 |
|
31 |
30 |
$452.64 |
| J7512 |
Prednisone ir or dr oral 1mg |
860 |
813 |
$438.69 |
| J0360 |
Hydralazine hcl injection |
48 |
38 |
$419.91 |
| 86038 |
|
51 |
51 |
$411.58 |
| 85018 |
|
175 |
161 |
$405.72 |
| 82465 |
|
88 |
88 |
$404.41 |
| 0272 |
|
43 |
42 |
$400.60 |
| 43235 |
|
13 |
13 |
$383.28 |
| 77062 |
|
13 |
13 |
$360.00 |
| 86787 |
|
31 |
30 |
$353.77 |
| J1020 |
Methylprednisolone 20 mg inj |
36 |
36 |
$340.59 |
| 77080 |
|
13 |
13 |
$338.65 |
| J2001 |
Lidocaine injection |
68 |
67 |
$321.01 |
| 82270 |
|
76 |
74 |
$313.16 |
| 82140 |
|
26 |
26 |
$304.04 |
| 83010 |
|
16 |
13 |
$278.85 |
| 84466 |
|
27 |
27 |
$274.16 |
| 0370 |
|
37 |
36 |
$270.54 |
| 84160 |
|
77 |
70 |
$266.37 |
| J1030 |
Methylprednisolone 40 mg inj |
28 |
27 |
$260.13 |
| Q0163 |
Diphenhydramine hcl 50mg |
641 |
530 |
$259.64 |
| 87210 |
|
72 |
71 |
$258.03 |
| 87147 |
|
48 |
48 |
$246.26 |
| 82952 |
|
62 |
62 |
$243.56 |
| 86304 |
|
13 |
12 |
$240.50 |
| 29065 |
|
21 |
18 |
$234.99 |
| J2919 |
Inj, methylpred sod succ 5mg |
186 |
117 |
$195.41 |
| J7613 |
Albuterol non-comp unit |
1,364 |
1,291 |
$183.36 |
| 97116 |
|
241 |
110 |
$181.75 |
| J2175 |
Meperidine hydrochl /100 mg |
177 |
177 |
$175.57 |
| 0278 |
|
15 |
13 |
$167.76 |
| 29075 |
|
18 |
17 |
$163.44 |
| 86803 |
|
12 |
12 |
$150.63 |
| 49083 |
|
12 |
12 |
$147.12 |
| J1940 |
Furosemide injection |
21 |
14 |
$133.90 |
| J1953 |
Levetiracetam injection |
15 |
14 |
$115.56 |
| 90471 |
|
44 |
39 |
$107.04 |
| J3411 |
Thiamine hcl 100 mg |
41 |
17 |
$96.00 |
| J7620 |
Albuterol ipratrop non-comp |
654 |
598 |
$92.26 |
| S0020 |
Injection, bupivicaine hydro |
12 |
12 |
$75.28 |
| J1040 |
Methylprednisolone 80 mg inj |
12 |
12 |
$63.78 |
| J2371 |
Inj phenylephrine hcl 20 mcg |
56 |
33 |
$56.50 |
| J2470 |
Inj pantoprazole sodium 40mg |
77 |
57 |
$51.37 |
| G0283 |
Elec stim other than wound |
28 |
14 |
$49.66 |
| 82043 |
|
12 |
12 |
$43.92 |
| J7644 |
Ipratropium bromide non-comp |
210 |
201 |
$39.44 |
| M0243 |
Casirivi and imdevi inj |
64 |
64 |
$32.00 |
| 84132 |
|
14 |
12 |
$30.24 |
| J0330 |
Succinycholine chloride inj |
12 |
12 |
$30.00 |
| J8540 |
Oral dexamethasone |
173 |
165 |
$23.94 |
| J1596 |
Inj, glycopyrrolate, 0.1 mg |
20 |
12 |
$13.00 |
| J2003 |
Inj, lidocaine hcl, 1 mg |
15 |
15 |
$8.50 |
| J7510 |
Prednisolone oral per 5 mg |
12 |
12 |
$1.90 |
| A9270 |
Non-covered item or service |
185 |
123 |
$0.00 |
| 96376 |
|
67 |
45 |
$0.00 |
| 80050 |
|
114 |
111 |
$0.00 |
| 0250R |
|
76 |
38 |
$0.00 |
| 80320 |
|
199 |
191 |
$0.00 |
| 0370R |
|
120 |
119 |
$0.00 |
| 0710R |
|
180 |
173 |
$0.00 |