| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99283 |
|
73,638 |
61,822 |
$18.07M |
| 99284 |
|
41,982 |
31,752 |
$15.33M |
| 99285 |
|
16,628 |
11,639 |
$6.74M |
| 74176 |
|
7,293 |
6,314 |
$3.67M |
| 74177 |
|
5,608 |
4,902 |
$3.28M |
| 99282 |
|
21,408 |
18,846 |
$2.92M |
| 70450 |
|
7,919 |
6,299 |
$1.76M |
| 93005 |
|
28,694 |
20,802 |
$1.47M |
| 96374 |
|
32,025 |
20,014 |
$1.29M |
| G0378 |
Hospital observation per hr |
5,048 |
2,860 |
$1.28M |
| 93458 |
|
1,426 |
628 |
$1.23M |
| 93306 |
|
3,062 |
2,275 |
$1.22M |
| 71045 |
|
19,995 |
16,194 |
$1.05M |
| 71046 |
|
13,796 |
11,889 |
$1.02M |
| 43239 |
|
2,177 |
1,620 |
$927K |
| 0241U |
|
11,456 |
9,455 |
$845K |
| 96365 |
|
13,305 |
6,756 |
$807K |
| 72125 |
|
2,246 |
1,928 |
$787K |
| 95714 |
|
911 |
373 |
$781K |
| 97110 |
|
13,434 |
4,521 |
$742K |
| 96375 |
|
19,157 |
15,356 |
$727K |
| 78452 |
|
2,315 |
822 |
$553K |
| 72131 |
|
1,597 |
1,344 |
$530K |
| 76705 |
|
1,828 |
1,659 |
$491K |
| 71275 |
|
1,348 |
1,166 |
$484K |
| 96372 |
|
18,525 |
11,376 |
$457K |
| 36415 |
|
86,977 |
52,135 |
$454K |
| G0480 |
Drug test def 1-7 classes |
5,758 |
4,167 |
$419K |
| 80053 |
|
42,486 |
35,058 |
$418K |
| C1713 |
Anchor/screw bn/bn,tis/bn |
328 |
254 |
$410K |
| 95700 |
|
937 |
471 |
$409K |
| 80307 |
|
7,472 |
6,536 |
$382K |
| 73630 |
|
4,569 |
4,091 |
$375K |
| C1769 |
Guide wire |
3,241 |
2,112 |
$360K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
13,065 |
10,694 |
$355K |
| G0463 |
Hospital outpt clinic visit |
8,334 |
5,997 |
$343K |
| 85025 |
|
49,579 |
40,553 |
$335K |
| 0240U |
|
6,045 |
5,263 |
$320K |
| 96361 |
|
17,941 |
10,233 |
$319K |
| 73130 |
|
3,600 |
3,210 |
$311K |
| 73610 |
|
3,452 |
3,101 |
$305K |
| 93017 |
|
1,061 |
910 |
$305K |
| 97140 |
|
5,473 |
2,004 |
$300K |
| 72100 |
|
2,756 |
2,447 |
$283K |
| G0283 |
Elec stim other than wound |
8,505 |
2,674 |
$263K |
| 73030 |
|
2,935 |
2,450 |
$252K |
| 96360 |
|
5,365 |
2,432 |
$250K |
| 45385 |
|
411 |
320 |
$240K |
| 87651 |
|
7,827 |
7,362 |
$227K |
| 71250 |
|
971 |
741 |
$212K |
| 93971 |
|
1,341 |
1,163 |
$207K |
| C1725 |
Cath, translumin non-laser |
2,206 |
1,056 |
$202K |
| 97161 |
|
3,256 |
2,919 |
$196K |
| 87804 |
|
13,110 |
6,223 |
$196K |
| 93356 |
|
1,580 |
1,365 |
$188K |
| 84484 |
|
17,424 |
12,896 |
$183K |
| 73110 |
|
2,341 |
2,026 |
$178K |
| 12001 |
|
1,098 |
989 |
$173K |
| U0004 |
Cov-19 test non-cdc hgh thru |
3,812 |
2,892 |
$171K |
| 96376 |
|
5,157 |
3,630 |
$169K |
| C1887 |
Catheter, guiding |
1,752 |
1,356 |
$166K |
| 71260 |
|
484 |
426 |
$159K |
| 83880 |
|
5,676 |
4,596 |
$156K |
| 73564 |
|
2,046 |
1,738 |
$141K |
| 87635 |
|
3,938 |
3,475 |
$140K |
| 99152 |
|
3,373 |
2,566 |
$139K |
| 73562 |
|
1,594 |
1,357 |
$138K |
| 80048 |
|
16,635 |
13,150 |
$134K |
| 97012 |
|
2,914 |
966 |
$130K |
| 11042 |
|
673 |
327 |
$124K |
| 94640 |
|
4,367 |
3,031 |
$123K |
| 74018 |
|
2,176 |
1,893 |
$122K |
| 10060 |
|
722 |
620 |
$117K |
| C1776 |
Joint device (implantable) |
1,124 |
802 |
$110K |
| 99281 |
|
1,292 |
1,162 |
$109K |
| 96366 |
|
2,711 |
1,739 |
$109K |
| 97035 |
|
2,407 |
874 |
$106K |
| 0399T |
|
956 |
745 |
$105K |
| 94761 |
|
2,245 |
1,669 |
$100K |
| 45378 |
|
222 |
184 |
$96K |
| 83690 |
|
16,301 |
14,218 |
$95K |
| 73080 |
|
1,169 |
1,009 |
$94K |
| 76830 |
|
396 |
366 |
$93K |
| 84443 |
|
5,421 |
4,905 |
$88K |
| 87491 |
|
2,693 |
2,451 |
$87K |
| 87591 |
|
2,655 |
2,459 |
$87K |
| 77067 |
|
1,733 |
1,670 |
$85K |
| 81001 |
|
27,536 |
23,789 |
$85K |
| 84703 |
|
10,908 |
9,817 |
$85K |
| 83605 |
|
8,604 |
6,932 |
$84K |
| 87880 |
|
5,434 |
5,107 |
$84K |
| 82947 |
|
13,068 |
5,421 |
$83K |
| J7030 |
Normal saline solution infus |
18,529 |
15,246 |
$81K |
| J2704 |
Inj, propofol, 10 mg |
10,614 |
7,769 |
$79K |
| 45380 |
|
235 |
158 |
$79K |
| 95711 |
|
406 |
355 |
$71K |
| 77014 |
|
550 |
40 |
$70K |
| 95951 |
|
140 |
41 |
$68K |
| 76937 |
|
1,034 |
742 |
$65K |
| 70486 |
|
270 |
246 |
$64K |
| 87086 |
|
8,693 |
7,693 |
$62K |
| 72040 |
|
721 |
644 |
$61K |
| 73502 |
|
1,193 |
924 |
$61K |
| 99153 |
Mod sedat endo service >5yrs |
1,177 |
920 |
$60K |
| 97010 |
|
5,460 |
1,753 |
$59K |
| 90715 |
|
1,740 |
1,585 |
$57K |
| 73590 |
|
570 |
508 |
$56K |
| 47562 |
|
12 |
12 |
$56K |
| 83735 |
|
9,466 |
7,744 |
$55K |
| 85014 |
|
2,725 |
2,141 |
$54K |
| 85027 |
|
7,883 |
6,521 |
$53K |
| 80061 |
|
3,908 |
3,093 |
$53K |
| G0481 |
Drug test def 8-14 classes |
478 |
417 |
$52K |
| 87040 |
|
4,545 |
2,674 |
$50K |
| 85049 |
|
1,338 |
1,062 |
$50K |
| C1894 |
Intro/sheath, non-laser |
1,584 |
1,064 |
$50K |
| A9502 |
Tc99m tetrofosmin |
333 |
286 |
$49K |
| 93970 |
|
209 |
187 |
$47K |
| 80047 |
|
1,650 |
1,357 |
$45K |
| 88305 |
|
454 |
402 |
$45K |
| U0005 |
Infec agen detec ampli probe |
2,996 |
2,386 |
$44K |
| 73090 |
|
495 |
429 |
$42K |
| 84702 |
|
3,169 |
2,723 |
$41K |
| 85610 |
|
7,710 |
6,142 |
$41K |
| 29125 |
|
329 |
296 |
$41K |
| J0696 |
Ceftriaxone sodium injection |
6,181 |
4,784 |
$40K |
| 97165 |
|
968 |
784 |
$39K |
| 71101 |
|
487 |
413 |
$38K |
| 45384 |
|
90 |
61 |
$37K |
| 87081 |
|
5,117 |
4,730 |
$35K |
| 74022 |
|
374 |
338 |
$34K |
| J1885 |
Ketorolac tromethamine inj |
14,052 |
12,166 |
$33K |
| 81025 |
|
4,829 |
4,319 |
$33K |
| 97162 |
|
485 |
420 |
$33K |
| 97542 |
|
1,757 |
1,194 |
$32K |
| 0202U |
|
185 |
129 |
$31K |
| 87186 |
|
3,535 |
3,152 |
$31K |
| 85379 |
|
3,744 |
3,368 |
$31K |
| 82306 |
|
1,254 |
1,131 |
$31K |
| 97033 |
|
773 |
292 |
$30K |
| 12011 |
|
215 |
204 |
$30K |
| J3010 |
Fentanyl citrate injection |
11,969 |
7,830 |
$29K |
| 87077 |
|
2,559 |
2,254 |
$29K |
| 97166 |
|
494 |
410 |
$27K |
| 72148 |
|
65 |
62 |
$26K |
| 87070 |
|
3,231 |
2,049 |
$25K |
| 90471 |
|
1,829 |
1,650 |
$25K |
| C8929 |
Tte w or wo fol wcon,doppler |
49 |
40 |
$25K |
| 87633 |
|
61 |
59 |
$24K |
| J1644 |
Inj heparin sodium per 1000u |
5,340 |
3,004 |
$23K |
| 72070 |
|
327 |
267 |
$23K |
| J2405 |
Ondansetron hcl injection |
20,608 |
16,625 |
$23K |
| J7120 |
Ringers lactate infusion |
4,496 |
3,493 |
$23K |
| 70553 |
|
45 |
40 |
$23K |
| 83036 |
|
2,673 |
2,289 |
$23K |
| C1760 |
Closure dev, vasc |
185 |
145 |
$22K |
| J3370 |
Vancomycin hcl injection |
1,337 |
959 |
$21K |
| 77336 |
|
279 |
56 |
$21K |
| C9803 |
Hopd covid-19 spec collect |
2,034 |
1,486 |
$20K |
| J2930 |
Methylprednisolone injection |
2,160 |
1,841 |
$20K |
| M0243 |
Casirivi and imdevi inj |
167 |
157 |
$20K |
| 80320 |
|
307 |
256 |
$19K |
| 84132 |
|
2,880 |
2,117 |
$18K |
| 87507 |
|
62 |
56 |
$18K |
| J0690 |
Cefazolin sodium injection |
3,599 |
2,566 |
$18K |
| 96367 |
|
807 |
482 |
$17K |
| 87088 |
|
2,148 |
1,888 |
$17K |
| J2270 |
Morphine sulfate injection |
6,975 |
5,391 |
$17K |
| 81003 |
|
7,446 |
6,614 |
$17K |
| 85730 |
|
3,883 |
3,056 |
$16K |
| 82565 |
|
1,742 |
1,044 |
$16K |
| J1100 |
Dexamethasone sodium phos |
6,538 |
5,376 |
$16K |
| 80074 |
|
430 |
319 |
$15K |
| J1170 |
Hydromorphone injection |
4,828 |
3,469 |
$15K |
| 87661 |
|
414 |
393 |
$14K |
| 73140 |
|
197 |
178 |
$14K |
| J1815 |
Insulin injection |
3,464 |
637 |
$14K |
| 94729 |
|
273 |
249 |
$14K |
| 12002 |
|
84 |
63 |
$14K |
| 97014 |
|
342 |
117 |
$14K |
| J2710 |
Neostigmine methylslfte inj |
2,132 |
1,731 |
$13K |
| J3475 |
Inj magnesium sulfate |
2,257 |
1,804 |
$13K |
| 84145 |
|
652 |
535 |
$13K |
| 97113 |
|
240 |
63 |
$13K |
| J0131 |
Inj, acetaminophen (nos) |
404 |
350 |
$12K |
| 82607 |
|
896 |
789 |
$12K |
| 62323 |
|
81 |
53 |
$12K |
| 87807 |
|
870 |
819 |
$12K |
| J0878 |
Daptomycin injection |
49 |
12 |
$12K |
| 77300 |
|
122 |
36 |
$11K |
| 72128 |
|
42 |
28 |
$11K |
| J2001 |
Lidocaine injection |
5,619 |
4,554 |
$11K |
| J2543 |
Piperacillin/tazobactam |
568 |
265 |
$11K |
| 80081 |
|
116 |
112 |
$10K |
| 80076 |
|
1,260 |
1,137 |
$10K |
| 76817 |
|
112 |
93 |
$9K |
| J7512 |
Prednisone ir or dr oral 1mg |
4,319 |
2,689 |
$9K |
| 87205 |
|
2,068 |
1,795 |
$8K |
| 97530 |
|
224 |
94 |
$8K |
| M0247 |
Sotrovimab infusion |
43 |
35 |
$8K |
| J7040 |
Normal saline solution infus |
4,196 |
2,621 |
$8K |
| 82803 |
|
453 |
305 |
$8K |
| J2550 |
Promethazine hcl injection |
4,712 |
3,762 |
$8K |
| 97535 |
|
359 |
228 |
$8K |
| Q0247 |
Sotrovimab |
18 |
16 |
$7K |
| J2250 |
Inj midazolam hydrochloride |
6,174 |
4,846 |
$7K |
| 70498 |
|
16 |
15 |
$7K |
| 87147 |
|
423 |
392 |
$7K |
| 80305 |
|
731 |
624 |
$7K |
| 94760 |
|
298 |
148 |
$7K |
| 80050 |
|
194 |
167 |
$6K |
| 80179 |
|
565 |
493 |
$6K |
| 82550 |
|
1,127 |
810 |
$6K |
| 84439 |
|
633 |
574 |
$6K |
| 70496 |
|
15 |
13 |
$6K |
| 87389 |
|
251 |
230 |
$6K |
| 82150 |
|
1,022 |
921 |
$6K |
| 86140 |
|
1,289 |
1,056 |
$6K |
| 43249 |
|
12 |
12 |
$6K |
| 94060 |
|
169 |
109 |
$6K |
| J2060 |
Lorazepam injection |
2,744 |
2,096 |
$6K |
| 70551 |
|
16 |
12 |
$6K |
| J0360 |
Hydralazine hcl injection |
847 |
609 |
$6K |
| J1200 |
Diphenhydramine hcl injectio |
3,215 |
2,638 |
$6K |
| 97597 |
|
92 |
64 |
$6K |
| 82948 |
|
881 |
542 |
$5K |
| 87522 |
Neg quan hep c or qual rna |
106 |
99 |
$5K |
| C9113 |
Inj pantoprazole sodium, via |
989 |
657 |
$5K |
| 64494 |
|
16 |
15 |
$5K |
| Q9956 |
Inj octafluoropropane mic,ml |
89 |
68 |
$5K |
| 77334 |
|
17 |
13 |
$5K |
| 76536 |
|
29 |
28 |
$5K |
| J0330 |
Succinycholine chloride inj |
582 |
467 |
$5K |
| J2785 |
Regadenoson injection |
52 |
41 |
$5K |
| U0003 |
Cov-19 amp prb hgh thruput |
54 |
47 |
$5K |
| J2272 |
Inj, morphine (fresenius) |
1,579 |
1,334 |
$4K |
| 87210 |
|
869 |
518 |
$4K |
| J1040 |
Methylprednisolone 80 mg inj |
460 |
381 |
$4K |
| 97112 |
|
168 |
70 |
$4K |
| Q0163 |
Diphenhydramine hcl 50mg |
1,388 |
1,079 |
$4K |
| G0483 |
Drug test def 22+ classes |
44 |
31 |
$4K |
| 88304 |
|
81 |
68 |
$4K |
| 93925 |
|
24 |
19 |
$4K |
| 36416 |
|
509 |
363 |
$4K |
| 94726 |
|
65 |
60 |
$4K |
| 93922 |
|
56 |
47 |
$4K |
| J7050 |
Normal saline solution infus |
932 |
629 |
$3K |
| J0561 |
Penicillin g benzathine inj |
26 |
24 |
$3K |
| A4213 |
20+ cc syringe only |
275 |
244 |
$3K |
| J3490 |
Drugs unclassified injection |
620 |
261 |
$3K |
| 84100 |
|
806 |
662 |
$3K |
| J3300 |
Triamcinolone a inj prs-free |
313 |
257 |
$3K |
| 82728 |
|
231 |
191 |
$3K |
| C1726 |
Cath, bal dil, non-vascular |
28 |
24 |
$3K |
| 80143 |
|
209 |
190 |
$3K |
| 96413 |
|
26 |
12 |
$3K |
| J2370 |
Phenylephrine hcl injection |
1,159 |
856 |
$3K |
| 86803 |
|
191 |
172 |
$3K |
| 84402 |
|
97 |
90 |
$3K |
| 84153 |
|
122 |
119 |
$3K |
| 64493 |
|
16 |
15 |
$3K |
| 84403 |
|
88 |
82 |
$3K |
| 82746 |
|
177 |
160 |
$3K |
| 86480 |
|
46 |
45 |
$3K |
| G8978 |
Mobility current status |
316 |
147 |
$2K |
| 96368 |
|
119 |
87 |
$2K |
| 87798 |
|
67 |
65 |
$2K |
| 99406 |
|
142 |
124 |
$2K |
| M0245 |
Bamlan and etesev infusion |
16 |
15 |
$2K |
| J3411 |
Thiamine hcl 100 mg |
280 |
223 |
$2K |
| 83516 |
|
120 |
68 |
$2K |
| 82330 |
|
211 |
161 |
$2K |
| 94664 |
|
365 |
309 |
$2K |
| J2765 |
Metoclopramide hcl injection |
1,375 |
1,230 |
$2K |
| 76870 |
|
12 |
12 |
$2K |
| 86787 |
|
139 |
134 |
$2K |
| 72170 |
|
37 |
30 |
$2K |
| 82570 |
|
375 |
340 |
$2K |
| 87486 |
|
59 |
57 |
$2K |
| 93880 |
|
16 |
12 |
$2K |
| 82105 |
|
100 |
92 |
$2K |
| 86900 |
|
588 |
479 |
$2K |
| 86901 |
|
573 |
477 |
$2K |
| 85651 |
|
424 |
382 |
$2K |
| 82677 |
|
65 |
58 |
$2K |
| 80361 |
|
106 |
98 |
$2K |
| 80365 |
|
106 |
98 |
$2K |
| 80356 |
|
106 |
98 |
$2K |
| 94618 |
|
40 |
37 |
$2K |
| 83550 |
|
187 |
160 |
$2K |
| J2919 |
Inj, methylpred sod succ 5mg |
204 |
181 |
$2K |
| 85347 |
|
42 |
27 |
$1K |
| Q0169 |
Promethazine hcl 12.5mg oral |
543 |
372 |
$1K |
| 83540 |
|
242 |
199 |
$1K |
| 86038 |
|
112 |
99 |
$1K |
| 86850 |
|
188 |
152 |
$1K |
| 83001 |
|
60 |
57 |
$1K |
| 73552 |
|
14 |
12 |
$1K |
| 87581 |
|
59 |
57 |
$1K |
| 77063 |
|
66 |
61 |
$1K |
| 82043 |
|
207 |
190 |
$1K |
| 76000 |
|
62 |
45 |
$1K |
| 87340 |
|
123 |
109 |
$1K |
| 82670 |
|
34 |
32 |
$1K |
| 84146 |
|
47 |
45 |
$1K |
| 86336 |
|
65 |
58 |
$1K |
| J0688 |
Inj cefazolin sodium, hikma |
309 |
200 |
$1K |
| 86376 |
|
59 |
58 |
$996.42 |
| J1956 |
Levofloxacin injection |
114 |
88 |
$988.05 |
| 83970 |
|
38 |
29 |
$944.18 |
| 84480 |
|
65 |
58 |
$919.64 |
| J0171 |
Adrenalin epinephrine inject |
154 |
126 |
$896.37 |
| 86706 |
|
80 |
68 |
$850.33 |
| 84144 |
|
31 |
30 |
$826.39 |
| 86704 |
|
67 |
58 |
$816.09 |
| 84481 |
|
47 |
43 |
$814.63 |
| 86708 |
|
63 |
55 |
$791.81 |
| J2795 |
Ropivacaine hcl injection |
21 |
14 |
$791.19 |
| J1596 |
Inj, glycopyrrolate, 0.1 mg |
212 |
171 |
$787.36 |
| 84550 |
|
158 |
150 |
$727.27 |
| 86431 |
|
105 |
93 |
$685.87 |
| 80069 |
|
87 |
75 |
$678.26 |
| A9577 |
Inj multihance |
14 |
14 |
$628.25 |
| J1650 |
Inj enoxaparin sodium |
20 |
12 |
$618.46 |
| J0735 |
Clonidine hydrochloride |
268 |
218 |
$597.63 |
| J7510 |
Prednisolone oral per 5 mg |
236 |
226 |
$587.16 |
| J2003 |
Inj, lidocaine hcl, 1 mg |
259 |
225 |
$586.71 |
| J0780 |
Prochlorperazine injection |
114 |
109 |
$584.52 |
| 87075 |
|
71 |
65 |
$579.28 |
| 86200 |
|
38 |
35 |
$577.23 |
| 87420 |
|
48 |
46 |
$552.71 |
| 82140 |
|
34 |
27 |
$529.57 |
| 86800 |
|
28 |
26 |
$525.14 |
| G8987 |
Self care current status |
61 |
44 |
$502.24 |
| 93799 |
|
16 |
13 |
$470.35 |
| J1642 |
Inj heparin sodium per 10 u |
126 |
73 |
$454.75 |
| J3480 |
Inj potassium chloride |
90 |
53 |
$442.91 |
| J2310 |
Inj naloxone hydrochloride |
19 |
13 |
$438.34 |
| 87184 |
|
58 |
46 |
$435.32 |
| 87338 |
|
24 |
24 |
$428.88 |
| 84520 |
|
151 |
101 |
$385.77 |
| J7060 |
5% dextrose/water |
66 |
30 |
$368.79 |
| 82784 |
|
54 |
33 |
$364.69 |
| J3360 |
Diazepam injection |
17 |
13 |
$357.91 |
| J2470 |
Inj pantoprazole sodium 40mg |
97 |
75 |
$353.92 |
| 87046 |
|
28 |
12 |
$351.95 |
| C1889 |
Implant/insert device, noc |
13 |
13 |
$347.42 |
| 85652 |
|
135 |
108 |
$326.28 |
| 85007 |
|
97 |
89 |
$325.91 |
| 83883 |
|
17 |
13 |
$314.19 |
| 84450 |
|
51 |
48 |
$312.88 |
| 36600 |
|
13 |
12 |
$285.35 |
| 85018 |
|
99 |
76 |
$282.22 |
| 84156 |
|
76 |
71 |
$280.55 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
42 |
31 |
$274.03 |
| 82962 |
|
126 |
100 |
$273.16 |
| G8988 |
Self care goal status |
63 |
44 |
$267.37 |
| 82553 |
|
29 |
12 |
$261.68 |
| 82951 |
|
17 |
15 |
$252.17 |
| 86592 |
|
51 |
50 |
$251.58 |
| 86039 |
|
18 |
17 |
$250.16 |
| 86308 |
|
43 |
38 |
$243.70 |
| J1598 |
Inj glycopyrrolate fres kabi |
79 |
71 |
$235.29 |
| 84295 |
|
162 |
129 |
$233.57 |
| 80164 |
|
13 |
13 |
$222.13 |
| 81015 |
|
721 |
602 |
$217.32 |
| 84165 |
|
16 |
15 |
$214.92 |
| G8979 |
Mobility goal status |
181 |
122 |
$180.94 |
| Q9963 |
Hocm 350-399mg/ml iodine,1ml |
15 |
12 |
$180.41 |
| J2371 |
Inj phenylephrine hcl 20 mcg |
363 |
214 |
$177.48 |
| 87045 |
|
19 |
13 |
$163.97 |
| Q0177 |
Hydroxyzine pamoate 25mg |
158 |
65 |
$163.55 |
| 86780 |
|
15 |
12 |
$162.82 |
| 82374 |
|
125 |
100 |
$159.72 |
| 82435 |
|
127 |
101 |
$150.53 |
| 82977 |
|
13 |
13 |
$145.55 |
| J1630 |
Haloperidol injection |
26 |
24 |
$135.03 |
| J1030 |
Methylprednisolone 40 mg inj |
33 |
25 |
$119.60 |
| J8540 |
Oral dexamethasone |
63 |
63 |
$114.60 |
| 84460 |
|
19 |
16 |
$107.13 |
| A9270 |
Non-covered item or service |
1,389 |
208 |
$84.00 |
| J1953 |
Levetiracetam injection |
16 |
12 |
$74.50 |
| 82952 |
|
16 |
14 |
$72.78 |
| J7070 |
D5w infusion |
30 |
26 |
$48.42 |
| Q9966 |
Locm 200-299mg/ml iodine,1ml |
17 |
13 |
$45.59 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
32 |
24 |
$36.41 |
| J2004 |
Inj, lidocaine w epinephrine |
12 |
12 |
$11.57 |
| Q0244 |
Casirivi and imdevi 1200 mg |
38 |
35 |
$0.00 |
| G8980 |
Mobility d/c status |
18 |
14 |
$0.00 |
| J2305 |
Inj, nitroglycerin, 5 mg |
28 |
14 |
$0.00 |