| Code | Description | Claims | Beneficiaries | Total Paid |
| H0005 |
Alcohol and/or drug services |
37,048 |
7,224 |
$2.65M |
| 99284 |
|
14,705 |
13,831 |
$1.78M |
| G0378 |
Hospital observation per hr |
7,986 |
4,764 |
$1.69M |
| 96361 |
|
8,582 |
7,228 |
$1.66M |
| 99213 |
|
15,856 |
12,677 |
$1.53M |
| G0396 |
Alcohol/subs interv 15-30mn |
12,894 |
7,936 |
$1.39M |
| 99283 |
|
9,549 |
8,980 |
$1.27M |
| 99214 |
|
12,541 |
11,418 |
$1.14M |
| 90853 |
|
12,796 |
2,513 |
$1.13M |
| 99285 |
|
10,258 |
9,718 |
$1.11M |
| 74177 |
|
4,710 |
4,616 |
$1.11M |
| G0463 |
Hospital outpt clinic visit |
10,856 |
8,221 |
$844K |
| 70450 |
|
3,272 |
3,196 |
$818K |
| 80053 |
|
45,356 |
39,114 |
$813K |
| 93306 |
|
2,976 |
2,961 |
$728K |
| 76856 |
|
1,639 |
1,614 |
$573K |
| 71275 |
|
1,964 |
1,938 |
$533K |
| 80307 |
|
17,264 |
12,150 |
$521K |
| Q9992 |
Buprenorphine xr over 100 mg |
266 |
258 |
$447K |
| 99282 |
|
3,300 |
3,086 |
$439K |
| 99212 |
|
3,821 |
3,080 |
$438K |
| 36415 |
|
62,740 |
50,275 |
$422K |
| 77067 |
|
4,288 |
4,286 |
$382K |
| 95810 |
|
616 |
607 |
$381K |
| H0002 |
Alcohol and/or drug screenin |
2,250 |
1,952 |
$368K |
| T1023 |
Program intake assessment |
6,559 |
2,499 |
$358K |
| G0397 |
Alcohol/subs interv >30 min |
2,513 |
1,834 |
$331K |
| S9480 |
Intensive outpatient psychia |
2,645 |
393 |
$311K |
| 99281 |
|
2,172 |
1,971 |
$295K |
| 93975 |
|
954 |
936 |
$276K |
| 96360 |
|
2,275 |
2,117 |
$266K |
| 74176 |
|
1,042 |
1,027 |
$253K |
| Q9991 |
Buprenorph xr 100 mg or less |
143 |
137 |
$236K |
| 96365 |
|
2,322 |
2,061 |
$231K |
| H0001 |
Alcohol and/or drug assess |
1,451 |
1,197 |
$207K |
| 93970 |
|
506 |
493 |
$203K |
| 78452 |
|
369 |
369 |
$194K |
| H0014 |
Alcohol and/or drug services |
1,386 |
743 |
$191K |
| U0003 |
Cov-19 amp prb hgh thruput |
2,501 |
2,452 |
$175K |
| C1776 |
Joint device (implantable) |
163 |
162 |
$165K |
| 88305 |
|
4,712 |
4,673 |
$165K |
| 99391 |
|
2,045 |
1,791 |
$162K |
| 59025 |
|
1,884 |
1,588 |
$160K |
| 96372 |
|
6,181 |
4,993 |
$159K |
| H0033 |
Oral med adm direct observe |
4,397 |
987 |
$155K |
| 86900 |
|
4,430 |
4,284 |
$149K |
| 99205 |
Prolong outpt/office vis |
1,371 |
400 |
$149K |
| 87491 |
|
4,893 |
4,816 |
$146K |
| 96413 |
|
1,752 |
1,014 |
$143K |
| 99392 |
|
1,726 |
1,703 |
$143K |
| 0223U |
|
614 |
573 |
$140K |
| 87635 |
|
3,966 |
3,691 |
$138K |
| H0050 |
Alcohol/drug service 15 min |
1,525 |
1,213 |
$133K |
| 82306 |
|
4,749 |
4,730 |
$129K |
| 93017 |
|
1,330 |
1,317 |
$128K |
| 76641 |
|
2,653 |
2,645 |
$118K |
| 99204 |
|
1,060 |
983 |
$112K |
| 99393 |
|
1,249 |
1,244 |
$111K |
| H2036 |
A/d tx program, per diem |
938 |
90 |
$110K |
| 87591 |
|
4,881 |
4,807 |
$109K |
| 96366 |
|
1,262 |
929 |
$107K |
| 84443 |
|
10,398 |
10,129 |
$103K |
| 76705 |
|
1,775 |
1,743 |
$96K |
| 88342 |
|
1,460 |
1,448 |
$95K |
| 80061 |
|
9,528 |
9,464 |
$94K |
| G0480 |
Drug test def 1-7 classes |
2,600 |
1,994 |
$94K |
| 96374 |
|
10,835 |
9,979 |
$90K |
| 43239 |
|
207 |
203 |
$89K |
| 0241U |
|
1,899 |
1,868 |
$88K |
| 76801 |
|
934 |
870 |
$88K |
| 86850 |
|
4,971 |
4,817 |
$88K |
| C1713 |
Anchor/screw bn/bn,tis/bn |
322 |
320 |
$86K |
| 76816 |
|
1,475 |
1,275 |
$82K |
| G0379 |
Direct refer hospital observ |
946 |
887 |
$80K |
| 71260 |
|
480 |
477 |
$80K |
| 70553 |
|
195 |
195 |
$80K |
| H0004 |
Alcohol and/or drug services |
1,278 |
1,001 |
$78K |
| 85025 |
|
42,869 |
36,365 |
$77K |
| 78815 |
|
99 |
97 |
$76K |
| 80048 |
|
4,802 |
4,087 |
$73K |
| C9803 |
Hopd covid-19 spec collect |
9,056 |
8,605 |
$72K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
7,708 |
7,450 |
$68K |
| 86901 |
|
4,922 |
4,767 |
$65K |
| 87637 |
|
657 |
644 |
$62K |
| 70496 |
|
258 |
256 |
$61K |
| 99394 |
|
695 |
687 |
$60K |
| 83036 |
|
8,295 |
8,214 |
$60K |
| 47562 |
|
25 |
25 |
$59K |
| 93971 |
|
892 |
867 |
$58K |
| H2001 |
Rehabilitation program 1/2 d |
598 |
137 |
$58K |
| 77063 |
|
4,272 |
4,270 |
$57K |
| 87502 |
|
1,367 |
1,345 |
$56K |
| 81220 |
|
173 |
173 |
$55K |
| 99215 |
Prolong outpt/office vis |
617 |
510 |
$55K |
| 76830 |
|
1,436 |
1,412 |
$52K |
| 96367 |
|
677 |
384 |
$52K |
| 77065 |
Tomosynthesis, mammo |
550 |
511 |
$50K |
| 83880 |
|
1,953 |
1,845 |
$50K |
| 99395 |
|
522 |
516 |
$48K |
| 87651 |
|
1,486 |
1,470 |
$47K |
| U0002 |
Covid-19 lab test non-cdc |
1,187 |
1,162 |
$46K |
| 71046 |
|
5,914 |
5,735 |
$45K |
| 97161 |
|
505 |
501 |
$44K |
| 77066 |
Tomosynthesis, mammo |
459 |
455 |
$43K |
| 95806 |
|
774 |
729 |
$43K |
| 87636 |
|
1,228 |
1,192 |
$41K |
| 88307 |
|
551 |
544 |
$39K |
| 99202 |
|
274 |
227 |
$36K |
| 87624 |
|
1,127 |
1,120 |
$34K |
| 86780 |
|
3,275 |
3,229 |
$34K |
| 87389 |
|
2,471 |
2,455 |
$34K |
| 88142 |
|
1,560 |
1,554 |
$33K |
| 81001 |
|
12,445 |
11,764 |
$33K |
| 84439 |
|
5,019 |
4,920 |
$33K |
| 99211 |
|
1,427 |
526 |
$32K |
| U0001 |
2019-ncov diagnostic p |
1,014 |
980 |
$32K |
| 90686 |
|
1,970 |
1,965 |
$32K |
| H0038 |
Self-help/peer svc per 15min |
323 |
213 |
$30K |
| 76811 |
|
183 |
179 |
$28K |
| 76817 |
|
691 |
656 |
$28K |
| 87480 |
|
1,883 |
1,852 |
$27K |
| 97165 |
|
386 |
384 |
$24K |
| 99385 |
|
252 |
250 |
$24K |
| 88304 |
|
746 |
738 |
$23K |
| 72125 |
|
751 |
742 |
$23K |
| 96375 |
|
8,415 |
6,977 |
$22K |
| 87086 |
|
4,404 |
4,246 |
$22K |
| 99396 |
|
251 |
247 |
$21K |
| 99238 |
|
481 |
474 |
$21K |
| 86803 |
|
2,531 |
2,509 |
$20K |
| 88112 |
|
377 |
373 |
$20K |
| 93005 |
|
13,539 |
11,836 |
$19K |
| 82607 |
|
1,904 |
1,874 |
$19K |
| 90715 |
|
831 |
828 |
$18K |
| 93010 |
|
2,930 |
2,635 |
$18K |
| 93458 |
|
12 |
12 |
$18K |
| 90670 |
|
1,020 |
1,018 |
$17K |
| 97530 |
|
776 |
439 |
$17K |
| 82728 |
|
1,915 |
1,859 |
$17K |
| 87660 |
|
2,026 |
1,993 |
$15K |
| 85027 |
|
6,245 |
5,524 |
$15K |
| Q3014 |
Telehealth facility fee |
600 |
558 |
$15K |
| 83655 |
|
1,357 |
1,337 |
$15K |
| 90698 |
|
894 |
893 |
$14K |
| 76937 |
|
93 |
92 |
$14K |
| 99460 |
|
226 |
226 |
$13K |
| D0140 |
|
400 |
197 |
$13K |
| D1110 |
|
332 |
127 |
$13K |
| 90471 |
|
1,890 |
1,869 |
$13K |
| 71250 |
|
122 |
120 |
$13K |
| 81002 |
|
1,501 |
1,314 |
$13K |
| 76805 |
|
155 |
155 |
$12K |
| 87510 |
|
1,831 |
1,800 |
$12K |
| 81329 |
|
94 |
93 |
$12K |
| 97110 |
|
267 |
146 |
$11K |
| 99291 |
|
105 |
105 |
$11K |
| 87340 |
|
1,630 |
1,612 |
$10K |
| 72197 |
|
27 |
27 |
$10K |
| G0475 |
Hiv combination assay |
722 |
717 |
$10K |
| 83550 |
|
1,987 |
1,936 |
$10K |
| 84702 |
|
2,064 |
1,800 |
$9K |
| 90680 |
|
560 |
559 |
$9K |
| D7140 |
|
159 |
71 |
$9K |
| 85610 |
|
3,348 |
2,692 |
$9K |
| 76700 |
|
66 |
66 |
$9K |
| 90651 |
|
330 |
330 |
$9K |
| 83540 |
|
2,084 |
2,009 |
$9K |
| 90633 |
|
608 |
606 |
$9K |
| 99406 |
|
679 |
640 |
$8K |
| 99203 |
|
120 |
105 |
$8K |
| 97116 |
|
323 |
206 |
$8K |
| C1781 |
Mesh (implantable) |
41 |
41 |
$8K |
| 45378 |
|
12 |
12 |
$8K |
| 81025 |
|
2,108 |
2,057 |
$8K |
| 99222 |
|
109 |
108 |
$8K |
| 71045 |
|
6,356 |
6,039 |
$8K |
| 87653 |
|
293 |
290 |
$8K |
| 83735 |
|
6,283 |
5,171 |
$7K |
| G0279 |
Tomosynthesis, mammo |
211 |
210 |
$7K |
| 82746 |
|
815 |
809 |
$7K |
| 90882 |
|
109 |
89 |
$7K |
| 70491 |
|
26 |
26 |
$7K |
| 90744 |
|
429 |
426 |
$7K |
| 77336 |
|
122 |
54 |
$7K |
| 45380 |
|
12 |
12 |
$7K |
| 81003 |
|
2,037 |
1,981 |
$7K |
| J7120 |
Ringers lactate infusion |
5,207 |
4,749 |
$7K |
| 86762 |
|
887 |
880 |
$7K |
| 84153 |
|
406 |
401 |
$6K |
| 82043 |
|
1,350 |
1,336 |
$6K |
| P9604 |
One-way allow prorated trip |
1,564 |
1,205 |
$6K |
| M0243 |
Casirivi and imdevi inj |
35 |
34 |
$6K |
| 87150 |
|
149 |
147 |
$6K |
| 96127 |
|
2,556 |
2,384 |
$6K |
| 82570 |
|
1,554 |
1,471 |
$6K |
| 76813 |
|
102 |
101 |
$6K |
| 87077 |
|
1,410 |
1,372 |
$5K |
| J3490 |
Drugs unclassified injection |
421 |
366 |
$5K |
| G0103 |
Psa screening |
350 |
333 |
$5K |
| 81420 |
|
13 |
12 |
$5K |
| 86618 |
|
557 |
432 |
$5K |
| 0002A |
|
179 |
179 |
$5K |
| 82962 |
|
1,070 |
826 |
$4K |
| 77080 |
|
51 |
51 |
$4K |
| G2023 |
Specimen collect covid-19 |
157 |
153 |
$4K |
| 86235 |
|
58 |
57 |
$4K |
| 86920 |
|
153 |
137 |
$4K |
| 88341 |
|
124 |
121 |
$4K |
| 99442 |
|
74 |
67 |
$4K |
| 84481 |
|
352 |
339 |
$4K |
| 82105 |
|
362 |
357 |
$4K |
| 86665 |
|
316 |
315 |
$4K |
| 86617 |
|
191 |
158 |
$4K |
| 80047 |
|
202 |
198 |
$4K |
| 93225 |
|
52 |
52 |
$3K |
| 85018 |
|
1,109 |
970 |
$3K |
| 87186 |
|
1,073 |
1,046 |
$3K |
| 93356 |
|
444 |
442 |
$3K |
| 72100 |
|
279 |
277 |
$3K |
| 76818 |
|
31 |
14 |
$3K |
| 86140 |
|
1,736 |
1,614 |
$3K |
| 70486 |
|
76 |
75 |
$3K |
| 97535 |
|
433 |
322 |
$3K |
| A9575 |
Inj gadoterate meglumi 0.1ml |
1,631 |
1,592 |
$3K |
| 70498 |
|
188 |
187 |
$3K |
| 0001A |
|
158 |
158 |
$3K |
| 90734 |
|
146 |
146 |
$3K |
| 83690 |
|
7,212 |
6,698 |
$3K |
| 77062 |
|
25 |
25 |
$3K |
| 76775 |
|
31 |
30 |
$2K |
| 77061 |
|
30 |
30 |
$2K |
| 85730 |
|
2,186 |
2,074 |
$2K |
| 87088 |
|
564 |
552 |
$2K |
| 99232 |
|
71 |
55 |
$2K |
| 84403 |
|
98 |
97 |
$2K |
| 86038 |
|
299 |
297 |
$2K |
| 86706 |
|
281 |
277 |
$2K |
| 70551 |
|
12 |
12 |
$2K |
| 83021 |
|
181 |
181 |
$2K |
| 74246 |
|
29 |
29 |
$2K |
| 84484 |
|
9,524 |
7,591 |
$2K |
| 86769 |
|
49 |
49 |
$2K |
| J2405 |
Ondansetron hcl injection |
9,625 |
8,418 |
$2K |
| 87798 |
|
62 |
62 |
$2K |
| 92551 |
|
27 |
27 |
$2K |
| 85652 |
|
1,798 |
1,715 |
$2K |
| 86787 |
|
453 |
450 |
$2K |
| 82950 |
|
450 |
446 |
$2K |
| 76770 |
|
13 |
13 |
$2K |
| C1769 |
Guide wire |
903 |
869 |
$2K |
| 87633 |
|
29 |
29 |
$2K |
| 82947 |
|
2,165 |
1,569 |
$2K |
| 80076 |
|
180 |
176 |
$2K |
| A4648 |
Implantable tissue marker |
49 |
49 |
$2K |
| 88312 |
|
114 |
114 |
$2K |
| 99386 |
|
13 |
13 |
$1K |
| 90674 |
|
71 |
71 |
$1K |
| 0012A |
|
44 |
44 |
$1K |
| 99201 |
|
14 |
12 |
$1K |
| 99462 |
|
57 |
57 |
$1K |
| 97162 |
|
13 |
13 |
$1K |
| 90710 |
|
88 |
88 |
$1K |
| 84703 |
|
6,612 |
6,338 |
$1K |
| 90460 |
|
4,763 |
4,541 |
$1K |
| 84550 |
|
448 |
426 |
$1K |
| 90716 |
|
93 |
93 |
$1K |
| D0120 |
|
29 |
12 |
$1K |
| G0399 |
Home sleep test/type 3 porta |
12 |
12 |
$1K |
| 99231 |
|
95 |
70 |
$1K |
| 82652 |
|
40 |
40 |
$1K |
| J7050 |
Normal saline solution infus |
1,800 |
1,173 |
$1K |
| 90696 |
|
80 |
80 |
$1K |
| 82248 |
|
332 |
306 |
$1K |
| 90648 |
|
72 |
71 |
$1K |
| A9552 |
F18 fdg |
65 |
65 |
$1K |
| J0574 |
Bupren/nal 6.1 to 10mg bupre |
899 |
279 |
$1K |
| 87428 |
|
51 |
51 |
$1K |
| 87522 |
Neg quan hep c or qual rna |
39 |
38 |
$1K |
| G0472 |
Hep c screen high risk/other |
42 |
41 |
$1K |
| 90707 |
|
87 |
87 |
$1K |
| 83615 |
|
428 |
376 |
$1K |
| 84100 |
|
1,360 |
1,191 |
$980.29 |
| 76536 |
|
12 |
12 |
$962.43 |
| 74220 |
|
14 |
14 |
$959.87 |
| 84146 |
|
55 |
55 |
$953.98 |
| 90723 |
|
56 |
55 |
$946.05 |
| 87581 |
|
29 |
29 |
$930.08 |
| 85379 |
|
1,798 |
1,759 |
$924.45 |
| 87040 |
|
2,661 |
1,864 |
$850.53 |
| 82550 |
|
528 |
490 |
$847.27 |
| 83001 |
|
49 |
49 |
$842.54 |
| J7030 |
Normal saline solution infus |
8,236 |
6,786 |
$793.19 |
| 82805 |
|
218 |
199 |
$791.00 |
| 87070 |
|
386 |
360 |
$770.03 |
| 73030 |
|
174 |
171 |
$748.10 |
| 86431 |
|
128 |
127 |
$736.35 |
| 74174 |
|
32 |
31 |
$717.67 |
| 96376 |
|
3,559 |
2,188 |
$711.07 |
| J1100 |
Dexamethasone sodium phos |
5,318 |
4,662 |
$676.92 |
| 0054A |
|
23 |
23 |
$633.32 |
| 87563 |
|
28 |
28 |
$621.58 |
| A9500 |
Tc99m sestamibi |
317 |
306 |
$616.59 |
| 83970 |
|
15 |
13 |
$612.58 |
| 92570 |
|
27 |
27 |
$593.82 |
| 80321 |
|
1,004 |
636 |
$566.32 |
| 76819 |
|
13 |
13 |
$559.92 |
| 83605 |
|
3,008 |
2,694 |
$557.25 |
| 86765 |
|
81 |
81 |
$556.22 |
| 0071A |
|
25 |
25 |
$554.10 |
| 73630 |
|
258 |
241 |
$503.72 |
| J2785 |
Regadenoson injection |
13 |
13 |
$491.84 |
| 86225 |
|
44 |
44 |
$477.30 |
| 0064A |
|
15 |
15 |
$464.48 |
| C1894 |
Intro/sheath, non-laser |
635 |
617 |
$463.63 |
| 90619 |
|
30 |
30 |
$434.95 |
| 99407 |
|
12 |
12 |
$429.72 |
| 90681 |
|
24 |
24 |
$428.40 |
| 85007 |
|
471 |
393 |
$416.54 |
| 0011A |
|
21 |
21 |
$407.14 |
| 82150 |
|
158 |
152 |
$399.67 |
| J2704 |
Inj, propofol, 10 mg |
6,043 |
5,895 |
$370.05 |
| 0072A |
|
15 |
14 |
$366.20 |
| 84156 |
|
209 |
193 |
$355.53 |
| 0004A |
|
41 |
41 |
$333.37 |
| 0124A |
|
16 |
16 |
$329.58 |
| J1644 |
Inj heparin sodium per 1000u |
1,004 |
793 |
$313.81 |
| 82247 |
|
108 |
105 |
$312.09 |
| 90732 |
|
12 |
12 |
$308.50 |
| J2469 |
Palonosetron hcl |
23 |
12 |
$298.87 |
| 87625 |
|
15 |
15 |
$276.96 |
| 88106 |
|
28 |
27 |
$267.91 |
| 86709 |
|
36 |
35 |
$264.48 |
| 72110 |
|
28 |
28 |
$256.16 |
| 96417 |
|
21 |
12 |
$253.93 |
| 84075 |
|
90 |
89 |
$253.82 |
| 84460 |
|
101 |
99 |
$253.44 |
| 86696 |
|
15 |
15 |
$248.70 |
| 73130 |
|
152 |
148 |
$245.70 |
| 80346 |
|
48 |
39 |
$245.45 |
| 84450 |
|
87 |
86 |
$233.10 |
| 83002 |
|
12 |
12 |
$228.22 |
| 76642 |
|
13 |
13 |
$226.52 |
| 83520 |
|
13 |
13 |
$218.98 |
| 82565 |
|
142 |
141 |
$216.98 |
| 82040 |
|
72 |
71 |
$216.29 |
| 86039 |
|
25 |
25 |
$211.16 |
| 73610 |
|
208 |
204 |
$201.79 |
| 90700 |
|
12 |
12 |
$196.35 |
| 80074 |
|
14 |
12 |
$195.05 |
| J1200 |
Diphenhydramine hcl injectio |
3,115 |
2,810 |
$192.11 |
| 80320 |
|
876 |
786 |
$182.92 |
| 83020 |
|
46 |
46 |
$170.82 |
| J1170 |
Hydromorphone injection |
1,772 |
1,504 |
$166.34 |
| 90620 |
|
12 |
12 |
$160.65 |
| 80178 |
|
28 |
28 |
$156.16 |
| J2270 |
Morphine sulfate injection |
2,425 |
1,883 |
$150.81 |
| 80362 |
|
30 |
17 |
$150.00 |
| J2543 |
Piperacillin/tazobactam |
144 |
84 |
$145.47 |
| 73564 |
|
129 |
122 |
$112.20 |
| 84155 |
|
44 |
43 |
$106.98 |
| 94640 |
|
756 |
530 |
$105.16 |
| J0330 |
Succinycholine chloride inj |
1,454 |
1,441 |
$99.02 |
| 86430 |
|
19 |
19 |
$98.83 |
| 80359 |
|
18 |
14 |
$90.30 |
| 80324 |
|
18 |
14 |
$90.30 |
| 81015 |
|
42 |
41 |
$81.26 |
| J0690 |
Cefazolin sodium injection |
3,087 |
2,683 |
$77.10 |
| J2765 |
Metoclopramide hcl injection |
1,810 |
1,606 |
$72.82 |
| J3010 |
Fentanyl citrate injection |
6,466 |
6,208 |
$59.44 |
| J1885 |
Ketorolac tromethamine inj |
5,481 |
4,940 |
$55.42 |
| 87147 |
|
12 |
12 |
$51.80 |
| 73502 |
|
25 |
24 |
$50.62 |
| 84132 |
|
222 |
211 |
$50.33 |
| 87205 |
|
140 |
117 |
$45.54 |
| J0696 |
Ceftriaxone sodium injection |
1,128 |
1,028 |
$40.51 |
| 86308 |
|
51 |
51 |
$38.25 |
| J7040 |
Normal saline solution infus |
99 |
86 |
$36.57 |
| 87426 |
|
26 |
26 |
$35.33 |
| J3370 |
Vancomycin hcl injection |
258 |
205 |
$34.14 |
| J0575 |
Bupren/nal over 10mg bupreno |
36 |
12 |
$30.06 |
| J1650 |
Inj enoxaparin sodium |
1,421 |
830 |
$26.37 |
| J2250 |
Inj midazolam hydrochloride |
7,043 |
6,858 |
$25.51 |
| 84145 |
|
40 |
39 |
$25.48 |
| 72170 |
|
28 |
27 |
$25.00 |
| C9113 |
Inj pantoprazole sodium, via |
66 |
51 |
$18.00 |
| 82310 |
|
13 |
13 |
$17.06 |
| J2060 |
Lorazepam injection |
871 |
719 |
$12.19 |
| J3475 |
Inj magnesium sulfate |
60 |
51 |
$11.68 |
| J2795 |
Ropivacaine hcl injection |
253 |
253 |
$11.52 |
| 87207 |
|
29 |
29 |
$10.18 |
| 85014 |
|
13 |
13 |
$4.06 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
495 |
414 |
$3.00 |
| 90472 |
|
130 |
127 |
$2.00 |
| J7512 |
Prednisone ir or dr oral 1mg |
42 |
27 |
$1.80 |
| 94760 |
|
14 |
13 |
$1.54 |
| J1815 |
Insulin injection |
386 |
213 |
$0.00 |
| 3074F |
|
334 |
332 |
$0.00 |
| A9270 |
Non-covered item or service |
6,199 |
4,186 |
$0.00 |
| S2900 |
Robotic surgical system |
183 |
182 |
$0.00 |
| 81000 |
|
132 |
112 |
$0.00 |
| 76820 |
|
27 |
12 |
$0.00 |
| J2370 |
Phenylephrine hcl injection |
190 |
190 |
$0.00 |
| 74019 |
|
12 |
12 |
$0.00 |
| 99000 |
|
29 |
29 |
$0.00 |
| 82803 |
|
34 |
34 |
$0.00 |
| 0352U |
|
88 |
85 |
$0.00 |
| 3078F |
|
133 |
132 |
$0.00 |
| J1596 |
Inj, glycopyrrolate, 0.1 mg |
241 |
240 |
$0.00 |
| J2930 |
Methylprednisolone injection |
54 |
49 |
$0.00 |
| J0780 |
Prochlorperazine injection |
95 |
86 |
$0.00 |
| 90461 |
|
1,252 |
1,241 |
$0.00 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
19 |
16 |
$0.00 |
| J0572 |
Bupren/nal up to 3mg bupreno |
59 |
26 |
$0.00 |
| A4312 |
Cath w/o bag 2-way silicone |
13 |
12 |
$0.00 |
| 87880 |
|
19 |
19 |
$0.00 |
| 91300 |
|
59 |
42 |
$0.00 |
| 88173 |
|
14 |
13 |
$0.00 |
| 87804 |
|
45 |
42 |
$0.00 |
| 99173 |
|
14 |
14 |
$0.00 |
| J2550 |
Promethazine hcl injection |
18 |
12 |
$0.00 |