| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99285 |
|
23,276 |
19,887 |
$7.83M |
| 99284 |
|
35,529 |
31,183 |
$5.49M |
| 99283 |
|
42,545 |
37,770 |
$4.19M |
| 87637 |
|
10,088 |
8,483 |
$958K |
| 96361 |
|
12,475 |
9,439 |
$845K |
| 85025 |
|
88,102 |
68,727 |
$762K |
| 80053 |
|
69,786 |
55,369 |
$663K |
| 96365 |
|
11,807 |
8,282 |
$595K |
| 74176 |
|
4,971 |
4,460 |
$488K |
| 99282 |
|
7,225 |
6,534 |
$481K |
| 97110 |
|
11,344 |
3,066 |
$471K |
| 80307 |
|
9,452 |
8,057 |
$467K |
| 70450 |
|
7,365 |
6,549 |
$459K |
| U0003 |
Cov-19 amp prb hgh thruput |
8,300 |
7,610 |
$443K |
| 74177 |
|
3,091 |
2,715 |
$443K |
| 96372 |
|
24,618 |
19,036 |
$423K |
| 96374 |
|
14,514 |
12,356 |
$402K |
| 71046 |
|
17,515 |
15,784 |
$394K |
| 36415 |
|
64,042 |
51,844 |
$381K |
| 78452 |
|
1,087 |
1,001 |
$381K |
| 96366 |
|
6,479 |
3,532 |
$360K |
| G0463 |
Hospital outpt clinic visit |
8,498 |
7,169 |
$359K |
| G0480 |
Drug test def 1-7 classes |
4,858 |
4,006 |
$354K |
| G0378 |
Hospital observation per hr |
5,025 |
2,011 |
$328K |
| 81001 |
|
39,303 |
33,231 |
$291K |
| J2405 |
Ondansetron hcl injection |
19,051 |
13,699 |
$275K |
| 84484 |
|
22,011 |
13,846 |
$273K |
| J3010 |
Fentanyl citrate injection |
12,647 |
8,496 |
$250K |
| 96375 |
|
14,381 |
10,743 |
$245K |
| 87502 |
|
2,908 |
2,611 |
$219K |
| 93005 |
|
27,008 |
22,880 |
$216K |
| 87880 |
|
12,752 |
11,532 |
$215K |
| J1100 |
Dexamethasone sodium phos |
12,791 |
10,254 |
$212K |
| 96413 |
|
2,979 |
1,642 |
$208K |
| 84443 |
|
15,692 |
14,043 |
$197K |
| 71275 |
|
1,586 |
1,376 |
$193K |
| 87070 |
|
12,607 |
11,373 |
$190K |
| 80048 |
|
17,751 |
14,757 |
$189K |
| A9500 |
Tc99m sestamibi |
1,778 |
1,028 |
$184K |
| 70553 |
|
716 |
644 |
$172K |
| J1885 |
Ketorolac tromethamine inj |
14,692 |
12,184 |
$168K |
| 83605 |
|
16,428 |
12,553 |
$165K |
| 87086 |
|
15,980 |
13,690 |
$160K |
| J2250 |
Inj midazolam hydrochloride |
7,000 |
5,580 |
$159K |
| 72148 |
|
1,140 |
1,091 |
$154K |
| 99212 |
|
3,266 |
2,819 |
$153K |
| 86140 |
|
15,126 |
12,611 |
$153K |
| 93017 |
|
1,593 |
1,492 |
$149K |
| 87040 |
|
11,807 |
6,710 |
$145K |
| G0383 |
Lev 4 hosp type b ed visit |
1,089 |
941 |
$144K |
| 96360 |
|
3,189 |
2,887 |
$143K |
| 93306 |
|
1,408 |
1,314 |
$139K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
6,598 |
5,715 |
$139K |
| 71045 |
|
13,967 |
11,878 |
$131K |
| J2785 |
Regadenoson injection |
938 |
840 |
$128K |
| 72110 |
|
3,823 |
3,586 |
$127K |
| 76705 |
|
2,340 |
2,176 |
$126K |
| 77067 |
|
1,847 |
1,771 |
$125K |
| 82306 |
|
5,700 |
5,226 |
$123K |
| 0241U |
|
5,411 |
5,020 |
$123K |
| 71260 |
|
1,475 |
1,346 |
$121K |
| 87633 |
|
312 |
286 |
$118K |
| 94640 |
|
4,331 |
3,322 |
$117K |
| 88305 |
|
3,964 |
3,606 |
$117K |
| 96376 |
|
4,484 |
2,634 |
$112K |
| A9585 |
Gadobutrol injection |
1,766 |
1,589 |
$111K |
| 85027 |
|
10,962 |
8,986 |
$109K |
| 74178 |
|
847 |
757 |
$109K |
| 59025 |
|
2,353 |
1,536 |
$108K |
| 82805 |
|
2,757 |
2,171 |
$107K |
| 81025 |
|
5,154 |
4,527 |
$106K |
| J2270 |
Morphine sulfate injection |
4,816 |
3,271 |
$106K |
| 83690 |
|
10,156 |
8,658 |
$98K |
| 80061 |
|
7,667 |
7,094 |
$91K |
| 88304 |
|
1,360 |
1,157 |
$91K |
| 73630 |
|
2,475 |
2,243 |
$86K |
| 82962 |
|
8,345 |
3,154 |
$86K |
| G0382 |
Lev 3 hosp type b ed visit |
782 |
676 |
$85K |
| J0690 |
Cefazolin sodium injection |
3,116 |
2,501 |
$80K |
| 74019 |
|
3,789 |
3,420 |
$79K |
| 80076 |
|
5,241 |
4,676 |
$78K |
| 87631 |
|
728 |
674 |
$77K |
| 72125 |
|
1,968 |
1,780 |
$75K |
| 80047 |
|
3,654 |
3,236 |
$74K |
| 82150 |
|
4,520 |
3,924 |
$73K |
| 43239 |
|
487 |
458 |
$72K |
| 82607 |
|
5,446 |
4,984 |
$70K |
| 36600 |
|
3,302 |
2,739 |
$69K |
| 93971 |
|
1,426 |
1,318 |
$68K |
| 49083 |
|
271 |
100 |
$67K |
| G0384 |
Lev 5 hosp type b ed visit |
513 |
475 |
$64K |
| 42820 |
|
56 |
42 |
$64K |
| 83735 |
|
13,309 |
10,000 |
$64K |
| 78227 |
|
237 |
177 |
$63K |
| 73030 |
|
2,926 |
2,580 |
$60K |
| 73562 |
|
2,545 |
2,241 |
$60K |
| 73721 |
|
384 |
351 |
$60K |
| 97140 |
|
1,957 |
763 |
$60K |
| 83880 |
|
3,556 |
3,117 |
$59K |
| 88342 |
|
1,210 |
1,103 |
$58K |
| J2710 |
Neostigmine methylslfte inj |
1,165 |
977 |
$56K |
| 86885 |
|
2,037 |
1,754 |
$55K |
| 97161 |
|
1,269 |
1,167 |
$54K |
| 47563 |
|
79 |
64 |
$54K |
| J1170 |
Hydromorphone injection |
1,097 |
707 |
$53K |
| 77063 |
|
1,681 |
1,613 |
$52K |
| 87635 |
|
1,956 |
1,753 |
$52K |
| 83036 |
|
6,289 |
5,785 |
$52K |
| 72050 |
|
1,275 |
1,193 |
$52K |
| 96367 |
|
3,165 |
2,179 |
$51K |
| A9552 |
F18 fdg |
98 |
91 |
$51K |
| J7060 |
5% dextrose/water |
5,555 |
3,256 |
$51K |
| J0696 |
Ceftriaxone sodium injection |
7,640 |
5,356 |
$50K |
| 99211 |
|
1,019 |
955 |
$50K |
| 86900 |
|
3,177 |
2,722 |
$50K |
| 85610 |
|
11,149 |
9,071 |
$50K |
| 80050 |
|
1,279 |
1,195 |
$49K |
| 85730 |
|
8,643 |
7,376 |
$48K |
| 90715 |
|
1,353 |
1,228 |
$48K |
| 73130 |
|
1,916 |
1,675 |
$47K |
| 70486 |
|
793 |
734 |
$46K |
| 73610 |
|
2,040 |
1,838 |
$46K |
| 82550 |
|
4,907 |
3,732 |
$45K |
| 87077 |
|
5,122 |
4,441 |
$44K |
| 99281 |
|
1,201 |
1,114 |
$43K |
| 87186 |
|
5,042 |
4,419 |
$43K |
| 76536 |
|
672 |
641 |
$42K |
| 84703 |
|
4,065 |
3,647 |
$41K |
| J1642 |
Inj heparin sodium per 10 u |
3,198 |
2,124 |
$39K |
| 78815 |
|
69 |
65 |
$38K |
| J2550 |
Promethazine hcl injection |
1,509 |
1,141 |
$38K |
| 90471 |
|
1,707 |
1,439 |
$37K |
| 73502 |
|
1,883 |
1,771 |
$33K |
| 73110 |
|
1,192 |
1,087 |
$33K |
| 85007 |
|
4,286 |
3,339 |
$33K |
| 82553 |
|
2,203 |
1,550 |
$33K |
| 82565 |
|
2,866 |
2,225 |
$33K |
| 87804 |
|
2,959 |
1,623 |
$32K |
| 82746 |
|
2,472 |
2,282 |
$32K |
| 72070 |
|
1,028 |
976 |
$32K |
| 87591 |
|
993 |
879 |
$31K |
| 87491 |
|
994 |
880 |
$31K |
| J2930 |
Methylprednisolone injection |
2,408 |
1,813 |
$29K |
| J0592 |
Buprenorphine hydrochloride |
1,037 |
715 |
$29K |
| 92507 |
|
599 |
225 |
$29K |
| 71250 |
|
906 |
843 |
$28K |
| M0243 |
Casirivi and imdevi inj |
83 |
76 |
$27K |
| 86901 |
|
3,177 |
2,722 |
$27K |
| 74018 |
|
1,329 |
1,188 |
$27K |
| J1200 |
Diphenhydramine hcl injectio |
2,984 |
2,190 |
$27K |
| 72141 |
|
122 |
117 |
$26K |
| 97162 |
|
416 |
387 |
$26K |
| 76830 |
|
339 |
316 |
$25K |
| 87081 |
|
5,257 |
4,617 |
$25K |
| 82140 |
|
2,297 |
1,851 |
$25K |
| 84702 |
|
1,628 |
1,273 |
$23K |
| 85379 |
|
2,816 |
2,521 |
$22K |
| 96415 |
|
733 |
425 |
$22K |
| 73564 |
|
899 |
768 |
$22K |
| C9113 |
Inj pantoprazole sodium, via |
1,844 |
1,214 |
$21K |
| 84466 |
|
1,916 |
1,661 |
$21K |
| 97530 |
|
337 |
110 |
$20K |
| A9537 |
Tc99m mebrofenin |
240 |
179 |
$20K |
| 88307 |
|
216 |
192 |
$20K |
| 87075 |
|
1,108 |
933 |
$19K |
| J0131 |
Inj, acetaminophen (nos) |
601 |
527 |
$19K |
| 82728 |
|
2,027 |
1,717 |
$18K |
| 84520 |
|
672 |
370 |
$18K |
| 83540 |
|
2,897 |
2,507 |
$17K |
| 73080 |
|
667 |
601 |
$16K |
| 76775 |
|
338 |
328 |
$16K |
| 73590 |
|
404 |
345 |
$15K |
| 80143 |
|
1,812 |
1,554 |
$15K |
| 97035 |
|
390 |
161 |
$14K |
| J0330 |
Succinycholine chloride inj |
1,374 |
1,249 |
$14K |
| 73221 |
|
61 |
58 |
$14K |
| 76770 |
|
355 |
335 |
$13K |
| 84439 |
|
1,597 |
1,480 |
$13K |
| 86308 |
|
370 |
340 |
$13K |
| 76700 |
|
143 |
138 |
$13K |
| P9047 |
Albumin (human), 25%, 50ml |
154 |
65 |
$12K |
| 36430 |
|
204 |
148 |
$12K |
| J2795 |
Ropivacaine hcl injection |
1,798 |
1,551 |
$12K |
| 87632 |
|
48 |
45 |
$12K |
| 86038 |
|
630 |
591 |
$11K |
| 76642 |
|
294 |
258 |
$11K |
| 82247 |
|
2,055 |
1,425 |
$11K |
| 97014 |
|
348 |
146 |
$11K |
| 85652 |
|
1,517 |
1,326 |
$11K |
| J2765 |
Metoclopramide hcl injection |
918 |
783 |
$10K |
| C9803 |
Hopd covid-19 spec collect |
2,294 |
2,141 |
$10K |
| 83970 |
|
461 |
425 |
$10K |
| 84436 |
|
1,180 |
977 |
$10K |
| P9016 |
Rbc leukocytes reduced |
173 |
123 |
$10K |
| 93880 |
|
107 |
102 |
$9K |
| 93975 |
|
93 |
91 |
$9K |
| 71100 |
|
387 |
362 |
$9K |
| 12001 |
|
72 |
68 |
$9K |
| 80179 |
|
1,093 |
929 |
$9K |
| 72100 |
|
493 |
457 |
$9K |
| 87150 |
|
306 |
295 |
$8K |
| 82542 |
|
119 |
96 |
$8K |
| 87389 |
|
219 |
190 |
$8K |
| 88104 |
|
238 |
218 |
$8K |
| 58661 |
|
17 |
13 |
$8K |
| 30802 |
|
13 |
12 |
$8K |
| J2060 |
Lorazepam injection |
1,722 |
1,062 |
$7K |
| 82248 |
|
1,900 |
1,458 |
$7K |
| 99213 |
|
180 |
173 |
$7K |
| 87420 |
|
208 |
179 |
$7K |
| J0561 |
Penicillin g benzathine inj |
48 |
41 |
$7K |
| 83655 |
|
529 |
512 |
$7K |
| 96368 |
|
830 |
553 |
$6K |
| 84112 |
|
68 |
51 |
$6K |
| 80074 |
|
180 |
152 |
$6K |
| 84550 |
|
1,592 |
1,318 |
$6K |
| 85018 |
|
674 |
588 |
$6K |
| 80305 |
|
1,046 |
902 |
$6K |
| 74300 |
|
65 |
51 |
$6K |
| 85014 |
|
540 |
461 |
$6K |
| 82784 |
|
273 |
246 |
$5K |
| 82803 |
|
988 |
779 |
$5K |
| 87653 |
|
189 |
168 |
$5K |
| 76856 |
|
108 |
105 |
$5K |
| 90686 |
|
547 |
442 |
$5K |
| Q3014 |
Telehealth facility fee |
304 |
256 |
$5K |
| J3370 |
Vancomycin hcl injection |
1,534 |
552 |
$5K |
| 84479 |
|
611 |
481 |
$5K |
| 82043 |
|
1,234 |
1,137 |
$5K |
| A4649 |
Surgical supplies |
75 |
58 |
$5K |
| J2805 |
Sincalide injection |
98 |
74 |
$4K |
| 86430 |
|
237 |
228 |
$4K |
| 73090 |
|
265 |
231 |
$4K |
| 82105 |
|
338 |
312 |
$4K |
| 77066 |
Tomosynthesis, mammo |
89 |
85 |
$4K |
| J3490 |
Drugs unclassified injection |
7,568 |
3,425 |
$4K |
| 76870 |
|
67 |
65 |
$4K |
| 10060 |
|
67 |
57 |
$4K |
| 69436 |
|
12 |
12 |
$4K |
| 31231 |
|
57 |
56 |
$4K |
| 87661 |
|
94 |
90 |
$4K |
| 87506 |
|
33 |
32 |
$4K |
| J3475 |
Inj magnesium sulfate |
2,062 |
1,339 |
$3K |
| P9612 |
Catheterize for urine spec |
207 |
189 |
$3K |
| 93226 |
|
104 |
100 |
$3K |
| 83550 |
|
851 |
754 |
$3K |
| J2704 |
Inj, propofol, 10 mg |
2,803 |
2,304 |
$3K |
| G0279 |
Tomosynthesis, mammo |
131 |
123 |
$3K |
| 86780 |
|
307 |
257 |
$3K |
| 82570 |
|
1,050 |
901 |
$3K |
| 82950 |
|
733 |
661 |
$3K |
| 99202 |
|
84 |
83 |
$3K |
| 93225 |
|
104 |
100 |
$3K |
| 81003 |
|
3,029 |
2,653 |
$3K |
| 83630 |
|
65 |
57 |
$3K |
| G0008 |
Admin influenza virus vac |
467 |
380 |
$3K |
| 97116 |
|
259 |
153 |
$3K |
| 93970 |
|
43 |
41 |
$3K |
| 86592 |
|
604 |
552 |
$3K |
| 36591 |
|
47 |
43 |
$3K |
| 82009 |
|
35 |
25 |
$3K |
| 87634 |
|
58 |
54 |
$3K |
| 84100 |
|
753 |
572 |
$2K |
| 70491 |
|
43 |
36 |
$2K |
| 94664 |
|
97 |
63 |
$2K |
| J1956 |
Levofloxacin injection |
167 |
105 |
$2K |
| 86850 |
|
679 |
570 |
$2K |
| 95117 |
|
253 |
104 |
$2K |
| 87426 |
|
78 |
75 |
$2K |
| 77080 |
|
50 |
50 |
$2K |
| J3480 |
Inj potassium chloride |
1,212 |
708 |
$2K |
| 86738 |
|
92 |
90 |
$2K |
| 31575 |
|
48 |
46 |
$2K |
| 80069 |
|
303 |
229 |
$2K |
| 84153 |
|
132 |
117 |
$2K |
| 76817 |
|
58 |
56 |
$2K |
| 87493 |
|
26 |
24 |
$2K |
| 86618 |
|
74 |
67 |
$2K |
| 95165 |
|
34 |
34 |
$2K |
| 70492 |
|
27 |
24 |
$2K |
| 83721 |
|
212 |
190 |
$2K |
| 86300 |
|
155 |
140 |
$2K |
| 51702 |
|
410 |
358 |
$2K |
| J0171 |
Adrenalin epinephrine inject |
218 |
173 |
$1K |
| 73140 |
|
91 |
80 |
$1K |
| J2790 |
Rho d immune globulin inj |
16 |
14 |
$1K |
| 84165 |
|
63 |
59 |
$1K |
| 86803 |
|
127 |
118 |
$1K |
| 97112 |
|
78 |
41 |
$1K |
| 87205 |
|
605 |
500 |
$1K |
| 76805 |
|
12 |
12 |
$1K |
| J1650 |
Inj enoxaparin sodium |
834 |
391 |
$1K |
| 88175 |
|
65 |
58 |
$1K |
| J2920 |
Methylprednisolone injection |
124 |
52 |
$1K |
| J1644 |
Inj heparin sodium per 1000u |
2,060 |
935 |
$1K |
| U0002 |
Covid-19 lab test non-cdc |
34 |
28 |
$1K |
| J1815 |
Insulin injection |
503 |
211 |
$1K |
| J2800 |
Methocarbamol injection |
97 |
78 |
$1K |
| 87340 |
|
69 |
65 |
$1K |
| 86706 |
|
48 |
46 |
$1K |
| 92567 |
|
180 |
174 |
$953.01 |
| C1769 |
Guide wire |
225 |
189 |
$949.76 |
| J2919 |
Inj, methylpred sod succ 5mg |
449 |
377 |
$869.78 |
| 83615 |
|
214 |
170 |
$848.76 |
| 86705 |
|
32 |
30 |
$762.53 |
| 97164 |
|
14 |
13 |
$759.55 |
| 86704 |
|
31 |
29 |
$668.51 |
| J2543 |
Piperacillin/tazobactam |
523 |
254 |
$617.63 |
| 86707 |
|
28 |
26 |
$615.95 |
| 87350 |
|
28 |
26 |
$615.34 |
| 99214 |
|
29 |
24 |
$598.68 |
| J1940 |
Furosemide injection |
1,014 |
569 |
$548.64 |
| 87521 |
Neg quan hep c or qual rna |
18 |
12 |
$540.64 |
| 82272 |
|
222 |
195 |
$532.98 |
| 87147 |
|
226 |
202 |
$519.54 |
| 87522 |
Neg quan hep c or qual rna |
13 |
13 |
$487.86 |
| 83021 |
|
33 |
28 |
$445.28 |
| 73552 |
|
41 |
40 |
$431.40 |
| 72131 |
|
16 |
15 |
$421.30 |
| 87210 |
|
91 |
77 |
$417.26 |
| 73522 |
|
43 |
37 |
$416.60 |
| 99152 |
|
140 |
126 |
$413.44 |
| 87076 |
|
40 |
36 |
$412.78 |
| 86431 |
|
93 |
89 |
$410.77 |
| 84156 |
|
291 |
247 |
$372.43 |
| 92610 |
|
14 |
14 |
$358.24 |
| 80055 |
|
15 |
14 |
$357.50 |
| 70551 |
|
13 |
12 |
$357.19 |
| 82378 |
|
53 |
44 |
$350.19 |
| 73560 |
|
27 |
24 |
$328.77 |
| 83498 |
|
15 |
12 |
$308.29 |
| 80164 |
|
39 |
37 |
$300.49 |
| 88302 |
|
17 |
13 |
$285.67 |
| 80051 |
|
53 |
27 |
$278.43 |
| 84132 |
|
31 |
28 |
$265.84 |
| 86703 |
|
32 |
29 |
$249.44 |
| 83789 |
|
15 |
12 |
$233.92 |
| 84460 |
|
129 |
97 |
$231.94 |
| 84144 |
|
14 |
13 |
$218.29 |
| J0780 |
Prochlorperazine injection |
571 |
463 |
$214.56 |
| 86769 |
|
14 |
12 |
$201.27 |
| 84450 |
|
112 |
85 |
$193.86 |
| 83520 |
|
16 |
13 |
$190.04 |
| 82010 |
|
39 |
37 |
$187.92 |
| J1040 |
Methylprednisolone 80 mg inj |
38 |
24 |
$176.97 |
| 82139 |
|
16 |
13 |
$171.45 |
| 82077 |
|
1,714 |
1,411 |
$163.16 |
| 86920 |
|
16 |
12 |
$162.16 |
| 82261 |
|
15 |
12 |
$156.27 |
| 82016 |
|
15 |
12 |
$153.21 |
| 82128 |
|
15 |
12 |
$131.77 |
| 86923 |
|
37 |
26 |
$126.67 |
| 83020 |
|
15 |
12 |
$123.59 |
| J1010 |
Inj, methylpred acetate 1 mg |
47 |
40 |
$122.23 |
| J1953 |
Levetiracetam injection |
33 |
14 |
$116.05 |
| 82040 |
|
25 |
24 |
$115.06 |
| 82776 |
|
15 |
12 |
$114.42 |
| 73060 |
|
13 |
12 |
$105.74 |
| 84510 |
|
15 |
12 |
$105.34 |
| J0456 |
Azithromycin |
97 |
56 |
$96.08 |
| 74022 |
|
13 |
12 |
$92.65 |
| J7120 |
Ringers lactate infusion |
1,460 |
1,184 |
$79.59 |
| 84437 |
|
15 |
12 |
$77.64 |
| 72170 |
|
13 |
13 |
$67.17 |
| 82270 |
|
55 |
50 |
$65.71 |
| 84030 |
|
15 |
12 |
$61.42 |
| J1630 |
Haloperidol injection |
57 |
41 |
$46.30 |
| 84155 |
|
12 |
12 |
$40.23 |
| 51798 |
|
12 |
12 |
$36.62 |
| 99153 |
Mod sedat endo service >5yrs |
17 |
13 |
$33.52 |
| J7510 |
Prednisolone oral per 5 mg |
131 |
113 |
$33.36 |
| 96523 |
|
30 |
25 |
$25.72 |
| G1010 |
Cdsm stanson |
14 |
12 |
$25.00 |
| 84075 |
|
39 |
25 |
$24.81 |
| J2371 |
Inj phenylephrine hcl 20 mcg |
89 |
78 |
$23.62 |
| J1580 |
Garamycin gentamicin inj |
22 |
14 |
$12.56 |
| J0688 |
Inj cefazolin sodium, hikma |
15 |
14 |
$11.76 |
| J0136 |
Inj, acetaminophen (b braun) |
14 |
13 |
$10.70 |
| J0737 |
Inj, clindamycin (baxter) |
14 |
13 |
$9.08 |
| J2370 |
Phenylephrine hcl injection |
262 |
241 |
$2.44 |
| A4648 |
Implantable tissue marker |
13 |
12 |
$1.07 |
| J3105 |
Terbutaline sulfate inj |
76 |
56 |
$0.98 |
| Q0162 |
Ondansetron oral |
828 |
666 |
$0.65 |
| J7512 |
Prednisone ir or dr oral 1mg |
40 |
36 |
$0.43 |
| C1894 |
Intro/sheath, non-laser |
17 |
12 |
$0.36 |
| A9270 |
Non-covered item or service |
103 |
67 |
$0.14 |
| J2003 |
Inj, lidocaine hcl, 1 mg |
106 |
98 |
$0.00 |
| J2470 |
Inj pantoprazole sodium 40mg |
89 |
70 |
$0.00 |
| Q0177 |
Hydroxyzine pamoate 25mg |
59 |
40 |
$0.00 |
| 77062 |
|
25 |
25 |
$0.00 |
| G8978 |
Mobility current status |
31 |
27 |
$0.00 |
| G8979 |
Mobility goal status |
32 |
27 |
$0.00 |