| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| G0463 |
Hospital outpt clinic visit |
305,789 |
278,012 |
$14.75M |
| 99284 |
|
25,509 |
24,705 |
$9.21M |
| 99283 |
|
28,225 |
27,499 |
$7.11M |
| 99285 |
|
8,549 |
8,178 |
$4.64M |
| 99211 |
|
72,806 |
64,361 |
$2.18M |
| G0378 |
Hospital observation per hr |
2,146 |
2,005 |
$1.72M |
| 42820 |
|
173 |
172 |
$1.29M |
| 95810 |
|
1,278 |
1,257 |
$1.11M |
| U0003 |
Cov-19 amp prb hgh thruput |
12,371 |
11,923 |
$1.06M |
| 96374 |
|
7,167 |
5,424 |
$945K |
| A0427 |
Als1-emergency |
2,654 |
2,210 |
$906K |
| J9271 |
Inj pembrolizumab |
382 |
322 |
$826K |
| J1745 |
Infliximab not biosimil 10mg |
2,613 |
2,062 |
$786K |
| 96413 |
|
3,831 |
2,772 |
$783K |
| 95004 |
|
2,261 |
2,225 |
$761K |
| 87633 |
|
3,722 |
3,614 |
$749K |
| 99282 |
|
4,856 |
4,776 |
$706K |
| 93304 |
|
1,807 |
1,748 |
$696K |
| 59025 |
|
3,872 |
1,803 |
$677K |
| J1459 |
Inj ivig privigen 500 mg |
2,834 |
994 |
$664K |
| A0431 |
Rotary wing air transport |
173 |
149 |
$612K |
| 95782 |
|
687 |
669 |
$606K |
| 74177 |
|
2,377 |
2,291 |
$601K |
| 70553 |
|
1,925 |
1,885 |
$589K |
| T1015 |
Clinic service |
7,945 |
5,206 |
$542K |
| 96365 |
|
4,019 |
3,191 |
$516K |
| A0428 |
Bls |
3,059 |
2,812 |
$505K |
| J3380 |
Inj vedolizumab iv 1 mg |
707 |
656 |
$453K |
| A0429 |
Bls-emergency |
1,632 |
1,332 |
$438K |
| 76770 |
|
4,449 |
4,371 |
$424K |
| 94010 |
|
3,654 |
3,602 |
$413K |
| 92014 |
|
6,509 |
6,415 |
$398K |
| 43239 |
|
754 |
734 |
$396K |
| J2357 |
Omalizumab injection |
1,703 |
1,272 |
$389K |
| 93005 |
|
12,855 |
11,985 |
$387K |
| 93306 |
|
985 |
972 |
$386K |
| J0585 |
Injection,onabotulinumtoxina |
4,199 |
3,303 |
$344K |
| 71045 |
|
5,840 |
5,552 |
$338K |
| 96361 |
|
5,332 |
4,222 |
$318K |
| 95117 |
|
7,277 |
5,435 |
$299K |
| 96372 |
|
7,362 |
6,174 |
$283K |
| A0425 |
Ground mileage |
6,520 |
5,488 |
$274K |
| 76816 |
|
2,783 |
2,596 |
$269K |
| 92557 |
|
2,522 |
2,498 |
$267K |
| C9803 |
Hopd covid-19 spec collect |
12,646 |
12,191 |
$259K |
| 45380 |
|
303 |
295 |
$241K |
| 94060 |
|
1,082 |
1,063 |
$233K |
| 64642 |
|
630 |
601 |
$233K |
| 80053 |
|
33,506 |
28,825 |
$231K |
| 96375 |
|
6,284 |
4,544 |
$230K |
| 92012 |
|
3,202 |
3,038 |
$226K |
| 85025 |
|
46,477 |
40,157 |
$225K |
| 71046 |
|
3,501 |
3,378 |
$217K |
| J2323 |
Natalizumab injection |
242 |
229 |
$217K |
| U0005 |
Infec agen detec ampli probe |
9,887 |
9,500 |
$216K |
| 96360 |
|
1,689 |
1,518 |
$211K |
| 92060 |
|
5,160 |
5,042 |
$211K |
| 95816 |
|
828 |
819 |
$209K |
| 87637 |
|
1,352 |
1,335 |
$200K |
| 45385 |
|
241 |
235 |
$197K |
| 93226 |
|
2,028 |
2,004 |
$197K |
| 87635 |
|
4,186 |
4,052 |
$194K |
| 90471 |
|
4,568 |
4,457 |
$188K |
| 36415 |
|
63,578 |
55,962 |
$185K |
| 86900 |
|
2,644 |
2,367 |
$182K |
| 76811 |
|
779 |
769 |
$181K |
| 97803 |
|
3,296 |
3,139 |
$179K |
| 92567 |
|
6,906 |
6,786 |
$175K |
| 92587 |
|
740 |
711 |
$175K |
| 36430 |
|
586 |
344 |
$168K |
| 97110 |
|
4,763 |
2,258 |
$150K |
| 20610 |
|
962 |
895 |
$150K |
| 71260 |
|
1,269 |
1,238 |
$149K |
| A0436 |
Rotary wing air mileage |
162 |
137 |
$149K |
| 70551 |
|
740 |
721 |
$147K |
| 78815 |
|
140 |
138 |
$142K |
| J0897 |
Denosumab injection |
1,207 |
1,176 |
$141K |
| 76815 |
|
1,626 |
841 |
$135K |
| 94640 |
|
1,041 |
606 |
$135K |
| 76830 |
|
1,301 |
1,256 |
$128K |
| 74176 |
|
831 |
795 |
$126K |
| 88305 |
|
2,590 |
2,480 |
$125K |
| 95708 |
|
310 |
248 |
$123K |
| G0101 |
Ca screen;pelvic/breast exam |
1,636 |
1,611 |
$122K |
| 70450 |
|
1,548 |
1,480 |
$121K |
| C8929 |
Tte w or wo fol wcon,doppler |
345 |
339 |
$118K |
| J1439 |
Inj ferric carboxymaltos 1mg |
1,029 |
743 |
$115K |
| 95811 |
|
147 |
139 |
$115K |
| 31575 |
|
763 |
750 |
$109K |
| 58300 |
|
269 |
264 |
$108K |
| 93303 |
|
305 |
302 |
$107K |
| G0108 |
Diab manage trn per indiv |
1,003 |
951 |
$104K |
| 77067 |
|
933 |
923 |
$104K |
| 84443 |
|
7,676 |
7,403 |
$103K |
| 80307 |
|
1,930 |
1,766 |
$102K |
| 93308 |
|
558 |
540 |
$102K |
| 87591 |
|
3,488 |
3,380 |
$100K |
| 87491 |
|
3,474 |
3,367 |
$99K |
| 43235 |
|
170 |
166 |
$94K |
| 76705 |
|
999 |
958 |
$91K |
| 93975 |
|
492 |
475 |
$90K |
| Q3014 |
Telehealth facility fee |
5,061 |
4,699 |
$90K |
| 97162 |
|
1,237 |
1,217 |
$87K |
| 69436 |
|
66 |
65 |
$84K |
| 95911 |
|
214 |
208 |
$84K |
| J9312 |
Inj., rituximab, 10 mg |
32 |
14 |
$83K |
| 96415 |
|
1,537 |
1,214 |
$83K |
| 96409 |
|
494 |
325 |
$81K |
| 93325 |
|
3,230 |
3,086 |
$80K |
| 96366 |
|
1,188 |
874 |
$80K |
| 93017 |
|
494 |
482 |
$76K |
| 80061 |
|
5,758 |
5,652 |
$74K |
| P9040 |
Rbc leukoreduced irradiated |
218 |
166 |
$73K |
| 72197 |
|
207 |
205 |
$73K |
| 74018 |
|
1,538 |
1,439 |
$70K |
| 94726 |
|
476 |
462 |
$69K |
| 64615 |
|
358 |
355 |
$69K |
| 72148 |
|
430 |
422 |
$69K |
| 97802 |
|
833 |
794 |
$67K |
| 95700 |
|
346 |
338 |
$67K |
| 72141 |
|
319 |
315 |
$65K |
| 92507 |
|
1,225 |
475 |
$64K |
| 73630 |
|
1,235 |
1,065 |
$64K |
| 97530 |
|
1,546 |
813 |
$63K |
| 74178 |
|
258 |
254 |
$63K |
| 76825 |
|
133 |
125 |
$61K |
| 74183 |
|
223 |
221 |
$61K |
| G0008 |
Admin influenza virus vac |
1,756 |
1,722 |
$61K |
| 86850 |
|
2,392 |
2,134 |
$61K |
| 80050 |
|
469 |
454 |
$60K |
| 72100 |
|
944 |
912 |
$60K |
| 92134 |
|
2,004 |
1,945 |
$60K |
| 82306 |
|
3,751 |
3,653 |
$59K |
| 11981 |
|
85 |
84 |
$58K |
| 97165 |
|
850 |
833 |
$56K |
| 76700 |
|
571 |
566 |
$55K |
| 11102 |
|
426 |
409 |
$54K |
| 76817 |
|
625 |
534 |
$54K |
| 58661 |
|
12 |
12 |
$53K |
| 71250 |
|
598 |
581 |
$53K |
| G0379 |
Direct refer hospital observ |
40 |
40 |
$53K |
| 97161 |
|
711 |
694 |
$51K |
| J7298 |
Mirena, 52 mg |
519 |
503 |
$51K |
| 95165 |
|
192 |
190 |
$51K |
| 76819 |
|
442 |
292 |
$49K |
| 76536 |
|
546 |
528 |
$49K |
| 77334 |
|
83 |
68 |
$49K |
| 74230 |
|
321 |
317 |
$48K |
| 72156 |
|
190 |
188 |
$47K |
| 93321 |
|
2,248 |
2,145 |
$47K |
| 72195 |
|
144 |
139 |
$46K |
| G0145 |
Scr c/v cyto,thinlayer,rescr |
1,614 |
1,590 |
$46K |
| 17110 |
|
409 |
393 |
$46K |
| 76801 |
|
408 |
392 |
$45K |
| 86780 |
|
3,158 |
3,070 |
$44K |
| 86901 |
|
2,392 |
2,128 |
$44K |
| 93970 |
|
239 |
231 |
$42K |
| 64493 |
|
66 |
64 |
$42K |
| 95076 |
|
89 |
84 |
$42K |
| 82728 |
|
4,167 |
3,962 |
$42K |
| G0476 |
Hpv combo assay ca screen |
1,232 |
1,208 |
$41K |
| 80048 |
|
7,911 |
6,791 |
$41K |
| 92004 |
|
772 |
762 |
$40K |
| 92228 |
|
1,285 |
1,267 |
$40K |
| 76805 |
|
334 |
326 |
$39K |
| 88342 |
|
519 |
503 |
$38K |
| 72158 |
|
164 |
161 |
$38K |
| 73721 |
|
197 |
188 |
$38K |
| 93225 |
|
542 |
536 |
$37K |
| 92083 |
|
593 |
584 |
$36K |
| 93971 |
|
478 |
462 |
$36K |
| 83036 |
|
4,880 |
4,784 |
$35K |
| 87389 |
|
1,047 |
1,038 |
$35K |
| 76820 |
|
421 |
239 |
$35K |
| 93350 |
|
104 |
101 |
$35K |
| 70491 |
|
237 |
235 |
$35K |
| 72170 |
|
517 |
509 |
$34K |
| 73030 |
|
717 |
661 |
$34K |
| 73610 |
|
741 |
646 |
$34K |
| 20611 |
|
198 |
193 |
$34K |
| 96367 |
|
840 |
645 |
$33K |
| 95886 |
|
390 |
379 |
$33K |
| 95115 |
|
1,051 |
697 |
$33K |
| 86003 |
|
546 |
506 |
$32K |
| 92579 |
|
333 |
317 |
$32K |
| 96411 |
|
543 |
377 |
$32K |
| C8928 |
Tte w or w/o fol w/con,stres |
97 |
95 |
$32K |
| 31231 |
|
228 |
218 |
$32K |
| 85027 |
|
7,242 |
6,236 |
$31K |
| 11900 |
|
276 |
260 |
$31K |
| 87086 |
|
5,545 |
5,182 |
$31K |
| 76642 |
|
462 |
449 |
$31K |
| 73560 |
|
797 |
700 |
$31K |
| A0434 |
Specialty care transport |
56 |
45 |
$31K |
| 90686 |
|
8,986 |
8,843 |
$30K |
| 84466 |
|
2,827 |
2,707 |
$29K |
| 77063 |
|
809 |
797 |
$29K |
| 86923 |
|
271 |
227 |
$29K |
| 77066 |
Tomosynthesis, mammo |
281 |
273 |
$28K |
| 83970 |
|
891 |
866 |
$28K |
| 96450 |
|
98 |
87 |
$28K |
| 20552 |
|
195 |
193 |
$28K |
| 92201 |
|
738 |
705 |
$28K |
| 45378 |
|
43 |
42 |
$27K |
| 77336 |
|
294 |
136 |
$27K |
| 86803 |
|
2,216 |
2,154 |
$27K |
| 88185 |
|
95 |
87 |
$27K |
| 70496 |
|
152 |
148 |
$27K |
| 99393 |
|
912 |
871 |
$27K |
| 86481 |
|
342 |
331 |
$26K |
| 74240 |
|
184 |
178 |
$26K |
| 97140 |
|
1,232 |
547 |
$25K |
| 83735 |
|
5,802 |
4,079 |
$25K |
| C8921 |
Tte w or w/o fol w/cont, com |
54 |
54 |
$25K |
| 72040 |
|
504 |
485 |
$25K |
| 11104 |
|
117 |
112 |
$24K |
| 70486 |
|
293 |
285 |
$24K |
| 93296 |
|
992 |
981 |
$24K |
| 67028 |
|
115 |
106 |
$24K |
| 92609 |
|
357 |
119 |
$23K |
| 77072 |
|
319 |
310 |
$23K |
| 84439 |
|
3,443 |
3,313 |
$23K |
| 92526 |
|
439 |
223 |
$23K |
| 76882 |
|
300 |
273 |
$23K |
| 97112 |
|
775 |
493 |
$23K |
| 87497 |
|
602 |
335 |
$23K |
| 73562 |
|
471 |
406 |
$23K |
| 92610 |
|
419 |
398 |
$23K |
| 38222 |
|
13 |
13 |
$23K |
| 77080 |
|
232 |
231 |
$23K |
| 70543 |
|
63 |
62 |
$22K |
| P9016 |
Rbc leukocytes reduced |
91 |
81 |
$22K |
| C1769 |
Guide wire |
705 |
628 |
$22K |
| 82784 |
|
1,690 |
1,505 |
$21K |
| 92552 |
|
292 |
286 |
$21K |
| 86235 |
|
355 |
340 |
$21K |
| 49452 |
|
18 |
17 |
$21K |
| 99394 |
|
546 |
537 |
$21K |
| 84403 |
|
583 |
561 |
$21K |
| 88184 |
|
126 |
116 |
$21K |
| 83037 |
|
3,301 |
3,278 |
$21K |
| 74455 |
|
98 |
95 |
$20K |
| 96158 |
|
409 |
393 |
$19K |
| 73590 |
|
458 |
405 |
$19K |
| 83516 |
|
936 |
911 |
$19K |
| 96416 |
|
82 |
62 |
$19K |
| 73130 |
|
454 |
391 |
$19K |
| 96417 |
|
387 |
264 |
$19K |
| 73564 |
|
285 |
249 |
$19K |
| 73502 |
|
397 |
383 |
$19K |
| 87536 |
|
344 |
332 |
$18K |
| 73120 |
|
232 |
162 |
$18K |
| 36591 |
|
205 |
162 |
$18K |
| 20553 |
|
117 |
116 |
$18K |
| 87426 |
|
356 |
355 |
$18K |
| 78264 |
|
65 |
64 |
$18K |
| 73110 |
|
356 |
320 |
$18K |
| G0475 |
Hiv combination assay |
1,527 |
1,468 |
$18K |
| 77065 |
Tomosynthesis, mammo |
206 |
189 |
$18K |
| 20550 |
|
113 |
104 |
$17K |
| 86828 |
|
353 |
344 |
$17K |
| 92553 |
|
231 |
229 |
$17K |
| 87340 |
|
1,988 |
1,931 |
$17K |
| 76870 |
|
202 |
197 |
$17K |
| 82607 |
|
1,593 |
1,539 |
$17K |
| J1750 |
Inj iron dextran |
555 |
511 |
$17K |
| G0480 |
Drug test def 1-7 classes |
801 |
738 |
$17K |
| 83880 |
|
821 |
772 |
$17K |
| 84702 |
|
1,352 |
1,062 |
$17K |
| 92133 |
|
722 |
712 |
$17K |
| 76856 |
|
183 |
180 |
$17K |
| 90651 |
|
1,356 |
1,322 |
$16K |
| 97113 |
|
387 |
184 |
$16K |
| 87799 |
|
342 |
198 |
$16K |
| 73221 |
|
85 |
85 |
$16K |
| 83540 |
|
3,012 |
2,888 |
$16K |
| J7307 |
Etonogestrel implant system |
176 |
168 |
$16K |
| 86140 |
|
4,784 |
4,367 |
$16K |
| 97166 |
|
248 |
243 |
$16K |
| 81025 |
|
2,574 |
2,435 |
$16K |
| 88307 |
|
226 |
213 |
$15K |
| 84484 |
|
2,179 |
1,880 |
$15K |
| 73090 |
|
285 |
258 |
$15K |
| 74019 |
|
248 |
236 |
$15K |
| 99392 |
|
691 |
679 |
$15K |
| 43762 |
|
60 |
59 |
$15K |
| 72157 |
|
58 |
58 |
$15K |
| 88341 |
|
180 |
172 |
$15K |
| 82077 |
|
206 |
199 |
$15K |
| 92551 |
|
613 |
606 |
$15K |
| 90715 |
|
4,487 |
4,044 |
$15K |
| 74181 |
|
110 |
106 |
$15K |
| 78306 |
|
64 |
64 |
$14K |
| 84100 |
|
4,461 |
3,062 |
$14K |
| 85610 |
|
5,447 |
4,145 |
$14K |
| 31579 |
|
50 |
50 |
$14K |
| 99395 |
|
870 |
853 |
$14K |
| A9585 |
Gadobutrol injection |
6,608 |
5,796 |
$14K |
| 83690 |
|
3,811 |
3,533 |
$14K |
| 72125 |
|
305 |
298 |
$14K |
| 99396 |
|
644 |
630 |
$14K |
| 87081 |
|
1,490 |
1,444 |
$14K |
| 92611 |
|
238 |
235 |
$14K |
| 92002 |
|
217 |
213 |
$13K |
| 72081 |
|
273 |
266 |
$13K |
| 83615 |
|
3,246 |
2,148 |
$13K |
| U0002 |
Covid-19 lab test non-cdc |
330 |
311 |
$13K |
| 88112 |
|
385 |
344 |
$13K |
| 81268 |
|
69 |
41 |
$12K |
| G2066 |
Inter devc remote 30d |
373 |
366 |
$12K |
| 86870 |
|
47 |
41 |
$12K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
10,944 |
9,290 |
$12K |
| 73552 |
|
330 |
296 |
$12K |
| 81001 |
|
5,404 |
5,119 |
$11K |
| J1453 |
Fosaprepitant injection |
528 |
342 |
$11K |
| 10060 |
|
51 |
50 |
$11K |
| 92015 |
|
8,514 |
8,411 |
$11K |
| 73080 |
|
228 |
207 |
$11K |
| 96156 |
|
232 |
227 |
$11K |
| 99391 |
|
812 |
793 |
$11K |
| 73070 |
|
206 |
175 |
$11K |
| 87631 |
|
87 |
86 |
$11K |
| 85652 |
|
5,609 |
5,200 |
$11K |
| 92582 |
|
149 |
143 |
$11K |
| 52000 |
|
40 |
39 |
$10K |
| 90670 |
|
717 |
701 |
$10K |
| 93320 |
|
237 |
233 |
$10K |
| 51728 |
|
29 |
29 |
$10K |
| 92555 |
|
530 |
518 |
$10K |
| 87077 |
|
1,804 |
1,743 |
$10K |
| 76512 |
|
127 |
121 |
$10K |
| 73140 |
|
225 |
212 |
$10K |
| C1713 |
Anchor/screw bn/bn,tis/bn |
160 |
141 |
$10K |
| 70498 |
|
97 |
94 |
$10K |
| 81003 |
|
5,669 |
5,352 |
$9K |
| 84481 |
|
655 |
616 |
$9K |
| 94729 |
|
461 |
448 |
$9K |
| 80197 |
|
865 |
539 |
$9K |
| 86762 |
|
707 |
694 |
$9K |
| 82746 |
|
785 |
759 |
$9K |
| 84146 |
|
478 |
457 |
$9K |
| 99153 |
Mod sedat endo service >5yrs |
352 |
338 |
$9K |
| 87880 |
|
538 |
518 |
$9K |
| 74174 |
|
28 |
28 |
$9K |
| 97804 |
|
317 |
292 |
$8K |
| 51798 |
|
384 |
369 |
$8K |
| 51702 |
|
139 |
132 |
$8K |
| 90734 |
|
452 |
438 |
$8K |
| 88304 |
|
415 |
399 |
$8K |
| 72082 |
|
157 |
149 |
$8K |
| 99495 |
|
121 |
120 |
$8K |
| 73620 |
|
151 |
123 |
$8K |
| 92593 |
|
681 |
652 |
$8K |
| 86580 |
|
314 |
279 |
$8K |
| 83655 |
|
637 |
614 |
$8K |
| 84460 |
|
2,096 |
1,908 |
$8K |
| 72070 |
|
124 |
119 |
$7K |
| 90732 |
|
474 |
462 |
$7K |
| 87653 |
|
231 |
222 |
$7K |
| 87186 |
|
1,246 |
1,213 |
$7K |
| 86160 |
|
484 |
451 |
$7K |
| C1887 |
Catheter, guiding |
360 |
339 |
$7K |
| 86038 |
|
772 |
742 |
$7K |
| 76885 |
|
76 |
73 |
$7K |
| 84550 |
|
2,092 |
1,235 |
$7K |
| 85046 |
|
1,745 |
1,575 |
$7K |
| 87522 |
Neg quan hep c or qual rna |
213 |
205 |
$7K |
| 76818 |
|
53 |
28 |
$7K |
| 58301 |
|
24 |
24 |
$7K |
| 83605 |
|
1,229 |
1,063 |
$7K |
| 99173 |
|
525 |
520 |
$7K |
| 10005 |
|
14 |
14 |
$7K |
| 49083 |
|
18 |
12 |
$7K |
| 99152 |
|
514 |
489 |
$7K |
| 86706 |
|
749 |
730 |
$7K |
| G0399 |
Home sleep test/type 3 porta |
96 |
94 |
$7K |
| 51705 |
|
62 |
56 |
$6K |
| 80069 |
|
984 |
809 |
$6K |
| 51741 |
|
111 |
109 |
$6K |
| 82670 |
|
268 |
251 |
$6K |
| 82570 |
|
1,517 |
1,380 |
$6K |
| 83001 |
|
393 |
376 |
$6K |
| 82962 |
|
3,402 |
2,593 |
$6K |
| 97163 |
|
61 |
60 |
$6K |
| 86335 |
|
292 |
262 |
$6K |
| 73100 |
|
118 |
97 |
$6K |
| 77073 |
|
98 |
97 |
$6K |
| 86618 |
|
387 |
372 |
$6K |
| 86704 |
|
565 |
551 |
$6K |
| J2704 |
Inj, propofol, 10 mg |
15,789 |
11,037 |
$6K |
| V5264 |
Ear mold/insert |
158 |
155 |
$6K |
| 77300 |
|
30 |
30 |
$6K |
| 82565 |
|
1,878 |
1,737 |
$6K |
| 70360 |
|
97 |
93 |
$6K |
| 11721 |
|
185 |
181 |
$6K |
| G0279 |
Tomosynthesis, mammo |
348 |
332 |
$6K |
| 87070 |
|
1,204 |
1,135 |
$6K |
| 80143 |
|
88 |
86 |
$6K |
| 91010 |
|
13 |
13 |
$5K |
| 73060 |
|
119 |
113 |
$5K |
| 87040 |
|
718 |
639 |
$5K |
| 87505 |
|
66 |
66 |
$5K |
| 83520 |
|
156 |
146 |
$5K |
| X0592 |
|
162 |
153 |
$5K |
| 86334 |
|
365 |
334 |
$5K |
| 84145 |
|
447 |
410 |
$5K |
| 97164 |
|
102 |
101 |
$5K |
| 91200 |
|
45 |
45 |
$5K |
| 70480 |
|
47 |
47 |
$5K |
| C1894 |
Intro/sheath, non-laser |
376 |
362 |
$5K |
| 83002 |
|
328 |
316 |
$5K |
| P9604 |
One-way allow prorated trip |
426 |
273 |
$5K |
| 76942 |
|
245 |
231 |
$5K |
| 82950 |
|
929 |
915 |
$5K |
| 87102 |
|
798 |
773 |
$5K |
| 93298 |
|
114 |
114 |
$5K |
| 84156 |
|
1,659 |
1,488 |
$5K |
| 71275 |
|
26 |
25 |
$5K |
| 87205 |
|
1,733 |
1,651 |
$5K |
| 82024 |
|
145 |
131 |
$4K |
| 83993 |
|
150 |
146 |
$4K |
| 82043 |
|
990 |
969 |
$4K |
| 82657 |
|
156 |
146 |
$4K |
| 82105 |
|
379 |
366 |
$4K |
| 96368 |
|
212 |
165 |
$4K |
| 36592 |
|
45 |
38 |
$4K |
| 80076 |
|
641 |
600 |
$4K |
| 92558 |
|
408 |
395 |
$4K |
| 80320 |
|
37 |
36 |
$4K |
| 83883 |
|
320 |
284 |
$4K |
| 97542 |
|
142 |
134 |
$4K |
| 11982 |
|
13 |
13 |
$4K |
| 94375 |
|
27 |
25 |
$4K |
| 96112 |
|
28 |
27 |
$4K |
| 87493 |
|
144 |
139 |
$4K |
| 84075 |
|
1,129 |
1,068 |
$4K |
| 84270 |
|
216 |
211 |
$4K |
| 90834 |
|
388 |
292 |
$4K |
| 64643 |
|
202 |
193 |
$4K |
| 84153 |
|
242 |
234 |
$4K |
| 86361 |
|
206 |
198 |
$4K |
| V5266 |
Battery for hearing device |
201 |
196 |
$4K |
| 86225 |
|
390 |
376 |
$4K |
| 96402 |
|
103 |
98 |
$4K |
| 36416 |
|
1,460 |
1,254 |
$4K |
| 82977 |
|
711 |
544 |
$4K |
| 82378 |
|
319 |
257 |
$4K |
| 85379 |
|
603 |
569 |
$4K |
| 82247 |
|
1,216 |
1,090 |
$4K |
| J2469 |
Palonosetron hcl |
1,657 |
866 |
$4K |
| 84450 |
|
936 |
816 |
$4K |
| 84425 |
|
194 |
182 |
$4K |
| 57454 |
|
12 |
12 |
$4K |
| A0426 |
Als 1 |
14 |
14 |
$3K |
| 97116 |
|
345 |
221 |
$3K |
| 87798 |
|
72 |
72 |
$3K |
| 72146 |
|
43 |
43 |
$3K |
| 83020 |
|
301 |
289 |
$3K |
| 74221 |
|
25 |
25 |
$3K |
| 85730 |
|
1,023 |
945 |
$3K |
| A4215 |
Sterile needle |
345 |
313 |
$3K |
| 82397 |
|
307 |
295 |
$3K |
| 82951 |
|
215 |
215 |
$3K |
| 11719 |
|
112 |
108 |
$3K |
| 51701 |
|
37 |
37 |
$3K |
| 92652 |
|
14 |
14 |
$3K |
| 64644 |
|
14 |
12 |
$3K |
| 95819 |
|
13 |
13 |
$3K |
| 90723 |
|
373 |
359 |
$3K |
| 82550 |
|
712 |
626 |
$3K |
| 86360 |
|
72 |
66 |
$3K |
| 84165 |
|
438 |
398 |
$3K |
| 82533 |
|
230 |
209 |
$3K |
| 76827 |
|
43 |
38 |
$3K |
| 82627 |
|
156 |
149 |
$3K |
| 93925 |
|
20 |
19 |
$3K |
| 73700 |
|
27 |
27 |
$3K |
| 95910 |
|
12 |
12 |
$3K |
| 91037 |
|
12 |
12 |
$3K |
| 88175 |
|
117 |
114 |
$3K |
| 95909 |
|
12 |
12 |
$3K |
| 88302 |
|
166 |
153 |
$3K |
| 84144 |
|
150 |
133 |
$3K |
| 93356 |
|
366 |
358 |
$3K |
| 82785 |
|
223 |
220 |
$3K |
| 86147 |
|
70 |
69 |
$3K |
| 96376 |
|
1,258 |
830 |
$3K |
| 87529 |
|
85 |
81 |
$3K |
| 76821 |
|
39 |
27 |
$3K |
| 87338 |
|
177 |
174 |
$2K |
| 96116 |
|
13 |
13 |
$2K |
| A0998 |
Ambulance response/treatment |
26 |
26 |
$2K |
| 11720 |
|
105 |
102 |
$2K |
| C1725 |
Cath, translumin non-laser |
14 |
12 |
$2K |
| 64405 |
|
13 |
12 |
$2K |
| 86039 |
|
267 |
254 |
$2K |
| 86200 |
|
245 |
235 |
$2K |
| 86359 |
|
72 |
66 |
$2K |
| 82248 |
|
523 |
357 |
$2K |
| 76937 |
|
60 |
58 |
$2K |
| 97760 |
|
60 |
54 |
$2K |
| 93880 |
|
17 |
17 |
$2K |
| 20605 |
|
13 |
12 |
$2K |
| G0123 |
Screen cerv/vag thin layer |
136 |
131 |
$2K |
| 86376 |
|
189 |
183 |
$2K |
| 99385 |
|
186 |
183 |
$2K |
| 58100 |
|
13 |
13 |
$2K |
| 87210 |
|
353 |
343 |
$2K |
| 83498 |
|
119 |
114 |
$2K |
| 86355 |
|
64 |
57 |
$2K |
| 80179 |
|
84 |
77 |
$2K |
| 90472 |
|
400 |
393 |
$2K |
| 86787 |
|
136 |
135 |
$2K |
| 88720 |
|
332 |
284 |
$2K |
| 99381 |
|
115 |
113 |
$2K |
| J3490 |
Drugs unclassified injection |
1,480 |
1,239 |
$2K |
| 83525 |
|
168 |
165 |
$2K |
| 51784 |
|
30 |
30 |
$2K |
| J3301 |
Triamcinolone acet inj nos |
4,009 |
3,424 |
$2K |
| 92504 |
|
482 |
471 |
$2K |
| C1729 |
Cath, drainage |
122 |
111 |
$2K |
| 86592 |
|
459 |
447 |
$2K |
| 86357 |
|
59 |
53 |
$2K |
| Q9969 |
Non-heu tc-99m add-on/dose |
248 |
244 |
$2K |
| 80177 |
|
164 |
154 |
$2K |
| 86431 |
|
413 |
400 |
$2K |
| 96132 |
|
14 |
14 |
$2K |
| 97535 |
|
155 |
134 |
$2K |
| 12001 |
|
27 |
27 |
$2K |
| 77002 |
|
29 |
27 |
$2K |
| 70250 |
|
32 |
30 |
$2K |
| 86146 |
|
52 |
52 |
$2K |
| 59430 |
|
42 |
42 |
$2K |
| 87075 |
|
301 |
270 |
$2K |
| 82150 |
|
367 |
341 |
$2K |
| 84630 |
|
162 |
159 |
$2K |
| 84305 |
|
103 |
101 |
$2K |
| 89051 |
|
373 |
324 |
$1K |
| 92523 |
|
12 |
12 |
$1K |
| 82947 |
|
427 |
414 |
$1K |
| 84520 |
|
707 |
651 |
$1K |
| 84207 |
|
27 |
26 |
$1K |
| 87899 |
|
69 |
68 |
$1K |
| 90647 |
|
483 |
407 |
$1K |
| 80164 |
|
108 |
101 |
$1K |
| 72131 |
|
27 |
27 |
$1K |
| 82232 |
|
109 |
96 |
$1K |
| 86141 |
|
126 |
121 |
$1K |
| 83921 |
|
73 |
71 |
$1K |
| 99281 |
|
13 |
12 |
$1K |
| G0009 |
Admin pneumococcal vaccine |
65 |
62 |
$1K |
| 92583 |
|
54 |
52 |
$1K |
| G0103 |
Psa screening |
122 |
121 |
$1K |
| Q9957 |
Inj perflutren lip micros,ml |
302 |
262 |
$1K |
| 86021 |
|
92 |
86 |
$1K |
| 94761 |
|
12 |
12 |
$998.72 |
| J1170 |
Hydromorphone injection |
5,635 |
3,295 |
$986.36 |
| 99386 |
|
43 |
43 |
$949.54 |
| 88172 |
|
14 |
14 |
$945.37 |
| 69209 |
|
27 |
27 |
$940.84 |
| 85018 |
|
429 |
361 |
$919.73 |
| 88173 |
|
32 |
32 |
$915.45 |
| 86708 |
|
84 |
84 |
$915.21 |
| 82103 |
|
38 |
37 |
$891.56 |
| 80175 |
|
75 |
75 |
$884.64 |
| 82040 |
|
391 |
370 |
$879.77 |
| 96113 |
|
27 |
25 |
$861.37 |
| 82330 |
|
103 |
91 |
$855.57 |
| 0081A |
|
14 |
14 |
$845.91 |
| 85384 |
|
109 |
84 |
$827.53 |
| J1100 |
Dexamethasone sodium phos |
11,401 |
8,965 |
$825.49 |
| 90662 |
|
419 |
412 |
$815.28 |
| 96161 |
|
92 |
91 |
$807.10 |
| J2270 |
Morphine sulfate injection |
3,119 |
2,144 |
$804.63 |
| 87206 |
|
266 |
247 |
$789.19 |
| 82952 |
|
174 |
174 |
$777.90 |
| A9541 |
Tc99m sulfur colloid |
28 |
27 |
$749.08 |
| 90746 |
|
54 |
54 |
$725.92 |
| 17250 |
|
13 |
12 |
$716.86 |
| J9370 |
Vincristine sulfate 1 mg inj |
665 |
430 |
$715.10 |
| 90750 |
|
41 |
41 |
$712.92 |
| 84703 |
|
151 |
144 |
$712.85 |
| 87106 |
|
83 |
81 |
$704.61 |
| 88313 |
|
12 |
12 |
$653.32 |
| 88300 |
|
154 |
150 |
$624.33 |
| 3078F |
|
71,131 |
61,153 |
$621.57 |
| 71271 |
|
12 |
12 |
$613.40 |
| 84446 |
|
54 |
54 |
$613.06 |
| J1644 |
Inj heparin sodium per 1000u |
2,314 |
1,306 |
$601.93 |
| 87661 |
|
14 |
13 |
$591.52 |
| 81002 |
|
184 |
175 |
$587.62 |
| J0780 |
Prochlorperazine injection |
1,373 |
1,138 |
$586.98 |
| 90681 |
|
86 |
85 |
$585.29 |
| J1885 |
Ketorolac tromethamine inj |
8,358 |
6,480 |
$577.28 |
| 86696 |
|
29 |
28 |
$576.06 |
| 82310 |
|
189 |
179 |
$575.93 |
| 82803 |
|
73 |
66 |
$572.24 |
| 85240 |
|
36 |
36 |
$535.22 |
| 87116 |
|
109 |
98 |
$509.87 |
| 86800 |
|
37 |
37 |
$508.14 |
| 86645 |
|
26 |
26 |
$505.76 |
| 82507 |
|
16 |
16 |
$486.46 |
| J2920 |
Methylprednisolone injection |
1,174 |
839 |
$480.20 |
| 87147 |
|
136 |
133 |
$475.29 |
| 86694 |
|
29 |
29 |
$474.66 |
| 86644 |
|
29 |
29 |
$467.79 |
| J1650 |
Inj enoxaparin sodium |
1,628 |
780 |
$458.70 |
| 90480 |
|
25 |
25 |
$456.66 |
| 73600 |
|
14 |
12 |
$454.78 |
| J3475 |
Inj magnesium sulfate |
1,617 |
943 |
$445.77 |
| J2405 |
Ondansetron hcl injection |
14,038 |
10,304 |
$430.12 |
| 93926 |
|
13 |
13 |
$426.66 |
| 86695 |
|
30 |
29 |
$421.64 |
| J0696 |
Ceftriaxone sodium injection |
2,314 |
1,612 |
$411.83 |
| J3010 |
Fentanyl citrate injection |
11,383 |
8,280 |
$398.75 |
| 84300 |
|
85 |
81 |
$395.53 |
| 51600 |
|
13 |
13 |
$371.74 |
| 92592 |
|
63 |
59 |
$352.07 |
| 80051 |
|
101 |
87 |
$349.84 |
| 82340 |
|
50 |
50 |
$332.06 |
| 84157 |
|
144 |
125 |
$331.73 |
| 82945 |
|
133 |
113 |
$320.46 |
| 87015 |
|
105 |
94 |
$315.06 |
| J1815 |
Insulin injection |
852 |
403 |
$313.62 |
| 86341 |
|
27 |
27 |
$310.75 |
| J2930 |
Methylprednisolone injection |
703 |
521 |
$307.43 |
| 95873 |
|
473 |
452 |
$302.70 |
| 82164 |
|
28 |
25 |
$299.10 |
| 90633 |
|
227 |
209 |
$282.93 |
| 83521 |
|
18 |
13 |
$282.58 |
| 87045 |
|
44 |
44 |
$276.50 |
| 87046 |
|
43 |
43 |
$276.50 |
| 86665 |
|
12 |
12 |
$273.27 |
| 83945 |
|
16 |
16 |
$260.80 |
| J0690 |
Cefazolin sodium injection |
4,409 |
2,833 |
$252.56 |
| J1200 |
Diphenhydramine hcl injectio |
3,322 |
2,357 |
$252.40 |
| 84681 |
|
14 |
14 |
$250.62 |
| 0352U |
|
13 |
13 |
$242.48 |
| 81015 |
|
141 |
139 |
$229.28 |
| 88311 |
|
47 |
46 |
$220.31 |
| 85598 |
|
14 |
14 |
$217.46 |
| J8501 |
Oral aprepitant |
95 |
71 |
$214.50 |
| 84105 |
|
35 |
34 |
$213.22 |
| 99417 |
Prolong home eval add 15m |
47 |
47 |
$210.85 |
| 86301 |
|
15 |
12 |
$209.96 |
| A9503 |
Tc99m medronate |
27 |
26 |
$206.40 |
| 84590 |
|
28 |
28 |
$204.55 |
| J3370 |
Vancomycin hcl injection |
365 |
226 |
$201.26 |
| 90832 |
|
15 |
12 |
$196.48 |
| J2997 |
Alteplase recombinant |
105 |
24 |
$192.46 |
| 82436 |
|
29 |
28 |
$184.75 |
| J8540 |
Oral dexamethasone |
691 |
375 |
$184.56 |
| 94760 |
|
12 |
12 |
$182.20 |
| 86664 |
|
12 |
12 |
$182.02 |
| 85246 |
|
12 |
12 |
$176.39 |
| 88312 |
|
12 |
12 |
$174.54 |
| 82390 |
|
13 |
13 |
$167.16 |
| 84560 |
|
29 |
29 |
$162.90 |
| 85999 |
|
95 |
93 |
$161.36 |
| 84133 |
|
30 |
29 |
$158.01 |
| 82010 |
|
48 |
44 |
$152.40 |
| A9552 |
F18 fdg |
82 |
79 |
$151.74 |
| 83986 |
|
42 |
42 |
$150.23 |
| J2250 |
Inj midazolam hydrochloride |
4,816 |
3,983 |
$128.08 |
| 82140 |
|
30 |
27 |
$125.75 |
| 80201 |
|
18 |
13 |
$125.16 |
| J2710 |
Neostigmine methylslfte inj |
1,002 |
715 |
$122.92 |
| 85613 |
|
14 |
14 |
$117.62 |
| J2765 |
Metoclopramide hcl injection |
1,014 |
807 |
$109.54 |
| 82525 |
|
13 |
13 |
$105.56 |
| 84392 |
|
16 |
16 |
$90.88 |
| J0461 |
Atropine sulfate injection |
173 |
133 |
$78.00 |
| J0171 |
Adrenalin epinephrine inject |
438 |
325 |
$77.80 |
| J7040 |
Normal saline solution infus |
965 |
589 |
$76.98 |
| J0330 |
Succinycholine chloride inj |
271 |
197 |
$57.97 |
| J2060 |
Lorazepam injection |
527 |
358 |
$57.82 |
| 86308 |
|
13 |
12 |
$53.59 |
| J1580 |
Garamycin gentamicin inj |
322 |
224 |
$53.42 |
| J3480 |
Inj potassium chloride |
140 |
78 |
$48.47 |
| 85660 |
|
12 |
12 |
$42.87 |
| J7512 |
Prednisone ir or dr oral 1mg |
1,327 |
948 |
$41.72 |
| J2543 |
Piperacillin/tazobactam |
21 |
12 |
$30.24 |
| V5275 |
Ear impression |
27 |
26 |
$28.80 |
| J0290 |
Ampicillin 500 mg inj |
27 |
13 |
$23.04 |
| J9250 |
Methotrexate sodium inj |
23 |
13 |
$21.26 |
| Q9966 |
Locm 200-299mg/ml iodine,1ml |
145 |
140 |
$17.00 |
| J2550 |
Promethazine hcl injection |
80 |
62 |
$12.28 |
| 85014 |
|
13 |
13 |
$11.90 |
| J0295 |
Ampicillin sulbactam 1.5 gm |
277 |
135 |
$9.84 |
| C9113 |
Inj pantoprazole sodium, via |
32 |
14 |
$7.31 |
| J0131 |
Inj, acetaminophen (nos) |
3,878 |
2,852 |
$4.40 |
| 3074F |
|
80,818 |
69,216 |
$0.16 |
| 3008F |
|
57,548 |
53,603 |
$0.12 |
| 3077F |
|
9,507 |
8,469 |
$0.02 |
| 3075F |
|
10,410 |
9,591 |
$0.02 |
| 3079F |
|
20,308 |
18,358 |
$0.02 |
| 1111F |
|
809 |
689 |
$0.02 |
| 3080F |
|
7,042 |
6,329 |
$0.01 |
| J0136 |
Inj, acetaminophen (b braun) |
554 |
514 |
$0.00 |
| J1756 |
Iron sucrose injection |
868 |
494 |
$0.00 |
| J2272 |
Inj, morphine (fresenius) |
283 |
238 |
$0.00 |
| J1050 |
Medroxyprogesterone acetate |
451 |
445 |
$0.00 |
| 3051F |
|
443 |
437 |
$0.00 |
| 3046F |
|
475 |
466 |
$0.00 |
| 90700 |
|
28 |
27 |
$0.00 |
| 91321 |
|
406 |
400 |
$0.00 |
| J1596 |
Inj, glycopyrrolate, 0.1 mg |
139 |
135 |
$0.00 |
| 91322 |
|
266 |
263 |
$0.00 |
| 91320 |
|
38 |
38 |
$0.00 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
1,196 |
973 |
$0.00 |
| J2919 |
Inj, methylpred sod succ 5mg |
367 |
285 |
$0.00 |
| A4314 |
Cath w/drainage 2-way latex |
27 |
25 |
$0.00 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
222 |
151 |
$0.00 |
| 0100U |
|
61 |
56 |
$0.00 |
| 90380 |
|
34 |
34 |
$0.00 |
| 90678 |
|
40 |
40 |
$0.00 |
| J1953 |
Levetiracetam injection |
17 |
13 |
$0.00 |
| 91308 |
|
87 |
85 |
$0.00 |
| J0134 |
Inj acetaminophen -fresenius |
14 |
14 |
$0.00 |
| J9201 |
In gemcitabine hcl nos 200mg |
23 |
12 |
$0.00 |
| A4649 |
Surgical supplies |
13 |
12 |
$0.00 |
| J0475 |
Baclofen 10 mg injection |
12 |
12 |
$0.00 |
| 3044F |
|
3,169 |
3,130 |
$0.00 |
| 90677 |
|
590 |
580 |
$0.00 |
| Q5121 |
Inj. avsola, 10 mg |
331 |
220 |
$0.00 |
| 3052F |
|
284 |
280 |
$0.00 |
| J1010 |
Inj, methylpred acetate 1 mg |
65 |
65 |
$0.00 |
| 3061F |
|
121 |
120 |
$0.00 |
| 90656 |
|
1,241 |
1,229 |
$0.00 |
| 91318 |
|
19 |
18 |
$0.00 |
| A9270 |
Non-covered item or service |
177 |
166 |
$0.00 |
| J2371 |
Inj phenylephrine hcl 20 mcg |
43 |
39 |
$0.00 |
| J2350 |
Injection, ocrelizumab, 1 mg |
28 |
26 |
$0.00 |
| 3060F |
|
95 |
95 |
$0.00 |
| 90381 |
|
12 |
12 |
$0.00 |
| J9299 |
Injection, nivolumab |
65 |
45 |
$0.00 |
| J1030 |
Methylprednisolone 40 mg inj |
13 |
13 |
$0.00 |
| J7050 |
Normal saline solution infus |
33 |
31 |
$0.00 |
| J0178 |
Aflibercept injection |
12 |
12 |
$0.00 |
| 96110 |
|
34 |
34 |
$0.00 |