ST. LUKE'S HOSPITAL GRAND VIEW CAMPUS

$2.45M

Total Medicaid Paid

26,916

Total Claims

21,659

Beneficiaries

64

Codes Billed

2019-11

First Month

2024-11

Last Month

Code	Description	Claims	Beneficiaries	Total Paid
99283		4,629	4,464	$807K
99284		3,605	3,459	$638K
99285		1,696	1,605	$449K
G0378	Hospital observation per hr	261	217	$236K
77067		469	461	$44K
97110		2,184	588	$38K
97140		1,128	338	$32K
76805		297	217	$18K
76830		307	302	$16K
93306		179	178	$16K
11042		53	25	$12K
76856		345	339	$12K
97112		556	212	$12K
77063		465	457	$11K
97010		828	258	$10K
0002A		148	143	$7K
97161		96	92	$6K
74177		55	53	$5K
99282		38	37	$5K
71046		401	382	$5K
76642		106	104	$5K
0001A		155	155	$5K
70450		173	164	$4K
99291		13	13	$4K
U0003	Cov-19 amp prb hgh thruput	124	119	$4K
80307		156	119	$4K
59025		574	231	$3K
76801		73	72	$3K
85025		1,070	909	$3K
80053		666	603	$3K
87635		264	241	$3K
93005		535	485	$2K
76536		39	37	$2K
76700		33	32	$2K
J1885	Ketorolac tromethamine inj	76	64	$2K
0031A		40	40	$2K
71250		24	24	$2K
96374		238	213	$2K
77080		26	25	$2K
76775		27	27	$1K
J7030	Normal saline solution infus	1,704	1,507	$956.58
73630		56	40	$695.88
80048		236	196	$675.37
71045		172	159	$620.83
81000		295	271	$552.06
73030		32	30	$473.70
96372		42	41	$342.57
76705		12	12	$336.41
0241U		17	17	$312.00
G0279	Tomosynthesis, mammo	13	13	$263.87
96375		32	31	$252.13
36415		1,285	1,085	$222.45
73610		12	12	$178.76
85730		103	97	$163.52
85610		124	114	$162.04
87088		33	30	$144.80
82947		95	71	$133.58
Q9967	Locm 300-399mg/ml iodine,1ml	74	72	$90.14
84484		33	26	$78.96
81025		36	34	$20.60
J7060	5% dextrose/water	15	14	$0.10
J3490	Drugs unclassified injection	33	26	$0.00
J7120	Ringers lactate infusion	262	214	$0.00
J2405	Ondansetron hcl injection	48	43	$0.00

Medicaid Provider Spending