| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| G0463 |
Hospital outpt clinic visit |
418,964 |
336,809 |
$38.13M |
| 96361 |
|
44,807 |
38,006 |
$12.58M |
| 99283 |
|
71,945 |
67,935 |
$7.64M |
| 99284 |
|
72,605 |
66,672 |
$4.30M |
| 99282 |
|
37,814 |
35,976 |
$4.22M |
| 99285 |
|
50,924 |
47,022 |
$3.09M |
| 74177 |
|
16,205 |
15,470 |
$2.25M |
| 70450 |
|
16,273 |
15,349 |
$1.99M |
| 97530 |
|
43,889 |
18,730 |
$1.83M |
| 96360 |
|
15,556 |
14,355 |
$1.76M |
| 96366 |
|
8,748 |
5,483 |
$1.55M |
| 92507 |
|
34,820 |
13,878 |
$1.54M |
| 96365 |
|
18,622 |
14,288 |
$1.54M |
| 87635 |
|
29,550 |
27,922 |
$1.36M |
| 59025 |
|
9,387 |
7,040 |
$1.35M |
| U0003 |
Cov-19 amp prb hgh thruput |
17,817 |
16,258 |
$1.25M |
| 43239 |
|
4,044 |
3,948 |
$1.19M |
| 93306 |
|
5,888 |
5,723 |
$1.10M |
| 45380 |
|
3,217 |
3,123 |
$1.09M |
| J9271 |
Inj pembrolizumab |
267 |
191 |
$1.01M |
| 74176 |
|
6,259 |
6,030 |
$1.00M |
| 97110 |
|
50,862 |
19,628 |
$988K |
| 95810 |
|
1,528 |
1,507 |
$765K |
| 76705 |
|
9,142 |
8,893 |
$734K |
| 70553 |
|
3,569 |
3,486 |
$722K |
| 45385 |
|
2,099 |
2,030 |
$717K |
| 76830 |
|
8,380 |
8,234 |
$701K |
| 70551 |
|
3,917 |
3,799 |
$636K |
| 77412 |
|
1,380 |
125 |
$623K |
| J0585 |
Injection,onabotulinumtoxina |
3,096 |
2,295 |
$584K |
| 96415 |
|
3,080 |
1,934 |
$550K |
| 71275 |
|
3,735 |
3,628 |
$538K |
| J1745 |
Infliximab not biosimil 10mg |
488 |
389 |
$505K |
| 76801 |
|
9,069 |
8,257 |
$483K |
| 97112 |
|
22,962 |
9,354 |
$470K |
| 76856 |
|
9,438 |
9,278 |
$462K |
| 80053 |
|
111,222 |
93,047 |
$427K |
| 76642 |
|
4,769 |
4,630 |
$420K |
| 17110 |
|
1,910 |
1,799 |
$410K |
| 96413 |
|
7,966 |
4,476 |
$384K |
| 95886 |
|
2,593 |
2,542 |
$368K |
| 11042 |
|
3,183 |
1,944 |
$365K |
| 76805 |
|
5,564 |
5,349 |
$364K |
| 78452 |
|
1,191 |
1,138 |
$364K |
| 95806 |
|
712 |
703 |
$355K |
| 12001 |
|
1,877 |
1,846 |
$355K |
| 29125 |
|
2,449 |
2,349 |
$343K |
| 76815 |
|
6,423 |
5,092 |
$325K |
| 12011 |
|
1,492 |
1,459 |
$314K |
| 97140 |
|
22,477 |
9,576 |
$308K |
| 90471 |
|
46,005 |
45,216 |
$305K |
| 76811 |
|
4,664 |
4,612 |
$305K |
| 90651 |
|
4,133 |
4,101 |
$304K |
| 77063 |
|
8,858 |
8,766 |
$293K |
| 70496 |
|
2,251 |
2,179 |
$293K |
| 10060 |
|
1,609 |
1,562 |
$285K |
| G0121 |
Colon ca scrn not hi rsk ind |
580 |
564 |
$281K |
| 76770 |
|
3,354 |
3,279 |
$280K |
| 76536 |
|
3,416 |
3,362 |
$274K |
| 29515 |
|
1,965 |
1,897 |
$273K |
| 72148 |
|
2,220 |
2,164 |
$273K |
| 20611 |
|
1,531 |
1,242 |
$250K |
| 97129 |
|
892 |
377 |
$242K |
| 95812 |
|
684 |
667 |
$228K |
| 76700 |
|
2,323 |
2,282 |
$214K |
| P9016 |
Rbc leukocytes reduced |
1,069 |
811 |
$205K |
| 97161 |
|
5,435 |
5,238 |
$204K |
| 93970 |
|
2,261 |
2,187 |
$192K |
| 10061 |
|
889 |
863 |
$191K |
| 93017 |
|
2,041 |
1,970 |
$190K |
| 12002 |
|
1,093 |
1,070 |
$185K |
| 71260 |
|
3,931 |
3,800 |
$180K |
| 49083 |
|
663 |
288 |
$172K |
| 71046 |
|
25,961 |
24,738 |
$169K |
| 45378 |
|
417 |
406 |
$164K |
| 96367 |
|
4,368 |
2,542 |
$164K |
| Q3014 |
Telehealth facility fee |
6,604 |
6,211 |
$161K |
| 72141 |
|
1,289 |
1,264 |
$160K |
| J0881 |
Darbepoetin alfa, non-esrd |
1,775 |
1,136 |
$158K |
| 95800 |
|
1,253 |
1,207 |
$155K |
| 52000 |
|
322 |
302 |
$149K |
| 90686 |
|
18,943 |
18,708 |
$148K |
| 78815 |
|
322 |
304 |
$144K |
| 90715 |
|
8,524 |
8,363 |
$140K |
| 29505 |
|
1,081 |
1,050 |
$140K |
| 97113 |
|
3,334 |
1,397 |
$138K |
| 64615 |
|
563 |
535 |
$136K |
| 76870 |
|
1,594 |
1,551 |
$136K |
| G0378 |
Hospital observation per hr |
16,897 |
6,257 |
$133K |
| 73721 |
|
883 |
842 |
$130K |
| 71250 |
|
2,710 |
2,629 |
$125K |
| 36902 |
|
166 |
152 |
$118K |
| 76817 |
|
4,352 |
3,860 |
$116K |
| J0897 |
Denosumab injection |
880 |
728 |
$116K |
| 97162 |
|
3,331 |
3,194 |
$115K |
| 99281 |
|
910 |
885 |
$111K |
| 76819 |
|
2,708 |
1,513 |
$109K |
| 80048 |
|
29,863 |
24,570 |
$108K |
| 70491 |
|
950 |
910 |
$105K |
| 84484 |
|
27,464 |
20,250 |
$105K |
| 36430 |
|
1,386 |
998 |
$102K |
| 74183 |
|
604 |
582 |
$101K |
| 70486 |
|
2,684 |
2,635 |
$95K |
| J1756 |
Iron sucrose injection |
4,379 |
2,186 |
$93K |
| 94640 |
|
11,587 |
9,684 |
$90K |
| 97535 |
|
5,306 |
3,636 |
$86K |
| 76816 |
|
1,316 |
1,274 |
$82K |
| 76942 |
|
1,548 |
1,439 |
$81K |
| 90750 |
|
732 |
727 |
$80K |
| 76882 |
|
1,148 |
1,019 |
$80K |
| G0480 |
Drug test def 1-7 classes |
14,386 |
12,447 |
$77K |
| 77066 |
Tomosynthesis, mammo |
3,059 |
2,958 |
$76K |
| 80307 |
|
6,364 |
5,623 |
$69K |
| 76813 |
|
2,085 |
2,056 |
$68K |
| 94060 |
|
1,906 |
1,871 |
$67K |
| 96372 |
|
31,600 |
21,589 |
$65K |
| 97116 |
|
5,952 |
2,978 |
$65K |
| 97165 |
|
2,017 |
1,904 |
$64K |
| 77067 |
|
9,127 |
9,031 |
$62K |
| 96374 |
|
52,923 |
46,159 |
$61K |
| 73630 |
|
7,974 |
6,805 |
$60K |
| 77080 |
|
1,990 |
1,957 |
$59K |
| 87040 |
|
8,476 |
5,902 |
$57K |
| 90674 |
|
3,330 |
3,278 |
$57K |
| 76937 |
|
2,433 |
2,083 |
$57K |
| 36415 |
|
151,302 |
118,769 |
$57K |
| 93005 |
|
48,097 |
42,967 |
$56K |
| 93971 |
|
813 |
786 |
$55K |
| 77336 |
|
1,237 |
512 |
$54K |
| J1453 |
Fosaprepitant injection |
1,093 |
661 |
$53K |
| 99291 |
|
1,171 |
1,113 |
$52K |
| 70498 |
|
2,191 |
2,120 |
$52K |
| 87591 |
|
4,756 |
4,594 |
$52K |
| 90647 |
|
3,978 |
3,947 |
$52K |
| 90472 |
|
14,443 |
14,271 |
$51K |
| 20610 |
|
427 |
382 |
$50K |
| 77065 |
Tomosynthesis, mammo |
1,978 |
1,763 |
$50K |
| 99001 |
|
14,890 |
13,690 |
$49K |
| 90670 |
|
5,865 |
5,793 |
$49K |
| 71271 |
|
944 |
926 |
$47K |
| 72125 |
|
4,761 |
4,556 |
$47K |
| 85025 |
|
125,330 |
104,757 |
$47K |
| 72100 |
|
5,092 |
4,976 |
$47K |
| 47562 |
|
24 |
24 |
$47K |
| 93978 |
|
1,248 |
1,205 |
$46K |
| 95816 |
|
301 |
294 |
$45K |
| 73030 |
|
5,593 |
5,012 |
$41K |
| 44970 |
|
13 |
13 |
$40K |
| Q5104 |
Injection, renflexis |
47 |
38 |
$39K |
| 72040 |
|
2,369 |
2,304 |
$39K |
| 73560 |
|
1,938 |
1,705 |
$37K |
| 83605 |
|
7,725 |
6,347 |
$36K |
| 97763 |
|
409 |
270 |
$35K |
| 73610 |
|
5,898 |
5,455 |
$35K |
| 29540 |
|
295 |
293 |
$35K |
| 73564 |
|
6,324 |
5,638 |
$35K |
| J3490 |
Drugs unclassified injection |
2,752 |
2,575 |
$34K |
| 74018 |
|
3,776 |
3,525 |
$34K |
| 83880 |
|
9,371 |
8,643 |
$34K |
| 73130 |
|
5,130 |
4,334 |
$32K |
| 64405 |
|
123 |
115 |
$30K |
| G0108 |
Diab manage trn per indiv |
1,097 |
984 |
$30K |
| 71045 |
|
24,505 |
22,709 |
$29K |
| 94726 |
|
1,779 |
1,748 |
$28K |
| 94729 |
|
1,844 |
1,809 |
$28K |
| 85380 |
|
5,781 |
5,613 |
$28K |
| 93798 |
|
4,362 |
607 |
$27K |
| 72110 |
|
1,228 |
1,207 |
$27K |
| 87633 |
|
506 |
476 |
$27K |
| Q5118 |
Inj., zirabev, 10 mg |
148 |
49 |
$26K |
| 76820 |
|
821 |
413 |
$25K |
| 90734 |
|
2,116 |
2,101 |
$25K |
| 42820 |
|
14 |
14 |
$24K |
| 64450 |
|
227 |
219 |
$24K |
| 73110 |
|
3,781 |
3,409 |
$23K |
| G0279 |
Tomosynthesis, mammo |
4,095 |
3,886 |
$23K |
| 96523 |
|
807 |
547 |
$22K |
| 73502 |
|
3,069 |
2,918 |
$20K |
| 36591 |
|
2,802 |
2,013 |
$19K |
| 90714 |
|
955 |
938 |
$18K |
| 0134A |
|
692 |
678 |
$18K |
| 72193 |
|
90 |
88 |
$18K |
| 0071A |
|
462 |
460 |
$18K |
| 84145 |
|
2,255 |
2,066 |
$18K |
| 90677 |
|
1,579 |
1,543 |
$18K |
| 0054A |
|
663 |
652 |
$18K |
| 66984 |
|
57 |
39 |
$18K |
| 97035 |
|
2,785 |
1,361 |
$18K |
| 72072 |
|
1,372 |
1,349 |
$17K |
| 36475 |
|
15 |
13 |
$17K |
| 11900 |
|
113 |
106 |
$17K |
| 90688 |
|
1,045 |
1,027 |
$17K |
| 29105 |
|
83 |
82 |
$16K |
| 82728 |
|
3,925 |
3,604 |
$16K |
| 64616 |
|
60 |
53 |
$16K |
| 76818 |
|
423 |
356 |
$16K |
| 0072A |
|
382 |
382 |
$15K |
| 29240 |
|
83 |
80 |
$15K |
| 95819 |
|
50 |
50 |
$15K |
| 96375 |
|
41,494 |
33,838 |
$15K |
| J0129 |
Abatacept injection |
27 |
24 |
$15K |
| 74174 |
|
265 |
254 |
$15K |
| 73140 |
|
2,551 |
2,419 |
$15K |
| 97166 |
|
437 |
411 |
$14K |
| 72156 |
|
141 |
138 |
$14K |
| 69209 |
|
358 |
346 |
$14K |
| 88307 |
|
1,316 |
1,001 |
$13K |
| M0243 |
Casirivi and imdevi inj |
108 |
105 |
$13K |
| 90707 |
|
1,551 |
1,541 |
$13K |
| 72050 |
|
938 |
921 |
$13K |
| 73080 |
|
2,394 |
2,249 |
$13K |
| 85027 |
|
23,254 |
18,582 |
$13K |
| 29130 |
|
80 |
79 |
$12K |
| 64644 |
|
354 |
303 |
$12K |
| 72197 |
|
51 |
50 |
$12K |
| 0064A |
|
499 |
489 |
$12K |
| 58300 |
|
93 |
91 |
$12K |
| 97803 |
|
391 |
286 |
$11K |
| 77001 |
|
252 |
233 |
$11K |
| G0105 |
Colorectal scrn; hi risk ind |
28 |
27 |
$11K |
| 0004A |
|
416 |
415 |
$10K |
| 95909 |
|
477 |
467 |
$10K |
| 76857 |
|
136 |
134 |
$10K |
| 73590 |
|
2,092 |
1,882 |
$10K |
| 51710 |
|
141 |
120 |
$10K |
| 70544 |
|
45 |
45 |
$10K |
| G0257 |
Unsched dialysis esrd pt hos |
193 |
102 |
$10K |
| 95811 |
|
24 |
24 |
$9K |
| 19083 |
|
15 |
15 |
$9K |
| 76821 |
|
269 |
155 |
$9K |
| 0124A |
|
412 |
399 |
$9K |
| 86300 |
|
1,593 |
1,107 |
$9K |
| 29530 |
|
51 |
49 |
$9K |
| 0001A |
|
243 |
235 |
$8K |
| 92557 |
|
149 |
146 |
$8K |
| G0297 |
Ldct for lung ca screen |
91 |
90 |
$8K |
| 90685 |
|
443 |
442 |
$8K |
| 86923 |
|
1,220 |
1,048 |
$8K |
| 97760 |
|
303 |
279 |
$8K |
| 51705 |
|
102 |
87 |
$7K |
| 51102 |
|
19 |
13 |
$7K |
| 73221 |
|
55 |
51 |
$7K |
| 84466 |
|
3,512 |
3,310 |
$7K |
| 82962 |
|
40,096 |
19,343 |
$7K |
| 74178 |
|
40 |
40 |
$7K |
| J3489 |
Zoledronic acid 1mg |
724 |
672 |
$7K |
| 71101 |
|
1,440 |
1,407 |
$7K |
| 82784 |
|
1,164 |
1,005 |
$7K |
| 31575 |
|
27 |
27 |
$7K |
| 97163 |
|
197 |
189 |
$7K |
| 95700 |
|
78 |
77 |
$6K |
| 0011A |
|
200 |
195 |
$6K |
| 83540 |
|
3,529 |
3,321 |
$6K |
| 51702 |
|
1,422 |
1,204 |
$6K |
| 82247 |
|
2,153 |
1,843 |
$6K |
| 72202 |
|
438 |
436 |
$6K |
| 73660 |
|
1,192 |
1,127 |
$6K |
| 99490 |
Ccm add 20min |
458 |
430 |
$6K |
| 90746 |
|
294 |
293 |
$6K |
| 0012A |
|
163 |
161 |
$6K |
| 29580 |
|
26 |
26 |
$6K |
| 64643 |
|
56 |
53 |
$6K |
| 73700 |
|
107 |
102 |
$6K |
| 96402 |
|
1,163 |
814 |
$6K |
| 90656 |
|
1,264 |
1,252 |
$5K |
| J0185 |
Inj., aprepitant, 1 mg |
66 |
37 |
$5K |
| 83735 |
|
15,167 |
11,765 |
$5K |
| 97018 |
|
2,364 |
987 |
$5K |
| 87804 |
|
22,248 |
12,564 |
$5K |
| 69210 |
|
163 |
161 |
$5K |
| 20552 |
|
46 |
44 |
$5K |
| C8929 |
Tte w or wo fol wcon,doppler |
25 |
25 |
$5K |
| 11100 |
|
13 |
13 |
$5K |
| 73090 |
|
1,437 |
1,289 |
$5K |
| 88305 |
|
15,738 |
10,980 |
$5K |
| 85018 |
|
4,303 |
3,772 |
$5K |
| 81001 |
|
32,777 |
30,317 |
$5K |
| 0002A |
|
136 |
136 |
$5K |
| 83690 |
|
32,170 |
29,407 |
$5K |
| 73562 |
|
297 |
252 |
$5K |
| 82553 |
|
1,061 |
746 |
$5K |
| 84703 |
|
20,887 |
19,621 |
$5K |
| 58301 |
|
40 |
39 |
$4K |
| 97802 |
|
87 |
87 |
$4K |
| 90713 |
|
317 |
315 |
$4K |
| 84702 |
|
6,605 |
5,844 |
$4K |
| 85610 |
|
36,837 |
26,854 |
$4K |
| 77290 |
|
21 |
15 |
$4K |
| 82378 |
|
1,970 |
1,466 |
$4K |
| 82607 |
|
1,345 |
1,253 |
$4K |
| 10005 |
|
13 |
13 |
$4K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
30,428 |
28,384 |
$4K |
| 81003 |
|
25,786 |
24,322 |
$4K |
| 20550 |
|
14 |
14 |
$4K |
| 84443 |
|
5,735 |
5,338 |
$4K |
| 64400 |
|
16 |
15 |
$3K |
| 87086 |
|
15,922 |
14,798 |
$3K |
| 11721 |
|
173 |
169 |
$3K |
| 81025 |
|
16,893 |
16,329 |
$3K |
| 92083 |
|
67 |
67 |
$3K |
| 96416 |
|
109 |
51 |
$3K |
| 87491 |
|
4,759 |
4,594 |
$3K |
| 77334 |
|
78 |
65 |
$3K |
| 12013 |
|
12 |
12 |
$3K |
| 92567 |
|
316 |
308 |
$3K |
| 86334 |
|
939 |
827 |
$3K |
| 82248 |
|
2,965 |
2,777 |
$3K |
| 92523 |
|
24 |
24 |
$3K |
| 97130 |
|
783 |
336 |
$3K |
| 74220 |
|
90 |
90 |
$3K |
| 36592 |
|
5,598 |
4,895 |
$3K |
| 86580 |
|
427 |
367 |
$3K |
| 0051A |
|
78 |
78 |
$3K |
| 87070 |
|
3,825 |
3,512 |
$2K |
| 86850 |
|
4,069 |
3,541 |
$2K |
| 0052A |
|
67 |
66 |
$2K |
| 11102 |
|
12 |
12 |
$2K |
| 87880 |
|
9,547 |
9,312 |
$2K |
| 82565 |
|
4,687 |
4,211 |
$2K |
| 11982 |
|
12 |
12 |
$2K |
| 88185 |
|
110 |
96 |
$2K |
| 77280 |
|
12 |
12 |
$2K |
| 70360 |
|
135 |
131 |
$2K |
| 86140 |
|
4,600 |
4,045 |
$2K |
| 86900 |
|
4,628 |
3,624 |
$2K |
| 90732 |
|
483 |
458 |
$2K |
| 93010 |
|
399 |
378 |
$2K |
| 90694 |
|
2,087 |
1,982 |
$2K |
| 96376 |
|
14,186 |
10,623 |
$2K |
| J1750 |
Inj iron dextran |
44 |
26 |
$2K |
| J0696 |
Ceftriaxone sodium injection |
10,525 |
8,107 |
$2K |
| 77300 |
|
31 |
27 |
$2K |
| M0222 |
Bebtelovimab injection |
75 |
75 |
$2K |
| A9585 |
Gadobutrol injection |
6,581 |
6,352 |
$2K |
| 83036 |
|
2,811 |
2,624 |
$2K |
| 87081 |
|
4,131 |
3,887 |
$2K |
| 72170 |
|
217 |
207 |
$2K |
| 83615 |
|
1,527 |
1,169 |
$2K |
| 83521 |
|
784 |
677 |
$2K |
| 99495 |
|
121 |
117 |
$2K |
| 86901 |
|
7,498 |
6,690 |
$2K |
| 77077 |
|
132 |
128 |
$2K |
| 84165 |
|
972 |
848 |
$1K |
| 0144A |
|
38 |
38 |
$1K |
| 73060 |
|
463 |
434 |
$1K |
| J1100 |
Dexamethasone sodium phos |
22,228 |
18,511 |
$1K |
| 99152 |
|
3,897 |
3,575 |
$1K |
| 73552 |
|
387 |
358 |
$1K |
| 96417 |
|
2,593 |
1,517 |
$1K |
| 84100 |
|
3,767 |
2,889 |
$1K |
| U0002 |
Covid-19 lab test non-cdc |
1,009 |
964 |
$1K |
| 83883 |
|
143 |
121 |
$1K |
| 81002 |
|
13,474 |
12,731 |
$1K |
| 36416 |
|
11,265 |
7,166 |
$1K |
| 91321 |
|
55 |
55 |
$1K |
| J2405 |
Ondansetron hcl injection |
41,992 |
35,804 |
$1K |
| J2704 |
Inj, propofol, 10 mg |
23,019 |
21,105 |
$1K |
| J1050 |
Medroxyprogesterone acetate |
763 |
743 |
$1K |
| 96401 |
|
160 |
49 |
$1K |
| 95910 |
|
61 |
60 |
$1K |
| 92133 |
|
568 |
555 |
$1K |
| 84439 |
|
1,164 |
1,069 |
$1K |
| 90480 |
|
90 |
89 |
$983.52 |
| 82550 |
|
2,771 |
2,306 |
$971.12 |
| 84153 |
|
847 |
675 |
$970.94 |
| J1885 |
Ketorolac tromethamine inj |
21,806 |
19,258 |
$967.45 |
| 84155 |
|
2,293 |
1,986 |
$963.55 |
| 0074A |
|
23 |
23 |
$929.60 |
| 85730 |
|
6,833 |
6,242 |
$922.06 |
| 85007 |
|
3,798 |
3,473 |
$873.05 |
| 90474 |
|
2,805 |
2,784 |
$830.43 |
| J2997 |
Alteplase recombinant |
28 |
25 |
$820.40 |
| J9217 |
Leuprolide acetate suspnsion |
13 |
13 |
$796.57 |
| A9552 |
F18 fdg |
380 |
360 |
$750.00 |
| 82803 |
|
2,450 |
2,102 |
$735.14 |
| 85652 |
|
3,440 |
3,245 |
$732.09 |
| 64447 |
|
40 |
40 |
$727.14 |
| C9803 |
Hopd covid-19 spec collect |
973 |
859 |
$719.71 |
| 87186 |
|
4,724 |
4,142 |
$696.67 |
| 51798 |
|
1,575 |
1,474 |
$689.43 |
| 87205 |
|
3,620 |
3,141 |
$683.09 |
| 87210 |
|
3,405 |
3,310 |
$668.49 |
| 92136 |
|
44 |
41 |
$658.39 |
| 0111A |
|
17 |
17 |
$652.00 |
| 74230 |
|
13 |
12 |
$651.75 |
| J2785 |
Regadenoson injection |
815 |
779 |
$644.82 |
| 90700 |
|
2,043 |
2,031 |
$632.66 |
| 73523 |
|
36 |
36 |
$632.40 |
| 90662 |
|
682 |
677 |
$632.10 |
| J2270 |
Morphine sulfate injection |
11,974 |
10,555 |
$614.90 |
| 97597 |
|
14 |
12 |
$587.18 |
| 82746 |
|
299 |
280 |
$574.54 |
| 0112A |
|
13 |
13 |
$569.20 |
| 88184 |
|
125 |
112 |
$564.24 |
| 76981 |
|
14 |
14 |
$541.49 |
| 80061 |
|
570 |
528 |
$536.34 |
| 0141A |
|
13 |
13 |
$516.40 |
| V2632 |
Post chmbr intraocular lens |
156 |
114 |
$485.98 |
| 88342 |
|
2,507 |
2,175 |
$478.13 |
| 88304 |
|
2,680 |
2,395 |
$472.77 |
| 80177 |
|
271 |
249 |
$469.99 |
| 97012 |
|
70 |
27 |
$465.91 |
| 80051 |
|
766 |
642 |
$464.51 |
| 87088 |
|
3,090 |
2,701 |
$454.22 |
| 0053A |
|
17 |
17 |
$450.80 |
| 90710 |
|
2,235 |
2,222 |
$448.78 |
| 91322 |
|
13 |
13 |
$440.60 |
| 87340 |
|
653 |
597 |
$425.38 |
| 72052 |
|
18 |
16 |
$424.21 |
| 90633 |
|
3,651 |
3,634 |
$407.99 |
| 87147 |
|
1,838 |
1,618 |
$380.62 |
| A9502 |
Tc99m tetrofosmin |
1,706 |
1,112 |
$367.02 |
| 87077 |
|
2,196 |
1,811 |
$359.23 |
| J2310 |
Inj naloxone hydrochloride |
57 |
49 |
$357.84 |
| 97750 |
|
44 |
42 |
$353.15 |
| 84550 |
|
1,889 |
1,567 |
$349.94 |
| 90716 |
|
1,590 |
1,577 |
$341.11 |
| 94664 |
|
69 |
62 |
$338.83 |
| 85014 |
|
1,049 |
708 |
$330.89 |
| 84156 |
|
948 |
799 |
$314.93 |
| J3301 |
Triamcinolone acet inj nos |
3,152 |
2,975 |
$312.13 |
| 74022 |
|
65 |
65 |
$310.58 |
| J3473 |
Hyaluronidase recombinant |
14 |
13 |
$307.58 |
| 84132 |
|
2,841 |
2,380 |
$304.56 |
| 99153 |
Mod sedat endo service >5yrs |
2,051 |
1,887 |
$283.56 |
| 82040 |
|
1,000 |
831 |
$269.67 |
| 92134 |
|
247 |
231 |
$268.20 |
| J2550 |
Promethazine hcl injection |
2,748 |
2,260 |
$265.74 |
| J1170 |
Hydromorphone injection |
15,726 |
12,158 |
$260.83 |
| 82010 |
|
1,523 |
1,330 |
$253.03 |
| 97014 |
|
24 |
12 |
$239.03 |
| 85046 |
|
241 |
224 |
$233.67 |
| 86304 |
|
70 |
61 |
$230.97 |
| J1200 |
Diphenhydramine hcl injectio |
11,164 |
9,191 |
$229.88 |
| 82570 |
|
1,000 |
875 |
$227.17 |
| J3475 |
Inj magnesium sulfate |
2,939 |
1,798 |
$225.08 |
| J3010 |
Fentanyl citrate injection |
22,445 |
18,261 |
$223.49 |
| C1713 |
Anchor/screw bn/bn,tis/bn |
1,258 |
1,208 |
$214.55 |
| 92610 |
|
13 |
13 |
$214.50 |
| 80076 |
|
76 |
70 |
$208.06 |
| 82947 |
|
888 |
760 |
$195.32 |
| 82306 |
|
296 |
279 |
$181.81 |
| 95874 |
|
1,056 |
932 |
$169.00 |
| 85520 |
|
930 |
778 |
$155.99 |
| 74021 |
|
32 |
32 |
$147.48 |
| 84460 |
|
909 |
773 |
$146.54 |
| 84450 |
|
910 |
770 |
$146.37 |
| 82360 |
|
14 |
12 |
$139.13 |
| 86317 |
|
103 |
93 |
$135.73 |
| J2930 |
Methylprednisolone injection |
4,009 |
3,271 |
$135.41 |
| 88341 |
|
1,199 |
707 |
$132.28 |
| 84520 |
|
857 |
728 |
$131.56 |
| 72020 |
|
13 |
12 |
$127.21 |
| J1642 |
Inj heparin sodium per 10 u |
4,879 |
2,478 |
$111.46 |
| 88175 |
|
25 |
25 |
$105.72 |
| J2060 |
Lorazepam injection |
5,413 |
4,640 |
$104.29 |
| J2765 |
Metoclopramide hcl injection |
6,280 |
5,570 |
$100.80 |
| J1644 |
Inj heparin sodium per 1000u |
13,034 |
5,649 |
$95.05 |
| J0780 |
Prochlorperazine injection |
2,583 |
2,383 |
$95.02 |
| J0171 |
Adrenalin epinephrine inject |
5,246 |
4,527 |
$93.90 |
| J0690 |
Cefazolin sodium injection |
11,548 |
9,488 |
$84.65 |
| U0005 |
Infec agen detec ampli probe |
2,464 |
2,101 |
$77.25 |
| 87798 |
|
94 |
88 |
$75.00 |
| 88112 |
|
14 |
13 |
$72.97 |
| 76376 |
|
422 |
415 |
$67.87 |
| 87624 |
|
18 |
18 |
$62.51 |
| 86780 |
|
85 |
76 |
$62.08 |
| 87075 |
|
452 |
367 |
$61.72 |
| 90723 |
|
3,401 |
3,372 |
$58.94 |
| 51703 |
|
14 |
14 |
$56.86 |
| C1769 |
Guide wire |
4,112 |
3,750 |
$56.54 |
| 99406 |
|
690 |
665 |
$55.29 |
| 82140 |
|
106 |
86 |
$54.45 |
| J2250 |
Inj midazolam hydrochloride |
15,508 |
14,282 |
$52.96 |
| 87324 |
|
83 |
78 |
$52.44 |
| C1776 |
Joint device (implantable) |
104 |
103 |
$44.92 |
| J1940 |
Furosemide injection |
2,699 |
1,927 |
$37.44 |
| 93356 |
|
471 |
463 |
$36.69 |
| 91301 |
|
419 |
405 |
$36.30 |
| 87449 |
|
96 |
91 |
$31.92 |
| 89050 |
|
56 |
52 |
$29.78 |
| J2710 |
Neostigmine methylslfte inj |
3,247 |
3,075 |
$25.93 |
| J2795 |
Ropivacaine hcl injection |
2,625 |
2,006 |
$23.17 |
| 72070 |
|
25 |
25 |
$22.60 |
| 36600 |
|
113 |
67 |
$21.68 |
| 87184 |
|
207 |
189 |
$20.42 |
| 72220 |
|
13 |
13 |
$20.40 |
| J3370 |
Vancomycin hcl injection |
2,627 |
1,404 |
$19.36 |
| A4648 |
Implantable tissue marker |
316 |
289 |
$18.35 |
| 90672 |
|
93 |
93 |
$16.34 |
| 94760 |
|
1,844 |
1,404 |
$16.04 |
| J1953 |
Levetiracetam injection |
334 |
269 |
$15.77 |
| Q0177 |
Hydroxyzine pamoate 25mg |
147 |
107 |
$12.00 |
| 80305 |
|
14 |
13 |
$8.51 |
| 82948 |
|
44 |
23 |
$7.83 |
| 86703 |
|
80 |
80 |
$7.16 |
| C1894 |
Intro/sheath, non-laser |
3,156 |
2,898 |
$7.04 |
| J1630 |
Haloperidol injection |
1,040 |
859 |
$5.71 |
| 82310 |
|
60 |
56 |
$5.29 |
| G0008 |
Admin influenza virus vac |
5,300 |
4,897 |
$4.80 |
| 90653 |
|
383 |
374 |
$4.44 |
| A9270 |
Non-covered item or service |
95,009 |
17,319 |
$4.19 |
| C9113 |
Inj pantoprazole sodium, via |
2,687 |
1,918 |
$4.09 |
| J0330 |
Succinycholine chloride inj |
1,040 |
951 |
$3.86 |
| J1790 |
Droperidol injection |
121 |
115 |
$3.54 |
| 82435 |
|
60 |
56 |
$3.51 |
| 82374 |
|
60 |
56 |
$3.51 |
| 84295 |
|
61 |
57 |
$3.51 |
| J3411 |
Thiamine hcl 100 mg |
351 |
206 |
$3.06 |
| J1836 |
Inj, metronidazole, 10 mg |
153 |
98 |
$2.95 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
689 |
649 |
$2.36 |
| J1596 |
Inj, glycopyrrolate, 0.1 mg |
395 |
380 |
$2.28 |
| C1758 |
Catheter, ureteral |
36 |
36 |
$2.09 |
| J2175 |
Meperidine hydrochl /100 mg |
1,281 |
1,236 |
$1.84 |
| 84075 |
|
42 |
40 |
$1.73 |
| J2919 |
Inj, methylpred sod succ 5mg |
534 |
442 |
$1.59 |
| J0360 |
Hydralazine hcl injection |
1,546 |
1,299 |
$1.36 |
| J3360 |
Diazepam injection |
161 |
138 |
$1.30 |
| 87807 |
|
348 |
341 |
$1.28 |
| J2370 |
Phenylephrine hcl injection |
1,957 |
1,837 |
$0.90 |
| J1650 |
Inj enoxaparin sodium |
4,460 |
1,449 |
$0.86 |
| J3420 |
Vitamin b12 injection |
636 |
501 |
$0.77 |
| J0689 |
Inj cefazolin sodium, baxter |
468 |
337 |
$0.77 |
| J2543 |
Piperacillin/tazobactam |
146 |
91 |
$0.70 |
| J2371 |
Inj phenylephrine hcl 20 mcg |
1,075 |
937 |
$0.36 |
| Q0222 |
Bebtelovimab 175 mg |
75 |
75 |
$0.30 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
377 |
303 |
$0.24 |
| Q0243 |
Casirivimab and imdevimab |
69 |
66 |
$0.17 |
| J3480 |
Inj potassium chloride |
1,541 |
895 |
$0.13 |
| J0735 |
Clonidine hydrochloride |
100 |
99 |
$0.02 |
| 91307 |
|
959 |
895 |
$0.00 |
| J1920 |
Inj, labetalol hcl, 5mg |
125 |
109 |
$0.00 |
| 90619 |
|
838 |
831 |
$0.00 |
| 96411 |
|
692 |
401 |
$0.00 |
| 90696 |
|
1,572 |
1,561 |
$0.00 |
| 90697 |
|
1,435 |
1,429 |
$0.00 |
| J7512 |
Prednisone ir or dr oral 1mg |
848 |
587 |
$0.00 |
| C1725 |
Cath, translumin non-laser |
1,541 |
1,410 |
$0.00 |
| 91314 |
|
51 |
51 |
$0.00 |
| S2900 |
Robotic surgical system |
278 |
264 |
$0.00 |
| A9500 |
Tc99m sestamibi |
54 |
50 |
$0.00 |
| D1208 |
|
37 |
37 |
$0.00 |
| 91305 |
|
946 |
919 |
$0.00 |
| 82043 |
|
90 |
73 |
$0.00 |
| G0009 |
Admin pneumococcal vaccine |
523 |
480 |
$0.00 |
| 91306 |
|
496 |
486 |
$0.00 |
| Q0162 |
Ondansetron oral |
449 |
256 |
$0.00 |
| J2920 |
Methylprednisolone injection |
163 |
134 |
$0.00 |
| G8987 |
Self care current status |
412 |
365 |
$0.00 |
| 87486 |
|
88 |
84 |
$0.00 |
| J1815 |
Insulin injection |
139 |
66 |
$0.00 |
| C1781 |
Mesh (implantable) |
195 |
185 |
$0.00 |
| J2003 |
Inj, lidocaine hcl, 1 mg |
891 |
664 |
$0.00 |
| C2617 |
Stent, non-cor, tem w/o del |
115 |
111 |
$0.00 |
| J9045 |
Carboplatin injection |
102 |
64 |
$0.00 |
| J1040 |
Methylprednisolone 80 mg inj |
379 |
366 |
$0.00 |
| 95911 |
|
38 |
38 |
$0.00 |
| J8540 |
Oral dexamethasone |
139 |
115 |
$0.00 |
| G8988 |
Self care goal status |
449 |
392 |
$0.00 |
| 85651 |
|
64 |
51 |
$0.00 |
| J2470 |
Inj pantoprazole sodium 40mg |
213 |
164 |
$0.00 |
| G8981 |
Body pos current status |
239 |
231 |
$0.00 |
| 87046 |
|
13 |
13 |
$0.00 |
| G8982 |
Body pos goal status |
287 |
275 |
$0.00 |
| 96368 |
|
215 |
119 |
$0.00 |
| J1030 |
Methylprednisolone 40 mg inj |
12 |
12 |
$0.00 |
| 87581 |
|
88 |
84 |
$0.00 |
| G8980 |
Mobility d/c status |
60 |
59 |
$0.00 |
| Q9963 |
Hocm 350-399mg/ml iodine,1ml |
69 |
66 |
$0.00 |
| 87389 |
|
13 |
13 |
$0.00 |
| 90744 |
|
17 |
17 |
$0.00 |
| 86803 |
|
33 |
28 |
$0.00 |
| J9267 |
Paclitaxel injection |
95 |
36 |
$0.00 |
| J1010 |
Inj, methylpred acetate 1 mg |
18 |
17 |
$0.00 |
| G0379 |
Direct refer hospital observ |
13 |
12 |
$0.00 |
| 90381 |
|
19 |
19 |
$0.00 |
| C9399 |
Unclassified drugs or biolog |
12 |
12 |
$0.00 |
| G8979 |
Mobility goal status |
697 |
644 |
$0.00 |
| G8978 |
Mobility current status |
608 |
575 |
$0.00 |
| C1887 |
Catheter, guiding |
315 |
296 |
$0.00 |
| C1760 |
Closure dev, vasc |
293 |
282 |
$0.00 |
| 90681 |
|
3,014 |
2,985 |
$0.00 |
| J1956 |
Levofloxacin injection |
344 |
299 |
$0.00 |
| 91300 |
|
850 |
817 |
$0.00 |
| J3260 |
Tobramycin sulfate injection |
80 |
77 |
$0.00 |
| Q0163 |
Diphenhydramine hcl 50mg |
140 |
105 |
$0.00 |
| 91313 |
|
691 |
677 |
$0.00 |
| G8984 |
Carry current status |
133 |
125 |
$0.00 |
| J0612 |
Inj, calcium gluconate, nos |
23 |
16 |
$0.00 |
| C1874 |
Stent, coated/cov w/del sys |
137 |
128 |
$0.00 |
| G0498 |
Chemo extend iv infus w/pump |
70 |
37 |
$0.00 |
| P9604 |
One-way allow prorated trip |
248 |
115 |
$0.00 |
| 90473 |
|
56 |
56 |
$0.00 |
| Q9950 |
Inj sulf hexa lipid microsph |
12 |
12 |
$0.00 |
| J9190 |
Fluorouracil injection |
393 |
112 |
$0.00 |
| 87045 |
|
13 |
13 |
$0.00 |
| 88313 |
|
49 |
25 |
$0.00 |
| J2916 |
Na ferric gluconate complex |
48 |
31 |
$0.00 |
| G8985 |
Carry goal status |
140 |
130 |
$0.00 |
| 83970 |
|
14 |
14 |
$0.00 |
| J0640 |
Leucovorin calcium injection |
261 |
62 |
$0.00 |
| 91311 |
|
112 |
111 |
$0.00 |
| J1580 |
Garamycin gentamicin inj |
49 |
42 |
$0.00 |
| G8989 |
Self care d/c status |
16 |
13 |
$0.00 |
| 89051 |
|
29 |
24 |
$0.00 |
| 31720 |
|
43 |
30 |
$0.00 |
| 88173 |
|
30 |
24 |
$0.00 |
| 87427 |
|
20 |
13 |
$0.00 |
| J3105 |
Terbutaline sulfate inj |
27 |
25 |
$0.00 |
| 91312 |
|
412 |
399 |
$0.00 |
| 85384 |
|
13 |
12 |
$0.00 |
| 16020 |
|
13 |
12 |
$0.00 |
| J2004 |
Inj, lidocaine w epinephrine |
45 |
44 |
$0.00 |
| 88360 |
|
46 |
26 |
$0.00 |
| J0295 |
Ampicillin sulbactam 1.5 gm |
18 |
14 |
$0.00 |
| 98927 |
|
13 |
13 |
$0.00 |