| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| G0463 |
Hospital outpt clinic visit |
187,209 |
125,108 |
$12.24M |
| 99284 |
|
32,429 |
26,000 |
$7.00M |
| 99285 |
|
18,771 |
11,083 |
$4.86M |
| 99211 |
|
85,564 |
70,666 |
$3.49M |
| 99283 |
|
24,455 |
21,301 |
$3.37M |
| 74177 |
|
7,872 |
5,689 |
$2.77M |
| 87502 |
|
45,793 |
40,579 |
$2.36M |
| 96374 |
|
24,775 |
17,503 |
$2.27M |
| 78452 |
|
8,478 |
3,232 |
$2.14M |
| 99213 |
|
46,149 |
41,682 |
$2.08M |
| 93306 |
|
8,588 |
6,834 |
$1.94M |
| 87635 |
|
47,487 |
40,389 |
$1.93M |
| 92507 |
|
36,490 |
11,405 |
$1.73M |
| 97530 |
|
34,994 |
10,513 |
$1.54M |
| G0379 |
Direct refer hospital observ |
2,582 |
1,929 |
$1.53M |
| 74176 |
|
4,546 |
3,344 |
$1.51M |
| 99212 |
|
27,606 |
25,064 |
$1.32M |
| 70450 |
|
8,819 |
5,921 |
$1.22M |
| 87633 |
|
4,438 |
4,077 |
$1.06M |
| G0378 |
Hospital observation per hr |
8,610 |
6,183 |
$1.03M |
| 47562 |
|
550 |
318 |
$1.02M |
| 96372 |
|
47,699 |
26,107 |
$995K |
| 71046 |
|
23,512 |
17,936 |
$939K |
| 97110 |
|
26,239 |
7,234 |
$923K |
| 96361 |
|
20,826 |
12,459 |
$920K |
| 70553 |
|
1,829 |
1,316 |
$896K |
| 43239 |
|
2,006 |
1,301 |
$878K |
| 80053 |
|
85,400 |
54,853 |
$857K |
| 96365 |
|
12,923 |
5,537 |
$839K |
| 93005 |
|
39,918 |
30,891 |
$808K |
| 36415 |
|
210,093 |
96,484 |
$801K |
| 76830 |
|
6,600 |
6,033 |
$759K |
| 87651 |
|
38,733 |
35,711 |
$676K |
| 72148 |
|
2,131 |
1,863 |
$644K |
| 96360 |
|
8,261 |
5,339 |
$642K |
| 69436 |
|
671 |
633 |
$640K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
12,048 |
10,204 |
$593K |
| 42820 |
|
256 |
244 |
$584K |
| 95810 |
|
1,153 |
1,030 |
$577K |
| 99214 |
|
12,391 |
11,435 |
$549K |
| 85025 |
|
89,724 |
73,370 |
$531K |
| 94640 |
|
8,591 |
5,293 |
$525K |
| 71260 |
|
2,666 |
1,637 |
$464K |
| 96375 |
|
14,823 |
10,984 |
$450K |
| 71045 |
|
17,057 |
10,111 |
$441K |
| 97597 |
|
7,258 |
2,660 |
$391K |
| 95811 |
|
837 |
724 |
$388K |
| 76705 |
|
3,717 |
3,275 |
$386K |
| 76805 |
|
4,208 |
3,926 |
$365K |
| 84443 |
|
28,715 |
26,454 |
$360K |
| 96413 |
|
2,163 |
831 |
$355K |
| 77067 |
|
5,033 |
4,835 |
$346K |
| 99282 |
|
3,995 |
3,678 |
$329K |
| 88305 |
|
6,903 |
5,317 |
$321K |
| 72141 |
|
976 |
803 |
$311K |
| 94060 |
|
3,803 |
2,266 |
$307K |
| 93017 |
|
3,286 |
2,877 |
$304K |
| 76816 |
|
4,620 |
4,182 |
$304K |
| J2785 |
Regadenoson injection |
2,075 |
1,751 |
$301K |
| 70551 |
|
1,055 |
791 |
$290K |
| 97113 |
|
3,954 |
1,173 |
$288K |
| J3490 |
Drugs unclassified injection |
35,178 |
14,441 |
$282K |
| 87801 |
|
7,512 |
6,979 |
$278K |
| 80048 |
|
45,352 |
27,303 |
$276K |
| 80061 |
|
25,445 |
19,669 |
$263K |
| 72125 |
|
1,778 |
1,533 |
$262K |
| 80081 |
|
3,736 |
3,515 |
$262K |
| C9803 |
Hopd covid-19 spec collect |
34,202 |
26,857 |
$240K |
| 76801 |
|
3,371 |
3,077 |
$234K |
| 96367 |
|
3,771 |
960 |
$228K |
| G0399 |
Home sleep test/type 3 porta |
2,329 |
2,083 |
$210K |
| C1713 |
Anchor/screw bn/bn,tis/bn |
833 |
640 |
$195K |
| 71275 |
|
920 |
688 |
$190K |
| 71250 |
|
1,659 |
1,108 |
$188K |
| 74018 |
|
5,701 |
4,921 |
$183K |
| 76770 |
|
1,765 |
1,423 |
$175K |
| J7307 |
Etonogestrel implant system |
244 |
213 |
$172K |
| 78227 |
|
575 |
457 |
$169K |
| G0483 |
Drug test def 22+ classes |
1,746 |
1,363 |
$163K |
| 93971 |
|
1,669 |
1,410 |
$156K |
| 82306 |
|
9,845 |
9,065 |
$151K |
| 45380 |
|
308 |
225 |
$149K |
| 92526 |
|
2,808 |
1,102 |
$142K |
| A9500 |
Tc99m sestamibi |
2,582 |
2,206 |
$142K |
| 97112 |
|
4,031 |
1,448 |
$141K |
| 74022 |
|
2,527 |
2,282 |
$138K |
| 76700 |
|
1,112 |
959 |
$136K |
| 73721 |
|
428 |
396 |
$133K |
| 11042 |
|
1,304 |
524 |
$132K |
| 82607 |
|
11,413 |
10,385 |
$128K |
| 77063 |
|
6,859 |
5,618 |
$126K |
| 83036 |
|
19,734 |
17,189 |
$125K |
| 87428 |
|
3,749 |
3,154 |
$124K |
| 72100 |
|
3,301 |
2,569 |
$124K |
| 45385 |
|
229 |
172 |
$122K |
| 97161 |
|
3,292 |
2,045 |
$121K |
| 80306 |
|
11,929 |
10,435 |
$120K |
| 87491 |
|
4,785 |
4,466 |
$120K |
| 81001 |
|
49,674 |
41,488 |
$119K |
| 73630 |
|
4,411 |
3,840 |
$119K |
| 97162 |
|
3,000 |
1,810 |
$118K |
| 92523 |
|
978 |
906 |
$117K |
| 97140 |
|
5,860 |
2,149 |
$115K |
| 87150 |
|
3,865 |
3,628 |
$115K |
| 87641 |
|
5,574 |
5,194 |
$113K |
| 90715 |
|
3,482 |
3,250 |
$112K |
| 43235 |
|
211 |
159 |
$112K |
| 84484 |
|
17,349 |
11,211 |
$112K |
| 73610 |
|
3,979 |
3,417 |
$110K |
| 87591 |
|
4,750 |
4,460 |
$108K |
| 96366 |
|
3,538 |
1,652 |
$106K |
| 90471 |
|
6,049 |
5,566 |
$105K |
| 74019 |
|
2,936 |
2,611 |
$104K |
| 87086 |
|
21,086 |
15,718 |
$103K |
| 80307 |
|
3,514 |
2,661 |
$103K |
| 73030 |
|
3,823 |
2,796 |
$102K |
| 73130 |
|
3,611 |
3,123 |
$101K |
| 87486 |
|
4,559 |
4,103 |
$101K |
| 87581 |
|
4,435 |
4,079 |
$99K |
| 83880 |
|
6,180 |
4,446 |
$94K |
| 20610 |
|
1,040 |
628 |
$93K |
| 76817 |
|
2,121 |
1,746 |
$91K |
| 94726 |
|
1,792 |
1,659 |
$90K |
| 76536 |
|
917 |
845 |
$88K |
| 73110 |
|
2,952 |
2,383 |
$87K |
| 93454 |
|
219 |
75 |
$87K |
| 99281 |
|
2,182 |
2,013 |
$87K |
| 73562 |
|
3,193 |
2,630 |
$86K |
| A9575 |
Inj gadoterate meglumi 0.1ml |
2,097 |
1,826 |
$84K |
| 84702 |
|
8,075 |
5,912 |
$83K |
| 70544 |
|
390 |
317 |
$81K |
| 87070 |
|
11,297 |
8,559 |
$81K |
| 88304 |
|
2,955 |
2,648 |
$80K |
| 84439 |
|
11,189 |
10,282 |
$77K |
| 76642 |
|
1,375 |
1,240 |
$76K |
| 72110 |
|
1,319 |
1,034 |
$73K |
| 85027 |
|
16,779 |
12,860 |
$67K |
| 86900 |
|
5,301 |
3,510 |
$67K |
| 81025 |
|
14,626 |
13,041 |
$65K |
| J2704 |
Inj, propofol, 10 mg |
12,380 |
10,446 |
$64K |
| J0696 |
Ceftriaxone sodium injection |
9,985 |
7,867 |
$60K |
| J1885 |
Ketorolac tromethamine inj |
18,155 |
15,041 |
$59K |
| 73502 |
|
1,932 |
1,318 |
$59K |
| 82565 |
|
7,674 |
5,434 |
$58K |
| 82728 |
|
5,469 |
4,968 |
$58K |
| 84403 |
|
2,695 |
2,478 |
$57K |
| 76856 |
|
547 |
513 |
$55K |
| 71271 |
|
1,253 |
1,006 |
$54K |
| 96376 |
|
3,635 |
2,149 |
$54K |
| 83690 |
|
12,558 |
10,615 |
$52K |
| 95117 |
|
4,071 |
1,490 |
$52K |
| 87186 |
|
8,926 |
7,930 |
$52K |
| 76815 |
|
805 |
736 |
$52K |
| 72072 |
|
1,184 |
942 |
$51K |
| 97750 |
|
2,007 |
1,667 |
$50K |
| J3010 |
Fentanyl citrate injection |
11,356 |
9,473 |
$50K |
| Q9966 |
Locm 200-299mg/ml iodine,1ml |
2,162 |
1,900 |
$49K |
| 76818 |
|
803 |
339 |
$49K |
| 41899 |
|
50 |
44 |
$49K |
| 80074 |
|
1,476 |
1,335 |
$48K |
| 99215 |
Prolong outpt/office vis |
1,117 |
1,062 |
$48K |
| 45378 |
|
99 |
79 |
$47K |
| 58563 |
|
32 |
27 |
$46K |
| 80051 |
|
8,900 |
4,044 |
$46K |
| J1030 |
Methylprednisolone 40 mg inj |
4,120 |
3,806 |
$45K |
| 70486 |
|
261 |
233 |
$43K |
| 0225U |
|
129 |
129 |
$43K |
| 83735 |
|
10,304 |
8,001 |
$43K |
| C1769 |
Guide wire |
1,970 |
1,576 |
$42K |
| 86803 |
|
4,112 |
3,860 |
$42K |
| 87389 |
|
2,321 |
2,163 |
$41K |
| 72040 |
|
1,235 |
958 |
$38K |
| 87804 |
|
3,495 |
1,718 |
$38K |
| 88312 |
|
1,396 |
1,240 |
$38K |
| 85610 |
|
13,796 |
9,886 |
$37K |
| 87880 |
|
3,721 |
3,433 |
$36K |
| 62323 |
|
171 |
115 |
$36K |
| J2405 |
Ondansetron hcl injection |
22,989 |
18,320 |
$35K |
| 87040 |
|
6,585 |
4,115 |
$35K |
| 83001 |
|
2,154 |
2,037 |
$35K |
| J0561 |
Penicillin g benzathine inj |
200 |
184 |
$34K |
| J0131 |
Inj, acetaminophen (nos) |
2,154 |
1,550 |
$34K |
| 85730 |
|
9,694 |
7,465 |
$33K |
| 73080 |
|
1,239 |
1,036 |
$33K |
| 77066 |
Tomosynthesis, mammo |
398 |
351 |
$32K |
| 87077 |
|
4,797 |
4,113 |
$31K |
| 64493 |
|
107 |
66 |
$31K |
| 90792 |
|
489 |
428 |
$31K |
| 94729 |
|
1,862 |
1,711 |
$31K |
| J0690 |
Cefazolin sodium injection |
5,960 |
4,665 |
$31K |
| 87088 |
|
5,722 |
5,077 |
$31K |
| 72050 |
|
494 |
354 |
$31K |
| 73560 |
|
992 |
745 |
$30K |
| 83002 |
|
1,926 |
1,817 |
$30K |
| 12001 |
|
605 |
563 |
$30K |
| G0008 |
Admin influenza virus vac |
1,066 |
924 |
$30K |
| 36600 |
|
1,788 |
1,388 |
$30K |
| J1815 |
Insulin injection |
2,053 |
960 |
$30K |
| 83540 |
|
6,685 |
6,186 |
$29K |
| J2360 |
Orphenadrine injection |
1,586 |
1,363 |
$28K |
| 84481 |
|
2,092 |
1,939 |
$28K |
| M0243 |
Casirivi and imdevi inj |
92 |
87 |
$28K |
| 82670 |
|
1,082 |
1,008 |
$28K |
| J1170 |
Hydromorphone injection |
7,854 |
5,571 |
$27K |
| 83550 |
|
4,692 |
4,338 |
$27K |
| 82746 |
|
2,627 |
2,409 |
$27K |
| 84703 |
|
4,144 |
3,788 |
$27K |
| 84146 |
|
1,569 |
1,480 |
$26K |
| C8929 |
Tte w or wo fol wcon,doppler |
112 |
89 |
$26K |
| 99153 |
Mod sedat endo service >5yrs |
873 |
685 |
$26K |
| 73090 |
|
965 |
775 |
$25K |
| 73221 |
|
99 |
86 |
$25K |
| 99152 |
|
1,452 |
1,162 |
$25K |
| 87075 |
|
4,110 |
3,420 |
$25K |
| A9552 |
F18 fdg |
215 |
145 |
$24K |
| J7999 |
Compounded drug, noc |
2,803 |
1,943 |
$24K |
| 73590 |
|
844 |
724 |
$24K |
| J2270 |
Morphine sulfate injection |
8,712 |
5,905 |
$24K |
| J1100 |
Dexamethasone sodium phos |
9,628 |
8,295 |
$24K |
| 82962 |
|
5,460 |
3,205 |
$23K |
| 86850 |
|
3,208 |
2,735 |
$21K |
| 81220 |
|
94 |
88 |
$21K |
| 82803 |
|
1,969 |
1,501 |
$20K |
| J2790 |
Rho d immune globulin inj |
244 |
230 |
$20K |
| 80076 |
|
3,239 |
2,803 |
$20K |
| 82947 |
|
6,034 |
4,444 |
$20K |
| 70491 |
|
91 |
62 |
$19K |
| 82950 |
|
3,570 |
3,418 |
$19K |
| 93458 |
|
135 |
14 |
$19K |
| J2805 |
Sincalide injection |
227 |
202 |
$18K |
| 86038 |
|
1,966 |
1,815 |
$18K |
| 80069 |
|
2,994 |
1,815 |
$18K |
| 78815 |
|
52 |
26 |
$18K |
| 90686 |
|
2,627 |
2,396 |
$18K |
| 90677 |
|
622 |
578 |
$18K |
| 99406 |
|
1,308 |
1,176 |
$18K |
| 83605 |
|
3,272 |
2,363 |
$17K |
| C1894 |
Intro/sheath, non-laser |
1,364 |
1,103 |
$16K |
| 80050 |
|
1,087 |
699 |
$16K |
| J2930 |
Methylprednisolone injection |
1,941 |
1,615 |
$16K |
| J7298 |
Mirena, 52 mg |
26 |
24 |
$16K |
| 81003 |
|
6,725 |
5,176 |
$16K |
| 0012A |
|
930 |
904 |
$16K |
| J1040 |
Methylprednisolone 80 mg inj |
829 |
723 |
$16K |
| M0245 |
Bamlan and etesev infusion |
69 |
59 |
$15K |
| 86140 |
|
3,955 |
3,282 |
$15K |
| J3370 |
Vancomycin hcl injection |
772 |
419 |
$15K |
| 90472 |
|
585 |
568 |
$15K |
| 96161 |
|
1,022 |
871 |
$15K |
| 97166 |
|
255 |
212 |
$15K |
| 82150 |
|
3,850 |
3,394 |
$15K |
| G0103 |
Psa screening |
1,829 |
1,134 |
$15K |
| A9579 |
Gad-base mr contrast nos,1ml |
250 |
215 |
$14K |
| 86376 |
|
1,357 |
1,284 |
$14K |
| 0011A |
|
1,003 |
935 |
$14K |
| 84144 |
|
909 |
859 |
$14K |
| 85007 |
|
5,662 |
4,459 |
$14K |
| 95816 |
|
113 |
103 |
$14K |
| J1644 |
Inj heparin sodium per 1000u |
4,341 |
1,782 |
$14K |
| 10060 |
|
117 |
85 |
$13K |
| 72131 |
|
110 |
83 |
$13K |
| 97165 |
|
448 |
294 |
$13K |
| J2765 |
Metoclopramide hcl injection |
8,112 |
6,786 |
$13K |
| J0585 |
Injection,onabotulinumtoxina |
24 |
12 |
$13K |
| C1889 |
Implant/insert device, noc |
445 |
290 |
$13K |
| 82043 |
|
3,234 |
2,658 |
$13K |
| 87522 |
Neg quan hep c or qual rna |
443 |
404 |
$12K |
| 82570 |
|
3,270 |
2,858 |
$12K |
| 86308 |
|
2,892 |
2,738 |
$12K |
| J3420 |
Vitamin b12 injection |
1,814 |
1,497 |
$12K |
| 95819 |
|
79 |
70 |
$12K |
| 84402 |
|
572 |
545 |
$12K |
| 86901 |
|
3,994 |
3,420 |
$11K |
| 17110 |
|
106 |
100 |
$11K |
| 99495 |
|
323 |
270 |
$11K |
| 84550 |
|
2,870 |
2,520 |
$11K |
| 87205 |
|
4,346 |
3,516 |
$11K |
| 84145 |
|
945 |
774 |
$11K |
| 71101 |
|
335 |
242 |
$10K |
| 76641 |
|
105 |
95 |
$10K |
| 59025 |
|
104 |
72 |
$10K |
| C1886 |
Catheter, ablation |
51 |
40 |
$10K |
| 86592 |
|
2,567 |
2,200 |
$10K |
| 82375 |
|
1,533 |
1,156 |
$10K |
| J0330 |
Succinycholine chloride inj |
995 |
829 |
$10K |
| 83525 |
|
1,025 |
961 |
$9K |
| G0297 |
Ldct for lung ca screen |
226 |
211 |
$9K |
| 87350 |
|
1,079 |
963 |
$9K |
| 93270 |
|
326 |
285 |
$9K |
| J2543 |
Piperacillin/tazobactam |
132 |
63 |
$9K |
| 84520 |
|
4,417 |
3,826 |
$9K |
| 85652 |
|
4,534 |
3,886 |
$9K |
| 84112 |
|
168 |
151 |
$9K |
| 87426 |
|
352 |
295 |
$9K |
| 85379 |
|
1,601 |
1,395 |
$9K |
| Q9950 |
Inj sulf hexa lipid microsph |
106 |
91 |
$8K |
| G0009 |
Admin pneumococcal vaccine |
244 |
223 |
$8K |
| J7050 |
Normal saline solution infus |
192 |
106 |
$8K |
| 82550 |
|
1,988 |
1,541 |
$8K |
| 87046 |
|
562 |
508 |
$8K |
| J2550 |
Promethazine hcl injection |
3,388 |
2,639 |
$8K |
| 80143 |
|
804 |
679 |
$7K |
| J1642 |
Inj heparin sodium per 10 u |
1,931 |
1,171 |
$7K |
| J1650 |
Inj enoxaparin sodium |
1,211 |
506 |
$7K |
| G0283 |
Elec stim other than wound |
1,305 |
350 |
$7K |
| 96523 |
|
453 |
331 |
$7K |
| J2250 |
Inj midazolam hydrochloride |
10,321 |
8,554 |
$7K |
| J2710 |
Neostigmine methylslfte inj |
742 |
622 |
$7K |
| 86800 |
|
633 |
615 |
$7K |
| J0780 |
Prochlorperazine injection |
653 |
569 |
$7K |
| 77065 |
Tomosynthesis, mammo |
99 |
81 |
$7K |
| 87634 |
|
173 |
164 |
$7K |
| 80179 |
|
689 |
597 |
$6K |
| J0500 |
Dicyclomine injection |
197 |
172 |
$6K |
| 87081 |
|
280 |
268 |
$6K |
| 58100 |
|
60 |
55 |
$6K |
| 83516 |
|
376 |
271 |
$6K |
| G0480 |
Drug test def 1-7 classes |
187 |
120 |
$6K |
| 76870 |
|
88 |
81 |
$6K |
| 97802 |
|
151 |
143 |
$6K |
| 29075 |
|
40 |
28 |
$6K |
| 86430 |
|
1,264 |
1,174 |
$6K |
| 84436 |
|
1,136 |
1,076 |
$6K |
| 90670 |
|
734 |
711 |
$5K |
| 85018 |
|
1,003 |
671 |
$5K |
| 87493 |
|
218 |
192 |
$5K |
| 72170 |
|
192 |
155 |
$5K |
| A9537 |
Tc99m mebrofenin |
436 |
406 |
$5K |
| 85014 |
|
2,802 |
2,469 |
$5K |
| J2920 |
Methylprednisolone injection |
453 |
243 |
$5K |
| 99499 |
|
85 |
80 |
$5K |
| 87045 |
|
679 |
570 |
$5K |
| J1010 |
Inj, methylpred acetate 1 mg |
646 |
603 |
$5K |
| 97010 |
|
1,687 |
525 |
$5K |
| 93242 |
|
259 |
237 |
$5K |
| 83655 |
|
514 |
499 |
$5K |
| 94664 |
|
186 |
116 |
$5K |
| 93225 |
|
86 |
78 |
$5K |
| J1596 |
Inj, glycopyrrolate, 0.1 mg |
790 |
564 |
$4K |
| 83615 |
|
965 |
800 |
$4K |
| 87340 |
|
664 |
604 |
$4K |
| J2795 |
Ropivacaine hcl injection |
444 |
357 |
$4K |
| 92583 |
|
137 |
137 |
$4K |
| 82627 |
|
202 |
193 |
$4K |
| 90651 |
|
71 |
68 |
$4K |
| 11102 |
|
43 |
40 |
$4K |
| J1200 |
Diphenhydramine hcl injectio |
3,103 |
2,322 |
$4K |
| 82247 |
|
859 |
594 |
$4K |
| 86003 |
|
71 |
67 |
$3K |
| 82784 |
|
398 |
366 |
$3K |
| 58300 |
|
230 |
209 |
$3K |
| 86665 |
|
199 |
122 |
$3K |
| 11981 |
|
39 |
39 |
$3K |
| 73564 |
|
95 |
82 |
$3K |
| J7040 |
Normal saline solution infus |
606 |
447 |
$3K |
| 0064A |
|
375 |
316 |
$3K |
| 86885 |
|
414 |
356 |
$3K |
| C1773 |
Ret dev, insertable |
293 |
260 |
$3K |
| 73620 |
|
92 |
82 |
$3K |
| G0279 |
Tomosynthesis, mammo |
221 |
173 |
$3K |
| 82951 |
|
249 |
243 |
$3K |
| 64615 |
|
31 |
12 |
$3K |
| 76882 |
|
79 |
67 |
$3K |
| 51798 |
|
219 |
185 |
$3K |
| 86480 |
|
63 |
58 |
$3K |
| 11982 |
|
14 |
13 |
$3K |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
1,092 |
915 |
$3K |
| 86618 |
|
234 |
215 |
$2K |
| 96127 |
|
324 |
319 |
$2K |
| J3301 |
Triamcinolone acet inj nos |
416 |
366 |
$2K |
| 86696 |
|
137 |
67 |
$2K |
| 77080 |
|
97 |
64 |
$2K |
| 93880 |
|
15 |
13 |
$2K |
| 86200 |
|
226 |
216 |
$2K |
| 96110 |
|
1,505 |
1,366 |
$2K |
| J2060 |
Lorazepam injection |
970 |
769 |
$2K |
| C9113 |
Inj pantoprazole sodium, via |
581 |
383 |
$2K |
| J0360 |
Hydralazine hcl injection |
203 |
133 |
$2K |
| 76819 |
|
25 |
14 |
$2K |
| C1887 |
Catheter, guiding |
80 |
74 |
$2K |
| 20553 |
|
20 |
12 |
$2K |
| 86695 |
|
132 |
67 |
$2K |
| 93970 |
|
19 |
15 |
$2K |
| 90697 |
|
755 |
737 |
$2K |
| 73700 |
|
15 |
12 |
$2K |
| A4624 |
Tracheal suction tube |
352 |
280 |
$2K |
| 86762 |
|
200 |
186 |
$2K |
| 93246 |
|
87 |
85 |
$2K |
| 84100 |
|
454 |
292 |
$1K |
| Q9965 |
Locm 100-199mg/ml iodine,1ml |
126 |
118 |
$1K |
| 25600 |
|
14 |
12 |
$1K |
| 87807 |
|
206 |
200 |
$1K |
| A9270 |
Non-covered item or service |
15,025 |
4,528 |
$1K |
| 86664 |
|
110 |
102 |
$1K |
| J2919 |
Inj, methylpred sod succ 5mg |
145 |
125 |
$1K |
| 17000 |
|
32 |
25 |
$1K |
| G8978 |
Mobility current status |
610 |
278 |
$1K |
| 73521 |
|
14 |
14 |
$1K |
| 94618 |
|
38 |
31 |
$1K |
| 97167 |
|
15 |
14 |
$1K |
| 12011 |
|
25 |
24 |
$1K |
| J2370 |
Phenylephrine hcl injection |
407 |
350 |
$1K |
| 72082 |
|
18 |
15 |
$1K |
| 29105 |
|
15 |
12 |
$1K |
| 87210 |
|
192 |
143 |
$1K |
| A9698 |
Non-rad contrast materialnoc |
135 |
57 |
$1K |
| 77062 |
|
56 |
37 |
$1K |
| 51701 |
|
29 |
26 |
$1K |
| J2305 |
Inj, nitroglycerin, 5 mg |
195 |
82 |
$1K |
| 86580 |
|
111 |
101 |
$985.33 |
| 90656 |
|
249 |
244 |
$893.18 |
| 86593 |
|
216 |
207 |
$891.03 |
| 17250 |
|
17 |
12 |
$885.13 |
| 84156 |
|
342 |
275 |
$877.44 |
| J1050 |
Medroxyprogesterone acetate |
25 |
24 |
$867.63 |
| 88307 |
|
19 |
12 |
$854.42 |
| 86920 |
|
17 |
12 |
$842.73 |
| 92610 |
|
16 |
15 |
$832.60 |
| 0001A |
|
37 |
25 |
$788.08 |
| J0295 |
Ampicillin sulbactam 1.5 gm |
17 |
13 |
$775.13 |
| 96160 |
|
67 |
56 |
$767.60 |
| 82952 |
|
220 |
214 |
$741.07 |
| 29125 |
|
27 |
25 |
$738.80 |
| 82977 |
|
159 |
150 |
$701.07 |
| 87209 |
|
47 |
41 |
$686.94 |
| 86255 |
|
78 |
72 |
$664.61 |
| 83013 |
|
16 |
15 |
$663.47 |
| J2001 |
Lidocaine injection |
238 |
200 |
$660.69 |
| 83970 |
|
32 |
25 |
$654.64 |
| 84165 |
|
94 |
91 |
$643.58 |
| 97150 |
|
79 |
50 |
$613.22 |
| 83921 |
|
47 |
46 |
$594.88 |
| 84460 |
|
158 |
141 |
$577.94 |
| 84207 |
|
40 |
38 |
$569.44 |
| 82140 |
|
29 |
25 |
$535.28 |
| 0002A |
|
22 |
17 |
$534.40 |
| J0171 |
Adrenalin epinephrine inject |
16 |
13 |
$524.94 |
| 86702 |
|
62 |
58 |
$513.92 |
| 86704 |
|
59 |
52 |
$505.09 |
| 73600 |
|
14 |
13 |
$503.19 |
| 84132 |
|
190 |
127 |
$480.67 |
| 82677 |
|
27 |
27 |
$469.45 |
| 86706 |
|
61 |
57 |
$464.30 |
| 73552 |
|
14 |
14 |
$445.38 |
| J8499 |
Oral prescrip drug non chemo |
515 |
200 |
$441.50 |
| J3475 |
Inj magnesium sulfate |
85 |
51 |
$432.99 |
| 90619 |
|
53 |
52 |
$432.70 |
| Q9956 |
Inj octafluoropropane mic,ml |
16 |
13 |
$423.30 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
117 |
98 |
$422.86 |
| 73120 |
|
15 |
13 |
$418.31 |
| 82679 |
|
25 |
25 |
$414.43 |
| 69210 |
|
13 |
12 |
$403.00 |
| 92504 |
|
54 |
47 |
$399.18 |
| 88302 |
|
54 |
25 |
$396.02 |
| 95115 |
|
28 |
12 |
$383.65 |
| 86701 |
|
63 |
59 |
$382.69 |
| 87177 |
|
47 |
41 |
$342.38 |
| 98929 |
|
44 |
26 |
$342.19 |
| 84446 |
|
41 |
36 |
$336.97 |
| 64494 |
|
42 |
38 |
$329.91 |
| 97810 |
|
28 |
13 |
$329.03 |
| A6449 |
Lt compres band >=3" <5"/yd |
221 |
195 |
$316.02 |
| 86060 |
|
40 |
38 |
$308.51 |
| J1940 |
Furosemide injection |
142 |
66 |
$296.35 |
| A6197 |
Alginate drsg >16 <=48 sq in |
127 |
57 |
$284.93 |
| 88300 |
|
43 |
38 |
$280.19 |
| A6250 |
Skin seal protect moisturizr |
48 |
46 |
$271.69 |
| 90723 |
|
178 |
173 |
$267.25 |
| 90716 |
|
75 |
75 |
$256.55 |
| 87425 |
|
27 |
26 |
$244.72 |
| J0736 |
Inj, clindamycin phosp 300mg |
32 |
12 |
$239.87 |
| C1729 |
Cath, drainage |
34 |
13 |
$230.37 |
| 85246 |
|
12 |
12 |
$229.40 |
| 84425 |
|
15 |
13 |
$228.43 |
| G8987 |
Self care current status |
39 |
15 |
$215.15 |
| 82105 |
|
12 |
12 |
$207.80 |
| 97035 |
|
26 |
13 |
$201.30 |
| J1956 |
Levofloxacin injection |
20 |
12 |
$192.03 |
| 84153 |
|
12 |
12 |
$190.66 |
| 90662 |
|
111 |
58 |
$187.43 |
| 84155 |
|
73 |
63 |
$163.07 |
| 86225 |
|
12 |
12 |
$158.80 |
| 90474 |
|
14 |
14 |
$144.72 |
| Q9963 |
Hocm 350-399mg/ml iodine,1ml |
21 |
20 |
$138.23 |
| 90833 |
|
15 |
15 |
$138.14 |
| 86334 |
|
13 |
12 |
$127.99 |
| G8984 |
Carry current status |
30 |
15 |
$126.14 |
| 89055 |
|
41 |
38 |
$120.09 |
| J2471 |
Inj pantoprazole(hikma) 40mg |
90 |
78 |
$112.68 |
| 82270 |
|
42 |
34 |
$110.21 |
| J1094 |
Inj dexamethasone acetate |
42 |
26 |
$109.12 |
| 86008 |
|
12 |
12 |
$107.58 |
| 82785 |
|
14 |
12 |
$100.15 |
| J0595 |
Butorphanol tartrate 1 mg |
35 |
28 |
$98.64 |
| 85045 |
|
34 |
29 |
$94.35 |
| 82009 |
|
45 |
37 |
$90.02 |
| 87106 |
|
15 |
12 |
$87.58 |
| G8979 |
Mobility goal status |
345 |
271 |
$83.67 |
| 83090 |
|
12 |
12 |
$71.68 |
| 97811 |
|
23 |
12 |
$62.64 |
| 90633 |
|
420 |
416 |
$60.45 |
| J1953 |
Levetiracetam injection |
15 |
12 |
$43.03 |
| 81050 |
|
14 |
12 |
$42.45 |
| 84134 |
|
14 |
13 |
$39.81 |
| A4351 |
Straight tip urine catheter |
112 |
92 |
$37.70 |
| 84450 |
|
16 |
12 |
$30.46 |
| Q0244 |
Casirivi and imdevi 1200 mg |
22 |
20 |
$22.23 |
| 85347 |
|
19 |
12 |
$17.12 |
| J7613 |
Albuterol non-comp unit |
40 |
28 |
$7.88 |
| J7620 |
Albuterol ipratrop non-comp |
44 |
25 |
$6.42 |
| J8597 |
Antiemetic drug oral nos |
51 |
49 |
$5.26 |
| 90681 |
|
551 |
533 |
$2.01 |
| 90647 |
|
206 |
200 |
$0.79 |
| 90700 |
|
78 |
77 |
$0.75 |
| 90707 |
|
88 |
87 |
$0.72 |
| Q0245 |
Bamlanivimab and etesevima |
13 |
12 |
$0.18 |
| 90671 |
|
27 |
26 |
$0.16 |
| 90381 |
|
13 |
13 |
$0.02 |
| 3078F |
|
660 |
541 |
$0.01 |
| G8985 |
Carry goal status |
14 |
12 |
$0.00 |
| G9163 |
Lang express goal status |
43 |
36 |
$0.00 |
| 1126F |
|
188 |
159 |
$0.00 |
| G8988 |
Self care goal status |
16 |
14 |
$0.00 |
| G9162 |
Lang express current status |
56 |
48 |
$0.00 |
| 1125F |
|
60 |
57 |
$0.00 |