| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90853 |
|
145,904 |
39,108 |
$22.40M |
| 99283 |
|
63,099 |
57,418 |
$17.26M |
| 99284 |
|
44,184 |
39,510 |
$14.49M |
| 99285 |
|
26,330 |
23,720 |
$8.56M |
| G0378 |
Hospital observation per hr |
18,876 |
10,027 |
$6.44M |
| 99213 |
|
74,855 |
69,953 |
$4.55M |
| 99282 |
|
25,418 |
23,574 |
$4.26M |
| 43239 |
|
6,237 |
6,052 |
$2.80M |
| 74177 |
|
8,958 |
8,608 |
$2.26M |
| 45380 |
|
4,454 |
4,303 |
$1.84M |
| OP272 |
|
32,058 |
20,568 |
$1.54M |
| A0427 |
Als1-emergency |
4,322 |
4,142 |
$1.48M |
| S9480 |
Intensive outpatient psychia |
1,813 |
1,680 |
$1.45M |
| 95810 |
|
1,612 |
1,585 |
$1.44M |
| 90837 |
|
26,111 |
12,538 |
$1.36M |
| 96374 |
|
35,956 |
29,123 |
$1.30M |
| 93005 |
|
43,123 |
37,435 |
$1.27M |
| 70450 |
|
10,638 |
9,942 |
$1.26M |
| OP251 |
|
123,779 |
89,950 |
$1.22M |
| 90832 |
|
23,513 |
20,188 |
$1.22M |
| 59025 |
|
6,430 |
3,675 |
$1.16M |
| 99211 |
|
36,477 |
24,892 |
$1.10M |
| 85025 |
|
115,214 |
90,744 |
$1.06M |
| 88305 |
|
9,655 |
9,211 |
$1.05M |
| 45378 |
|
2,427 |
2,370 |
$1.04M |
| 71046 |
|
24,493 |
23,484 |
$993K |
| 93306 |
|
3,243 |
3,138 |
$983K |
| 77067 |
|
10,675 |
10,448 |
$947K |
| 76819 |
|
9,115 |
5,256 |
$932K |
| 90834 |
|
15,190 |
7,274 |
$913K |
| 96375 |
|
19,608 |
15,448 |
$898K |
| 96365 |
|
14,655 |
12,951 |
$828K |
| 96372 |
|
40,137 |
30,553 |
$806K |
| 99281 |
|
6,268 |
5,490 |
$778K |
| 96361 |
|
11,042 |
9,287 |
$758K |
| 76817 |
|
7,293 |
6,423 |
$712K |
| 80053 |
|
63,530 |
52,190 |
$692K |
| 76816 |
|
7,118 |
6,571 |
$656K |
| 76856 |
|
5,107 |
4,949 |
$596K |
| 96413 |
|
4,276 |
2,286 |
$591K |
| 90791 |
|
8,406 |
8,141 |
$588K |
| 74176 |
|
3,163 |
3,024 |
$588K |
| 76805 |
|
4,495 |
4,232 |
$571K |
| 76830 |
|
4,899 |
4,748 |
$538K |
| 90792 |
|
7,343 |
7,048 |
$530K |
| 71045 |
|
19,131 |
17,470 |
$509K |
| 97110 |
|
16,261 |
4,153 |
$482K |
| 11042 |
|
6,741 |
2,666 |
$472K |
| 78452 |
|
1,673 |
1,607 |
$467K |
| 71275 |
|
2,127 |
2,046 |
$450K |
| 93458 |
|
388 |
357 |
$440K |
| 0241U |
|
9,607 |
8,870 |
$440K |
| 76801 |
|
4,364 |
3,735 |
$433K |
| G0463 |
Hospital outpt clinic visit |
30,193 |
24,622 |
$399K |
| A0428 |
Bls |
11,453 |
5,853 |
$370K |
| 76700 |
|
3,205 |
3,136 |
$358K |
| 77066 |
Tomosynthesis, mammo |
2,713 |
2,638 |
$354K |
| OP270 |
|
5,952 |
4,465 |
$349K |
| 88342 |
|
4,744 |
4,624 |
$347K |
| A0425 |
Ground mileage |
16,588 |
10,243 |
$337K |
| 71250 |
|
2,461 |
2,383 |
$323K |
| J1885 |
Ketorolac tromethamine inj |
19,381 |
17,565 |
$319K |
| 72125 |
|
2,540 |
2,355 |
$318K |
| 93017 |
|
2,006 |
1,928 |
$309K |
| 99212 |
|
5,805 |
5,381 |
$287K |
| 90847 |
|
5,711 |
4,572 |
$286K |
| 93970 |
|
1,383 |
1,321 |
$273K |
| 96360 |
|
4,559 |
4,088 |
$273K |
| 45385 |
|
717 |
696 |
$267K |
| 76642 |
|
3,216 |
3,118 |
$262K |
| 73630 |
|
5,833 |
5,584 |
$244K |
| 80305 |
|
15,520 |
12,348 |
$242K |
| 71260 |
|
1,421 |
1,357 |
$239K |
| 80320 |
|
9,458 |
7,993 |
$231K |
| OP250 |
|
32,243 |
21,945 |
$222K |
| 76811 |
|
1,030 |
1,005 |
$218K |
| 77080 |
|
2,830 |
2,748 |
$216K |
| 76705 |
|
2,973 |
2,863 |
$216K |
| A0429 |
Bls-emergency |
1,104 |
1,032 |
$215K |
| 80048 |
|
34,926 |
29,798 |
$214K |
| 87536 |
|
2,749 |
2,699 |
$200K |
| 84484 |
|
25,861 |
21,941 |
$190K |
| 87491 |
|
6,710 |
6,507 |
$189K |
| 76815 |
|
2,997 |
2,653 |
$188K |
| J1439 |
Inj ferric carboxymaltos 1mg |
313 |
201 |
$186K |
| 77063 |
|
5,555 |
5,343 |
$180K |
| 83880 |
|
10,313 |
9,493 |
$176K |
| 87631 |
|
4,047 |
3,749 |
$175K |
| 70486 |
|
1,188 |
1,142 |
$173K |
| 97802 |
|
3,375 |
2,689 |
$172K |
| 99391 |
|
9,115 |
8,900 |
$171K |
| 76813 |
|
1,512 |
1,477 |
$170K |
| 86850 |
|
13,694 |
12,054 |
$168K |
| 84443 |
|
12,821 |
12,103 |
$167K |
| 96376 |
|
4,336 |
3,285 |
$166K |
| 73560 |
|
4,441 |
4,273 |
$163K |
| 72110 |
|
2,314 |
2,257 |
$161K |
| 77065 |
Tomosynthesis, mammo |
2,281 |
2,135 |
$161K |
| 87591 |
|
6,712 |
6,510 |
$161K |
| 95811 |
|
190 |
190 |
$159K |
| J2250 |
Inj midazolam hydrochloride |
8,176 |
7,569 |
$143K |
| 58558 |
|
98 |
98 |
$143K |
| G0480 |
Drug test def 1-7 classes |
3,483 |
2,871 |
$139K |
| U0003 |
Cov-19 amp prb hgh thruput |
3,597 |
3,393 |
$138K |
| J1756 |
Iron sucrose injection |
1,108 |
315 |
$124K |
| 64483 |
|
185 |
183 |
$124K |
| 73030 |
|
3,194 |
3,054 |
$121K |
| 73610 |
|
3,662 |
3,508 |
$119K |
| 93971 |
|
669 |
635 |
$116K |
| 84702 |
|
12,128 |
10,571 |
$116K |
| 80061 |
|
10,544 |
10,148 |
$114K |
| G0283 |
Elec stim other than wound |
3,718 |
1,044 |
$113K |
| 80330 |
|
3,637 |
3,370 |
$108K |
| C9803 |
Hopd covid-19 spec collect |
10,357 |
9,519 |
$107K |
| 86900 |
|
13,867 |
12,156 |
$103K |
| 73130 |
|
2,935 |
2,807 |
$102K |
| 59050 |
|
866 |
760 |
$101K |
| 36415 |
|
16,409 |
13,363 |
$100K |
| 80076 |
|
19,447 |
17,948 |
$92K |
| 76820 |
|
1,603 |
832 |
$90K |
| 80051 |
|
16,948 |
15,788 |
$90K |
| 86901 |
|
13,881 |
12,164 |
$89K |
| 82306 |
|
4,352 |
4,200 |
$88K |
| OP259 |
|
5,915 |
4,742 |
$88K |
| J2405 |
Ondansetron hcl injection |
14,188 |
12,481 |
$86K |
| J0696 |
Ceftriaxone sodium injection |
3,354 |
2,729 |
$85K |
| 76536 |
|
845 |
828 |
$82K |
| J2469 |
Palonosetron hcl |
1,197 |
635 |
$82K |
| 86703 |
|
4,669 |
4,540 |
$81K |
| 86360 |
|
1,908 |
1,883 |
$80K |
| 83735 |
|
17,946 |
13,936 |
$78K |
| 76000 |
|
1,386 |
1,337 |
$77K |
| 92507 |
|
752 |
270 |
$76K |
| 90671 |
|
930 |
906 |
$75K |
| 85610 |
|
19,304 |
17,368 |
$74K |
| 70551 |
|
370 |
347 |
$74K |
| 86480 |
|
1,621 |
1,587 |
$73K |
| 76775 |
|
999 |
972 |
$72K |
| 90460 |
|
5,248 |
5,138 |
$70K |
| 96523 |
|
1,331 |
894 |
$70K |
| T2034 |
Crisis interven waiver/diem |
78 |
78 |
$67K |
| 96367 |
|
985 |
516 |
$65K |
| 82728 |
|
8,351 |
7,556 |
$62K |
| 97162 |
|
1,561 |
1,473 |
$62K |
| 83690 |
|
18,220 |
16,713 |
$61K |
| 85730 |
|
16,342 |
15,082 |
$61K |
| 82947 |
|
16,933 |
15,742 |
$61K |
| 87070 |
|
7,245 |
7,068 |
$61K |
| 90471 |
|
5,016 |
4,750 |
$59K |
| 90846 |
|
1,148 |
930 |
$58K |
| J0897 |
Denosumab injection |
99 |
87 |
$57K |
| 97140 |
|
1,400 |
471 |
$56K |
| 82607 |
|
7,230 |
6,701 |
$55K |
| 78815 |
|
67 |
66 |
$53K |
| OP258 |
|
5,584 |
3,981 |
$53K |
| 97161 |
|
1,495 |
1,438 |
$52K |
| 83036 |
|
8,731 |
8,401 |
$51K |
| 81002 |
|
24,592 |
14,526 |
$51K |
| 82565 |
|
16,723 |
15,566 |
$50K |
| 97010 |
|
5,191 |
1,653 |
$49K |
| 73502 |
|
1,439 |
1,359 |
$49K |
| 96417 |
|
440 |
257 |
$49K |
| 90461 |
|
3,110 |
3,072 |
$49K |
| J3010 |
Fentanyl citrate injection |
5,954 |
5,653 |
$48K |
| 99392 |
|
2,478 |
2,432 |
$48K |
| 87088 |
|
13,772 |
12,917 |
$48K |
| 81001 |
|
20,803 |
19,526 |
$47K |
| 47562 |
|
25 |
25 |
$47K |
| 72050 |
|
686 |
679 |
$46K |
| 84439 |
|
6,591 |
6,287 |
$46K |
| 74018 |
|
1,317 |
1,220 |
$46K |
| 84520 |
|
16,617 |
15,443 |
$45K |
| J1100 |
Dexamethasone sodium phos |
2,794 |
1,437 |
$45K |
| 83605 |
|
4,981 |
4,571 |
$45K |
| 77412 |
|
123 |
12 |
$44K |
| 87636 |
|
3,630 |
3,303 |
$44K |
| 97164 |
|
1,423 |
1,331 |
$44K |
| 73110 |
|
1,344 |
1,290 |
$43K |
| Q5106 |
Inj retacrit non-esrd use |
161 |
77 |
$42K |
| 82542 |
|
1,500 |
1,056 |
$42K |
| 29580 |
|
1,140 |
415 |
$41K |
| J7120 |
Ringers lactate infusion |
2,390 |
2,186 |
$41K |
| 84100 |
|
10,612 |
8,494 |
$41K |
| 87635 |
|
1,243 |
1,182 |
$41K |
| 70498 |
|
242 |
232 |
$41K |
| 85014 |
|
15,323 |
14,163 |
$40K |
| 88142 |
|
2,348 |
2,336 |
$40K |
| 87040 |
|
3,364 |
3,082 |
$38K |
| 99214 |
|
573 |
530 |
$38K |
| 90723 |
|
2,879 |
2,821 |
$37K |
| 90472 |
|
2,340 |
2,282 |
$37K |
| 72131 |
|
397 |
361 |
$37K |
| 84480 |
|
3,224 |
3,093 |
$35K |
| 11045 |
|
316 |
127 |
$35K |
| 90670 |
|
3,401 |
3,320 |
$35K |
| 82746 |
|
6,059 |
5,595 |
$34K |
| 88304 |
|
902 |
886 |
$34K |
| J1200 |
Diphenhydramine hcl injectio |
4,836 |
3,671 |
$34K |
| 82550 |
|
6,661 |
5,755 |
$34K |
| 86803 |
|
2,296 |
2,220 |
$34K |
| 87502 |
|
844 |
843 |
$34K |
| 87624 |
|
1,161 |
1,156 |
$34K |
| A9500 |
Tc99m sestamibi |
520 |
516 |
$33K |
| 94640 |
|
1,802 |
837 |
$33K |
| 76818 |
|
291 |
184 |
$32K |
| 95782 |
|
32 |
32 |
$32K |
| G0279 |
Tomosynthesis, mammo |
1,438 |
1,320 |
$32K |
| 95816 |
|
173 |
172 |
$31K |
| 82378 |
|
2,194 |
1,813 |
$30K |
| 83550 |
|
8,268 |
7,482 |
$30K |
| 94664 |
|
1,133 |
1,061 |
$29K |
| 77334 |
|
49 |
36 |
$28K |
| 86922 |
|
999 |
800 |
$28K |
| 96415 |
|
225 |
161 |
$26K |
| 87340 |
|
3,542 |
3,426 |
$26K |
| 70496 |
|
156 |
150 |
$26K |
| J0690 |
Cefazolin sodium injection |
3,399 |
2,943 |
$26K |
| 87186 |
|
3,177 |
3,020 |
$26K |
| J2785 |
Regadenoson injection |
681 |
630 |
$26K |
| 64484 |
|
74 |
74 |
$25K |
| 96366 |
|
478 |
335 |
$25K |
| 81420 |
|
126 |
125 |
$24K |
| 12001 |
|
498 |
468 |
$23K |
| 87811 |
|
1,672 |
1,549 |
$23K |
| 81003 |
|
10,854 |
10,290 |
$23K |
| 73080 |
|
827 |
788 |
$23K |
| 73590 |
|
737 |
689 |
$22K |
| 70553 |
|
52 |
52 |
$22K |
| OP710 |
|
139 |
110 |
$22K |
| 90935 |
|
519 |
290 |
$22K |
| 83540 |
|
8,425 |
7,633 |
$22K |
| OP370 |
|
317 |
280 |
$21K |
| 82951 |
|
3,013 |
2,798 |
$21K |
| J1630 |
Haloperidol injection |
1,249 |
1,044 |
$20K |
| 86580 |
|
1,920 |
1,853 |
$20K |
| 72100 |
|
627 |
614 |
$19K |
| 93975 |
|
85 |
79 |
$19K |
| 77062 |
|
756 |
747 |
$19K |
| 85378 |
|
3,878 |
3,692 |
$18K |
| 72170 |
|
633 |
576 |
$18K |
| 88307 |
|
161 |
158 |
$17K |
| 83615 |
|
3,411 |
3,255 |
$17K |
| 82105 |
|
1,638 |
1,579 |
$17K |
| A9502 |
Tc99m tetrofosmin |
859 |
703 |
$17K |
| 80329 |
|
2,356 |
2,161 |
$17K |
| 66984 |
|
29 |
27 |
$17K |
| J1815 |
Insulin injection |
1,246 |
777 |
$16K |
| OP271 |
|
5,214 |
5,027 |
$16K |
| 86592 |
|
7,774 |
7,557 |
$15K |
| 0002A |
|
535 |
531 |
$15K |
| 82677 |
|
520 |
515 |
$14K |
| 36430 |
|
146 |
119 |
$14K |
| 83020 |
|
2,179 |
2,146 |
$14K |
| 99393 |
|
762 |
756 |
$13K |
| 81025 |
|
3,139 |
3,032 |
$13K |
| 93880 |
|
87 |
87 |
$13K |
| 87320 |
|
956 |
947 |
$12K |
| C1713 |
Anchor/screw bn/bn,tis/bn |
13 |
12 |
$12K |
| 84153 |
|
758 |
699 |
$12K |
| 12011 |
|
240 |
231 |
$12K |
| 73140 |
|
391 |
376 |
$12K |
| 19083 |
|
27 |
24 |
$11K |
| 86704 |
|
513 |
489 |
$11K |
| 82803 |
|
1,055 |
959 |
$11K |
| 86706 |
|
545 |
529 |
$11K |
| 86677 |
|
1,835 |
1,818 |
$10K |
| 83874 |
|
550 |
383 |
$10K |
| 84703 |
|
2,586 |
2,466 |
$10K |
| 86870 |
|
158 |
143 |
$10K |
| 82248 |
|
1,483 |
1,193 |
$10K |
| 82553 |
|
694 |
469 |
$10K |
| 90681 |
|
2,840 |
2,787 |
$9K |
| 70491 |
|
60 |
53 |
$9K |
| 76641 |
|
73 |
68 |
$9K |
| 71100 |
|
335 |
322 |
$9K |
| A6251 |
Absorpt drg <=16 sq in w/o b |
6,461 |
2,257 |
$9K |
| 90714 |
|
1,699 |
1,604 |
$9K |
| 74021 |
|
226 |
221 |
$9K |
| 96161 |
|
685 |
648 |
$9K |
| 90380 |
|
41 |
39 |
$9K |
| 0001A |
|
496 |
493 |
$9K |
| 86762 |
|
2,217 |
2,172 |
$9K |
| C8929 |
Tte w or wo fol wcon,doppler |
55 |
54 |
$9K |
| 90647 |
|
2,694 |
2,632 |
$8K |
| 80164 |
|
817 |
740 |
$8K |
| J1644 |
Inj heparin sodium per 1000u |
368 |
327 |
$8K |
| J2710 |
Neostigmine methylslfte inj |
551 |
535 |
$8K |
| 72074 |
|
222 |
214 |
$8K |
| J2060 |
Lorazepam injection |
1,650 |
1,330 |
$8K |
| 77336 |
|
94 |
39 |
$8K |
| J1650 |
Inj enoxaparin sodium |
3,405 |
1,498 |
$8K |
| 90686 |
|
1,317 |
1,280 |
$7K |
| 77061 |
|
427 |
395 |
$7K |
| 86336 |
|
496 |
491 |
$7K |
| J2930 |
Methylprednisolone injection |
2,518 |
2,051 |
$7K |
| 82465 |
|
1,830 |
1,802 |
$7K |
| 82009 |
|
2,378 |
2,194 |
$7K |
| 96402 |
|
65 |
62 |
$7K |
| 87634 |
|
212 |
211 |
$7K |
| J2270 |
Morphine sulfate injection |
4,901 |
4,347 |
$7K |
| OP720 |
|
47 |
38 |
$7K |
| 76870 |
|
71 |
70 |
$7K |
| 87110 |
|
463 |
459 |
$6K |
| J1245 |
Dipyridamole injection |
76 |
76 |
$6K |
| A0434 |
Specialty care transport |
20 |
13 |
$6K |
| G2023 |
Specimen collect covid-19 |
418 |
401 |
$6K |
| J1170 |
Hydromorphone injection |
2,541 |
2,078 |
$6K |
| 96411 |
|
39 |
26 |
$6K |
| A4649 |
Surgical supplies |
1,155 |
488 |
$6K |
| J2765 |
Metoclopramide hcl injection |
5,289 |
4,793 |
$6K |
| 86701 |
|
762 |
732 |
$6K |
| 87205 |
|
1,526 |
1,442 |
$6K |
| 85044 |
|
1,362 |
1,154 |
$5K |
| 97530 |
|
388 |
216 |
$5K |
| 93923 |
|
39 |
39 |
$5K |
| 10060 |
|
103 |
97 |
$5K |
| 36600 |
|
427 |
384 |
$5K |
| 72084 |
|
40 |
40 |
$5K |
| C9113 |
Inj pantoprazole sodium, via |
1,533 |
894 |
$5K |
| 73090 |
|
169 |
159 |
$5K |
| 97116 |
|
287 |
133 |
$4K |
| 82247 |
|
947 |
768 |
$4K |
| 74183 |
|
12 |
12 |
$4K |
| 86140 |
|
1,888 |
1,816 |
$4K |
| G0121 |
Colon ca scrn not hi rsk ind |
26 |
26 |
$4K |
| 84163 |
|
262 |
262 |
$4K |
| 85651 |
|
2,270 |
2,193 |
$4K |
| 82043 |
|
1,098 |
1,082 |
$4K |
| 80307 |
|
142 |
126 |
$4K |
| J0330 |
Succinycholine chloride inj |
1,546 |
1,350 |
$4K |
| M0243 |
Casirivi and imdevi inj |
63 |
62 |
$3K |
| A9552 |
F18 fdg |
61 |
54 |
$3K |
| 99202 |
|
73 |
73 |
$3K |
| 0011A |
|
108 |
107 |
$3K |
| 87426 |
|
226 |
221 |
$3K |
| 93325 |
|
13 |
13 |
$3K |
| 73562 |
|
71 |
68 |
$3K |
| 76821 |
|
40 |
27 |
$3K |
| 86300 |
|
266 |
225 |
$3K |
| 83970 |
|
180 |
171 |
$3K |
| 0012A |
|
94 |
93 |
$3K |
| J0280 |
Aminophyllin 250 mg inj |
263 |
263 |
$3K |
| G0379 |
Direct refer hospital observ |
64 |
56 |
$3K |
| 90677 |
|
24 |
24 |
$3K |
| 83930 |
|
717 |
659 |
$3K |
| 99394 |
|
121 |
120 |
$2K |
| G0008 |
Admin influenza virus vac |
248 |
243 |
$2K |
| 87400 |
|
208 |
205 |
$2K |
| U0002 |
Covid-19 lab test non-cdc |
798 |
728 |
$2K |
| J3420 |
Vitamin b12 injection |
1,472 |
890 |
$2K |
| 90474 |
|
259 |
259 |
$2K |
| 82570 |
|
873 |
788 |
$2K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
190 |
185 |
$2K |
| A6196 |
Alginate dressing <=16 sq in |
547 |
263 |
$2K |
| G8978 |
Mobility current status |
83 |
79 |
$2K |
| 87075 |
|
255 |
237 |
$1K |
| 29125 |
|
33 |
33 |
$1K |
| J3301 |
Triamcinolone acet inj nos |
260 |
258 |
$1K |
| 86769 |
|
52 |
52 |
$1K |
| 83883 |
|
247 |
223 |
$1K |
| 73060 |
|
44 |
41 |
$1K |
| 85384 |
|
220 |
212 |
$1K |
| 84550 |
|
454 |
427 |
$1K |
| Q9963 |
Hocm 350-399mg/ml iodine,1ml |
12 |
12 |
$1K |
| M0247 |
Sotrovimab infusion |
16 |
12 |
$1K |
| OP229 |
|
25 |
16 |
$1K |
| 96110 |
|
65 |
64 |
$1K |
| 97803 |
|
17 |
17 |
$1K |
| 76881 |
|
12 |
12 |
$1K |
| G8979 |
Mobility goal status |
44 |
41 |
$1K |
| 84202 |
|
161 |
152 |
$1K |
| 29130 |
|
28 |
28 |
$976.53 |
| 82962 |
|
330 |
285 |
$950.88 |
| P9040 |
Rbc leukoreduced irradiated |
12 |
12 |
$920.18 |
| 73552 |
|
42 |
41 |
$802.46 |
| 83655 |
|
161 |
152 |
$796.03 |
| 90633 |
|
787 |
765 |
$795.69 |
| 80179 |
|
105 |
92 |
$774.90 |
| A6021 |
Collagen dressing <=16 sq in |
628 |
332 |
$766.90 |
| 90673 |
|
13 |
13 |
$724.90 |
| J0702 |
Betamethasone acet&sod phosp |
19 |
12 |
$721.36 |
| 0031A |
|
40 |
40 |
$711.44 |
| 12002 |
|
16 |
13 |
$688.18 |
| J2916 |
Na ferric gluconate complex |
130 |
42 |
$683.03 |
| 87880 |
|
118 |
113 |
$680.07 |
| 90685 |
|
1,089 |
1,085 |
$667.30 |
| 84155 |
|
414 |
401 |
$661.04 |
| 0003A |
|
24 |
23 |
$655.12 |
| 80143 |
|
105 |
93 |
$646.79 |
| 82150 |
|
200 |
190 |
$636.01 |
| 90715 |
|
16 |
16 |
$629.01 |
| 90662 |
|
42 |
36 |
$617.30 |
| J2370 |
Phenylephrine hcl injection |
353 |
320 |
$588.78 |
| 90658 |
|
65 |
65 |
$585.38 |
| 85027 |
|
191 |
159 |
$557.09 |
| 90656 |
|
62 |
62 |
$519.20 |
| A6222 |
Gauze <=16 in no w/sal w/o b |
175 |
92 |
$517.96 |
| J2704 |
Inj, propofol, 10 mg |
263 |
254 |
$517.93 |
| 73522 |
|
14 |
13 |
$482.47 |
| 82805 |
|
15 |
13 |
$480.89 |
| G0499 |
Hepb screen high risk indiv |
97 |
78 |
$477.79 |
| 88311 |
|
24 |
24 |
$470.93 |
| A9270 |
Non-covered item or service |
200 |
108 |
$445.86 |
| 86709 |
|
97 |
92 |
$414.16 |
| 90716 |
|
170 |
164 |
$407.66 |
| 84403 |
|
15 |
14 |
$393.27 |
| 97112 |
|
12 |
12 |
$387.44 |
| 80074 |
|
12 |
12 |
$363.18 |
| 86694 |
|
19 |
19 |
$360.19 |
| 86705 |
|
55 |
54 |
$358.27 |
| 29515 |
|
12 |
12 |
$334.66 |
| 87389 |
|
23 |
22 |
$330.56 |
| J2920 |
Methylprednisolone injection |
147 |
72 |
$280.76 |
| 84402 |
|
12 |
12 |
$262.59 |
| J2003 |
Inj, lidocaine hcl, 1 mg |
232 |
219 |
$252.00 |
| J2919 |
Inj, methylpred sod succ 5mg |
142 |
109 |
$247.56 |
| 90707 |
|
179 |
173 |
$243.39 |
| 85379 |
|
35 |
34 |
$234.77 |
| A6197 |
Alginate drsg >16 <=48 sq in |
52 |
27 |
$191.31 |
| 15853 |
|
63 |
55 |
$188.44 |
| 86335 |
|
12 |
12 |
$186.35 |
| 82652 |
|
16 |
15 |
$184.06 |
| 87086 |
|
41 |
38 |
$183.02 |
| 85007 |
|
68 |
66 |
$177.71 |
| 90697 |
|
670 |
653 |
$176.00 |
| A4311 |
Catheter w/o bag 2-way latex |
160 |
137 |
$170.66 |
| 86320 |
|
17 |
15 |
$166.43 |
| 96127 |
|
13 |
13 |
$164.47 |
| 87045 |
|
24 |
24 |
$158.69 |
| J2274 |
Inj morphine pf epid ithc |
117 |
110 |
$150.30 |
| A4452 |
Waterproof tape |
22 |
16 |
$143.61 |
| J0171 |
Adrenalin epinephrine inject |
13 |
13 |
$141.69 |
| 83001 |
|
13 |
13 |
$140.13 |
| 84165 |
|
55 |
55 |
$135.43 |
| G0103 |
Psa screening |
12 |
12 |
$130.12 |
| 80178 |
|
24 |
24 |
$127.89 |
| 82575 |
|
25 |
25 |
$124.36 |
| 82270 |
|
64 |
60 |
$110.79 |
| 82952 |
|
37 |
37 |
$110.57 |
| 87081 |
|
41 |
38 |
$108.74 |
| 90710 |
|
61 |
60 |
$101.97 |
| G0009 |
Admin pneumococcal vaccine |
24 |
24 |
$97.19 |
| 86317 |
|
15 |
14 |
$76.26 |
| 90700 |
|
104 |
104 |
$70.54 |
| 82140 |
|
55 |
43 |
$66.27 |
| 84436 |
|
30 |
27 |
$63.25 |
| V2632 |
Post chmbr intraocular lens |
14 |
13 |
$62.37 |
| 85652 |
|
39 |
37 |
$60.11 |
| OP252 |
|
101 |
92 |
$56.47 |
| J0134 |
Inj acetaminophen -fresenius |
84 |
70 |
$51.35 |
| J2371 |
Inj phenylephrine hcl 20 mcg |
164 |
151 |
$49.28 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
46 |
32 |
$48.38 |
| 90689 |
|
36 |
36 |
$48.23 |
| J3370 |
Vancomycin hcl injection |
78 |
49 |
$46.67 |
| J7040 |
Normal saline solution infus |
17 |
12 |
$38.49 |
| 85045 |
|
13 |
12 |
$34.99 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
13 |
13 |
$27.24 |
| J2004 |
Inj, lidocaine w epinephrine |
18 |
18 |
$25.83 |
| J0360 |
Hydralazine hcl injection |
25 |
13 |
$25.45 |
| 82310 |
|
26 |
26 |
$23.87 |
| J2471 |
Inj pantoprazole(hikma) 40mg |
13 |
13 |
$22.65 |
| 84300 |
|
12 |
12 |
$21.12 |
| 36410 |
|
13 |
12 |
$20.28 |
| J1596 |
Inj, glycopyrrolate, 0.1 mg |
25 |
12 |
$14.50 |
| J3475 |
Inj magnesium sulfate |
18 |
15 |
$14.38 |
| OP637 |
|
196 |
112 |
$11.81 |
| 84479 |
|
17 |
14 |
$10.68 |
| J1631 |
Haloperidol decanoate inj |
31 |
30 |
$6.89 |
| 91300 |
|
30 |
29 |
$3.00 |
| J2426 |
Inj, invega sustenna, 1 mg |
69 |
65 |
$0.12 |
| J0401 |
Inj, abilify maintena, 1 mg |
44 |
42 |
$0.11 |
| J0688 |
Inj cefazolin sodium, hikma |
50 |
50 |
$0.00 |