| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 0450 |
|
97,889 |
86,182 |
$5.08M |
| 87633 |
|
8,504 |
8,151 |
$3.53M |
| 80053 |
|
164,563 |
148,795 |
$1.61M |
| 74177 |
|
8,279 |
7,872 |
$1.46M |
| 82306 |
|
51,423 |
50,946 |
$1.26M |
| U0002 |
Covid-19 lab test non-cdc |
24,097 |
22,747 |
$1.06M |
| 0202U |
|
4,684 |
4,552 |
$1.02M |
| 84443 |
|
68,761 |
67,258 |
$1.02M |
| 85025 |
|
166,970 |
147,067 |
$1.01M |
| 87507 |
|
2,456 |
2,394 |
$959K |
| 77067 |
|
9,870 |
9,849 |
$850K |
| 86480 |
|
19,685 |
19,548 |
$834K |
| 76700 |
|
12,127 |
11,798 |
$829K |
| 96374 |
|
15,004 |
13,772 |
$782K |
| 0250 |
|
34,690 |
27,849 |
$772K |
| 80061 |
|
73,968 |
73,364 |
$747K |
| 96365 |
|
12,665 |
9,336 |
$686K |
| 70450 |
|
8,166 |
7,689 |
$682K |
| 93005 |
|
31,786 |
29,291 |
$666K |
| 99499 |
|
11,641 |
8,676 |
$625K |
| G9012 |
Other specified case mgmt |
3,500 |
3,463 |
$609K |
| 96375 |
|
15,108 |
13,248 |
$547K |
| 99284 |
|
7,730 |
7,273 |
$505K |
| 87798 |
|
13,908 |
7,782 |
$504K |
| 87491 |
|
14,432 |
14,167 |
$501K |
| 87591 |
|
14,460 |
14,194 |
$500K |
| 96361 |
|
14,591 |
13,239 |
$488K |
| 83036 |
|
57,374 |
56,628 |
$484K |
| 99283 |
|
7,730 |
6,633 |
$482K |
| 0270 |
|
42,701 |
34,916 |
$419K |
| 96372 |
|
21,292 |
16,482 |
$411K |
| 76856 |
|
6,727 |
6,610 |
$405K |
| 87486 |
|
8,329 |
7,979 |
$368K |
| 72125 |
|
2,787 |
2,666 |
$367K |
| 87581 |
|
8,328 |
7,978 |
$365K |
| 80307 |
|
5,907 |
5,605 |
$358K |
| 71046 |
|
19,731 |
18,873 |
$333K |
| 76641 |
|
5,086 |
4,635 |
$321K |
| 78815 |
|
394 |
393 |
$319K |
| 0762 |
|
5,818 |
2,933 |
$314K |
| 87088 |
|
45,180 |
42,435 |
$301K |
| 66984 |
|
3,503 |
2,698 |
$290K |
| 96360 |
|
5,307 |
4,926 |
$288K |
| 71275 |
|
1,874 |
1,775 |
$285K |
| 76830 |
|
4,537 |
4,443 |
$282K |
| J9271 |
Inj pembrolizumab |
72 |
58 |
$276K |
| 0360 |
|
2,000 |
1,420 |
$264K |
| 74176 |
|
2,986 |
2,880 |
$254K |
| 70551 |
|
1,241 |
1,204 |
$252K |
| 93306 |
|
1,876 |
1,791 |
$251K |
| 81000 |
|
99,316 |
93,297 |
$251K |
| G9008 |
Mccd,phys coor-care ovrsght |
711 |
711 |
$242K |
| 99285 |
|
2,147 |
1,952 |
$241K |
| 80074 |
|
4,880 |
4,810 |
$224K |
| 77066 |
Tomosynthesis, mammo |
2,386 |
2,367 |
$224K |
| 96367 |
|
7,382 |
4,754 |
$221K |
| 71260 |
|
2,028 |
1,965 |
$218K |
| 71045 |
|
24,301 |
22,416 |
$208K |
| 76770 |
|
3,662 |
3,583 |
$207K |
| 0761 |
|
6,565 |
5,365 |
$192K |
| 93970 |
|
1,292 |
1,264 |
$176K |
| 96413 |
|
7,565 |
4,042 |
$176K |
| 84484 |
|
21,802 |
18,243 |
$170K |
| 77063 |
|
7,664 |
7,653 |
$169K |
| J0897 |
Denosumab injection |
338 |
328 |
$168K |
| 87070 |
|
20,499 |
20,083 |
$166K |
| G0463 |
Hospital outpt clinic visit |
10,312 |
9,471 |
$153K |
| J7030 |
Normal saline solution infus |
19,296 |
16,072 |
$145K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
12,356 |
11,708 |
$140K |
| 87389 |
|
8,159 |
8,099 |
$139K |
| 96366 |
|
4,183 |
3,434 |
$135K |
| 73562 |
|
6,094 |
5,488 |
$132K |
| G0108 |
Diab manage trn per indiv |
1,917 |
1,645 |
$132K |
| 93971 |
|
1,431 |
1,378 |
$131K |
| 72110 |
|
3,485 |
3,414 |
$131K |
| 83880 |
|
6,139 |
5,681 |
$130K |
| 76536 |
|
2,655 |
2,610 |
$125K |
| 83690 |
|
20,399 |
18,654 |
$123K |
| 87400 |
|
15,248 |
11,616 |
$122K |
| 93000 |
|
3,798 |
3,742 |
$114K |
| 84439 |
|
13,867 |
13,600 |
$112K |
| J2469 |
Palonosetron hcl |
1,266 |
718 |
$111K |
| 73630 |
|
4,881 |
4,444 |
$111K |
| 0241U |
|
1,227 |
1,204 |
$109K |
| 76801 |
|
2,010 |
1,784 |
$108K |
| G0378 |
Hospital observation per hr |
3,597 |
3,016 |
$107K |
| 0710 |
|
4,693 |
4,302 |
$103K |
| 83525 |
|
10,320 |
10,242 |
$101K |
| 73030 |
|
4,591 |
4,303 |
$100K |
| 87186 |
|
13,550 |
12,661 |
$98K |
| 85027 |
|
15,055 |
14,289 |
$97K |
| 82043 |
|
20,603 |
20,377 |
$97K |
| 82607 |
|
6,890 |
6,817 |
$96K |
| 76805 |
|
1,150 |
1,113 |
$95K |
| 72148 |
|
522 |
498 |
$92K |
| 90715 |
|
2,466 |
2,407 |
$90K |
| Q3014 |
Telehealth facility fee |
8,744 |
8,528 |
$90K |
| 94640 |
|
4,255 |
3,091 |
$87K |
| 80048 |
|
12,944 |
10,873 |
$87K |
| J1885 |
Ketorolac tromethamine inj |
12,979 |
12,028 |
$85K |
| 74018 |
|
5,783 |
5,519 |
$85K |
| 87077 |
|
14,697 |
13,573 |
$84K |
| 73610 |
|
3,312 |
3,155 |
$82K |
| 73130 |
|
3,148 |
2,929 |
$82K |
| 86780 |
|
7,663 |
7,550 |
$76K |
| Z7502 |
|
2,862 |
2,701 |
$75K |
| J1453 |
Fosaprepitant injection |
716 |
391 |
$73K |
| 11042 |
|
5,501 |
2,715 |
$73K |
| 81025 |
|
10,131 |
9,656 |
$71K |
| 83970 |
|
3,217 |
3,153 |
$70K |
| G0109 |
Diab manage trn ind/group |
1,538 |
1,097 |
$70K |
| 82570 |
|
19,249 |
18,532 |
$69K |
| G0480 |
Drug test def 1-7 classes |
1,186 |
1,119 |
$69K |
| 85730 |
|
14,110 |
13,097 |
$68K |
| P9016 |
Rbc leukocytes reduced |
419 |
372 |
$67K |
| 74178 |
|
478 |
464 |
$66K |
| 87040 |
|
5,218 |
4,274 |
$64K |
| 88305 |
|
2,641 |
2,267 |
$64K |
| J2405 |
Ondansetron hcl injection |
12,739 |
10,532 |
$60K |
| A9552 |
F18 fdg |
349 |
349 |
$59K |
| 73502 |
|
2,296 |
2,123 |
$59K |
| 76705 |
|
1,127 |
1,110 |
$59K |
| J3010 |
Fentanyl citrate injection |
8,475 |
7,528 |
$59K |
| 87205 |
|
15,774 |
15,438 |
$57K |
| 76870 |
|
1,195 |
1,144 |
$57K |
| 87880 |
|
5,932 |
5,777 |
$56K |
| 73110 |
|
2,278 |
2,156 |
$55K |
| 77065 |
Tomosynthesis, mammo |
874 |
865 |
$55K |
| 72100 |
|
2,076 |
2,027 |
$54K |
| 70553 |
|
156 |
156 |
$54K |
| G0279 |
Tomosynthesis, mammo |
2,814 |
2,790 |
$53K |
| 85610 |
|
17,478 |
16,024 |
$52K |
| 76819 |
|
1,025 |
535 |
$50K |
| 96415 |
|
2,096 |
1,333 |
$50K |
| 70498 |
|
543 |
525 |
$49K |
| 84153 |
|
2,994 |
2,946 |
$49K |
| 0720 |
|
847 |
344 |
$49K |
| 77080 |
|
2,309 |
2,289 |
$49K |
| 70496 |
|
455 |
442 |
$48K |
| 83605 |
|
5,166 |
4,542 |
$47K |
| 82962 |
|
13,662 |
9,486 |
$47K |
| 86140 |
|
10,491 |
9,967 |
$47K |
| 93880 |
|
428 |
410 |
$45K |
| 72050 |
|
1,453 |
1,422 |
$45K |
| 70486 |
|
371 |
363 |
$43K |
| 83540 |
|
8,985 |
8,809 |
$42K |
| 86703 |
|
2,971 |
2,948 |
$42K |
| 71250 |
|
625 |
615 |
$42K |
| M0243 |
Casirivi and imdevi inj |
150 |
149 |
$41K |
| 82746 |
|
3,138 |
3,098 |
$41K |
| Z9725 |
|
1,356 |
1,355 |
$41K |
| J0696 |
Ceftriaxone sodium injection |
6,095 |
4,880 |
$40K |
| 86235 |
|
2,348 |
1,663 |
$40K |
| J1100 |
Dexamethasone sodium phos |
6,776 |
4,635 |
$39K |
| 76775 |
|
1,287 |
1,225 |
$39K |
| 72131 |
|
405 |
400 |
$38K |
| 73560 |
|
1,961 |
1,757 |
$38K |
| 83735 |
|
7,618 |
6,409 |
$37K |
| 83550 |
|
7,142 |
7,010 |
$37K |
| 0760 |
|
1,059 |
984 |
$37K |
| J1170 |
Hydromorphone injection |
4,669 |
3,911 |
$37K |
| 76881 |
|
986 |
948 |
$37K |
| 84702 |
|
2,859 |
2,361 |
$36K |
| M0222 |
Bebtelovimab injection |
134 |
134 |
$35K |
| 84480 |
|
3,687 |
3,652 |
$35K |
| 82728 |
|
5,616 |
5,501 |
$35K |
| 96417 |
|
1,549 |
978 |
$32K |
| 87811 |
|
920 |
753 |
$31K |
| 73080 |
|
1,265 |
1,216 |
$31K |
| 82550 |
|
5,311 |
4,785 |
$31K |
| 84550 |
|
9,441 |
9,228 |
$31K |
| 73590 |
|
1,477 |
1,376 |
$30K |
| J1200 |
Diphenhydramine hcl injectio |
7,831 |
5,531 |
$30K |
| 84436 |
|
5,215 |
5,178 |
$30K |
| 72070 |
|
1,248 |
1,218 |
$29K |
| J1815 |
Insulin injection |
1,313 |
1,136 |
$29K |
| 86038 |
|
3,624 |
3,566 |
$28K |
| 87210 |
|
6,192 |
6,107 |
$27K |
| 99282 |
|
326 |
304 |
$27K |
| 87635 |
|
621 |
579 |
$27K |
| 45378 |
|
321 |
320 |
$26K |
| 73721 |
|
130 |
116 |
$26K |
| J2270 |
Morphine sulfate injection |
3,212 |
2,649 |
$25K |
| 85378 |
|
3,991 |
3,736 |
$25K |
| 87653 |
|
776 |
772 |
$24K |
| 73090 |
|
1,297 |
1,232 |
$24K |
| 96523 |
|
1,020 |
996 |
$23K |
| 59025 |
|
1,087 |
454 |
$23K |
| 43239 |
|
410 |
409 |
$22K |
| 85651 |
|
10,466 |
9,960 |
$22K |
| 86431 |
|
4,021 |
3,314 |
$21K |
| 86376 |
|
2,060 |
1,989 |
$21K |
| 86922 |
|
398 |
340 |
$20K |
| 86803 |
|
1,512 |
1,478 |
$20K |
| 80069 |
|
3,599 |
3,411 |
$19K |
| J1642 |
Inj heparin sodium per 10 u |
4,373 |
2,857 |
$19K |
| 84481 |
|
1,795 |
1,775 |
$19K |
| 87522 |
Neg quan hep c or qual rna |
384 |
368 |
$19K |
| 94060 |
|
565 |
553 |
$19K |
| M0245 |
Bamlan and etesev infusion |
75 |
75 |
$19K |
| 86901 |
|
6,449 |
5,542 |
$18K |
| 80076 |
|
2,882 |
2,771 |
$18K |
| A9575 |
Inj gadoterate meglumi 0.1ml |
459 |
453 |
$18K |
| 84703 |
|
2,406 |
2,160 |
$17K |
| J7120 |
Ringers lactate infusion |
2,585 |
2,384 |
$17K |
| 87340 |
|
1,541 |
1,523 |
$17K |
| 76817 |
|
312 |
287 |
$17K |
| 87420 |
|
3,245 |
3,185 |
$17K |
| 36415 |
|
12,925 |
11,000 |
$16K |
| M0247 |
Sotrovimab infusion |
65 |
65 |
$16K |
| 73140 |
|
917 |
870 |
$16K |
| 72170 |
|
1,008 |
975 |
$16K |
| J0131 |
Inj, acetaminophen (nos) |
938 |
913 |
$16K |
| 82274 |
|
1,356 |
1,350 |
$16K |
| 86592 |
|
3,610 |
3,577 |
$15K |
| 82270 |
|
4,534 |
4,500 |
$15K |
| 74019 |
|
688 |
676 |
$15K |
| 86850 |
|
4,898 |
4,207 |
$15K |
| 85018 |
|
6,793 |
6,706 |
$14K |
| 72040 |
|
644 |
634 |
$14K |
| 86003 |
|
287 |
245 |
$14K |
| 87147 |
|
3,254 |
3,121 |
$13K |
| 73620 |
|
707 |
658 |
$13K |
| 86225 |
|
1,138 |
1,114 |
$13K |
| 83516 |
|
1,361 |
1,291 |
$13K |
| 84156 |
|
5,734 |
5,569 |
$13K |
| 83655 |
|
2,597 |
2,567 |
$13K |
| 86762 |
|
972 |
954 |
$13K |
| J0780 |
Prochlorperazine injection |
1,004 |
946 |
$12K |
| J0171 |
Adrenalin epinephrine inject |
3,983 |
3,219 |
$12K |
| J2704 |
Inj, propofol, 10 mg |
2,769 |
2,707 |
$12K |
| 86900 |
|
5,216 |
4,457 |
$11K |
| 36430 |
|
97 |
93 |
$11K |
| 84100 |
|
3,888 |
3,374 |
$11K |
| 83001 |
|
1,159 |
1,149 |
$11K |
| 0004A |
|
274 |
274 |
$11K |
| 96376 |
|
232 |
226 |
$11K |
| 82785 |
|
549 |
542 |
$11K |
| 82803 |
|
1,093 |
1,018 |
$11K |
| J2060 |
Lorazepam injection |
1,915 |
1,627 |
$11K |
| J9217 |
Leuprolide acetate suspnsion |
97 |
96 |
$10K |
| 84403 |
|
1,303 |
1,291 |
$10K |
| 82378 |
|
801 |
701 |
$10K |
| 87081 |
|
1,628 |
1,560 |
$10K |
| 87045 |
|
1,087 |
1,045 |
$10K |
| 83002 |
|
1,008 |
999 |
$10K |
| 86160 |
|
1,123 |
814 |
$9K |
| 85007 |
|
4,027 |
3,428 |
$9K |
| 99281 |
|
217 |
212 |
$9K |
| 10060 |
|
472 |
447 |
$9K |
| 0001A |
|
262 |
262 |
$9K |
| 86300 |
|
628 |
580 |
$9K |
| 0002A |
|
253 |
252 |
$9K |
| G0202 |
Scr mammo bi incl cad |
96 |
90 |
$9K |
| J0690 |
Cefazolin sodium injection |
1,839 |
1,764 |
$8K |
| J3490 |
Drugs unclassified injection |
8,009 |
5,979 |
$8K |
| 73120 |
|
453 |
421 |
$8K |
| Z7610 |
|
1,301 |
1,099 |
$8K |
| J1439 |
Inj ferric carboxymaltos 1mg |
19 |
12 |
$7K |
| 73552 |
|
412 |
378 |
$7K |
| J7040 |
Normal saline solution infus |
2,014 |
1,805 |
$7K |
| 82150 |
|
1,182 |
1,136 |
$7K |
| 73060 |
|
427 |
410 |
$7K |
| 81003 |
|
4,258 |
3,998 |
$7K |
| 99213 |
|
579 |
530 |
$7K |
| 95819 |
|
94 |
94 |
$6K |
| 0064A |
|
159 |
159 |
$6K |
| 0071A |
|
154 |
154 |
$6K |
| 72082 |
|
136 |
136 |
$6K |
| V2632 |
Post chmbr intraocular lens |
1,810 |
1,442 |
$6K |
| 83615 |
|
1,246 |
1,110 |
$6K |
| 85044 |
|
2,329 |
2,250 |
$6K |
| J3370 |
Vancomycin hcl injection |
548 |
373 |
$6K |
| 0072A |
|
139 |
139 |
$6K |
| 86200 |
|
853 |
846 |
$5K |
| 86039 |
|
856 |
822 |
$5K |
| 82784 |
|
744 |
627 |
$5K |
| J9202 |
Goserelin acetate implant |
13 |
12 |
$5K |
| 87899 |
|
695 |
680 |
$5K |
| J2930 |
Methylprednisolone injection |
394 |
340 |
$5K |
| 87046 |
|
1,738 |
1,074 |
$5K |
| 12011 |
|
83 |
82 |
$5K |
| 84681 |
|
369 |
366 |
$5K |
| J1756 |
Iron sucrose injection |
84 |
37 |
$5K |
| 82553 |
|
390 |
308 |
$5K |
| 45380 |
|
87 |
87 |
$4K |
| 83883 |
|
326 |
224 |
$4K |
| 0160 |
|
66 |
60 |
$4K |
| 86334 |
|
604 |
588 |
$4K |
| 82950 |
|
882 |
877 |
$4K |
| Z7500 |
|
122 |
105 |
$4K |
| 43235 |
|
138 |
138 |
$4K |
| 72141 |
|
28 |
26 |
$4K |
| 86580 |
|
868 |
849 |
$4K |
| 87209 |
|
729 |
682 |
$4K |
| 84402 |
|
490 |
488 |
$4K |
| 86255 |
|
292 |
289 |
$3K |
| 72128 |
|
51 |
50 |
$3K |
| 82140 |
|
343 |
291 |
$3K |
| 96368 |
|
236 |
164 |
$3K |
| J1650 |
Inj enoxaparin sodium |
603 |
268 |
$3K |
| 99070 |
|
593 |
386 |
$3K |
| 12001 |
|
136 |
132 |
$3K |
| 87493 |
|
102 |
100 |
$3K |
| 0011A |
|
121 |
121 |
$3K |
| 71020 |
|
122 |
104 |
$3K |
| 0510 |
|
103 |
101 |
$3K |
| 82951 |
|
209 |
208 |
$3K |
| 82565 |
|
909 |
881 |
$3K |
| 86308 |
|
548 |
518 |
$3K |
| 97161 |
|
105 |
105 |
$3K |
| 12002 |
|
77 |
76 |
$3K |
| 52000 |
|
181 |
180 |
$3K |
| 84166 |
|
320 |
311 |
$2K |
| J7050 |
Normal saline solution infus |
1,571 |
1,052 |
$2K |
| 66982 |
|
94 |
88 |
$2K |
| 51798 |
|
363 |
359 |
$2K |
| 90714 |
|
80 |
79 |
$2K |
| 84460 |
|
480 |
480 |
$2K |
| J2175 |
Meperidine hydrochl /100 mg |
258 |
258 |
$2K |
| G0498 |
Chemo extend iv infus w/pump |
25 |
13 |
$2K |
| 86335 |
|
341 |
332 |
$2K |
| 84450 |
|
470 |
470 |
$2K |
| 57454 |
|
24 |
24 |
$2K |
| J2550 |
Promethazine hcl injection |
258 |
241 |
$2K |
| A9585 |
Gadobutrol injection |
202 |
198 |
$2K |
| 0012A |
|
76 |
76 |
$2K |
| 29125 |
|
144 |
136 |
$2K |
| 87177 |
|
722 |
676 |
$2K |
| J1644 |
Inj heparin sodium per 1000u |
632 |
374 |
$2K |
| J0360 |
Hydralazine hcl injection |
314 |
264 |
$2K |
| 78306 |
|
25 |
25 |
$2K |
| 84520 |
|
793 |
769 |
$2K |
| 73100 |
|
108 |
103 |
$2K |
| 84146 |
|
199 |
199 |
$2K |
| 72197 |
|
12 |
12 |
$2K |
| 74220 |
|
61 |
60 |
$2K |
| 74183 |
|
13 |
13 |
$2K |
| 73600 |
|
92 |
90 |
$2K |
| 96402 |
|
404 |
394 |
$2K |
| 94729 |
|
41 |
41 |
$1K |
| 80178 |
|
205 |
194 |
$1K |
| Q0138 |
Ferumoxytol, non-esrd |
18 |
13 |
$1K |
| 84154 |
|
125 |
123 |
$1K |
| J1790 |
Droperidol injection |
99 |
88 |
$1K |
| 82239 |
|
159 |
155 |
$1K |
| 90471 |
|
302 |
283 |
$1K |
| 99214 |
|
55 |
53 |
$1K |
| 0636 |
|
143 |
109 |
$1K |
| 86787 |
|
84 |
83 |
$1K |
| G0204 |
Dx mammo incl cad bi |
14 |
13 |
$1K |
| 0621 |
|
301 |
289 |
$1K |
| 94727 |
|
41 |
41 |
$1K |
| J9045 |
Carboplatin injection |
48 |
37 |
$1K |
| 72220 |
|
53 |
53 |
$1K |
| 93925 |
|
42 |
42 |
$1K |
| 82105 |
|
56 |
53 |
$1K |
| 82805 |
|
41 |
36 |
$991.63 |
| 87338 |
|
92 |
92 |
$990.97 |
| 70360 |
|
57 |
51 |
$981.28 |
| 73660 |
|
59 |
52 |
$972.67 |
| 98960 |
|
31 |
29 |
$961.09 |
| 88304 |
|
118 |
114 |
$939.42 |
| J1940 |
Furosemide injection |
348 |
252 |
$895.87 |
| J9190 |
Fluorouracil injection |
82 |
50 |
$891.78 |
| J1630 |
Haloperidol injection |
137 |
109 |
$888.11 |
| 73565 |
|
66 |
65 |
$842.84 |
| 80081 |
|
12 |
12 |
$822.48 |
| 86593 |
|
176 |
175 |
$785.81 |
| 85014 |
|
328 |
292 |
$765.00 |
| J3480 |
Inj potassium chloride |
13 |
13 |
$748.33 |
| 73700 |
|
12 |
12 |
$713.80 |
| 62323 |
|
16 |
16 |
$713.56 |
| 86800 |
|
83 |
80 |
$710.26 |
| 84145 |
|
68 |
66 |
$704.79 |
| 82670 |
|
43 |
43 |
$703.58 |
| 86141 |
|
69 |
66 |
$668.03 |
| 90656 |
|
30 |
26 |
$641.88 |
| 84155 |
|
290 |
278 |
$613.51 |
| 82247 |
|
124 |
76 |
$606.74 |
| 96521 |
|
119 |
75 |
$598.18 |
| 82977 |
|
82 |
81 |
$587.60 |
| 97116 |
|
85 |
45 |
$576.76 |
| 84165 |
|
104 |
103 |
$566.15 |
| 86705 |
|
27 |
26 |
$557.46 |
| 0124A |
|
13 |
13 |
$520.00 |
| 94644 |
|
29 |
27 |
$517.19 |
| 74000 |
|
32 |
31 |
$483.49 |
| 86305 |
|
26 |
26 |
$476.50 |
| 58100 |
|
12 |
12 |
$442.57 |
| 82248 |
|
119 |
97 |
$422.74 |
| 90792 |
|
13 |
13 |
$421.25 |
| 97530 |
|
34 |
16 |
$418.68 |
| 73523 |
|
12 |
12 |
$414.09 |
| 31500 |
|
13 |
13 |
$363.05 |
| 94760 |
|
683 |
583 |
$355.34 |
| 87086 |
|
70 |
70 |
$354.75 |
| 86403 |
|
27 |
26 |
$345.27 |
| 85049 |
|
282 |
270 |
$315.73 |
| 73070 |
|
12 |
12 |
$294.72 |
| J3420 |
Vitamin b12 injection |
211 |
203 |
$289.20 |
| G9873 |
1 em core session |
13 |
13 |
$280.79 |
| 71010 |
|
23 |
18 |
$277.58 |
| 83013 |
|
17 |
17 |
$273.50 |
| 51702 |
|
35 |
33 |
$270.18 |
| A9503 |
Tc99m medronate |
26 |
26 |
$259.84 |
| 0637 |
|
249 |
218 |
$247.46 |
| 76882 |
|
28 |
28 |
$232.19 |
| 83520 |
|
30 |
29 |
$229.37 |
| 86021 |
|
19 |
12 |
$219.87 |
| 87220 |
|
57 |
40 |
$217.94 |
| 29515 |
|
12 |
12 |
$191.93 |
| J3301 |
Triamcinolone acet inj nos |
13 |
13 |
$186.18 |
| 99203 |
|
28 |
28 |
$180.50 |
| J2920 |
Methylprednisolone injection |
14 |
14 |
$156.22 |
| 0370 |
|
174 |
161 |
$150.55 |
| J2919 |
Inj, methylpred sod succ 5mg |
31 |
28 |
$146.78 |
| 62322 |
|
12 |
12 |
$142.66 |
| 86765 |
|
14 |
13 |
$136.40 |
| 86735 |
|
13 |
13 |
$130.97 |
| 11045 |
|
101 |
13 |
$114.78 |
| 87101 |
|
12 |
12 |
$112.86 |
| 82627 |
|
12 |
12 |
$87.00 |
| 86696 |
|
17 |
17 |
$58.24 |
| 96411 |
|
17 |
12 |
$55.50 |
| 86695 |
|
17 |
17 |
$38.36 |
| 80320 |
|
174 |
150 |
$24.15 |
| 93010 |
|
48 |
46 |
$12.62 |
| J0881 |
Darbepoetin alfa, non-esrd |
423 |
276 |
$0.00 |
| 0370R |
|
2,028 |
1,705 |
$0.00 |
| 0270R |
|
2,073 |
1,741 |
$0.00 |
| 0710R |
|
2,021 |
1,700 |
$0.00 |
| A4649 |
Surgical supplies |
176 |
134 |
$0.00 |
| 99221 |
|
64 |
60 |
$0.00 |
| 0637R |
|
3,667 |
2,901 |
$0.00 |
| 0250R |
|
8,391 |
5,520 |
$0.00 |
| G0103 |
Psa screening |
164 |
160 |
$0.00 |
| C9740 |
Cysto impl 4 or more |
72 |
72 |
$0.00 |
| 0621R |
|
68 |
66 |
$0.00 |
| L8699 |
Prosthetic implant nos |
132 |
102 |
$0.00 |