| Code | Description | Claims | Beneficiaries | Total Paid |
| G0463 |
Hospital outpt clinic visit |
710,035 |
597,489 |
$74.72M |
| 99284 |
|
33,136 |
29,732 |
$5.01M |
| 99283 |
|
31,003 |
29,161 |
$4.67M |
| 96361 |
|
7,964 |
6,528 |
$2.82M |
| 0241U |
|
12,553 |
11,595 |
$2.44M |
| 70450 |
|
5,230 |
4,787 |
$1.64M |
| 97110 |
|
15,578 |
4,797 |
$1.53M |
| U0003 |
Cov-19 amp prb hgh thruput |
6,331 |
6,183 |
$1.38M |
| 74177 |
|
4,066 |
3,530 |
$1.28M |
| 43239 |
|
2,578 |
2,422 |
$1.20M |
| 0240U |
|
5,504 |
5,124 |
$1.18M |
| 99282 |
|
7,336 |
7,021 |
$946K |
| 69436 |
|
462 |
429 |
$939K |
| 99285 |
|
4,570 |
4,006 |
$750K |
| 96366 |
|
1,927 |
1,064 |
$749K |
| 74176 |
|
2,122 |
1,877 |
$748K |
| J0585 |
Injection,onabotulinumtoxina |
1,429 |
881 |
$706K |
| 80053 |
|
47,031 |
42,350 |
$698K |
| 87633 |
|
3,939 |
3,545 |
$697K |
| 96365 |
|
3,804 |
3,203 |
$650K |
| 99281 |
|
4,599 |
4,463 |
$547K |
| 45385 |
|
641 |
572 |
$493K |
| 71275 |
|
1,183 |
984 |
$483K |
| 59025 |
|
2,588 |
1,516 |
$457K |
| 93306 |
|
1,203 |
1,126 |
$432K |
| 95810 |
|
508 |
484 |
$404K |
| 85025 |
|
90,159 |
77,116 |
$374K |
| 45378 |
|
446 |
386 |
$364K |
| 20610 |
|
2,342 |
2,095 |
$333K |
| 36415 |
|
107,894 |
93,130 |
$315K |
| 84443 |
|
21,428 |
19,969 |
$309K |
| 78452 |
|
409 |
372 |
$302K |
| 95886 |
|
1,304 |
1,108 |
$265K |
| 94640 |
|
2,686 |
1,532 |
$262K |
| 76830 |
|
1,678 |
1,568 |
$258K |
| 80048 |
|
31,806 |
27,140 |
$254K |
| 97530 |
|
3,583 |
1,510 |
$240K |
| 97597 |
|
2,307 |
1,270 |
$240K |
| 76705 |
|
1,569 |
1,449 |
$235K |
| 81003 |
|
14,456 |
12,216 |
$219K |
| 96360 |
|
768 |
669 |
$199K |
| 11042 |
|
1,716 |
970 |
$196K |
| 64615 |
|
544 |
487 |
$192K |
| 80061 |
|
15,845 |
14,978 |
$191K |
| 70553 |
|
416 |
387 |
$181K |
| 95117 |
|
4,829 |
2,133 |
$181K |
| 71046 |
|
8,800 |
8,057 |
$179K |
| 92507 |
|
1,444 |
554 |
$175K |
| 73721 |
|
469 |
451 |
$163K |
| 71260 |
|
751 |
663 |
$155K |
| 96372 |
|
32,311 |
24,740 |
$154K |
| 71271 |
|
635 |
604 |
$148K |
| 77067 |
|
2,134 |
1,976 |
$146K |
| J1050 |
Medroxyprogesterone acetate |
1,917 |
1,711 |
$138K |
| G0378 |
Hospital observation per hr |
2,960 |
2,002 |
$138K |
| 83036 |
|
12,569 |
11,935 |
$135K |
| 82306 |
|
7,344 |
6,855 |
$132K |
| 62323 |
|
263 |
227 |
$131K |
| J7307 |
Etonogestrel implant system |
114 |
104 |
$130K |
| 92557 |
|
1,398 |
1,323 |
$130K |
| 81001 |
|
27,621 |
24,934 |
$127K |
| 76536 |
|
859 |
807 |
$126K |
| 80307 |
|
5,057 |
4,005 |
$124K |
| 93005 |
|
22,336 |
19,281 |
$122K |
| 97140 |
|
1,893 |
818 |
$110K |
| 47562 |
|
29 |
26 |
$109K |
| 76770 |
|
478 |
452 |
$102K |
| 95004 |
|
1,895 |
1,633 |
$95K |
| 90460 |
|
7,567 |
6,775 |
$95K |
| 96413 |
|
738 |
424 |
$91K |
| 97161 |
|
1,285 |
1,203 |
$91K |
| 81025 |
|
9,349 |
8,387 |
$88K |
| 93017 |
|
619 |
568 |
$88K |
| 87804 |
|
26,234 |
13,768 |
$87K |
| 45380 |
|
204 |
177 |
$87K |
| 76642 |
|
535 |
480 |
$86K |
| 86850 |
|
3,022 |
2,746 |
$81K |
| 66984 |
|
140 |
126 |
$77K |
| 94060 |
|
1,566 |
1,510 |
$74K |
| 71250 |
|
951 |
852 |
$72K |
| 84484 |
|
16,318 |
11,790 |
$71K |
| 72148 |
|
243 |
231 |
$69K |
| 87591 |
|
5,961 |
5,556 |
$69K |
| 73630 |
|
4,758 |
4,160 |
$68K |
| U0002 |
Covid-19 lab test non-cdc |
1,758 |
1,715 |
$66K |
| G0123 |
Screen cerv/vag thin layer |
9,212 |
8,396 |
$65K |
| 76816 |
|
1,618 |
1,467 |
$60K |
| 80076 |
|
13,615 |
12,059 |
$59K |
| 90686 |
|
4,131 |
3,760 |
$57K |
| 72110 |
|
1,674 |
1,562 |
$55K |
| 87507 |
|
545 |
503 |
$54K |
| 80069 |
|
2,287 |
2,104 |
$54K |
| 87880 |
|
27,404 |
25,930 |
$53K |
| 93971 |
|
461 |
423 |
$53K |
| 85610 |
|
11,360 |
9,869 |
$51K |
| 90670 |
|
1,985 |
1,762 |
$51K |
| U0005 |
Infec agen detec ampli probe |
6,035 |
5,942 |
$50K |
| 87491 |
|
5,964 |
5,558 |
$50K |
| 97112 |
|
618 |
267 |
$50K |
| 98940 |
|
1,718 |
1,007 |
$49K |
| 76815 |
|
461 |
415 |
$49K |
| 84439 |
|
3,729 |
3,452 |
$47K |
| 70491 |
|
113 |
98 |
$47K |
| 70551 |
|
179 |
167 |
$46K |
| 96367 |
|
466 |
356 |
$46K |
| 76805 |
|
713 |
661 |
$46K |
| 82607 |
|
4,909 |
4,556 |
$45K |
| 82553 |
|
6,410 |
4,984 |
$45K |
| 73221 |
|
149 |
141 |
$45K |
| 90677 |
|
538 |
500 |
$44K |
| 87902 |
|
194 |
162 |
$44K |
| 70486 |
|
424 |
387 |
$44K |
| 87086 |
|
8,115 |
7,219 |
$44K |
| G0481 |
Drug test def 8-14 classes |
583 |
423 |
$41K |
| 76000 |
|
281 |
236 |
$41K |
| 96374 |
|
12,333 |
10,858 |
$40K |
| 90715 |
|
2,267 |
2,024 |
$39K |
| 96368 |
|
720 |
473 |
$39K |
| 42820 |
|
14 |
14 |
$38K |
| 88305 |
|
8,594 |
4,969 |
$38K |
| 97162 |
|
578 |
538 |
$38K |
| 92133 |
|
892 |
843 |
$37K |
| 31575 |
|
179 |
158 |
$37K |
| 71045 |
|
8,531 |
7,767 |
$37K |
| 73610 |
|
2,186 |
1,924 |
$37K |
| 92567 |
|
1,591 |
1,477 |
$36K |
| 73130 |
|
1,927 |
1,663 |
$36K |
| 77063 |
|
1,808 |
1,685 |
$36K |
| 87340 |
|
2,737 |
2,478 |
$36K |
| 86140 |
|
7,317 |
6,495 |
$35K |
| 73562 |
|
2,237 |
2,005 |
$35K |
| 73110 |
|
1,372 |
1,172 |
$34K |
| 12001 |
|
154 |
139 |
$34K |
| 72050 |
|
887 |
833 |
$34K |
| 98941 |
|
701 |
448 |
$34K |
| 93975 |
|
131 |
118 |
$33K |
| 80306 |
|
1,922 |
1,589 |
$32K |
| 87635 |
|
2,242 |
2,074 |
$32K |
| 84702 |
|
1,610 |
1,096 |
$32K |
| 86780 |
|
2,364 |
2,156 |
$32K |
| 87522 |
Neg quan hep c or qual rna |
951 |
853 |
$32K |
| 94729 |
|
1,458 |
1,406 |
$31K |
| 94726 |
|
1,459 |
1,406 |
$31K |
| 86803 |
|
2,681 |
2,427 |
$31K |
| 87420 |
|
1,410 |
1,304 |
$28K |
| 82550 |
|
7,088 |
5,522 |
$27K |
| 17110 |
|
339 |
299 |
$27K |
| 85730 |
|
8,489 |
7,409 |
$27K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
9,448 |
8,077 |
$26K |
| 76817 |
|
1,047 |
764 |
$26K |
| 43235 |
|
57 |
55 |
$25K |
| 72131 |
|
177 |
167 |
$25K |
| 82746 |
|
4,416 |
4,097 |
$25K |
| 72125 |
|
1,010 |
911 |
$25K |
| 83655 |
|
1,251 |
1,141 |
$25K |
| 93458 |
|
15 |
12 |
$25K |
| 88304 |
|
607 |
478 |
$25K |
| 96127 |
|
272 |
145 |
$25K |
| 93242 |
|
442 |
421 |
$25K |
| G0480 |
Drug test def 1-7 classes |
1,125 |
967 |
$23K |
| 73030 |
|
1,750 |
1,594 |
$23K |
| 82570 |
|
3,056 |
2,815 |
$23K |
| 74018 |
|
1,637 |
1,462 |
$22K |
| 86900 |
|
1,351 |
1,180 |
$22K |
| 77080 |
|
228 |
212 |
$21K |
| 96375 |
|
6,849 |
5,454 |
$21K |
| 80320 |
|
1,330 |
1,031 |
$21K |
| 89190 |
|
2,466 |
2,400 |
$21K |
| 82728 |
|
1,831 |
1,657 |
$20K |
| 95165 |
|
610 |
423 |
$20K |
| 70498 |
|
81 |
72 |
$20K |
| 10060 |
|
95 |
82 |
$19K |
| 87389 |
|
1,971 |
1,795 |
$19K |
| 74178 |
|
52 |
45 |
$18K |
| 83540 |
|
2,811 |
2,592 |
$18K |
| 87661 |
|
3,144 |
2,896 |
$17K |
| 83605 |
|
5,251 |
3,932 |
$17K |
| 86709 |
|
978 |
866 |
$17K |
| 11981 |
|
57 |
53 |
$17K |
| 86480 |
|
367 |
343 |
$16K |
| 76882 |
|
119 |
109 |
$16K |
| 87624 |
|
2,245 |
2,159 |
$16K |
| 83690 |
|
9,403 |
8,137 |
$16K |
| 83735 |
|
3,992 |
3,102 |
$16K |
| 83550 |
|
2,589 |
2,397 |
$15K |
| 84156 |
|
1,888 |
1,686 |
$15K |
| 77066 |
Tomosynthesis, mammo |
260 |
239 |
$15K |
| G0482 |
Drug test def 15-21 classes |
241 |
233 |
$15K |
| J0558 |
Peng benzathine/procaine inj |
67 |
43 |
$14K |
| 72072 |
|
596 |
576 |
$14K |
| 73502 |
|
837 |
778 |
$14K |
| 82947 |
|
2,622 |
2,428 |
$14K |
| 86706 |
|
1,164 |
1,054 |
$14K |
| J0561 |
Penicillin g benzathine inj |
58 |
41 |
$14K |
| 76700 |
|
53 |
51 |
$14K |
| 83970 |
|
531 |
458 |
$14K |
| J2405 |
Ondansetron hcl injection |
11,709 |
9,502 |
$14K |
| 86762 |
|
828 |
764 |
$13K |
| 90648 |
|
2,904 |
2,665 |
$13K |
| 97598 |
|
49 |
25 |
$13K |
| 70496 |
|
82 |
73 |
$13K |
| 86376 |
|
964 |
907 |
$13K |
| 97166 |
|
168 |
156 |
$13K |
| 20605 |
|
62 |
52 |
$13K |
| 87186 |
|
4,085 |
3,061 |
$12K |
| 87070 |
|
1,949 |
1,767 |
$12K |
| J3490 |
Drugs unclassified injection |
1,969 |
1,476 |
$12K |
| 87077 |
|
4,149 |
3,087 |
$12K |
| 81596 |
|
61 |
56 |
$12K |
| 92587 |
|
127 |
124 |
$12K |
| 90723 |
|
2,082 |
1,918 |
$11K |
| 51798 |
|
548 |
523 |
$11K |
| 85018 |
|
2,365 |
2,118 |
$11K |
| 90633 |
|
1,735 |
1,532 |
$11K |
| 90651 |
|
1,151 |
1,079 |
$11K |
| 73080 |
|
683 |
575 |
$11K |
| 87210 |
|
1,018 |
928 |
$11K |
| 90837 |
|
61 |
50 |
$11K |
| 74019 |
|
634 |
586 |
$10K |
| 86705 |
|
710 |
634 |
$10K |
| 86704 |
|
613 |
547 |
$10K |
| 76856 |
|
32 |
27 |
$10K |
| G0008 |
Admin influenza virus vac |
4,569 |
4,359 |
$10K |
| J0702 |
Betamethasone acet&sod phosp |
531 |
472 |
$10K |
| 99174 |
|
186 |
178 |
$10K |
| 86038 |
|
1,056 |
911 |
$10K |
| 76819 |
|
374 |
173 |
$10K |
| 82247 |
|
579 |
323 |
$10K |
| 90734 |
|
1,210 |
1,110 |
$9K |
| 92134 |
|
333 |
308 |
$9K |
| 86003 |
|
1,306 |
564 |
$9K |
| 31237 |
|
20 |
14 |
$9K |
| 93296 |
|
639 |
591 |
$9K |
| 85652 |
|
3,258 |
2,972 |
$9K |
| 90471 |
|
1,871 |
1,593 |
$9K |
| 31231 |
|
46 |
42 |
$9K |
| 84112 |
|
107 |
87 |
$9K |
| 93880 |
|
73 |
69 |
$8K |
| 99214 |
|
1,254 |
1,084 |
$8K |
| 82962 |
|
3,864 |
1,151 |
$8K |
| 64493 |
|
34 |
28 |
$8K |
| 95811 |
|
24 |
24 |
$8K |
| 11750 |
|
69 |
52 |
$8K |
| 86364 |
|
1,149 |
540 |
$8K |
| 86901 |
|
1,351 |
1,180 |
$8K |
| 82784 |
|
1,343 |
815 |
$7K |
| 73590 |
|
463 |
412 |
$7K |
| 82043 |
|
1,188 |
1,127 |
$7K |
| 82785 |
|
874 |
813 |
$7K |
| 99152 |
|
361 |
292 |
$7K |
| J1885 |
Ketorolac tromethamine inj |
11,092 |
9,357 |
$7K |
| 84436 |
|
757 |
689 |
$7K |
| 84100 |
|
823 |
552 |
$7K |
| 84403 |
|
520 |
429 |
$7K |
| 74183 |
|
27 |
24 |
$7K |
| 82248 |
|
706 |
557 |
$6K |
| 94010 |
|
1,518 |
1,464 |
$6K |
| 80361 |
|
568 |
318 |
$6K |
| 90656 |
|
555 |
554 |
$6K |
| 73140 |
|
391 |
364 |
$6K |
| 86430 |
|
946 |
761 |
$6K |
| 11982 |
|
34 |
27 |
$6K |
| 84153 |
|
416 |
403 |
$6K |
| 83880 |
|
1,770 |
1,535 |
$6K |
| 71101 |
|
322 |
293 |
$5K |
| 80346 |
|
457 |
231 |
$5K |
| 84402 |
|
325 |
294 |
$5K |
| G0127 |
Trim nail(s) |
317 |
313 |
$5K |
| 99213 |
|
1,023 |
899 |
$5K |
| 80324 |
|
488 |
240 |
$5K |
| 86258 |
|
801 |
375 |
$5K |
| 87150 |
|
485 |
451 |
$5K |
| 90716 |
|
548 |
519 |
$5K |
| 90696 |
|
755 |
695 |
$5K |
| 83001 |
|
394 |
356 |
$5K |
| 87040 |
|
2,956 |
1,433 |
$4K |
| 90710 |
|
862 |
797 |
$4K |
| 86757 |
|
1,308 |
609 |
$4K |
| 84479 |
|
654 |
595 |
$4K |
| 84550 |
|
1,149 |
938 |
$4K |
| 86618 |
|
767 |
705 |
$4K |
| H1003 |
Prenatal at risk education |
197 |
172 |
$4K |
| 82565 |
|
722 |
551 |
$4K |
| 84481 |
|
397 |
373 |
$4K |
| 83992 |
|
275 |
155 |
$4K |
| 84270 |
|
313 |
284 |
$4K |
| 73090 |
|
372 |
319 |
$4K |
| 90791 |
|
13 |
13 |
$4K |
| J0131 |
Inj, acetaminophen (nos) |
470 |
352 |
$4K |
| 80365 |
|
433 |
218 |
$4K |
| 86231 |
|
408 |
376 |
$4K |
| 90700 |
|
610 |
579 |
$4K |
| 96376 |
|
1,289 |
826 |
$4K |
| 84146 |
|
267 |
244 |
$4K |
| 99406 |
|
193 |
186 |
$4K |
| 95912 |
|
69 |
67 |
$4K |
| 90662 |
|
304 |
298 |
$4K |
| 80348 |
|
535 |
256 |
$4K |
| 90707 |
|
571 |
517 |
$3K |
| J7050 |
Normal saline solution infus |
5,607 |
3,060 |
$3K |
| 86235 |
|
385 |
170 |
$3K |
| 83993 |
|
121 |
113 |
$3K |
| 87798 |
|
486 |
224 |
$3K |
| 77002 |
|
16 |
14 |
$3K |
| 86666 |
|
700 |
303 |
$3K |
| 93970 |
|
15 |
12 |
$3K |
| 80350 |
|
275 |
155 |
$3K |
| 73560 |
|
176 |
152 |
$3K |
| 20550 |
|
16 |
15 |
$3K |
| 73564 |
|
151 |
127 |
$3K |
| 12002 |
|
12 |
12 |
$3K |
| 11721 |
|
215 |
208 |
$3K |
| 74022 |
|
221 |
198 |
$3K |
| 82274 |
|
151 |
136 |
$3K |
| 90681 |
|
983 |
899 |
$3K |
| 86580 |
|
98 |
82 |
$3K |
| 83615 |
|
758 |
581 |
$3K |
| 80356 |
|
357 |
197 |
$3K |
| 94664 |
|
925 |
714 |
$3K |
| 86008 |
|
428 |
370 |
$3K |
| 80349 |
|
322 |
173 |
$3K |
| 80354 |
|
349 |
183 |
$3K |
| 80353 |
|
414 |
203 |
$3K |
| J1100 |
Dexamethasone sodium phos |
4,469 |
3,684 |
$2K |
| 95909 |
|
63 |
60 |
$2K |
| 86317 |
|
143 |
53 |
$2K |
| 93922 |
|
15 |
13 |
$2K |
| 99153 |
Mod sedat endo service >5yrs |
356 |
205 |
$2K |
| 82040 |
|
313 |
268 |
$2K |
| 93270 |
|
26 |
25 |
$2K |
| 84703 |
|
661 |
562 |
$2K |
| 72100 |
|
36 |
29 |
$2K |
| 83721 |
|
248 |
234 |
$2K |
| 85379 |
|
1,703 |
1,493 |
$2K |
| J0897 |
Denosumab injection |
13 |
12 |
$2K |
| 80373 |
|
275 |
155 |
$2K |
| 82105 |
|
419 |
388 |
$2K |
| 85384 |
|
604 |
553 |
$2K |
| 00840 |
|
188 |
144 |
$2K |
| 64450 |
|
14 |
12 |
$2K |
| 85014 |
|
856 |
787 |
$2K |
| 81000 |
|
320 |
288 |
$2K |
| 82150 |
|
2,335 |
2,046 |
$2K |
| 86200 |
|
199 |
184 |
$2K |
| Q0162 |
Ondansetron oral |
940 |
818 |
$2K |
| 97116 |
|
42 |
24 |
$2K |
| 00731 |
|
1,041 |
951 |
$2K |
| 73552 |
|
118 |
104 |
$2K |
| 85027 |
|
511 |
414 |
$2K |
| 86225 |
|
208 |
189 |
$2K |
| J0696 |
Ceftriaxone sodium injection |
3,503 |
2,805 |
$2K |
| 84165 |
|
301 |
276 |
$2K |
| 86696 |
|
323 |
278 |
$2K |
| 84460 |
|
436 |
280 |
$1K |
| 86695 |
|
307 |
275 |
$1K |
| 86665 |
|
219 |
96 |
$1K |
| 86708 |
|
134 |
121 |
$1K |
| 84450 |
|
393 |
261 |
$1K |
| 86308 |
|
401 |
341 |
$1K |
| J3420 |
Vitamin b12 injection |
1,734 |
1,242 |
$1K |
| 80360 |
|
143 |
48 |
$1K |
| 80355 |
|
263 |
143 |
$1K |
| 80358 |
|
275 |
155 |
$1K |
| 73060 |
|
63 |
57 |
$1K |
| 96523 |
|
33 |
26 |
$1K |
| 82670 |
|
96 |
88 |
$1K |
| 92083 |
|
42 |
41 |
$1K |
| 76870 |
|
70 |
59 |
$1K |
| A9500 |
Tc99m sestamibi |
412 |
375 |
$1K |
| J2704 |
Inj, propofol, 10 mg |
7,485 |
6,484 |
$1K |
| 80164 |
|
47 |
44 |
$1K |
| 86753 |
|
283 |
257 |
$1K |
| 82977 |
|
126 |
79 |
$1K |
| 82731 |
|
15 |
12 |
$977.75 |
| G0009 |
Admin pneumococcal vaccine |
731 |
681 |
$944.20 |
| 76820 |
|
56 |
27 |
$923.98 |
| 85007 |
|
488 |
395 |
$880.21 |
| 73521 |
|
35 |
33 |
$850.29 |
| 80362 |
|
88 |
32 |
$828.88 |
| 86160 |
|
74 |
33 |
$805.67 |
| 82140 |
|
184 |
142 |
$801.23 |
| 84145 |
|
348 |
293 |
$749.05 |
| 82803 |
|
798 |
605 |
$748.13 |
| J1170 |
Hydromorphone injection |
1,928 |
1,350 |
$726.10 |
| 90732 |
|
24 |
24 |
$709.91 |
| 80047 |
|
150 |
133 |
$679.15 |
| 95024 |
|
327 |
320 |
$656.87 |
| 00170 |
|
480 |
415 |
$636.91 |
| 82533 |
|
16 |
13 |
$623.60 |
| 29125 |
|
181 |
150 |
$620.29 |
| 88342 |
|
1,607 |
1,309 |
$617.19 |
| 86664 |
|
113 |
98 |
$604.80 |
| 69210 |
|
233 |
223 |
$595.29 |
| J2270 |
Morphine sulfate injection |
1,766 |
1,323 |
$588.76 |
| 80329 |
|
396 |
320 |
$571.02 |
| 00126 |
|
237 |
223 |
$566.97 |
| J7030 |
Normal saline solution infus |
5,203 |
3,640 |
$542.14 |
| 84207 |
|
102 |
96 |
$497.90 |
| J2785 |
Regadenoson injection |
218 |
187 |
$480.61 |
| 77065 |
Tomosynthesis, mammo |
12 |
12 |
$478.55 |
| 00813 |
|
1,072 |
940 |
$478.50 |
| 83520 |
|
39 |
29 |
$467.20 |
| J7120 |
Ringers lactate infusion |
3,767 |
2,935 |
$461.01 |
| 87641 |
|
37 |
37 |
$460.15 |
| 11055 |
|
14 |
12 |
$452.08 |
| 36600 |
|
165 |
137 |
$447.90 |
| 72081 |
|
14 |
13 |
$433.37 |
| 87205 |
|
486 |
460 |
$432.09 |
| J2930 |
Methylprednisolone injection |
4,724 |
3,958 |
$427.70 |
| 87338 |
|
12 |
12 |
$364.76 |
| 84520 |
|
89 |
56 |
$358.56 |
| 69209 |
|
411 |
364 |
$358.33 |
| 86677 |
|
60 |
52 |
$354.77 |
| J1644 |
Inj heparin sodium per 1000u |
1,328 |
715 |
$349.48 |
| 86738 |
|
13 |
13 |
$334.36 |
| J3301 |
Triamcinolone acet inj nos |
4,145 |
3,655 |
$325.26 |
| 86703 |
|
41 |
39 |
$281.75 |
| J1815 |
Insulin injection |
124 |
60 |
$272.58 |
| 84480 |
|
12 |
12 |
$271.27 |
| 80345 |
|
15 |
15 |
$265.66 |
| 90620 |
|
51 |
48 |
$251.78 |
| J3486 |
Ziprasidone mesylate |
17 |
12 |
$247.74 |
| 86334 |
|
15 |
14 |
$240.58 |
| J0690 |
Cefazolin sodium injection |
1,377 |
1,129 |
$220.54 |
| 92504 |
|
1,328 |
1,188 |
$218.15 |
| J2360 |
Orphenadrine injection |
494 |
397 |
$213.18 |
| J2543 |
Piperacillin/tazobactam |
198 |
109 |
$208.60 |
| 83002 |
|
14 |
13 |
$207.38 |
| 36416 |
|
358 |
309 |
$201.00 |
| J1650 |
Inj enoxaparin sodium |
197 |
86 |
$200.10 |
| 84425 |
|
24 |
24 |
$199.15 |
| 82375 |
|
178 |
134 |
$185.58 |
| 85045 |
|
57 |
54 |
$182.89 |
| J1040 |
Methylprednisolone 80 mg inj |
1,173 |
969 |
$161.32 |
| 01992 |
|
299 |
247 |
$151.28 |
| 90381 |
|
14 |
14 |
$143.80 |
| 88341 |
|
17 |
12 |
$142.92 |
| J3010 |
Fentanyl citrate injection |
3,797 |
3,188 |
$132.37 |
| J2919 |
Inj, methylpred sod succ 5mg |
1,296 |
1,174 |
$118.28 |
| 73565 |
|
33 |
29 |
$115.82 |
| J2550 |
Promethazine hcl injection |
476 |
363 |
$96.77 |
| J2175 |
Meperidine hydrochl /100 mg |
399 |
342 |
$92.75 |
| 83090 |
|
12 |
12 |
$91.84 |
| 92136 |
|
12 |
12 |
$91.31 |
| J3370 |
Vancomycin hcl injection |
111 |
59 |
$90.59 |
| G0103 |
Psa screening |
259 |
240 |
$88.05 |
| J2250 |
Inj midazolam hydrochloride |
3,048 |
2,537 |
$71.39 |
| J1200 |
Diphenhydramine hcl injectio |
881 |
676 |
$60.33 |
| 82103 |
|
13 |
13 |
$52.03 |
| J2920 |
Methylprednisolone injection |
294 |
200 |
$44.37 |
| J2001 |
Lidocaine injection |
3,127 |
2,845 |
$43.06 |
| J2060 |
Lorazepam injection |
459 |
348 |
$39.28 |
| A9585 |
Gadobutrol injection |
940 |
831 |
$39.10 |
| 86774 |
|
13 |
13 |
$38.60 |
| J7040 |
Normal saline solution infus |
761 |
568 |
$32.13 |
| J2765 |
Metoclopramide hcl injection |
446 |
372 |
$30.96 |
| J0134 |
Inj acetaminophen -fresenius |
469 |
429 |
$29.72 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
790 |
728 |
$28.45 |
| G0379 |
Direct refer hospital observ |
332 |
297 |
$20.00 |
| J3475 |
Inj magnesium sulfate |
22 |
13 |
$19.14 |
| J1010 |
Inj, methylpred acetate 1 mg |
494 |
450 |
$11.88 |
| J7512 |
Prednisone ir or dr oral 1mg |
346 |
244 |
$11.00 |
| J2470 |
Inj pantoprazole sodium 40mg |
38 |
31 |
$7.19 |
| J3480 |
Inj potassium chloride |
566 |
306 |
$6.65 |
| J1790 |
Droperidol injection |
81 |
72 |
$6.42 |
| 94760 |
|
527 |
248 |
$4.55 |
| 91320 |
|
27 |
27 |
$4.34 |
| J0330 |
Succinycholine chloride inj |
44 |
30 |
$4.02 |
| J7060 |
5% dextrose/water |
181 |
89 |
$3.48 |
| J0171 |
Adrenalin epinephrine inject |
149 |
111 |
$2.96 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
94 |
84 |
$2.70 |
| J1940 |
Furosemide injection |
19 |
12 |
$1.16 |
| Q0163 |
Diphenhydramine hcl 50mg |
98 |
77 |
$1.13 |
| J1596 |
Inj, glycopyrrolate, 0.1 mg |
210 |
203 |
$0.64 |
| 91300 |
|
20 |
16 |
$0.15 |
| C1773 |
Ret dev, insertable |
199 |
192 |
$0.00 |
| A9270 |
Non-covered item or service |
793 |
602 |
$0.00 |
| 00142 |
|
41 |
38 |
$0.00 |
| 90480 |
|
70 |
70 |
$0.00 |
| 01480 |
|
18 |
13 |
$0.00 |
| C1769 |
Guide wire |
633 |
358 |
$0.00 |
| J0173 |
Inj, epinephrine (belcher) |
162 |
153 |
$0.00 |
| C1766 |
Intro/sheath,strble,non-peel |
174 |
124 |
$0.00 |
| J2003 |
Inj, lidocaine hcl, 1 mg |
229 |
224 |
$0.00 |
| 95012 |
|
25 |
25 |
$0.00 |
| J1030 |
Methylprednisolone 40 mg inj |
54 |
52 |
$0.00 |
| 00790 |
|
37 |
25 |
$0.00 |
| 00952 |
|
19 |
14 |
$0.00 |
| Q9960 |
Hocm 200-249mg/ml iodine,1ml |
474 |
413 |
$0.00 |
| Q9966 |
Locm 200-299mg/ml iodine,1ml |
270 |
247 |
$0.00 |
| 00812 |
|
72 |
66 |
$0.00 |
| 00811 |
|
453 |
365 |
$0.00 |
| 80305 |
|
30 |
12 |
$0.00 |
| 90671 |
|
662 |
648 |
$0.00 |
| C1887 |
Catheter, guiding |
214 |
121 |
$0.00 |
| C1713 |
Anchor/screw bn/bn,tis/bn |
296 |
194 |
$0.00 |
| 01810 |
|
90 |
75 |
$0.00 |
| J2710 |
Neostigmine methylslfte inj |
87 |
70 |
$0.00 |
| H1000 |
Prenatal care atrisk assessm |
197 |
172 |
$0.00 |
| 92015 |
|
53 |
51 |
$0.00 |
| C1760 |
Closure dev, vasc |
14 |
13 |
$0.00 |
| A4649 |
Surgical supplies |
13 |
12 |
$0.00 |
| J2272 |
Inj, morphine (fresenius) |
24 |
16 |
$0.00 |