| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| G0463 |
Hospital outpt clinic visit |
112,720 |
98,900 |
$5.76M |
| G0378 |
Hospital observation per hr |
7,119 |
6,801 |
$4.44M |
| 99284 |
|
21,778 |
20,181 |
$4.42M |
| 99283 |
|
24,032 |
22,730 |
$3.09M |
| 99285 |
|
8,030 |
7,721 |
$2.45M |
| 96374 |
|
16,369 |
14,666 |
$1.38M |
| 96361 |
|
22,835 |
15,544 |
$1.04M |
| 99282 |
|
11,629 |
11,185 |
$822K |
| 93306 |
|
3,809 |
3,792 |
$819K |
| H0019 |
Alcohol and/or drug services |
4,452 |
368 |
$805K |
| 96413 |
|
4,731 |
3,084 |
$728K |
| 74177 |
|
5,087 |
4,976 |
$618K |
| 96365 |
|
7,648 |
5,883 |
$596K |
| 96360 |
|
5,672 |
5,328 |
$536K |
| 96375 |
|
17,588 |
12,919 |
$476K |
| 64483 |
|
930 |
912 |
$412K |
| 97112 |
|
13,766 |
5,810 |
$387K |
| H0018 |
Alcohol and/or drug services |
1,037 |
159 |
$366K |
| U0003 |
Cov-19 amp prb hgh thruput |
8,144 |
7,965 |
$364K |
| 70553 |
|
2,068 |
2,057 |
$363K |
| 90837 |
|
3,201 |
2,148 |
$358K |
| 36415 |
|
108,552 |
90,989 |
$339K |
| 78815 |
|
494 |
492 |
$338K |
| 70450 |
|
4,519 |
4,358 |
$321K |
| 71045 |
|
9,260 |
8,755 |
$292K |
| 97530 |
|
8,556 |
3,949 |
$288K |
| 71046 |
|
7,717 |
7,497 |
$286K |
| 96366 |
|
6,593 |
3,779 |
$281K |
| 87491 |
|
15,764 |
15,251 |
$274K |
| 87591 |
|
15,700 |
15,187 |
$272K |
| 92507 |
|
6,272 |
2,446 |
$253K |
| 77067 |
|
5,230 |
5,165 |
$245K |
| 41899 |
|
731 |
729 |
$241K |
| J9271 |
Inj pembrolizumab |
45 |
36 |
$236K |
| 86900 |
|
8,797 |
8,201 |
$234K |
| G0382 |
Lev 3 hosp type b ed visit |
3,006 |
2,849 |
$231K |
| 76705 |
|
4,338 |
4,241 |
$231K |
| Q9992 |
Buprenorphine xr over 100 mg |
216 |
194 |
$220K |
| S9976 |
Lodging per diem |
1,107 |
647 |
$220K |
| 71260 |
|
1,967 |
1,937 |
$215K |
| 80061 |
|
19,488 |
19,174 |
$212K |
| 97110 |
|
10,117 |
4,198 |
$205K |
| 87636 |
|
2,760 |
2,707 |
$198K |
| G0145 |
Scr c/v cyto,thinlayer,rescr |
13,022 |
12,961 |
$197K |
| Q9991 |
Buprenorph xr 100 mg or less |
202 |
175 |
$197K |
| 88305 |
|
12,055 |
11,787 |
$187K |
| G0383 |
Lev 4 hosp type b ed visit |
1,862 |
1,787 |
$186K |
| 90834 |
|
2,051 |
1,575 |
$182K |
| 84443 |
|
28,474 |
27,523 |
$181K |
| 80053 |
|
46,758 |
42,280 |
$179K |
| 76830 |
|
2,967 |
2,906 |
$168K |
| 74176 |
|
1,731 |
1,698 |
$163K |
| 59025 |
|
1,782 |
1,433 |
$157K |
| 87624 |
|
7,655 |
7,626 |
$150K |
| 85025 |
|
80,352 |
67,373 |
$138K |
| 99281 |
|
3,535 |
3,257 |
$137K |
| 92557 |
|
2,376 |
2,368 |
$134K |
| 97162 |
|
2,915 |
2,868 |
$134K |
| 80307 |
|
14,673 |
12,497 |
$131K |
| 92587 |
|
902 |
896 |
$123K |
| 82306 |
|
7,829 |
7,689 |
$116K |
| 78452 |
|
276 |
269 |
$115K |
| G0108 |
Diab manage trn per indiv |
1,478 |
1,224 |
$95K |
| 96372 |
|
11,294 |
9,583 |
$94K |
| 43239 |
|
318 |
318 |
$91K |
| 76811 |
|
767 |
762 |
$89K |
| 72148 |
|
961 |
951 |
$89K |
| 97140 |
|
5,173 |
2,229 |
$86K |
| G0260 |
Inj for sacroiliac jt anesth |
293 |
279 |
$85K |
| 73721 |
|
748 |
744 |
$85K |
| 87389 |
|
8,487 |
8,341 |
$83K |
| 93971 |
|
1,584 |
1,539 |
$82K |
| 76642 |
|
1,976 |
1,969 |
$78K |
| 90853 |
|
1,154 |
414 |
$77K |
| 76801 |
|
1,363 |
1,245 |
$76K |
| U0005 |
Infec agen detec ampli probe |
5,047 |
4,929 |
$74K |
| 71275 |
|
827 |
814 |
$74K |
| G0472 |
Hep c screen high risk/other |
2,993 |
2,911 |
$73K |
| J7050 |
Normal saline solution infus |
7,486 |
4,579 |
$72K |
| 86850 |
|
11,311 |
10,730 |
$67K |
| 76816 |
|
1,885 |
1,670 |
$66K |
| 77065 |
Tomosynthesis, mammo |
1,515 |
1,434 |
$63K |
| U0002 |
Covid-19 lab test non-cdc |
3,435 |
3,299 |
$61K |
| 88342 |
|
1,690 |
1,633 |
$61K |
| 87651 |
|
5,487 |
5,389 |
$59K |
| 86780 |
|
7,590 |
5,585 |
$58K |
| 77336 |
|
881 |
389 |
$56K |
| 93017 |
|
1,269 |
1,254 |
$56K |
| 83036 |
|
15,009 |
14,721 |
$55K |
| 11042 |
|
305 |
203 |
$54K |
| 94726 |
|
1,011 |
1,003 |
$52K |
| 76805 |
|
871 |
871 |
$51K |
| 72170 |
|
1,382 |
1,368 |
$50K |
| 96415 |
|
1,171 |
955 |
$50K |
| 93005 |
|
24,572 |
21,981 |
$49K |
| 87637 |
|
652 |
646 |
$49K |
| 72082 |
|
871 |
854 |
$49K |
| G0379 |
Direct refer hospital observ |
135 |
132 |
$47K |
| 80048 |
|
46,126 |
38,121 |
$45K |
| 77334 |
|
107 |
76 |
$45K |
| 69436 |
|
90 |
89 |
$45K |
| 73564 |
|
2,357 |
2,327 |
$45K |
| 88307 |
|
1,218 |
1,198 |
$44K |
| 45380 |
|
94 |
94 |
$43K |
| 90471 |
|
4,685 |
4,534 |
$42K |
| 96376 |
|
7,597 |
4,539 |
$41K |
| 72110 |
|
1,581 |
1,567 |
$39K |
| 82728 |
|
6,150 |
5,956 |
$39K |
| 87086 |
|
14,991 |
13,929 |
$39K |
| Q5103 |
Injection, inflectra |
28 |
25 |
$38K |
| 87653 |
|
1,969 |
1,957 |
$37K |
| 85027 |
|
19,983 |
18,542 |
$36K |
| 94060 |
|
287 |
283 |
$36K |
| C9399 |
Unclassified drugs or biolog |
755 |
746 |
$36K |
| 87635 |
|
1,328 |
1,300 |
$35K |
| 93975 |
|
305 |
296 |
$35K |
| 93458 |
|
24 |
24 |
$34K |
| 93225 |
|
762 |
753 |
$34K |
| 97597 |
|
397 |
295 |
$34K |
| 97161 |
|
811 |
804 |
$34K |
| 96367 |
|
1,213 |
870 |
$34K |
| 93351 |
|
400 |
397 |
$34K |
| 77386 |
|
104 |
13 |
$34K |
| 76775 |
|
1,864 |
1,784 |
$33K |
| 76536 |
|
665 |
655 |
$32K |
| 77066 |
Tomosynthesis, mammo |
555 |
553 |
$32K |
| C9803 |
Hopd covid-19 spec collect |
3,018 |
2,967 |
$30K |
| 87150 |
|
1,605 |
1,571 |
$30K |
| 95811 |
|
66 |
64 |
$29K |
| 92526 |
|
662 |
297 |
$29K |
| G0480 |
Drug test def 1-7 classes |
1,941 |
1,722 |
$28K |
| 99213 |
|
728 |
624 |
$28K |
| 93296 |
|
1,759 |
1,732 |
$27K |
| 72197 |
|
144 |
143 |
$26K |
| 87507 |
|
175 |
174 |
$25K |
| 87077 |
|
8,408 |
7,419 |
$25K |
| 73630 |
|
2,809 |
2,763 |
$25K |
| J0585 |
Injection,onabotulinumtoxina |
90 |
67 |
$25K |
| 64493 |
|
38 |
37 |
$25K |
| 90832 |
|
375 |
308 |
$24K |
| 49083 |
|
51 |
25 |
$24K |
| 77063 |
|
1,949 |
1,948 |
$23K |
| 92523 |
|
286 |
278 |
$23K |
| 87340 |
|
5,941 |
5,827 |
$23K |
| 86803 |
|
3,545 |
3,497 |
$23K |
| 87186 |
|
7,691 |
7,412 |
$23K |
| 82607 |
|
3,482 |
3,419 |
$23K |
| 87522 |
Neg quan hep c or qual rna |
1,301 |
1,257 |
$23K |
| 83970 |
|
1,221 |
1,110 |
$22K |
| 84439 |
|
5,748 |
5,463 |
$22K |
| 12001 |
|
779 |
773 |
$22K |
| G0103 |
Psa screening |
1,971 |
1,954 |
$21K |
| 73030 |
|
1,988 |
1,939 |
$21K |
| 87070 |
|
6,230 |
5,873 |
$19K |
| 84702 |
|
3,839 |
2,801 |
$19K |
| 74018 |
|
1,925 |
1,836 |
$18K |
| 72141 |
|
146 |
145 |
$18K |
| 87661 |
|
1,147 |
1,131 |
$18K |
| 86762 |
|
3,492 |
3,419 |
$17K |
| 73610 |
|
2,298 |
2,257 |
$17K |
| 72125 |
|
1,408 |
1,378 |
$17K |
| 73130 |
|
2,109 |
2,079 |
$16K |
| 81001 |
|
35,902 |
32,585 |
$16K |
| H0001 |
Alcohol and/or drug assess |
116 |
116 |
$16K |
| 84403 |
|
1,657 |
1,592 |
$16K |
| H0004 |
Alcohol and/or drug services |
185 |
126 |
$16K |
| 83550 |
|
4,100 |
3,991 |
$16K |
| 77300 |
|
55 |
48 |
$15K |
| 96417 |
|
398 |
243 |
$15K |
| 52000 |
|
55 |
54 |
$15K |
| 83540 |
|
4,910 |
4,761 |
$15K |
| 90472 |
|
1,065 |
1,041 |
$14K |
| 73110 |
|
1,741 |
1,706 |
$14K |
| 88304 |
|
1,496 |
1,483 |
$14K |
| 82570 |
|
6,067 |
5,696 |
$14K |
| C1769 |
Guide wire |
2,754 |
2,611 |
$13K |
| 83735 |
|
17,573 |
13,970 |
$13K |
| 52310 |
|
13 |
12 |
$13K |
| 76770 |
|
234 |
232 |
$12K |
| 95810 |
|
25 |
24 |
$12K |
| H0005 |
Alcohol and/or drug services |
214 |
76 |
$12K |
| 71271 |
|
230 |
228 |
$12K |
| S0280 |
Medical home, initial plan |
84 |
36 |
$12K |
| Q3014 |
Telehealth facility fee |
851 |
829 |
$11K |
| 97535 |
|
839 |
639 |
$11K |
| 77080 |
|
196 |
196 |
$11K |
| 83880 |
|
2,643 |
2,464 |
$11K |
| 84481 |
|
1,377 |
1,347 |
$11K |
| 73502 |
|
959 |
938 |
$10K |
| 95819 |
|
89 |
89 |
$10K |
| 82043 |
|
3,883 |
3,831 |
$10K |
| 86140 |
|
7,349 |
6,852 |
$10K |
| 97166 |
|
231 |
225 |
$10K |
| 87634 |
|
761 |
749 |
$10K |
| 88175 |
|
498 |
498 |
$10K |
| 80076 |
|
14,302 |
13,206 |
$9K |
| 70498 |
|
70 |
68 |
$9K |
| 82784 |
|
1,893 |
1,469 |
$9K |
| 87081 |
|
4,075 |
3,992 |
$9K |
| 87205 |
|
6,087 |
5,726 |
$9K |
| 87088 |
|
3,026 |
2,952 |
$9K |
| 90688 |
|
661 |
658 |
$9K |
| 86480 |
|
336 |
324 |
$9K |
| 87502 |
|
1,040 |
1,024 |
$8K |
| 82950 |
|
3,263 |
3,209 |
$8K |
| 76882 |
|
205 |
204 |
$8K |
| 90686 |
|
520 |
506 |
$8K |
| 95806 |
|
99 |
98 |
$8K |
| M0243 |
Casirivi and imdevi inj |
29 |
29 |
$8K |
| G0279 |
Tomosynthesis, mammo |
726 |
692 |
$8K |
| 85610 |
|
11,999 |
9,714 |
$8K |
| 70486 |
|
255 |
253 |
$7K |
| 86706 |
|
1,727 |
1,701 |
$7K |
| 72100 |
|
360 |
356 |
$7K |
| 82746 |
|
1,274 |
1,237 |
$7K |
| 86376 |
|
983 |
969 |
$7K |
| 10060 |
|
82 |
80 |
$7K |
| 73140 |
|
845 |
833 |
$7K |
| G2066 |
Inter devc remote 30d |
587 |
584 |
$7K |
| 87804 |
|
4,656 |
2,646 |
$6K |
| 85652 |
|
7,579 |
7,148 |
$6K |
| 99214 |
|
113 |
100 |
$6K |
| 36591 |
|
151 |
110 |
$6K |
| J7030 |
Normal saline solution infus |
454 |
195 |
$6K |
| 97116 |
|
905 |
623 |
$6K |
| 86704 |
|
1,029 |
1,019 |
$6K |
| 92567 |
|
3,691 |
3,647 |
$5K |
| 95909 |
|
38 |
37 |
$5K |
| 94640 |
|
5,235 |
3,274 |
$5K |
| 84146 |
|
536 |
522 |
$5K |
| 74022 |
|
1,248 |
1,207 |
$5K |
| 92586 |
|
69 |
68 |
$5K |
| 86038 |
|
926 |
912 |
$5K |
| 86039 |
|
942 |
924 |
$5K |
| 12011 |
|
216 |
215 |
$5K |
| 72070 |
|
208 |
205 |
$5K |
| 82565 |
|
3,210 |
2,764 |
$5K |
| 88112 |
|
429 |
409 |
$4K |
| 82947 |
|
1,600 |
1,560 |
$4K |
| T1007 |
Treatment plan development |
48 |
48 |
$4K |
| 83690 |
|
12,307 |
11,148 |
$4K |
| 76700 |
|
68 |
68 |
$4K |
| 73080 |
|
691 |
676 |
$4K |
| 82248 |
|
2,489 |
2,053 |
$4K |
| 83001 |
|
464 |
450 |
$4K |
| 87529 |
|
296 |
149 |
$4K |
| J0185 |
Inj., aprepitant, 1 mg |
41 |
25 |
$4K |
| 84460 |
|
2,095 |
1,825 |
$4K |
| 84100 |
|
3,945 |
2,945 |
$4K |
| 97165 |
|
97 |
94 |
$4K |
| 93970 |
|
41 |
39 |
$4K |
| 83516 |
|
873 |
710 |
$4K |
| 0012A |
|
114 |
114 |
$4K |
| 82670 |
|
288 |
268 |
$4K |
| J1453 |
Fosaprepitant injection |
69 |
39 |
$3K |
| 73590 |
|
532 |
521 |
$3K |
| 94010 |
|
219 |
216 |
$3K |
| 87798 |
|
252 |
139 |
$3K |
| 76825 |
|
12 |
12 |
$3K |
| 81025 |
|
10,286 |
9,725 |
$3K |
| 75574 |
|
42 |
42 |
$3K |
| 76870 |
|
127 |
125 |
$3K |
| 80305 |
|
5,411 |
4,537 |
$3K |
| 84156 |
|
2,282 |
1,973 |
$3K |
| 51798 |
|
1,718 |
1,622 |
$3K |
| 87902 |
|
71 |
62 |
$3K |
| M0247 |
Sotrovimab infusion |
12 |
12 |
$3K |
| 84550 |
|
1,938 |
1,736 |
$3K |
| 91320 |
|
27 |
27 |
$3K |
| 87426 |
|
187 |
185 |
$3K |
| 0011A |
|
120 |
120 |
$3K |
| 93350 |
|
12 |
12 |
$3K |
| 87480 |
|
502 |
491 |
$3K |
| 87510 |
|
501 |
490 |
$3K |
| 86431 |
|
1,112 |
1,098 |
$3K |
| 87660 |
|
501 |
490 |
$3K |
| 29515 |
|
38 |
38 |
$3K |
| 84450 |
|
1,470 |
1,336 |
$2K |
| 86364 |
|
398 |
367 |
$2K |
| G0123 |
Screen cerv/vag thin layer |
193 |
191 |
$2K |
| 87210 |
|
1,616 |
1,581 |
$2K |
| 73090 |
|
305 |
299 |
$2K |
| 87075 |
|
1,294 |
1,123 |
$2K |
| 87807 |
|
681 |
669 |
$2K |
| 73560 |
|
245 |
240 |
$2K |
| 82150 |
|
2,257 |
2,195 |
$2K |
| 86200 |
|
365 |
347 |
$2K |
| 84153 |
|
256 |
247 |
$2K |
| 74019 |
|
53 |
53 |
$2K |
| 84703 |
|
7,154 |
6,772 |
$2K |
| 88300 |
|
199 |
195 |
$2K |
| 83874 |
|
1,732 |
992 |
$2K |
| 87631 |
|
34 |
33 |
$2K |
| G8978 |
Mobility current status |
72 |
66 |
$2K |
| 87505 |
|
27 |
25 |
$2K |
| 93299 |
|
91 |
89 |
$2K |
| 82550 |
|
890 |
814 |
$1K |
| 72050 |
|
57 |
56 |
$1K |
| 87899 |
|
256 |
251 |
$1K |
| 85730 |
|
5,669 |
5,329 |
$1K |
| 83615 |
|
909 |
780 |
$1K |
| G0008 |
Admin influenza virus vac |
247 |
244 |
$1K |
| 96523 |
|
65 |
63 |
$1K |
| 73221 |
|
12 |
12 |
$1K |
| 92651 |
|
17 |
16 |
$1K |
| 70551 |
|
13 |
13 |
$1K |
| G0297 |
Ldct for lung ca screen |
36 |
36 |
$1K |
| 80074 |
|
53 |
53 |
$1K |
| C1894 |
Intro/sheath, non-laser |
2,020 |
1,962 |
$1K |
| 93298 |
|
71 |
71 |
$1K |
| 85018 |
|
3,707 |
3,233 |
$1K |
| 76819 |
|
18 |
14 |
$1K |
| 87427 |
|
256 |
251 |
$1K |
| 97163 |
|
27 |
26 |
$1K |
| 85014 |
|
3,369 |
2,971 |
$1K |
| 90480 |
|
32 |
32 |
$1K |
| 90791 |
|
14 |
14 |
$1K |
| 0001A |
|
29 |
29 |
$1K |
| 86800 |
|
152 |
140 |
$1K |
| 87046 |
|
255 |
251 |
$1K |
| 87536 |
|
39 |
38 |
$1K |
| 87045 |
|
256 |
251 |
$997.48 |
| 84132 |
|
1,288 |
958 |
$967.27 |
| 93880 |
|
12 |
12 |
$962.36 |
| 85379 |
|
2,489 |
2,432 |
$901.90 |
| 83002 |
|
106 |
103 |
$861.56 |
| 99406 |
|
60 |
60 |
$855.80 |
| 81596 |
|
31 |
31 |
$802.88 |
| 93923 |
|
12 |
12 |
$791.21 |
| 84520 |
|
611 |
459 |
$785.43 |
| 76815 |
|
59 |
53 |
$759.56 |
| 95800 |
|
13 |
13 |
$758.23 |
| 12002 |
|
27 |
27 |
$749.65 |
| 0002A |
|
19 |
19 |
$719.15 |
| 70496 |
|
32 |
31 |
$713.66 |
| 99496 |
|
12 |
12 |
$706.50 |
| 86225 |
|
121 |
117 |
$705.94 |
| 82533 |
|
135 |
113 |
$705.10 |
| 92591 |
|
13 |
13 |
$684.93 |
| 0134A |
|
20 |
20 |
$683.39 |
| 87040 |
|
4,483 |
2,699 |
$670.31 |
| 86481 |
|
24 |
24 |
$643.56 |
| 86923 |
|
61 |
54 |
$631.30 |
| 72081 |
|
13 |
13 |
$630.24 |
| 71101 |
|
85 |
84 |
$625.38 |
| 82077 |
|
4,943 |
4,384 |
$608.21 |
| 90792 |
|
12 |
12 |
$567.81 |
| 90656 |
|
46 |
46 |
$567.19 |
| 29125 |
|
250 |
245 |
$563.83 |
| 87880 |
|
3,564 |
3,501 |
$553.17 |
| 92610 |
|
13 |
12 |
$550.80 |
| 81003 |
|
7,730 |
7,422 |
$529.05 |
| 87329 |
|
108 |
105 |
$524.82 |
| 0064A |
|
20 |
20 |
$511.55 |
| 82105 |
|
77 |
76 |
$510.11 |
| 0124A |
|
24 |
24 |
$504.91 |
| 88341 |
|
419 |
407 |
$497.20 |
| 0071A |
|
14 |
14 |
$492.05 |
| 0072A |
|
14 |
14 |
$492.05 |
| 86308 |
|
348 |
331 |
$491.01 |
| 87328 |
|
95 |
93 |
$481.24 |
| 93226 |
|
731 |
726 |
$451.61 |
| 84402 |
|
56 |
55 |
$443.78 |
| 80164 |
|
81 |
69 |
$378.13 |
| 82803 |
|
1,449 |
1,176 |
$360.36 |
| 80069 |
|
94 |
82 |
$360.03 |
| 97602 |
|
13 |
12 |
$344.00 |
| 84484 |
|
13,768 |
7,697 |
$323.24 |
| 82140 |
|
108 |
91 |
$319.15 |
| 82962 |
|
18,342 |
12,912 |
$312.49 |
| 83993 |
|
27 |
26 |
$294.79 |
| 86920 |
|
38 |
37 |
$286.00 |
| 83605 |
|
5,524 |
4,553 |
$260.27 |
| 86901 |
|
8,796 |
8,199 |
$230.27 |
| 96402 |
|
13 |
12 |
$227.71 |
| 87428 |
|
15 |
13 |
$214.50 |
| J3490 |
Drugs unclassified injection |
1,351 |
1,313 |
$194.65 |
| 87147 |
|
100 |
93 |
$188.61 |
| 92579 |
|
13 |
13 |
$162.30 |
| 86235 |
|
25 |
13 |
$160.21 |
| 82948 |
|
2,189 |
2,089 |
$143.45 |
| 87641 |
|
13 |
13 |
$137.06 |
| 80178 |
|
58 |
53 |
$133.93 |
| 83630 |
|
25 |
25 |
$131.40 |
| 86709 |
|
24 |
24 |
$127.44 |
| 82378 |
|
14 |
12 |
$106.80 |
| 86708 |
|
26 |
26 |
$87.74 |
| 87640 |
|
12 |
12 |
$78.32 |
| 86618 |
|
12 |
12 |
$76.00 |
| 83525 |
|
12 |
12 |
$74.80 |
| 82330 |
|
40 |
37 |
$71.03 |
| 76820 |
|
147 |
99 |
$64.84 |
| 82977 |
|
29 |
28 |
$63.42 |
| 82365 |
|
38 |
38 |
$61.20 |
| 90715 |
|
1,705 |
1,686 |
$60.30 |
| J0690 |
Cefazolin sodium injection |
5,981 |
5,294 |
$57.38 |
| 80051 |
|
68 |
64 |
$54.55 |
| 80143 |
|
967 |
906 |
$47.99 |
| 82247 |
|
28 |
26 |
$45.72 |
| 81002 |
|
328 |
311 |
$42.48 |
| 84165 |
|
12 |
12 |
$38.34 |
| J3010 |
Fentanyl citrate injection |
13,642 |
12,837 |
$37.68 |
| 80179 |
|
896 |
861 |
$37.09 |
| J2250 |
Inj midazolam hydrochloride |
8,664 |
8,288 |
$36.46 |
| 70360 |
|
12 |
12 |
$31.62 |
| J0780 |
Prochlorperazine injection |
3,091 |
2,552 |
$23.15 |
| 80177 |
|
26 |
24 |
$21.75 |
| 82010 |
|
192 |
150 |
$21.45 |
| 85384 |
|
12 |
12 |
$17.34 |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
9,022 |
8,703 |
$12.96 |
| 82075 |
|
575 |
405 |
$11.87 |
| J1885 |
Ketorolac tromethamine inj |
14,794 |
12,531 |
$11.66 |
| 85045 |
|
19 |
18 |
$11.65 |
| J2765 |
Metoclopramide hcl injection |
1,268 |
1,186 |
$10.78 |
| J2405 |
Ondansetron hcl injection |
21,213 |
17,955 |
$8.10 |
| J2704 |
Inj, propofol, 10 mg |
10,902 |
10,646 |
$7.15 |
| 80047 |
|
105 |
102 |
$6.96 |
| 84155 |
|
12 |
12 |
$4.36 |
| J2930 |
Methylprednisolone injection |
1,849 |
1,496 |
$4.02 |
| J1100 |
Dexamethasone sodium phos |
12,264 |
10,933 |
$3.95 |
| 89050 |
|
49 |
25 |
$2.76 |
| 81000 |
|
25 |
25 |
$2.05 |
| J1170 |
Hydromorphone injection |
10,053 |
8,161 |
$2.01 |
| J1200 |
Diphenhydramine hcl injectio |
4,403 |
3,396 |
$0.86 |
| 90670 |
|
14 |
14 |
$0.40 |
| G1004 |
Cdsm ndsc |
2,178 |
2,078 |
$0.01 |
| Q9966 |
Locm 200-299mg/ml iodine,1ml |
2,163 |
2,024 |
$0.00 |
| J3475 |
Inj magnesium sulfate |
3,065 |
2,192 |
$0.00 |
| 99001 |
|
54 |
52 |
$0.00 |
| J0295 |
Ampicillin sulbactam 1.5 gm |
37 |
24 |
$0.00 |
| J1644 |
Inj heparin sodium per 1000u |
2,929 |
2,132 |
$0.00 |
| J3301 |
Triamcinolone acet inj nos |
1,410 |
1,349 |
$0.00 |
| 93325 |
|
1,081 |
1,067 |
$0.00 |
| J2270 |
Morphine sulfate injection |
2,444 |
1,999 |
$0.00 |
| J2710 |
Neostigmine methylslfte inj |
2,173 |
1,971 |
$0.00 |
| C1887 |
Catheter, guiding |
891 |
862 |
$0.00 |
| C1729 |
Cath, drainage |
600 |
355 |
$0.00 |
| A9552 |
F18 fdg |
484 |
482 |
$0.00 |
| J0688 |
Inj cefazolin sodium, hikma |
452 |
372 |
$0.00 |
| 94729 |
|
963 |
955 |
$0.00 |
| A9575 |
Inj gadoterate meglumi 0.1ml |
2,874 |
2,839 |
$0.00 |
| 99152 |
|
68 |
66 |
$0.00 |
| J1650 |
Inj enoxaparin sodium |
192 |
110 |
$0.00 |
| J3370 |
Vancomycin hcl injection |
539 |
380 |
$0.00 |
| J0171 |
Adrenalin epinephrine inject |
561 |
403 |
$0.00 |
| C1713 |
Anchor/screw bn/bn,tis/bn |
877 |
860 |
$0.00 |
| 76942 |
|
38 |
37 |
$0.00 |
| J2004 |
Inj, lidocaine w epinephrine |
12 |
12 |
$0.00 |
| C9113 |
Inj pantoprazole sodium, via |
116 |
85 |
$0.00 |
| 77002 |
|
31 |
31 |
$0.00 |
| 91300 |
|
45 |
38 |
$0.00 |
| 88312 |
|
15 |
15 |
$0.00 |
| J7040 |
Normal saline solution infus |
266 |
185 |
$0.00 |
| J2919 |
Inj, methylpred sod succ 5mg |
83 |
70 |
$0.00 |
| J1596 |
Inj, glycopyrrolate, 0.1 mg |
73 |
71 |
$0.00 |
| C1776 |
Joint device (implantable) |
13 |
12 |
$0.00 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
89 |
66 |
$0.00 |
| 76937 |
|
12 |
12 |
$0.00 |
| G8979 |
Mobility goal status |
78 |
69 |
$0.00 |
| J0735 |
Clonidine hydrochloride |
45 |
44 |
$0.00 |
| J2550 |
Promethazine hcl injection |
260 |
219 |
$0.00 |
| 84145 |
|
12 |
12 |
$0.00 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
13 |
13 |
$0.00 |
| 88313 |
|
14 |
12 |
$0.00 |
| J2060 |
Lorazepam injection |
2,952 |
2,344 |
$0.00 |
| 93320 |
|
573 |
565 |
$0.00 |
| 95886 |
|
705 |
696 |
$0.00 |
| J0696 |
Ceftriaxone sodium injection |
2,364 |
1,887 |
$0.00 |
| J1040 |
Methylprednisolone 80 mg inj |
649 |
624 |
$0.00 |
| J3480 |
Inj potassium chloride |
439 |
313 |
$0.00 |
| A9270 |
Non-covered item or service |
503 |
322 |
$0.00 |
| J2469 |
Palonosetron hcl |
373 |
228 |
$0.00 |
| J2795 |
Ropivacaine hcl injection |
276 |
255 |
$0.00 |
| J7060 |
5% dextrose/water |
937 |
595 |
$0.00 |
| J1030 |
Methylprednisolone 40 mg inj |
415 |
403 |
$0.00 |
| J3411 |
Thiamine hcl 100 mg |
30 |
14 |
$0.00 |
| J2175 |
Meperidine hydrochl /100 mg |
612 |
605 |
$0.00 |
| A9585 |
Gadobutrol injection |
643 |
631 |
$0.00 |
| J2370 |
Phenylephrine hcl injection |
965 |
943 |
$0.00 |
| 96368 |
|
764 |
527 |
$0.00 |
| J2790 |
Rho d immune globulin inj |
107 |
105 |
$0.00 |
| 91301 |
|
239 |
232 |
$0.00 |
| J1630 |
Haloperidol injection |
110 |
97 |
$0.00 |
| A9500 |
Tc99m sestamibi |
329 |
322 |
$0.00 |
| J3360 |
Diazepam injection |
69 |
65 |
$0.00 |
| A4648 |
Implantable tissue marker |
52 |
50 |
$0.00 |
| J2791 |
Rhophylac injection |
24 |
24 |
$0.00 |
| J1790 |
Droperidol injection |
142 |
137 |
$0.00 |
| 99156 |
|
13 |
13 |
$0.00 |
| J2003 |
Inj, lidocaine hcl, 1 mg |
132 |
130 |
$0.00 |
| C2617 |
Stent, non-cor, tem w/o del |
42 |
42 |
$0.00 |
| G8980 |
Mobility d/c status |
44 |
42 |
$0.00 |
| 64494 |
|
25 |
25 |
$0.00 |
| 88311 |
|
12 |
12 |
$0.00 |
| 74420 |
|
66 |
65 |
$0.00 |
| J1010 |
Inj, methylpred acetate 1 mg |
13 |
13 |
$0.00 |
| 93297 |
|
12 |
12 |
$0.00 |
| J2785 |
Regadenoson injection |
37 |
37 |
$0.00 |
| 0240U |
|
12 |
12 |
$0.00 |
| C1725 |
Cath, translumin non-laser |
25 |
24 |
$0.00 |
| J0330 |
Succinycholine chloride inj |
109 |
108 |
$0.00 |
| 91307 |
|
36 |
34 |
$0.00 |
| J1250 |
Inj dobutamine hcl/250 mg |
13 |
12 |
$0.00 |
| J2371 |
Inj phenylephrine hcl 20 mcg |
15 |
14 |
$0.00 |