138 / 208
Top 20 Procedures
0370
0206
J3357
0272
0214
90999
0278
0173
0110
0111
G0483
99213
99285
99284
99214
0250
J2796
0360
0120
J0878
$0
$50,000
$100,000
$150,000
$200,000
$250,000
$300,000
MEMBER PAID
# OF CLAIMS
# OF
CLAIMANTS
PLAN PAID
PROCEDURE
CODE
$0.00
3
1
$306,252.83
DAPTOMYCIN INJECTION
J0878
$12,795.22
24
15
$203,168.45
ROOM & BOARD (SEMI-PRIVATE 2
BEDS)
0120
$1,257.66
37
26
$133,695.27
OPERATING ROOM SERVICES
0360
$0.00
29
1
$133,295.15
ROMIPLOSTIM INJECTION
J2796
$10,658.40
458
269
$126,862.73
PHARMACY
0250
$98,884.79
1,961
840
$116,264.23
OFFICE/OUTPATIENT VISIT, EST
99214
$73,445.82
308
197
$115,052.35
EMERGENCY DEPT VISIT
99284
$38,418.95
242
145
$93,218.63
EMERGENCY DEPT VISIT
99285
$117,017.53
2,725
1,027
$88,494.04
OFFICE/OUTPATIENT VISIT, EST
99213
$1,364.56
71
10
$86,914.83
G0483
$5,837.01
16
8
$78,205.53
MEDICAL/SURGICAL/GYN
0111
$13,953.35
12
12
$76,634.03
ROOM & BOARD (PRIVATE)
0110
$1,202.25
2
2
$75,900.86
NEWBORN-LEVEL III
0173
Page 37 of 41
Incurred: 2/1/2016 to 1/31/2017
Episode Treatment Groups, third party software included in Design180 ™, is the proprietary and copyrighted
intellectual property of Symmetry ™. Copyright © 2015, NavigatorMD, Inc.
Sample Company