| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J9271 |
Inj pembrolizumab |
1,896 |
1,185 |
$14.60M |
| 99283 |
|
89,345 |
80,982 |
$13.03M |
| 99214 |
|
98,130 |
85,631 |
$12.78M |
| 99284 |
|
67,712 |
60,780 |
$10.43M |
| 99213 |
|
71,776 |
62,589 |
$9.24M |
| 99285 |
|
55,703 |
47,270 |
$8.09M |
| 76816 |
|
32,383 |
29,657 |
$4.54M |
| 96361 |
|
14,788 |
10,797 |
$4.27M |
| 70450 |
|
13,277 |
10,826 |
$3.81M |
| 99215 |
Prolong outpt/office vis |
26,191 |
20,822 |
$3.14M |
| 97110 |
|
33,063 |
13,736 |
$2.81M |
| 76819 |
|
27,360 |
21,445 |
$2.51M |
| 77386 |
|
5,947 |
453 |
$2.18M |
| 76811 |
|
12,603 |
12,014 |
$2.04M |
| 95810 |
|
2,540 |
2,452 |
$1.78M |
| 96413 |
|
12,464 |
6,383 |
$1.75M |
| 59025 |
|
9,830 |
7,605 |
$1.74M |
| D2930 |
|
3,239 |
934 |
$1.70M |
| 96365 |
|
10,081 |
6,199 |
$1.58M |
| 41899 |
|
1,468 |
1,245 |
$1.45M |
| 76801 |
|
9,322 |
8,708 |
$1.41M |
| 96366 |
|
5,031 |
2,773 |
$1.32M |
| 74177 |
|
8,130 |
6,452 |
$1.31M |
| 99211 |
|
12,028 |
7,136 |
$1.29M |
| J9299 |
Injection, nivolumab |
227 |
107 |
$1.11M |
| G0378 |
Hospital observation per hr |
17,310 |
7,437 |
$1.05M |
| 96360 |
|
3,722 |
2,575 |
$853K |
| 92507 |
|
9,430 |
4,162 |
$815K |
| 93306 |
|
3,080 |
2,609 |
$808K |
| 94640 |
|
6,267 |
3,242 |
$759K |
| G0463 |
Hospital outpt clinic visit |
37,643 |
27,921 |
$753K |
| 99395 |
|
5,598 |
5,218 |
$749K |
| 92557 |
|
9,574 |
9,184 |
$718K |
| 80053 |
|
106,546 |
80,823 |
$696K |
| 76813 |
|
5,605 |
5,322 |
$663K |
| D3220 |
|
1,193 |
500 |
$656K |
| 71275 |
|
2,261 |
1,695 |
$639K |
| 76856 |
|
2,953 |
2,535 |
$596K |
| 97530 |
|
7,822 |
3,524 |
$580K |
| 70553 |
|
2,078 |
1,777 |
$576K |
| 36512 |
|
397 |
274 |
$574K |
| J1050 |
Medroxyprogesterone acetate |
6,990 |
6,457 |
$551K |
| 69436 |
|
323 |
277 |
$538K |
| 95886 |
|
1,894 |
1,707 |
$519K |
| J7307 |
Etonogestrel implant system |
512 |
426 |
$509K |
| J0897 |
Denosumab injection |
449 |
323 |
$505K |
| 71260 |
|
3,883 |
3,165 |
$503K |
| 92587 |
|
7,711 |
7,475 |
$493K |
| 78815 |
|
815 |
697 |
$492K |
| 99212 |
|
4,316 |
3,999 |
$488K |
| 76820 |
|
6,144 |
3,634 |
$481K |
| Q5107 |
Inj mvasi 10 mg |
896 |
253 |
$473K |
| 99281 |
|
2,999 |
2,566 |
$472K |
| 95811 |
|
698 |
676 |
$463K |
| 77300 |
|
917 |
733 |
$460K |
| 77295 |
|
523 |
430 |
$428K |
| 43239 |
|
912 |
637 |
$425K |
| 92550 |
|
5,168 |
4,938 |
$414K |
| 77334 |
|
1,156 |
746 |
$409K |
| J9144 |
Daratumumab, hyaluronidase |
82 |
36 |
$401K |
| 45385 |
|
676 |
471 |
$400K |
| 95806 |
|
627 |
602 |
$394K |
| 77412 |
|
2,731 |
330 |
$392K |
| 82805 |
|
12,290 |
7,396 |
$388K |
| 74176 |
|
1,495 |
1,214 |
$370K |
| 76817 |
|
5,019 |
4,105 |
$367K |
| 66984 |
|
572 |
408 |
$339K |
| J9022 |
Inj, atezolizumab,10 mg |
55 |
38 |
$338K |
| 92567 |
|
8,564 |
8,319 |
$336K |
| 96367 |
|
3,457 |
2,056 |
$334K |
| 71046 |
|
23,875 |
20,215 |
$320K |
| 76770 |
|
1,655 |
1,529 |
$309K |
| D7140 |
|
1,247 |
508 |
$307K |
| 76805 |
|
2,582 |
2,472 |
$306K |
| J2506 |
Inj pegfilgrast ex bio 0.5mg |
521 |
284 |
$300K |
| 76815 |
|
3,659 |
3,018 |
$298K |
| 96416 |
|
1,133 |
530 |
$298K |
| 99282 |
|
2,449 |
2,005 |
$296K |
| 96415 |
|
1,943 |
1,028 |
$287K |
| 97161 |
|
5,383 |
4,508 |
$278K |
| 95782 |
|
355 |
351 |
$262K |
| J1745 |
Infliximab not biosimil 10mg |
101 |
91 |
$260K |
| 77336 |
|
2,378 |
991 |
$258K |
| 77063 |
|
5,173 |
4,646 |
$257K |
| 80307 |
|
13,859 |
10,855 |
$257K |
| 86850 |
|
12,850 |
9,467 |
$255K |
| 77290 |
|
457 |
381 |
$241K |
| 80048 |
|
18,583 |
15,234 |
$238K |
| 90853 |
|
2,434 |
395 |
$233K |
| P9016 |
Rbc leukocytes reduced |
1,070 |
793 |
$221K |
| 70491 |
|
782 |
626 |
$215K |
| 88185 |
|
5,281 |
2,217 |
$215K |
| 45380 |
|
487 |
302 |
$214K |
| 97140 |
|
8,619 |
3,726 |
$213K |
| 76642 |
|
2,387 |
2,050 |
$212K |
| 36430 |
|
1,671 |
923 |
$203K |
| 77301 |
|
244 |
201 |
$199K |
| J7298 |
Mirena, 52 mg |
206 |
166 |
$195K |
| J9173 |
Inj., durvalumab, 10 mg |
58 |
24 |
$194K |
| 76830 |
|
3,601 |
3,070 |
$192K |
| 76705 |
|
2,035 |
1,725 |
$189K |
| 70551 |
|
1,013 |
865 |
$178K |
| 87636 |
|
9,138 |
7,269 |
$177K |
| 85025 |
|
135,133 |
104,656 |
$171K |
| 70496 |
|
610 |
496 |
$167K |
| 93308 |
|
709 |
556 |
$163K |
| 36556 |
|
420 |
281 |
$162K |
| 95816 |
|
898 |
860 |
$158K |
| 73721 |
|
641 |
583 |
$155K |
| 73610 |
|
4,273 |
3,408 |
$151K |
| 71250 |
|
1,648 |
1,467 |
$149K |
| 96372 |
|
41,590 |
31,917 |
$148K |
| 93970 |
|
982 |
818 |
$147K |
| 84484 |
|
31,028 |
18,127 |
$146K |
| J2997 |
Alteplase recombinant |
875 |
202 |
$145K |
| 93005 |
|
51,459 |
40,128 |
$145K |
| 99396 |
|
1,124 |
1,007 |
$144K |
| 73630 |
|
4,056 |
3,325 |
$140K |
| 11042 |
|
1,229 |
847 |
$140K |
| 86900 |
|
12,985 |
9,557 |
$140K |
| 19083 |
|
156 |
121 |
$137K |
| 76536 |
|
1,179 |
1,091 |
$135K |
| C1713 |
Anchor/screw bn/bn,tis/bn |
1,108 |
618 |
$135K |
| 97165 |
|
1,849 |
1,410 |
$132K |
| 87661 |
|
13,871 |
12,246 |
$132K |
| 31575 |
|
689 |
609 |
$127K |
| P9040 |
Rbc leukoreduced irradiated |
833 |
498 |
$122K |
| 87591 |
|
14,380 |
13,035 |
$122K |
| 70498 |
|
876 |
699 |
$117K |
| 74183 |
|
531 |
473 |
$114K |
| 93971 |
|
1,436 |
1,182 |
$114K |
| J0561 |
Penicillin g benzathine inj |
410 |
297 |
$111K |
| 90937 |
|
273 |
28 |
$108K |
| 88184 |
|
2,719 |
2,254 |
$107K |
| 93975 |
|
745 |
629 |
$107K |
| 0002A |
|
3,126 |
2,900 |
$106K |
| 77387 |
|
2,171 |
257 |
$106K |
| 0001A |
|
3,255 |
3,005 |
$105K |
| 92579 |
|
3,406 |
3,314 |
$103K |
| 87635 |
|
12,477 |
10,117 |
$101K |
| 72148 |
|
747 |
657 |
$100K |
| D1351 |
|
234 |
141 |
$99K |
| J9306 |
Injection, pertuzumab, 1 mg |
23 |
12 |
$99K |
| 78452 |
|
257 |
196 |
$98K |
| J9305 |
Inj. pemetrexed nos 10mg |
415 |
147 |
$94K |
| 01922 |
|
413 |
356 |
$94K |
| 72141 |
|
532 |
465 |
$92K |
| 80069 |
|
9,282 |
5,043 |
$91K |
| D2391 |
|
189 |
72 |
$90K |
| 95924 |
|
246 |
217 |
$89K |
| 45378 |
|
220 |
143 |
$89K |
| J1569 |
Gammagard liquid injection |
174 |
91 |
$88K |
| 71045 |
|
13,576 |
10,891 |
$87K |
| 73030 |
|
3,457 |
2,731 |
$85K |
| 92585 |
|
364 |
354 |
$85K |
| 73560 |
|
1,911 |
1,536 |
$83K |
| 96374 |
|
44,766 |
37,084 |
$83K |
| 90651 |
|
442 |
394 |
$82K |
| 76700 |
|
414 |
372 |
$82K |
| 97112 |
|
2,532 |
1,231 |
$81K |
| 88341 |
|
1,523 |
561 |
$80K |
| 73130 |
|
3,544 |
2,729 |
$80K |
| 71271 |
|
517 |
483 |
$80K |
| 97016 |
|
2,029 |
782 |
$78K |
| 72197 |
|
300 |
250 |
$75K |
| 77067 |
|
5,194 |
4,676 |
$75K |
| J1756 |
Iron sucrose injection |
3,090 |
1,248 |
$73K |
| 85027 |
|
21,435 |
12,544 |
$73K |
| 97113 |
|
856 |
383 |
$72K |
| 99291 |
|
572 |
451 |
$71K |
| J7297 |
Liletta, 52 mg |
98 |
73 |
$71K |
| 70486 |
|
2,081 |
1,679 |
$71K |
| 10060 |
|
412 |
337 |
$70K |
| 74018 |
|
1,410 |
1,132 |
$69K |
| 82947 |
|
35,420 |
17,070 |
$69K |
| 73562 |
|
1,676 |
1,388 |
$69K |
| 73502 |
|
2,139 |
1,785 |
$68K |
| 97116 |
|
1,761 |
930 |
$68K |
| 72110 |
|
1,207 |
1,084 |
$68K |
| 73110 |
|
2,412 |
1,931 |
$64K |
| 93017 |
|
807 |
653 |
$64K |
| 36415 |
|
67,941 |
45,367 |
$64K |
| 73590 |
|
2,661 |
2,090 |
$64K |
| 97162 |
|
1,184 |
1,020 |
$63K |
| 77280 |
|
552 |
417 |
$63K |
| 76982 |
|
1,520 |
1,326 |
$62K |
| 97535 |
|
1,687 |
1,197 |
$62K |
| 77338 |
|
248 |
202 |
$61K |
| P9045 |
Albumin (human), 5%, 250 ml |
202 |
104 |
$60K |
| 90715 |
|
4,547 |
3,606 |
$59K |
| 94060 |
|
591 |
532 |
$59K |
| 88307 |
|
814 |
516 |
$59K |
| 12001 |
|
373 |
319 |
$59K |
| 90870 |
|
123 |
37 |
$58K |
| 73564 |
|
2,906 |
2,324 |
$57K |
| Q5117 |
Inj., kanjinti, 10 mg |
206 |
66 |
$57K |
| 72125 |
|
5,165 |
4,081 |
$56K |
| 94618 |
|
673 |
614 |
$56K |
| 11982 |
|
264 |
228 |
$56K |
| 83605 |
|
21,691 |
13,743 |
$54K |
| 80320 |
|
2,715 |
2,157 |
$51K |
| 75574 |
|
191 |
139 |
$51K |
| 75561 |
|
181 |
151 |
$50K |
| Q0138 |
Ferumoxytol, non-esrd |
398 |
231 |
$49K |
| 58558 |
|
46 |
29 |
$49K |
| H2019 |
Ther behav svc, per 15 min |
842 |
340 |
$49K |
| 99152 |
|
3,567 |
2,650 |
$49K |
| 20610 |
|
384 |
286 |
$47K |
| 87624 |
|
1,951 |
1,815 |
$47K |
| 74230 |
|
253 |
234 |
$47K |
| 96523 |
|
1,369 |
949 |
$46K |
| 74174 |
|
667 |
507 |
$46K |
| 76000 |
|
427 |
245 |
$46K |
| 86901 |
|
12,993 |
9,559 |
$46K |
| 88175 |
|
3,379 |
3,189 |
$45K |
| 88305 |
|
6,505 |
3,587 |
$45K |
| 96376 |
|
9,550 |
4,517 |
$45K |
| 93296 |
|
2,043 |
1,921 |
$45K |
| 36591 |
|
3,806 |
2,332 |
$45K |
| 97802 |
|
475 |
439 |
$45K |
| 29581 |
|
439 |
150 |
$44K |
| 96375 |
|
34,440 |
23,317 |
$44K |
| 73552 |
|
1,799 |
1,434 |
$44K |
| 77062 |
|
1,023 |
932 |
$43K |
| 92626 |
|
577 |
546 |
$43K |
| 93880 |
|
444 |
379 |
$43K |
| 82728 |
|
7,014 |
5,868 |
$42K |
| 58300 |
|
430 |
317 |
$42K |
| 81025 |
|
51,376 |
45,706 |
$42K |
| 87491 |
|
14,367 |
13,026 |
$41K |
| 72050 |
|
692 |
619 |
$40K |
| 83735 |
|
21,600 |
12,021 |
$40K |
| Q5103 |
Injection, inflectra |
31 |
26 |
$39K |
| 73140 |
|
633 |
560 |
$38K |
| 12002 |
|
263 |
206 |
$38K |
| 83021 |
|
4,434 |
3,173 |
$37K |
| 86920 |
|
1,871 |
821 |
$37K |
| 77080 |
|
588 |
547 |
$37K |
| 92526 |
|
604 |
375 |
$35K |
| 72100 |
|
875 |
757 |
$35K |
| 73090 |
|
1,501 |
1,175 |
$34K |
| 70544 |
|
232 |
183 |
$34K |
| 90791 |
|
181 |
168 |
$34K |
| 93242 |
|
290 |
236 |
$33K |
| 72170 |
|
1,811 |
1,432 |
$33K |
| 83615 |
|
12,345 |
8,355 |
$33K |
| T1002 |
Rn services up to 15 minutes |
331 |
142 |
$33K |
| 90471 |
|
8,323 |
6,487 |
$33K |
| 93325 |
|
415 |
345 |
$33K |
| 92523 |
|
379 |
342 |
$32K |
| 72082 |
|
529 |
478 |
$32K |
| 77061 |
|
751 |
668 |
$32K |
| 87637 |
|
821 |
632 |
$32K |
| 85610 |
|
26,517 |
16,312 |
$32K |
| 70487 |
|
119 |
86 |
$32K |
| 94726 |
|
612 |
556 |
$32K |
| J3490 |
Drugs unclassified injection |
10,063 |
5,033 |
$31K |
| 93922 |
|
451 |
404 |
$31K |
| 58301 |
|
282 |
233 |
$31K |
| 77072 |
|
311 |
283 |
$31K |
| 87536 |
|
1,886 |
1,652 |
$31K |
| 92551 |
|
283 |
277 |
$31K |
| 72131 |
|
1,010 |
808 |
$31K |
| 92604 |
|
836 |
766 |
$30K |
| 94729 |
|
755 |
690 |
$30K |
| 76818 |
|
321 |
250 |
$30K |
| 57454 |
|
91 |
74 |
$30K |
| 73700 |
|
254 |
203 |
$30K |
| 86780 |
|
5,653 |
4,582 |
$30K |
| 76981 |
|
455 |
401 |
$30K |
| 95885 |
|
91 |
83 |
$30K |
| 73221 |
|
139 |
124 |
$29K |
| 59430 |
|
252 |
235 |
$29K |
| 87081 |
|
2,890 |
2,503 |
$29K |
| 95923 |
|
233 |
206 |
$28K |
| 87086 |
|
11,031 |
9,017 |
$28K |
| 84443 |
|
7,753 |
6,105 |
$28K |
| 62323 |
|
99 |
85 |
$28K |
| 12011 |
|
185 |
145 |
$28K |
| 82330 |
|
17,582 |
11,157 |
$27K |
| 73080 |
|
1,147 |
929 |
$26K |
| 86141 |
|
2,581 |
2,189 |
$26K |
| J3535 |
Metered dose inhaler drug |
1,046 |
474 |
$26K |
| 38222 |
|
58 |
40 |
$26K |
| J1950 |
Leuprolide acetate /3.75 mg |
15 |
15 |
$26K |
| 91200 |
|
209 |
177 |
$25K |
| 99153 |
Mod sedat endo service >5yrs |
2,133 |
1,544 |
$25K |
| 11045 |
|
73 |
52 |
$25K |
| 31579 |
|
87 |
78 |
$24K |
| D2934 |
|
41 |
13 |
$24K |
| 58661 |
|
18 |
12 |
$24K |
| 77470 |
|
46 |
38 |
$23K |
| D2330 |
|
49 |
27 |
$23K |
| 87800 |
|
5,137 |
4,107 |
$23K |
| 72128 |
|
815 |
650 |
$23K |
| 77065 |
Tomosynthesis, mammo |
1,129 |
977 |
$22K |
| 81001 |
|
31,568 |
27,326 |
$22K |
| 73070 |
|
520 |
425 |
$22K |
| 86922 |
|
929 |
462 |
$22K |
| J9070 |
Cyclophosphamide 100 mg inj |
201 |
57 |
$21K |
| 76882 |
|
194 |
164 |
$21K |
| 42820 |
|
14 |
12 |
$21K |
| 99406 |
|
1,082 |
925 |
$21K |
| 73060 |
|
1,104 |
849 |
$20K |
| 85007 |
|
2,907 |
1,489 |
$20K |
| 78816 |
|
27 |
27 |
$20K |
| 86808 |
|
1,036 |
937 |
$20K |
| 90686 |
|
1,542 |
1,141 |
$20K |
| J1453 |
Fosaprepitant injection |
1,641 |
856 |
$19K |
| 99391 |
|
165 |
158 |
$19K |
| C8929 |
Tte w or wo fol wcon,doppler |
344 |
282 |
$19K |
| 82306 |
|
2,319 |
2,028 |
$19K |
| 93798 |
|
231 |
52 |
$19K |
| 76870 |
|
361 |
315 |
$18K |
| 83036 |
|
3,983 |
3,317 |
$18K |
| 43235 |
|
65 |
45 |
$18K |
| 81003 |
|
24,641 |
20,846 |
$18K |
| 97166 |
|
288 |
211 |
$17K |
| 93350 |
|
75 |
68 |
$17K |
| 94010 |
|
535 |
442 |
$17K |
| 83880 |
|
6,374 |
4,758 |
$17K |
| 86902 |
|
1,487 |
657 |
$17K |
| J1815 |
Insulin injection |
1,136 |
392 |
$17K |
| J1750 |
Inj iron dextran |
120 |
61 |
$16K |
| 97010 |
|
469 |
226 |
$16K |
| 90837 |
|
130 |
79 |
$16K |
| 85045 |
|
9,046 |
6,077 |
$16K |
| 84702 |
|
5,288 |
4,090 |
$16K |
| 72040 |
|
316 |
273 |
$16K |
| 72190 |
|
239 |
185 |
$16K |
| 82607 |
|
2,082 |
1,801 |
$15K |
| 93356 |
|
129 |
106 |
$15K |
| 92611 |
|
192 |
179 |
$15K |
| 96116 |
|
79 |
64 |
$15K |
| 73100 |
|
342 |
290 |
$15K |
| 80061 |
|
2,695 |
2,332 |
$15K |
| J2469 |
Palonosetron hcl |
3,861 |
1,862 |
$15K |
| J9395 |
Injection, fulvestrant |
157 |
116 |
$15K |
| 77066 |
Tomosynthesis, mammo |
1,183 |
1,067 |
$14K |
| 96401 |
|
1,308 |
496 |
$14K |
| 88360 |
|
214 |
100 |
$14K |
| 95911 |
|
143 |
123 |
$14K |
| 0004A |
|
373 |
372 |
$13K |
| 00170 |
|
2,654 |
2,283 |
$13K |
| 87389 |
|
4,975 |
4,197 |
$13K |
| 93246 |
|
210 |
195 |
$13K |
| 96368 |
|
747 |
416 |
$12K |
| 36561 |
|
20 |
13 |
$12K |
| 83540 |
|
3,526 |
2,894 |
$12K |
| 87205 |
|
3,760 |
3,012 |
$11K |
| J1170 |
Hydromorphone injection |
12,238 |
5,115 |
$11K |
| 86832 |
|
287 |
239 |
$11K |
| 0072A |
|
283 |
283 |
$11K |
| 87631 |
|
58 |
56 |
$11K |
| 86140 |
|
2,047 |
1,530 |
$11K |
| 92652 |
|
214 |
209 |
$11K |
| J8499 |
Oral prescrip drug non chemo |
5,841 |
1,665 |
$11K |
| 74240 |
|
57 |
51 |
$10K |
| 87210 |
|
10,323 |
9,109 |
$10K |
| 99385 |
|
265 |
244 |
$10K |
| 99392 |
|
155 |
151 |
$10K |
| 94660 |
|
89 |
39 |
$10K |
| 93321 |
|
222 |
177 |
$10K |
| 0012A |
|
502 |
445 |
$10K |
| 0071A |
|
259 |
257 |
$10K |
| J9217 |
Leuprolide acetate suspnsion |
56 |
40 |
$10K |
| J9045 |
Carboplatin injection |
1,311 |
577 |
$10K |
| 85730 |
|
6,492 |
4,653 |
$10K |
| C1760 |
Closure dev, vasc |
332 |
244 |
$10K |
| 71101 |
|
411 |
353 |
$10K |
| 88342 |
|
1,331 |
883 |
$10K |
| 83550 |
|
3,561 |
2,925 |
$10K |
| 31500 |
|
38 |
12 |
$10K |
| 95910 |
|
61 |
53 |
$9K |
| 85097 |
|
109 |
56 |
$9K |
| 70360 |
|
123 |
119 |
$9K |
| 82435 |
|
13,950 |
9,696 |
$9K |
| 77073 |
|
230 |
197 |
$9K |
| 84439 |
|
1,879 |
1,448 |
$9K |
| 82077 |
|
5,584 |
4,179 |
$9K |
| 29075 |
|
78 |
61 |
$8K |
| 80143 |
|
5,260 |
3,914 |
$8K |
| 0011A |
|
697 |
507 |
$8K |
| 72072 |
|
195 |
176 |
$8K |
| 86870 |
|
300 |
173 |
$8K |
| 0003A |
|
224 |
224 |
$8K |
| 97803 |
|
112 |
105 |
$8K |
| 82570 |
|
2,723 |
2,149 |
$8K |
| J0500 |
Dicyclomine injection |
396 |
267 |
$8K |
| 86923 |
|
241 |
132 |
$8K |
| 85018 |
|
10,527 |
6,800 |
$8K |
| 80346 |
|
516 |
438 |
$8K |
| 95913 |
|
58 |
51 |
$8K |
| 87070 |
|
1,655 |
1,166 |
$8K |
| 80361 |
|
741 |
612 |
$8K |
| G0121 |
Colon ca scrn not hi rsk ind |
15 |
14 |
$8K |
| 72081 |
|
108 |
97 |
$7K |
| 82533 |
|
1,389 |
1,008 |
$7K |
| 86833 |
|
280 |
237 |
$7K |
| J0885 |
Epoetin alfa, non-esrd |
322 |
120 |
$7K |
| 72156 |
|
43 |
41 |
$7K |
| 86803 |
|
2,555 |
2,192 |
$7K |
| 73000 |
|
212 |
180 |
$7K |
| 82784 |
|
3,285 |
1,152 |
$7K |
| 84132 |
|
15,208 |
10,573 |
$7K |
| 97035 |
|
67 |
33 |
$7K |
| 99386 |
|
103 |
91 |
$7K |
| 82024 |
|
1,012 |
770 |
$6K |
| 83690 |
|
11,229 |
8,890 |
$6K |
| J9263 |
Oxaliplatin |
1,282 |
380 |
$6K |
| 80076 |
|
1,060 |
824 |
$6K |
| C1776 |
Joint device (implantable) |
60 |
42 |
$6K |
| 58100 |
|
43 |
40 |
$6K |
| 73521 |
|
182 |
139 |
$6K |
| 80185 |
|
290 |
257 |
$6K |
| 86334 |
|
794 |
622 |
$6K |
| 90999 |
|
85 |
14 |
$6K |
| 92610 |
|
88 |
82 |
$6K |
| 73620 |
|
154 |
116 |
$6K |
| 83970 |
|
449 |
326 |
$6K |
| 82378 |
|
1,211 |
826 |
$6K |
| 82248 |
|
1,758 |
1,273 |
$5K |
| 87186 |
|
2,542 |
1,911 |
$5K |
| 84295 |
|
14,127 |
9,852 |
$5K |
| 94762 |
|
98 |
58 |
$5K |
| J2800 |
Methocarbamol injection |
1,645 |
1,075 |
$5K |
| 96402 |
|
1,046 |
734 |
$5K |
| 87075 |
|
2,573 |
1,532 |
$5K |
| 88237 |
|
77 |
38 |
$5K |
| 86706 |
|
1,069 |
861 |
$5K |
| 81379 |
|
14 |
13 |
$5K |
| 80197 |
|
906 |
373 |
$5K |
| 11981 |
|
26 |
13 |
$5K |
| 77293 |
|
49 |
40 |
$5K |
| 87340 |
|
1,342 |
1,110 |
$5K |
| J7120 |
Ringers lactate infusion |
25,583 |
17,328 |
$5K |
| 76937 |
|
766 |
569 |
$5K |
| 87497 |
|
656 |
328 |
$5K |
| 82746 |
|
1,257 |
1,059 |
$5K |
| 72120 |
|
138 |
130 |
$5K |
| 87651 |
|
2,038 |
1,699 |
$5K |
| 82550 |
|
2,196 |
1,384 |
$5K |
| 92524 |
|
69 |
61 |
$5K |
| J0585 |
Injection,onabotulinumtoxina |
38 |
15 |
$5K |
| J1650 |
Inj enoxaparin sodium |
5,302 |
1,642 |
$5K |
| 95819 |
|
27 |
26 |
$5K |
| 84153 |
|
783 |
670 |
$4K |
| 87077 |
|
1,555 |
1,015 |
$4K |
| 99195 |
|
300 |
246 |
$4K |
| 74178 |
|
14 |
13 |
$4K |
| 87040 |
|
2,334 |
907 |
$4K |
| 99407 |
|
126 |
96 |
$4K |
| J9060 |
Cisplatin 10 mg injection |
392 |
131 |
$4K |
| 84100 |
|
4,100 |
2,849 |
$4K |
| 29065 |
|
40 |
31 |
$4K |
| 80349 |
|
530 |
416 |
$4K |
| 80179 |
|
5,214 |
3,911 |
$4K |
| 76885 |
|
33 |
28 |
$4K |
| 81382 |
|
30 |
13 |
$4K |
| 82962 |
|
3,583 |
2,683 |
$4K |
| Q2036 |
Flulaval vacc, 3 yrs & >, im |
338 |
260 |
$4K |
| 92950 |
|
48 |
28 |
$4K |
| 86318 |
|
447 |
385 |
$4K |
| 96158 |
|
44 |
27 |
$4K |
| 95909 |
|
44 |
38 |
$4K |
| J8501 |
Oral aprepitant |
214 |
129 |
$4K |
| 84403 |
|
509 |
420 |
$4K |
| 84550 |
|
2,245 |
1,422 |
$4K |
| 87799 |
|
830 |
314 |
$3K |
| 87535 |
|
103 |
94 |
$3K |
| 88350 |
|
53 |
28 |
$3K |
| J2543 |
Piperacillin/tazobactam |
1,037 |
432 |
$3K |
| J2270 |
Morphine sulfate injection |
6,620 |
4,581 |
$3K |
| 90677 |
|
95 |
92 |
$3K |
| 77370 |
|
20 |
14 |
$3K |
| J9206 |
Irinotecan injection |
291 |
126 |
$3K |
| 80198 |
|
287 |
254 |
$3K |
| 0064A |
|
95 |
95 |
$3K |
| 73120 |
|
83 |
51 |
$3K |
| 86704 |
|
602 |
507 |
$3K |
| J3260 |
Tobramycin sulfate injection |
171 |
89 |
$3K |
| J1885 |
Ketorolac tromethamine inj |
30,365 |
23,711 |
$3K |
| 86317 |
|
258 |
215 |
$3K |
| 88304 |
|
419 |
284 |
$3K |
| J2704 |
Inj, propofol, 10 mg |
9,712 |
6,664 |
$3K |
| 00300 |
|
312 |
219 |
$3K |
| 97014 |
|
68 |
26 |
$3K |
| 83883 |
|
502 |
189 |
$3K |
| 92014 |
|
21 |
21 |
$3K |
| 82565 |
|
429 |
356 |
$3K |
| 76983 |
|
69 |
68 |
$3K |
| 90656 |
|
275 |
270 |
$3K |
| J9201 |
In gemcitabine hcl nos 200mg |
233 |
99 |
$3K |
| 84165 |
|
1,196 |
910 |
$2K |
| 88112 |
|
309 |
211 |
$2K |
| 76942 |
|
457 |
350 |
$2K |
| 77001 |
|
365 |
251 |
$2K |
| 87502 |
|
389 |
377 |
$2K |
| 96409 |
|
450 |
249 |
$2K |
| Q5106 |
Inj retacrit non-esrd use |
42 |
26 |
$2K |
| 00731 |
|
714 |
541 |
$2K |
| 84156 |
|
1,761 |
1,381 |
$2K |
| J1610 |
Glucagon hydrochloride/1 mg |
18 |
13 |
$2K |
| C9113 |
Inj pantoprazole sodium, via |
974 |
447 |
$2K |
| 80365 |
|
536 |
422 |
$2K |
| A9270 |
Non-covered item or service |
35,494 |
5,959 |
$2K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
17,825 |
14,065 |
$2K |
| J1953 |
Levetiracetam injection |
442 |
276 |
$2K |
| 83521 |
|
969 |
705 |
$2K |
| 85384 |
|
1,565 |
1,054 |
$2K |
| 99393 |
|
110 |
109 |
$2K |
| 76825 |
|
35 |
33 |
$2K |
| J1644 |
Inj heparin sodium per 1000u |
5,693 |
1,573 |
$2K |
| 83010 |
|
695 |
473 |
$2K |
| J0640 |
Leucovorin calcium injection |
81 |
33 |
$2K |
| 86880 |
|
145 |
107 |
$2K |
| 70547 |
|
13 |
13 |
$2K |
| 87529 |
|
326 |
148 |
$2K |
| 85652 |
|
1,886 |
1,457 |
$2K |
| 88313 |
|
460 |
244 |
$2K |
| 73200 |
|
13 |
13 |
$2K |
| 87632 |
|
18 |
13 |
$2K |
| 81002 |
|
3,156 |
2,657 |
$2K |
| 72158 |
|
15 |
15 |
$2K |
| 88346 |
|
42 |
29 |
$2K |
| 82948 |
|
1,118 |
802 |
$2K |
| 73660 |
|
30 |
25 |
$2K |
| 85014 |
|
2,792 |
2,475 |
$2K |
| 90662 |
|
371 |
283 |
$2K |
| J7030 |
Normal saline solution infus |
11,001 |
7,220 |
$2K |
| 87522 |
Neg quan hep c or qual rna |
183 |
140 |
$2K |
| 80358 |
|
291 |
232 |
$2K |
| 76604 |
|
14 |
12 |
$2K |
| 85660 |
|
997 |
460 |
$2K |
| 73600 |
|
58 |
38 |
$2K |
| 84155 |
|
1,207 |
911 |
$2K |
| 85379 |
|
1,640 |
1,282 |
$2K |
| 82803 |
|
2,812 |
2,266 |
$2K |
| 90472 |
|
456 |
341 |
$2K |
| 12013 |
|
18 |
13 |
$2K |
| 51798 |
|
288 |
251 |
$2K |
| 86038 |
|
222 |
202 |
$2K |
| 80354 |
|
294 |
234 |
$2K |
| 82043 |
|
529 |
481 |
$2K |
| 90688 |
|
119 |
93 |
$2K |
| 76827 |
|
34 |
32 |
$1K |
| 87101 |
|
72 |
71 |
$1K |
| 86481 |
|
75 |
68 |
$1K |
| 80373 |
|
263 |
210 |
$1K |
| J3411 |
Thiamine hcl 100 mg |
911 |
362 |
$1K |
| J3475 |
Inj magnesium sulfate |
3,972 |
1,924 |
$1K |
| 80177 |
|
644 |
455 |
$1K |
| 99204 |
|
12 |
12 |
$1K |
| 90678 |
|
104 |
103 |
$1K |
| 99401 |
|
15 |
13 |
$1K |
| 82247 |
|
370 |
249 |
$1K |
| 86762 |
|
133 |
95 |
$1K |
| J2274 |
Inj morphine pf epid ithc |
299 |
245 |
$1K |
| C1769 |
Guide wire |
1,352 |
964 |
$1K |
| 96417 |
|
2,702 |
1,399 |
$1K |
| 83516 |
|
41 |
18 |
$1K |
| 72146 |
|
16 |
16 |
$1K |
| J7999 |
Compounded drug, noc |
1,556 |
1,115 |
$1K |
| 88312 |
|
62 |
30 |
$1K |
| 76821 |
|
30 |
12 |
$1K |
| 96132 |
|
26 |
24 |
$1K |
| 89240 |
|
148 |
129 |
$978.34 |
| 82977 |
|
276 |
170 |
$972.79 |
| 87102 |
|
315 |
206 |
$957.76 |
| 00840 |
|
584 |
367 |
$952.94 |
| 97022 |
|
32 |
13 |
$947.29 |
| G0404 |
Ekg tracing for initial prev |
249 |
185 |
$928.92 |
| 80368 |
|
263 |
210 |
$923.71 |
| C1725 |
Cath, translumin non-laser |
71 |
51 |
$899.85 |
| 82375 |
|
622 |
490 |
$893.19 |
| 86825 |
|
35 |
28 |
$881.19 |
| 80329 |
|
705 |
249 |
$871.58 |
| 91300 |
|
6,866 |
6,102 |
$861.80 |
| 90670 |
|
92 |
91 |
$858.43 |
| J2360 |
Orphenadrine injection |
1,851 |
1,383 |
$825.48 |
| J3370 |
Vancomycin hcl injection |
1,750 |
856 |
$824.80 |
| 87467 |
|
158 |
105 |
$823.09 |
| J9000 |
Doxorubicin hcl injection |
80 |
41 |
$809.67 |
| J2359 |
Inj. olanzapine, 0.5mg |
268 |
127 |
$795.56 |
| 83050 |
|
599 |
474 |
$790.71 |
| J1642 |
Inj heparin sodium per 10 u |
5,470 |
2,580 |
$787.45 |
| J2405 |
Ondansetron hcl injection |
24,337 |
16,297 |
$783.44 |
| J0131 |
Inj, acetaminophen (nos) |
930 |
781 |
$774.95 |
| J0696 |
Ceftriaxone sodium injection |
4,072 |
2,801 |
$760.59 |
| C1887 |
Catheter, guiding |
483 |
339 |
$741.39 |
| 84460 |
|
378 |
258 |
$732.60 |
| 84450 |
|
375 |
254 |
$715.78 |
| 80074 |
|
154 |
116 |
$713.52 |
| A9575 |
Inj gadoterate meglumi 0.1ml |
4,025 |
3,295 |
$711.53 |
| 84075 |
|
371 |
248 |
$692.14 |
| 29125 |
|
253 |
188 |
$687.41 |
| 86592 |
|
115 |
80 |
$659.91 |
| 86301 |
|
139 |
99 |
$653.96 |
| 73523 |
|
22 |
16 |
$652.94 |
| 86364 |
|
26 |
26 |
$652.89 |
| C1894 |
Intro/sheath, non-laser |
1,033 |
734 |
$648.76 |
| 86225 |
|
82 |
70 |
$628.54 |
| J0360 |
Hydralazine hcl injection |
827 |
523 |
$622.26 |
| 76776 |
|
20 |
13 |
$621.96 |
| 00142 |
|
595 |
427 |
$615.65 |
| 87506 |
|
12 |
12 |
$611.68 |
| J8540 |
Oral dexamethasone |
1,412 |
622 |
$608.24 |
| 0013A |
|
18 |
18 |
$585.08 |
| J0295 |
Ampicillin sulbactam 1.5 gm |
519 |
228 |
$583.31 |
| J1200 |
Diphenhydramine hcl injectio |
5,063 |
2,835 |
$578.54 |
| 90833 |
|
14 |
12 |
$577.62 |
| 86235 |
|
84 |
45 |
$570.56 |
| 84445 |
|
19 |
19 |
$570.23 |
| 88311 |
|
176 |
122 |
$567.33 |
| 74220 |
|
13 |
12 |
$566.50 |
| J2930 |
Methylprednisolone injection |
1,131 |
642 |
$559.83 |
| J0690 |
Cefazolin sodium injection |
4,046 |
2,613 |
$557.43 |
| 00120 |
|
37 |
26 |
$553.71 |
| 72157 |
|
12 |
12 |
$547.17 |
| 86787 |
|
46 |
39 |
$540.53 |
| J0780 |
Prochlorperazine injection |
1,024 |
656 |
$539.78 |
| 72070 |
|
13 |
12 |
$536.71 |
| 88142 |
|
39 |
31 |
$528.60 |
| 82150 |
|
206 |
151 |
$519.23 |
| 97032 |
|
18 |
12 |
$512.57 |
| 95012 |
|
12 |
12 |
$501.65 |
| J3010 |
Fentanyl citrate injection |
12,355 |
8,815 |
$500.37 |
| J2785 |
Regadenoson injection |
194 |
140 |
$494.89 |
| J1100 |
Dexamethasone sodium phos |
11,112 |
7,093 |
$488.64 |
| 86580 |
|
14 |
14 |
$488.01 |
| 84145 |
|
59 |
40 |
$475.90 |
| G0008 |
Admin influenza virus vac |
391 |
331 |
$475.67 |
| J3420 |
Vitamin b12 injection |
970 |
663 |
$473.61 |
| J2250 |
Inj midazolam hydrochloride |
16,490 |
11,816 |
$463.39 |
| 86431 |
|
70 |
60 |
$460.65 |
| 85347 |
|
234 |
98 |
$455.81 |
| 86735 |
|
35 |
27 |
$453.25 |
| 86765 |
|
37 |
29 |
$453.25 |
| 80164 |
|
82 |
57 |
$442.27 |
| 87634 |
|
130 |
103 |
$435.32 |
| J3489 |
Zoledronic acid 1mg |
79 |
60 |
$433.29 |
| J2765 |
Metoclopramide hcl injection |
2,783 |
2,006 |
$425.20 |
| J7060 |
5% dextrose/water |
8,706 |
3,151 |
$419.81 |
| U0002 |
Covid-19 lab test non-cdc |
755 |
535 |
$414.83 |
| 82010 |
|
364 |
255 |
$401.40 |
| 99417 |
Prolong home eval add 15m |
686 |
579 |
$398.23 |
| 87015 |
|
193 |
112 |
$369.16 |
| 99394 |
|
24 |
24 |
$355.33 |
| 82232 |
|
51 |
40 |
$348.74 |
| 89051 |
|
167 |
113 |
$338.82 |
| 83002 |
|
32 |
28 |
$337.16 |
| J0689 |
Inj cefazolin sodium, baxter |
1,057 |
546 |
$335.72 |
| A9502 |
Tc99m tetrofosmin |
361 |
239 |
$334.66 |
| 88173 |
|
103 |
64 |
$330.57 |
| 82465 |
|
51 |
48 |
$328.07 |
| 87206 |
|
207 |
97 |
$326.61 |
| 86703 |
|
143 |
115 |
$323.36 |
| J2920 |
Methylprednisolone injection |
720 |
369 |
$321.52 |
| J1630 |
Haloperidol injection |
1,459 |
929 |
$316.68 |
| 90633 |
|
31 |
31 |
$307.55 |
| G0480 |
Drug test def 1-7 classes |
290 |
158 |
$296.09 |
| 83001 |
|
18 |
16 |
$290.22 |
| 92555 |
|
25 |
24 |
$286.78 |
| 90732 |
|
20 |
15 |
$285.97 |
| 86308 |
|
35 |
29 |
$268.44 |
| 90698 |
|
53 |
52 |
$267.43 |
| 51702 |
|
33 |
24 |
$265.05 |
| 84146 |
|
15 |
12 |
$263.59 |
| 87185 |
|
114 |
71 |
$250.75 |
| Q9957 |
Inj perflutren lip micros,ml |
1,164 |
938 |
$247.93 |
| 86300 |
|
136 |
106 |
$243.69 |
| 86304 |
|
21 |
15 |
$240.91 |
| 84540 |
|
79 |
51 |
$237.91 |
| J9190 |
Fluorouracil injection |
1,786 |
676 |
$233.66 |
| 87449 |
|
48 |
39 |
$230.18 |
| J3590 |
Unclassified biologics |
24 |
12 |
$228.17 |
| J7512 |
Prednisone ir or dr oral 1mg |
3,928 |
2,003 |
$226.90 |
| 82668 |
|
74 |
64 |
$215.81 |
| J2919 |
Inj, methylpred sod succ 5mg |
560 |
390 |
$211.92 |
| G2066 |
Inter devc remote 30d |
88 |
79 |
$208.48 |
| 82810 |
|
381 |
267 |
$208.10 |
| J1720 |
Hydrocortisone sodium succ i |
285 |
181 |
$196.38 |
| 84300 |
|
91 |
62 |
$193.21 |
| 82670 |
|
13 |
13 |
$189.47 |
| 93290 |
|
33 |
29 |
$188.29 |
| J3480 |
Inj potassium chloride |
1,704 |
920 |
$187.24 |
| 80202 |
|
21 |
12 |
$186.27 |
| 84133 |
|
76 |
53 |
$186.19 |
| J1940 |
Furosemide injection |
1,132 |
565 |
$174.28 |
| 82436 |
|
47 |
37 |
$162.13 |
| A4217 |
Sterile water/saline, 500 ml |
2,637 |
1,641 |
$161.59 |
| C1780 |
Lens, intraocular (new tech) |
327 |
237 |
$158.66 |
| G0279 |
Tomosynthesis, mammo |
143 |
114 |
$155.59 |
| 36600 |
|
30 |
25 |
$154.84 |
| 76376 |
|
640 |
556 |
$148.88 |
| J7050 |
Normal saline solution infus |
10,107 |
4,324 |
$145.05 |
| 90696 |
|
14 |
14 |
$132.90 |
| 36410 |
|
19 |
13 |
$123.80 |
| J7620 |
Albuterol ipratrop non-comp |
1,463 |
686 |
$121.40 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
680 |
364 |
$116.73 |
| J1805 |
Inj, esmolol hcl, 10mg |
314 |
259 |
$114.36 |
| 93299 |
|
14 |
12 |
$114.02 |
| 83935 |
|
35 |
24 |
$111.58 |
| 0753T |
|
368 |
243 |
$109.12 |
| J9267 |
Paclitaxel injection |
1,157 |
444 |
$109.10 |
| G0498 |
Chemo extend iv infus w/pump |
44 |
25 |
$95.68 |
| J2060 |
Lorazepam injection |
499 |
353 |
$95.25 |
| J1790 |
Droperidol injection |
638 |
453 |
$94.42 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
852 |
580 |
$92.28 |
| 90710 |
|
16 |
15 |
$91.86 |
| 90460 |
|
79 |
67 |
$90.17 |
| 76377 |
|
1,034 |
819 |
$89.94 |
| 86147 |
|
26 |
13 |
$86.20 |
| 94761 |
|
548 |
376 |
$85.98 |
| 82945 |
|
30 |
25 |
$81.72 |
| J1920 |
Inj, labetalol hcl, 5mg |
309 |
217 |
$79.25 |
| 96411 |
|
1,144 |
677 |
$73.87 |
| 87116 |
|
41 |
25 |
$73.24 |
| 86593 |
|
18 |
13 |
$71.85 |
| Q4081 |
Epoetin alfa, 100 units esrd |
94 |
14 |
$66.65 |
| 87880 |
|
278 |
267 |
$63.81 |
| 87804 |
|
184 |
80 |
$63.65 |
| H0048 |
Spec coll non-blood:a/d test |
13 |
13 |
$59.15 |
| J2175 |
Meperidine hydrochl /100 mg |
607 |
459 |
$58.45 |
| J2470 |
Inj pantoprazole sodium 40mg |
89 |
65 |
$56.25 |
| 83718 |
|
45 |
42 |
$55.67 |
| J2550 |
Promethazine hcl injection |
285 |
103 |
$55.58 |
| J0330 |
Succinycholine chloride inj |
624 |
374 |
$53.05 |
| 86146 |
|
14 |
14 |
$47.67 |
| J7040 |
Normal saline solution infus |
1,651 |
948 |
$47.08 |
| 84436 |
|
16 |
14 |
$46.29 |
| 82140 |
|
54 |
40 |
$45.01 |
| J1030 |
Methylprednisolone 40 mg inj |
31 |
25 |
$44.46 |
| 84157 |
|
49 |
37 |
$40.85 |
| G1004 |
Cdsm ndsc |
298 |
248 |
$39.30 |
| 46600 |
|
160 |
125 |
$38.09 |
| J3301 |
Triamcinolone acet inj nos |
821 |
636 |
$37.49 |
| J2710 |
Neostigmine methylslfte inj |
448 |
246 |
$32.80 |
| J0613 |
Calcium glucon (wg critical) |
72 |
31 |
$32.80 |
| G0500 |
Mod sedat endo service >5yrs |
129 |
77 |
$30.44 |
| A4648 |
Implantable tissue marker |
372 |
284 |
$30.09 |
| 86705 |
|
13 |
12 |
$29.62 |
| 29515 |
|
12 |
12 |
$27.03 |
| J2003 |
Inj, lidocaine hcl, 1 mg |
726 |
666 |
$26.03 |
| 90648 |
|
14 |
14 |
$21.03 |
| 82950 |
|
15 |
13 |
$17.64 |
| J2001 |
Lidocaine injection |
779 |
520 |
$16.63 |
| J1596 |
Inj, glycopyrrolate, 0.1 mg |
276 |
255 |
$14.97 |
| J0173 |
Inj, epinephrine (belcher) |
289 |
183 |
$14.33 |
| J0461 |
Atropine sulfate injection |
207 |
108 |
$12.50 |
| 00400 |
|
177 |
105 |
$12.40 |
| J2795 |
Ropivacaine hcl injection |
149 |
129 |
$12.28 |
| J0456 |
Azithromycin |
42 |
31 |
$10.37 |
| J7613 |
Albuterol non-comp unit |
443 |
244 |
$10.17 |
| 91301 |
|
1,240 |
991 |
$6.65 |
| 91307 |
|
624 |
601 |
$5.94 |
| J0171 |
Adrenalin epinephrine inject |
470 |
343 |
$4.96 |
| 96377 |
|
297 |
156 |
$3.90 |
| 36416 |
|
343 |
301 |
$3.32 |
| Q0162 |
Ondansetron oral |
22 |
13 |
$3.25 |
| J2004 |
Inj, lidocaine w epinephrine |
141 |
135 |
$2.83 |
| 91305 |
|
132 |
123 |
$1.22 |
| 91306 |
|
86 |
86 |
$0.77 |
| J0741 |
Inj, cabote rilpivir 2mg 3mg |
24 |
24 |
$0.07 |
| A9552 |
F18 fdg |
1,079 |
752 |
$0.00 |
| C1788 |
Port, indwelling, imp |
20 |
13 |
$0.00 |
| D1120 |
|
623 |
511 |
$0.00 |
| C1752 |
Cath,hemodialysis,short-term |
112 |
62 |
$0.00 |
| Q9966 |
Locm 200-299mg/ml iodine,1ml |
494 |
435 |
$0.00 |
| 00520 |
|
221 |
147 |
$0.00 |
| J0736 |
Inj, clindamycin phosp 300mg |
20 |
12 |
$0.00 |
| 15853 |
|
43 |
42 |
$0.00 |
| 00811 |
|
91 |
67 |
$0.00 |
| Q0508 |
Mis sup/acc imp vad |
17 |
16 |
$0.00 |
| J0134 |
Inj acetaminophen -fresenius |
432 |
289 |
$0.00 |
| A4649 |
Surgical supplies |
144 |
102 |
$0.00 |
| 01810 |
|
24 |
24 |
$0.00 |
| 00145 |
|
20 |
15 |
$0.00 |
| 00140 |
|
23 |
16 |
$0.00 |
| 00940 |
|
18 |
12 |
$0.00 |
| 96159 |
|
19 |
12 |
$0.00 |
| C1729 |
Cath, drainage |
28 |
26 |
$0.00 |
| 77003 |
|
19 |
12 |
$0.00 |
| 96138 |
|
13 |
12 |
$0.00 |
| 96133 |
|
13 |
12 |
$0.00 |
| J2371 |
Inj phenylephrine hcl 20 mcg |
63 |
60 |
$0.00 |
| 00126 |
|
218 |
190 |
$0.00 |
| 80050 |
|
74 |
54 |
$0.00 |
| G0103 |
Psa screening |
12 |
12 |
$0.00 |
| D0272 |
|
267 |
222 |
$0.00 |
| 00790 |
|
66 |
39 |
$0.00 |
| 00160 |
|
96 |
74 |
$0.00 |
| 00952 |
|
79 |
59 |
$0.00 |
| 00320 |
|
111 |
77 |
$0.00 |
| 94760 |
|
379 |
247 |
$0.00 |
| 01480 |
|
80 |
39 |
$0.00 |
| J0610 |
Calcium glucon (fresenius) |
20 |
13 |
$0.00 |
| C1819 |
Tissue localization-excision |
45 |
38 |
$0.00 |
| J2305 |
Inj, nitroglycerin, 5 mg |
13 |
12 |
$0.00 |
| A9698 |
Non-rad contrast materialnoc |
45 |
26 |
$0.00 |
| J1010 |
Inj, methylpred acetate 1 mg |
14 |
12 |
$0.00 |
| C1727 |
Cath, bal tis dis, non-vas |
20 |
12 |
$0.00 |
| 96139 |
|
13 |
12 |
$0.00 |
| L8699 |
Prosthetic implant nos |
13 |
12 |
$0.00 |
| 00813 |
|
23 |
14 |
$0.00 |