| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| G0463 |
Hospital outpt clinic visit |
80,379 |
68,337 |
$8.86M |
| 99213 |
|
36,815 |
35,591 |
$3.32M |
| 99214 |
|
25,840 |
24,788 |
$2.61M |
| 99284 |
|
19,047 |
17,823 |
$1.98M |
| U0003 |
Cov-19 amp prb hgh thruput |
25,713 |
22,733 |
$1.63M |
| 99283 |
|
14,790 |
14,106 |
$1.62M |
| 97530 |
|
18,539 |
5,470 |
$1.53M |
| 99285 |
|
10,954 |
10,382 |
$1.25M |
| 74177 |
|
4,253 |
4,158 |
$1.16M |
| 96361 |
|
5,534 |
4,536 |
$1.12M |
| 70450 |
|
3,953 |
3,805 |
$1.03M |
| 80053 |
|
36,751 |
32,519 |
$736K |
| 99203 |
|
5,701 |
5,688 |
$614K |
| 96365 |
|
4,568 |
3,053 |
$566K |
| 99212 |
|
6,604 |
6,382 |
$545K |
| 43239 |
|
786 |
786 |
$455K |
| 93975 |
|
1,238 |
1,207 |
$454K |
| 90832 |
|
3,847 |
2,685 |
$369K |
| 71275 |
|
1,258 |
1,238 |
$361K |
| 74176 |
|
1,258 |
1,236 |
$347K |
| 87426 |
|
12,106 |
11,621 |
$310K |
| U0005 |
Infec agen detec ampli probe |
17,146 |
16,268 |
$306K |
| 90834 |
|
2,407 |
1,830 |
$303K |
| 97163 |
|
2,108 |
2,108 |
$284K |
| 77067 |
|
3,526 |
3,515 |
$273K |
| D2930 |
|
1,132 |
1,132 |
$259K |
| 93306 |
|
1,412 |
1,403 |
$256K |
| 99282 |
|
2,160 |
2,108 |
$255K |
| G0378 |
Hospital observation per hr |
761 |
746 |
$242K |
| 76856 |
|
1,104 |
1,085 |
$241K |
| 59025 |
|
1,366 |
882 |
$240K |
| 96366 |
|
1,719 |
961 |
$216K |
| C9803 |
Hopd covid-19 spec collect |
24,120 |
21,999 |
$198K |
| 99204 |
|
1,588 |
1,579 |
$179K |
| 36415 |
|
36,680 |
30,424 |
$170K |
| 80307 |
|
6,298 |
5,609 |
$167K |
| 96360 |
|
1,466 |
1,248 |
$167K |
| 45380 |
|
284 |
283 |
$161K |
| 88305 |
|
3,867 |
3,773 |
$160K |
| 92014 |
|
1,268 |
1,258 |
$130K |
| 70553 |
|
328 |
327 |
$129K |
| U0004 |
Cov-19 test non-cdc hgh thru |
1,304 |
1,247 |
$129K |
| 99202 |
|
1,171 |
1,169 |
$123K |
| 51798 |
|
404 |
391 |
$122K |
| 12001 |
|
284 |
280 |
$108K |
| 41899 |
|
90 |
90 |
$107K |
| D7210 |
|
823 |
823 |
$105K |
| 90837 |
|
800 |
587 |
$103K |
| 99050 |
|
8,102 |
7,793 |
$89K |
| 82306 |
|
2,956 |
2,935 |
$89K |
| 76705 |
|
2,213 |
2,166 |
$87K |
| 36416 |
|
4,407 |
3,507 |
$87K |
| 96413 |
|
884 |
515 |
$84K |
| 99218 |
|
167 |
163 |
$83K |
| 87491 |
|
3,334 |
3,283 |
$83K |
| 99215 |
Prolong outpt/office vis |
794 |
782 |
$82K |
| 76700 |
|
343 |
341 |
$79K |
| 92060 |
|
1,249 |
1,200 |
$79K |
| 96372 |
|
6,292 |
5,556 |
$77K |
| 76000 |
|
409 |
406 |
$75K |
| J0585 |
Injection,onabotulinumtoxina |
277 |
151 |
$73K |
| 90686 |
|
2,726 |
2,718 |
$71K |
| 93010 |
|
10,404 |
9,590 |
$69K |
| 76830 |
|
1,966 |
1,911 |
$69K |
| 87591 |
|
3,341 |
3,286 |
$66K |
| 99396 |
|
660 |
655 |
$66K |
| D3220 |
|
807 |
807 |
$59K |
| 92004 |
|
477 |
477 |
$57K |
| 92567 |
|
832 |
800 |
$57K |
| 90715 |
|
1,989 |
1,985 |
$55K |
| 86850 |
|
2,379 |
2,300 |
$54K |
| 88142 |
|
2,527 |
2,521 |
$53K |
| 84443 |
|
8,300 |
8,162 |
$53K |
| 87624 |
|
1,830 |
1,825 |
$50K |
| 87635 |
|
1,702 |
1,673 |
$50K |
| 80048 |
|
3,213 |
2,902 |
$47K |
| 80061 |
|
6,405 |
6,352 |
$46K |
| 99395 |
|
445 |
444 |
$45K |
| 97161 |
|
525 |
512 |
$45K |
| 70551 |
|
132 |
132 |
$45K |
| 93971 |
|
830 |
812 |
$43K |
| 70496 |
|
188 |
187 |
$43K |
| 64615 |
|
125 |
125 |
$43K |
| 82728 |
|
3,492 |
3,437 |
$42K |
| 71260 |
|
532 |
530 |
$42K |
| 87801 |
|
1,277 |
1,265 |
$41K |
| 72148 |
|
113 |
113 |
$40K |
| 83036 |
|
6,408 |
6,352 |
$40K |
| 92557 |
|
677 |
664 |
$38K |
| 77063 |
|
3,524 |
3,513 |
$37K |
| 86901 |
|
2,470 |
2,363 |
$37K |
| 76801 |
|
672 |
587 |
$37K |
| 85025 |
|
33,227 |
29,096 |
$37K |
| 69436 |
|
25 |
25 |
$36K |
| 71271 |
|
867 |
867 |
$33K |
| 86900 |
|
2,469 |
2,362 |
$32K |
| 88342 |
|
817 |
809 |
$31K |
| 93017 |
|
259 |
259 |
$30K |
| 87798 |
|
858 |
826 |
$29K |
| 99152 |
|
2,772 |
956 |
$29K |
| 71250 |
|
275 |
274 |
$29K |
| 62323 |
|
70 |
53 |
$28K |
| 84439 |
|
3,913 |
3,832 |
$27K |
| 90792 |
|
160 |
160 |
$25K |
| 76817 |
|
475 |
404 |
$25K |
| 87389 |
|
1,895 |
1,884 |
$25K |
| 78815 |
|
43 |
43 |
$24K |
| 88304 |
|
942 |
938 |
$23K |
| 81025 |
|
6,946 |
6,740 |
$22K |
| 76642 |
|
953 |
927 |
$22K |
| 0241U |
|
4,190 |
4,083 |
$21K |
| 83880 |
|
812 |
769 |
$21K |
| 93005 |
|
16,467 |
14,583 |
$21K |
| 94010 |
|
870 |
859 |
$21K |
| 71046 |
|
6,070 |
5,933 |
$20K |
| 92133 |
|
249 |
249 |
$20K |
| 76815 |
|
679 |
388 |
$20K |
| 96160 |
|
379 |
376 |
$19K |
| 82607 |
|
1,713 |
1,700 |
$18K |
| 72125 |
|
1,615 |
1,555 |
$17K |
| 93970 |
|
43 |
42 |
$17K |
| 76816 |
|
898 |
859 |
$17K |
| 12011 |
|
41 |
40 |
$16K |
| 87086 |
|
5,486 |
5,272 |
$16K |
| J1756 |
Iron sucrose injection |
307 |
155 |
$16K |
| 11721 |
|
382 |
382 |
$16K |
| 76805 |
|
344 |
341 |
$16K |
| 76536 |
|
534 |
527 |
$15K |
| H0001 |
Alcohol and/or drug assess |
115 |
84 |
$15K |
| 92250 |
|
210 |
209 |
$15K |
| 80362 |
|
1,585 |
1,263 |
$15K |
| A9575 |
Inj gadoterate meglumi 0.1ml |
1,205 |
1,180 |
$14K |
| 90791 |
|
88 |
88 |
$14K |
| U0002 |
Covid-19 lab test non-cdc |
550 |
533 |
$14K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
4,581 |
4,417 |
$13K |
| 99051 |
|
1,315 |
1,255 |
$13K |
| 99205 |
Prolong outpt/office vis |
110 |
108 |
$13K |
| 97165 |
|
229 |
224 |
$12K |
| 84153 |
|
773 |
766 |
$12K |
| 87661 |
|
882 |
872 |
$12K |
| 70486 |
|
309 |
305 |
$12K |
| 76775 |
|
269 |
264 |
$12K |
| 90750 |
|
83 |
83 |
$12K |
| 76641 |
|
390 |
379 |
$11K |
| 99493 |
|
322 |
321 |
$11K |
| 85027 |
|
3,830 |
3,755 |
$11K |
| 64493 |
|
111 |
30 |
$11K |
| 86803 |
|
1,307 |
1,298 |
$11K |
| D2394 |
|
117 |
117 |
$11K |
| 84702 |
|
1,786 |
1,406 |
$10K |
| 99393 |
|
96 |
96 |
$10K |
| 58300 |
|
96 |
95 |
$10K |
| G2066 |
Inter devc remote 30d |
137 |
137 |
$10K |
| 96375 |
|
7,455 |
6,068 |
$8K |
| 99222 |
|
13 |
13 |
$8K |
| 64635 |
|
16 |
13 |
$8K |
| 97803 |
|
334 |
327 |
$8K |
| 76770 |
|
40 |
39 |
$8K |
| 87502 |
|
215 |
213 |
$8K |
| 99394 |
|
75 |
72 |
$8K |
| G0297 |
Ldct for lung ca screen |
80 |
80 |
$7K |
| 83540 |
|
1,784 |
1,770 |
$7K |
| 86618 |
|
1,014 |
1,006 |
$7K |
| J1439 |
Inj ferric carboxymaltos 1mg |
17 |
13 |
$7K |
| 83735 |
|
9,415 |
8,497 |
$7K |
| 87468 |
|
222 |
218 |
$7K |
| 80305 |
|
5,335 |
4,649 |
$7K |
| 78452 |
|
15 |
14 |
$7K |
| 83655 |
|
532 |
530 |
$7K |
| 83550 |
|
1,698 |
1,685 |
$7K |
| 87631 |
|
129 |
127 |
$7K |
| 96374 |
|
8,295 |
7,539 |
$7K |
| 87804 |
|
6,127 |
4,744 |
$6K |
| 96367 |
|
88 |
57 |
$6K |
| 70491 |
|
24 |
24 |
$6K |
| 88307 |
|
64 |
63 |
$5K |
| 82570 |
|
1,165 |
1,145 |
$5K |
| 86140 |
|
2,047 |
1,937 |
$5K |
| 81003 |
|
11,433 |
10,927 |
$5K |
| 82043 |
|
1,093 |
1,084 |
$5K |
| 12002 |
|
12 |
12 |
$4K |
| G0108 |
Diab manage trn per indiv |
97 |
93 |
$4K |
| 97010 |
|
221 |
100 |
$4K |
| 76882 |
|
98 |
95 |
$4K |
| 85610 |
|
1,840 |
1,685 |
$4K |
| 87484 |
|
222 |
218 |
$4K |
| 81001 |
|
8,370 |
7,956 |
$4K |
| 72141 |
|
12 |
12 |
$4K |
| 70498 |
|
142 |
142 |
$4K |
| 80323 |
|
1,514 |
1,266 |
$4K |
| 87340 |
|
627 |
620 |
$4K |
| 87077 |
|
1,581 |
1,540 |
$4K |
| 31231 |
|
30 |
30 |
$3K |
| 86592 |
|
1,410 |
1,403 |
$3K |
| 86769 |
|
92 |
88 |
$3K |
| 90677 |
|
68 |
68 |
$3K |
| 74018 |
|
883 |
861 |
$3K |
| 97802 |
|
146 |
144 |
$3K |
| 64483 |
|
16 |
13 |
$3K |
| 87088 |
|
3,561 |
3,464 |
$3K |
| 72110 |
|
524 |
520 |
$3K |
| 90471 |
|
5,381 |
5,233 |
$3K |
| 77066 |
Tomosynthesis, mammo |
38 |
38 |
$3K |
| 73630 |
|
2,299 |
2,171 |
$3K |
| 87081 |
|
669 |
669 |
$3K |
| 80299 |
|
3,691 |
3,033 |
$3K |
| 87469 |
|
153 |
151 |
$3K |
| 86747 |
|
177 |
174 |
$3K |
| 99392 |
|
29 |
25 |
$3K |
| A9552 |
F18 fdg |
15 |
15 |
$2K |
| 85652 |
|
1,977 |
1,923 |
$2K |
| 71045 |
|
5,392 |
5,162 |
$2K |
| 73030 |
|
840 |
828 |
$2K |
| 99406 |
|
394 |
368 |
$2K |
| 80348 |
|
1,648 |
1,323 |
$2K |
| 84100 |
|
1,030 |
944 |
$2K |
| 83690 |
|
6,078 |
5,603 |
$2K |
| 77065 |
Tomosynthesis, mammo |
25 |
25 |
$2K |
| 85730 |
|
729 |
701 |
$2K |
| 87186 |
|
1,208 |
1,179 |
$2K |
| 99407 |
|
49 |
49 |
$2K |
| 82784 |
|
157 |
152 |
$2K |
| J3490 |
Drugs unclassified injection |
62 |
62 |
$2K |
| 76857 |
|
144 |
142 |
$2K |
| 91322 |
|
18 |
12 |
$2K |
| 77080 |
|
28 |
28 |
$2K |
| 84484 |
|
7,131 |
5,746 |
$2K |
| 73130 |
|
950 |
941 |
$2K |
| 92015 |
|
419 |
419 |
$2K |
| 95806 |
|
556 |
500 |
$2K |
| 72100 |
|
166 |
166 |
$2K |
| 82962 |
|
2,990 |
2,059 |
$2K |
| 87880 |
|
5,292 |
5,213 |
$2K |
| 86762 |
|
215 |
211 |
$1K |
| 82105 |
|
235 |
234 |
$1K |
| 80076 |
|
147 |
146 |
$1K |
| 73564 |
|
765 |
753 |
$1K |
| 73610 |
|
1,295 |
1,279 |
$1K |
| 99385 |
|
12 |
12 |
$1K |
| 76819 |
|
44 |
38 |
$1K |
| 82746 |
|
121 |
121 |
$1K |
| 73110 |
|
537 |
532 |
$1K |
| 94729 |
|
92 |
91 |
$1K |
| 94727 |
|
115 |
114 |
$1K |
| 87625 |
|
40 |
40 |
$1K |
| J2405 |
Ondansetron hcl injection |
9,042 |
8,539 |
$999.78 |
| 74246 |
|
17 |
17 |
$987.78 |
| 90734 |
|
49 |
49 |
$918.52 |
| 82950 |
|
177 |
177 |
$846.34 |
| 87070 |
|
435 |
418 |
$823.13 |
| G2211 |
Complex e/m visit add on |
65 |
65 |
$820.41 |
| 84403 |
|
36 |
36 |
$818.27 |
| 87205 |
|
826 |
771 |
$799.48 |
| 87641 |
|
38 |
37 |
$798.77 |
| 85379 |
|
1,165 |
1,154 |
$777.46 |
| 70310 |
|
930 |
928 |
$771.70 |
| 73502 |
|
269 |
265 |
$769.97 |
| J0131 |
Inj, acetaminophen (nos) |
5,061 |
4,834 |
$739.93 |
| 90460 |
|
858 |
830 |
$739.53 |
| 76818 |
|
27 |
26 |
$738.15 |
| 82947 |
|
1,926 |
1,483 |
$730.86 |
| T2022 |
Case management, per month |
13 |
13 |
$719.72 |
| 80349 |
|
501 |
390 |
$687.71 |
| 85007 |
|
463 |
451 |
$685.78 |
| 90656 |
|
54 |
54 |
$675.86 |
| 99211 |
|
34 |
29 |
$640.00 |
| 84480 |
|
242 |
242 |
$637.61 |
| 97035 |
|
36 |
13 |
$623.15 |
| 90480 |
|
18 |
13 |
$584.05 |
| 84703 |
|
2,614 |
2,547 |
$582.13 |
| 87040 |
|
1,645 |
1,162 |
$550.51 |
| 84146 |
|
28 |
28 |
$536.83 |
| 87210 |
|
281 |
272 |
$503.65 |
| 84436 |
|
159 |
159 |
$476.64 |
| 90732 |
|
12 |
12 |
$475.75 |
| G8510 |
Scr dep neg, no plan reqd |
412 |
399 |
$462.46 |
| 86308 |
|
603 |
599 |
$459.15 |
| 82550 |
|
279 |
264 |
$417.99 |
| 82803 |
|
12 |
12 |
$406.68 |
| 86039 |
|
79 |
77 |
$385.08 |
| 76870 |
|
40 |
40 |
$355.44 |
| G0008 |
Admin influenza virus vac |
37 |
37 |
$334.00 |
| 84156 |
|
120 |
110 |
$329.33 |
| 72040 |
|
55 |
54 |
$321.63 |
| 85014 |
|
144 |
135 |
$320.92 |
| 86787 |
|
39 |
39 |
$318.75 |
| 80320 |
|
4,916 |
4,350 |
$312.09 |
| 82747 |
|
40 |
40 |
$307.20 |
| 86038 |
|
57 |
57 |
$288.82 |
| 11719 |
|
27 |
27 |
$285.39 |
| G8431 |
Pos clin depres scrn f/u doc |
302 |
288 |
$280.80 |
| 86704 |
|
52 |
50 |
$276.27 |
| 82150 |
|
73 |
70 |
$271.42 |
| 94640 |
|
491 |
439 |
$266.33 |
| 94060 |
|
13 |
13 |
$261.60 |
| 80324 |
|
145 |
120 |
$250.00 |
| 84550 |
|
73 |
66 |
$241.63 |
| 80346 |
|
228 |
183 |
$235.00 |
| 73140 |
|
294 |
287 |
$227.11 |
| 83605 |
|
902 |
821 |
$213.95 |
| 84481 |
|
25 |
25 |
$207.99 |
| 86706 |
|
38 |
38 |
$191.90 |
| 84425 |
|
24 |
24 |
$186.79 |
| 96376 |
|
1,832 |
1,254 |
$172.34 |
| 73620 |
|
163 |
127 |
$168.93 |
| 97535 |
|
17 |
15 |
$149.59 |
| 90662 |
|
12 |
12 |
$144.85 |
| 86430 |
|
27 |
27 |
$122.00 |
| 90461 |
|
103 |
101 |
$120.24 |
| 73080 |
|
70 |
70 |
$115.92 |
| 73562 |
|
25 |
25 |
$102.27 |
| 72050 |
|
18 |
18 |
$100.24 |
| 87636 |
|
30 |
30 |
$99.84 |
| 80321 |
|
172 |
144 |
$96.86 |
| 87807 |
|
83 |
83 |
$94.32 |
| 94760 |
|
3,621 |
3,491 |
$90.79 |
| J1100 |
Dexamethasone sodium phos |
7,869 |
7,299 |
$82.44 |
| 86708 |
|
24 |
24 |
$80.00 |
| 71101 |
|
27 |
27 |
$66.50 |
| 82565 |
|
14 |
14 |
$65.39 |
| J3475 |
Inj magnesium sulfate |
237 |
199 |
$63.84 |
| 86580 |
|
12 |
12 |
$60.00 |
| J3010 |
Fentanyl citrate injection |
7,087 |
6,886 |
$58.09 |
| J1885 |
Ketorolac tromethamine inj |
5,782 |
5,451 |
$51.15 |
| J0690 |
Cefazolin sodium injection |
2,651 |
2,546 |
$48.35 |
| 87420 |
|
28 |
28 |
$47.24 |
| 83615 |
|
41 |
38 |
$43.58 |
| 81015 |
|
40 |
39 |
$34.45 |
| 74019 |
|
12 |
12 |
$30.00 |
| 90472 |
|
311 |
311 |
$27.00 |
| J1200 |
Diphenhydramine hcl injectio |
2,896 |
2,549 |
$26.74 |
| J2930 |
Methylprednisolone injection |
73 |
64 |
$26.46 |
| 73590 |
|
25 |
25 |
$25.45 |
| 73090 |
|
29 |
28 |
$25.32 |
| J0696 |
Ceftriaxone sodium injection |
1,460 |
1,320 |
$25.18 |
| 87400 |
|
342 |
192 |
$22.91 |
| 83930 |
|
378 |
357 |
$20.64 |
| J2250 |
Inj midazolam hydrochloride |
6,625 |
6,409 |
$18.06 |
| 86617 |
|
12 |
12 |
$15.49 |
| J2270 |
Morphine sulfate injection |
1,723 |
1,538 |
$15.45 |
| 82553 |
|
28 |
28 |
$12.12 |
| J0330 |
Succinycholine chloride inj |
31 |
31 |
$11.50 |
| J2060 |
Lorazepam injection |
951 |
838 |
$8.41 |
| J1642 |
Inj heparin sodium per 10 u |
132 |
70 |
$7.38 |
| 87071 |
|
246 |
225 |
$6.92 |
| J1644 |
Inj heparin sodium per 1000u |
187 |
180 |
$3.75 |
| J2765 |
Metoclopramide hcl injection |
97 |
93 |
$2.09 |
| J2550 |
Promethazine hcl injection |
278 |
263 |
$1.58 |
| J3420 |
Vitamin b12 injection |
188 |
147 |
$0.98 |
| J1170 |
Hydromorphone injection |
1,440 |
1,295 |
$0.89 |
| J7030 |
Normal saline solution infus |
930 |
888 |
$0.35 |
| J1815 |
Insulin injection |
23 |
13 |
$0.00 |
| J7512 |
Prednisone ir or dr oral 1mg |
285 |
264 |
$0.00 |
| Q9963 |
Hocm 350-399mg/ml iodine,1ml |
159 |
157 |
$0.00 |
| G8420 |
Calc bmi norm parameters |
366 |
345 |
$0.00 |
| 99496 |
|
43 |
43 |
$0.00 |
| C9290 |
Inj, bupivacaine liposome |
40 |
39 |
$0.00 |
| A9500 |
Tc99m sestamibi |
14 |
13 |
$0.00 |
| 3075F |
|
25 |
25 |
$0.00 |
| 99492 |
|
12 |
12 |
$0.00 |
| 96127 |
|
67 |
63 |
$0.00 |
| J1630 |
Haloperidol injection |
29 |
24 |
$0.00 |
| J3360 |
Diazepam injection |
40 |
37 |
$0.00 |
| J2470 |
Inj pantoprazole sodium 40mg |
20 |
13 |
$0.00 |
| 99494 |
|
50 |
50 |
$0.00 |
| J2003 |
Inj, lidocaine hcl, 1 mg |
40 |
40 |
$0.00 |
| 64494 |
|
24 |
13 |
$0.00 |
| J2795 |
Ropivacaine hcl injection |
99 |
99 |
$0.00 |
| J7999 |
Compounded drug, noc |
15 |
15 |
$0.00 |
| 1036F |
|
38 |
38 |
$0.00 |
| C1769 |
Guide wire |
25 |
25 |
$0.00 |
| J2704 |
Inj, propofol, 10 mg |
76 |
76 |
$0.00 |
| J2710 |
Neostigmine methylslfte inj |
150 |
150 |
$0.00 |
| C1713 |
Anchor/screw bn/bn,tis/bn |
166 |
165 |
$0.00 |
| 3085F |
|
702 |
681 |
$0.00 |
| C1776 |
Joint device (implantable) |
144 |
142 |
$0.00 |
| 1159F |
|
343 |
329 |
$0.00 |
| J1650 |
Inj enoxaparin sodium |
127 |
66 |
$0.00 |
| C1894 |
Intro/sheath, non-laser |
40 |
39 |
$0.00 |
| C9113 |
Inj pantoprazole sodium, via |
16 |
12 |
$0.00 |
| J0171 |
Adrenalin epinephrine inject |
101 |
101 |
$0.00 |
| 69209 |
|
15 |
15 |
$0.00 |
| 1124F |
|
12 |
12 |
$0.00 |
| 81002 |
|
24 |
24 |
$0.00 |
| 64636 |
|
15 |
12 |
$0.00 |
| J2919 |
Inj, methylpred sod succ 5mg |
26 |
14 |
$0.00 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
25 |
20 |
$0.00 |
| 84145 |
|
14 |
12 |
$0.00 |
| J7120 |
Ringers lactate infusion |
69 |
69 |
$0.00 |
| 3078F |
|
25 |
25 |
$0.00 |
| J0137 |
Inj, acetaminophen (hikma) |
33 |
33 |
$0.00 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
21 |
14 |
$0.00 |