| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99284 |
|
175,059 |
149,104 |
$22.41M |
| 99283 |
|
176,460 |
156,332 |
$20.45M |
| 96361 |
|
64,729 |
43,626 |
$18.74M |
| 99285 |
|
75,674 |
62,483 |
$10.91M |
| J2350 |
Injection, ocrelizumab, 1 mg |
498 |
325 |
$10.61M |
| 70450 |
|
23,106 |
16,881 |
$5.27M |
| G0463 |
Hospital outpt clinic visit |
43,148 |
33,038 |
$4.03M |
| J9271 |
Inj pembrolizumab |
531 |
289 |
$3.94M |
| 0241U |
|
32,990 |
25,889 |
$3.74M |
| G0378 |
Hospital observation per hr |
60,569 |
20,872 |
$3.67M |
| 74177 |
|
17,360 |
12,152 |
$3.32M |
| 97110 |
|
48,389 |
15,907 |
$3.26M |
| A0431 |
Rotary wing air transport |
2,190 |
2,004 |
$3.19M |
| 99282 |
|
32,518 |
27,336 |
$3.07M |
| 59025 |
|
17,687 |
7,681 |
$2.56M |
| 96365 |
|
17,192 |
9,792 |
$1.85M |
| 94640 |
|
20,714 |
8,026 |
$1.76M |
| 96366 |
|
8,894 |
4,238 |
$1.60M |
| 74176 |
|
6,866 |
4,690 |
$1.47M |
| 71260 |
|
8,730 |
6,073 |
$1.43M |
| A0434 |
Specialty care transport |
8,099 |
7,444 |
$1.25M |
| 76816 |
|
9,546 |
7,526 |
$1.13M |
| 80048 |
|
175,347 |
130,272 |
$1.11M |
| 96360 |
|
7,403 |
5,315 |
$1.02M |
| 67311 |
|
562 |
374 |
$965K |
| 78452 |
|
2,720 |
1,895 |
$913K |
| 47562 |
|
450 |
335 |
$806K |
| 90791 |
|
4,352 |
3,190 |
$758K |
| J2323 |
Natalizumab injection |
144 |
88 |
$742K |
| 93306 |
|
3,335 |
2,444 |
$648K |
| 70496 |
|
2,937 |
2,062 |
$603K |
| 70553 |
|
2,800 |
2,111 |
$601K |
| 76811 |
|
4,263 |
3,893 |
$600K |
| 76801 |
|
3,683 |
3,306 |
$493K |
| 95810 |
|
787 |
701 |
$485K |
| 76805 |
|
5,303 |
4,985 |
$450K |
| 58661 |
|
247 |
158 |
$439K |
| 76830 |
|
5,266 |
4,192 |
$437K |
| 97140 |
|
16,031 |
6,324 |
$426K |
| A0436 |
Rotary wing air mileage |
2,125 |
1,946 |
$402K |
| A0425 |
Ground mileage |
8,170 |
7,507 |
$392K |
| 97530 |
|
16,859 |
8,047 |
$372K |
| 66984 |
|
753 |
438 |
$341K |
| 76705 |
|
4,612 |
3,423 |
$322K |
| U0003 |
Cov-19 amp prb hgh thruput |
1,877 |
1,800 |
$317K |
| 93970 |
|
2,831 |
2,080 |
$316K |
| 70491 |
|
1,313 |
929 |
$315K |
| 43239 |
|
1,021 |
709 |
$291K |
| 78815 |
|
605 |
464 |
$280K |
| 41899 |
|
442 |
376 |
$278K |
| 96367 |
|
3,963 |
1,885 |
$245K |
| C8929 |
Tte w or wo fol wcon,doppler |
1,317 |
932 |
$243K |
| 93971 |
|
4,127 |
3,009 |
$237K |
| 96413 |
|
3,792 |
1,507 |
$233K |
| 84484 |
|
89,660 |
45,304 |
$229K |
| P9016 |
Rbc leukocytes reduced |
1,121 |
648 |
$221K |
| 71046 |
|
24,119 |
21,059 |
$221K |
| 93017 |
|
3,071 |
2,169 |
$209K |
| 77063 |
|
4,989 |
4,000 |
$203K |
| 11042 |
|
2,601 |
1,186 |
$203K |
| 71250 |
|
2,820 |
2,082 |
$203K |
| 96415 |
|
1,169 |
531 |
$198K |
| 76642 |
|
1,941 |
1,411 |
$198K |
| 76817 |
|
4,717 |
3,706 |
$195K |
| 72131 |
|
4,326 |
3,019 |
$195K |
| 70551 |
|
1,445 |
1,033 |
$192K |
| 12001 |
|
1,419 |
1,086 |
$191K |
| 73721 |
|
922 |
744 |
$190K |
| 97112 |
|
6,018 |
2,490 |
$184K |
| 64400 |
|
693 |
487 |
$183K |
| 90853 |
|
2,416 |
541 |
$182K |
| J1745 |
Infliximab not biosimil 10mg |
259 |
186 |
$182K |
| 72148 |
|
1,337 |
1,017 |
$173K |
| 64721 |
|
378 |
244 |
$172K |
| 97162 |
|
6,747 |
4,694 |
$169K |
| 36430 |
|
1,354 |
733 |
$167K |
| 71270 |
|
787 |
519 |
$158K |
| 76813 |
|
2,348 |
2,149 |
$155K |
| 93458 |
|
196 |
133 |
$150K |
| 76856 |
|
958 |
799 |
$148K |
| 30520 |
|
160 |
104 |
$147K |
| 93005 |
|
110,896 |
84,466 |
$146K |
| 70487 |
|
564 |
369 |
$141K |
| 97116 |
|
6,300 |
2,763 |
$139K |
| 10060 |
|
952 |
749 |
$138K |
| J0561 |
Penicillin g benzathine inj |
593 |
392 |
$137K |
| 97166 |
|
4,695 |
2,979 |
$136K |
| G0257 |
Unsched dialysis esrd pt hos |
1,019 |
274 |
$136K |
| 97602 |
|
1,070 |
813 |
$129K |
| 72125 |
|
10,059 |
7,114 |
$122K |
| 72141 |
|
876 |
659 |
$121K |
| 76815 |
|
5,215 |
3,264 |
$120K |
| 95811 |
|
205 |
180 |
$120K |
| 86850 |
|
7,301 |
4,919 |
$116K |
| 97535 |
|
6,428 |
3,026 |
$112K |
| 97161 |
|
3,160 |
2,479 |
$110K |
| 80307 |
|
10,194 |
7,117 |
$110K |
| 76536 |
|
1,100 |
914 |
$110K |
| 95819 |
|
845 |
631 |
$108K |
| 95886 |
|
467 |
365 |
$105K |
| 96374 |
|
85,939 |
67,673 |
$104K |
| 71271 |
|
748 |
590 |
$101K |
| 71045 |
|
68,582 |
54,194 |
$100K |
| 80053 |
|
58,076 |
38,677 |
$97K |
| 94060 |
|
759 |
604 |
$95K |
| 74178 |
|
1,237 |
838 |
$94K |
| 70486 |
|
3,282 |
2,428 |
$94K |
| 73221 |
|
511 |
393 |
$92K |
| 12002 |
|
661 |
503 |
$84K |
| 76775 |
|
1,331 |
1,008 |
$83K |
| 85025 |
|
215,196 |
166,535 |
$83K |
| 76700 |
|
536 |
420 |
$81K |
| 27130 |
|
17 |
12 |
$78K |
| 99281 |
|
927 |
770 |
$78K |
| 72100 |
|
2,093 |
1,677 |
$77K |
| 19083 |
|
116 |
82 |
$76K |
| 93308 |
|
381 |
280 |
$76K |
| 80320 |
|
9,844 |
6,893 |
$75K |
| 30140 |
|
180 |
121 |
$75K |
| 86900 |
|
8,076 |
5,542 |
$75K |
| 88307 |
|
1,168 |
740 |
$73K |
| 74183 |
|
385 |
276 |
$72K |
| 12011 |
|
583 |
451 |
$71K |
| 96372 |
|
91,832 |
63,667 |
$71K |
| 93976 |
|
505 |
384 |
$65K |
| J0897 |
Denosumab injection |
51 |
42 |
$64K |
| 93925 |
|
741 |
521 |
$64K |
| 74018 |
|
2,330 |
1,752 |
$63K |
| 85027 |
|
22,902 |
11,011 |
$62K |
| 97035 |
|
1,250 |
553 |
$61K |
| 88341 |
|
2,580 |
1,095 |
$60K |
| 73700 |
|
573 |
432 |
$60K |
| J3490 |
Drugs unclassified injection |
32,547 |
14,742 |
$57K |
| 73630 |
|
6,237 |
4,676 |
$57K |
| 72156 |
|
520 |
389 |
$57K |
| 73030 |
|
5,012 |
3,618 |
$57K |
| J3032 |
Inj. eptinezumab-jjmr 1 mg |
36 |
28 |
$57K |
| 78264 |
|
295 |
221 |
$55K |
| 73560 |
|
3,756 |
2,543 |
$53K |
| 72128 |
|
2,533 |
1,768 |
$52K |
| 75635 |
|
276 |
181 |
$51K |
| 90715 |
|
3,619 |
2,617 |
$51K |
| 80076 |
|
8,009 |
7,266 |
$51K |
| 77067 |
|
5,009 |
4,045 |
$50K |
| 72040 |
|
1,137 |
871 |
$49K |
| 58558 |
|
34 |
24 |
$49K |
| 15271 |
|
64 |
29 |
$48K |
| 70544 |
|
358 |
246 |
$48K |
| J1756 |
Iron sucrose injection |
2,810 |
899 |
$48K |
| 10061 |
|
315 |
251 |
$47K |
| 76870 |
|
889 |
651 |
$45K |
| 94729 |
|
792 |
623 |
$45K |
| 97163 |
|
2,700 |
1,744 |
$45K |
| 72158 |
|
379 |
266 |
$44K |
| 73130 |
|
5,931 |
4,339 |
$44K |
| 97167 |
|
1,683 |
1,038 |
$43K |
| 94726 |
|
684 |
542 |
$43K |
| 72110 |
|
745 |
620 |
$42K |
| 92507 |
|
936 |
368 |
$42K |
| G0279 |
Tomosynthesis, mammo |
1,307 |
1,081 |
$41K |
| 93880 |
|
644 |
466 |
$41K |
| 0001A |
|
1,293 |
1,242 |
$40K |
| 49083 |
|
174 |
75 |
$39K |
| 36415 |
|
155,669 |
123,658 |
$38K |
| 73562 |
|
3,941 |
2,854 |
$37K |
| 96375 |
|
65,504 |
42,874 |
$37K |
| 76770 |
|
291 |
240 |
$36K |
| 58571 |
|
31 |
14 |
$36K |
| 96376 |
|
22,121 |
8,383 |
$36K |
| 97165 |
|
689 |
489 |
$35K |
| 93325 |
|
600 |
398 |
$35K |
| 77080 |
|
688 |
523 |
$35K |
| 0002A |
|
1,006 |
984 |
$35K |
| 64483 |
|
168 |
124 |
$34K |
| 94660 |
|
358 |
121 |
$34K |
| 76882 |
|
396 |
308 |
$34K |
| 73610 |
|
4,990 |
3,688 |
$33K |
| 73502 |
|
2,607 |
1,840 |
$31K |
| 76641 |
|
184 |
164 |
$30K |
| D1351 |
|
1,422 |
403 |
$30K |
| 77065 |
Tomosynthesis, mammo |
1,130 |
814 |
$29K |
| 52356 |
|
27 |
13 |
$28K |
| 97113 |
|
458 |
171 |
$27K |
| 36561 |
|
44 |
26 |
$26K |
| 78227 |
|
102 |
58 |
$26K |
| 74420 |
|
334 |
213 |
$26K |
| 70498 |
|
2,812 |
1,957 |
$26K |
| S9472 |
Cardiac rehabilitation progr |
734 |
96 |
$26K |
| 76820 |
|
822 |
361 |
$25K |
| 44970 |
|
18 |
14 |
$25K |
| 73110 |
|
3,314 |
2,389 |
$23K |
| 77066 |
Tomosynthesis, mammo |
1,129 |
924 |
$23K |
| 20680 |
|
35 |
24 |
$22K |
| 97802 |
|
257 |
231 |
$22K |
| 97597 |
|
294 |
207 |
$21K |
| 86923 |
|
1,248 |
588 |
$21K |
| 69436 |
|
18 |
14 |
$21K |
| 78582 |
|
59 |
40 |
$20K |
| J0500 |
Dicyclomine injection |
1,683 |
1,166 |
$20K |
| 83735 |
|
15,468 |
8,110 |
$20K |
| 80069 |
|
3,502 |
1,204 |
$20K |
| 72192 |
|
737 |
501 |
$20K |
| J1650 |
Inj enoxaparin sodium |
25,282 |
8,988 |
$18K |
| 88360 |
|
627 |
355 |
$18K |
| J7307 |
Etonogestrel implant system |
14 |
13 |
$18K |
| J2800 |
Methocarbamol injection |
5,928 |
3,675 |
$18K |
| 0240U |
|
185 |
148 |
$18K |
| 81003 |
|
74,965 |
67,217 |
$18K |
| 85610 |
|
16,036 |
9,780 |
$17K |
| 97012 |
|
747 |
269 |
$17K |
| 87591 |
|
8,960 |
6,898 |
$17K |
| J1453 |
Fosaprepitant injection |
1,511 |
641 |
$17K |
| 72050 |
|
265 |
213 |
$16K |
| J1459 |
Inj ivig privigen 500 mg |
40 |
12 |
$16K |
| 80061 |
|
3,418 |
2,270 |
$16K |
| 81001 |
|
38,585 |
28,783 |
$15K |
| 36569 |
|
63 |
37 |
$15K |
| 82248 |
|
46,525 |
33,169 |
$14K |
| J2805 |
Sincalide injection |
119 |
68 |
$14K |
| 84443 |
|
5,227 |
3,553 |
$14K |
| 82565 |
|
2,237 |
1,589 |
$13K |
| 01922 |
|
134 |
87 |
$13K |
| 86920 |
|
798 |
328 |
$13K |
| 72146 |
|
156 |
107 |
$12K |
| J1439 |
Inj ferric carboxymaltos 1mg |
18 |
12 |
$12K |
| 87070 |
|
3,999 |
2,828 |
$12K |
| 87086 |
|
15,735 |
12,398 |
$12K |
| 72072 |
|
331 |
265 |
$12K |
| 73590 |
|
2,277 |
1,642 |
$12K |
| 81025 |
|
64,291 |
55,357 |
$11K |
| J1170 |
Hydromorphone injection |
15,824 |
6,490 |
$11K |
| 72070 |
|
267 |
204 |
$11K |
| 83036 |
|
4,333 |
3,025 |
$11K |
| 74230 |
|
133 |
92 |
$10K |
| 87491 |
|
8,915 |
6,856 |
$10K |
| G0260 |
Inj for sacroiliac jt anesth |
55 |
43 |
$10K |
| 36591 |
|
972 |
520 |
$10K |
| 92610 |
|
600 |
373 |
$9K |
| 45378 |
|
42 |
32 |
$9K |
| 45380 |
|
47 |
25 |
$9K |
| P9047 |
Albumin (human), 25%, 50ml |
75 |
28 |
$9K |
| J2997 |
Alteplase recombinant |
21 |
13 |
$8K |
| U0002 |
Covid-19 lab test non-cdc |
6,786 |
6,134 |
$8K |
| 93225 |
|
64 |
52 |
$8K |
| 97803 |
|
102 |
76 |
$8K |
| J2270 |
Morphine sulfate injection |
18,186 |
9,928 |
$8K |
| 72197 |
|
49 |
28 |
$8K |
| C5271 |
Low cost skin substitute app |
21 |
12 |
$8K |
| 72157 |
|
103 |
69 |
$8K |
| J2930 |
Methylprednisolone injection |
2,743 |
1,596 |
$8K |
| 87040 |
|
6,542 |
2,443 |
$7K |
| 45385 |
|
21 |
13 |
$7K |
| 76819 |
|
118 |
83 |
$7K |
| 86901 |
|
8,088 |
5,544 |
$7K |
| J1815 |
Insulin injection |
9,529 |
1,897 |
$7K |
| 90471 |
|
4,065 |
2,877 |
$7K |
| 83880 |
|
7,616 |
5,126 |
$7K |
| 71275 |
|
56 |
39 |
$7K |
| 87661 |
|
5,495 |
4,342 |
$7K |
| 96368 |
|
1,086 |
574 |
$7K |
| 84439 |
|
2,427 |
1,661 |
$7K |
| J1953 |
Levetiracetam injection |
889 |
504 |
$6K |
| 73552 |
|
1,308 |
923 |
$6K |
| 90686 |
|
367 |
239 |
$6K |
| 75574 |
|
16 |
13 |
$6K |
| 92526 |
|
155 |
77 |
$6K |
| 73070 |
|
1,490 |
1,079 |
$6K |
| 85379 |
|
9,247 |
6,793 |
$6K |
| 85730 |
|
11,021 |
7,004 |
$6K |
| J2469 |
Palonosetron hcl |
1,511 |
578 |
$6K |
| J1885 |
Ketorolac tromethamine inj |
66,284 |
52,200 |
$6K |
| G0008 |
Admin influenza virus vac |
542 |
367 |
$6K |
| 85014 |
|
3,056 |
1,068 |
$6K |
| J7030 |
Normal saline solution infus |
48,055 |
28,376 |
$5K |
| J2543 |
Piperacillin/tazobactam |
1,693 |
647 |
$5K |
| 84702 |
|
5,191 |
3,694 |
$5K |
| 84100 |
|
5,360 |
2,734 |
$5K |
| 71100 |
|
422 |
325 |
$5K |
| 83605 |
|
9,929 |
5,665 |
$5K |
| 83690 |
|
41,202 |
30,728 |
$5K |
| 72170 |
|
2,206 |
1,578 |
$5K |
| 72114 |
|
82 |
71 |
$5K |
| 76937 |
|
416 |
284 |
$5K |
| J9045 |
Carboplatin injection |
377 |
115 |
$5K |
| 93922 |
|
74 |
56 |
$5K |
| 95806 |
|
33 |
27 |
$4K |
| 94667 |
|
230 |
166 |
$4K |
| 73060 |
|
942 |
668 |
$4K |
| 87088 |
|
10,418 |
7,663 |
$4K |
| 73140 |
|
801 |
600 |
$4K |
| J2310 |
Inj naloxone hydrochloride |
384 |
191 |
$4K |
| 00731 |
|
1,462 |
1,086 |
$4K |
| 97014 |
|
115 |
58 |
$4K |
| 86140 |
|
1,770 |
1,182 |
$4K |
| C9113 |
Inj pantoprazole sodium, via |
3,615 |
1,260 |
$4K |
| J0702 |
Betamethasone acet&sod phosp |
406 |
176 |
$4K |
| 73620 |
|
155 |
114 |
$4K |
| 82803 |
|
8,205 |
5,232 |
$4K |
| 82728 |
|
1,092 |
776 |
$4K |
| 87077 |
|
4,890 |
3,136 |
$4K |
| 73080 |
|
411 |
323 |
$3K |
| 87430 |
|
6,479 |
5,102 |
$3K |
| 82607 |
|
1,084 |
701 |
$3K |
| 73090 |
|
1,428 |
1,045 |
$3K |
| 78306 |
|
19 |
14 |
$3K |
| 87641 |
|
344 |
235 |
$3K |
| 93923 |
|
34 |
29 |
$3K |
| 82550 |
|
4,679 |
2,741 |
$3K |
| 84145 |
|
1,422 |
911 |
$3K |
| J0131 |
Inj, acetaminophen (nos) |
484 |
316 |
$3K |
| 82140 |
|
1,661 |
959 |
$3K |
| J3471 |
Ovine, up to 999 usp units |
211 |
109 |
$3K |
| J8501 |
Oral aprepitant |
157 |
98 |
$3K |
| 85018 |
|
3,100 |
1,090 |
$3K |
| 93312 |
|
19 |
12 |
$3K |
| 88365 |
|
186 |
133 |
$3K |
| J0696 |
Ceftriaxone sodium injection |
9,374 |
5,020 |
$3K |
| 83540 |
|
1,403 |
895 |
$3K |
| 74160 |
|
15 |
12 |
$3K |
| 95700 |
|
28 |
14 |
$3K |
| J3370 |
Vancomycin hcl injection |
2,641 |
1,130 |
$2K |
| J3486 |
Ziprasidone mesylate |
220 |
121 |
$2K |
| 00170 |
|
966 |
726 |
$2K |
| 94668 |
|
32 |
12 |
$2K |
| J2790 |
Rho d immune globulin inj |
28 |
27 |
$2K |
| 83550 |
|
1,308 |
878 |
$2K |
| 86592 |
|
676 |
512 |
$2K |
| 74019 |
|
79 |
60 |
$2K |
| 87186 |
|
4,573 |
2,965 |
$2K |
| J3411 |
Thiamine hcl 100 mg |
1,932 |
787 |
$2K |
| 82746 |
|
934 |
588 |
$2K |
| 73522 |
|
65 |
49 |
$2K |
| 73600 |
|
126 |
92 |
$2K |
| 86870 |
|
82 |
49 |
$2K |
| 87147 |
|
1,749 |
1,202 |
$2K |
| 88305 |
|
5,254 |
3,361 |
$2K |
| 29581 |
|
23 |
12 |
$2K |
| 76604 |
|
30 |
25 |
$2K |
| 92523 |
|
52 |
42 |
$2K |
| J2550 |
Promethazine hcl injection |
7,808 |
3,892 |
$2K |
| J0360 |
Hydralazine hcl injection |
2,391 |
1,197 |
$2K |
| C1713 |
Anchor/screw bn/bn,tis/bn |
1,396 |
962 |
$2K |
| J7120 |
Ringers lactate infusion |
20,911 |
12,987 |
$2K |
| 00140 |
|
1,012 |
705 |
$2K |
| J0295 |
Ampicillin sulbactam 1.5 gm |
1,167 |
433 |
$2K |
| 20553 |
|
21 |
13 |
$2K |
| 00300 |
|
728 |
503 |
$2K |
| 93321 |
|
104 |
70 |
$2K |
| 29125 |
|
784 |
604 |
$2K |
| 86922 |
|
116 |
42 |
$1K |
| 87633 |
|
19 |
14 |
$1K |
| J1644 |
Inj heparin sodium per 1000u |
7,744 |
2,284 |
$1K |
| G0475 |
Hiv combination assay |
477 |
360 |
$1K |
| 80164 |
|
652 |
400 |
$1K |
| 87426 |
|
271 |
137 |
$1K |
| J2704 |
Inj, propofol, 10 mg |
24,722 |
14,018 |
$1K |
| 97750 |
|
55 |
48 |
$1K |
| J3010 |
Fentanyl citrate injection |
30,975 |
17,628 |
$1K |
| 00160 |
|
314 |
216 |
$1K |
| 99404 |
|
15 |
12 |
$1K |
| G0480 |
Drug test def 1-7 classes |
1,272 |
685 |
$1K |
| 0012A |
|
40 |
39 |
$1K |
| 0011A |
|
68 |
58 |
$1K |
| 20552 |
|
38 |
26 |
$1K |
| 74174 |
|
21 |
12 |
$1K |
| 82330 |
|
1,018 |
456 |
$1K |
| 92611 |
|
38 |
24 |
$1K |
| 90714 |
|
41 |
27 |
$1K |
| 00537 |
|
18 |
12 |
$1K |
| 80143 |
|
2,600 |
1,801 |
$1K |
| J0737 |
Inj, clindamycin (baxter) |
734 |
449 |
$1K |
| J0690 |
Cefazolin sodium injection |
9,582 |
5,630 |
$1K |
| 36600 |
|
126 |
62 |
$1K |
| 85652 |
|
2,027 |
1,395 |
$1K |
| 82977 |
|
852 |
560 |
$943.75 |
| J3535 |
Metered dose inhaler drug |
2,158 |
577 |
$915.72 |
| 88331 |
|
33 |
13 |
$904.46 |
| 87563 |
|
1,172 |
1,088 |
$888.62 |
| 85049 |
|
1,292 |
769 |
$879.60 |
| 82306 |
|
197 |
141 |
$859.70 |
| J1642 |
Inj heparin sodium per 10 u |
5,496 |
2,344 |
$838.69 |
| J2405 |
Ondansetron hcl injection |
52,436 |
32,617 |
$831.86 |
| 84132 |
|
834 |
445 |
$831.23 |
| J1200 |
Diphenhydramine hcl injectio |
12,836 |
6,748 |
$807.78 |
| 76857 |
|
34 |
26 |
$803.09 |
| 82570 |
|
914 |
659 |
$798.50 |
| J3475 |
Inj magnesium sulfate |
3,428 |
1,817 |
$780.95 |
| 82010 |
|
1,734 |
1,149 |
$778.15 |
| 83615 |
|
494 |
305 |
$758.31 |
| J0780 |
Prochlorperazine injection |
4,788 |
3,148 |
$737.46 |
| 72220 |
|
47 |
38 |
$730.29 |
| 73000 |
|
79 |
56 |
$725.60 |
| 84134 |
|
66 |
51 |
$718.92 |
| 70250 |
|
52 |
26 |
$708.30 |
| 87905 |
|
1,293 |
1,190 |
$700.67 |
| J1790 |
Droperidol injection |
3,669 |
2,453 |
$626.52 |
| 0003A |
|
15 |
15 |
$613.40 |
| 84703 |
|
1,400 |
1,017 |
$612.58 |
| 73100 |
|
40 |
24 |
$603.06 |
| 87449 |
|
612 |
261 |
$601.88 |
| 97022 |
|
21 |
13 |
$596.18 |
| 86308 |
|
439 |
326 |
$591.94 |
| 71101 |
|
162 |
108 |
$586.97 |
| 86803 |
|
330 |
241 |
$586.78 |
| J2060 |
Lorazepam injection |
4,115 |
2,454 |
$572.28 |
| 73120 |
|
20 |
12 |
$565.12 |
| 87804 |
|
4,065 |
2,057 |
$559.38 |
| J1940 |
Furosemide injection |
2,268 |
920 |
$553.23 |
| J3360 |
Diazepam injection |
1,689 |
1,149 |
$549.12 |
| J7040 |
Normal saline solution infus |
10,408 |
5,251 |
$518.53 |
| J1100 |
Dexamethasone sodium phos |
20,494 |
13,345 |
$513.37 |
| 84156 |
|
900 |
632 |
$506.00 |
| 00400 |
|
951 |
607 |
$499.41 |
| 72082 |
|
12 |
12 |
$490.48 |
| 77002 |
|
12 |
12 |
$486.72 |
| J2920 |
Methylprednisolone injection |
686 |
281 |
$475.76 |
| 80074 |
|
117 |
69 |
$469.90 |
| 87340 |
|
254 |
175 |
$468.36 |
| 29515 |
|
50 |
39 |
$441.46 |
| 77001 |
|
75 |
50 |
$439.82 |
| 85347 |
|
481 |
232 |
$432.58 |
| 80179 |
|
2,490 |
1,762 |
$417.82 |
| 36416 |
|
3,435 |
2,117 |
$397.38 |
| 87081 |
|
344 |
250 |
$394.45 |
| 87205 |
|
867 |
560 |
$393.17 |
| 00940 |
|
157 |
85 |
$378.44 |
| 85045 |
|
1,176 |
374 |
$351.54 |
| 80177 |
|
319 |
213 |
$342.29 |
| 76000 |
|
19 |
15 |
$327.78 |
| J0171 |
Adrenalin epinephrine inject |
2,478 |
1,471 |
$309.17 |
| 88342 |
|
2,937 |
1,687 |
$302.73 |
| J7999 |
Compounded drug, noc |
520 |
295 |
$286.57 |
| 90656 |
|
43 |
43 |
$280.90 |
| 82040 |
|
81 |
41 |
$263.30 |
| 81015 |
|
709 |
537 |
$257.27 |
| J3480 |
Inj potassium chloride |
3,260 |
1,402 |
$257.13 |
| 87481 |
|
133 |
81 |
$256.54 |
| 51702 |
|
166 |
97 |
$251.67 |
| J2919 |
Inj, methylpred sod succ 5mg |
956 |
702 |
$247.40 |
| 87529 |
|
342 |
134 |
$239.96 |
| J2765 |
Metoclopramide hcl injection |
2,959 |
1,666 |
$238.29 |
| C1889 |
Implant/insert device, noc |
605 |
393 |
$231.46 |
| 00840 |
|
1,288 |
878 |
$230.51 |
| 70360 |
|
20 |
15 |
$218.72 |
| 88304 |
|
1,708 |
1,208 |
$168.03 |
| 87075 |
|
473 |
269 |
$165.67 |
| J2371 |
Inj phenylephrine hcl 20 mcg |
816 |
500 |
$157.82 |
| J8499 |
Oral prescrip drug non chemo |
1,592 |
612 |
$153.79 |
| 87486 |
|
20 |
15 |
$146.15 |
| 84295 |
|
83 |
12 |
$143.19 |
| 97763 |
|
127 |
68 |
$136.58 |
| J3410 |
Hydroxyzine hcl injection |
265 |
195 |
$134.19 |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
33,524 |
23,548 |
$123.46 |
| J0280 |
Aminophyllin 250 mg inj |
18 |
12 |
$115.25 |
| 87798 |
|
122 |
67 |
$106.42 |
| J1630 |
Haloperidol injection |
1,064 |
709 |
$105.38 |
| 82784 |
|
44 |
26 |
$102.26 |
| J2370 |
Phenylephrine hcl injection |
718 |
393 |
$97.76 |
| J0330 |
Succinycholine chloride inj |
1,815 |
1,189 |
$95.79 |
| A9575 |
Inj gadoterate meglumi 0.1ml |
4,088 |
3,023 |
$87.75 |
| J2175 |
Meperidine hydrochl /100 mg |
993 |
632 |
$87.46 |
| 87324 |
|
46 |
25 |
$87.02 |
| J2360 |
Orphenadrine injection |
846 |
546 |
$80.91 |
| 0031A |
|
26 |
23 |
$79.19 |
| 87653 |
|
31 |
26 |
$78.87 |
| J7042 |
5% dextrose/normal saline |
1,742 |
630 |
$78.83 |
| J2250 |
Inj midazolam hydrochloride |
15,552 |
10,457 |
$76.13 |
| 87581 |
|
20 |
15 |
$73.06 |
| J0456 |
Azithromycin |
749 |
344 |
$72.98 |
| J7512 |
Prednisone ir or dr oral 1mg |
2,371 |
931 |
$72.30 |
| 86304 |
|
29 |
12 |
$69.04 |
| J0137 |
Inj, acetaminophen (hikma) |
256 |
187 |
$54.94 |
| J7060 |
5% dextrose/water |
1,794 |
463 |
$53.21 |
| 90694 |
|
23 |
13 |
$52.92 |
| 84550 |
|
115 |
83 |
$48.11 |
| J1956 |
Levofloxacin injection |
243 |
110 |
$47.44 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
5,398 |
3,330 |
$40.19 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
611 |
415 |
$36.39 |
| J1805 |
Inj, esmolol hcl, 10mg |
376 |
195 |
$36.11 |
| 80305 |
|
134 |
118 |
$34.44 |
| 89051 |
|
306 |
188 |
$34.04 |
| 84436 |
|
36 |
24 |
$30.87 |
| J0613 |
Calcium glucon (wg critical) |
71 |
41 |
$29.88 |
| 83930 |
|
56 |
27 |
$27.30 |
| J1836 |
Inj, metronidazole, 10 mg |
106 |
41 |
$27.11 |
| J1040 |
Methylprednisolone 80 mg inj |
985 |
837 |
$26.75 |
| 85651 |
|
42 |
27 |
$24.78 |
| J1596 |
Inj, glycopyrrolate, 0.1 mg |
1,750 |
1,419 |
$24.38 |
| J9267 |
Paclitaxel injection |
265 |
94 |
$23.79 |
| J8540 |
Oral dexamethasone |
179 |
83 |
$23.28 |
| J1920 |
Inj, labetalol hcl, 5mg |
1,271 |
644 |
$22.53 |
| 91300 |
|
2,164 |
2,000 |
$19.36 |
| J3301 |
Triamcinolone acet inj nos |
668 |
470 |
$18.47 |
| C1762 |
Conn tiss, human(inc fascia) |
15 |
12 |
$17.74 |
| Q4102 |
Oasis wound matrix |
106 |
53 |
$17.00 |
| 95909 |
|
15 |
13 |
$13.23 |
| J2470 |
Inj pantoprazole sodium 40mg |
335 |
212 |
$12.93 |
| Q9969 |
Non-heu tc-99m add-on/dose |
3,097 |
2,157 |
$12.60 |
| J0692 |
Cefepime hcl for injection |
49 |
13 |
$10.26 |
| J7050 |
Normal saline solution infus |
11,478 |
4,843 |
$5.20 |
| J8597 |
Antiemetic drug oral nos |
337 |
138 |
$2.12 |
| J3420 |
Vitamin b12 injection |
18 |
14 |
$1.20 |
| J2003 |
Inj, lidocaine hcl, 1 mg |
193 |
187 |
$0.80 |
| 91301 |
|
95 |
85 |
$0.74 |
| 91303 |
|
26 |
23 |
$0.02 |
| J2785 |
Regadenoson injection |
2,299 |
1,557 |
$0.00 |
| J2001 |
Lidocaine injection |
70 |
58 |
$0.00 |
| 00790 |
|
691 |
499 |
$0.00 |
| C1726 |
Cath, bal dil, non-vascular |
233 |
149 |
$0.00 |
| C1781 |
Mesh (implantable) |
451 |
312 |
$0.00 |
| C1893 |
Intro/sheath, fixed,non-peel |
248 |
143 |
$0.00 |
| A9270 |
Non-covered item or service |
1,091 |
167 |
$0.00 |
| C1725 |
Cath, translumin non-laser |
155 |
99 |
$0.00 |
| 00813 |
|
169 |
112 |
$0.00 |
| 88377 |
|
99 |
52 |
$0.00 |
| 85576 |
|
53 |
26 |
$0.00 |
| C1769 |
Guide wire |
2,128 |
1,366 |
$0.00 |
| 00952 |
|
192 |
132 |
$0.00 |
| 94761 |
|
259 |
147 |
$0.00 |
| A4648 |
Implantable tissue marker |
461 |
296 |
$0.00 |
| 00142 |
|
918 |
534 |
$0.00 |
| 01480 |
|
287 |
190 |
$0.00 |
| 00902 |
|
41 |
28 |
$0.00 |
| J0697 |
Sterile cefuroxime injection |
303 |
201 |
$0.00 |
| 88364 |
|
21 |
12 |
$0.00 |
| 80178 |
|
24 |
14 |
$0.00 |
| J2795 |
Ropivacaine hcl injection |
62 |
48 |
$0.00 |
| 94760 |
|
16 |
12 |
$0.00 |
| 00320 |
|
36 |
25 |
$0.00 |
| 0051A |
|
40 |
40 |
$0.00 |
| J1010 |
Inj, methylpred acetate 1 mg |
90 |
74 |
$0.00 |
| 01214 |
|
17 |
12 |
$0.00 |
| C2617 |
Stent, non-cor, tem w/o del |
162 |
88 |
$0.00 |
| J1030 |
Methylprednisolone 40 mg inj |
17 |
12 |
$0.00 |
| 84157 |
|
19 |
12 |
$0.00 |
| 96411 |
|
114 |
43 |
$0.00 |
| 94762 |
|
68 |
38 |
$0.00 |
| 91305 |
|
37 |
37 |
$0.00 |
| 82945 |
|
19 |
12 |
$0.00 |
| 93356 |
|
1,073 |
839 |
$0.00 |
| 15853 |
|
242 |
207 |
$0.00 |
| C1776 |
Joint device (implantable) |
657 |
455 |
$0.00 |
| 00918 |
|
138 |
78 |
$0.00 |
| 01810 |
|
809 |
568 |
$0.00 |
| C1894 |
Intro/sheath, non-laser |
343 |
210 |
$0.00 |
| C1887 |
Catheter, guiding |
770 |
476 |
$0.00 |
| A9552 |
F18 fdg |
628 |
481 |
$0.00 |
| 01965 |
|
43 |
25 |
$0.00 |
| J1580 |
Garamycin gentamicin inj |
177 |
112 |
$0.00 |
| 96417 |
|
1,508 |
657 |
$0.00 |
| 01830 |
|
175 |
126 |
$0.00 |
| Q9956 |
Inj octafluoropropane mic,ml |
951 |
648 |
$0.00 |
| 88302 |
|
239 |
159 |
$0.00 |
| A9502 |
Tc99m tetrofosmin |
29 |
14 |
$0.00 |
| Q9966 |
Locm 200-299mg/ml iodine,1ml |
738 |
495 |
$0.00 |
| 82365 |
|
48 |
25 |
$0.00 |
| C1760 |
Closure dev, vasc |
170 |
104 |
$0.00 |
| S0596 |
Phakic iol refractive error |
525 |
335 |
$0.00 |
| 99408 |
|
230 |
151 |
$0.00 |
| 00910 |
|
180 |
119 |
$0.00 |
| Q9957 |
Inj perflutren lip micros,ml |
50 |
47 |
$0.00 |
| C1875 |
Stent, coated/cov w/o del sy |
12 |
12 |
$0.00 |
| Q0144 |
Azithromycin dihydrate, oral |
326 |
180 |
$0.00 |
| 00811 |
|
116 |
65 |
$0.00 |
| 88112 |
|
30 |
13 |
$0.00 |
| 94150 |
|
37 |
24 |
$0.00 |
| J2710 |
Neostigmine methylslfte inj |
73 |
71 |
$0.00 |
| C1729 |
Cath, drainage |
25 |
17 |
$0.00 |
| 88173 |
|
29 |
16 |
$0.00 |
| C1758 |
Catheter, ureteral |
13 |
12 |
$0.00 |
| C1751 |
Cath, inf, per/cent/midline |
45 |
26 |
$0.00 |
| 69209 |
|
43 |
32 |
$0.00 |
| 88313 |
|
18 |
13 |
$0.00 |
| C1788 |
Port, indwelling, imp |
45 |
26 |
$0.00 |
| 77012 |
|
17 |
12 |
$0.00 |