| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99285 |
|
61,788 |
57,632 |
$19.35M |
| 99284 |
|
37,320 |
36,243 |
$6.86M |
| G0463 |
Hospital outpt clinic visit |
100,252 |
90,578 |
$5.88M |
| 99283 |
|
30,043 |
29,139 |
$3.72M |
| 96374 |
|
35,502 |
32,772 |
$3.31M |
| 96365 |
|
16,971 |
11,314 |
$1.64M |
| 96413 |
|
9,308 |
6,102 |
$1.48M |
| 99282 |
|
12,659 |
12,449 |
$1.02M |
| 96375 |
|
30,399 |
25,109 |
$982K |
| 71046 |
|
17,295 |
16,893 |
$872K |
| 97110 |
|
33,145 |
8,923 |
$831K |
| 74177 |
|
6,391 |
6,287 |
$824K |
| 93975 |
|
6,634 |
6,355 |
$745K |
| 80061 |
|
49,538 |
49,351 |
$706K |
| 93306 |
|
3,726 |
3,710 |
$679K |
| 96361 |
|
19,242 |
16,701 |
$653K |
| 59025 |
|
7,200 |
3,751 |
$633K |
| 43239 |
|
1,826 |
1,816 |
$614K |
| 45380 |
|
1,134 |
1,127 |
$593K |
| G0378 |
Hospital observation per hr |
6,532 |
5,920 |
$593K |
| 87491 |
|
31,609 |
31,112 |
$580K |
| 96360 |
|
5,886 |
4,839 |
$578K |
| 87591 |
|
31,372 |
30,883 |
$576K |
| J9271 |
Inj pembrolizumab |
92 |
69 |
$567K |
| 70450 |
|
6,833 |
6,685 |
$524K |
| U0003 |
Cov-19 amp prb hgh thruput |
9,777 |
9,549 |
$468K |
| 87637 |
|
6,163 |
6,014 |
$461K |
| 82947 |
|
19,033 |
15,270 |
$455K |
| 76830 |
|
7,045 |
6,932 |
$420K |
| 71045 |
|
9,560 |
9,193 |
$399K |
| 84443 |
|
50,030 |
49,472 |
$377K |
| 82306 |
|
25,510 |
25,416 |
$374K |
| 77067 |
|
7,685 |
7,672 |
$370K |
| 76856 |
|
7,534 |
7,406 |
$357K |
| J1745 |
Infliximab not biosimil 10mg |
294 |
275 |
$341K |
| 97140 |
|
23,934 |
6,793 |
$337K |
| 74176 |
|
2,977 |
2,956 |
$301K |
| 80053 |
|
66,238 |
63,863 |
$282K |
| 87389 |
|
21,993 |
21,908 |
$275K |
| 96372 |
|
31,609 |
27,199 |
$264K |
| 85025 |
|
124,799 |
113,274 |
$262K |
| Q5103 |
Injection, inflectra |
440 |
412 |
$250K |
| 87480 |
|
21,791 |
21,505 |
$237K |
| 87660 |
|
21,536 |
21,267 |
$233K |
| 97162 |
|
4,069 |
4,043 |
$223K |
| 87510 |
|
20,913 |
20,641 |
$222K |
| G0480 |
Drug test def 1-7 classes |
10,077 |
8,873 |
$215K |
| G0121 |
Colon ca scrn not hi rsk ind |
520 |
520 |
$214K |
| 71260 |
|
1,570 |
1,568 |
$212K |
| J2505 |
Injection, pegfilgrastim 6mg |
138 |
106 |
$209K |
| 76801 |
|
3,312 |
3,133 |
$208K |
| 99291 |
|
381 |
377 |
$208K |
| 83036 |
|
44,100 |
43,938 |
$207K |
| 76700 |
|
2,992 |
2,981 |
$203K |
| 96415 |
|
4,217 |
3,301 |
$202K |
| 97161 |
|
1,975 |
1,959 |
$194K |
| 87661 |
|
9,329 |
9,227 |
$181K |
| 71275 |
|
2,269 |
2,231 |
$175K |
| 94060 |
|
1,258 |
1,254 |
$171K |
| 96367 |
|
4,980 |
3,457 |
$168K |
| 70553 |
|
846 |
845 |
$167K |
| 90471 |
|
16,616 |
16,377 |
$163K |
| 93970 |
|
1,777 |
1,758 |
$162K |
| 87636 |
|
1,815 |
1,744 |
$157K |
| 76705 |
|
2,554 |
2,500 |
$147K |
| 45385 |
|
326 |
323 |
$144K |
| 93350 |
|
752 |
751 |
$143K |
| 90651 |
|
1,012 |
1,004 |
$138K |
| 93971 |
|
2,612 |
2,573 |
$132K |
| 96366 |
|
4,257 |
2,956 |
$131K |
| 80307 |
|
13,054 |
12,581 |
$128K |
| 76770 |
|
1,998 |
1,982 |
$125K |
| 96417 |
|
3,073 |
2,035 |
$120K |
| 76642 |
|
3,168 |
3,129 |
$119K |
| 87624 |
|
6,180 |
6,170 |
$118K |
| 82607 |
|
16,984 |
16,888 |
$114K |
| 80048 |
|
46,888 |
42,401 |
$112K |
| 99281 |
|
2,590 |
2,480 |
$112K |
| 90686 |
|
6,479 |
6,469 |
$111K |
| 88175 |
|
7,459 |
7,450 |
$104K |
| 86803 |
|
12,352 |
12,314 |
$101K |
| U0005 |
Infec agen detec ampli probe |
6,174 |
6,044 |
$101K |
| 77066 |
Tomosynthesis, mammo |
1,712 |
1,699 |
$100K |
| 87633 |
|
447 |
445 |
$96K |
| 86900 |
|
11,012 |
10,416 |
$94K |
| 90750 |
|
620 |
615 |
$86K |
| 10060 |
|
990 |
967 |
$82K |
| J1453 |
Fosaprepitant injection |
2,399 |
1,606 |
$80K |
| 72148 |
|
843 |
843 |
$80K |
| 76536 |
|
1,532 |
1,523 |
$76K |
| 76816 |
|
1,426 |
1,368 |
$70K |
| 90732 |
|
868 |
863 |
$70K |
| 93005 |
|
30,377 |
28,667 |
$68K |
| 87086 |
|
16,979 |
16,597 |
$66K |
| 87635 |
|
2,308 |
2,230 |
$66K |
| 73721 |
|
505 |
502 |
$65K |
| 45378 |
|
179 |
178 |
$63K |
| 86780 |
|
7,559 |
7,500 |
$62K |
| 80074 |
|
2,696 |
2,676 |
$62K |
| 94640 |
|
14,104 |
10,372 |
$60K |
| 74022 |
|
3,071 |
3,029 |
$59K |
| 82728 |
|
9,540 |
9,433 |
$59K |
| 97165 |
|
1,410 |
1,394 |
$58K |
| 90472 |
|
4,255 |
4,216 |
$58K |
| 87651 |
|
2,610 |
2,589 |
$57K |
| 70491 |
|
564 |
560 |
$57K |
| 84702 |
|
21,443 |
19,571 |
$57K |
| 87340 |
|
10,712 |
10,672 |
$56K |
| 70486 |
|
1,509 |
1,499 |
$56K |
| 77065 |
Tomosynthesis, mammo |
1,289 |
1,235 |
$55K |
| G0472 |
Hep c screen high risk/other |
4,241 |
4,224 |
$55K |
| 90670 |
|
627 |
621 |
$52K |
| 84466 |
|
8,758 |
8,671 |
$52K |
| 36415 |
|
68,503 |
62,397 |
$51K |
| 96411 |
|
1,427 |
927 |
$51K |
| 84439 |
|
11,705 |
11,578 |
$51K |
| 82746 |
|
7,248 |
7,199 |
$47K |
| 90677 |
|
183 |
182 |
$42K |
| 97166 |
|
1,019 |
1,006 |
$42K |
| 88305 |
|
7,361 |
7,090 |
$41K |
| 77063 |
|
3,183 |
3,181 |
$41K |
| 73630 |
|
4,208 |
4,032 |
$39K |
| 74018 |
|
2,312 |
2,278 |
$39K |
| J0897 |
Denosumab injection |
127 |
126 |
$38K |
| 71250 |
|
690 |
688 |
$38K |
| G0103 |
Psa screening |
3,093 |
3,088 |
$38K |
| 78815 |
|
50 |
50 |
$36K |
| 97112 |
|
1,497 |
450 |
$35K |
| 78452 |
|
67 |
66 |
$35K |
| 84481 |
|
3,989 |
3,953 |
$34K |
| 73562 |
|
1,929 |
1,844 |
$34K |
| 73130 |
|
3,096 |
2,995 |
$34K |
| 74019 |
|
1,560 |
1,545 |
$34K |
| 85027 |
|
15,770 |
14,111 |
$33K |
| 86235 |
|
1,436 |
1,283 |
$33K |
| 76805 |
|
533 |
527 |
$32K |
| 96416 |
|
173 |
104 |
$32K |
| J2469 |
Palonosetron hcl |
2,956 |
1,937 |
$31K |
| 83735 |
|
31,463 |
26,029 |
$31K |
| 83540 |
|
9,792 |
9,697 |
$30K |
| 58558 |
|
24 |
24 |
$30K |
| 73610 |
|
3,043 |
2,935 |
$30K |
| 71271 |
|
511 |
511 |
$29K |
| 73030 |
|
2,569 |
2,476 |
$28K |
| 87653 |
|
1,743 |
1,724 |
$28K |
| 84403 |
|
1,923 |
1,911 |
$28K |
| 87631 |
|
7,603 |
7,481 |
$27K |
| 86592 |
|
9,832 |
9,790 |
$27K |
| 86769 |
|
1,473 |
1,470 |
$26K |
| 72125 |
|
2,422 |
2,390 |
$26K |
| 87428 |
|
688 |
684 |
$25K |
| 82670 |
|
1,592 |
1,587 |
$25K |
| 93017 |
|
1,888 |
1,866 |
$25K |
| G0279 |
Tomosynthesis, mammo |
2,052 |
2,048 |
$25K |
| 84153 |
|
2,891 |
2,880 |
$25K |
| 84460 |
|
10,243 |
9,892 |
$24K |
| 84450 |
|
10,758 |
10,399 |
$24K |
| 82565 |
|
10,181 |
9,891 |
$23K |
| 83001 |
|
2,268 |
2,264 |
$23K |
| 87186 |
|
4,976 |
4,895 |
$21K |
| 86696 |
|
1,921 |
1,912 |
$21K |
| 87077 |
|
4,732 |
4,641 |
$20K |
| 99396 |
|
285 |
283 |
$19K |
| 20610 |
|
143 |
136 |
$19K |
| 73110 |
|
1,704 |
1,666 |
$19K |
| 82043 |
|
6,670 |
6,643 |
$19K |
| 88184 |
|
231 |
230 |
$19K |
| 99406 |
|
1,255 |
1,243 |
$19K |
| 80069 |
|
8,656 |
6,653 |
$18K |
| 86038 |
|
3,266 |
3,249 |
$18K |
| 83021 |
|
2,101 |
2,097 |
$18K |
| 90746 |
|
268 |
268 |
$18K |
| 87070 |
|
4,429 |
4,360 |
$18K |
| 83002 |
|
1,759 |
1,754 |
$18K |
| 99395 |
|
258 |
257 |
$17K |
| 83970 |
|
829 |
810 |
$17K |
| J2506 |
Inj pegfilgrast ex bio 0.5mg |
37 |
26 |
$17K |
| 96523 |
|
537 |
393 |
$17K |
| 86762 |
|
2,404 |
2,397 |
$16K |
| 84146 |
|
1,471 |
1,464 |
$16K |
| Q5107 |
Inj mvasi 10 mg |
32 |
12 |
$15K |
| 86160 |
|
1,613 |
1,580 |
$15K |
| 97014 |
|
1,881 |
627 |
$15K |
| 87502 |
|
255 |
250 |
$15K |
| 72110 |
|
888 |
883 |
$15K |
| 73502 |
|
1,315 |
1,292 |
$15K |
| 82105 |
|
1,744 |
1,735 |
$14K |
| 80051 |
|
4,649 |
4,509 |
$14K |
| 86140 |
|
9,939 |
9,685 |
$14K |
| 83880 |
|
3,742 |
3,605 |
$14K |
| 86695 |
|
1,918 |
1,910 |
$14K |
| 90739 |
|
107 |
107 |
$13K |
| 86850 |
|
11,004 |
10,413 |
$13K |
| 84520 |
|
6,933 |
6,751 |
$13K |
| 86706 |
|
2,407 |
2,398 |
$13K |
| 76815 |
|
4,473 |
3,194 |
$13K |
| 86480 |
|
364 |
361 |
$12K |
| 74183 |
|
64 |
64 |
$12K |
| 84402 |
|
794 |
792 |
$11K |
| 87147 |
|
2,721 |
2,657 |
$11K |
| 81003 |
|
28,732 |
27,720 |
$11K |
| 86225 |
|
1,872 |
1,857 |
$10K |
| 64450 |
|
80 |
78 |
$10K |
| M0245 |
Bamlan and etesev infusion |
57 |
57 |
$10K |
| 88307 |
|
174 |
173 |
$10K |
| 76811 |
|
78 |
77 |
$10K |
| Q0111 |
Wet mounts/ w preparations |
392 |
383 |
$10K |
| 81514 |
|
56 |
56 |
$10K |
| 81001 |
|
29,687 |
28,324 |
$10K |
| 84550 |
|
4,889 |
4,752 |
$9K |
| 84100 |
|
15,487 |
14,052 |
$9K |
| 87426 |
|
420 |
415 |
$9K |
| 90671 |
|
60 |
60 |
$9K |
| 84478 |
|
714 |
700 |
$9K |
| 86003 |
|
170 |
169 |
$9K |
| 85652 |
|
8,226 |
8,072 |
$9K |
| 82784 |
|
1,031 |
1,018 |
$9K |
| 76377 |
|
1,124 |
1,104 |
$8K |
| 85610 |
|
18,562 |
17,141 |
$8K |
| 86200 |
|
1,540 |
1,531 |
$8K |
| 97530 |
|
846 |
397 |
$8K |
| 82570 |
|
3,938 |
3,822 |
$8K |
| 82550 |
|
6,395 |
6,008 |
$8K |
| 80076 |
|
6,271 |
6,010 |
$8K |
| 73590 |
|
1,299 |
1,272 |
$8K |
| 72170 |
|
1,250 |
1,239 |
$8K |
| 93798 |
|
167 |
26 |
$8K |
| G0475 |
Hiv combination assay |
599 |
596 |
$7K |
| 82248 |
|
12,321 |
11,324 |
$7K |
| 83690 |
|
16,944 |
15,964 |
$7K |
| 10061 |
|
36 |
36 |
$7K |
| 72141 |
|
50 |
50 |
$7K |
| 72100 |
|
315 |
312 |
$7K |
| 83013 |
|
214 |
214 |
$7K |
| 91322 |
|
51 |
50 |
$7K |
| 82950 |
|
2,757 |
2,734 |
$7K |
| J1750 |
Inj iron dextran |
254 |
111 |
$7K |
| 83655 |
|
1,022 |
1,021 |
$7K |
| 82040 |
|
3,363 |
3,197 |
$7K |
| 86787 |
|
1,015 |
1,010 |
$7K |
| 82977 |
|
2,133 |
2,075 |
$7K |
| 73564 |
|
1,240 |
1,230 |
$7K |
| 82247 |
|
2,943 |
2,413 |
$7K |
| 86431 |
|
2,378 |
2,371 |
$6K |
| 87634 |
|
123 |
121 |
$6K |
| 87529 |
|
242 |
242 |
$6K |
| 90734 |
|
202 |
196 |
$6K |
| 0241U |
|
1,307 |
1,286 |
$6K |
| 81025 |
|
15,266 |
14,815 |
$6K |
| 85730 |
|
15,398 |
14,491 |
$5K |
| 70551 |
|
49 |
49 |
$5K |
| 99495 |
|
82 |
82 |
$5K |
| G0008 |
Admin influenza virus vac |
761 |
754 |
$5K |
| 99385 |
|
74 |
74 |
$5K |
| 80305 |
|
1,118 |
1,097 |
$5K |
| 97116 |
|
633 |
345 |
$5K |
| 82150 |
|
2,224 |
2,149 |
$5K |
| 73090 |
|
793 |
763 |
$5K |
| 88304 |
|
1,763 |
1,746 |
$5K |
| 87632 |
|
65 |
65 |
$5K |
| 83615 |
|
2,189 |
2,052 |
$5K |
| 36430 |
|
29 |
24 |
$5K |
| 82627 |
|
328 |
327 |
$4K |
| 76870 |
|
269 |
267 |
$4K |
| 90656 |
|
235 |
234 |
$4K |
| 86704 |
|
651 |
647 |
$4K |
| 87205 |
|
2,327 |
2,268 |
$4K |
| 85046 |
|
1,927 |
1,836 |
$4K |
| 86901 |
|
10,659 |
10,076 |
$4K |
| 84075 |
|
1,547 |
1,416 |
$4K |
| 88342 |
|
344 |
338 |
$4K |
| 64415 |
|
79 |
78 |
$4K |
| 82785 |
|
428 |
401 |
$4K |
| M0239 |
Bamlanivimab-xxxx infusion |
34 |
34 |
$4K |
| 83516 |
|
500 |
497 |
$4K |
| M0243 |
Casirivi and imdevi inj |
13 |
13 |
$4K |
| 87880 |
|
4,049 |
4,005 |
$3K |
| 72131 |
|
75 |
75 |
$3K |
| 86162 |
|
311 |
309 |
$3K |
| 90480 |
|
68 |
67 |
$3K |
| 99393 |
|
37 |
37 |
$3K |
| 87536 |
|
53 |
53 |
$3K |
| 73140 |
|
211 |
205 |
$2K |
| 80050 |
|
464 |
462 |
$2K |
| 72197 |
|
12 |
12 |
$2K |
| 93880 |
|
26 |
26 |
$2K |
| 84156 |
|
1,690 |
1,579 |
$2K |
| 81002 |
|
1,521 |
1,513 |
$2K |
| 82533 |
|
381 |
360 |
$2K |
| 99394 |
|
33 |
33 |
$2K |
| 99496 |
|
36 |
36 |
$2K |
| 64400 |
|
15 |
14 |
$2K |
| 93225 |
|
39 |
39 |
$2K |
| 74178 |
|
12 |
12 |
$2K |
| 87109 |
|
296 |
291 |
$2K |
| 86039 |
|
363 |
362 |
$2K |
| 87075 |
|
644 |
626 |
$2K |
| 84155 |
|
1,124 |
995 |
$2K |
| 84165 |
|
373 |
369 |
$2K |
| 85379 |
|
5,260 |
5,146 |
$2K |
| 99392 |
|
24 |
24 |
$2K |
| 82652 |
|
111 |
111 |
$2K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
11,359 |
10,498 |
$2K |
| 72040 |
|
221 |
220 |
$2K |
| 93308 |
|
15 |
14 |
$2K |
| 76817 |
|
2,809 |
2,650 |
$2K |
| 99213 |
|
52 |
42 |
$1K |
| 76881 |
|
24 |
24 |
$1K |
| 86376 |
|
192 |
192 |
$1K |
| 94010 |
|
71 |
66 |
$1K |
| 96376 |
|
6,318 |
4,452 |
$1K |
| 84144 |
|
101 |
100 |
$1K |
| 76942 |
|
2,162 |
2,142 |
$1K |
| 77336 |
|
21 |
12 |
$1K |
| 73070 |
|
103 |
99 |
$1K |
| 87522 |
Neg quan hep c or qual rna |
57 |
55 |
$1K |
| 84484 |
|
16,876 |
13,491 |
$1K |
| 73080 |
|
176 |
173 |
$1K |
| 76818 |
|
18 |
12 |
$1K |
| 86360 |
|
43 |
43 |
$1K |
| G0297 |
Ldct for lung ca screen |
24 |
24 |
$1K |
| 86580 |
|
200 |
194 |
$1K |
| G0145 |
Scr c/v cyto,thinlayer,rescr |
73 |
73 |
$999.81 |
| 96127 |
|
157 |
154 |
$987.49 |
| 97035 |
|
186 |
72 |
$981.05 |
| 99214 |
|
16 |
14 |
$976.24 |
| 88142 |
|
90 |
90 |
$971.96 |
| 87210 |
|
2,348 |
2,291 |
$893.72 |
| 86147 |
|
25 |
25 |
$855.17 |
| 86359 |
|
43 |
43 |
$826.67 |
| J1050 |
Medroxyprogesterone acetate |
558 |
558 |
$813.12 |
| 88143 |
|
71 |
71 |
$810.58 |
| J1170 |
Hydromorphone injection |
4,953 |
3,932 |
$800.00 |
| 73560 |
|
212 |
210 |
$772.64 |
| 82310 |
|
384 |
381 |
$770.65 |
| 70498 |
|
26 |
26 |
$750.85 |
| 11721 |
|
54 |
54 |
$735.17 |
| 86705 |
|
132 |
131 |
$722.53 |
| C1729 |
Cath, drainage |
271 |
253 |
$700.00 |
| 77080 |
|
12 |
12 |
$660.80 |
| 94726 |
|
1,040 |
1,037 |
$638.36 |
| 83550 |
|
235 |
228 |
$636.31 |
| 73060 |
|
176 |
175 |
$622.72 |
| 84238 |
|
46 |
46 |
$587.18 |
| G0010 |
Admin hepatitis b vaccine |
40 |
40 |
$581.66 |
| 86146 |
|
25 |
25 |
$580.22 |
| 87808 |
|
507 |
494 |
$519.89 |
| 97163 |
|
12 |
12 |
$505.82 |
| 90662 |
|
40 |
39 |
$504.38 |
| 89051 |
|
188 |
181 |
$491.70 |
| U0002 |
Covid-19 lab test non-cdc |
31 |
31 |
$456.49 |
| 71101 |
|
134 |
132 |
$440.35 |
| 12001 |
|
713 |
708 |
$409.95 |
| 87040 |
|
2,066 |
1,871 |
$375.65 |
| 73120 |
|
18 |
12 |
$340.70 |
| 0003A |
|
13 |
13 |
$337.77 |
| 86923 |
|
68 |
65 |
$324.65 |
| 84134 |
|
71 |
66 |
$302.40 |
| 83605 |
|
10,411 |
9,358 |
$299.87 |
| 87804 |
|
64 |
59 |
$297.11 |
| 82465 |
|
99 |
99 |
$288.15 |
| 82140 |
|
901 |
821 |
$285.81 |
| 85018 |
|
437 |
409 |
$267.84 |
| 84703 |
|
8,765 |
8,430 |
$252.84 |
| 97012 |
|
43 |
12 |
$231.80 |
| 96377 |
|
79 |
57 |
$228.90 |
| 86364 |
|
39 |
39 |
$196.82 |
| 72070 |
|
27 |
27 |
$195.15 |
| 70496 |
|
12 |
12 |
$191.52 |
| 82378 |
|
29 |
26 |
$190.05 |
| 86308 |
|
823 |
815 |
$181.74 |
| 84145 |
|
745 |
724 |
$173.44 |
| 94760 |
|
3,064 |
1,901 |
$166.50 |
| 97535 |
|
34 |
26 |
$156.64 |
| 82044 |
|
72 |
71 |
$154.82 |
| G0009 |
Admin pneumococcal vaccine |
13 |
13 |
$145.17 |
| 82805 |
|
1,907 |
1,785 |
$145.03 |
| 82962 |
|
3,213 |
2,487 |
$128.79 |
| 80164 |
|
57 |
53 |
$128.35 |
| 82677 |
|
13 |
13 |
$112.50 |
| 12011 |
|
182 |
182 |
$110.05 |
| 29125 |
|
83 |
83 |
$107.98 |
| 86765 |
|
15 |
14 |
$94.90 |
| 73552 |
|
111 |
110 |
$92.91 |
| 12002 |
|
177 |
177 |
$89.46 |
| 83014 |
|
17 |
17 |
$87.14 |
| 82010 |
|
2,000 |
1,872 |
$86.51 |
| 85045 |
|
36 |
36 |
$84.70 |
| 82077 |
|
428 |
382 |
$81.07 |
| 86336 |
|
13 |
13 |
$72.51 |
| 83993 |
|
12 |
12 |
$69.40 |
| 94618 |
|
13 |
13 |
$64.79 |
| 84132 |
|
193 |
176 |
$56.67 |
| 70360 |
|
12 |
12 |
$48.33 |
| 83930 |
|
299 |
287 |
$45.27 |
| J2930 |
Methylprednisolone injection |
3,772 |
3,056 |
$38.33 |
| 90474 |
|
12 |
12 |
$36.00 |
| 98925 |
|
15 |
15 |
$31.88 |
| J1885 |
Ketorolac tromethamine inj |
34,806 |
32,142 |
$24.44 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
680 |
668 |
$23.68 |
| J1100 |
Dexamethasone sodium phos |
19,051 |
15,776 |
$22.36 |
| J2704 |
Inj, propofol, 10 mg |
13,141 |
12,833 |
$22.22 |
| J0696 |
Ceftriaxone sodium injection |
7,087 |
5,413 |
$21.26 |
| J1200 |
Diphenhydramine hcl injectio |
14,794 |
12,435 |
$19.45 |
| J2250 |
Inj midazolam hydrochloride |
7,779 |
6,869 |
$18.22 |
| J2405 |
Ondansetron hcl injection |
24,564 |
21,523 |
$17.60 |
| J3010 |
Fentanyl citrate injection |
11,382 |
9,575 |
$14.27 |
| J1790 |
Droperidol injection |
902 |
816 |
$13.41 |
| J0330 |
Succinycholine chloride inj |
1,839 |
1,801 |
$12.07 |
| 85014 |
|
25 |
25 |
$11.82 |
| J3480 |
Inj potassium chloride |
1,127 |
642 |
$10.62 |
| 80179 |
|
528 |
496 |
$10.20 |
| 80143 |
|
535 |
502 |
$10.20 |
| J1644 |
Inj heparin sodium per 1000u |
7,250 |
3,829 |
$7.04 |
| 88300 |
|
63 |
63 |
$6.39 |
| J2765 |
Metoclopramide hcl injection |
3,314 |
3,077 |
$5.55 |
| 85384 |
|
92 |
85 |
$5.23 |
| J1650 |
Inj enoxaparin sodium |
1,810 |
828 |
$2.29 |
| J0690 |
Cefazolin sodium injection |
5,825 |
5,018 |
$1.91 |
| J3475 |
Inj magnesium sulfate |
3,164 |
2,430 |
$1.68 |
| J1920 |
Inj, labetalol hcl, 5mg |
14 |
12 |
$0.20 |
| G1004 |
Cdsm ndsc |
1,178 |
1,122 |
$0.02 |
| 90714 |
|
2,149 |
2,144 |
$0.00 |
| C1713 |
Anchor/screw bn/bn,tis/bn |
124 |
123 |
$0.00 |
| J1953 |
Levetiracetam injection |
189 |
148 |
$0.00 |
| J2919 |
Inj, methylpred sod succ 5mg |
466 |
358 |
$0.00 |
| J1580 |
Garamycin gentamicin inj |
198 |
191 |
$0.00 |
| 90715 |
|
2,520 |
2,508 |
$0.00 |
| 94729 |
|
1,034 |
1,032 |
$0.00 |
| J0780 |
Prochlorperazine injection |
5,095 |
4,677 |
$0.00 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
120 |
90 |
$0.00 |
| J1596 |
Inj, glycopyrrolate, 0.1 mg |
214 |
213 |
$0.00 |
| J0640 |
Leucovorin calcium injection |
568 |
231 |
$0.00 |
| J2270 |
Morphine sulfate injection |
4,414 |
3,581 |
$0.00 |
| A9502 |
Tc99m tetrofosmin |
31 |
30 |
$0.00 |
| C9113 |
Inj pantoprazole sodium, via |
2,682 |
1,801 |
$0.00 |
| J2710 |
Neostigmine methylslfte inj |
1,792 |
1,768 |
$0.00 |
| J1756 |
Iron sucrose injection |
2,898 |
1,253 |
$0.00 |
| J7120 |
Ringers lactate infusion |
681 |
604 |
$0.00 |
| J9190 |
Fluorouracil injection |
1,228 |
372 |
$0.00 |
| J2004 |
Inj, lidocaine w epinephrine |
44 |
43 |
$0.00 |
| 90633 |
|
51 |
50 |
$0.00 |
| 99173 |
|
63 |
61 |
$0.00 |
| A9577 |
Inj multihance |
874 |
866 |
$0.00 |
| J0171 |
Adrenalin epinephrine inject |
979 |
962 |
$0.00 |
| J2550 |
Promethazine hcl injection |
50 |
45 |
$0.00 |
| J3301 |
Triamcinolone acet inj nos |
182 |
176 |
$0.00 |
| J7040 |
Normal saline solution infus |
459 |
407 |
$0.00 |
| J7030 |
Normal saline solution infus |
1,657 |
1,446 |
$0.00 |
| 58340 |
|
17 |
12 |
$0.00 |
| 3078F |
|
46 |
39 |
$0.00 |
| J3370 |
Vancomycin hcl injection |
296 |
163 |
$0.00 |
| A9552 |
F18 fdg |
12 |
12 |
$0.00 |
| G0498 |
Chemo extend iv infus w/pump |
16 |
12 |
$0.00 |
| 91300 |
|
84 |
82 |
$0.00 |
| 90707 |
|
12 |
12 |
$0.00 |
| J0295 |
Ampicillin sulbactam 1.5 gm |
88 |
51 |
$0.00 |
| J0736 |
Inj, clindamycin phosp 300mg |
42 |
30 |
$0.00 |
| Q0245 |
Bamlanivimab and etesevima |
100 |
57 |
$0.00 |
| J2272 |
Inj, morphine (fresenius) |
202 |
154 |
$0.00 |
| G0390 |
Trauma respons w/hosp criti |
12 |
12 |
$0.00 |
| J2800 |
Methocarbamol injection |
27 |
25 |
$0.00 |
| 76000 |
|
14 |
14 |
$0.00 |
| Q0239 |
Bamlanivimab-xxxx |
34 |
34 |
$0.00 |
| J2310 |
Inj naloxone hydrochloride |
19 |
14 |
$0.00 |
| J3420 |
Vitamin b12 injection |
2,483 |
1,943 |
$0.00 |
| J2370 |
Phenylephrine hcl injection |
2,486 |
2,244 |
$0.00 |
| J1630 |
Haloperidol injection |
6,614 |
6,238 |
$0.00 |
| J2795 |
Ropivacaine hcl injection |
1,199 |
1,186 |
$0.00 |
| J3360 |
Diazepam injection |
1,496 |
1,431 |
$0.00 |
| A9270 |
Non-covered item or service |
538 |
136 |
$0.00 |
| 96368 |
|
960 |
633 |
$0.00 |
| J2371 |
Inj phenylephrine hcl 20 mcg |
472 |
445 |
$0.00 |
| J2060 |
Lorazepam injection |
4,434 |
3,045 |
$0.00 |
| 97010 |
|
6,131 |
1,988 |
$0.00 |
| J2360 |
Orphenadrine injection |
75 |
75 |
$0.00 |
| A9585 |
Gadobutrol injection |
717 |
704 |
$0.00 |
| J3411 |
Thiamine hcl 100 mg |
353 |
280 |
$0.00 |
| 64488 |
|
160 |
159 |
$0.00 |
| 36416 |
|
59 |
57 |
$0.00 |
| J0360 |
Hydralazine hcl injection |
561 |
494 |
$0.00 |
| J2920 |
Methylprednisolone injection |
340 |
188 |
$0.00 |
| 94761 |
|
500 |
426 |
$0.00 |
| J2470 |
Inj pantoprazole sodium 40mg |
335 |
243 |
$0.00 |
| J7050 |
Normal saline solution infus |
1,571 |
852 |
$0.00 |
| J1642 |
Inj heparin sodium per 10 u |
1,011 |
600 |
$0.00 |
| 90632 |
|
162 |
161 |
$0.00 |
| J9045 |
Carboplatin injection |
266 |
170 |
$0.00 |
| 3074F |
|
120 |
108 |
$0.00 |
| J1030 |
Methylprednisolone 40 mg inj |
28 |
27 |
$0.00 |
| 91305 |
|
45 |
45 |
$0.00 |
| A9573 |
Inj, gadopiclenol, 1 ml |
223 |
221 |
$0.00 |
| J1836 |
Inj, metronidazole, 10 mg |
130 |
73 |
$0.00 |
| J7999 |
Compounded drug, noc |
229 |
220 |
$0.00 |
| A4648 |
Implantable tissue marker |
25 |
25 |
$0.00 |
| G0283 |
Elec stim other than wound |
1,006 |
315 |
$0.00 |
| J7060 |
5% dextrose/water |
347 |
143 |
$0.00 |
| J2003 |
Inj, lidocaine hcl, 1 mg |
377 |
348 |
$0.00 |
| J3490 |
Drugs unclassified injection |
549 |
527 |
$0.00 |
| 84270 |
|
26 |
25 |
$0.00 |
| J9267 |
Paclitaxel injection |
38 |
24 |
$0.00 |
| 90680 |
|
37 |
37 |
$0.00 |
| 90698 |
|
38 |
38 |
$0.00 |
| C1769 |
Guide wire |
127 |
125 |
$0.00 |
| C1781 |
Mesh (implantable) |
12 |
12 |
$0.00 |
| J1940 |
Furosemide injection |
15 |
12 |
$0.00 |
| J1010 |
Inj, methylpred acetate 1 mg |
13 |
12 |
$0.00 |
| 80320 |
|
18 |
12 |
$0.00 |
| J3410 |
Hydroxyzine hcl injection |
14 |
14 |
$0.00 |