| Code | Description | Claims | Beneficiaries | Total Paid |
| A0427 |
Als1-emergency |
33,081 |
29,266 |
$4.34M |
| 99284 |
|
23,116 |
22,200 |
$3.92M |
| A0429 |
Bls-emergency |
36,569 |
32,497 |
$3.86M |
| 74177 |
|
12,377 |
12,200 |
$3.41M |
| 99214 |
|
21,072 |
20,388 |
$2.95M |
| 99213 |
|
21,979 |
18,118 |
$2.72M |
| 70553 |
|
5,077 |
4,997 |
$2.63M |
| 99283 |
|
13,665 |
13,339 |
$2.59M |
| 99285 |
|
12,888 |
12,508 |
$2.24M |
| C1713 |
Anchor/screw bn/bn,tis/bn |
1,131 |
1,121 |
$2.11M |
| C1889 |
Implant/insert device, noc |
20,938 |
3,729 |
$2.11M |
| 77067 |
|
16,453 |
16,255 |
$1.96M |
| 78815 |
|
1,710 |
1,664 |
$1.87M |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
21,265 |
20,926 |
$1.67M |
| 73721 |
|
4,118 |
3,893 |
$1.53M |
| G0378 |
Hospital observation per hr |
2,335 |
1,728 |
$1.49M |
| 70551 |
|
3,865 |
3,782 |
$1.46M |
| 76641 |
|
12,047 |
10,865 |
$1.38M |
| 19083 |
|
1,093 |
1,049 |
$1.30M |
| 72148 |
|
3,530 |
3,502 |
$1.27M |
| 72197 |
|
2,673 |
2,602 |
$1.25M |
| 93975 |
|
2,927 |
2,844 |
$1.19M |
| 74183 |
|
2,463 |
2,425 |
$1.12M |
| A9585 |
Gadobutrol injection |
12,735 |
12,461 |
$1.06M |
| 76700 |
|
6,777 |
6,687 |
$928K |
| 70450 |
|
5,893 |
5,765 |
$899K |
| 95810 |
|
1,123 |
1,097 |
$888K |
| 71260 |
|
5,038 |
4,967 |
$873K |
| 52000 |
|
941 |
931 |
$867K |
| U0003 |
Cov-19 amp prb hgh thruput |
12,248 |
11,605 |
$837K |
| 72141 |
|
2,260 |
2,243 |
$767K |
| 76830 |
|
6,449 |
6,376 |
$765K |
| 71250 |
|
5,074 |
5,010 |
$712K |
| 80053 |
|
39,524 |
37,147 |
$675K |
| A9552 |
F18 fdg |
2,052 |
2,041 |
$670K |
| 77049 |
|
1,387 |
1,288 |
$670K |
| 73221 |
|
2,011 |
1,946 |
$642K |
| 74176 |
|
3,127 |
3,064 |
$629K |
| 76536 |
|
5,475 |
5,424 |
$604K |
| A0434 |
Specialty care transport |
2,334 |
2,202 |
$597K |
| A0425 |
Ground mileage |
72,599 |
62,623 |
$587K |
| 74178 |
|
1,489 |
1,466 |
$576K |
| 99282 |
|
3,045 |
3,011 |
$576K |
| 96361 |
|
2,948 |
2,871 |
$562K |
| 76856 |
|
4,355 |
4,332 |
$538K |
| 93454 |
|
304 |
292 |
$505K |
| 43239 |
|
1,006 |
1,004 |
$467K |
| 93970 |
|
1,754 |
1,732 |
$462K |
| A4648 |
Implantable tissue marker |
1,769 |
1,723 |
$447K |
| 77063 |
|
16,444 |
16,246 |
$440K |
| 71275 |
|
2,038 |
2,003 |
$439K |
| 77066 |
Tomosynthesis, mammo |
3,041 |
2,999 |
$413K |
| C1769 |
Guide wire |
3,012 |
2,925 |
$404K |
| 76770 |
|
2,493 |
2,454 |
$391K |
| 93306 |
|
2,142 |
2,068 |
$367K |
| 77065 |
Tomosynthesis, mammo |
3,710 |
3,390 |
$361K |
| C1887 |
Catheter, guiding |
1,868 |
1,816 |
$360K |
| 75574 |
|
1,442 |
1,419 |
$360K |
| 99212 |
|
3,923 |
3,182 |
$358K |
| 95806 |
|
600 |
583 |
$356K |
| 86850 |
|
13,956 |
12,201 |
$355K |
| 93458 |
|
177 |
172 |
$345K |
| 70491 |
|
1,681 |
1,640 |
$342K |
| 76642 |
|
4,128 |
4,014 |
$341K |
| 71046 |
|
11,375 |
11,140 |
$282K |
| 95782 |
|
285 |
276 |
$272K |
| 70486 |
|
1,911 |
1,895 |
$270K |
| 99203 |
|
2,201 |
2,179 |
$269K |
| 59025 |
|
1,466 |
1,267 |
$263K |
| 76775 |
|
3,560 |
3,518 |
$246K |
| 77080 |
|
3,409 |
3,373 |
$234K |
| 10005 |
|
635 |
625 |
$232K |
| 99396 |
|
1,776 |
1,757 |
$231K |
| 86901 |
|
13,619 |
11,839 |
$228K |
| 70498 |
|
1,243 |
1,232 |
$220K |
| 62323 |
|
473 |
444 |
$213K |
| 86900 |
|
14,120 |
12,312 |
$209K |
| 45380 |
|
302 |
302 |
$206K |
| 70544 |
|
841 |
828 |
$200K |
| 93971 |
|
1,770 |
1,749 |
$196K |
| 11042 |
|
521 |
407 |
$196K |
| 80048 |
|
11,763 |
10,864 |
$196K |
| 76705 |
|
3,026 |
2,981 |
$183K |
| U0005 |
Infec agen detec ampli probe |
9,642 |
9,275 |
$177K |
| D0120 |
|
3,438 |
2,003 |
$175K |
| 73700 |
|
1,109 |
1,061 |
$171K |
| G0279 |
Tomosynthesis, mammo |
4,564 |
4,504 |
$170K |
| 77085 |
|
785 |
771 |
$165K |
| A0428 |
Bls |
2,598 |
2,407 |
$162K |
| 96365 |
|
1,237 |
1,227 |
$161K |
| 96374 |
|
12,974 |
12,504 |
$160K |
| J0131 |
Inj, acetaminophen (nos) |
8,702 |
8,379 |
$155K |
| 87591 |
|
6,292 |
6,239 |
$154K |
| C1894 |
Intro/sheath, non-laser |
2,344 |
2,265 |
$153K |
| 71271 |
|
1,385 |
1,374 |
$152K |
| 96360 |
|
947 |
941 |
$150K |
| 86923 |
|
1,171 |
844 |
$146K |
| 36415 |
|
25,820 |
23,773 |
$143K |
| 99204 |
|
986 |
980 |
$142K |
| 88305 |
|
5,043 |
4,912 |
$141K |
| 51700 |
|
516 |
332 |
$141K |
| 72146 |
|
467 |
461 |
$138K |
| 70496 |
|
1,372 |
1,360 |
$136K |
| 99215 |
Prolong outpt/office vis |
807 |
798 |
$128K |
| P9016 |
Rbc leukocytes reduced |
105 |
88 |
$122K |
| 99395 |
|
941 |
939 |
$117K |
| 86922 |
|
1,138 |
786 |
$114K |
| 76000 |
|
1,560 |
1,535 |
$109K |
| 87491 |
|
6,308 |
6,259 |
$107K |
| 95800 |
|
561 |
515 |
$106K |
| C9803 |
Hopd covid-19 spec collect |
5,718 |
5,481 |
$106K |
| 82803 |
|
7,570 |
7,256 |
$104K |
| 76942 |
|
792 |
777 |
$96K |
| 86480 |
|
1,640 |
1,628 |
$96K |
| 76817 |
|
1,112 |
962 |
$95K |
| G0463 |
Hospital outpt clinic visit |
1,406 |
1,329 |
$95K |
| 95811 |
|
131 |
127 |
$93K |
| 78816 |
|
92 |
89 |
$91K |
| J3490 |
Drugs unclassified injection |
14,039 |
12,872 |
$85K |
| D1110 |
|
1,636 |
1,355 |
$84K |
| 80307 |
|
2,904 |
2,655 |
$83K |
| 93356 |
|
351 |
349 |
$79K |
| 96375 |
|
7,510 |
7,141 |
$78K |
| C9399 |
Unclassified drugs or biolog |
1,793 |
1,777 |
$75K |
| 86902 |
|
144 |
100 |
$74K |
| 76870 |
|
865 |
846 |
$73K |
| 74174 |
|
231 |
231 |
$72K |
| C8937 |
Cad breast mri |
1,144 |
1,136 |
$72K |
| 72156 |
|
200 |
197 |
$69K |
| 87624 |
|
2,962 |
2,950 |
$67K |
| 73130 |
|
1,933 |
1,814 |
$64K |
| 87536 |
|
1,429 |
1,407 |
$63K |
| 97161 |
|
807 |
795 |
$63K |
| 90715 |
|
2,299 |
2,286 |
$62K |
| 51797 |
|
237 |
229 |
$62K |
| 72125 |
|
1,339 |
1,311 |
$61K |
| C9290 |
Inj, bupivacaine liposome |
250 |
250 |
$60K |
| 72100 |
|
1,684 |
1,674 |
$59K |
| 73718 |
|
169 |
153 |
$57K |
| 88185 |
|
239 |
223 |
$57K |
| 73030 |
|
1,940 |
1,874 |
$55K |
| 72110 |
|
1,018 |
1,005 |
$55K |
| 87641 |
|
1,907 |
1,893 |
$49K |
| 73630 |
|
2,062 |
1,941 |
$48K |
| 83880 |
|
2,664 |
2,613 |
$47K |
| D0140 |
|
1,320 |
1,004 |
$46K |
| 72157 |
|
115 |
109 |
$46K |
| 86360 |
|
1,218 |
1,208 |
$46K |
| 96372 |
|
2,801 |
2,503 |
$46K |
| 90834 |
|
318 |
274 |
$44K |
| 73562 |
|
1,603 |
1,537 |
$43K |
| 81420 |
|
174 |
170 |
$42K |
| 93880 |
|
170 |
169 |
$42K |
| 76882 |
|
1,070 |
1,019 |
$41K |
| 88321 |
|
269 |
265 |
$41K |
| 72158 |
|
113 |
109 |
$40K |
| 75561 |
|
49 |
49 |
$39K |
| 0241U |
|
3,881 |
3,791 |
$38K |
| 77072 |
|
1,160 |
1,142 |
$38K |
| 88271 |
|
179 |
119 |
$38K |
| 76816 |
|
472 |
420 |
$38K |
| 0225U |
|
3,467 |
3,392 |
$38K |
| 76377 |
|
1,286 |
1,243 |
$38K |
| A0426 |
Als 1 |
551 |
527 |
$37K |
| 93017 |
|
616 |
614 |
$37K |
| 87635 |
|
1,915 |
1,881 |
$37K |
| 93308 |
|
287 |
259 |
$35K |
| 85027 |
|
23,518 |
22,162 |
$34K |
| 78306 |
|
146 |
145 |
$34K |
| 80061 |
|
3,553 |
3,499 |
$33K |
| 72131 |
|
309 |
300 |
$33K |
| 88307 |
|
546 |
514 |
$33K |
| 70480 |
|
191 |
190 |
$33K |
| J7030 |
Normal saline solution infus |
11,043 |
10,476 |
$33K |
| 70543 |
|
77 |
76 |
$32K |
| 74018 |
|
1,060 |
1,022 |
$32K |
| 76376 |
|
905 |
840 |
$32K |
| 64483 |
|
56 |
54 |
$31K |
| 99202 |
|
261 |
260 |
$31K |
| 83020 |
|
1,326 |
1,102 |
$31K |
| 73110 |
|
1,103 |
1,060 |
$31K |
| J2704 |
Inj, propofol, 10 mg |
7,824 |
7,705 |
$30K |
| 93005 |
|
17,164 |
16,053 |
$30K |
| 66984 |
|
14 |
13 |
$29K |
| 87389 |
|
3,267 |
3,246 |
$29K |
| 88175 |
|
1,037 |
1,035 |
$29K |
| 71045 |
|
6,636 |
6,463 |
$28K |
| G0297 |
Ldct for lung ca screen |
192 |
192 |
$28K |
| 73610 |
|
1,472 |
1,413 |
$28K |
| 88237 |
|
155 |
98 |
$27K |
| 85610 |
|
10,043 |
9,284 |
$27K |
| D7140 |
|
309 |
218 |
$27K |
| 45385 |
|
39 |
39 |
$26K |
| 88304 |
|
1,118 |
1,098 |
$26K |
| 19281 |
|
25 |
25 |
$26K |
| 76937 |
|
221 |
210 |
$25K |
| 76818 |
|
300 |
174 |
$25K |
| G0008 |
Admin influenza virus vac |
1,640 |
1,637 |
$24K |
| 90651 |
|
92 |
92 |
$24K |
| 96376 |
|
1,768 |
1,580 |
$24K |
| 73564 |
|
793 |
762 |
$24K |
| G0108 |
Diab manage trn per indiv |
829 |
478 |
$22K |
| 90471 |
|
3,383 |
3,265 |
$22K |
| 86359 |
|
1,169 |
1,160 |
$22K |
| 72040 |
|
649 |
647 |
$22K |
| 19081 |
|
13 |
13 |
$21K |
| M0239 |
Bamlanivimab-xxxx infusion |
104 |
104 |
$20K |
| 88173 |
|
716 |
684 |
$20K |
| 99386 |
|
156 |
156 |
$20K |
| 36000 |
|
886 |
867 |
$20K |
| 90688 |
|
1,063 |
1,061 |
$19K |
| C1760 |
Closure dev, vasc |
53 |
53 |
$19K |
| 73502 |
|
708 |
701 |
$19K |
| 87800 |
|
928 |
920 |
$19K |
| 82306 |
|
980 |
972 |
$18K |
| 87798 |
|
741 |
736 |
$18K |
| 87653 |
|
578 |
575 |
$17K |
| 81025 |
|
6,670 |
6,558 |
$17K |
| 86769 |
|
784 |
778 |
$17K |
| 88275 |
|
175 |
116 |
$17K |
| 82565 |
|
2,498 |
2,482 |
$16K |
| 88172 |
|
323 |
316 |
$15K |
| 86780 |
|
3,774 |
3,742 |
$15K |
| J7120 |
Ringers lactate infusion |
5,159 |
4,970 |
$15K |
| 99291 |
|
84 |
82 |
$14K |
| Q9966 |
Locm 200-299mg/ml iodine,1ml |
117 |
111 |
$14K |
| 36224 |
|
27 |
26 |
$14K |
| 76498 |
|
318 |
276 |
$14K |
| 84702 |
|
7,612 |
7,089 |
$14K |
| D0274 |
|
369 |
237 |
$13K |
| 51784 |
|
170 |
165 |
$13K |
| 87086 |
|
10,877 |
10,419 |
$13K |
| C1874 |
Stent, coated/cov w/del sys |
12 |
12 |
$13K |
| 99385 |
|
105 |
105 |
$13K |
| 81003 |
|
9,441 |
7,337 |
$12K |
| 84443 |
|
4,491 |
4,434 |
$12K |
| 72070 |
|
298 |
297 |
$11K |
| 85025 |
|
22,541 |
21,204 |
$11K |
| D2392 |
|
123 |
96 |
$11K |
| 83036 |
|
7,092 |
7,047 |
$11K |
| 74160 |
|
63 |
63 |
$11K |
| 12001 |
|
27 |
27 |
$11K |
| 86703 |
|
1,083 |
1,069 |
$10K |
| J2250 |
Inj midazolam hydrochloride |
7,094 |
6,988 |
$10K |
| 20611 |
|
15 |
15 |
$10K |
| 55700 |
|
12 |
12 |
$10K |
| 78830 |
|
27 |
27 |
$9K |
| J0690 |
Cefazolin sodium injection |
3,789 |
3,563 |
$9K |
| J1885 |
Ketorolac tromethamine inj |
6,541 |
6,233 |
$9K |
| 87631 |
|
251 |
249 |
$9K |
| 86803 |
|
1,778 |
1,772 |
$9K |
| M0243 |
Casirivi and imdevi inj |
41 |
41 |
$9K |
| J2405 |
Ondansetron hcl injection |
9,983 |
9,625 |
$9K |
| 49083 |
|
18 |
13 |
$9K |
| C8929 |
Tte w or wo fol wcon,doppler |
14 |
14 |
$9K |
| 86353 |
|
199 |
198 |
$9K |
| A0433 |
Als 2 |
59 |
56 |
$9K |
| C9600 |
Perc drug-el cor stent sing |
12 |
12 |
$9K |
| 99281 |
|
50 |
50 |
$8K |
| A9500 |
Tc99m sestamibi |
52 |
52 |
$8K |
| J1170 |
Hydromorphone injection |
2,100 |
2,014 |
$8K |
| J2270 |
Morphine sulfate injection |
1,938 |
1,804 |
$8K |
| D0150 |
|
180 |
148 |
$8K |
| 78452 |
|
25 |
25 |
$8K |
| T1013 |
Sign lang/oral interpreter |
638 |
610 |
$8K |
| 94640 |
|
1,755 |
1,543 |
$8K |
| 81513 |
|
133 |
132 |
$7K |
| A9561 |
Tc99m oxidronate |
134 |
134 |
$7K |
| J3010 |
Fentanyl citrate injection |
6,878 |
6,759 |
$7K |
| D0220 |
|
484 |
447 |
$7K |
| 87633 |
|
156 |
155 |
$7K |
| 83690 |
|
7,903 |
7,634 |
$7K |
| 82330 |
|
6,281 |
6,000 |
$7K |
| 90732 |
|
127 |
126 |
$7K |
| 88184 |
|
202 |
194 |
$6K |
| 77001 |
|
28 |
27 |
$6K |
| 83655 |
|
482 |
479 |
$6K |
| 82962 |
|
6,640 |
5,817 |
$6K |
| 99205 |
Prolong outpt/office vis |
39 |
39 |
$6K |
| 88312 |
|
193 |
192 |
$6K |
| 87340 |
|
1,814 |
1,808 |
$6K |
| 90656 |
|
374 |
373 |
$6K |
| J1644 |
Inj heparin sodium per 1000u |
1,848 |
1,509 |
$6K |
| 72195 |
|
12 |
12 |
$6K |
| D0330 |
|
157 |
147 |
$6K |
| 73120 |
|
120 |
100 |
$5K |
| 12011 |
|
13 |
13 |
$5K |
| 87481 |
|
133 |
132 |
$5K |
| 85730 |
|
8,125 |
7,865 |
$5K |
| J1100 |
Dexamethasone sodium phos |
5,244 |
5,066 |
$5K |
| 86762 |
|
577 |
574 |
$5K |
| Q3014 |
Telehealth facility fee |
209 |
203 |
$5K |
| 88341 |
|
179 |
176 |
$5K |
| 86765 |
|
618 |
616 |
$5K |
| D2391 |
|
67 |
52 |
$5K |
| 87640 |
|
1,800 |
1,783 |
$5K |
| J2765 |
Metoclopramide hcl injection |
3,781 |
3,686 |
$5K |
| 86481 |
|
116 |
115 |
$5K |
| 73590 |
|
367 |
357 |
$5K |
| 81001 |
|
11,760 |
11,325 |
$4K |
| 76801 |
|
53 |
50 |
$4K |
| 87651 |
|
333 |
330 |
$4K |
| J2001 |
Lidocaine injection |
3,431 |
3,400 |
$4K |
| J2370 |
Phenylephrine hcl injection |
1,182 |
1,165 |
$4K |
| C1758 |
Catheter, ureteral |
89 |
87 |
$4K |
| 87661 |
|
163 |
161 |
$3K |
| 81220 |
|
38 |
38 |
$3K |
| J7040 |
Normal saline solution infus |
1,311 |
1,281 |
$3K |
| 90686 |
|
160 |
160 |
$3K |
| 88360 |
|
53 |
52 |
$3K |
| J0330 |
Succinycholine chloride inj |
399 |
398 |
$3K |
| 82677 |
|
277 |
269 |
$3K |
| 83615 |
|
1,160 |
947 |
$3K |
| 88342 |
|
107 |
106 |
$3K |
| 83605 |
|
6,946 |
6,626 |
$3K |
| J7050 |
Normal saline solution infus |
954 |
874 |
$3K |
| 84484 |
|
7,252 |
6,779 |
$3K |
| 76881 |
|
30 |
25 |
$3K |
| G0009 |
Admin pneumococcal vaccine |
212 |
211 |
$3K |
| J0696 |
Ceftriaxone sodium injection |
1,126 |
1,089 |
$3K |
| 76815 |
|
25 |
24 |
$3K |
| 58300 |
|
15 |
14 |
$3K |
| 86880 |
|
220 |
196 |
$2K |
| 73080 |
|
120 |
114 |
$2K |
| 86870 |
|
99 |
85 |
$2K |
| 87581 |
|
195 |
194 |
$2K |
| 87486 |
|
195 |
194 |
$2K |
| 73560 |
|
88 |
82 |
$2K |
| 83735 |
|
5,698 |
5,480 |
$2K |
| 81002 |
|
1,527 |
1,246 |
$2K |
| 82947 |
|
6,801 |
6,507 |
$2K |
| 84295 |
|
6,798 |
6,509 |
$2K |
| 90682 |
|
41 |
41 |
$2K |
| 82435 |
|
6,788 |
6,499 |
$2K |
| Q9957 |
Inj perflutren lip micros,ml |
15 |
13 |
$2K |
| 82950 |
|
717 |
716 |
$2K |
| 96366 |
|
13 |
12 |
$2K |
| 95004 |
|
26 |
26 |
$2K |
| 88313 |
|
38 |
38 |
$2K |
| 87186 |
|
1,502 |
1,469 |
$2K |
| 82105 |
|
344 |
337 |
$2K |
| 73200 |
|
12 |
12 |
$2K |
| 84550 |
|
605 |
509 |
$2K |
| 82570 |
|
618 |
567 |
$2K |
| 86336 |
|
389 |
316 |
$2K |
| C1725 |
Cath, translumin non-laser |
14 |
14 |
$2K |
| 88300 |
|
246 |
239 |
$1K |
| 84704 |
|
213 |
204 |
$1K |
| 84156 |
|
706 |
625 |
$1K |
| 82607 |
|
247 |
246 |
$1K |
| 76805 |
|
14 |
14 |
$1K |
| 72050 |
|
25 |
25 |
$1K |
| 90649 |
|
15 |
15 |
$1K |
| 87077 |
|
888 |
867 |
$1K |
| 82728 |
|
322 |
315 |
$1K |
| G0101 |
Ca screen;pelvic/breast exam |
13 |
13 |
$1K |
| 84439 |
|
308 |
305 |
$1K |
| 72082 |
|
14 |
13 |
$1K |
| 87205 |
|
858 |
759 |
$1K |
| 99152 |
|
529 |
513 |
$1K |
| 86140 |
|
1,392 |
1,357 |
$1K |
| 84100 |
|
2,611 |
2,537 |
$1K |
| 97165 |
|
12 |
12 |
$971.11 |
| D0210 |
|
50 |
49 |
$969.10 |
| 73090 |
|
89 |
83 |
$771.01 |
| 85379 |
|
1,897 |
1,872 |
$762.64 |
| 81329 |
|
13 |
13 |
$739.80 |
| 87070 |
|
671 |
620 |
$738.05 |
| 81243 |
|
27 |
27 |
$729.38 |
| 73521 |
|
30 |
27 |
$709.23 |
| 97802 |
|
66 |
64 |
$675.35 |
| 86706 |
|
118 |
117 |
$664.60 |
| J1200 |
Diphenhydramine hcl injectio |
731 |
689 |
$662.16 |
| 87040 |
|
1,581 |
1,527 |
$626.43 |
| 73620 |
|
41 |
38 |
$615.36 |
| J2371 |
Inj phenylephrine hcl 20 mcg |
553 |
551 |
$610.69 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
468 |
421 |
$497.65 |
| 84132 |
|
6,962 |
6,663 |
$455.80 |
| J1040 |
Methylprednisolone 80 mg inj |
28 |
26 |
$445.43 |
| 85652 |
|
1,173 |
1,145 |
$437.20 |
| J2060 |
Lorazepam injection |
214 |
193 |
$430.52 |
| 73522 |
|
15 |
15 |
$413.40 |
| 82550 |
|
1,020 |
986 |
$386.46 |
| Q0091 |
Obtaining screen pap smear |
363 |
363 |
$347.59 |
| J3475 |
Inj magnesium sulfate |
66 |
63 |
$313.41 |
| 95117 |
|
20 |
12 |
$286.44 |
| C9113 |
Inj pantoprazole sodium, via |
97 |
96 |
$277.37 |
| 73140 |
|
27 |
26 |
$253.79 |
| J1580 |
Garamycin gentamicin inj |
124 |
82 |
$250.45 |
| 93321 |
|
20 |
15 |
$234.08 |
| 85384 |
|
60 |
52 |
$231.58 |
| 84145 |
|
257 |
248 |
$230.60 |
| 85014 |
|
6,871 |
6,578 |
$228.44 |
| 72170 |
|
51 |
50 |
$222.26 |
| J1650 |
Inj enoxaparin sodium |
37 |
36 |
$188.44 |
| 71100 |
|
12 |
12 |
$181.82 |
| 74019 |
|
26 |
26 |
$176.17 |
| J1596 |
Inj, glycopyrrolate, 0.1 mg |
102 |
102 |
$162.52 |
| 82746 |
|
29 |
29 |
$154.90 |
| 82043 |
|
28 |
28 |
$112.99 |
| 95165 |
|
20 |
12 |
$98.20 |
| 83550 |
|
77 |
76 |
$98.14 |
| 85018 |
|
5,908 |
5,661 |
$89.35 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
43 |
43 |
$87.93 |
| J2003 |
Inj, lidocaine hcl, 1 mg |
90 |
90 |
$84.14 |
| J2919 |
Inj, methylpred sod succ 5mg |
12 |
12 |
$80.16 |
| 80076 |
|
14 |
14 |
$65.20 |
| J2543 |
Piperacillin/tazobactam |
13 |
13 |
$63.50 |
| 87081 |
|
111 |
111 |
$59.97 |
| 84157 |
|
70 |
51 |
$55.99 |
| 83540 |
|
44 |
43 |
$55.33 |
| 82945 |
|
69 |
50 |
$55.01 |
| 87880 |
|
111 |
111 |
$45.79 |
| J7060 |
5% dextrose/water |
26 |
25 |
$45.13 |
| 89051 |
|
111 |
83 |
$36.70 |
| A0888 |
Noncovered ambulance mileage |
715 |
676 |
$36.22 |
| J2710 |
Neostigmine methylslfte inj |
12 |
12 |
$32.46 |
| 84480 |
|
24 |
24 |
$25.64 |
| 99153 |
Mod sedat endo service >5yrs |
59 |
54 |
$25.33 |
| J1050 |
Medroxyprogesterone acetate |
15 |
15 |
$22.01 |
| 82365 |
|
26 |
24 |
$21.61 |
| 86592 |
|
14 |
13 |
$19.62 |
| 84436 |
|
38 |
38 |
$11.40 |
| 82553 |
|
12 |
12 |
$0.00 |
| 87625 |
|
27 |
27 |
$0.00 |
| 99429 |
|
55 |
39 |
$0.00 |
| 99080 |
|
1,956 |
368 |
$0.00 |
| 82010 |
|
26 |
24 |
$0.00 |