| Code | Description | Claims | Beneficiaries | Total Paid |
| 99284 |
|
55,781 |
53,515 |
$6.03M |
| G0378 |
Hospital observation per hr |
4,325 |
4,158 |
$3.22M |
| 99283 |
|
37,621 |
36,134 |
$2.96M |
| 99285 |
|
12,137 |
11,440 |
$1.37M |
| 93306 |
|
5,836 |
5,724 |
$834K |
| U0003 |
Cov-19 amp prb hgh thruput |
6,087 |
5,902 |
$489K |
| 74177 |
|
2,190 |
2,110 |
$429K |
| 80053 |
|
38,746 |
35,267 |
$415K |
| 85025 |
|
68,017 |
62,534 |
$345K |
| 96374 |
|
13,344 |
11,811 |
$334K |
| 87536 |
|
2,566 |
2,502 |
$292K |
| 93005 |
|
26,158 |
24,231 |
$272K |
| 87491 |
|
10,024 |
9,261 |
$270K |
| U0002 |
Covid-19 lab test non-cdc |
9,778 |
9,279 |
$266K |
| 80061 |
|
18,041 |
17,700 |
$258K |
| X0620 |
|
1,145 |
1,123 |
$252K |
| 80048 |
|
33,227 |
28,853 |
$247K |
| 87591 |
|
9,152 |
8,402 |
$240K |
| 99282 |
|
5,146 |
4,958 |
$215K |
| 96372 |
|
16,398 |
13,739 |
$202K |
| 87661 |
|
5,029 |
4,859 |
$198K |
| 80050 |
|
4,125 |
4,050 |
$187K |
| 96413 |
|
1,920 |
1,153 |
$184K |
| 93303 |
|
1,467 |
1,420 |
$174K |
| 70450 |
|
2,636 |
2,528 |
$173K |
| 95810 |
|
454 |
445 |
$172K |
| 80307 |
|
3,813 |
3,436 |
$169K |
| 71046 |
|
11,216 |
10,800 |
$163K |
| 70553 |
|
571 |
565 |
$157K |
| 77067 |
|
1,858 |
1,834 |
$156K |
| 78815 |
|
155 |
154 |
$147K |
| 84443 |
|
6,205 |
6,006 |
$140K |
| 71275 |
|
845 |
820 |
$132K |
| G0480 |
Drug test def 1-7 classes |
2,264 |
2,087 |
$122K |
| 99281 |
|
5,171 |
4,866 |
$118K |
| J9271 |
Inj pembrolizumab |
568 |
446 |
$117K |
| 0241U |
|
2,441 |
2,371 |
$115K |
| 82306 |
|
3,450 |
3,353 |
$114K |
| 74176 |
|
1,121 |
1,076 |
$110K |
| 70551 |
|
539 |
512 |
$105K |
| J1439 |
Inj ferric carboxymaltos 1mg |
1,834 |
1,223 |
$102K |
| 78452 |
|
590 |
578 |
$100K |
| 88175 |
|
2,920 |
2,880 |
$96K |
| 95811 |
|
199 |
192 |
$94K |
| 76830 |
|
1,850 |
1,794 |
$94K |
| 96375 |
|
6,821 |
5,304 |
$93K |
| T1015 |
Clinic service |
1,959 |
1,254 |
$84K |
| 72148 |
|
441 |
425 |
$81K |
| 87633 |
|
172 |
170 |
$78K |
| 96365 |
|
2,639 |
1,929 |
$76K |
| 83036 |
|
10,980 |
10,727 |
$76K |
| 84484 |
|
10,430 |
8,993 |
$75K |
| 76817 |
|
1,208 |
1,097 |
$71K |
| 87389 |
|
2,382 |
2,315 |
$70K |
| 80081 |
|
710 |
696 |
$67K |
| 93971 |
|
1,065 |
1,009 |
$67K |
| 86803 |
|
3,247 |
3,178 |
$66K |
| 96361 |
|
6,003 |
4,709 |
$65K |
| 73721 |
|
254 |
249 |
$65K |
| 93320 |
|
1,501 |
1,450 |
$64K |
| 87624 |
|
1,525 |
1,489 |
$63K |
| 85027 |
|
9,955 |
7,781 |
$59K |
| 76705 |
|
1,597 |
1,547 |
$58K |
| 86480 |
|
786 |
756 |
$57K |
| 72141 |
|
213 |
206 |
$52K |
| 88305 |
|
3,014 |
2,833 |
$51K |
| 76801 |
|
1,113 |
1,081 |
$50K |
| 87086 |
|
6,200 |
5,864 |
$50K |
| 93970 |
|
530 |
520 |
$49K |
| 81001 |
|
17,939 |
16,908 |
$48K |
| 83735 |
|
9,765 |
7,340 |
$47K |
| 93976 |
|
832 |
801 |
$46K |
| J2785 |
Regadenoson injection |
1,161 |
1,121 |
$46K |
| 72125 |
|
596 |
581 |
$45K |
| 76700 |
|
744 |
732 |
$44K |
| 71250 |
|
654 |
638 |
$44K |
| 76857 |
|
1,626 |
1,573 |
$44K |
| 93017 |
|
1,002 |
979 |
$44K |
| 74183 |
|
113 |
111 |
$43K |
| J0897 |
Denosumab injection |
381 |
364 |
$43K |
| 76536 |
|
816 |
805 |
$42K |
| G0463 |
Hospital outpt clinic visit |
2,515 |
2,090 |
$42K |
| 71045 |
|
5,302 |
5,008 |
$41K |
| 86361 |
|
1,287 |
1,251 |
$41K |
| 83880 |
|
1,866 |
1,691 |
$40K |
| 93325 |
|
1,280 |
1,241 |
$40K |
| 88312 |
|
719 |
694 |
$38K |
| M0243 |
Casirivi and imdevi inj |
110 |
98 |
$38K |
| 84702 |
|
2,320 |
1,918 |
$37K |
| 77066 |
Tomosynthesis, mammo |
417 |
409 |
$37K |
| 96360 |
|
1,266 |
1,075 |
$35K |
| 71260 |
|
438 |
424 |
$34K |
| 77063 |
|
1,444 |
1,424 |
$33K |
| 97597 |
|
1,472 |
896 |
$32K |
| X0621 |
|
141 |
118 |
$29K |
| 76642 |
|
676 |
660 |
$29K |
| 83690 |
|
6,805 |
6,305 |
$29K |
| J1750 |
Inj iron dextran |
219 |
109 |
$28K |
| 87150 |
|
653 |
632 |
$28K |
| 93798 |
|
612 |
101 |
$28K |
| 84439 |
|
3,419 |
3,316 |
$28K |
| 82607 |
|
2,136 |
2,089 |
$27K |
| 96417 |
|
468 |
292 |
$27K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
11,095 |
10,195 |
$26K |
| 77065 |
Tomosynthesis, mammo |
374 |
357 |
$26K |
| 70486 |
|
313 |
309 |
$26K |
| 74174 |
|
84 |
81 |
$25K |
| G0399 |
Home sleep test/type 3 porta |
91 |
88 |
$24K |
| 72100 |
|
998 |
978 |
$23K |
| 82728 |
|
1,843 |
1,792 |
$23K |
| 76816 |
|
440 |
408 |
$22K |
| G0108 |
Diab manage trn per indiv |
775 |
698 |
$22K |
| 76770 |
|
559 |
537 |
$22K |
| C9803 |
Hopd covid-19 spec collect |
5,583 |
5,324 |
$22K |
| 93880 |
|
299 |
291 |
$21K |
| 43239 |
|
87 |
84 |
$19K |
| 84703 |
|
2,122 |
2,020 |
$19K |
| 73564 |
|
802 |
723 |
$19K |
| 73221 |
|
82 |
78 |
$19K |
| 76805 |
|
337 |
332 |
$19K |
| J1756 |
Iron sucrose injection |
3,999 |
1,609 |
$19K |
| 83605 |
|
2,882 |
2,631 |
$19K |
| 82570 |
|
2,628 |
2,550 |
$19K |
| A9585 |
Gadobutrol injection |
2,607 |
2,505 |
$18K |
| 70496 |
|
155 |
143 |
$18K |
| 93925 |
|
230 |
224 |
$18K |
| 73610 |
|
886 |
844 |
$18K |
| 86592 |
|
3,998 |
3,886 |
$18K |
| 73030 |
|
991 |
933 |
$17K |
| 87481 |
|
366 |
241 |
$17K |
| 70498 |
|
141 |
133 |
$17K |
| 87522 |
Neg quan hep c or qual rna |
400 |
368 |
$17K |
| 96366 |
|
749 |
580 |
$17K |
| 80076 |
|
2,204 |
2,090 |
$17K |
| 82043 |
|
2,007 |
1,967 |
$16K |
| 70491 |
|
183 |
180 |
$16K |
| 86003 |
|
222 |
164 |
$16K |
| 96415 |
|
418 |
281 |
$16K |
| 83970 |
|
395 |
382 |
$16K |
| 83540 |
|
1,889 |
1,834 |
$15K |
| 73630 |
|
1,087 |
1,023 |
$15K |
| 85610 |
|
4,430 |
3,262 |
$15K |
| 73130 |
|
897 |
834 |
$14K |
| C1713 |
Anchor/screw bn/bn,tis/bn |
67 |
66 |
$13K |
| 96376 |
|
2,171 |
1,480 |
$13K |
| 86900 |
|
1,701 |
1,561 |
$13K |
| 84403 |
|
415 |
406 |
$13K |
| G0279 |
Tomosynthesis, mammo |
670 |
659 |
$13K |
| 76870 |
|
280 |
267 |
$13K |
| 87186 |
|
1,430 |
1,367 |
$13K |
| 87340 |
|
836 |
817 |
$12K |
| 84481 |
|
519 |
488 |
$12K |
| 87081 |
|
1,442 |
1,396 |
$11K |
| 86235 |
|
304 |
252 |
$11K |
| J7307 |
Etonogestrel implant system |
14 |
14 |
$11K |
| 77080 |
|
208 |
208 |
$11K |
| 87077 |
|
1,407 |
1,347 |
$11K |
| Q9957 |
Inj perflutren lip micros,ml |
630 |
601 |
$11K |
| 74018 |
|
735 |
681 |
$11K |
| 86696 |
|
436 |
423 |
$11K |
| 12001 |
|
318 |
312 |
$11K |
| 73502 |
|
552 |
533 |
$10K |
| 86140 |
|
3,327 |
2,914 |
$10K |
| 87799 |
|
186 |
176 |
$10K |
| 80074 |
|
193 |
186 |
$10K |
| 83550 |
|
1,745 |
1,693 |
$9K |
| 86695 |
|
442 |
432 |
$9K |
| 96367 |
|
507 |
372 |
$9K |
| 86038 |
|
574 |
553 |
$9K |
| 93922 |
|
280 |
273 |
$9K |
| 86618 |
|
367 |
356 |
$9K |
| 93975 |
|
71 |
71 |
$8K |
| 85652 |
|
2,898 |
2,534 |
$8K |
| 58661 |
|
13 |
12 |
$8K |
| 73560 |
|
456 |
421 |
$8K |
| 86850 |
|
1,122 |
1,060 |
$8K |
| 72110 |
|
352 |
339 |
$8K |
| 87040 |
|
701 |
634 |
$8K |
| 90715 |
|
1,518 |
1,494 |
$8K |
| 73110 |
|
571 |
540 |
$8K |
| 84146 |
|
300 |
291 |
$8K |
| 73700 |
|
89 |
86 |
$8K |
| 82784 |
|
460 |
442 |
$8K |
| 85730 |
|
1,266 |
1,194 |
$7K |
| 93350 |
|
74 |
74 |
$7K |
| 86901 |
|
1,685 |
1,547 |
$7K |
| 82746 |
|
597 |
584 |
$7K |
| M0247 |
Sotrovimab infusion |
31 |
31 |
$7K |
| 72040 |
|
434 |
421 |
$7K |
| 85379 |
|
773 |
750 |
$7K |
| 36430 |
|
95 |
70 |
$7K |
| 86317 |
|
319 |
312 |
$7K |
| 80164 |
|
378 |
349 |
$7K |
| Q9966 |
Locm 200-299mg/ml iodine,1ml |
1,622 |
1,582 |
$7K |
| 73590 |
|
387 |
364 |
$7K |
| 97802 |
|
319 |
315 |
$7K |
| 87486 |
|
171 |
169 |
$7K |
| 87625 |
|
165 |
162 |
$7K |
| 94640 |
|
178 |
86 |
$7K |
| 73562 |
|
355 |
319 |
$6K |
| 74178 |
|
30 |
30 |
$6K |
| 84100 |
|
1,485 |
1,196 |
$6K |
| 73090 |
|
381 |
358 |
$6K |
| 72072 |
|
271 |
263 |
$6K |
| 72050 |
|
207 |
201 |
$6K |
| 76856 |
|
116 |
113 |
$6K |
| 83001 |
|
293 |
288 |
$6K |
| 78264 |
|
54 |
54 |
$6K |
| 82550 |
|
831 |
704 |
$6K |
| 82950 |
|
749 |
734 |
$5K |
| 82565 |
|
831 |
780 |
$5K |
| 83655 |
|
446 |
438 |
$5K |
| 12011 |
|
146 |
145 |
$5K |
| 87070 |
|
830 |
799 |
$5K |
| 74022 |
|
209 |
193 |
$5K |
| 10061 |
|
92 |
90 |
$5K |
| 84153 |
|
205 |
202 |
$5K |
| 84550 |
|
818 |
765 |
$5K |
| 72197 |
|
12 |
12 |
$5K |
| A9502 |
Tc99m tetrofosmin |
468 |
459 |
$5K |
| 87660 |
|
203 |
202 |
$5K |
| 83615 |
|
630 |
572 |
$4K |
| J3490 |
Drugs unclassified injection |
7,106 |
5,444 |
$4K |
| J2469 |
Palonosetron hcl |
1,654 |
1,046 |
$4K |
| J1885 |
Ketorolac tromethamine inj |
21,360 |
18,631 |
$4K |
| 36415 |
|
3,363 |
2,262 |
$4K |
| 12002 |
|
99 |
99 |
$4K |
| 86200 |
|
264 |
256 |
$4K |
| 83002 |
|
203 |
200 |
$4K |
| 71271 |
|
72 |
72 |
$4K |
| 84460 |
|
518 |
468 |
$4K |
| 87902 |
|
15 |
12 |
$4K |
| 73070 |
|
238 |
224 |
$4K |
| 86431 |
|
457 |
442 |
$4K |
| 83525 |
|
287 |
280 |
$4K |
| 72156 |
|
12 |
12 |
$4K |
| 84450 |
|
500 |
453 |
$4K |
| 73140 |
|
262 |
250 |
$3K |
| 90471 |
|
528 |
506 |
$3K |
| 87502 |
|
25 |
25 |
$3K |
| 96368 |
|
204 |
151 |
$3K |
| 82803 |
|
217 |
204 |
$3K |
| 36591 |
|
354 |
248 |
$3K |
| 96401 |
|
123 |
95 |
$3K |
| 87512 |
|
124 |
119 |
$3K |
| 94729 |
|
70 |
69 |
$3K |
| 81003 |
|
926 |
899 |
$3K |
| 86704 |
|
203 |
194 |
$3K |
| 86800 |
|
147 |
142 |
$3K |
| C1769 |
Guide wire |
167 |
162 |
$3K |
| 87798 |
|
38 |
36 |
$3K |
| 83516 |
|
385 |
375 |
$3K |
| 99000 |
|
572 |
554 |
$3K |
| 96523 |
|
168 |
143 |
$3K |
| 82951 |
|
181 |
179 |
$3K |
| 86832 |
|
30 |
28 |
$3K |
| 73120 |
|
175 |
147 |
$3K |
| 87205 |
|
642 |
615 |
$3K |
| 87147 |
|
637 |
617 |
$2K |
| 86833 |
|
30 |
28 |
$2K |
| J3489 |
Zoledronic acid 1mg |
207 |
199 |
$2K |
| 84156 |
|
639 |
597 |
$2K |
| 82947 |
|
537 |
528 |
$2K |
| 80202 |
|
116 |
50 |
$2K |
| 85660 |
|
470 |
360 |
$2K |
| 73620 |
|
175 |
163 |
$2K |
| G0103 |
Psa screening |
326 |
318 |
$2K |
| 80069 |
|
233 |
206 |
$2K |
| J2270 |
Morphine sulfate injection |
4,045 |
3,050 |
$2K |
| 88304 |
|
301 |
296 |
$2K |
| 82248 |
|
337 |
279 |
$2K |
| J1100 |
Dexamethasone sodium phos |
9,048 |
6,749 |
$2K |
| J0696 |
Ceftriaxone sodium injection |
3,835 |
2,963 |
$2K |
| 80197 |
|
188 |
140 |
$2K |
| 82247 |
|
277 |
196 |
$2K |
| 97161 |
|
222 |
199 |
$2K |
| 73552 |
|
117 |
110 |
$2K |
| 82977 |
|
191 |
173 |
$2K |
| J1815 |
Insulin injection |
202 |
113 |
$2K |
| 97803 |
|
144 |
135 |
$2K |
| 73080 |
|
124 |
118 |
$2K |
| 80143 |
|
143 |
135 |
$2K |
| 76882 |
|
135 |
132 |
$2K |
| 75574 |
|
12 |
12 |
$2K |
| 73060 |
|
130 |
126 |
$2K |
| 86160 |
|
56 |
55 |
$2K |
| J3475 |
Inj magnesium sulfate |
3,455 |
2,317 |
$2K |
| 97165 |
|
199 |
186 |
$2K |
| 71101 |
|
84 |
84 |
$2K |
| J0780 |
Prochlorperazine injection |
1,576 |
1,442 |
$2K |
| 86376 |
|
162 |
157 |
$2K |
| 82670 |
|
71 |
71 |
$2K |
| J2930 |
Methylprednisolone injection |
1,017 |
819 |
$2K |
| P9016 |
Rbc leukocytes reduced |
47 |
38 |
$2K |
| J2704 |
Inj, propofol, 10 mg |
3,355 |
2,551 |
$2K |
| 86304 |
|
86 |
75 |
$2K |
| 87880 |
|
172 |
167 |
$1K |
| 80178 |
|
182 |
167 |
$1K |
| 82785 |
|
81 |
80 |
$1K |
| J9045 |
Carboplatin injection |
530 |
357 |
$1K |
| 82533 |
|
110 |
101 |
$1K |
| 80179 |
|
130 |
125 |
$1K |
| 36569 |
|
13 |
13 |
$1K |
| 86708 |
|
91 |
86 |
$1K |
| C1819 |
Tissue localization-excision |
12 |
12 |
$1K |
| 87581 |
|
148 |
146 |
$1K |
| 94727 |
|
42 |
42 |
$1K |
| 86258 |
|
79 |
73 |
$1K |
| 72170 |
|
109 |
107 |
$1K |
| 73200 |
|
16 |
16 |
$1K |
| 82150 |
|
245 |
238 |
$1K |
| 88342 |
|
42 |
41 |
$1K |
| 84270 |
|
45 |
42 |
$1K |
| 77334 |
|
15 |
14 |
$1K |
| 84165 |
|
89 |
86 |
$1K |
| 82105 |
|
58 |
57 |
$1K |
| J0690 |
Cefazolin sodium injection |
1,810 |
1,246 |
$1K |
| J9267 |
Paclitaxel injection |
254 |
133 |
$1K |
| 77336 |
|
20 |
12 |
$1K |
| 82140 |
|
187 |
154 |
$1K |
| J2405 |
Ondansetron hcl injection |
11,962 |
9,167 |
$1K |
| 84520 |
|
222 |
213 |
$1K |
| 87493 |
|
41 |
41 |
$1K |
| 82172 |
|
56 |
56 |
$1K |
| J1170 |
Hydromorphone injection |
1,827 |
1,269 |
$1K |
| 82310 |
|
156 |
148 |
$1K |
| 86923 |
|
32 |
29 |
$1K |
| 96402 |
|
30 |
28 |
$1K |
| 81513 |
|
59 |
57 |
$1K |
| 73100 |
|
78 |
73 |
$1K |
| J3010 |
Fentanyl citrate injection |
4,520 |
3,324 |
$999.06 |
| 94010 |
|
79 |
79 |
$983.47 |
| 81596 |
|
13 |
13 |
$983.45 |
| 84132 |
|
261 |
239 |
$953.44 |
| 82010 |
|
236 |
216 |
$928.27 |
| 85018 |
|
436 |
382 |
$903.61 |
| C1887 |
Catheter, guiding |
26 |
25 |
$840.03 |
| 85014 |
|
423 |
371 |
$837.69 |
| Q0162 |
Ondansetron oral |
10,215 |
9,537 |
$836.88 |
| 86780 |
|
45 |
42 |
$750.08 |
| 84402 |
|
24 |
24 |
$726.41 |
| 87075 |
|
96 |
93 |
$715.08 |
| S9470 |
Nutritional counseling, diet |
17 |
17 |
$700.67 |
| 82024 |
|
17 |
14 |
$678.00 |
| J1200 |
Diphenhydramine hcl injectio |
4,900 |
3,703 |
$664.11 |
| 87088 |
|
89 |
89 |
$660.26 |
| 86705 |
|
37 |
37 |
$653.50 |
| 82952 |
|
167 |
165 |
$644.33 |
| 86787 |
|
36 |
34 |
$639.98 |
| 59025 |
|
13 |
12 |
$639.94 |
| J1040 |
Methylprednisolone 80 mg inj |
117 |
111 |
$626.60 |
| C1894 |
Intro/sheath, non-laser |
90 |
86 |
$623.61 |
| 87563 |
|
31 |
30 |
$605.27 |
| 87807 |
|
41 |
41 |
$597.60 |
| 93308 |
|
34 |
30 |
$596.10 |
| 64400 |
|
28 |
27 |
$593.81 |
| 83721 |
|
46 |
46 |
$576.33 |
| 86762 |
|
25 |
25 |
$548.95 |
| J1630 |
Haloperidol injection |
1,130 |
893 |
$514.67 |
| J1030 |
Methylprednisolone 40 mg inj |
415 |
400 |
$498.01 |
| J0500 |
Dicyclomine injection |
26 |
24 |
$490.31 |
| J3420 |
Vitamin b12 injection |
2,462 |
1,948 |
$461.45 |
| 84155 |
|
125 |
115 |
$457.64 |
| J2765 |
Metoclopramide hcl injection |
2,102 |
1,809 |
$449.68 |
| J2060 |
Lorazepam injection |
2,256 |
1,781 |
$419.31 |
| J1642 |
Inj heparin sodium per 10 u |
3,901 |
2,155 |
$415.08 |
| 86039 |
|
25 |
25 |
$413.46 |
| 85384 |
|
39 |
38 |
$387.43 |
| J1644 |
Inj heparin sodium per 1000u |
1,506 |
878 |
$382.83 |
| 87209 |
|
13 |
13 |
$360.20 |
| 82627 |
|
14 |
14 |
$352.56 |
| J2710 |
Neostigmine methylslfte inj |
297 |
194 |
$351.84 |
| A9552 |
F18 fdg |
27 |
27 |
$340.84 |
| 84305 |
|
12 |
12 |
$332.33 |
| J1650 |
Inj enoxaparin sodium |
1,230 |
629 |
$331.39 |
| 84145 |
|
58 |
52 |
$329.94 |
| 82272 |
|
126 |
122 |
$308.64 |
| 72081 |
|
13 |
13 |
$308.62 |
| 87045 |
|
44 |
44 |
$308.24 |
| 83498 |
|
12 |
12 |
$307.18 |
| 72070 |
|
12 |
12 |
$298.40 |
| J2550 |
Promethazine hcl injection |
385 |
309 |
$291.12 |
| 80299 |
|
14 |
13 |
$290.43 |
| 82040 |
|
84 |
80 |
$285.84 |
| 87046 |
|
44 |
44 |
$284.35 |
| 85044 |
|
79 |
72 |
$276.98 |
| J7512 |
Prednisone ir or dr oral 1mg |
2,903 |
2,421 |
$257.16 |
| J3480 |
Inj potassium chloride |
1,129 |
671 |
$254.05 |
| 73660 |
|
13 |
13 |
$216.28 |
| 86308 |
|
29 |
29 |
$208.82 |
| J2250 |
Inj midazolam hydrochloride |
3,657 |
3,102 |
$207.25 |
| 80177 |
|
15 |
12 |
$195.99 |
| 36416 |
|
254 |
201 |
$183.65 |
| 81025 |
|
111 |
105 |
$178.90 |
| 83695 |
|
12 |
12 |
$165.68 |
| 97162 |
|
30 |
28 |
$165.16 |
| 87899 |
|
12 |
12 |
$140.68 |
| 87177 |
|
13 |
13 |
$136.92 |
| 95819 |
|
12 |
12 |
$132.30 |
| 84436 |
|
13 |
13 |
$129.20 |
| 93356 |
|
37 |
35 |
$128.49 |
| A9503 |
Tc99m medronate |
39 |
39 |
$116.18 |
| 86593 |
|
14 |
14 |
$93.20 |
| J3370 |
Vancomycin hcl injection |
65 |
41 |
$92.84 |
| J7510 |
Prednisolone oral per 5 mg |
471 |
450 |
$76.44 |
| 73600 |
|
13 |
13 |
$72.95 |
| Q0163 |
Diphenhydramine hcl 50mg |
1,017 |
806 |
$71.48 |
| 89051 |
|
13 |
13 |
$69.76 |
| 81002 |
|
15 |
13 |
$58.97 |
| J7611 |
Albuterol non-comp con |
14 |
14 |
$46.61 |
| 88307 |
|
15 |
15 |
$25.30 |
| 97166 |
|
14 |
12 |
$18.29 |
| A4215 |
Sterile needle |
47 |
44 |
$17.82 |
| J0360 |
Hydralazine hcl injection |
19 |
12 |
$17.70 |
| J7620 |
Albuterol ipratrop non-comp |
119 |
98 |
$15.66 |
| A9270 |
Non-covered item or service |
268 |
169 |
$4.95 |
| J8540 |
Oral dexamethasone |
166 |
116 |
$4.80 |
| J2916 |
Na ferric gluconate complex |
750 |
311 |
$0.00 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
501 |
474 |
$0.00 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
43 |
34 |
$0.00 |
| J1453 |
Fosaprepitant injection |
255 |
177 |
$0.00 |
| J2919 |
Inj, methylpred sod succ 5mg |
252 |
206 |
$0.00 |
| J3301 |
Triamcinolone acet inj nos |
670 |
649 |
$0.00 |
| J9263 |
Oxaliplatin |
54 |
26 |
$0.00 |
| J0640 |
Leucovorin calcium injection |
78 |
38 |
$0.00 |
| J1569 |
Gammagard liquid injection |
23 |
12 |
$0.00 |
| J1437 |
Inj. fe derisomaltose 10 mg |
15 |
13 |
$0.00 |
| J9217 |
Leuprolide acetate suspnsion |
12 |
12 |
$0.00 |
| J9190 |
Fluorouracil injection |
26 |
12 |
$0.00 |
| Q5108 |
Injection, fulphila |
201 |
148 |
$0.00 |
| Q5121 |
Inj. avsola, 10 mg |
120 |
80 |
$0.00 |
| J0185 |
Inj., aprepitant, 1 mg |
585 |
388 |
$0.00 |
| Q5120 |
Inj pegfilgrastim-bmez 0.5mg |
56 |
39 |
$0.00 |
| A9573 |
Inj, gadopiclenol, 1 ml |
367 |
356 |
$0.00 |
| J1790 |
Droperidol injection |
125 |
110 |
$0.00 |