| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 0450 |
|
174,462 |
153,882 |
$7.32M |
| 0202U |
|
7,323 |
7,172 |
$2.14M |
| 97110 |
|
34,184 |
14,037 |
$2.12M |
| 99283 |
|
33,961 |
31,188 |
$1.95M |
| 70450 |
|
18,605 |
18,020 |
$1.88M |
| 74177 |
|
12,017 |
11,624 |
$1.84M |
| Z7502 |
|
47,923 |
47,435 |
$1.80M |
| 92507 |
|
22,146 |
9,325 |
$1.40M |
| J3490 |
Drugs unclassified injection |
60,524 |
33,297 |
$1.06M |
| 0241U |
|
8,709 |
8,351 |
$990K |
| 0360 |
|
10,092 |
5,809 |
$911K |
| 93005 |
|
42,765 |
39,720 |
$879K |
| 80053 |
|
80,084 |
73,172 |
$875K |
| S3620 |
Newborn metabolic screening |
3,899 |
3,405 |
$734K |
| Z9725 |
|
15,405 |
15,349 |
$663K |
| 85027 |
|
98,940 |
89,083 |
$610K |
| 78815 |
|
653 |
614 |
$593K |
| U0002 |
Covid-19 lab test non-cdc |
13,923 |
12,725 |
$579K |
| 99221 |
|
4,145 |
3,769 |
$575K |
| 70551 |
|
2,650 |
2,590 |
$559K |
| 72125 |
|
4,432 |
4,332 |
$556K |
| 0949 |
|
17,278 |
12,169 |
$538K |
| 99285 |
|
2,516 |
2,384 |
$527K |
| J9271 |
Inj pembrolizumab |
135 |
52 |
$514K |
| 74176 |
|
6,300 |
6,160 |
$514K |
| 76805 |
|
7,928 |
7,740 |
$505K |
| G0463 |
Hospital outpt clinic visit |
15,094 |
10,790 |
$496K |
| 76705 |
|
10,689 |
10,433 |
$458K |
| 99499 |
|
3,919 |
3,166 |
$449K |
| G0480 |
Drug test def 1-7 classes |
8,831 |
8,107 |
$431K |
| 96374 |
|
11,064 |
10,337 |
$431K |
| 99199 |
|
10,486 |
9,303 |
$426K |
| 80307 |
|
10,220 |
9,637 |
$417K |
| 77067 |
|
8,015 |
7,974 |
$413K |
| 93975 |
|
2,939 |
2,849 |
$407K |
| 71045 |
|
38,707 |
36,702 |
$404K |
| 96372 |
|
19,787 |
18,482 |
$392K |
| 71260 |
|
2,612 |
2,561 |
$391K |
| 99284 |
|
4,297 |
4,029 |
$388K |
| 99070 |
|
47,950 |
26,483 |
$366K |
| J0131 |
Inj, acetaminophen (nos) |
1,487 |
1,368 |
$366K |
| 70553 |
|
1,101 |
1,082 |
$363K |
| 99281 |
|
9,954 |
8,723 |
$362K |
| 71046 |
|
22,647 |
22,078 |
$361K |
| C9803 |
Hopd covid-19 spec collect |
18,386 |
17,143 |
$354K |
| 80048 |
|
37,162 |
34,784 |
$340K |
| Z7500 |
|
9,955 |
6,185 |
$338K |
| 97763 |
|
4,156 |
1,963 |
$334K |
| 97139 |
|
8,994 |
2,976 |
$328K |
| 96365 |
|
6,353 |
5,570 |
$315K |
| 76830 |
|
7,831 |
7,697 |
$312K |
| 99234 |
|
9,065 |
6,342 |
$308K |
| 59025 |
|
15,135 |
12,028 |
$307K |
| 72148 |
|
1,847 |
1,818 |
$307K |
| 73721 |
|
1,909 |
1,748 |
$304K |
| 76856 |
|
8,298 |
8,181 |
$304K |
| 96375 |
|
11,394 |
9,615 |
$295K |
| 76801 |
|
6,736 |
5,899 |
$283K |
| Q3014 |
Telehealth facility fee |
11,952 |
7,636 |
$280K |
| 71275 |
|
1,912 |
1,874 |
$270K |
| 93306 |
|
1,969 |
1,917 |
$269K |
| 95810 |
|
1,154 |
1,142 |
$268K |
| 84484 |
|
29,029 |
25,220 |
$263K |
| 36415 |
|
41,372 |
35,819 |
$255K |
| 76817 |
|
5,952 |
5,256 |
$253K |
| 97161 |
|
5,404 |
5,223 |
$244K |
| 93971 |
|
3,111 |
3,029 |
$239K |
| 0750 |
|
2,373 |
1,777 |
$234K |
| 83690 |
|
33,288 |
31,285 |
$209K |
| 96360 |
|
4,726 |
4,569 |
$205K |
| 96361 |
|
10,116 |
8,918 |
$201K |
| 85025 |
|
32,666 |
29,180 |
$196K |
| 87086 |
|
27,276 |
25,766 |
$187K |
| 92523 |
|
2,129 |
2,078 |
$183K |
| 88305 |
|
4,790 |
4,685 |
$177K |
| 0710 |
|
7,741 |
7,501 |
$175K |
| Z4300 |
|
1,666 |
1,621 |
$172K |
| 97799 |
|
2,991 |
1,475 |
$165K |
| 70496 |
|
1,154 |
1,133 |
$165K |
| Z7610 |
|
16,389 |
11,539 |
$165K |
| 93970 |
|
1,288 |
1,268 |
$158K |
| 0250 |
|
25,531 |
18,287 |
$156K |
| 76641 |
|
3,743 |
3,055 |
$156K |
| 84702 |
|
12,234 |
11,215 |
$150K |
| 94640 |
|
8,565 |
7,803 |
$150K |
| 93976 |
|
1,332 |
1,315 |
$150K |
| 97802 |
|
1,956 |
1,947 |
$149K |
| 0270 |
|
23,689 |
14,764 |
$148K |
| 83880 |
|
8,187 |
7,613 |
$145K |
| 0762 |
|
3,086 |
2,946 |
$140K |
| 96413 |
|
4,328 |
2,639 |
$139K |
| 70498 |
|
1,228 |
1,207 |
$139K |
| Q5118 |
Inj., zirabev, 10 mg |
92 |
37 |
$139K |
| 72141 |
|
831 |
819 |
$137K |
| 81003 |
|
54,730 |
51,522 |
$137K |
| 99231 |
|
2,713 |
2,365 |
$135K |
| 71250 |
|
1,451 |
1,430 |
$135K |
| 0301 |
|
2,890 |
2,623 |
$128K |
| 76700 |
|
3,977 |
3,936 |
$125K |
| 95811 |
|
544 |
541 |
$124K |
| 96367 |
|
3,282 |
2,333 |
$118K |
| 70486 |
|
1,206 |
1,185 |
$118K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
17,354 |
16,720 |
$116K |
| 96112 |
|
739 |
536 |
$114K |
| 83605 |
|
11,632 |
10,385 |
$112K |
| 76770 |
|
2,629 |
2,596 |
$111K |
| 73630 |
|
7,198 |
6,162 |
$109K |
| P9016 |
Rbc leukocytes reduced |
492 |
439 |
$107K |
| 82948 |
|
17,504 |
12,905 |
$101K |
| 72100 |
|
4,812 |
4,752 |
$100K |
| 77063 |
|
8,002 |
7,961 |
$99K |
| 77066 |
Tomosynthesis, mammo |
1,555 |
1,547 |
$97K |
| 73030 |
|
5,818 |
5,242 |
$97K |
| A9552 |
F18 fdg |
566 |
566 |
$95K |
| J7030 |
Normal saline solution infus |
19,157 |
16,936 |
$93K |
| 73130 |
|
5,223 |
4,726 |
$91K |
| Q0162 |
Ondansetron oral |
18,828 |
17,739 |
$91K |
| 99291 |
|
235 |
232 |
$89K |
| 99238 |
|
2,984 |
2,954 |
$89K |
| 99218 |
|
628 |
622 |
$88K |
| 73562 |
|
5,327 |
4,648 |
$88K |
| 73610 |
|
4,957 |
4,547 |
$86K |
| J1100 |
Dexamethasone sodium phos |
14,323 |
12,524 |
$86K |
| 85730 |
|
15,924 |
15,119 |
$86K |
| G0378 |
Hospital observation per hr |
1,238 |
1,203 |
$81K |
| 96366 |
|
2,074 |
1,651 |
$80K |
| 86901 |
|
15,579 |
13,789 |
$77K |
| 84145 |
|
5,488 |
5,225 |
$77K |
| 0637 |
|
9,849 |
6,527 |
$71K |
| 93798 |
|
4,225 |
806 |
$71K |
| 77336 |
|
664 |
277 |
$70K |
| 73221 |
|
473 |
445 |
$70K |
| 84703 |
|
9,194 |
8,898 |
$69K |
| 90715 |
|
2,533 |
2,495 |
$66K |
| 85610 |
|
18,045 |
16,994 |
$65K |
| 86850 |
|
9,050 |
8,719 |
$63K |
| 81025 |
|
12,578 |
12,184 |
$63K |
| J2001 |
Lidocaine injection |
4,491 |
4,319 |
$63K |
| 87040 |
|
5,079 |
3,824 |
$61K |
| J2405 |
Ondansetron hcl injection |
17,099 |
14,317 |
$61K |
| 87077 |
|
10,123 |
9,593 |
$61K |
| 85004 |
|
27,273 |
24,844 |
$60K |
| J1885 |
Ketorolac tromethamine inj |
17,203 |
16,121 |
$60K |
| 87631 |
|
1,265 |
1,208 |
$59K |
| 96417 |
|
1,895 |
1,244 |
$58K |
| 87635 |
|
1,322 |
1,274 |
$57K |
| 87502 |
|
1,285 |
1,235 |
$56K |
| 86900 |
|
15,540 |
13,774 |
$56K |
| 99232 |
|
879 |
875 |
$56K |
| 72040 |
|
2,873 |
2,844 |
$56K |
| 87491 |
|
1,786 |
1,733 |
$56K |
| 73110 |
|
3,065 |
2,911 |
$55K |
| 0760 |
|
1,835 |
1,457 |
$54K |
| 73502 |
|
2,617 |
2,550 |
$50K |
| 84443 |
|
3,435 |
3,310 |
$49K |
| 83036 |
|
6,282 |
6,048 |
$49K |
| 81001 |
|
12,883 |
12,074 |
$49K |
| 87591 |
|
1,477 |
1,441 |
$47K |
| 76536 |
|
1,809 |
1,799 |
$47K |
| 76870 |
|
1,313 |
1,284 |
$45K |
| J0696 |
Ceftriaxone sodium injection |
6,383 |
5,540 |
$44K |
| S0020 |
Injection, bupivicaine hydro |
2,364 |
2,183 |
$42K |
| 73560 |
|
3,755 |
2,807 |
$42K |
| 97010 |
|
2,107 |
875 |
$41K |
| 87653 |
|
1,713 |
1,667 |
$41K |
| 0121 |
|
12 |
12 |
$40K |
| J1815 |
Insulin injection |
2,149 |
1,490 |
$39K |
| 83735 |
|
6,745 |
5,868 |
$39K |
| Q5114 |
Inj ogivri 10 mg |
23 |
13 |
$39K |
| 97165 |
|
791 |
775 |
$39K |
| 43239 |
|
1,159 |
1,144 |
$39K |
| 96110 |
|
398 |
396 |
$38K |
| 73590 |
|
2,253 |
2,145 |
$37K |
| 86140 |
|
6,803 |
6,545 |
$34K |
| 74022 |
|
1,164 |
1,139 |
$34K |
| 96415 |
|
1,285 |
901 |
$33K |
| 87186 |
|
4,645 |
4,481 |
$32K |
| 74018 |
|
2,230 |
2,162 |
$31K |
| 86923 |
|
470 |
448 |
$30K |
| 73070 |
|
1,825 |
1,675 |
$29K |
| 88304 |
|
1,723 |
1,702 |
$29K |
| 87651 |
|
803 |
797 |
$29K |
| J2270 |
Morphine sulfate injection |
5,671 |
4,788 |
$29K |
| 73564 |
|
1,941 |
1,563 |
$29K |
| 73090 |
|
1,785 |
1,684 |
$28K |
| 77334 |
|
32 |
27 |
$27K |
| 72110 |
|
1,292 |
1,282 |
$26K |
| J1953 |
Levetiracetam injection |
624 |
376 |
$26K |
| 0257 |
|
5,763 |
4,863 |
$25K |
| 0510 |
|
919 |
851 |
$24K |
| 96111 |
|
223 |
219 |
$24K |
| 99282 |
|
674 |
616 |
$24K |
| 0160 |
|
696 |
651 |
$24K |
| 96376 |
|
1,117 |
1,034 |
$24K |
| 12001 |
|
920 |
910 |
$23K |
| 97113 |
|
679 |
195 |
$23K |
| G0279 |
Tomosynthesis, mammo |
1,762 |
1,746 |
$22K |
| 97530 |
|
1,376 |
471 |
$22K |
| 71101 |
|
744 |
727 |
$21K |
| 82550 |
|
3,224 |
3,002 |
$21K |
| 82803 |
|
1,496 |
1,407 |
$21K |
| 99152 |
|
733 |
725 |
$21K |
| J3010 |
Fentanyl citrate injection |
3,367 |
3,192 |
$21K |
| 72070 |
|
1,098 |
1,090 |
$20K |
| 85378 |
|
2,902 |
2,829 |
$19K |
| 0272 |
|
1,827 |
1,687 |
$19K |
| 87081 |
|
2,806 |
2,683 |
$18K |
| 81015 |
|
10,760 |
10,204 |
$17K |
| 0682 |
|
78 |
75 |
$17K |
| 73552 |
|
984 |
941 |
$17K |
| 84100 |
|
4,251 |
3,817 |
$17K |
| J0640 |
Leucovorin calcium injection |
242 |
117 |
$16K |
| 45378 |
|
292 |
291 |
$16K |
| 99217 |
|
551 |
549 |
$15K |
| 82010 |
|
2,038 |
1,907 |
$15K |
| 73080 |
|
827 |
778 |
$14K |
| 0761 |
|
327 |
239 |
$14K |
| 82375 |
|
1,495 |
1,406 |
$14K |
| J1642 |
Inj heparin sodium per 10 u |
2,989 |
1,708 |
$14K |
| 80061 |
|
1,641 |
1,561 |
$14K |
| 0214 |
|
45 |
42 |
$13K |
| 73100 |
|
1,097 |
945 |
$13K |
| M0239 |
Bamlanivimab-xxxx infusion |
55 |
54 |
$13K |
| Z4302 |
|
1,053 |
1,047 |
$13K |
| 85384 |
|
1,236 |
1,092 |
$13K |
| J1750 |
Inj iron dextran |
63 |
58 |
$12K |
| 99224 |
|
199 |
199 |
$12K |
| 87184 |
|
1,876 |
1,834 |
$12K |
| J2704 |
Inj, propofol, 10 mg |
1,451 |
1,411 |
$11K |
| J1453 |
Fosaprepitant injection |
542 |
277 |
$11K |
| Z4307 |
|
450 |
449 |
$11K |
| 73060 |
|
728 |
694 |
$11K |
| J2916 |
Na ferric gluconate complex |
277 |
109 |
$11K |
| J7050 |
Normal saline solution infus |
4,790 |
3,108 |
$11K |
| 73600 |
|
673 |
573 |
$11K |
| 88307 |
|
260 |
256 |
$10K |
| J1200 |
Diphenhydramine hcl injectio |
4,309 |
3,375 |
$10K |
| J2250 |
Inj midazolam hydrochloride |
2,513 |
2,420 |
$10K |
| J1170 |
Hydromorphone injection |
1,582 |
1,272 |
$10K |
| 12011 |
|
597 |
580 |
$10K |
| 72170 |
|
626 |
613 |
$10K |
| 97140 |
|
1,204 |
485 |
$10K |
| 94060 |
|
287 |
287 |
$10K |
| 82553 |
|
740 |
654 |
$10K |
| 99215 |
Prolong outpt/office vis |
184 |
157 |
$9K |
| J7120 |
Ringers lactate infusion |
1,616 |
1,347 |
$9K |
| 77290 |
|
32 |
28 |
$9K |
| 77080 |
|
701 |
699 |
$9K |
| 86592 |
|
1,838 |
1,790 |
$9K |
| 85007 |
|
4,655 |
4,411 |
$9K |
| 73521 |
|
537 |
535 |
$9K |
| 82731 |
|
105 |
96 |
$9K |
| 99153 |
Mod sedat endo service >5yrs |
913 |
888 |
$9K |
| 73620 |
|
497 |
476 |
$9K |
| 94729 |
|
261 |
261 |
$9K |
| 29125 |
|
1,081 |
1,054 |
$8K |
| Q5117 |
Inj., kanjinti, 10 mg |
18 |
12 |
$8K |
| 72050 |
|
479 |
475 |
$8K |
| 73140 |
|
618 |
607 |
$8K |
| J7040 |
Normal saline solution infus |
2,965 |
2,410 |
$8K |
| 82552 |
|
1,016 |
917 |
$8K |
| 82140 |
|
789 |
719 |
$8K |
| 85009 |
|
2,123 |
2,024 |
$7K |
| J9190 |
Fluorouracil injection |
412 |
141 |
$7K |
| 70491 |
|
55 |
55 |
$7K |
| J1756 |
Iron sucrose injection |
102 |
51 |
$7K |
| J3489 |
Zoledronic acid 1mg |
150 |
135 |
$7K |
| A9585 |
Gadobutrol injection |
1,969 |
1,919 |
$6K |
| J2060 |
Lorazepam injection |
1,831 |
1,589 |
$6K |
| 77065 |
Tomosynthesis, mammo |
112 |
112 |
$6K |
| 94727 |
|
260 |
260 |
$6K |
| 78452 |
|
41 |
40 |
$6K |
| J1650 |
Inj enoxaparin sodium |
932 |
617 |
$6K |
| Q0144 |
Azithromycin dihydrate, oral |
100 |
84 |
$5K |
| 73120 |
|
555 |
419 |
$5K |
| 10060 |
|
237 |
226 |
$5K |
| J2358 |
Olanzapine long-acting inj |
141 |
122 |
$5K |
| 0410 |
|
273 |
104 |
$5K |
| J2930 |
Methylprednisolone injection |
383 |
343 |
$5K |
| 74178 |
|
26 |
25 |
$5K |
| 96523 |
|
42 |
24 |
$5K |
| A0429 |
Bls-emergency |
196 |
160 |
$5K |
| 29515 |
|
686 |
664 |
$5K |
| 99225 |
|
87 |
87 |
$5K |
| 97116 |
|
647 |
305 |
$5K |
| J2765 |
Metoclopramide hcl injection |
1,741 |
1,594 |
$4K |
| 85651 |
|
1,641 |
1,588 |
$4K |
| 12002 |
|
335 |
330 |
$4K |
| J0690 |
Cefazolin sodium injection |
1,123 |
1,006 |
$4K |
| J1644 |
Inj heparin sodium per 1000u |
1,225 |
628 |
$4K |
| 86703 |
|
433 |
421 |
$4K |
| 76816 |
|
114 |
112 |
$4K |
| 97172 |
|
97 |
95 |
$4K |
| 0258 |
|
1,145 |
742 |
$4K |
| 80076 |
|
501 |
493 |
$4K |
| 84439 |
|
582 |
555 |
$4K |
| 0370 |
|
50 |
49 |
$4K |
| 71020 |
|
146 |
107 |
$3K |
| 0271 |
|
678 |
643 |
$3K |
| 70360 |
|
230 |
226 |
$3K |
| 96416 |
|
72 |
39 |
$3K |
| 87880 |
|
410 |
398 |
$3K |
| 93880 |
|
31 |
27 |
$3K |
| 94664 |
|
328 |
291 |
$3K |
| J2003 |
Inj, lidocaine hcl, 1 mg |
77 |
77 |
$3K |
| 75571 |
|
84 |
84 |
$3K |
| 87420 |
|
152 |
148 |
$3K |
| J0171 |
Adrenalin epinephrine inject |
111 |
105 |
$2K |
| 71010 |
|
144 |
114 |
$2K |
| 70547 |
|
13 |
12 |
$2K |
| 36600 |
|
703 |
673 |
$2K |
| 85576 |
|
298 |
294 |
$2K |
| 87070 |
|
158 |
150 |
$2K |
| 45380 |
|
80 |
80 |
$2K |
| Z7514 |
|
31 |
30 |
$2K |
| 76937 |
|
69 |
67 |
$2K |
| A4649 |
Surgical supplies |
1,382 |
771 |
$2K |
| 90471 |
|
647 |
631 |
$2K |
| 49083 |
|
24 |
14 |
$2K |
| 82607 |
|
180 |
177 |
$2K |
| J3480 |
Inj potassium chloride |
438 |
300 |
$2K |
| 85008 |
|
2,095 |
1,944 |
$2K |
| 73000 |
|
91 |
89 |
$1K |
| X4303 |
|
22 |
12 |
$1K |
| 47562 |
|
12 |
12 |
$1K |
| J2543 |
Piperacillin/tazobactam |
80 |
63 |
$1K |
| J3475 |
Inj magnesium sulfate |
269 |
186 |
$1K |
| 0324 |
|
167 |
159 |
$1K |
| 93017 |
|
31 |
29 |
$1K |
| J2785 |
Regadenoson injection |
12 |
12 |
$1K |
| 96368 |
|
86 |
58 |
$1K |
| 87340 |
|
174 |
171 |
$1K |
| J7060 |
5% dextrose/water |
370 |
237 |
$1K |
| 88342 |
|
44 |
43 |
$1K |
| 92521 |
|
12 |
12 |
$1K |
| 27502 |
|
47 |
44 |
$1K |
| J1940 |
Furosemide injection |
344 |
216 |
$1K |
| 29505 |
|
105 |
105 |
$1K |
| 93925 |
|
16 |
16 |
$990.33 |
| A9502 |
Tc99m tetrofosmin |
28 |
28 |
$946.41 |
| 87210 |
|
107 |
104 |
$944.17 |
| 82533 |
|
138 |
125 |
$914.64 |
| 88341 |
|
12 |
12 |
$889.24 |
| 58558 |
|
12 |
12 |
$864.00 |
| 0420 |
|
37 |
28 |
$843.25 |
| 97162 |
|
39 |
39 |
$838.90 |
| S0164 |
Injection pantroprazole |
33 |
26 |
$816.45 |
| 97152 |
|
16 |
16 |
$799.52 |
| J0780 |
Prochlorperazine injection |
167 |
161 |
$753.74 |
| 29105 |
|
64 |
63 |
$670.61 |
| 87493 |
|
32 |
26 |
$634.61 |
| 84132 |
|
177 |
173 |
$629.49 |
| 86803 |
|
48 |
46 |
$596.80 |
| J0360 |
Hydralazine hcl injection |
106 |
94 |
$581.01 |
| 86870 |
|
13 |
12 |
$562.84 |
| 87205 |
|
109 |
98 |
$549.47 |
| A6222 |
Gauze <=16 in no w/sal w/o b |
15 |
15 |
$504.00 |
| J2919 |
Inj, methylpred sod succ 5mg |
30 |
26 |
$496.40 |
| 87045 |
|
45 |
41 |
$469.78 |
| 85018 |
|
515 |
465 |
$451.94 |
| J1630 |
Haloperidol injection |
135 |
129 |
$448.94 |
| J2370 |
Phenylephrine hcl injection |
13 |
13 |
$407.00 |
| 82150 |
|
97 |
96 |
$380.97 |
| J0330 |
Succinycholine chloride inj |
56 |
56 |
$370.30 |
| 71271 |
|
12 |
12 |
$368.08 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
210 |
186 |
$347.69 |
| 82728 |
|
25 |
25 |
$322.06 |
| J7512 |
Prednisone ir or dr oral 1mg |
225 |
211 |
$315.19 |
| 29705 |
|
55 |
53 |
$310.98 |
| 27610 |
|
29 |
24 |
$305.35 |
| J2310 |
Inj naloxone hydrochloride |
14 |
13 |
$293.77 |
| 87425 |
|
29 |
25 |
$280.87 |
| 72081 |
|
12 |
12 |
$279.10 |
| 92611 |
|
13 |
12 |
$264.60 |
| 87075 |
|
18 |
16 |
$238.18 |
| 0300 |
|
461 |
428 |
$235.43 |
| 74000 |
|
15 |
14 |
$225.82 |
| 88302 |
|
12 |
12 |
$225.04 |
| 45385 |
|
13 |
13 |
$216.00 |
| 87427 |
|
30 |
29 |
$205.71 |
| 97163 |
|
15 |
15 |
$200.00 |
| 29130 |
|
25 |
24 |
$174.51 |
| 87798 |
|
14 |
13 |
$168.84 |
| 74019 |
|
13 |
12 |
$161.36 |
| J7042 |
5% dextrose/normal saline |
36 |
29 |
$157.48 |
| 89055 |
|
43 |
39 |
$138.65 |
| 87209 |
|
14 |
13 |
$137.42 |
| 85347 |
|
47 |
40 |
$114.31 |
| 84156 |
|
42 |
31 |
$112.52 |
| 82330 |
|
13 |
12 |
$108.46 |
| J3370 |
Vancomycin hcl injection |
31 |
25 |
$101.05 |
| 87177 |
|
12 |
12 |
$96.71 |
| J2175 |
Meperidine hydrochl /100 mg |
13 |
13 |
$91.28 |
| 76882 |
|
24 |
24 |
$79.66 |
| 82746 |
|
12 |
12 |
$77.11 |
| 29075 |
|
14 |
14 |
$64.80 |
| 87046 |
|
33 |
29 |
$62.81 |
| 80164 |
|
12 |
12 |
$55.84 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
76 |
60 |
$49.65 |
| J8597 |
Antiemetic drug oral nos |
75 |
71 |
$45.18 |
| C9113 |
Inj pantoprazole sodium, via |
14 |
12 |
$39.24 |
| 82248 |
|
48 |
28 |
$35.52 |
| 85390 |
|
12 |
12 |
$27.99 |
| 0305 |
|
398 |
366 |
$13.50 |
| J2371 |
Inj phenylephrine hcl 20 mcg |
31 |
31 |
$12.50 |
| 0307 |
|
18 |
16 |
$2.80 |
| 0730 |
|
85 |
79 |
$0.00 |
| 0302 |
|
42 |
37 |
$0.00 |
| S9445 |
Pt education noc individ |
359 |
238 |
$0.00 |
| 0306 |
|
293 |
272 |
$0.00 |
| Q4051 |
Splint supplies misc |
31 |
16 |
$0.00 |