| Code | Description | Claims | Beneficiaries | Total Paid |
| 99283 |
|
27,509 |
25,692 |
$4.49M |
| 99284 |
|
23,152 |
20,974 |
$3.53M |
| 99212 |
|
13,392 |
12,254 |
$2.41M |
| 99213 |
|
14,411 |
13,843 |
$2.39M |
| 96361 |
|
8,502 |
6,889 |
$2.18M |
| 99285 |
|
9,916 |
9,021 |
$1.55M |
| 97110 |
|
13,341 |
3,737 |
$1.52M |
| 99282 |
|
8,114 |
7,712 |
$1.35M |
| 96365 |
|
5,431 |
3,601 |
$1.28M |
| 80053 |
|
70,009 |
63,252 |
$1.20M |
| 87635 |
|
27,231 |
24,959 |
$1.11M |
| 43239 |
|
1,678 |
1,665 |
$1.08M |
| 87633 |
|
2,411 |
2,351 |
$1.05M |
| 99214 |
|
5,801 |
5,717 |
$980K |
| 70450 |
|
3,880 |
3,712 |
$952K |
| 74177 |
|
4,186 |
4,086 |
$944K |
| 45378 |
|
1,107 |
1,104 |
$918K |
| 45380 |
|
1,095 |
1,086 |
$876K |
| C1713 |
Anchor/screw bn/bn,tis/bn |
466 |
463 |
$632K |
| 76700 |
|
2,655 |
2,627 |
$627K |
| 76856 |
|
1,934 |
1,903 |
$587K |
| 96360 |
|
2,575 |
1,962 |
$450K |
| 82306 |
|
13,868 |
13,723 |
$395K |
| 74176 |
|
1,662 |
1,633 |
$373K |
| 36415 |
|
74,580 |
45,886 |
$363K |
| 87502 |
|
6,130 |
6,017 |
$335K |
| 88305 |
|
5,821 |
5,667 |
$332K |
| 93306 |
|
2,267 |
2,256 |
$332K |
| 73721 |
|
1,143 |
1,134 |
$323K |
| 77067 |
|
5,116 |
5,076 |
$321K |
| 86850 |
|
8,417 |
7,907 |
$299K |
| 96413 |
|
1,876 |
1,136 |
$294K |
| 99215 |
Prolong outpt/office vis |
1,815 |
1,717 |
$289K |
| 97140 |
|
9,223 |
2,884 |
$288K |
| 87491 |
|
11,682 |
11,410 |
$283K |
| 87798 |
|
2,531 |
2,471 |
$276K |
| 70551 |
|
1,087 |
1,080 |
$265K |
| 93970 |
|
697 |
689 |
$262K |
| 72148 |
|
1,055 |
1,049 |
$245K |
| 80061 |
|
27,529 |
27,249 |
$245K |
| 45385 |
|
425 |
421 |
$243K |
| 80048 |
|
12,560 |
11,172 |
$236K |
| 71275 |
|
833 |
823 |
$233K |
| 96366 |
|
1,161 |
1,013 |
$229K |
| 87591 |
|
11,678 |
11,406 |
$225K |
| 80307 |
|
5,537 |
4,875 |
$213K |
| 99281 |
|
1,290 |
1,181 |
$210K |
| 59025 |
|
1,069 |
874 |
$204K |
| 87637 |
|
3,622 |
3,557 |
$196K |
| 76641 |
|
5,171 |
5,118 |
$189K |
| 70553 |
|
630 |
628 |
$175K |
| 86900 |
|
8,401 |
8,016 |
$164K |
| 86901 |
|
8,399 |
8,013 |
$153K |
| 84443 |
|
22,238 |
21,830 |
$144K |
| 77065 |
Tomosynthesis, mammo |
1,828 |
1,709 |
$141K |
| 87661 |
|
7,056 |
6,934 |
$140K |
| J9271 |
Inj pembrolizumab |
14 |
12 |
$138K |
| 83036 |
|
19,035 |
18,800 |
$136K |
| 88142 |
|
6,540 |
6,518 |
$134K |
| 87651 |
|
3,689 |
3,628 |
$131K |
| 85025 |
|
56,641 |
50,481 |
$129K |
| 78815 |
|
205 |
204 |
$124K |
| G0378 |
Hospital observation per hr |
230 |
220 |
$119K |
| 77066 |
Tomosynthesis, mammo |
1,504 |
1,481 |
$115K |
| 86480 |
|
2,147 |
2,130 |
$114K |
| 73221 |
|
451 |
449 |
$111K |
| 93976 |
|
255 |
252 |
$106K |
| 76819 |
|
2,186 |
1,547 |
$104K |
| 72141 |
|
461 |
459 |
$101K |
| 76830 |
|
1,967 |
1,910 |
$101K |
| 76817 |
|
1,823 |
1,677 |
$101K |
| 97162 |
|
635 |
631 |
$100K |
| 96415 |
|
185 |
133 |
$97K |
| 96374 |
|
10,355 |
9,397 |
$97K |
| 84439 |
|
13,126 |
12,854 |
$97K |
| 71250 |
|
1,152 |
1,145 |
$94K |
| 82607 |
|
8,405 |
8,299 |
$90K |
| 88304 |
|
3,703 |
3,677 |
$89K |
| 96372 |
|
5,937 |
4,960 |
$89K |
| 87389 |
|
5,838 |
5,774 |
$87K |
| 82728 |
|
7,430 |
7,225 |
$85K |
| 76816 |
|
2,186 |
1,922 |
$76K |
| 87486 |
|
2,547 |
2,483 |
$75K |
| J3490 |
Drugs unclassified injection |
6,930 |
4,496 |
$75K |
| 84270 |
|
1,270 |
1,257 |
$70K |
| 87624 |
|
2,547 |
2,542 |
$69K |
| 86769 |
|
2,063 |
2,033 |
$69K |
| 95810 |
|
82 |
82 |
$64K |
| 74183 |
|
257 |
256 |
$62K |
| 87086 |
|
10,848 |
10,204 |
$62K |
| 76770 |
|
389 |
387 |
$61K |
| 82746 |
|
5,531 |
5,467 |
$58K |
| 90686 |
|
2,565 |
2,550 |
$58K |
| 76811 |
|
849 |
839 |
$56K |
| 87581 |
|
2,549 |
2,485 |
$56K |
| 86803 |
|
6,496 |
6,426 |
$55K |
| 84403 |
|
2,068 |
2,043 |
$52K |
| A9585 |
Gadobutrol injection |
2,941 |
2,667 |
$52K |
| 71260 |
|
443 |
439 |
$50K |
| U0003 |
Cov-19 amp prb hgh thruput |
710 |
700 |
$50K |
| C1889 |
Implant/insert device, noc |
907 |
903 |
$49K |
| 71046 |
|
6,074 |
5,903 |
$48K |
| 76536 |
|
1,391 |
1,384 |
$46K |
| 83516 |
|
1,349 |
1,301 |
$45K |
| 97161 |
|
336 |
330 |
$44K |
| 83880 |
|
1,501 |
1,441 |
$44K |
| 84153 |
|
2,748 |
2,713 |
$42K |
| 83001 |
|
2,189 |
2,162 |
$41K |
| 87340 |
|
5,115 |
5,070 |
$41K |
| 77063 |
|
4,012 |
3,992 |
$40K |
| 86885 |
|
1,043 |
984 |
$39K |
| 96375 |
|
9,317 |
7,542 |
$37K |
| G0463 |
Hospital outpt clinic visit |
665 |
601 |
$36K |
| 88342 |
|
711 |
696 |
$36K |
| 83002 |
|
2,033 |
2,003 |
$36K |
| 82784 |
|
2,244 |
2,162 |
$36K |
| 93971 |
|
647 |
637 |
$35K |
| 87077 |
|
4,377 |
4,232 |
$35K |
| 76642 |
|
1,311 |
1,295 |
$34K |
| 85610 |
|
11,365 |
10,789 |
$34K |
| 83655 |
|
2,429 |
2,420 |
$34K |
| 77049 |
|
123 |
123 |
$33K |
| C9803 |
Hopd covid-19 spec collect |
16,610 |
15,069 |
$33K |
| 12001 |
|
69 |
69 |
$33K |
| 84702 |
|
3,765 |
2,993 |
$33K |
| 84146 |
|
1,670 |
1,646 |
$32K |
| 70496 |
|
139 |
139 |
$32K |
| 90715 |
|
1,234 |
1,227 |
$32K |
| A9552 |
F18 fdg |
231 |
230 |
$32K |
| 80076 |
|
3,615 |
3,280 |
$32K |
| 83540 |
|
7,413 |
7,225 |
$32K |
| 76705 |
|
855 |
846 |
$32K |
| 86706 |
|
3,667 |
3,633 |
$32K |
| 82670 |
|
1,109 |
1,077 |
$31K |
| 87081 |
|
6,247 |
6,119 |
$30K |
| 96402 |
|
438 |
407 |
$30K |
| 82378 |
|
2,123 |
1,976 |
$30K |
| 83550 |
|
6,693 |
6,540 |
$29K |
| 86300 |
|
1,720 |
1,621 |
$28K |
| 87070 |
|
3,937 |
3,845 |
$28K |
| 76801 |
|
516 |
505 |
$28K |
| 96367 |
|
290 |
170 |
$27K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
4,631 |
4,461 |
$26K |
| 86762 |
|
1,884 |
1,873 |
$25K |
| 86704 |
|
2,829 |
2,808 |
$24K |
| 86320 |
|
1,011 |
979 |
$24K |
| 83970 |
|
661 |
650 |
$24K |
| 87636 |
|
190 |
189 |
$23K |
| 29580 |
|
73 |
27 |
$23K |
| 83520 |
|
328 |
317 |
$22K |
| 12011 |
|
41 |
41 |
$22K |
| 93303 |
|
177 |
177 |
$21K |
| 93320 |
|
439 |
439 |
$21K |
| 77062 |
|
417 |
416 |
$21K |
| 76815 |
|
232 |
199 |
$21K |
| 86765 |
|
1,786 |
1,776 |
$21K |
| 72197 |
|
83 |
83 |
$20K |
| 81003 |
|
17,255 |
16,662 |
$20K |
| 86140 |
|
5,664 |
5,436 |
$20K |
| 81001 |
|
10,635 |
10,095 |
$19K |
| Q3014 |
Telehealth facility fee |
717 |
567 |
$18K |
| 86708 |
|
2,344 |
2,325 |
$18K |
| 86200 |
|
664 |
659 |
$18K |
| 99203 |
|
113 |
112 |
$18K |
| 99211 |
|
918 |
858 |
$18K |
| 93005 |
|
11,819 |
10,505 |
$18K |
| 86618 |
|
1,226 |
1,212 |
$17K |
| 86003 |
|
294 |
285 |
$17K |
| 83883 |
|
460 |
365 |
$17K |
| J1756 |
Iron sucrose injection |
393 |
142 |
$17K |
| 82627 |
|
701 |
693 |
$17K |
| 86694 |
|
497 |
493 |
$16K |
| 85730 |
|
7,519 |
7,186 |
$16K |
| 81025 |
|
4,310 |
4,112 |
$15K |
| 76813 |
|
388 |
385 |
$15K |
| 77080 |
|
242 |
242 |
$14K |
| 86787 |
|
1,654 |
1,623 |
$14K |
| 86735 |
|
1,741 |
1,729 |
$14K |
| 86376 |
|
990 |
978 |
$14K |
| 87507 |
|
31 |
31 |
$14K |
| 70486 |
|
173 |
171 |
$14K |
| 83735 |
|
5,431 |
4,804 |
$13K |
| J0131 |
Inj, acetaminophen (nos) |
1,783 |
1,678 |
$13K |
| 82533 |
|
917 |
869 |
$13K |
| 86747 |
|
758 |
667 |
$13K |
| 71045 |
|
2,611 |
2,462 |
$13K |
| 86780 |
|
1,163 |
1,123 |
$13K |
| 82550 |
|
3,181 |
3,060 |
$13K |
| 83020 |
|
930 |
927 |
$12K |
| 29125 |
|
54 |
54 |
$12K |
| 85027 |
|
6,995 |
6,532 |
$12K |
| 87088 |
|
2,137 |
2,063 |
$12K |
| 86161 |
|
1,117 |
1,102 |
$12K |
| 86709 |
|
1,626 |
1,612 |
$12K |
| 87186 |
|
2,661 |
2,556 |
$12K |
| 86235 |
|
776 |
743 |
$12K |
| 90834 |
|
186 |
105 |
$12K |
| 84144 |
|
555 |
484 |
$11K |
| 86593 |
|
3,368 |
3,327 |
$11K |
| 86160 |
|
1,135 |
1,119 |
$11K |
| 94060 |
|
358 |
355 |
$11K |
| 88307 |
|
139 |
137 |
$11K |
| 86304 |
|
537 |
508 |
$10K |
| 73562 |
|
944 |
935 |
$10K |
| 85652 |
|
7,291 |
6,996 |
$10K |
| 77061 |
|
196 |
194 |
$10K |
| 82947 |
|
5,590 |
4,899 |
$10K |
| 84481 |
|
1,477 |
1,452 |
$10K |
| 62323 |
|
27 |
27 |
$10K |
| 82105 |
|
1,509 |
1,477 |
$10K |
| 83615 |
|
2,478 |
2,226 |
$10K |
| 90750 |
|
66 |
66 |
$10K |
| 83525 |
|
737 |
733 |
$9K |
| 86800 |
|
744 |
735 |
$9K |
| 73700 |
|
94 |
94 |
$9K |
| 93325 |
|
474 |
474 |
$9K |
| 90471 |
|
7,125 |
6,975 |
$9K |
| 76805 |
|
164 |
162 |
$9K |
| J2704 |
Inj, propofol, 10 mg |
4,909 |
4,722 |
$9K |
| 90677 |
|
122 |
122 |
$9K |
| 83690 |
|
7,005 |
6,557 |
$9K |
| 85380 |
|
1,332 |
1,299 |
$9K |
| 82043 |
|
2,254 |
2,237 |
$8K |
| 87634 |
|
468 |
459 |
$8K |
| 86812 |
|
126 |
126 |
$8K |
| 87641 |
|
261 |
243 |
$8K |
| A4648 |
Implantable tissue marker |
317 |
307 |
$8K |
| 86141 |
|
875 |
866 |
$8K |
| 86334 |
|
463 |
437 |
$8K |
| 86778 |
|
588 |
581 |
$8K |
| 72195 |
|
25 |
24 |
$8K |
| 77085 |
|
53 |
53 |
$8K |
| 72125 |
|
110 |
109 |
$8K |
| 93017 |
|
262 |
261 |
$8K |
| 81050 |
|
1,059 |
1,003 |
$8K |
| 80050 |
|
258 |
256 |
$7K |
| 87510 |
|
565 |
547 |
$7K |
| 87480 |
|
565 |
547 |
$7K |
| J7030 |
Normal saline solution infus |
6,248 |
5,260 |
$7K |
| 84703 |
|
5,943 |
5,607 |
$7K |
| 84550 |
|
1,937 |
1,792 |
$7K |
| 82570 |
|
1,517 |
1,450 |
$7K |
| 87660 |
|
638 |
617 |
$7K |
| 85045 |
|
2,282 |
2,230 |
$7K |
| 73130 |
|
697 |
678 |
$7K |
| 94729 |
|
382 |
379 |
$7K |
| 86431 |
|
1,465 |
1,454 |
$7K |
| 93975 |
|
17 |
17 |
$6K |
| 84480 |
|
1,291 |
1,269 |
$6K |
| 82977 |
|
1,254 |
1,227 |
$6K |
| 94640 |
|
1,020 |
937 |
$6K |
| 10060 |
|
16 |
15 |
$6K |
| 86695 |
|
171 |
169 |
$6K |
| 73030 |
|
639 |
623 |
$5K |
| 86039 |
|
1,054 |
1,046 |
$5K |
| 84512 |
|
3,855 |
3,330 |
$5K |
| 86038 |
|
1,081 |
1,000 |
$5K |
| 94727 |
|
381 |
378 |
$5K |
| 99441 |
|
97 |
81 |
$5K |
| 86710 |
|
1,024 |
1,014 |
$5K |
| 84100 |
|
2,142 |
1,895 |
$5K |
| 87040 |
|
1,097 |
953 |
$4K |
| C1769 |
Guide wire |
157 |
155 |
$4K |
| 82950 |
|
899 |
893 |
$4K |
| 86225 |
|
845 |
830 |
$4K |
| 72100 |
|
355 |
354 |
$4K |
| 76000 |
|
80 |
77 |
$4K |
| J7120 |
Ringers lactate infusion |
2,924 |
2,662 |
$4K |
| 73630 |
|
732 |
720 |
$4K |
| 86317 |
|
62 |
62 |
$4K |
| 74181 |
|
13 |
13 |
$4K |
| 86920 |
|
44 |
40 |
$4K |
| 99442 |
|
44 |
39 |
$4K |
| 90656 |
|
217 |
217 |
$4K |
| 84305 |
|
176 |
175 |
$3K |
| 84156 |
|
1,087 |
1,030 |
$3K |
| 78452 |
|
14 |
13 |
$3K |
| J0134 |
Inj acetaminophen -fresenius |
1,099 |
1,011 |
$3K |
| 73110 |
|
312 |
299 |
$3K |
| 84445 |
|
25 |
25 |
$3K |
| 82565 |
|
474 |
468 |
$3K |
| J7050 |
Normal saline solution infus |
5,754 |
3,316 |
$3K |
| M0239 |
Bamlanivimab-xxxx infusion |
13 |
13 |
$3K |
| 82948 |
|
1,942 |
1,537 |
$3K |
| J2469 |
Palonosetron hcl |
345 |
206 |
$3K |
| 84436 |
|
677 |
660 |
$2K |
| 86696 |
|
186 |
184 |
$2K |
| 88112 |
|
77 |
76 |
$2K |
| 93351 |
|
28 |
28 |
$2K |
| J0690 |
Cefazolin sodium injection |
1,935 |
1,776 |
$2K |
| J1170 |
Hydromorphone injection |
1,205 |
941 |
$2K |
| 85007 |
|
1,958 |
1,773 |
$2K |
| 90698 |
|
210 |
210 |
$2K |
| 80159 |
|
234 |
220 |
$2K |
| 86146 |
|
108 |
107 |
$2K |
| J2001 |
Lidocaine injection |
4,167 |
3,967 |
$2K |
| 82652 |
|
20 |
19 |
$2K |
| 82150 |
|
892 |
836 |
$2K |
| 82465 |
|
499 |
499 |
$2K |
| 70491 |
|
12 |
12 |
$2K |
| 83695 |
|
112 |
111 |
$2K |
| 90472 |
|
1,649 |
1,644 |
$2K |
| 83010 |
|
174 |
164 |
$2K |
| 82248 |
|
454 |
353 |
$2K |
| 73610 |
|
395 |
394 |
$2K |
| 97116 |
|
62 |
37 |
$2K |
| 0031A |
|
51 |
49 |
$2K |
| 86147 |
|
128 |
127 |
$2K |
| J0136 |
Inj, acetaminophen (b braun) |
782 |
755 |
$2K |
| 87205 |
|
717 |
678 |
$2K |
| 87338 |
|
228 |
227 |
$2K |
| J1885 |
Ketorolac tromethamine inj |
4,657 |
4,355 |
$2K |
| 76870 |
|
55 |
53 |
$2K |
| 77336 |
|
28 |
12 |
$2K |
| 83605 |
|
1,600 |
1,468 |
$2K |
| J2270 |
Morphine sulfate injection |
1,261 |
1,114 |
$2K |
| 86301 |
|
114 |
104 |
$2K |
| 84165 |
|
229 |
208 |
$2K |
| 83921 |
|
83 |
83 |
$2K |
| 86777 |
|
113 |
112 |
$2K |
| J3010 |
Fentanyl citrate injection |
3,001 |
2,814 |
$1K |
| J1100 |
Dexamethasone sodium phos |
3,128 |
2,724 |
$1K |
| 82247 |
|
304 |
209 |
$1K |
| 90732 |
|
13 |
13 |
$1K |
| 86592 |
|
677 |
672 |
$1K |
| 88300 |
|
163 |
162 |
$1K |
| 99202 |
|
25 |
23 |
$1K |
| 0012A |
|
47 |
47 |
$1K |
| 0011A |
|
86 |
86 |
$1K |
| 97035 |
|
56 |
24 |
$1K |
| 82785 |
|
94 |
94 |
$1K |
| 90746 |
|
37 |
37 |
$1K |
| 90670 |
|
25 |
25 |
$1K |
| J2405 |
Ondansetron hcl injection |
5,746 |
5,102 |
$1K |
| A9502 |
Tc99m tetrofosmin |
12 |
12 |
$1K |
| 99235 |
|
24 |
24 |
$1K |
| P9604 |
One-way allow prorated trip |
570 |
387 |
$988.57 |
| 72110 |
|
39 |
39 |
$969.65 |
| 86255 |
|
111 |
110 |
$951.50 |
| 82164 |
|
27 |
26 |
$927.42 |
| J7060 |
5% dextrose/water |
675 |
333 |
$922.53 |
| 88360 |
|
13 |
13 |
$914.65 |
| 83718 |
|
186 |
186 |
$880.81 |
| J7040 |
Normal saline solution infus |
1,354 |
1,071 |
$871.09 |
| C1894 |
Intro/sheath, non-laser |
85 |
54 |
$845.20 |
| 86021 |
|
25 |
25 |
$842.44 |
| U0002 |
Covid-19 lab test non-cdc |
18 |
18 |
$836.35 |
| 73502 |
|
94 |
94 |
$823.90 |
| 83993 |
|
70 |
69 |
$774.46 |
| 90681 |
|
73 |
73 |
$716.79 |
| Q9965 |
Locm 100-199mg/ml iodine,1ml |
85 |
84 |
$680.53 |
| 91301 |
|
95 |
78 |
$653.30 |
| G0475 |
Hiv combination assay |
29 |
28 |
$648.71 |
| J0171 |
Adrenalin epinephrine inject |
42 |
41 |
$635.18 |
| 86325 |
|
36 |
32 |
$634.30 |
| 96376 |
|
1,092 |
897 |
$620.12 |
| 90744 |
|
55 |
55 |
$580.67 |
| J3301 |
Triamcinolone acet inj nos |
159 |
150 |
$580.66 |
| 80051 |
|
99 |
96 |
$564.60 |
| 82024 |
|
13 |
13 |
$559.32 |
| J2765 |
Metoclopramide hcl injection |
1,430 |
1,369 |
$540.31 |
| 76820 |
|
37 |
25 |
$515.81 |
| 82397 |
|
16 |
15 |
$500.94 |
| 77072 |
|
54 |
54 |
$495.11 |
| 86580 |
|
99 |
96 |
$490.01 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
522 |
501 |
$476.13 |
| 82172 |
|
29 |
29 |
$475.51 |
| J1200 |
Diphenhydramine hcl injectio |
1,375 |
1,097 |
$474.81 |
| J2930 |
Methylprednisolone injection |
101 |
86 |
$466.78 |
| 90832 |
|
16 |
13 |
$442.00 |
| 80164 |
|
44 |
39 |
$424.55 |
| J0696 |
Ceftriaxone sodium injection |
671 |
507 |
$424.01 |
| 85613 |
|
57 |
57 |
$421.98 |
| 84425 |
|
25 |
25 |
$378.00 |
| J2250 |
Inj midazolam hydrochloride |
2,576 |
2,513 |
$357.03 |
| 83498 |
|
12 |
12 |
$353.21 |
| 83721 |
|
64 |
64 |
$341.07 |
| 87177 |
|
76 |
74 |
$340.20 |
| 84207 |
|
12 |
12 |
$336.64 |
| G0103 |
Psa screening |
12 |
12 |
$312.33 |
| 70498 |
|
13 |
13 |
$307.84 |
| 87420 |
|
84 |
82 |
$300.32 |
| 87430 |
|
151 |
150 |
$299.40 |
| 90734 |
|
16 |
16 |
$285.24 |
| 90620 |
|
13 |
13 |
$273.34 |
| J1453 |
Fosaprepitant injection |
19 |
12 |
$263.59 |
| 90633 |
|
29 |
29 |
$250.00 |
| 72040 |
|
26 |
26 |
$218.18 |
| 82955 |
|
25 |
25 |
$213.94 |
| 73521 |
|
12 |
12 |
$210.68 |
| 84132 |
|
132 |
128 |
$208.78 |
| J8540 |
Oral dexamethasone |
112 |
99 |
$169.82 |
| J1644 |
Inj heparin sodium per 1000u |
183 |
133 |
$169.24 |
| J2919 |
Inj, methylpred sod succ 5mg |
48 |
39 |
$157.30 |
| 87184 |
|
24 |
24 |
$150.36 |
| J3535 |
Metered dose inhaler drug |
65 |
65 |
$145.76 |
| 84466 |
|
12 |
12 |
$138.55 |
| 90474 |
|
72 |
72 |
$138.54 |
| 72070 |
|
13 |
13 |
$136.98 |
| J2060 |
Lorazepam injection |
320 |
271 |
$129.83 |
| 91200 |
|
13 |
13 |
$125.88 |
| 87106 |
|
13 |
13 |
$125.61 |
| 90460 |
|
345 |
340 |
$108.15 |
| J1630 |
Haloperidol injection |
244 |
224 |
$105.36 |
| J0330 |
Succinycholine chloride inj |
52 |
52 |
$102.17 |
| 87209 |
|
15 |
15 |
$95.51 |
| 84155 |
|
45 |
43 |
$92.64 |
| J2272 |
Inj, morphine (fresenius) |
52 |
44 |
$92.23 |
| 86705 |
|
12 |
12 |
$82.18 |
| 73590 |
|
12 |
12 |
$78.12 |
| 87341 |
|
14 |
12 |
$66.38 |
| G0480 |
Drug test def 1-7 classes |
15 |
13 |
$59.85 |
| J2003 |
Inj, lidocaine hcl, 1 mg |
153 |
146 |
$55.09 |
| 74018 |
|
15 |
13 |
$54.54 |
| 84484 |
|
119 |
116 |
$53.29 |
| 80178 |
|
13 |
12 |
$52.88 |
| J1596 |
Inj, glycopyrrolate, 0.1 mg |
82 |
81 |
$46.67 |
| J7512 |
Prednisone ir or dr oral 1mg |
335 |
250 |
$46.08 |
| J7620 |
Albuterol ipratrop non-comp |
322 |
270 |
$42.48 |
| 73080 |
|
13 |
13 |
$37.90 |
| 82040 |
|
12 |
12 |
$34.65 |
| 85041 |
|
24 |
24 |
$30.23 |
| G1004 |
Cdsm ndsc |
540 |
511 |
$26.89 |
| Q9966 |
Locm 200-299mg/ml iodine,1ml |
13 |
13 |
$23.46 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
40 |
34 |
$20.25 |
| 85018 |
|
24 |
24 |
$20.12 |
| 85014 |
|
25 |
25 |
$20.12 |
| C9113 |
Inj pantoprazole sodium, via |
15 |
14 |
$19.87 |
| Q0162 |
Ondansetron oral |
694 |
657 |
$16.29 |
| 81000 |
|
16 |
16 |
$15.00 |
| J2370 |
Phenylephrine hcl injection |
94 |
92 |
$12.74 |
| J2371 |
Inj phenylephrine hcl 20 mcg |
179 |
168 |
$5.94 |
| A9270 |
Non-covered item or service |
159 |
83 |
$5.14 |
| J1642 |
Inj heparin sodium per 10 u |
25 |
13 |
$1.60 |
| Q0163 |
Diphenhydramine hcl 50mg |
233 |
193 |
$1.43 |
| A6402 |
Sterile gauze <= 16 sq in |
26 |
25 |
$0.89 |
| J7613 |
Albuterol non-comp unit |
13 |
12 |
$0.56 |
| 91303 |
|
16 |
14 |
$0.07 |
| G0499 |
Hepb screen high risk indiv |
20 |
12 |
$0.00 |
| 99080 |
|
5,380 |
1,214 |
$0.00 |
| 80342 |
|
87 |
81 |
$0.00 |
| J2004 |
Inj, lidocaine w epinephrine |
36 |
36 |
$0.00 |