| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99284 |
|
48,048 |
42,550 |
$8.64M |
| J2350 |
Injection, ocrelizumab, 1 mg |
379 |
281 |
$8.21M |
| J2323 |
Natalizumab injection |
1,221 |
1,064 |
$6.76M |
| 99285 |
|
31,692 |
27,516 |
$6.37M |
| 96361 |
|
20,294 |
13,502 |
$5.90M |
| G0378 |
Hospital observation per hr |
47,036 |
20,666 |
$3.87M |
| 99283 |
|
25,712 |
23,049 |
$3.67M |
| 70450 |
|
7,188 |
5,871 |
$1.73M |
| 76816 |
|
8,938 |
8,080 |
$1.67M |
| 74177 |
|
6,599 |
5,390 |
$1.47M |
| 96365 |
|
6,561 |
5,050 |
$1.41M |
| 43239 |
|
1,982 |
1,730 |
$1.12M |
| 76811 |
|
5,867 |
5,454 |
$1.08M |
| 59025 |
|
5,084 |
2,449 |
$1.01M |
| 96366 |
|
3,721 |
1,971 |
$767K |
| 99212 |
|
4,949 |
4,324 |
$665K |
| 97803 |
|
8,174 |
7,819 |
$657K |
| 74176 |
|
2,471 |
2,042 |
$627K |
| 71275 |
|
2,323 |
1,850 |
$614K |
| 96360 |
|
2,728 |
2,163 |
$500K |
| H2020 |
Ther behav svc, per diem |
3,280 |
446 |
$489K |
| 58661 |
|
172 |
111 |
$468K |
| 70553 |
|
1,672 |
1,435 |
$465K |
| 97110 |
|
7,430 |
2,124 |
$464K |
| 93976 |
|
2,999 |
2,491 |
$456K |
| 93306 |
|
1,517 |
1,307 |
$404K |
| 96413 |
|
2,748 |
1,854 |
$399K |
| 70496 |
|
1,491 |
1,204 |
$396K |
| 64483 |
|
695 |
574 |
$395K |
| 76856 |
|
2,103 |
1,803 |
$391K |
| 99282 |
|
3,400 |
2,963 |
$367K |
| 80048 |
|
39,759 |
28,525 |
$357K |
| 94640 |
|
3,073 |
2,331 |
$336K |
| 76817 |
|
4,429 |
3,677 |
$336K |
| 71260 |
|
2,108 |
1,760 |
$323K |
| 80053 |
|
25,770 |
20,395 |
$285K |
| 36415 |
|
124,430 |
86,978 |
$271K |
| 58571 |
|
87 |
52 |
$269K |
| 77063 |
|
4,830 |
4,393 |
$268K |
| 78431 |
|
482 |
395 |
$253K |
| 96415 |
|
687 |
473 |
$234K |
| 72148 |
|
1,452 |
1,256 |
$229K |
| 70551 |
|
1,236 |
1,086 |
$228K |
| 96375 |
|
22,786 |
15,579 |
$228K |
| 76705 |
|
2,290 |
1,952 |
$224K |
| 76819 |
|
1,636 |
1,068 |
$190K |
| 93797 |
|
2,615 |
474 |
$189K |
| 97802 |
|
1,817 |
1,715 |
$187K |
| 97112 |
|
4,596 |
1,483 |
$186K |
| 97530 |
|
6,572 |
2,557 |
$185K |
| 93970 |
|
1,141 |
989 |
$181K |
| 93005 |
|
34,330 |
28,755 |
$173K |
| 36223 |
|
108 |
91 |
$161K |
| 78815 |
|
238 |
215 |
$157K |
| 36226 |
|
165 |
136 |
$155K |
| 96374 |
|
25,768 |
21,856 |
$153K |
| 76642 |
|
1,059 |
964 |
$149K |
| 73721 |
|
606 |
563 |
$148K |
| 80307 |
|
9,023 |
7,379 |
$148K |
| 76820 |
|
1,599 |
835 |
$148K |
| 72141 |
|
950 |
819 |
$147K |
| 47562 |
|
44 |
29 |
$144K |
| 71046 |
|
4,484 |
3,987 |
$143K |
| G0463 |
Hospital outpt clinic visit |
2,930 |
2,583 |
$142K |
| 11042 |
|
950 |
580 |
$139K |
| 99214 |
|
1,018 |
881 |
$135K |
| 99213 |
|
1,084 |
939 |
$134K |
| 70491 |
|
442 |
368 |
$133K |
| 86900 |
|
5,895 |
4,748 |
$132K |
| 22551 |
|
33 |
25 |
$131K |
| 71045 |
|
17,708 |
14,921 |
$131K |
| 76821 |
|
1,316 |
645 |
$130K |
| J7307 |
Etonogestrel implant system |
106 |
80 |
$130K |
| 58558 |
|
95 |
69 |
$129K |
| 72100 |
|
2,296 |
2,050 |
$128K |
| 76536 |
|
1,037 |
959 |
$128K |
| 93458 |
|
110 |
83 |
$124K |
| 76815 |
|
848 |
647 |
$124K |
| 93971 |
|
1,458 |
1,247 |
$123K |
| 70498 |
|
1,656 |
1,332 |
$122K |
| 87636 |
|
6,086 |
5,043 |
$118K |
| 96372 |
|
16,596 |
8,170 |
$117K |
| 88305 |
|
4,377 |
3,598 |
$116K |
| 76830 |
|
2,236 |
1,934 |
$116K |
| 62323 |
|
252 |
198 |
$116K |
| 73221 |
|
486 |
443 |
$111K |
| 85025 |
|
96,507 |
81,894 |
$107K |
| C8929 |
Tte w or wo fol wcon,doppler |
542 |
468 |
$107K |
| 93798 |
|
2,189 |
587 |
$107K |
| 99152 |
|
2,112 |
1,679 |
$98K |
| 76805 |
|
611 |
577 |
$94K |
| 88307 |
|
881 |
673 |
$91K |
| 82805 |
|
3,324 |
2,595 |
$91K |
| 97162 |
|
2,030 |
1,595 |
$90K |
| J3490 |
Drugs unclassified injection |
8,088 |
4,325 |
$90K |
| 72125 |
|
2,898 |
2,327 |
$89K |
| 84484 |
|
14,373 |
10,973 |
$88K |
| 76801 |
|
1,630 |
1,364 |
$87K |
| 93017 |
|
952 |
784 |
$87K |
| 96376 |
|
7,275 |
3,483 |
$83K |
| 97166 |
|
1,888 |
1,480 |
$83K |
| 99215 |
Prolong outpt/office vis |
907 |
693 |
$82K |
| 97116 |
|
2,476 |
1,205 |
$81K |
| 77067 |
|
5,282 |
4,821 |
$77K |
| 99211 |
|
830 |
573 |
$76K |
| 71250 |
|
914 |
817 |
$73K |
| 99153 |
Mod sedat endo service >5yrs |
1,725 |
1,361 |
$72K |
| 93296 |
|
3,268 |
3,134 |
$72K |
| 80051 |
|
23,632 |
20,163 |
$67K |
| 95716 |
|
74 |
52 |
$66K |
| 92507 |
|
1,313 |
691 |
$65K |
| 85027 |
|
15,734 |
9,729 |
$60K |
| 72131 |
|
894 |
730 |
$60K |
| 70486 |
|
938 |
775 |
$60K |
| 86850 |
|
5,557 |
4,434 |
$59K |
| 73560 |
|
2,064 |
1,728 |
$59K |
| 96367 |
|
1,153 |
820 |
$59K |
| 76770 |
|
339 |
295 |
$59K |
| 73030 |
|
1,708 |
1,453 |
$58K |
| 64493 |
|
95 |
66 |
$57K |
| 95700 |
|
363 |
287 |
$57K |
| 97129 |
|
1,552 |
537 |
$55K |
| 72040 |
|
968 |
819 |
$55K |
| 74174 |
|
574 |
476 |
$55K |
| 76700 |
|
267 |
243 |
$53K |
| 45385 |
|
64 |
51 |
$51K |
| 96125 |
|
243 |
217 |
$49K |
| 97535 |
|
2,023 |
1,187 |
$49K |
| 93299 |
|
1,898 |
1,753 |
$48K |
| 88341 |
|
604 |
465 |
$48K |
| 94660 |
|
352 |
137 |
$48K |
| J7298 |
Mirena, 52 mg |
46 |
30 |
$46K |
| 97165 |
|
824 |
628 |
$45K |
| 97161 |
|
803 |
631 |
$45K |
| 97163 |
|
1,158 |
890 |
$42K |
| 81001 |
|
45,375 |
40,214 |
$39K |
| 72050 |
|
594 |
542 |
$39K |
| 77336 |
|
288 |
130 |
$38K |
| 73130 |
|
1,558 |
1,316 |
$37K |
| 82077 |
|
8,355 |
6,515 |
$37K |
| 10060 |
|
213 |
177 |
$35K |
| 76641 |
|
173 |
153 |
$35K |
| 73502 |
|
1,195 |
981 |
$33K |
| 73630 |
|
1,495 |
1,251 |
$33K |
| 87086 |
|
3,404 |
2,729 |
$33K |
| 84443 |
|
7,064 |
5,892 |
$32K |
| 74018 |
|
841 |
703 |
$32K |
| 97130 |
|
1,483 |
507 |
$32K |
| 93922 |
|
447 |
407 |
$31K |
| 95816 |
|
189 |
163 |
$30K |
| 85610 |
|
8,810 |
6,330 |
$29K |
| J7030 |
Normal saline solution infus |
18,551 |
12,575 |
$28K |
| 20930 |
|
53 |
37 |
$28K |
| 73700 |
|
232 |
195 |
$28K |
| 77062 |
|
584 |
528 |
$28K |
| 74183 |
|
115 |
98 |
$28K |
| A9555 |
Rb82 rubidium |
522 |
426 |
$28K |
| 84703 |
|
20,435 |
17,645 |
$27K |
| 99281 |
|
210 |
185 |
$27K |
| 73610 |
|
1,342 |
1,110 |
$27K |
| 80320 |
|
1,593 |
1,471 |
$27K |
| 72146 |
|
325 |
257 |
$26K |
| 83605 |
|
6,247 |
4,527 |
$25K |
| 95813 |
|
25 |
25 |
$25K |
| 86901 |
|
5,892 |
4,748 |
$24K |
| 72110 |
|
387 |
370 |
$24K |
| 22853 |
|
37 |
25 |
$24K |
| 74178 |
|
83 |
70 |
$23K |
| 19083 |
|
32 |
24 |
$23K |
| 97167 |
|
720 |
553 |
$23K |
| 77300 |
|
33 |
29 |
$23K |
| J1885 |
Ketorolac tromethamine inj |
9,949 |
6,613 |
$22K |
| 77080 |
|
309 |
287 |
$22K |
| U0002 |
Covid-19 lab test non-cdc |
3,743 |
3,259 |
$21K |
| 93325 |
|
189 |
163 |
$21K |
| 78434 |
|
482 |
395 |
$21K |
| 73110 |
|
854 |
669 |
$21K |
| 82248 |
|
12,319 |
10,167 |
$21K |
| 76377 |
|
1,117 |
889 |
$20K |
| 97140 |
|
651 |
335 |
$19K |
| 83036 |
|
2,794 |
2,240 |
$18K |
| 82306 |
|
1,026 |
876 |
$18K |
| 72072 |
|
382 |
334 |
$17K |
| J7120 |
Ringers lactate infusion |
8,903 |
5,200 |
$17K |
| 82565 |
|
24,105 |
20,534 |
$17K |
| 83690 |
|
12,670 |
10,700 |
$17K |
| J1170 |
Hydromorphone injection |
7,004 |
4,044 |
$17K |
| 83880 |
|
3,473 |
2,809 |
$16K |
| 92523 |
|
800 |
614 |
$16K |
| 77334 |
|
53 |
40 |
$16K |
| 90715 |
|
856 |
691 |
$16K |
| J0561 |
Penicillin g benzathine inj |
72 |
45 |
$16K |
| J3535 |
Metered dose inhaler drug |
1,164 |
790 |
$15K |
| 94060 |
|
122 |
104 |
$15K |
| 82947 |
|
25,199 |
21,448 |
$15K |
| 93308 |
|
56 |
45 |
$15K |
| J2405 |
Ondansetron hcl injection |
18,548 |
11,558 |
$15K |
| 93880 |
|
174 |
153 |
$15K |
| 72156 |
|
106 |
82 |
$15K |
| J3010 |
Fentanyl citrate injection |
11,048 |
6,813 |
$15K |
| G2066 |
Inter devc remote 30d |
628 |
598 |
$15K |
| 62321 |
|
24 |
13 |
$14K |
| 72128 |
|
393 |
323 |
$14K |
| 80076 |
|
6,157 |
5,077 |
$14K |
| 84520 |
|
23,794 |
20,295 |
$14K |
| 80061 |
|
1,534 |
1,296 |
$14K |
| 64494 |
|
61 |
38 |
$13K |
| 83735 |
|
5,322 |
3,314 |
$13K |
| J1815 |
Insulin injection |
3,610 |
1,511 |
$13K |
| 88342 |
|
1,186 |
913 |
$13K |
| 87491 |
|
1,220 |
1,000 |
$12K |
| J2704 |
Inj, propofol, 10 mg |
9,664 |
6,533 |
$12K |
| J1650 |
Inj enoxaparin sodium |
6,816 |
2,335 |
$12K |
| 73080 |
|
580 |
445 |
$12K |
| 82607 |
|
1,216 |
957 |
$11K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
16,417 |
13,369 |
$11K |
| 43235 |
|
15 |
15 |
$11K |
| 86140 |
|
1,721 |
1,351 |
$11K |
| 77061 |
|
201 |
191 |
$11K |
| 92610 |
|
503 |
398 |
$11K |
| J2250 |
Inj midazolam hydrochloride |
8,150 |
6,062 |
$10K |
| 94727 |
|
198 |
166 |
$10K |
| 87040 |
|
1,031 |
782 |
$10K |
| J0689 |
Inj cefazolin sodium, baxter |
3,716 |
2,442 |
$10K |
| 87081 |
|
563 |
479 |
$10K |
| 94729 |
|
199 |
167 |
$10K |
| 45378 |
|
23 |
13 |
$10K |
| 80143 |
|
2,143 |
1,682 |
$9K |
| 88304 |
|
582 |
450 |
$9K |
| 85730 |
|
2,715 |
2,152 |
$9K |
| A9552 |
F18 fdg |
284 |
249 |
$9K |
| 73590 |
|
691 |
567 |
$8K |
| 87653 |
|
459 |
380 |
$8K |
| C1769 |
Guide wire |
1,545 |
1,210 |
$8K |
| 80179 |
|
2,106 |
1,654 |
$8K |
| 72170 |
|
860 |
669 |
$8K |
| 87591 |
|
1,221 |
1,001 |
$8K |
| 96368 |
|
179 |
119 |
$8K |
| 81025 |
|
2,091 |
1,588 |
$8K |
| 80047 |
|
2,938 |
2,276 |
$8K |
| C1725 |
Cath, translumin non-laser |
267 |
199 |
$8K |
| 12001 |
|
68 |
56 |
$8K |
| 77066 |
Tomosynthesis, mammo |
629 |
569 |
$8K |
| 87661 |
|
1,214 |
1,007 |
$7K |
| 76870 |
|
262 |
230 |
$7K |
| 87077 |
|
1,303 |
1,054 |
$7K |
| 36416 |
|
922 |
548 |
$7K |
| 87070 |
|
961 |
756 |
$7K |
| J0690 |
Cefazolin sodium injection |
463 |
279 |
$7K |
| 76937 |
|
306 |
235 |
$7K |
| 82728 |
|
1,186 |
960 |
$7K |
| 85379 |
|
1,502 |
1,229 |
$7K |
| 84702 |
|
2,144 |
1,667 |
$7K |
| 73562 |
|
66 |
56 |
$6K |
| 96112 |
|
20 |
12 |
$6K |
| 93320 |
|
16 |
13 |
$6K |
| 85014 |
|
3,106 |
2,401 |
$6K |
| C1760 |
Closure dev, vasc |
474 |
379 |
$6K |
| J1100 |
Dexamethasone sodium phos |
7,856 |
5,633 |
$6K |
| C1887 |
Catheter, guiding |
721 |
569 |
$6K |
| 87506 |
|
51 |
36 |
$6K |
| 78452 |
|
14 |
13 |
$5K |
| 87651 |
|
1,515 |
1,250 |
$5K |
| J7040 |
Normal saline solution infus |
4,255 |
3,140 |
$5K |
| 82746 |
|
1,057 |
826 |
$5K |
| 84439 |
|
793 |
633 |
$5K |
| 85652 |
|
1,696 |
1,341 |
$5K |
| 84100 |
|
2,445 |
1,506 |
$5K |
| 87210 |
|
834 |
694 |
$5K |
| 86880 |
|
265 |
238 |
$5K |
| J2469 |
Palonosetron hcl |
46 |
24 |
$4K |
| 86703 |
|
489 |
408 |
$4K |
| C1894 |
Intro/sheath, non-laser |
1,432 |
1,115 |
$4K |
| J0696 |
Ceftriaxone sodium injection |
1,799 |
1,118 |
$4K |
| 72158 |
|
15 |
14 |
$4K |
| 83540 |
|
1,141 |
928 |
$4K |
| 86803 |
|
461 |
390 |
$4K |
| 90791 |
|
37 |
27 |
$4K |
| G0257 |
Unsched dialysis esrd pt hos |
47 |
24 |
$4K |
| J1756 |
Iron sucrose injection |
116 |
67 |
$4K |
| 97542 |
|
114 |
82 |
$4K |
| 82330 |
|
814 |
554 |
$4K |
| 86780 |
|
418 |
338 |
$4K |
| 87075 |
|
647 |
511 |
$4K |
| J3486 |
Ziprasidone mesylate |
354 |
212 |
$4K |
| 83550 |
|
1,128 |
918 |
$4K |
| 87502 |
|
139 |
125 |
$4K |
| 76882 |
|
33 |
29 |
$4K |
| 0202U |
|
25 |
18 |
$4K |
| 74420 |
|
20 |
12 |
$4K |
| 86923 |
|
100 |
69 |
$3K |
| 87205 |
|
1,049 |
822 |
$3K |
| 87186 |
|
1,156 |
939 |
$3K |
| 76775 |
|
40 |
37 |
$3K |
| 99204 |
|
54 |
46 |
$3K |
| J1644 |
Inj heparin sodium per 1000u |
3,824 |
2,036 |
$3K |
| J2543 |
Piperacillin/tazobactam |
502 |
215 |
$3K |
| 77065 |
Tomosynthesis, mammo |
267 |
248 |
$3K |
| 71101 |
|
161 |
122 |
$3K |
| 76813 |
|
33 |
31 |
$3K |
| 82570 |
|
829 |
670 |
$3K |
| J3480 |
Inj potassium chloride |
901 |
470 |
$3K |
| 73090 |
|
278 |
218 |
$3K |
| 93298 |
|
574 |
562 |
$3K |
| G0500 |
Mod sedat endo service >5yrs |
80 |
59 |
$3K |
| J1200 |
Diphenhydramine hcl injectio |
4,091 |
2,980 |
$3K |
| 87340 |
|
560 |
428 |
$3K |
| 73564 |
|
28 |
26 |
$3K |
| 88302 |
|
57 |
38 |
$3K |
| C1782 |
Morcellator |
35 |
26 |
$3K |
| 92526 |
|
100 |
62 |
$3K |
| 73552 |
|
244 |
206 |
$3K |
| J2765 |
Metoclopramide hcl injection |
2,804 |
2,018 |
$2K |
| 90471 |
|
912 |
721 |
$2K |
| J3475 |
Inj magnesium sulfate |
1,028 |
670 |
$2K |
| 83615 |
|
1,111 |
795 |
$2K |
| 12002 |
|
18 |
13 |
$2K |
| 86038 |
|
79 |
65 |
$2K |
| 80069 |
|
361 |
180 |
$2K |
| J2270 |
Morphine sulfate injection |
1,267 |
882 |
$2K |
| J1642 |
Inj heparin sodium per 10 u |
843 |
486 |
$2K |
| J0574 |
Bupren/nal 6.1 to 10mg bupre |
114 |
58 |
$2K |
| J2785 |
Regadenoson injection |
666 |
537 |
$2K |
| 82977 |
|
1,343 |
1,072 |
$2K |
| 93356 |
|
29 |
27 |
$2K |
| 73522 |
|
39 |
39 |
$2K |
| J7050 |
Normal saline solution infus |
3,462 |
2,503 |
$2K |
| 89051 |
|
109 |
84 |
$2K |
| 88360 |
|
13 |
12 |
$2K |
| 82550 |
|
807 |
550 |
$2K |
| J3360 |
Diazepam injection |
612 |
436 |
$2K |
| J1836 |
Inj, metronidazole, 10 mg |
746 |
473 |
$2K |
| 85384 |
|
509 |
364 |
$2K |
| J0780 |
Prochlorperazine injection |
1,153 |
783 |
$2K |
| 82010 |
|
658 |
474 |
$2K |
| 84550 |
|
1,033 |
753 |
$1K |
| J0736 |
Inj, clindamycin phosp 300mg |
290 |
166 |
$1K |
| J3370 |
Vancomycin hcl injection |
943 |
535 |
$1K |
| 73060 |
|
152 |
110 |
$1K |
| G0480 |
Drug test def 1-7 classes |
62 |
40 |
$1K |
| 84156 |
|
723 |
540 |
$1K |
| J0134 |
Inj acetaminophen -fresenius |
587 |
394 |
$1K |
| J7999 |
Compounded drug, noc |
626 |
423 |
$1K |
| 80164 |
|
402 |
297 |
$1K |
| J7121 |
5% dextrose in lac ringers |
550 |
279 |
$1K |
| 85007 |
|
352 |
270 |
$1K |
| 72157 |
|
21 |
12 |
$1K |
| J2175 |
Meperidine hydrochl /100 mg |
369 |
264 |
$1K |
| C1729 |
Cath, drainage |
312 |
254 |
$1K |
| 84145 |
|
100 |
71 |
$1K |
| J2930 |
Methylprednisolone injection |
1,247 |
826 |
$1K |
| J0360 |
Hydralazine hcl injection |
692 |
446 |
$1K |
| 74230 |
|
21 |
13 |
$1K |
| 80177 |
|
292 |
219 |
$1K |
| J1790 |
Droperidol injection |
968 |
754 |
$1K |
| 86870 |
|
17 |
12 |
$1K |
| 82784 |
|
435 |
311 |
$1K |
| C9113 |
Inj pantoprazole sodium, via |
452 |
186 |
$1K |
| J3411 |
Thiamine hcl 100 mg |
661 |
287 |
$1K |
| 82140 |
|
453 |
351 |
$1K |
| Q9957 |
Inj perflutren lip micros,ml |
742 |
623 |
$1K |
| J0330 |
Succinycholine chloride inj |
612 |
349 |
$1K |
| 80329 |
|
69 |
66 |
$997.92 |
| A9575 |
Inj gadoterate meglumi 0.1ml |
2,794 |
2,382 |
$986.29 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
1,968 |
1,129 |
$952.12 |
| 86704 |
|
72 |
63 |
$928.31 |
| 84132 |
|
594 |
466 |
$911.87 |
| J2060 |
Lorazepam injection |
1,030 |
734 |
$860.60 |
| 87641 |
|
18 |
12 |
$821.08 |
| J1630 |
Haloperidol injection |
1,037 |
743 |
$779.16 |
| Q9966 |
Locm 200-299mg/ml iodine,1ml |
2,242 |
1,923 |
$773.56 |
| 88112 |
|
52 |
38 |
$738.34 |
| 83970 |
|
81 |
65 |
$674.08 |
| J0295 |
Ampicillin sulbactam 1.5 gm |
415 |
167 |
$670.06 |
| J2795 |
Ropivacaine hcl injection |
117 |
81 |
$668.18 |
| J1940 |
Furosemide injection |
692 |
346 |
$637.32 |
| 86592 |
|
234 |
182 |
$569.90 |
| 84295 |
|
339 |
272 |
$565.04 |
| J0702 |
Betamethasone acet&sod phosp |
57 |
25 |
$553.07 |
| 85018 |
|
713 |
500 |
$552.73 |
| 86706 |
|
64 |
54 |
$532.70 |
| 87420 |
|
14 |
14 |
$488.08 |
| J2370 |
Phenylephrine hcl injection |
375 |
246 |
$484.38 |
| 85045 |
|
296 |
209 |
$472.60 |
| J1580 |
Garamycin gentamicin inj |
169 |
102 |
$472.11 |
| 92611 |
|
21 |
13 |
$470.56 |
| J2360 |
Orphenadrine injection |
197 |
143 |
$469.22 |
| J1920 |
Inj, labetalol hcl, 5mg |
438 |
258 |
$448.50 |
| J3301 |
Triamcinolone acet inj nos |
307 |
218 |
$441.69 |
| 86200 |
|
17 |
13 |
$415.27 |
| 76942 |
|
121 |
93 |
$361.26 |
| 84450 |
|
141 |
117 |
$349.09 |
| J1953 |
Levetiracetam injection |
60 |
40 |
$337.60 |
| 84460 |
|
139 |
115 |
$329.06 |
| 86235 |
|
16 |
13 |
$297.85 |
| J1596 |
Inj, glycopyrrolate, 0.1 mg |
411 |
366 |
$297.10 |
| 86431 |
|
15 |
14 |
$294.03 |
| J7512 |
Prednisone ir or dr oral 1mg |
1,668 |
1,036 |
$276.65 |
| J2359 |
Inj. olanzapine, 0.5mg |
26 |
13 |
$266.74 |
| 87147 |
|
37 |
24 |
$220.84 |
| J2310 |
Inj naloxone hydrochloride |
26 |
15 |
$207.86 |
| 82375 |
|
53 |
36 |
$165.24 |
| 80074 |
|
33 |
24 |
$128.07 |
| J2919 |
Inj, methylpred sod succ 5mg |
148 |
127 |
$123.80 |
| J1720 |
Hydrocortisone sodium succ i |
17 |
12 |
$118.14 |
| 51701 |
|
122 |
95 |
$111.78 |
| A9500 |
Tc99m sestamibi |
72 |
51 |
$106.92 |
| 83050 |
|
36 |
24 |
$97.20 |
| J2471 |
Inj pantoprazole(hikma) 40mg |
123 |
87 |
$92.28 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
188 |
131 |
$82.32 |
| 82435 |
|
131 |
98 |
$74.73 |
| J2305 |
Inj, nitroglycerin, 5 mg |
182 |
161 |
$64.01 |
| 82803 |
|
13 |
12 |
$48.15 |
| J0456 |
Azithromycin |
52 |
31 |
$47.41 |
| 82150 |
|
28 |
26 |
$45.75 |
| J2272 |
Inj, morphine (fresenius) |
52 |
45 |
$42.60 |
| 84425 |
|
20 |
17 |
$40.29 |
| Q9965 |
Locm 100-199mg/ml iodine,1ml |
113 |
108 |
$39.87 |
| 86308 |
|
18 |
13 |
$32.58 |
| 82310 |
|
19 |
12 |
$27.18 |
| 80175 |
|
14 |
12 |
$26.28 |
| J1010 |
Inj, methylpred acetate 1 mg |
13 |
13 |
$11.14 |
| J3420 |
Vitamin b12 injection |
28 |
14 |
$3.40 |
| 84155 |
|
13 |
12 |
$1.80 |
| 87176 |
|
17 |
14 |
$0.00 |
| J2470 |
Inj pantoprazole sodium 40mg |
21 |
14 |
$0.00 |
| J7060 |
5% dextrose/water |
17 |
12 |
$0.00 |
| C9399 |
Unclassified drugs or biolog |
208 |
169 |
$0.00 |
| C1726 |
Cath, bal dil, non-vascular |
15 |
13 |
$0.00 |
| 84134 |
|
15 |
13 |
$0.00 |