| Code | Description | Claims | Beneficiaries | Total Paid |
| 99284 |
|
32,670 |
30,379 |
$5.87M |
| 99283 |
|
37,795 |
35,502 |
$4.71M |
| 99285 |
|
15,913 |
14,800 |
$4.58M |
| 96374 |
|
16,541 |
15,146 |
$1.32M |
| G0463 |
Hospital outpt clinic visit |
38,770 |
30,841 |
$1.25M |
| 93458 |
|
699 |
657 |
$731K |
| 99282 |
|
8,481 |
8,166 |
$715K |
| 97110 |
|
24,887 |
6,620 |
$654K |
| A0427 |
Als1-emergency |
3,614 |
3,102 |
$649K |
| 74177 |
|
4,823 |
4,704 |
$639K |
| 70450 |
|
5,947 |
5,730 |
$449K |
| 93306 |
|
2,456 |
2,404 |
$445K |
| 74176 |
|
4,350 |
4,192 |
$408K |
| 96365 |
|
4,893 |
3,990 |
$404K |
| 96413 |
|
2,492 |
1,505 |
$353K |
| 71045 |
|
10,374 |
9,702 |
$352K |
| 96375 |
|
13,866 |
11,697 |
$348K |
| 71046 |
|
10,163 |
9,795 |
$340K |
| 96361 |
|
10,446 |
9,021 |
$337K |
| 78452 |
|
743 |
713 |
$317K |
| 87637 |
|
5,347 |
5,269 |
$287K |
| 96360 |
|
3,032 |
2,554 |
$268K |
| 20610 |
|
1,884 |
1,378 |
$248K |
| 77067 |
|
5,125 |
5,111 |
$245K |
| A0429 |
Bls-emergency |
2,410 |
2,039 |
$242K |
| A0425 |
Ground mileage |
7,764 |
5,956 |
$223K |
| 43239 |
|
733 |
689 |
$197K |
| 59025 |
|
2,362 |
1,592 |
$196K |
| 80061 |
|
17,477 |
17,270 |
$192K |
| 45385 |
|
497 |
472 |
$176K |
| 11042 |
|
1,046 |
523 |
$175K |
| 99291 |
|
334 |
330 |
$159K |
| 97161 |
|
3,341 |
3,264 |
$151K |
| 76705 |
|
2,857 |
2,802 |
$147K |
| 87635 |
|
6,537 |
6,271 |
$145K |
| G0260 |
Inj for sacroiliac jt anesth |
555 |
475 |
$138K |
| 97140 |
|
9,682 |
3,017 |
$136K |
| A0428 |
Bls |
1,348 |
1,114 |
$131K |
| 70553 |
|
573 |
568 |
$114K |
| 72148 |
|
1,058 |
1,038 |
$109K |
| 95810 |
|
217 |
217 |
$95K |
| 71275 |
|
1,211 |
1,180 |
$92K |
| 82947 |
|
3,600 |
2,194 |
$91K |
| 97530 |
|
3,652 |
1,386 |
$90K |
| 73564 |
|
4,245 |
3,756 |
$88K |
| G0378 |
Hospital observation per hr |
2,760 |
2,357 |
$81K |
| 76856 |
|
1,541 |
1,497 |
$76K |
| 93971 |
|
1,537 |
1,477 |
$73K |
| 71260 |
|
926 |
898 |
$66K |
| 72110 |
|
2,815 |
2,764 |
$65K |
| 76830 |
|
1,250 |
1,215 |
$64K |
| 73721 |
|
567 |
545 |
$64K |
| 95811 |
|
145 |
143 |
$60K |
| 62323 |
|
213 |
188 |
$59K |
| 99391 |
|
1,531 |
1,516 |
$59K |
| 90472 |
|
3,189 |
2,926 |
$56K |
| 96366 |
|
1,995 |
1,414 |
$55K |
| 93017 |
|
1,453 |
1,405 |
$53K |
| 90471 |
|
5,331 |
5,187 |
$51K |
| 96372 |
|
16,327 |
14,261 |
$50K |
| U0003 |
Cov-19 amp prb hgh thruput |
1,995 |
1,931 |
$49K |
| 80053 |
|
59,433 |
52,937 |
$48K |
| 72141 |
|
361 |
355 |
$42K |
| 84443 |
|
19,440 |
19,081 |
$41K |
| 73030 |
|
3,515 |
3,214 |
$40K |
| 97112 |
|
1,701 |
591 |
$40K |
| 85025 |
|
68,893 |
59,385 |
$38K |
| 82306 |
|
9,290 |
9,224 |
$37K |
| 72100 |
|
1,264 |
1,222 |
$37K |
| 99392 |
|
1,407 |
1,407 |
$37K |
| 73630 |
|
3,738 |
3,470 |
$36K |
| 93005 |
|
19,012 |
16,594 |
$36K |
| 76642 |
|
992 |
911 |
$34K |
| 96367 |
|
1,056 |
711 |
$34K |
| 74018 |
|
1,710 |
1,654 |
$33K |
| 73610 |
|
3,212 |
2,981 |
$33K |
| 76801 |
|
623 |
586 |
$32K |
| 95910 |
|
233 |
227 |
$31K |
| 93975 |
|
300 |
283 |
$31K |
| 77063 |
|
2,489 |
2,485 |
$30K |
| 93880 |
|
317 |
316 |
$30K |
| 73130 |
|
3,199 |
2,871 |
$27K |
| 78815 |
|
38 |
38 |
$26K |
| 86900 |
|
4,014 |
3,760 |
$25K |
| 45378 |
|
102 |
98 |
$25K |
| 76536 |
|
523 |
519 |
$25K |
| 96127 |
|
2,517 |
1,736 |
$24K |
| 73110 |
|
2,396 |
2,167 |
$24K |
| 36415 |
|
47,925 |
42,859 |
$24K |
| 71250 |
|
509 |
506 |
$24K |
| 73502 |
|
1,758 |
1,689 |
$24K |
| G0008 |
Admin influenza virus vac |
2,239 |
2,213 |
$23K |
| 72050 |
|
793 |
778 |
$22K |
| 87491 |
|
3,216 |
3,142 |
$22K |
| 87591 |
|
3,154 |
3,077 |
$21K |
| 93970 |
|
212 |
209 |
$20K |
| 72125 |
|
2,020 |
1,961 |
$20K |
| 76700 |
|
352 |
351 |
$20K |
| 45380 |
|
77 |
65 |
$20K |
| 73221 |
|
164 |
158 |
$19K |
| 71271 |
|
347 |
346 |
$19K |
| 76775 |
|
560 |
548 |
$18K |
| 76641 |
|
378 |
307 |
$17K |
| 90677 |
|
50 |
50 |
$14K |
| 94726 |
|
397 |
392 |
$14K |
| 99393 |
|
683 |
683 |
$14K |
| 83036 |
|
10,546 |
10,427 |
$14K |
| 76770 |
|
272 |
266 |
$13K |
| 99281 |
|
224 |
212 |
$13K |
| 77066 |
Tomosynthesis, mammo |
234 |
232 |
$13K |
| 64493 |
|
28 |
25 |
$12K |
| 90686 |
|
775 |
772 |
$12K |
| 73562 |
|
868 |
749 |
$12K |
| 80307 |
|
9,294 |
8,777 |
$12K |
| 70486 |
|
397 |
389 |
$11K |
| G0009 |
Admin pneumococcal vaccine |
1,193 |
1,192 |
$11K |
| 94060 |
|
84 |
83 |
$11K |
| 97162 |
|
212 |
211 |
$10K |
| 72072 |
|
584 |
574 |
$9K |
| C8929 |
Tte w or wo fol wcon,doppler |
40 |
39 |
$9K |
| 82607 |
|
4,684 |
4,652 |
$9K |
| 80048 |
|
12,530 |
11,121 |
$9K |
| 99394 |
|
777 |
777 |
$8K |
| Q9950 |
Inj sulf hexa lipid microsph |
356 |
332 |
$8K |
| A0426 |
Als 1 |
44 |
41 |
$8K |
| 84439 |
|
6,806 |
6,704 |
$8K |
| 97165 |
|
165 |
162 |
$8K |
| 72131 |
|
202 |
194 |
$8K |
| 73080 |
|
843 |
792 |
$7K |
| 95806 |
|
96 |
95 |
$7K |
| 71101 |
|
664 |
642 |
$7K |
| 96415 |
|
187 |
131 |
$7K |
| 77065 |
Tomosynthesis, mammo |
164 |
154 |
$7K |
| 90670 |
|
214 |
212 |
$7K |
| 87086 |
|
9,710 |
9,200 |
$6K |
| G0279 |
Tomosynthesis, mammo |
525 |
523 |
$6K |
| G0103 |
Psa screening |
1,706 |
1,701 |
$6K |
| 82728 |
|
2,871 |
2,797 |
$5K |
| 99395 |
|
232 |
229 |
$5K |
| 99396 |
|
290 |
289 |
$5K |
| U0005 |
Infec agen detec ampli probe |
642 |
635 |
$5K |
| 72040 |
|
240 |
229 |
$4K |
| G0480 |
Drug test def 1-7 classes |
4,378 |
3,890 |
$4K |
| 83880 |
|
3,122 |
2,955 |
$4K |
| 85610 |
|
19,256 |
15,293 |
$4K |
| 87502 |
|
3,697 |
3,577 |
$4K |
| 96523 |
|
152 |
130 |
$4K |
| C9803 |
Hopd covid-19 spec collect |
343 |
330 |
$3K |
| 74022 |
|
2,102 |
2,059 |
$3K |
| 82746 |
|
1,710 |
1,697 |
$3K |
| 96376 |
|
3,047 |
2,258 |
$3K |
| 93296 |
|
189 |
176 |
$3K |
| 87077 |
|
3,516 |
3,320 |
$3K |
| 87390 |
|
890 |
883 |
$3K |
| 87186 |
|
3,202 |
3,027 |
$3K |
| 88305 |
|
3,725 |
3,359 |
$3K |
| 87070 |
|
3,234 |
3,094 |
$3K |
| 70551 |
|
26 |
26 |
$3K |
| 90474 |
|
455 |
455 |
$3K |
| 83540 |
|
3,133 |
3,065 |
$3K |
| 83550 |
|
2,264 |
2,223 |
$3K |
| 80076 |
|
2,092 |
1,860 |
$3K |
| 82570 |
|
3,336 |
3,189 |
$3K |
| 84702 |
|
2,588 |
2,203 |
$2K |
| 20553 |
|
17 |
16 |
$2K |
| 97035 |
|
584 |
171 |
$2K |
| 76882 |
|
54 |
49 |
$2K |
| 83735 |
|
8,169 |
7,092 |
$2K |
| 87660 |
|
793 |
781 |
$2K |
| 96417 |
|
77 |
52 |
$2K |
| 87480 |
|
736 |
724 |
$2K |
| 87510 |
|
736 |
724 |
$2K |
| Q9969 |
Non-heu tc-99m add-on/dose |
314 |
305 |
$2K |
| 74019 |
|
51 |
51 |
$2K |
| 80074 |
|
282 |
281 |
$2K |
| 82043 |
|
2,739 |
2,722 |
$2K |
| 76000 |
|
162 |
147 |
$2K |
| 81001 |
|
18,939 |
17,802 |
$2K |
| G0482 |
Drug test def 15-21 classes |
240 |
238 |
$2K |
| 86140 |
|
3,789 |
3,517 |
$2K |
| 73590 |
|
395 |
357 |
$2K |
| 70496 |
|
39 |
38 |
$2K |
| 86038 |
|
1,292 |
1,276 |
$2K |
| 95908 |
|
13 |
13 |
$2K |
| 86702 |
|
911 |
902 |
$2K |
| 83970 |
|
228 |
224 |
$2K |
| 94640 |
|
3,635 |
2,805 |
$2K |
| 85027 |
|
3,356 |
3,002 |
$2K |
| 87624 |
|
357 |
357 |
$2K |
| 95819 |
|
14 |
14 |
$2K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
6,681 |
6,491 |
$2K |
| 73140 |
|
169 |
159 |
$2K |
| 86850 |
|
3,927 |
3,654 |
$2K |
| 73090 |
|
328 |
307 |
$1K |
| 82565 |
|
1,616 |
1,453 |
$1K |
| 93299 |
|
77 |
75 |
$1K |
| 86803 |
|
642 |
639 |
$1K |
| 10060 |
|
17 |
13 |
$1K |
| 86701 |
|
908 |
900 |
$1K |
| G0297 |
Ldct for lung ca screen |
26 |
26 |
$1K |
| 99406 |
|
69 |
67 |
$1K |
| 83655 |
|
614 |
613 |
$998.01 |
| 85730 |
|
9,997 |
8,945 |
$986.95 |
| 84403 |
|
211 |
210 |
$933.85 |
| 83690 |
|
9,874 |
9,176 |
$904.22 |
| 72170 |
|
126 |
122 |
$841.39 |
| 84550 |
|
1,236 |
1,211 |
$837.65 |
| G0108 |
Diab manage trn per indiv |
14 |
13 |
$801.65 |
| 83721 |
|
425 |
424 |
$760.62 |
| A9270 |
Non-covered item or service |
35,995 |
16,841 |
$753.49 |
| 80164 |
|
306 |
298 |
$687.15 |
| 85652 |
|
2,232 |
2,154 |
$684.42 |
| 90688 |
|
68 |
68 |
$668.88 |
| 77080 |
|
12 |
12 |
$657.23 |
| 84156 |
|
1,201 |
1,057 |
$653.69 |
| 81003 |
|
9,818 |
9,444 |
$632.95 |
| 82150 |
|
3,539 |
3,373 |
$627.58 |
| 87205 |
|
1,478 |
1,378 |
$614.48 |
| 29581 |
|
25 |
12 |
$595.06 |
| 84450 |
|
813 |
778 |
$565.12 |
| 84460 |
|
751 |
724 |
$548.01 |
| 86901 |
|
4,515 |
4,227 |
$544.69 |
| 84100 |
|
1,269 |
1,111 |
$539.88 |
| 93225 |
|
12 |
12 |
$536.84 |
| 84703 |
|
861 |
854 |
$507.40 |
| 86431 |
|
720 |
718 |
$488.85 |
| 87340 |
|
301 |
294 |
$443.09 |
| 84153 |
|
91 |
91 |
$432.10 |
| 88175 |
|
104 |
104 |
$422.17 |
| 81025 |
|
8,600 |
8,197 |
$395.59 |
| 93293 |
|
25 |
25 |
$383.96 |
| 73560 |
|
17 |
13 |
$380.78 |
| 72114 |
|
13 |
13 |
$358.79 |
| 86780 |
|
102 |
98 |
$357.33 |
| 82550 |
|
977 |
906 |
$347.75 |
| 87880 |
|
2,160 |
2,123 |
$345.28 |
| 93922 |
|
12 |
12 |
$332.90 |
| 87147 |
|
546 |
527 |
$308.66 |
| 90656 |
|
18 |
18 |
$288.45 |
| 85379 |
|
2,195 |
2,101 |
$277.29 |
| 84484 |
|
12,488 |
8,449 |
$267.45 |
| 84520 |
|
320 |
265 |
$265.25 |
| 87634 |
|
773 |
753 |
$265.22 |
| 87040 |
|
2,406 |
1,592 |
$254.21 |
| 87081 |
|
1,971 |
1,934 |
$243.85 |
| 94729 |
|
372 |
367 |
$227.80 |
| 93280 |
|
13 |
13 |
$207.19 |
| 88142 |
|
162 |
162 |
$205.10 |
| 82077 |
|
4,956 |
4,437 |
$198.94 |
| 76817 |
|
181 |
176 |
$192.31 |
| 85651 |
|
583 |
509 |
$183.28 |
| J7120 |
Ringers lactate infusion |
2,323 |
2,052 |
$175.72 |
| 80143 |
|
2,826 |
2,674 |
$172.30 |
| 83516 |
|
59 |
39 |
$148.12 |
| 82248 |
|
103 |
81 |
$146.68 |
| G0328 |
Fecal blood scrn immunoassay |
58 |
58 |
$141.36 |
| 88341 |
|
14 |
12 |
$141.00 |
| 86480 |
|
14 |
14 |
$134.57 |
| G0123 |
Screen cerv/vag thin layer |
12 |
12 |
$121.92 |
| 80179 |
|
2,529 |
2,409 |
$121.70 |
| 84146 |
|
48 |
48 |
$113.84 |
| 87522 |
Neg quan hep c or qual rna |
14 |
13 |
$112.88 |
| 12001 |
|
747 |
739 |
$106.59 |
| 83615 |
|
178 |
169 |
$101.79 |
| J1885 |
Ketorolac tromethamine inj |
19,371 |
17,376 |
$100.15 |
| 88342 |
|
149 |
138 |
$95.55 |
| 83605 |
|
4,033 |
3,545 |
$95.22 |
| 82652 |
|
27 |
27 |
$90.95 |
| 76870 |
|
77 |
75 |
$87.60 |
| 87661 |
|
12 |
12 |
$77.04 |
| 87075 |
|
221 |
206 |
$75.34 |
| 80051 |
|
70 |
64 |
$69.76 |
| 82247 |
|
57 |
51 |
$65.78 |
| 86200 |
|
38 |
38 |
$58.88 |
| 81015 |
|
82 |
81 |
$58.14 |
| Q3014 |
Telehealth facility fee |
28 |
25 |
$57.36 |
| 86592 |
|
66 |
66 |
$56.80 |
| 87651 |
|
1,400 |
1,391 |
$55.84 |
| 87801 |
|
143 |
139 |
$49.78 |
| 80178 |
|
68 |
63 |
$48.78 |
| J7030 |
Normal saline solution infus |
12,967 |
10,932 |
$47.12 |
| 87046 |
|
24 |
12 |
$41.92 |
| 85046 |
|
57 |
55 |
$39.43 |
| Q0144 |
Azithromycin dihydrate, oral |
100 |
96 |
$38.39 |
| 82140 |
|
68 |
64 |
$37.90 |
| 84481 |
|
16 |
14 |
$31.77 |
| J3490 |
Drugs unclassified injection |
11,699 |
6,679 |
$31.38 |
| 85018 |
|
80 |
69 |
$28.04 |
| 82803 |
|
102 |
92 |
$26.89 |
| 87427 |
|
13 |
12 |
$26.63 |
| Q2036 |
Flulaval vacc, 3 yrs & >, im |
32 |
32 |
$26.08 |
| 87045 |
|
13 |
12 |
$20.96 |
| 84165 |
|
13 |
13 |
$16.61 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
283 |
262 |
$14.73 |
| C1894 |
Intro/sheath, non-laser |
2,074 |
1,789 |
$13.53 |
| 86308 |
|
30 |
28 |
$13.32 |
| 84132 |
|
45 |
39 |
$12.85 |
| 87210 |
|
130 |
120 |
$11.49 |
| J2060 |
Lorazepam injection |
1,291 |
1,109 |
$10.34 |
| 99152 |
|
1,408 |
1,308 |
$7.13 |
| 85007 |
|
18 |
13 |
$6.72 |
| 84436 |
|
39 |
39 |
$6.44 |
| J2765 |
Metoclopramide hcl injection |
911 |
892 |
$5.83 |
| J7512 |
Prednisone ir or dr oral 1mg |
720 |
682 |
$5.66 |
| J1200 |
Diphenhydramine hcl injectio |
4,850 |
4,202 |
$4.34 |
| 85045 |
|
14 |
13 |
$2.93 |
| J2405 |
Ondansetron hcl injection |
17,951 |
15,208 |
$2.87 |
| 85014 |
|
17 |
16 |
$2.66 |
| J1642 |
Inj heparin sodium per 10 u |
2,460 |
1,372 |
$0.05 |
| J1170 |
Hydromorphone injection |
3,820 |
2,951 |
$0.00 |
| J2250 |
Inj midazolam hydrochloride |
3,535 |
3,412 |
$0.00 |
| 94760 |
|
152 |
115 |
$0.00 |
| 95886 |
|
1,119 |
1,093 |
$0.00 |
| A9500 |
Tc99m sestamibi |
568 |
552 |
$0.00 |
| J1630 |
Haloperidol injection |
83 |
81 |
$0.00 |
| C1769 |
Guide wire |
931 |
783 |
$0.00 |
| J1100 |
Dexamethasone sodium phos |
5,964 |
5,243 |
$0.00 |
| A9585 |
Gadobutrol injection |
1,083 |
1,066 |
$0.00 |
| J2175 |
Meperidine hydrochl /100 mg |
152 |
139 |
$0.00 |
| 93320 |
|
246 |
232 |
$0.00 |
| J0696 |
Ceftriaxone sodium injection |
2,619 |
2,395 |
$0.00 |
| J0690 |
Cefazolin sodium injection |
3,191 |
2,751 |
$0.00 |
| J2360 |
Orphenadrine injection |
1,462 |
1,412 |
$0.00 |
| J7050 |
Normal saline solution infus |
3,788 |
2,640 |
$0.00 |
| J3010 |
Fentanyl citrate injection |
4,199 |
3,882 |
$0.00 |
| 90716 |
|
12 |
12 |
$0.00 |
| J0131 |
Inj, acetaminophen (nos) |
1,263 |
1,257 |
$0.00 |
| J2371 |
Inj phenylephrine hcl 20 mcg |
234 |
229 |
$0.00 |
| 90647 |
|
100 |
100 |
$0.00 |
| J2704 |
Inj, propofol, 10 mg |
3,365 |
3,296 |
$0.00 |
| 64494 |
|
44 |
37 |
$0.00 |
| J0330 |
Succinycholine chloride inj |
252 |
250 |
$0.00 |
| 90723 |
|
120 |
120 |
$0.00 |
| J0500 |
Dicyclomine injection |
176 |
173 |
$0.00 |
| G8980 |
Mobility d/c status |
12 |
12 |
$0.00 |
| J2785 |
Regadenoson injection |
234 |
224 |
$0.00 |
| J1815 |
Insulin injection |
20 |
12 |
$0.00 |
| 99153 |
Mod sedat endo service >5yrs |
285 |
252 |
$0.00 |
| 70498 |
|
25 |
24 |
$0.00 |
| J2370 |
Phenylephrine hcl injection |
114 |
110 |
$0.00 |
| J2001 |
Lidocaine injection |
122 |
107 |
$0.00 |
| 12002 |
|
107 |
107 |
$0.00 |
| J7042 |
5% dextrose/normal saline |
29 |
26 |
$0.00 |
| 99024 |
|
56 |
49 |
$0.00 |
| J8540 |
Oral dexamethasone |
44 |
25 |
$0.00 |
| C1889 |
Implant/insert device, noc |
30 |
30 |
$0.00 |
| 88307 |
|
28 |
26 |
$0.00 |
| 96368 |
|
18 |
15 |
$0.00 |
| 82962 |
|
16 |
16 |
$0.00 |
| J3360 |
Diazepam injection |
60 |
53 |
$0.00 |
| 94010 |
|
14 |
12 |
$0.00 |
| J7040 |
Normal saline solution infus |
3,102 |
2,461 |
$0.00 |
| G8979 |
Mobility goal status |
111 |
95 |
$0.00 |
| J3301 |
Triamcinolone acet inj nos |
3,423 |
2,890 |
$0.00 |
| J2270 |
Morphine sulfate injection |
5,271 |
4,173 |
$0.00 |
| G8978 |
Mobility current status |
75 |
66 |
$0.00 |
| 90715 |
|
2,076 |
2,059 |
$0.00 |
| J0171 |
Adrenalin epinephrine inject |
149 |
124 |
$0.00 |
| J0780 |
Prochlorperazine injection |
407 |
390 |
$0.00 |
| J2930 |
Methylprednisolone injection |
3,169 |
2,917 |
$0.00 |
| G1004 |
Cdsm ndsc |
348 |
328 |
$0.00 |
| A9502 |
Tc99m tetrofosmin |
113 |
103 |
$0.00 |
| J1644 |
Inj heparin sodium per 1000u |
2,070 |
1,472 |
$0.00 |
| 87220 |
|
102 |
92 |
$0.00 |
| J1650 |
Inj enoxaparin sodium |
16 |
13 |
$0.00 |
| 93325 |
|
293 |
277 |
$0.00 |
| 29125 |
|
184 |
184 |
$0.00 |
| C1713 |
Anchor/screw bn/bn,tis/bn |
297 |
286 |
$0.00 |
| C1887 |
Catheter, guiding |
70 |
67 |
$0.00 |
| J0735 |
Clonidine hydrochloride |
93 |
84 |
$0.00 |
| J3475 |
Inj magnesium sulfate |
644 |
548 |
$0.00 |
| J2710 |
Neostigmine methylslfte inj |
120 |
118 |
$0.00 |
| 82010 |
|
88 |
81 |
$0.00 |
| 93226 |
|
12 |
12 |
$0.00 |
| 12011 |
|
66 |
65 |
$0.00 |
| 90681 |
|
13 |
13 |
$0.00 |
| 76942 |
|
47 |
39 |
$0.00 |
| A9552 |
F18 fdg |
26 |
26 |
$0.00 |
| J2919 |
Inj, methylpred sod succ 5mg |
224 |
210 |
$0.00 |
| 94664 |
|
83 |
68 |
$0.00 |
| J3370 |
Vancomycin hcl injection |
163 |
116 |
$0.00 |
| 64495 |
|
44 |
37 |
$0.00 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
66 |
55 |
$0.00 |
| C9113 |
Inj pantoprazole sodium, via |
34 |
25 |
$0.00 |
| 99211 |
|
17 |
14 |
$0.00 |