| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99285 |
|
83,404 |
59,689 |
$25.20M |
| 99283 |
|
46,904 |
41,322 |
$17.29M |
| 0762 |
|
8,267 |
3,119 |
$7.48M |
| 0450 |
|
47,763 |
41,636 |
$7.00M |
| J9271 |
Inj pembrolizumab |
346 |
272 |
$6.23M |
| 78815 |
|
3,704 |
3,646 |
$4.15M |
| 99284 |
|
7,203 |
6,478 |
$3.37M |
| Q5118 |
Inj., zirabev, 10 mg |
303 |
128 |
$1.84M |
| 74176 |
|
34,581 |
30,990 |
$1.75M |
| G0463 |
Hospital outpt clinic visit |
34,030 |
25,576 |
$1.55M |
| J9306 |
Injection, pertuzumab, 1 mg |
74 |
53 |
$1.22M |
| 74177 |
|
14,639 |
13,537 |
$1.13M |
| 96413 |
|
8,682 |
4,255 |
$1.10M |
| 70450 |
|
33,942 |
31,295 |
$1.02M |
| 93458 |
|
453 |
414 |
$982K |
| 0360 |
|
3,837 |
2,460 |
$869K |
| Q5116 |
Inj., trazimera, 10 mg |
82 |
52 |
$789K |
| 80053 |
|
140,759 |
111,672 |
$663K |
| 70551 |
|
7,143 |
6,873 |
$604K |
| 71046 |
|
57,669 |
52,362 |
$555K |
| 70553 |
|
2,817 |
2,718 |
$509K |
| 99214 |
|
12,205 |
10,764 |
$506K |
| 71045 |
|
87,687 |
71,584 |
$499K |
| 71260 |
|
11,023 |
10,384 |
$486K |
| 85025 |
|
157,093 |
122,515 |
$436K |
| 72141 |
|
3,885 |
3,788 |
$404K |
| 66984 |
|
456 |
340 |
$400K |
| 77067 |
|
5,441 |
5,147 |
$397K |
| 78452 |
|
2,297 |
2,064 |
$387K |
| 96374 |
|
39,266 |
32,107 |
$382K |
| G0378 |
Hospital observation per hr |
650 |
488 |
$370K |
| 97112 |
|
18,191 |
4,523 |
$348K |
| C1776 |
Joint device (implantable) |
53 |
52 |
$348K |
| 72148 |
|
3,270 |
3,094 |
$339K |
| 97110 |
|
18,549 |
4,565 |
$339K |
| 99282 |
|
1,995 |
1,825 |
$331K |
| J3490 |
Drugs unclassified injection |
50,029 |
24,595 |
$331K |
| 96549 |
|
330 |
180 |
$330K |
| Z7502 |
|
8,701 |
8,521 |
$326K |
| 96365 |
|
11,161 |
9,538 |
$319K |
| 97530 |
|
17,951 |
4,722 |
$317K |
| 96375 |
|
40,125 |
27,884 |
$312K |
| 97802 |
|
3,084 |
2,858 |
$308K |
| 73721 |
|
2,250 |
2,089 |
$287K |
| 93005 |
|
60,784 |
46,487 |
$285K |
| 97140 |
|
9,951 |
3,056 |
$284K |
| 76700 |
|
5,992 |
5,556 |
$279K |
| 71250 |
|
5,369 |
5,204 |
$269K |
| 76641 |
|
4,266 |
4,026 |
$269K |
| 76705 |
|
13,526 |
12,424 |
$264K |
| 80307 |
|
17,405 |
14,901 |
$236K |
| 76805 |
|
4,753 |
4,266 |
$209K |
| 82306 |
|
9,241 |
8,333 |
$206K |
| 96360 |
|
6,648 |
5,081 |
$201K |
| J0185 |
Inj., aprepitant, 1 mg |
867 |
564 |
$199K |
| 77066 |
Tomosynthesis, mammo |
1,896 |
1,802 |
$189K |
| 99233 |
Prolong inpt eval add15 m |
3,923 |
1,463 |
$188K |
| 84443 |
|
17,416 |
15,272 |
$176K |
| 93970 |
|
4,105 |
3,931 |
$174K |
| 43239 |
|
116 |
113 |
$173K |
| 96372 |
|
39,983 |
31,897 |
$166K |
| 93306 |
|
2,577 |
2,364 |
$158K |
| C1713 |
Anchor/screw bn/bn,tis/bn |
306 |
209 |
$157K |
| J0897 |
Denosumab injection |
78 |
77 |
$156K |
| 93454 |
|
83 |
82 |
$156K |
| 96367 |
|
4,308 |
2,964 |
$155K |
| Z9725 |
|
3,709 |
3,686 |
$147K |
| 96417 |
|
3,044 |
1,712 |
$145K |
| 99215 |
Prolong outpt/office vis |
2,160 |
1,983 |
$143K |
| 96366 |
|
4,572 |
2,947 |
$141K |
| 96361 |
|
19,518 |
15,677 |
$138K |
| 77063 |
|
5,297 |
5,014 |
$134K |
| G6015 |
Radiation tx delivery imrt |
281 |
24 |
$132K |
| 73221 |
|
1,025 |
966 |
$131K |
| 81001 |
|
80,132 |
67,009 |
$130K |
| J9171 |
Docetaxel injection |
33 |
26 |
$129K |
| J2785 |
Regadenoson injection |
1,702 |
1,485 |
$128K |
| 74246 |
|
1,591 |
1,582 |
$128K |
| 0202U |
|
1,879 |
1,871 |
$127K |
| 76830 |
|
5,076 |
4,438 |
$123K |
| 97803 |
|
1,925 |
1,868 |
$115K |
| 93971 |
|
4,763 |
4,394 |
$114K |
| 11042 |
|
235 |
139 |
$112K |
| 76770 |
|
2,915 |
2,717 |
$111K |
| 87389 |
|
30,563 |
30,070 |
$108K |
| 97804 |
|
3,238 |
3,156 |
$107K |
| 76856 |
|
2,825 |
2,556 |
$102K |
| 80061 |
|
13,602 |
12,059 |
$101K |
| J7030 |
Normal saline solution infus |
37,959 |
28,258 |
$101K |
| 76801 |
|
6,027 |
4,885 |
$101K |
| 97162 |
|
1,591 |
1,583 |
$97K |
| 80074 |
|
2,921 |
2,665 |
$96K |
| 84484 |
|
52,661 |
36,652 |
$94K |
| 76536 |
|
2,102 |
1,952 |
$93K |
| A9502 |
Tc99m tetrofosmin |
1,423 |
1,245 |
$89K |
| 84702 |
|
25,893 |
20,280 |
$88K |
| 77049 |
|
357 |
355 |
$82K |
| 72125 |
|
2,546 |
2,334 |
$81K |
| 74178 |
|
338 |
335 |
$77K |
| U0003 |
Cov-19 amp prb hgh thruput |
7,704 |
7,510 |
$74K |
| 74018 |
|
6,932 |
6,379 |
$74K |
| 78227 |
|
198 |
198 |
$73K |
| 83880 |
|
25,013 |
21,543 |
$72K |
| G0279 |
Tomosynthesis, mammo |
2,983 |
2,791 |
$72K |
| A9552 |
F18 fdg |
561 |
529 |
$72K |
| 80048 |
|
17,819 |
13,740 |
$71K |
| 83036 |
|
11,827 |
10,769 |
$70K |
| 27447 |
|
26 |
25 |
$70K |
| J2405 |
Ondansetron hcl injection |
35,533 |
24,842 |
$69K |
| 70486 |
|
1,702 |
1,535 |
$69K |
| 82607 |
|
6,028 |
5,266 |
$68K |
| 83690 |
|
40,135 |
33,152 |
$67K |
| 36905 |
|
18 |
12 |
$66K |
| 0270 |
|
9,348 |
5,407 |
$66K |
| 86803 |
|
27,829 |
27,627 |
$64K |
| 82728 |
|
5,870 |
5,415 |
$63K |
| 70496 |
|
1,020 |
982 |
$62K |
| J9070 |
Cyclophosphamide 100 mg inj |
18 |
13 |
$61K |
| 86780 |
|
29,997 |
29,243 |
$60K |
| 76642 |
|
1,108 |
972 |
$59K |
| 93017 |
|
1,782 |
1,552 |
$58K |
| 99205 |
Prolong outpt/office vis |
634 |
629 |
$58K |
| 99213 |
|
2,137 |
2,052 |
$58K |
| 83970 |
|
1,843 |
1,701 |
$58K |
| 73562 |
|
5,040 |
4,550 |
$57K |
| 96368 |
|
1,113 |
645 |
$54K |
| 96523 |
|
2,461 |
1,701 |
$53K |
| 77336 |
|
1,051 |
416 |
$53K |
| 70544 |
|
474 |
463 |
$52K |
| 75571 |
|
1,686 |
1,628 |
$51K |
| 77427 |
|
412 |
207 |
$51K |
| J1750 |
Inj iron dextran |
105 |
88 |
$51K |
| 87502 |
|
7,710 |
6,547 |
$51K |
| 72110 |
|
1,552 |
1,399 |
$50K |
| J7050 |
Normal saline solution infus |
11,718 |
6,456 |
$49K |
| 73630 |
|
4,340 |
3,943 |
$49K |
| J1100 |
Dexamethasone sodium phos |
15,761 |
11,332 |
$48K |
| 0729 |
|
914 |
696 |
$48K |
| J1885 |
Ketorolac tromethamine inj |
29,707 |
25,344 |
$47K |
| 85730 |
|
19,026 |
16,856 |
$46K |
| 87637 |
|
3,111 |
3,047 |
$46K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
10,072 |
9,081 |
$45K |
| 84466 |
|
4,820 |
4,486 |
$45K |
| 82746 |
|
4,064 |
3,851 |
$44K |
| 83735 |
|
20,353 |
14,565 |
$44K |
| J0696 |
Ceftriaxone sodium injection |
11,669 |
9,771 |
$43K |
| 76870 |
|
1,646 |
1,442 |
$43K |
| 72197 |
|
200 |
195 |
$43K |
| 94640 |
|
6,397 |
4,810 |
$42K |
| 96411 |
|
1,631 |
752 |
$42K |
| 87491 |
|
3,818 |
3,334 |
$40K |
| 87591 |
|
3,816 |
3,334 |
$40K |
| 73030 |
|
3,486 |
3,145 |
$40K |
| G0480 |
Drug test def 1-7 classes |
7,860 |
6,886 |
$39K |
| 97150 |
|
3,003 |
1,388 |
$39K |
| 85610 |
|
23,975 |
20,882 |
$39K |
| 76817 |
|
3,464 |
2,813 |
$38K |
| 72081 |
|
1,356 |
1,205 |
$35K |
| 87635 |
|
4,855 |
4,711 |
$35K |
| 83540 |
|
6,576 |
6,124 |
$33K |
| J0640 |
Leucovorin calcium injection |
691 |
235 |
$33K |
| 87040 |
|
17,076 |
8,937 |
$32K |
| 17250 |
|
154 |
91 |
$32K |
| 72100 |
|
2,543 |
2,322 |
$32K |
| 73610 |
|
2,789 |
2,476 |
$32K |
| C9600 |
Perc drug-el cor stent sing |
12 |
12 |
$31K |
| 84439 |
|
5,002 |
4,516 |
$31K |
| 70498 |
|
927 |
899 |
$31K |
| 83605 |
|
23,468 |
17,362 |
$31K |
| 73130 |
|
2,541 |
2,242 |
$31K |
| 87086 |
|
11,256 |
9,515 |
$30K |
| 99223 |
Prolong inpt eval add15 m |
352 |
345 |
$29K |
| P9016 |
Rbc leukocytes reduced |
440 |
358 |
$29K |
| J2704 |
Inj, propofol, 10 mg |
3,798 |
3,176 |
$28K |
| 72131 |
|
475 |
439 |
$28K |
| 97161 |
|
705 |
698 |
$26K |
| 84100 |
|
10,325 |
8,098 |
$25K |
| J7040 |
Normal saline solution infus |
5,649 |
3,978 |
$25K |
| J9263 |
Oxaliplatin |
254 |
103 |
$25K |
| 99070 |
|
87,585 |
36,608 |
$24K |
| J2270 |
Morphine sulfate injection |
26,651 |
17,599 |
$23K |
| 59025 |
|
807 |
544 |
$23K |
| J3010 |
Fentanyl citrate injection |
7,773 |
6,464 |
$22K |
| 84480 |
|
1,924 |
1,758 |
$22K |
| 87798 |
|
3,596 |
3,512 |
$21K |
| 82378 |
|
2,062 |
1,729 |
$21K |
| 73110 |
|
1,471 |
1,291 |
$21K |
| 77065 |
Tomosynthesis, mammo |
348 |
307 |
$20K |
| 85379 |
|
8,330 |
7,575 |
$20K |
| 99212 |
|
588 |
522 |
$20K |
| J0561 |
Penicillin g benzathine inj |
417 |
370 |
$18K |
| 77300 |
|
105 |
91 |
$18K |
| 73502 |
|
1,115 |
1,024 |
$17K |
| J7120 |
Ringers lactate infusion |
5,564 |
4,380 |
$16K |
| 86635 |
|
2,951 |
1,571 |
$16K |
| 84153 |
|
1,555 |
1,439 |
$16K |
| 86038 |
|
1,669 |
1,564 |
$16K |
| 0510 |
|
545 |
440 |
$16K |
| 45380 |
|
12 |
12 |
$15K |
| 84425 |
|
784 |
723 |
$15K |
| 99152 |
|
1,422 |
1,274 |
$15K |
| J2250 |
Inj midazolam hydrochloride |
5,556 |
4,706 |
$15K |
| 85027 |
|
5,184 |
3,697 |
$15K |
| 81025 |
|
7,440 |
6,798 |
$14K |
| 73700 |
|
173 |
167 |
$14K |
| 72052 |
|
363 |
302 |
$14K |
| 71020 |
|
382 |
172 |
$13K |
| 87186 |
|
4,278 |
3,632 |
$13K |
| 96415 |
|
1,106 |
678 |
$13K |
| 84550 |
|
3,749 |
3,323 |
$13K |
| 72040 |
|
988 |
939 |
$12K |
| 0160 |
|
287 |
103 |
$12K |
| 74022 |
|
1,157 |
949 |
$12K |
| 86140 |
|
4,819 |
4,236 |
$12K |
| 96402 |
|
684 |
651 |
$12K |
| 74247 |
|
105 |
77 |
$12K |
| 86901 |
|
7,936 |
6,723 |
$12K |
| 72050 |
|
381 |
303 |
$12K |
| J1200 |
Diphenhydramine hcl injectio |
8,257 |
6,072 |
$11K |
| 99495 |
|
454 |
446 |
$11K |
| 87631 |
|
1,308 |
927 |
$11K |
| C2629 |
Intro/sheath, laser |
348 |
316 |
$11K |
| 84403 |
|
655 |
564 |
$11K |
| J1953 |
Levetiracetam injection |
633 |
446 |
$10K |
| 99199 |
|
164 |
129 |
$10K |
| 73590 |
|
1,074 |
912 |
$10K |
| 77080 |
|
264 |
263 |
$10K |
| 99496 |
|
291 |
288 |
$10K |
| 87522 |
Neg quan hep c or qual rna |
1,711 |
1,695 |
$10K |
| J1644 |
Inj heparin sodium per 1000u |
3,776 |
1,905 |
$10K |
| 71271 |
|
91 |
90 |
$10K |
| 82948 |
|
6,528 |
3,814 |
$10K |
| A9537 |
Tc99m mebrofenin |
191 |
191 |
$9K |
| 84436 |
|
1,666 |
1,525 |
$9K |
| 80076 |
|
2,210 |
1,835 |
$9K |
| 73080 |
|
685 |
584 |
$9K |
| 86900 |
|
4,523 |
4,173 |
$9K |
| 84145 |
|
2,499 |
2,381 |
$9K |
| J9267 |
Paclitaxel injection |
108 |
53 |
$9K |
| 90715 |
|
1,085 |
985 |
$9K |
| 87633 |
|
413 |
368 |
$9K |
| 82043 |
|
1,886 |
1,714 |
$9K |
| J3475 |
Inj magnesium sulfate |
2,994 |
1,854 |
$8K |
| 87077 |
|
3,668 |
3,121 |
$8K |
| 82550 |
|
4,614 |
3,893 |
$8K |
| 82805 |
|
1,986 |
1,771 |
$8K |
| 86850 |
|
4,182 |
3,577 |
$8K |
| 0710 |
|
2,844 |
2,304 |
$8K |
| C9803 |
Hopd covid-19 spec collect |
919 |
904 |
$8K |
| 83615 |
|
2,058 |
1,796 |
$7K |
| 36415 |
|
6,079 |
4,385 |
$7K |
| 71275 |
|
365 |
362 |
$7K |
| 82784 |
|
659 |
568 |
$7K |
| 82962 |
|
6,194 |
3,354 |
$7K |
| 85007 |
|
4,710 |
3,239 |
$7K |
| 85652 |
|
4,327 |
3,647 |
$7K |
| J2060 |
Lorazepam injection |
6,279 |
5,088 |
$7K |
| A9575 |
Inj gadoterate meglumi 0.1ml |
1,116 |
1,046 |
$7K |
| 84156 |
|
2,373 |
1,595 |
$7K |
| 86481 |
|
111 |
95 |
$6K |
| 72070 |
|
431 |
390 |
$6K |
| 77338 |
|
16 |
12 |
$6K |
| 82310 |
|
1,501 |
1,376 |
$6K |
| 82105 |
|
176 |
169 |
$6K |
| 97163 |
|
45 |
44 |
$6K |
| 86300 |
|
533 |
304 |
$6K |
| U0005 |
Infec agen detec ampli probe |
1,258 |
1,240 |
$6K |
| V2632 |
Post chmbr intraocular lens |
452 |
334 |
$6K |
| 86431 |
|
1,293 |
1,148 |
$6K |
| 70491 |
|
95 |
93 |
$6K |
| J9190 |
Fluorouracil injection |
1,329 |
344 |
$6K |
| S0119 |
Ondansetron 4 mg |
1,944 |
1,906 |
$5K |
| 70547 |
|
39 |
39 |
$5K |
| 97116 |
|
619 |
343 |
$5K |
| 85384 |
|
889 |
792 |
$5K |
| 83521 |
|
225 |
212 |
$5K |
| 82150 |
|
3,096 |
2,827 |
$5K |
| 86334 |
|
409 |
392 |
$5K |
| Q9965 |
Locm 100-199mg/ml iodine,1ml |
205 |
161 |
$5K |
| 72072 |
|
200 |
189 |
$5K |
| 84478 |
|
1,035 |
919 |
$5K |
| J3489 |
Zoledronic acid 1mg |
188 |
180 |
$5K |
| 84165 |
|
680 |
657 |
$5K |
| 84481 |
|
393 |
351 |
$5K |
| 86301 |
|
344 |
303 |
$5K |
| 87081 |
|
2,267 |
1,829 |
$4K |
| 0259 |
|
2,449 |
1,120 |
$4K |
| J2765 |
Metoclopramide hcl injection |
4,505 |
3,779 |
$4K |
| 87340 |
|
777 |
732 |
$4K |
| 77002 |
|
12 |
12 |
$4K |
| 74174 |
|
168 |
167 |
$4K |
| S0028 |
Injection, famotidine, 20 mg |
825 |
623 |
$4K |
| 93798 |
|
198 |
31 |
$4K |
| 74183 |
|
12 |
12 |
$4K |
| J0131 |
Inj, acetaminophen (nos) |
235 |
228 |
$4K |
| 83520 |
|
317 |
182 |
$4K |
| 76882 |
|
279 |
250 |
$4K |
| J3360 |
Diazepam injection |
1,289 |
1,227 |
$4K |
| 86769 |
|
147 |
140 |
$3K |
| 0250 |
|
1,271 |
633 |
$3K |
| 76937 |
|
453 |
362 |
$3K |
| 77012 |
|
111 |
78 |
$3K |
| 86317 |
|
393 |
375 |
$3K |
| 76818 |
|
60 |
53 |
$3K |
| 82465 |
|
816 |
786 |
$3K |
| J1815 |
Insulin injection |
3,550 |
1,877 |
$3K |
| 0300 |
|
87 |
64 |
$3K |
| J2930 |
Methylprednisolone injection |
2,350 |
2,053 |
$3K |
| 82140 |
|
1,358 |
1,223 |
$3K |
| A9579 |
Gad-base mr contrast nos,1ml |
100 |
86 |
$3K |
| 77001 |
|
343 |
236 |
$3K |
| S0020 |
Injection, bupivicaine hydro |
704 |
575 |
$3K |
| 0324 |
|
120 |
116 |
$3K |
| 87880 |
|
1,244 |
985 |
$3K |
| J1120 |
Acetazolamid sodium injectio |
397 |
296 |
$3K |
| 87070 |
|
582 |
522 |
$3K |
| J3370 |
Vancomycin hcl injection |
1,686 |
1,335 |
$3K |
| 99153 |
Mod sedat endo service >5yrs |
471 |
395 |
$3K |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
232 |
222 |
$3K |
| 82010 |
|
2,105 |
1,865 |
$3K |
| 73090 |
|
362 |
304 |
$3K |
| J1650 |
Inj enoxaparin sodium |
1,241 |
612 |
$3K |
| 86704 |
|
334 |
320 |
$2K |
| 77334 |
|
14 |
13 |
$2K |
| 87205 |
|
1,811 |
1,473 |
$2K |
| J2919 |
Inj, methylpred sod succ 5mg |
270 |
239 |
$2K |
| P9011 |
Blood split unit |
3,321 |
2,496 |
$2K |
| 99232 |
|
52 |
28 |
$2K |
| 74170 |
|
12 |
12 |
$2K |
| 82570 |
|
630 |
562 |
$2K |
| 0761 |
|
101 |
71 |
$2K |
| 97597 |
|
15 |
13 |
$2K |
| 87651 |
|
526 |
524 |
$2K |
| 74019 |
|
386 |
287 |
$2K |
| 85045 |
|
627 |
599 |
$2K |
| 87210 |
|
1,695 |
1,446 |
$2K |
| 86331 |
|
248 |
215 |
$2K |
| 80143 |
|
1,005 |
947 |
$2K |
| 73552 |
|
171 |
157 |
$2K |
| 94760 |
|
217 |
101 |
$2K |
| 32555 |
|
17 |
12 |
$2K |
| 86923 |
|
421 |
326 |
$2K |
| 93880 |
|
24 |
24 |
$2K |
| 86592 |
|
1,927 |
1,905 |
$2K |
| S0164 |
Injection pantroprazole |
1,596 |
1,055 |
$2K |
| 76819 |
|
32 |
25 |
$2K |
| 87536 |
|
40 |
39 |
$2K |
| S0077 |
Injection, clindamycin phosp |
398 |
289 |
$2K |
| 74000 |
|
107 |
103 |
$2K |
| 86171 |
|
236 |
214 |
$2K |
| 73564 |
|
55 |
55 |
$2K |
| 73140 |
|
152 |
121 |
$1K |
| 71010 |
|
121 |
60 |
$1K |
| 99204 |
|
25 |
25 |
$1K |
| 20610 |
|
12 |
12 |
$1K |
| J7060 |
5% dextrose/water |
292 |
183 |
$1K |
| J2805 |
Sincalide injection |
90 |
89 |
$1K |
| J2710 |
Neostigmine methylslfte inj |
274 |
202 |
$1K |
| 84155 |
|
619 |
598 |
$1K |
| 77072 |
|
83 |
82 |
$1K |
| 82668 |
|
82 |
81 |
$1K |
| J0690 |
Cefazolin sodium injection |
287 |
257 |
$1K |
| 45385 |
|
12 |
12 |
$1K |
| J1642 |
Inj heparin sodium per 10 u |
644 |
353 |
$1K |
| 86335 |
|
57 |
42 |
$1K |
| 80179 |
|
664 |
634 |
$1K |
| 83010 |
|
101 |
99 |
$1K |
| J0780 |
Prochlorperazine injection |
812 |
716 |
$1K |
| 83013 |
|
16 |
16 |
$1K |
| 93016 |
|
41 |
41 |
$986.36 |
| 86235 |
|
25 |
15 |
$924.67 |
| 86141 |
|
585 |
462 |
$920.42 |
| 84479 |
|
217 |
209 |
$903.32 |
| 73620 |
|
105 |
105 |
$890.86 |
| 76857 |
|
48 |
48 |
$873.77 |
| 82670 |
|
37 |
25 |
$829.11 |
| 73560 |
|
142 |
139 |
$806.44 |
| Z9727 |
|
26 |
26 |
$780.00 |
| 87486 |
|
413 |
368 |
$775.82 |
| 87581 |
|
413 |
368 |
$775.82 |
| 87507 |
|
13 |
13 |
$762.53 |
| 86920 |
|
119 |
94 |
$748.53 |
| 86480 |
|
16 |
16 |
$739.68 |
| Z7610 |
|
536 |
410 |
$724.41 |
| J1790 |
Droperidol injection |
305 |
288 |
$722.57 |
| J0500 |
Dicyclomine injection |
264 |
149 |
$702.43 |
| 82553 |
|
365 |
262 |
$654.71 |
| J1940 |
Furosemide injection |
1,256 |
878 |
$610.85 |
| 84154 |
|
38 |
37 |
$594.24 |
| J0360 |
Hydralazine hcl injection |
681 |
506 |
$569.80 |
| J3105 |
Terbutaline sulfate inj |
226 |
161 |
$565.44 |
| 82731 |
|
31 |
28 |
$558.69 |
| 84270 |
|
26 |
25 |
$533.89 |
| 77417 |
|
34 |
12 |
$470.90 |
| 47562 |
|
12 |
12 |
$465.00 |
| 82248 |
|
183 |
154 |
$460.61 |
| 74181 |
|
13 |
12 |
$459.45 |
| Q4051 |
Splint supplies misc |
150 |
102 |
$455.76 |
| J2920 |
Methylprednisolone injection |
36 |
24 |
$453.52 |
| 85018 |
|
106 |
53 |
$450.33 |
| 85014 |
|
103 |
51 |
$447.28 |
| 86593 |
|
737 |
731 |
$400.21 |
| 94664 |
|
301 |
283 |
$399.12 |
| 86694 |
|
38 |
13 |
$374.76 |
| 93308 |
|
13 |
13 |
$373.06 |
| 83516 |
|
41 |
29 |
$371.95 |
| 74328 |
|
17 |
16 |
$371.08 |
| 83001 |
|
23 |
12 |
$345.09 |
| J9045 |
Carboplatin injection |
171 |
99 |
$329.76 |
| 86701 |
|
62 |
61 |
$296.07 |
| 0258 |
|
175 |
61 |
$286.99 |
| 84166 |
|
30 |
30 |
$278.11 |
| 71101 |
|
26 |
26 |
$264.15 |
| 81003 |
|
64 |
40 |
$257.33 |
| 72170 |
|
49 |
48 |
$242.51 |
| 86880 |
|
46 |
43 |
$192.61 |
| 82533 |
|
34 |
26 |
$184.60 |
| J3301 |
Triamcinolone acet inj nos |
26 |
25 |
$178.63 |
| J2470 |
Inj pantoprazole sodium 40mg |
185 |
148 |
$169.27 |
| 87147 |
|
69 |
69 |
$164.22 |
| 73120 |
|
38 |
37 |
$161.52 |
| 12001 |
|
23 |
12 |
$159.96 |
| J1170 |
Hydromorphone injection |
511 |
344 |
$154.98 |
| J0171 |
Adrenalin epinephrine inject |
90 |
69 |
$151.32 |
| 83655 |
|
14 |
13 |
$148.82 |
| J2003 |
Inj, lidocaine hcl, 1 mg |
119 |
118 |
$130.66 |
| 84132 |
|
313 |
270 |
$129.91 |
| 83014 |
|
16 |
16 |
$128.00 |
| 86039 |
|
16 |
16 |
$125.13 |
| J8597 |
Antiemetic drug oral nos |
146 |
144 |
$122.05 |
| 74230 |
|
13 |
12 |
$121.81 |
| 76000 |
|
25 |
25 |
$115.68 |
| C1760 |
Closure dev, vasc |
62 |
54 |
$98.65 |
| 86225 |
|
12 |
12 |
$93.48 |
| 82272 |
|
62 |
26 |
$81.46 |
| J1920 |
Inj, labetalol hcl, 5mg |
76 |
64 |
$77.14 |
| J0134 |
Inj acetaminophen -fresenius |
12 |
12 |
$63.29 |
| 90674 |
|
32 |
19 |
$59.21 |
| 87088 |
|
63 |
57 |
$56.74 |
| J2550 |
Promethazine hcl injection |
227 |
132 |
$49.38 |
| 80164 |
|
13 |
12 |
$41.34 |
| J2272 |
Inj, morphine (fresenius) |
38 |
34 |
$41.00 |
| J1580 |
Garamycin gentamicin inj |
56 |
29 |
$19.60 |
| A4649 |
Surgical supplies |
551 |
530 |
$16.35 |
| 86308 |
|
14 |
13 |
$14.19 |
| J2543 |
Piperacillin/tazobactam |
15 |
13 |
$9.90 |
| 85347 |
|
38 |
25 |
$6.89 |
| J0456 |
Azithromycin |
75 |
65 |
$1.61 |
| 0710R |
|
44 |
42 |
$0.00 |
| J1596 |
Inj, glycopyrrolate, 0.1 mg |
27 |
26 |
$0.00 |
| J9000 |
Doxorubicin hcl injection |
34 |
12 |
$0.00 |
| 0258R |
|
108 |
80 |
$0.00 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
21 |
12 |
$0.00 |
| 0370R |
|
88 |
86 |
$0.00 |
| J9206 |
Irinotecan injection |
32 |
12 |
$0.00 |
| C1887 |
Catheter, guiding |
30 |
30 |
$0.00 |
| 72128 |
|
39 |
39 |
$0.00 |
| 0250R |
|
61 |
53 |
$0.00 |
| J0330 |
Succinycholine chloride inj |
92 |
52 |
$0.00 |
| 0259R |
|
402 |
154 |
$0.00 |
| J7042 |
5% dextrose/normal saline |
20 |
12 |
$0.00 |
| J7999 |
Compounded drug, noc |
52 |
50 |
$0.00 |
| 87493 |
|
13 |
13 |
$0.00 |
| J2305 |
Inj, nitroglycerin, 5 mg |
126 |
92 |
$0.00 |
| 87640 |
|
41 |
39 |
$0.00 |
| 96376 |
|
17 |
12 |
$0.00 |
| J1836 |
Inj, metronidazole, 10 mg |
15 |
12 |
$0.00 |