| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90999 |
|
57,838 |
4,006 |
$14.13M |
| 78815 |
|
2,724 |
2,591 |
$4.42M |
| J9306 |
Injection, pertuzumab, 1 mg |
847 |
569 |
$2.49M |
| 0450 |
|
131,678 |
113,327 |
$2.10M |
| 96374 |
|
44,361 |
36,732 |
$2.03M |
| J0897 |
Denosumab injection |
2,188 |
1,829 |
$1.87M |
| J9355 |
Inj trastuzumab excl biosimi |
1,076 |
680 |
$1.83M |
| 74177 |
|
8,315 |
7,566 |
$1.59M |
| 96375 |
|
44,660 |
30,957 |
$1.43M |
| Z7502 |
|
33,674 |
33,390 |
$1.27M |
| A0429 |
Bls-emergency |
25,672 |
15,661 |
$1.13M |
| 97110 |
|
33,509 |
7,109 |
$1.05M |
| 76805 |
|
11,543 |
11,230 |
$902K |
| J2505 |
Injection, pegfilgrastim 6mg |
547 |
360 |
$860K |
| 76815 |
|
15,692 |
9,454 |
$749K |
| A9552 |
F18 fdg |
2,678 |
2,541 |
$713K |
| J0882 |
Darbepoetin alfa, esrd use |
4,892 |
1,138 |
$684K |
| 93005 |
|
42,870 |
37,691 |
$678K |
| 74176 |
|
6,549 |
6,010 |
$652K |
| 85025 |
|
110,217 |
91,764 |
$641K |
| Q5114 |
Inj ogivri 10 mg |
818 |
473 |
$621K |
| 96365 |
|
11,686 |
8,884 |
$603K |
| 80053 |
|
65,737 |
57,556 |
$593K |
| 96372 |
|
28,844 |
21,203 |
$586K |
| 76811 |
|
6,266 |
5,744 |
$579K |
| U0003 |
Cov-19 amp prb hgh thruput |
7,996 |
7,105 |
$570K |
| 70450 |
|
9,064 |
8,340 |
$563K |
| 93975 |
|
3,589 |
3,346 |
$558K |
| 77067 |
|
4,685 |
4,390 |
$551K |
| 87636 |
|
3,097 |
3,066 |
$547K |
| 96361 |
|
17,098 |
13,043 |
$526K |
| J3490 |
Drugs unclassified injection |
97,481 |
33,124 |
$522K |
| 76817 |
|
8,412 |
7,292 |
$483K |
| P9016 |
Rbc leukocytes reduced |
2,135 |
1,519 |
$471K |
| 80307 |
|
10,261 |
8,867 |
$463K |
| 59025 |
|
20,283 |
5,718 |
$444K |
| 99199 |
|
7,051 |
6,318 |
$414K |
| 70553 |
|
1,506 |
1,359 |
$356K |
| Q4081 |
Epoetin alfa, 100 units esrd |
27,719 |
2,281 |
$343K |
| 93306 |
|
2,247 |
2,102 |
$342K |
| Q5111 |
Injection, udenyca 0.5 mg |
349 |
223 |
$337K |
| 76830 |
|
5,978 |
5,734 |
$332K |
| 71275 |
|
1,802 |
1,649 |
$316K |
| 97750 |
|
5,210 |
2,726 |
$312K |
| 76801 |
|
5,872 |
5,138 |
$312K |
| Z9725 |
|
7,160 |
7,092 |
$308K |
| 76705 |
|
6,729 |
6,210 |
$294K |
| G0378 |
Hospital observation per hr |
1,331 |
939 |
$289K |
| 96413 |
|
10,314 |
5,557 |
$288K |
| 71045 |
|
28,415 |
25,200 |
$264K |
| 80048 |
|
54,494 |
40,835 |
$257K |
| 97140 |
|
4,927 |
1,653 |
$251K |
| 76816 |
|
5,661 |
4,860 |
$248K |
| 87635 |
|
5,562 |
4,807 |
$240K |
| 0760 |
|
18,228 |
13,180 |
$239K |
| 76856 |
|
6,629 |
6,367 |
$227K |
| 93971 |
|
2,045 |
1,918 |
$203K |
| 77066 |
Tomosynthesis, mammo |
1,550 |
1,521 |
$201K |
| 96366 |
|
5,023 |
3,231 |
$189K |
| 83690 |
|
36,397 |
31,725 |
$182K |
| 84484 |
|
25,457 |
19,891 |
$174K |
| 97139 |
|
8,239 |
979 |
$173K |
| 77334 |
|
1,019 |
602 |
$172K |
| 71260 |
|
1,935 |
1,787 |
$172K |
| 96417 |
|
4,215 |
2,571 |
$170K |
| 96360 |
|
3,667 |
3,057 |
$166K |
| 99285 |
|
6,092 |
4,732 |
$164K |
| 77412 |
|
3,510 |
327 |
$163K |
| 87631 |
|
3,242 |
3,018 |
$160K |
| 83880 |
|
7,381 |
6,405 |
$158K |
| J2997 |
Alteplase recombinant |
4,496 |
248 |
$157K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
14,656 |
12,953 |
$137K |
| 77063 |
|
4,670 |
4,376 |
$137K |
| 93325 |
|
1,105 |
1,051 |
$133K |
| 76642 |
|
2,275 |
2,194 |
$133K |
| J1756 |
Iron sucrose injection |
7,550 |
3,053 |
$130K |
| J9271 |
Inj pembrolizumab |
29 |
24 |
$117K |
| 96367 |
|
3,737 |
2,343 |
$116K |
| 99283 |
|
7,263 |
6,582 |
$111K |
| 77336 |
|
2,092 |
880 |
$111K |
| 77065 |
Tomosynthesis, mammo |
1,183 |
1,089 |
$109K |
| 77386 |
|
448 |
29 |
$106K |
| 71046 |
|
6,505 |
6,164 |
$103K |
| 76770 |
|
1,771 |
1,674 |
$100K |
| 83970 |
|
2,759 |
2,281 |
$97K |
| C1769 |
Guide wire |
2,610 |
1,929 |
$95K |
| J2501 |
Paricalcitol |
29,746 |
2,396 |
$89K |
| 96376 |
|
17,914 |
10,549 |
$86K |
| 84443 |
|
7,344 |
6,765 |
$86K |
| 80061 |
|
7,331 |
7,117 |
$86K |
| J1453 |
Fosaprepitant injection |
1,754 |
1,021 |
$85K |
| 87086 |
|
16,038 |
14,157 |
$84K |
| 94640 |
|
5,790 |
3,598 |
$82K |
| 81001 |
|
37,034 |
33,096 |
$82K |
| Q5120 |
Inj pegfilgrastim-bmez 0.5mg |
104 |
68 |
$81K |
| 84702 |
|
18,190 |
16,084 |
$78K |
| J2469 |
Palonosetron hcl |
4,658 |
2,537 |
$77K |
| 85027 |
|
15,528 |
8,766 |
$75K |
| J1170 |
Hydromorphone injection |
28,382 |
17,282 |
$75K |
| J1644 |
Inj heparin sodium per 1000u |
31,915 |
4,565 |
$74K |
| 90715 |
|
2,605 |
2,450 |
$74K |
| 87040 |
|
10,038 |
5,636 |
$74K |
| 80076 |
|
18,393 |
15,129 |
$73K |
| 96415 |
|
2,311 |
1,457 |
$73K |
| 83036 |
|
8,652 |
8,236 |
$70K |
| 36902 |
|
132 |
89 |
$68K |
| 82330 |
|
7,788 |
6,510 |
$68K |
| J2405 |
Ondansetron hcl injection |
37,884 |
26,292 |
$68K |
| Q5118 |
Inj., zirabev, 10 mg |
98 |
38 |
$67K |
| 71250 |
|
768 |
749 |
$64K |
| 73562 |
|
3,446 |
3,036 |
$64K |
| 73630 |
|
3,232 |
2,909 |
$59K |
| 93970 |
|
309 |
291 |
$57K |
| 82947 |
|
32,119 |
21,673 |
$55K |
| 87637 |
|
506 |
389 |
$55K |
| 0241U |
|
2,004 |
1,919 |
$55K |
| 0160 |
|
6,702 |
3,405 |
$55K |
| A9585 |
Gadobutrol injection |
3,201 |
2,836 |
$54K |
| 82805 |
|
3,677 |
2,941 |
$53K |
| 84145 |
|
3,073 |
2,618 |
$49K |
| 76536 |
|
910 |
899 |
$49K |
| 81025 |
|
15,967 |
14,840 |
$49K |
| 86923 |
|
1,703 |
1,237 |
$48K |
| 99284 |
|
3,629 |
2,904 |
$48K |
| 70551 |
|
416 |
388 |
$48K |
| 81003 |
|
32,658 |
29,880 |
$46K |
| C1725 |
Cath, translumin non-laser |
1,033 |
771 |
$45K |
| 95811 |
|
186 |
185 |
$43K |
| 87502 |
|
808 |
735 |
$43K |
| 73610 |
|
2,399 |
2,231 |
$42K |
| 82803 |
|
3,869 |
3,536 |
$42K |
| 72100 |
|
1,921 |
1,813 |
$41K |
| G0279 |
Tomosynthesis, mammo |
1,431 |
1,424 |
$41K |
| 73130 |
|
2,238 |
2,033 |
$40K |
| 73030 |
|
2,326 |
2,100 |
$40K |
| 97010 |
|
1,347 |
229 |
$40K |
| G0463 |
Hospital outpt clinic visit |
1,912 |
1,479 |
$39K |
| 11042 |
|
1,955 |
932 |
$39K |
| M0222 |
Bebtelovimab injection |
137 |
136 |
$39K |
| 88305 |
|
2,908 |
2,588 |
$39K |
| 87077 |
|
6,070 |
5,540 |
$38K |
| Z7500 |
|
1,113 |
662 |
$38K |
| A4216 |
Sterile water/saline, 10 ml |
9,097 |
4,345 |
$37K |
| C1887 |
Catheter, guiding |
929 |
673 |
$37K |
| 72148 |
|
263 |
257 |
$36K |
| 77080 |
|
1,104 |
1,095 |
$35K |
| C1894 |
Intro/sheath, non-laser |
1,986 |
1,492 |
$34K |
| J9070 |
Cyclophosphamide 100 mg inj |
208 |
87 |
$34K |
| J0606 |
Inj, etelcalcetide, 0.1 mg |
764 |
55 |
$34K |
| J7030 |
Normal saline solution infus |
5,263 |
4,049 |
$34K |
| J1885 |
Ketorolac tromethamine inj |
17,947 |
14,830 |
$32K |
| J0185 |
Inj., aprepitant, 1 mg |
265 |
203 |
$32K |
| 83735 |
|
8,716 |
5,881 |
$31K |
| 99153 |
Mod sedat endo service >5yrs |
1,145 |
855 |
$31K |
| 87186 |
|
5,045 |
4,595 |
$30K |
| 76813 |
|
378 |
378 |
$29K |
| J2270 |
Morphine sulfate injection |
11,965 |
8,217 |
$29K |
| J1100 |
Dexamethasone sodium phos |
12,425 |
8,054 |
$29K |
| 93976 |
|
181 |
178 |
$28K |
| 83550 |
|
4,050 |
3,278 |
$28K |
| J1642 |
Inj heparin sodium per 10 u |
10,354 |
5,404 |
$27K |
| 86141 |
|
3,467 |
2,833 |
$26K |
| Z6004 |
|
12 |
12 |
$26K |
| 82306 |
|
1,097 |
913 |
$26K |
| 77300 |
|
253 |
208 |
$26K |
| J2704 |
Inj, propofol, 10 mg |
7,217 |
5,807 |
$25K |
| 36430 |
|
189 |
120 |
$25K |
| 82728 |
|
3,588 |
2,814 |
$25K |
| J0690 |
Cefazolin sodium injection |
6,767 |
4,880 |
$24K |
| 85610 |
|
10,276 |
8,407 |
$24K |
| Z7610 |
|
5,982 |
3,965 |
$24K |
| 74018 |
|
1,594 |
1,462 |
$24K |
| 83540 |
|
4,235 |
3,512 |
$24K |
| 86901 |
|
11,759 |
9,903 |
$24K |
| 82375 |
|
3,606 |
2,896 |
$23K |
| 83605 |
|
4,037 |
3,177 |
$23K |
| 86803 |
|
1,717 |
1,599 |
$23K |
| 76937 |
|
1,962 |
1,436 |
$23K |
| 86900 |
|
11,766 |
9,907 |
$23K |
| 88720 |
|
4,400 |
4,386 |
$23K |
| 85379 |
|
3,229 |
2,844 |
$22K |
| 87081 |
|
2,358 |
2,084 |
$22K |
| J1200 |
Diphenhydramine hcl injectio |
11,958 |
8,260 |
$22K |
| 82570 |
|
5,349 |
4,396 |
$22K |
| 84100 |
|
7,348 |
4,976 |
$22K |
| 97165 |
|
806 |
581 |
$21K |
| J0696 |
Ceftriaxone sodium injection |
10,095 |
8,059 |
$21K |
| 99152 |
|
1,232 |
949 |
$21K |
| 76819 |
|
382 |
345 |
$21K |
| 72125 |
|
228 |
212 |
$21K |
| 73110 |
|
1,117 |
1,035 |
$20K |
| 73502 |
|
721 |
653 |
$19K |
| 88307 |
|
438 |
353 |
$18K |
| 85730 |
|
5,369 |
4,367 |
$18K |
| J7050 |
Normal saline solution infus |
4,200 |
2,094 |
$18K |
| 96402 |
|
1,318 |
1,071 |
$17K |
| 76700 |
|
285 |
284 |
$17K |
| Q5107 |
Inj mvasi 10 mg |
28 |
14 |
$17K |
| 72040 |
|
667 |
636 |
$17K |
| 87651 |
|
504 |
503 |
$16K |
| 86850 |
|
7,526 |
6,078 |
$16K |
| J3010 |
Fentanyl citrate injection |
7,599 |
5,981 |
$16K |
| 10060 |
|
1,182 |
1,120 |
$15K |
| J2060 |
Lorazepam injection |
7,312 |
5,059 |
$15K |
| 87491 |
|
1,398 |
1,337 |
$15K |
| 87591 |
|
1,403 |
1,341 |
$15K |
| J2543 |
Piperacillin/tazobactam |
3,493 |
1,578 |
$14K |
| 84550 |
|
4,764 |
3,595 |
$14K |
| G0257 |
Unsched dialysis esrd pt hos |
242 |
157 |
$14K |
| 87389 |
|
689 |
686 |
$14K |
| 97014 |
|
823 |
321 |
$14K |
| 77280 |
|
181 |
159 |
$14K |
| 83050 |
|
3,609 |
2,896 |
$13K |
| G0480 |
Drug test def 1-7 classes |
335 |
315 |
$13K |
| A4217 |
Sterile water/saline, 500 ml |
2,185 |
1,784 |
$13K |
| 90834 |
|
202 |
110 |
$13K |
| 90471 |
|
3,062 |
2,778 |
$13K |
| J1815 |
Insulin injection |
5,570 |
2,627 |
$13K |
| 82043 |
|
2,444 |
2,403 |
$13K |
| J9171 |
Docetaxel injection |
157 |
104 |
$12K |
| J2710 |
Neostigmine methylslfte inj |
1,413 |
1,129 |
$12K |
| 87340 |
|
1,472 |
1,259 |
$11K |
| 88304 |
|
1,638 |
1,397 |
$11K |
| 96523 |
|
1,706 |
1,363 |
$11K |
| 82550 |
|
3,237 |
2,599 |
$11K |
| J2765 |
Metoclopramide hcl injection |
5,400 |
4,362 |
$11K |
| J3370 |
Vancomycin hcl injection |
2,563 |
1,499 |
$11K |
| 73590 |
|
672 |
628 |
$11K |
| 0270 |
|
100,279 |
37,052 |
$11K |
| J2250 |
Inj midazolam hydrochloride |
6,141 |
5,020 |
$10K |
| 80069 |
|
1,579 |
1,108 |
$10K |
| 49083 |
|
286 |
121 |
$10K |
| 77001 |
|
270 |
177 |
$10K |
| J0780 |
Prochlorperazine injection |
1,901 |
1,633 |
$10K |
| M0247 |
Sotrovimab infusion |
28 |
27 |
$10K |
| 77290 |
|
72 |
64 |
$9K |
| 80197 |
|
1,678 |
982 |
$9K |
| J9045 |
Carboplatin injection |
381 |
252 |
$9K |
| 77295 |
|
31 |
26 |
$9K |
| 84156 |
|
3,555 |
2,705 |
$9K |
| 99401 |
|
524 |
457 |
$8K |
| 84132 |
|
10,504 |
7,857 |
$8K |
| S0164 |
Injection pantroprazole |
1,774 |
1,108 |
$8K |
| 97162 |
|
1,447 |
1,273 |
$8K |
| 76870 |
|
200 |
187 |
$8K |
| 73080 |
|
373 |
343 |
$8K |
| 77417 |
|
711 |
121 |
$7K |
| 47562 |
|
44 |
43 |
$7K |
| 85007 |
|
4,612 |
3,219 |
$7K |
| 76825 |
|
360 |
349 |
$7K |
| 84703 |
|
4,185 |
3,933 |
$7K |
| 87070 |
|
1,693 |
1,469 |
$7K |
| 0360 |
|
3,101 |
2,678 |
$7K |
| 83615 |
|
2,546 |
1,615 |
$7K |
| 87210 |
|
1,991 |
1,717 |
$7K |
| 84439 |
|
984 |
892 |
$7K |
| 96411 |
|
373 |
229 |
$7K |
| 87804 |
|
1,104 |
966 |
$7K |
| 36415 |
|
6,744 |
4,161 |
$6K |
| M0243 |
Casirivi and imdevi inj |
167 |
162 |
$6K |
| C1751 |
Cath, inf, per/cent/midline |
111 |
78 |
$6K |
| 82731 |
|
328 |
303 |
$6K |
| 96156 |
|
363 |
361 |
$6K |
| 84460 |
|
1,379 |
1,124 |
$6K |
| 82040 |
|
1,688 |
1,513 |
$5K |
| 84295 |
|
7,319 |
6,344 |
$5K |
| 84520 |
|
1,979 |
1,522 |
$5K |
| 93880 |
|
39 |
38 |
$5K |
| 87205 |
|
2,103 |
1,703 |
$5K |
| 86920 |
|
282 |
238 |
$5K |
| 0710 |
|
6,756 |
5,654 |
$5K |
| 76820 |
|
660 |
331 |
$5K |
| J1650 |
Inj enoxaparin sodium |
1,844 |
980 |
$5K |
| 12001 |
|
434 |
428 |
$5K |
| 85652 |
|
2,354 |
2,027 |
$5K |
| 90686 |
|
209 |
181 |
$5K |
| 82435 |
|
7,234 |
6,278 |
$5K |
| J2930 |
Methylprednisolone injection |
1,262 |
989 |
$4K |
| S0020 |
Injection, bupivicaine hydro |
964 |
809 |
$4K |
| J2175 |
Meperidine hydrochl /100 mg |
1,265 |
1,005 |
$4K |
| 87633 |
|
17 |
15 |
$4K |
| 87075 |
|
923 |
783 |
$4K |
| 88342 |
|
437 |
381 |
$4K |
| 70496 |
|
26 |
25 |
$4K |
| J7120 |
Ringers lactate infusion |
586 |
520 |
$4K |
| 10061 |
|
185 |
179 |
$4K |
| 87880 |
|
732 |
702 |
$4K |
| G0109 |
Diab manage trn ind/group |
54 |
53 |
$4K |
| 0250 |
|
11,440 |
4,893 |
$4K |
| 87799 |
|
265 |
217 |
$4K |
| 77049 |
|
12 |
12 |
$4K |
| 85018 |
|
7,936 |
6,570 |
$4K |
| J2360 |
Orphenadrine injection |
1,043 |
888 |
$3K |
| 86706 |
|
381 |
278 |
$3K |
| J1940 |
Furosemide injection |
1,646 |
1,032 |
$3K |
| G0202 |
Scr mammo bi incl cad |
61 |
61 |
$3K |
| 87147 |
|
1,168 |
1,047 |
$3K |
| 82465 |
|
1,142 |
771 |
$3K |
| 97802 |
|
56 |
55 |
$3K |
| J0330 |
Succinycholine chloride inj |
1,236 |
923 |
$3K |
| C1713 |
Anchor/screw bn/bn,tis/bn |
26 |
25 |
$3K |
| 70486 |
|
28 |
28 |
$3K |
| J2001 |
Lidocaine injection |
3,455 |
2,841 |
$3K |
| 84480 |
|
283 |
258 |
$3K |
| 87430 |
|
636 |
614 |
$3K |
| 99215 |
Prolong outpt/office vis |
32 |
32 |
$3K |
| 97116 |
|
123 |
86 |
$2K |
| 43239 |
|
87 |
83 |
$2K |
| 93017 |
|
59 |
58 |
$2K |
| 0761 |
|
5,259 |
3,908 |
$2K |
| 82553 |
|
446 |
355 |
$2K |
| 82140 |
|
262 |
166 |
$2K |
| 96401 |
|
161 |
55 |
$2K |
| J9267 |
Paclitaxel injection |
137 |
66 |
$2K |
| 73721 |
|
13 |
12 |
$2K |
| 71020 |
|
113 |
111 |
$2K |
| 93320 |
|
52 |
49 |
$2K |
| H1003 |
Prenatal at risk education |
66 |
66 |
$2K |
| J7040 |
Normal saline solution infus |
429 |
306 |
$2K |
| J8540 |
Oral dexamethasone |
2,292 |
1,301 |
$2K |
| 82150 |
|
430 |
395 |
$2K |
| 95806 |
|
33 |
33 |
$2K |
| J2720 |
Inj protamine sulfate/10 mg |
500 |
345 |
$2K |
| 74181 |
|
12 |
12 |
$2K |
| 87493 |
|
89 |
79 |
$2K |
| 92507 |
|
28 |
13 |
$2K |
| 76827 |
|
126 |
126 |
$2K |
| 90747 |
|
16 |
16 |
$2K |
| 80047 |
|
296 |
292 |
$2K |
| 87497 |
|
171 |
139 |
$2K |
| 71010 |
|
176 |
172 |
$2K |
| G0204 |
Dx mammo incl cad bi |
23 |
23 |
$2K |
| J1630 |
Haloperidol injection |
3,043 |
2,250 |
$2K |
| 73140 |
|
160 |
154 |
$2K |
| 72141 |
|
13 |
13 |
$2K |
| J0360 |
Hydralazine hcl injection |
509 |
395 |
$2K |
| 29125 |
|
463 |
442 |
$2K |
| J3475 |
Inj magnesium sulfate |
666 |
475 |
$2K |
| 41899 |
|
54 |
52 |
$2K |
| 88341 |
|
26 |
26 |
$2K |
| 85045 |
|
592 |
465 |
$1K |
| 70498 |
|
14 |
13 |
$1K |
| 29515 |
|
291 |
283 |
$1K |
| J3480 |
Inj potassium chloride |
859 |
504 |
$1K |
| C1760 |
Closure dev, vasc |
12 |
12 |
$1K |
| J0171 |
Adrenalin epinephrine inject |
231 |
173 |
$1K |
| J9190 |
Fluorouracil injection |
135 |
61 |
$1K |
| 0272 |
|
6,997 |
4,588 |
$1K |
| J0692 |
Cefepime hcl for injection |
200 |
103 |
$1K |
| 80179 |
|
65 |
64 |
$1K |
| C1893 |
Intro/sheath, fixed,non-peel |
638 |
457 |
$1K |
| 72170 |
|
163 |
156 |
$1K |
| 90688 |
|
40 |
40 |
$1K |
| 80143 |
|
61 |
60 |
$1K |
| G0206 |
Dx mammo incl cad uni |
14 |
14 |
$1K |
| 86902 |
|
70 |
51 |
$987.18 |
| 99281 |
|
324 |
213 |
$986.90 |
| 99211 |
|
269 |
269 |
$946.31 |
| 0258 |
|
7,473 |
4,254 |
$921.19 |
| 96368 |
|
82 |
63 |
$918.99 |
| J1953 |
Levetiracetam injection |
108 |
66 |
$853.70 |
| J0640 |
Leucovorin calcium injection |
88 |
49 |
$829.14 |
| 73090 |
|
54 |
51 |
$822.11 |
| 92610 |
|
13 |
13 |
$815.84 |
| J8499 |
Oral prescrip drug non chemo |
9,541 |
613 |
$797.53 |
| 77331 |
|
27 |
13 |
$787.78 |
| 99499 |
|
15 |
14 |
$744.00 |
| J2550 |
Promethazine hcl injection |
212 |
159 |
$670.07 |
| 85014 |
|
377 |
352 |
$665.01 |
| 0637 |
|
3,371 |
1,629 |
$661.67 |
| J0456 |
Azithromycin |
318 |
191 |
$656.62 |
| 74022 |
|
42 |
36 |
$640.57 |
| U0005 |
Infec agen detec ampli probe |
4,093 |
3,909 |
$633.98 |
| 87801 |
|
13 |
13 |
$564.98 |
| J2919 |
Inj, methylpred sod succ 5mg |
130 |
101 |
$551.19 |
| G0498 |
Chemo extend iv infus w/pump |
19 |
12 |
$550.60 |
| 90656 |
|
22 |
22 |
$535.51 |
| 86140 |
|
173 |
138 |
$531.90 |
| 97803 |
|
40 |
39 |
$529.70 |
| 97530 |
|
66 |
37 |
$499.73 |
| 84540 |
|
142 |
109 |
$480.44 |
| J7512 |
Prednisone ir or dr oral 1mg |
1,923 |
1,488 |
$434.62 |
| 93350 |
|
12 |
12 |
$430.01 |
| J2370 |
Phenylephrine hcl injection |
307 |
296 |
$412.64 |
| 82565 |
|
263 |
252 |
$381.96 |
| 93798 |
|
50 |
12 |
$355.08 |
| 82270 |
|
107 |
107 |
$347.70 |
| 84436 |
|
79 |
79 |
$344.83 |
| C1789 |
Prosthesis, breast, imp |
12 |
12 |
$334.43 |
| 73552 |
|
13 |
12 |
$307.26 |
| H2000 |
Comp multidisipln evaluation |
12 |
12 |
$306.15 |
| J3411 |
Thiamine hcl 100 mg |
38 |
29 |
$300.02 |
| 74000 |
|
31 |
31 |
$290.34 |
| J3420 |
Vitamin b12 injection |
162 |
131 |
$288.22 |
| Q0144 |
Azithromycin dihydrate, oral |
57 |
55 |
$278.93 |
| Q9966 |
Locm 200-299mg/ml iodine,1ml |
182 |
179 |
$277.29 |
| 73560 |
|
16 |
14 |
$276.36 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
284 |
230 |
$265.94 |
| J3535 |
Metered dose inhaler drug |
298 |
275 |
$259.14 |
| 88312 |
|
32 |
28 |
$249.94 |
| J1956 |
Levofloxacin injection |
71 |
50 |
$237.06 |
| J1836 |
Inj, metronidazole, 10 mg |
15 |
12 |
$235.88 |
| A4648 |
Implantable tissue marker |
29 |
28 |
$226.26 |
| 73060 |
|
14 |
13 |
$209.40 |
| 84153 |
|
13 |
13 |
$180.01 |
| 80306 |
|
17 |
17 |
$175.56 |
| 99070 |
|
997 |
445 |
$170.27 |
| 84450 |
|
63 |
59 |
$161.70 |
| S9452 |
Nutrition class |
12 |
12 |
$141.24 |
| J2470 |
Inj pantoprazole sodium 40mg |
139 |
111 |
$139.16 |
| 36600 |
|
43 |
43 |
$124.74 |
| 82310 |
|
235 |
192 |
$90.72 |
| 86780 |
|
17 |
15 |
$89.56 |
| 82607 |
|
25 |
25 |
$81.22 |
| 0370 |
|
537 |
365 |
$73.45 |
| 87899 |
|
40 |
25 |
$72.15 |
| 84075 |
|
231 |
153 |
$71.70 |
| 0391 |
|
372 |
292 |
$68.20 |
| 94664 |
|
131 |
126 |
$63.74 |
| 59425 |
|
39 |
27 |
$60.48 |
| 87045 |
|
16 |
13 |
$59.47 |
| 88300 |
|
50 |
38 |
$59.05 |
| 81050 |
|
53 |
53 |
$55.16 |
| 29130 |
|
13 |
13 |
$54.00 |
| G1004 |
Cdsm ndsc |
14,464 |
12,107 |
$49.78 |
| 77062 |
|
468 |
447 |
$49.32 |
| 87324 |
|
12 |
12 |
$43.15 |
| 87015 |
|
17 |
12 |
$42.68 |
| Q0163 |
Diphenhydramine hcl 50mg |
1,386 |
1,105 |
$38.70 |
| 87046 |
|
16 |
13 |
$31.45 |
| 87102 |
|
13 |
13 |
$26.81 |
| 89051 |
|
28 |
24 |
$24.37 |
| 77061 |
|
163 |
152 |
$23.67 |
| 84155 |
|
127 |
123 |
$17.75 |
| Q0162 |
Ondansetron oral |
125 |
70 |
$17.51 |
| 84466 |
|
27 |
27 |
$11.01 |
| A9270 |
Non-covered item or service |
5,831 |
1,530 |
$10.33 |
| 82077 |
|
44 |
39 |
$8.40 |
| S0074 |
Injection, cefotetan disodiu |
14 |
12 |
$7.58 |
| J0295 |
Ampicillin sulbactam 1.5 gm |
17 |
12 |
$7.23 |
| 64450 |
|
12 |
12 |
$7.00 |
| J7613 |
Albuterol non-comp unit |
64 |
59 |
$4.97 |
| S0028 |
Injection, famotidine, 20 mg |
2,584 |
1,288 |
$4.95 |
| J2371 |
Inj phenylephrine hcl 20 mcg |
12 |
12 |
$0.68 |
| G8978 |
Mobility current status |
93 |
84 |
$0.01 |
| G8979 |
Mobility goal status |
143 |
121 |
$0.01 |
| 0331 |
|
40 |
22 |
$0.00 |
| 0307 |
|
387 |
344 |
$0.00 |
| 0610 |
|
30 |
27 |
$0.00 |
| 0636 |
|
1,877 |
678 |
$0.00 |
| 0310 |
|
129 |
74 |
$0.00 |
| G0008 |
Admin influenza virus vac |
56 |
53 |
$0.00 |
| A4913 |
Misc dialysis supplies noc |
768 |
94 |
$0.00 |
| 0335 |
|
299 |
77 |
$0.00 |
| 0404 |
|
38 |
38 |
$0.00 |
| 0949 |
|
551 |
168 |
$0.00 |
| 0401 |
|
86 |
43 |
$0.00 |
| 97166 |
|
55 |
55 |
$0.00 |
| 0305 |
|
379 |
186 |
$0.00 |
| 0372 |
|
38 |
16 |
$0.00 |
| G8988 |
Self care goal status |
12 |
12 |
$0.00 |
| C1889 |
Implant/insert device, noc |
27 |
27 |
$0.00 |
| 0922 |
|
71 |
70 |
$0.00 |
| 80050 |
|
128 |
79 |
$0.00 |
| 0352 |
|
218 |
177 |
$0.00 |
| 0324 |
|
462 |
386 |
$0.00 |
| 0306 |
|
1,557 |
941 |
$0.00 |
| Q4051 |
Splint supplies misc |
23 |
16 |
$0.00 |
| 0301 |
|
5,052 |
941 |
$0.00 |
| 0611 |
|
13 |
12 |
$0.00 |
| 0420 |
|
186 |
47 |
$0.00 |
| 0612 |
Calcium glucon (wg critical) |
15 |
13 |
$0.00 |
| G8980 |
Mobility d/c status |
15 |
14 |
$0.00 |
| 0410 |
|
56 |
19 |
$0.00 |
| G8987 |
Self care current status |
12 |
12 |
$0.00 |
| A4657 |
Syringe w/wo needle |
405 |
22 |
$0.00 |
| 0300 |
|
2,171 |
895 |
$0.00 |
| 0361 |
|
454 |
389 |
$0.00 |
| 0260 |
|
340 |
58 |
$0.00 |
| 0510 |
|
261 |
222 |
$0.00 |
| 84112 |
|
33 |
32 |
$0.00 |
| 0403 |
|
94 |
46 |
$0.00 |
| 0320 |
|
301 |
206 |
$0.00 |
| 0351 |
|
88 |
73 |
$0.00 |
| 0302 |
|
191 |
105 |
$0.00 |
| 0489 |
|
33 |
27 |
$0.00 |
| 0634 |
|
293 |
51 |
$0.00 |
| 0424 |
|
23 |
13 |
$0.00 |
| 0402 |
|
995 |
573 |
$0.00 |
| 0349 |
|
34 |
34 |
$0.00 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
21 |
21 |
$0.00 |
| 0333 |
|
212 |
13 |
$0.00 |
| 0762 |
|
31 |
14 |
$0.00 |
| 0343 |
|
15 |
13 |
$0.00 |
| 0278 |
|
154 |
61 |
$0.00 |
| 0390 |
|
31 |
21 |
$0.00 |