| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99284 |
|
17,457 |
15,443 |
$4.35M |
| 99283 |
|
26,704 |
23,677 |
$3.65M |
| 99285 |
|
11,646 |
9,831 |
$2.73M |
| 99282 |
|
14,293 |
12,953 |
$1.92M |
| 74177 |
|
6,740 |
5,929 |
$1.15M |
| 96374 |
|
18,528 |
14,178 |
$784K |
| 43239 |
|
2,635 |
2,136 |
$740K |
| G0463 |
Hospital outpt clinic visit |
13,346 |
8,261 |
$667K |
| G0378 |
Hospital observation per hr |
1,903 |
1,614 |
$625K |
| 80053 |
|
81,327 |
55,671 |
$554K |
| 72148 |
|
1,525 |
1,356 |
$536K |
| 45385 |
|
1,009 |
855 |
$533K |
| 47562 |
|
197 |
185 |
$526K |
| 70553 |
|
1,535 |
1,152 |
$516K |
| 45380 |
|
1,186 |
1,044 |
$478K |
| 73721 |
|
1,231 |
1,099 |
$466K |
| 70450 |
|
4,971 |
4,103 |
$435K |
| 74176 |
|
2,470 |
2,112 |
$410K |
| 41899 |
|
626 |
601 |
$381K |
| J3490 |
Drugs unclassified injection |
67,584 |
23,406 |
$376K |
| 71260 |
|
2,426 |
1,942 |
$371K |
| 97110 |
|
18,954 |
4,846 |
$369K |
| C1713 |
Anchor/screw bn/bn,tis/bn |
531 |
420 |
$364K |
| 78452 |
|
929 |
477 |
$342K |
| 36415 |
|
147,681 |
61,991 |
$338K |
| 77067 |
|
3,766 |
3,629 |
$320K |
| 85025 |
|
67,165 |
54,957 |
$313K |
| 66984 |
|
342 |
223 |
$301K |
| 72141 |
|
875 |
738 |
$293K |
| 84443 |
|
20,898 |
19,070 |
$285K |
| 96365 |
|
5,204 |
2,855 |
$281K |
| 96413 |
|
2,192 |
841 |
$260K |
| 69436 |
|
288 |
277 |
$259K |
| 71046 |
|
11,222 |
9,931 |
$255K |
| 97530 |
|
8,448 |
2,412 |
$254K |
| 71250 |
|
1,665 |
1,252 |
$252K |
| 59025 |
|
3,676 |
2,218 |
$249K |
| 73221 |
|
733 |
628 |
$245K |
| 92507 |
|
5,774 |
1,684 |
$243K |
| 93306 |
|
1,041 |
921 |
$220K |
| 76705 |
|
3,004 |
2,707 |
$213K |
| 45378 |
|
395 |
354 |
$201K |
| 80061 |
|
15,311 |
13,942 |
$184K |
| 71045 |
|
10,409 |
8,592 |
$183K |
| 96375 |
|
12,497 |
9,972 |
$178K |
| 87635 |
|
6,728 |
5,761 |
$178K |
| 80307 |
|
5,828 |
5,113 |
$164K |
| 82306 |
|
6,236 |
5,676 |
$161K |
| 76830 |
|
2,151 |
2,027 |
$161K |
| 93005 |
|
12,508 |
10,310 |
$161K |
| 96361 |
|
12,997 |
10,271 |
$159K |
| 97140 |
|
8,960 |
2,882 |
$153K |
| 70551 |
|
556 |
468 |
$152K |
| 76642 |
|
1,548 |
1,423 |
$144K |
| 96372 |
|
11,139 |
9,181 |
$143K |
| 87070 |
|
14,950 |
14,238 |
$135K |
| 99281 |
|
2,045 |
1,886 |
$134K |
| 96360 |
|
3,082 |
2,344 |
$132K |
| 52356 |
|
44 |
39 |
$131K |
| 88305 |
|
6,897 |
4,896 |
$124K |
| 76536 |
|
1,169 |
1,077 |
$121K |
| G0480 |
Drug test def 1-7 classes |
4,373 |
3,460 |
$116K |
| 78226 |
|
389 |
325 |
$115K |
| 84439 |
|
15,216 |
13,730 |
$113K |
| 96367 |
|
2,754 |
552 |
$99K |
| 99291 |
|
429 |
388 |
$97K |
| 87088 |
|
17,225 |
14,752 |
$96K |
| 97161 |
|
2,256 |
1,985 |
$93K |
| 72125 |
|
1,122 |
1,014 |
$93K |
| 70486 |
|
718 |
664 |
$85K |
| 76815 |
|
1,053 |
990 |
$84K |
| 76770 |
|
697 |
629 |
$84K |
| 82607 |
|
6,095 |
5,324 |
$81K |
| 78815 |
|
81 |
67 |
$80K |
| U0002 |
Covid-19 lab test non-cdc |
3,438 |
3,186 |
$79K |
| 83036 |
|
9,001 |
8,316 |
$75K |
| G0279 |
Tomosynthesis, mammo |
1,479 |
1,182 |
$75K |
| 72100 |
|
2,696 |
2,047 |
$74K |
| 87491 |
|
3,135 |
2,891 |
$74K |
| 87591 |
|
3,072 |
2,871 |
$72K |
| A9552 |
F18 fdg |
798 |
471 |
$71K |
| 87804 |
|
22,695 |
10,334 |
$71K |
| 72110 |
|
1,380 |
1,142 |
$70K |
| 87800 |
|
2,611 |
2,415 |
$69K |
| 93971 |
|
1,057 |
912 |
$68K |
| 72050 |
|
1,797 |
1,383 |
$67K |
| 97112 |
|
2,956 |
1,019 |
$65K |
| 76817 |
|
1,181 |
1,032 |
$63K |
| 74022 |
|
2,013 |
1,843 |
$62K |
| 94640 |
|
4,801 |
2,764 |
$62K |
| 82746 |
|
4,336 |
4,031 |
$59K |
| 74178 |
|
217 |
171 |
$57K |
| 93017 |
|
574 |
493 |
$57K |
| 87071 |
|
6,241 |
5,173 |
$55K |
| 84466 |
|
4,791 |
4,400 |
$54K |
| 73562 |
|
3,325 |
2,454 |
$54K |
| V2632 |
Post chmbr intraocular lens |
766 |
278 |
$54K |
| J2704 |
Inj, propofol, 10 mg |
11,983 |
9,972 |
$54K |
| 95810 |
|
108 |
93 |
$53K |
| 72072 |
|
1,389 |
1,148 |
$51K |
| 84702 |
|
7,919 |
6,726 |
$50K |
| 80074 |
|
1,259 |
1,148 |
$50K |
| 73030 |
|
2,652 |
1,921 |
$49K |
| 73630 |
|
2,920 |
2,381 |
$49K |
| 73130 |
|
2,641 |
2,024 |
$47K |
| 83880 |
|
3,264 |
2,789 |
$46K |
| 87077 |
|
9,072 |
7,098 |
$45K |
| 82947 |
|
9,371 |
5,279 |
$43K |
| 74018 |
|
1,819 |
1,583 |
$42K |
| 92526 |
|
461 |
228 |
$42K |
| 80048 |
|
8,076 |
5,759 |
$42K |
| 82565 |
|
3,978 |
2,064 |
$42K |
| 77080 |
|
1,092 |
806 |
$42K |
| J7050 |
Normal saline solution infus |
5,174 |
2,809 |
$41K |
| 73610 |
|
2,494 |
2,005 |
$40K |
| 58661 |
|
13 |
13 |
$39K |
| 87186 |
|
6,055 |
5,467 |
$39K |
| 94729 |
|
607 |
552 |
$38K |
| 94060 |
|
1,138 |
703 |
$38K |
| 84484 |
|
8,678 |
6,805 |
$37K |
| 70491 |
|
237 |
184 |
$37K |
| 94726 |
|
601 |
548 |
$35K |
| 83690 |
|
16,098 |
13,996 |
$35K |
| 81001 |
|
18,916 |
16,408 |
$34K |
| 73502 |
|
1,425 |
1,075 |
$34K |
| 82728 |
|
2,881 |
2,475 |
$34K |
| 77066 |
Tomosynthesis, mammo |
1,061 |
832 |
$33K |
| 84112 |
|
404 |
351 |
$32K |
| 87880 |
|
10,010 |
9,366 |
$31K |
| 85610 |
|
11,513 |
9,418 |
$31K |
| 74019 |
|
1,280 |
1,174 |
$30K |
| 73110 |
|
1,744 |
1,374 |
$29K |
| 96376 |
|
1,992 |
1,679 |
$29K |
| J7120 |
Ringers lactate infusion |
10,566 |
9,067 |
$29K |
| 83540 |
|
4,996 |
4,551 |
$28K |
| 76870 |
|
338 |
295 |
$28K |
| 77065 |
Tomosynthesis, mammo |
941 |
696 |
$28K |
| J2405 |
Ondansetron hcl injection |
14,997 |
12,531 |
$28K |
| 87522 |
Neg quan hep c or qual rna |
668 |
621 |
$27K |
| 83013 |
|
464 |
414 |
$27K |
| J1885 |
Ketorolac tromethamine inj |
12,588 |
11,000 |
$26K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
8,998 |
8,089 |
$26K |
| 97165 |
|
753 |
651 |
$25K |
| 87899 |
|
2,457 |
1,122 |
$25K |
| C1894 |
Intro/sheath, non-laser |
635 |
419 |
$24K |
| 95819 |
|
244 |
225 |
$24K |
| G0297 |
Ldct for lung ca screen |
361 |
328 |
$24K |
| 86256 |
|
928 |
867 |
$24K |
| 83735 |
|
6,506 |
5,173 |
$23K |
| 77063 |
|
4,314 |
3,693 |
$23K |
| A9577 |
Inj multihance |
1,554 |
1,370 |
$22K |
| 87493 |
|
1,003 |
875 |
$22K |
| 87798 |
|
286 |
274 |
$22K |
| J2001 |
Lidocaine injection |
4,878 |
4,374 |
$22K |
| 86665 |
|
595 |
542 |
$21K |
| 97010 |
|
5,130 |
1,388 |
$21K |
| 97014 |
|
1,501 |
551 |
$21K |
| C2617 |
Stent, non-cor, tem w/o del |
246 |
206 |
$20K |
| 84403 |
|
841 |
776 |
$20K |
| 93798 |
|
401 |
55 |
$20K |
| 76700 |
|
176 |
154 |
$20K |
| 10060 |
|
461 |
395 |
$20K |
| J2250 |
Inj midazolam hydrochloride |
7,149 |
6,176 |
$20K |
| J0696 |
Ceftriaxone sodium injection |
3,898 |
3,102 |
$20K |
| A9500 |
Tc99m sestamibi |
367 |
310 |
$19K |
| 88304 |
|
1,552 |
1,374 |
$19K |
| 85730 |
|
6,102 |
5,274 |
$19K |
| 42820 |
|
13 |
13 |
$19K |
| J2469 |
Palonosetron hcl |
187 |
93 |
$19K |
| 96366 |
|
1,046 |
692 |
$18K |
| C1776 |
Joint device (implantable) |
14 |
12 |
$18K |
| 71101 |
|
677 |
485 |
$18K |
| 93880 |
|
183 |
156 |
$18K |
| J2785 |
Regadenoson injection |
181 |
151 |
$17K |
| J3010 |
Fentanyl citrate injection |
7,230 |
6,480 |
$17K |
| J1170 |
Hydromorphone injection |
6,268 |
4,862 |
$17K |
| 83516 |
|
700 |
602 |
$17K |
| 88142 |
|
1,039 |
968 |
$17K |
| 82570 |
|
3,787 |
3,395 |
$17K |
| C1769 |
Guide wire |
681 |
420 |
$17K |
| 12001 |
|
535 |
513 |
$17K |
| 82043 |
|
3,123 |
2,781 |
$17K |
| 81003 |
|
10,923 |
9,682 |
$16K |
| 82553 |
|
5,136 |
4,377 |
$16K |
| 82784 |
|
749 |
642 |
$16K |
| G0283 |
Elec stim other than wound |
1,984 |
436 |
$15K |
| G0103 |
Psa screening |
1,733 |
1,011 |
$15K |
| 74183 |
|
36 |
30 |
$15K |
| 97113 |
|
594 |
187 |
$14K |
| J1100 |
Dexamethasone sodium phos |
5,728 |
4,930 |
$14K |
| 82550 |
|
4,423 |
3,793 |
$13K |
| 87801 |
|
307 |
258 |
$13K |
| 73080 |
|
913 |
759 |
$13K |
| 81025 |
|
2,890 |
2,553 |
$13K |
| 87807 |
|
3,274 |
3,097 |
$13K |
| J0500 |
Dicyclomine injection |
887 |
810 |
$13K |
| 86803 |
|
932 |
880 |
$13K |
| J0690 |
Cefazolin sodium injection |
1,993 |
1,599 |
$12K |
| 88307 |
|
454 |
397 |
$12K |
| 73590 |
|
837 |
679 |
$12K |
| 36591 |
|
347 |
237 |
$12K |
| 83970 |
|
409 |
332 |
$12K |
| 86701 |
|
1,380 |
1,260 |
$12K |
| 86696 |
|
597 |
510 |
$12K |
| 85027 |
|
2,224 |
1,933 |
$12K |
| 87040 |
|
1,761 |
1,489 |
$11K |
| 86376 |
|
807 |
754 |
$11K |
| 86039 |
|
1,076 |
987 |
$11K |
| 86850 |
|
2,170 |
1,221 |
$11K |
| J2270 |
Morphine sulfate injection |
4,538 |
3,649 |
$11K |
| J1453 |
Fosaprepitant injection |
94 |
38 |
$11K |
| 87449 |
|
1,262 |
1,141 |
$11K |
| 64450 |
|
43 |
39 |
$10K |
| 73090 |
|
837 |
686 |
$10K |
| 86677 |
|
1,154 |
1,068 |
$10K |
| 83630 |
|
773 |
582 |
$9K |
| 85379 |
|
1,454 |
1,357 |
$9K |
| 86901 |
|
2,626 |
2,253 |
$9K |
| 80076 |
|
1,033 |
853 |
$9K |
| 82274 |
|
1,118 |
852 |
$9K |
| 86225 |
|
829 |
770 |
$9K |
| 87045 |
|
1,309 |
1,086 |
$9K |
| 82150 |
|
1,469 |
1,340 |
$9K |
| A9537 |
Tc99m mebrofenin |
300 |
272 |
$9K |
| 86038 |
|
868 |
805 |
$9K |
| 86664 |
|
553 |
515 |
$9K |
| 36600 |
|
273 |
222 |
$8K |
| 82785 |
|
519 |
483 |
$8K |
| 83001 |
|
473 |
439 |
$8K |
| J7030 |
Normal saline solution infus |
4,055 |
3,298 |
$8K |
| 87046 |
|
1,176 |
1,067 |
$8K |
| 73140 |
|
531 |
476 |
$8K |
| 86663 |
|
571 |
528 |
$8K |
| 95811 |
|
13 |
12 |
$8K |
| 84703 |
|
1,663 |
1,500 |
$8K |
| 84146 |
|
436 |
416 |
$8K |
| 86800 |
|
500 |
467 |
$8K |
| 86618 |
|
517 |
452 |
$7K |
| L8699 |
Prosthetic implant nos |
155 |
147 |
$7K |
| 72158 |
|
16 |
13 |
$7K |
| 85652 |
|
3,162 |
2,743 |
$7K |
| 86695 |
|
565 |
511 |
$7K |
| 94618 |
|
162 |
138 |
$7K |
| 91200 |
|
111 |
103 |
$7K |
| J2930 |
Methylprednisolone injection |
2,134 |
1,787 |
$7K |
| 81002 |
|
2,197 |
1,755 |
$7K |
| 93970 |
|
61 |
53 |
$7K |
| 86757 |
|
223 |
210 |
$7K |
| 86780 |
|
608 |
553 |
$7K |
| 84550 |
|
1,635 |
1,470 |
$7K |
| 70470 |
|
39 |
28 |
$6K |
| 77336 |
|
125 |
37 |
$6K |
| 83605 |
|
1,806 |
1,542 |
$6K |
| 84481 |
|
398 |
368 |
$6K |
| 83002 |
|
338 |
325 |
$6K |
| 90471 |
|
842 |
747 |
$6K |
| 86431 |
|
1,112 |
1,038 |
$6K |
| 84402 |
|
264 |
242 |
$6K |
| 88342 |
|
359 |
313 |
$6K |
| 82803 |
|
654 |
514 |
$5K |
| 86694 |
|
376 |
332 |
$5K |
| 86060 |
|
789 |
736 |
$5K |
| 12011 |
|
235 |
224 |
$5K |
| 83655 |
|
379 |
371 |
$5K |
| 73718 |
|
15 |
13 |
$5K |
| J1642 |
Inj heparin sodium per 10 u |
1,018 |
411 |
$5K |
| 88360 |
|
117 |
105 |
$5K |
| 83721 |
|
578 |
544 |
$5K |
| 97802 |
|
131 |
124 |
$5K |
| 86403 |
|
808 |
754 |
$5K |
| A4648 |
Implantable tissue marker |
150 |
86 |
$5K |
| 86705 |
|
422 |
391 |
$5K |
| 86140 |
|
1,034 |
845 |
$5K |
| 87328 |
|
487 |
454 |
$5K |
| 87329 |
|
500 |
467 |
$5K |
| 80165 |
|
409 |
366 |
$5K |
| G0424 |
Pulmonary rehab w exer |
135 |
28 |
$4K |
| 86707 |
|
390 |
367 |
$4K |
| 84100 |
|
1,171 |
870 |
$4K |
| 86003 |
|
93 |
90 |
$4K |
| 78264 |
|
39 |
27 |
$4K |
| 70496 |
|
39 |
13 |
$4K |
| 72082 |
|
76 |
70 |
$4K |
| 83883 |
|
238 |
222 |
$4K |
| 74420 |
|
66 |
49 |
$4K |
| J7040 |
Normal saline solution infus |
1,062 |
795 |
$4K |
| 29125 |
|
129 |
123 |
$4K |
| 96523 |
|
113 |
105 |
$3K |
| 84156 |
|
1,181 |
971 |
$3K |
| 85007 |
|
1,423 |
1,199 |
$3K |
| 87350 |
|
305 |
287 |
$3K |
| J2550 |
Promethazine hcl injection |
1,521 |
1,227 |
$3K |
| 83615 |
|
514 |
441 |
$3K |
| J2360 |
Orphenadrine injection |
880 |
801 |
$3K |
| 83014 |
|
435 |
409 |
$3K |
| 96417 |
|
49 |
26 |
$3K |
| J1200 |
Diphenhydramine hcl injectio |
2,004 |
1,682 |
$3K |
| J2710 |
Neostigmine methylslfte inj |
696 |
647 |
$3K |
| 97022 |
|
384 |
105 |
$3K |
| 88108 |
|
176 |
141 |
$3K |
| 87902 |
|
12 |
12 |
$3K |
| 73552 |
|
199 |
143 |
$3K |
| J0330 |
Succinycholine chloride inj |
565 |
528 |
$3K |
| J2175 |
Meperidine hydrochl /100 mg |
1,435 |
1,307 |
$3K |
| U0003 |
Cov-19 amp prb hgh thruput |
297 |
215 |
$3K |
| 90715 |
|
366 |
339 |
$3K |
| 73523 |
|
86 |
69 |
$3K |
| 86900 |
|
1,367 |
1,182 |
$3K |
| 77417 |
|
61 |
27 |
$3K |
| 86141 |
|
280 |
258 |
$3K |
| 83010 |
|
195 |
185 |
$2K |
| 73060 |
|
193 |
162 |
$2K |
| 86704 |
|
212 |
200 |
$2K |
| J0171 |
Adrenalin epinephrine inject |
271 |
211 |
$2K |
| 86235 |
|
41 |
37 |
$2K |
| J1644 |
Inj heparin sodium per 1000u |
383 |
229 |
$2K |
| J2765 |
Metoclopramide hcl injection |
1,406 |
1,252 |
$2K |
| 84460 |
|
390 |
373 |
$2K |
| 83525 |
|
168 |
165 |
$2K |
| 74230 |
|
70 |
36 |
$2K |
| J2060 |
Lorazepam injection |
847 |
718 |
$2K |
| 93922 |
|
16 |
15 |
$2K |
| 76805 |
|
22 |
13 |
$2K |
| J2370 |
Phenylephrine hcl injection |
560 |
490 |
$2K |
| 12002 |
|
44 |
42 |
$2K |
| 86706 |
|
187 |
166 |
$2K |
| 97535 |
|
177 |
104 |
$2K |
| A9579 |
Gad-base mr contrast nos,1ml |
294 |
268 |
$2K |
| 78306 |
|
27 |
12 |
$2K |
| 87502 |
|
111 |
96 |
$2K |
| 82247 |
|
299 |
243 |
$2K |
| 72040 |
|
48 |
41 |
$2K |
| 84165 |
|
189 |
166 |
$2K |
| 84270 |
|
85 |
82 |
$2K |
| 82977 |
|
216 |
213 |
$2K |
| 87340 |
|
187 |
179 |
$2K |
| 82310 |
|
132 |
90 |
$2K |
| Q9968 |
Visualization adjunct |
103 |
88 |
$2K |
| 96415 |
|
46 |
25 |
$1K |
| 76000 |
|
81 |
73 |
$1K |
| 87624 |
|
53 |
46 |
$1K |
| 84436 |
|
218 |
205 |
$1K |
| J2795 |
Ropivacaine hcl injection |
191 |
175 |
$1K |
| 82248 |
|
282 |
215 |
$1K |
| 72170 |
|
54 |
41 |
$1K |
| A9541 |
Tc99m sulfur colloid |
13 |
12 |
$1K |
| 88300 |
|
210 |
185 |
$1K |
| 84153 |
|
79 |
68 |
$1K |
| 82103 |
|
90 |
88 |
$1K |
| 72220 |
|
50 |
42 |
$1K |
| 89051 |
|
444 |
131 |
$1K |
| 85014 |
|
910 |
735 |
$926.84 |
| 76856 |
|
12 |
12 |
$920.95 |
| C1758 |
Catheter, ureteral |
16 |
14 |
$904.56 |
| 86592 |
|
214 |
206 |
$873.99 |
| 87529 |
|
27 |
13 |
$869.43 |
| 80047 |
|
286 |
229 |
$856.54 |
| J2791 |
Rhophylac injection |
141 |
128 |
$834.40 |
| 85046 |
|
170 |
155 |
$822.89 |
| 88302 |
|
104 |
97 |
$776.22 |
| J1953 |
Levetiracetam injection |
46 |
40 |
$765.61 |
| J0561 |
Penicillin g benzathine inj |
31 |
30 |
$764.12 |
| 80320 |
|
87 |
81 |
$761.39 |
| 84144 |
|
39 |
39 |
$748.87 |
| J1815 |
Insulin injection |
565 |
299 |
$743.85 |
| J1650 |
Inj enoxaparin sodium |
97 |
40 |
$710.34 |
| J7620 |
Albuterol ipratrop non-comp |
1,352 |
1,149 |
$703.91 |
| 82077 |
|
53 |
28 |
$673.57 |
| 87205 |
|
212 |
165 |
$661.32 |
| J1956 |
Levofloxacin injection |
191 |
148 |
$631.46 |
| 84450 |
|
127 |
123 |
$629.53 |
| 82525 |
|
59 |
44 |
$625.31 |
| 97012 |
|
78 |
25 |
$616.91 |
| 80329 |
|
63 |
58 |
$602.78 |
| 84479 |
|
92 |
86 |
$592.39 |
| 97116 |
|
134 |
56 |
$564.73 |
| 82672 |
|
32 |
25 |
$562.41 |
| 73560 |
|
31 |
26 |
$533.39 |
| 0011A |
|
36 |
31 |
$511.18 |
| J2543 |
Piperacillin/tazobactam |
64 |
42 |
$486.86 |
| 85018 |
|
371 |
296 |
$454.48 |
| G0379 |
Direct refer hospital observ |
12 |
12 |
$441.60 |
| 84480 |
|
29 |
26 |
$427.18 |
| 80202 |
|
29 |
12 |
$396.07 |
| A9585 |
Gadobutrol injection |
33 |
25 |
$367.85 |
| 80069 |
|
49 |
37 |
$321.26 |
| 80143 |
|
45 |
24 |
$309.41 |
| 84681 |
|
14 |
14 |
$299.01 |
| 84520 |
|
74 |
59 |
$278.75 |
| 82009 |
|
231 |
190 |
$276.35 |
| 80179 |
|
45 |
24 |
$274.46 |
| 73660 |
|
16 |
12 |
$263.64 |
| 86200 |
|
25 |
25 |
$262.46 |
| J7512 |
Prednisone ir or dr oral 1mg |
812 |
525 |
$224.87 |
| C9113 |
Inj pantoprazole sodium, via |
51 |
42 |
$186.14 |
| 83986 |
|
127 |
111 |
$180.76 |
| 87102 |
|
34 |
26 |
$166.22 |
| J3411 |
Thiamine hcl 100 mg |
30 |
26 |
$154.49 |
| 80178 |
|
29 |
27 |
$150.88 |
| 84630 |
|
26 |
14 |
$141.78 |
| 88720 |
|
27 |
26 |
$139.31 |
| 86709 |
|
14 |
14 |
$125.10 |
| J3370 |
Vancomycin hcl injection |
13 |
12 |
$112.09 |
| 82140 |
|
13 |
12 |
$102.92 |
| J1790 |
Droperidol injection |
72 |
56 |
$87.14 |
| J1630 |
Haloperidol injection |
63 |
56 |
$86.90 |
| 88311 |
|
13 |
12 |
$81.90 |
| J7613 |
Albuterol non-comp unit |
272 |
248 |
$79.58 |
| 82040 |
|
12 |
12 |
$75.60 |
| 82330 |
|
13 |
12 |
$63.00 |
| J3070 |
Pentazocine injection |
231 |
203 |
$52.31 |
| J1580 |
Garamycin gentamicin inj |
17 |
14 |
$37.19 |
| J3480 |
Inj potassium chloride |
17 |
13 |
$16.17 |
| A9270 |
Non-covered item or service |
18 |
16 |
$0.00 |
| G8996 |
Swallow current status |
14 |
13 |
$0.00 |
| G8979 |
Mobility goal status |
119 |
87 |
$0.00 |
| G8978 |
Mobility current status |
75 |
59 |
$0.00 |
| G8997 |
Swallow goal status |
14 |
13 |
$0.00 |