| Code | Description | Claims | Beneficiaries | Total Paid |
| 99202 |
|
73,238 |
56,280 |
$7.94M |
| 99201 |
|
54,132 |
43,571 |
$4.31M |
| Q3014 |
Telehealth facility fee |
75,679 |
68,561 |
$3.72M |
| 70553 |
|
3,023 |
2,969 |
$2.53M |
| U0003 |
Cov-19 amp prb hgh thruput |
17,932 |
16,649 |
$2.45M |
| 88305 |
|
11,518 |
7,870 |
$1.88M |
| 99211 |
|
46,738 |
44,670 |
$1.73M |
| 99281 |
|
22,986 |
22,521 |
$1.64M |
| A9552 |
F18 fdg |
1,889 |
1,869 |
$1.35M |
| 0760 |
|
20,989 |
19,856 |
$1.17M |
| J1561 |
Gamunex-c/gammaked |
995 |
464 |
$1.15M |
| 74177 |
|
2,198 |
2,142 |
$1.08M |
| 99283 |
|
15,895 |
12,860 |
$1.07M |
| 71260 |
|
2,039 |
1,989 |
$954K |
| 78815 |
|
209 |
209 |
$842K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
7,299 |
6,373 |
$830K |
| 96365 |
|
3,748 |
2,798 |
$801K |
| 87635 |
|
9,780 |
8,011 |
$760K |
| A9575 |
Inj gadoterate meglumi 0.1ml |
5,115 |
4,968 |
$726K |
| 93306 |
|
2,046 |
2,022 |
$717K |
| 80053 |
|
16,693 |
11,925 |
$643K |
| 70551 |
|
1,139 |
1,108 |
$561K |
| 0450 |
|
3,650 |
3,454 |
$497K |
| 93325 |
|
2,326 |
2,158 |
$485K |
| 72197 |
|
834 |
828 |
$481K |
| 85025 |
|
27,217 |
20,741 |
$409K |
| 96375 |
|
5,322 |
3,448 |
$405K |
| 96413 |
|
6,212 |
4,144 |
$400K |
| 88341 |
|
1,246 |
1,155 |
$375K |
| J1745 |
Infliximab not biosimil 10mg |
82 |
74 |
$315K |
| J0585 |
Injection,onabotulinumtoxina |
389 |
243 |
$305K |
| 87799 |
|
2,167 |
1,606 |
$303K |
| 74183 |
|
493 |
489 |
$296K |
| J9271 |
Inj pembrolizumab |
27 |
24 |
$289K |
| 92557 |
|
1,816 |
1,773 |
$280K |
| J3490 |
Drugs unclassified injection |
5,956 |
3,933 |
$266K |
| 93005 |
|
6,144 |
5,792 |
$264K |
| 71250 |
|
742 |
731 |
$251K |
| 96366 |
|
2,070 |
1,524 |
$205K |
| 96374 |
|
2,141 |
1,898 |
$195K |
| 92567 |
|
3,360 |
3,272 |
$189K |
| 59426 |
|
1,190 |
950 |
$165K |
| J2704 |
Inj, propofol, 10 mg |
10,785 |
9,772 |
$165K |
| G9002 |
Mccd,maintenance rate |
1,227 |
1,090 |
$160K |
| 83735 |
|
7,472 |
4,903 |
$156K |
| 88342 |
|
2,200 |
2,118 |
$150K |
| 99070 |
|
4,527 |
3,710 |
$147K |
| T1024 |
Team evaluation & management |
2,222 |
1,763 |
$143K |
| 0510 |
|
2,270 |
2,174 |
$142K |
| 76770 |
|
1,049 |
1,021 |
$138K |
| 87497 |
|
1,815 |
1,152 |
$137K |
| 77067 |
|
613 |
611 |
$135K |
| 80048 |
|
5,212 |
4,457 |
$130K |
| 99417 |
Prolong home eval add 15m |
1,598 |
1,476 |
$123K |
| 80197 |
|
2,753 |
1,623 |
$119K |
| J0131 |
Inj, acetaminophen (nos) |
3,513 |
3,380 |
$119K |
| 96415 |
|
1,710 |
1,393 |
$118K |
| 93303 |
|
458 |
445 |
$115K |
| 82306 |
|
2,694 |
2,634 |
$115K |
| 78812 |
|
25 |
25 |
$110K |
| 92507 |
|
932 |
631 |
$109K |
| 72082 |
|
1,290 |
1,278 |
$106K |
| 71046 |
|
2,862 |
2,770 |
$105K |
| 90686 |
|
4,335 |
4,320 |
$104K |
| 84443 |
|
3,791 |
3,595 |
$101K |
| 92522 |
|
461 |
443 |
$98K |
| 76536 |
|
1,042 |
1,010 |
$97K |
| 80307 |
|
883 |
823 |
$94K |
| 31575 |
|
1,140 |
1,096 |
$90K |
| 84600 |
|
2,275 |
2,162 |
$86K |
| 87633 |
|
148 |
137 |
$85K |
| 93975 |
|
191 |
186 |
$83K |
| 88185 |
|
142 |
114 |
$82K |
| 96361 |
|
1,407 |
1,130 |
$81K |
| 99199 |
|
1,019 |
735 |
$80K |
| 76815 |
|
1,074 |
705 |
$76K |
| 82670 |
|
1,460 |
1,405 |
$74K |
| 43239 |
|
714 |
703 |
$69K |
| 84100 |
|
5,149 |
3,743 |
$69K |
| 94010 |
|
1,582 |
1,526 |
$69K |
| 95810 |
|
102 |
102 |
$68K |
| 96367 |
|
836 |
550 |
$68K |
| 99231 |
|
662 |
622 |
$68K |
| 84630 |
|
1,205 |
1,199 |
$66K |
| 76700 |
|
419 |
409 |
$63K |
| S0302 |
Completed epsdt |
498 |
306 |
$63K |
| L8699 |
Prosthetic implant nos |
14 |
14 |
$61K |
| 72156 |
|
55 |
55 |
$59K |
| G9008 |
Mccd,phys coor-care ovrsght |
183 |
67 |
$59K |
| 93320 |
|
483 |
469 |
$56K |
| 86317 |
|
1,525 |
1,418 |
$56K |
| 76811 |
|
373 |
366 |
$54K |
| 86003 |
|
357 |
351 |
$54K |
| 88112 |
|
751 |
734 |
$54K |
| J7030 |
Normal saline solution infus |
6,723 |
4,210 |
$53K |
| U0004 |
Cov-19 test non-cdc hgh thru |
583 |
543 |
$50K |
| U0005 |
Infec agen detec ampli probe |
1,727 |
1,583 |
$50K |
| 82784 |
|
2,193 |
1,988 |
$47K |
| 88307 |
|
392 |
368 |
$42K |
| J8499 |
Oral prescrip drug non chemo |
5,906 |
2,811 |
$42K |
| 82977 |
|
2,245 |
1,765 |
$42K |
| 97110 |
|
1,006 |
591 |
$40K |
| 83520 |
|
671 |
649 |
$40K |
| 0710 |
|
78 |
76 |
$39K |
| J7120 |
Ringers lactate infusion |
6,299 |
5,715 |
$39K |
| 85027 |
|
4,266 |
3,910 |
$38K |
| 82803 |
|
1,441 |
1,347 |
$38K |
| J1642 |
Inj heparin sodium per 10 u |
3,679 |
1,693 |
$37K |
| 86900 |
|
5,902 |
5,003 |
$37K |
| 86901 |
|
5,895 |
5,007 |
$36K |
| 86923 |
|
425 |
373 |
$36K |
| 84439 |
|
2,682 |
2,532 |
$36K |
| 84466 |
|
1,482 |
1,432 |
$36K |
| 76705 |
|
272 |
259 |
$36K |
| 99368 |
|
1,420 |
1,118 |
$36K |
| 91320 |
|
121 |
121 |
$36K |
| 83615 |
|
2,244 |
1,514 |
$35K |
| J2405 |
Ondansetron hcl injection |
11,646 |
10,106 |
$35K |
| J0171 |
Adrenalin epinephrine inject |
899 |
813 |
$35K |
| T1001 |
Nursing assessment/evaluatn |
919 |
869 |
$34K |
| 41899 |
|
321 |
316 |
$34K |
| 96372 |
|
696 |
524 |
$34K |
| 82947 |
|
4,139 |
3,745 |
$33K |
| 82728 |
|
1,562 |
1,439 |
$33K |
| J3010 |
Fentanyl citrate injection |
8,372 |
6,960 |
$33K |
| 87389 |
|
885 |
865 |
$32K |
| 96417 |
|
524 |
332 |
$32K |
| 85610 |
|
4,090 |
3,525 |
$31K |
| 86850 |
|
5,147 |
4,457 |
$31K |
| J1100 |
Dexamethasone sodium phos |
6,161 |
5,511 |
$30K |
| 83036 |
|
1,976 |
1,938 |
$30K |
| 92700 |
|
193 |
167 |
$29K |
| 0761 |
|
809 |
742 |
$29K |
| Z7500 |
|
837 |
793 |
$28K |
| 99244 |
|
159 |
157 |
$28K |
| 93321 |
|
335 |
305 |
$27K |
| 80061 |
|
1,021 |
1,000 |
$27K |
| 83993 |
|
636 |
610 |
$27K |
| 0360 |
|
143 |
57 |
$27K |
| 92060 |
|
1,460 |
1,406 |
$27K |
| 82565 |
|
3,653 |
3,360 |
$27K |
| 73630 |
|
617 |
497 |
$27K |
| 93296 |
|
220 |
213 |
$27K |
| 87340 |
|
1,523 |
1,466 |
$26K |
| 99401 |
|
786 |
692 |
$25K |
| 90656 |
|
811 |
811 |
$25K |
| 0270 |
|
175 |
143 |
$24K |
| 92550 |
|
276 |
276 |
$24K |
| 92552 |
|
232 |
227 |
$24K |
| 86140 |
|
2,719 |
2,540 |
$24K |
| 73110 |
|
573 |
492 |
$24K |
| 88304 |
|
381 |
363 |
$23K |
| 86704 |
|
1,227 |
1,185 |
$23K |
| 82570 |
|
2,030 |
1,705 |
$23K |
| 0004A |
|
575 |
575 |
$23K |
| 82040 |
|
2,121 |
1,987 |
$22K |
| 77336 |
|
258 |
127 |
$22K |
| 84460 |
|
3,241 |
2,956 |
$22K |
| 86803 |
|
1,072 |
1,034 |
$22K |
| 83655 |
|
2,405 |
2,393 |
$22K |
| C9803 |
Hopd covid-19 spec collect |
643 |
628 |
$22K |
| 84450 |
|
3,153 |
2,871 |
$22K |
| J2250 |
Inj midazolam hydrochloride |
5,551 |
5,272 |
$21K |
| 82525 |
|
805 |
801 |
$21K |
| 86360 |
|
304 |
284 |
$21K |
| 81001 |
|
2,571 |
2,339 |
$20K |
| 77073 |
|
408 |
401 |
$20K |
| 83540 |
|
1,569 |
1,514 |
$20K |
| 82247 |
|
2,618 |
2,351 |
$19K |
| 0064A |
|
481 |
481 |
$19K |
| 83880 |
|
356 |
314 |
$19K |
| 84156 |
|
1,798 |
1,490 |
$19K |
| 90471 |
|
1,755 |
1,747 |
$19K |
| 98967 |
|
516 |
379 |
$18K |
| 59025 |
|
838 |
457 |
$18K |
| J0690 |
Cefazolin sodium injection |
3,576 |
3,258 |
$18K |
| 93356 |
|
186 |
184 |
$18K |
| 0071A |
|
440 |
439 |
$18K |
| 83605 |
|
1,062 |
971 |
$17K |
| 90677 |
|
44 |
44 |
$17K |
| 70450 |
|
68 |
64 |
$17K |
| 87491 |
|
293 |
290 |
$16K |
| 77074 |
|
231 |
228 |
$16K |
| 87591 |
|
293 |
290 |
$16K |
| 87070 |
|
987 |
944 |
$16K |
| 0072A |
|
402 |
402 |
$16K |
| 99366 |
|
606 |
556 |
$16K |
| 86359 |
|
283 |
264 |
$16K |
| 73562 |
|
396 |
342 |
$16K |
| J2370 |
Phenylephrine hcl injection |
1,449 |
1,386 |
$15K |
| 71045 |
|
636 |
580 |
$15K |
| 77063 |
|
250 |
250 |
$15K |
| 88184 |
|
157 |
126 |
$15K |
| 83690 |
|
1,340 |
1,254 |
$15K |
| 94729 |
|
141 |
138 |
$15K |
| 84305 |
|
272 |
270 |
$14K |
| 84075 |
|
2,362 |
2,137 |
$14K |
| J1170 |
Hydromorphone injection |
2,614 |
2,003 |
$14K |
| 86357 |
|
260 |
242 |
$14K |
| 77300 |
|
43 |
37 |
$14K |
| 86481 |
|
90 |
90 |
$14K |
| 86355 |
|
259 |
242 |
$14K |
| 85730 |
|
1,210 |
1,116 |
$14K |
| 92570 |
|
158 |
155 |
$13K |
| 0002A |
|
325 |
325 |
$13K |
| 82610 |
|
370 |
336 |
$13K |
| 97039 |
|
442 |
205 |
$12K |
| 92083 |
|
676 |
647 |
$12K |
| 67028 |
|
111 |
89 |
$12K |
| 73030 |
|
240 |
223 |
$12K |
| 86665 |
|
165 |
165 |
$12K |
| 73610 |
|
245 |
220 |
$12K |
| 85651 |
|
2,545 |
2,436 |
$12K |
| 92579 |
|
75 |
75 |
$12K |
| 0001A |
|
383 |
383 |
$12K |
| 0054A |
|
284 |
284 |
$11K |
| 70543 |
|
26 |
24 |
$11K |
| 0124A |
|
286 |
286 |
$11K |
| 72170 |
|
288 |
273 |
$11K |
| 80051 |
|
1,103 |
1,016 |
$11K |
| 77080 |
|
166 |
163 |
$11K |
| 83970 |
|
135 |
127 |
$10K |
| 78452 |
|
13 |
13 |
$10K |
| 97750 |
|
97 |
71 |
$10K |
| 45380 |
|
114 |
112 |
$10K |
| 86644 |
|
527 |
503 |
$10K |
| 88313 |
|
222 |
214 |
$10K |
| 81003 |
|
2,097 |
1,904 |
$10K |
| 82962 |
|
1,357 |
1,233 |
$10K |
| A9585 |
Gadobutrol injection |
103 |
100 |
$10K |
| 74018 |
|
314 |
300 |
$10K |
| 73080 |
|
219 |
175 |
$9K |
| 87077 |
|
497 |
484 |
$9K |
| 87624 |
|
118 |
117 |
$9K |
| 72141 |
|
12 |
12 |
$9K |
| 82248 |
|
595 |
525 |
$9K |
| J7060 |
5% dextrose/water |
1,831 |
1,021 |
$9K |
| H1003 |
Prenatal at risk education |
345 |
281 |
$8K |
| J1644 |
Inj heparin sodium per 1000u |
1,612 |
736 |
$8K |
| 90739 |
|
19 |
19 |
$8K |
| 76856 |
|
57 |
57 |
$8K |
| 82105 |
|
63 |
62 |
$8K |
| 86592 |
|
808 |
779 |
$8K |
| 73130 |
|
177 |
139 |
$8K |
| 71275 |
|
16 |
16 |
$8K |
| S0265 |
Genetic counsel 15 mins |
80 |
80 |
$8K |
| 92250 |
|
323 |
300 |
$8K |
| 69436 |
|
42 |
39 |
$8K |
| 83519 |
|
182 |
179 |
$8K |
| 31579 |
|
96 |
91 |
$8K |
| 84295 |
|
916 |
873 |
$8K |
| 97802 |
|
151 |
145 |
$8K |
| 95819 |
|
112 |
112 |
$8K |
| V2632 |
Post chmbr intraocular lens |
19 |
12 |
$8K |
| 90480 |
|
188 |
188 |
$8K |
| 84484 |
|
424 |
388 |
$7K |
| 0134A |
|
190 |
190 |
$7K |
| 90750 |
|
13 |
13 |
$7K |
| 84445 |
|
174 |
171 |
$7K |
| 84425 |
|
377 |
374 |
$7K |
| 97140 |
|
132 |
88 |
$7K |
| 84520 |
|
1,150 |
1,041 |
$7K |
| 72083 |
|
109 |
109 |
$7K |
| 86664 |
|
213 |
213 |
$7K |
| 90651 |
|
22 |
22 |
$7K |
| A6250 |
Skin seal protect moisturizr |
967 |
835 |
$7K |
| 72100 |
|
120 |
119 |
$7K |
| 87205 |
|
691 |
662 |
$7K |
| 96360 |
|
71 |
53 |
$7K |
| 87338 |
|
183 |
182 |
$7K |
| 87536 |
|
42 |
40 |
$7K |
| 87088 |
|
602 |
573 |
$7K |
| 84481 |
|
255 |
238 |
$7K |
| 83001 |
|
184 |
180 |
$7K |
| 84132 |
|
952 |
909 |
$6K |
| Z9725 |
|
148 |
146 |
$6K |
| 72125 |
|
15 |
14 |
$6K |
| J1453 |
Fosaprepitant injection |
400 |
365 |
$6K |
| 87631 |
|
53 |
53 |
$6K |
| 69210 |
|
315 |
300 |
$6K |
| 83921 |
|
397 |
396 |
$6K |
| 99284 |
|
64 |
53 |
$6K |
| 86160 |
|
40 |
28 |
$6K |
| 76825 |
|
40 |
39 |
$6K |
| 82397 |
|
101 |
101 |
$6K |
| 96910 |
|
150 |
49 |
$5K |
| 76937 |
|
148 |
141 |
$5K |
| 76805 |
|
53 |
51 |
$5K |
| 82310 |
|
669 |
605 |
$5K |
| J1885 |
Ketorolac tromethamine inj |
1,384 |
1,193 |
$5K |
| 66984 |
|
15 |
13 |
$5K |
| 73560 |
|
178 |
154 |
$5K |
| 84590 |
|
393 |
389 |
$5K |
| 72148 |
|
12 |
12 |
$5K |
| H1001 |
Antepartum management |
30 |
28 |
$5K |
| 0012A |
|
149 |
149 |
$5K |
| J0330 |
Succinycholine chloride inj |
133 |
128 |
$5K |
| 73502 |
|
72 |
72 |
$5K |
| 86777 |
|
137 |
134 |
$4K |
| J0185 |
Inj., aprepitant, 1 mg |
19 |
13 |
$4K |
| T1999 |
Noc retail items andsupplies |
101 |
101 |
$4K |
| 46600 |
|
148 |
147 |
$4K |
| 76827 |
|
40 |
39 |
$4K |
| 0011A |
|
146 |
146 |
$4K |
| 87186 |
|
184 |
181 |
$4K |
| 85018 |
|
1,108 |
1,034 |
$4K |
| 0003A |
|
94 |
94 |
$4K |
| 93308 |
|
14 |
14 |
$4K |
| 92526 |
|
36 |
26 |
$4K |
| 76830 |
|
28 |
28 |
$4K |
| J2001 |
Lidocaine injection |
1,323 |
1,271 |
$4K |
| 97803 |
|
51 |
51 |
$4K |
| 84702 |
|
96 |
82 |
$3K |
| 93971 |
|
18 |
15 |
$3K |
| G0463 |
Hospital outpt clinic visit |
801 |
670 |
$3K |
| 90715 |
|
30 |
30 |
$3K |
| 73590 |
|
64 |
54 |
$3K |
| 31231 |
|
117 |
116 |
$3K |
| 0154A |
|
73 |
73 |
$3K |
| 93270 |
|
41 |
41 |
$3K |
| 82607 |
|
87 |
87 |
$3K |
| 95117 |
|
111 |
72 |
$3K |
| 0081A |
|
65 |
65 |
$3K |
| 83521 |
|
27 |
26 |
$3K |
| J1200 |
Diphenhydramine hcl injectio |
1,302 |
937 |
$3K |
| 0074A |
|
63 |
63 |
$3K |
| 0160 |
|
22 |
12 |
$2K |
| 90662 |
|
12 |
12 |
$2K |
| 84207 |
|
75 |
75 |
$2K |
| 84255 |
|
73 |
72 |
$2K |
| 93225 |
|
28 |
28 |
$2K |
| 90620 |
|
16 |
16 |
$2K |
| 88173 |
|
96 |
86 |
$2K |
| 87075 |
|
122 |
111 |
$2K |
| 72050 |
|
28 |
28 |
$2K |
| 84153 |
|
52 |
51 |
$2K |
| J2795 |
Ropivacaine hcl injection |
701 |
651 |
$2K |
| 88323 |
|
66 |
66 |
$2K |
| 59430 |
|
13 |
13 |
$2K |
| 83021 |
|
95 |
93 |
$2K |
| 87661 |
|
23 |
23 |
$2K |
| 92555 |
|
43 |
43 |
$2K |
| 99213 |
|
14 |
12 |
$2K |
| 87081 |
|
120 |
119 |
$2K |
| 93017 |
|
13 |
13 |
$2K |
| Z7502 |
|
50 |
50 |
$2K |
| 84403 |
|
34 |
33 |
$2K |
| 93304 |
|
15 |
13 |
$2K |
| 94640 |
|
24 |
23 |
$2K |
| 95886 |
|
14 |
14 |
$2K |
| 87517 |
|
18 |
17 |
$2K |
| 76816 |
|
18 |
16 |
$2K |
| 86780 |
|
110 |
107 |
$2K |
| 86334 |
|
26 |
26 |
$2K |
| 0082A |
|
39 |
39 |
$2K |
| 83789 |
|
24 |
24 |
$1K |
| 71020 |
|
61 |
53 |
$1K |
| 83020 |
|
95 |
93 |
$1K |
| 84446 |
|
159 |
156 |
$1K |
| 86833 |
|
17 |
17 |
$1K |
| 86832 |
|
17 |
17 |
$1K |
| 95004 |
|
12 |
12 |
$1K |
| 94060 |
|
12 |
12 |
$1K |
| 76000 |
|
40 |
38 |
$1K |
| 88142 |
|
199 |
199 |
$1K |
| J2930 |
Methylprednisolone injection |
145 |
120 |
$1K |
| 73552 |
|
27 |
25 |
$1K |
| 82172 |
|
40 |
39 |
$1K |
| 96409 |
|
29 |
24 |
$1K |
| 73140 |
|
43 |
36 |
$1K |
| 76820 |
|
14 |
13 |
$1K |
| 82378 |
|
28 |
26 |
$1K |
| 74455 |
|
12 |
12 |
$1K |
| J3301 |
Triamcinolone acet inj nos |
123 |
119 |
$1K |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
664 |
640 |
$1K |
| 0031A |
|
27 |
27 |
$1K |
| 82043 |
|
90 |
88 |
$1K |
| 84165 |
|
44 |
44 |
$1K |
| 82627 |
|
53 |
53 |
$1K |
| 87102 |
|
49 |
42 |
$1K |
| 0083A |
|
24 |
24 |
$960.00 |
| 84402 |
|
20 |
20 |
$956.24 |
| 84550 |
|
106 |
91 |
$949.41 |
| 82274 |
|
29 |
29 |
$920.41 |
| 97112 |
|
16 |
14 |
$903.22 |
| 88172 |
|
71 |
67 |
$903.01 |
| 88312 |
|
13 |
12 |
$882.17 |
| 82550 |
|
65 |
63 |
$872.66 |
| 87206 |
|
45 |
40 |
$872.44 |
| 92556 |
|
25 |
25 |
$862.97 |
| 82746 |
|
29 |
29 |
$825.10 |
| 86038 |
|
37 |
37 |
$821.17 |
| J2371 |
Inj phenylephrine hcl 20 mcg |
434 |
390 |
$815.31 |
| 82435 |
|
115 |
102 |
$777.47 |
| 0111A |
|
19 |
19 |
$760.00 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
44 |
40 |
$746.78 |
| 86364 |
|
24 |
24 |
$736.33 |
| G0279 |
Tomosynthesis, mammo |
12 |
12 |
$707.52 |
| 82533 |
|
15 |
13 |
$695.40 |
| 92626 |
|
12 |
12 |
$683.96 |
| 0052A |
|
17 |
17 |
$680.00 |
| 82374 |
|
109 |
97 |
$636.25 |
| 85045 |
|
90 |
75 |
$635.95 |
| 81025 |
|
75 |
75 |
$619.50 |
| 10005 |
|
15 |
14 |
$608.33 |
| 64615 |
|
12 |
12 |
$606.83 |
| 0112A |
|
15 |
15 |
$600.00 |
| 90648 |
|
24 |
24 |
$599.60 |
| 87040 |
|
29 |
26 |
$594.92 |
| A9698 |
Non-rad contrast materialnoc |
58 |
56 |
$577.00 |
| 99354 |
|
17 |
15 |
$576.00 |
| 77072 |
|
25 |
25 |
$538.09 |
| J0780 |
Prochlorperazine injection |
47 |
39 |
$529.89 |
| 94760 |
|
26 |
26 |
$498.70 |
| 0051A |
|
12 |
12 |
$480.00 |
| 86790 |
|
44 |
42 |
$478.76 |
| 91319 |
|
25 |
25 |
$453.60 |
| J3475 |
Inj magnesium sulfate |
139 |
108 |
$438.36 |
| J0696 |
Ceftriaxone sodium injection |
36 |
35 |
$394.04 |
| 17110 |
|
24 |
24 |
$393.18 |
| Q9958 |
Hocm <=149 mg/ml iodine, 1ml |
13 |
12 |
$371.87 |
| 97535 |
|
18 |
16 |
$368.50 |
| J1610 |
Glucagon hydrochloride/1 mg |
13 |
13 |
$361.40 |
| 84432 |
|
12 |
12 |
$341.34 |
| 90723 |
|
13 |
13 |
$327.60 |
| 46607 |
|
13 |
13 |
$309.50 |
| 83695 |
|
14 |
14 |
$304.48 |
| 90633 |
|
12 |
12 |
$302.40 |
| 87147 |
|
20 |
19 |
$284.46 |
| 86800 |
|
13 |
13 |
$275.09 |
| 85379 |
|
14 |
13 |
$272.37 |
| 82365 |
|
13 |
12 |
$234.00 |
| 95115 |
|
17 |
13 |
$226.96 |
| 94664 |
|
14 |
14 |
$224.00 |
| 87880 |
|
14 |
14 |
$220.35 |
| 86774 |
|
13 |
13 |
$218.58 |
| 89051 |
|
82 |
76 |
$216.64 |
| 86762 |
|
13 |
13 |
$201.95 |
| 86200 |
|
12 |
12 |
$173.80 |
| J2175 |
Meperidine hydrochl /100 mg |
12 |
12 |
$165.21 |
| 86225 |
|
12 |
12 |
$146.49 |
| 84270 |
|
12 |
12 |
$145.40 |
| 11900 |
|
12 |
12 |
$145.23 |
| 88300 |
|
38 |
38 |
$141.18 |
| 81002 |
|
30 |
29 |
$140.19 |
| 86431 |
|
13 |
13 |
$136.81 |
| J2003 |
Inj, lidocaine hcl, 1 mg |
96 |
88 |
$101.79 |
| 82985 |
|
12 |
12 |
$97.44 |
| J1596 |
Inj, glycopyrrolate, 0.1 mg |
41 |
41 |
$25.03 |
| 85008 |
|
15 |
15 |
$17.22 |
| Q9966 |
Locm 200-299mg/ml iodine,1ml |
12 |
12 |
$13.69 |
| J7613 |
Albuterol non-comp unit |
13 |
12 |
$11.30 |
| J7050 |
Normal saline solution infus |
202 |
147 |
$2.38 |