| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J9271 |
Inj pembrolizumab |
9,622 |
3,285 |
$20.37M |
| J9299 |
Injection, nivolumab |
3,965 |
1,106 |
$7.23M |
| J1561 |
Gamunex-c/gammaked |
9,071 |
1,900 |
$6.79M |
| G0463 |
Hospital outpt clinic visit |
162,270 |
113,863 |
$6.70M |
| J9035 |
Bevacizumab injection |
4,514 |
2,554 |
$5.37M |
| J1745 |
Infliximab not biosimil 10mg |
2,247 |
1,736 |
$4.57M |
| 78815 |
|
3,345 |
3,246 |
$4.37M |
| 74177 |
|
20,789 |
19,548 |
$3.84M |
| 99285 |
|
8,323 |
7,731 |
$2.95M |
| 77386 |
|
13,708 |
1,268 |
$2.77M |
| 87636 |
|
19,891 |
17,917 |
$2.34M |
| A0429 |
Bls-emergency |
53,752 |
32,391 |
$2.22M |
| 0760 |
|
168,916 |
127,575 |
$2.12M |
| J0897 |
Denosumab injection |
4,346 |
2,928 |
$2.11M |
| 96413 |
|
34,962 |
19,756 |
$1.97M |
| J9306 |
Injection, pertuzumab, 1 mg |
3,056 |
433 |
$1.88M |
| J9312 |
Inj., rituximab, 10 mg |
1,467 |
519 |
$1.85M |
| J2505 |
Injection, pegfilgrastim 6mg |
1,578 |
1,079 |
$1.82M |
| 0450 |
|
99,173 |
86,430 |
$1.80M |
| 96374 |
|
33,087 |
26,759 |
$1.78M |
| 71275 |
|
7,884 |
7,369 |
$1.39M |
| Q5108 |
Injection, fulphila |
1,868 |
1,289 |
$1.34M |
| 70553 |
|
5,980 |
5,783 |
$1.26M |
| 87637 |
|
8,540 |
8,038 |
$1.22M |
| 96375 |
|
39,188 |
26,562 |
$1.19M |
| 96365 |
|
18,916 |
12,708 |
$1.14M |
| 80053 |
|
164,182 |
116,872 |
$1.12M |
| J0585 |
Injection,onabotulinumtoxina |
5,320 |
2,209 |
$1.12M |
| 93306 |
|
7,776 |
7,521 |
$1.12M |
| 99284 |
|
6,673 |
6,152 |
$1.07M |
| Q5118 |
Inj., zirabev, 10 mg |
1,441 |
524 |
$1.00M |
| G0378 |
Hospital observation per hr |
3,680 |
3,440 |
$985K |
| A9552 |
F18 fdg |
3,450 |
3,361 |
$828K |
| J0178 |
Aflibercept injection |
1,572 |
1,393 |
$798K |
| J3490 |
Drugs unclassified injection |
184,272 |
69,799 |
$787K |
| Q5117 |
Inj., kanjinti, 10 mg |
877 |
541 |
$770K |
| 70450 |
|
14,827 |
13,746 |
$756K |
| J9355 |
Inj trastuzumab excl biosimi |
784 |
355 |
$753K |
| 85025 |
|
156,154 |
109,869 |
$734K |
| 93975 |
|
3,744 |
3,502 |
$701K |
| 77301 |
|
868 |
807 |
$688K |
| 71260 |
|
7,459 |
7,269 |
$686K |
| J9310 |
Rituximab injection |
396 |
186 |
$662K |
| J9202 |
Goserelin acetate implant |
1,749 |
1,523 |
$645K |
| 70498 |
|
4,576 |
4,389 |
$630K |
| U0003 |
Cov-19 amp prb hgh thruput |
10,783 |
9,504 |
$625K |
| P9021 |
Red blood cells unit |
4,770 |
2,871 |
$616K |
| 93005 |
|
46,661 |
39,964 |
$609K |
| 80307 |
|
14,845 |
12,844 |
$589K |
| 96367 |
|
18,066 |
9,362 |
$562K |
| 96415 |
|
13,331 |
7,839 |
$548K |
| 0250 |
|
37,832 |
25,427 |
$547K |
| J0490 |
Belimumab injection |
479 |
207 |
$541K |
| Q5123 |
Inj. riabni, 10 mg |
790 |
316 |
$531K |
| 96372 |
|
30,423 |
22,868 |
$524K |
| 77014 |
|
8,721 |
927 |
$517K |
| 99283 |
|
5,577 |
5,046 |
$511K |
| Q3014 |
Telehealth facility fee |
40,279 |
33,983 |
$505K |
| 74176 |
|
5,457 |
5,117 |
$478K |
| Q5107 |
Inj mvasi 10 mg |
473 |
173 |
$475K |
| 88185 |
|
2,738 |
1,212 |
$472K |
| 99199 |
|
11,486 |
9,571 |
$466K |
| 76705 |
|
11,702 |
10,964 |
$464K |
| 72125 |
|
4,730 |
4,449 |
$462K |
| 43259 |
|
1,532 |
1,446 |
$455K |
| 0682 |
|
530 |
525 |
$449K |
| 96360 |
|
9,492 |
4,077 |
$440K |
| 96417 |
|
10,445 |
6,204 |
$415K |
| P9034 |
Platelets, pheresis |
1,136 |
329 |
$412K |
| 36430 |
|
6,814 |
2,915 |
$408K |
| 93308 |
|
5,834 |
5,530 |
$399K |
| J0185 |
Inj., aprepitant, 1 mg |
5,449 |
1,674 |
$374K |
| 43239 |
|
2,556 |
2,467 |
$370K |
| 71046 |
|
19,277 |
17,686 |
$366K |
| P9073 |
Platelets pheresis path redu |
706 |
203 |
$361K |
| 45380 |
|
1,609 |
1,511 |
$361K |
| G0480 |
Drug test def 1-7 classes |
6,681 |
6,130 |
$347K |
| J3380 |
Inj vedolizumab iv 1 mg |
278 |
86 |
$346K |
| G2023 |
Specimen collect covid-19 |
11,733 |
10,416 |
$345K |
| J9395 |
Injection, fulvestrant |
938 |
777 |
$340K |
| 93970 |
|
2,424 |
2,276 |
$331K |
| J2469 |
Palonosetron hcl |
11,139 |
6,443 |
$330K |
| 70496 |
|
2,252 |
2,152 |
$329K |
| 74183 |
|
1,788 |
1,744 |
$329K |
| J0485 |
Belatacept injection |
982 |
346 |
$320K |
| 96361 |
|
12,125 |
6,586 |
$319K |
| 87497 |
|
8,538 |
5,276 |
$317K |
| 0121 |
|
100 |
98 |
$304K |
| 93971 |
|
3,589 |
3,295 |
$303K |
| 72197 |
|
1,268 |
1,234 |
$303K |
| 83735 |
|
66,193 |
39,326 |
$301K |
| 71045 |
|
25,025 |
22,375 |
$294K |
| 77334 |
|
2,020 |
1,550 |
$294K |
| Z7502 |
|
7,671 |
7,596 |
$292K |
| 96366 |
|
8,084 |
4,604 |
$286K |
| 0214 |
|
94 |
90 |
$284K |
| 87635 |
|
9,012 |
7,908 |
$277K |
| C8929 |
Tte w or wo fol wcon,doppler |
1,164 |
1,126 |
$274K |
| 84443 |
|
26,661 |
23,720 |
$268K |
| 59025 |
|
8,814 |
5,019 |
$267K |
| 67028 |
|
6,685 |
5,613 |
$267K |
| 77412 |
|
4,884 |
657 |
$253K |
| 87491 |
|
9,201 |
8,649 |
$248K |
| 83880 |
|
12,178 |
10,770 |
$248K |
| 87591 |
|
9,202 |
8,648 |
$247K |
| 88341 |
|
3,435 |
3,136 |
$239K |
| 77336 |
|
5,173 |
2,203 |
$237K |
| 80197 |
|
19,937 |
10,735 |
$233K |
| 74178 |
|
1,565 |
1,535 |
$226K |
| L0172 |
Cerv col sr foam 2pc pre ots |
2,010 |
1,919 |
$224K |
| 71250 |
|
3,472 |
3,388 |
$216K |
| 78452 |
|
1,087 |
1,018 |
$209K |
| 96416 |
|
3,267 |
1,678 |
$208K |
| 82306 |
|
11,360 |
10,840 |
$204K |
| 88305 |
|
11,117 |
10,112 |
$201K |
| 84484 |
|
27,486 |
21,539 |
$200K |
| 76604 |
|
6,033 |
5,634 |
$197K |
| 70551 |
|
1,904 |
1,815 |
$192K |
| 0270 |
|
87,569 |
60,476 |
$192K |
| 80048 |
|
34,283 |
29,391 |
$190K |
| Q5111 |
Injection, udenyca 0.5 mg |
152 |
80 |
$190K |
| 76830 |
|
3,390 |
3,195 |
$187K |
| 31237 |
|
859 |
734 |
$185K |
| 81001 |
|
79,528 |
64,562 |
$180K |
| 85027 |
|
36,527 |
27,092 |
$177K |
| 77338 |
|
912 |
799 |
$177K |
| 87631 |
|
3,774 |
3,249 |
$175K |
| 0352 |
|
594 |
448 |
$172K |
| 83036 |
|
25,934 |
24,882 |
$172K |
| 87799 |
|
6,347 |
4,779 |
$169K |
| 80061 |
|
18,143 |
17,479 |
$169K |
| 84100 |
|
52,474 |
31,857 |
$168K |
| 70486 |
|
1,862 |
1,780 |
$168K |
| J9305 |
Inj. pemetrexed nos 10mg |
189 |
64 |
$163K |
| 76815 |
|
3,835 |
2,879 |
$163K |
| 87389 |
|
9,206 |
8,794 |
$162K |
| 97110 |
|
26,762 |
8,524 |
$156K |
| 70491 |
|
1,328 |
1,283 |
$149K |
| 45385 |
|
1,047 |
998 |
$149K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
25,116 |
14,378 |
$143K |
| 99231 |
|
1,936 |
1,721 |
$140K |
| J9228 |
Ipilimumab injection |
30 |
14 |
$139K |
| 0300 |
|
13,448 |
2,707 |
$135K |
| 66984 |
|
1,131 |
908 |
$132K |
| 87086 |
|
25,046 |
21,189 |
$131K |
| 91010 |
|
388 |
384 |
$130K |
| 74174 |
|
612 |
592 |
$129K |
| 83690 |
|
28,271 |
24,911 |
$126K |
| 87536 |
|
2,136 |
1,945 |
$124K |
| 97597 |
|
2,692 |
1,747 |
$124K |
| Z9725 |
|
2,828 |
2,811 |
$121K |
| 86923 |
|
5,978 |
3,729 |
$121K |
| 83605 |
|
17,028 |
14,332 |
$120K |
| 85730 |
|
32,147 |
28,691 |
$117K |
| 83970 |
|
4,232 |
3,977 |
$115K |
| 76817 |
|
2,193 |
1,969 |
$114K |
| J2704 |
Inj, propofol, 10 mg |
31,940 |
19,644 |
$113K |
| C1769 |
Guide wire |
3,713 |
3,307 |
$113K |
| 93017 |
|
3,089 |
2,928 |
$111K |
| C1713 |
Anchor/screw bn/bn,tis/bn |
425 |
389 |
$108K |
| C8928 |
Tte w or w/o fol w/con,stres |
464 |
462 |
$105K |
| 0510 |
|
64,209 |
48,916 |
$104K |
| 85610 |
|
43,893 |
35,223 |
$101K |
| 95708 |
|
371 |
369 |
$100K |
| J7030 |
Normal saline solution infus |
33,072 |
21,399 |
$98K |
| 77300 |
|
926 |
777 |
$97K |
| J2785 |
Regadenoson injection |
1,301 |
1,219 |
$95K |
| 97750 |
|
3,345 |
1,767 |
$93K |
| 77290 |
|
719 |
635 |
$93K |
| 76770 |
|
2,369 |
2,259 |
$92K |
| C1760 |
Closure dev, vasc |
784 |
689 |
$91K |
| J9070 |
Cyclophosphamide 100 mg inj |
622 |
282 |
$91K |
| 93325 |
|
1,698 |
1,625 |
$90K |
| 52000 |
|
1,645 |
1,584 |
$89K |
| 72131 |
|
1,556 |
1,455 |
$87K |
| 73610 |
|
5,514 |
4,967 |
$87K |
| 70543 |
|
470 |
450 |
$87K |
| 0360 |
|
25,163 |
10,678 |
$86K |
| 88307 |
|
1,178 |
1,098 |
$86K |
| 73562 |
|
5,820 |
5,218 |
$84K |
| 52310 |
|
316 |
312 |
$83K |
| J2777 |
Inj, faricimab-svoa, 0.1mg |
87 |
65 |
$82K |
| 73130 |
|
4,998 |
4,438 |
$81K |
| 87624 |
|
2,480 |
2,423 |
$81K |
| 82378 |
|
7,531 |
5,365 |
$80K |
| J9267 |
Paclitaxel injection |
8,810 |
1,874 |
$80K |
| 73630 |
|
5,312 |
4,807 |
$79K |
| 0160 |
|
6,768 |
6,242 |
$79K |
| 86803 |
|
7,247 |
6,933 |
$79K |
| 59841 |
|
51 |
39 |
$78K |
| 77067 |
|
996 |
987 |
$78K |
| V2632 |
Post chmbr intraocular lens |
1,371 |
1,118 |
$78K |
| 86480 |
|
2,369 |
2,287 |
$78K |
| 72157 |
|
492 |
462 |
$77K |
| 86900 |
|
19,047 |
15,055 |
$76K |
| 88342 |
|
4,712 |
4,320 |
$76K |
| 88184 |
|
1,712 |
1,259 |
$75K |
| 77080 |
|
1,138 |
1,124 |
$75K |
| J2353 |
Octreotide injection, depot |
59 |
56 |
$75K |
| 36591 |
|
17,351 |
7,546 |
$75K |
| 82570 |
|
18,991 |
14,863 |
$74K |
| 73030 |
|
5,121 |
4,643 |
$74K |
| 86360 |
|
2,149 |
2,009 |
$73K |
| 87077 |
|
13,769 |
10,679 |
$73K |
| 83615 |
|
17,817 |
7,954 |
$73K |
| 92507 |
|
4,159 |
1,548 |
$71K |
| 72156 |
|
405 |
390 |
$70K |
| 20610 |
|
2,445 |
2,212 |
$70K |
| 77295 |
|
284 |
181 |
$69K |
| 31231 |
|
2,077 |
2,013 |
$69K |
| 0710 |
|
24,778 |
22,030 |
$68K |
| Q9957 |
Inj perflutren lip micros,ml |
2,575 |
2,360 |
$67K |
| 90715 |
|
2,649 |
2,454 |
$65K |
| C1887 |
Catheter, guiding |
1,610 |
1,441 |
$65K |
| 72158 |
|
523 |
511 |
$65K |
| 73110 |
|
4,152 |
3,615 |
$65K |
| 49083 |
|
1,089 |
514 |
$64K |
| C9803 |
Hopd covid-19 spec collect |
13,388 |
11,972 |
$64K |
| 84439 |
|
11,593 |
10,378 |
$63K |
| J7518 |
Mycophenolic acid |
1,144 |
986 |
$63K |
| J1100 |
Dexamethasone sodium phos |
33,194 |
22,141 |
$63K |
| J2997 |
Alteplase recombinant |
1,051 |
821 |
$63K |
| 86780 |
|
6,379 |
6,018 |
$63K |
| 31575 |
|
2,638 |
2,459 |
$63K |
| 82947 |
|
21,966 |
19,345 |
$62K |
| 95700 |
|
391 |
386 |
$62K |
| 84702 |
|
17,440 |
15,421 |
$61K |
| J9217 |
Leuprolide acetate suspnsion |
456 |
414 |
$59K |
| 86359 |
|
2,161 |
2,019 |
$59K |
| 36415 |
|
34,882 |
27,154 |
$59K |
| J1756 |
Iron sucrose injection |
5,102 |
906 |
$59K |
| 36561 |
|
138 |
125 |
$58K |
| 76981 |
|
1,010 |
991 |
$57K |
| J7040 |
Normal saline solution infus |
18,495 |
9,918 |
$57K |
| 72128 |
|
919 |
850 |
$56K |
| 97165 |
|
2,179 |
1,468 |
$56K |
| J1642 |
Inj heparin sodium per 10 u |
34,392 |
13,437 |
$55K |
| 76641 |
|
836 |
735 |
$55K |
| 76536 |
|
1,722 |
1,662 |
$55K |
| J7120 |
Ringers lactate infusion |
7,031 |
4,539 |
$54K |
| 96402 |
|
4,127 |
3,626 |
$54K |
| 73590 |
|
3,884 |
3,512 |
$53K |
| J9045 |
Carboplatin injection |
3,501 |
2,006 |
$52K |
| 96411 |
|
2,154 |
1,303 |
$52K |
| 73502 |
|
2,959 |
2,757 |
$52K |
| 96523 |
|
7,565 |
4,591 |
$51K |
| 72148 |
|
696 |
672 |
$51K |
| 73552 |
|
2,995 |
2,752 |
$50K |
| 84466 |
|
6,293 |
5,812 |
$50K |
| J0881 |
Darbepoetin alfa, non-esrd |
762 |
439 |
$50K |
| J7050 |
Normal saline solution infus |
23,098 |
10,433 |
$50K |
| Z7500 |
|
1,455 |
1,259 |
$49K |
| C1894 |
Intro/sheath, non-laser |
2,070 |
1,858 |
$48K |
| 97140 |
|
9,374 |
3,973 |
$48K |
| 82728 |
|
8,423 |
7,581 |
$48K |
| 86850 |
|
17,644 |
13,803 |
$47K |
| 0011A |
|
1,246 |
1,245 |
$47K |
| 99213 |
|
2,477 |
2,120 |
$47K |
| 72100 |
|
3,317 |
3,110 |
$46K |
| C1729 |
Cath, drainage |
3,655 |
2,910 |
$46K |
| 92504 |
|
5,351 |
5,092 |
$45K |
| 93880 |
|
563 |
539 |
$45K |
| 77066 |
Tomosynthesis, mammo |
568 |
563 |
$45K |
| A9502 |
Tc99m tetrofosmin |
1,133 |
1,030 |
$44K |
| 94060 |
|
956 |
946 |
$44K |
| 92134 |
|
11,419 |
10,721 |
$44K |
| 31579 |
|
728 |
716 |
$43K |
| 73080 |
|
2,673 |
2,464 |
$43K |
| 93798 |
|
1,867 |
290 |
$43K |
| 74018 |
|
2,384 |
2,119 |
$43K |
| P9035 |
Platelet pheres leukoreduced |
91 |
37 |
$42K |
| 93356 |
|
1,538 |
1,506 |
$42K |
| 0012A |
|
1,067 |
1,066 |
$41K |
| 96376 |
|
1,593 |
1,399 |
$41K |
| 86901 |
|
19,006 |
15,019 |
$41K |
| 87633 |
|
111 |
96 |
$41K |
| 50435 |
|
215 |
154 |
$41K |
| 94640 |
|
2,722 |
1,998 |
$40K |
| 87186 |
|
8,985 |
7,832 |
$39K |
| 0370 |
|
7,618 |
6,972 |
$39K |
| 0402 |
|
559 |
454 |
$38K |
| 87070 |
|
7,712 |
6,930 |
$38K |
| C1726 |
Cath, bal dil, non-vascular |
2,341 |
2,182 |
$38K |
| 43235 |
|
212 |
193 |
$37K |
| 88142 |
|
4,173 |
4,077 |
$37K |
| 86140 |
|
10,650 |
9,851 |
$37K |
| 93296 |
|
2,088 |
2,046 |
$36K |
| 84156 |
|
12,965 |
9,374 |
$34K |
| C1788 |
Port, indwelling, imp |
499 |
474 |
$33K |
| 97010 |
|
3,813 |
828 |
$33K |
| 87040 |
|
3,974 |
3,169 |
$33K |
| 82043 |
|
7,968 |
7,582 |
$33K |
| C2617 |
Stent, non-cor, tem w/o del |
1,045 |
949 |
$33K |
| 76377 |
|
1,808 |
1,703 |
$33K |
| J9190 |
Fluorouracil injection |
3,855 |
1,571 |
$32K |
| 87088 |
|
6,889 |
6,133 |
$32K |
| 36593 |
|
493 |
395 |
$32K |
| J2506 |
Inj pegfilgrast ex bio 0.5mg |
36 |
26 |
$32K |
| 38222 |
|
130 |
117 |
$32K |
| 77370 |
|
418 |
380 |
$31K |
| 87340 |
|
4,336 |
4,124 |
$31K |
| J0330 |
Succinycholine chloride inj |
5,548 |
5,001 |
$31K |
| 86160 |
|
1,904 |
1,669 |
$30K |
| 87081 |
|
8,463 |
7,750 |
$30K |
| 82803 |
|
3,312 |
2,944 |
$29K |
| 94729 |
|
1,482 |
1,453 |
$29K |
| 85379 |
|
4,235 |
3,850 |
$29K |
| 88313 |
|
932 |
854 |
$28K |
| 82610 |
|
2,451 |
2,140 |
$28K |
| J1453 |
Fosaprepitant injection |
601 |
204 |
$28K |
| 31622 |
|
158 |
149 |
$28K |
| 73090 |
|
2,113 |
1,943 |
$28K |
| 83540 |
|
6,752 |
6,253 |
$28K |
| J1644 |
Inj heparin sodium per 1000u |
8,265 |
4,781 |
$28K |
| 86301 |
|
2,420 |
1,702 |
$27K |
| 86255 |
|
2,666 |
2,454 |
$27K |
| 86235 |
|
661 |
603 |
$27K |
| 84550 |
|
8,957 |
3,922 |
$27K |
| 78306 |
|
258 |
239 |
$27K |
| 77065 |
Tomosynthesis, mammo |
431 |
405 |
$26K |
| Q5103 |
Injection, inflectra |
27 |
25 |
$26K |
| 0320 |
|
730 |
548 |
$26K |
| 67228 |
|
343 |
295 |
$26K |
| 76776 |
|
301 |
284 |
$26K |
| J2405 |
Ondansetron hcl injection |
32,041 |
24,405 |
$25K |
| 72170 |
|
2,368 |
2,253 |
$25K |
| 72141 |
|
313 |
305 |
$25K |
| 0351 |
|
163 |
152 |
$25K |
| J3010 |
Fentanyl citrate injection |
29,849 |
24,973 |
$25K |
| 97162 |
|
1,778 |
1,731 |
$25K |
| A9579 |
Gad-base mr contrast nos,1ml |
3,180 |
2,900 |
$25K |
| J9263 |
Oxaliplatin |
3,748 |
623 |
$24K |
| 86304 |
|
2,871 |
2,186 |
$24K |
| 92521 |
|
418 |
380 |
$24K |
| 82105 |
|
1,982 |
1,775 |
$24K |
| 73564 |
|
2,052 |
1,866 |
$24K |
| G0279 |
Tomosynthesis, mammo |
1,362 |
1,335 |
$24K |
| 87517 |
|
816 |
753 |
$24K |
| 84403 |
|
1,538 |
1,461 |
$24K |
| 76700 |
|
478 |
473 |
$24K |
| 90471 |
|
6,068 |
5,494 |
$23K |
| 93458 |
|
40 |
38 |
$23K |
| 93321 |
|
1,469 |
1,412 |
$23K |
| A9577 |
Inj multihance |
804 |
773 |
$23K |
| 62323 |
|
184 |
181 |
$23K |
| J3475 |
Inj magnesium sulfate |
8,507 |
3,942 |
$23K |
| 82784 |
|
3,575 |
2,226 |
$23K |
| 76376 |
|
1,488 |
1,472 |
$23K |
| J9201 |
In gemcitabine hcl nos 200mg |
1,439 |
558 |
$23K |
| 81025 |
|
8,267 |
7,699 |
$22K |
| J9264 |
Paclitaxel protein bound |
45 |
14 |
$22K |
| 84153 |
|
1,876 |
1,684 |
$22K |
| 97602 |
|
853 |
567 |
$22K |
| 73060 |
|
1,714 |
1,561 |
$21K |
| J0131 |
Inj, acetaminophen (nos) |
1,543 |
865 |
$21K |
| 85652 |
|
11,405 |
10,533 |
$21K |
| 76512 |
|
1,123 |
984 |
$21K |
| 86141 |
|
2,312 |
2,056 |
$21K |
| 76998 |
|
266 |
249 |
$21K |
| 86334 |
|
1,564 |
1,364 |
$20K |
| 87808 |
|
2,295 |
2,146 |
$20K |
| J2270 |
Morphine sulfate injection |
10,911 |
7,927 |
$20K |
| 92202 |
|
2,187 |
2,104 |
$20K |
| 77063 |
|
928 |
919 |
$20K |
| 85018 |
|
13,917 |
9,519 |
$19K |
| 69210 |
|
4,404 |
4,170 |
$19K |
| 83521 |
|
1,647 |
766 |
$19K |
| J0171 |
Adrenalin epinephrine inject |
2,642 |
2,148 |
$19K |
| 90677 |
|
329 |
315 |
$19K |
| 73560 |
|
1,699 |
1,581 |
$18K |
| 72040 |
|
1,269 |
1,204 |
$18K |
| Q9968 |
Visualization adjunct |
488 |
425 |
$18K |
| 90686 |
|
1,759 |
1,669 |
$18K |
| 82746 |
|
2,202 |
2,068 |
$18K |
| 87205 |
|
7,614 |
6,847 |
$18K |
| 0306 |
|
1,243 |
1,186 |
$18K |
| J0690 |
Cefazolin sodium injection |
9,520 |
7,799 |
$17K |
| 86704 |
|
2,042 |
1,940 |
$17K |
| 92083 |
|
3,245 |
3,158 |
$17K |
| 52356 |
|
30 |
28 |
$17K |
| 82330 |
|
2,510 |
2,267 |
$17K |
| J7507 |
Tacrolimus imme rel oral 1mg |
1,297 |
936 |
$17K |
| 87522 |
Neg quan hep c or qual rna |
534 |
507 |
$17K |
| 64615 |
|
735 |
707 |
$17K |
| J9206 |
Irinotecan injection |
802 |
334 |
$16K |
| 97799 |
|
3,157 |
513 |
$16K |
| 76870 |
|
489 |
471 |
$16K |
| 86706 |
|
2,205 |
2,108 |
$16K |
| L0130 |
Flex thermoplastic collar mo |
290 |
278 |
$16K |
| 93923 |
|
201 |
199 |
$16K |
| 78816 |
|
12 |
12 |
$16K |
| 0324 |
|
585 |
550 |
$16K |
| J7060 |
5% dextrose/water |
5,126 |
1,782 |
$16K |
| 76856 |
|
555 |
525 |
$15K |
| 51798 |
|
2,207 |
2,099 |
$15K |
| J9060 |
Cisplatin 10 mg injection |
2,162 |
824 |
$15K |
| G0008 |
Admin influenza virus vac |
2,630 |
2,593 |
$15K |
| 0002A |
|
400 |
400 |
$15K |
| P9047 |
Albumin (human), 25%, 50ml |
229 |
123 |
$15K |
| 94726 |
|
397 |
389 |
$15K |
| 82274 |
|
1,207 |
1,175 |
$15K |
| 73700 |
|
206 |
197 |
$15K |
| 0001A |
|
406 |
406 |
$15K |
| 51700 |
|
804 |
739 |
$15K |
| J0612 |
Inj, calcium gluconate, nos |
307 |
38 |
$14K |
| 80074 |
|
416 |
406 |
$14K |
| 10060 |
|
647 |
610 |
$14K |
| 82550 |
|
3,564 |
3,182 |
$14K |
| 77280 |
|
208 |
168 |
$14K |
| J2250 |
Inj midazolam hydrochloride |
22,238 |
20,088 |
$14K |
| 76937 |
|
1,185 |
1,037 |
$14K |
| 82010 |
|
2,455 |
2,160 |
$14K |
| G0108 |
Diab manage trn per indiv |
270 |
248 |
$14K |
| 76642 |
|
333 |
330 |
$14K |
| 92133 |
|
3,809 |
3,695 |
$14K |
| 76942 |
|
1,043 |
977 |
$14K |
| 93350 |
|
245 |
236 |
$14K |
| 0258 |
|
207 |
163 |
$13K |
| 96409 |
|
445 |
228 |
$13K |
| J1885 |
Ketorolac tromethamine inj |
17,166 |
14,412 |
$13K |
| 94762 |
|
1,279 |
1,188 |
$13K |
| 76000 |
|
757 |
644 |
$13K |
| 80076 |
|
2,846 |
2,609 |
$13K |
| 90632 |
|
235 |
215 |
$13K |
| 99291 |
|
50 |
49 |
$13K |
| 86762 |
|
1,069 |
1,003 |
$12K |
| 97139 |
|
2,911 |
545 |
$12K |
| 82607 |
|
4,546 |
4,281 |
$12K |
| 97161 |
|
862 |
812 |
$12K |
| J0696 |
Ceftriaxone sodium injection |
8,505 |
6,880 |
$12K |
| 88112 |
|
524 |
511 |
$12K |
| G2066 |
Inter devc remote 30d |
807 |
792 |
$12K |
| 43249 |
|
41 |
38 |
$12K |
| 86038 |
|
1,428 |
1,392 |
$12K |
| J3489 |
Zoledronic acid 1mg |
688 |
655 |
$11K |
| 96401 |
|
1,660 |
700 |
$11K |
| 99499 |
|
192 |
152 |
$11K |
| 90662 |
|
2,019 |
1,987 |
$11K |
| 84165 |
|
1,836 |
1,610 |
$11K |
| 97166 |
|
740 |
726 |
$11K |
| 84402 |
|
647 |
622 |
$11K |
| 92523 |
|
152 |
147 |
$11K |
| 84270 |
|
782 |
739 |
$11K |
| 87102 |
|
2,396 |
2,146 |
$11K |
| J3301 |
Triamcinolone acet inj nos |
4,842 |
4,395 |
$11K |
| J1650 |
Inj enoxaparin sodium |
2,421 |
1,444 |
$11K |
| 87184 |
|
2,678 |
2,384 |
$10K |
| 82533 |
|
964 |
785 |
$10K |
| 88173 |
|
486 |
444 |
$10K |
| 92136 |
|
1,279 |
1,257 |
$10K |
| J1170 |
Hydromorphone injection |
6,300 |
4,306 |
$10K |
| 20553 |
|
747 |
645 |
$10K |
| J0640 |
Leucovorin calcium injection |
1,288 |
620 |
$10K |
| 90732 |
|
363 |
351 |
$10K |
| 83516 |
|
1,178 |
831 |
$10K |
| J3370 |
Vancomycin hcl injection |
2,441 |
1,540 |
$10K |
| C9463 |
Injection, aprepitant |
129 |
47 |
$10K |
| 84478 |
|
3,313 |
2,367 |
$10K |
| 0762 |
|
2,094 |
2,020 |
$10K |
| 0350 |
|
300 |
175 |
$10K |
| J2001 |
Lidocaine injection |
7,017 |
6,157 |
$9K |
| 93925 |
|
102 |
102 |
$9K |
| J2710 |
Neostigmine methylslfte inj |
2,561 |
2,380 |
$9K |
| J2370 |
Phenylephrine hcl injection |
6,382 |
5,423 |
$9K |
| 74230 |
|
186 |
183 |
$9K |
| C9257 |
Bevacizumab injection |
1,398 |
1,240 |
$9K |
| 0301 |
|
449 |
392 |
$9K |
| 87206 |
|
2,836 |
2,328 |
$9K |
| 99282 |
|
121 |
121 |
$9K |
| 0420 |
|
229 |
137 |
$9K |
| 82140 |
|
992 |
898 |
$8K |
| J1200 |
Diphenhydramine hcl injectio |
13,057 |
8,950 |
$8K |
| C1751 |
Cath, inf, per/cent/midline |
402 |
360 |
$8K |
| 51702 |
|
920 |
791 |
$8K |
| 97530 |
|
1,777 |
1,029 |
$8K |
| 91122 |
|
27 |
26 |
$8K |
| M0247 |
Sotrovimab infusion |
13 |
13 |
$8K |
| C1762 |
Conn tiss, human(inc fascia) |
12 |
12 |
$8K |
| 93990 |
|
114 |
103 |
$8K |
| Q5101 |
Injection, zarxio |
467 |
54 |
$8K |
| 88312 |
|
471 |
443 |
$7K |
| 0730 |
|
147 |
141 |
$7K |
| 97802 |
|
83 |
83 |
$7K |
| 85384 |
|
1,262 |
841 |
$7K |
| 92250 |
|
1,211 |
1,160 |
$7K |
| 0761 |
|
1,080 |
751 |
$7K |
| J2930 |
Methylprednisolone injection |
3,088 |
2,044 |
$7K |
| 96368 |
|
600 |
397 |
$7K |
| 99153 |
Mod sedat endo service >5yrs |
323 |
297 |
$7K |
| 80180 |
|
750 |
648 |
$7K |
| 88360 |
|
339 |
325 |
$7K |
| U0002 |
Covid-19 lab test non-cdc |
301 |
281 |
$7K |
| 99152 |
|
860 |
807 |
$7K |
| 81003 |
|
4,153 |
3,420 |
$7K |
| 77001 |
|
182 |
166 |
$7K |
| 87075 |
|
1,555 |
1,399 |
$6K |
| 77470 |
|
168 |
143 |
$6K |
| 76380 |
|
74 |
41 |
$6K |
| 0430 |
|
144 |
81 |
$6K |
| 43242 |
|
27 |
24 |
$6K |
| 87880 |
|
1,133 |
1,065 |
$6K |
| 92226 |
|
833 |
587 |
$6K |
| 0480 |
|
128 |
122 |
$6K |
| 0949 |
|
845 |
517 |
$6K |
| 90670 |
|
125 |
121 |
$6K |
| J0134 |
Inj acetaminophen -fresenius |
1,616 |
864 |
$6K |
| 86920 |
|
232 |
107 |
$6K |
| J2795 |
Ropivacaine hcl injection |
2,693 |
1,345 |
$6K |
| 16020 |
|
707 |
480 |
$6K |
| C1725 |
Cath, translumin non-laser |
108 |
88 |
$5K |
| 45378 |
|
44 |
44 |
$5K |
| 94010 |
|
330 |
316 |
$5K |
| 11730 |
|
1,305 |
1,251 |
$5K |
| 82248 |
|
1,493 |
1,241 |
$5K |
| 72190 |
|
274 |
259 |
$5K |
| 88304 |
|
766 |
740 |
$5K |
| J2543 |
Piperacillin/tazobactam |
736 |
341 |
$5K |
| 87015 |
|
1,646 |
1,252 |
$5K |
| A9576 |
Inj prohance multipack |
732 |
702 |
$5K |
| 99281 |
|
780 |
540 |
$5K |
| 86200 |
|
684 |
679 |
$5K |
| 92020 |
|
1,507 |
1,459 |
$5K |
| 84145 |
|
330 |
273 |
$5K |
| 0459 |
|
873 |
810 |
$5K |
| 93041 |
|
1,648 |
1,579 |
$4K |
| Q0511 |
Sup fee antiem,antica,immuno |
1,033 |
1,013 |
$4K |
| 64415 |
|
350 |
337 |
$4K |
| 82150 |
|
1,227 |
868 |
$4K |
| 73140 |
|
290 |
261 |
$4K |
| 82670 |
|
188 |
184 |
$4K |
| 74170 |
|
37 |
37 |
$4K |
| J2765 |
Metoclopramide hcl injection |
4,065 |
3,471 |
$4K |
| J1815 |
Insulin injection |
6,193 |
3,234 |
$4K |
| 86431 |
|
925 |
908 |
$4K |
| 97116 |
|
1,298 |
963 |
$4K |
| J3480 |
Inj potassium chloride |
2,098 |
1,363 |
$4K |
| 88237 |
|
171 |
162 |
$4K |
| 88177 |
|
221 |
201 |
$4K |
| J0456 |
Azithromycin |
509 |
416 |
$4K |
| 87116 |
|
947 |
748 |
$4K |
| 92025 |
|
1,324 |
1,282 |
$4K |
| J2920 |
Methylprednisolone injection |
2,303 |
828 |
$4K |
| 86355 |
|
133 |
119 |
$4K |
| 36416 |
|
1,652 |
1,444 |
$4K |
| A9503 |
Tc99m medronate |
290 |
269 |
$4K |
| 96152 |
|
106 |
68 |
$4K |
| 88108 |
|
545 |
466 |
$4K |
| 86357 |
|
124 |
110 |
$4K |
| 78264 |
|
17 |
12 |
$4K |
| G0009 |
Admin pneumococcal vaccine |
630 |
615 |
$4K |
| 0064A |
|
119 |
119 |
$3K |
| 87581 |
|
112 |
98 |
$3K |
| 66821 |
|
178 |
154 |
$3K |
| 83883 |
|
563 |
245 |
$3K |
| 87486 |
|
110 |
96 |
$3K |
| 86800 |
|
305 |
299 |
$3K |
| J7042 |
5% dextrose/normal saline |
621 |
453 |
$3K |
| 84132 |
|
2,196 |
1,945 |
$3K |
| 76882 |
|
352 |
330 |
$3K |
| 86833 |
|
136 |
128 |
$3K |
| 86832 |
|
136 |
128 |
$3K |
| 76775 |
|
80 |
79 |
$3K |
| 71020 |
|
179 |
172 |
$3K |
| 87147 |
|
1,017 |
917 |
$3K |
| 62270 |
|
31 |
25 |
$3K |
| C1763 |
Conn tiss, non-human |
42 |
39 |
$3K |
| Q0512 |
Px sup fee anti-can sub pres |
1,338 |
1,046 |
$3K |
| 77002 |
|
462 |
435 |
$3K |
| J0780 |
Prochlorperazine injection |
1,060 |
914 |
$3K |
| 88300 |
|
841 |
788 |
$3K |
| 88172 |
|
325 |
297 |
$3K |
| 94761 |
|
208 |
199 |
$3K |
| 82977 |
|
559 |
538 |
$3K |
| 11732 |
|
994 |
961 |
$3K |
| 82565 |
|
1,545 |
1,430 |
$3K |
| 88309 |
|
38 |
37 |
$3K |
| U0005 |
Infec agen detec ampli probe |
1,354 |
1,289 |
$3K |
| Z7610 |
|
440 |
402 |
$3K |
| J1720 |
Hydrocortisone sodium succ i |
3,143 |
2,579 |
$3K |
| J7312 |
Dexamethasone intra implant |
16 |
13 |
$3K |
| 82950 |
|
664 |
649 |
$3K |
| 99234 |
|
3,715 |
2,976 |
$3K |
| 84295 |
|
1,736 |
1,540 |
$3K |
| 11056 |
|
1,155 |
1,099 |
$3K |
| 93922 |
|
70 |
66 |
$3K |
| 73200 |
|
27 |
26 |
$3K |
| 72110 |
|
164 |
161 |
$3K |
| 84146 |
|
262 |
247 |
$3K |
| 88264 |
|
103 |
96 |
$3K |
| A6197 |
Alginate drsg >16 <=48 sq in |
167 |
111 |
$2K |
| J0610 |
Calcium glucon (fresenius) |
402 |
149 |
$2K |
| 87801 |
|
62 |
52 |
$2K |
| 97112 |
|
367 |
203 |
$2K |
| 88321 |
|
110 |
110 |
$2K |
| 0004A |
|
73 |
73 |
$2K |
| 88720 |
|
457 |
370 |
$2K |
| 87176 |
|
810 |
736 |
$2K |
| J0295 |
Ampicillin sulbactam 1.5 gm |
992 |
608 |
$2K |
| 72082 |
|
94 |
94 |
$2K |
| 87798 |
|
98 |
88 |
$2K |
| 82365 |
|
317 |
300 |
$2K |
| J9000 |
Doxorubicin hcl injection |
301 |
128 |
$2K |
| 99214 |
|
44 |
40 |
$2K |
| 93280 |
|
306 |
297 |
$2K |
| 93297 |
|
123 |
123 |
$2K |
| 74022 |
|
132 |
123 |
$2K |
| 73000 |
|
151 |
133 |
$2K |
| 64450 |
|
71 |
66 |
$2K |
| 83520 |
|
281 |
247 |
$2K |
| J2060 |
Lorazepam injection |
3,322 |
2,375 |
$2K |
| 77077 |
|
144 |
135 |
$2K |
| 86147 |
|
67 |
48 |
$2K |
| 51741 |
|
303 |
290 |
$2K |
| Q9966 |
Locm 200-299mg/ml iodine,1ml |
1,376 |
1,242 |
$2K |
| 0390 |
|
443 |
163 |
$2K |
| 76857 |
|
123 |
122 |
$2K |
| 85097 |
|
66 |
64 |
$2K |
| 83001 |
|
165 |
146 |
$2K |
| C1781 |
Mesh (implantable) |
12 |
12 |
$2K |
| 84432 |
|
152 |
147 |
$2K |
| 51728 |
|
15 |
15 |
$2K |
| 82024 |
|
44 |
39 |
$2K |
| 84520 |
|
1,350 |
1,245 |
$2K |
| J9394 |
Inj, fulvestrant (fresenius) |
33 |
25 |
$2K |
| 95970 |
|
88 |
88 |
$2K |
| 86300 |
|
116 |
98 |
$2K |
| J9370 |
Vincristine sulfate 1 mg inj |
316 |
178 |
$2K |
| J7121 |
5% dextrose in lac ringers |
478 |
339 |
$2K |
| 92060 |
|
260 |
246 |
$2K |
| 86256 |
|
180 |
167 |
$2K |
| 90935 |
|
17 |
13 |
$2K |
| J9171 |
Docetaxel injection |
154 |
75 |
$2K |
| J0360 |
Hydralazine hcl injection |
1,162 |
901 |
$2K |
| 36573 |
|
15 |
12 |
$2K |
| 86769 |
|
132 |
83 |
$2K |
| 82435 |
|
1,324 |
1,220 |
$2K |
| J7512 |
Prednisone ir or dr oral 1mg |
854 |
613 |
$2K |
| 96150 |
|
55 |
52 |
$2K |
| 80164 |
|
217 |
181 |
$2K |
| 12002 |
|
173 |
170 |
$2K |
| 84300 |
|
599 |
535 |
$2K |
| J7070 |
D5w infusion |
324 |
222 |
$2K |
| 80158 |
|
117 |
37 |
$2K |
| 88311 |
|
483 |
450 |
$2K |
| 74246 |
|
24 |
24 |
$2K |
| 95957 |
|
18 |
18 |
$2K |
| 87106 |
|
280 |
239 |
$2K |
| 85045 |
|
671 |
543 |
$2K |
| 86870 |
|
14 |
13 |
$1K |
| Q0162 |
Ondansetron oral |
8,613 |
7,602 |
$1K |
| 86376 |
|
129 |
127 |
$1K |
| 72070 |
|
139 |
139 |
$1K |
| G0257 |
Unsched dialysis esrd pt hos |
33 |
26 |
$1K |
| 88262 |
|
43 |
42 |
$1K |
| 89051 |
|
1,794 |
1,430 |
$1K |
| 43762 |
|
38 |
37 |
$1K |
| 90750 |
|
69 |
60 |
$1K |
| 85576 |
|
197 |
101 |
$1K |
| J3420 |
Vitamin b12 injection |
1,796 |
1,526 |
$1K |
| S0077 |
Injection, clindamycin phosp |
321 |
251 |
$1K |
| 0071A |
|
34 |
34 |
$1K |
| 86592 |
|
396 |
374 |
$1K |
| J1940 |
Furosemide injection |
1,302 |
997 |
$1K |
| 97003 |
|
157 |
90 |
$1K |
| 12001 |
|
146 |
144 |
$1K |
| 99497 |
|
61 |
61 |
$1K |
| 11900 |
|
123 |
118 |
$1K |
| 86039 |
|
147 |
144 |
$1K |
| A4649 |
Surgical supplies |
29 |
27 |
$1K |
| 11102 |
|
90 |
89 |
$1K |
| 11100 |
|
26 |
25 |
$1K |
| 88333 |
|
67 |
64 |
$1K |
| 92611 |
|
39 |
39 |
$1K |
| 77012 |
|
30 |
28 |
$1K |
| 10005 |
|
14 |
12 |
$1K |
| 70487 |
|
12 |
12 |
$1K |
| G0103 |
Psa screening |
384 |
355 |
$1K |
| 0072A |
|
28 |
28 |
$1K |
| 96377 |
|
206 |
154 |
$1K |
| J1030 |
Methylprednisolone 40 mg inj |
1,446 |
1,285 |
$1K |
| 87493 |
|
54 |
51 |
$1K |
| 97535 |
|
527 |
472 |
$1K |
| 86593 |
|
287 |
274 |
$1K |
| 87533 |
|
27 |
13 |
$1K |
| J1580 |
Garamycin gentamicin inj |
555 |
429 |
$1K |
| 84703 |
|
317 |
294 |
$983.05 |
| 99070 |
|
336 |
192 |
$968.58 |
| 36590 |
|
12 |
12 |
$967.05 |
| J0689 |
Inj cefazolin sodium, baxter |
122 |
95 |
$951.08 |
| 86644 |
|
78 |
54 |
$922.97 |
| 80177 |
|
238 |
195 |
$914.05 |
| C1773 |
Ret dev, insertable |
98 |
98 |
$893.68 |
| J3535 |
Metered dose inhaler drug |
285 |
227 |
$849.49 |
| 92612 |
|
12 |
12 |
$803.67 |
| 84157 |
|
493 |
384 |
$802.01 |
| 88334 |
|
49 |
48 |
$776.58 |
| J2371 |
Inj phenylephrine hcl 20 mcg |
564 |
410 |
$745.11 |
| J0461 |
Atropine sulfate injection |
303 |
197 |
$707.59 |
| 0346T |
|
26 |
25 |
$707.41 |
| 86146 |
|
52 |
25 |
$706.03 |
| 95816 |
|
24 |
24 |
$702.92 |
| L0140 |
Cervical semi-rigid adjustab |
13 |
12 |
$699.85 |
| J1250 |
Inj dobutamine hcl/250 mg |
227 |
219 |
$689.92 |
| 51784 |
|
27 |
27 |
$677.99 |
| A9541 |
Tc99m sulfur colloid |
24 |
24 |
$673.23 |
| 94727 |
|
64 |
61 |
$672.77 |
| 83002 |
|
66 |
62 |
$664.71 |
| J1630 |
Haloperidol injection |
1,075 |
887 |
$661.90 |
| 88331 |
|
37 |
37 |
$659.44 |
| J0744 |
Ciprofloxacin iv |
270 |
235 |
$652.14 |
| 51797 |
|
27 |
27 |
$632.43 |
| 93246 |
|
298 |
295 |
$631.63 |
| 99201 |
|
12 |
12 |
$620.34 |
| 94799 |
|
167 |
153 |
$620.00 |
| 90656 |
|
40 |
40 |
$609.44 |
| 71010 |
|
57 |
56 |
$595.60 |
| J2175 |
Meperidine hydrochl /100 mg |
721 |
667 |
$588.32 |
| 86787 |
|
46 |
28 |
$587.76 |
| A6258 |
Transparent film >16<=48 in |
873 |
806 |
$585.87 |
| 12011 |
|
41 |
40 |
$585.27 |
| S0164 |
Injection pantroprazole |
174 |
117 |
$547.24 |
| 82945 |
|
298 |
234 |
$536.44 |
| A4216 |
Sterile water/saline, 10 ml |
5,280 |
3,689 |
$531.70 |
| J2919 |
Inj, methylpred sod succ 5mg |
455 |
294 |
$502.87 |
| 96549 |
|
214 |
131 |
$492.05 |
| 86922 |
|
16 |
13 |
$483.65 |
| 29125 |
|
80 |
75 |
$481.43 |
| 83935 |
|
160 |
149 |
$474.63 |
| J1610 |
Glucagon hydrochloride/1 mg |
13 |
13 |
$456.29 |
| 92610 |
|
30 |
28 |
$435.68 |
| 31624 |
|
13 |
12 |
$435.30 |
| 77387 |
|
227 |
50 |
$432.76 |
| J7620 |
Albuterol ipratrop non-comp |
1,168 |
879 |
$427.26 |
| 84681 |
|
31 |
30 |
$425.32 |
| 76001 |
|
28 |
24 |
$421.50 |
| J0688 |
Inj cefazolin sodium, hikma |
161 |
153 |
$416.40 |
| S0119 |
Ondansetron 4 mg |
1,555 |
572 |
$413.13 |
| 92225 |
|
29 |
26 |
$374.73 |
| 99221 |
|
14 |
12 |
$371.36 |
| J2550 |
Promethazine hcl injection |
563 |
492 |
$370.97 |
| 90472 |
|
282 |
260 |
$367.03 |
| 93270 |
|
12 |
12 |
$364.00 |
| 85613 |
|
52 |
49 |
$351.66 |
| J8540 |
Oral dexamethasone |
1,157 |
602 |
$342.76 |
| 73522 |
|
26 |
25 |
$339.08 |
| 92522 |
|
28 |
24 |
$324.19 |
| 11721 |
|
909 |
885 |
$316.73 |
| 17110 |
|
119 |
115 |
$315.35 |
| C1758 |
Catheter, ureteral |
65 |
49 |
$309.81 |
| 93978 |
|
13 |
12 |
$293.01 |
| 36589 |
|
12 |
12 |
$288.54 |
| 77332 |
|
17 |
14 |
$280.70 |
| 95983 |
|
15 |
14 |
$261.66 |
| J3371 |
Inj, vancomycin hcl (mylan) |
164 |
127 |
$251.98 |
| 84480 |
|
26 |
24 |
$242.94 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
34 |
19 |
$241.87 |
| 86430 |
|
73 |
72 |
$232.57 |
| 95836 |
|
27 |
26 |
$231.14 |
| 81015 |
|
178 |
165 |
$226.84 |
| 86317 |
|
41 |
37 |
$226.49 |
| 83930 |
|
57 |
53 |
$218.69 |
| 87400 |
|
94 |
93 |
$216.51 |
| 84425 |
|
40 |
39 |
$206.22 |
| 84155 |
|
137 |
132 |
$205.30 |
| 97163 |
|
25 |
24 |
$180.06 |
| 92201 |
|
13 |
12 |
$180.04 |
| 82787 |
|
27 |
13 |
$176.67 |
| 86753 |
|
16 |
12 |
$174.28 |
| 71101 |
|
12 |
12 |
$173.70 |
| 83655 |
|
30 |
30 |
$166.60 |
| 84481 |
|
14 |
14 |
$163.42 |
| 82247 |
|
33 |
24 |
$156.39 |
| 96127 |
|
12 |
12 |
$154.86 |
| 83010 |
|
15 |
12 |
$140.95 |
| Q9963 |
Hocm 350-399mg/ml iodine,1ml |
35 |
25 |
$132.51 |
| 85014 |
|
111 |
101 |
$132.43 |
| 85347 |
|
61 |
38 |
$125.51 |
| 86308 |
|
28 |
28 |
$118.12 |
| G0127 |
Trim nail(s) |
13 |
13 |
$114.66 |
| 96110 |
|
13 |
13 |
$110.25 |
| J2003 |
Inj, lidocaine hcl, 1 mg |
52 |
39 |
$105.20 |
| 87045 |
|
13 |
12 |
$103.40 |
| 76514 |
|
110 |
110 |
$103.26 |
| 83550 |
|
28 |
27 |
$102.07 |
| L4386 |
Non-pneum walk boot pre cst |
13 |
13 |
$99.66 |
| 20550 |
|
14 |
12 |
$96.52 |
| J1596 |
Inj, glycopyrrolate, 0.1 mg |
51 |
49 |
$95.96 |
| S0028 |
Injection, famotidine, 20 mg |
5,239 |
3,061 |
$94.68 |
| 82962 |
|
129 |
104 |
$94.38 |
| A6257 |
Transparent film <= 16 sq in |
1,107 |
939 |
$88.76 |
| 99212 |
|
12 |
12 |
$82.66 |
| 99001 |
|
247 |
225 |
$80.00 |
| 83006 |
|
14 |
13 |
$78.51 |
| 82042 |
|
59 |
39 |
$76.24 |
| J0692 |
Cefepime hcl for injection |
18 |
12 |
$70.67 |
| J2590 |
Oxytocin injection |
12 |
12 |
$67.86 |
| 86580 |
|
43 |
41 |
$67.82 |
| 84460 |
|
13 |
12 |
$64.74 |
| 81479 |
|
29 |
27 |
$62.87 |
| 51736 |
|
15 |
15 |
$62.58 |
| J1950 |
Leuprolide acetate /3.75 mg |
12 |
12 |
$61.52 |
| 87046 |
|
26 |
12 |
$60.91 |
| 82595 |
|
14 |
13 |
$60.29 |
| 84540 |
|
27 |
25 |
$48.61 |
| J1953 |
Levetiracetam injection |
23 |
12 |
$48.23 |
| J7613 |
Albuterol non-comp unit |
304 |
274 |
$47.80 |
| J1920 |
Inj, labetalol hcl, 5mg |
17 |
15 |
$42.50 |
| 51701 |
|
13 |
13 |
$42.00 |
| L3908 |
Who cock-up nonmolde pre ots |
12 |
12 |
$40.74 |
| 69209 |
|
17 |
16 |
$37.61 |
| 0272 |
|
891 |
545 |
$37.59 |
| A6457 |
Tubular dressing |
14 |
13 |
$35.86 |
| A6213 |
Foam drg >16<=48 sq in w/bdr |
12 |
12 |
$33.96 |
| J1643 |
Inj heparin, pfizer, 1000u |
46 |
46 |
$32.68 |
| J8499 |
Oral prescrip drug non chemo |
399 |
158 |
$25.84 |
| 82465 |
|
14 |
13 |
$25.52 |
| S5010 |
5% dextrose and 0.45% saline |
426 |
314 |
$24.50 |
| J2470 |
Inj pantoprazole sodium 40mg |
17 |
14 |
$24.21 |
| 81050 |
|
14 |
13 |
$23.64 |
| 83986 |
|
15 |
13 |
$19.57 |
| A4217 |
Sterile water/saline, 500 ml |
28 |
27 |
$15.98 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
32 |
29 |
$15.88 |
| J2004 |
Inj, lidocaine w epinephrine |
23 |
16 |
$10.88 |
| A9150 |
Misc/exper non-prescript dru |
174 |
126 |
$9.94 |
| 72050 |
|
14 |
14 |
$9.29 |
| A6222 |
Gauze <=16 in no w/sal w/o b |
146 |
124 |
$7.88 |
| 11000 |
|
15 |
13 |
$6.00 |
| A9270 |
Non-covered item or service |
829 |
453 |
$4.42 |
| 20611 |
|
12 |
12 |
$3.38 |
| J2730 |
Pralidoxime chloride inj |
12 |
12 |
$2.88 |
| G8979 |
Mobility goal status |
628 |
580 |
$1.59 |
| G8978 |
Mobility current status |
571 |
530 |
$1.55 |
| G8988 |
Self care goal status |
139 |
122 |
$0.69 |
| G8987 |
Self care current status |
134 |
117 |
$0.68 |
| Q0164 |
Prochlorperazine maleate 5mg |
67 |
59 |
$0.59 |
| G8996 |
Swallow current status |
135 |
116 |
$0.24 |
| G8997 |
Swallow goal status |
144 |
123 |
$0.24 |
| G8980 |
Mobility d/c status |
227 |
209 |
$0.08 |
| G8989 |
Self care d/c status |
16 |
13 |
$0.05 |
| 0519 |
|
221 |
179 |
$0.00 |
| 0611 |
|
89 |
87 |
$0.00 |
| 0305 |
|
103 |
87 |
$0.00 |
| 90480 |
|
13 |
13 |
$0.00 |
| 0440 |
|
22 |
15 |
$0.00 |
| 0610 |
|
51 |
43 |
$0.00 |
| 0335 |
|
687 |
228 |
$0.00 |
| 0310 |
|
406 |
164 |
$0.00 |
| 0341 |
|
21 |
20 |
$0.00 |
| G8998 |
Swallow d/c status |
49 |
38 |
$0.00 |
| 0780 |
|
1,576 |
1,418 |
$0.00 |
| 3044F |
|
51 |
51 |
$0.00 |
| 0636 |
|
4,468 |
1,474 |
$0.00 |
| 0482 |
|
17 |
17 |
$0.00 |
| 0409 |
|
14 |
13 |
$0.00 |
| 0612 |
Calcium glucon (wg critical) |
23 |
13 |
$0.00 |
| 0280 |
|
66 |
47 |
$0.00 |
| S0030 |
Injection, metronidazole |
162 |
94 |
$0.00 |
| 0349 |
|
37 |
32 |
$0.00 |
| 0276 |
|
17 |
14 |
$0.00 |
| 0481 |
|
37 |
13 |
$0.00 |
| 99072 |
|
282 |
149 |
$0.00 |
| G8985 |
Carry goal status |
91 |
87 |
$0.00 |
| 0489 |
|
95 |
62 |
$0.00 |
| 0260 |
|
560 |
237 |
$0.00 |
| 0278 |
|
140 |
104 |
$0.00 |
| 0483 |
|
62 |
50 |
$0.00 |
| 0311 |
|
41 |
40 |
$0.00 |
| 0361 |
|
49 |
28 |
$0.00 |
| 0920 |
|
406 |
251 |
$0.00 |
| 0921 |
|
22 |
18 |
$0.00 |
| 0750 |
|
107 |
76 |
$0.00 |
| 0333 |
|
209 |
23 |
$0.00 |
| G8984 |
Carry current status |
73 |
70 |
$0.00 |
| 0343 |
|
27 |
27 |
$0.00 |
| 0940 |
|
94 |
61 |
$0.00 |
| 0460 |
|
60 |
36 |
$0.00 |
| 0274 |
|
21 |
19 |
$0.00 |
| 0623 |
|
37 |
25 |
$0.00 |
| 91322 |
|
13 |
13 |
$0.00 |