| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| G0463 |
Hospital outpt clinic visit |
135,194 |
81,782 |
$17.05M |
| J9271 |
Inj pembrolizumab |
2,872 |
2,184 |
$15.52M |
| 96413 |
|
35,131 |
19,481 |
$6.48M |
| J9299 |
Injection, nivolumab |
1,170 |
813 |
$4.76M |
| 96416 |
|
6,262 |
3,703 |
$3.70M |
| J9306 |
Injection, pertuzumab, 1 mg |
971 |
736 |
$3.68M |
| 96415 |
|
7,072 |
2,745 |
$3.47M |
| J9358 |
Inj fam-trastu deru-nxki 1mg |
863 |
361 |
$3.32M |
| Q5117 |
Inj., kanjinti, 10 mg |
1,913 |
1,381 |
$2.95M |
| J2506 |
Inj pegfilgrast ex bio 0.5mg |
2,356 |
1,753 |
$2.84M |
| 77412 |
|
8,280 |
1,138 |
$2.60M |
| J2505 |
Injection, pegfilgrastim 6mg |
1,975 |
1,407 |
$2.48M |
| 77336 |
|
5,475 |
2,971 |
$2.37M |
| Q5111 |
Injection, udenyca 0.5 mg |
1,777 |
1,419 |
$2.31M |
| 80053 |
|
89,996 |
59,780 |
$2.29M |
| 77386 |
|
10,969 |
1,194 |
$2.18M |
| J9348 |
Inj. naxitamab-gqgk, 1 mg |
72 |
26 |
$1.91M |
| 96361 |
|
9,194 |
4,364 |
$1.81M |
| Q5107 |
Inj mvasi 10 mg |
2,002 |
1,327 |
$1.69M |
| 71260 |
|
13,655 |
13,083 |
$1.68M |
| 36430 |
|
3,497 |
1,624 |
$1.58M |
| 78815 |
|
4,361 |
4,201 |
$1.49M |
| 70553 |
|
5,140 |
4,910 |
$1.44M |
| J9264 |
Paclitaxel protein bound |
864 |
462 |
$1.28M |
| 96365 |
|
8,027 |
4,815 |
$1.22M |
| 77373 |
|
1,664 |
485 |
$1.17M |
| 96367 |
|
9,899 |
5,007 |
$1.15M |
| 77387 |
|
3,118 |
548 |
$1.07M |
| 96360 |
|
4,784 |
2,953 |
$1.04M |
| P9040 |
Rbc leukoreduced irradiated |
2,287 |
1,560 |
$1.02M |
| 78816 |
|
1,614 |
1,540 |
$995K |
| 93306 |
|
3,923 |
3,785 |
$978K |
| 77300 |
|
2,407 |
2,193 |
$974K |
| J9217 |
Leuprolide acetate suspnsion |
2,515 |
2,345 |
$933K |
| J0897 |
Denosumab injection |
1,458 |
1,350 |
$908K |
| J9144 |
Daratumumab, hyaluronidase |
325 |
195 |
$877K |
| P9073 |
Platelets pheresis path redu |
1,245 |
508 |
$820K |
| 77334 |
|
2,736 |
2,188 |
$814K |
| 38222 |
|
1,521 |
1,376 |
$789K |
| 97110 |
|
9,050 |
3,312 |
$740K |
| J0185 |
Inj., aprepitant, 1 mg |
7,603 |
5,126 |
$719K |
| 36591 |
|
26,376 |
14,978 |
$716K |
| J2796 |
Romiplostim injection |
794 |
354 |
$650K |
| 96366 |
|
3,714 |
1,676 |
$641K |
| J9263 |
Oxaliplatin |
2,475 |
1,505 |
$639K |
| J2469 |
Palonosetron hcl |
13,629 |
7,741 |
$553K |
| 36415 |
|
77,743 |
54,312 |
$550K |
| 36561 |
|
416 |
400 |
$534K |
| J9305 |
Inj. pemetrexed nos 10mg |
350 |
277 |
$516K |
| 74177 |
|
11,274 |
10,725 |
$511K |
| 77385 |
|
2,513 |
254 |
$477K |
| 86901 |
|
11,772 |
6,503 |
$475K |
| J9316 |
Pertuzu, trastuzu, 10 mg |
179 |
133 |
$440K |
| Q5115 |
Inj truxima 10 mg |
167 |
109 |
$439K |
| 80048 |
|
18,436 |
10,528 |
$435K |
| 96375 |
|
52,965 |
16,349 |
$432K |
| 86850 |
|
12,832 |
7,077 |
$426K |
| 88185 |
|
3,981 |
3,323 |
$415K |
| J9206 |
Irinotecan injection |
3,970 |
1,626 |
$406K |
| 77290 |
|
976 |
888 |
$378K |
| 72197 |
|
1,844 |
1,761 |
$377K |
| J9395 |
Injection, fulvestrant |
442 |
376 |
$365K |
| 72156 |
|
1,737 |
1,679 |
$343K |
| 87635 |
|
8,366 |
6,974 |
$326K |
| 19301 |
|
169 |
166 |
$325K |
| 85025 |
|
66,125 |
42,746 |
$307K |
| 97140 |
|
6,439 |
2,474 |
$302K |
| G0383 |
Lev 4 hosp type b ed visit |
2,003 |
1,817 |
$293K |
| 71250 |
|
3,083 |
2,946 |
$280K |
| 96411 |
|
9,611 |
5,049 |
$276K |
| 81455 |
|
855 |
754 |
$274K |
| 77301 |
|
1,242 |
1,142 |
$259K |
| 74183 |
|
1,823 |
1,721 |
$256K |
| 96409 |
|
5,019 |
3,098 |
$250K |
| J9070 |
Cyclophosphamide 100 mg inj |
1,601 |
916 |
$248K |
| 77338 |
|
1,245 |
1,156 |
$247K |
| 96417 |
|
10,222 |
5,407 |
$243K |
| 96402 |
|
4,702 |
3,611 |
$235K |
| J2353 |
Octreotide injection, depot |
98 |
86 |
$228K |
| 70543 |
|
854 |
822 |
$220K |
| 86900 |
|
11,775 |
6,512 |
$219K |
| 52000 |
|
176 |
174 |
$215K |
| 88305 |
|
5,924 |
5,409 |
$208K |
| 96372 |
|
13,361 |
8,124 |
$206K |
| 77280 |
|
422 |
383 |
$205K |
| J9045 |
Carboplatin injection |
2,708 |
1,888 |
$201K |
| 76536 |
|
2,084 |
2,042 |
$192K |
| 87497 |
|
4,536 |
2,114 |
$192K |
| 77001 |
|
666 |
632 |
$192K |
| 85097 |
|
1,922 |
1,748 |
$191K |
| 43239 |
|
411 |
391 |
$186K |
| Q2050 |
Doxorubicin inj 10mg |
299 |
252 |
$183K |
| J9173 |
Inj., durvalumab, 10 mg |
25 |
24 |
$179K |
| P9037 |
Plate pheres leukoredu irrad |
352 |
121 |
$178K |
| 72158 |
|
1,692 |
1,628 |
$175K |
| 45330 |
|
240 |
237 |
$171K |
| 72157 |
|
1,604 |
1,539 |
$164K |
| 88184 |
|
3,280 |
2,713 |
$164K |
| 70491 |
|
1,253 |
1,215 |
$164K |
| 88307 |
|
2,151 |
2,043 |
$162K |
| J0640 |
Leucovorin calcium injection |
4,909 |
2,798 |
$162K |
| 93005 |
|
8,427 |
7,408 |
$157K |
| 88360 |
|
2,456 |
2,308 |
$156K |
| 97535 |
|
2,589 |
1,406 |
$151K |
| 87799 |
|
4,408 |
2,045 |
$140K |
| G0382 |
Lev 3 hosp type b ed visit |
916 |
850 |
$139K |
| 99211 |
|
10,570 |
6,346 |
$139K |
| 93970 |
|
297 |
277 |
$139K |
| J9355 |
Inj trastuzumab excl biosimi |
287 |
172 |
$137K |
| 76937 |
|
732 |
696 |
$137K |
| J9201 |
In gemcitabine hcl nos 200mg |
2,914 |
1,418 |
$135K |
| J1561 |
Gamunex-c/gammaked |
135 |
119 |
$134K |
| U0002 |
Covid-19 lab test non-cdc |
4,675 |
3,364 |
$134K |
| 77332 |
|
265 |
262 |
$129K |
| 77049 |
|
553 |
551 |
$127K |
| Q5101 |
Injection, zarxio |
1,003 |
552 |
$126K |
| 80076 |
|
9,665 |
5,823 |
$125K |
| 36592 |
|
5,252 |
1,604 |
$124K |
| 19281 |
|
86 |
86 |
$122K |
| 97530 |
|
2,078 |
652 |
$121K |
| 77065 |
Tomosynthesis, mammo |
1,603 |
1,415 |
$117K |
| 82306 |
|
5,632 |
5,433 |
$112K |
| 77295 |
|
576 |
537 |
$110K |
| 77067 |
|
3,274 |
3,225 |
$104K |
| J1569 |
Gammagard liquid injection |
58 |
39 |
$100K |
| G0384 |
Lev 5 hosp type b ed visit |
617 |
582 |
$95K |
| 78802 |
|
238 |
231 |
$95K |
| 88342 |
|
2,749 |
2,557 |
$94K |
| 92250 |
|
1,884 |
1,801 |
$94K |
| 96401 |
|
2,391 |
1,242 |
$94K |
| J9203 |
Gemtuzumab ozogamicin 0.1 mg |
315 |
201 |
$94K |
| 88341 |
|
2,051 |
1,882 |
$92K |
| 45380 |
|
124 |
121 |
$87K |
| 72195 |
|
349 |
338 |
$87K |
| 38220 |
|
131 |
125 |
$82K |
| J9000 |
Doxorubicin hcl injection |
2,165 |
1,168 |
$82K |
| 19083 |
|
59 |
57 |
$82K |
| 78195 |
|
186 |
185 |
$82K |
| 86923 |
|
2,371 |
1,706 |
$81K |
| 85027 |
|
13,285 |
7,658 |
$80K |
| 92134 |
|
1,032 |
982 |
$78K |
| 36590 |
|
85 |
83 |
$77K |
| 84439 |
|
7,393 |
6,738 |
$76K |
| A9552 |
F18 fdg |
4,150 |
3,952 |
$74K |
| 38525 |
|
109 |
108 |
$72K |
| 88237 |
|
854 |
767 |
$71K |
| 96368 |
|
3,723 |
2,019 |
$71K |
| 96377 |
|
2,974 |
2,224 |
$71K |
| 77080 |
|
1,219 |
1,190 |
$70K |
| C2638 |
Brachytx, stranded, i-125 |
84 |
84 |
$70K |
| 70450 |
|
293 |
280 |
$68K |
| OP370 |
|
496 |
430 |
$65K |
| 76641 |
|
1,508 |
1,468 |
$65K |
| 87517 |
|
1,687 |
1,592 |
$64K |
| 97112 |
|
1,337 |
697 |
$64K |
| 77063 |
|
2,296 |
2,266 |
$64K |
| J9267 |
Paclitaxel injection |
3,702 |
1,781 |
$62K |
| 76942 |
|
366 |
351 |
$61K |
| 74176 |
|
453 |
435 |
$60K |
| 83615 |
|
21,855 |
14,869 |
$59K |
| 83735 |
|
23,369 |
13,298 |
$58K |
| 84443 |
|
9,900 |
8,888 |
$57K |
| J9035 |
Bevacizumab injection |
206 |
125 |
$57K |
| 81445 |
|
867 |
725 |
$52K |
| J9171 |
Docetaxel injection |
382 |
268 |
$48K |
| 71046 |
|
2,757 |
2,555 |
$47K |
| J1200 |
Diphenhydramine hcl injectio |
4,941 |
2,993 |
$47K |
| J9190 |
Fluorouracil injection |
8,602 |
3,205 |
$47K |
| 96450 |
|
62 |
52 |
$46K |
| 76642 |
|
1,284 |
1,256 |
$43K |
| 97161 |
|
402 |
394 |
$42K |
| J1610 |
Glucagon hydrochloride/1 mg |
606 |
586 |
$41K |
| 87633 |
|
511 |
424 |
$38K |
| 84153 |
|
2,591 |
2,386 |
$38K |
| 82378 |
|
6,478 |
5,623 |
$38K |
| 97116 |
|
964 |
466 |
$38K |
| Q5108 |
Injection, fulphila |
41 |
33 |
$38K |
| 80061 |
|
2,561 |
2,413 |
$37K |
| C1788 |
Port, indwelling, imp |
330 |
321 |
$37K |
| 88112 |
|
796 |
754 |
$37K |
| 77790 |
|
136 |
134 |
$36K |
| J2820 |
Sargramostim injection |
380 |
104 |
$36K |
| J9370 |
Vincristine sulfate 1 mg inj |
1,307 |
826 |
$36K |
| 77066 |
Tomosynthesis, mammo |
600 |
582 |
$36K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
11,887 |
10,983 |
$36K |
| 38900 |
|
85 |
83 |
$36K |
| 71275 |
|
159 |
156 |
$35K |
| 84432 |
|
1,647 |
1,571 |
$35K |
| 82784 |
|
4,215 |
3,654 |
$34K |
| 87507 |
|
407 |
381 |
$34K |
| 85610 |
|
12,232 |
9,874 |
$34K |
| 84100 |
|
16,363 |
9,704 |
$34K |
| 86353 |
|
938 |
765 |
$34K |
| 96374 |
|
4,031 |
2,863 |
$33K |
| 74178 |
|
597 |
579 |
$32K |
| 84403 |
|
1,860 |
1,772 |
$32K |
| 76770 |
|
103 |
96 |
$32K |
| 97162 |
|
204 |
203 |
$30K |
| 90686 |
|
1,420 |
1,395 |
$29K |
| 81450 |
|
391 |
357 |
$27K |
| 94010 |
|
348 |
329 |
$26K |
| A9582 |
Iodine i-123 iobenguane |
141 |
139 |
$26K |
| J2997 |
Alteplase recombinant |
170 |
153 |
$26K |
| 88262 |
|
318 |
293 |
$25K |
| 85730 |
|
5,203 |
4,389 |
$25K |
| 88271 |
|
470 |
419 |
$24K |
| 77370 |
|
65 |
59 |
$24K |
| 92018 |
|
82 |
80 |
$23K |
| OP710 |
|
165 |
142 |
$23K |
| G0378 |
Hospital observation per hr |
213 |
198 |
$22K |
| 76098 |
|
115 |
113 |
$22K |
| G0279 |
Tomosynthesis, mammo |
572 |
550 |
$21K |
| 78832 |
|
243 |
235 |
$21K |
| 0002A |
|
768 |
766 |
$21K |
| 84702 |
|
1,422 |
1,063 |
$19K |
| 86769 |
|
925 |
828 |
$19K |
| 76377 |
|
1,664 |
1,545 |
$18K |
| 81162 |
|
44 |
42 |
$18K |
| 96376 |
|
1,640 |
923 |
$18K |
| C9803 |
Hopd covid-19 spec collect |
9,139 |
7,701 |
$18K |
| A9575 |
Inj gadoterate meglumi 0.1ml |
4,593 |
4,019 |
$17K |
| 73720 |
|
54 |
51 |
$17K |
| 0001A |
|
806 |
806 |
$17K |
| J1453 |
Fosaprepitant injection |
442 |
329 |
$16K |
| A9585 |
Gadobutrol injection |
3,685 |
3,210 |
$16K |
| 81206 |
|
145 |
133 |
$16K |
| 81378 |
|
143 |
79 |
$16K |
| 83970 |
|
367 |
345 |
$16K |
| 93356 |
|
708 |
683 |
$15K |
| J9060 |
Cisplatin 10 mg injection |
1,401 |
601 |
$15K |
| 82728 |
|
2,436 |
2,154 |
$15K |
| 77012 |
|
80 |
75 |
$15K |
| 84703 |
|
3,877 |
3,431 |
$15K |
| 86334 |
|
2,165 |
1,928 |
$15K |
| 10005 |
|
30 |
29 |
$15K |
| 86300 |
|
2,379 |
2,095 |
$15K |
| 36593 |
|
104 |
92 |
$15K |
| 86304 |
|
2,958 |
2,528 |
$14K |
| 88275 |
|
447 |
401 |
$14K |
| 85045 |
|
6,392 |
3,539 |
$14K |
| 82024 |
|
269 |
244 |
$13K |
| 86355 |
|
376 |
349 |
$13K |
| 82670 |
|
495 |
485 |
$13K |
| 94729 |
|
431 |
410 |
$13K |
| 10021 |
|
28 |
25 |
$13K |
| 31575 |
|
107 |
101 |
$13K |
| 86356 |
|
541 |
472 |
$12K |
| 83883 |
|
2,155 |
1,893 |
$12K |
| 81003 |
|
5,231 |
3,967 |
$12K |
| C8957 |
Prolonged iv inf, req pump |
50 |
26 |
$12K |
| 82105 |
|
1,818 |
1,428 |
$12K |
| 82248 |
|
4,655 |
3,212 |
$12K |
| 83001 |
|
961 |
931 |
$11K |
| 83002 |
|
1,133 |
1,096 |
$11K |
| 81267 |
|
408 |
329 |
$11K |
| J3489 |
Zoledronic acid 1mg |
129 |
128 |
$11K |
| 82607 |
|
1,159 |
1,102 |
$11K |
| 81301 |
|
86 |
84 |
$11K |
| 88325 |
|
362 |
315 |
$11K |
| J1756 |
Iron sucrose injection |
437 |
299 |
$10K |
| 86360 |
|
447 |
419 |
$10K |
| 88333 |
|
713 |
659 |
$10K |
| 82962 |
|
5,636 |
5,167 |
$10K |
| 88311 |
|
1,013 |
915 |
$9K |
| 88108 |
|
206 |
187 |
$9K |
| 0004A |
|
249 |
249 |
$9K |
| J9209 |
Mesna injection |
229 |
81 |
$9K |
| 86359 |
|
448 |
420 |
$9K |
| J9075 |
Inj, cyclophosphamide, nos |
111 |
74 |
$9K |
| 87040 |
|
1,417 |
1,162 |
$9K |
| 86704 |
|
2,724 |
2,548 |
$8K |
| 84165 |
|
2,256 |
1,999 |
$8K |
| 87340 |
|
2,809 |
2,628 |
$8K |
| 83036 |
|
2,167 |
2,069 |
$8K |
| 92285 |
|
140 |
140 |
$8K |
| 88365 |
|
166 |
158 |
$8K |
| 80197 |
|
807 |
260 |
$8K |
| 82533 |
|
642 |
561 |
$7K |
| 86357 |
|
374 |
347 |
$7K |
| J1100 |
Dexamethasone sodium phos |
13,291 |
7,703 |
$7K |
| 81268 |
|
46 |
38 |
$7K |
| 84550 |
|
3,343 |
1,929 |
$7K |
| 86141 |
|
1,925 |
1,462 |
$7K |
| 83880 |
|
282 |
255 |
$7K |
| 93971 |
|
199 |
194 |
$7K |
| J1442 |
Inj filgrastim excl biosimil |
334 |
166 |
$7K |
| 45385 |
|
12 |
12 |
$7K |
| 90677 |
|
129 |
127 |
$7K |
| 82550 |
|
1,449 |
1,024 |
$6K |
| 90471 |
|
2,835 |
2,705 |
$6K |
| 92567 |
|
72 |
71 |
$6K |
| 86803 |
|
1,507 |
1,409 |
$5K |
| A9573 |
Inj, gadopiclenol, 1 ml |
897 |
826 |
$5K |
| 96522 |
|
141 |
88 |
$5K |
| 86800 |
|
914 |
873 |
$5K |
| 92201 |
|
695 |
676 |
$5K |
| 87088 |
|
1,728 |
1,580 |
$5K |
| 83690 |
|
1,926 |
1,415 |
$5K |
| A4648 |
Implantable tissue marker |
392 |
373 |
$5K |
| 0003A |
|
135 |
134 |
$5K |
| 86301 |
|
1,187 |
1,013 |
$5K |
| 87389 |
|
976 |
907 |
$5K |
| 94726 |
|
26 |
25 |
$5K |
| 86870 |
|
89 |
79 |
$4K |
| 90671 |
|
95 |
84 |
$4K |
| U0003 |
Cov-19 amp prb hgh thruput |
66 |
62 |
$4K |
| 84480 |
|
1,178 |
1,043 |
$4K |
| 90648 |
|
220 |
198 |
$4K |
| 86880 |
|
168 |
139 |
$4K |
| 76498 |
|
36 |
36 |
$4K |
| A9541 |
Tc99m sulfur colloid |
237 |
235 |
$4K |
| 92226 |
|
113 |
96 |
$4K |
| 80307 |
|
73 |
65 |
$4K |
| 81001 |
|
1,568 |
1,331 |
$4K |
| 86413 |
|
437 |
413 |
$4K |
| J9181 |
Etoposide injection |
581 |
160 |
$4K |
| 90670 |
|
98 |
96 |
$4K |
| 91320 |
|
105 |
104 |
$4K |
| 92557 |
|
55 |
52 |
$3K |
| J9208 |
Ifosfamide injection |
38 |
12 |
$3K |
| 81479 |
|
32 |
26 |
$3K |
| 90480 |
|
110 |
109 |
$3K |
| 88173 |
|
336 |
323 |
$3K |
| S0028 |
Injection, famotidine, 20 mg |
4,172 |
2,123 |
$3K |
| 81458 |
|
14 |
13 |
$3K |
| 86706 |
|
800 |
750 |
$3K |
| J3010 |
Fentanyl citrate injection |
3,439 |
2,966 |
$3K |
| 86787 |
|
496 |
444 |
$3K |
| 76705 |
|
32 |
29 |
$3K |
| 90715 |
|
191 |
179 |
$2K |
| 85651 |
|
1,362 |
1,153 |
$2K |
| 92526 |
|
58 |
40 |
$2K |
| 82150 |
|
674 |
460 |
$2K |
| 82565 |
|
1,175 |
1,088 |
$2K |
| 83550 |
|
922 |
902 |
$2K |
| J0131 |
Inj, acetaminophen (nos) |
2,148 |
1,513 |
$2K |
| 86765 |
|
308 |
279 |
$2K |
| 73552 |
|
116 |
91 |
$2K |
| S0080 |
Injection, pentamidine iseth |
447 |
414 |
$2K |
| 0399T |
|
12 |
12 |
$2K |
| C1769 |
Guide wire |
176 |
159 |
$2K |
| G0008 |
Admin influenza virus vac |
351 |
349 |
$2K |
| 90713 |
|
124 |
123 |
$2K |
| 96521 |
|
53 |
27 |
$2K |
| 87077 |
|
516 |
486 |
$2K |
| C1715 |
Brachytherapy needle |
198 |
196 |
$2K |
| 88172 |
|
152 |
147 |
$2K |
| 82746 |
|
375 |
359 |
$1K |
| 97166 |
|
12 |
12 |
$1K |
| J2545 |
Pentamidine non-comp unit |
13 |
12 |
$1K |
| 71045 |
|
184 |
165 |
$1K |
| 0124A |
|
37 |
36 |
$1K |
| 73590 |
|
33 |
26 |
$1K |
| OP637 |
|
700 |
381 |
$1K |
| OP250 |
|
323 |
185 |
$1K |
| J2405 |
Ondansetron hcl injection |
6,961 |
4,085 |
$1K |
| 87798 |
|
46 |
37 |
$1K |
| 87625 |
|
40 |
40 |
$1K |
| 76510 |
|
13 |
13 |
$1K |
| 76830 |
|
26 |
26 |
$1K |
| J8540 |
Oral dexamethasone |
445 |
250 |
$1K |
| 87070 |
|
314 |
287 |
$1K |
| J2704 |
Inj, propofol, 10 mg |
2,883 |
2,309 |
$1K |
| 90656 |
|
85 |
85 |
$1K |
| 99214 |
|
29 |
12 |
$992.62 |
| 84466 |
|
301 |
294 |
$992.52 |
| 84484 |
|
467 |
384 |
$941.05 |
| 99215 |
Prolong outpt/office vis |
18 |
12 |
$926.57 |
| 80158 |
|
47 |
12 |
$911.68 |
| OP272 |
|
13 |
12 |
$884.22 |
| 86644 |
|
135 |
122 |
$855.08 |
| 82977 |
|
345 |
243 |
$830.26 |
| 87486 |
|
16 |
12 |
$768.99 |
| 82310 |
|
229 |
212 |
$751.48 |
| 90636 |
|
12 |
12 |
$725.96 |
| 86708 |
|
152 |
142 |
$702.52 |
| 84207 |
|
25 |
24 |
$689.36 |
| 84060 |
|
125 |
109 |
$675.45 |
| 87581 |
|
16 |
12 |
$673.24 |
| 84436 |
|
221 |
196 |
$673.07 |
| 88313 |
|
42 |
38 |
$650.63 |
| 90662 |
|
60 |
59 |
$633.47 |
| 88177 |
|
12 |
12 |
$629.01 |
| J0461 |
Atropine sulfate injection |
1,355 |
779 |
$620.85 |
| 86709 |
|
151 |
141 |
$618.83 |
| 0663T |
|
64 |
38 |
$576.05 |
| 83520 |
|
153 |
117 |
$565.82 |
| 89051 |
|
203 |
165 |
$538.26 |
| 88300 |
|
67 |
65 |
$535.15 |
| 82570 |
|
267 |
232 |
$532.00 |
| 84156 |
|
407 |
355 |
$529.42 |
| 88309 |
|
12 |
12 |
$525.34 |
| 0064A |
|
14 |
14 |
$520.00 |
| 86790 |
|
127 |
118 |
$516.90 |
| 87533 |
|
29 |
12 |
$509.29 |
| 83605 |
|
291 |
263 |
$492.78 |
| J0136 |
Inj, acetaminophen (b braun) |
1,805 |
1,576 |
$461.39 |
| 83010 |
|
92 |
75 |
$443.85 |
| 90694 |
|
29 |
29 |
$436.65 |
| J9360 |
Vinblastine sulfate inj |
21 |
12 |
$393.96 |
| 84481 |
|
101 |
96 |
$386.10 |
| 87205 |
|
238 |
215 |
$365.08 |
| 88363 |
|
43 |
43 |
$358.36 |
| 87186 |
|
159 |
151 |
$341.82 |
| J2370 |
Phenylephrine hcl injection |
334 |
298 |
$323.63 |
| J9130 |
Dacarbazine 100 mg inj |
16 |
12 |
$322.35 |
| 82232 |
|
55 |
50 |
$302.90 |
| 0031A |
|
18 |
18 |
$293.53 |
| C1729 |
Cath, drainage |
102 |
94 |
$286.15 |
| J1170 |
Hydromorphone injection |
1,222 |
951 |
$280.24 |
| J3475 |
Inj magnesium sulfate |
785 |
392 |
$275.69 |
| 86780 |
|
52 |
50 |
$248.94 |
| J3480 |
Inj potassium chloride |
1,254 |
464 |
$226.43 |
| J0184 |
Inj, amisulpride, 1 mg |
33 |
33 |
$207.60 |
| 77417 |
|
495 |
262 |
$183.88 |
| 82985 |
|
16 |
15 |
$165.93 |
| J0689 |
Inj cefazolin sodium, baxter |
678 |
558 |
$163.69 |
| J7612 |
Levalbuterol non-comp con |
163 |
104 |
$161.92 |
| Q9968 |
Visualization adjunct |
18 |
12 |
$161.53 |
| 85385 |
|
50 |
28 |
$120.86 |
| 74019 |
|
17 |
14 |
$120.15 |
| 86705 |
|
73 |
70 |
$92.12 |
| 84520 |
|
42 |
38 |
$81.35 |
| OP270 |
|
14 |
14 |
$80.00 |
| 87102 |
|
39 |
37 |
$72.49 |
| Q0162 |
Ondansetron oral |
151 |
109 |
$71.53 |
| J2250 |
Inj midazolam hydrochloride |
2,198 |
2,060 |
$57.30 |
| J9250 |
Methotrexate sodium inj |
53 |
37 |
$56.65 |
| 84270 |
|
12 |
12 |
$52.73 |
| J2270 |
Morphine sulfate injection |
181 |
144 |
$51.48 |
| 87220 |
|
27 |
25 |
$36.30 |
| J1885 |
Ketorolac tromethamine inj |
694 |
516 |
$30.23 |
| J3410 |
Hydroxyzine hcl injection |
28 |
13 |
$29.40 |
| 99153 |
Mod sedat endo service >5yrs |
27 |
27 |
$27.12 |
| J2060 |
Lorazepam injection |
292 |
196 |
$14.47 |
| J2371 |
Inj phenylephrine hcl 20 mcg |
641 |
619 |
$14.06 |
| 99152 |
|
58 |
58 |
$10.24 |
| J0690 |
Cefazolin sodium injection |
116 |
96 |
$9.08 |
| J1596 |
Inj, glycopyrrolate, 0.1 mg |
103 |
86 |
$8.12 |
| 94640 |
|
13 |
12 |
$6.00 |
| 94642 |
|
13 |
12 |
$6.00 |
| J2001 |
Lidocaine injection |
429 |
409 |
$4.52 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
53 |
44 |
$3.33 |
| Q0163 |
Diphenhydramine hcl 50mg |
350 |
179 |
$1.94 |
| J2003 |
Inj, lidocaine hcl, 1 mg |
64 |
64 |
$1.30 |
| J3420 |
Vitamin b12 injection |
14 |
13 |
$0.00 |
| 88331 |
|
18 |
16 |
$0.00 |