| Code | Description | Claims | Beneficiaries | Total Paid |
| 0450 |
|
99,287 |
84,593 |
$5.36M |
| 99199 |
|
59,010 |
48,969 |
$3.08M |
| 74177 |
|
13,274 |
12,960 |
$2.19M |
| U0003 |
Cov-19 amp prb hgh thruput |
21,908 |
20,529 |
$1.80M |
| 70450 |
|
17,093 |
16,459 |
$1.74M |
| 99281 |
|
21,615 |
18,756 |
$1.67M |
| 80053 |
|
131,828 |
107,226 |
$1.36M |
| 93005 |
|
48,832 |
43,943 |
$1.17M |
| 85025 |
|
161,715 |
128,031 |
$916K |
| 97110 |
|
35,554 |
8,515 |
$892K |
| 93306 |
|
5,266 |
5,205 |
$870K |
| Z7502 |
|
23,083 |
22,300 |
$870K |
| 87502 |
|
17,283 |
16,557 |
$852K |
| 80307 |
|
12,300 |
10,972 |
$805K |
| 96374 |
|
13,058 |
12,113 |
$741K |
| 76700 |
|
10,411 |
10,216 |
$735K |
| G0480 |
Drug test def 1-7 classes |
11,229 |
9,604 |
$700K |
| 96372 |
|
26,158 |
23,092 |
$663K |
| 72125 |
|
3,988 |
3,925 |
$648K |
| 74176 |
|
6,430 |
6,265 |
$637K |
| 87637 |
|
4,165 |
4,032 |
$636K |
| 97140 |
|
17,238 |
5,428 |
$587K |
| 97112 |
|
23,682 |
6,306 |
$544K |
| 71045 |
|
54,353 |
44,930 |
$531K |
| 71046 |
|
25,398 |
24,708 |
$501K |
| 97530 |
|
22,422 |
6,282 |
$482K |
| 71260 |
|
2,367 |
2,335 |
$457K |
| 83880 |
|
20,671 |
18,094 |
$395K |
| 96375 |
|
10,156 |
8,603 |
$386K |
| 76856 |
|
5,445 |
5,336 |
$340K |
| U0005 |
Infec agen detec ampli probe |
15,013 |
13,987 |
$333K |
| 78452 |
|
1,486 |
1,367 |
$333K |
| J3490 |
Drugs unclassified injection |
23,265 |
11,034 |
$326K |
| 84484 |
|
38,399 |
32,408 |
$325K |
| 96365 |
|
4,497 |
3,727 |
$312K |
| 97750 |
|
5,404 |
3,665 |
$308K |
| 76815 |
|
5,407 |
4,094 |
$296K |
| 83690 |
|
40,430 |
36,857 |
$291K |
| 87798 |
|
9,306 |
8,882 |
$285K |
| 99202 |
|
2,936 |
2,074 |
$284K |
| 76830 |
|
4,504 |
4,393 |
$282K |
| 0250 |
|
12,907 |
6,793 |
$269K |
| 84443 |
|
21,043 |
19,525 |
$263K |
| 99283 |
|
5,539 |
5,021 |
$259K |
| 99284 |
|
5,079 |
4,838 |
$256K |
| S0119 |
Ondansetron 4 mg |
8,259 |
7,762 |
$252K |
| 0270 |
|
22,556 |
10,063 |
$245K |
| 80048 |
|
32,839 |
25,952 |
$245K |
| 59025 |
|
8,222 |
2,835 |
$234K |
| 76805 |
|
2,785 |
2,651 |
$230K |
| 70486 |
|
1,209 |
1,198 |
$225K |
| 96360 |
|
3,807 |
3,534 |
$224K |
| 96361 |
|
7,920 |
7,049 |
$220K |
| 99285 |
|
4,158 |
3,922 |
$209K |
| 93971 |
|
2,303 |
2,273 |
$204K |
| 76801 |
|
3,775 |
3,143 |
$204K |
| Z9725 |
|
4,659 |
4,231 |
$200K |
| A9502 |
Tc99m tetrofosmin |
1,501 |
1,391 |
$174K |
| 97139 |
|
9,126 |
1,955 |
$168K |
| 87635 |
|
2,354 |
2,289 |
$163K |
| 81001 |
|
56,745 |
52,157 |
$159K |
| 76817 |
|
2,860 |
2,448 |
$154K |
| 71250 |
|
1,460 |
1,421 |
$153K |
| 87491 |
|
5,323 |
5,185 |
$148K |
| 73610 |
|
6,058 |
5,773 |
$147K |
| 87591 |
|
5,492 |
5,348 |
$147K |
| 73630 |
|
7,222 |
6,796 |
$145K |
| 71275 |
|
994 |
979 |
$144K |
| 78815 |
|
314 |
279 |
$144K |
| 76770 |
|
1,979 |
1,947 |
$140K |
| 80143 |
|
4,713 |
4,142 |
$140K |
| 93017 |
|
2,585 |
2,418 |
$139K |
| 99291 |
|
1,846 |
1,148 |
$139K |
| 87086 |
|
25,578 |
23,783 |
$138K |
| 73030 |
|
5,279 |
5,090 |
$127K |
| 0762 |
|
891 |
304 |
$126K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
9,233 |
9,023 |
$115K |
| 94640 |
|
5,297 |
4,612 |
$114K |
| 73130 |
|
4,245 |
4,070 |
$111K |
| 88307 |
|
1,487 |
1,436 |
$110K |
| J1885 |
Ketorolac tromethamine inj |
18,132 |
16,554 |
$106K |
| 73721 |
|
304 |
294 |
$106K |
| 73562 |
|
4,828 |
4,563 |
$106K |
| 87040 |
|
11,081 |
8,967 |
$105K |
| 72131 |
|
539 |
537 |
$104K |
| 93970 |
|
962 |
925 |
$103K |
| L8699 |
Prosthetic implant nos |
13 |
13 |
$103K |
| 80179 |
|
4,615 |
4,083 |
$102K |
| 88305 |
|
3,845 |
3,139 |
$98K |
| 73110 |
|
3,870 |
3,678 |
$95K |
| 82805 |
|
6,537 |
5,235 |
$95K |
| 80061 |
|
10,292 |
10,022 |
$89K |
| 90715 |
|
2,211 |
2,201 |
$89K |
| T1999 |
Noc retail items andsupplies |
14,311 |
7,022 |
$86K |
| J2785 |
Regadenoson injection |
514 |
433 |
$86K |
| J7030 |
Normal saline solution infus |
11,494 |
9,930 |
$84K |
| 83605 |
|
12,316 |
9,623 |
$83K |
| 80076 |
|
9,240 |
8,582 |
$80K |
| 99070 |
|
56,519 |
28,502 |
$79K |
| 82962 |
|
10,597 |
5,781 |
$76K |
| 0637 |
|
10,443 |
5,246 |
$71K |
| 73502 |
|
1,884 |
1,822 |
$66K |
| 96367 |
|
1,701 |
1,066 |
$66K |
| 76819 |
|
1,685 |
1,426 |
$63K |
| 73080 |
|
1,940 |
1,869 |
$62K |
| 72148 |
|
161 |
161 |
$61K |
| 0510 |
|
1,994 |
1,585 |
$60K |
| 82306 |
|
3,805 |
3,773 |
$60K |
| 97116 |
|
3,508 |
1,423 |
$59K |
| 83735 |
|
24,390 |
9,632 |
$58K |
| 84702 |
|
5,917 |
4,868 |
$56K |
| 76705 |
|
1,040 |
1,011 |
$55K |
| 86900 |
|
8,716 |
7,985 |
$54K |
| 82803 |
|
3,500 |
2,446 |
$53K |
| 0729 |
|
1,419 |
1,155 |
$52K |
| 81003 |
|
20,989 |
19,599 |
$52K |
| 86850 |
|
5,392 |
4,894 |
$52K |
| 76870 |
|
906 |
874 |
$51K |
| 72100 |
|
1,653 |
1,640 |
$50K |
| 96413 |
|
1,994 |
1,121 |
$50K |
| 36415 |
|
26,220 |
23,453 |
$49K |
| 72110 |
|
986 |
978 |
$48K |
| 83036 |
|
8,068 |
7,888 |
$46K |
| J2270 |
Morphine sulfate injection |
5,303 |
4,458 |
$46K |
| 73590 |
|
1,714 |
1,634 |
$44K |
| 84132 |
|
1,660 |
1,588 |
$43K |
| 86901 |
|
9,710 |
8,905 |
$43K |
| 70553 |
|
73 |
73 |
$43K |
| 0360 |
|
306 |
204 |
$42K |
| J2405 |
Ondansetron hcl injection |
7,630 |
6,542 |
$41K |
| 81025 |
|
6,042 |
5,767 |
$41K |
| G0378 |
Hospital observation per hr |
1,132 |
889 |
$39K |
| 82330 |
|
5,812 |
4,376 |
$39K |
| 85610 |
|
14,771 |
12,166 |
$37K |
| J0696 |
Ceftriaxone sodium injection |
5,203 |
4,925 |
$37K |
| 87641 |
|
3,327 |
3,123 |
$36K |
| 0761 |
|
1,162 |
891 |
$36K |
| 01967 |
|
113 |
110 |
$36K |
| 73090 |
|
1,484 |
1,405 |
$35K |
| Z7610 |
|
10,436 |
5,007 |
$34K |
| 93880 |
|
330 |
329 |
$34K |
| 85027 |
|
9,201 |
6,861 |
$34K |
| 74018 |
|
2,079 |
1,870 |
$33K |
| 70491 |
|
146 |
142 |
$32K |
| 85730 |
|
7,343 |
6,528 |
$32K |
| 73564 |
|
936 |
909 |
$31K |
| 88304 |
|
1,792 |
1,649 |
$31K |
| 99233 |
Prolong inpt eval add15 m |
1,127 |
404 |
$31K |
| J1100 |
Dexamethasone sodium phos |
5,073 |
4,332 |
$30K |
| C1776 |
Joint device (implantable) |
15 |
15 |
$29K |
| 84703 |
|
12,502 |
11,549 |
$29K |
| 76536 |
|
420 |
417 |
$28K |
| 72040 |
|
989 |
981 |
$28K |
| 87186 |
|
6,183 |
5,924 |
$28K |
| 93226 |
|
525 |
510 |
$27K |
| 99282 |
|
287 |
271 |
$27K |
| 84145 |
|
2,933 |
2,306 |
$25K |
| 87077 |
|
5,779 |
5,542 |
$24K |
| 96366 |
|
518 |
362 |
$24K |
| J0131 |
Inj, acetaminophen (nos) |
1,014 |
976 |
$23K |
| 87081 |
|
3,636 |
3,572 |
$23K |
| 82728 |
|
2,675 |
2,500 |
$22K |
| 82550 |
|
4,418 |
3,416 |
$22K |
| 73560 |
|
1,249 |
1,182 |
$22K |
| A9552 |
F18 fdg |
112 |
111 |
$22K |
| J1170 |
Hydromorphone injection |
2,187 |
1,747 |
$21K |
| 93225 |
|
519 |
502 |
$21K |
| 84439 |
|
3,170 |
3,061 |
$20K |
| 92507 |
|
366 |
188 |
$20K |
| 70551 |
|
54 |
54 |
$19K |
| 87880 |
|
2,806 |
2,768 |
$19K |
| 84466 |
|
2,602 |
2,535 |
$19K |
| 82948 |
|
5,640 |
3,066 |
$18K |
| J1642 |
Inj heparin sodium per 10 u |
3,334 |
1,329 |
$18K |
| 73140 |
|
937 |
918 |
$16K |
| 86140 |
|
6,647 |
4,490 |
$16K |
| G0463 |
Hospital outpt clinic visit |
2,729 |
2,162 |
$15K |
| 82746 |
|
1,776 |
1,753 |
$15K |
| 83970 |
|
638 |
637 |
$15K |
| J2060 |
Lorazepam injection |
2,529 |
2,051 |
$14K |
| J3010 |
Fentanyl citrate injection |
2,620 |
2,346 |
$14K |
| 87389 |
|
1,094 |
1,090 |
$14K |
| J2704 |
Inj, propofol, 10 mg |
1,712 |
1,637 |
$14K |
| 76857 |
|
314 |
312 |
$14K |
| 94729 |
|
305 |
300 |
$13K |
| J7120 |
Ringers lactate infusion |
1,762 |
1,616 |
$13K |
| 82495 |
|
697 |
681 |
$13K |
| 99232 |
|
659 |
271 |
$13K |
| 94060 |
|
320 |
316 |
$13K |
| 94664 |
|
586 |
454 |
$13K |
| J1200 |
Diphenhydramine hcl injectio |
2,593 |
2,141 |
$13K |
| J1815 |
Insulin injection |
1,419 |
642 |
$13K |
| 85007 |
|
6,494 |
4,817 |
$12K |
| 82553 |
|
684 |
589 |
$12K |
| 59409 |
|
25 |
24 |
$12K |
| 83540 |
|
3,331 |
3,238 |
$12K |
| 94726 |
|
297 |
292 |
$12K |
| 0001A |
|
294 |
294 |
$12K |
| J7040 |
Normal saline solution infus |
2,241 |
1,549 |
$11K |
| J3475 |
Inj magnesium sulfate |
1,466 |
985 |
$11K |
| 0683 |
|
80 |
80 |
$11K |
| 87400 |
|
1,123 |
1,086 |
$10K |
| J2765 |
Metoclopramide hcl injection |
1,655 |
1,571 |
$9K |
| 82140 |
|
2,350 |
1,208 |
$9K |
| 72072 |
|
271 |
266 |
$9K |
| 12001 |
|
276 |
275 |
$9K |
| 87430 |
|
769 |
758 |
$9K |
| 0710 |
|
248 |
244 |
$9K |
| 97799 |
|
387 |
65 |
$9K |
| 85379 |
|
1,042 |
872 |
$9K |
| 73700 |
|
57 |
56 |
$9K |
| 87147 |
|
1,501 |
1,452 |
$8K |
| 94644 |
|
448 |
425 |
$8K |
| 86592 |
|
2,795 |
2,711 |
$8K |
| 84550 |
|
1,923 |
1,645 |
$8K |
| 73552 |
|
252 |
248 |
$7K |
| J0690 |
Cefazolin sodium injection |
931 |
789 |
$7K |
| 72128 |
|
49 |
49 |
$7K |
| J2001 |
Lidocaine injection |
1,387 |
1,289 |
$7K |
| 01961 |
|
25 |
25 |
$7K |
| J0780 |
Prochlorperazine injection |
669 |
617 |
$7K |
| 87631 |
|
112 |
106 |
$7K |
| 82247 |
|
2,420 |
1,474 |
$7K |
| 73120 |
|
316 |
308 |
$6K |
| 93242 |
|
414 |
413 |
$6K |
| J2930 |
Methylprednisolone injection |
614 |
588 |
$6K |
| 82010 |
|
1,065 |
954 |
$6K |
| 0259 |
|
1,517 |
523 |
$6K |
| 72070 |
|
201 |
199 |
$6K |
| 72050 |
|
167 |
166 |
$6K |
| 87210 |
|
1,108 |
1,086 |
$6K |
| 82607 |
|
968 |
948 |
$6K |
| 10060 |
|
218 |
209 |
$6K |
| 84425 |
|
313 |
313 |
$6K |
| J2550 |
Promethazine hcl injection |
791 |
719 |
$6K |
| J1453 |
Fosaprepitant injection |
42 |
26 |
$6K |
| 99253 |
|
114 |
110 |
$5K |
| 99152 |
|
148 |
140 |
$5K |
| 83615 |
|
1,391 |
1,096 |
$5K |
| C9803 |
Hopd covid-19 spec collect |
260 |
256 |
$5K |
| 97010 |
|
482 |
230 |
$5K |
| 72141 |
|
12 |
12 |
$5K |
| 84153 |
|
479 |
470 |
$5K |
| 85652 |
|
3,003 |
2,681 |
$5K |
| 84436 |
|
829 |
813 |
$5K |
| 86780 |
|
687 |
676 |
$5K |
| J1953 |
Levetiracetam injection |
283 |
240 |
$5K |
| 12011 |
|
74 |
74 |
$4K |
| 99214 |
|
111 |
108 |
$4K |
| 59514 |
|
14 |
14 |
$4K |
| 86803 |
|
451 |
448 |
$4K |
| 73221 |
|
12 |
12 |
$4K |
| 0636 |
|
374 |
332 |
$4K |
| 73620 |
|
212 |
206 |
$4K |
| 77300 |
|
13 |
13 |
$4K |
| 29125 |
|
334 |
327 |
$4K |
| A4344 |
Cath indw foley 2 way silicn |
328 |
314 |
$4K |
| J2250 |
Inj midazolam hydrochloride |
819 |
795 |
$4K |
| 84100 |
|
4,412 |
1,574 |
$4K |
| 90471 |
|
816 |
756 |
$4K |
| C1713 |
Anchor/screw bn/bn,tis/bn |
14 |
13 |
$4K |
| A9500 |
Tc99m sestamibi |
31 |
29 |
$4K |
| 0011A |
|
87 |
87 |
$3K |
| 0760 |
|
130 |
111 |
$3K |
| J1644 |
Inj heparin sodium per 1000u |
626 |
224 |
$3K |
| 96402 |
|
46 |
40 |
$3K |
| U0002 |
Covid-19 lab test non-cdc |
63 |
61 |
$3K |
| 87088 |
|
1,072 |
1,053 |
$3K |
| 73600 |
|
75 |
70 |
$3K |
| 87340 |
|
599 |
591 |
$3K |
| 99222 |
|
92 |
91 |
$3K |
| 82435 |
|
1,471 |
1,424 |
$3K |
| J0185 |
Inj., aprepitant, 1 mg |
21 |
12 |
$3K |
| J7050 |
Normal saline solution infus |
662 |
473 |
$3K |
| J0330 |
Succinycholine chloride inj |
248 |
246 |
$3K |
| 73100 |
|
137 |
129 |
$3K |
| 80074 |
|
251 |
242 |
$3K |
| 0002A |
|
70 |
70 |
$3K |
| 70498 |
|
39 |
39 |
$3K |
| 12002 |
|
87 |
87 |
$3K |
| 96417 |
|
167 |
79 |
$3K |
| 99254 |
|
41 |
40 |
$3K |
| 93270 |
|
72 |
72 |
$3K |
| J3486 |
Ziprasidone mesylate |
66 |
36 |
$3K |
| 86141 |
|
225 |
214 |
$3K |
| 94799 |
|
135 |
128 |
$2K |
| 87070 |
|
939 |
815 |
$2K |
| 80202 |
|
959 |
534 |
$2K |
| 73060 |
|
90 |
90 |
$2K |
| 0258 |
|
230 |
125 |
$2K |
| 87420 |
|
234 |
227 |
$2K |
| 99223 |
Prolong inpt eval add15 m |
134 |
130 |
$2K |
| 87205 |
|
1,310 |
1,083 |
$2K |
| 99499 |
|
39 |
27 |
$2K |
| A9575 |
Inj gadoterate meglumi 0.1ml |
433 |
427 |
$2K |
| 72170 |
|
100 |
100 |
$2K |
| 88311 |
|
522 |
505 |
$2K |
| 87220 |
|
289 |
283 |
$2K |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
248 |
225 |
$2K |
| 80069 |
|
957 |
412 |
$2K |
| 82947 |
|
896 |
861 |
$2K |
| 93925 |
|
26 |
26 |
$2K |
| 82800 |
|
176 |
152 |
$2K |
| 64445 |
|
24 |
24 |
$2K |
| 85651 |
|
491 |
460 |
$2K |
| 82652 |
|
48 |
48 |
$2K |
| 82043 |
|
524 |
521 |
$2K |
| 88313 |
|
34 |
34 |
$2K |
| X3908 |
|
48 |
13 |
$1K |
| 86762 |
|
246 |
238 |
$1K |
| J3370 |
Vancomycin hcl injection |
112 |
105 |
$1K |
| 30140 |
|
12 |
12 |
$1K |
| 97124 |
|
135 |
88 |
$1K |
| 82570 |
|
840 |
745 |
$1K |
| A9579 |
Gad-base mr contrast nos,1ml |
44 |
43 |
$1K |
| 84481 |
|
135 |
135 |
$1K |
| 86923 |
|
194 |
167 |
$1K |
| 81513 |
|
12 |
12 |
$1K |
| 94150 |
|
106 |
88 |
$1K |
| 87149 |
|
50 |
50 |
$1K |
| 27447 |
|
13 |
12 |
$1K |
| 86038 |
|
137 |
137 |
$1K |
| J1630 |
Haloperidol injection |
323 |
280 |
$1K |
| 99204 |
|
25 |
25 |
$1K |
| Q0162 |
Ondansetron oral |
2,880 |
2,598 |
$994.57 |
| X3910 |
|
48 |
13 |
$905.28 |
| 88302 |
|
50 |
43 |
$901.67 |
| 87522 |
Neg quan hep c or qual rna |
29 |
29 |
$891.18 |
| 73070 |
|
38 |
36 |
$860.71 |
| 84630 |
|
87 |
87 |
$859.04 |
| 73660 |
|
43 |
41 |
$797.34 |
| 36600 |
|
201 |
196 |
$786.36 |
| 85520 |
|
348 |
148 |
$771.73 |
| 84403 |
|
42 |
41 |
$767.40 |
| 64447 |
|
29 |
29 |
$763.75 |
| 97150 |
|
263 |
96 |
$744.80 |
| J7999 |
Compounded drug, noc |
26 |
25 |
$722.28 |
| 97164 |
|
57 |
53 |
$703.37 |
| 82248 |
|
276 |
177 |
$692.21 |
| 88312 |
|
29 |
29 |
$655.44 |
| 87661 |
|
14 |
14 |
$650.94 |
| 83631 |
|
30 |
27 |
$619.73 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
13 |
12 |
$617.31 |
| 82378 |
|
19 |
12 |
$608.79 |
| 74022 |
|
13 |
12 |
$566.77 |
| 73000 |
|
28 |
25 |
$542.79 |
| 93356 |
|
33 |
33 |
$537.72 |
| 72120 |
|
14 |
14 |
$537.29 |
| 82150 |
|
163 |
133 |
$485.11 |
| J7512 |
Prednisone ir or dr oral 1mg |
567 |
533 |
$482.03 |
| 86300 |
|
25 |
24 |
$462.50 |
| J0561 |
Penicillin g benzathine inj |
13 |
12 |
$439.78 |
| 84156 |
|
422 |
350 |
$418.75 |
| J2003 |
Inj, lidocaine hcl, 1 mg |
43 |
41 |
$415.66 |
| 70496 |
|
12 |
12 |
$397.93 |
| J2919 |
Inj, methylpred sod succ 5mg |
30 |
29 |
$397.67 |
| 83525 |
|
41 |
41 |
$395.22 |
| 86077 |
|
18 |
14 |
$388.35 |
| J7060 |
5% dextrose/water |
84 |
37 |
$387.99 |
| 86431 |
|
98 |
98 |
$381.17 |
| J8540 |
Oral dexamethasone |
2,024 |
1,653 |
$369.60 |
| 31500 |
|
14 |
12 |
$355.20 |
| 86481 |
|
25 |
25 |
$349.00 |
| 88112 |
|
30 |
25 |
$342.88 |
| J0736 |
Inj, clindamycin phosp 300mg |
32 |
30 |
$328.00 |
| 87481 |
|
12 |
12 |
$308.70 |
| 86880 |
|
312 |
310 |
$301.62 |
| 88142 |
|
18 |
17 |
$299.40 |
| 87075 |
|
171 |
158 |
$288.98 |
| 87493 |
|
45 |
43 |
$252.12 |
| 96415 |
|
13 |
12 |
$242.28 |
| 86708 |
|
31 |
31 |
$227.85 |
| S0164 |
Injection pantroprazole |
17 |
13 |
$199.30 |
| 80306 |
|
98 |
92 |
$198.23 |
| 97039 |
|
37 |
25 |
$176.96 |
| 82950 |
|
68 |
68 |
$166.21 |
| 82784 |
|
13 |
12 |
$160.44 |
| 85045 |
|
70 |
66 |
$148.56 |
| 99001 |
|
822 |
720 |
$137.20 |
| S0020 |
Injection, bupivicaine hydro |
14 |
14 |
$133.54 |
| 84300 |
|
150 |
138 |
$125.35 |
| 86308 |
|
33 |
33 |
$117.42 |
| 82533 |
|
40 |
37 |
$116.00 |
| J0571 |
Buprenorphine oral 1mg |
24 |
12 |
$110.33 |
| 85384 |
|
71 |
55 |
$108.63 |
| 76882 |
|
16 |
14 |
$108.34 |
| 89051 |
|
28 |
24 |
$101.14 |
| 88300 |
|
25 |
25 |
$98.77 |
| 87807 |
|
12 |
12 |
$86.72 |
| 84133 |
|
109 |
100 |
$81.43 |
| 82274 |
|
28 |
27 |
$79.24 |
| J1940 |
Furosemide injection |
15 |
12 |
$79.06 |
| Q0163 |
Diphenhydramine hcl 50mg |
59 |
54 |
$72.95 |
| 85014 |
|
118 |
94 |
$68.46 |
| 80051 |
|
13 |
13 |
$55.37 |
| 36591 |
|
236 |
131 |
$52.50 |
| 84165 |
|
14 |
14 |
$49.59 |
| 86709 |
|
12 |
12 |
$41.42 |
| J8597 |
Antiemetic drug oral nos |
30 |
25 |
$38.69 |
| 85018 |
|
91 |
75 |
$37.16 |
| 83721 |
|
15 |
14 |
$23.28 |
| 87045 |
|
13 |
13 |
$20.41 |
| 87076 |
|
13 |
13 |
$18.72 |
| 87046 |
|
13 |
13 |
$6.76 |
| 84155 |
|
13 |
13 |
$3.53 |
| G1004 |
Cdsm ndsc |
151 |
150 |
$0.01 |
| 0637R |
|
2,434 |
1,605 |
$0.00 |
| 0259R |
|
1,485 |
938 |
$0.00 |
| 80320 |
|
49 |
43 |
$0.00 |
| 99213 |
|
106 |
88 |
$0.00 |
| 96376 |
|
104 |
100 |
$0.00 |
| 97162 |
|
26 |
26 |
$0.00 |
| 0370 |
|
13 |
12 |
$0.00 |
| J7620 |
Albuterol ipratrop non-comp |
15 |
15 |
$0.00 |
| 84112 |
|
58 |
55 |
$0.00 |
| J7614 |
Levalbuterol non-comp unit |
32 |
27 |
$0.00 |