NPI: 1750332565 · LOGAN, WV 25601 · Rural Acute Care Hospital · NPI assigned 05/15/2006
Authorized official TRAYLOR, JOHNETTA controls 20+ related entities in our dataset. Read more
| Authorized Official | TRAYLOR, JOHNETTA (AO) |
| NPI Enumeration Date | 05/15/2006 |
Other providers sharing the same authorized official: TRAYLOR, JOHNETTA
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 194,112 | $14.30M |
| 2019 | 113,090 | $8.98M |
| 2020 | 154,568 | $10.10M |
| 2021 | 132,304 | $3.73M |
| 2022 | 76,705 | $2.24M |
| 2023 | 93,297 | $2.56M |
| 2024 | 64,940 | $1.53M |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| 99285 | Emergency department visit for the evaluation and management, high severity with immediate threat to life | 14,125 | 11,807 | $5.36M |
| 99284 | Emergency department visit for the evaluation and management, high severity | 33,903 | 29,220 | $5.00M |
| 87633 | Infectious agent detection by nucleic acid, respiratory virus, 12-25 targets | 11,729 | 10,517 | $2.71M |
| 99283 | Emergency department visit for the evaluation and management, moderate severity | 19,046 | 17,638 | $1.76M |
| G0378 | Hospital observation service, per hour | 4,660 | 2,561 | $1.50M |
| 80053 | Comprehensive metabolic panel | 65,159 | 52,246 | $1.30M |
| 85025 | Blood count; complete (CBC), automated, and automated differential WBC count | 67,097 | 51,815 | $1.20M |
| 96361 | Intravenous infusion, hydration; each additional hour | 5,014 | 3,323 | $958K |
| 74177 | Computed tomography, abdomen and pelvis; with contrast material | 4,660 | 4,083 | $832K |
| 78452 | Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress | 1,515 | 1,344 | $635K |
| J2704 | Injection, propofol, 10 mg | 7,331 | 6,539 | $542K |
| 36415 | Collection of venous blood by venipuncture | 46,658 | 39,119 | $521K |
| 96365 | Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour | 6,558 | 5,236 | $471K |
| 11042 | Debridement, subcutaneous tissue (includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm | 4,777 | 2,505 | $459K |
| 71045 | Radiologic examination, chest; single view | 17,460 | 14,784 | $437K |
| 84484 | 17,556 | 12,310 | $434K | |
| 88305 | Level IV - Surgical pathology, gross and microscopic examination | 5,747 | 5,066 | $430K |
| J2405 | Injection, ondansetron hydrochloride, per 1 mg | 8,934 | 7,153 | $408K |
| 83605 | 21,628 | 17,775 | $399K | |
| 70450 | Computed tomography, head or brain; without contrast material | 6,224 | 5,436 | $397K |
| 80307 | Drug test(s), presumptive, any number of drug classes; immunoassay | 6,509 | 5,350 | $397K |
| J7030 | Infusion, normal saline solution , 1000 cc | 6,681 | 4,928 | $396K |
| 43239 | Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple | 2,257 | 2,076 | $391K |
| 96374 | Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance | 7,584 | 6,390 | $375K |
| 93005 | Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report | 21,143 | 17,535 | $375K |
| J2001 | Injection, lidocaine hcl for intravenous infusion, 10 mg | 6,428 | 5,589 | $352K |
| 74176 | Computed tomography, abdomen and pelvis; without contrast material | 3,504 | 3,088 | $323K |
| 81000 | 27,883 | 23,792 | $323K | |
| J7120 | Ringers lactate infusion, up to 1000 cc | 2,324 | 1,568 | $308K |
| 71260 | Computed tomography, thorax, diagnostic; with contrast material | 1,877 | 1,617 | $289K |
| 83874 | 4,983 | 3,260 | $281K | |
| J3010 | Injection, fentanyl citrate, 0.1 mg | 3,653 | 3,095 | $276K |
| Q9967 | Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml | 5,874 | 5,146 | $276K |
| J1885 | Injection, ketorolac tromethamine, per 15 mg | 7,577 | 6,247 | $274K |
| 93306 | Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete | 2,471 | 2,264 | $270K |
| 96375 | Therapeutic injection; each additional sequential IV push | 6,742 | 5,394 | $266K |
| 82553 | 4,797 | 3,142 | $264K | |
| 87040 | 7,734 | 4,868 | $263K | |
| 45380 | Colonoscopy, flexible; with biopsy, single or multiple | 1,203 | 1,083 | $258K |
| 83880 | 5,899 | 4,913 | $256K | |
| 82550 | 5,321 | 3,526 | $253K | |
| A9500 | Technetium tc-99m sestamibi, diagnostic, per study dose | 1,528 | 1,354 | $251K |
| 96372 | Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular | 6,572 | 5,409 | $241K |
| 85610 | 10,301 | 8,353 | $235K | |
| 99282 | Emergency department visit for the evaluation and management, low to moderate severity | 4,976 | 4,738 | $228K |
| 84443 | Thyroid stimulating hormone (TSH) | 9,826 | 9,069 | $228K |
| 71046 | Radiologic examination, chest; 2 views | 7,822 | 7,135 | $226K |
| 85730 | 8,864 | 7,500 | $220K | |
| 83735 | 8,189 | 6,374 | $212K | |
| 93017 | 1,681 | 1,491 | $204K | |
| J1100 | Injection, dexamethasone sodium phosphate, 1 mg | 4,845 | 4,222 | $191K |
| 97110 | Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion | 5,692 | 1,409 | $188K |
| 94640 | Pressurized or nonpressurized inhalation treatment for acute airway obstruction | 3,840 | 1,877 | $184K |
| 80061 | Lipid panel | 9,797 | 9,193 | $182K |
| 87086 | Culture, bacterial; quantitative colony count, urine | 12,258 | 10,594 | $182K |
| J2710 | Injection, neostigmine methylsulfate, up to 0.5 mg | 1,110 | 957 | $179K |
| 96366 | Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour | 2,229 | 1,555 | $176K |
| J0690 | Injection, cefazolin sodium, 500 mg | 1,759 | 1,375 | $166K |
| J1170 | Injection, hydromorphone, up to 4 mg | 1,688 | 1,325 | $166K |
| J2543 | Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams) | 1,175 | 706 | $165K |
| J2250 | Injection, midazolam hydrochloride, per 1 mg | 1,979 | 1,708 | $158K |
| U0002 | 2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc | 3,295 | 2,877 | $158K |
| 83690 | 7,873 | 6,553 | $156K | |
| 82803 | 3,121 | 2,399 | $156K | |
| 76705 | Ultrasound, abdominal, real time with image documentation; limited | 2,230 | 2,024 | $153K |
| 82948 | 6,392 | 2,944 | $148K | |
| 71250 | 2,449 | 2,209 | $144K | |
| 77067 | Screening mammography, bilateral, including computer-aided detection | 1,395 | 1,370 | $132K |
| J2785 | Injection, regadenoson, 0.1 mg | 646 | 570 | $127K |
| 45378 | Colonoscopy, flexible; diagnostic, including collection of specimen(s) | 496 | 438 | $118K |
| 80048 | Basic metabolic panel (calcium, ionized) | 6,508 | 5,252 | $117K |
| J0696 | Injection, ceftriaxone sodium, per 250 mg | 4,274 | 3,049 | $117K |
| 96376 | 899 | 529 | $112K | |
| 82306 | Vitamin D; 25 hydroxy, includes fraction(s), if performed | 4,348 | 4,132 | $110K |
| 81025 | 3,194 | 2,781 | $106K | |
| 80074 | 1,156 | 1,068 | $103K | |
| 96360 | Intravenous infusion, hydration; initial, 31 minutes to 1 hour | 1,093 | 921 | $102K |
| 84439 | 5,186 | 4,826 | $101K | |
| 87811 | Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) | 4,413 | 4,087 | $100K |
| 72125 | Computed tomography, cervical spine; without contrast material | 1,300 | 1,163 | $98K |
| 84703 | 3,894 | 3,379 | $97K | |
| J1650 | Injection, enoxaparin sodium, 10 mg | 1,480 | 825 | $95K |
| 36600 | 2,861 | 2,148 | $91K | |
| 87070 | 4,061 | 3,612 | $90K | |
| C9113 | Injection, pantoprazole sodium, per vial | 561 | 378 | $90K |
| 87798 | Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism | 729 | 643 | $86K |
| 87486 | 728 | 643 | $86K | |
| 87581 | 728 | 643 | $86K | |
| J2270 | Injection, morphine sulfate, up to 10 mg | 1,346 | 1,007 | $85K |
| 73562 | 2,334 | 1,850 | $85K | |
| 87880 | Infectious agent antigen detection by immunoassay; Streptococcus, group A | 3,014 | 2,740 | $83K |
| 73630 | 2,875 | 2,388 | $80K | |
| 82150 | 1,563 | 1,302 | $78K | |
| 82607 | 3,033 | 2,863 | $75K | |
| 70553 | Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences | 200 | 188 | $73K |
| 86140 | 2,590 | 2,311 | $72K | |
| 87507 | 307 | 261 | $72K | |
| 97597 | 3,166 | 1,781 | $71K | |
| 83036 | Hemoglobin; glycosylated (A1C) | 6,393 | 5,957 | $71K |
| 93971 | 1,090 | 1,003 | $67K | |
| 86850 | 2,553 | 1,987 | $64K | |
| 87186 | 3,766 | 3,211 | $64K | |
| 76536 | 831 | 804 | $61K | |
| 74022 | 1,383 | 1,184 | $60K | |
| 85652 | 2,662 | 2,316 | $59K | |
| C9803 | Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source | 5,064 | 4,666 | $59K |
| 73610 | 1,686 | 1,450 | $58K | |
| 85045 | 4,133 | 2,968 | $56K | |
| J1644 | Injection, heparin sodium, per 1000 units | 1,688 | 1,077 | $55K |
| 73030 | 1,862 | 1,594 | $55K | |
| 72110 | 1,122 | 1,069 | $54K | |
| 73130 | 1,608 | 1,371 | $53K | |
| 87804 | Infectious agent antigen detection by immunoassay; Influenza, each type | 1,921 | 1,691 | $53K |
| 82728 | 1,827 | 1,615 | $53K | |
| 86900 | 2,639 | 2,002 | $51K | |
| 86901 | 2,643 | 2,003 | $50K | |
| 82746 | 1,512 | 1,422 | $49K | |
| J2920 | Injection, methylprednisolone sodium succinate, up to 40 mg | 671 | 285 | $48K |
| 96367 | 482 | 344 | $47K | |
| 83540 | 2,042 | 1,867 | $45K | |
| 70486 | 446 | 393 | $45K | |
| 85027 | 3,986 | 3,667 | $44K | |
| 97161 | 806 | 719 | $43K | |
| 87522 | Neg quan hep c or qual rna | 495 | 470 | $42K |
| 83550 | 1,083 | 982 | $39K | |
| M0243 | Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring | 93 | 91 | $38K |
| 83615 | 4,432 | 3,082 | $38K | |
| 80076 | 1,311 | 1,205 | $37K | |
| J3370 | Injection, vancomycin hcl, 500 mg | 775 | 458 | $37K |
| 73110 | 1,012 | 854 | $36K | |
| J2274 | Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg | 1,099 | 797 | $35K |
| J1815 | Injection, insulin, per 5 units | 1,219 | 900 | $35K |
| 72148 | Magnetic resonance imaging, lumbar spine; without contrast material | 233 | 226 | $33K |
| 93880 | 108 | 102 | $33K | |
| J7040 | Infusion, normal saline solution, sterile (500 ml = 1 unit) | 699 | 569 | $30K |
| 84702 | 1,093 | 857 | $30K | |
| 85378 | 1,175 | 1,013 | $30K | |
| 74018 | 918 | 799 | $29K | |
| J2175 | Injection, meperidine hydrochloride, per 100 mg | 77 | 51 | $29K |
| 59025 | Fetal non-stress test | 1,294 | 848 | $28K |
| 88312 | 244 | 233 | $28K | |
| 51702 | 556 | 460 | $28K | |
| 76830 | Ultrasound, transvaginal | 355 | 323 | $28K |
| 82140 | 1,449 | 1,174 | $27K | |
| J0330 | Injection, succinylcholine chloride, up to 20 mg | 588 | 525 | $27K |
| 99218 | 804 | 320 | $27K | |
| G0463 | Hospital outpatient clinic visit for assessment and management of a patient | 1,990 | 1,749 | $27K |
| 87389 | Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies | 705 | 661 | $26K |
| 80164 | 44 | 38 | $25K | |
| 99281 | Emergency department visit for the evaluation and management, self-limited or minor | 789 | 728 | $25K |
| J2930 | Injection, methylprednisolone sodium succinate, up to 125 mg | 1,283 | 1,043 | $24K |
| 72131 | 284 | 257 | $24K | |
| 74019 | 480 | 413 | $24K | |
| A9576 | Injection, gadoteridol, (prohance multipack), per ml | 307 | 289 | $23K |
| 94060 | 474 | 461 | $23K | |
| 73564 | 475 | 407 | $23K | |
| 80050 | General health panel | 638 | 592 | $23K |
| 73502 | 863 | 777 | $22K | |
| 82248 | 1,712 | 1,463 | $22K | |
| 97140 | Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) | 1,089 | 302 | $22K |
| 87902 | 27 | 27 | $21K | |
| J7050 | Infusion, normal saline solution, 250 cc | 671 | 526 | $21K |
| 64483 | 23 | 12 | $20K | |
| G0283 | Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care | 1,192 | 297 | $20K |
| 82565 | 911 | 858 | $20K | |
| 76770 | 343 | 329 | $20K | |
| 86780 | 746 | 700 | $19K | |
| 90715 | 323 | 277 | $19K | |
| 84520 | 860 | 814 | $19K | |
| A9585 | Injection, gadobutrol, 0.1 ml | 234 | 210 | $18K |
| J1956 | Injection, levofloxacin, 250 mg | 527 | 316 | $18K |
| J2550 | Injection, promethazine hcl, up to 50 mg | 318 | 243 | $18K |
| 84481 | 849 | 784 | $18K | |
| 73721 | Magnetic resonance imaging, any joint of lower extremity; without contrast material | 55 | 50 | $17K |
| J1200 | Injection, diphenhydramine hcl, up to 50 mg | 991 | 806 | $16K |
| 94729 | 320 | 314 | $16K | |
| 99211 | Office or other outpatient visit for the evaluation and management of an established patient, minimal severity | 1,092 | 1,048 | $15K |
| 77065 | Tomosynthesis, mammo | 118 | 115 | $15K |
| M0245 | Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring | 37 | 37 | $15K |
| 87635 | Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe | 648 | 620 | $15K |
| J2765 | Injection, metoclopramide hcl, up to 10 mg | 837 | 671 | $14K |
| J1642 | Injection, heparin sodium, (heparin lock flush), per 10 units | 661 | 412 | $14K |
| 96413 | Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance | 204 | 123 | $14K |
| 70551 | Magnetic resonance imaging, brain; without contrast material | 61 | 56 | $13K |
| Q0162 | Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen | 631 | 508 | $13K |
| 52000 | 41 | 38 | $13K | |
| 82009 | 546 | 431 | $13K | |
| 72050 | 254 | 239 | $13K | |
| 72100 | 398 | 378 | $13K | |
| 94726 | 339 | 333 | $13K | |
| J0171 | Injection, adrenalin, epinephrine, 0.1 mg | 106 | 87 | $13K |
| 82270 | 446 | 382 | $12K | |
| 76815 | Ultrasound, pregnant uterus, real time with image documentation, limited | 195 | 176 | $12K |
| 86063 | 336 | 279 | $12K | |
| 87075 | 582 | 493 | $12K | |
| 11045 | 252 | 52 | $12K | |
| 82784 | 76 | 66 | $12K | |
| J3475 | Injection, magnesium sulfate, per 500 mg | 582 | 435 | $12K |
| 88304 | 265 | 238 | $12K | |
| 83516 | 509 | 484 | $11K | |
| 73590 | 252 | 219 | $11K | |
| 77063 | Screening digital breast tomosynthesis, bilateral | 661 | 649 | $11K |
| 99152 | 56 | 36 | $11K | |
| 73090 | 229 | 198 | $11K | |
| 73080 | 357 | 328 | $10K | |
| J2370 | Injection, phenylephrine hcl, up to 1 ml | 204 | 168 | $10K |
| J2060 | Injection, lorazepam, 2 mg | 310 | 215 | $10K |
| J2360 | Injection, orphenadrine citrate, up to 60 mg | 210 | 183 | $9K |
| 72072 | 161 | 151 | $9K | |
| 90471 | Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine | 192 | 175 | $9K |
| J1580 | Injection, garamycin, gentamicin, up to 80 mg | 33 | 25 | $9K |
| 96368 | 268 | 205 | $9K | |
| 86038 | 520 | 500 | $8K | |
| 71275 | Computed tomographic angiography, chest, with contrast material | 118 | 111 | $8K |
| 86706 | 412 | 400 | $8K | |
| 93970 | 135 | 125 | $8K | |
| 76817 | Ultrasound, pregnant uterus, real time with image documentation, transvaginal | 155 | 132 | $7K |
| 89220 | 20 | 12 | $7K | |
| 88104 | 31 | 25 | $6K | |
| 45385 | Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) | 52 | 47 | $6K |
| 95810 | Polysomnography; sleep staging with 4 or more additional parameters | 13 | 12 | $6K |
| 70491 | 41 | 39 | $6K | |
| 87205 | 178 | 156 | $6K | |
| 77066 | Tomosynthesis, mammo | 58 | 56 | $6K |
| 76642 | 127 | 105 | $5K | |
| 99291 | Critical care, evaluation and management of the critically ill patient, first 30-74 minutes | 44 | 41 | $5K |
| 84550 | 432 | 379 | $5K | |
| 86803 | 232 | 213 | $5K | |
| 87651 | Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe | 206 | 187 | $5K |
| 31500 | 76 | 63 | $5K | |
| 88311 | 25 | 14 | $4K | |
| 12001 | 52 | 50 | $4K | |
| 12002 | 35 | 31 | $4K | |
| 10060 | 47 | 37 | $4K | |
| 87340 | 193 | 173 | $4K | |
| J3301 | Injection, triamcinolone acetonide, not otherwise specified, 10 mg | 232 | 202 | $4K |
| 93925 | 29 | 26 | $4K | |
| 97164 | 111 | 104 | $4K | |
| 93922 | 39 | 38 | $3K | |
| 11043 | 23 | 13 | $3K | |
| 82397 | 647 | 559 | $3K | |
| 71101 | 32 | 29 | $3K | |
| G0279 | Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066) | 107 | 106 | $2K |
| 87320 | 137 | 135 | $2K | |
| J1940 | Injection, furosemide, up to 20 mg | 98 | 77 | $2K |
| 82103 | 103 | 91 | $2K | |
| 83970 | 57 | 56 | $2K | |
| 86308 | 106 | 94 | $2K | |
| 70496 | 29 | 29 | $2K | |
| 72170 | 55 | 50 | $2K | |
| 36430 | 14 | 12 | $2K | |
| J7512 | Prednisone, immediate release or delayed release, oral, 1 mg | 50 | 41 | $2K |
| 82043 | 172 | 169 | $2K | |
| 72128 | 15 | 13 | $2K | |
| 84153 | 74 | 72 | $2K | |
| 76856 | Ultrasound, pelvic (nonobstetric), real time with image documentation; complete | 12 | 12 | $1K |
| 86762 | 110 | 96 | $1K | |
| 72040 | 14 | 13 | $1K | |
| 77080 | 14 | 14 | $1K | |
| 0002A | 88 | 81 | $1K | |
| 83655 | 74 | 71 | $1K | |
| 70498 | 15 | 15 | $1K | |
| 73552 | 33 | 28 | $998.17 | |
| 99204 | Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity | 18 | 13 | $963.40 |
| 86677 | 54 | 51 | $934.35 | |
| 99203 | Office or other outpatient visit for the evaluation and management of a new patient, low complexity | 16 | 15 | $933.81 |
| 0001A | 82 | 78 | $914.32 | |
| 87420 | 20 | 13 | $907.72 | |
| 86787 | 63 | 55 | $885.29 | |
| 87449 | 68 | 67 | $880.62 | |
| 87081 | 65 | 64 | $803.81 | |
| 86430 | 104 | 100 | $788.51 | |
| J0456 | Injection, azithromycin, 500 mg | 23 | 15 | $783.88 |
| 85018 | 86 | 64 | $763.04 | |
| 84156 | 65 | 61 | $760.95 | |
| 82247 | 78 | 68 | $727.19 | |
| 83010 | 39 | 38 | $700.59 | |
| Q3014 | Telehealth originating site facility fee | 50 | 37 | $647.44 |
| A9270 | Non-covered item or service | 108 | 80 | $616.58 |
| A9537 | Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries | 13 | 12 | $612.27 |
| 76870 | 14 | 13 | $595.26 | |
| 83525 | 53 | 52 | $577.37 | |
| 82378 | 30 | 25 | $443.83 | |
| 99213 | Office or other outpatient visit for the evaluation and management of an established patient, low complexity | 20 | 20 | $404.00 |
| 43753 | 12 | 12 | $392.00 | |
| C1769 | Guide wire | 55 | 52 | $389.00 |
| 88300 | 15 | 12 | $368.03 | |
| 83883 | 40 | 38 | $366.36 | |
| 97116 | 31 | 12 | $356.17 | |
| J2310 | Injection, naloxone hydrochloride, per 1 mg | 12 | 12 | $310.03 |
| 84436 | 49 | 47 | $256.24 | |
| 97530 | Therapeutic activities, direct patient contact, each 15 minutes | 24 | 13 | $251.91 |
| 84460 | 26 | 26 | $226.78 | |
| 86922 | 16 | 13 | $223.59 | |
| 82950 | 17 | 15 | $212.10 | |
| Q0245 | Injection, bamlanivimab and etesevimab, 2100 mg | 51 | 51 | $194.94 |
| 86735 | 13 | 13 | $154.05 | |
| 86765 | 13 | 13 | $151.96 | |
| 82172 | 13 | 13 | $151.84 | |
| 82977 | 27 | 26 | $131.68 | |
| 82542 | 16 | 15 | $130.08 | |
| 82465 | 36 | 36 | $114.35 | |
| J1953 | Injection, levetiracetam, 10 mg | 30 | 24 | $75.23 |
| J0744 | Injection, ciprofloxacin for intravenous infusion, 200 mg | 20 | 12 | $69.25 |
| 82947 | 14 | 13 | $38.94 | |
| J2919 | Injection, methylprednisolone sodium succinate, 5 mg | 15 | 12 | $1.47 |
| G0103 | Prostate cancer screening; prostate specific antigen test (psa) | 16 | 16 | $0.00 |