| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J9271 |
Inj pembrolizumab |
3,611 |
2,777 |
$21.33M |
| 77386 |
|
6,719 |
785 |
$8.50M |
| 78815 |
|
5,736 |
5,627 |
$8.16M |
| J9299 |
Injection, nivolumab |
1,978 |
1,319 |
$8.09M |
| J9144 |
Daratumumab, hyaluronidase |
1,319 |
827 |
$6.01M |
| J9306 |
Injection, pertuzumab, 1 mg |
1,142 |
824 |
$5.12M |
| 80053 |
|
92,593 |
61,318 |
$4.92M |
| J9358 |
Inj fam-trastu deru-nxki 1mg |
1,270 |
593 |
$4.84M |
| J2506 |
Inj pegfilgrast ex bio 0.5mg |
3,574 |
2,623 |
$4.51M |
| 96413 |
|
37,635 |
22,884 |
$4.47M |
| J2505 |
Injection, pegfilgrastim 6mg |
1,877 |
1,424 |
$4.38M |
| J0897 |
Denosumab injection |
3,869 |
3,659 |
$4.24M |
| Q5107 |
Inj mvasi 10 mg |
4,141 |
1,774 |
$3.54M |
| 74178 |
|
5,768 |
5,612 |
$3.31M |
| 71260 |
|
11,999 |
11,548 |
$3.21M |
| 0510 |
|
44,843 |
32,071 |
$3.11M |
| 38204 |
|
651 |
445 |
$3.00M |
| 96375 |
|
25,848 |
15,490 |
$2.77M |
| Q5117 |
Inj., kanjinti, 10 mg |
2,858 |
1,533 |
$2.70M |
| J9355 |
Inj trastuzumab excl biosimi |
830 |
517 |
$2.25M |
| G0463 |
Hospital outpt clinic visit |
93,378 |
63,069 |
$2.23M |
| 70553 |
|
3,208 |
3,131 |
$1.91M |
| 85025 |
|
84,672 |
55,281 |
$1.82M |
| 88185 |
|
2,614 |
1,660 |
$1.65M |
| P9037 |
Plate pheres leukoredu irrad |
2,349 |
993 |
$1.64M |
| J9354 |
Inj, ado-trastuzumab emt 1mg |
428 |
190 |
$1.47M |
| 77334 |
|
2,692 |
2,090 |
$1.42M |
| J0185 |
Inj., aprepitant, 1 mg |
8,416 |
5,490 |
$1.40M |
| 81455 |
|
526 |
512 |
$1.35M |
| 96365 |
|
8,442 |
5,439 |
$1.27M |
| 77301 |
|
1,051 |
996 |
$1.26M |
| 77373 |
|
891 |
275 |
$1.24M |
| 93306 |
|
2,016 |
1,958 |
$1.23M |
| 74177 |
|
2,177 |
2,148 |
$1.22M |
| A9552 |
F18 fdg |
5,689 |
5,458 |
$1.04M |
| 77412 |
|
7,641 |
948 |
$1.01M |
| J2353 |
Octreotide injection, depot |
254 |
233 |
$1.01M |
| P9040 |
Rbc leukoreduced irradiated |
4,588 |
2,617 |
$1.01M |
| 78816 |
|
574 |
565 |
$926K |
| J9202 |
Goserelin acetate implant |
1,496 |
1,371 |
$920K |
| J1569 |
Gammagard liquid injection |
841 |
441 |
$890K |
| 88341 |
|
3,328 |
2,544 |
$876K |
| 96417 |
|
10,916 |
7,118 |
$861K |
| 77300 |
|
2,063 |
1,857 |
$853K |
| 0710 |
|
2,509 |
2,157 |
$842K |
| 96367 |
|
9,982 |
6,831 |
$735K |
| 74183 |
|
1,475 |
1,460 |
$711K |
| 96415 |
|
8,631 |
5,892 |
$705K |
| 38222 |
|
977 |
849 |
$664K |
| 83735 |
|
20,939 |
12,174 |
$664K |
| 71250 |
|
2,687 |
2,608 |
$661K |
| 0370 |
|
2,022 |
1,522 |
$659K |
| 72197 |
|
1,192 |
1,176 |
$648K |
| Q5115 |
Inj truxima 10 mg |
738 |
286 |
$634K |
| 96372 |
|
14,795 |
10,882 |
$605K |
| J1439 |
Inj ferric carboxymaltos 1mg |
1,025 |
680 |
$604K |
| J9035 |
Bevacizumab injection |
283 |
147 |
$578K |
| 77336 |
|
5,326 |
2,702 |
$555K |
| 96361 |
|
5,927 |
3,326 |
$537K |
| J9173 |
Inj., durvalumab, 10 mg |
92 |
80 |
$513K |
| 83615 |
|
27,506 |
16,632 |
$495K |
| Z7500 |
|
14,558 |
10,269 |
$492K |
| 87497 |
|
6,068 |
2,997 |
$491K |
| 77338 |
|
1,082 |
991 |
$474K |
| 88305 |
|
4,792 |
4,395 |
$474K |
| J9217 |
Leuprolide acetate suspnsion |
1,234 |
1,204 |
$470K |
| 0760 |
|
11,274 |
7,396 |
$458K |
| 87633 |
|
947 |
887 |
$428K |
| 99203 |
|
1,836 |
929 |
$396K |
| 88342 |
|
3,998 |
3,544 |
$390K |
| J3490 |
Drugs unclassified injection |
14,538 |
7,061 |
$383K |
| J9395 |
Injection, fulvestrant |
1,587 |
1,390 |
$374K |
| 96366 |
|
3,790 |
2,529 |
$365K |
| 99070 |
|
17,222 |
6,065 |
$340K |
| 96416 |
|
2,636 |
1,596 |
$326K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
11,387 |
10,895 |
$322K |
| 99499 |
|
734 |
486 |
$321K |
| 76641 |
|
2,821 |
2,678 |
$320K |
| 96374 |
|
3,422 |
2,315 |
$313K |
| 80197 |
|
4,848 |
1,931 |
$304K |
| A9270 |
Non-covered item or service |
6,953 |
4,195 |
$301K |
| 86885 |
|
6,781 |
5,040 |
$300K |
| 77295 |
|
312 |
268 |
$296K |
| 82784 |
|
13,672 |
8,690 |
$294K |
| 88261 |
|
753 |
672 |
$286K |
| 78306 |
|
999 |
981 |
$283K |
| 96360 |
|
2,331 |
1,423 |
$275K |
| 88360 |
|
1,524 |
1,288 |
$265K |
| 70491 |
|
1,012 |
977 |
$262K |
| 96377 |
|
3,006 |
2,328 |
$259K |
| 97110 |
|
4,796 |
1,963 |
$252K |
| 93307 |
|
732 |
721 |
$249K |
| J1950 |
Leuprolide acetate /3.75 mg |
205 |
191 |
$243K |
| J9305 |
Inj. pemetrexed nos 10mg |
601 |
282 |
$243K |
| 81479 |
|
500 |
471 |
$242K |
| J9264 |
Paclitaxel protein bound |
329 |
92 |
$241K |
| 87635 |
|
3,286 |
2,801 |
$236K |
| 96402 |
|
4,094 |
3,777 |
$235K |
| 81378 |
|
272 |
212 |
$233K |
| J1442 |
Inj filgrastim excl biosimil |
1,015 |
431 |
$222K |
| P9073 |
Platelets pheresis path redu |
380 |
186 |
$221K |
| 77290 |
|
608 |
507 |
$220K |
| J0881 |
Darbepoetin alfa, non-esrd |
522 |
393 |
$220K |
| J0640 |
Leucovorin calcium injection |
4,912 |
2,686 |
$216K |
| 86900 |
|
8,103 |
5,705 |
$213K |
| 93005 |
|
3,626 |
3,362 |
$208K |
| 99213 |
|
6,115 |
4,535 |
$207K |
| 85027 |
|
12,799 |
9,552 |
$207K |
| 84100 |
|
11,743 |
7,047 |
$202K |
| 86901 |
|
8,069 |
5,704 |
$193K |
| 96401 |
|
3,013 |
1,595 |
$190K |
| J9070 |
Cyclophosphamide 100 mg inj |
1,020 |
357 |
$190K |
| 36430 |
|
1,603 |
697 |
$180K |
| J9171 |
Docetaxel injection |
621 |
428 |
$179K |
| 88184 |
|
2,008 |
1,711 |
$179K |
| A9595 |
Piflu f-18, dia 1 millicurie |
57 |
54 |
$174K |
| A9585 |
Gadobutrol injection |
5,043 |
4,788 |
$173K |
| 82378 |
|
7,496 |
6,552 |
$173K |
| 84443 |
|
9,140 |
8,248 |
$170K |
| 96368 |
|
4,005 |
2,495 |
$167K |
| 80195 |
|
2,487 |
1,025 |
$161K |
| 86923 |
|
1,935 |
1,288 |
$158K |
| 76536 |
|
1,369 |
1,353 |
$153K |
| 88271 |
|
485 |
259 |
$150K |
| 71046 |
|
2,267 |
2,093 |
$149K |
| 80048 |
|
4,182 |
3,312 |
$144K |
| 81382 |
|
272 |
210 |
$140K |
| 0250 |
|
9,759 |
4,718 |
$139K |
| 84550 |
|
9,585 |
5,748 |
$131K |
| 77470 |
|
494 |
480 |
$130K |
| 88307 |
|
747 |
664 |
$128K |
| 96409 |
|
1,311 |
743 |
$126K |
| 86316 |
|
8,099 |
6,778 |
$123K |
| 77065 |
Tomosynthesis, mammo |
1,504 |
1,436 |
$122K |
| 99221 |
|
814 |
749 |
$118K |
| 77066 |
Tomosynthesis, mammo |
1,185 |
1,173 |
$117K |
| 84439 |
|
7,364 |
6,648 |
$117K |
| 36591 |
|
4,976 |
3,161 |
$115K |
| 96523 |
|
718 |
701 |
$112K |
| 82565 |
|
9,668 |
9,235 |
$111K |
| J3489 |
Zoledronic acid 1mg |
2,106 |
1,999 |
$111K |
| J1453 |
Fosaprepitant injection |
767 |
546 |
$109K |
| J7060 |
5% dextrose/water |
15,043 |
5,901 |
$108K |
| J7050 |
Normal saline solution infus |
26,615 |
13,114 |
$108K |
| C9803 |
Hopd covid-19 spec collect |
5,105 |
4,516 |
$107K |
| G0498 |
Chemo extend iv infus w/pump |
1,065 |
673 |
$101K |
| 0391 |
|
318 |
174 |
$100K |
| 85007 |
|
5,348 |
3,235 |
$100K |
| U0002 |
Covid-19 lab test non-cdc |
2,115 |
1,893 |
$96K |
| 88237 |
|
868 |
778 |
$96K |
| 97530 |
|
2,119 |
875 |
$95K |
| 82948 |
|
7,376 |
6,627 |
$94K |
| 85610 |
|
5,681 |
4,733 |
$94K |
| J2997 |
Alteplase recombinant |
795 |
707 |
$93K |
| 99199 |
|
994 |
764 |
$91K |
| 94729 |
|
842 |
813 |
$90K |
| J7030 |
Normal saline solution infus |
9,059 |
5,027 |
$90K |
| 80061 |
|
4,651 |
4,505 |
$89K |
| J1642 |
Inj heparin sodium per 10 u |
16,029 |
6,944 |
$89K |
| 82306 |
|
3,580 |
3,504 |
$88K |
| 97140 |
|
1,363 |
657 |
$84K |
| J9190 |
Fluorouracil injection |
6,046 |
2,949 |
$82K |
| 94727 |
|
684 |
662 |
$82K |
| 83883 |
|
5,053 |
3,284 |
$81K |
| Q3014 |
Telehealth facility fee |
4,619 |
4,163 |
$80K |
| 84165 |
|
3,668 |
3,281 |
$80K |
| J9267 |
Paclitaxel injection |
2,925 |
1,474 |
$78K |
| 96411 |
|
1,655 |
1,155 |
$77K |
| 77280 |
|
362 |
338 |
$76K |
| C9290 |
Inj, bupivacaine liposome |
266 |
256 |
$75K |
| 77080 |
|
1,025 |
1,011 |
$74K |
| 81001 |
|
4,752 |
4,284 |
$74K |
| 88381 |
|
405 |
390 |
$73K |
| 0761 |
|
603 |
362 |
$73K |
| 88108 |
|
1,139 |
957 |
$72K |
| 81268 |
|
371 |
259 |
$71K |
| 85730 |
|
4,148 |
3,507 |
$71K |
| 82728 |
|
2,988 |
2,301 |
$70K |
| 74176 |
|
299 |
294 |
$69K |
| A0429 |
Bls-emergency |
510 |
198 |
$68K |
| 86334 |
|
1,809 |
1,645 |
$66K |
| J9308 |
Injection, ramucirumab |
29 |
12 |
$66K |
| J9263 |
Oxaliplatin |
2,337 |
1,152 |
$65K |
| 76856 |
|
360 |
358 |
$64K |
| 82248 |
|
5,730 |
3,726 |
$64K |
| 88275 |
|
121 |
95 |
$63K |
| 72158 |
|
96 |
92 |
$62K |
| J9206 |
Irinotecan injection |
1,871 |
974 |
$61K |
| 77049 |
|
63 |
63 |
$60K |
| 83721 |
|
3,775 |
3,642 |
$59K |
| J9075 |
Inj, cyclophosphamide, nos |
529 |
137 |
$59K |
| 86304 |
|
2,439 |
2,019 |
$58K |
| J9045 |
Carboplatin injection |
2,424 |
1,639 |
$57K |
| J2405 |
Ondansetron hcl injection |
18,331 |
10,766 |
$56K |
| A9577 |
Inj multihance |
1,413 |
1,351 |
$55K |
| 76830 |
|
352 |
350 |
$55K |
| 87086 |
|
2,194 |
2,023 |
$53K |
| 94010 |
|
438 |
424 |
$50K |
| 99231 |
|
1,477 |
1,215 |
$47K |
| G0279 |
Tomosynthesis, mammo |
1,556 |
1,537 |
$46K |
| J1100 |
Dexamethasone sodium phos |
15,612 |
9,679 |
$45K |
| 81371 |
|
49 |
37 |
$45K |
| 87040 |
|
582 |
444 |
$43K |
| 0636 |
|
4,051 |
1,557 |
$43K |
| 83036 |
|
3,528 |
3,455 |
$42K |
| 99152 |
|
792 |
747 |
$42K |
| J9041 |
Injection, bortezomib, 0.1mg |
625 |
142 |
$42K |
| 88280 |
|
731 |
655 |
$41K |
| 81267 |
|
273 |
234 |
$41K |
| 77387 |
|
132 |
13 |
$40K |
| J9201 |
In gemcitabine hcl nos 200mg |
1,618 |
715 |
$38K |
| 86301 |
|
1,835 |
1,610 |
$35K |
| 82746 |
|
1,815 |
1,782 |
$34K |
| 0401 |
|
455 |
450 |
$34K |
| A9581 |
Gadoxetate disodium inj |
399 |
380 |
$34K |
| 82105 |
|
582 |
499 |
$34K |
| J7040 |
Normal saline solution infus |
5,876 |
3,506 |
$32K |
| 84153 |
|
2,731 |
2,569 |
$32K |
| 87070 |
|
587 |
461 |
$32K |
| 84403 |
|
1,848 |
1,778 |
$31K |
| 36593 |
|
492 |
426 |
$31K |
| G0378 |
Hospital observation per hr |
538 |
247 |
$31K |
| J9317 |
Sacituzumab govitecan-hziy |
48 |
13 |
$31K |
| J7120 |
Ringers lactate infusion |
2,428 |
2,058 |
$30K |
| 90734 |
|
26 |
24 |
$30K |
| 90677 |
|
108 |
102 |
$29K |
| 88311 |
|
1,131 |
969 |
$29K |
| 99238 |
|
1,023 |
869 |
$29K |
| J1720 |
Hydrocortisone sodium succ i |
2,669 |
1,997 |
$29K |
| 77067 |
|
377 |
376 |
$28K |
| 82607 |
|
2,013 |
1,975 |
$28K |
| J1561 |
Gamunex-c/gammaked |
44 |
28 |
$26K |
| 88285 |
|
680 |
616 |
$26K |
| 82533 |
|
991 |
877 |
$25K |
| J2704 |
Inj, propofol, 10 mg |
4,881 |
3,458 |
$23K |
| 71045 |
|
482 |
455 |
$23K |
| 36592 |
|
1,436 |
533 |
$23K |
| 86480 |
|
648 |
577 |
$22K |
| 83690 |
|
694 |
547 |
$22K |
| 84481 |
|
1,315 |
1,224 |
$22K |
| 86140 |
|
1,372 |
842 |
$21K |
| 93971 |
|
145 |
139 |
$21K |
| Q5112 |
Inj ontruzant 10 mg |
27 |
15 |
$21K |
| 76770 |
|
143 |
142 |
$21K |
| A9503 |
Tc99m medronate |
849 |
835 |
$20K |
| 93970 |
|
42 |
41 |
$19K |
| 97802 |
|
181 |
178 |
$19K |
| 84466 |
|
1,386 |
1,319 |
$19K |
| 96156 |
|
189 |
165 |
$18K |
| 90471 |
|
1,219 |
1,153 |
$17K |
| 82570 |
|
1,995 |
1,929 |
$17K |
| 86833 |
|
151 |
135 |
$16K |
| 86832 |
|
147 |
135 |
$16K |
| 83970 |
|
499 |
481 |
$16K |
| 78452 |
|
52 |
50 |
$16K |
| 0270 |
|
2,180 |
742 |
$16K |
| G0108 |
Diab manage trn per indiv |
195 |
184 |
$15K |
| 81025 |
|
960 |
856 |
$14K |
| 82150 |
|
521 |
407 |
$14K |
| J9000 |
Doxorubicin hcl injection |
659 |
338 |
$13K |
| 87624 |
|
620 |
576 |
$13K |
| 77417 |
|
238 |
119 |
$13K |
| 83540 |
|
1,384 |
1,316 |
$13K |
| 88323 |
|
100 |
99 |
$13K |
| 99218 |
|
84 |
83 |
$13K |
| J1200 |
Diphenhydramine hcl injectio |
10,807 |
6,457 |
$12K |
| J0780 |
Prochlorperazine injection |
2,419 |
1,480 |
$11K |
| 76705 |
|
82 |
81 |
$11K |
| 87340 |
|
582 |
546 |
$11K |
| 99153 |
Mod sedat endo service >5yrs |
245 |
230 |
$10K |
| 87799 |
|
151 |
121 |
$10K |
| 90686 |
|
525 |
508 |
$10K |
| 82043 |
|
1,446 |
1,422 |
$10K |
| 87389 |
|
342 |
325 |
$10K |
| 87077 |
|
573 |
502 |
$10K |
| 84702 |
|
607 |
527 |
$9K |
| 82550 |
|
410 |
356 |
$9K |
| 86300 |
|
465 |
382 |
$9K |
| 77063 |
|
378 |
377 |
$9K |
| J9060 |
Cisplatin 10 mg injection |
600 |
249 |
$9K |
| J1170 |
Hydromorphone injection |
2,333 |
1,622 |
$8K |
| 87186 |
|
335 |
306 |
$8K |
| 77332 |
|
42 |
38 |
$8K |
| 86704 |
|
449 |
428 |
$7K |
| 84478 |
|
241 |
122 |
$7K |
| 99234 |
|
769 |
633 |
$7K |
| 86803 |
|
374 |
359 |
$7K |
| 93017 |
|
39 |
38 |
$7K |
| Q5101 |
Injection, zarxio |
99 |
41 |
$7K |
| J0690 |
Cefazolin sodium injection |
1,690 |
1,313 |
$7K |
| 88142 |
|
195 |
194 |
$7K |
| 72157 |
|
13 |
13 |
$7K |
| 84480 |
|
461 |
446 |
$6K |
| 84156 |
|
466 |
432 |
$6K |
| 96450 |
|
15 |
13 |
$6K |
| J2001 |
Lidocaine injection |
2,653 |
2,280 |
$6K |
| J0461 |
Atropine sulfate injection |
1,540 |
956 |
$6K |
| J3010 |
Fentanyl citrate injection |
3,664 |
3,122 |
$5K |
| Z7610 |
|
524 |
318 |
$5K |
| 88374 |
|
16 |
15 |
$5K |
| J3475 |
Inj magnesium sulfate |
2,083 |
1,029 |
$5K |
| 88313 |
|
88 |
81 |
$5K |
| 81002 |
|
792 |
530 |
$5K |
| 84432 |
|
406 |
370 |
$5K |
| 86359 |
|
94 |
90 |
$5K |
| 86706 |
|
253 |
246 |
$5K |
| 77293 |
|
12 |
12 |
$5K |
| 81206 |
|
28 |
24 |
$5K |
| 86800 |
|
554 |
524 |
$5K |
| 85384 |
|
205 |
96 |
$4K |
| 81207 |
|
28 |
24 |
$4K |
| 0360 |
|
54 |
37 |
$4K |
| J0131 |
Inj, acetaminophen (nos) |
212 |
175 |
$4K |
| 52000 |
|
112 |
108 |
$4K |
| 93702 |
|
40 |
40 |
$4K |
| 85046 |
|
450 |
367 |
$4K |
| 90670 |
|
14 |
14 |
$4K |
| 88264 |
|
33 |
32 |
$4K |
| 99217 |
|
126 |
114 |
$4K |
| 86870 |
|
69 |
42 |
$3K |
| 36561 |
|
25 |
24 |
$3K |
| 0160 |
|
97 |
37 |
$3K |
| J1644 |
Inj heparin sodium per 1000u |
1,033 |
558 |
$3K |
| 90746 |
|
44 |
40 |
$3K |
| J2785 |
Regadenoson injection |
37 |
36 |
$3K |
| A9502 |
Tc99m tetrofosmin |
29 |
26 |
$3K |
| 86360 |
|
52 |
50 |
$3K |
| 0001A |
|
68 |
68 |
$3K |
| 76642 |
|
30 |
29 |
$2K |
| 77790 |
|
26 |
26 |
$2K |
| 83550 |
|
476 |
463 |
$2K |
| 87205 |
|
178 |
167 |
$2K |
| 83605 |
|
147 |
128 |
$2K |
| 86960 |
|
123 |
41 |
$2K |
| 90715 |
|
43 |
39 |
$2K |
| 90713 |
|
43 |
39 |
$2K |
| 97167 |
|
24 |
24 |
$2K |
| 97112 |
|
28 |
14 |
$2K |
| G1004 |
Cdsm ndsc |
1,415 |
1,170 |
$2K |
| 94726 |
|
20 |
20 |
$1K |
| 88312 |
|
39 |
37 |
$1K |
| J2250 |
Inj midazolam hydrochloride |
2,798 |
2,401 |
$1K |
| 76937 |
|
47 |
47 |
$1K |
| 82681 |
|
27 |
27 |
$1K |
| 82024 |
|
60 |
55 |
$1K |
| J9999 |
Chemotherapy drug |
339 |
167 |
$1K |
| 89051 |
|
54 |
38 |
$1K |
| 0002A |
|
31 |
31 |
$1K |
| 85652 |
|
207 |
196 |
$1K |
| J2060 |
Lorazepam injection |
954 |
642 |
$1K |
| 76942 |
|
27 |
27 |
$1K |
| 76700 |
|
12 |
12 |
$1K |
| 90662 |
|
216 |
214 |
$1K |
| 85651 |
|
33 |
29 |
$1K |
| J3420 |
Vitamin b12 injection |
764 |
688 |
$1K |
| 77001 |
|
15 |
15 |
$1K |
| 82523 |
|
279 |
252 |
$1K |
| 87517 |
|
57 |
54 |
$1K |
| 90648 |
|
68 |
65 |
$990.71 |
| J1756 |
Iron sucrose injection |
27 |
12 |
$942.59 |
| J2270 |
Morphine sulfate injection |
111 |
85 |
$928.49 |
| A4648 |
Implantable tissue marker |
13 |
12 |
$915.99 |
| 77062 |
|
33 |
28 |
$906.70 |
| J2003 |
Inj, lidocaine hcl, 1 mg |
59 |
58 |
$850.56 |
| J9370 |
Vincristine sulfate 1 mg inj |
95 |
62 |
$796.87 |
| 0300 |
|
209 |
75 |
$780.46 |
| 71020 |
|
27 |
14 |
$658.51 |
| J3480 |
Inj potassium chloride |
727 |
374 |
$654.99 |
| 85049 |
|
43 |
29 |
$650.21 |
| 96150 |
|
13 |
13 |
$645.76 |
| 88173 |
|
12 |
12 |
$563.64 |
| 86592 |
|
185 |
178 |
$542.54 |
| 82945 |
|
36 |
26 |
$507.91 |
| 82977 |
|
47 |
36 |
$491.00 |
| 83001 |
|
24 |
24 |
$479.47 |
| 84157 |
|
35 |
26 |
$462.32 |
| 82575 |
|
28 |
27 |
$439.59 |
| 87075 |
|
12 |
12 |
$406.06 |
| 97162 |
|
12 |
12 |
$401.60 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
140 |
132 |
$376.60 |
| J2371 |
Inj phenylephrine hcl 20 mcg |
72 |
69 |
$373.00 |
| 83010 |
|
14 |
12 |
$349.68 |
| 45330 |
|
12 |
12 |
$315.23 |
| 88172 |
|
12 |
12 |
$270.26 |
| 0305 |
|
163 |
70 |
$266.00 |
| 86376 |
|
40 |
39 |
$263.61 |
| 88300 |
|
12 |
12 |
$255.89 |
| 87493 |
|
12 |
12 |
$254.28 |
| 83002 |
|
12 |
12 |
$229.36 |
| 90472 |
|
14 |
14 |
$227.30 |
| 0306 |
|
55 |
16 |
$192.00 |
| 90656 |
|
13 |
13 |
$187.90 |
| 86644 |
|
28 |
26 |
$180.64 |
| 83516 |
|
27 |
25 |
$171.75 |
| G0008 |
Admin influenza virus vac |
223 |
221 |
$166.22 |
| 86705 |
|
14 |
14 |
$163.45 |
| 0301 |
|
204 |
57 |
$157.81 |
| 83520 |
|
14 |
12 |
$144.37 |
| 84155 |
|
13 |
12 |
$114.48 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
30 |
25 |
$76.48 |
| J0136 |
Inj, acetaminophen (b braun) |
85 |
73 |
$74.73 |
| J1580 |
Garamycin gentamicin inj |
13 |
13 |
$67.70 |
| J0689 |
Inj cefazolin sodium, baxter |
29 |
25 |
$65.22 |
| J2919 |
Inj, methylpred sod succ 5mg |
15 |
12 |
$56.10 |
| J0330 |
Succinycholine chloride inj |
15 |
13 |
$48.45 |
| J1956 |
Levofloxacin injection |
12 |
12 |
$46.82 |
| 81003 |
|
15 |
12 |
$35.08 |
| J7613 |
Albuterol non-comp unit |
32 |
27 |
$30.28 |
| J9260 |
Inj methotrexate sodium 50mg |
22 |
12 |
$28.76 |
| J1885 |
Ketorolac tromethamine inj |
18 |
12 |
$9.61 |
| 0260 |
|
84 |
25 |
$0.00 |
| 0335 |
|
59 |
16 |
$0.00 |