| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
|
355,637 |
314,455 |
$38.41M |
| 99283 |
|
180,908 |
165,764 |
$18.27M |
| 99212 |
|
143,014 |
126,499 |
$14.91M |
| 99214 |
|
100,861 |
92,492 |
$10.92M |
| 99282 |
|
85,830 |
80,332 |
$8.47M |
| 80053 |
|
65,160 |
51,972 |
$5.75M |
| D0120 |
|
59,735 |
56,417 |
$5.60M |
| 99211 |
|
38,930 |
33,872 |
$5.41M |
| 99284 |
|
43,169 |
39,573 |
$4.39M |
| 97110 |
|
80,499 |
38,264 |
$4.35M |
| 87637 |
|
23,508 |
22,245 |
$3.62M |
| P9016 |
Rbc leukocytes reduced |
4,930 |
4,066 |
$3.40M |
| 99215 |
Prolong outpt/office vis |
37,851 |
32,025 |
$3.40M |
| 41899 |
|
5,074 |
4,491 |
$3.29M |
| 42820 |
|
4,113 |
3,930 |
$3.08M |
| 97112 |
|
65,316 |
30,513 |
$2.79M |
| D2930 |
|
19,264 |
4,634 |
$2.77M |
| G0378 |
Hospital observation per hr |
15,551 |
13,921 |
$2.60M |
| 96365 |
|
19,144 |
15,524 |
$2.58M |
| 93303 |
|
10,700 |
10,021 |
$2.38M |
| 87635 |
|
36,292 |
33,463 |
$2.37M |
| 92567 |
|
36,231 |
33,963 |
$1.98M |
| 96361 |
|
10,224 |
9,086 |
$1.97M |
| 94640 |
|
25,551 |
18,372 |
$1.88M |
| J1745 |
Infliximab not biosimil 10mg |
2,141 |
1,974 |
$1.86M |
| 43239 |
|
5,721 |
5,355 |
$1.84M |
| 70551 |
|
11,189 |
10,294 |
$1.78M |
| U0003 |
Cov-19 amp prb hgh thruput |
20,091 |
18,373 |
$1.69M |
| 97530 |
|
33,887 |
18,013 |
$1.67M |
| D1120 |
|
51,472 |
48,556 |
$1.65M |
| 69436 |
|
3,381 |
3,228 |
$1.62M |
| 93320 |
|
10,789 |
10,043 |
$1.59M |
| 85025 |
|
88,941 |
73,458 |
$1.52M |
| 92507 |
|
29,172 |
13,530 |
$1.39M |
| D2391 |
|
6,851 |
5,230 |
$1.37M |
| D1206 |
|
67,166 |
63,221 |
$1.28M |
| 95810 |
|
3,861 |
3,702 |
$1.22M |
| 93306 |
|
5,044 |
4,711 |
$1.17M |
| J1569 |
Gammagard liquid injection |
1,490 |
1,182 |
$1.15M |
| 93325 |
|
17,754 |
16,328 |
$1.13M |
| 80048 |
|
15,370 |
12,695 |
$1.11M |
| 70450 |
|
6,643 |
6,198 |
$1.08M |
| 36430 |
|
5,154 |
3,997 |
$1.07M |
| 87651 |
|
16,889 |
16,078 |
$1.05M |
| C9803 |
Hopd covid-19 spec collect |
12,633 |
12,125 |
$1.04M |
| D8670 |
|
4,969 |
4,382 |
$1.04M |
| 96040 |
|
8,142 |
7,523 |
$1.01M |
| 90834 |
|
10,321 |
7,065 |
$983K |
| D2392 |
|
4,988 |
3,455 |
$962K |
| D7140 |
|
7,526 |
3,665 |
$955K |
| 82306 |
|
20,894 |
19,009 |
$920K |
| 64643 |
|
3,226 |
3,149 |
$909K |
| 95782 |
|
2,632 |
2,486 |
$888K |
| 81229 |
|
1,582 |
1,491 |
$887K |
| 76775 |
|
10,431 |
9,802 |
$873K |
| 86900 |
|
9,123 |
7,476 |
$866K |
| 70553 |
|
4,057 |
3,778 |
$860K |
| 93321 |
|
5,501 |
5,090 |
$860K |
| 87502 |
|
6,530 |
6,155 |
$857K |
| 96366 |
|
4,542 |
2,858 |
$843K |
| D1351 |
|
20,752 |
8,793 |
$837K |
| J0585 |
Injection,onabotulinumtoxina |
3,919 |
3,774 |
$819K |
| 92579 |
|
16,267 |
15,312 |
$817K |
| 87491 |
|
16,568 |
12,308 |
$795K |
| 96413 |
|
6,722 |
4,777 |
$776K |
| 76705 |
|
13,064 |
11,867 |
$756K |
| 96360 |
|
6,326 |
5,834 |
$751K |
| 87070 |
|
13,524 |
11,030 |
$749K |
| 93308 |
|
3,594 |
3,293 |
$746K |
| 86003 |
|
49,661 |
5,481 |
$738K |
| 82728 |
|
26,582 |
23,601 |
$722K |
| 93356 |
|
3,995 |
3,760 |
$685K |
| D9920 |
|
3,272 |
3,125 |
$671K |
| 83036 |
|
28,359 |
25,796 |
$668K |
| 42830 |
|
968 |
925 |
$668K |
| 87591 |
|
16,770 |
12,283 |
$630K |
| D0150 |
|
4,996 |
4,677 |
$625K |
| 84443 |
|
31,186 |
28,359 |
$610K |
| 80061 |
|
17,897 |
16,389 |
$608K |
| 11900 |
|
5,195 |
4,902 |
$606K |
| 82803 |
|
8,155 |
7,406 |
$596K |
| 96367 |
|
5,211 |
4,079 |
$586K |
| 92587 |
|
9,279 |
8,823 |
$564K |
| 99281 |
|
5,472 |
5,222 |
$553K |
| 84439 |
|
18,957 |
17,154 |
$552K |
| 95819 |
|
3,410 |
3,240 |
$546K |
| 92523 |
|
5,604 |
5,282 |
$540K |
| 64642 |
|
3,704 |
3,609 |
$518K |
| G0483 |
Drug test def 22+ classes |
2,975 |
2,665 |
$498K |
| 81003 |
|
23,638 |
20,346 |
$491K |
| D1110 |
|
12,924 |
12,278 |
$491K |
| 81025 |
|
18,176 |
16,334 |
$468K |
| 44970 |
|
318 |
297 |
$466K |
| 93304 |
|
2,032 |
1,915 |
$454K |
| D0272 |
|
30,647 |
28,744 |
$451K |
| 80197 |
|
9,770 |
5,302 |
$447K |
| 83021 |
|
7,737 |
6,859 |
$445K |
| 87077 |
|
25,693 |
15,853 |
$443K |
| 17110 |
|
4,249 |
4,016 |
$430K |
| 99285 |
|
4,351 |
3,953 |
$426K |
| 71046 |
|
27,215 |
24,818 |
$423K |
| 29075 |
|
4,737 |
4,228 |
$406K |
| 80307 |
|
4,661 |
4,163 |
$404K |
| 94010 |
|
22,798 |
20,676 |
$396K |
| 92555 |
|
8,006 |
7,569 |
$389K |
| 82247 |
|
9,527 |
6,234 |
$373K |
| 97162 |
|
6,464 |
6,213 |
$373K |
| 93976 |
|
5,761 |
5,252 |
$369K |
| 96910 |
|
4,445 |
937 |
$366K |
| 96415 |
|
2,055 |
1,587 |
$365K |
| 87086 |
|
22,331 |
19,695 |
$362K |
| 97161 |
|
6,080 |
5,850 |
$353K |
| 82962 |
|
15,129 |
9,354 |
$352K |
| 95700 |
|
2,224 |
1,987 |
$350K |
| 92557 |
|
3,090 |
2,946 |
$345K |
| 76856 |
|
4,265 |
3,942 |
$344K |
| 95874 |
|
3,076 |
2,994 |
$344K |
| 74177 |
|
2,260 |
2,082 |
$344K |
| 12011 |
|
3,085 |
2,933 |
$339K |
| 83655 |
|
10,611 |
9,891 |
$335K |
| 92504 |
|
9,787 |
8,991 |
$320K |
| 92610 |
|
5,005 |
4,675 |
$313K |
| 95816 |
|
1,688 |
1,608 |
$310K |
| 97116 |
|
10,382 |
5,864 |
$302K |
| 95117 |
|
6,147 |
3,390 |
$295K |
| 29065 |
|
3,214 |
2,873 |
$292K |
| 74018 |
|
11,819 |
10,554 |
$291K |
| 87799 |
|
6,708 |
3,543 |
$290K |
| 45380 |
|
989 |
922 |
$289K |
| 85027 |
|
31,949 |
25,970 |
$288K |
| 99170 |
|
1,923 |
1,720 |
$287K |
| 73721 |
|
1,895 |
1,724 |
$287K |
| 93225 |
|
2,878 |
2,704 |
$284K |
| 97140 |
|
10,475 |
5,891 |
$284K |
| 92588 |
|
6,686 |
6,335 |
$282K |
| 82657 |
|
5,932 |
2,903 |
$280K |
| 20670 |
|
475 |
440 |
$279K |
| 92552 |
|
5,181 |
4,884 |
$277K |
| 29405 |
|
4,180 |
2,174 |
$276K |
| 72148 |
|
2,369 |
2,219 |
$272K |
| 92526 |
|
5,602 |
4,058 |
$270K |
| 85007 |
|
15,763 |
11,702 |
$270K |
| 96372 |
|
12,888 |
10,388 |
$267K |
| 82784 |
|
14,997 |
10,361 |
$264K |
| 87798 |
|
6,522 |
3,400 |
$259K |
| D9230 |
|
7,960 |
7,316 |
$254K |
| 81001 |
|
22,927 |
20,596 |
$254K |
| 92582 |
|
7,359 |
6,940 |
$251K |
| 74230 |
|
1,616 |
1,529 |
$250K |
| 70543 |
|
929 |
868 |
$248K |
| 72141 |
|
1,819 |
1,702 |
$247K |
| 12001 |
|
2,039 |
1,940 |
$238K |
| 85610 |
|
14,573 |
11,968 |
$233K |
| 49452 |
|
716 |
667 |
$228K |
| 96450 |
|
1,374 |
1,078 |
$227K |
| G0480 |
Drug test def 1-7 classes |
3,513 |
3,107 |
$226K |
| 84450 |
|
15,967 |
14,509 |
$222K |
| D0140 |
|
1,429 |
1,356 |
$220K |
| 31575 |
|
2,173 |
2,036 |
$216K |
| 86140 |
|
18,081 |
15,571 |
$211K |
| 80164 |
|
2,959 |
2,650 |
$207K |
| 86832 |
|
1,593 |
1,447 |
$204K |
| 83880 |
|
5,069 |
4,420 |
$203K |
| 92556 |
|
4,456 |
4,229 |
$201K |
| 81415 |
|
245 |
211 |
$201K |
| 87506 |
|
986 |
890 |
$200K |
| 94644 |
|
7,116 |
6,567 |
$200K |
| 90686 |
|
18,104 |
16,936 |
$199K |
| 31622 |
|
325 |
313 |
$195K |
| 24538 |
|
103 |
97 |
$195K |
| 87497 |
|
4,553 |
2,836 |
$191K |
| 76536 |
|
2,609 |
2,474 |
$188K |
| V5020 |
Conformity evaluation |
1,741 |
1,664 |
$187K |
| 86833 |
|
1,594 |
1,449 |
$185K |
| D0330 |
|
3,321 |
3,216 |
$182K |
| 82330 |
|
4,878 |
3,955 |
$181K |
| 72082 |
|
7,240 |
6,808 |
$178K |
| 76700 |
|
1,788 |
1,684 |
$175K |
| D0220 |
|
10,854 |
9,980 |
$174K |
| 87088 |
|
7,166 |
6,367 |
$174K |
| 97535 |
|
8,250 |
5,170 |
$170K |
| 76885 |
|
1,898 |
1,764 |
$167K |
| 43762 |
|
3,068 |
2,849 |
$166K |
| 85576 |
|
2,776 |
1,833 |
$166K |
| 89051 |
|
2,313 |
1,849 |
$166K |
| 97166 |
|
2,970 |
2,851 |
$165K |
| 86920 |
|
8,969 |
4,743 |
$164K |
| 70486 |
|
1,717 |
1,605 |
$159K |
| 72146 |
|
1,554 |
1,460 |
$159K |
| 74240 |
|
1,852 |
1,734 |
$154K |
| 96156 |
|
2,724 |
2,287 |
$151K |
| 80051 |
|
2,263 |
1,657 |
$151K |
| 93005 |
|
19,751 |
17,711 |
$150K |
| 92611 |
|
1,414 |
1,344 |
$149K |
| G0379 |
Direct refer hospital observ |
2,670 |
2,378 |
$147K |
| 87507 |
|
417 |
381 |
$147K |
| D0240 |
|
12,849 |
7,075 |
$146K |
| 76870 |
|
2,102 |
1,952 |
$146K |
| 95951 |
|
766 |
545 |
$146K |
| 81479 |
|
2,090 |
1,503 |
$145K |
| 83986 |
|
1,846 |
1,351 |
$145K |
| 73610 |
|
9,698 |
8,105 |
$140K |
| 82565 |
|
7,851 |
6,398 |
$138K |
| 73630 |
|
10,849 |
8,882 |
$137K |
| 87186 |
|
14,458 |
10,851 |
$133K |
| 85397 |
|
4,175 |
3,683 |
$130K |
| 83970 |
|
3,077 |
2,762 |
$130K |
| 92015 |
|
33,283 |
31,859 |
$127K |
| 95712 |
|
936 |
853 |
$127K |
| 96136 |
|
1,108 |
954 |
$121K |
| 97165 |
|
2,137 |
2,040 |
$120K |
| 86902 |
|
7,495 |
3,210 |
$120K |
| 84460 |
|
19,425 |
17,379 |
$119K |
| 0241U |
|
1,971 |
1,839 |
$118K |
| 85246 |
|
4,057 |
3,702 |
$116K |
| G0463 |
Hospital outpt clinic visit |
4,194 |
3,408 |
$116K |
| 87661 |
|
3,640 |
3,198 |
$115K |
| 92553 |
|
1,488 |
1,419 |
$114K |
| 92585 |
|
981 |
914 |
$114K |
| 83735 |
|
15,223 |
10,341 |
$113K |
| 83550 |
|
12,008 |
10,839 |
$113K |
| 16020 |
|
1,780 |
1,269 |
$109K |
| 82397 |
|
2,508 |
2,253 |
$108K |
| J2545 |
Pentamidine non-comp unit |
752 |
677 |
$106K |
| 95715 |
|
451 |
392 |
$105K |
| 90792 |
|
733 |
671 |
$104K |
| 10060 |
|
1,121 |
1,035 |
$103K |
| 72170 |
|
6,994 |
6,513 |
$101K |
| 24640 |
|
483 |
464 |
$101K |
| 83540 |
|
12,335 |
11,109 |
$100K |
| 73140 |
|
6,663 |
5,647 |
$100K |
| 87040 |
|
6,187 |
5,184 |
$99K |
| 76770 |
|
968 |
914 |
$99K |
| 82785 |
|
2,382 |
2,069 |
$96K |
| 82150 |
|
3,580 |
3,251 |
$95K |
| 88305 |
|
15,980 |
8,917 |
$95K |
| 83520 |
|
2,551 |
2,243 |
$94K |
| 85045 |
|
20,097 |
15,035 |
$93K |
| 94660 |
|
329 |
289 |
$93K |
| 96158 |
|
3,903 |
2,738 |
$93K |
| 29345 |
|
897 |
791 |
$93K |
| 96132 |
|
1,183 |
925 |
$92K |
| 82570 |
|
6,847 |
5,764 |
$92K |
| 96112 |
|
2,151 |
1,709 |
$91K |
| 82043 |
|
2,895 |
2,564 |
$91K |
| 83002 |
|
2,853 |
2,524 |
$91K |
| 92586 |
|
630 |
595 |
$89K |
| 86592 |
|
3,488 |
3,203 |
$88K |
| 94645 |
|
3,929 |
3,664 |
$88K |
| 84403 |
|
3,192 |
2,789 |
$87K |
| 87529 |
|
2,234 |
950 |
$85K |
| 83516 |
|
6,053 |
4,795 |
$84K |
| 84100 |
|
15,941 |
11,150 |
$81K |
| 92524 |
|
1,864 |
1,740 |
$81K |
| 80076 |
|
2,228 |
2,010 |
$81K |
| 76000 |
|
4,566 |
4,088 |
$80K |
| D0274 |
|
4,662 |
4,476 |
$78K |
| 77072 |
|
3,150 |
2,906 |
$77K |
| 80195 |
|
1,874 |
1,222 |
$77K |
| 80177 |
|
486 |
443 |
$76K |
| 87633 |
|
251 |
197 |
$75K |
| 82310 |
|
1,777 |
1,456 |
$75K |
| 86481 |
|
839 |
771 |
$74K |
| 25605 |
|
344 |
320 |
$73K |
| 83690 |
|
6,970 |
6,223 |
$73K |
| 83615 |
|
8,445 |
5,626 |
$72K |
| 83993 |
|
1,368 |
1,182 |
$71K |
| 87389 |
|
2,979 |
2,727 |
$71K |
| 92593 |
|
1,158 |
1,112 |
$70K |
| 84305 |
|
2,697 |
2,464 |
$69K |
| 73110 |
|
3,888 |
3,367 |
$68K |
| 73090 |
|
8,888 |
6,715 |
$68K |
| 96374 |
|
10,635 |
9,296 |
$67K |
| 96137 |
|
523 |
481 |
$67K |
| 96133 |
|
955 |
753 |
$67K |
| 73590 |
|
8,052 |
6,054 |
$67K |
| 96139 |
|
1,030 |
813 |
$66K |
| 96138 |
|
1,085 |
861 |
$65K |
| 74183 |
|
321 |
292 |
$65K |
| 87101 |
|
2,726 |
2,387 |
$65K |
| 73130 |
|
5,868 |
5,044 |
$64K |
| 73552 |
|
4,516 |
3,447 |
$63K |
| 92060 |
|
15,259 |
14,645 |
$63K |
| 12051 |
|
480 |
453 |
$62K |
| D1354 |
|
2,674 |
1,514 |
$62K |
| 82139 |
|
726 |
630 |
$61K |
| 82947 |
|
7,546 |
6,662 |
$61K |
| 70360 |
|
4,036 |
3,800 |
$61K |
| 75561 |
|
330 |
302 |
$61K |
| 83001 |
|
2,653 |
2,369 |
$61K |
| 76377 |
|
1,409 |
1,294 |
$60K |
| 49465 |
|
204 |
175 |
$60K |
| 85730 |
|
8,890 |
7,748 |
$60K |
| D2393 |
|
714 |
464 |
$59K |
| 82550 |
|
4,405 |
3,671 |
$59K |
| 77080 |
|
945 |
872 |
$58K |
| 85652 |
|
17,460 |
15,393 |
$58K |
| 73560 |
|
6,435 |
5,150 |
$58K |
| 96152 |
|
1,400 |
990 |
$57K |
| 82105 |
|
1,756 |
1,510 |
$57K |
| 72156 |
|
280 |
256 |
$56K |
| 88185 |
|
3,864 |
1,617 |
$54K |
| 76881 |
|
707 |
606 |
$54K |
| 87205 |
|
12,949 |
10,543 |
$54K |
| 75565 |
|
632 |
590 |
$54K |
| 82670 |
|
1,466 |
1,319 |
$53K |
| 86803 |
|
3,101 |
2,762 |
$52K |
| 82977 |
|
6,286 |
5,174 |
$52K |
| 87081 |
|
3,577 |
2,990 |
$52K |
| 76882 |
|
1,084 |
986 |
$52K |
| 73070 |
|
8,015 |
5,675 |
$51K |
| 72158 |
|
269 |
246 |
$51K |
| J7120 |
Ringers lactate infusion |
39,311 |
35,673 |
$50K |
| 76825 |
|
1,224 |
1,034 |
$50K |
| 80143 |
|
2,185 |
1,812 |
$50K |
| 51600 |
|
706 |
669 |
$50K |
| 86850 |
|
8,538 |
6,929 |
$49K |
| 86160 |
|
3,587 |
1,668 |
$49K |
| 82040 |
|
1,681 |
1,467 |
$49K |
| 83498 |
|
1,700 |
1,528 |
$48K |
| 86364 |
|
4,723 |
4,186 |
$48K |
| 82248 |
|
5,511 |
4,357 |
$48K |
| 99157 |
|
9,908 |
9,198 |
$48K |
| 87210 |
|
2,455 |
2,208 |
$48K |
| 86945 |
|
7,463 |
3,942 |
$48K |
| 96376 |
|
5,231 |
3,552 |
$47K |
| 82607 |
|
2,040 |
1,874 |
$47K |
| 93226 |
|
2,889 |
2,706 |
$47K |
| 96375 |
|
10,971 |
8,458 |
$47K |
| 72157 |
|
245 |
221 |
$47K |
| 72081 |
|
6,687 |
6,207 |
$46K |
| 94642 |
|
718 |
635 |
$46K |
| 86376 |
|
2,938 |
2,593 |
$45K |
| 97163 |
|
807 |
771 |
$44K |
| 84145 |
|
1,125 |
1,004 |
$44K |
| 82533 |
|
1,512 |
1,196 |
$44K |
| G0108 |
Diab manage trn per indiv |
1,196 |
1,082 |
$44K |
| 43760 |
|
356 |
335 |
$44K |
| 74019 |
|
4,475 |
4,079 |
$43K |
| 84484 |
|
3,260 |
2,740 |
$43K |
| 85240 |
|
2,802 |
2,503 |
$43K |
| J2997 |
Alteplase recombinant |
505 |
283 |
$43K |
| 29105 |
|
1,211 |
1,105 |
$42K |
| 29450 |
|
294 |
124 |
$42K |
| 94060 |
|
2,668 |
2,447 |
$41K |
| 70544 |
|
164 |
151 |
$41K |
| 69210 |
|
2,597 |
2,475 |
$40K |
| 96130 |
|
291 |
260 |
$40K |
| 90791 |
|
695 |
571 |
$40K |
| 77076 |
|
1,236 |
1,082 |
$39K |
| 84402 |
|
1,443 |
1,290 |
$39K |
| 73562 |
|
1,904 |
1,600 |
$38K |
| 92652 |
|
1,139 |
1,077 |
$38K |
| 97803 |
|
13,056 |
11,653 |
$38K |
| 80299 |
|
602 |
499 |
$37K |
| 0001A |
|
1,302 |
1,067 |
$37K |
| 96116 |
|
524 |
375 |
$36K |
| 82627 |
|
1,141 |
1,029 |
$36K |
| G0109 |
Diab manage trn ind/group |
830 |
779 |
$36K |
| D9420 |
|
350 |
268 |
$35K |
| 87631 |
|
267 |
230 |
$35K |
| 51701 |
|
6,073 |
5,663 |
$35K |
| 51741 |
|
416 |
392 |
$35K |
| 90847 |
|
520 |
312 |
$35K |
| 86038 |
|
2,522 |
2,202 |
$35K |
| 82017 |
|
531 |
470 |
$35K |
| 92592 |
|
537 |
512 |
$35K |
| 81002 |
|
1,457 |
1,317 |
$34K |
| 92595 |
|
329 |
307 |
$34K |
| 90832 |
|
661 |
482 |
$34K |
| 86706 |
|
2,684 |
2,418 |
$33K |
| 90656 |
|
3,261 |
3,049 |
$32K |
| 74455 |
|
465 |
440 |
$32K |
| J2515 |
Pentobarbital sodium inj |
1,105 |
1,018 |
$32K |
| 87185 |
|
360 |
310 |
$32K |
| 71260 |
|
271 |
248 |
$32K |
| 84295 |
|
3,273 |
2,822 |
$31K |
| 49446 |
|
78 |
69 |
$31K |
| 29125 |
|
1,007 |
923 |
$31K |
| 20680 |
|
35 |
32 |
$31K |
| 87880 |
|
537 |
503 |
$31K |
| 86901 |
|
9,094 |
7,463 |
$31K |
| 87808 |
|
2,218 |
2,003 |
$31K |
| 86355 |
|
913 |
787 |
$31K |
| 82272 |
|
1,234 |
1,120 |
$31K |
| 85014 |
|
4,124 |
3,575 |
$30K |
| 94621 |
|
379 |
350 |
$30K |
| 92602 |
|
153 |
140 |
$29K |
| 72100 |
|
2,262 |
2,130 |
$29K |
| 80179 |
|
2,005 |
1,725 |
$29K |
| 87340 |
|
2,572 |
2,298 |
$29K |
| J7040 |
Normal saline solution infus |
24,524 |
17,462 |
$29K |
| J7030 |
Normal saline solution infus |
29,891 |
23,475 |
$29K |
| 83525 |
|
2,309 |
2,106 |
$29K |
| 94770 |
|
172 |
155 |
$29K |
| 87806 |
|
1,159 |
1,059 |
$29K |
| 86039 |
|
2,522 |
2,202 |
$29K |
| 84146 |
|
1,226 |
1,098 |
$29K |
| D1208 |
|
736 |
664 |
$28K |
| J2405 |
Ondansetron hcl injection |
42,420 |
36,491 |
$28K |
| J1439 |
Inj ferric carboxymaltos 1mg |
108 |
96 |
$28K |
| 70491 |
|
162 |
149 |
$28K |
| 73660 |
|
1,615 |
1,406 |
$27K |
| 96113 |
|
1,113 |
876 |
$27K |
| 70250 |
|
990 |
905 |
$27K |
| 86665 |
|
1,594 |
725 |
$27K |
| 85378 |
|
2,286 |
1,857 |
$27K |
| 72040 |
|
2,945 |
2,595 |
$27K |
| 88184 |
|
2,041 |
1,638 |
$26K |
| 99001 |
|
982 |
866 |
$26K |
| 71555 |
|
145 |
134 |
$26K |
| 73000 |
|
2,455 |
2,079 |
$26K |
| 92551 |
|
253 |
230 |
$26K |
| 87581 |
|
647 |
576 |
$26K |
| 0002A |
|
818 |
720 |
$26K |
| 86704 |
|
1,685 |
1,482 |
$25K |
| 80184 |
|
295 |
258 |
$25K |
| 84132 |
|
3,769 |
3,232 |
$25K |
| 86225 |
|
1,698 |
1,480 |
$25K |
| 69200 |
|
1,232 |
1,063 |
$25K |
| 96131 |
|
234 |
204 |
$25K |
| J3590 |
Unclassified biologics |
652 |
444 |
$24K |
| 85384 |
|
2,328 |
1,886 |
$24K |
| 73060 |
|
2,437 |
1,987 |
$24K |
| 90734 |
|
772 |
669 |
$24K |
| 90651 |
|
564 |
474 |
$23K |
| J2704 |
Inj, propofol, 10 mg |
40,395 |
35,338 |
$23K |
| 85250 |
|
951 |
852 |
$23K |
| 73100 |
|
7,258 |
5,241 |
$23K |
| 86800 |
|
1,445 |
1,292 |
$23K |
| 76816 |
|
856 |
639 |
$22K |
| 76819 |
|
1,002 |
475 |
$22K |
| 87046 |
|
1,259 |
1,141 |
$22K |
| 84520 |
|
4,835 |
4,128 |
$22K |
| 85660 |
|
2,853 |
1,851 |
$21K |
| 87206 |
|
3,534 |
2,945 |
$21K |
| 93017 |
|
247 |
224 |
$21K |
| 42821 |
|
26 |
24 |
$20K |
| 71250 |
|
266 |
246 |
$20K |
| 93886 |
|
150 |
128 |
$20K |
| 87493 |
|
486 |
435 |
$20K |
| 71045 |
|
4,344 |
3,756 |
$20K |
| 92522 |
|
641 |
597 |
$20K |
| 87209 |
|
802 |
697 |
$20K |
| 77073 |
|
2,729 |
2,515 |
$20K |
| 49580 |
|
25 |
24 |
$19K |
| 99195 |
|
1,946 |
1,675 |
$19K |
| J1100 |
Dexamethasone sodium phos |
27,252 |
23,517 |
$18K |
| J0588 |
Incobotulinumtoxin a |
87 |
86 |
$18K |
| 64999 |
|
114 |
43 |
$18K |
| 76010 |
|
1,352 |
1,249 |
$18K |
| 96409 |
|
2,567 |
1,838 |
$18K |
| 90837 |
|
194 |
130 |
$18K |
| 87632 |
|
87 |
83 |
$18K |
| 92604 |
|
246 |
231 |
$18K |
| 73030 |
|
2,382 |
2,039 |
$18K |
| 84478 |
|
2,417 |
2,053 |
$18K |
| 72070 |
|
1,650 |
1,540 |
$17K |
| 87103 |
|
700 |
583 |
$17K |
| 90715 |
|
1,598 |
1,464 |
$17K |
| J1885 |
Ketorolac tromethamine inj |
23,245 |
20,347 |
$17K |
| 88307 |
|
922 |
817 |
$17K |
| 76827 |
|
1,226 |
1,034 |
$17K |
| J2274 |
Inj morphine pf epid ithc |
13,609 |
12,526 |
$17K |
| 73564 |
|
2,198 |
1,701 |
$17K |
| 90670 |
|
579 |
487 |
$16K |
| 87107 |
|
329 |
274 |
$16K |
| J3490 |
Drugs unclassified injection |
15,558 |
11,768 |
$16K |
| 86359 |
|
591 |
503 |
$16K |
| 86308 |
|
902 |
839 |
$16K |
| 99155 |
|
6,194 |
5,704 |
$16K |
| 17250 |
|
139 |
121 |
$16K |
| 82610 |
|
819 |
736 |
$15K |
| 88304 |
|
2,481 |
2,208 |
$15K |
| 86235 |
|
386 |
180 |
$15K |
| 99291 |
|
94 |
93 |
$15K |
| 54640 |
|
12 |
12 |
$15K |
| 84156 |
|
3,244 |
2,622 |
$15K |
| C1713 |
Anchor/screw bn/bn,tis/bn |
569 |
530 |
$14K |
| 87177 |
|
803 |
698 |
$14K |
| 73502 |
|
575 |
474 |
$14K |
| 82805 |
|
234 |
162 |
$14K |
| 80175 |
|
192 |
185 |
$14K |
| 96159 |
|
2,130 |
1,515 |
$14K |
| 25565 |
|
80 |
73 |
$13K |
| 29130 |
|
190 |
184 |
$13K |
| 87272 |
|
1,058 |
920 |
$13K |
| 80183 |
|
349 |
335 |
$13K |
| 82140 |
|
556 |
467 |
$13K |
| 87338 |
|
487 |
439 |
$13K |
| 86664 |
|
762 |
697 |
$13K |
| D7111 |
|
27 |
25 |
$13K |
| D0230 |
|
2,044 |
1,805 |
$13K |
| 36415 |
|
104,484 |
87,983 |
$13K |
| 86769 |
|
336 |
314 |
$13K |
| 95713 |
|
177 |
147 |
$13K |
| 85018 |
|
2,226 |
2,008 |
$13K |
| 84202 |
|
713 |
621 |
$12K |
| 92134 |
|
306 |
293 |
$12K |
| 86618 |
|
540 |
368 |
$12K |
| J0131 |
Inj, acetaminophen (nos) |
8,383 |
7,691 |
$12K |
| 97802 |
|
2,007 |
1,746 |
$12K |
| 84590 |
|
998 |
837 |
$12K |
| 84446 |
|
915 |
770 |
$11K |
| 97167 |
|
213 |
205 |
$11K |
| J1050 |
Medroxyprogesterone acetate |
2,693 |
2,510 |
$11K |
| 77075 |
|
271 |
240 |
$11K |
| 51784 |
|
103 |
97 |
$11K |
| 87486 |
|
272 |
209 |
$11K |
| 97150 |
|
1,383 |
936 |
$11K |
| J3010 |
Fentanyl citrate injection |
12,180 |
11,077 |
$10K |
| 86317 |
|
243 |
79 |
$10K |
| 92609 |
|
182 |
126 |
$10K |
| 92594 |
|
77 |
74 |
$10K |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
1,220 |
1,152 |
$10K |
| 70480 |
|
92 |
89 |
$10K |
| 84480 |
|
652 |
584 |
$10K |
| 82104 |
|
448 |
372 |
$9K |
| 82390 |
|
721 |
608 |
$9K |
| 86644 |
|
344 |
272 |
$8K |
| 84550 |
|
1,640 |
1,196 |
$8K |
| 69209 |
|
442 |
414 |
$8K |
| J3480 |
Inj potassium chloride |
4,874 |
3,570 |
$8K |
| 96150 |
|
124 |
116 |
$8K |
| 87533 |
|
273 |
112 |
$8K |
| 99153 |
Mod sedat endo service >5yrs |
1,303 |
1,193 |
$8K |
| 86341 |
|
312 |
142 |
$8K |
| 86480 |
|
90 |
82 |
$8K |
| 88271 |
|
373 |
141 |
$7K |
| 82525 |
|
273 |
247 |
$7K |
| 83605 |
|
526 |
433 |
$7K |
| 87634 |
|
116 |
103 |
$7K |
| 92650 |
|
455 |
428 |
$7K |
| 86922 |
|
387 |
166 |
$7K |
| 86357 |
|
225 |
197 |
$7K |
| 99156 |
|
4,820 |
4,510 |
$7K |
| J2001 |
Lidocaine injection |
12,548 |
11,284 |
$7K |
| 92591 |
|
226 |
220 |
$7K |
| J0475 |
Baclofen 10 mg injection |
26 |
26 |
$7K |
| 62270 |
|
28 |
26 |
$6K |
| 73592 |
|
621 |
376 |
$6K |
| 81267 |
|
58 |
28 |
$6K |
| 96368 |
|
43 |
42 |
$6K |
| 96167 |
|
876 |
685 |
$6K |
| 90648 |
|
544 |
468 |
$6K |
| 90633 |
|
447 |
362 |
$6K |
| 11100 |
|
25 |
24 |
$6K |
| 92018 |
|
15 |
14 |
$6K |
| 84630 |
|
585 |
533 |
$6K |
| 12002 |
|
63 |
55 |
$6K |
| 74220 |
|
153 |
139 |
$6K |
| 82746 |
|
375 |
340 |
$6K |
| J7042 |
5% dextrose/normal saline |
3,984 |
2,904 |
$6K |
| 82379 |
|
299 |
269 |
$6K |
| 87498 |
|
130 |
115 |
$5K |
| 93975 |
|
64 |
61 |
$5K |
| 86880 |
|
728 |
579 |
$5K |
| 93786 |
|
159 |
151 |
$5K |
| 41010 |
|
16 |
13 |
$5K |
| 82542 |
|
102 |
82 |
$5K |
| 88342 |
|
1,733 |
1,453 |
$5K |
| 11901 |
|
54 |
52 |
$5K |
| 80201 |
|
189 |
176 |
$5K |
| S0119 |
Ondansetron 4 mg |
25,261 |
23,414 |
$5K |
| 97164 |
|
96 |
96 |
$5K |
| 72197 |
|
32 |
30 |
$5K |
| 84703 |
|
220 |
202 |
$5K |
| 92250 |
|
1,140 |
1,070 |
$5K |
| 80158 |
|
65 |
37 |
$5K |
| 29505 |
|
105 |
101 |
$5K |
| 76811 |
|
172 |
147 |
$5K |
| J2270 |
Morphine sulfate injection |
3,483 |
3,024 |
$4K |
| V5264 |
Ear mold/insert |
3,678 |
3,143 |
$4K |
| 93242 |
|
55 |
54 |
$4K |
| 76642 |
|
56 |
49 |
$4K |
| 36591 |
|
394 |
302 |
$4K |
| J0690 |
Cefazolin sodium injection |
6,284 |
5,455 |
$4K |
| 83921 |
|
159 |
136 |
$4K |
| 90620 |
|
84 |
83 |
$4K |
| P9035 |
Platelet pheres leukoreduced |
18 |
12 |
$4K |
| 84436 |
|
57 |
54 |
$4K |
| 85245 |
|
103 |
96 |
$4K |
| 99151 |
|
764 |
696 |
$4K |
| 83789 |
|
156 |
145 |
$4K |
| 51728 |
|
31 |
28 |
$3K |
| D0210 |
|
47 |
45 |
$3K |
| 86015 |
|
333 |
290 |
$3K |
| J0295 |
Ampicillin sulbactam 1.5 gm |
1,842 |
925 |
$3K |
| 30300 |
|
100 |
93 |
$3K |
| 36416 |
|
6,471 |
5,066 |
$3K |
| J9070 |
Cyclophosphamide 100 mg inj |
18 |
12 |
$3K |
| 76506 |
|
32 |
26 |
$3K |
| 83918 |
|
68 |
60 |
$3K |
| 12032 |
|
31 |
26 |
$3K |
| 74181 |
|
15 |
15 |
$3K |
| 84075 |
|
389 |
346 |
$3K |
| 88313 |
|
2,257 |
1,355 |
$3K |
| 11104 |
|
15 |
12 |
$3K |
| 86684 |
|
214 |
176 |
$3K |
| 29515 |
|
269 |
250 |
$3K |
| 90471 |
|
1,904 |
1,602 |
$3K |
| 42975 |
|
130 |
125 |
$3K |
| 0296T |
|
23 |
21 |
$3K |
| J8540 |
Oral dexamethasone |
18,332 |
16,766 |
$3K |
| J0171 |
Adrenalin epinephrine inject |
1,209 |
1,077 |
$3K |
| 82652 |
|
38 |
28 |
$2K |
| 87536 |
|
33 |
27 |
$2K |
| 90700 |
|
193 |
173 |
$2K |
| 85347 |
|
316 |
162 |
$2K |
| J7620 |
Albuterol ipratrop non-comp |
11,783 |
10,723 |
$2K |
| 81243 |
|
15 |
14 |
$2K |
| 85247 |
|
71 |
68 |
$2K |
| 99188 |
|
3,375 |
2,600 |
$2K |
| J7070 |
D5w infusion |
1,040 |
782 |
$2K |
| J0696 |
Ceftriaxone sodium injection |
2,578 |
2,096 |
$2K |
| 94617 |
|
13 |
13 |
$2K |
| 92508 |
|
107 |
61 |
$2K |
| J1200 |
Diphenhydramine hcl injectio |
4,403 |
3,519 |
$2K |
| 82747 |
|
97 |
90 |
$2K |
| 92583 |
|
779 |
737 |
$2K |
| 95165 |
|
64 |
55 |
$2K |
| 85670 |
|
2,863 |
2,410 |
$2K |
| J1170 |
Hydromorphone injection |
1,803 |
1,581 |
$2K |
| 95250 |
|
129 |
110 |
$2K |
| 82157 |
|
31 |
25 |
$2K |
| 0202U |
|
1,063 |
1,010 |
$2K |
| J7611 |
Albuterol non-comp con |
10,300 |
8,950 |
$2K |
| 86645 |
|
223 |
197 |
$2K |
| 95076 |
|
14 |
13 |
$2K |
| J9370 |
Vincristine sulfate 1 mg inj |
2,729 |
1,809 |
$2K |
| D0270 |
|
85 |
83 |
$2K |
| 0071A |
|
75 |
53 |
$2K |
| C1769 |
Guide wire |
2,822 |
2,565 |
$2K |
| 80050 |
|
556 |
498 |
$2K |
| J3475 |
Inj magnesium sulfate |
2,076 |
1,943 |
$2K |
| J0780 |
Prochlorperazine injection |
1,984 |
1,786 |
$2K |
| J0561 |
Penicillin g benzathine inj |
50 |
47 |
$2K |
| 93243 |
|
55 |
54 |
$2K |
| 86787 |
|
120 |
106 |
$2K |
| 51798 |
|
250 |
241 |
$2K |
| 82085 |
|
51 |
38 |
$2K |
| 86337 |
|
86 |
67 |
$2K |
| J3301 |
Triamcinolone acet inj nos |
1,320 |
1,172 |
$1K |
| 90723 |
|
329 |
281 |
$1K |
| 94726 |
|
350 |
324 |
$1K |
| 71275 |
|
12 |
12 |
$1K |
| 84030 |
|
100 |
81 |
$1K |
| 92590 |
|
15 |
14 |
$1K |
| 0072A |
|
52 |
41 |
$1K |
| J2250 |
Inj midazolam hydrochloride |
1,885 |
1,724 |
$1K |
| 11981 |
|
15 |
13 |
$1K |
| 73620 |
|
174 |
117 |
$1K |
| 81000 |
|
66 |
63 |
$1K |
| 82024 |
|
29 |
26 |
$1K |
| 87075 |
|
150 |
109 |
$1K |
| 82465 |
|
53 |
42 |
$1K |
| J1756 |
Iron sucrose injection |
254 |
162 |
$1K |
| C1894 |
Intro/sheath, non-laser |
742 |
698 |
$1K |
| J7060 |
5% dextrose/water |
1,128 |
877 |
$1K |
| J1815 |
Insulin injection |
259 |
204 |
$997.54 |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
8,046 |
7,215 |
$987.78 |
| 85732 |
|
103 |
93 |
$966.68 |
| D0340 |
|
36 |
29 |
$951.94 |
| 91200 |
|
795 |
727 |
$917.34 |
| 86008 |
|
26 |
18 |
$895.37 |
| V5241 |
Dispensing fee, monaural |
37 |
30 |
$851.12 |
| 76604 |
|
12 |
12 |
$813.35 |
| 86774 |
|
29 |
25 |
$794.39 |
| J7644 |
Ipratropium bromide non-comp |
6,186 |
5,694 |
$772.05 |
| 86709 |
|
54 |
50 |
$750.20 |
| 93971 |
|
26 |
24 |
$744.90 |
| 84481 |
|
26 |
26 |
$717.33 |
| 88280 |
|
26 |
24 |
$701.62 |
| 97168 |
|
14 |
13 |
$694.90 |
| 51797 |
|
13 |
12 |
$681.39 |
| 94761 |
|
1,343 |
963 |
$680.16 |
| 85280 |
|
27 |
24 |
$678.04 |
| 82261 |
|
41 |
39 |
$655.27 |
| 88291 |
|
43 |
43 |
$650.75 |
| Q0163 |
Diphenhydramine hcl 50mg |
9,204 |
8,413 |
$645.88 |
| 76937 |
|
14 |
14 |
$641.49 |
| 90685 |
|
58 |
56 |
$637.95 |
| 87522 |
Neg quan hep c or qual rna |
13 |
12 |
$626.10 |
| 97804 |
|
131 |
124 |
$624.76 |
| 88312 |
|
601 |
420 |
$608.53 |
| C9290 |
Inj, bupivacaine liposome |
110 |
104 |
$570.81 |
| 73092 |
|
30 |
26 |
$566.33 |
| 86258 |
|
90 |
40 |
$538.15 |
| 73700 |
|
13 |
12 |
$533.00 |
| 82775 |
|
27 |
26 |
$527.99 |
| 98960 |
|
60 |
51 |
$525.81 |
| D0470 |
|
19 |
15 |
$524.81 |
| 83930 |
|
27 |
25 |
$455.22 |
| 83090 |
|
13 |
12 |
$436.90 |
| 95012 |
|
462 |
422 |
$428.94 |
| 76857 |
|
25 |
24 |
$428.89 |
| 95199 |
|
133 |
118 |
$426.92 |
| 96411 |
|
314 |
176 |
$418.94 |
| 83020 |
|
27 |
26 |
$418.49 |
| 92511 |
|
15 |
14 |
$408.83 |
| J7510 |
Prednisolone oral per 5 mg |
2,111 |
1,568 |
$361.21 |
| 98961 |
|
17 |
14 |
$351.42 |
| 84445 |
|
13 |
12 |
$339.72 |
| 0124A |
|
16 |
13 |
$322.27 |
| 90677 |
|
109 |
92 |
$316.56 |
| 36592 |
|
34 |
24 |
$302.38 |
| 84510 |
|
27 |
26 |
$296.06 |
| 0297T |
|
23 |
21 |
$294.40 |
| 87184 |
|
44 |
38 |
$291.31 |
| J0330 |
Succinycholine chloride inj |
463 |
433 |
$277.32 |
| J2371 |
Inj phenylephrine hcl 20 mcg |
358 |
333 |
$265.57 |
| J9260 |
Inj methotrexate sodium 50mg |
1,607 |
1,107 |
$263.29 |
| J1642 |
Inj heparin sodium per 10 u |
6,969 |
3,162 |
$262.13 |
| 82945 |
|
64 |
59 |
$259.39 |
| 84210 |
|
13 |
12 |
$253.38 |
| 90732 |
|
28 |
24 |
$253.16 |
| 84157 |
|
64 |
59 |
$245.97 |
| J2003 |
Inj, lidocaine hcl, 1 mg |
346 |
252 |
$237.55 |
| 73600 |
|
104 |
80 |
$226.05 |
| Q9958 |
Hocm <=149 mg/ml iodine, 1ml |
633 |
604 |
$208.23 |
| J1940 |
Furosemide injection |
93 |
85 |
$205.08 |
| 82438 |
|
26 |
24 |
$204.79 |
| J2930 |
Methylprednisolone injection |
275 |
202 |
$198.51 |
| 92133 |
|
156 |
148 |
$192.55 |
| 85270 |
|
13 |
12 |
$191.86 |
| J7613 |
Albuterol non-comp unit |
1,047 |
916 |
$184.62 |
| 94760 |
|
272 |
258 |
$174.35 |
| 91300 |
|
2,116 |
1,619 |
$155.32 |
| A4216 |
Sterile water/saline, 10 ml |
934 |
700 |
$154.81 |
| 86765 |
|
14 |
12 |
$146.41 |
| J2919 |
Inj, methylpred sod succ 5mg |
241 |
172 |
$141.67 |
| J0706 |
Caffeine citrate injection |
197 |
187 |
$140.08 |
| 90710 |
|
56 |
43 |
$138.97 |
| 89230 |
|
13 |
12 |
$127.18 |
| 86060 |
|
15 |
12 |
$117.18 |
| J1817 |
Insulin for insulin pump use |
292 |
236 |
$115.72 |
| J7699 |
Inhalation solution for dme |
1,477 |
1,287 |
$111.49 |
| J2370 |
Phenylephrine hcl injection |
209 |
192 |
$109.43 |
| D0350 |
|
42 |
40 |
$99.63 |
| J0136 |
Inj, acetaminophen (b braun) |
100 |
78 |
$98.83 |
| 94664 |
|
171 |
166 |
$90.61 |
| J1596 |
Inj, glycopyrrolate, 0.1 mg |
131 |
123 |
$84.08 |
| 90472 |
|
35 |
28 |
$83.32 |
| 90674 |
|
13 |
13 |
$80.60 |
| J2004 |
Inj, lidocaine w epinephrine |
91 |
63 |
$78.82 |
| 86431 |
|
13 |
13 |
$71.98 |
| 73120 |
|
24 |
13 |
$66.60 |
| J7512 |
Prednisone ir or dr oral 1mg |
671 |
443 |
$60.96 |
| 99152 |
|
162 |
155 |
$39.30 |
| J1644 |
Inj heparin sodium per 1000u |
519 |
347 |
$33.90 |
| 88341 |
|
19 |
12 |
$28.51 |
| 70260 |
|
12 |
12 |
$21.17 |
| 36593 |
|
13 |
12 |
$20.52 |
| J8499 |
Oral prescrip drug non chemo |
145 |
107 |
$12.57 |
| 73080 |
|
28 |
26 |
$0.00 |
| J1643 |
Inj heparin, pfizer, 1000u |
56 |
52 |
$0.00 |
| 94690 |
|
26 |
24 |
$0.00 |
| Q9966 |
Locm 200-299mg/ml iodine,1ml |
16 |
12 |
$0.00 |
| J2710 |
Neostigmine methylslfte inj |
147 |
138 |
$0.00 |
| V5261 |
Hearing aid, digit, bin, bte |
44 |
43 |
$0.00 |
| J0290 |
Ampicillin 500 mg inj |
79 |
54 |
$0.00 |
| 95018 |
|
14 |
13 |
$0.00 |
| J0736 |
Inj, clindamycin phosp 300mg |
47 |
25 |
$0.00 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
42 |
32 |
$0.00 |
| C1751 |
Cath, inf, per/cent/midline |
28 |
26 |
$0.00 |
| J2300 |
Inj nalbuphine hydrochloride |
12 |
12 |
$0.00 |
| V5257 |
Hearing aid, digit, mon, bte |
13 |
12 |
$0.00 |
| A9552 |
F18 fdg |
12 |
12 |
$0.00 |
| 96168 |
|
329 |
275 |
$0.00 |
| 91307 |
|
143 |
104 |
$0.00 |
| V5160 |
Dispensing fee binaural |
60 |
59 |
$0.00 |
| J7609 |
Albuterol comp unit |
2,920 |
2,569 |
$0.00 |
| D9997 |
|
441 |
425 |
$0.00 |
| C9399 |
Unclassified drugs or biolog |
46 |
44 |
$0.00 |
| J2060 |
Lorazepam injection |
123 |
105 |
$0.00 |
| J7050 |
Normal saline solution infus |
313 |
266 |
$0.00 |
| Q0164 |
Prochlorperazine maleate 5mg |
17 |
16 |
$0.00 |
| 88311 |
|
16 |
13 |
$0.00 |
| J3410 |
Hydroxyzine hcl injection |
21 |
13 |
$0.00 |
| D9248 |
|
37 |
37 |
$0.00 |
| J3360 |
Diazepam injection |
19 |
16 |
$0.00 |