| Code | Description | Claims | Beneficiaries | Total Paid |
| 99283 |
|
55,821 |
50,471 |
$6.51M |
| 99284 |
|
48,629 |
42,607 |
$6.39M |
| 96361 |
|
18,200 |
14,840 |
$5.02M |
| 99285 |
|
21,061 |
17,887 |
$3.17M |
| G0463 |
Hospital outpt clinic visit |
32,293 |
24,605 |
$2.58M |
| 99282 |
|
15,930 |
14,695 |
$1.61M |
| 97110 |
|
25,409 |
8,647 |
$1.59M |
| 74176 |
|
4,251 |
3,580 |
$1.21M |
| 70450 |
|
4,795 |
4,025 |
$1.03M |
| 74177 |
|
3,290 |
2,672 |
$962K |
| 80053 |
|
76,654 |
62,652 |
$705K |
| 96365 |
|
4,716 |
2,769 |
$665K |
| 87491 |
|
22,147 |
19,894 |
$574K |
| 87591 |
|
22,248 |
20,024 |
$467K |
| G0378 |
Hospital observation per hr |
6,138 |
2,169 |
$420K |
| 95811 |
|
729 |
665 |
$418K |
| 96360 |
|
2,769 |
2,024 |
$416K |
| 80061 |
|
22,266 |
20,072 |
$368K |
| 84443 |
|
22,664 |
20,164 |
$350K |
| 94640 |
|
3,213 |
2,453 |
$341K |
| 71275 |
|
1,341 |
1,142 |
$336K |
| U0003 |
Cov-19 amp prb hgh thruput |
3,284 |
2,816 |
$330K |
| 36415 |
|
178,079 |
138,915 |
$320K |
| 0241U |
|
2,653 |
2,242 |
$316K |
| 93306 |
|
1,737 |
1,567 |
$304K |
| 11042 |
|
2,413 |
1,388 |
$257K |
| C1776 |
Joint device (implantable) |
470 |
382 |
$256K |
| 95810 |
|
398 |
371 |
$228K |
| 80048 |
|
27,647 |
21,453 |
$226K |
| 96366 |
|
983 |
561 |
$220K |
| 80307 |
|
8,785 |
7,308 |
$215K |
| 82306 |
|
12,737 |
9,709 |
$215K |
| 97140 |
|
6,462 |
2,668 |
$211K |
| 85025 |
|
88,494 |
72,671 |
$200K |
| 78452 |
|
534 |
439 |
$192K |
| 76816 |
|
1,555 |
1,223 |
$188K |
| 85027 |
|
31,987 |
26,330 |
$183K |
| 27447 |
|
60 |
53 |
$182K |
| 96413 |
|
1,401 |
628 |
$177K |
| C9803 |
Hopd covid-19 spec collect |
5,805 |
5,121 |
$175K |
| 62323 |
|
425 |
359 |
$163K |
| 58661 |
|
145 |
72 |
$161K |
| 43239 |
|
460 |
394 |
$159K |
| 71046 |
|
5,184 |
4,558 |
$158K |
| 86780 |
|
9,007 |
7,889 |
$156K |
| 83036 |
|
19,984 |
18,043 |
$148K |
| G0144 |
Scr c/v cyto,thinlayer,rescr |
5,969 |
5,500 |
$140K |
| 87800 |
|
3,012 |
2,682 |
$136K |
| 86850 |
|
7,325 |
5,613 |
$134K |
| 72148 |
|
729 |
661 |
$133K |
| 70553 |
|
510 |
431 |
$130K |
| 87389 |
|
6,636 |
5,735 |
$130K |
| 59025 |
|
862 |
668 |
$128K |
| 97161 |
|
2,347 |
1,975 |
$126K |
| 87086 |
|
19,808 |
17,063 |
$126K |
| 84484 |
|
33,656 |
22,029 |
$125K |
| 93005 |
|
40,915 |
34,356 |
$124K |
| 77067 |
|
2,674 |
2,392 |
$123K |
| C8929 |
Tte w or wo fol wcon,doppler |
582 |
505 |
$117K |
| 76642 |
|
1,094 |
957 |
$115K |
| 27130 |
|
21 |
18 |
$106K |
| G0476 |
Hpv combo assay ca screen |
3,715 |
3,345 |
$105K |
| 86803 |
|
5,554 |
4,766 |
$105K |
| S9472 |
Cardiac rehabilitation progr |
1,673 |
240 |
$105K |
| 96374 |
|
32,242 |
27,729 |
$103K |
| 93356 |
|
521 |
451 |
$102K |
| 83880 |
|
14,013 |
11,972 |
$101K |
| 97162 |
|
1,845 |
1,635 |
$100K |
| C1713 |
Anchor/screw bn/bn,tis/bn |
787 |
636 |
$99K |
| 71250 |
|
1,018 |
872 |
$97K |
| 71045 |
|
25,225 |
21,827 |
$97K |
| 97530 |
|
3,956 |
2,127 |
$96K |
| 76811 |
|
797 |
704 |
$96K |
| 76819 |
|
1,166 |
529 |
$95K |
| G0480 |
Drug test def 1-7 classes |
4,500 |
3,613 |
$94K |
| 82607 |
|
6,798 |
5,566 |
$93K |
| 97112 |
|
2,864 |
1,400 |
$92K |
| 78815 |
|
183 |
156 |
$91K |
| 80076 |
|
13,185 |
11,267 |
$91K |
| J0485 |
Belatacept injection |
624 |
293 |
$89K |
| 52000 |
|
142 |
103 |
$88K |
| 70491 |
|
324 |
267 |
$88K |
| 87502 |
|
4,022 |
3,471 |
$85K |
| 96375 |
|
19,355 |
15,853 |
$85K |
| 73721 |
|
358 |
327 |
$82K |
| 45385 |
|
153 |
131 |
$82K |
| 64483 |
|
187 |
155 |
$78K |
| 93971 |
|
1,017 |
895 |
$78K |
| 93308 |
|
432 |
330 |
$77K |
| 76536 |
|
733 |
675 |
$74K |
| 76700 |
|
472 |
421 |
$74K |
| 93458 |
|
57 |
38 |
$68K |
| 88305 |
|
3,661 |
2,843 |
$68K |
| 87150 |
|
1,663 |
1,472 |
$64K |
| 71271 |
|
430 |
387 |
$63K |
| 82728 |
|
4,969 |
4,287 |
$61K |
| 76705 |
|
633 |
570 |
$60K |
| 80069 |
|
4,163 |
3,581 |
$59K |
| 87661 |
|
3,794 |
3,318 |
$58K |
| 93017 |
|
726 |
635 |
$57K |
| C1889 |
Implant/insert device, noc |
657 |
509 |
$56K |
| 76830 |
|
928 |
811 |
$54K |
| H2020 |
Ther behav svc, per diem |
332 |
43 |
$54K |
| 82570 |
|
7,444 |
5,929 |
$52K |
| 71260 |
|
674 |
600 |
$52K |
| 76817 |
|
1,076 |
891 |
$52K |
| 85610 |
|
21,290 |
16,167 |
$51K |
| 72141 |
|
285 |
262 |
$50K |
| 87481 |
|
2,580 |
2,332 |
$50K |
| 93970 |
|
354 |
318 |
$50K |
| 87340 |
|
4,841 |
4,136 |
$49K |
| 86900 |
|
5,552 |
4,490 |
$48K |
| 81025 |
|
36,801 |
32,516 |
$47K |
| 93325 |
|
793 |
652 |
$47K |
| 70486 |
|
590 |
520 |
$46K |
| 72100 |
|
2,044 |
1,805 |
$46K |
| 83550 |
|
5,858 |
5,082 |
$45K |
| 84702 |
|
3,530 |
2,512 |
$44K |
| 10060 |
|
274 |
233 |
$44K |
| 84439 |
|
4,799 |
4,215 |
$44K |
| 88307 |
|
630 |
475 |
$43K |
| 76770 |
|
308 |
281 |
$43K |
| 72131 |
|
530 |
460 |
$42K |
| 83540 |
|
6,311 |
5,469 |
$41K |
| 81003 |
|
30,040 |
23,941 |
$40K |
| 76856 |
|
225 |
208 |
$39K |
| 87511 |
|
2,558 |
2,328 |
$39K |
| 86140 |
|
4,344 |
3,495 |
$37K |
| 83735 |
|
16,298 |
12,423 |
$37K |
| 97165 |
|
596 |
494 |
$36K |
| 70496 |
|
157 |
136 |
$36K |
| 86762 |
|
2,226 |
1,939 |
$35K |
| 93925 |
|
340 |
316 |
$35K |
| 83970 |
|
1,378 |
1,168 |
$35K |
| 72125 |
|
877 |
736 |
$34K |
| 64447 |
|
297 |
232 |
$34K |
| 77063 |
|
2,578 |
2,312 |
$33K |
| 73221 |
|
159 |
132 |
$33K |
| C9290 |
Inj, bupivacaine liposome |
467 |
379 |
$32K |
| 00840 |
|
403 |
305 |
$32K |
| 93351 |
|
117 |
96 |
$32K |
| 76820 |
|
328 |
136 |
$32K |
| 87077 |
|
4,343 |
3,153 |
$31K |
| J1756 |
Iron sucrose injection |
1,292 |
474 |
$31K |
| 82565 |
|
23,030 |
19,944 |
$31K |
| 93976 |
|
216 |
170 |
$30K |
| 77066 |
Tomosynthesis, mammo |
685 |
592 |
$30K |
| 70551 |
|
182 |
159 |
$29K |
| 86787 |
|
1,143 |
1,002 |
$29K |
| 73562 |
|
1,622 |
1,276 |
$29K |
| 83605 |
|
9,714 |
7,234 |
$29K |
| 73630 |
|
1,620 |
1,319 |
$28K |
| 36430 |
|
154 |
99 |
$27K |
| 84153 |
|
1,735 |
1,552 |
$26K |
| 81001 |
|
23,231 |
20,785 |
$26K |
| 96372 |
|
15,391 |
11,934 |
$26K |
| 99396 |
|
219 |
216 |
$26K |
| 83690 |
|
24,302 |
21,125 |
$25K |
| 74018 |
|
774 |
653 |
$25K |
| 86901 |
|
5,450 |
4,480 |
$25K |
| 82330 |
|
16,581 |
13,654 |
$24K |
| U0005 |
Infec agen detec ampli probe |
1,931 |
1,691 |
$24K |
| 93880 |
|
312 |
273 |
$24K |
| 64415 |
|
107 |
89 |
$24K |
| 72040 |
|
1,103 |
956 |
$24K |
| 87624 |
|
987 |
884 |
$23K |
| 97166 |
|
482 |
406 |
$22K |
| 90791 |
|
90 |
87 |
$22K |
| 87635 |
|
5,657 |
4,713 |
$22K |
| 87480 |
|
1,063 |
917 |
$21K |
| 77065 |
Tomosynthesis, mammo |
526 |
428 |
$21K |
| 88175 |
|
1,234 |
1,126 |
$21K |
| 73130 |
|
1,040 |
825 |
$20K |
| 87536 |
|
473 |
391 |
$20K |
| 82746 |
|
2,783 |
2,375 |
$20K |
| 73030 |
|
1,319 |
1,069 |
$20K |
| 87641 |
|
507 |
406 |
$20K |
| 85730 |
|
9,731 |
8,282 |
$19K |
| 86480 |
|
490 |
401 |
$19K |
| 96367 |
|
1,232 |
574 |
$19K |
| 82950 |
|
1,773 |
1,617 |
$19K |
| 77334 |
|
49 |
26 |
$19K |
| 82043 |
|
3,394 |
3,020 |
$18K |
| 99211 |
|
276 |
212 |
$18K |
| 86003 |
|
571 |
268 |
$18K |
| 84403 |
|
1,093 |
932 |
$18K |
| 83020 |
|
904 |
814 |
$17K |
| 75561 |
|
59 |
54 |
$17K |
| 62321 |
|
38 |
37 |
$16K |
| 87522 |
Neg quan hep c or qual rna |
585 |
449 |
$16K |
| 94060 |
|
137 |
124 |
$16K |
| 88341 |
|
310 |
241 |
$16K |
| 84146 |
|
867 |
721 |
$15K |
| 82670 |
|
532 |
466 |
$15K |
| 77080 |
|
250 |
222 |
$15K |
| 83001 |
|
884 |
764 |
$15K |
| 73610 |
|
980 |
826 |
$14K |
| 11043 |
|
45 |
26 |
$14K |
| 29581 |
|
143 |
61 |
$14K |
| P9016 |
Rbc leukocytes reduced |
132 |
92 |
$14K |
| C8908 |
Mri w/o fol w/cont, breast, |
45 |
40 |
$14K |
| 87070 |
|
1,718 |
1,321 |
$14K |
| 96415 |
|
62 |
27 |
$14K |
| 85652 |
|
4,164 |
3,460 |
$14K |
| 86360 |
|
382 |
328 |
$14K |
| 85380 |
|
3,445 |
3,003 |
$14K |
| 86038 |
|
771 |
653 |
$14K |
| 73501 |
|
602 |
507 |
$13K |
| 87660 |
|
1,057 |
915 |
$13K |
| 84132 |
|
22,831 |
19,579 |
$13K |
| 82533 |
|
864 |
571 |
$13K |
| 77336 |
|
92 |
40 |
$13K |
| 76801 |
|
104 |
86 |
$13K |
| 95886 |
|
61 |
48 |
$13K |
| 74174 |
|
58 |
56 |
$12K |
| 19083 |
|
16 |
12 |
$12K |
| 97113 |
|
157 |
68 |
$12K |
| G0472 |
Hep c screen high risk/other |
504 |
393 |
$12K |
| 84481 |
|
999 |
874 |
$12K |
| 82947 |
|
21,165 |
18,098 |
$12K |
| 84550 |
|
2,332 |
1,936 |
$12K |
| 86704 |
|
968 |
791 |
$12K |
| 96376 |
|
2,542 |
1,414 |
$12K |
| G0279 |
Tomosynthesis, mammo |
976 |
854 |
$12K |
| 87510 |
|
1,056 |
914 |
$11K |
| 72070 |
|
399 |
348 |
$11K |
| 84295 |
|
22,301 |
19,245 |
$11K |
| 84156 |
|
2,976 |
2,384 |
$11K |
| 86431 |
|
736 |
600 |
$11K |
| 84520 |
|
20,823 |
18,224 |
$11K |
| 97116 |
|
656 |
361 |
$11K |
| 73110 |
|
588 |
497 |
$11K |
| 86706 |
|
1,065 |
883 |
$11K |
| 86160 |
|
449 |
189 |
$10K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
8,738 |
7,233 |
$10K |
| 82435 |
|
20,535 |
17,987 |
$10K |
| C1769 |
Guide wire |
1,292 |
958 |
$9K |
| 36591 |
|
1,551 |
729 |
$9K |
| 84144 |
|
517 |
405 |
$9K |
| 83615 |
|
1,945 |
1,376 |
$9K |
| 82784 |
|
860 |
449 |
$9K |
| 90715 |
|
591 |
520 |
$9K |
| 86200 |
|
322 |
259 |
$9K |
| 86800 |
|
373 |
311 |
$9K |
| 80197 |
|
1,144 |
449 |
$8K |
| 90686 |
|
483 |
462 |
$8K |
| 97535 |
|
427 |
232 |
$8K |
| 70498 |
|
188 |
159 |
$8K |
| 86235 |
|
383 |
161 |
$8K |
| C1887 |
Catheter, guiding |
366 |
289 |
$7K |
| J2405 |
Ondansetron hcl injection |
19,005 |
14,149 |
$7K |
| 86359 |
|
379 |
328 |
$7K |
| 86357 |
|
379 |
328 |
$7K |
| 71101 |
|
432 |
376 |
$7K |
| 86355 |
|
371 |
324 |
$7K |
| 82550 |
|
1,303 |
1,045 |
$7K |
| 76376 |
|
683 |
567 |
$7K |
| 87186 |
|
1,506 |
1,148 |
$7K |
| 82105 |
|
396 |
352 |
$7K |
| 88185 |
|
71 |
41 |
$6K |
| 83002 |
|
352 |
298 |
$6K |
| 94729 |
|
120 |
112 |
$6K |
| 74022 |
|
444 |
385 |
$6K |
| 99213 |
|
114 |
73 |
$6K |
| 84100 |
|
2,986 |
1,966 |
$6K |
| 45378 |
|
13 |
13 |
$6K |
| 88342 |
|
673 |
546 |
$6K |
| 87147 |
|
1,219 |
975 |
$6K |
| 84480 |
|
519 |
415 |
$6K |
| 84165 |
|
599 |
517 |
$5K |
| 93926 |
|
99 |
92 |
$5K |
| 86225 |
|
297 |
246 |
$5K |
| 86665 |
|
476 |
211 |
$5K |
| 94726 |
|
103 |
99 |
$5K |
| 84134 |
|
715 |
531 |
$5K |
| 11045 |
|
17 |
16 |
$5K |
| 73502 |
|
468 |
391 |
$5K |
| 64493 |
|
16 |
13 |
$5K |
| 87205 |
|
1,278 |
969 |
$5K |
| 83516 |
|
172 |
100 |
$5K |
| 97163 |
|
75 |
72 |
$4K |
| J2800 |
Methocarbamol injection |
1,378 |
997 |
$4K |
| J0561 |
Penicillin g benzathine inj |
15 |
12 |
$4K |
| 83525 |
|
259 |
234 |
$4K |
| 72197 |
|
15 |
12 |
$4K |
| 73560 |
|
454 |
343 |
$4K |
| 88304 |
|
536 |
423 |
$4K |
| J3010 |
Fentanyl citrate injection |
7,731 |
5,422 |
$4K |
| 0002A |
|
565 |
370 |
$4K |
| 74183 |
|
12 |
12 |
$4K |
| 00400 |
|
42 |
40 |
$4K |
| 82785 |
|
221 |
181 |
$4K |
| 86592 |
|
396 |
316 |
$4K |
| 93750 |
|
738 |
516 |
$4K |
| C9145 |
Inj, aponvie, 1 mg |
90 |
82 |
$4K |
| J1100 |
Dexamethasone sodium phos |
9,299 |
6,907 |
$4K |
| 12001 |
|
26 |
26 |
$4K |
| 83521 |
|
577 |
251 |
$4K |
| 87040 |
|
2,055 |
872 |
$4K |
| 0001A |
|
579 |
422 |
$3K |
| 73590 |
|
381 |
298 |
$3K |
| U0002 |
Covid-19 lab test non-cdc |
1,285 |
1,184 |
$3K |
| 87210 |
|
3,408 |
2,993 |
$3K |
| 82627 |
|
222 |
183 |
$3K |
| 82378 |
|
293 |
206 |
$3K |
| 87651 |
|
1,703 |
1,469 |
$3K |
| 82040 |
|
445 |
346 |
$3K |
| 86696 |
|
148 |
125 |
$3K |
| 83721 |
|
196 |
151 |
$3K |
| A9552 |
F18 fdg |
180 |
153 |
$3K |
| 85018 |
|
976 |
680 |
$3K |
| 88184 |
|
64 |
40 |
$3K |
| 73140 |
|
155 |
120 |
$3K |
| 93321 |
|
348 |
287 |
$3K |
| J0131 |
Inj, acetaminophen (nos) |
424 |
251 |
$3K |
| G0008 |
Admin influenza virus vac |
1,131 |
1,024 |
$3K |
| 85384 |
|
841 |
667 |
$3K |
| Q9957 |
Inj perflutren lip micros,ml |
1,039 |
927 |
$3K |
| C1760 |
Closure dev, vasc |
252 |
191 |
$3K |
| J7120 |
Ringers lactate infusion |
1,236 |
757 |
$3K |
| 87081 |
|
208 |
177 |
$3K |
| J1885 |
Ketorolac tromethamine inj |
10,343 |
8,635 |
$3K |
| 86709 |
|
239 |
185 |
$3K |
| C1725 |
Cath, translumin non-laser |
139 |
104 |
$3K |
| 82150 |
|
3,924 |
3,471 |
$2K |
| A9585 |
Gadobutrol injection |
1,445 |
1,265 |
$2K |
| 82803 |
|
1,242 |
958 |
$2K |
| C1894 |
Intro/sheath, non-laser |
1,206 |
924 |
$2K |
| 84155 |
|
452 |
386 |
$2K |
| 84238 |
|
137 |
99 |
$2K |
| J2250 |
Inj midazolam hydrochloride |
5,541 |
4,204 |
$2K |
| 88302 |
|
154 |
102 |
$2K |
| 00731 |
|
386 |
319 |
$2K |
| 84145 |
|
594 |
469 |
$2K |
| J1170 |
Hydromorphone injection |
2,991 |
1,852 |
$2K |
| 01402 |
|
28 |
26 |
$2K |
| 86334 |
|
153 |
131 |
$2K |
| 86705 |
|
168 |
136 |
$2K |
| 73070 |
|
87 |
72 |
$2K |
| 86664 |
|
214 |
190 |
$2K |
| 97012 |
|
59 |
25 |
$2K |
| J1644 |
Inj heparin sodium per 1000u |
3,909 |
1,700 |
$2K |
| 86147 |
|
32 |
12 |
$2K |
| 85014 |
|
650 |
506 |
$1K |
| 01214 |
|
20 |
17 |
$1K |
| 86593 |
|
107 |
82 |
$1K |
| 73700 |
|
12 |
12 |
$1K |
| 82951 |
|
77 |
67 |
$1K |
| 81015 |
|
606 |
529 |
$1K |
| 73620 |
|
41 |
28 |
$1K |
| 86923 |
|
48 |
25 |
$1K |
| 76870 |
|
33 |
29 |
$1K |
| 82805 |
|
26 |
24 |
$1K |
| 86695 |
|
98 |
79 |
$1K |
| 86880 |
|
85 |
61 |
$1K |
| J0690 |
Cefazolin sodium injection |
1,325 |
947 |
$1K |
| G1004 |
Cdsm ndsc |
2,779 |
2,027 |
$954.77 |
| 84436 |
|
255 |
193 |
$943.25 |
| 80320 |
|
101 |
86 |
$909.11 |
| 90471 |
|
124 |
103 |
$868.54 |
| 86870 |
|
22 |
12 |
$868.16 |
| 85046 |
|
300 |
232 |
$861.47 |
| 87497 |
|
135 |
90 |
$851.88 |
| J2270 |
Morphine sulfate injection |
1,633 |
1,255 |
$843.63 |
| 83051 |
|
31 |
27 |
$800.87 |
| 82010 |
|
847 |
683 |
$773.28 |
| 20561 |
|
27 |
17 |
$748.14 |
| J0330 |
Succinycholine chloride inj |
1,008 |
781 |
$722.32 |
| J2785 |
Regadenoson injection |
494 |
427 |
$704.16 |
| 84703 |
|
468 |
415 |
$701.99 |
| 81374 |
|
17 |
13 |
$672.28 |
| J3370 |
Vancomycin hcl injection |
760 |
473 |
$670.63 |
| 85347 |
|
697 |
275 |
$659.56 |
| J2550 |
Promethazine hcl injection |
1,535 |
1,074 |
$646.11 |
| 86146 |
|
32 |
12 |
$635.86 |
| 82140 |
|
167 |
139 |
$621.96 |
| 94761 |
|
575 |
325 |
$612.42 |
| 11721 |
|
27 |
25 |
$588.01 |
| 83520 |
|
21 |
15 |
$572.63 |
| 88112 |
|
37 |
29 |
$568.00 |
| A9502 |
Tc99m tetrofosmin |
502 |
437 |
$567.63 |
| 87529 |
|
19 |
12 |
$561.42 |
| 97016 |
|
20 |
12 |
$551.08 |
| J1200 |
Diphenhydramine hcl injectio |
2,777 |
2,030 |
$550.51 |
| 83010 |
|
63 |
56 |
$532.25 |
| 00910 |
|
57 |
43 |
$514.99 |
| 87075 |
|
83 |
50 |
$506.86 |
| 99214 |
|
15 |
14 |
$502.62 |
| 86812 |
|
52 |
46 |
$502.33 |
| 86304 |
|
83 |
64 |
$471.35 |
| 84402 |
|
16 |
12 |
$441.04 |
| 76937 |
|
166 |
113 |
$440.32 |
| 86300 |
|
30 |
27 |
$440.10 |
| 86708 |
|
14 |
12 |
$431.83 |
| Q3014 |
Telehealth facility fee |
71 |
47 |
$430.26 |
| J2371 |
Inj phenylephrine hcl 20 mcg |
947 |
777 |
$429.17 |
| 73552 |
|
32 |
24 |
$418.24 |
| 86231 |
|
48 |
38 |
$388.14 |
| 83695 |
|
39 |
32 |
$387.55 |
| 86364 |
|
32 |
26 |
$359.53 |
| J3475 |
Inj magnesium sulfate |
657 |
396 |
$347.07 |
| 90656 |
|
38 |
36 |
$338.84 |
| J0360 |
Hydralazine hcl injection |
540 |
400 |
$336.37 |
| J0696 |
Ceftriaxone sodium injection |
2,015 |
1,590 |
$336.34 |
| 82952 |
|
47 |
40 |
$334.89 |
| 86039 |
|
16 |
12 |
$323.32 |
| 90653 |
|
26 |
24 |
$320.39 |
| J1956 |
Levofloxacin injection |
266 |
185 |
$316.56 |
| 80171 |
|
17 |
13 |
$304.06 |
| J1580 |
Garamycin gentamicin inj |
152 |
95 |
$295.27 |
| J3301 |
Triamcinolone acet inj nos |
1,107 |
956 |
$283.20 |
| J2370 |
Phenylephrine hcl injection |
444 |
314 |
$280.14 |
| J1940 |
Furosemide injection |
703 |
414 |
$280.10 |
| J2360 |
Orphenadrine injection |
488 |
412 |
$270.32 |
| J2060 |
Lorazepam injection |
884 |
604 |
$253.41 |
| 76942 |
|
34 |
27 |
$241.40 |
| 00811 |
|
61 |
50 |
$238.75 |
| 82810 |
|
205 |
93 |
$236.68 |
| 00952 |
|
28 |
25 |
$236.54 |
| 96402 |
|
13 |
12 |
$198.70 |
| J0780 |
Prochlorperazine injection |
966 |
743 |
$193.37 |
| 87015 |
|
129 |
55 |
$190.23 |
| 90662 |
|
26 |
25 |
$179.56 |
| 80143 |
|
67 |
61 |
$168.43 |
| 72170 |
|
15 |
14 |
$162.60 |
| 85004 |
|
21 |
13 |
$151.93 |
| J1790 |
Droperidol injection |
859 |
671 |
$143.89 |
| J3480 |
Inj potassium chloride |
349 |
204 |
$142.61 |
| 87206 |
|
88 |
37 |
$141.81 |
| J2543 |
Piperacillin/tazobactam |
63 |
38 |
$128.71 |
| J1650 |
Inj enoxaparin sodium |
173 |
90 |
$126.21 |
| 87799 |
|
151 |
88 |
$125.44 |
| 88173 |
|
18 |
13 |
$121.04 |
| 84460 |
|
13 |
13 |
$111.58 |
| 73090 |
|
20 |
13 |
$111.34 |
| J2175 |
Meperidine hydrochl /100 mg |
56 |
41 |
$104.88 |
| 88300 |
|
12 |
12 |
$103.85 |
| J2765 |
Metoclopramide hcl injection |
385 |
311 |
$102.03 |
| 87880 |
|
54 |
48 |
$88.21 |
| Q0114 |
Fern test |
43 |
34 |
$87.91 |
| J1642 |
Inj heparin sodium per 10 u |
865 |
563 |
$81.25 |
| 87804 |
|
321 |
283 |
$80.07 |
| 73060 |
|
14 |
12 |
$79.91 |
| 88738 |
|
20 |
14 |
$76.29 |
| J1626 |
Granisetron hcl injection |
692 |
260 |
$75.81 |
| G0009 |
Admin pneumococcal vaccine |
15 |
13 |
$70.27 |
| J0134 |
Inj acetaminophen -fresenius |
34 |
24 |
$56.89 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
138 |
106 |
$54.61 |
| C1819 |
Tissue localization-excision |
31 |
25 |
$39.73 |
| J2272 |
Inj, morphine (fresenius) |
53 |
50 |
$39.39 |
| 80181 |
|
24 |
24 |
$19.57 |
| 82272 |
|
20 |
12 |
$8.80 |
| 00812 |
|
17 |
14 |
$0.00 |
| 91300 |
|
273 |
245 |
$0.00 |
| 77001 |
|
96 |
78 |
$0.00 |
| 00790 |
|
15 |
12 |
$0.00 |
| J1630 |
Haloperidol injection |
16 |
16 |
$0.00 |
| 72072 |
|
13 |
12 |
$0.00 |
| J0500 |
Dicyclomine injection |
13 |
12 |
$0.00 |