| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99284 |
|
50,142 |
41,586 |
$11.85M |
| 74177 |
|
12,209 |
9,560 |
$7.69M |
| 99285 |
|
22,433 |
15,559 |
$7.23M |
| 0202U |
|
18,900 |
17,019 |
$6.85M |
| 99283 |
|
37,092 |
32,321 |
$5.16M |
| 70450 |
|
11,194 |
8,159 |
$2.51M |
| 74176 |
|
4,021 |
3,060 |
$2.24M |
| G0378 |
Hospital observation per hr |
4,575 |
2,852 |
$1.81M |
| 71275 |
|
4,280 |
3,306 |
$1.75M |
| 87633 |
|
3,886 |
3,428 |
$1.48M |
| 93306 |
|
2,728 |
2,270 |
$1.42M |
| 93005 |
|
24,761 |
20,125 |
$1.21M |
| 71046 |
|
15,726 |
12,246 |
$1.12M |
| 96374 |
|
21,165 |
16,833 |
$961K |
| 80053 |
|
115,183 |
65,747 |
$910K |
| 96361 |
|
40,969 |
15,763 |
$909K |
| 71045 |
|
22,442 |
15,478 |
$907K |
| 76705 |
|
4,728 |
4,201 |
$850K |
| 96375 |
|
14,863 |
9,986 |
$764K |
| 96365 |
|
10,551 |
6,293 |
$712K |
| 72131 |
|
2,323 |
1,817 |
$688K |
| 43239 |
|
2,978 |
2,364 |
$659K |
| 72125 |
|
2,565 |
2,158 |
$644K |
| 99282 |
|
7,069 |
6,449 |
$628K |
| 69436 |
|
903 |
824 |
$607K |
| 80307 |
|
15,409 |
12,899 |
$586K |
| 96372 |
|
12,793 |
9,504 |
$586K |
| 85025 |
|
77,971 |
63,129 |
$529K |
| 71250 |
|
2,207 |
1,515 |
$438K |
| 70553 |
|
1,218 |
890 |
$437K |
| 97530 |
|
7,142 |
2,598 |
$431K |
| 94640 |
|
8,477 |
5,689 |
$417K |
| C1713 |
Anchor/screw bn/bn,tis/bn |
549 |
379 |
$398K |
| U0003 |
Cov-19 amp prb hgh thruput |
6,424 |
5,522 |
$387K |
| 96360 |
|
14,292 |
5,358 |
$382K |
| 11042 |
|
7,559 |
2,077 |
$376K |
| 71260 |
|
1,440 |
1,034 |
$356K |
| 74018 |
|
5,975 |
5,111 |
$347K |
| 45380 |
|
1,434 |
1,210 |
$338K |
| 42820 |
|
402 |
370 |
$335K |
| 73630 |
|
4,343 |
3,720 |
$321K |
| 70486 |
|
1,054 |
908 |
$320K |
| 0240U |
|
5,255 |
4,537 |
$307K |
| 97110 |
|
5,976 |
1,932 |
$300K |
| 87507 |
|
992 |
897 |
$297K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
22,815 |
15,674 |
$290K |
| 36415 |
|
68,645 |
33,332 |
$289K |
| 76376 |
|
2,388 |
1,761 |
$287K |
| 72148 |
|
802 |
717 |
$286K |
| 92507 |
|
5,581 |
2,125 |
$280K |
| 77067 |
|
4,068 |
3,883 |
$275K |
| 73610 |
|
3,705 |
3,073 |
$270K |
| 73130 |
|
4,109 |
3,301 |
$256K |
| 72128 |
|
918 |
773 |
$249K |
| 73564 |
|
2,992 |
2,248 |
$247K |
| 84443 |
|
17,707 |
15,981 |
$242K |
| 78452 |
|
452 |
242 |
$235K |
| 73030 |
|
3,234 |
2,406 |
$230K |
| 72110 |
|
1,985 |
1,584 |
$226K |
| 87804 |
|
9,231 |
7,906 |
$220K |
| 76817 |
|
1,185 |
1,050 |
$205K |
| 84484 |
|
19,056 |
14,318 |
$205K |
| C9803 |
Hopd covid-19 spec collect |
36,681 |
23,210 |
$204K |
| 76536 |
|
1,440 |
1,277 |
$199K |
| 95810 |
|
225 |
196 |
$198K |
| 76830 |
|
1,137 |
999 |
$198K |
| 0241U |
|
1,458 |
1,140 |
$188K |
| 94060 |
|
2,359 |
1,772 |
$186K |
| 73110 |
|
2,539 |
2,117 |
$185K |
| 87070 |
|
24,569 |
20,395 |
$182K |
| 93971 |
|
1,755 |
1,518 |
$175K |
| J2704 |
Inj, propofol, 10 mg |
11,808 |
10,362 |
$174K |
| J2405 |
Ondansetron hcl injection |
14,226 |
11,649 |
$170K |
| 76642 |
|
1,985 |
1,758 |
$170K |
| 93017 |
|
858 |
749 |
$163K |
| 45378 |
|
366 |
321 |
$154K |
| 96366 |
|
2,920 |
2,038 |
$151K |
| 87430 |
|
11,518 |
10,584 |
$150K |
| 80061 |
|
13,158 |
11,547 |
$140K |
| 74022 |
|
1,318 |
1,204 |
$139K |
| 87798 |
|
4,027 |
3,570 |
$135K |
| 87581 |
|
3,827 |
3,424 |
$131K |
| 87486 |
|
4,398 |
3,462 |
$129K |
| 88305 |
|
1,407 |
853 |
$129K |
| 96376 |
|
2,753 |
1,794 |
$124K |
| 80048 |
|
15,575 |
10,082 |
$124K |
| 80074 |
|
3,576 |
2,806 |
$113K |
| 45385 |
|
430 |
342 |
$110K |
| 82306 |
|
5,164 |
4,520 |
$106K |
| J1885 |
Ketorolac tromethamine inj |
21,787 |
18,438 |
$101K |
| 73080 |
|
1,477 |
1,149 |
$101K |
| 83690 |
|
18,004 |
15,253 |
$101K |
| 87088 |
|
14,139 |
12,053 |
$98K |
| 84145 |
|
4,802 |
3,815 |
$94K |
| 36600 |
|
5,138 |
1,752 |
$92K |
| 70551 |
|
380 |
297 |
$88K |
| 73590 |
|
1,295 |
995 |
$85K |
| 99211 |
|
2,905 |
1,491 |
$85K |
| 94760 |
|
2,801 |
2,425 |
$84K |
| 83880 |
|
3,678 |
2,757 |
$84K |
| 87591 |
|
2,809 |
2,589 |
$83K |
| 87491 |
|
2,828 |
2,593 |
$83K |
| 73502 |
|
1,625 |
1,107 |
$82K |
| 84703 |
|
12,740 |
11,235 |
$81K |
| 83036 |
|
10,570 |
9,466 |
$80K |
| 76700 |
|
445 |
379 |
$78K |
| 81001 |
|
20,814 |
17,733 |
$74K |
| 73090 |
|
1,178 |
978 |
$74K |
| 73562 |
|
1,118 |
789 |
$71K |
| J0561 |
Penicillin g benzathine inj |
484 |
411 |
$71K |
| 47562 |
|
73 |
70 |
$69K |
| Q0162 |
Ondansetron oral |
8,458 |
5,721 |
$68K |
| 94729 |
|
1,787 |
1,634 |
$68K |
| U0005 |
Infec agen detec ampli probe |
3,728 |
3,407 |
$68K |
| 59025 |
|
418 |
252 |
$68K |
| 82607 |
|
5,826 |
5,092 |
$66K |
| A9579 |
Gad-base mr contrast nos,1ml |
2,067 |
1,786 |
$65K |
| 10060 |
|
564 |
478 |
$62K |
| 87522 |
Neg quan hep c or qual rna |
1,610 |
1,491 |
$62K |
| J0696 |
Ceftriaxone sodium injection |
3,803 |
3,025 |
$61K |
| 87077 |
|
9,127 |
7,050 |
$61K |
| 84439 |
|
7,781 |
7,041 |
$60K |
| J0690 |
Cefazolin sodium injection |
3,891 |
3,017 |
$59K |
| 87186 |
|
7,380 |
6,428 |
$58K |
| 87040 |
|
4,704 |
3,542 |
$58K |
| 85027 |
|
9,083 |
7,707 |
$57K |
| 81025 |
|
5,926 |
5,232 |
$56K |
| 85610 |
|
13,878 |
9,003 |
$56K |
| G0480 |
Drug test def 1-7 classes |
1,654 |
1,005 |
$55K |
| J3010 |
Fentanyl citrate injection |
10,562 |
8,941 |
$53K |
| 94726 |
|
690 |
660 |
$52K |
| 77063 |
|
4,970 |
4,301 |
$51K |
| 83605 |
|
5,422 |
4,282 |
$50K |
| 81003 |
|
17,445 |
15,114 |
$48K |
| J1100 |
Dexamethasone sodium phos |
13,756 |
11,735 |
$47K |
| 82962 |
|
11,669 |
5,435 |
$45K |
| 96413 |
|
405 |
195 |
$45K |
| 94750 |
|
869 |
778 |
$40K |
| 70496 |
|
138 |
113 |
$40K |
| 84702 |
|
2,985 |
2,470 |
$39K |
| 82746 |
|
3,394 |
3,119 |
$39K |
| U0002 |
Covid-19 lab test non-cdc |
1,089 |
828 |
$39K |
| 84403 |
|
1,694 |
1,538 |
$38K |
| 58661 |
|
72 |
51 |
$37K |
| 82728 |
|
3,518 |
3,045 |
$37K |
| 12001 |
|
450 |
379 |
$37K |
| 90471 |
|
1,722 |
1,515 |
$35K |
| 41899 |
|
28 |
28 |
$35K |
| 84402 |
|
1,570 |
1,401 |
$34K |
| J1815 |
Insulin injection |
1,939 |
1,310 |
$34K |
| 72050 |
|
314 |
225 |
$33K |
| 95886 |
|
568 |
479 |
$33K |
| 87635 |
|
926 |
774 |
$32K |
| 99281 |
|
543 |
504 |
$32K |
| M0243 |
Casirivi and imdevi inj |
233 |
224 |
$32K |
| 87902 |
|
141 |
112 |
$32K |
| J3370 |
Vancomycin hcl injection |
1,169 |
859 |
$32K |
| 82803 |
|
1,934 |
1,467 |
$30K |
| 80358 |
|
1,436 |
1,382 |
$29K |
| 83516 |
|
1,081 |
969 |
$29K |
| 90715 |
|
1,662 |
1,486 |
$28K |
| 76815 |
|
223 |
202 |
$28K |
| 70498 |
|
148 |
122 |
$28K |
| 84112 |
|
332 |
284 |
$28K |
| 84153 |
|
2,163 |
1,887 |
$27K |
| 83992 |
|
1,449 |
1,397 |
$27K |
| 72141 |
|
83 |
68 |
$26K |
| 85730 |
|
4,749 |
4,069 |
$25K |
| 70491 |
|
77 |
62 |
$25K |
| J2270 |
Morphine sulfate injection |
5,958 |
4,713 |
$25K |
| 83550 |
|
3,587 |
3,290 |
$24K |
| 76000 |
|
296 |
257 |
$24K |
| 95816 |
|
143 |
111 |
$23K |
| 77080 |
|
496 |
352 |
$23K |
| 97162 |
|
849 |
417 |
$23K |
| J7030 |
Normal saline solution infus |
3,025 |
1,209 |
$23K |
| 29125 |
|
370 |
344 |
$22K |
| 83540 |
|
3,944 |
3,543 |
$22K |
| 88304 |
|
250 |
242 |
$22K |
| G0283 |
Elec stim other than wound |
2,001 |
577 |
$21K |
| 83735 |
|
4,105 |
3,191 |
$21K |
| J2250 |
Inj midazolam hydrochloride |
8,440 |
7,140 |
$21K |
| 86850 |
|
2,903 |
2,204 |
$21K |
| 86140 |
|
4,955 |
4,097 |
$21K |
| 97535 |
|
810 |
328 |
$20K |
| 80348 |
|
445 |
413 |
$20K |
| 85378 |
|
2,688 |
2,425 |
$20K |
| J2930 |
Methylprednisolone injection |
2,814 |
1,982 |
$20K |
| 77066 |
Tomosynthesis, mammo |
386 |
332 |
$20K |
| J2001 |
Lidocaine injection |
14,339 |
12,467 |
$20K |
| 86038 |
|
1,912 |
1,724 |
$19K |
| 80143 |
|
1,335 |
1,177 |
$18K |
| Q9963 |
Hocm 350-399mg/ml iodine,1ml |
2,951 |
1,578 |
$17K |
| 87205 |
|
4,046 |
3,288 |
$17K |
| G0279 |
Tomosynthesis, mammo |
1,793 |
1,238 |
$17K |
| 80179 |
|
1,236 |
1,104 |
$17K |
| 87807 |
|
1,420 |
1,320 |
$17K |
| 71101 |
|
227 |
175 |
$16K |
| 82565 |
|
3,061 |
2,171 |
$16K |
| A9500 |
Tc99m sestamibi |
98 |
87 |
$15K |
| 71271 |
|
639 |
574 |
$14K |
| J2765 |
Metoclopramide hcl injection |
3,275 |
2,848 |
$14K |
| 11045 |
|
203 |
24 |
$14K |
| 76775 |
|
199 |
178 |
$13K |
| 96367 |
|
666 |
259 |
$13K |
| 85651 |
|
4,016 |
3,402 |
$13K |
| J2710 |
Neostigmine methylslfte inj |
1,759 |
1,470 |
$13K |
| 93976 |
|
122 |
110 |
$13K |
| 77065 |
Tomosynthesis, mammo |
269 |
223 |
$13K |
| 86703 |
|
1,042 |
935 |
$13K |
| 73721 |
|
31 |
26 |
$13K |
| C9113 |
Inj pantoprazole sodium, via |
1,484 |
944 |
$12K |
| J1644 |
Inj heparin sodium per 1000u |
2,026 |
1,056 |
$11K |
| J7120 |
Ringers lactate infusion |
1,302 |
770 |
$11K |
| 76870 |
|
60 |
56 |
$11K |
| 80076 |
|
1,337 |
1,079 |
$11K |
| J7050 |
Normal saline solution infus |
1,242 |
525 |
$11K |
| J1040 |
Methylprednisolone 80 mg inj |
588 |
516 |
$11K |
| J1650 |
Inj enoxaparin sodium |
532 |
330 |
$11K |
| 84270 |
|
575 |
465 |
$10K |
| 83883 |
|
822 |
716 |
$10K |
| 99406 |
|
875 |
703 |
$10K |
| 82550 |
|
1,666 |
1,365 |
$10K |
| 97166 |
|
353 |
236 |
$10K |
| 84436 |
|
1,775 |
1,481 |
$9K |
| P9612 |
Catheterize for urine spec |
1,916 |
559 |
$9K |
| 86901 |
|
3,221 |
2,684 |
$9K |
| 81596 |
|
138 |
128 |
$9K |
| 72170 |
|
228 |
135 |
$9K |
| 84550 |
|
1,940 |
1,612 |
$9K |
| 84479 |
|
1,608 |
1,382 |
$9K |
| 72100 |
|
156 |
126 |
$8K |
| D1351 |
|
48 |
25 |
$8K |
| 97112 |
|
321 |
162 |
$8K |
| 11043 |
|
142 |
40 |
$8K |
| 72072 |
|
59 |
54 |
$8K |
| 83013 |
|
140 |
132 |
$8K |
| 82172 |
|
562 |
460 |
$8K |
| 86900 |
|
3,344 |
2,697 |
$8K |
| M0245 |
Bamlan and etesev infusion |
35 |
34 |
$8K |
| 86318 |
|
541 |
488 |
$7K |
| C1769 |
Guide wire |
116 |
87 |
$7K |
| 83010 |
|
693 |
631 |
$7K |
| 74019 |
|
111 |
105 |
$7K |
| J0131 |
Inj, acetaminophen (nos) |
300 |
279 |
$7K |
| J1170 |
Hydromorphone injection |
2,082 |
1,557 |
$7K |
| 86708 |
|
689 |
657 |
$7K |
| 86706 |
|
826 |
784 |
$7K |
| 83721 |
|
1,126 |
1,038 |
$7K |
| 12002 |
|
73 |
70 |
$7K |
| J1200 |
Diphenhydramine hcl injectio |
3,422 |
2,602 |
$7K |
| 97140 |
|
333 |
134 |
$6K |
| 62323 |
|
78 |
53 |
$6K |
| J2550 |
Promethazine hcl injection |
2,416 |
1,938 |
$6K |
| J2785 |
Regadenoson injection |
83 |
79 |
$6K |
| 92523 |
|
58 |
53 |
$6K |
| G0463 |
Hospital outpt clinic visit |
481 |
233 |
$6K |
| 99499 |
|
71 |
54 |
$6K |
| 83520 |
|
406 |
359 |
$5K |
| J1580 |
Garamycin gentamicin inj |
483 |
395 |
$5K |
| 73060 |
|
99 |
78 |
$5K |
| 83921 |
|
329 |
301 |
$5K |
| 82150 |
|
783 |
712 |
$5K |
| J1596 |
Inj, glycopyrrolate, 0.1 mg |
313 |
278 |
$5K |
| 86702 |
|
451 |
420 |
$5K |
| 86701 |
|
674 |
622 |
$4K |
| 82570 |
|
944 |
835 |
$4K |
| 43233 |
|
14 |
14 |
$4K |
| 82103 |
|
435 |
363 |
$4K |
| J2795 |
Ropivacaine hcl injection |
326 |
262 |
$4K |
| J2543 |
Piperacillin/tazobactam |
363 |
242 |
$4K |
| 85007 |
|
1,305 |
1,217 |
$4K |
| 87661 |
|
86 |
78 |
$4K |
| 84520 |
|
749 |
649 |
$4K |
| J2916 |
Na ferric gluconate complex |
132 |
37 |
$4K |
| 82043 |
|
952 |
793 |
$4K |
| 82785 |
|
330 |
276 |
$4K |
| 82542 |
|
228 |
192 |
$4K |
| 99152 |
|
129 |
93 |
$4K |
| J0360 |
Hydralazine hcl injection |
473 |
364 |
$4K |
| J0330 |
Succinycholine chloride inj |
562 |
472 |
$3K |
| 93970 |
|
29 |
25 |
$3K |
| 86317 |
|
135 |
119 |
$3K |
| 83615 |
|
649 |
533 |
$3K |
| 82784 |
|
478 |
439 |
$3K |
| 82977 |
|
519 |
473 |
$3K |
| 87081 |
|
442 |
409 |
$3K |
| 82104 |
|
242 |
227 |
$3K |
| 74220 |
|
27 |
27 |
$3K |
| 86431 |
|
640 |
585 |
$3K |
| 86665 |
|
94 |
80 |
$3K |
| J7512 |
Prednisone ir or dr oral 1mg |
1,396 |
1,244 |
$3K |
| 93225 |
|
27 |
25 |
$3K |
| 66984 |
|
41 |
13 |
$3K |
| J2060 |
Lorazepam injection |
796 |
659 |
$3K |
| G0103 |
Psa screening |
265 |
141 |
$3K |
| 95913 |
|
29 |
24 |
$2K |
| 82009 |
|
665 |
554 |
$2K |
| 77061 |
|
33 |
27 |
$2K |
| 82272 |
|
802 |
685 |
$2K |
| U0001 |
2019-ncov diagnostic p |
96 |
83 |
$2K |
| 86666 |
|
66 |
59 |
$2K |
| 82247 |
|
429 |
291 |
$2K |
| 82140 |
|
170 |
132 |
$2K |
| 86308 |
|
474 |
445 |
$2K |
| J2919 |
Inj, methylpred sod succ 5mg |
207 |
155 |
$2K |
| J0171 |
Adrenalin epinephrine inject |
288 |
218 |
$2K |
| 76770 |
|
19 |
12 |
$2K |
| 87220 |
|
461 |
434 |
$2K |
| 87210 |
|
428 |
404 |
$2K |
| 87641 |
|
77 |
66 |
$2K |
| 82670 |
|
98 |
63 |
$2K |
| D2332 |
|
19 |
12 |
$2K |
| C9399 |
Unclassified drugs or biolog |
36 |
12 |
$2K |
| 97161 |
|
30 |
26 |
$2K |
| 86617 |
|
62 |
57 |
$2K |
| 86255 |
|
184 |
170 |
$2K |
| 82390 |
|
190 |
173 |
$2K |
| D2930 |
|
38 |
12 |
$1K |
| 72040 |
|
29 |
27 |
$1K |
| 88307 |
|
13 |
13 |
$1K |
| 84460 |
|
277 |
239 |
$1K |
| 43249 |
|
15 |
12 |
$1K |
| J3411 |
Thiamine hcl 100 mg |
326 |
271 |
$1K |
| 96368 |
|
52 |
42 |
$1K |
| J2370 |
Phenylephrine hcl injection |
837 |
684 |
$1K |
| 87449 |
|
113 |
100 |
$1K |
| 83970 |
|
41 |
36 |
$1K |
| J3475 |
Inj magnesium sulfate |
109 |
74 |
$1K |
| 95806 |
|
18 |
17 |
$1K |
| G0297 |
Ldct for lung ca screen |
57 |
41 |
$1K |
| J1171 |
Inj, hydromorphone, 0.1 mg |
41 |
32 |
$1K |
| 82947 |
|
499 |
466 |
$1K |
| 86920 |
|
34 |
25 |
$1K |
| 86664 |
|
76 |
67 |
$1K |
| 29515 |
|
13 |
12 |
$985.25 |
| J0500 |
Dicyclomine injection |
12 |
12 |
$942.29 |
| 86663 |
|
76 |
67 |
$859.48 |
| 77062 |
|
14 |
13 |
$820.86 |
| 86592 |
|
244 |
206 |
$814.98 |
| 83021 |
|
18 |
17 |
$811.46 |
| 81374 |
|
12 |
12 |
$770.28 |
| 93922 |
|
14 |
12 |
$766.88 |
| A9552 |
F18 fdg |
22 |
13 |
$762.12 |
| J2310 |
Inj naloxone hydrochloride |
33 |
25 |
$753.81 |
| 99213 |
|
16 |
12 |
$728.82 |
| 84146 |
|
40 |
38 |
$725.33 |
| 51702 |
|
17 |
13 |
$712.46 |
| J1010 |
Inj, methylpred acetate 1 mg |
67 |
66 |
$698.67 |
| 87529 |
|
12 |
12 |
$697.59 |
| 83001 |
|
38 |
36 |
$638.91 |
| 76857 |
|
13 |
12 |
$637.24 |
| 85014 |
|
305 |
234 |
$627.89 |
| 80055 |
|
15 |
15 |
$620.56 |
| A9502 |
Tc99m tetrofosmin |
45 |
43 |
$551.10 |
| J0702 |
Betamethasone acet&sod phosp |
39 |
25 |
$520.61 |
| 84100 |
|
192 |
148 |
$518.33 |
| 87340 |
|
45 |
41 |
$508.32 |
| 83655 |
|
41 |
39 |
$485.58 |
| 86803 |
|
47 |
45 |
$476.34 |
| 86747 |
|
18 |
17 |
$427.64 |
| 88175 |
|
12 |
12 |
$417.40 |
| 84165 |
|
58 |
52 |
$410.07 |
| 86677 |
|
12 |
12 |
$398.76 |
| 86376 |
|
34 |
27 |
$327.31 |
| 82951 |
|
28 |
24 |
$308.03 |
| J0592 |
Buprenorphine hydrochloride |
33 |
26 |
$296.08 |
| 86696 |
|
19 |
18 |
$277.11 |
| 84425 |
|
39 |
12 |
$266.07 |
| 81256 |
|
14 |
13 |
$263.33 |
| G0432 |
Eia hiv-1/hiv-2 screen |
24 |
19 |
$260.26 |
| 86800 |
|
21 |
17 |
$242.81 |
| 86645 |
|
18 |
17 |
$239.70 |
| 76981 |
|
43 |
40 |
$227.76 |
| 86618 |
|
12 |
12 |
$206.56 |
| 86644 |
|
17 |
16 |
$204.72 |
| 86787 |
|
18 |
17 |
$183.24 |
| 86762 |
|
17 |
15 |
$180.49 |
| J1642 |
Inj heparin sodium per 10 u |
99 |
49 |
$160.83 |
| 82800 |
|
14 |
13 |
$143.70 |
| Q3014 |
Telehealth facility fee |
13 |
12 |
$124.51 |
| 89051 |
|
17 |
12 |
$108.60 |
| J1790 |
Droperidol injection |
17 |
13 |
$81.97 |
| J3480 |
Inj potassium chloride |
14 |
12 |
$70.87 |
| J7510 |
Prednisolone oral per 5 mg |
54 |
52 |
$65.30 |
| 84156 |
|
38 |
25 |
$64.03 |
| 84155 |
|
45 |
39 |
$55.13 |
| Q9966 |
Locm 200-299mg/ml iodine,1ml |
27 |
18 |
$45.56 |
| 85018 |
|
16 |
12 |
$22.88 |
| Q0244 |
Casirivi and imdevi 1200 mg |
98 |
92 |
$0.01 |
| A9270 |
Non-covered item or service |
16 |
12 |
$0.00 |