| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| G0378 |
Hospital observation per hr |
11,903 |
10,557 |
$14.43M |
| 99284 |
|
43,424 |
41,464 |
$9.60M |
| 99283 |
|
43,363 |
40,923 |
$9.52M |
| 99285 |
|
43,322 |
40,949 |
$9.30M |
| J2350 |
Injection, ocrelizumab, 1 mg |
1,080 |
1,001 |
$6.40M |
| A0431 |
Rotary wing air transport |
706 |
622 |
$2.20M |
| H0013 |
Alcohol and/or drug services |
5,168 |
1,446 |
$2.12M |
| J9271 |
Inj pembrolizumab |
1,833 |
1,481 |
$2.00M |
| P9040 |
Rbc leukoreduced irradiated |
1,724 |
1,387 |
$1.84M |
| J1745 |
Infliximab not biosimil 10mg |
695 |
662 |
$1.67M |
| U0003 |
Cov-19 amp prb hgh thruput |
15,094 |
13,965 |
$1.13M |
| 96413 |
|
6,270 |
4,239 |
$869K |
| A9555 |
Rb82 rubidium |
254 |
240 |
$749K |
| H2011 |
Crisis interven svc, 15 min |
1,098 |
1,029 |
$706K |
| 74177 |
|
3,886 |
3,694 |
$671K |
| 77386 |
|
1,862 |
178 |
$525K |
| 95810 |
|
1,376 |
1,341 |
$512K |
| 76811 |
|
3,586 |
3,521 |
$501K |
| 70553 |
|
1,708 |
1,637 |
$496K |
| C8929 |
Tte w or wo fol wcon,doppler |
340 |
326 |
$409K |
| 78815 |
|
493 |
442 |
$395K |
| 43239 |
|
514 |
490 |
$392K |
| 45380 |
|
570 |
554 |
$383K |
| 74183 |
|
794 |
759 |
$356K |
| 36415 |
|
109,199 |
86,539 |
$337K |
| 99235 |
|
303 |
244 |
$311K |
| 70450 |
|
3,276 |
3,109 |
$299K |
| 72197 |
|
588 |
558 |
$297K |
| A0436 |
Rotary wing air mileage |
663 |
571 |
$294K |
| J9144 |
Daratumumab, hyaluronidase |
624 |
413 |
$288K |
| 71260 |
|
2,893 |
2,770 |
$282K |
| 70551 |
|
995 |
949 |
$267K |
| 45378 |
|
292 |
276 |
$253K |
| 85025 |
|
65,060 |
52,424 |
$250K |
| 77067 |
|
2,416 |
2,372 |
$248K |
| 76816 |
|
3,938 |
3,706 |
$243K |
| 87491 |
|
12,963 |
12,537 |
$230K |
| 80048 |
|
46,218 |
38,972 |
$226K |
| 76815 |
|
4,178 |
2,641 |
$224K |
| 99281 |
|
1,182 |
962 |
$215K |
| 78431 |
|
226 |
213 |
$210K |
| 36430 |
|
1,692 |
1,290 |
$197K |
| 96374 |
|
10,474 |
9,375 |
$196K |
| 80053 |
|
27,282 |
19,076 |
$190K |
| 93005 |
|
21,483 |
18,649 |
$182K |
| 93306 |
|
1,390 |
1,317 |
$181K |
| OP250 |
|
4,350 |
2,589 |
$171K |
| 99282 |
|
870 |
783 |
$165K |
| 72141 |
|
571 |
553 |
$161K |
| 81220 |
|
590 |
568 |
$159K |
| 93325 |
|
479 |
452 |
$151K |
| 76830 |
|
2,317 |
2,235 |
$143K |
| A0427 |
Als1-emergency |
305 |
274 |
$141K |
| J9299 |
Injection, nivolumab |
69 |
51 |
$139K |
| 73721 |
|
407 |
390 |
$138K |
| 96365 |
|
3,617 |
2,634 |
$134K |
| 76801 |
|
2,375 |
2,218 |
$129K |
| A9575 |
Inj gadoterate meglumi 0.1ml |
6,417 |
6,071 |
$128K |
| 59025 |
|
7,170 |
3,950 |
$125K |
| T1015 |
Clinic service |
5,465 |
4,881 |
$123K |
| 71250 |
|
1,597 |
1,519 |
$122K |
| J7307 |
Etonogestrel implant system |
539 |
520 |
$120K |
| 76856 |
|
2,432 |
2,344 |
$117K |
| 85027 |
|
19,253 |
15,649 |
$117K |
| 76817 |
|
1,659 |
1,426 |
$114K |
| 87389 |
|
5,883 |
5,699 |
$113K |
| 72148 |
|
549 |
527 |
$113K |
| G0483 |
Drug test def 22+ classes |
902 |
773 |
$112K |
| 77066 |
Tomosynthesis, mammo |
932 |
909 |
$110K |
| 87636 |
|
1,311 |
1,253 |
$110K |
| 96375 |
|
6,638 |
5,263 |
$109K |
| 87637 |
|
1,303 |
1,215 |
$106K |
| 45385 |
|
221 |
215 |
$104K |
| 81329 |
|
1,492 |
1,445 |
$102K |
| J9035 |
Bevacizumab injection |
20 |
13 |
$99K |
| 36591 |
|
1,022 |
688 |
$98K |
| 84443 |
|
6,905 |
6,258 |
$97K |
| 72156 |
|
322 |
304 |
$97K |
| 77412 |
|
1,498 |
207 |
$96K |
| 96361 |
|
6,764 |
5,549 |
$93K |
| 71046 |
|
6,454 |
5,739 |
$93K |
| 76805 |
|
1,235 |
1,207 |
$88K |
| 96415 |
|
1,809 |
1,433 |
$88K |
| 77338 |
|
81 |
68 |
$86K |
| J1756 |
Iron sucrose injection |
3,939 |
2,288 |
$86K |
| G0463 |
Hospital outpt clinic visit |
13,548 |
11,491 |
$86K |
| OP710 |
|
642 |
445 |
$84K |
| 80307 |
|
2,415 |
2,239 |
$83K |
| 72157 |
|
300 |
278 |
$83K |
| J9395 |
Injection, fulvestrant |
145 |
135 |
$83K |
| 83735 |
|
23,914 |
17,096 |
$82K |
| 76642 |
|
1,395 |
1,157 |
$82K |
| 70543 |
|
181 |
174 |
$82K |
| 77387 |
|
1,230 |
150 |
$81K |
| 93303 |
|
407 |
374 |
$81K |
| 76818 |
|
824 |
532 |
$79K |
| 73221 |
|
280 |
257 |
$79K |
| 95811 |
|
147 |
142 |
$79K |
| 76700 |
|
1,114 |
1,052 |
$79K |
| 87536 |
|
998 |
923 |
$78K |
| C9803 |
Hopd covid-19 spec collect |
3,948 |
3,734 |
$78K |
| 36592 |
|
124 |
74 |
$78K |
| 74176 |
|
806 |
768 |
$77K |
| 96417 |
|
1,102 |
705 |
$74K |
| 87591 |
|
10,588 |
10,240 |
$72K |
| 86902 |
|
660 |
521 |
$70K |
| 76536 |
|
1,009 |
978 |
$67K |
| 80061 |
|
6,764 |
6,460 |
$65K |
| 72125 |
|
626 |
602 |
$65K |
| 77063 |
|
2,405 |
2,361 |
$64K |
| 77336 |
|
1,231 |
541 |
$64K |
| 82803 |
|
4,457 |
3,824 |
$64K |
| 77334 |
|
472 |
345 |
$64K |
| 81420 |
|
486 |
479 |
$63K |
| 82306 |
|
2,415 |
2,284 |
$62K |
| 86900 |
|
8,867 |
7,537 |
$59K |
| 70486 |
|
519 |
499 |
$57K |
| 86850 |
|
7,087 |
6,037 |
$56K |
| 80076 |
|
13,043 |
11,439 |
$56K |
| A9552 |
F18 fdg |
359 |
329 |
$56K |
| 96376 |
|
1,259 |
864 |
$54K |
| 77301 |
|
72 |
63 |
$54K |
| 84484 |
|
5,915 |
4,812 |
$51K |
| 88175 |
|
2,346 |
2,328 |
$49K |
| 93971 |
|
829 |
770 |
$49K |
| J2785 |
Regadenoson injection |
1,193 |
1,166 |
$49K |
| 19083 |
|
80 |
78 |
$48K |
| 76820 |
|
1,216 |
727 |
$48K |
| 95708 |
|
317 |
171 |
$48K |
| 86803 |
|
3,046 |
2,950 |
$47K |
| 83880 |
|
2,378 |
2,102 |
$47K |
| 36512 |
|
552 |
467 |
$46K |
| 94729 |
|
1,212 |
1,174 |
$45K |
| 86480 |
|
815 |
791 |
$45K |
| 87624 |
|
1,564 |
1,540 |
$44K |
| 77065 |
Tomosynthesis, mammo |
487 |
468 |
$44K |
| 70491 |
|
430 |
411 |
$44K |
| 72158 |
|
149 |
145 |
$44K |
| 36593 |
|
171 |
134 |
$44K |
| 83036 |
|
9,399 |
9,026 |
$43K |
| 80197 |
|
3,917 |
2,276 |
$41K |
| 94010 |
|
2,534 |
2,332 |
$41K |
| 86360 |
|
907 |
847 |
$41K |
| 86832 |
|
593 |
544 |
$40K |
| 74178 |
|
148 |
144 |
$40K |
| 88305 |
|
3,163 |
2,916 |
$39K |
| 70544 |
|
182 |
175 |
$39K |
| 72146 |
|
185 |
177 |
$38K |
| 74174 |
|
168 |
160 |
$37K |
| 86833 |
|
595 |
545 |
$37K |
| 71275 |
|
232 |
219 |
$37K |
| 76770 |
|
666 |
634 |
$37K |
| 86790 |
|
133 |
126 |
$37K |
| 93356 |
|
390 |
367 |
$36K |
| Q0162 |
Ondansetron oral |
6,975 |
4,555 |
$36K |
| 87661 |
|
5,226 |
5,056 |
$35K |
| 87086 |
|
6,846 |
6,420 |
$35K |
| 70496 |
|
217 |
205 |
$34K |
| 94640 |
|
858 |
677 |
$33K |
| 73630 |
|
2,089 |
1,510 |
$32K |
| 86359 |
|
920 |
859 |
$32K |
| 93017 |
|
566 |
538 |
$32K |
| 94726 |
|
964 |
937 |
$32K |
| 93970 |
|
291 |
283 |
$32K |
| 76705 |
|
784 |
749 |
$31K |
| 85610 |
|
11,324 |
8,625 |
$31K |
| 43235 |
|
67 |
66 |
$31K |
| 95700 |
|
148 |
144 |
$30K |
| Q3014 |
Telehealth facility fee |
10,281 |
7,616 |
$29K |
| 93975 |
|
309 |
299 |
$29K |
| 77300 |
|
464 |
385 |
$29K |
| 96411 |
|
429 |
279 |
$29K |
| A9500 |
Tc99m sestamibi |
87 |
82 |
$29K |
| 81025 |
|
10,137 |
9,335 |
$29K |
| 86901 |
|
7,327 |
6,217 |
$28K |
| 93320 |
|
483 |
444 |
$28K |
| 84100 |
|
9,139 |
6,686 |
$28K |
| 36561 |
|
12 |
12 |
$27K |
| 77062 |
|
893 |
877 |
$27K |
| 82728 |
|
2,772 |
2,529 |
$27K |
| 82784 |
|
1,464 |
1,249 |
$26K |
| 10005 |
|
45 |
41 |
$26K |
| 76819 |
|
336 |
287 |
$26K |
| 84702 |
|
2,463 |
2,045 |
$26K |
| 96366 |
|
1,741 |
1,273 |
$25K |
| 95886 |
|
545 |
526 |
$25K |
| 77290 |
|
327 |
288 |
$25K |
| 85730 |
|
5,969 |
4,941 |
$25K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
8,889 |
8,167 |
$25K |
| 77295 |
|
70 |
62 |
$24K |
| 87088 |
|
4,934 |
4,659 |
$23K |
| 78452 |
|
88 |
83 |
$23K |
| 71045 |
|
3,830 |
3,469 |
$23K |
| 84466 |
|
2,238 |
2,060 |
$23K |
| 76813 |
|
306 |
299 |
$23K |
| Q9950 |
Inj sulf hexa lipid microsph |
406 |
396 |
$23K |
| 96372 |
|
3,208 |
2,698 |
$23K |
| 96360 |
|
1,311 |
1,173 |
$22K |
| 70498 |
|
155 |
145 |
$22K |
| 84134 |
|
1,343 |
646 |
$21K |
| 77080 |
|
412 |
395 |
$21K |
| 76376 |
|
544 |
518 |
$20K |
| 73564 |
|
913 |
781 |
$20K |
| 80050 |
|
538 |
505 |
$20K |
| 83605 |
|
4,489 |
3,798 |
$20K |
| A0434 |
Specialty care transport |
13 |
12 |
$20K |
| 83970 |
|
719 |
670 |
$19K |
| 88185 |
|
136 |
124 |
$19K |
| 83690 |
|
6,920 |
6,277 |
$19K |
| 77049 |
|
73 |
70 |
$19K |
| 87340 |
|
1,897 |
1,806 |
$19K |
| 74240 |
|
314 |
299 |
$18K |
| 86592 |
|
6,406 |
6,196 |
$18K |
| 58558 |
|
13 |
13 |
$18K |
| 87653 |
|
650 |
637 |
$17K |
| 93923 |
|
311 |
296 |
$17K |
| J9070 |
Cyclophosphamide 100 mg inj |
194 |
116 |
$17K |
| 86762 |
|
1,196 |
1,164 |
$17K |
| 96367 |
|
1,002 |
647 |
$17K |
| 82330 |
|
3,663 |
3,122 |
$16K |
| 86923 |
|
331 |
255 |
$16K |
| 77280 |
|
397 |
339 |
$16K |
| 73030 |
|
883 |
768 |
$16K |
| 82607 |
|
1,731 |
1,655 |
$15K |
| 99291 |
|
80 |
72 |
$15K |
| 72100 |
|
620 |
587 |
$15K |
| 81003 |
|
8,972 |
8,368 |
$15K |
| A9503 |
Tc99m medronate |
123 |
112 |
$15K |
| 83540 |
|
2,430 |
2,251 |
$15K |
| 84153 |
|
928 |
869 |
$15K |
| 95911 |
|
171 |
165 |
$14K |
| 82570 |
|
3,074 |
2,835 |
$14K |
| 77061 |
|
462 |
446 |
$14K |
| 85007 |
|
4,788 |
3,262 |
$14K |
| 82375 |
|
3,645 |
3,142 |
$14K |
| 88173 |
|
147 |
136 |
$14K |
| 87497 |
|
613 |
320 |
$14K |
| G0277 |
Hbot, full body chamber, 30m |
41 |
13 |
$13K |
| 83020 |
|
1,839 |
1,393 |
$13K |
| 78306 |
|
177 |
160 |
$12K |
| A0888 |
Noncovered ambulance mileage |
1,106 |
1,049 |
$12K |
| 73610 |
|
668 |
575 |
$12K |
| 86141 |
|
1,364 |
811 |
$12K |
| 73562 |
|
540 |
416 |
$11K |
| 73130 |
|
853 |
682 |
$11K |
| J1453 |
Fosaprepitant injection |
892 |
638 |
$11K |
| 76377 |
|
491 |
457 |
$11K |
| G0399 |
Home sleep test/type 3 porta |
12 |
12 |
$11K |
| 82947 |
|
5,127 |
4,655 |
$11K |
| 81001 |
|
4,832 |
4,447 |
$11K |
| A0429 |
Bls-emergency |
42 |
28 |
$11K |
| 83883 |
|
603 |
504 |
$11K |
| OP370 |
|
80 |
56 |
$11K |
| 87633 |
|
104 |
100 |
$10K |
| 72110 |
|
333 |
318 |
$10K |
| 96416 |
|
62 |
39 |
$10K |
| 82105 |
|
855 |
779 |
$10K |
| 93880 |
|
95 |
92 |
$10K |
| 88313 |
|
180 |
168 |
$10K |
| 73502 |
|
400 |
382 |
$10K |
| 86704 |
|
794 |
763 |
$10K |
| 83516 |
|
489 |
324 |
$9K |
| 87631 |
|
149 |
139 |
$9K |
| C1769 |
Guide wire |
533 |
493 |
$9K |
| 76870 |
|
161 |
158 |
$9K |
| J3489 |
Zoledronic acid 1mg |
173 |
169 |
$9K |
| 87522 |
Neg quan hep c or qual rna |
345 |
321 |
$9K |
| 87635 |
|
460 |
436 |
$9K |
| 87799 |
|
327 |
220 |
$9K |
| 88321 |
|
186 |
169 |
$8K |
| 84403 |
|
496 |
466 |
$8K |
| 82962 |
|
8,388 |
6,465 |
$8K |
| 86706 |
|
1,058 |
1,007 |
$8K |
| 88360 |
|
209 |
186 |
$8K |
| 86160 |
|
647 |
301 |
$8K |
| 93505 |
|
21 |
14 |
$8K |
| 96402 |
|
322 |
278 |
$8K |
| 86922 |
|
479 |
360 |
$8K |
| 82043 |
|
1,346 |
1,298 |
$8K |
| 95816 |
|
215 |
207 |
$7K |
| 83615 |
|
2,038 |
1,517 |
$7K |
| J0610 |
Calcium glucon (fresenius) |
693 |
503 |
$7K |
| 86300 |
|
423 |
331 |
$7K |
| 87077 |
|
1,688 |
1,551 |
$7K |
| J9217 |
Leuprolide acetate suspnsion |
83 |
76 |
$7K |
| 72040 |
|
332 |
308 |
$7K |
| 86787 |
|
532 |
513 |
$7K |
| 95910 |
|
90 |
87 |
$7K |
| 81479 |
|
42 |
29 |
$6K |
| 82746 |
|
816 |
777 |
$6K |
| J9045 |
Carboplatin injection |
1,201 |
831 |
$6K |
| 75561 |
|
13 |
13 |
$6K |
| 80320 |
|
894 |
827 |
$6K |
| 80364 |
|
388 |
375 |
$6K |
| 86038 |
|
502 |
488 |
$6K |
| 83050 |
|
3,550 |
3,060 |
$6K |
| 86147 |
|
103 |
99 |
$6K |
| 73521 |
|
196 |
190 |
$6K |
| 87186 |
|
1,256 |
1,182 |
$5K |
| 84439 |
|
884 |
811 |
$5K |
| 31575 |
|
37 |
29 |
$5K |
| 85652 |
|
2,162 |
1,985 |
$5K |
| 86235 |
|
144 |
121 |
$5K |
| J8540 |
Oral dexamethasone |
8,722 |
4,365 |
$5K |
| 73110 |
|
396 |
347 |
$5K |
| 73560 |
|
239 |
178 |
$5K |
| 82550 |
|
1,057 |
889 |
$5K |
| 87517 |
|
148 |
140 |
$5K |
| J7120 |
Ringers lactate infusion |
16,207 |
13,878 |
$5K |
| 72195 |
|
16 |
16 |
$5K |
| 84146 |
|
264 |
255 |
$5K |
| 84165 |
|
700 |
614 |
$4K |
| 86146 |
|
103 |
99 |
$4K |
| 99211 |
|
3,373 |
2,944 |
$4K |
| 87040 |
|
602 |
521 |
$4K |
| 85379 |
|
869 |
805 |
$4K |
| 82977 |
|
580 |
412 |
$4K |
| 82248 |
|
863 |
666 |
$4K |
| 96523 |
|
320 |
221 |
$4K |
| 49083 |
|
15 |
12 |
$4K |
| 86140 |
|
1,575 |
1,470 |
$4K |
| 84156 |
|
1,752 |
1,574 |
$4K |
| 82670 |
|
257 |
240 |
$4K |
| 78434 |
|
215 |
202 |
$4K |
| U0002 |
Covid-19 lab test non-cdc |
95 |
92 |
$4K |
| 88341 |
|
193 |
181 |
$4K |
| 86355 |
|
129 |
120 |
$4K |
| 83520 |
|
250 |
239 |
$4K |
| 10060 |
|
28 |
27 |
$4K |
| 87070 |
|
1,060 |
970 |
$4K |
| 94618 |
|
272 |
258 |
$3K |
| 74246 |
|
69 |
68 |
$3K |
| 88342 |
|
349 |
318 |
$3K |
| 90471 |
|
568 |
535 |
$3K |
| J2930 |
Methylprednisolone injection |
2,627 |
2,309 |
$3K |
| 87081 |
|
1,044 |
1,023 |
$3K |
| 82378 |
|
408 |
315 |
$3K |
| 86334 |
|
235 |
217 |
$3K |
| 88184 |
|
160 |
147 |
$3K |
| 77470 |
|
62 |
51 |
$3K |
| 84436 |
|
570 |
528 |
$3K |
| 74220 |
|
98 |
92 |
$3K |
| 70549 |
|
13 |
13 |
$3K |
| 90715 |
|
895 |
875 |
$3K |
| Q9957 |
Inj perflutren lip micros,ml |
906 |
890 |
$3K |
| 74019 |
|
150 |
143 |
$3K |
| J9267 |
Paclitaxel injection |
923 |
470 |
$3K |
| J1642 |
Inj heparin sodium per 10 u |
5,509 |
3,227 |
$3K |
| C1894 |
Intro/sheath, non-laser |
131 |
114 |
$3K |
| 86225 |
|
224 |
200 |
$3K |
| 86304 |
|
216 |
186 |
$3K |
| 76000 |
|
93 |
83 |
$3K |
| A0425 |
Ground mileage |
213 |
169 |
$3K |
| 84479 |
|
554 |
513 |
$3K |
| 70487 |
|
26 |
25 |
$3K |
| 72131 |
|
25 |
25 |
$3K |
| J9263 |
Oxaliplatin |
551 |
318 |
$3K |
| 88307 |
|
229 |
211 |
$3K |
| 84550 |
|
752 |
642 |
$3K |
| 88177 |
|
30 |
27 |
$3K |
| 81000 |
|
805 |
734 |
$3K |
| 87502 |
|
60 |
57 |
$3K |
| 84402 |
|
122 |
117 |
$2K |
| 83001 |
|
206 |
198 |
$2K |
| 88172 |
|
31 |
28 |
$2K |
| 80353 |
|
341 |
318 |
$2K |
| 76882 |
|
187 |
174 |
$2K |
| 76937 |
|
267 |
246 |
$2K |
| 84207 |
|
97 |
90 |
$2K |
| 87205 |
|
962 |
902 |
$2K |
| 96401 |
|
30 |
12 |
$2K |
| 74018 |
|
145 |
129 |
$2K |
| 87467 |
|
332 |
329 |
$2K |
| J1170 |
Hydromorphone injection |
5,228 |
3,377 |
$2K |
| 86800 |
|
177 |
156 |
$2K |
| 86708 |
|
219 |
211 |
$2K |
| 84295 |
|
3,341 |
2,843 |
$2K |
| 85045 |
|
674 |
577 |
$2K |
| 73080 |
|
197 |
175 |
$2K |
| 72070 |
|
85 |
80 |
$2K |
| 84478 |
|
390 |
307 |
$2K |
| 88112 |
|
169 |
151 |
$2K |
| 87506 |
|
14 |
13 |
$2K |
| 73590 |
|
150 |
137 |
$2K |
| 86301 |
|
176 |
122 |
$2K |
| 93308 |
|
136 |
114 |
$2K |
| 81351 |
|
12 |
12 |
$2K |
| 84432 |
|
112 |
99 |
$2K |
| 74230 |
|
50 |
45 |
$2K |
| 82565 |
|
801 |
745 |
$1K |
| 81015 |
|
876 |
844 |
$1K |
| 84480 |
|
238 |
220 |
$1K |
| 86431 |
|
229 |
224 |
$1K |
| J2997 |
Alteplase recombinant |
470 |
387 |
$1K |
| C1729 |
Cath, drainage |
43 |
40 |
$1K |
| 92014 |
|
165 |
148 |
$1K |
| J2704 |
Inj, propofol, 10 mg |
7,135 |
5,218 |
$1K |
| 78264 |
|
13 |
12 |
$1K |
| 82533 |
|
156 |
145 |
$1K |
| 92133 |
|
84 |
79 |
$1K |
| 83921 |
|
103 |
99 |
$1K |
| 86735 |
|
38 |
37 |
$1K |
| J3475 |
Inj magnesium sulfate |
3,655 |
2,772 |
$1K |
| 82150 |
|
326 |
244 |
$1K |
| 92083 |
|
46 |
41 |
$1K |
| 83002 |
|
94 |
92 |
$1K |
| 85018 |
|
2,783 |
2,396 |
$1K |
| 93296 |
|
246 |
212 |
$1K |
| 82247 |
|
303 |
240 |
$1K |
| 72050 |
|
30 |
25 |
$1K |
| 84425 |
|
248 |
236 |
$1K |
| J2405 |
Ondansetron hcl injection |
13,077 |
9,865 |
$1K |
| J2001 |
Lidocaine injection |
4,354 |
3,929 |
$999.67 |
| 85613 |
|
102 |
97 |
$994.25 |
| 81513 |
|
159 |
158 |
$993.49 |
| 96368 |
|
154 |
117 |
$961.56 |
| 94060 |
|
41 |
41 |
$941.52 |
| 73552 |
|
47 |
41 |
$896.55 |
| J3010 |
Fentanyl citrate injection |
7,009 |
5,778 |
$895.06 |
| 95819 |
|
31 |
29 |
$879.96 |
| 86200 |
|
90 |
89 |
$878.54 |
| J1885 |
Ketorolac tromethamine inj |
13,091 |
10,687 |
$828.47 |
| 84132 |
|
1,392 |
1,252 |
$825.96 |
| 76942 |
|
29 |
27 |
$793.21 |
| 82274 |
|
332 |
322 |
$792.32 |
| 73120 |
|
65 |
38 |
$790.78 |
| 80177 |
|
77 |
66 |
$787.51 |
| 86618 |
|
30 |
30 |
$785.57 |
| 88312 |
|
64 |
60 |
$738.75 |
| 84255 |
|
12 |
12 |
$737.55 |
| 84460 |
|
282 |
238 |
$736.84 |
| 95909 |
|
12 |
12 |
$718.24 |
| 36000 |
|
296 |
285 |
$706.93 |
| 86255 |
|
74 |
47 |
$684.42 |
| 73090 |
|
62 |
55 |
$678.67 |
| 85660 |
|
347 |
284 |
$653.59 |
| 86765 |
|
66 |
64 |
$639.62 |
| 84450 |
|
249 |
214 |
$615.62 |
| J2270 |
Morphine sulfate injection |
3,717 |
2,880 |
$611.06 |
| OP270 |
|
71 |
50 |
$611.02 |
| G0008 |
Admin influenza virus vac |
175 |
170 |
$610.56 |
| 82951 |
|
69 |
64 |
$601.45 |
| A9541 |
Tc99m sulfur colloid |
26 |
26 |
$582.00 |
| J1200 |
Diphenhydramine hcl injectio |
4,875 |
3,810 |
$576.24 |
| J0640 |
Leucovorin calcium injection |
104 |
65 |
$567.24 |
| J2250 |
Inj midazolam hydrochloride |
2,826 |
2,547 |
$549.46 |
| 87481 |
|
156 |
155 |
$543.35 |
| 90686 |
|
80 |
76 |
$541.56 |
| 86593 |
|
121 |
113 |
$540.31 |
| 97802 |
|
43 |
39 |
$532.22 |
| 87529 |
|
45 |
42 |
$514.70 |
| 82088 |
|
26 |
25 |
$513.87 |
| 95885 |
|
12 |
12 |
$507.24 |
| 81050 |
|
86 |
85 |
$472.00 |
| 87015 |
|
196 |
179 |
$451.16 |
| J1100 |
Dexamethasone sodium phos |
997 |
807 |
$445.66 |
| J1940 |
Furosemide injection |
1,348 |
1,047 |
$416.53 |
| 84075 |
|
196 |
171 |
$414.46 |
| 73140 |
|
39 |
34 |
$413.27 |
| J3490 |
Drugs unclassified injection |
4,031 |
3,320 |
$409.25 |
| 80164 |
|
28 |
27 |
$409.13 |
| 82040 |
|
152 |
136 |
$399.32 |
| 86870 |
|
80 |
69 |
$389.53 |
| 84630 |
|
39 |
39 |
$378.61 |
| 87493 |
|
30 |
28 |
$377.36 |
| 80354 |
|
12 |
12 |
$366.29 |
| 83021 |
|
27 |
24 |
$364.15 |
| 82010 |
|
201 |
181 |
$363.27 |
| J0780 |
Prochlorperazine injection |
688 |
578 |
$359.42 |
| J3480 |
Inj potassium chloride |
1,017 |
724 |
$348.82 |
| 87328 |
|
27 |
27 |
$347.41 |
| J1644 |
Inj heparin sodium per 1000u |
1,946 |
1,027 |
$333.27 |
| J0696 |
Ceftriaxone sodium injection |
1,753 |
1,564 |
$314.94 |
| 86077 |
|
15 |
13 |
$305.78 |
| 84481 |
|
12 |
12 |
$304.76 |
| 94680 |
|
12 |
12 |
$301.74 |
| 51798 |
|
59 |
52 |
$299.44 |
| 82435 |
|
287 |
244 |
$296.41 |
| 80143 |
|
70 |
63 |
$294.43 |
| 87116 |
|
144 |
132 |
$286.48 |
| 87102 |
|
111 |
102 |
$270.48 |
| 77333 |
|
15 |
15 |
$263.18 |
| 80179 |
|
62 |
59 |
$252.36 |
| 84166 |
|
15 |
15 |
$249.40 |
| 84155 |
|
98 |
92 |
$248.69 |
| 82785 |
|
15 |
14 |
$230.74 |
| 92134 |
|
42 |
39 |
$227.82 |
| 92557 |
|
16 |
14 |
$227.13 |
| 80325 |
|
28 |
28 |
$222.78 |
| 85008 |
|
370 |
276 |
$217.02 |
| 73060 |
|
13 |
13 |
$215.76 |
| 11102 |
|
38 |
28 |
$214.99 |
| 86780 |
|
29 |
29 |
$214.02 |
| 86769 |
|
14 |
13 |
$199.47 |
| J2765 |
Metoclopramide hcl injection |
3,689 |
2,937 |
$197.16 |
| 82465 |
|
76 |
67 |
$193.98 |
| 89050 |
|
122 |
92 |
$185.03 |
| 99201 |
|
164 |
147 |
$177.54 |
| 82525 |
|
24 |
24 |
$175.59 |
| 85014 |
|
307 |
258 |
$173.34 |
| J2370 |
Phenylephrine hcl injection |
872 |
811 |
$171.61 |
| J1815 |
Insulin injection |
1,012 |
750 |
$162.11 |
| J2060 |
Lorazepam injection |
1,514 |
1,229 |
$158.61 |
| 90662 |
|
36 |
36 |
$158.34 |
| 82103 |
|
24 |
24 |
$158.18 |
| 82104 |
|
24 |
24 |
$157.00 |
| 94200 |
|
12 |
12 |
$152.96 |
| 89051 |
|
50 |
43 |
$148.67 |
| 83012 |
|
28 |
25 |
$145.79 |
| 82310 |
|
31 |
25 |
$144.95 |
| J3370 |
Vancomycin hcl injection |
84 |
67 |
$129.97 |
| 85384 |
|
28 |
27 |
$126.96 |
| J7512 |
Prednisone ir or dr oral 1mg |
3,802 |
2,413 |
$115.83 |
| 86309 |
|
14 |
12 |
$114.25 |
| 87206 |
|
145 |
133 |
$114.11 |
| 99202 |
|
179 |
170 |
$109.76 |
| 87329 |
|
29 |
29 |
$101.08 |
| 88311 |
|
17 |
17 |
$100.83 |
| 86376 |
|
13 |
13 |
$100.76 |
| 72170 |
|
15 |
13 |
$97.73 |
| 82390 |
|
14 |
14 |
$86.48 |
| J0690 |
Cefazolin sodium injection |
506 |
420 |
$85.15 |
| 82952 |
|
42 |
37 |
$83.73 |
| J9190 |
Fluorouracil injection |
236 |
137 |
$74.92 |
| 87046 |
|
44 |
42 |
$69.36 |
| J1630 |
Haloperidol injection |
650 |
568 |
$60.44 |
| 84157 |
|
12 |
12 |
$42.39 |
| 87651 |
|
13 |
13 |
$39.59 |
| C1725 |
Cath, translumin non-laser |
16 |
13 |
$34.10 |
| 87147 |
|
24 |
24 |
$28.90 |
| 90837 |
|
204 |
124 |
$26.84 |
| Q9963 |
Hocm 350-399mg/ml iodine,1ml |
14 |
14 |
$26.64 |
| 80329 |
|
12 |
12 |
$23.19 |
| C9113 |
Inj pantoprazole sodium, via |
548 |
313 |
$19.20 |
| J1650 |
Inj enoxaparin sodium |
1,222 |
708 |
$16.24 |
| S5000 |
Prescription drug, generic |
652 |
451 |
$3.31 |
| J2371 |
Inj phenylephrine hcl 20 mcg |
661 |
629 |
$1.53 |
| S0028 |
Injection, famotidine, 20 mg |
2,909 |
2,405 |
$1.17 |
| G1004 |
Cdsm ndsc |
874 |
729 |
$0.02 |
| J7644 |
Ipratropium bromide non-comp |
1,868 |
1,216 |
$0.00 |
| J2470 |
Inj pantoprazole sodium 40mg |
129 |
90 |
$0.00 |
| J1920 |
Inj, labetalol hcl, 5mg |
212 |
182 |
$0.00 |
| J1790 |
Droperidol injection |
421 |
362 |
$0.00 |
| J0360 |
Hydralazine hcl injection |
69 |
59 |
$0.00 |
| J7613 |
Albuterol non-comp unit |
3,353 |
2,145 |
$0.00 |
| J0461 |
Atropine sulfate injection |
81 |
53 |
$0.00 |
| J0613 |
Calcium glucon (wg critical) |
641 |
523 |
$0.00 |
| 83521 |
|
28 |
24 |
$0.00 |
| Q5121 |
Inj. avsola, 10 mg |
232 |
211 |
$0.00 |
| J2920 |
Methylprednisolone injection |
101 |
65 |
$0.00 |
| J0456 |
Azithromycin |
64 |
53 |
$0.00 |
| J2469 |
Palonosetron hcl |
86 |
56 |
$0.00 |
| J0185 |
Inj., aprepitant, 1 mg |
549 |
398 |
$0.00 |
| J7611 |
Albuterol non-comp con |
168 |
139 |
$0.00 |
| J0611 |
Calcium glucon (wg critical) |
80 |
64 |
$0.00 |
| J2003 |
Inj, lidocaine hcl, 1 mg |
313 |
301 |
$0.00 |
| C2627 |
Cath, suprapubic/cystoscopic |
43 |
39 |
$0.00 |
| J0330 |
Succinycholine chloride inj |
28 |
25 |
$0.00 |
| J3420 |
Vitamin b12 injection |
29 |
25 |
$0.00 |
| J2471 |
Inj pantoprazole(hikma) 40mg |
29 |
25 |
$0.00 |
| 88304 |
|
15 |
14 |
$0.00 |
| J7612 |
Levalbuterol non-comp con |
18 |
14 |
$0.00 |
| J1953 |
Levetiracetam injection |
217 |
178 |
$0.00 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
693 |
682 |
$0.00 |
| J2919 |
Inj, methylpred sod succ 5mg |
571 |
490 |
$0.00 |
| J0171 |
Adrenalin epinephrine inject |
14 |
12 |
$0.00 |
| J9201 |
In gemcitabine hcl nos 200mg |
132 |
77 |
$0.00 |
| J2272 |
Inj, morphine (fresenius) |
320 |
275 |
$0.00 |
| Q5107 |
Inj mvasi 10 mg |
45 |
26 |
$0.00 |
| J3380 |
Inj vedolizumab iv 1 mg |
26 |
26 |
$0.00 |
| J0612 |
Inj, calcium gluconate, nos |
105 |
81 |
$0.00 |
| J1596 |
Inj, glycopyrrolate, 0.1 mg |
123 |
117 |
$0.00 |
| J9000 |
Doxorubicin hcl injection |
13 |
13 |
$0.00 |
| Q0163 |
Diphenhydramine hcl 50mg |
31 |
27 |
$0.00 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
330 |
196 |
$0.00 |
| J0295 |
Ampicillin sulbactam 1.5 gm |
15 |
12 |
$0.00 |
| J9206 |
Irinotecan injection |
67 |
40 |
$0.00 |
| J9060 |
Cisplatin 10 mg injection |
30 |
12 |
$0.00 |
| J0897 |
Denosumab injection |
26 |
24 |
$0.00 |
| J3250 |
Trimethobenzamide hcl inj |
30 |
27 |
$0.00 |
| J1956 |
Levofloxacin injection |
18 |
13 |
$0.00 |
| J1230 |
Methadone injection |
17 |
13 |
$0.00 |