| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J1561 |
Gamunex-c/gammaked |
5,340 |
1,500 |
$2.82M |
| J9271 |
Inj pembrolizumab |
1,184 |
981 |
$2.81M |
| 0450 |
|
43,796 |
37,233 |
$2.33M |
| G0463 |
Hospital outpt clinic visit |
54,630 |
41,051 |
$2.01M |
| 80053 |
|
54,576 |
39,507 |
$1.25M |
| 78815 |
|
1,412 |
1,388 |
$993K |
| 0949 |
|
27,433 |
21,012 |
$949K |
| J9144 |
Daratumumab, hyaluronidase |
315 |
200 |
$889K |
| 70553 |
|
1,028 |
990 |
$871K |
| 93325 |
|
4,399 |
4,125 |
$688K |
| 93306 |
|
3,040 |
2,952 |
$669K |
| 74177 |
|
3,331 |
3,181 |
$662K |
| 93303 |
|
2,367 |
2,312 |
$659K |
| J0897 |
Denosumab injection |
1,452 |
1,414 |
$633K |
| 0710 |
|
3,254 |
3,072 |
$611K |
| 96365 |
|
11,227 |
8,073 |
$520K |
| 70450 |
|
4,249 |
4,040 |
$518K |
| 87636 |
|
6,057 |
5,557 |
$490K |
| 85025 |
|
54,481 |
39,105 |
$451K |
| 96375 |
|
16,191 |
11,636 |
$442K |
| 93005 |
|
14,646 |
13,340 |
$427K |
| U0003 |
Cov-19 amp prb hgh thruput |
8,167 |
7,341 |
$425K |
| 99283 |
|
3,029 |
2,874 |
$419K |
| J3490 |
Drugs unclassified injection |
26,900 |
12,454 |
$407K |
| 87497 |
|
8,920 |
6,537 |
$402K |
| 99285 |
|
1,762 |
1,666 |
$397K |
| 96374 |
|
8,831 |
7,950 |
$394K |
| Q5118 |
Inj., zirabev, 10 mg |
446 |
205 |
$377K |
| 0471 |
|
3,653 |
1,699 |
$351K |
| 80197 |
|
20,281 |
12,973 |
$327K |
| 96413 |
|
10,245 |
7,063 |
$322K |
| 0370 |
|
3,378 |
2,273 |
$318K |
| 93320 |
|
2,373 |
2,299 |
$307K |
| 0762 |
|
192 |
93 |
$291K |
| 0761 |
|
10,281 |
8,289 |
$289K |
| 99284 |
|
4,103 |
3,883 |
$286K |
| 80307 |
|
6,376 |
5,796 |
$278K |
| J0178 |
Aflibercept injection |
781 |
689 |
$276K |
| 96361 |
|
7,298 |
6,024 |
$258K |
| 74178 |
|
1,029 |
995 |
$248K |
| 71275 |
|
1,346 |
1,307 |
$233K |
| 87799 |
|
5,140 |
4,095 |
$232K |
| Z7500 |
|
6,639 |
4,754 |
$225K |
| 72125 |
|
1,602 |
1,536 |
$222K |
| 93308 |
|
1,908 |
1,739 |
$221K |
| 96366 |
|
5,499 |
3,516 |
$221K |
| 83735 |
|
30,218 |
20,843 |
$201K |
| J9312 |
Inj., rituximab, 10 mg |
64 |
32 |
$195K |
| 99281 |
|
2,764 |
2,380 |
$191K |
| 83880 |
|
7,626 |
6,672 |
$179K |
| 80051 |
|
20,179 |
18,419 |
$177K |
| J9299 |
Injection, nivolumab |
50 |
25 |
$175K |
| 71046 |
|
7,833 |
7,348 |
$175K |
| Q3014 |
Telehealth facility fee |
16,808 |
14,607 |
$168K |
| 0250 |
|
44,168 |
17,040 |
$161K |
| 99213 |
|
543 |
440 |
$160K |
| 71250 |
|
1,274 |
1,250 |
$159K |
| 88185 |
|
506 |
369 |
$155K |
| 96372 |
|
9,911 |
8,082 |
$154K |
| 85027 |
|
29,226 |
25,778 |
$152K |
| 81001 |
|
29,114 |
23,542 |
$141K |
| 0258 |
|
14,476 |
7,143 |
$140K |
| 86850 |
|
10,064 |
7,534 |
$133K |
| 67028 |
|
1,193 |
1,017 |
$129K |
| 99000 |
|
27,893 |
22,289 |
$128K |
| J2405 |
Ondansetron hcl injection |
9,812 |
7,769 |
$127K |
| 86900 |
|
10,437 |
7,803 |
$119K |
| 84443 |
|
10,405 |
9,773 |
$118K |
| 96415 |
|
3,490 |
2,717 |
$118K |
| 96360 |
|
2,404 |
2,066 |
$117K |
| 0301 |
|
3,203 |
1,059 |
$115K |
| Z5942 |
|
726 |
302 |
$115K |
| 84100 |
|
23,438 |
16,247 |
$115K |
| 74183 |
|
275 |
269 |
$113K |
| 0360 |
|
669 |
336 |
$112K |
| A9552 |
F18 fdg |
943 |
927 |
$110K |
| J2506 |
Inj pegfilgrast ex bio 0.5mg |
176 |
138 |
$109K |
| 80048 |
|
9,269 |
7,869 |
$107K |
| 86833 |
|
3,309 |
2,973 |
$106K |
| 86832 |
|
3,304 |
2,967 |
$103K |
| 87491 |
|
3,846 |
3,551 |
$102K |
| 71045 |
|
7,840 |
7,333 |
$102K |
| 82306 |
|
4,488 |
4,363 |
$102K |
| 87591 |
|
3,824 |
3,540 |
$101K |
| 88305 |
|
1,733 |
1,646 |
$98K |
| 86481 |
|
1,656 |
1,596 |
$96K |
| 71260 |
|
779 |
766 |
$93K |
| 87631 |
|
2,108 |
1,979 |
$91K |
| 99199 |
|
2,415 |
2,028 |
$91K |
| 0760 |
|
3,232 |
2,473 |
$89K |
| 82565 |
|
20,907 |
19,124 |
$87K |
| 96367 |
|
3,305 |
2,430 |
$87K |
| 76700 |
|
1,095 |
1,062 |
$84K |
| 87086 |
|
7,170 |
6,676 |
$83K |
| 87635 |
|
2,768 |
2,416 |
$82K |
| 99203 |
|
1,006 |
746 |
$81K |
| J2778 |
Ranibizumab injection |
274 |
209 |
$80K |
| J9022 |
Inj, atezolizumab,10 mg |
36 |
29 |
$79K |
| C9803 |
Hopd covid-19 spec collect |
5,244 |
4,771 |
$78K |
| Q0138 |
Ferumoxytol, non-esrd |
297 |
218 |
$77K |
| 86901 |
|
10,401 |
7,794 |
$77K |
| 87633 |
|
318 |
298 |
$76K |
| 80076 |
|
7,139 |
6,583 |
$76K |
| 97530 |
|
3,159 |
1,645 |
$76K |
| 80061 |
|
8,520 |
8,174 |
$76K |
| 74176 |
|
761 |
733 |
$74K |
| 99291 |
|
383 |
371 |
$74K |
| 97140 |
|
3,949 |
2,053 |
$73K |
| 82947 |
|
21,363 |
19,549 |
$71K |
| 84484 |
|
7,864 |
5,984 |
$71K |
| 97110 |
|
7,082 |
3,548 |
$70K |
| 76705 |
|
1,357 |
1,271 |
$69K |
| 0636 |
|
420 |
222 |
$67K |
| 84703 |
|
6,345 |
5,904 |
$66K |
| H1001 |
Antepartum management |
1,086 |
709 |
$65K |
| 83970 |
|
2,169 |
2,047 |
$63K |
| 97112 |
|
4,389 |
2,408 |
$61K |
| 83036 |
|
8,176 |
7,939 |
$60K |
| J1642 |
Inj heparin sodium per 10 u |
6,923 |
3,498 |
$60K |
| 85610 |
|
10,956 |
9,689 |
$60K |
| 87389 |
|
3,227 |
3,106 |
$59K |
| J7030 |
Normal saline solution infus |
7,735 |
6,387 |
$59K |
| 93321 |
|
714 |
619 |
$58K |
| 82105 |
|
1,934 |
1,783 |
$58K |
| 83615 |
|
8,239 |
5,399 |
$57K |
| 96417 |
|
2,874 |
2,023 |
$57K |
| J2505 |
Injection, pegfilgrastim 6mg |
71 |
58 |
$57K |
| 70486 |
|
372 |
359 |
$56K |
| 94729 |
|
1,158 |
1,127 |
$54K |
| 96376 |
|
1,616 |
1,286 |
$53K |
| 94010 |
|
1,401 |
1,340 |
$51K |
| 82784 |
|
3,832 |
2,562 |
$51K |
| 92507 |
|
1,099 |
534 |
$51K |
| 93971 |
|
646 |
598 |
$50K |
| 93296 |
|
607 |
601 |
$50K |
| J2704 |
Inj, propofol, 10 mg |
3,698 |
3,175 |
$49K |
| 76856 |
|
831 |
791 |
$49K |
| 99070 |
|
982 |
379 |
$48K |
| Z1034 |
|
668 |
611 |
$48K |
| 82728 |
|
4,006 |
3,648 |
$46K |
| 76815 |
|
811 |
711 |
$46K |
| 86140 |
|
6,051 |
5,535 |
$45K |
| 87040 |
|
2,962 |
1,652 |
$44K |
| 76830 |
|
801 |
756 |
$43K |
| 83605 |
|
3,840 |
3,064 |
$43K |
| Q5108 |
Injection, fulphila |
68 |
53 |
$40K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
8,171 |
7,494 |
$40K |
| J1100 |
Dexamethasone sodium phos |
4,329 |
3,384 |
$40K |
| 83690 |
|
5,623 |
5,177 |
$39K |
| 94726 |
|
660 |
645 |
$39K |
| 0510 |
|
2,433 |
2,225 |
$39K |
| 84520 |
|
11,577 |
10,832 |
$39K |
| Q5119 |
Inj ruxience, 10 mg |
34 |
24 |
$35K |
| 76770 |
|
420 |
413 |
$35K |
| J1170 |
Hydromorphone injection |
3,327 |
2,068 |
$35K |
| 86803 |
|
2,504 |
2,413 |
$34K |
| 90715 |
|
1,369 |
1,329 |
$34K |
| 93798 |
|
372 |
62 |
$34K |
| 82805 |
|
1,344 |
1,216 |
$33K |
| 73562 |
|
1,419 |
1,124 |
$33K |
| 0306 |
|
645 |
399 |
$33K |
| 87517 |
|
736 |
678 |
$32K |
| 73630 |
|
1,277 |
1,055 |
$31K |
| J1453 |
Fosaprepitant injection |
1,103 |
787 |
$30K |
| 73130 |
|
1,230 |
962 |
$30K |
| J1885 |
Ketorolac tromethamine inj |
5,036 |
4,547 |
$30K |
| 82570 |
|
5,436 |
4,261 |
$29K |
| J1200 |
Diphenhydramine hcl injectio |
6,401 |
4,257 |
$28K |
| 82465 |
|
5,524 |
3,590 |
$28K |
| 82550 |
|
3,734 |
3,197 |
$28K |
| J1745 |
Infliximab not biosimil 10mg |
52 |
49 |
$28K |
| 87340 |
|
2,727 |
2,618 |
$28K |
| 95810 |
|
89 |
89 |
$28K |
| 90471 |
|
2,629 |
2,526 |
$27K |
| 88184 |
|
611 |
467 |
$27K |
| 85652 |
|
5,827 |
5,342 |
$26K |
| Z7502 |
|
749 |
732 |
$26K |
| 87186 |
|
2,841 |
2,300 |
$26K |
| J0696 |
Ceftriaxone sodium injection |
2,057 |
1,805 |
$25K |
| 86160 |
|
1,706 |
841 |
$25K |
| 83550 |
|
3,293 |
3,167 |
$25K |
| 83540 |
|
3,540 |
3,397 |
$24K |
| 85730 |
|
2,926 |
2,685 |
$24K |
| 73610 |
|
1,034 |
904 |
$24K |
| J3475 |
Inj magnesium sulfate |
1,416 |
1,014 |
$24K |
| P9016 |
Rbc leukocytes reduced |
194 |
145 |
$23K |
| 87624 |
|
763 |
747 |
$23K |
| 36430 |
|
226 |
112 |
$23K |
| J2274 |
Inj morphine pf epid ithc |
1,235 |
1,042 |
$23K |
| 59425 |
|
372 |
258 |
$22K |
| 87088 |
|
3,308 |
3,109 |
$22K |
| 73030 |
|
972 |
853 |
$22K |
| 87077 |
|
3,399 |
2,677 |
$22K |
| 84439 |
|
2,783 |
2,640 |
$21K |
| 74018 |
|
731 |
702 |
$21K |
| 82977 |
|
2,489 |
2,314 |
$21K |
| J3010 |
Fentanyl citrate injection |
3,191 |
2,964 |
$21K |
| 87522 |
Neg quan hep c or qual rna |
403 |
370 |
$20K |
| 87536 |
|
265 |
252 |
$19K |
| 0270 |
|
6,821 |
3,001 |
$19K |
| 86592 |
|
3,374 |
3,229 |
$18K |
| 87070 |
|
1,455 |
1,309 |
$17K |
| 94618 |
|
380 |
369 |
$17K |
| 90662 |
|
1,000 |
992 |
$16K |
| 84156 |
|
3,292 |
3,003 |
$16K |
| 83520 |
|
967 |
882 |
$16K |
| 0160 |
|
123 |
78 |
$16K |
| 77301 |
|
57 |
50 |
$16K |
| 94640 |
|
929 |
685 |
$15K |
| 86706 |
|
1,155 |
1,102 |
$15K |
| 36415 |
|
9,583 |
7,815 |
$15K |
| 87637 |
|
235 |
191 |
$15K |
| Z9725 |
|
347 |
341 |
$15K |
| 76817 |
|
319 |
285 |
$15K |
| J1644 |
Inj heparin sodium per 1000u |
950 |
565 |
$15K |
| 82746 |
|
1,296 |
1,255 |
$15K |
| 82607 |
|
1,767 |
1,726 |
$14K |
| 86360 |
|
386 |
357 |
$14K |
| 92557 |
|
475 |
472 |
$14K |
| 82330 |
|
1,505 |
1,237 |
$14K |
| A0429 |
Bls-emergency |
506 |
234 |
$14K |
| 86359 |
|
440 |
399 |
$13K |
| J7999 |
Compounded drug, noc |
625 |
396 |
$13K |
| 77334 |
|
93 |
80 |
$13K |
| J2270 |
Morphine sulfate injection |
1,807 |
1,599 |
$13K |
| 77300 |
|
82 |
65 |
$13K |
| 93976 |
|
104 |
99 |
$13K |
| 86704 |
|
944 |
904 |
$13K |
| 88342 |
|
230 |
221 |
$13K |
| J2250 |
Inj midazolam hydrochloride |
2,259 |
2,100 |
$13K |
| 93970 |
|
83 |
78 |
$12K |
| 82803 |
|
580 |
543 |
$12K |
| 85379 |
|
993 |
925 |
$12K |
| 86225 |
|
720 |
698 |
$12K |
| 0300 |
|
533 |
329 |
$12K |
| J9310 |
Rituximab injection |
16 |
14 |
$12K |
| 90686 |
|
747 |
730 |
$12K |
| 93226 |
|
111 |
110 |
$11K |
| J0131 |
Inj, acetaminophen (nos) |
459 |
391 |
$11K |
| 87205 |
|
2,373 |
2,183 |
$11K |
| Z6500 |
|
55 |
55 |
$10K |
| 96409 |
|
416 |
283 |
$10K |
| 87102 |
|
899 |
862 |
$10K |
| 93225 |
|
116 |
115 |
$10K |
| J2469 |
Palonosetron hcl |
1,001 |
679 |
$10K |
| 0305 |
|
819 |
569 |
$10K |
| 84165 |
|
938 |
889 |
$10K |
| 86235 |
|
309 |
172 |
$10K |
| 41899 |
|
98 |
96 |
$9K |
| J7040 |
Normal saline solution infus |
2,061 |
1,569 |
$9K |
| 86334 |
|
552 |
536 |
$9K |
| 84702 |
|
779 |
697 |
$9K |
| 97161 |
|
218 |
215 |
$9K |
| 77067 |
|
339 |
339 |
$9K |
| 84550 |
|
1,785 |
1,394 |
$8K |
| J7050 |
Normal saline solution infus |
2,568 |
1,671 |
$8K |
| 87505 |
|
142 |
100 |
$8K |
| 82310 |
|
2,016 |
1,902 |
$8K |
| 73110 |
|
405 |
345 |
$8K |
| 0940 |
|
383 |
290 |
$8K |
| 82378 |
|
890 |
764 |
$8K |
| 76811 |
|
80 |
79 |
$8K |
| 99221 |
|
226 |
193 |
$8K |
| 86635 |
|
361 |
289 |
$7K |
| 86923 |
|
178 |
92 |
$7K |
| 86038 |
|
558 |
546 |
$7K |
| 80195 |
|
673 |
517 |
$7K |
| 77338 |
|
64 |
54 |
$7K |
| 77336 |
|
180 |
108 |
$7K |
| 82077 |
|
877 |
828 |
$7K |
| 0720 |
|
230 |
194 |
$7K |
| 86787 |
|
546 |
515 |
$7K |
| 87486 |
|
288 |
269 |
$7K |
| 87581 |
|
293 |
270 |
$7K |
| 90677 |
|
56 |
54 |
$7K |
| 73590 |
|
357 |
293 |
$7K |
| 84145 |
|
404 |
367 |
$7K |
| 85007 |
|
1,617 |
1,093 |
$7K |
| 82962 |
|
2,388 |
2,106 |
$7K |
| 99231 |
|
240 |
199 |
$6K |
| 82043 |
|
1,681 |
1,644 |
$6K |
| H1000 |
Prenatal care atrisk assessm |
53 |
53 |
$6K |
| 73502 |
|
251 |
242 |
$6K |
| 43239 |
|
39 |
38 |
$6K |
| 86255 |
|
201 |
188 |
$6K |
| J9370 |
Vincristine sulfate 1 mg inj |
472 |
228 |
$6K |
| 84460 |
|
1,354 |
1,279 |
$6K |
| 87653 |
|
245 |
242 |
$6K |
| J7120 |
Ringers lactate infusion |
2,058 |
1,807 |
$6K |
| 99282 |
|
369 |
353 |
$6K |
| 82232 |
|
646 |
600 |
$6K |
| 95700 |
|
36 |
36 |
$6K |
| 84450 |
|
1,308 |
1,231 |
$6K |
| 97116 |
|
386 |
256 |
$5K |
| J2930 |
Methylprednisolone injection |
620 |
455 |
$5K |
| 92567 |
|
191 |
187 |
$5K |
| J2060 |
Lorazepam injection |
864 |
746 |
$5K |
| 85384 |
|
451 |
375 |
$5K |
| 88341 |
|
29 |
29 |
$5K |
| 87798 |
|
157 |
129 |
$5K |
| J0134 |
Inj acetaminophen -fresenius |
259 |
219 |
$5K |
| 82610 |
|
538 |
502 |
$5K |
| 82247 |
|
1,241 |
1,160 |
$5K |
| J0690 |
Cefazolin sodium injection |
531 |
449 |
$5K |
| 82248 |
|
824 |
743 |
$5K |
| 83521 |
|
474 |
434 |
$5K |
| 84075 |
|
1,213 |
1,138 |
$5K |
| 87808 |
|
652 |
624 |
$4K |
| G0378 |
Hospital observation per hr |
111 |
52 |
$4K |
| 96416 |
|
20 |
12 |
$4K |
| C1769 |
Guide wire |
89 |
77 |
$4K |
| 85046 |
|
629 |
523 |
$4K |
| 85018 |
|
1,863 |
1,795 |
$4K |
| 88112 |
|
195 |
194 |
$4K |
| 96401 |
|
541 |
285 |
$4K |
| 70498 |
|
12 |
12 |
$4K |
| A9585 |
Gadobutrol injection |
791 |
763 |
$4K |
| Z6400 |
|
67 |
67 |
$4K |
| 88142 |
|
227 |
225 |
$4K |
| J9267 |
Paclitaxel injection |
44 |
27 |
$4K |
| 84403 |
|
407 |
396 |
$4K |
| 82150 |
|
447 |
387 |
$4K |
| 80143 |
|
368 |
337 |
$4K |
| 82670 |
|
203 |
185 |
$4K |
| G0480 |
Drug test def 1-7 classes |
97 |
92 |
$4K |
| 86644 |
|
308 |
294 |
$4K |
| 92626 |
|
34 |
28 |
$4K |
| 86352 |
|
199 |
164 |
$4K |
| J0780 |
Prochlorperazine injection |
605 |
545 |
$4K |
| G0008 |
Admin influenza virus vac |
976 |
969 |
$4K |
| 0770 |
|
105 |
105 |
$4K |
| Q9957 |
Inj perflutren lip micros,ml |
53 |
40 |
$3K |
| 76642 |
|
113 |
104 |
$3K |
| 82375 |
|
165 |
152 |
$3K |
| 86357 |
|
121 |
109 |
$3K |
| 59430 |
|
57 |
51 |
$3K |
| 86355 |
|
121 |
109 |
$3K |
| 93017 |
|
40 |
40 |
$3K |
| 0302 |
|
155 |
68 |
$3K |
| 84153 |
|
347 |
340 |
$3K |
| 96156 |
|
190 |
169 |
$3K |
| 93350 |
|
26 |
24 |
$3K |
| 91320 |
|
74 |
63 |
$3K |
| J2997 |
Alteplase recombinant |
16 |
12 |
$3K |
| 82107 |
|
62 |
59 |
$3K |
| 86301 |
|
158 |
138 |
$3K |
| 86765 |
|
199 |
192 |
$3K |
| 0942 |
|
216 |
181 |
$2K |
| 90656 |
|
123 |
123 |
$2K |
| Z5910 |
|
51 |
51 |
$2K |
| 86708 |
|
128 |
124 |
$2K |
| 87206 |
|
410 |
332 |
$2K |
| 94621 |
|
12 |
12 |
$2K |
| 84425 |
|
365 |
345 |
$2K |
| H1002 |
Carecoordination prenatal |
13 |
13 |
$2K |
| 83050 |
|
164 |
151 |
$2K |
| 81003 |
|
886 |
851 |
$2K |
| 80179 |
|
196 |
179 |
$2K |
| 27500 |
|
29 |
27 |
$2K |
| J2919 |
Inj, methylpred sod succ 5mg |
165 |
111 |
$2K |
| 84630 |
|
684 |
659 |
$2K |
| 76805 |
|
24 |
24 |
$2K |
| 86665 |
|
125 |
107 |
$2K |
| 82533 |
|
122 |
111 |
$2K |
| 76870 |
|
44 |
42 |
$2K |
| 83001 |
|
105 |
105 |
$2K |
| 84134 |
|
83 |
80 |
$2K |
| C1894 |
Intro/sheath, non-laser |
30 |
24 |
$2K |
| 76536 |
|
27 |
27 |
$2K |
| 86364 |
|
179 |
177 |
$2K |
| 87493 |
|
82 |
80 |
$2K |
| 0324 |
|
78 |
73 |
$2K |
| 92611 |
|
24 |
24 |
$2K |
| Z7506 |
|
16 |
14 |
$2K |
| 81025 |
|
347 |
329 |
$2K |
| 99152 |
|
82 |
73 |
$1K |
| 72100 |
|
54 |
52 |
$1K |
| 90480 |
|
69 |
66 |
$1K |
| 83951 |
|
26 |
26 |
$1K |
| 86682 |
|
128 |
115 |
$1K |
| 86480 |
|
40 |
40 |
$1K |
| X4540 |
|
40 |
40 |
$1K |
| 96402 |
|
321 |
305 |
$1K |
| 0272 |
|
211 |
189 |
$1K |
| J0171 |
Adrenalin epinephrine inject |
111 |
104 |
$1K |
| Z4302 |
|
95 |
91 |
$1K |
| J3370 |
Vancomycin hcl injection |
104 |
64 |
$1K |
| S0302 |
Completed epsdt |
44 |
37 |
$1K |
| 83655 |
|
207 |
204 |
$1K |
| 86645 |
|
86 |
82 |
$1K |
| 80074 |
|
15 |
15 |
$1K |
| H1003 |
Prenatal at risk education |
25 |
25 |
$1K |
| Z7610 |
|
132 |
66 |
$1K |
| 86147 |
|
24 |
24 |
$950.96 |
| 86870 |
|
18 |
12 |
$934.72 |
| 99153 |
Mod sedat endo service >5yrs |
56 |
49 |
$926.56 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
148 |
121 |
$926.00 |
| 87880 |
|
175 |
173 |
$896.83 |
| G0009 |
Admin pneumococcal vaccine |
81 |
81 |
$873.88 |
| 86762 |
|
68 |
67 |
$871.06 |
| 36600 |
|
13 |
13 |
$858.22 |
| A4649 |
Surgical supplies |
461 |
194 |
$856.55 |
| 86431 |
|
128 |
127 |
$835.98 |
| 84146 |
|
45 |
39 |
$818.90 |
| 82951 |
|
68 |
52 |
$804.21 |
| 77063 |
|
148 |
148 |
$780.96 |
| 97162 |
|
12 |
12 |
$769.88 |
| 92522 |
|
13 |
12 |
$757.92 |
| 82785 |
|
59 |
58 |
$747.70 |
| 86376 |
|
51 |
51 |
$736.85 |
| 86800 |
|
52 |
52 |
$711.34 |
| 0307 |
|
61 |
45 |
$686.00 |
| 83883 |
|
91 |
87 |
$676.08 |
| 83010 |
|
61 |
55 |
$669.02 |
| J1836 |
Inj, metronidazole, 10 mg |
16 |
12 |
$661.49 |
| 86705 |
|
54 |
51 |
$660.92 |
| 86036 |
|
28 |
28 |
$641.37 |
| J7060 |
5% dextrose/water |
103 |
41 |
$607.12 |
| 83002 |
|
36 |
36 |
$603.24 |
| 84481 |
|
42 |
40 |
$581.17 |
| 86777 |
|
26 |
26 |
$577.16 |
| 80158 |
|
86 |
43 |
$565.68 |
| 88313 |
|
16 |
15 |
$556.48 |
| 99401 |
|
62 |
54 |
$529.86 |
| 83993 |
|
49 |
47 |
$527.91 |
| 86880 |
|
54 |
39 |
$497.10 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
72 |
45 |
$487.43 |
| J2765 |
Metoclopramide hcl injection |
132 |
123 |
$460.13 |
| J0136 |
Inj, acetaminophen (b braun) |
52 |
37 |
$449.78 |
| 82525 |
|
49 |
41 |
$412.38 |
| X4532 |
|
12 |
12 |
$401.40 |
| 76775 |
|
14 |
14 |
$398.60 |
| S0020 |
Injection, bupivicaine hydro |
30 |
27 |
$393.56 |
| 73090 |
|
46 |
40 |
$381.59 |
| 82040 |
|
83 |
79 |
$360.52 |
| 0771 |
|
12 |
12 |
$350.64 |
| G2023 |
Specimen collect covid-19 |
18 |
17 |
$347.38 |
| 92250 |
|
15 |
15 |
$333.60 |
| J9045 |
Carboplatin injection |
19 |
13 |
$330.50 |
| 89051 |
|
35 |
28 |
$330.12 |
| 81002 |
|
105 |
100 |
$328.96 |
| 73564 |
|
29 |
27 |
$290.66 |
| 82103 |
|
38 |
36 |
$281.90 |
| 73070 |
|
13 |
12 |
$274.96 |
| 82140 |
|
20 |
16 |
$271.72 |
| J9201 |
In gemcitabine hcl nos 200mg |
22 |
12 |
$258.61 |
| 86146 |
|
23 |
12 |
$243.66 |
| 97535 |
|
13 |
12 |
$240.00 |
| 86258 |
|
27 |
14 |
$230.36 |
| 0124A |
|
14 |
13 |
$221.82 |
| 87116 |
|
17 |
14 |
$219.87 |
| 86304 |
|
15 |
14 |
$216.39 |
| J1790 |
Droperidol injection |
13 |
12 |
$200.96 |
| 96368 |
|
13 |
13 |
$198.14 |
| C9285 |
Patch, lidocaine/tetracaine |
13 |
12 |
$198.08 |
| 73552 |
|
30 |
26 |
$196.78 |
| 81015 |
|
69 |
66 |
$191.90 |
| 86231 |
|
25 |
25 |
$186.66 |
| 96411 |
|
33 |
26 |
$179.25 |
| 88108 |
|
13 |
13 |
$174.20 |
| 83021 |
|
14 |
12 |
$173.05 |
| 85049 |
|
29 |
27 |
$160.49 |
| Z6406 |
|
13 |
13 |
$156.78 |
| G0439 |
Ppps, subseq visit |
12 |
12 |
$146.10 |
| Z6410 |
|
12 |
12 |
$144.72 |
| 87075 |
|
15 |
14 |
$133.72 |
| 73560 |
|
31 |
25 |
$131.50 |
| 84300 |
|
29 |
28 |
$129.52 |
| 84132 |
|
25 |
24 |
$127.51 |
| 84295 |
|
13 |
13 |
$125.48 |
| 84157 |
|
12 |
12 |
$122.46 |
| 82435 |
|
13 |
13 |
$119.83 |
| 85613 |
|
12 |
12 |
$115.98 |
| 83921 |
|
14 |
14 |
$114.33 |
| 86300 |
|
30 |
24 |
$103.16 |
| J2272 |
Inj, morphine (fresenius) |
27 |
26 |
$102.44 |
| 86200 |
|
26 |
26 |
$99.96 |
| 87015 |
|
17 |
14 |
$98.31 |
| 84255 |
|
14 |
13 |
$97.08 |
| 86039 |
|
12 |
12 |
$93.32 |
| 96127 |
|
18 |
15 |
$81.77 |
| 84270 |
|
14 |
14 |
$78.23 |
| 82104 |
|
13 |
12 |
$78.00 |
| 84207 |
|
14 |
14 |
$71.18 |
| 87081 |
|
15 |
15 |
$67.05 |
| J2370 |
Phenylephrine hcl injection |
13 |
12 |
$63.38 |
| 0637 |
|
95 |
53 |
$53.58 |
| 82085 |
|
13 |
13 |
$53.36 |
| 92558 |
|
40 |
40 |
$30.00 |
| 0780 |
|
18 |
13 |
$28.00 |
| 99072 |
|
155 |
78 |
$10.40 |
| 0260 |
|
12 |
12 |
$0.00 |
| G8979 |
Mobility goal status |
13 |
12 |
$0.00 |
| 0730 |
|
12 |
12 |
$0.00 |
| 0372 |
|
12 |
12 |
$0.00 |
| 0206 |
|
12 |
12 |
$0.00 |