| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99284 |
|
32,247 |
30,952 |
$6.15M |
| T1015 |
Clinic service |
99,188 |
88,781 |
$3.55M |
| J9271 |
Inj pembrolizumab |
3,892 |
3,017 |
$2.72M |
| 96413 |
|
15,774 |
10,356 |
$1.37M |
| J9312 |
Inj., rituximab, 10 mg |
830 |
653 |
$1.23M |
| J2323 |
Natalizumab injection |
1,963 |
1,885 |
$1.20M |
| 99283 |
|
9,928 |
9,650 |
$1.16M |
| J9299 |
Injection, nivolumab |
1,136 |
737 |
$1.05M |
| J9173 |
Inj., durvalumab, 10 mg |
576 |
413 |
$973K |
| J9306 |
Injection, pertuzumab, 1 mg |
1,161 |
838 |
$965K |
| Q5107 |
Inj mvasi 10 mg |
2,160 |
938 |
$888K |
| 99285 |
|
3,558 |
3,433 |
$753K |
| 99215 |
Prolong outpt/office vis |
7,794 |
5,260 |
$717K |
| G0378 |
Hospital observation per hr |
2,077 |
907 |
$659K |
| 59410 |
|
497 |
484 |
$657K |
| J9022 |
Inj, atezolizumab,10 mg |
852 |
645 |
$654K |
| 87661 |
|
20,089 |
19,688 |
$650K |
| 87491 |
|
28,523 |
27,950 |
$638K |
| 87591 |
|
28,280 |
27,715 |
$615K |
| G9012 |
Other specified case mgmt |
3,985 |
3,012 |
$613K |
| Q5116 |
Inj., trazimera, 10 mg |
1,833 |
1,103 |
$531K |
| 77067 |
|
5,013 |
4,975 |
$414K |
| 85025 |
|
91,839 |
59,699 |
$404K |
| 88175 |
|
12,461 |
12,403 |
$383K |
| J7298 |
Mirena, 52 mg |
957 |
939 |
$346K |
| 87624 |
|
8,679 |
8,612 |
$342K |
| J2350 |
Injection, ocrelizumab, 1 mg |
198 |
190 |
$321K |
| 80307 |
|
5,342 |
4,067 |
$320K |
| J7307 |
Etonogestrel implant system |
929 |
907 |
$313K |
| Q5108 |
Injection, fulphila |
872 |
646 |
$305K |
| Q5111 |
Injection, udenyca 0.5 mg |
242 |
168 |
$299K |
| 96374 |
|
15,126 |
14,331 |
$292K |
| J1569 |
Gammagard liquid injection |
2,242 |
1,233 |
$281K |
| 74177 |
|
1,997 |
1,940 |
$270K |
| 93976 |
|
4,773 |
4,636 |
$259K |
| 96365 |
|
8,083 |
4,891 |
$255K |
| J1745 |
Infliximab not biosimil 10mg |
460 |
439 |
$255K |
| 80053 |
|
21,736 |
16,222 |
$252K |
| 81507 |
|
431 |
429 |
$249K |
| 99213 |
|
3,877 |
3,404 |
$242K |
| J9264 |
Paclitaxel protein bound |
480 |
156 |
$239K |
| T1001 |
Nursing assessment/evaluatn |
1,142 |
1,106 |
$234K |
| 81220 |
|
512 |
507 |
$232K |
| 76816 |
|
5,175 |
4,936 |
$223K |
| 76811 |
|
2,300 |
2,274 |
$209K |
| 76817 |
|
4,596 |
3,954 |
$203K |
| 76830 |
|
5,095 |
5,010 |
$194K |
| 84703 |
|
29,749 |
28,796 |
$192K |
| J9305 |
Inj. pemetrexed nos 10mg |
356 |
134 |
$191K |
| 96375 |
|
13,749 |
11,825 |
$186K |
| 76801 |
|
5,849 |
5,210 |
$182K |
| 59515 |
|
131 |
129 |
$174K |
| 96372 |
|
12,677 |
10,876 |
$151K |
| J9355 |
Inj trastuzumab excl biosimi |
66 |
49 |
$149K |
| 77066 |
Tomosynthesis, mammo |
1,802 |
1,766 |
$146K |
| 86702 |
|
9,506 |
9,365 |
$127K |
| 96367 |
|
6,526 |
3,389 |
$124K |
| 86780 |
|
6,874 |
6,683 |
$114K |
| 96417 |
|
2,432 |
1,552 |
$114K |
| 86701 |
|
9,507 |
9,365 |
$112K |
| 80048 |
|
18,446 |
16,728 |
$111K |
| 82330 |
|
15,742 |
10,248 |
$111K |
| 77063 |
|
4,966 |
4,929 |
$108K |
| 81025 |
|
17,339 |
16,827 |
$107K |
| J0185 |
Inj., aprepitant, 1 mg |
3,496 |
2,268 |
$103K |
| 99212 |
|
1,487 |
1,338 |
$101K |
| 77065 |
Tomosynthesis, mammo |
1,664 |
1,544 |
$98K |
| J0897 |
Denosumab injection |
366 |
326 |
$97K |
| 87390 |
|
9,504 |
9,363 |
$97K |
| H0004 |
Alcohol and/or drug services |
2,797 |
2,662 |
$95K |
| 76642 |
|
2,563 |
2,494 |
$94K |
| 87086 |
|
12,353 |
11,804 |
$93K |
| 99214 |
|
1,177 |
1,065 |
$92K |
| 76819 |
|
1,725 |
1,068 |
$91K |
| 96415 |
|
3,008 |
2,097 |
$89K |
| 84702 |
|
6,536 |
5,389 |
$85K |
| Q5119 |
Inj ruxience, 10 mg |
1,408 |
942 |
$84K |
| 83735 |
|
15,152 |
10,408 |
$79K |
| 81003 |
|
37,423 |
35,466 |
$76K |
| 81329 |
|
680 |
676 |
$75K |
| J9395 |
Injection, fulvestrant |
1,051 |
745 |
$74K |
| 59409 |
|
48 |
41 |
$73K |
| 58571 |
|
120 |
119 |
$71K |
| 87653 |
|
1,611 |
1,595 |
$68K |
| 43239 |
|
278 |
273 |
$65K |
| J3490 |
Drugs unclassified injection |
7,657 |
4,362 |
$64K |
| 99429 |
|
249 |
229 |
$63K |
| 88185 |
|
250 |
227 |
$61K |
| J1756 |
Iron sucrose injection |
11,218 |
5,380 |
$61K |
| 80050 |
|
1,274 |
1,171 |
$58K |
| 83615 |
|
10,289 |
7,084 |
$56K |
| 78815 |
|
69 |
65 |
$55K |
| 76813 |
|
996 |
985 |
$55K |
| 84100 |
|
11,413 |
7,903 |
$53K |
| 80076 |
|
8,655 |
8,307 |
$52K |
| 71275 |
|
322 |
318 |
$50K |
| 76815 |
|
1,345 |
1,202 |
$50K |
| 11981 |
|
261 |
258 |
$49K |
| 19083 |
|
325 |
308 |
$48K |
| J9217 |
Leuprolide acetate suspnsion |
1,162 |
1,104 |
$47K |
| G0472 |
Hep c screen high risk/other |
2,265 |
2,245 |
$47K |
| G0279 |
Tomosynthesis, mammo |
2,910 |
2,848 |
$46K |
| 36430 |
|
425 |
255 |
$45K |
| 96040 |
|
1,709 |
1,694 |
$44K |
| Q0111 |
Wet mounts/ w preparations |
8,216 |
8,016 |
$44K |
| J9202 |
Goserelin acetate implant |
765 |
705 |
$44K |
| 76805 |
|
850 |
843 |
$43K |
| 96402 |
|
1,394 |
1,244 |
$41K |
| 11982 |
|
198 |
196 |
$40K |
| 96361 |
|
3,878 |
2,904 |
$40K |
| 84443 |
|
2,104 |
1,978 |
$40K |
| 88341 |
|
614 |
562 |
$38K |
| 99211 |
|
630 |
589 |
$37K |
| 96411 |
|
887 |
570 |
$37K |
| U0003 |
Cov-19 amp prb hgh thruput |
562 |
550 |
$35K |
| J9070 |
Cyclophosphamide 100 mg inj |
573 |
312 |
$34K |
| 58558 |
|
40 |
40 |
$34K |
| J1561 |
Gamunex-c/gammaked |
68 |
50 |
$33K |
| 0241U |
|
573 |
568 |
$33K |
| 58301 |
|
282 |
280 |
$33K |
| 86300 |
|
1,499 |
1,253 |
$31K |
| 77080 |
|
573 |
567 |
$31K |
| 96360 |
|
1,127 |
742 |
$29K |
| 96156 |
|
508 |
504 |
$29K |
| 82728 |
|
3,066 |
2,899 |
$29K |
| 71260 |
|
435 |
429 |
$29K |
| 58661 |
|
44 |
41 |
$29K |
| 88305 |
|
3,500 |
3,388 |
$28K |
| 93005 |
|
4,058 |
3,871 |
$28K |
| J2505 |
Injection, pegfilgrastim 6mg |
30 |
26 |
$27K |
| Q3014 |
Telehealth facility fee |
1,644 |
1,591 |
$27K |
| 70551 |
|
131 |
127 |
$27K |
| 74176 |
|
407 |
399 |
$25K |
| 80055 |
|
1,831 |
1,818 |
$25K |
| 90715 |
|
2,233 |
2,181 |
$24K |
| 58300 |
|
457 |
453 |
$24K |
| 93306 |
|
326 |
323 |
$24K |
| J2997 |
Alteplase recombinant |
563 |
427 |
$23K |
| 82784 |
|
1,454 |
1,083 |
$23K |
| 88342 |
|
913 |
883 |
$23K |
| J1930 |
Lanreotide injection |
40 |
36 |
$23K |
| Q0112 |
Potassium hydroxide preps |
4,336 |
4,258 |
$22K |
| 83690 |
|
6,557 |
6,251 |
$21K |
| J2469 |
Palonosetron hcl |
5,739 |
3,417 |
$21K |
| G0399 |
Home sleep test/type 3 porta |
169 |
166 |
$21K |
| 71046 |
|
1,226 |
1,202 |
$21K |
| 96401 |
|
654 |
311 |
$20K |
| 82607 |
|
2,014 |
1,957 |
$20K |
| 57452 |
|
189 |
184 |
$20K |
| 77386 |
|
94 |
13 |
$19K |
| 82105 |
|
1,088 |
1,049 |
$19K |
| 84460 |
|
6,066 |
4,239 |
$18K |
| 76827 |
|
483 |
465 |
$18K |
| 81001 |
|
7,694 |
7,472 |
$18K |
| J0881 |
Darbepoetin alfa, non-esrd |
130 |
100 |
$18K |
| 76641 |
|
347 |
335 |
$18K |
| 84450 |
|
6,183 |
4,340 |
$18K |
| 84550 |
|
3,201 |
2,144 |
$18K |
| 96366 |
|
1,598 |
1,133 |
$17K |
| 86592 |
|
3,962 |
3,917 |
$17K |
| 99282 |
|
266 |
261 |
$17K |
| 86850 |
|
3,243 |
2,972 |
$17K |
| 83540 |
|
2,523 |
2,389 |
$17K |
| 70450 |
|
325 |
321 |
$17K |
| 72148 |
|
113 |
110 |
$16K |
| 84163 |
|
946 |
943 |
$16K |
| P9021 |
Red blood cells unit |
175 |
161 |
$16K |
| 19081 |
|
111 |
108 |
$15K |
| 93971 |
|
270 |
258 |
$15K |
| 76820 |
|
614 |
351 |
$15K |
| 83021 |
|
776 |
649 |
$15K |
| 82565 |
|
6,058 |
4,478 |
$15K |
| 76705 |
|
448 |
443 |
$15K |
| 59820 |
|
25 |
25 |
$14K |
| 96409 |
|
192 |
134 |
$14K |
| M0222 |
Bebtelovimab injection |
65 |
63 |
$14K |
| 77049 |
|
62 |
62 |
$14K |
| J0640 |
Leucovorin calcium injection |
4,279 |
1,120 |
$14K |
| 88360 |
|
470 |
450 |
$14K |
| 82306 |
|
748 |
738 |
$13K |
| 59025 |
|
2,708 |
1,340 |
$13K |
| J1439 |
Inj ferric carboxymaltos 1mg |
980 |
686 |
$13K |
| 82950 |
|
1,712 |
1,700 |
$12K |
| 72197 |
|
27 |
27 |
$12K |
| 84484 |
|
1,909 |
1,740 |
$12K |
| 82746 |
|
1,352 |
1,307 |
$12K |
| 90651 |
|
939 |
938 |
$12K |
| G0463 |
Hospital outpt clinic visit |
2,243 |
1,704 |
$12K |
| 58662 |
|
18 |
18 |
$12K |
| M0243 |
Casirivi and imdevi inj |
29 |
28 |
$12K |
| 86923 |
|
352 |
257 |
$12K |
| 87522 |
Neg quan hep c or qual rna |
321 |
313 |
$12K |
| 76856 |
|
288 |
281 |
$11K |
| 84439 |
|
1,905 |
1,717 |
$11K |
| 82570 |
|
1,644 |
1,476 |
$11K |
| 85027 |
|
2,027 |
1,756 |
$11K |
| 83986 |
|
4,918 |
4,825 |
$11K |
| J9045 |
Carboplatin injection |
2,726 |
1,727 |
$11K |
| 96523 |
|
779 |
622 |
$11K |
| 85730 |
|
1,888 |
1,776 |
$11K |
| 87077 |
|
1,532 |
1,469 |
$11K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
8,846 |
8,296 |
$10K |
| 45385 |
|
25 |
25 |
$10K |
| J9263 |
Oxaliplatin |
3,186 |
960 |
$10K |
| 85610 |
|
3,545 |
3,302 |
$10K |
| 77334 |
|
113 |
81 |
$10K |
| 76770 |
|
254 |
250 |
$10K |
| 83550 |
|
2,476 |
2,348 |
$10K |
| J9267 |
Paclitaxel injection |
2,570 |
1,148 |
$10K |
| 57455 |
|
44 |
43 |
$9K |
| 86900 |
|
3,373 |
3,084 |
$9K |
| 76536 |
|
201 |
198 |
$9K |
| 76700 |
|
171 |
170 |
$9K |
| 82247 |
|
4,807 |
3,216 |
$9K |
| 86901 |
|
3,373 |
3,081 |
$9K |
| 88142 |
|
529 |
524 |
$9K |
| G0480 |
Drug test def 1-7 classes |
302 |
247 |
$9K |
| 86334 |
|
481 |
413 |
$8K |
| 71045 |
|
1,699 |
1,639 |
$8K |
| C9399 |
Unclassified drugs or biolog |
195 |
173 |
$8K |
| 88184 |
|
254 |
232 |
$8K |
| 71250 |
|
143 |
138 |
$8K |
| 87497 |
|
207 |
104 |
$8K |
| G0008 |
Admin influenza virus vac |
771 |
765 |
$8K |
| 83880 |
|
308 |
293 |
$8K |
| 84075 |
|
4,827 |
3,200 |
$8K |
| 84146 |
|
281 |
273 |
$7K |
| 87340 |
|
557 |
528 |
$7K |
| 82378 |
|
600 |
510 |
$7K |
| 83036 |
|
1,168 |
1,133 |
$7K |
| 84403 |
|
306 |
295 |
$7K |
| 80061 |
|
571 |
562 |
$7K |
| 86803 |
|
384 |
360 |
$7K |
| 88237 |
|
43 |
39 |
$7K |
| J1170 |
Hydromorphone injection |
13,750 |
5,392 |
$7K |
| 84156 |
|
1,720 |
1,476 |
$7K |
| 96368 |
|
773 |
514 |
$7K |
| 73721 |
|
29 |
28 |
$7K |
| 85018 |
|
3,091 |
2,941 |
$7K |
| 83605 |
|
1,228 |
1,131 |
$7K |
| 84520 |
|
4,756 |
3,349 |
$7K |
| 72141 |
|
29 |
29 |
$6K |
| 77336 |
|
170 |
89 |
$6K |
| 99281 |
|
176 |
166 |
$6K |
| 82977 |
|
833 |
527 |
$6K |
| 81002 |
|
1,647 |
1,580 |
$6K |
| 87186 |
|
804 |
770 |
$6K |
| 82232 |
|
470 |
398 |
$5K |
| 73564 |
|
299 |
286 |
$5K |
| 45380 |
|
13 |
13 |
$5K |
| 86704 |
|
384 |
361 |
$5K |
| 84165 |
|
530 |
460 |
$5K |
| J7120 |
Ringers lactate infusion |
17,334 |
10,448 |
$5K |
| 70491 |
|
73 |
73 |
$5K |
| J3535 |
Metered dose inhaler drug |
319 |
283 |
$5K |
| 86304 |
|
334 |
298 |
$5K |
| M0245 |
Bamlan and etesev infusion |
13 |
13 |
$5K |
| 77412 |
|
124 |
17 |
$5K |
| J3489 |
Zoledronic acid 1mg |
1,230 |
1,156 |
$5K |
| 84402 |
|
167 |
164 |
$5K |
| 87040 |
|
382 |
263 |
$5K |
| 86902 |
|
196 |
147 |
$4K |
| M0247 |
Sotrovimab infusion |
13 |
13 |
$4K |
| 90682 |
|
282 |
279 |
$4K |
| 84155 |
|
4,425 |
2,913 |
$4K |
| 84153 |
|
332 |
306 |
$4K |
| P9058 |
Rbc, l/r, cmv-neg, irrad |
159 |
109 |
$4K |
| 86706 |
|
342 |
334 |
$4K |
| 36593 |
|
245 |
211 |
$4K |
| 93970 |
|
60 |
57 |
$4K |
| 87102 |
|
444 |
425 |
$4K |
| 58100 |
|
73 |
72 |
$4K |
| 82310 |
|
3,999 |
2,629 |
$4K |
| 93325 |
|
177 |
176 |
$4K |
| J2790 |
Rho d immune globulin inj |
482 |
416 |
$4K |
| 82677 |
|
193 |
193 |
$4K |
| J1815 |
Insulin injection |
273 |
181 |
$4K |
| 83001 |
|
202 |
201 |
$4K |
| 77295 |
|
14 |
13 |
$3K |
| 88264 |
|
25 |
25 |
$3K |
| J1100 |
Dexamethasone sodium phos |
17,841 |
10,979 |
$3K |
| J7030 |
Normal saline solution infus |
12,181 |
7,404 |
$3K |
| 84132 |
|
3,901 |
2,541 |
$3K |
| 82947 |
|
4,148 |
2,816 |
$3K |
| 74181 |
|
13 |
12 |
$3K |
| 70553 |
|
13 |
13 |
$3K |
| 86038 |
|
229 |
220 |
$3K |
| 36415 |
|
4,953 |
3,922 |
$3K |
| 86147 |
|
138 |
132 |
$3K |
| A9577 |
Inj multihance |
684 |
672 |
$3K |
| 86301 |
|
244 |
191 |
$3K |
| 84295 |
|
3,791 |
2,480 |
$3K |
| 82951 |
|
199 |
197 |
$3K |
| J1626 |
Granisetron hcl injection |
7,134 |
3,674 |
$3K |
| 86235 |
|
45 |
42 |
$3K |
| J9206 |
Irinotecan injection |
1,053 |
387 |
$3K |
| 82435 |
|
3,734 |
2,441 |
$3K |
| 86922 |
|
68 |
58 |
$3K |
| 82962 |
|
1,828 |
1,337 |
$3K |
| 74018 |
|
205 |
196 |
$3K |
| J2930 |
Methylprednisolone injection |
1,240 |
1,043 |
$3K |
| 90674 |
|
879 |
865 |
$3K |
| 86708 |
|
178 |
175 |
$2K |
| 73562 |
|
210 |
202 |
$2K |
| 82374 |
|
3,408 |
2,244 |
$2K |
| 82040 |
|
3,311 |
2,251 |
$2K |
| 85379 |
|
296 |
284 |
$2K |
| 83970 |
|
55 |
55 |
$2K |
| J1720 |
Hydrocortisone sodium succ i |
871 |
633 |
$2K |
| 73501 |
|
219 |
214 |
$2K |
| 82248 |
|
300 |
231 |
$2K |
| 38222 |
|
24 |
24 |
$2K |
| 82670 |
|
91 |
88 |
$2K |
| 81000 |
|
466 |
446 |
$2K |
| 76942 |
|
186 |
181 |
$2K |
| 73610 |
|
142 |
137 |
$2K |
| 82550 |
|
376 |
297 |
$2K |
| 85240 |
|
142 |
140 |
$2K |
| 86360 |
|
29 |
29 |
$2K |
| J9181 |
Etoposide injection |
221 |
56 |
$2K |
| 72100 |
|
98 |
97 |
$2K |
| 85384 |
|
204 |
191 |
$2K |
| 84480 |
|
302 |
261 |
$2K |
| 73630 |
|
207 |
202 |
$2K |
| 86880 |
|
253 |
237 |
$2K |
| J9060 |
Cisplatin 10 mg injection |
754 |
370 |
$2K |
| 86359 |
|
31 |
31 |
$2K |
| 76857 |
|
95 |
93 |
$2K |
| 82103 |
|
102 |
99 |
$2K |
| 86870 |
|
142 |
138 |
$2K |
| 87205 |
|
456 |
435 |
$2K |
| 73560 |
|
143 |
135 |
$1K |
| 80051 |
|
252 |
229 |
$1K |
| 85041 |
|
503 |
499 |
$1K |
| 85044 |
|
447 |
406 |
$1K |
| 87070 |
|
318 |
303 |
$1K |
| 99203 |
|
24 |
24 |
$1K |
| 70486 |
|
24 |
24 |
$1K |
| J1610 |
Glucagon hydrochloride/1 mg |
13 |
13 |
$1K |
| S9443 |
Lactation class |
25 |
25 |
$1K |
| J3475 |
Inj magnesium sulfate |
2,605 |
1,649 |
$1K |
| 86355 |
|
29 |
29 |
$1K |
| 86357 |
|
29 |
29 |
$1K |
| 86146 |
|
15 |
15 |
$1K |
| 85007 |
|
409 |
351 |
$1K |
| 82150 |
|
304 |
251 |
$1K |
| 73130 |
|
132 |
129 |
$1K |
| J0670 |
Inj mepivacaine hcl/10 ml |
642 |
574 |
$1K |
| 85732 |
|
139 |
138 |
$1K |
| 80081 |
|
12 |
12 |
$1K |
| 51701 |
|
48 |
47 |
$1K |
| 82533 |
|
124 |
113 |
$1K |
| 36512 |
|
39 |
38 |
$1K |
| 86256 |
|
112 |
108 |
$1K |
| J0780 |
Prochlorperazine injection |
2,034 |
1,600 |
$1K |
| 99202 |
|
18 |
17 |
$1K |
| J1885 |
Ketorolac tromethamine inj |
9,804 |
8,091 |
$1K |
| 86140 |
|
503 |
471 |
$995.04 |
| 83010 |
|
95 |
85 |
$992.55 |
| J9171 |
Docetaxel injection |
230 |
158 |
$981.84 |
| 88307 |
|
419 |
408 |
$978.99 |
| 99195 |
|
111 |
95 |
$946.02 |
| 84425 |
|
151 |
151 |
$940.86 |
| 73030 |
|
66 |
65 |
$939.48 |
| A9576 |
Inj prohance multipack |
350 |
341 |
$902.56 |
| J9000 |
Doxorubicin hcl injection |
279 |
139 |
$894.56 |
| 85652 |
|
487 |
452 |
$891.15 |
| J2405 |
Ondansetron hcl injection |
14,193 |
10,547 |
$886.17 |
| J3420 |
Vitamin b12 injection |
3,597 |
2,913 |
$864.64 |
| J1200 |
Diphenhydramine hcl injectio |
9,294 |
6,333 |
$858.17 |
| 76882 |
|
150 |
147 |
$848.37 |
| 88368 |
|
17 |
13 |
$820.43 |
| 85597 |
|
30 |
30 |
$807.08 |
| 86644 |
|
28 |
26 |
$790.13 |
| 73110 |
|
87 |
85 |
$721.93 |
| 82043 |
|
96 |
93 |
$678.70 |
| Q9963 |
Hocm 350-399mg/ml iodine,1ml |
1,281 |
1,255 |
$670.55 |
| J7040 |
Normal saline solution infus |
2,721 |
1,527 |
$652.72 |
| 85660 |
|
178 |
141 |
$648.08 |
| 82952 |
|
183 |
181 |
$645.62 |
| J3010 |
Fentanyl citrate injection |
3,610 |
2,920 |
$639.09 |
| 87081 |
|
197 |
193 |
$636.56 |
| 77280 |
|
18 |
15 |
$623.80 |
| 73502 |
|
31 |
29 |
$616.64 |
| J9201 |
In gemcitabine hcl nos 200mg |
458 |
109 |
$587.05 |
| 51798 |
|
60 |
54 |
$586.17 |
| J3480 |
Inj potassium chloride |
1,898 |
917 |
$563.97 |
| 83030 |
|
119 |
111 |
$552.30 |
| 87426 |
|
288 |
284 |
$549.68 |
| 78306 |
|
14 |
12 |
$501.85 |
| J0690 |
Cefazolin sodium injection |
1,145 |
828 |
$500.64 |
| J2765 |
Metoclopramide hcl injection |
4,263 |
3,630 |
$493.89 |
| 82627 |
|
24 |
24 |
$476.49 |
| S0028 |
Injection, famotidine, 20 mg |
2,081 |
1,430 |
$442.32 |
| J9190 |
Fluorouracil injection |
692 |
338 |
$440.40 |
| J0694 |
Cefoxitin sodium injection |
329 |
250 |
$428.66 |
| 82390 |
|
47 |
46 |
$423.12 |
| J0696 |
Ceftriaxone sodium injection |
2,103 |
1,895 |
$416.84 |
| J1644 |
Inj heparin sodium per 1000u |
1,233 |
641 |
$404.00 |
| 74240 |
|
16 |
13 |
$389.17 |
| 85670 |
|
45 |
45 |
$385.37 |
| 87106 |
|
38 |
37 |
$385.15 |
| 85014 |
|
158 |
154 |
$384.70 |
| J2250 |
Inj midazolam hydrochloride |
4,502 |
3,968 |
$379.90 |
| 86769 |
|
27 |
25 |
$372.28 |
| J7121 |
5% dextrose in lac ringers |
712 |
413 |
$371.25 |
| 86376 |
|
48 |
48 |
$359.23 |
| J1650 |
Inj enoxaparin sodium |
1,212 |
646 |
$356.77 |
| 82140 |
|
92 |
91 |
$346.16 |
| J2270 |
Morphine sulfate injection |
987 |
651 |
$338.27 |
| 85705 |
|
43 |
43 |
$337.38 |
| 86645 |
|
12 |
12 |
$302.41 |
| 87075 |
|
42 |
39 |
$284.20 |
| 86787 |
|
14 |
14 |
$273.39 |
| 83883 |
|
85 |
58 |
$243.95 |
| 85097 |
|
12 |
12 |
$242.97 |
| 85046 |
|
53 |
49 |
$233.87 |
| 87430 |
|
72 |
69 |
$219.24 |
| 85613 |
|
18 |
18 |
$218.47 |
| 82803 |
|
16 |
12 |
$205.87 |
| 84134 |
|
14 |
13 |
$202.23 |
| J0131 |
Inj, acetaminophen (nos) |
5,713 |
4,887 |
$193.01 |
| J8501 |
Oral aprepitant |
14 |
14 |
$180.00 |
| 96377 |
|
14 |
13 |
$178.11 |
| J0702 |
Betamethasone acet&sod phosp |
21 |
12 |
$158.00 |
| J7050 |
Normal saline solution infus |
2,019 |
1,260 |
$141.42 |
| J7060 |
5% dextrose/water |
612 |
421 |
$139.40 |
| S0119 |
Ondansetron 4 mg |
603 |
464 |
$136.44 |
| 88112 |
|
16 |
16 |
$136.17 |
| J2704 |
Inj, propofol, 10 mg |
4,927 |
3,639 |
$132.09 |
| 86431 |
|
12 |
12 |
$78.28 |
| 85048 |
|
29 |
28 |
$77.13 |
| 97161 |
|
15 |
15 |
$69.97 |
| J2060 |
Lorazepam injection |
413 |
271 |
$65.84 |
| 88304 |
|
82 |
82 |
$57.20 |
| S0020 |
Injection, bupivicaine hydro |
760 |
666 |
$53.09 |
| 94760 |
|
152 |
96 |
$48.41 |
| J0360 |
Hydralazine hcl injection |
37 |
26 |
$47.46 |
| 87220 |
|
12 |
12 |
$47.19 |
| A4648 |
Implantable tissue marker |
107 |
88 |
$46.43 |
| Q0163 |
Diphenhydramine hcl 50mg |
327 |
257 |
$46.36 |
| J2920 |
Methylprednisolone injection |
342 |
208 |
$46.34 |
| J1580 |
Garamycin gentamicin inj |
33 |
24 |
$44.52 |
| 85651 |
|
16 |
16 |
$39.57 |
| J8540 |
Oral dexamethasone |
1,169 |
561 |
$36.91 |
| J1630 |
Haloperidol injection |
101 |
79 |
$8.23 |
| J7620 |
Albuterol ipratrop non-comp |
712 |
454 |
$7.43 |
| J2710 |
Neostigmine methylslfte inj |
356 |
321 |
$6.86 |
| J7613 |
Albuterol non-comp unit |
311 |
200 |
$4.10 |
| J0134 |
Inj acetaminophen -fresenius |
461 |
426 |
$4.00 |
| J7512 |
Prednisone ir or dr oral 1mg |
741 |
533 |
$3.37 |
| J2001 |
Lidocaine injection |
54 |
53 |
$0.20 |
| Q0247 |
Sotrovimab |
89 |
89 |
$0.03 |
| J9358 |
Inj fam-trastu deru-nxki 1mg |
51 |
27 |
$0.00 |
| J1750 |
Inj iron dextran |
293 |
264 |
$0.00 |
| J1050 |
Medroxyprogesterone acetate |
2,942 |
2,923 |
$0.00 |
| 90678 |
|
32 |
32 |
$0.00 |
| J9144 |
Daratumumab, hyaluronidase |
649 |
366 |
$0.00 |
| J2916 |
Na ferric gluconate complex |
1,938 |
995 |
$0.00 |
| C9803 |
Hopd covid-19 spec collect |
59 |
59 |
$0.00 |
| J0137 |
Inj, acetaminophen (hikma) |
213 |
202 |
$0.00 |
| J1453 |
Fosaprepitant injection |
239 |
168 |
$0.00 |
| J9035 |
Bevacizumab injection |
281 |
98 |
$0.00 |
| J2919 |
Inj, methylpred sod succ 5mg |
270 |
169 |
$0.00 |
| J1596 |
Inj, glycopyrrolate, 0.1 mg |
27 |
26 |
$0.00 |
| J9073 |
Inj cyclophos dr reddys 5 mg |
25 |
15 |
$0.00 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
277 |
175 |
$0.00 |
| J2506 |
Inj pegfilgrast ex bio 0.5mg |
15 |
12 |
$0.00 |
| 88302 |
|
47 |
46 |
$0.00 |
| S0030 |
Injection, metronidazole |
50 |
12 |
$0.00 |
| J0461 |
Atropine sulfate injection |
328 |
188 |
$0.00 |
| 36591 |
|
861 |
597 |
$0.00 |
| J9304 |
Inj. pemetrexed, 10 mg |
16 |
12 |
$0.00 |
| Q5121 |
Inj. avsola, 10 mg |
796 |
736 |
$0.00 |
| J0330 |
Succinycholine chloride inj |
816 |
727 |
$0.00 |
| J7999 |
Compounded drug, noc |
1,853 |
1,424 |
$0.00 |
| Q5120 |
Inj pegfilgrastim-bmez 0.5mg |
566 |
425 |
$0.00 |
| A9579 |
Gad-base mr contrast nos,1ml |
310 |
309 |
$0.00 |
| S0074 |
Injection, cefotetan disodiu |
230 |
203 |
$0.00 |
| Q5104 |
Injection, renflexis |
338 |
325 |
$0.00 |
| J7611 |
Albuterol non-comp con |
12 |
12 |
$0.00 |
| Q0222 |
Bebtelovimab 175 mg |
82 |
81 |
$0.00 |
| 90673 |
|
15 |
15 |
$0.00 |
| J2150 |
Mannitol injection |
19 |
13 |
$0.00 |
| J0490 |
Belimumab injection |
27 |
12 |
$0.00 |