| J1568 | Injection, immune globulin, (octagam), intravenous, non-lyophilized (e.g., liquid), 500 mg | 6,500 | $30 | $221K |
| 96365 | The provider administers the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease. | 1,100 | $50 | $50.4K |
| J0875 | Injection, dalbavancin, 5 mg | 4,100 | $10 | $49.2K |
| 99214 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the… | 290 | $100 | $28K |
| 99213 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the… | 390 | $70 | $26.2K |
| J0561 | Injection, penicillin g benzathine, 100,000 units | 1,130 | $10 | $15.8K |
| 96367 | The provider administers an additional intravenous infusion or infusions, after an initial infusion, of a different medication or substance for a period up to one hour to prevent, treat, or diagnose… | 440 | $20 | $9.3K |
| 96366 | The provider administers an intravenous infusion or infusions of a medication for an additional hour or subsequent hours after the first hour to prevent, treat, or diagnose a condition or disease. | 390 | $20 | $5.8K |
| 99205 | The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the provider… | 30 | $170 | $5.7K |
| J1335 | Injection, ertapenem sodium, 500 mg | 420 | $10 | $4.6K |