| Code | Description | Claims | Beneficiaries | Total Paid |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
8,033 |
6,682 |
$995K |
| 70450 |
Computed tomography, head or brain; without contrast material |
9,594 |
7,852 |
$814K |
| U0003 |
Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high throughput technologies as described by cms-2020-01-r |
6,554 |
5,354 |
$486K |
| 87631 |
|
7,149 |
5,999 |
$472K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
30,208 |
21,436 |
$415K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
2,503 |
2,065 |
$387K |
| 72125 |
Computed tomography, cervical spine; without contrast material |
3,727 |
3,109 |
$387K |
| 80053 |
Comprehensive metabolic panel |
20,929 |
16,175 |
$344K |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
3,886 |
2,938 |
$318K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
4,727 |
3,938 |
$292K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
45,448 |
32,164 |
$285K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
4,282 |
3,047 |
$250K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
16,036 |
12,404 |
$210K |
| 78452 |
Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress |
1,551 |
1,175 |
$191K |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
6,722 |
2,130 |
$172K |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
5,082 |
4,200 |
$169K |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
3,201 |
2,577 |
$167K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
2,911 |
2,431 |
$167K |
| 59025 |
Fetal non-stress test |
1,547 |
648 |
$143K |
| 96361 |
Intravenous infusion, hydration; each additional hour |
10,254 |
7,587 |
$139K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
18,123 |
11,392 |
$139K |
| 11042 |
Debridement, subcutaneous tissue (includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm |
1,538 |
734 |
$133K |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
4,920 |
4,170 |
$121K |
| 84484 |
|
16,870 |
8,495 |
$117K |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
825 |
687 |
$112K |
| 86901 |
|
5,706 |
4,151 |
$107K |
| 71045 |
Radiologic examination, chest; single view |
15,633 |
12,065 |
$106K |
| 81025 |
|
13,443 |
11,213 |
$101K |
| 80076 |
|
12,709 |
10,171 |
$93K |
| 83690 |
|
14,160 |
11,504 |
$87K |
| 83880 |
|
4,624 |
3,688 |
$84K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
10,545 |
8,085 |
$77K |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
557 |
415 |
$77K |
| 87633 |
Infectious agent detection by nucleic acid, respiratory virus, 12-25 targets |
388 |
346 |
$74K |
| 70498 |
|
766 |
584 |
$67K |
| 72131 |
|
672 |
537 |
$65K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
2,761 |
2,287 |
$64K |
| C1769 |
Guide wire |
2,479 |
1,590 |
$62K |
| 70496 |
|
669 |
517 |
$62K |
| 80320 |
|
4,332 |
3,444 |
$58K |
| 82962 |
|
11,972 |
4,471 |
$55K |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
1,496 |
505 |
$55K |
| 82565 |
|
8,992 |
7,077 |
$54K |
| 71046 |
Radiologic examination, chest; 2 views |
3,233 |
2,715 |
$52K |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
13,781 |
9,726 |
$51K |
| 87077 |
|
7,275 |
4,678 |
$51K |
| A9502 |
Technetium tc-99m tetrofosmin, diagnostic, per study dose |
1,386 |
1,047 |
$50K |
| 85730 |
|
12,455 |
9,556 |
$48K |
| 76801 |
|
1,302 |
1,107 |
$42K |
| 84145 |
|
3,687 |
2,839 |
$41K |
| 97162 |
|
1,131 |
801 |
$40K |
| 80329 |
|
3,367 |
2,328 |
$40K |
| 85610 |
|
14,039 |
10,586 |
$40K |
| 81002 |
|
12,827 |
10,816 |
$39K |
| 85027 |
|
8,073 |
5,352 |
$39K |
| 93017 |
|
1,954 |
1,533 |
$37K |
| 81001 |
|
10,176 |
8,446 |
$36K |
| 87660 |
|
1,695 |
1,449 |
$35K |
| 87480 |
|
1,698 |
1,451 |
$34K |
| 87510 |
|
1,696 |
1,449 |
$34K |
| 87798 |
Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism |
831 |
379 |
$33K |
| 97161 |
|
604 |
427 |
$33K |
| 70486 |
|
282 |
255 |
$33K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
3,325 |
2,671 |
$32K |
| 83735 |
|
7,395 |
4,693 |
$32K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
11,147 |
8,277 |
$30K |
| 83605 |
|
4,056 |
2,877 |
$29K |
| 72148 |
Magnetic resonance imaging, lumbar spine; without contrast material |
143 |
115 |
$29K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
829 |
565 |
$27K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
829 |
565 |
$27K |
| 86850 |
|
4,248 |
2,910 |
$26K |
| C1894 |
Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser |
2,708 |
1,792 |
$26K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
2,408 |
2,166 |
$25K |
| 87081 |
|
3,675 |
3,090 |
$25K |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
5,313 |
3,533 |
$25K |
| C1725 |
Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability) |
266 |
180 |
$25K |
| 93458 |
|
285 |
228 |
$24K |
| J2785 |
Injection, regadenoson, 0.1 mg |
797 |
572 |
$24K |
| 87186 |
|
4,896 |
3,629 |
$23K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
552 |
468 |
$23K |
| 84702 |
|
2,264 |
1,888 |
$23K |
| 87040 |
|
3,474 |
1,653 |
$23K |
| 73562 |
|
991 |
822 |
$22K |
| 82803 |
|
1,646 |
1,211 |
$22K |
| U0002 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
1,583 |
1,136 |
$21K |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
3,287 |
2,201 |
$21K |
| 87070 |
|
2,857 |
1,958 |
$21K |
| 73630 |
|
1,035 |
861 |
$21K |
| 84703 |
|
2,659 |
1,829 |
$20K |
| 84132 |
|
3,065 |
2,125 |
$20K |
| 93971 |
|
655 |
522 |
$20K |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
6,087 |
4,646 |
$19K |
| 36415 |
Collection of venous blood by venipuncture |
12,862 |
7,509 |
$18K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
594 |
503 |
$18K |
| 85379 |
|
1,879 |
1,606 |
$17K |
| J3490 |
Unclassified drugs |
7,831 |
4,344 |
$17K |
| 87581 |
|
421 |
377 |
$17K |
| 87486 |
|
421 |
377 |
$17K |
| 76830 |
Ultrasound, transvaginal |
331 |
276 |
$17K |
| 87400 |
|
3,001 |
2,743 |
$17K |
| 97001 |
|
329 |
307 |
$15K |
| 73610 |
|
1,027 |
853 |
$15K |
| 86900 |
|
5,765 |
4,164 |
$14K |
| 87637 |
Infectious agent detection by nucleic acid; SARS-CoV-2, influenza, and RSV |
289 |
227 |
$14K |
| 80050 |
General health panel |
361 |
342 |
$14K |
| 84443 |
Thyroid stimulating hormone (TSH) |
2,769 |
2,255 |
$14K |
| 73130 |
|
728 |
597 |
$13K |
| G0378 |
Hospital observation service, per hour |
1,033 |
833 |
$12K |
| 73030 |
|
835 |
670 |
$12K |
| C1887 |
Catheter, guiding (may include infusion/perfusion capability) |
1,920 |
1,334 |
$11K |
| 94760 |
|
1,641 |
1,010 |
$10K |
| 90715 |
|
506 |
419 |
$10K |
| 87420 |
|
957 |
902 |
$10K |
| C9803 |
Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
4,696 |
3,778 |
$9K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
576 |
505 |
$9K |
| C1760 |
Closure device, vascular (implantable/insertable) |
172 |
115 |
$9K |
| 36430 |
|
126 |
86 |
$9K |
| 80061 |
Lipid panel |
863 |
705 |
$9K |
| 82330 |
|
1,170 |
807 |
$8K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
600 |
494 |
$8K |
| 71020 |
|
935 |
876 |
$8K |
| 84100 |
|
2,794 |
1,441 |
$8K |
| 87205 |
|
2,625 |
1,804 |
$7K |
| 96376 |
|
3,446 |
2,189 |
$7K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
498 |
424 |
$7K |
| 81003 |
|
2,676 |
2,252 |
$7K |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
676 |
519 |
$6K |
| J1650 |
Injection, enoxaparin sodium, 10 mg |
749 |
272 |
$6K |
| 85007 |
|
2,314 |
1,696 |
$6K |
| C1713 |
Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable) |
482 |
321 |
$6K |
| J7030 |
Infusion, normal saline solution , 1000 cc |
1,969 |
1,480 |
$6K |
| 71250 |
|
65 |
57 |
$6K |
| 85520 |
|
1,446 |
949 |
$5K |
| 73110 |
|
309 |
260 |
$5K |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
8,071 |
5,527 |
$5K |
| C1751 |
Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis) |
135 |
101 |
$4K |
| 95810 |
Polysomnography; sleep staging with 4 or more additional parameters |
44 |
39 |
$4K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
1,215 |
988 |
$4K |
| 85014 |
|
1,480 |
1,032 |
$4K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
970 |
802 |
$4K |
| 88720 |
|
651 |
589 |
$3K |
| 86140 |
|
814 |
534 |
$3K |
| J7050 |
Infusion, normal saline solution, 250 cc |
456 |
277 |
$3K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
651 |
403 |
$3K |
| 72128 |
|
29 |
24 |
$3K |
| 77080 |
|
64 |
53 |
$3K |
| 71010 |
|
608 |
544 |
$3K |
| A9577 |
Injection, gadobenate dimeglumine (multihance), per ml |
242 |
173 |
$3K |
| 87075 |
|
567 |
416 |
$3K |
| 97597 |
|
307 |
169 |
$3K |
| J1644 |
Injection, heparin sodium, per 1000 units |
3,487 |
1,774 |
$2K |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
465 |
435 |
$2K |
| J1815 |
Injection, insulin, per 5 units |
1,016 |
375 |
$2K |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
1,100 |
367 |
$2K |
| 82550 |
|
393 |
221 |
$2K |
| G0480 |
Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed |
77 |
70 |
$2K |
| 72100 |
|
122 |
95 |
$2K |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
9,575 |
6,582 |
$2K |
| 94761 |
|
229 |
133 |
$2K |
| A9573 |
Injection, gadopiclenol, 1 ml |
97 |
66 |
$2K |
| 36592 |
|
111 |
85 |
$2K |
| J0330 |
Injection, succinylcholine chloride, up to 20 mg |
1,048 |
696 |
$2K |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
5,528 |
3,883 |
$2K |
| J0690 |
Injection, cefazolin sodium, 500 mg |
2,340 |
1,452 |
$1K |
| J2550 |
Injection, promethazine hcl, up to 50 mg |
2,090 |
1,444 |
$1K |
| 84295 |
|
841 |
616 |
$1K |
| 87088 |
|
164 |
143 |
$1K |
| 73502 |
|
134 |
93 |
$1K |
| 73080 |
|
103 |
78 |
$1K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
264 |
186 |
$1K |
| 85384 |
|
114 |
77 |
$1K |
| J1170 |
Injection, hydromorphone, up to 4 mg |
4,952 |
3,120 |
$1K |
| 82010 |
|
136 |
105 |
$885.26 |
| U0005 |
Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2 |
5,848 |
4,907 |
$875.83 |
| 84550 |
|
177 |
130 |
$827.79 |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
15 |
12 |
$815.51 |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
1,649 |
1,165 |
$784.84 |
| J1642 |
Injection, heparin sodium, (heparin lock flush), per 10 units |
135 |
64 |
$727.42 |
| G0379 |
Direct admission of patient for hospital observation care |
2,667 |
1,707 |
$721.39 |
| 87045 |
|
84 |
64 |
$705.23 |
| 0001A |
|
18 |
14 |
$700.00 |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
457 |
314 |
$685.58 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
678 |
497 |
$665.05 |
| J2060 |
Injection, lorazepam, 2 mg |
296 |
234 |
$649.65 |
| A9270 |
Non-covered item or service |
39,543 |
13,101 |
$644.02 |
| J3370 |
Injection, vancomycin hcl, 500 mg |
956 |
447 |
$513.10 |
| 85652 |
|
268 |
225 |
$511.05 |
| J2710 |
Injection, neostigmine methylsulfate, up to 0.5 mg |
1,275 |
792 |
$499.47 |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
752 |
354 |
$496.00 |
| 97165 |
|
22 |
12 |
$494.40 |
| 82570 |
|
102 |
84 |
$487.33 |
| C1729 |
Catheter, drainage |
177 |
115 |
$455.63 |
| 87427 |
|
49 |
37 |
$403.60 |
| 97163 |
|
30 |
12 |
$395.52 |
| 74018 |
|
28 |
25 |
$385.45 |
| 73090 |
|
26 |
25 |
$370.00 |
| J1245 |
Injection, dipyridamole, per 10 mg |
190 |
137 |
$359.45 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
626 |
396 |
$296.63 |
| 74022 |
|
13 |
12 |
$296.51 |
| 93970 |
|
15 |
14 |
$291.50 |
| J7040 |
Infusion, normal saline solution, sterile (500 ml = 1 unit) |
59 |
55 |
$244.20 |
| A9579 |
Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (nos), per ml |
46 |
29 |
$239.74 |
| 83986 |
|
47 |
43 |
$218.50 |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
201 |
122 |
$208.85 |
| 87147 |
|
42 |
29 |
$207.18 |
| 84156 |
|
45 |
37 |
$199.23 |
| Q9969 |
Tc-99m from non-highly enriched uranium source, full cost recovery add-on, per study dose |
934 |
631 |
$197.10 |
| 87340 |
|
17 |
14 |
$195.73 |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
336 |
264 |
$158.39 |
| 87046 |
|
67 |
52 |
$149.49 |
| J0689 |
Injection, cefazolin sodium (baxter), not therapeutically equivalent to j0690, 500 mg |
759 |
492 |
$144.80 |
| J1790 |
Injection, droperidol, up to 5 mg |
147 |
123 |
$143.74 |
| 86923 |
|
38 |
27 |
$106.13 |
| 82728 |
|
18 |
13 |
$102.55 |
| 83550 |
|
19 |
13 |
$94.10 |
| 82247 |
|
14 |
12 |
$93.21 |
| J0171 |
Injection, adrenalin, epinephrine, 0.1 mg |
182 |
101 |
$88.79 |
| J2371 |
Injection, phenylephrine hydrochloride, 20 micrograms |
214 |
149 |
$87.70 |
| 90653 |
|
17 |
15 |
$83.49 |
| J2001 |
Injection, lidocaine hcl for intravenous infusion, 10 mg |
1,437 |
906 |
$72.39 |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
11,374 |
8,255 |
$71.99 |
| 86592 |
|
14 |
13 |
$70.80 |
| J2370 |
Injection, phenylephrine hcl, up to 1 ml |
283 |
195 |
$66.40 |
| 76819 |
Fetal biophysical profile; without non-stress testing |
17 |
12 |
$63.01 |
| 82947 |
|
12 |
12 |
$61.60 |
| 85347 |
|
58 |
38 |
$58.64 |
| 84439 |
|
33 |
26 |
$51.52 |
| 83540 |
|
17 |
12 |
$48.75 |
| A6211 |
Foam dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
74 |
40 |
$46.98 |
| J2003 |
Injection, lidocaine hydrochloride, 1 mg |
127 |
93 |
$45.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
266 |
229 |
$44.68 |
| 97535 |
Self-care/home management training, each 15 minutes |
399 |
253 |
$36.91 |
| J0737 |
Injection, clindamycin phosphate (baxter), not therapeutically equivalent to j0736, 300 mg |
44 |
29 |
$34.80 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
1,078 |
769 |
$34.22 |
| 89051 |
|
17 |
12 |
$31.44 |
| C1758 |
Catheter, ureteral |
178 |
118 |
$19.70 |
| J8499 |
Prescription drug, oral, non chemotherapeutic, nos |
4,509 |
2,071 |
$17.80 |
| J1171 |
Injection, hydromorphone, 0.1 mg |
76 |
59 |
$16.20 |
| J2919 |
Injection, methylprednisolone sodium succinate, 5 mg |
79 |
41 |
$15.78 |
| G0008 |
Administration of influenza virus vaccine |
35 |
30 |
$15.45 |
| J2175 |
Injection, meperidine hydrochloride, per 100 mg |
172 |
102 |
$7.37 |
| J1940 |
Injection, furosemide, up to 20 mg |
155 |
74 |
$7.34 |
| 85018 |
|
23 |
12 |
$6.76 |
| J7510 |
Prednisolone oral, per 5 mg |
16 |
16 |
$1.80 |
| 91300 |
|
18 |
14 |
$0.10 |
| G8979 |
Mobility: walking & moving around functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting |
26 |
26 |
$0.01 |
| 90662 |
|
18 |
15 |
$0.00 |
| 97116 |
|
681 |
320 |
$0.00 |
| Q9957 |
Injection, perflutren lipid microspheres, per ml |
38 |
28 |
$0.00 |
| J7643 |
Glycopyrrolate, inhalation solution, compounded product, administered through dme, unit dose form, per milligram |
87 |
57 |
$0.00 |
| 36600 |
|
18 |
17 |
$0.00 |
| P9016 |
Red blood cells, leukocytes reduced, each unit |
31 |
24 |
$0.00 |
| L4387 |
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf |
16 |
14 |
$0.00 |
| 82055 |
|
12 |
12 |
$0.00 |
| G8978 |
Mobility: walking & moving around functional limitation, current status, at therapy episode outset and at reporting intervals |
14 |
14 |
$0.00 |
| J2274 |
Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg |
45 |
36 |
$0.00 |
| J7999 |
Compounded drug, not otherwise classified |
305 |
215 |
$0.00 |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
99 |
66 |
$0.00 |
| 88304 |
|
39 |
25 |
$0.00 |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
280 |
195 |
$0.00 |
| A4217 |
Sterile water/saline, 500 ml |
17 |
12 |
$0.00 |
| 0352U |
|
18 |
16 |
$0.00 |
| J0360 |
Injection, hydralazine hcl, up to 20 mg |
75 |
44 |
$0.00 |