| Code | Description | Claims | Beneficiaries | Total Paid |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
24,108 |
22,472 |
$5.17M |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
22,479 |
20,588 |
$4.51M |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
20,079 |
17,734 |
$2.50M |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
9,780 |
7,505 |
$1.97M |
| 96361 |
Intravenous infusion, hydration; each additional hour |
4,065 |
3,390 |
$1.83M |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
5,482 |
5,127 |
$1.49M |
| 59025 |
Fetal non-stress test |
4,749 |
2,139 |
$1.31M |
| 70450 |
Computed tomography, head or brain; without contrast material |
5,349 |
4,848 |
$1.15M |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
2,811 |
2,230 |
$1.00M |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
6,950 |
6,636 |
$891K |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
4,011 |
3,782 |
$749K |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
7,773 |
3,656 |
$636K |
| 11042 |
Debridement, subcutaneous tissue (includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm |
2,173 |
1,093 |
$581K |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
6,931 |
4,110 |
$546K |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
13,479 |
4,461 |
$535K |
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
2,690 |
2,602 |
$523K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
1,831 |
1,731 |
$517K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
10,484 |
9,124 |
$515K |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
2,294 |
2,187 |
$507K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
1,421 |
1,325 |
$380K |
| 92507 |
Treatment of speech, language, voice, communication, and/or auditory processing disorder |
5,375 |
2,210 |
$356K |
| 80053 |
Comprehensive metabolic panel |
40,183 |
33,774 |
$336K |
| 76830 |
Ultrasound, transvaginal |
1,767 |
1,731 |
$329K |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
856 |
825 |
$293K |
| 76801 |
|
2,191 |
1,981 |
$282K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
1,984 |
1,944 |
$250K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
1,619 |
1,596 |
$237K |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
628 |
599 |
$191K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
1,276 |
1,213 |
$178K |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
6,438 |
2,701 |
$168K |
| 71046 |
Radiologic examination, chest; 2 views |
11,684 |
10,953 |
$155K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
914 |
810 |
$152K |
| 36415 |
Collection of venous blood by venipuncture |
26,608 |
22,235 |
$138K |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
317 |
288 |
$133K |
| 93971 |
|
911 |
865 |
$130K |
| 84443 |
Thyroid stimulating hormone (TSH) |
8,760 |
8,256 |
$117K |
| 78452 |
Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress |
315 |
288 |
$107K |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
1,042 |
1,034 |
$106K |
| G0378 |
Hospital observation service, per hour |
2,141 |
1,735 |
$101K |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
1,337 |
1,264 |
$97K |
| 85027 |
|
13,649 |
12,416 |
$85K |
| 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 |
845 |
813 |
$84K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
5,715 |
5,433 |
$83K |
| 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 |
7,261 |
6,087 |
$80K |
| 80050 |
General health panel |
9,168 |
4,256 |
$79K |
| 10060 |
|
221 |
209 |
$78K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
18,297 |
15,720 |
$78K |
| 97162 |
|
1,359 |
1,303 |
$73K |
| 72100 |
|
1,854 |
1,790 |
$69K |
| 84484 |
|
13,062 |
10,333 |
$65K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
1,060 |
960 |
$65K |
| 76770 |
|
366 |
359 |
$62K |
| 45380 |
Colonoscopy, flexible; with biopsy, single or multiple |
195 |
184 |
$60K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
5,933 |
5,716 |
$55K |
| 87653 |
|
2,679 |
2,611 |
$53K |
| 12001 |
|
130 |
129 |
$51K |
| 90715 |
|
1,669 |
1,590 |
$50K |
| 99291 |
Critical care, evaluation and management of the critically ill patient, first 30-74 minutes |
831 |
764 |
$50K |
| 73564 |
|
1,802 |
1,655 |
$48K |
| 70496 |
|
136 |
130 |
$48K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
33,223 |
27,641 |
$48K |
| 74018 |
|
1,111 |
1,064 |
$47K |
| 83880 |
|
8,082 |
6,998 |
$46K |
| 84702 |
|
4,175 |
3,391 |
$44K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
8,986 |
8,203 |
$44K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
1,256 |
1,245 |
$43K |
| 80061 |
Lipid panel |
4,984 |
4,889 |
$42K |
| 87040 |
|
3,556 |
2,734 |
$42K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
4,709 |
3,835 |
$40K |
| 93017 |
|
485 |
398 |
$39K |
| 96368 |
|
1,330 |
1,235 |
$39K |
| 83605 |
|
4,988 |
4,180 |
$38K |
| 73030 |
|
1,763 |
1,649 |
$38K |
| 72125 |
Computed tomography, cervical spine; without contrast material |
2,106 |
1,965 |
$36K |
| 82553 |
|
5,028 |
4,349 |
$36K |
| 84439 |
|
2,002 |
1,927 |
$35K |
| 97597 |
|
367 |
226 |
$35K |
| 73630 |
|
1,751 |
1,668 |
$33K |
| 97112 |
Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination |
917 |
459 |
$32K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
2,874 |
2,719 |
$31K |
| 87634 |
|
1,255 |
1,209 |
$31K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
1,412 |
1,359 |
$31K |
| 76642 |
|
176 |
165 |
$30K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
3,039 |
2,309 |
$24K |
| 73610 |
|
1,521 |
1,439 |
$23K |
| 71250 |
|
344 |
328 |
$23K |
| 85379 |
|
2,715 |
2,550 |
$22K |
| 82607 |
|
1,096 |
1,056 |
$21K |
| 73502 |
|
908 |
857 |
$20K |
| 96367 |
|
520 |
419 |
$20K |
| 72148 |
Magnetic resonance imaging, lumbar spine; without contrast material |
128 |
123 |
$19K |
| 73130 |
|
1,430 |
1,343 |
$18K |
| 86762 |
|
1,504 |
1,368 |
$18K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
85 |
84 |
$18K |
| 86803 |
|
1,695 |
1,554 |
$18K |
| 82728 |
|
1,158 |
1,109 |
$17K |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
2,070 |
1,915 |
$17K |
| 84145 |
|
1,327 |
1,177 |
$15K |
| 86900 |
|
3,006 |
2,711 |
$14K |
| 73110 |
|
903 |
862 |
$13K |
| 87340 |
|
1,914 |
1,765 |
$12K |
| 72040 |
|
266 |
261 |
$12K |
| 92523 |
|
78 |
77 |
$12K |
| 83540 |
|
1,545 |
1,475 |
$12K |
| 83550 |
|
1,477 |
1,408 |
$12K |
| 82570 |
|
1,016 |
985 |
$11K |
| 90853 |
Group psychotherapy (other than of a multiple-family group) |
1,113 |
470 |
$11K |
| 87077 |
|
3,213 |
2,996 |
$11K |
| 71045 |
Radiologic examination, chest; single view |
9,178 |
7,924 |
$11K |
| 97129 |
|
64 |
26 |
$11K |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
159 |
158 |
$10K |
| 59409 |
Vaginal delivery only (with or without episiotomy and/or forceps) |
18 |
12 |
$10K |
| 86850 |
|
2,976 |
2,685 |
$10K |
| 72141 |
|
51 |
51 |
$10K |
| 76937 |
|
94 |
83 |
$10K |
| 59514 |
|
13 |
13 |
$9K |
| 70498 |
|
209 |
197 |
$9K |
| 82746 |
|
671 |
649 |
$7K |
| 81001 |
|
22,526 |
19,863 |
$7K |
| 87186 |
|
4,456 |
4,105 |
$7K |
| 82947 |
|
987 |
960 |
$7K |
| 86901 |
|
3,464 |
3,090 |
$7K |
| 83655 |
|
229 |
224 |
$7K |
| 85610 |
|
11,256 |
9,619 |
$7K |
| 83690 |
|
10,877 |
9,778 |
$7K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
6,799 |
5,597 |
$7K |
| 99460 |
|
118 |
113 |
$6K |
| 29125 |
|
31 |
31 |
$6K |
| 87081 |
|
498 |
483 |
$6K |
| 84403 |
|
326 |
318 |
$6K |
| 73721 |
Magnetic resonance imaging, any joint of lower extremity; without contrast material |
16 |
13 |
$6K |
| 85651 |
|
2,048 |
1,853 |
$6K |
| 12011 |
|
13 |
13 |
$6K |
| 84703 |
|
1,842 |
1,774 |
$6K |
| 70486 |
|
152 |
142 |
$5K |
| 87070 |
|
1,881 |
1,725 |
$5K |
| 70491 |
|
44 |
38 |
$5K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
1,211 |
1,164 |
$5K |
| 92526 |
|
98 |
63 |
$5K |
| 86141 |
|
1,628 |
1,484 |
$5K |
| 84436 |
|
4,691 |
4,175 |
$5K |
| 82043 |
|
787 |
773 |
$4K |
| 83735 |
|
7,546 |
6,426 |
$4K |
| 97161 |
|
129 |
120 |
$4K |
| 84153 |
|
258 |
255 |
$3K |
| 99238 |
Hospital discharge day management, 30 minutes or less |
94 |
89 |
$3K |
| 76536 |
|
12 |
12 |
$3K |
| 86592 |
|
251 |
240 |
$3K |
| 84146 |
|
157 |
154 |
$3K |
| 82550 |
|
8,721 |
7,442 |
$3K |
| 97166 |
|
27 |
27 |
$2K |
| 73080 |
|
171 |
166 |
$2K |
| 81003 |
|
1,388 |
1,338 |
$2K |
| 87205 |
|
1,764 |
1,617 |
$2K |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
1,346 |
1,079 |
$2K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
10,483 |
9,282 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
30 |
25 |
$2K |
| 73590 |
|
185 |
178 |
$2K |
| 86038 |
|
135 |
126 |
$2K |
| 85730 |
|
6,971 |
6,207 |
$1K |
| 77066 |
Tomosynthesis, mammo |
24 |
24 |
$1K |
| 76870 |
|
12 |
12 |
$1K |
| A9502 |
Technetium tc-99m tetrofosmin, diagnostic, per study dose |
269 |
221 |
$1K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
30 |
25 |
$1K |
| 73140 |
|
74 |
72 |
$1K |
| J2785 |
Injection, regadenoson, 0.1 mg |
363 |
307 |
$1K |
| 86695 |
|
71 |
66 |
$1K |
| 81025 |
|
6,638 |
5,956 |
$1K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
1,418 |
1,372 |
$1K |
| 82805 |
|
3,364 |
2,876 |
$951.77 |
| 87088 |
|
528 |
493 |
$927.23 |
| 82140 |
|
695 |
581 |
$906.82 |
| 99152 |
|
115 |
92 |
$897.65 |
| 74022 |
|
105 |
97 |
$855.66 |
| 0002A |
|
42 |
41 |
$853.63 |
| 84550 |
|
207 |
179 |
$805.71 |
| 97163 |
|
26 |
24 |
$793.26 |
| 82627 |
|
29 |
29 |
$715.21 |
| 96375 |
Therapeutic injection; each additional sequential IV push |
9,058 |
7,934 |
$669.94 |
| 86696 |
|
71 |
66 |
$645.79 |
| 97165 |
|
13 |
12 |
$600.29 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
4,817 |
3,977 |
$559.67 |
| 87512 |
|
33 |
32 |
$532.15 |
| 83001 |
|
24 |
24 |
$509.51 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,782 |
1,681 |
$465.05 |
| 0001A |
|
40 |
39 |
$461.58 |
| J7050 |
Infusion, normal saline solution, 250 cc |
14,116 |
10,884 |
$385.49 |
| 97035 |
|
56 |
27 |
$361.34 |
| 87799 |
|
34 |
33 |
$350.52 |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
39 |
38 |
$344.18 |
| 85018 |
|
121 |
87 |
$303.05 |
| 82248 |
|
45 |
40 |
$301.35 |
| 99462 |
|
13 |
12 |
$286.56 |
| 83516 |
|
27 |
25 |
$262.37 |
| J2919 |
Injection, methylprednisolone sodium succinate, 5 mg |
40 |
30 |
$234.90 |
| 99153 |
Mod sedat endo service >5yrs |
128 |
102 |
$223.36 |
| 73090 |
|
27 |
25 |
$218.72 |
| 87210 |
|
488 |
459 |
$200.03 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
4,712 |
4,209 |
$199.84 |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
3,119 |
2,371 |
$171.84 |
| 85014 |
|
92 |
64 |
$147.35 |
| 73560 |
|
38 |
36 |
$135.82 |
| J2060 |
Injection, lorazepam, 2 mg |
1,907 |
1,503 |
$104.47 |
| 97116 |
|
21 |
12 |
$100.01 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
5,386 |
4,783 |
$97.83 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
6,917 |
5,843 |
$96.53 |
| 84100 |
|
148 |
119 |
$93.37 |
| 82150 |
|
41 |
40 |
$79.51 |
| 87481 |
|
40 |
32 |
$73.10 |
| J3370 |
Injection, vancomycin hcl, 500 mg |
664 |
403 |
$51.99 |
| U0002 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
1,815 |
1,559 |
$51.76 |
| 94664 |
|
13 |
13 |
$50.47 |
| 87801 |
Infectious agent detection by nucleic acid; amplified probe, multiple organisms |
51 |
49 |
$37.77 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
8,390 |
7,215 |
$35.42 |
| 82009 |
|
366 |
333 |
$30.87 |
| 96376 |
|
2,455 |
2,012 |
$30.40 |
| 87075 |
|
43 |
42 |
$26.29 |
| J2543 |
Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams) |
475 |
337 |
$18.90 |
| 36600 |
|
131 |
105 |
$18.26 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
3,959 |
3,588 |
$17.12 |
| S0119 |
Ondansetron, oral, 4 mg (for circumstances falling under the medicare statute, use hcpcs q code) |
1,443 |
1,371 |
$14.00 |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
2,168 |
1,853 |
$12.17 |
| 86920 |
|
33 |
24 |
$7.06 |
| J2704 |
Injection, propofol, 10 mg |
4,264 |
3,644 |
$5.98 |
| J0690 |
Injection, cefazolin sodium, 500 mg |
1,300 |
1,114 |
$5.87 |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
419 |
377 |
$3.58 |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
2,194 |
1,974 |
$1.61 |
| J0330 |
Injection, succinylcholine chloride, up to 20 mg |
268 |
242 |
$0.00 |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
446 |
354 |
$0.00 |
| J1630 |
Injection, haloperidol, up to 5 mg |
776 |
596 |
$0.00 |
| A9270 |
Non-covered item or service |
26,103 |
6,258 |
$0.00 |
| J1170 |
Injection, hydromorphone, up to 4 mg |
2,629 |
1,973 |
$0.00 |
| A9500 |
Technetium tc-99m sestamibi, diagnostic, per study dose |
489 |
278 |
$0.00 |
| J7620 |
Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme |
52 |
39 |
$0.00 |
| G0283 |
Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care |
1,258 |
524 |
$0.00 |
| J1815 |
Injection, insulin, per 5 units |
128 |
107 |
$0.00 |
| J1940 |
Injection, furosemide, up to 20 mg |
625 |
443 |
$0.00 |
| A9585 |
Injection, gadobutrol, 0.1 ml |
16 |
16 |
$0.00 |
| G2024 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]) from an individual in a snf or by a laboratory on behalf of a hha, any specimen source |
15 |
15 |
$0.00 |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
13 |
13 |
$0.00 |
| J2780 |
Injection, ranitidine hydrochloride, 25 mg |
16 |
15 |
$0.00 |
| 71101 |
|
13 |
13 |
$0.00 |
| J7040 |
Infusion, normal saline solution, sterile (500 ml = 1 unit) |
736 |
583 |
$0.00 |
| T1015 |
Clinic visit/encounter, all-inclusive |
59 |
56 |
$0.00 |
| J1644 |
Injection, heparin sodium, per 1000 units |
1,030 |
422 |
$0.00 |
| J0665 |
Injection, bupivicaine, not otherwise specified, 0.5 mg |
97 |
88 |
$0.00 |
| S0077 |
Injection, clindamycin phosphate, 300 mg |
110 |
95 |
$0.00 |
| S0028 |
Injection, famotidine, 20 mg |
206 |
195 |
$0.00 |
| J2550 |
Injection, promethazine hcl, up to 50 mg |
281 |
232 |
$0.00 |
| G0500 |
Moderate sedation services provided by the same physician or other qualified health care professional performing a gastrointestinal endoscopic service that sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; initial 15 minutes of intra-service time; patient age 5 years or older (additional time may be reported with 99153, as appropriate) |
29 |
27 |
$0.00 |
| S0164 |
Injection, pantoprazole sodium, 40 mg |
123 |
87 |
$0.00 |
| J2710 |
Injection, neostigmine methylsulfate, up to 0.5 mg |
287 |
268 |
$0.00 |
| J1953 |
Injection, levetiracetam, 10 mg |
16 |
12 |
$0.00 |
| G8978 |
Mobility: walking & moving around functional limitation, current status, at therapy episode outset and at reporting intervals |
38 |
36 |
$0.00 |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
128 |
108 |
$0.00 |
| J1171 |
Injection, hydromorphone, 0.1 mg |
21 |
15 |
$0.00 |
| J1650 |
Injection, enoxaparin sodium, 10 mg |
119 |
55 |
$0.00 |
| G8979 |
Mobility: walking & moving around functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting |
51 |
48 |
$0.00 |
| C1713 |
Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable) |
16 |
12 |
$0.00 |
| J7030 |
Infusion, normal saline solution , 1000 cc |
464 |
397 |
$0.00 |
| J0689 |
Injection, cefazolin sodium (baxter), not therapeutically equivalent to j0690, 500 mg |
49 |
45 |
$0.00 |
| 91300 |
|
15 |
15 |
$0.00 |
| S4991 |
Nicotine patches, non-legend |
15 |
13 |
$0.00 |