Medicaid Provider Spending

$1.09 trillion in Medicaid claims data, 2018–2024 · 617K+ providers
Home › LA › BATON ROUGE › OUR LADY OF THE LAKE HOSPITAL INC.

OUR LADY OF THE LAKE HOSPITAL INC.

NPI: 1366436123 · BATON ROUGE, LA 70808 · General Acute Care Hospital · NPI assigned 09/08/2005

$205.69M
Total Medicaid Paid
3,827,381
Total Claims
3,155,878
Beneficiaries
405
Codes Billed
2018-01
First Month
2024-12
Last Month

Provider Details

Authorized OfficialSPICER, CHUCK (CHIEF EXECUTIVE OFFICER)
Parent OrganizationFRANCISCAN MISSIONARIES OF OUR LADY HEALTH SYSTEM
NPI Enumeration Date09/08/2005

Related Entities

Other providers sharing the same authorized official: SPICER, CHUCK

ProviderCityStateTotal Paid
OUR LADY OF THE ANGELS HOSPITAL, INC. BOGALUSA LA $16.10M
OUR LADY OF THE ANGELS HOSPITAL, INC. BOGALUSA LA $8.94M
OUR LADY OF THE ANGELS CLINIC BOGALUSA LA $10K

Monthly Spending Trend

Yearly Breakdown

YearClaimsTotal Paid
2018 434,770 $18.76M
2019 516,048 $21.53M
2020 419,766 $19.05M
2021 593,142 $34.50M
2022 668,483 $38.25M
2023 690,045 $40.16M
2024 505,127 $33.44M

Billing Codes

CodeDescriptionClaimsBeneficiariesTotal Paid
99283 Emergency department visit for the evaluation and management, moderate severity 258,303 236,181 $45.94M
99284 Emergency department visit for the evaluation and management, high severity 142,749 128,408 $37.39M
99285 Emergency department visit for the evaluation and management, high severity with immediate threat to life 69,946 60,817 $19.61M
74177 Computed tomography, abdomen and pelvis; with contrast material 6,219 5,519 $7.63M
99282 Emergency department visit for the evaluation and management, low to moderate severity 56,571 52,794 $7.44M
G0378 Hospital observation service, per hour 17,401 12,169 $7.34M
70450 Computed tomography, head or brain; without contrast material 17,856 15,764 $6.01M
99213 Office or other outpatient visit for the evaluation and management of an established patient, low complexity 195,348 173,041 $5.77M
99212 Office or other outpatient visit for the evaluation and management of an established patient, straightforward 193,081 170,851 $4.97M
93005 Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report 106,491 86,791 $4.85M
96375 Therapeutic injection; each additional sequential IV push 71,115 52,657 $3.46M
99214 Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity 77,011 68,438 $3.45M
96374 Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance 106,529 86,156 $3.23M
71045 Radiologic examination, chest; single view 68,410 60,630 $2.82M
87428 108,132 91,516 $2.81M
96372 Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular 73,899 56,703 $2.64M
99211 Office or other outpatient visit for the evaluation and management of an established patient, minimal severity 102,609 88,387 $2.53M
41899 Unlisted procedure, dentoalveolar structures 4,397 3,814 $2.42M
71046 Radiologic examination, chest; 2 views 29,056 25,962 $2.12M
96413 Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance 12,714 6,933 $1.89M
80053 Comprehensive metabolic panel 259,444 221,042 $1.87M
74176 Computed tomography, abdomen and pelvis; without contrast material 1,486 1,365 $1.67M
80307 Drug test(s), presumptive, any number of drug classes; immunoassay 34,473 28,862 $1.42M
43239 Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple 4,757 4,140 $1.41M
85025 Blood count; complete (CBC), automated, and automated differential WBC count 251,185 208,721 $1.27M
87426 Infectious agent antigen detection, SARS-CoV-2 (COVID-19) 34,352 29,726 $1.26M
96361 Intravenous infusion, hydration; each additional hour 24,517 17,481 $1.15M
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 13,597 12,514 $945K
20610 1,969 1,677 $779K
87804 Infectious agent antigen detection by immunoassay; Influenza, each type 57,138 28,102 $751K
0202U Oncology (prostate), multianalyte, gene expression profiling 2,188 1,944 $749K
87880 Infectious agent antigen detection by immunoassay; Streptococcus, group A 51,830 46,415 $693K
36415 Collection of venous blood by venipuncture 304,719 242,487 $563K
84484 83,216 59,692 $536K
11042 Debridement, subcutaneous tissue (includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm 2,378 1,255 $524K
99215 Prolong outpt/office vis 8,621 7,115 $425K
92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder 14,208 4,967 $416K
87491 Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe 11,647 10,444 $361K
94010 4,021 3,737 $358K
87591 Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe 11,774 10,443 $354K
31575 1,232 1,070 $350K
73564 2,689 1,809 $321K
74178 168 162 $297K
73630 3,094 2,343 $295K
71260 Computed tomography, thorax, diagnostic; with contrast material 657 613 $295K
81025 42,254 35,845 $266K
87661 Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe 8,678 7,617 $253K
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 10,522 9,884 $239K
74018 2,305 2,110 $234K
81001 126,081 106,017 $232K
90686 11,036 9,824 $228K
76770 1,155 1,077 $227K
92557 2,600 2,302 $212K
31231 813 712 $212K
73610 2,067 1,775 $205K
83880 10,271 9,193 $203K
G0330 Facility services for dental rehabilitation procedure(s) performed on a patient who requires monitored anesthesia (e.g., general, intravenous sedation (monitored anesthesia care) and use of an operating room 186 146 $200K
97530 Therapeutic activities, direct patient contact, each 15 minutes 9,031 3,296 $199K
87536 3,548 3,147 $193K
45378 Colonoscopy, flexible; diagnostic, including collection of specimen(s) 851 633 $190K
80050 General health panel 5,266 4,815 $184K
95004 Percutaneous tests with allergenic extracts, immediate type reaction 447 404 $184K
72125 Computed tomography, cervical spine; without contrast material 591 522 $183K
93306 Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete 308 290 $182K
72082 702 645 $182K
73130 1,961 1,585 $179K
45385 Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) 878 730 $176K
83690 35,741 31,555 $173K
77067 Screening mammography, bilateral, including computer-aided detection 2,017 1,875 $158K
96376 3,504 1,999 $151K
J0561 Injection, penicillin g benzathine, 100,000 units 898 747 $151K
J1885 Injection, ketorolac tromethamine, per 15 mg 41,455 33,154 $150K
96365 Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour 1,901 1,432 $149K
80061 Lipid panel 13,765 12,377 $148K
73502 1,987 1,382 $148K
83036 Hemoglobin; glycosylated (A1C) 18,118 16,026 $143K
97110 Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion 3,928 1,005 $130K
82077 14,623 11,881 $123K
73110 1,392 1,115 $122K
76775 685 632 $121K
70551 Magnetic resonance imaging, brain; without contrast material 174 153 $114K
20605 222 198 $113K
94640 Pressurized or nonpressurized inhalation treatment for acute airway obstruction 3,051 1,646 $108K
87807 9,472 8,388 $103K
73100 2,186 1,742 $102K
92551 4,493 3,918 $101K
J2405 Injection, ondansetron hydrochloride, per 1 mg 52,620 40,583 $96K
76700 Ultrasound, abdominal, real time with image documentation; complete 352 332 $95K
J2469 Injection, palonosetron hcl, 25 mcg 979 552 $89K
C1776 Joint device (implantable) 51 25 $88K
74019 834 769 $85K
70553 Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences 59 58 $84K
87070 10,332 9,476 $83K
92134 2,759 2,295 $81K
87389 Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies 4,037 3,450 $77K
0002A 2,227 2,007 $74K
J2270 Injection, morphine sulfate, up to 10 mg 17,846 13,767 $74K
84703 12,721 11,225 $73K
80048 Basic metabolic panel (calcium, ionized) 16,172 12,415 $71K
73140 929 764 $71K
45380 Colonoscopy, flexible; with biopsy, single or multiple 562 431 $69K
11719 1,351 1,186 $68K
31579 232 212 $68K
76856 Ultrasound, pelvic (nonobstetric), real time with image documentation; complete 295 275 $67K
82306 Vitamin D; 25 hydroxy, includes fraction(s), if performed 2,796 2,396 $66K
95117 4,982 2,670 $64K
0001A 2,341 2,007 $63K
73030 635 534 $63K
90677 483 365 $60K
J1100 Injection, dexamethasone sodium phosphate, 1 mg 24,240 15,854 $60K
76705 Ultrasound, abdominal, real time with image documentation; limited 351 317 $60K
97597 1,135 631 $59K
90670 337 308 $58K
C1713 Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable) 499 374 $57K
88184 2,422 2,134 $57K
88185 3,051 2,132 $56K
73080 632 502 $56K
96417 706 394 $54K
95806 280 260 $54K
97602 993 676 $54K
96360 Intravenous infusion, hydration; initial, 31 minutes to 1 hour 856 621 $51K
73721 Magnetic resonance imaging, any joint of lower extremity; without contrast material 56 53 $50K
87633 Infectious agent detection by nucleic acid, respiratory virus, 12-25 targets 216 156 $49K
96367 1,158 655 $48K
86003 532 383 $48K
71250 259 248 $46K
94729 676 610 $45K
73090 457 345 $45K
92567 2,072 1,848 $45K
72100 342 321 $45K
82550 11,302 9,341 $45K
82962 30,250 14,289 $44K
87635 Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe 1,390 1,257 $43K
69436 Tympanostomy (requiring insertion of ventilating tube), general anesthesia 185 156 $42K
84439 5,316 4,705 $42K
92250 451 433 $42K
73560 441 221 $42K
92587 259 243 $40K
99281 Emergency department visit for the evaluation and management, self-limited or minor 375 354 $40K
50590 92 86 $40K
92523 306 281 $39K
70486 61 57 $39K
94060 440 397 $39K
94726 532 482 $38K
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg 5,228 3,101 $37K
84443 Thyroid stimulating hormone (TSH) 2,457 2,262 $37K
83735 8,570 7,291 $33K
87086 Culture, bacterial; quantitative colony count, urine 5,156 4,612 $32K
29580 566 224 $32K
96366 Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour 268 118 $32K
17110 277 237 $32K
95115 2,575 1,499 $31K
81002 11,086 9,843 $31K
99173 4,780 3,668 $30K
87905 2,891 2,536 $29K
73562 315 231 $29K
G0108 Diabetes outpatient self-management training services, individual, per 30 minutes 1,571 1,383 $28K
99291 Critical care, evaluation and management of the critically ill patient, first 30-74 minutes 33 31 $28K
95012 583 532 $27K
85027 8,836 6,765 $27K
77073 170 121 $26K
73620 314 246 $26K
51798 528 473 $26K
J1756 Injection, iron sucrose, 1 mg 216 100 $25K
73590 292 208 $24K
96110 Developmental screening, with scoring and documentation, per standardized instrument 1,509 1,088 $24K
99202 Office or other outpatient visit for the evaluation and management of a new patient, straightforward 1,108 912 $24K
64483 67 29 $22K
73120 439 321 $22K
11900 219 196 $22K
76830 Ultrasound, transvaginal 141 136 $22K
92133 552 466 $22K
J1642 Injection, heparin sodium, (heparin lock flush), per 10 units 9,789 4,024 $21K
95165 Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy, multiple dose vials 70 66 $21K
92504 875 731 $20K
77072 188 152 $19K
72052 121 116 $19K
86780 1,933 1,400 $19K
82043 4,011 3,411 $19K
P9016 Red blood cells, leukocytes reduced, each unit 67 52 $19K
99201 855 693 $18K
92083 337 289 $18K
73522 132 123 $17K
96415 290 188 $17K
83655 1,215 1,181 $16K
85610 5,959 3,622 $16K
86803 1,276 1,097 $16K
71271 161 145 $15K
J3010 Injection, fentanyl citrate, 0.1 mg 17,894 12,371 $15K
90750 119 99 $15K
82570 4,550 3,495 $15K
0003A 448 372 $15K
72070 123 115 $14K
J1170 Injection, hydromorphone, up to 4 mg 1,698 919 $14K
78452 Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress 14 14 $13K
90732 123 115 $13K
80074 302 262 $12K
52000 59 41 $12K
90832 Psychotherapy, 30 minutes with patient 242 166 $12K
83605 1,956 1,384 $12K
90656 1,538 1,303 $12K
92588 166 149 $11K
86704 1,105 947 $11K
M0243 Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring 43 30 $11K
78815 Positron emission tomography (PET) for limited area imaging 19 12 $11K
70355 125 107 $10K
72114 70 67 $10K
86706 1,106 948 $10K
80076 1,845 1,645 $10K
83021 560 487 $10K
86592 2,752 2,451 $10K
25600 72 64 $10K
72050 61 56 $10K
85018 3,816 3,667 $10K
86481 174 164 $10K
87340 1,066 913 $9K
86140 2,866 2,561 $9K
43235 58 49 $9K
85045 2,903 2,595 $9K
55700 25 25 $9K
92579 123 111 $9K
J2704 Injection, propofol, 10 mg 14,331 7,549 $9K
84153 508 471 $9K
36430 55 37 $9K
90734 79 75 $8K
67028 Intravitreal injection of a pharmacologic agent 53 40 $8K
86708 784 659 $8K
86920 118 95 $8K
94760 443 382 $7K
81003 5,223 4,525 $7K
J1453 Injection, fosaprepitant, 1 mg 55 25 $7K
86709 764 644 $7K
95810 Polysomnography; sleep staging with 4 or more additional parameters 12 12 $7K
J0696 Injection, ceftriaxone sodium, per 250 mg 1,990 1,645 $7K
76000 731 590 $7K
72170 70 63 $6K
99203 Office or other outpatient visit for the evaluation and management of a new patient, low complexity 216 208 $6K
74240 26 24 $6K
47562 12 12 $6K
93017 32 30 $6K
95819 25 25 $6K
J2250 Injection, midazolam hydrochloride, per 1 mg 9,122 6,642 $6K
C9290 Injection, bupivacaine liposome, 1 mg 18 13 $6K
52356 18 12 $5K
90715 208 165 $5K
82378 318 297 $5K
82728 632 554 $5K
87798 Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism 190 131 $5K
G0498 Chemotherapy administration, intravenous infusion technique; initiation of infusion in the office/clinic setting using office/clinic pump/supplies, with continuation of the infusion in the community setting (e.g., home, domiciliary, rest home or assisted living) using a portable pump provided by the office/clinic, includes follow up office/clinic visit at the conclusion of the infusion 32 12 $5K
96409 48 25 $5K
0004A 150 112 $5K
96411 77 37 $5K
90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine 19,128 14,511 $5K
86850 902 714 $4K
C1769 Guide wire 1,028 705 $4K
86300 250 226 $4K
70360 42 38 $4K
J1200 Injection, diphenhydramine hcl, up to 50 mg 1,769 1,355 $4K
87486 196 155 $4K
87581 196 155 $4K
99406 664 545 $4K
85730 1,255 1,045 $4K
64721 18 15 $4K
93970 12 12 $4K
76870 13 12 $4K
87641 122 115 $4K
87040 454 354 $3K
J0690 Injection, cefazolin sodium, 500 mg 6,129 3,706 $3K
31237 20 13 $3K
97166 54 46 $3K
92550 85 75 $3K
C9803 Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source 46,623 37,780 $3K
73000 46 36 $3K
87640 124 115 $3K
0071A 75 68 $3K
92012 Ophthalmological services: medical examination and evaluation, intermediate, established patient 148 119 $3K
C1894 Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser 1,599 1,092 $2K
92014 Ophthalmological services: medical examination and evaluation, comprehensive, established patient 67 56 $2K
93971 13 12 $2K
29581 43 12 $2K
0072A 67 60 $2K
85652 1,354 1,233 $2K
C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability) 444 288 $2K
90746 32 25 $2K
J1650 Injection, enoxaparin sodium, 10 mg 172 75 $2K
86901 890 700 $2K
86900 889 700 $2K
31624 13 13 $2K
J0665 Injection, bupivicaine, not otherwise specified, 0.5 mg 598 427 $2K
L3702 Elbow orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment 15 14 $2K
90756 97 82 $2K
97803 87 80 $2K
82553 252 208 $2K
97162 30 24 $2K
83718 185 179 $2K
83615 302 277 $2K
26720 12 12 $1K
92610 88 72 $1K
0124A 83 44 $1K
92552 31 29 $1K
90472 Immunization administration, each additional vaccine (list separately) 3,322 2,426 $1K
80069 350 195 $1K
69210 13 13 $1K
83516 105 97 $1K
0054A 35 34 $1K
86701 112 97 $1K
95816 14 14 $1K
93922 14 13 $1K
J0500 Injection, dicyclomine hcl, up to 20 mg 13 12 $1K
C9399 Unclassified drugs or biologicals 307 240 $1K
82784 105 101 $1K
96160 36 32 $912.78
J2360 Injection, orphenadrine citrate, up to 60 mg 27 26 $886.08
87522 Neg quan hep c or qual rna 26 24 $796.34
73070 16 12 $789.60
90651 75 63 $758.27
J2001 Injection, lidocaine hcl for intravenous infusion, 10 mg 1,896 1,365 $750.06
86160 117 65 $738.11
82465 186 180 $737.90
J2003 Injection, lidocaine hydrochloride, 1 mg 836 636 $695.42
J7512 Prednisone, immediate release or delayed release, oral, 1 mg 429 348 $658.61
J7613 Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg 407 305 $628.04
U0002 2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc 24 24 $615.96
93289 12 12 $607.92
J9060 Injection, cisplatin, powder or solution, 10 mg 25 13 $595.65
80177 42 41 $586.99
J9045 Injection, carboplatin, 50 mg 14 12 $584.46
82150 120 104 $572.32
92556 23 17 $556.48
J7620 Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme 243 212 $509.25
J1644 Injection, heparin sodium, per 1000 units 4,849 2,675 $486.35
J0330 Injection, succinylcholine chloride, up to 20 mg 1,184 1,003 $486.31
85660 142 52 $484.88
85007 222 205 $480.38
J3370 Injection, vancomycin hcl, 500 mg 209 130 $454.30
87210 119 113 $452.38
90621 129 107 $397.29
J0780 Injection, prochlorperazine, up to 10 mg 32 28 $381.86
82607 28 26 $367.88
84702 27 26 $346.15
J7644 Ipratropium bromide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram 171 149 $342.80
J3490 Unclassified drugs 376 295 $313.86
84466 40 29 $309.10
J2272 Injection, morphine sulfate (fresenius kabi), not therapeutically equivalent to j2270, up to 10 mg 114 50 $293.67
90662 104 93 $285.11
J1790 Injection, droperidol, up to 5 mg 52 44 $265.77
86225 43 39 $251.22
J2060 Injection, lorazepam, 2 mg 55 51 $251.11
82652 15 15 $249.48
88175 Cytopathology, cervical or vaginal, any reporting system; collected in preservative fluid, automated thin layer 18 12 $248.00
90619 116 90 $246.90
94618 12 12 $238.92
91300 6,370 4,522 $197.97
82375 29 25 $193.02
85379 33 26 $172.60
86777 16 15 $165.60
82105 12 12 $150.21
J7510 Prednisolone oral, per 5 mg 73 67 $148.59
90480 15 15 $147.90
80143 21 12 $140.22
S0077 Injection, clindamycin phosphate, 300 mg 56 12 $127.67
83050 29 25 $123.00
J2550 Injection, promethazine hcl, up to 50 mg 214 172 $121.52
84156 34 30 $111.56
82977 12 12 $105.54
J2710 Injection, neostigmine methylsulfate, up to 0.5 mg 544 416 $99.67
J1596 Injection, glycopyrrolate, 0.1 mg 19 12 $97.32
82247 25 12 $84.42
82248 25 12 $84.42
92015 Determination of refractive state 16 12 $81.78
83540 25 17 $76.08
J2765 Injection, metoclopramide hcl, up to 10 mg 34 29 $67.92
97802 12 12 $61.80
87205 32 24 $52.58
86593 17 12 $50.29
85014 17 13 $34.45
J0670 Injection, mepivacaine hydrochloride, per 10 ml 55 39 $24.87
83550 29 15 $8.74
G0463 Hospital outpatient clinic visit for assessment and management of a patient 6,120 3,930 $8.49
90474 35 24 $6.28
91305 118 113 $0.28
91312 94 46 $0.28
G1004 Clinical decision support mechanism national decision support company, as defined by the medicare appropriate use criteria program 1,741 1,366 $0.05
90697 295 228 $0.00
C1768 Graft, vascular 21 13 $0.00
84132 613 336 $0.00
31653 12 12 $0.00
A9270 Non-covered item or service 777 675 $0.00
91307 155 114 $0.00
C2617 Stent, non-coronary, temporary, without delivery system 57 51 $0.00
C1726 Catheter, balloon dilatation, non-vascular 70 68 $0.00
90680 67 44 $0.00
02024 12 12 $0.00
36832 21 12 $0.00
87077 17 12 $0.00
90671 97 70 $0.00
A6402 Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing 264 225 $0.00
76942 25 25 $0.00
J1580 Injection, garamycin, gentamicin, up to 80 mg 24 24 $0.00
90633 71 67 $0.00
31627 27 26 $0.00
U0001 Cdc 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel 38 38 $0.00
90710 21 12 $0.00
Q0244 Injection, casirivimab and imdevimab, 1200 mg 47 32 $0.00
J2720 Injection, protamine sulfate, per 10 mg 49 24 $0.00