Medicaid Provider Spending

$1.09 trillion in Medicaid claims data, 2018–2024 · 617K+ providers
Home › AZ › TUCSON › BANNER - UNIVERSITY MEDICAL CENTER SOUTH CAMPUS LLC

BANNER - UNIVERSITY MEDICAL CENTER SOUTH CAMPUS LLC

NPI: 1558759498 · TUCSON, AZ 85713 · General Acute Care Hospital · NPI assigned 12/30/2014

$82.41M
Total Medicaid Paid
1,760,577
Total Claims
1,343,845
Beneficiaries
355
Codes Billed
2018-01
First Month
2024-12
Last Month

Provider Details

Authorized OfficialPOST, DAN (CEO)
Parent OrganizationBANNER HEALTH
NPI Enumeration Date12/30/2014

Related Entities

Other providers sharing the same authorized official: POST, DAN

ProviderCityStateTotal Paid
BANNER - UNIVERSITY MEDICAL CENTER TUCSON CAMPUS LLC TUCSON AZ $194.42M
BANNER - UNIVERSITY MEDICAL CENTER PHOENIX PHOENIX AZ $140.85M

Monthly Spending Trend

Yearly Breakdown

YearClaimsTotal Paid
2018 276,304 $13.08M
2019 259,214 $14.13M
2020 208,481 $11.64M
2021 255,654 $11.85M
2022 273,746 $11.39M
2023 275,122 $11.68M
2024 212,056 $8.65M

Billing Codes

CodeDescriptionClaimsBeneficiariesTotal Paid
99285 Emergency department visit for the evaluation and management, high severity with immediate threat to life 45,840 39,961 $21.06M
99284 Emergency department visit for the evaluation and management, high severity 54,284 49,035 $17.50M
99283 Emergency department visit for the evaluation and management, moderate severity 39,839 36,811 $9.98M
74177 Computed tomography, abdomen and pelvis; with contrast material 11,894 10,891 $8.72M
70450 Computed tomography, head or brain; without contrast material 13,360 11,968 $2.79M
99282 Emergency department visit for the evaluation and management, low to moderate severity 15,246 14,085 $2.16M
47562 444 421 $2.13M
43239 Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple 2,614 2,483 $1.69M
93306 Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete 3,626 3,327 $1.46M
C1713 Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable) 933 828 $1.42M
J1745 Injection, infliximab, excludes biosimilar, 10 mg 531 430 $1.37M
74176 Computed tomography, abdomen and pelvis; without contrast material 3,127 2,875 $1.35M
70553 Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences 1,712 1,541 $1.32M
78452 Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress 491 401 $560K
G0378 Hospital observation service, per hour 16,958 8,028 $558K
45385 Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) 874 821 $534K
66984 Extracapsular cataract removal with insertion of intraocular lens prosthesis 450 332 $411K
45380 Colonoscopy, flexible; with biopsy, single or multiple 676 601 $408K
45378 Colonoscopy, flexible; diagnostic, including collection of specimen(s) 637 595 $383K
Q9966 Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml 1,538 1,211 $380K
J1561 Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mg 150 36 $342K
93975 4,333 4,046 $335K
71260 Computed tomography, thorax, diagnostic; with contrast material 3,632 3,296 $311K
71275 Computed tomographic angiography, chest, with contrast material 1,955 1,817 $310K
74183 1,656 1,522 $303K
C8929 Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiography 1,418 1,222 $272K
72197 428 388 $271K
96365 Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour 22,283 17,112 $181K
76700 Ultrasound, abdominal, real time with image documentation; complete 1,852 1,754 $180K
96366 Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour 8,901 5,086 $174K
G0463 Hospital outpatient clinic visit for assessment and management of a patient 10,957 8,903 $173K
76705 Ultrasound, abdominal, real time with image documentation; limited 3,832 3,570 $168K
80053 Comprehensive metabolic panel 90,653 73,922 $153K
70498 333 318 $124K
97110 Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion 3,043 1,092 $123K
70491 399 371 $122K
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 5,938 5,581 $116K
73130 5,269 4,259 $114K
71250 1,674 1,577 $98K
96360 Intravenous infusion, hydration; initial, 31 minutes to 1 hour 6,078 4,835 $95K
99281 Emergency department visit for the evaluation and management, self-limited or minor 1,377 1,247 $94K
76770 1,396 1,318 $94K
J0129 Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered) 82 50 $91K
77002 300 215 $90K
71046 Radiologic examination, chest; 2 views 12,409 11,064 $89K
J0490 Injection, belimumab, 10 mg 59 36 $88K
72148 Magnetic resonance imaging, lumbar spine; without contrast material 605 548 $83K
72125 Computed tomography, cervical spine; without contrast material 3,874 3,529 $82K
72141 328 293 $76K
73630 6,124 4,989 $69K
76856 Ultrasound, pelvic (nonobstetric), real time with image documentation; complete 2,577 2,432 $60K
76000 255 230 $52K
71045 Radiologic examination, chest; single view 34,654 30,646 $50K
73721 Magnetic resonance imaging, any joint of lower extremity; without contrast material 248 221 $50K
93017 881 770 $49K
93970 923 845 $46K
72100 1,376 1,277 $46K
64721 41 38 $45K
72131 542 516 $45K
95819 217 188 $45K
70486 2,014 1,875 $41K
96361 Intravenous infusion, hydration; each additional hour 14,916 12,105 $39K
93971 2,423 2,203 $39K
73562 5,018 4,263 $39K
J3490 Unclassified drugs 73,213 33,959 $38K
73030 4,320 3,705 $35K
78815 Positron emission tomography (PET) for limited area imaging 34 34 $34K
C1755 Catheter, intraspinal 2,177 1,662 $32K
20553 318 270 $31K
43235 62 60 $28K
93005 Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report 50,666 36,326 $27K
92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder 434 179 $26K
73610 3,729 3,286 $24K
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg 2,350 1,939 $23K
72128 132 128 $23K
C1781 Mesh (implantable) 152 141 $21K
74175 52 52 $21K
76536 246 235 $20K
20610 478 379 $17K
73564 295 252 $16K
73110 2,442 2,101 $15K
70496 265 247 $14K
93308 674 607 $14K
88305 Level IV - Surgical pathology, gross and microscopic examination 7,542 4,956 $14K
76830 Ultrasound, transvaginal 2,351 2,207 $14K
96374 Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance 35,475 31,385 $12K
73080 1,578 1,435 $12K
62323 227 189 $11K
73502 1,727 1,452 $11K
97140 Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) 495 202 $11K
10060 754 688 $10K
72156 13 12 $10K
12001 1,294 1,238 $9K
20552 125 104 $9K
80307 Drug test(s), presumptive, any number of drug classes; immunoassay 13,883 11,812 $8K
73700 87 78 $8K
80320 14,741 13,192 $8K
70551 Magnetic resonance imaging, brain; without contrast material 13 13 $8K
73221 44 41 $7K
70487 25 24 $7K
76857 560 534 $7K
93976 3,503 3,289 $7K
70546 134 120 $6K
96372 Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular 15,134 10,816 $6K
96375 Therapeutic injection; each additional sequential IV push 31,890 25,807 $6K
74178 14 13 $5K
74018 1,272 1,113 $4K
87636 Infectious agent detection by nucleic acid; SARS-CoV-2 and influenza virus types A and B 7,215 6,782 $4K
72040 248 232 $4K
72072 77 69 $4K
91010 12 12 $4K
72146 31 28 $4K
72110 59 51 $3K
80048 Basic metabolic panel (calcium, ionized) 16,734 11,589 $3K
95812 14 12 $3K
73590 2,789 2,385 $3K
97162 311 250 $3K
84484 43,671 25,027 $3K
C1769 Guide wire 500 442 $2K
96413 Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance 2,166 1,742 $2K
85025 Blood count; complete (CBC), automated, and automated differential WBC count 94,132 75,863 $2K
94640 Pressurized or nonpressurized inhalation treatment for acute airway obstruction 5,619 3,207 $2K
83605 21,050 14,640 $2K
J0665 Injection, bupivicaine, not otherwise specified, 0.5 mg 1,869 1,333 $2K
73552 623 551 $2K
96376 10,519 7,206 $2K
87631 2,037 1,973 $2K
82805 7,629 5,807 $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 2,240 1,926 $2K
73140 780 729 $2K
73090 1,982 1,749 $2K
73620 135 107 $2K
87186 6,194 5,255 $1K
76870 784 729 $1K
82947 35,199 20,041 $1K
81025 8,417 7,874 $1K
76801 1,488 1,353 $1K
72170 1,229 1,131 $1K
87635 Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe 2,696 2,597 $1K
97161 432 345 $1K
J0585 Injection, onabotulinumtoxina, 1 unit 20 12 $1K
12002 670 630 $975.93
87661 Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe 2,929 2,770 $868.34
76775 32 29 $857.58
87491 Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe 4,946 4,627 $827.99
J2785 Injection, regadenoson, 0.1 mg 461 347 $822.40
87086 Culture, bacterial; quantitative colony count, urine 14,002 12,508 $784.06
84703 19,621 18,005 $700.11
J1170 Injection, hydromorphone, up to 4 mg 7,097 5,883 $633.48
87591 Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe 5,036 4,711 $630.45
12011 398 379 $628.38
83690 29,613 26,117 $621.06
Q9957 Injection, perflutren lipid microspheres, per ml 3,203 2,817 $602.57
J1885 Injection, ketorolac tromethamine, per 15 mg 17,430 15,354 $594.02
90715 4,465 4,223 $593.96
84443 Thyroid stimulating hormone (TSH) 16,810 14,893 $565.80
Q9967 Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml 18,325 16,654 $560.60
76817 Ultrasound, pregnant uterus, real time with image documentation, transvaginal 922 837 $474.87
81001 29,398 26,053 $447.90
96415 2,038 1,659 $413.00
36430 39 27 $398.41
87651 Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe 551 523 $386.96
84702 6,821 6,223 $366.82
J2405 Injection, ondansetron hydrochloride, per 1 mg 31,294 26,740 $366.51
83735 16,519 12,022 $356.34
G0379 Direct admission of patient for hospital observation care 59 50 $345.46
87088 12,039 10,164 $334.45
83880 7,286 6,269 $323.06
J7999 Compounded drug, not otherwise classified 5,317 3,606 $304.24
J2270 Injection, morphine sulfate, up to 10 mg 14,842 11,823 $285.36
87040 9,526 4,636 $273.29
J8499 Prescription drug, oral, non chemotherapeutic, nos 50,757 21,897 $268.19
J1100 Injection, dexamethasone sodium phosphate, 1 mg 9,007 8,204 $268.06
G0257 Unscheduled or emergency dialysis treatment for an esrd patient in a hospital outpatient department that is not certified as an esrd facility 17 12 $244.77
73120 59 52 $240.30
U0002 2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc 34 33 $222.87
A9502 Technetium tc-99m tetrofosmin, diagnostic, per study dose 491 402 $222.20
73060 800 683 $202.25
96367 2,915 2,621 $201.54
73070 48 41 $192.80
J2704 Injection, propofol, 10 mg 15,380 13,038 $190.76
82550 4,142 3,464 $185.84
97014 602 253 $184.40
J2060 Injection, lorazepam, 2 mg 3,163 2,673 $180.09
87502 Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets 660 326 $176.72
85610 12,823 10,731 $163.93
87077 7,563 5,943 $158.03
J0696 Injection, ceftriaxone sodium, per 250 mg 9,196 7,609 $153.23
J7120 Ringers lactate infusion, up to 1000 cc 12,180 10,554 $150.51
J3475 Injection, magnesium sulfate, per 500 mg 5,984 5,267 $149.88
76882 14 12 $135.02
81003 12,986 11,870 $124.95
80329 1,939 1,642 $121.81
85027 9,759 7,009 $119.37
84439 2,882 2,550 $118.41
J3370 Injection, vancomycin hcl, 500 mg 2,820 2,077 $112.52
86703 2,232 2,133 $106.84
97530 Therapeutic activities, direct patient contact, each 15 minutes 710 443 $101.34
87804 Infectious agent antigen detection by immunoassay; Influenza, each type 1,936 949 $97.39
87210 3,577 3,357 $95.14
J7030 Infusion, normal saline solution , 1000 cc 12,816 10,955 $95.07
85379 2,782 2,546 $89.71
84100 10,059 7,236 $83.08
27096 23 14 $81.19
80061 Lipid panel 1,912 1,634 $74.40
87081 33 30 $72.37
A9577 Injection, gadobenate dimeglumine (multihance), per ml 4,293 3,869 $71.52
90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine 4,982 4,567 $71.33
85730 3,978 3,485 $69.85
83036 Hemoglobin; glycosylated (A1C) 2,788 2,442 $68.84
76377 1,082 992 $64.39
86850 3,985 3,621 $53.35
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 3,374 3,180 $52.95
87880 Infectious agent antigen detection by immunoassay; Streptococcus, group A 1,791 1,694 $46.52
82140 1,727 1,526 $44.49
87389 Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies 286 278 $42.79
86140 5,364 4,789 $42.02
J0690 Injection, cefazolin sodium, 500 mg 6,020 5,114 $41.40
J2543 Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams) 1,393 934 $39.77
84145 1,108 1,007 $39.63
87205 1,604 1,361 $39.23
86780 299 279 $37.62
A9270 Non-covered item or service 78,994 14,438 $36.35
J8540 Dexamethasone, oral, 0.25 mg 2,239 1,709 $36.00
80164 54 50 $34.30
J1644 Injection, heparin sodium, per 1000 units 3,939 1,581 $31.66
J1790 Injection, droperidol, up to 5 mg 826 733 $31.03
J2930 Injection, methylprednisolone sodium succinate, up to 125 mg 1,887 1,525 $30.61
86592 1,014 967 $28.94
82330 1,255 1,037 $27.42
82010 1,551 1,376 $26.49
J3010 Injection, fentanyl citrate, 0.1 mg 12,701 10,808 $25.54
J2250 Injection, midazolam hydrochloride, per 1 mg 11,675 10,292 $24.66
J1650 Injection, enoxaparin sodium, 10 mg 4,238 2,056 $23.86
85055 1,328 931 $22.87
86901 4,458 4,055 $18.75
97535 Self-care/home management training, each 15 minutes 273 217 $18.14
J7512 Prednisone, immediate release or delayed release, oral, 1 mg 2,642 1,785 $18.02
96368 815 764 $17.96
84132 1,623 1,371 $17.20
J1815 Injection, insulin, per 5 units 6,635 3,246 $17.05
86900 4,445 4,046 $16.48
87070 1,106 920 $16.13
73560 15 12 $15.96
J0171 Injection, adrenalin, epinephrine, 0.1 mg 1,594 1,492 $14.19
J1940 Injection, furosemide, up to 20 mg 825 552 $13.96
J0780 Injection, prochlorperazine, up to 10 mg 1,823 1,684 $13.07
J0330 Injection, succinylcholine chloride, up to 20 mg 1,250 1,104 $12.61
80076 75 70 $12.23
J1200 Injection, diphenhydramine hcl, up to 50 mg 6,762 5,649 $12.10
J1630 Injection, haloperidol, up to 5 mg 2,328 1,953 $9.70
J2765 Injection, metoclopramide hcl, up to 10 mg 3,879 3,469 $8.95
J7040 Infusion, normal saline solution, sterile (500 ml = 1 unit) 1,915 1,529 $7.19
J0456 Injection, azithromycin, 500 mg 262 219 $7.09
J8597 Antiemetic drug, oral, not otherwise specified 5,269 4,483 $5.85
84295 1,129 970 $4.79
82270 561 506 $3.98
85652 2,240 1,956 $1.93
88304 1,667 1,515 $0.00
J7050 Infusion, normal saline solution, 250 cc 1,509 1,121 $0.00
90686 60 54 $0.00
J2795 Injection, ropivacaine hydrochloride, 1 mg 747 668 $0.00
80349 12 12 $0.00
88342 472 425 $0.00
J3411 Injection, thiamine hcl, 100 mg 296 244 $0.00
86769 139 131 $0.00
88307 145 134 $0.00
J3480 Injection, potassium chloride, per 2 meq 1,056 828 $0.00
99153 Mod sedat endo service >5yrs 30 25 $0.00
73600 22 13 $0.00
J2370 Injection, phenylephrine hcl, up to 1 ml 1,251 1,041 $0.00
J1836 Injection, metronidazole, 10 mg 83 56 $0.00
36416 188 177 $0.00
J2001 Injection, lidocaine hcl for intravenous infusion, 10 mg 2,081 1,913 $0.00
C1889 Implantable/insertable device, not otherwise classified 15 12 $0.00
97166 83 76 $0.00
87206 16 12 $0.00
86635 240 114 $0.00
G0008 Administration of influenza virus vaccine 148 134 $0.00
87430 183 176 $0.00
J2371 Injection, phenylephrine hydrochloride, 20 micrograms 286 274 $0.00
94760 638 412 $0.00
J1642 Injection, heparin sodium, (heparin lock flush), per 10 units 57 13 $0.00
70548 55 53 $0.00
86803 130 123 $0.00
85018 135 107 $0.00
87147 337 294 $0.00
71101 59 57 $0.00
A9573 Injection, gadopiclenol, 1 ml 15 13 $0.00
C9399 Unclassified drugs or biologicals 108 103 $0.00
J0610 Injection, calcium gluconate (fresenius kabi), per 10 ml 45 39 $0.00
87340 142 136 $0.00
80177 12 12 $0.00
J3535 Drug administered through a metered dose inhaler 17 15 $0.00
G8980 Mobility: walking & moving around functional limitation, discharge status, at discharge from therapy or to end reporting 46 38 $0.00
J0571 Buprenorphine, oral, 1 mg 50 37 $0.00
G8987 Self care functional limitation, current status, at therapy episode outset and at reporting intervals 13 12 $0.00
64494 39 26 $0.00
90632 54 51 $0.00
82728 42 36 $0.00
82607 12 12 $0.00
J2470 Injection, pantoprazole sodium, 40 mg 43 31 $0.00
J2003 Injection, lidocaine hydrochloride, 1 mg 329 283 $0.00
J0360 Injection, hydralazine hcl, up to 20 mg 19 14 $0.00
84478 22 12 $0.00
94762 18 15 $0.00
64493 42 26 $0.00
G8988 Self care functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting 13 12 $0.00
J2175 Injection, meperidine hydrochloride, per 100 mg 96 87 $0.00
87506 20 15 $0.00
36415 Collection of venous blood by venipuncture 35 23 $0.00
83615 12 12 $0.00
87075 382 316 $0.00
J1953 Injection, levetiracetam, 10 mg 358 254 $0.00
J2710 Injection, neostigmine methylsulfate, up to 0.5 mg 1,246 1,090 $0.00
J1596 Injection, glycopyrrolate, 0.1 mg 147 140 $0.00
85007 616 558 $0.00
G8978 Mobility: walking & moving around functional limitation, current status, at therapy episode outset and at reporting intervals 167 120 $0.00
J0692 Injection, cefepime hydrochloride, 500 mg 1,037 750 $0.00
84466 71 60 $0.00
J2550 Injection, promethazine hcl, up to 50 mg 694 568 $0.00
95957 531 471 $0.00
93325 14 12 $0.00
J1171 Injection, hydromorphone, 0.1 mg 124 109 $0.00
C9113 Injection, pantoprazole sodium, per vial 950 678 $0.00
97163 140 122 $0.00
Q9956 Injection, octafluoropropane microspheres, per ml 36 33 $0.00
A9552 Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries 53 53 $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 207 145 $0.00
S0028 Injection, famotidine, 20 mg 1,171 1,040 $0.00
73100 30 27 $0.00
84460 73 68 $0.00
C1894 Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser 93 73 $0.00
97150 Therapeutic procedure(s), group (2 or more individuals) 20 12 $0.00
51702 62 54 $0.00
J2310 Injection, naloxone hydrochloride, per 1 mg 29 26 $0.00
J0694 Injection, cefoxitin sodium, 1 gm 185 113 $0.00
J3371 Injection, vancomycin hcl (mylan), not therapeutically equivalent to j3370, 500 mg 44 25 $0.00
31500 37 30 $0.00
99152 30 25 $0.00
P9016 Red blood cells, leukocytes reduced, each unit 54 40 $0.00
29125 16 14 $0.00
87149 55 26 $0.00
83540 86 72 $0.00
93041 42 40 $0.00
86923 26 12 $0.00
J2919 Injection, methylprednisolone sodium succinate, 5 mg 185 161 $0.00
J2004 Injection, lidocaine hcl with epinephrine, 1 mg 19 19 $0.00
85014 15 12 $0.00
80074 14 13 $0.00
76805 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation 13 12 $0.00
88302 16 14 $0.00
J0744 Injection, ciprofloxacin for intravenous infusion, 200 mg 22 14 $0.00
J0295 Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm 40 24 $0.00
97012 36 13 $0.00