NPI: 1568414589 · CLARE, MI 48617 · General Acute Care Hospital · NPI assigned 05/17/2006
Authorized official JAMES, SARAH controls 20+ related entities in our dataset. Read more
| Authorized Official | JAMES, SARAH (MANAGER, PROVIDER ENROLLMENT) |
| NPI Enumeration Date | 05/17/2006 |
Other providers sharing the same authorized official: JAMES, SARAH
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 89,445 | $1.84M |
| 2019 | 88,675 | $1.72M |
| 2020 | 78,896 | $1.53M |
| 2021 | 94,410 | $2.13M |
| 2022 | 95,307 | $2.28M |
| 2023 | 185,227 | $4.22M |
| 2024 | 182,382 | $3.94M |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| 99284 | Emergency department visit for the evaluation and management, high severity | 16,424 | 15,484 | $2.91M |
| 99283 | Emergency department visit for the evaluation and management, moderate severity | 19,919 | 18,981 | $2.35M |
| 99285 | Emergency department visit for the evaluation and management, high severity with immediate threat to life | 7,487 | 6,978 | $2.10M |
| 96374 | Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance | 8,594 | 7,882 | $874K |
| 97110 | Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion | 27,643 | 8,559 | $655K |
| 96365 | Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour | 6,699 | 4,855 | $617K |
| 99282 | Emergency department visit for the evaluation and management, low to moderate severity | 7,516 | 7,288 | $594K |
| 74177 | Computed tomography, abdomen and pelvis; with contrast material | 4,455 | 4,313 | $583K |
| 70450 | Computed tomography, head or brain; without contrast material | 4,399 | 4,248 | $432K |
| 87635 | Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe | 12,693 | 12,317 | $344K |
| G0463 | Hospital outpatient clinic visit for assessment and management of a patient | 5,340 | 3,662 | $325K |
| 96375 | Therapeutic injection; each additional sequential IV push | 8,423 | 7,459 | $300K |
| 96361 | Intravenous infusion, hydration; each additional hour | 8,909 | 7,099 | $274K |
| 11042 | Debridement, subcutaneous tissue (includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm | 1,411 | 691 | $261K |
| 71046 | Radiologic examination, chest; 2 views | 7,225 | 6,995 | $260K |
| 96360 | Intravenous infusion, hydration; initial, 31 minutes to 1 hour | 3,139 | 2,040 | $250K |
| 93306 | Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete | 1,039 | 1,034 | $226K |
| 80061 | Lipid panel | 18,580 | 18,452 | $211K |
| 74176 | Computed tomography, abdomen and pelvis; without contrast material | 2,183 | 2,101 | $204K |
| 97140 | Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) | 12,635 | 4,683 | $189K |
| 80053 | Comprehensive metabolic panel | 54,369 | 49,276 | $175K |
| 36415 | Collection of venous blood by venipuncture | 75,494 | 66,393 | $170K |
| 84443 | Thyroid stimulating hormone (TSH) | 20,464 | 20,064 | $162K |
| 77067 | Screening mammography, bilateral, including computer-aided detection | 2,901 | 2,896 | $146K |
| 71045 | Radiologic examination, chest; single view | 3,854 | 3,676 | $136K |
| 97112 | Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination | 6,451 | 2,665 | $136K |
| 85025 | Blood count; complete (CBC), automated, and automated differential WBC count | 55,815 | 49,075 | $127K |
| 82306 | Vitamin D; 25 hydroxy, includes fraction(s), if performed | 7,810 | 7,767 | $117K |
| 97530 | Therapeutic activities, direct patient contact, each 15 minutes | 4,004 | 1,672 | $114K |
| 97162 | 2,053 | 2,034 | $101K | |
| 97161 | 1,843 | 1,831 | $92K | |
| 76830 | Ultrasound, transvaginal | 1,663 | 1,649 | $91K |
| 96366 | Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour | 2,474 | 1,591 | $83K |
| 92507 | Treatment of speech, language, voice, communication, and/or auditory processing disorder | 1,868 | 632 | $81K |
| 71275 | Computed tomographic angiography, chest, with contrast material | 926 | 893 | $75K |
| 76705 | Ultrasound, abdominal, real time with image documentation; limited | 1,296 | 1,274 | $69K |
| 83036 | Hemoglobin; glycosylated (A1C) | 13,312 | 13,238 | $66K |
| 86900 | 2,168 | 1,981 | $65K | |
| 76856 | Ultrasound, pelvic (nonobstetric), real time with image documentation; complete | 1,310 | 1,306 | $64K |
| 99281 | Emergency department visit for the evaluation and management, self-limited or minor | 1,110 | 1,098 | $61K |
| 87491 | Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe | 3,244 | 3,184 | $57K |
| 87591 | Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe | 3,183 | 3,127 | $54K |
| 80307 | Drug test(s), presumptive, any number of drug classes; immunoassay | 3,887 | 3,688 | $49K |
| 71260 | Computed tomography, thorax, diagnostic; with contrast material | 595 | 585 | $45K |
| 95810 | Polysomnography; sleep staging with 4 or more additional parameters | 80 | 80 | $44K |
| 82607 | 5,289 | 5,244 | $38K | |
| 94060 | 276 | 276 | $36K | |
| G0433 | Infectious agent antibody detection by enzyme-linked immunosorbent assay (elisa) technique, hiv-1 and/or hiv-2, screening | 3,344 | 3,333 | $34K |
| 82728 | 4,735 | 4,660 | $33K | |
| 97597 | 363 | 186 | $31K | |
| 84439 | 6,467 | 6,351 | $30K | |
| 99291 | Critical care, evaluation and management of the critically ill patient, first 30-74 minutes | 67 | 63 | $28K |
| 93005 | Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report | 11,306 | 10,416 | $28K |
| 77063 | Screening digital breast tomosynthesis, bilateral | 2,056 | 2,056 | $27K |
| 73564 | 1,504 | 1,442 | $26K | |
| 71271 | 436 | 436 | $26K | |
| 93971 | 488 | 480 | $26K | |
| 86803 | 3,935 | 3,925 | $26K | |
| G0145 | Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system and manual rescreening under physician supervision | 1,583 | 1,571 | $25K |
| G0378 | Hospital observation service, per hour | 683 | 412 | $25K |
| 80048 | Basic metabolic panel (calcium, ionized) | 6,686 | 6,078 | $22K |
| 73030 | 1,644 | 1,583 | $22K | |
| 72100 | 882 | 882 | $21K | |
| 87086 | Culture, bacterial; quantitative colony count, urine | 9,249 | 8,848 | $21K |
| 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 | 4,253 | 3,816 | $20K |
| 82746 | 2,452 | 2,431 | $18K | |
| 83550 | 4,087 | 4,037 | $18K | |
| G0103 | Prostate cancer screening; prostate specific antigen test (psa) | 1,693 | 1,683 | $18K |
| 87624 | Infectious agent detection by nucleic acid; human papillomavirus (HPV), high-risk types | 915 | 914 | $18K |
| 72125 | Computed tomography, cervical spine; without contrast material | 1,610 | 1,572 | $18K |
| 45378 | Colonoscopy, flexible; diagnostic, including collection of specimen(s) | 36 | 36 | $17K |
| 71250 | 411 | 406 | $17K | |
| 86481 | 315 | 314 | $16K | |
| 73630 | 2,107 | 2,026 | $16K | |
| 76536 | 360 | 359 | $16K | |
| 85027 | 4,930 | 4,832 | $16K | |
| 72131 | 402 | 399 | $15K | |
| 73130 | 1,780 | 1,686 | $15K | |
| 73610 | 1,560 | 1,473 | $15K | |
| 73110 | 1,211 | 1,135 | $15K | |
| 83540 | 4,366 | 4,305 | $14K | |
| 78452 | Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress | 25 | 25 | $14K |
| 83735 | 8,915 | 8,061 | $13K | |
| 97533 | 497 | 197 | $13K | |
| 87081 | 8,657 | 8,375 | $12K | |
| 87186 | 3,850 | 3,682 | $11K | |
| 76642 | 307 | 303 | $11K | |
| 82043 | 3,735 | 3,704 | $11K | |
| 83970 | 498 | 495 | $11K | |
| 84702 | 1,869 | 1,278 | $11K | |
| 83880 | 3,125 | 2,954 | $11K | |
| 80076 | 2,492 | 2,338 | $10K | |
| 87088 | 3,342 | 3,233 | $10K | |
| 72148 | Magnetic resonance imaging, lumbar spine; without contrast material | 105 | 105 | $10K |
| 97116 | 694 | 340 | $9K | |
| 87340 | 2,324 | 2,313 | $9K | |
| 88305 | Level IV - Surgical pathology, gross and microscopic examination | 853 | 837 | $9K |
| 86140 | 5,576 | 4,986 | $9K | |
| 81001 | 20,147 | 18,736 | $9K | |
| 87808 | 1,400 | 1,376 | $9K | |
| 80306 | 3,107 | 2,937 | $8K | |
| 96372 | Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular | 5,820 | 5,280 | $8K |
| 76801 | 180 | 170 | $8K | |
| 87077 | 3,090 | 2,962 | $8K | |
| 87070 | 2,024 | 1,986 | $8K | |
| 90471 | Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine | 659 | 645 | $8K |
| G0108 | Diabetes outpatient self-management training services, individual, per 30 minutes | 186 | 159 | $8K |
| 76770 | 168 | 167 | $8K | |
| 87522 | Neg quan hep c or qual rna | 298 | 295 | $7K |
| 93798 | 97 | 14 | $7K | |
| 84403 | 481 | 463 | $7K | |
| 86038 | 1,129 | 1,122 | $7K | |
| 96367 | 207 | 195 | $7K | |
| 85610 | 9,920 | 8,380 | $7K | |
| 86706 | 1,063 | 1,060 | $6K | |
| 73502 | 397 | 390 | $6K | |
| G0328 | Colorectal cancer screening; fecal occult blood test, immunoassay, 1-3 simultaneous | 249 | 243 | $6K |
| 76857 | 94 | 91 | $5K | |
| 82570 | 2,040 | 2,014 | $5K | |
| 86592 | 2,133 | 2,119 | $5K | |
| 93017 | 150 | 150 | $5K | |
| 84146 | 520 | 504 | $5K | |
| 73562 | 274 | 273 | $5K | |
| 80074 | 213 | 213 | $5K | |
| J7030 | Infusion, normal saline solution , 1000 cc | 8,819 | 6,913 | $5K |
| 86704 | 746 | 743 | $5K | |
| 86708 | 666 | 664 | $4K | |
| 82784 | 516 | 484 | $4K | |
| 84481 | 483 | 469 | $4K | |
| 82951 | 578 | 527 | $4K | |
| 85652 | 3,932 | 3,774 | $4K | |
| 72110 | 156 | 155 | $4K | |
| 74018 | 264 | 260 | $4K | |
| 83001 | 350 | 349 | $4K | |
| 87075 | 1,570 | 1,489 | $3K | |
| G0476 | Infectious agent detection by nucleic acid (dna or rna); human papillomavirus (hpv), high-risk types (e.g., 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) for cervical cancer screening, must be performed in addition to pap test | 165 | 164 | $3K |
| L4350 | Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf | 59 | 57 | $3K |
| 83690 | 7,476 | 6,869 | $3K | |
| 97035 | 564 | 268 | $3K | |
| 82670 | 200 | 199 | $3K | |
| 73080 | 242 | 236 | $3K | |
| 85730 | 3,793 | 3,534 | $3K | |
| 70496 | 171 | 168 | $3K | |
| 70491 | 30 | 30 | $3K | |
| 84153 | 251 | 251 | $2K | |
| 87426 | Infectious agent antigen detection, SARS-CoV-2 (COVID-19) | 128 | 121 | $2K |
| 76816 | Ultrasound, pregnant uterus, real time with image documentation, follow-up | 52 | 41 | $2K |
| 93225 | 49 | 49 | $2K | |
| 82947 | 163 | 163 | $2K | |
| 82550 | 1,056 | 900 | $2K | |
| 70486 | 68 | 68 | $2K | |
| 77080 | 39 | 39 | $2K | |
| 97163 | 40 | 40 | $2K | |
| 74019 | 123 | 123 | $2K | |
| 84402 | 139 | 138 | $2K | |
| 86431 | 663 | 662 | $2K | |
| 82565 | 662 | 633 | $2K | |
| Q9967 | Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml | 5,050 | 4,866 | $2K |
| 83516 | 260 | 245 | $2K | |
| 73221 | 12 | 12 | $2K | |
| 84100 | 833 | 681 | $2K | |
| 81025 | 6,358 | 6,038 | $1K | |
| 87276 | 7,338 | 7,148 | $1K | |
| 84550 | 663 | 654 | $1K | |
| 73140 | 78 | 74 | $1K | |
| 83721 | 244 | 244 | $1K | |
| 87430 | 6,840 | 6,709 | $1K | |
| 82105 | 138 | 135 | $1K | |
| 86703 | 178 | 177 | $1K | |
| 87275 | 7,338 | 7,148 | $1K | |
| 73590 | 144 | 134 | $1K | |
| 85576 | 73 | 73 | $1K | |
| 74022 | 873 | 854 | $1K | |
| 72040 | 52 | 52 | $1K | |
| 85379 | 2,540 | 2,482 | $1K | |
| 84703 | 1,926 | 1,873 | $1K | |
| 86200 | 215 | 215 | $1K | |
| G0279 | Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066) | 92 | 92 | $1K |
| 83002 | 96 | 96 | $1K | |
| 82248 | 387 | 317 | $972.62 | |
| 72050 | 25 | 25 | $915.11 | |
| 84480 | 149 | 145 | $898.11 | |
| 80069 | 192 | 185 | $880.28 | |
| 81373 | 28 | 27 | $842.71 | |
| 87427 | 119 | 94 | $826.88 | |
| 77066 | Tomosynthesis, mammo | 13 | 13 | $817.53 |
| 84156 | 430 | 419 | $804.49 | |
| 87807 | 1,721 | 1,685 | $798.98 | |
| 88304 | 146 | 144 | $793.32 | |
| 83655 | 119 | 119 | $777.78 | |
| 84460 | 255 | 247 | $652.24 | |
| 86003 | 12 | 12 | $618.82 | |
| 84145 | 884 | 845 | $557.00 | |
| 83605 | 6,351 | 5,711 | $539.83 | |
| 84450 | 218 | 210 | $534.83 | |
| G0297 | Low dose ct scan (ldct) for lung cancer screening | 12 | 12 | $528.16 |
| 83993 | 50 | 50 | $513.62 | |
| 73090 | 88 | 86 | $501.52 | |
| 83615 | 199 | 189 | $484.34 | |
| 86376 | 59 | 59 | $475.45 | |
| 84165 | 87 | 81 | $466.68 | |
| 87040 | 2,221 | 1,856 | $447.87 | |
| 80164 | 81 | 77 | $422.69 | |
| 84484 | 8,165 | 6,896 | $401.91 | |
| 86480 | 12 | 12 | $388.18 | |
| 76870 | 25 | 24 | $369.75 | |
| 85046 | 123 | 119 | $356.99 | |
| 87046 | 94 | 94 | $345.22 | |
| 87045 | 94 | 94 | $342.15 | |
| 86318 | 58 | 57 | $311.21 | |
| 86762 | 428 | 427 | $271.71 | |
| 82533 | 27 | 25 | $229.92 | |
| 70498 | 168 | 166 | $198.94 | |
| 87220 | 178 | 177 | $185.15 | |
| 87661 | Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe | 15 | 15 | $179.16 |
| 96376 | 2,471 | 2,009 | $150.63 | |
| 82140 | 56 | 52 | $141.76 | |
| 87209 | 14 | 14 | $133.84 | |
| 84155 | 72 | 68 | $130.89 | |
| 85018 | 114 | 114 | $128.52 | |
| 73552 | 12 | 12 | $122.33 | |
| 86800 | 13 | 13 | $104.80 | |
| 86308 | 142 | 138 | $84.16 | |
| 86850 | 1,763 | 1,606 | $74.90 | |
| 71101 | 13 | 13 | $68.59 | |
| 82310 | 30 | 30 | $67.25 | |
| 82962 | 4,123 | 2,938 | $63.87 | |
| 87324 | 17 | 17 | $61.76 | |
| 87449 | 17 | 17 | $61.76 | |
| J0665 | Injection, bupivicaine, not otherwise specified, 0.5 mg | 196 | 128 | $56.70 |
| 85014 | 52 | 52 | $51.86 | |
| 87177 | 14 | 14 | $43.83 | |
| 82803 | 312 | 279 | $43.36 | |
| 80178 | 15 | 12 | $42.54 | |
| 82150 | 12 | 12 | $41.59 | |
| 82040 | 17 | 17 | $40.70 | |
| 82010 | 165 | 144 | $40.47 | |
| 80051 | 12 | 12 | $36.56 | |
| 85651 | 14 | 12 | $32.54 | |
| 84520 | 15 | 15 | $27.72 | |
| 87205 | 40 | 40 | $15.72 | |
| 94640 | Pressurized or nonpressurized inhalation treatment for acute airway obstruction | 2,204 | 1,819 | $11.70 |
| J2765 | Injection, metoclopramide hcl, up to 10 mg | 883 | 827 | $6.66 |
| J1885 | Injection, ketorolac tromethamine, per 15 mg | 5,969 | 5,516 | $3.09 |
| Q0162 | Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen | 1,370 | 1,271 | $3.00 |
| J2270 | Injection, morphine sulfate, up to 10 mg | 3,990 | 3,256 | $2.46 |
| A9270 | Non-covered item or service | 1,358 | 1,101 | $0.31 |
| J0696 | Injection, ceftriaxone sodium, per 250 mg | 2,377 | 1,955 | $0.15 |
| J1200 | Injection, diphenhydramine hcl, up to 50 mg | 2,160 | 1,872 | $0.00 |
| J2930 | Injection, methylprednisolone sodium succinate, up to 125 mg | 1,767 | 1,517 | $0.00 |
| J7120 | Ringers lactate infusion, up to 1000 cc | 1,843 | 1,734 | $0.00 |
| J2405 | Injection, ondansetron hydrochloride, per 1 mg | 8,113 | 6,839 | $0.00 |
| 94729 | 331 | 331 | $0.00 | |
| J7040 | Infusion, normal saline solution, sterile (500 ml = 1 unit) | 781 | 727 | $0.00 |
| 90715 | 578 | 575 | $0.00 | |
| 93226 | 49 | 49 | $0.00 | |
| J2919 | Injection, methylprednisolone sodium succinate, 5 mg | 240 | 224 | $0.00 |
| J2550 | Injection, promethazine hcl, up to 50 mg | 136 | 111 | $0.00 |
| J1644 | Injection, heparin sodium, per 1000 units | 27 | 12 | $0.00 |
| J0780 | Injection, prochlorperazine, up to 10 mg | 41 | 39 | $0.00 |
| 94726 | 199 | 199 | $0.00 | |
| J3475 | Injection, magnesium sulfate, per 500 mg | 303 | 285 | $0.00 |
| C9113 | Injection, pantoprazole sodium, per vial | 182 | 155 | $0.00 |
| L1830 | Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf | 13 | 12 | $0.00 |
| G1004 | Clinical decision support mechanism national decision support company, as defined by the medicare appropriate use criteria program | 158 | 123 | $0.00 |
| J1171 | Injection, hydromorphone, 0.1 mg | 74 | 56 | $0.00 |
| 94664 | 16 | 13 | $0.00 | |
| J2710 | Injection, neostigmine methylsulfate, up to 0.5 mg | 14 | 13 | $0.00 |
| 12011 | 14 | 14 | $0.00 | |
| 29125 | 12 | 12 | $0.00 | |
| J1100 | Injection, dexamethasone sodium phosphate, 1 mg | 2,843 | 2,755 | $0.00 |
| G0471 | Collection of venous blood by venipuncture or urine sample by catheterization from an individual in a skilled nursing facility (snf) or by a laboratory on behalf of a home health agency (hha) | 265 | 180 | $0.00 |
| J1170 | Injection, hydromorphone, up to 4 mg | 2,609 | 1,948 | $0.00 |
| J3010 | Injection, fentanyl citrate, 0.1 mg | 1,659 | 1,582 | $0.00 |
| J7050 | Infusion, normal saline solution, 250 cc | 1,656 | 1,134 | $0.00 |
| J2704 | Injection, propofol, 10 mg | 814 | 780 | $0.00 |
| 12001 | 210 | 209 | $0.00 | |
| J2360 | Injection, orphenadrine citrate, up to 60 mg | 353 | 341 | $0.00 |
| J1642 | Injection, heparin sodium, (heparin lock flush), per 10 units | 432 | 124 | $0.00 |
| J0690 | Injection, cefazolin sodium, 500 mg | 755 | 687 | $0.00 |
| J7512 | Prednisone, immediate release or delayed release, oral, 1 mg | 234 | 210 | $0.00 |
| J3480 | Injection, potassium chloride, per 2 meq | 102 | 68 | $0.00 |
| J0131 | Injection, acetaminophen, not otherwise specified,10 mg | 1,044 | 1,012 | $0.00 |
| 86901 | 2,166 | 1,979 | $0.00 | |
| J2250 | Injection, midazolam hydrochloride, per 1 mg | 1,488 | 1,420 | $0.00 |
| J2543 | Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams) | 36 | 25 | $0.00 |
| J2060 | Injection, lorazepam, 2 mg | 485 | 378 | $0.00 |
| A9579 | Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (nos), per ml | 37 | 36 | $0.00 |
| J1815 | Injection, insulin, per 5 units | 13 | 12 | $0.00 |
| 96368 | 70 | 66 | $0.00 | |
| 0241U | Neonatal screening for hereditary disorders, genomic sequence analysis panel | 58 | 58 | $0.00 |
| A9500 | Technetium tc-99m sestamibi, diagnostic, per study dose | 12 | 12 | $0.00 |
| J3360 | Injection, diazepam, up to 5 mg | 13 | 12 | $0.00 |