NPI: 1770280299 · ORANGEBURG, SC 29118 · General Acute Care Hospital · NPI assigned 02/15/2023
Authorized official RAE, KARYN controls 20+ related entities in our dataset. Read more
| Authorized Official | RAE, KARYN (CHIEF, PAYOR RELATIONS) |
| NPI Enumeration Date | 02/15/2023 |
Other providers sharing the same authorized official: RAE, KARYN
| Year | Claims | Total Paid |
|---|---|---|
| 2023 | 117,383 | $4.31M |
| 2024 | 173,024 | $4.41M |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| 96375 | Therapeutic injection; each additional sequential IV push | 3,398 | 2,745 | $885K |
| 85025 | Blood count; complete (CBC), automated, and automated differential WBC count | 15,663 | 12,473 | $573K |
| 96372 | Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular | 4,552 | 3,503 | $559K |
| 87637 | Infectious agent detection by nucleic acid; SARS-CoV-2, influenza, and RSV | 5,342 | 4,976 | $524K |
| 80053 | Comprehensive metabolic panel | 15,289 | 12,558 | $502K |
| Q9967 | Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml | 3,886 | 2,895 | $472K |
| 99282 | Emergency department visit for the evaluation and management, low to moderate severity | 4,659 | 4,436 | $430K |
| 99283 | Emergency department visit for the evaluation and management, moderate severity | 13,850 | 12,803 | $390K |
| 87651 | Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe | 3,451 | 3,316 | $298K |
| 96374 | Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance | 3,961 | 3,467 | $253K |
| 96366 | Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour | 867 | 568 | $238K |
| 0241U | Neonatal screening for hereditary disorders, genomic sequence analysis panel | 3,720 | 3,464 | $237K |
| J7050 | Infusion, normal saline solution, 250 cc | 426 | 263 | $163K |
| 81001 | 10,550 | 9,272 | $137K | |
| 84703 | 2,586 | 2,367 | $125K | |
| 99211 | Office or other outpatient visit for the evaluation and management of an established patient, minimal severity | 3,355 | 3,028 | $123K |
| 97110 | Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion | 4,000 | 1,058 | $121K |
| 99212 | Office or other outpatient visit for the evaluation and management of an established patient, straightforward | 3,955 | 3,675 | $110K |
| 99284 | Emergency department visit for the evaluation and management, high severity | 9,178 | 8,277 | $84K |
| 80047 | 1,109 | 915 | $83K | |
| 36000 | 808 | 711 | $79K | |
| 86850 | 926 | 796 | $78K | |
| 85730 | 2,147 | 1,894 | $75K | |
| 96367 | 530 | 403 | $73K | |
| 80048 | Basic metabolic panel (calcium, ionized) | 2,180 | 1,677 | $70K |
| 86901 | 1,322 | 1,120 | $65K | |
| 87591 | Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe | 1,051 | 967 | $63K |
| 85027 | 2,734 | 2,311 | $61K | |
| 73630 | 924 | 808 | $60K | |
| 82947 | 1,770 | 1,251 | $59K | |
| 93306 | Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete | 538 | 520 | $59K |
| 96365 | Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour | 2,046 | 1,710 | $57K |
| 70450 | Computed tomography, head or brain; without contrast material | 2,399 | 2,202 | $57K |
| 99213 | Office or other outpatient visit for the evaluation and management of an established patient, low complexity | 964 | 898 | $57K |
| 78452 | Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress | 246 | 230 | $52K |
| 88305 | Level IV - Surgical pathology, gross and microscopic examination | 652 | 528 | $52K |
| 73610 | 729 | 658 | $50K | |
| 93005 | Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report | 7,509 | 6,636 | $50K |
| 71046 | Radiologic examination, chest; 2 views | 1,894 | 1,815 | $44K |
| 86900 | 1,189 | 999 | $42K | |
| 96361 | Intravenous infusion, hydration; each additional hour | 2,213 | 1,888 | $41K |
| 81025 | 2,343 | 2,142 | $41K | |
| 96360 | Intravenous infusion, hydration; initial, 31 minutes to 1 hour | 776 | 720 | $40K |
| 96376 | 1,115 | 670 | $40K | |
| 99281 | Emergency department visit for the evaluation and management, self-limited or minor | 527 | 503 | $39K |
| 73560 | 981 | 844 | $39K | |
| 80307 | Drug test(s), presumptive, any number of drug classes; immunoassay | 2,752 | 2,477 | $38K |
| 81003 | 681 | 587 | $34K | |
| 73130 | 517 | 453 | $32K | |
| 97530 | Therapeutic activities, direct patient contact, each 15 minutes | 2,788 | 827 | $32K |
| 93971 | 301 | 285 | $28K | |
| 73030 | 864 | 760 | $28K | |
| 74018 | 503 | 491 | $28K | |
| 87210 | 581 | 548 | $28K | |
| 71045 | Radiologic examination, chest; single view | 4,895 | 4,352 | $26K |
| 73110 | 389 | 363 | $26K | |
| 99285 | Emergency department visit for the evaluation and management, high severity with immediate threat to life | 4,570 | 4,042 | $24K |
| 74176 | Computed tomography, abdomen and pelvis; without contrast material | 1,007 | 924 | $23K |
| 87491 | Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe | 1,124 | 1,039 | $22K |
| 87086 | Culture, bacterial; quantitative colony count, urine | 2,769 | 2,518 | $21K |
| 77067 | Screening mammography, bilateral, including computer-aided detection | 397 | 390 | $20K |
| 77063 | Screening digital breast tomosynthesis, bilateral | 347 | 340 | $20K |
| 70551 | Magnetic resonance imaging, brain; without contrast material | 58 | 53 | $19K |
| 84153 | 387 | 352 | $17K | |
| 76805 | Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation | 116 | 113 | $17K |
| 99202 | Office or other outpatient visit for the evaluation and management of a new patient, straightforward | 524 | 514 | $17K |
| 85610 | 2,985 | 2,552 | $16K | |
| 76856 | Ultrasound, pelvic (nonobstetric), real time with image documentation; complete | 210 | 205 | $15K |
| 93970 | 139 | 127 | $15K | |
| 73562 | 537 | 400 | $15K | |
| 73590 | 345 | 299 | $14K | |
| C1887 | Catheter, guiding (may include infusion/perfusion capability) | 48 | 38 | $14K |
| 76830 | Ultrasound, transvaginal | 120 | 117 | $14K |
| 72100 | 571 | 548 | $13K | |
| 84702 | 1,047 | 822 | $12K | |
| 72040 | 218 | 207 | $12K | |
| 70486 | 253 | 241 | $11K | |
| 76801 | 342 | 306 | $11K | |
| 73140 | 93 | 87 | $11K | |
| 82728 | 916 | 847 | $11K | |
| 82565 | 199 | 182 | $11K | |
| C9803 | Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source | 106 | 95 | $11K |
| 87077 | 1,012 | 845 | $11K | |
| 84443 | Thyroid stimulating hormone (TSH) | 2,247 | 1,980 | $10K |
| 83036 | Hemoglobin; glycosylated (A1C) | 1,485 | 1,345 | $10K |
| 93017 | 355 | 324 | $9K | |
| 85378 | 184 | 174 | $9K | |
| 82607 | 549 | 515 | $9K | |
| 73502 | 474 | 444 | $8K | |
| 80061 | Lipid panel | 1,432 | 1,297 | $8K |
| 74177 | Computed tomography, abdomen and pelvis; with contrast material | 1,582 | 1,458 | $7K |
| 73070 | 151 | 131 | $7K | |
| 66984 | Extracapsular cataract removal with insertion of intraocular lens prosthesis | 36 | 30 | $7K |
| 86780 | 457 | 434 | $6K | |
| 76815 | Ultrasound, pregnant uterus, real time with image documentation, limited | 80 | 79 | $6K |
| G0378 | Hospital observation service, per hour | 2,404 | 963 | $6K |
| 83735 | 3,251 | 2,586 | $6K | |
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 99 | 93 | $5K |
| 71250 | 97 | 95 | $5K | |
| 76705 | Ultrasound, abdominal, real time with image documentation; limited | 138 | 135 | $5K |
| 99214 | Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity | 202 | 181 | $5K |
| J1644 | Injection, heparin sodium, per 1000 units | 1,777 | 969 | $5K |
| C1725 | Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability) | 577 | 460 | $4K |
| 93296 | 89 | 88 | $4K | |
| 73090 | 89 | 86 | $4K | |
| 36415 | Collection of venous blood by venipuncture | 14,717 | 11,101 | $4K |
| 12001 | 40 | 38 | $4K | |
| 84484 | 4,391 | 3,248 | $4K | |
| 94640 | Pressurized or nonpressurized inhalation treatment for acute airway obstruction | 1,153 | 987 | $3K |
| 87147 | 56 | 53 | $3K | |
| 52000 | 15 | 14 | $3K | |
| J1100 | Injection, dexamethasone sodium phosphate, 1 mg | 2,731 | 2,399 | $3K |
| 76700 | Ultrasound, abdominal, real time with image documentation; complete | 14 | 13 | $3K |
| 97116 | 438 | 195 | $3K | |
| 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 | 509 | 479 | $3K |
| 83880 | 3,215 | 2,803 | $3K | |
| 82306 | Vitamin D; 25 hydroxy, includes fraction(s), if performed | 793 | 715 | $3K |
| C1769 | Guide wire | 827 | 698 | $3K |
| 73060 | 44 | 40 | $3K | |
| 85045 | 60 | 53 | $3K | |
| 71260 | Computed tomography, thorax, diagnostic; with contrast material | 786 | 737 | $3K |
| 84439 | 1,029 | 943 | $2K | |
| J1815 | Injection, insulin, per 5 units | 224 | 156 | $2K |
| 72125 | Computed tomography, cervical spine; without contrast material | 818 | 764 | $2K |
| J2270 | Injection, morphine sulfate, up to 10 mg | 1,028 | 842 | $2K |
| G0463 | Hospital outpatient clinic visit for assessment and management of a patient | 392 | 348 | $2K |
| 76536 | 29 | 28 | $2K | |
| 93990 | 72 | 62 | $2K | |
| 84100 | 462 | 362 | $2K | |
| J7040 | Infusion, normal saline solution, sterile (500 ml = 1 unit) | 591 | 438 | $2K |
| 73552 | 46 | 41 | $2K | |
| 73620 | 14 | 13 | $2K | |
| 86762 | 13 | 13 | $2K | |
| J2250 | Injection, midazolam hydrochloride, per 1 mg | 1,648 | 1,460 | $1K |
| 94644 | 131 | 120 | $1K | |
| J0696 | Injection, ceftriaxone sodium, per 250 mg | 1,559 | 1,266 | $1K |
| 82247 | 48 | 26 | $1K | |
| J1170 | Injection, hydromorphone, up to 4 mg | 828 | 621 | $1K |
| 93985 | 15 | 13 | $1K | |
| 80069 | 33 | 28 | $1K | |
| 85007 | 1,482 | 1,209 | $1K | |
| 97112 | Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination | 139 | 69 | $1K |
| 80329 | 432 | 382 | $1K | |
| 83690 | 3,778 | 3,365 | $1K | |
| J0690 | Injection, cefazolin sodium, 500 mg | 1,222 | 844 | $1K |
| J2704 | Injection, propofol, 10 mg | 2,045 | 1,277 | $1K |
| J3010 | Injection, fentanyl citrate, 0.1 mg | 1,925 | 1,674 | $974.30 |
| 99291 | Critical care, evaluation and management of the critically ill patient, first 30-74 minutes | 216 | 197 | $927.70 |
| J1940 | Injection, furosemide, up to 20 mg | 209 | 125 | $884.88 |
| J2785 | Injection, regadenoson, 0.1 mg | 162 | 154 | $882.52 |
| J3480 | Injection, potassium chloride, per 2 meq | 231 | 167 | $849.37 |
| 12011 | 16 | 15 | $844.65 | |
| 93975 | 118 | 110 | $841.69 | |
| 76770 | 12 | 12 | $821.50 | |
| 86140 | 109 | 97 | $803.10 | |
| 82105 | 15 | 14 | $778.21 | |
| 86920 | 13 | 12 | $776.79 | |
| 87389 | Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies | 463 | 434 | $739.43 |
| 76642 | 16 | 13 | $725.94 | |
| 97162 | 235 | 219 | $684.91 | |
| 87340 | 354 | 331 | $659.21 | |
| 87205 | 30 | 29 | $608.92 | |
| 74019 | 14 | 14 | $606.72 | |
| A9502 | Technetium tc-99m tetrofosmin, diagnostic, per study dose | 210 | 194 | $602.74 |
| J3475 | Injection, magnesium sulfate, per 500 mg | 243 | 173 | $544.13 |
| 72170 | 12 | 12 | $516.55 | |
| 83540 | 1,048 | 970 | $516.42 | |
| 97161 | 188 | 178 | $498.10 | |
| 72070 | 24 | 24 | $494.71 | |
| J0330 | Injection, succinylcholine chloride, up to 20 mg | 138 | 132 | $468.66 |
| 82570 | 228 | 196 | $450.02 | |
| 82043 | 180 | 158 | $421.31 | |
| 85379 | 256 | 242 | $356.80 | |
| 82550 | 714 | 596 | $332.30 | |
| 76817 | Ultrasound, pregnant uterus, real time with image documentation, transvaginal | 13 | 13 | $324.30 |
| 51702 | 32 | 28 | $320.57 | |
| 84403 | 106 | 96 | $307.59 | |
| 84550 | 190 | 165 | $293.41 | |
| 82803 | 300 | 254 | $281.91 | |
| 86803 | 211 | 204 | $281.32 | |
| 80143 | 468 | 406 | $240.69 | |
| J0131 | Injection, acetaminophen, not otherwise specified,10 mg | 411 | 378 | $220.42 |
| 80320 | 710 | 640 | $190.58 | |
| 73521 | 13 | 13 | $190.04 | |
| J7120 | Ringers lactate infusion, up to 1000 cc | 306 | 249 | $180.42 |
| 83550 | 1,025 | 950 | $170.42 | |
| 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 | 121 | 112 | $145.18 |
| 90471 | Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine | 335 | 298 | $128.27 |
| 87186 | 786 | 672 | $124.56 | |
| 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 | 31 | 27 | $112.25 |
| 82951 | 89 | 84 | $105.75 | |
| 83615 | 31 | 26 | $102.60 | |
| 87040 | 765 | 475 | $77.79 | |
| 73080 | 14 | 13 | $76.74 | |
| 80076 | 44 | 42 | $55.06 | |
| 82378 | 116 | 82 | $51.46 | |
| J1885 | Injection, ketorolac tromethamine, per 15 mg | 2,502 | 2,185 | $45.36 |
| 82248 | 262 | 219 | $35.19 | |
| 71101 | 14 | 14 | $34.22 | |
| 82077 | 934 | 834 | $31.09 | |
| 36416 | 102 | 97 | $27.92 | |
| J2765 | Injection, metoclopramide hcl, up to 10 mg | 324 | 274 | $25.17 |
| 85652 | 100 | 97 | $21.72 | |
| J0360 | Injection, hydralazine hcl, up to 20 mg | 275 | 209 | $20.58 |
| J0665 | Injection, bupivicaine, not otherwise specified, 0.5 mg | 265 | 158 | $20.48 |
| 80179 | 509 | 440 | $18.64 | |
| J7030 | Infusion, normal saline solution , 1000 cc | 1,198 | 961 | $18.45 |
| 97140 | Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) | 58 | 26 | $17.32 |
| 83605 | 853 | 727 | $12.15 | |
| J2405 | Injection, ondansetron hydrochloride, per 1 mg | 3,211 | 2,745 | $7.29 |
| J7613 | Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg | 104 | 85 | $5.68 |
| J1200 | Injection, diphenhydramine hcl, up to 50 mg | 565 | 478 | $2.49 |
| J2060 | Injection, lorazepam, 2 mg | 157 | 111 | $2.21 |
| J1642 | Injection, heparin sodium, (heparin lock flush), per 10 units | 735 | 483 | $0.48 |
| 96417 | 77 | 60 | $0.00 | |
| 36901 | 64 | 54 | $0.00 | |
| J0171 | Injection, adrenalin, epinephrine, 0.1 mg | 73 | 63 | $0.00 |
| C1757 | Catheter, thrombectomy/embolectomy | 171 | 90 | $0.00 |
| 99152 | 56 | 55 | $0.00 | |
| 86923 | 68 | 37 | $0.00 | |
| 96413 | Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance | 518 | 333 | $0.00 |
| 82010 | 131 | 111 | $0.00 | |
| G1004 | Clinical decision support mechanism national decision support company, as defined by the medicare appropriate use criteria program | 213 | 194 | $0.00 |
| 36905 | 63 | 53 | $0.00 | |
| J1596 | Injection, glycopyrrolate, 0.1 mg | 153 | 143 | $0.00 |
| J2919 | Injection, methylprednisolone sodium succinate, 5 mg | 210 | 164 | $0.00 |
| C1894 | Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser | 655 | 558 | $0.00 |
| J1171 | Injection, hydromorphone, 0.1 mg | 74 | 53 | $0.00 |
| J0780 | Injection, prochlorperazine, up to 10 mg | 26 | 25 | $0.00 |
| C9113 | Injection, pantoprazole sodium, per vial | 93 | 61 | $0.00 |
| 59025 | Fetal non-stress test | 26 | 25 | $0.00 |
| J1953 | Injection, levetiracetam, 10 mg | 202 | 169 | $0.00 |
| 80164 | 16 | 12 | $0.00 | |
| P9016 | Red blood cells, leukocytes reduced, each unit | 14 | 13 | $0.00 |
| 90715 | 300 | 287 | $0.00 | |
| 36600 | 65 | 60 | $0.00 | |
| J1650 | Injection, enoxaparin sodium, 10 mg | 223 | 119 | $0.00 |
| J3301 | Injection, triamcinolone acetonide, not otherwise specified, 10 mg | 566 | 555 | $0.00 |
| J7510 | Prednisolone oral, per 5 mg | 152 | 145 | $0.00 |
| C1751 | Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis) | 14 | 14 | $0.00 |
| 78815 | Positron emission tomography (PET) for limited area imaging | 12 | 12 | $0.00 |
| J2930 | Injection, methylprednisolone sodium succinate, up to 125 mg | 84 | 72 | $0.00 |
| J3372 | Injection, vancomycin hcl (xellia), not therapeutically equivalent to j3370, 500 mg | 18 | 16 | $0.00 |
| 85046 | 31 | 25 | $0.00 | |
| 96402 | 13 | 12 | $0.00 | |
| 84481 | 16 | 12 | $0.00 | |
| 76937 | 15 | 15 | $0.00 | |
| 36830 | 12 | 12 | $0.00 | |
| 83970 | 21 | 13 | $0.00 | |
| J2370 | Injection, phenylephrine hcl, up to 1 ml | 47 | 42 | $0.00 |
| J2371 | Injection, phenylephrine hydrochloride, 20 micrograms | 245 | 225 | $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 | 284 | 228 | $0.00 |
| Q9969 | Tc-99m from non-highly enriched uranium source, full cost recovery add-on, per study dose | 31 | 26 | $0.00 |
| 96415 | 60 | 40 | $0.00 | |
| A9270 | Non-covered item or service | 2,970 | 634 | $0.00 |
| 82746 | 420 | 396 | $0.00 | |
| J2003 | Injection, lidocaine hydrochloride, 1 mg | 268 | 236 | $0.00 |
| 36902 | 177 | 161 | $0.00 | |
| 99153 | Mod sedat endo service >5yrs | 12 | 12 | $0.00 |
| 51798 | 179 | 171 | $0.00 | |
| 97166 | 94 | 87 | $0.00 | |
| 97165 | 41 | 38 | $0.00 | |
| 36430 | 30 | 28 | $0.00 | |
| J2469 | Injection, palonosetron hcl, 25 mcg | 93 | 60 | $0.00 |
| J1630 | Injection, haloperidol, up to 5 mg | 129 | 97 | $0.00 |
| J7512 | Prednisone, immediate release or delayed release, oral, 1 mg | 79 | 62 | $0.00 |
| V2632 | Posterior chamber intraocular lens | 34 | 30 | $0.00 |
| C9290 | Injection, bupivacaine liposome, 1 mg | 13 | 12 | $0.00 |
| J2001 | Injection, lidocaine hcl for intravenous infusion, 10 mg | 146 | 130 | $0.00 |
| J3360 | Injection, diazepam, up to 5 mg | 25 | 14 | $0.00 |
| 87661 | Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe | 30 | 28 | $0.00 |
| J2470 | Injection, pantoprazole sodium, 40 mg | 44 | 24 | $0.00 |
| J7644 | Ipratropium bromide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram | 16 | 15 | $0.00 |
| 76998 | 14 | 14 | $0.00 | |
| J1920 | Injection, labetalol hydrochloride, 5 mg | 24 | 16 | $0.00 |
| C1750 | Catheter, hemodialysis/peritoneal, long-term | 16 | 14 | $0.00 |
| J2920 | Injection, methylprednisolone sodium succinate, up to 40 mg | 22 | 15 | $0.00 |
| J7060 | 5% dextrose/water (500 ml = 1 unit) | 75 | 40 | $0.00 |
| 96368 | 16 | 12 | $0.00 | |
| J2543 | Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams) | 21 | 12 | $0.00 |