| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99284 |
Emergency department visit for the evaluation and management, high severity |
43,138 |
34,451 |
$5.50M |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
44,150 |
36,124 |
$4.10M |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
17,695 |
14,692 |
$2.68M |
| G0378 |
Hospital observation service, per hour |
2,937 |
2,382 |
$1.32M |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
11,494 |
9,283 |
$1.19M |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
10,574 |
7,127 |
$1.10M |
| A0427 |
Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) |
8,650 |
6,284 |
$958K |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
34,596 |
7,399 |
$956K |
| 69436 |
Tympanostomy (requiring insertion of ventilating tube), general anesthesia |
670 |
609 |
$852K |
| A0425 |
Ground mileage, per statute mile |
12,143 |
7,637 |
$822K |
| A0429 |
Ambulance service, basic life support, emergency transport (bls-emergency) |
5,053 |
3,669 |
$548K |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
3,287 |
2,882 |
$535K |
| 92507 |
Treatment of speech, language, voice, communication, and/or auditory processing disorder |
11,004 |
3,005 |
$532K |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
6,943 |
5,764 |
$521K |
| 96361 |
Intravenous infusion, hydration; each additional hour |
8,342 |
5,777 |
$517K |
| D0272 |
Bitewings - two radiographic images |
727 |
618 |
$500K |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
13,556 |
3,280 |
$474K |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
4,324 |
3,444 |
$459K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
5,685 |
3,144 |
$449K |
| 59025 |
Fetal non-stress test |
4,142 |
2,629 |
$433K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
10,026 |
7,979 |
$344K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
10,716 |
8,091 |
$310K |
| 11042 |
Debridement, subcutaneous tissue (includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm |
2,669 |
1,313 |
$292K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
2,361 |
1,850 |
$287K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
21,751 |
10,684 |
$285K |
| 71045 |
Radiologic examination, chest; single view |
9,181 |
7,775 |
$279K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
13,724 |
11,547 |
$270K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
9,955 |
8,727 |
$270K |
| 70450 |
Computed tomography, head or brain; without contrast material |
5,468 |
4,740 |
$261K |
| 71046 |
Radiologic examination, chest; 2 views |
5,473 |
4,888 |
$233K |
| 36902 |
|
323 |
262 |
$232K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,280 |
544 |
$215K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
1,933 |
1,683 |
$190K |
| 80053 |
Comprehensive metabolic panel |
25,212 |
20,628 |
$178K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
34,665 |
26,696 |
$174K |
| 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 |
2,996 |
2,629 |
$161K |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
3,449 |
3,034 |
$152K |
| 42820 |
Tonsillectomy and adenoidectomy; younger than age 12 |
39 |
37 |
$134K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
3,222 |
1,715 |
$122K |
| 97162 |
|
2,848 |
2,537 |
$117K |
| D2390 |
|
438 |
196 |
$110K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
2,818 |
2,153 |
$105K |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
4,060 |
3,612 |
$105K |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
7,255 |
5,395 |
$104K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
4,111 |
3,128 |
$101K |
| 78452 |
Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress |
292 |
269 |
$98K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
1,420 |
1,246 |
$85K |
| 87637 |
Infectious agent detection by nucleic acid; SARS-CoV-2, influenza, and RSV |
669 |
618 |
$82K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
13,865 |
11,371 |
$78K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
5,221 |
4,626 |
$75K |
| D7140 |
Extraction, erupted tooth or exposed root |
238 |
38 |
$74K |
| 97161 |
|
1,473 |
1,279 |
$74K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,287 |
1,863 |
$72K |
| 86900 |
|
1,561 |
1,233 |
$71K |
| 86850 |
|
1,537 |
1,211 |
$69K |
| 73564 |
|
1,215 |
1,076 |
$67K |
| 84703 |
|
9,494 |
7,860 |
$59K |
| 99291 |
Critical care, evaluation and management of the critically ill patient, first 30-74 minutes |
337 |
238 |
$59K |
| 80061 |
Lipid panel |
5,786 |
5,188 |
$58K |
| 36600 |
|
1,849 |
1,541 |
$56K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
9,400 |
7,987 |
$56K |
| 84443 |
Thyroid stimulating hormone (TSH) |
4,335 |
3,843 |
$55K |
| 73721 |
Magnetic resonance imaging, any joint of lower extremity; without contrast material |
356 |
315 |
$49K |
| 83880 |
|
2,636 |
2,276 |
$46K |
| 93971 |
|
1,163 |
981 |
$43K |
| 81001 |
|
18,568 |
14,919 |
$39K |
| 96367 |
|
1,345 |
1,100 |
$39K |
| 73630 |
|
951 |
853 |
$38K |
| 62323 |
|
384 |
332 |
$38K |
| 86901 |
|
2,423 |
1,947 |
$38K |
| 84484 |
|
5,626 |
4,728 |
$37K |
| 72148 |
Magnetic resonance imaging, lumbar spine; without contrast material |
464 |
418 |
$37K |
| 83690 |
|
7,921 |
6,573 |
$36K |
| 97010 |
|
8,224 |
1,988 |
$36K |
| 72125 |
Computed tomography, cervical spine; without contrast material |
767 |
642 |
$36K |
| 74018 |
|
885 |
789 |
$36K |
| 87186 |
|
5,309 |
4,602 |
$35K |
| 87077 |
|
5,681 |
4,926 |
$35K |
| 87040 |
|
3,541 |
3,032 |
$32K |
| 87807 |
|
2,608 |
2,333 |
$32K |
| 95810 |
Polysomnography; sleep staging with 4 or more additional parameters |
77 |
66 |
$31K |
| 73610 |
|
694 |
620 |
$31K |
| 93017 |
|
528 |
483 |
$31K |
| 99232 |
Subsequent hospital care, per day, moderate complexity |
1,636 |
870 |
$30K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
387 |
359 |
$30K |
| M0243 |
Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring |
131 |
119 |
$25K |
| 93970 |
|
353 |
322 |
$24K |
| 82803 |
|
1,918 |
1,594 |
$22K |
| 99239 |
Hospital discharge day management, more than 30 minutes |
1,124 |
951 |
$21K |
| 73030 |
|
569 |
515 |
$20K |
| 76801 |
|
283 |
228 |
$20K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
767 |
554 |
$20K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
630 |
537 |
$19K |
| A0428 |
Ambulance service, basic life support, non-emergency transport, (bls) |
1,255 |
793 |
$19K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
2,795 |
2,565 |
$18K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
220 |
192 |
$18K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
608 |
523 |
$18K |
| 87070 |
|
2,675 |
2,259 |
$18K |
| 97032 |
|
1,519 |
525 |
$18K |
| 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 |
1,236 |
1,059 |
$18K |
| 36415 |
Collection of venous blood by venipuncture |
9,940 |
8,202 |
$17K |
| 73130 |
|
386 |
337 |
$17K |
| 83605 |
|
3,246 |
2,466 |
$16K |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
1,016 |
286 |
$13K |
| 84702 |
|
1,134 |
879 |
$13K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
712 |
613 |
$13K |
| 97014 |
|
1,275 |
382 |
$13K |
| 88304 |
|
507 |
377 |
$12K |
| J0690 |
Injection, cefazolin sodium, 500 mg |
598 |
514 |
$12K |
| 97165 |
|
236 |
204 |
$12K |
| 99223 |
Prolong inpt eval add15 m |
370 |
268 |
$11K |
| 92523 |
|
69 |
67 |
$10K |
| 81003 |
|
6,041 |
5,113 |
$10K |
| 80076 |
|
1,715 |
1,486 |
$10K |
| 83735 |
|
2,232 |
1,765 |
$9K |
| 76770 |
|
194 |
174 |
$8K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
360 |
326 |
$8K |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
38 |
37 |
$8K |
| 86920 |
|
93 |
76 |
$8K |
| 86140 |
|
1,918 |
1,640 |
$7K |
| 73110 |
|
141 |
130 |
$7K |
| 51702 |
|
241 |
212 |
$6K |
| 88307 |
|
91 |
53 |
$6K |
| 94664 |
|
1,866 |
1,376 |
$5K |
| 72110 |
|
127 |
120 |
$5K |
| 85651 |
|
1,754 |
1,502 |
$5K |
| 84439 |
|
724 |
660 |
$5K |
| 74019 |
|
92 |
80 |
$5K |
| 36573 |
|
12 |
12 |
$5K |
| 85610 |
|
2,004 |
1,731 |
$4K |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
407 |
317 |
$4K |
| 82550 |
|
1,003 |
883 |
$4K |
| 88300 |
|
352 |
267 |
$4K |
| 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 |
69 |
37 |
$4K |
| 76536 |
|
68 |
67 |
$4K |
| 93925 |
|
60 |
53 |
$4K |
| 85730 |
|
1,128 |
1,016 |
$4K |
| 76642 |
|
113 |
92 |
$4K |
| 73502 |
|
130 |
118 |
$4K |
| 97113 |
|
98 |
27 |
$3K |
| 10060 |
|
35 |
25 |
$3K |
| 99233 |
Prolong inpt eval add15 m |
313 |
118 |
$3K |
| J1642 |
Injection, heparin sodium, (heparin lock flush), per 10 units |
2,017 |
1,485 |
$3K |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
1,427 |
1,285 |
$3K |
| 99222 |
Initial hospital care, per day, moderate complexity |
153 |
125 |
$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 |
3,216 |
2,769 |
$3K |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
1,090 |
1,005 |
$3K |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
10,850 |
8,768 |
$3K |
| 84550 |
|
912 |
684 |
$2K |
| 85014 |
|
2,103 |
1,812 |
$2K |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
31 |
24 |
$2K |
| P9016 |
Red blood cells, leukocytes reduced, each unit |
34 |
26 |
$2K |
| 92652 |
|
15 |
13 |
$2K |
| 73221 |
|
13 |
13 |
$2K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
29 |
24 |
$2K |
| 73080 |
|
38 |
36 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
120 |
68 |
$2K |
| 72131 |
|
49 |
40 |
$2K |
| 74022 |
|
30 |
25 |
$2K |
| 80164 |
|
177 |
131 |
$2K |
| 80299 |
|
139 |
55 |
$2K |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
5,817 |
4,545 |
$2K |
| C9803 |
Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
87 |
82 |
$2K |
| 82553 |
|
281 |
270 |
$2K |
| 97116 |
|
116 |
51 |
$2K |
| J2704 |
Injection, propofol, 10 mg |
7,677 |
6,452 |
$1K |
| 82077 |
|
131 |
116 |
$1K |
| J7030 |
Infusion, normal saline solution , 1000 cc |
4,825 |
3,342 |
$1K |
| 83655 |
|
116 |
113 |
$1K |
| 95819 |
|
13 |
13 |
$1K |
| 85379 |
|
239 |
209 |
$1K |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
14 |
13 |
$1K |
| 85027 |
|
195 |
150 |
$1K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
19 |
12 |
$1K |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
2,900 |
2,489 |
$1K |
| 73590 |
|
35 |
26 |
$1K |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
2,613 |
2,060 |
$995.08 |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
13 |
13 |
$855.10 |
| G0283 |
Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care |
730 |
234 |
$835.37 |
| 87046 |
|
72 |
63 |
$833.87 |
| Q9969 |
Tc-99m from non-highly enriched uranium source, full cost recovery add-on, per study dose |
183 |
165 |
$796.60 |
| 87220 |
|
197 |
169 |
$772.97 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
4,773 |
3,754 |
$718.57 |
| 97035 |
|
79 |
26 |
$716.50 |
| 80074 |
|
16 |
14 |
$690.21 |
| 86703 |
|
56 |
39 |
$689.54 |
| 87045 |
|
92 |
75 |
$688.42 |
| U0002 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
15 |
12 |
$663.10 |
| 96376 |
|
3,005 |
1,992 |
$650.51 |
| 82150 |
|
146 |
125 |
$568.55 |
| 82043 |
|
149 |
137 |
$564.04 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
33 |
15 |
$517.30 |
| D0220 |
Intraoral - periapical first radiographic image |
688 |
580 |
$466.14 |
| J7050 |
Infusion, normal saline solution, 250 cc |
4,365 |
3,021 |
$456.70 |
| 86592 |
|
93 |
67 |
$376.12 |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
992 |
706 |
$369.59 |
| 85018 |
|
356 |
328 |
$359.10 |
| D0230 |
Intraoral - periapical each additional radiographic image |
612 |
524 |
$324.00 |
| 99238 |
Hospital discharge day management, 30 minutes or less |
18 |
13 |
$308.08 |
| 99217 |
|
26 |
26 |
$296.40 |
| 93018 |
|
59 |
56 |
$279.49 |
| 72170 |
|
13 |
12 |
$277.21 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
1,548 |
1,366 |
$226.45 |
| 93270 |
|
29 |
26 |
$224.27 |
| 82728 |
|
28 |
25 |
$183.00 |
| 72100 |
|
12 |
12 |
$170.34 |
| 90714 |
|
369 |
330 |
$157.93 |
| 82565 |
|
138 |
108 |
$125.43 |
| 82140 |
|
20 |
16 |
$100.31 |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
547 |
200 |
$88.90 |
| C9113 |
Injection, pantoprazole sodium, per vial |
734 |
522 |
$73.82 |
| 80069 |
|
18 |
12 |
$68.98 |
| 84460 |
|
17 |
14 |
$57.84 |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
286 |
214 |
$34.79 |
| J3370 |
Injection, vancomycin hcl, 500 mg |
461 |
210 |
$34.27 |
| L3650 |
Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf |
20 |
15 |
$28.76 |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
115 |
98 |
$25.78 |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
28 |
12 |
$24.00 |
| J2550 |
Injection, promethazine hcl, up to 50 mg |
30 |
21 |
$7.93 |
| G0238 |
Therapeutic procedures to improve respiratory function, other than described by g0237, one on one, face to face, per 15 minutes (includes monitoring) |
46 |
25 |
$5.95 |
| J2060 |
Injection, lorazepam, 2 mg |
48 |
36 |
$4.65 |
| J2919 |
Injection, methylprednisolone sodium succinate, 5 mg |
200 |
126 |
$3.35 |
| C1769 |
Guide wire |
597 |
510 |
$0.00 |
| A0888 |
Noncovered ambulance mileage, per mile (e.g., for miles traveled beyond closest appropriate facility) |
2,298 |
1,511 |
$0.00 |
| C1725 |
Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability) |
1,399 |
688 |
$0.00 |
| J1010 |
Injection, methylprednisolone acetate, 1 mg |
123 |
120 |
$0.00 |
| 86710 |
|
27 |
25 |
$0.00 |
| J2785 |
Injection, regadenoson, 0.1 mg |
233 |
212 |
$0.00 |
| A9579 |
Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (nos), per ml |
88 |
79 |
$0.00 |
| G8988 |
Self care functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting |
57 |
50 |
$0.00 |
| J1170 |
Injection, hydromorphone, up to 4 mg |
97 |
65 |
$0.00 |
| J2470 |
Injection, pantoprazole sodium, 40 mg |
58 |
43 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
67 |
63 |
$0.00 |
| 87430 |
|
13 |
13 |
$0.00 |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
49 |
43 |
$0.00 |
| J2543 |
Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams) |
18 |
13 |
$0.00 |
| G8987 |
Self care functional limitation, current status, at therapy episode outset and at reporting intervals |
15 |
12 |
$0.00 |
| J1644 |
Injection, heparin sodium, per 1000 units |
616 |
425 |
$0.00 |
| 76937 |
|
566 |
487 |
$0.00 |
| C1894 |
Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser |
598 |
511 |
$0.00 |
| G1004 |
Clinical decision support mechanism national decision support company, as defined by the medicare appropriate use criteria program |
795 |
655 |
$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 |
306 |
255 |
$0.00 |
| A9502 |
Technetium tc-99m tetrofosmin, diagnostic, per study dose |
291 |
268 |
$0.00 |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
1,509 |
1,080 |
$0.00 |
| 77002 |
|
115 |
97 |
$0.00 |
| 90662 |
|
17 |
16 |
$0.00 |
| G8978 |
Mobility: walking & moving around functional limitation, current status, at therapy episode outset and at reporting intervals |
223 |
194 |
$0.00 |
| J2710 |
Injection, neostigmine methylsulfate, up to 0.5 mg |
63 |
50 |
$0.00 |
| G0444 |
Annual depression screening, 5 to 15 minutes |
29 |
29 |
$0.00 |
| J0595 |
Injection, butorphanol tartrate, 1 mg |
42 |
27 |
$0.00 |
| 84112 |
|
14 |
12 |
$0.00 |
| J1650 |
Injection, enoxaparin sodium, 10 mg |
47 |
25 |
$0.00 |