Description - DE Medical Assistance Program

95967 26 3 175.28
78701 TC 3 175.41
E1310 RR 3 175.72
93642 TC 3 175.78
78305 TC 3 176.89
75630 TC 3 177.76
77776 TC 3 178.12
78258 TC 3 179.48
75746 TC 3 179.61
75959 26 3 179.68
95811 26 3 179.78
78707 TC 3 180.22
75842 TC 3 181.09
75833 TC 3 181.46
78594 TC 3 182.81
75722 TC 3 182.94
K0005 RR 3 183.95
78710 TC 3 184.66
78190 TC 3 184.79
75658 TC 3 185.16
74150 TC 3 185.9
78320 TC 3 186.14
E0197 UE 3 186.21
75726 TC 3 186.27
78205 TC 3 186.51
75676 TC 3 187.01
75705 TC 3 187.01
75736 TC 3 187.01
75660 TC 3 187.38
75685 TC 3 187.38
72192 TC 3 187.75
95957 TC 3 188.48
75731 TC 3 188.86
70490 TC 3 189.23
75710 TC 3 189.23