Description - DE Medical Assistance Program

95953 TC 3 256.78
E0791 RR 3 257.13
77778 TC 3 258.85
88384 TC 3 258.95
78018 TC 3 258.99
93724 26 3 260.03
78588 TC 3 262.33
78635 TC 3 262.7
E1405 RR 5 263.04
93642 26 3 263.37
78223 TC 3 263.81
77285 TC 3 263.93
78195 TC 3 264.54
74160 TC 3 265.04
E0730 UE 3 265.88
78802 TC 3 266.02
78491 TC 3 268.45
78492 TC 3 268.45
78608 TC 3 268.45
78609 TC 3 268.45
78606 TC 3 268.98
78647 TC 3 268.98
E0668 UE 3 269.5
E1298 UE 3 274.02
93624 26 3 274.36
78709 TC 3 274.53
78650 TC 3 274.9
93529 26 3 275.49
E0958 UE 3 278.25
E0941 UE 3 278.4
78585 TC 3 278.59
78806 TC 3 278.59
E0462 RR 3 278.78
78630 TC 3 279.34
78206 TC 3 281.93