|
33249
|
CDM
|
Aicd-auto Implant Cardio-defib
|
1
|
1
|
$55,000.00
|
$55,000.00
|
$48,400.00
|
$48,400.00
|
$48,400.00
|
2025-07-02
|
|
28725
|
CDM
|
Subtalar Arthodesis
|
1
|
1
|
$37,779.00
|
$37,779.00
|
$33,245.52
|
$33,245.52
|
$33,245.52
|
2025-07-02
|
|
33208
|
CDM
|
Insert Pacemaker Dual Chamber
|
1
|
1
|
$30,000.00
|
$30,000.00
|
$26,400.00
|
$26,400.00
|
$26,400.00
|
2025-07-02
|
|
37184
|
CDM
|
Percut Translu Thrombectomy
|
1
|
1
|
$29,730.00
|
$29,730.00
|
$26,162.40
|
$26,162.40
|
$26,162.40
|
2025-07-02
|
|
37244
|
CDM
|
Vasc Embol Art/ven Hemorrhage
|
1
|
1
|
$29,000.00
|
$29,000.00
|
$25,520.00
|
$25,520.00
|
$25,520.00
|
2025-07-02
|
|
92928
|
CDM
|
Perc Transcath Intracoron Angi
|
1
|
1
|
$29,000.00
|
$29,000.00
|
$25,520.00
|
$25,520.00
|
$25,520.00
|
2025-07-02
|
|
27590
|
CDM
|
Aka-above Knee Amputation
|
1
|
1
|
$27,500.00
|
$27,500.00
|
$24,200.00
|
$24,200.00
|
$24,200.00
|
2025-07-02
|
|
93460
|
CDM
|
Heart Cath W Rt And Lft Placem
|
1
|
1
|
$23,200.00
|
$23,200.00
|
$20,416.00
|
$20,416.00
|
$20,416.00
|
2025-07-02
|
|
PH008838
|
CDM
|
Alteplase Inj 100 Mg Vial
|
1
|
1
|
$21,838.05
|
$21,838.05
|
$19,217.48
|
$19,217.48
|
$19,217.48
|
2025-07-02
|
|
21620
|
CDM
|
Partial Removal Sternum
|
1
|
1
|
$18,795.00
|
$18,795.00
|
$16,539.60
|
$16,539.60
|
$16,539.60
|
2025-07-02
|
|
28415
|
CDM
|
Open Trt CALCANEAl Fx, Int Fix
|
1
|
1
|
$18,750.00
|
$18,750.00
|
$16,500.00
|
$16,500.00
|
$16,500.00
|
2025-07-02
|
|
36085015
|
CDM
|
Chole Tube Placement Ir (Gall)
|
1
|
1
|
$18,111.00
|
$18,111.00
|
$15,937.68
|
$15,937.68
|
$15,937.68
|
2025-07-02
|
|
21627
|
CDM
|
Sternal Debridement
|
1
|
1
|
$18,000.00
|
$18,000.00
|
$15,840.00
|
$15,840.00
|
$15,840.00
|
2025-07-02
|
|
37183
|
CDM
|
Tips Rev Trans Intrahep Shunt
|
1
|
1
|
$18,000.00
|
$18,000.00
|
$15,840.00
|
$15,840.00
|
$15,840.00
|
2025-07-02
|
|
37230
|
CDM
|
Revasculr, Translum Stent-angi
|
1
|
1
|
$15,000.00
|
$15,000.00
|
$13,200.00
|
$13,200.00
|
$13,200.00
|
2025-07-02
|
|
43635
|
CDM
|
Hemigastrect.subtot Gast
|
1
|
1
|
$14,500.00
|
$14,500.00
|
$12,760.00
|
$12,760.00
|
$12,760.00
|
2025-07-02
|
|
43405
|
CDM
|
Ligation Or Stap Gastroesophag
|
1
|
1
|
$14,500.00
|
$14,500.00
|
$12,760.00
|
$12,760.00
|
$12,760.00
|
2025-07-02
|
|
44227
|
CDM
|
Bypass Transver Colon To Cutan
|
1
|
1
|
$14,500.00
|
$14,500.00
|
$12,760.00
|
$12,760.00
|
$12,760.00
|
2025-07-02
|
|
28122
|
CDM
|
Par Exc. Bone; Tarsal Or Metat
|
1
|
1
|
$14,256.00
|
$14,256.00
|
$12,545.28
|
$12,545.28
|
$12,545.28
|
2025-07-02
|
|
37225
|
CDM
|
Revasc With Atherectomy. Angiopl
|
1
|
1
|
$14,000.00
|
$14,000.00
|
$12,320.00
|
$12,320.00
|
$12,320.00
|
2025-07-02
|
|
47556
|
CDM
|
Biliary Endo, Percutan T-tube
|
1
|
1
|
$13,785.00
|
$13,785.00
|
$12,130.80
|
$12,130.80
|
$12,130.80
|
2025-07-02
|
|
45347
|
CDM
|
Sigmoidoscopy, W Stent Insert
|
1
|
1
|
$13,500.00
|
$13,500.00
|
$11,880.00
|
$11,880.00
|
$11,880.00
|
2025-07-02
|
|
60200
|
CDM
|
Exc Of Cyst Or Adema Of Thyroi
|
1
|
1
|
$13,500.00
|
$13,500.00
|
$11,880.00
|
$11,880.00
|
$11,880.00
|
2025-07-02
|
|
43266
|
CDM
|
Egd W Stent Placement
|
1
|
1
|
$13,488.00
|
$13,488.00
|
$11,869.44
|
$11,869.44
|
$11,869.44
|
2025-07-02
|
|
37224
|
CDM
|
Angio, Fem Popliteal Artery Un
|
1
|
1
|
$13,420.00
|
$13,420.00
|
$11,809.60
|
$11,809.60
|
$11,809.60
|
2025-07-02
|
|
52601
|
CDM
|
Turp
|
1
|
1
|
$13,240.00
|
$13,240.00
|
$11,651.20
|
$11,651.20
|
$11,651.20
|
2025-07-02
|
|
27130
|
CDM
|
Hip Replacement
|
1
|
1
|
$13,000.00
|
$13,000.00
|
$11,440.00
|
$11,440.00
|
$11,440.00
|
2025-07-02
|
|
37226
|
CDM
|
Stent Plcmt, W Angioplas Femor
|
1
|
1
|
$12,500.00
|
$12,500.00
|
$11,000.00
|
$11,000.00
|
$11,000.00
|
2025-07-02
|
|
PHAR0250
|
CDM
|
Ritauxin
|
1
|
1
|
$12,495.00
|
$12,495.00
|
$10,995.60
|
$10,995.60
|
$10,995.60
|
2025-07-02
|
|
37221
|
CDM
|
Revascul, With Stent/angioplas
|
1
|
1
|
$12,000.00
|
$12,000.00
|
$10,560.00
|
$10,560.00
|
$10,560.00
|
2025-07-02
|
|
15830
|
CDM
|
Exc, Excess Skin-sub Tissue Ab
|
1
|
1
|
$12,000.00
|
$12,000.00
|
$10,560.00
|
$10,560.00
|
$10,560.00
|
2025-07-02
|
|
37205
|
CDM
|
Transcath Placement Of Stent
|
1
|
1
|
$12,000.00
|
$12,000.00
|
$10,560.00
|
$10,560.00
|
$10,560.00
|
2025-07-02
|
|
36058018
|
CDM
|
Chole Tube Placement Ir (Gall)
|
1
|
1
|
$12,000.00
|
$12,000.00
|
$10,560.00
|
$10,560.00
|
$10,560.00
|
2025-07-02
|
|
37220
|
CDM
|
Revascularization Lowe Extrem
|
1
|
1
|
$12,000.00
|
$12,000.00
|
$10,560.00
|
$10,560.00
|
$10,560.00
|
2025-07-02
|
|
35476
|
CDM
|
Trans Balloon Angioplasty
|
1
|
1
|
$11,570.00
|
$11,570.00
|
$10,181.60
|
$10,181.60
|
$10,181.60
|
2025-07-02
|
|
33228
|
CDM
|
Replace Pacemaker Generator
|
1
|
1
|
$11,051.00
|
$11,051.00
|
$9,724.88
|
$9,724.88
|
$9,724.88
|
2025-07-02
|
|
66180
|
CDM
|
Glau Shunt With Peri Patch Gra
|
1
|
1
|
$10,920.00
|
$10,920.00
|
$9,609.60
|
$9,609.60
|
$9,609.60
|
2025-07-02
|
|
43274
|
CDM
|
Endo Retro Cholangiopan Stent
|
1
|
1
|
$10,840.00
|
$10,840.00
|
$9,539.20
|
$9,539.20
|
$9,539.20
|
2025-07-02
|
|
52353
|
CDM
|
Cystoureth,w Lithotripsy
|
1
|
1
|
$10,452.00
|
$10,452.00
|
$9,197.76
|
$9,197.76
|
$9,197.76
|
2025-07-02
|
|
27880
|
CDM
|
Bka- Below Knee Amputation
|
1
|
1
|
$10,350.00
|
$10,350.00
|
$9,108.00
|
$9,108.00
|
$9,108.00
|
2025-07-02
|
|
27122
|
CDM
|
Resection Fem Head Girdlestone
|
1
|
1
|
$10,000.00
|
$10,000.00
|
$8,800.00
|
$8,800.00
|
$8,800.00
|
2025-07-02
|
|
43653
|
CDM
|
Gastrostomy Without Tube
|
1
|
1
|
$9,800.00
|
$9,800.00
|
$8,624.00
|
$8,624.00
|
$8,624.00
|
2025-07-02
|
|
49418
|
CDM
|
Insert Tun Peri Cath Wo Port
|
1
|
1
|
$9,327.00
|
$9,327.00
|
$8,207.76
|
$8,207.76
|
$8,207.76
|
2025-07-02
|
|
44180
|
CDM
|
Lap. Enterolysis Lysis Adh Int
|
1
|
1
|
$9,000.00
|
$9,000.00
|
$7,920.00
|
$7,920.00
|
$7,920.00
|
2025-07-02
|
|
44345
|
CDM
|
Revision Of Colostomy
|
1
|
1
|
$9,000.00
|
$9,000.00
|
$7,920.00
|
$7,920.00
|
$7,920.00
|
2025-07-02
|
|
54120
|
CDM
|
Partial Amputation Of Penis
|
1
|
1
|
$8,920.00
|
$8,920.00
|
$7,849.60
|
$7,849.60
|
$7,849.60
|
2025-07-02
|
|
PH009581
|
CDM
|
Digoxin Immune Fab
|
1
|
1
|
$8,909.67
|
$8,909.67
|
$7,840.51
|
$7,840.51
|
$7,840.51
|
2025-07-02
|
|
47500
|
CDM
|
Cholangiogram
|
1
|
1
|
$8,733.48
|
$8,733.48
|
$7,685.46
|
$7,685.46
|
$7,685.46
|
2025-07-02
|
|
27704
|
CDM
|
Removal Of Ankle Implant
|
1
|
1
|
$8,679.00
|
$8,679.00
|
$7,637.52
|
$7,637.52
|
$7,637.52
|
2025-07-02
|
|
35860
|
CDM
|
Expl Postop Hemor Extremity
|
1
|
1
|
$8,500.00
|
$8,500.00
|
$7,480.00
|
$7,480.00
|
$7,480.00
|
2025-07-02
|
|
27687
|
CDM
|
Gastrocnemius Recession
|
1
|
1
|
$8,500.00
|
$8,500.00
|
$7,480.00
|
$7,480.00
|
$7,480.00
|
2025-07-02
|
|
36831
|
CDM
|
Thrombectomy Open
|
1
|
1
|
$8,300.00
|
$8,300.00
|
$7,304.00
|
$7,304.00
|
$7,304.00
|
2025-07-02
|
|
PH001868
|
CDM
|
Aa 2.75%/callyts/d10 Sol 100
|
1
|
1
|
$8,096.16
|
$8,096.16
|
$7,124.62
|
$7,124.62
|
$7,124.62
|
2025-07-02
|
|
36821
|
CDM
|
Insert Of Cn For Dialysis Any
|
1
|
1
|
$8,000.00
|
$8,000.00
|
$7,040.00
|
$7,040.00
|
$7,040.00
|
2025-07-02
|
|
47562
|
CDM
|
Lap Cholecystectomy
|
1
|
1
|
$7,825.00
|
$7,825.00
|
$6,886.00
|
$6,886.00
|
$6,886.00
|
2025-07-02
|
|
49320
|
CDM
|
Laparoscopy, Abd Perineur
|
1
|
1
|
$7,700.00
|
$7,700.00
|
$6,776.00
|
$6,776.00
|
$6,776.00
|
2025-07-02
|
|
27886
|
CDM
|
Re-amputation - Leg Bk
|
1
|
1
|
$7,678.00
|
$7,678.00
|
$6,756.64
|
$6,756.64
|
$6,756.64
|
2025-07-02
|
|
36561
|
CDM
|
Insert Venous Access Dev W/por
|
1
|
1
|
$7,560.00
|
$7,560.00
|
$6,652.80
|
$6,652.80
|
$6,652.80
|
2025-07-02
|
|
35475
|
CDM
|
Balloon Angioplasty
|
1
|
1
|
$7,500.00
|
$7,500.00
|
$6,600.00
|
$6,600.00
|
$6,600.00
|
2025-07-02
|
|
62365
|
CDM
|
Removal Of Pump, Infusion
|
1
|
1
|
$7,500.00
|
$7,500.00
|
$6,600.00
|
$6,600.00
|
$6,600.00
|
2025-07-02
|
|
PH011740
|
CDM
|
Immune Globulin Premix 1 Gm/10
|
1
|
1
|
$7,436.25
|
$7,436.25
|
$6,543.90
|
$6,543.90
|
$6,543.90
|
2025-07-02
|
|
15273IH
|
CDM
|
Ap Sk Sub Tr/le/ue Up To 100sc
|
1
|
1
|
$7,210.00
|
$7,210.00
|
$6,344.80
|
$6,344.80
|
$6,344.80
|
2025-07-02
|
|
15277
|
CDM
|
Ap Sk Sub Fa/sc/ne 1st 100sqcm
|
1
|
1
|
$7,210.00
|
$7,210.00
|
$6,344.80
|
$6,344.80
|
$6,344.80
|
2025-07-02
|
|
15273
|
CDM
|
Ap Sk Sub Tr/le/ue Up To 100sc
|
1
|
1
|
$7,210.00
|
$7,210.00
|
$6,344.80
|
$6,344.80
|
$6,344.80
|
2025-07-02
|
|
15277IH
|
CDM
|
Ap Sk Sub Fa/sc/ne 1st 100sqcm
|
1
|
1
|
$7,210.00
|
$7,210.00
|
$6,344.80
|
$6,344.80
|
$6,344.80
|
2025-07-02
|
|
27598
|
CDM
|
Amputation At The Knee
|
1
|
1
|
$7,200.00
|
$7,200.00
|
$6,336.00
|
$6,336.00
|
$6,336.00
|
2025-07-02
|
|
20240
|
CDM
|
Biopsy, Bone Open, Superficial
|
1
|
1
|
$7,140.00
|
$7,140.00
|
$6,283.20
|
$6,283.20
|
$6,283.20
|
2025-07-02
|
|
28118
|
CDM
|
Ostectomy, Calcaneus
|
1
|
1
|
$7,127.00
|
$7,127.00
|
$6,271.76
|
$6,271.76
|
$6,271.76
|
2025-07-02
|
|
38222
|
CDM
|
Bone Marrow Biopsy & Aspiratio
|
1
|
1
|
$7,110.00
|
$7,110.00
|
$6,256.80
|
$6,256.80
|
$6,256.80
|
2025-07-02
|
|
19370
|
CDM
|
Open Peripr Capsulect Breast
|
1
|
1
|
$7,000.00
|
$7,000.00
|
$6,160.00
|
$6,160.00
|
$6,160.00
|
2025-07-02
|
|
36861
|
CDM
|
Ext Can/fistula Declot W Ballo
|
1
|
1
|
$7,000.00
|
$7,000.00
|
$6,160.00
|
$6,160.00
|
$6,160.00
|
2025-07-02
|
|
20680
|
CDM
|
Removal Of Hardware Hip
|
1
|
1
|
$7,000.00
|
$7,000.00
|
$6,160.00
|
$6,160.00
|
$6,160.00
|
2025-07-02
|
|
11006
|
CDM
|
Debride Genitalia
|
1
|
1
|
$7,000.00
|
$7,000.00
|
$6,160.00
|
$6,160.00
|
$6,160.00
|
2025-07-02
|
|
27596
|
CDM
|
Re- Amputation Knee
|
1
|
1
|
$7,000.00
|
$7,000.00
|
$6,160.00
|
$6,160.00
|
$6,160.00
|
2025-07-02
|
|
10140IH
|
CDM
|
I&d Hematoma Seroma Fluid Coll
|
1
|
1
|
$6,900.00
|
$6,900.00
|
$6,072.00
|
$6,072.00
|
$6,072.00
|
2025-07-02
|
|
10140
|
CDM
|
I&d Hematoma Seroma Fluid Coll
|
1
|
1
|
$6,900.00
|
$6,900.00
|
$6,072.00
|
$6,072.00
|
$6,072.00
|
2025-07-02
|
|
36565
|
CDM
|
Insert Venous Acc Dev 2sites N
|
1
|
1
|
$6,750.00
|
$6,750.00
|
$5,940.00
|
$5,940.00
|
$5,940.00
|
2025-07-02
|
|
38525
|
CDM
|
Biop / Exc Lymph Node Deep Axi
|
1
|
1
|
$6,700.00
|
$6,700.00
|
$5,896.00
|
$5,896.00
|
$5,896.00
|
2025-07-02
|
|
31820
|
CDM
|
Surg Closure Trach/fis Wo Plas
|
1
|
1
|
$6,600.00
|
$6,600.00
|
$5,808.00
|
$5,808.00
|
$5,808.00
|
2025-07-02
|
|
27610
|
CDM
|
Arthrotomy Ankle
|
1
|
1
|
$6,500.00
|
$6,500.00
|
$5,720.00
|
$5,720.00
|
$5,720.00
|
2025-07-02
|
|
35840
|
CDM
|
Explor Postop Hemorrhage
|
1
|
1
|
$6,500.00
|
$6,500.00
|
$5,720.00
|
$5,720.00
|
$5,720.00
|
2025-07-02
|
|
27310
|
CDM
|
Arthrotomy Knee
|
1
|
1
|
$6,500.00
|
$6,500.00
|
$5,720.00
|
$5,720.00
|
$5,720.00
|
2025-07-02
|
|
35556
|
CDM
|
Bypass Graft, Fem-pop
|
1
|
1
|
$6,500.00
|
$6,500.00
|
$5,720.00
|
$5,720.00
|
$5,720.00
|
2025-07-02
|
|
20692
|
CDM
|
Insert External Fixation Syste
|
1
|
1
|
$6,425.00
|
$6,425.00
|
$5,654.00
|
$5,654.00
|
$5,654.00
|
2025-07-02
|
|
PH001408
|
CDM
|
Hydrocortisone 2.5% Crm 1 Hy
|
1
|
1
|
$6,045.96
|
$6,045.96
|
$5,320.44
|
$5,320.44
|
$5,320.44
|
2025-07-02
|
|
44204
|
CDM
|
Lap Colectomy, Partial
|
1
|
1
|
$6,000.00
|
$6,000.00
|
$5,280.00
|
$5,280.00
|
$5,280.00
|
2025-07-02
|
|
47532
|
CDM
|
Perc Transher Cholangiogram
|
1
|
1
|
$6,000.00
|
$6,000.00
|
$5,280.00
|
$5,280.00
|
$5,280.00
|
2025-07-02
|
|
36475
|
CDM
|
Ablation Of Incom Vein, Extrem
|
1
|
1
|
$6,000.00
|
$6,000.00
|
$5,280.00
|
$5,280.00
|
$5,280.00
|
2025-07-02
|
|
92980
|
CDM
|
Stent/trans Cath Placement
|
1
|
1
|
$6,000.00
|
$6,000.00
|
$5,280.00
|
$5,280.00
|
$5,280.00
|
2025-07-02
|
|
37765
|
CDM
|
Stab Phlebectomy Of Var Vein E
|
1
|
1
|
$6,000.00
|
$6,000.00
|
$5,280.00
|
$5,280.00
|
$5,280.00
|
2025-07-02
|
|
50395
|
CDM
|
Placement Nephrostomy Tube
|
1
|
1
|
$6,000.00
|
$6,000.00
|
$5,280.00
|
$5,280.00
|
$5,280.00
|
2025-07-02
|
|
33227
|
CDM
|
Rem/rep Pacemaker Generator
|
1
|
1
|
$6,000.00
|
$6,000.00
|
$5,280.00
|
$5,280.00
|
$5,280.00
|
2025-07-02
|
|
14040
|
CDM
|
Adj Tissue Transfer 10 Cm /les
|
1
|
1
|
$5,750.00
|
$5,750.00
|
$5,060.00
|
$5,060.00
|
$5,060.00
|
2025-07-02
|
|
74178
|
CDM
|
CT Abdomen/Pelvis
|
1
|
1
|
$5,562.00
|
$5,562.00
|
$4,894.56
|
$4,894.56
|
$4,894.56
|
2025-07-02
|
|
31603
|
CDM
|
Tracheostomy Emergent
|
1
|
1
|
$5,500.00
|
$5,500.00
|
$4,840.00
|
$4,840.00
|
$4,840.00
|
2025-07-02
|
|
27331
|
CDM
|
Arthrotomy, Exc, Exp Removal
|
1
|
1
|
$5,500.00
|
$5,500.00
|
$4,840.00
|
$4,840.00
|
$4,840.00
|
2025-07-02
|
|
36558
|
CDM
|
Insert Venous Cath N/port Pump
|
1
|
1
|
$5,400.00
|
$5,400.00
|
$4,752.00
|
$4,752.00
|
$4,752.00
|
2025-07-02
|
|
36571
|
CDM
|
Insert Of Vascular Access Dev
|
1
|
1
|
$5,400.00
|
$5,400.00
|
$4,752.00
|
$4,752.00
|
$4,752.00
|
2025-07-02
|
|
36478
|
CDM
|
Endovenous Ablation Therapy
|
1
|
1
|
$5,373.00
|
$5,373.00
|
$4,728.24
|
$4,728.24
|
$4,728.24
|
2025-07-02
|
|
11450
|
CDM
|
Exc Skin /subc Tiss Simple Axi
|
1
|
1
|
$5,300.00
|
$5,300.00
|
$4,664.00
|
$4,664.00
|
$4,664.00
|
2025-07-02
|
|
11451
|
CDM
|
Exc Of Skin/subcu Tis Complex
|
1
|
1
|
$5,300.00
|
$5,300.00
|
$4,664.00
|
$4,664.00
|
$4,664.00
|
2025-07-02
|
|
28140
|
CDM
|
Metatarsectomy
|
1
|
1
|
$5,200.00
|
$5,200.00
|
$4,576.00
|
$4,576.00
|
$4,576.00
|
2025-07-02
|
|
28805
|
CDM
|
Amputation, Foot, Transmetatar
|
1
|
1
|
$5,175.00
|
$5,175.00
|
$4,554.00
|
$4,554.00
|
$4,554.00
|
2025-07-02
|
|
13160
|
CDM
|
Secondary Closure Wound/dehis
|
1
|
1
|
$5,160.00
|
$5,160.00
|
$4,540.80
|
$4,540.80
|
$4,540.80
|
2025-07-02
|
|
28120
|
CDM
|
Partial Exc Bone, Talus Or Cal
|
1
|
1
|
$5,160.00
|
$5,160.00
|
$4,540.80
|
$4,540.80
|
$4,540.80
|
2025-07-02
|
|
52317
|
CDM
|
Litholapaxy, Simple Or Small
|
1
|
1
|
$5,100.00
|
$5,100.00
|
$4,488.00
|
$4,488.00
|
$4,488.00
|
2025-07-02
|
|
44208
|
CDM
|
Lap Loop Colostomy
|
1
|
1
|
$5,000.00
|
$5,000.00
|
$4,400.00
|
$4,400.00
|
$4,400.00
|
2025-07-02
|
|
50040
|
CDM
|
Nephrostomy,w Drainage
|
1
|
1
|
$5,000.00
|
$5,000.00
|
$4,400.00
|
$4,400.00
|
$4,400.00
|
2025-07-02
|
|
43239
|
CDM
|
Upper Gi Endoscopy W/biopsy
|
1
|
1
|
$5,000.00
|
$5,000.00
|
$4,400.00
|
$4,400.00
|
$4,400.00
|
2025-07-02
|
|
31600
|
CDM
|
Tracheostomy Planned
|
1
|
1
|
$5,000.00
|
$5,000.00
|
$4,400.00
|
$4,400.00
|
$4,400.00
|
2025-07-02
|
|
36901
|
CDM
|
Fistulagram
|
1
|
1
|
$5,000.00
|
$5,000.00
|
$4,400.00
|
$4,400.00
|
$4,400.00
|
2025-07-02
|
|
44360
|
CDM
|
Small Bowel Endoscopy
|
1
|
1
|
$4,977.00
|
$4,977.00
|
$4,379.76
|
$4,379.76
|
$4,379.76
|
2025-07-02
|
|
PH006274
|
CDM
|
Acyclovir Sodium 50 Mg
|
1
|
1
|
$4,902.00
|
$4,902.00
|
$4,313.76
|
$4,313.76
|
$4,313.76
|
2025-07-02
|
|
58120
|
CDM
|
D&c Diag/ther.
|
1
|
1
|
$4,900.00
|
$4,900.00
|
$4,312.00
|
$4,312.00
|
$4,312.00
|
2025-07-02
|
|
36581
|
CDM
|
Replace Venous Cath No Port Pu
|
1
|
1
|
$4,860.00
|
$4,860.00
|
$4,276.80
|
$4,276.80
|
$4,276.80
|
2025-07-02
|
|
95811
|
CDM
|
Polysomnography W/cpap Titrati
|
1
|
1
|
$4,860.00
|
$4,860.00
|
$4,276.80
|
$4,276.80
|
$4,276.80
|
2025-07-02
|
|
PH013524
|
CDM
|
Prolia Sol 60mg/ml
|
1
|
1
|
$4,837.89
|
$4,837.89
|
$4,257.34
|
$4,257.34
|
$4,257.34
|
2025-07-02
|
|
15922
|
CDM
|
Exc Coccy Pres Ulcer Wi/ Flap
|
1
|
1
|
$4,800.00
|
$4,800.00
|
$4,224.00
|
$4,224.00
|
$4,224.00
|
2025-07-02
|
|
19020
|
CDM
|
Mastotomy W/exp Or Drain Abces
|
1
|
1
|
$4,773.00
|
$4,773.00
|
$4,200.24
|
$4,200.24
|
$4,200.24
|
2025-07-02
|
|
15946
|
CDM
|
Exc., Ischial Pr Ulcer. Ostect
|
1
|
1
|
$4,762.00
|
$4,762.00
|
$4,190.56
|
$4,190.56
|
$4,190.56
|
2025-07-02
|
|
75860
|
CDM
|
Venography,sinus/jugular Cath
|
1
|
1
|
$4,758.00
|
$4,758.00
|
$4,187.04
|
$4,187.04
|
$4,187.04
|
2025-07-02
|
|
52281
|
CDM
|
Cystourethroscopy
|
1
|
1
|
$4,729.00
|
$4,729.00
|
$4,161.52
|
$4,161.52
|
$4,161.52
|
2025-07-02
|
|
43255
|
CDM
|
Upper Endo Control Bleeding
|
1
|
1
|
$4,700.00
|
$4,700.00
|
$4,136.00
|
$4,136.00
|
$4,136.00
|
2025-07-02
|
|
PH001739
|
CDM
|
Nitroglycerin Patch Pat 1 Ni
|
1
|
1
|
$4,699.17
|
$4,699.17
|
$4,135.27
|
$4,135.27
|
$4,135.27
|
2025-07-02
|
|
PH012618
|
CDM
|
Miacalcin Inj 200/ml
|
1
|
1
|
$4,666.47
|
$4,666.47
|
$4,106.49
|
$4,106.49
|
$4,106.49
|
2025-07-02
|
|
43760
|
CDM
|
Peg Replacement
|
1
|
1
|
$4,600.00
|
$4,600.00
|
$4,048.00
|
$4,048.00
|
$4,048.00
|
2025-07-02
|
|
29871
|
CDM
|
Arthrosopy, Knee Lav Drainage
|
1
|
1
|
$4,500.00
|
$4,500.00
|
$3,960.00
|
$3,960.00
|
$3,960.00
|
2025-07-02
|
|
28825
|
CDM
|
Amputation Toe Interphalangeal
|
1
|
1
|
$4,500.00
|
$4,500.00
|
$3,960.00
|
$3,960.00
|
$3,960.00
|
2025-07-02
|
|
49419
|
CDM
|
Insert Tun Peri Cath W Port
|
1
|
1
|
$4,500.00
|
$4,500.00
|
$3,960.00
|
$3,960.00
|
$3,960.00
|
2025-07-02
|
|
49904
|
CDM
|
Omental Flap Abd
|
1
|
1
|
$4,500.00
|
$4,500.00
|
$3,960.00
|
$3,960.00
|
$3,960.00
|
2025-07-02
|
|
95810
|
CDM
|
Polysomnography, 4/+ Add Param
|
1
|
1
|
$4,455.00
|
$4,455.00
|
$3,920.40
|
$3,920.40
|
$3,920.40
|
2025-07-02
|
|
206940
|
CDM
|
Removal Of External Fixation S
|
1
|
1
|
$4,452.00
|
$4,452.00
|
$3,917.76
|
$3,917.76
|
$3,917.76
|
2025-07-02
|
|
20694
|
CDM
|
Removal Of External Fixation
|
1
|
1
|
$4,452.00
|
$4,452.00
|
$3,917.76
|
$3,917.76
|
$3,917.76
|
2025-07-02
|
|
20693
|
CDM
|
Revision Of External Fixation
|
1
|
1
|
$4,452.00
|
$4,452.00
|
$3,917.76
|
$3,917.76
|
$3,917.76
|
2025-07-02
|
|
75635
|
CDM
|
CTA Abd Aorta W/runoff
|
1
|
1
|
$4,400.00
|
$4,400.00
|
$3,872.00
|
$3,872.00
|
$3,872.00
|
2025-07-02
|
|
36555
|
CDM
|
Insert Tunnel Cv Cath
|
1
|
1
|
$4,400.00
|
$4,400.00
|
$3,872.00
|
$3,872.00
|
$3,872.00
|
2025-07-02
|
|
28003
|
CDM
|
I&d Below Fascia Toes, Multipl
|
1
|
1
|
$4,365.00
|
$4,365.00
|
$3,841.20
|
$3,841.20
|
$3,841.20
|
2025-07-02
|
|
28003IH
|
CDM
|
I&d Below Fascia Toes Multiple
|
1
|
1
|
$4,365.00
|
$4,365.00
|
$3,841.20
|
$3,841.20
|
$3,841.20
|
2025-07-02
|
|
15002IH
|
CDM
|
Prep/graft Debrid Skin 1st 100
|
1
|
1
|
$4,359.99
|
$4,359.99
|
$3,836.79
|
$3,836.79
|
$3,836.79
|
2025-07-02
|
|
15002
|
CDM
|
Prep/graft Debrid Skin 1st 100
|
1
|
1
|
$4,359.99
|
$4,359.99
|
$3,836.79
|
$3,836.79
|
$3,836.79
|
2025-07-02
|
|
49405
|
CDM
|
Image Guide Fluid Drain-cath
|
1
|
1
|
$4,311.00
|
$4,311.00
|
$3,793.68
|
$3,793.68
|
$3,793.68
|
2025-07-02
|
|
15003IH
|
CDM
|
Pre/graft Debrid Skin Add 100
|
1
|
1
|
$4,300.00
|
$4,300.00
|
$3,784.00
|
$3,784.00
|
$3,784.00
|
2025-07-02
|
|
49424
|
CDM
|
Contrast Inj Asses Abscess/cys
|
1
|
1
|
$4,300.00
|
$4,300.00
|
$3,784.00
|
$3,784.00
|
$3,784.00
|
2025-07-02
|
|
15120IH
|
CDM
|
St Autogr Fa/sc/ne/h/f 100sqcm
|
1
|
1
|
$4,243.84
|
$4,243.84
|
$3,734.58
|
$3,734.58
|
$3,734.58
|
2025-07-02
|
|
15100
|
CDM
|
Sp Th Autogr Tr/ue/le 100 Sqcm
|
1
|
1
|
$4,243.84
|
$4,243.84
|
$3,734.58
|
$3,734.58
|
$3,734.58
|
2025-07-02
|
|
15120
|
CDM
|
St Autogr Fa/sc/ne/h/f 100sqcm
|
1
|
1
|
$4,243.84
|
$4,243.84
|
$3,734.58
|
$3,734.58
|
$3,734.58
|
2025-07-02
|
|
15100IH
|
CDM
|
Sp Th Autogr Tr/ue/le 100 Sqcm
|
1
|
1
|
$4,243.84
|
$4,243.84
|
$3,734.58
|
$3,734.58
|
$3,734.58
|
2025-07-02
|
|
15240IH
|
CDM
|
Fu Th Autogr Fh/ch/ne 20sqcm
|
1
|
1
|
$4,243.84
|
$4,243.84
|
$3,734.58
|
$3,734.58
|
$3,734.58
|
2025-07-02
|
|
15240
|
CDM
|
Fu Th Autogr Fh,ch,ne 20sqcm
|
1
|
1
|
$4,243.84
|
$4,243.84
|
$3,734.58
|
$3,734.58
|
$3,734.58
|
2025-07-02
|
|
15220IH
|
CDM
|
Fu Th Autogr Sc/ue/le 20sqcm
|
1
|
1
|
$4,243.84
|
$4,243.84
|
$3,734.58
|
$3,734.58
|
$3,734.58
|
2025-07-02
|
|
15220
|
CDM
|
Fu Th Autogr Sc/ue/le 20sqcm
|
1
|
1
|
$4,243.84
|
$4,243.84
|
$3,734.58
|
$3,734.58
|
$3,734.58
|
2025-07-02
|
|
15200IH
|
CDM
|
Fu Th Autogr Tr 20sqcm Or Less
|
1
|
1
|
$4,243.84
|
$4,243.84
|
$3,734.58
|
$3,734.58
|
$3,734.58
|
2025-07-02
|
|
15200
|
CDM
|
Fu Th Autogr Tr 20sqcm Or Less
|
1
|
1
|
$4,243.84
|
$4,243.84
|
$3,734.58
|
$3,734.58
|
$3,734.58
|
2025-07-02
|
|
20225
|
CDM
|
Biopsy Deep Bone Troc Needle
|
1
|
1
|
$4,242.00
|
$4,242.00
|
$3,732.96
|
$3,732.96
|
$3,732.96
|
2025-07-02
|
|
20225IH
|
CDM
|
Biopsy Deep Bone Troc Needle
|
1
|
1
|
$4,242.00
|
$4,242.00
|
$3,732.96
|
$3,732.96
|
$3,732.96
|
2025-07-02
|
|
15003
|
CDM
|
Prep/graft Debrid Skin Add 100
|
1
|
1
|
$4,233.00
|
$4,233.00
|
$3,725.04
|
$3,725.04
|
$3,725.04
|
2025-07-02
|
|
49407
|
CDM
|
Image Guid Drain Transvag/rect
|
1
|
1
|
$4,130.00
|
$4,130.00
|
$3,634.40
|
$3,634.40
|
$3,634.40
|
2025-07-02
|
|
62269
|
CDM
|
Needle Biopsy Spinal Cord
|
1
|
1
|
$4,126.00
|
$4,126.00
|
$3,630.88
|
$3,630.88
|
$3,630.88
|
2025-07-02
|
|
78813
|
CDM
|
PET Scan
|
1
|
1
|
$4,120.00
|
$4,120.00
|
$3,625.60
|
$3,625.60
|
$3,625.60
|
2025-07-02
|
|
78315
|
CDM
|
Bone Imaging 3 Phase
|
1
|
1
|
$4,120.00
|
$4,120.00
|
$3,625.60
|
$3,625.60
|
$3,625.60
|
2025-07-02
|
|
15275IH
|
CDM
|
Ap Sk Sub Fa/sc/ne Up To 100sq
|
1
|
1
|
$4,120.00
|
$4,120.00
|
$3,625.60
|
$3,625.60
|
$3,625.60
|
2025-07-02
|
|
15275
|
CDM
|
Ap Sk Sub Fa/sc/ne Up To 100sq
|
1
|
1
|
$4,120.00
|
$4,120.00
|
$3,625.60
|
$3,625.60
|
$3,625.60
|
2025-07-02
|
|
15271IH
|
CDM
|
Ap Sk Sub Tr/le/ue 20sc To 100
|
1
|
1
|
$4,120.00
|
$4,120.00
|
$3,625.60
|
$3,625.60
|
$3,625.60
|
2025-07-02
|
|
15271
|
CDM
|
Ap Sk Sub/tr/le/ue 20sc To 100
|
1
|
1
|
$4,120.00
|
$4,120.00
|
$3,625.60
|
$3,625.60
|
$3,625.60
|
2025-07-02
|
|
95805
|
CDM
|
Multiple Sleep Latency Test
|
1
|
1
|
$4,050.00
|
$4,050.00
|
$3,564.00
|
$3,564.00
|
$3,564.00
|
2025-07-02
|
|
35800
|
CDM
|
Explor For Hemorrhage Neck
|
1
|
1
|
$4,000.00
|
$4,000.00
|
$3,520.00
|
$3,520.00
|
$3,520.00
|
2025-07-02
|
|
37232
|
CDM
|
Angioplas, Tib/per Ar Ea Add V
|
1
|
1
|
$4,000.00
|
$4,000.00
|
$3,520.00
|
$3,520.00
|
$3,520.00
|
2025-07-02
|
|
44202
|
CDM
|
Lap Enterectomy Resect Intesti
|
1
|
1
|
$4,000.00
|
$4,000.00
|
$3,520.00
|
$3,520.00
|
$3,520.00
|
2025-07-02
|
|
37233
|
CDM
|
Angioplas-tib/per W/ather Addi
|
1
|
1
|
$4,000.00
|
$4,000.00
|
$3,520.00
|
$3,520.00
|
$3,520.00
|
2025-07-02
|
|
37191
|
CDM
|
Insert Intra Vencav Filter-gf
|
1
|
1
|
$4,000.00
|
$4,000.00
|
$3,520.00
|
$3,520.00
|
$3,520.00
|
2025-07-02
|
|
37229
|
CDM
|
Angioplasty Tib/per W Atherect
|
1
|
1
|
$4,000.00
|
$4,000.00
|
$3,520.00
|
$3,520.00
|
$3,520.00
|
2025-07-02
|
|
43247
|
CDM
|
Upper Gi-endosc Rem For. Body
|
1
|
1
|
$4,000.00
|
$4,000.00
|
$3,520.00
|
$3,520.00
|
$3,520.00
|
2025-07-02
|
|
75825
|
CDM
|
Venography, Vena Cava
|
1
|
1
|
$4,000.00
|
$4,000.00
|
$3,520.00
|
$3,520.00
|
$3,520.00
|
2025-07-02
|
|
45380
|
CDM
|
Colonoscopy W/biopsy
|
1
|
1
|
$4,000.00
|
$4,000.00
|
$3,520.00
|
$3,520.00
|
$3,520.00
|
2025-07-02
|
|
43248
|
CDM
|
Upper Gi Endos W Guidewire
|
1
|
1
|
$4,000.00
|
$4,000.00
|
$3,520.00
|
$3,520.00
|
$3,520.00
|
2025-07-02
|
|
35820
|
CDM
|
Explor For Hemmorr-chest
|
1
|
1
|
$4,000.00
|
$4,000.00
|
$3,520.00
|
$3,520.00
|
$3,520.00
|
2025-07-02
|
|
37228
|
CDM
|
Angioplasty, Tib/per Art In Ve
|
1
|
1
|
$4,000.00
|
$4,000.00
|
$3,520.00
|
$3,520.00
|
$3,520.00
|
2025-07-02
|
|
49021
|
CDM
|
Drainage Of Periton Abcess Per
|
1
|
1
|
$3,900.00
|
$3,900.00
|
$3,432.00
|
$3,432.00
|
$3,432.00
|
2025-07-02
|
|
47011
|
CDM
|
Hepatotomy, Percut Drain Abces
|
1
|
1
|
$3,900.00
|
$3,900.00
|
$3,432.00
|
$3,432.00
|
$3,432.00
|
2025-07-02
|
|
PH003874
|
CDM
|
Tracleer 62.5 Mg Tablet
|
1
|
1
|
$3,833.16
|
$3,833.16
|
$3,373.18
|
$3,373.18
|
$3,373.18
|
2025-07-02
|
|
46255
|
CDM
|
Hemorrhoidectomy, Int/ext Sing
|
1
|
1
|
$3,800.00
|
$3,800.00
|
$3,344.00
|
$3,344.00
|
$3,344.00
|
2025-07-02
|
|
43820
|
CDM
|
Gastrojejunostomy
|
1
|
1
|
$3,800.00
|
$3,800.00
|
$3,344.00
|
$3,344.00
|
$3,344.00
|
2025-07-02
|
|
PH012727
|
CDM
|
Darbepoetin Alfa Vl 300mcg A
|
1
|
1
|
$3,776.34
|
$3,776.34
|
$3,323.18
|
$3,323.18
|
$3,323.18
|
2025-07-02
|
|
27603
|
CDM
|
I&d , Leg Or Ankle
|
1
|
1
|
$3,773.00
|
$3,773.00
|
$3,320.24
|
$3,320.24
|
$3,320.24
|
2025-07-02
|
|
PH001823
|
CDM
|
Hydrocortisone Ont 1 Hydro
|
1
|
1
|
$3,763.44
|
$3,763.44
|
$3,311.83
|
$3,311.83
|
$3,311.83
|
2025-07-02
|
|
PH007955
|
CDM
|
Vancomycin Cap 250mg Vanco
|
1
|
1
|
$3,644.82
|
$3,644.82
|
$3,207.44
|
$3,207.44
|
$3,207.44
|
2025-07-02
|
|
15999
|
CDM
|
Excision Pressure Ulcer
|
1
|
1
|
$3,600.00
|
$3,600.00
|
$3,168.00
|
$3,168.00
|
$3,168.00
|
2025-07-02
|
|
32551
|
CDM
|
Insert Chest Tube A/o Drainage
|
1
|
1
|
$3,600.00
|
$3,600.00
|
$3,168.00
|
$3,168.00
|
$3,168.00
|
2025-07-02
|
|
75724
|
CDM
|
Angio, Renal, Bil, Sel W/Aorto
|
1
|
1
|
$3,600.00
|
$3,600.00
|
$3,168.00
|
$3,168.00
|
$3,168.00
|
2025-07-02
|
|
26160
|
CDM
|
Exc Of Lesion Of Tendon Or Joi
|
1
|
1
|
$3,600.00
|
$3,600.00
|
$3,168.00
|
$3,168.00
|
$3,168.00
|
2025-07-02
|
|
27884
|
CDM
|
Amputation, Scar Rev Sec Closu
|
1
|
1
|
$3,600.00
|
$3,600.00
|
$3,168.00
|
$3,168.00
|
$3,168.00
|
2025-07-02
|
|
PH005700
|
CDM
|
Enalapril Maleate 10 Mg
|
1
|
1
|
$3,542.19
|
$3,542.19
|
$3,117.13
|
$3,117.13
|
$3,117.13
|
2025-07-02
|
|
75733
|
CDM
|
Angio, Adrenal, Bil, Sel
|
1
|
1
|
$3,540.00
|
$3,540.00
|
$3,115.20
|
$3,115.20
|
$3,115.20
|
2025-07-02
|
|
7001
|
CDM
|
Noxafil 4 Oz
|
1
|
1
|
$3,510.00
|
$3,510.00
|
$3,088.80
|
$3,088.80
|
$3,088.80
|
2025-07-02
|
|
19301
|
CDM
|
Lumpectomy,partial Mastectomy
|
1
|
1
|
$3,500.00
|
$3,500.00
|
$3,080.00
|
$3,080.00
|
$3,080.00
|
2025-07-02
|
|
54415
|
CDM
|
Rem Penile Prosth Inf/non Infl
|
1
|
1
|
$3,500.00
|
$3,500.00
|
$3,080.00
|
$3,080.00
|
$3,080.00
|
2025-07-02
|
|
69436
|
CDM
|
Tympanostomy With Tube Insert
|
1
|
1
|
$3,500.00
|
$3,500.00
|
$3,080.00
|
$3,080.00
|
$3,080.00
|
2025-07-02
|
|
36245
|
CDM
|
Sel Cath Plc Arterial
|
1
|
1
|
$3,500.00
|
$3,500.00
|
$3,080.00
|
$3,080.00
|
$3,080.00
|
2025-07-02
|
|
52332
|
CDM
|
Cystourethroscopy W Stent Plac
|
1
|
1
|
$3,500.00
|
$3,500.00
|
$3,080.00
|
$3,080.00
|
$3,080.00
|
2025-07-02
|
|
44120
|
CDM
|
Enterectomy, Resec Sm Intestin
|
1
|
1
|
$3,500.00
|
$3,500.00
|
$3,080.00
|
$3,080.00
|
$3,080.00
|
2025-07-02
|
|
27266
|
CDM
|
Closed Treat Of Post Hip Arthr
|
1
|
1
|
$3,500.00
|
$3,500.00
|
$3,080.00
|
$3,080.00
|
$3,080.00
|
2025-07-02
|
|
11960
|
CDM
|
Inser Tissue-expander
|
1
|
1
|
$3,475.00
|
$3,475.00
|
$3,058.00
|
$3,058.00
|
$3,058.00
|
2025-07-02
|
|
28820
|
CDM
|
Amputation Of Toe
|
1
|
1
|
$3,450.00
|
$3,450.00
|
$3,036.00
|
$3,036.00
|
$3,036.00
|
2025-07-02
|
|
28810
|
CDM
|
Amputation, Metatarsal, W Toe
|
1
|
1
|
$3,450.00
|
$3,450.00
|
$3,036.00
|
$3,036.00
|
$3,036.00
|
2025-07-02
|
|
26952
|
CDM
|
Amputation Of Finger
|
1
|
1
|
$3,450.00
|
$3,450.00
|
$3,036.00
|
$3,036.00
|
$3,036.00
|
2025-07-02
|
|
25931
|
CDM
|
Reamputation Of Index Finger
|
1
|
1
|
$3,450.00
|
$3,450.00
|
$3,036.00
|
$3,036.00
|
$3,036.00
|
2025-07-02
|
|
75716
|
CDM
|
Angio, Extremity, Bil
|
1
|
1
|
$3,400.00
|
$3,400.00
|
$2,992.00
|
$2,992.00
|
$2,992.00
|
2025-07-02
|
|
46615
|
CDM
|
Endo Polypectomy
|
1
|
1
|
$3,300.00
|
$3,300.00
|
$2,904.00
|
$2,904.00
|
$2,904.00
|
2025-07-02
|
|
31624
|
CDM
|
Bronchoscopy W Lavage
|
1
|
1
|
$3,115.00
|
$3,115.00
|
$2,741.20
|
$2,741.20
|
$2,741.20
|
2025-07-02
|
|
PH012365
|
CDM
|
Mycophenolate Mofet. Sus 250
|
1
|
1
|
$3,092.85
|
$3,092.85
|
$2,721.71
|
$2,721.71
|
$2,721.71
|
2025-07-02
|
|
PH007036
|
CDM
|
carBAMazepine
|
1
|
1
|
$3,072.78
|
$3,072.78
|
$2,704.05
|
$2,704.05
|
$2,704.05
|
2025-07-02
|
|
49440
|
CDM
|
Placement Of Gastro Tube
|
1
|
1
|
$3,052.00
|
$3,052.00
|
$2,685.76
|
$2,685.76
|
$2,685.76
|
2025-07-02
|
|
35036000
|
CDM
|
Lower Extremity W/Contrast
|
1
|
1
|
$3,004.00
|
$3,004.00
|
$2,643.52
|
$2,643.52
|
$2,643.52
|
2025-07-02
|
|
PH006964
|
CDM
|
rOPINIRole Hcl
|
1
|
1
|
$3,003.15
|
$3,003.15
|
$2,642.77
|
$2,642.77
|
$2,642.77
|
2025-07-02
|
|
37211
|
CDM
|
Transcath Ther, Arter Infusion
|
1
|
1
|
$3,000.00
|
$3,000.00
|
$2,640.00
|
$2,640.00
|
$2,640.00
|
2025-07-02
|
|
51102
|
CDM
|
Asp Of Bladder, Suprapub Cath
|
1
|
1
|
$3,000.00
|
$3,000.00
|
$2,640.00
|
$2,640.00
|
$2,640.00
|
2025-07-02
|
|
54161
|
CDM
|
Circumcision, Older Than 28
|
1
|
1
|
$3,000.00
|
$3,000.00
|
$2,640.00
|
$2,640.00
|
$2,640.00
|
2025-07-02
|
|
15937
|
CDM
|
Exc. Sacral Pres Ulcer Ostecto
|
1
|
1
|
$3,000.00
|
$3,000.00
|
$2,640.00
|
$2,640.00
|
$2,640.00
|
2025-07-02
|
|
31525
|
CDM
|
Laryngoscopy Direct
|
1
|
1
|
$3,000.00
|
$3,000.00
|
$2,640.00
|
$2,640.00
|
$2,640.00
|
2025-07-02
|
|
63267
|
CDM
|
Laminectomy Excision Or Eval
|
1
|
1
|
$3,000.00
|
$3,000.00
|
$2,640.00
|
$2,640.00
|
$2,640.00
|
2025-07-02
|
|
36905
|
CDM
|
Perc Translum Thrombectomy
|
1
|
1
|
$3,000.00
|
$3,000.00
|
$2,640.00
|
$2,640.00
|
$2,640.00
|
2025-07-02
|
|
11971
|
CDM
|
Remo Of Tissue Expander
|
1
|
1
|
$2,975.00
|
$2,975.00
|
$2,618.00
|
$2,618.00
|
$2,618.00
|
2025-07-02
|
|
45332
|
CDM
|
Sigmoidoscopy, Rem Foreign Bod
|
1
|
1
|
$2,940.00
|
$2,940.00
|
$2,587.20
|
$2,587.20
|
$2,587.20
|
2025-07-02
|
|
11752
|
CDM
|
Amput.finger Tip -nail Removal
|
1
|
1
|
$2,875.00
|
$2,875.00
|
$2,530.00
|
$2,530.00
|
$2,530.00
|
2025-07-02
|
|
20999
|
CDM
|
Sacral Debridement
|
1
|
1
|
$2,875.00
|
$2,875.00
|
$2,530.00
|
$2,530.00
|
$2,530.00
|
2025-07-02
|
|
PH001032
|
CDM
|
Valproic Acid Syr 250mg Depa
|
1
|
1
|
$2,857.65
|
$2,857.65
|
$2,514.73
|
$2,514.73
|
$2,514.73
|
2025-07-02
|
|
28001IH
|
CDM
|
I&d Bursa Foot
|
1
|
1
|
$2,826.00
|
$2,826.00
|
$2,486.88
|
$2,486.88
|
$2,486.88
|
2025-07-02
|
|
28001
|
CDM
|
I&d Bursa Foot
|
1
|
1
|
$2,826.00
|
$2,826.00
|
$2,486.88
|
$2,486.88
|
$2,486.88
|
2025-07-02
|
|
PH004039
|
CDM
|
Hydralazine 20 Mg/ml Vial
|
1
|
1
|
$2,790.48
|
$2,790.48
|
$2,455.62
|
$2,455.62
|
$2,455.62
|
2025-07-02
|
|
72157
|
CDM
|
MRI T SPINEW/&without Contrast
|
1
|
1
|
$2,781.00
|
$2,781.00
|
$2,447.28
|
$2,447.28
|
$2,447.28
|
2025-07-02
|
|
72156
|
CDM
|
MRI Spinal Canl W/&without Contras
|
1
|
1
|
$2,781.00
|
$2,781.00
|
$2,447.28
|
$2,447.28
|
$2,447.28
|
2025-07-02
|
|
ICUA
|
CDM
|
ICU - Advanced
|
1
|
1
|
$2,755.00
|
$2,755.00
|
$2,424.40
|
$2,424.40
|
$2,424.40
|
2025-07-02
|
|
70553
|
CDM
|
MRI Brain W/&without Contrast
|
1
|
1
|
$2,752.65
|
$2,752.65
|
$2,422.33
|
$2,422.33
|
$2,422.33
|
2025-07-02
|
|
72158
|
CDM
|
MRI L Spine W/&without Contrast
|
1
|
1
|
$2,752.65
|
$2,752.65
|
$2,422.33
|
$2,422.33
|
$2,422.33
|
2025-07-02
|
|
PH008101
|
CDM
|
Privigen(10%)10g/100 Ml Premix
|
1
|
1
|
$2,718.72
|
$2,718.72
|
$2,392.47
|
$2,392.47
|
$2,392.47
|
2025-07-02
|
|
19101
|
CDM
|
Biopsy Breast Open Incisional
|
1
|
1
|
$2,700.00
|
$2,700.00
|
$2,376.00
|
$2,376.00
|
$2,376.00
|
2025-07-02
|
|
50392
|
CDM
|
Intro Intracath Renal Pelv Dra
|
1
|
1
|
$2,700.00
|
$2,700.00
|
$2,376.00
|
$2,376.00
|
$2,376.00
|
2025-07-02
|
|
43800
|
CDM
|
Pyloroplasty
|
1
|
1
|
$2,700.00
|
$2,700.00
|
$2,376.00
|
$2,376.00
|
$2,376.00
|
2025-07-02
|
|
75722
|
CDM
|
Angio, Renal, Uni, W/Aortog
|
1
|
1
|
$2,700.00
|
$2,700.00
|
$2,376.00
|
$2,376.00
|
$2,376.00
|
2025-07-02
|
|
PH005240
|
CDM
|
Clindamycin Phosphate 1 %
|
1
|
1
|
$2,663.46
|
$2,663.46
|
$2,343.84
|
$2,343.84
|
$2,343.84
|
2025-07-02
|
|
PH001838
|
CDM
|
Tobramycin/dexametha Sus 2 T
|
1
|
1
|
$2,564.28
|
$2,564.28
|
$2,256.57
|
$2,256.57
|
$2,256.57
|
2025-07-02
|
|
32099082
|
CDM
|
CTA Chest/Abd/Pelvis
|
1
|
1
|
$2,545.00
|
$2,545.00
|
$2,239.60
|
$2,239.60
|
$2,239.60
|
2025-07-02
|
|
32035202
|
CDM
|
CT Chest/abd/pelvis
|
1
|
1
|
$2,545.00
|
$2,545.00
|
$2,239.60
|
$2,239.60
|
$2,239.60
|
2025-07-02
|
|
32099013
|
CDM
|
CTA Chest
|
1
|
1
|
$2,545.00
|
$2,545.00
|
$2,239.60
|
$2,239.60
|
$2,239.60
|
2025-07-02
|
|
PH007525
|
CDM
|
Cubicin 600mg/100ml Ns
|
1
|
1
|
$2,535.30
|
$2,535.30
|
$2,231.06
|
$2,231.06
|
$2,231.06
|
2025-07-02
|
|
PH007521
|
CDM
|
Cubicin 750mg
|
1
|
1
|
$2,521.38
|
$2,521.38
|
$2,218.81
|
$2,218.81
|
$2,218.81
|
2025-07-02
|
|
49441
|
CDM
|
Insertion Of J-tube
|
1
|
1
|
$2,500.00
|
$2,500.00
|
$2,200.00
|
$2,200.00
|
$2,200.00
|
2025-07-02
|
|
75731
|
CDM
|
Angio, Adrenal, Uni, Sel
|
1
|
1
|
$2,500.00
|
$2,500.00
|
$2,200.00
|
$2,200.00
|
$2,200.00
|
2025-07-02
|
|
58823
|
CDM
|
Pelvic Abcess Drainage Intrava
|
1
|
1
|
$2,500.00
|
$2,500.00
|
$2,200.00
|
$2,200.00
|
$2,200.00
|
2025-07-02
|
|
47000
|
CDM
|
Biopsy Of Liver
|
1
|
1
|
$2,500.00
|
$2,500.00
|
$2,200.00
|
$2,200.00
|
$2,200.00
|
2025-07-02
|
|
47537
|
CDM
|
Removal Drain Cath, Percutan
|
1
|
1
|
$2,500.00
|
$2,500.00
|
$2,200.00
|
$2,200.00
|
$2,200.00
|
2025-07-02
|
|
36147
|
CDM
|
Dialysis Fistulagram
|
1
|
1
|
$2,500.00
|
$2,500.00
|
$2,200.00
|
$2,200.00
|
$2,200.00
|
2025-07-02
|
|
49000
|
CDM
|
Exploratory Laparotomy
|
1
|
1
|
$2,500.00
|
$2,500.00
|
$2,200.00
|
$2,200.00
|
$2,200.00
|
2025-07-02
|
|
75710
|
CDM
|
Angio, Extremity, Uni
|
1
|
1
|
$2,500.00
|
$2,500.00
|
$2,200.00
|
$2,200.00
|
$2,200.00
|
2025-07-02
|
|
27065
|
CDM
|
Excision Of Bone Cyst
|
1
|
1
|
$2,500.00
|
$2,500.00
|
$2,200.00
|
$2,200.00
|
$2,200.00
|
2025-07-02
|
|
44050
|
CDM
|
Reduct Internal Hernia Lap
|
1
|
1
|
$2,500.00
|
$2,500.00
|
$2,200.00
|
$2,200.00
|
$2,200.00
|
2025-07-02
|
|
45381
|
CDM
|
Colonoscopy W/submucos Inj
|
1
|
1
|
$2,500.00
|
$2,500.00
|
$2,200.00
|
$2,200.00
|
$2,200.00
|
2025-07-02
|
|
42800
|
CDM
|
Biopsy Oropharynx
|
1
|
1
|
$2,500.00
|
$2,500.00
|
$2,200.00
|
$2,200.00
|
$2,200.00
|
2025-07-02
|
|
49450
|
CDM
|
Replace G Tube Percutan
|
1
|
1
|
$2,500.00
|
$2,500.00
|
$2,200.00
|
$2,200.00
|
$2,200.00
|
2025-07-02
|
|
49460
|
CDM
|
Rem Of Obstruct Material Gastr
|
1
|
1
|
$2,500.00
|
$2,500.00
|
$2,200.00
|
$2,200.00
|
$2,200.00
|
2025-07-02
|
|
45385
|
CDM
|
Colonoscopy W Les/pol Removal
|
1
|
1
|
$2,500.00
|
$2,500.00
|
$2,200.00
|
$2,200.00
|
$2,200.00
|
2025-07-02
|
|
75791
|
CDM
|
Shunt, Arteriovenous
|
1
|
1
|
$2,500.00
|
$2,500.00
|
$2,200.00
|
$2,200.00
|
$2,200.00
|
2025-07-02
|
|
20670
|
CDM
|
Rem Of Implant,wire,pin,rod
|
1
|
1
|
$2,447.00
|
$2,447.00
|
$2,153.36
|
$2,153.36
|
$2,153.36
|
2025-07-02
|
|
PH011359
|
CDM
|
Darbepoetin Alfa Vl 400mcg A
|
1
|
1
|
$2,438.40
|
$2,438.40
|
$2,145.79
|
$2,145.79
|
$2,145.79
|
2025-07-02
|
|
3700004
|
CDM
|
Anesthesia 1 Hour
|
1
|
1
|
$2,430.00
|
$2,430.00
|
$2,138.40
|
$2,138.40
|
$2,138.40
|
2025-07-02
|
|
3700005
|
CDM
|
Anesthesia Each Addl Hour
|
1
|
1
|
$2,430.00
|
$2,430.00
|
$2,138.40
|
$2,138.40
|
$2,138.40
|
2025-07-02
|
|
PRCOL01
|
CDM
|
Colonoscopy
|
1
|
1
|
$2,415.00
|
$2,415.00
|
$2,125.20
|
$2,125.20
|
$2,125.20
|
2025-07-02
|
|
32601
|
CDM
|
Vats Video Assisted Thoracosco
|
1
|
1
|
$2,400.00
|
$2,400.00
|
$2,112.00
|
$2,112.00
|
$2,112.00
|
2025-07-02
|
|
75630
|
CDM
|
Aortography, Abd+bil Iliofem L
|
1
|
1
|
$2,400.00
|
$2,400.00
|
$2,112.00
|
$2,112.00
|
$2,112.00
|
2025-07-02
|
|
55700
|
CDM
|
Biopsy, Prostate
|
1
|
1
|
$2,400.00
|
$2,400.00
|
$2,112.00
|
$2,112.00
|
$2,112.00
|
2025-07-02
|
|
75625
|
CDM
|
Aortogram Abdominal
|
1
|
1
|
$2,400.00
|
$2,400.00
|
$2,112.00
|
$2,112.00
|
$2,112.00
|
2025-07-02
|
|
75605
|
CDM
|
Aortography, Thoracic, Serialo
|
1
|
1
|
$2,400.00
|
$2,400.00
|
$2,112.00
|
$2,112.00
|
$2,112.00
|
2025-07-02
|
|
75626
|
CDM
|
Angio, Visceral, Sel W/without Aor
|
1
|
1
|
$2,400.00
|
$2,400.00
|
$2,112.00
|
$2,112.00
|
$2,112.00
|
2025-07-02
|
|
75685
|
CDM
|
Angio Vert, Cervi, Intracra
|
1
|
1
|
$2,400.00
|
$2,400.00
|
$2,112.00
|
$2,112.00
|
$2,112.00
|
2025-07-02
|
|
43246
|
CDM
|
Peg Tube Placement
|
1
|
1
|
$2,369.00
|
$2,369.00
|
$2,084.72
|
$2,084.72
|
$2,084.72
|
2025-07-02
|
|
PH000756
|
CDM
|
Methocarbamol Sdv 500mg Roba
|
1
|
1
|
$2,367.09
|
$2,367.09
|
$2,083.04
|
$2,083.04
|
$2,083.04
|
2025-07-02
|
|
28002IH
|
CDM
|
I&d Below Fascia Foot
|
1
|
1
|
$2,350.00
|
$2,350.00
|
$2,068.00
|
$2,068.00
|
$2,068.00
|
2025-07-02
|
|
28002
|
CDM
|
I&d Below Fascia, Foot Single
|
1
|
1
|
$2,350.00
|
$2,350.00
|
$2,068.00
|
$2,068.00
|
$2,068.00
|
2025-07-02
|
|
PH007071
|
CDM
|
Immune Globul 10 Gm
|
1
|
1
|
$2,333.31
|
$2,333.31
|
$2,053.31
|
$2,053.31
|
$2,053.31
|
2025-07-02
|
|
PH011593
|
CDM
|
Collagenase Oin 1 Santy
|
1
|
1
|
$2,316.42
|
$2,316.42
|
$2,038.45
|
$2,038.45
|
$2,038.45
|
2025-07-02
|
|
36005001
|
CDM
|
Insert Tunneled Cv Cath
|
1
|
1
|
$2,303.00
|
$2,303.00
|
$2,026.64
|
$2,026.64
|
$2,026.64
|
2025-07-02
|
|
PH008807
|
CDM
|
Econazole Nitrate 1% Crea
|
1
|
1
|
$2,285.70
|
$2,285.70
|
$2,011.42
|
$2,011.42
|
$2,011.42
|
2025-07-02
|
|
PH001443
|
CDM
|
Primidone Tab 50mg Primi
|
1
|
1
|
$2,283.69
|
$2,283.69
|
$2,009.65
|
$2,009.65
|
$2,009.65
|
2025-07-02
|
|
35000010
|
CDM
|
CT Guided Ndl Place
|
1
|
1
|
$2,267.20
|
$2,267.20
|
$1,995.14
|
$1,995.14
|
$1,995.14
|
2025-07-02
|
|
PH010459
|
CDM
|
Argatroban Inj 1.00 Argat
|
1
|
1
|
$2,255.82
|
$2,255.82
|
$1,985.12
|
$1,985.12
|
$1,985.12
|
2025-07-02
|
|
PHAR1331
|
CDM
|
Lupron Depot 7.5mg Kit
|
1
|
1
|
$2,250.00
|
$2,250.00
|
$1,980.00
|
$1,980.00
|
$1,980.00
|
2025-07-02
|
|
PH006682
|
CDM
|
Vasostrict 20 Unit
|
1
|
1
|
$2,211.18
|
$2,211.18
|
$1,945.84
|
$1,945.84
|
$1,945.84
|
2025-07-02
|
|
49406
|
CDM
|
Image Guide Drain Preitoneal
|
1
|
1
|
$2,200.00
|
$2,200.00
|
$1,936.00
|
$1,936.00
|
$1,936.00
|
2025-07-02
|
|
43241
|
CDM
|
Egd With Transendo Tube/cath Pla
|
1
|
1
|
$2,190.00
|
$2,190.00
|
$1,927.20
|
$1,927.20
|
$1,927.20
|
2025-07-02
|
|
PH007843
|
CDM
|
Ferric Carboxymaltose Inj 750
|
1
|
1
|
$2,183.64
|
$2,183.64
|
$1,921.60
|
$1,921.60
|
$1,921.60
|
2025-07-02
|
|
43245
|
CDM
|
Egd
|
1
|
1
|
$2,150.00
|
$2,150.00
|
$1,892.00
|
$1,892.00
|
$1,892.00
|
2025-07-02
|
|
ICUI
|
CDM
|
ICU/Intermediate Care Room
|
1
|
1
|
$2,135.00
|
$2,135.00
|
$1,878.80
|
$1,878.80
|
$1,878.80
|
2025-07-02
|
|
ICUP
|
CDM
|
ICU - Private
|
1
|
1
|
$2,135.00
|
$2,135.00
|
$1,878.80
|
$1,878.80
|
$1,878.80
|
2025-07-02
|
|
PH004003
|
CDM
|
Zovirax 5% Ointment
|
1
|
1
|
$2,122.38
|
$2,122.38
|
$1,867.69
|
$1,867.69
|
$1,867.69
|
2025-07-02
|
|
74230
|
CDM
|
Modified Barium Swallow (mbs)
|
1
|
1
|
$2,110.47
|
$2,110.47
|
$1,857.21
|
$1,857.21
|
$1,857.21
|
2025-07-02
|
|
MSC6009
|
CDM
|
Flexi Seal
|
1
|
1
|
$2,106.00
|
$2,106.00
|
$1,853.28
|
$1,853.28
|
$1,853.28
|
2025-07-02
|
|
36569
|
CDM
|
Insert Of Picc Without Port Pump O
|
1
|
1
|
$2,085.75
|
$2,085.75
|
$1,835.46
|
$1,835.46
|
$1,835.46
|
2025-07-02
|
|
15274IH
|
CDM
|
Ap Sk Sub Tr/le/ue Add 100sqcm
|
1
|
1
|
$2,060.00
|
$2,060.00
|
$1,812.80
|
$1,812.80
|
$1,812.80
|
2025-07-02
|
|
15274
|
CDM
|
Ap Sk Sub Tr/le/ue Add 100sqcm
|
1
|
1
|
$2,060.00
|
$2,060.00
|
$1,812.80
|
$1,812.80
|
$1,812.80
|
2025-07-02
|
|
15241IH
|
CDM
|
Fu Th Autogr Fh/ch/ne Add 20sc
|
1
|
1
|
$2,060.00
|
$2,060.00
|
$1,812.80
|
$1,812.80
|
$1,812.80
|
2025-07-02
|