|
1
|
CDM
|
Private Room
|
1
|
1
|
$2,589.00
|
$2,589.00
|
$2,589.00
|
$2,589.00
|
$2,589.00
|
2025-11-25
|
|
1000001
|
CDM
|
Intensive Care/high Acuity
|
1
|
1
|
$3,683.00
|
$3,683.00
|
$3,683.00
|
$3,683.00
|
$3,683.00
|
2025-11-25
|
|
1000002
|
CDM
|
Intermediate Care
|
1
|
1
|
$3,197.00
|
$3,197.00
|
$3,197.00
|
$3,197.00
|
$3,197.00
|
2025-11-25
|
|
10060
|
CPT
|
I&d Abscesssimple/single
|
1
|
1
|
$386.00
|
$386.00
|
$386.00
|
$386.00
|
$386.00
|
2025-11-25
|
|
11042
|
CPT
|
Debr Sq Tis 1st <= 20 Sqcm
|
1
|
1
|
$680.00
|
$680.00
|
$680.00
|
$680.00
|
$680.00
|
2025-11-25
|
|
11043
|
CPT
|
Debr Musl/fas 1st <= 20 Sqcm
|
1
|
1
|
$680.00
|
$680.00
|
$680.00
|
$680.00
|
$680.00
|
2025-11-25
|
|
11044
|
CPT
|
Debr Bone 1st <= 20 Sq Cm
|
1
|
1
|
$1,734.00
|
$1,734.00
|
$1,734.00
|
$1,734.00
|
$1,734.00
|
2025-11-25
|
|
11045
|
CPT
|
Debr Sq Tis Ea Add <=20 Sq
|
1
|
1
|
$680.00
|
$680.00
|
$680.00
|
$680.00
|
$680.00
|
2025-11-25
|
|
11046
|
CPT
|
Debr Musl/fas Ea Addl <=20 Sq
|
1
|
1
|
$1,085.00
|
$1,085.00
|
$1,085.00
|
$1,085.00
|
$1,085.00
|
2025-11-25
|
|
11047
|
CPT
|
Debr Bone Ea Addl <=20 Sq
|
1
|
1
|
$1,998.00
|
$1,998.00
|
$1,998.00
|
$1,998.00
|
$1,998.00
|
2025-11-25
|
|
12032
|
CPT
|
Lac. Rep Intermed 2.6-7.5cm Tr
|
1
|
1
|
$620.00
|
$620.00
|
$620.00
|
$620.00
|
$620.00
|
2025-11-25
|
|
12034
|
CPT
|
Lac. Rep Intermed 7.6-12.5 Trn
|
1
|
1
|
$630.00
|
$630.00
|
$630.00
|
$630.00
|
$630.00
|
2025-11-25
|
|
13160
|
CPT
|
Secondary Wound Closure Simple
|
1
|
1
|
$1,703.00
|
$1,703.00
|
$1,703.00
|
$1,703.00
|
$1,703.00
|
2025-11-25
|
|
15120
|
CPT
|
Splt Thck Gft Face 1st 100sq
|
1
|
1
|
$3,170.00
|
$3,170.00
|
$3,170.00
|
$3,170.00
|
$3,170.00
|
2025-11-25
|
|
16025
|
CPT
|
Dress/debrid P-thick Burn Med
|
1
|
1
|
$648.00
|
$648.00
|
$648.00
|
$648.00
|
$648.00
|
2025-11-25
|
|
2
|
CDM
|
Semi Private Room
|
1
|
1
|
$2,589.00
|
$2,589.00
|
$2,589.00
|
$2,589.00
|
$2,589.00
|
2025-11-25
|
|
24592
|
CPT
|
Insulin Lispro 100units/ml
|
1
|
1
|
$1.00
|
$1.00
|
$1.00
|
$1.00
|
$1.00
|
2025-11-25
|
|
25410
|
CPT
|
Posaconazole 200 Mg/5 Ml Oral
|
1
|
1
|
$59.00
|
$59.00
|
$59.00
|
$59.00
|
$59.00
|
2025-11-25
|
|
26495
|
CPT
|
Heparin 20k Units/500ml D5w
|
2
|
1
|
$61.00
|
$61.00
|
$56.00
|
$66.00
|
$61.00
|
2025-11-25
|
|
27737
|
CPT
|
Insulin Lispro 100unit/ml
|
1
|
1
|
$10.00
|
$10.00
|
$10.00
|
$10.00
|
$10.00
|
2025-11-25
|
|
31500
|
CPT
|
Endotrachael Intubation
|
2
|
1
|
$627.50
|
$627.50
|
$612.00
|
$643.00
|
$627.50
|
2025-11-25
|
|
31502
|
CPT
|
Tracheotomy Tube Change
|
1
|
1
|
$273.00
|
$273.00
|
$273.00
|
$273.00
|
$273.00
|
2025-11-25
|
|
31575
|
CPT
|
Laryngoscopy Flex Dx
|
1
|
1
|
$494.00
|
$494.00
|
$494.00
|
$494.00
|
$494.00
|
2025-11-25
|
|
31600
|
CPT
|
Tracheostomy Planned
|
1
|
1
|
$4,087.00
|
$4,087.00
|
$4,087.00
|
$4,087.00
|
$4,087.00
|
2025-11-25
|
|
31603
|
CPT
|
Tracheostomy Emergent
|
1
|
1
|
$1,358.00
|
$1,358.00
|
$1,358.00
|
$1,358.00
|
$1,358.00
|
2025-11-25
|
|
31615
|
CPT
|
Tracheobronchoscopy Thru Incis
|
1
|
1
|
$1,358.00
|
$1,358.00
|
$1,358.00
|
$1,358.00
|
$1,358.00
|
2025-11-25
|
|
31622
|
CPT
|
Bronchoscopy Dx W/wo Cell Wash
|
1
|
1
|
$721.00
|
$721.00
|
$721.00
|
$721.00
|
$721.00
|
2025-11-25
|
|
31624
|
CPT
|
Bronchoscopy W Lavage
|
1
|
1
|
$2,216.00
|
$2,216.00
|
$2,216.00
|
$2,216.00
|
$2,216.00
|
2025-11-25
|
|
31645
|
CPT
|
Bronchoscopy W Aspiration Init
|
1
|
1
|
$2,216.00
|
$2,216.00
|
$2,216.00
|
$2,216.00
|
$2,216.00
|
2025-11-25
|
|
31646
|
CPT
|
Bronchoscopy W Aspiration Subs
|
1
|
1
|
$1,899.00
|
$1,899.00
|
$1,899.00
|
$1,899.00
|
$1,899.00
|
2025-11-25
|
|
31720
|
CPT
|
Catheter Aspiration Nasotrache
|
1
|
1
|
$127.00
|
$127.00
|
$127.00
|
$127.00
|
$127.00
|
2025-11-25
|
|
32551
|
CPT
|
Chest Tube Insertion
|
1
|
1
|
$1,028.00
|
$1,028.00
|
$1,028.00
|
$1,028.00
|
$1,028.00
|
2025-11-25
|
|
32554
|
CPT
|
Thoracentesis W/out Imaging
|
1
|
1
|
$1,028.00
|
$1,028.00
|
$1,028.00
|
$1,028.00
|
$1,028.00
|
2025-11-25
|
|
32555
|
CPT
|
Thoracentesis With Imaging
|
1
|
1
|
$1,233.00
|
$1,233.00
|
$1,233.00
|
$1,233.00
|
$1,233.00
|
2025-11-25
|
|
33801
|
CPT
|
Insulin Regular In 0.9 % Nacl
|
2
|
1
|
$136.50
|
$136.50
|
$133.00
|
$140.00
|
$136.50
|
2025-11-25
|
|
33810
|
CPT
|
Clinimix5/15-2l
|
1
|
1
|
$241.00
|
$241.00
|
$241.00
|
$241.00
|
$241.00
|
2025-11-25
|
|
33811
|
CPT
|
Clinimix E
|
14
|
1
|
$185.50
|
$185.50
|
$154.00
|
$261.00
|
$185.50
|
2025-11-25
|
|
36410
|
CPT
|
Midline Insertion Venipuncture
|
1
|
1
|
$630.00
|
$630.00
|
$630.00
|
$630.00
|
$630.00
|
2025-11-25
|
|
36430
|
CPT
|
Adm Bld Transfusion Per Visit
|
1
|
1
|
$869.00
|
$869.00
|
$869.00
|
$869.00
|
$869.00
|
2025-11-25
|
|
36558
|
CPT
|
Insert Central Line Without Port
|
1
|
1
|
$2,492.00
|
$2,492.00
|
$2,492.00
|
$2,492.00
|
$2,492.00
|
2025-11-25
|
|
36569
|
CPT
|
Picc Line Insert Without Pump
|
1
|
1
|
$1,771.00
|
$1,771.00
|
$1,771.00
|
$1,771.00
|
$1,771.00
|
2025-11-25
|
|
36571
|
CPT
|
Picc Line Insert W Pump
|
1
|
1
|
$4,696.00
|
$4,696.00
|
$4,696.00
|
$4,696.00
|
$4,696.00
|
2025-11-25
|
|
36584
|
CPT
|
Picc Line Replacement Without Pump
|
1
|
1
|
$1,771.00
|
$1,771.00
|
$1,771.00
|
$1,771.00
|
$1,771.00
|
2025-11-25
|
|
36600
|
CPT
|
Arterial Puncture
|
1
|
1
|
$74.00
|
$74.00
|
$74.00
|
$74.00
|
$74.00
|
2025-11-25
|
|
40912
|
CPT
|
Dilaudid 0.5mg/0.5ml
|
1
|
1
|
$14.00
|
$14.00
|
$14.00
|
$14.00
|
$14.00
|
2025-11-25
|
|
40927
|
CPT
|
Heparin Sodium,porcine 1000uni
|
1
|
1
|
$7.00
|
$7.00
|
$7.00
|
$7.00
|
$7.00
|
2025-11-25
|
|
40933
|
CPT
|
Hydromorphone 2mg Inj
|
2
|
1
|
$46.50
|
$46.50
|
$3.00
|
$90.00
|
$46.50
|
2025-11-25
|
|
40949
|
CPT
|
Epinephrine 1mg/10ml
|
1
|
1
|
$21.00
|
$21.00
|
$21.00
|
$21.00
|
$21.00
|
2025-11-25
|
|
40976
|
CPT
|
Heparin 25,000 Units/500ml
|
2
|
1
|
$46.00
|
$46.00
|
$35.00
|
$57.00
|
$46.00
|
2025-11-25
|
|
40977
|
CPT
|
Heparin Sodium 25000unit/250ml
|
1
|
1
|
$38.00
|
$38.00
|
$38.00
|
$38.00
|
$38.00
|
2025-11-25
|
|
40990
|
CPT
|
Fentanyl 100/2 Pf*
|
6
|
1
|
$19.00
|
$19.00
|
$6.00
|
$125.00
|
$19.00
|
2025-11-25
|
|
43000039
|
CDM
|
Daily O2 Charge
|
1
|
1
|
$528.00
|
$528.00
|
$528.00
|
$528.00
|
$528.00
|
2025-11-25
|
|
43000046
|
CDM
|
Daily Heated High Flow O2
|
1
|
1
|
$793.00
|
$793.00
|
$793.00
|
$793.00
|
$793.00
|
2025-11-25
|
|
43246
|
CPT
|
Peg Placement
|
1
|
1
|
$2,236.00
|
$2,236.00
|
$2,236.00
|
$2,236.00
|
$2,236.00
|
2025-11-25
|
|
51701
|
CPT
|
Straight Cath Insert
|
1
|
1
|
$366.00
|
$366.00
|
$366.00
|
$366.00
|
$366.00
|
2025-11-25
|
|
51798
|
CPT
|
Bladder Scan
|
1
|
1
|
$110.00
|
$110.00
|
$110.00
|
$110.00
|
$110.00
|
2025-11-25
|
|
52716
|
CPT
|
Butalb/acetaminophen/caffeine
|
1
|
1
|
$7.00
|
$7.00
|
$7.00
|
$7.00
|
$7.00
|
2025-11-25
|
|
53637
|
CPT
|
Phenylephrine Hcl
|
1
|
1
|
$1.00
|
$1.00
|
$1.00
|
$1.00
|
$1.00
|
2025-11-25
|
|
54018
|
CPT
|
Buprenorphine Hcl/naloxone Hcl
|
1
|
1
|
$42.00
|
$42.00
|
$42.00
|
$42.00
|
$42.00
|
2025-11-25
|
|
54457
|
CPT
|
Methadone Hcl
|
1
|
1
|
$1.00
|
$1.00
|
$1.00
|
$1.00
|
$1.00
|
2025-11-25
|
|
54855
|
CPT
|
Methotrexate Sodium
|
1
|
1
|
$14.00
|
$14.00
|
$14.00
|
$14.00
|
$14.00
|
2025-11-25
|
|
55180
|
CPT
|
Revision Of Scrotum
|
1
|
1
|
$4,515.00
|
$4,515.00
|
$4,515.00
|
$4,515.00
|
$4,515.00
|
2025-11-25
|
|
56017
|
CPT
|
Warfarin 10mg Tab
|
1
|
1
|
$13.00
|
$13.00
|
$13.00
|
$13.00
|
$13.00
|
2025-11-25
|
|
57470
|
CPT
|
Opium/belladonna Alkaloids
|
1
|
1
|
$110.00
|
$110.00
|
$110.00
|
$110.00
|
$110.00
|
2025-11-25
|
|
59132
|
CPT
|
Hydrocodone/acetam7.5/325
|
1
|
1
|
$2.00
|
$2.00
|
$2.00
|
$2.00
|
$2.00
|
2025-11-25
|
|
64160
|
CPT
|
Fentanyl Citrate/pf50mcg/ml 2m
|
1
|
1
|
$7.00
|
$7.00
|
$7.00
|
$7.00
|
$7.00
|
2025-11-25
|
|
64161
|
CPT
|
Morphine 4mg Cpj
|
2
|
1
|
$7.50
|
$7.50
|
$5.00
|
$10.00
|
$7.50
|
2025-11-25
|
|
70316
|
CPT
|
Phenylephrine Hcl
|
1
|
1
|
$7.00
|
$7.00
|
$7.00
|
$7.00
|
$7.00
|
2025-11-25
|
|
74909
|
CPT
|
Fentanyl 50mcg/ml 50ml
|
1
|
1
|
$160.00
|
$160.00
|
$160.00
|
$160.00
|
$160.00
|
2025-11-25
|
|
78130
|
CPT
|
Digoxin0.5mg/2ml
|
1
|
1
|
$15.00
|
$15.00
|
$15.00
|
$15.00
|
$15.00
|
2025-11-25
|
|
78172
|
CPT
|
Fentanyl 100mcg Patch
|
1
|
1
|
$160.00
|
$160.00
|
$160.00
|
$160.00
|
$160.00
|
2025-11-25
|
|
83212
|
CPT
|
Warfarin Sodium 1 Mg Ud
|
2
|
1
|
$2.50
|
$2.50
|
$2.00
|
$3.00
|
$2.50
|
2025-11-25
|
|
90465
|
CPT
|
Methadone Hcl
|
2
|
1
|
$3.00
|
$3.00
|
$1.00
|
$5.00
|
$3.00
|
2025-11-25
|
|
90468
|
CPT
|
Hydrocodone/acetam10/325
|
2
|
1
|
$1.50
|
$1.50
|
$1.00
|
$2.00
|
$1.50
|
2025-11-25
|
|
90469
|
CPT
|
Oxycodone Ir 5mg
|
1
|
1
|
$1.00
|
$1.00
|
$1.00
|
$1.00
|
$1.00
|
2025-11-25
|
|
90470
|
CPT
|
Oxycodone Hcl/acetam10/325
|
2
|
1
|
$3.00
|
$3.00
|
$1.00
|
$5.00
|
$3.00
|
2025-11-25
|
|
90476
|
CPT
|
Phenylephrine Hcl 0.25%
|
1
|
1
|
$5.00
|
$5.00
|
$5.00
|
$5.00
|
$5.00
|
2025-11-25
|
|
90935
|
CPT
|
Hemodialysis
|
1
|
1
|
$901.00
|
$901.00
|
$901.00
|
$901.00
|
$901.00
|
2025-11-25
|
|
90945
|
CPT
|
Peritoneal Dialysis
|
1
|
1
|
$451.00
|
$451.00
|
$451.00
|
$451.00
|
$451.00
|
2025-11-25
|
|
92004467
|
CDM
|
Broncoflex 5.6/2.8mm
|
1
|
1
|
$447.00
|
$447.00
|
$447.00
|
$447.00
|
$447.00
|
2025-11-25
|
|
92507
|
CPT
|
Tx Speech/lang/voice
|
1
|
1
|
$184.00
|
$184.00
|
$184.00
|
$184.00
|
$184.00
|
2025-11-25
|
|
92521
|
CPT
|
Eval Of Speech Fluency
|
1
|
1
|
$236.00
|
$236.00
|
$236.00
|
$236.00
|
$236.00
|
2025-11-25
|
|
92522
|
CPT
|
Eval Speech Sound Production
|
1
|
1
|
$236.00
|
$236.00
|
$236.00
|
$236.00
|
$236.00
|
2025-11-25
|
|
92523
|
CPT
|
Eval Speech Sound Prod W Lang
|
1
|
1
|
$328.00
|
$328.00
|
$328.00
|
$328.00
|
$328.00
|
2025-11-25
|
|
92524
|
CPT
|
Behav/qual Analysis Voice/res
|
1
|
1
|
$184.00
|
$184.00
|
$184.00
|
$184.00
|
$184.00
|
2025-11-25
|
|
92526
|
CPT
|
Tx Swallow Function
|
5
|
1
|
$184.00
|
$184.00
|
$96.00
|
$284.00
|
$184.00
|
2025-11-25
|
|
92597
|
CPT
|
Eval Fitting Pros Device
|
1
|
1
|
$315.00
|
$315.00
|
$315.00
|
$315.00
|
$315.00
|
2025-11-25
|
|
92607
|
CPT
|
Eval Rx Speech Device 1st Hr
|
1
|
1
|
$315.00
|
$315.00
|
$315.00
|
$315.00
|
$315.00
|
2025-11-25
|
|
92609
|
CPT
|
Speech Generating Device Svc
|
1
|
1
|
$289.00
|
$289.00
|
$289.00
|
$289.00
|
$289.00
|
2025-11-25
|
|
92610
|
CPT
|
Swallowing/oral Function Eval
|
1
|
1
|
$328.00
|
$328.00
|
$328.00
|
$328.00
|
$328.00
|
2025-11-25
|
|
92611
|
CPT
|
Swallowing Eval By Cine/video
|
1
|
1
|
$489.00
|
$489.00
|
$489.00
|
$489.00
|
$489.00
|
2025-11-25
|
|
92612
|
CPT
|
Stfees Procedure
|
1
|
1
|
$630.00
|
$630.00
|
$630.00
|
$630.00
|
$630.00
|
2025-11-25
|
|
92950
|
CPT
|
Cpr (Code Blue)
|
1
|
1
|
$620.00
|
$620.00
|
$620.00
|
$620.00
|
$620.00
|
2025-11-25
|
|
93000001
|
CDM
|
Respite Care
|
1
|
1
|
$500.00
|
$500.00
|
$500.00
|
$500.00
|
$500.00
|
2025-11-25
|
|
93005
|
CPT
|
ECG 12 Lead Tracing Only
|
1
|
1
|
$165.00
|
$165.00
|
$165.00
|
$165.00
|
$165.00
|
2025-11-25
|
|
93365
|
CPT
|
Buprenorphine 20mcg/hr Patch
|
1
|
1
|
$406.00
|
$406.00
|
$406.00
|
$406.00
|
$406.00
|
2025-11-25
|
|
94002
|
CPT
|
Ventilation Mgmt 1st Day
|
1
|
1
|
$3,254.00
|
$3,254.00
|
$3,254.00
|
$3,254.00
|
$3,254.00
|
2025-11-25
|
|
94003
|
CPT
|
Ventilation Mgmt Ea Subsq Day
|
1
|
1
|
$2,303.00
|
$2,303.00
|
$2,303.00
|
$2,303.00
|
$2,303.00
|
2025-11-25
|
|
94640
|
CPT
|
Inhalation Treatment
|
1
|
1
|
$152.00
|
$152.00
|
$152.00
|
$152.00
|
$152.00
|
2025-11-25
|
|
94660
|
CPT
|
Cpap/bipap Initiation & Mgmt
|
1
|
1
|
$2,194.00
|
$2,194.00
|
$2,194.00
|
$2,194.00
|
$2,194.00
|
2025-11-25
|
|
94664
|
CPT
|
Demo/eval Pt Inhal/neb/ippb
|
1
|
1
|
$217.00
|
$217.00
|
$217.00
|
$217.00
|
$217.00
|
2025-11-25
|
|
94667
|
CPT
|
Manip Chest Wall (Cpt) Initial
|
1
|
1
|
$231.00
|
$231.00
|
$231.00
|
$231.00
|
$231.00
|
2025-11-25
|
|
94668
|
CPT
|
Manip Chest Wall (Cpt) Subseq
|
1
|
1
|
$209.00
|
$209.00
|
$209.00
|
$209.00
|
$209.00
|
2025-11-25
|
|
94669
|
CPT
|
Mech Chest Wall Oscill
|
1
|
1
|
$406.00
|
$406.00
|
$406.00
|
$406.00
|
$406.00
|
2025-11-25
|
|
94760
|
CPT
|
Pulse Ox Single Det
|
1
|
1
|
$223.00
|
$223.00
|
$223.00
|
$223.00
|
$223.00
|
2025-11-25
|
|
94761
|
CPT
|
Pulse Ox Multiple Det
|
1
|
1
|
$365.00
|
$365.00
|
$365.00
|
$365.00
|
$365.00
|
2025-11-25
|
|
94762
|
CPT
|
Pulse Ox Continuous/overnight
|
1
|
1
|
$1,800.00
|
$1,800.00
|
$1,800.00
|
$1,800.00
|
$1,800.00
|
2025-11-25
|
|
96105
|
CPT
|
Assessment Of Aphasia
|
1
|
1
|
$324.00
|
$324.00
|
$324.00
|
$324.00
|
$324.00
|
2025-11-25
|
|
97010
|
CPT
|
Appl Hot/cold Packs
|
1
|
1
|
$95.00
|
$95.00
|
$95.00
|
$95.00
|
$95.00
|
2025-11-25
|
|
97014
|
CPT
|
E Stim (Unattended)
|
1
|
1
|
$72.00
|
$72.00
|
$72.00
|
$72.00
|
$72.00
|
2025-11-25
|
|
97032
|
CPT
|
E Stim (Manual) Ea 15m
|
2
|
1
|
$111.00
|
$111.00
|
$102.00
|
$120.00
|
$111.00
|
2025-11-25
|
|
97035
|
CPT
|
Ultrasound Ea 15m
|
1
|
1
|
$116.00
|
$116.00
|
$116.00
|
$116.00
|
$116.00
|
2025-11-25
|
|
97110
|
CPT
|
Physical Therapy, Therapeutic Exercise
|
1
|
1
|
$148.00
|
$148.00
|
$148.00
|
$148.00
|
$148.00
|
2025-11-25
|
|
97112
|
CPT
|
Neuromusc Reed Ea 15m
|
1
|
1
|
$120.00
|
$120.00
|
$120.00
|
$120.00
|
$120.00
|
2025-11-25
|
|
97116
|
CPT
|
Gait Training Ea 15m
|
1
|
1
|
$121.00
|
$121.00
|
$121.00
|
$121.00
|
$121.00
|
2025-11-25
|
|
97124
|
CPT
|
Massage Therapy Ea 15m
|
1
|
1
|
$121.00
|
$121.00
|
$121.00
|
$121.00
|
$121.00
|
2025-11-25
|
|
97140
|
CPT
|
Manual Therapy Ea 15m
|
1
|
1
|
$132.00
|
$132.00
|
$132.00
|
$132.00
|
$132.00
|
2025-11-25
|
|
97150
|
CPT
|
Therapeutic Procedures (Group)
|
1
|
1
|
$169.00
|
$169.00
|
$169.00
|
$169.00
|
$169.00
|
2025-11-25
|
|
97161
|
CPT
|
Pt Eval Low Complexity
|
1
|
1
|
$243.00
|
$243.00
|
$243.00
|
$243.00
|
$243.00
|
2025-11-25
|
|
97162
|
CPT
|
Pt Eval Mod Complexity
|
1
|
1
|
$304.00
|
$304.00
|
$304.00
|
$304.00
|
$304.00
|
2025-11-25
|
|
97163
|
CPT
|
Pt Eval High Complexity
|
1
|
1
|
$365.00
|
$365.00
|
$365.00
|
$365.00
|
$365.00
|
2025-11-25
|
|
97164
|
CPT
|
Physical Therapy Re-eval
|
1
|
1
|
$250.00
|
$250.00
|
$250.00
|
$250.00
|
$250.00
|
2025-11-25
|
|
97165
|
CPT
|
Ot Eval Low Complexity
|
1
|
1
|
$243.00
|
$243.00
|
$243.00
|
$243.00
|
$243.00
|
2025-11-25
|
|
97166
|
CPT
|
Ot Eval Mod Complexity
|
1
|
1
|
$304.00
|
$304.00
|
$304.00
|
$304.00
|
$304.00
|
2025-11-25
|
|
97167
|
CPT
|
Ot Eval High Complexity
|
1
|
1
|
$365.00
|
$365.00
|
$365.00
|
$365.00
|
$365.00
|
2025-11-25
|
|
97168
|
CPT
|
Occupational Therapy Re-eval
|
1
|
1
|
$336.00
|
$336.00
|
$336.00
|
$336.00
|
$336.00
|
2025-11-25
|
|
97530
|
CPT
|
Ther Act For Func Perf Ea 15m
|
1
|
1
|
$124.00
|
$124.00
|
$124.00
|
$124.00
|
$124.00
|
2025-11-25
|
|
97533
|
CPT
|
Sensory Integration
|
1
|
1
|
$147.00
|
$147.00
|
$147.00
|
$147.00
|
$147.00
|
2025-11-25
|
|
97535
|
CPT
|
Adl Training Ea 15 Min
|
1
|
1
|
$124.00
|
$124.00
|
$124.00
|
$124.00
|
$124.00
|
2025-11-25
|
|
97542
|
CPT
|
Wheelchair Management Ea 15m
|
1
|
1
|
$137.00
|
$137.00
|
$137.00
|
$137.00
|
$137.00
|
2025-11-25
|
|
97597
|
CPT
|
Rmvl Devital Tis 20 Cm/<
|
1
|
1
|
$330.00
|
$330.00
|
$330.00
|
$330.00
|
$330.00
|
2025-11-25
|
|
97598
|
CPT
|
Rmvl Devital Tis Addl 20 Cm<
|
1
|
1
|
$268.00
|
$268.00
|
$268.00
|
$268.00
|
$268.00
|
2025-11-25
|
|
97605
|
CPT
|
Vaccuum Therapy <50cm
|
1
|
1
|
$268.00
|
$268.00
|
$268.00
|
$268.00
|
$268.00
|
2025-11-25
|
|
97606
|
CPT
|
Vaccuum Therapy >50cm
|
1
|
1
|
$358.00
|
$358.00
|
$358.00
|
$358.00
|
$358.00
|
2025-11-25
|
|
97760
|
CPT
|
Orthotic Mgmt 1st Enc Ea 15m
|
1
|
1
|
$137.00
|
$137.00
|
$137.00
|
$137.00
|
$137.00
|
2025-11-25
|
|
97761
|
CPT
|
Prosthetic Trn 1st Enc Ea 15m
|
1
|
1
|
$95.00
|
$95.00
|
$95.00
|
$95.00
|
$95.00
|
2025-11-25
|
|
97763
|
CPT
|
Orth/pros Mgmt Sub Enc Ea 15m
|
2
|
1
|
$150.50
|
$150.50
|
$120.00
|
$181.00
|
$150.50
|
2025-11-25
|
|
CP17660070348710106
|
CDM
|
Osteomyelitis W Mcc
|
10
|
7
|
$91,360.00
|
$91,360.00
|
$1,809.00
|
$91,360.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348710179
|
CDM
|
O.r. Proc W Diagnoses Of Other Contact W Health Services W Mcc
|
10
|
7
|
$171,792.00
|
$171,792.00
|
$1,809.00
|
$171,792.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348710233
|
CDM
|
Nutritional & Misc Metabolic Disorders W Mcc
|
10
|
7
|
$109,617.00
|
$109,617.00
|
$1,809.00
|
$109,617.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348710270
|
CDM
|
Diabetes W Mcc
|
10
|
7
|
$119,106.00
|
$119,106.00
|
$1,809.00
|
$119,106.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348710416
|
CDM
|
Postoperative & Post-traumatic Infections W Mcc
|
10
|
7
|
$119,511.00
|
$119,511.00
|
$1,809.00
|
$119,511.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348710609
|
CDM
|
Respiratory System Diagnosis W Ventilator Support <96 Hours
|
10
|
7
|
$114,485.00
|
$114,485.00
|
$1,809.00
|
$114,485.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348711150
|
CDM
|
Viral Illness W Mcc
|
10
|
7
|
$158,033.00
|
$158,033.00
|
$1,809.00
|
$158,033.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348711184
|
CDM
|
Heart Failure & Shock W Mcc
|
10
|
7
|
$79,794.00
|
$79,794.00
|
$1,809.00
|
$79,794.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348711320
|
CDM
|
Respiratory System Diagnosis W Ventilator Support 96+ Hours
|
10
|
7
|
$255,706.00
|
$255,706.00
|
$1,809.00
|
$255,706.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348711384
|
CDM
|
Other Digestive System Diagnoses W Cc
|
10
|
7
|
$186,782.00
|
$186,782.00
|
$1,809.00
|
$186,782.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348711445
|
CDM
|
Nonspecific Cerebrovascular Disorders W Mcc
|
10
|
7
|
$73,485.00
|
$73,485.00
|
$1,809.00
|
$73,485.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348712006
|
CDM
|
Complications Of Treatment W Cc
|
10
|
7
|
$92,690.00
|
$92,690.00
|
$1,809.00
|
$92,690.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348712264
|
CDM
|
Other Skin, Subcut Tiss & Breast Proc W Cc
|
10
|
7
|
$152,509.00
|
$152,509.00
|
$1,809.00
|
$152,509.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348712780
|
CDM
|
Wnd Debrid & Skn Grft Exc Hand, For Musculo-conn Tiss Dis W Cc
|
10
|
7
|
$88,144.00
|
$88,144.00
|
$1,809.00
|
$88,144.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348712962
|
CDM
|
Acute & Subacute Endocarditis W Cc
|
10
|
7
|
$54,445.00
|
$54,445.00
|
$1,809.00
|
$54,445.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348713229
|
CDM
|
Skin Debridement W Cc
|
10
|
7
|
$213,034.00
|
$213,034.00
|
$1,809.00
|
$213,034.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348713325
|
CDM
|
Soft Tissue Procedures W Mcc
|
10
|
7
|
$217,588.00
|
$217,588.00
|
$1,809.00
|
$217,588.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348713481
|
CDM
|
Inflammation Of The Male Reproductive System Without Mcc
|
10
|
7
|
$85,294.00
|
$85,294.00
|
$1,809.00
|
$85,294.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348713798
|
CDM
|
Renal Failure W Cc
|
10
|
7
|
$197,406.00
|
$197,406.00
|
$1,809.00
|
$197,406.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348713843
|
CDM
|
Degenerative Nervous System Disorders Without Mcc
|
10
|
7
|
$113,893.00
|
$113,893.00
|
$1,809.00
|
$113,893.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348714224
|
CDM
|
Disorders Of Pancreas Except Malignancy W Mcc
|
10
|
7
|
$36,939.00
|
$36,939.00
|
$1,809.00
|
$36,939.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348714246
|
CDM
|
Aftercare, Musculoskeletal System & Connective Tissue W Mcc
|
10
|
7
|
$113,327.00
|
$113,327.00
|
$1,809.00
|
$113,327.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348714867
|
CDM
|
Other Resp System O.r. Procedures W Mcc
|
10
|
7
|
$424,978.00
|
$424,978.00
|
$1,809.00
|
$424,978.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348715408
|
CDM
|
Major Skin Disorders Without Mcc
|
10
|
7
|
$29,407.00
|
$29,407.00
|
$1,809.00
|
$29,407.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348715587
|
CDM
|
Pulmonary Edema & Respiratory Failure
|
10
|
7
|
$155,979.00
|
$155,979.00
|
$1,809.00
|
$155,979.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348715768
|
CDM
|
Skin Graft &/Or Debrid For Skn Ulcer Or Cellulitis W Mcc
|
10
|
7
|
$218,957.00
|
$218,957.00
|
$1,809.00
|
$218,957.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348715794
|
CDM
|
Degenerative Nervous System Disorders W Mcc
|
10
|
7
|
$214,846.00
|
$214,846.00
|
$1,809.00
|
$214,846.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348715938
|
CDM
|
Extensive O.r. Procedure Unrelated To Principal Diagnosis W Cc
|
10
|
7
|
$227,261.00
|
$227,261.00
|
$1,809.00
|
$227,261.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348716160
|
CDM
|
Septicemia Without Mv 96+ Hours Without Mcc
|
10
|
7
|
$57,655.00
|
$57,655.00
|
$1,809.00
|
$57,655.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348716503
|
CDM
|
Renal Failure W Mcc
|
10
|
7
|
$74,259.00
|
$74,259.00
|
$1,809.00
|
$74,259.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348716634
|
CDM
|
Non-extensive O.r. Proc Unrelated To Principal Diagnosis W Mcc
|
10
|
7
|
$306,944.00
|
$306,944.00
|
$1,809.00
|
$306,944.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348716645
|
CDM
|
Other Skin, Subcut Tiss & Breast Proc W Mcc
|
10
|
7
|
$271,109.00
|
$271,109.00
|
$1,809.00
|
$271,109.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348716766
|
CDM
|
Septicemia Without Mv 96+ Hours W Mcc
|
10
|
7
|
$140,950.00
|
$140,950.00
|
$1,809.00
|
$140,950.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348716834
|
CDM
|
Other Infectious & Parasitic Diseases Diagnoses W Mcc
|
10
|
7
|
$4,537.00
|
$4,537.00
|
$1,809.00
|
$4,537.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348717069
|
CDM
|
Aftercare W Cc/mcc
|
10
|
7
|
$122,480.00
|
$122,480.00
|
$1,809.00
|
$122,480.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348717078
|
CDM
|
Other Disorders Of Nervous System W Mcc
|
10
|
7
|
$57,169.00
|
$57,169.00
|
$1,809.00
|
$57,169.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348717272
|
CDM
|
Other Digestive System Diagnoses W Mcc
|
10
|
7
|
$218,837.00
|
$218,837.00
|
$1,809.00
|
$218,837.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348717396
|
CDM
|
Infectious & Parasitic Diseases W O.r. Procedure W Cc
|
10
|
7
|
$161,787.00
|
$161,787.00
|
$1,809.00
|
$161,787.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348717473
|
CDM
|
Extensive O.r. Procedure Unrelated To Principal Diagnosis W Mcc
|
10
|
7
|
$276,538.00
|
$276,538.00
|
$1,809.00
|
$276,538.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348717488
|
CDM
|
Respiratory Infections & Inflammations W Mcc
|
10
|
7
|
$194,265.00
|
$194,265.00
|
$1,809.00
|
$194,265.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348717516
|
CDM
|
HIV W Major Related Condition W Mcc
|
10
|
7
|
$109,169.00
|
$109,169.00
|
$1,809.00
|
$109,169.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348717844
|
CDM
|
Major Chest Procedures W Mcc
|
10
|
7
|
$363,043.00
|
$363,043.00
|
$1,809.00
|
$363,043.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348718137
|
CDM
|
Other Digestive System O.r. Procedures W Mcc
|
10
|
7
|
$334,321.00
|
$334,321.00
|
$1,809.00
|
$334,321.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348718217
|
CDM
|
Inflammation Of The Male Reproductive System W Mcc
|
10
|
7
|
$80,469.00
|
$80,469.00
|
$1,809.00
|
$80,469.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348718267
|
CDM
|
Skin Debridement W Mcc
|
10
|
7
|
$203,421.00
|
$203,421.00
|
$1,809.00
|
$203,421.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348718424
|
CDM
|
Non-extensive O.r. Proc Unrelated To Principal Diagnosis W Cc
|
10
|
7
|
$99,683.00
|
$99,683.00
|
$1,809.00
|
$99,683.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348718489
|
CDM
|
Skin Ulcers W Mcc
|
10
|
7
|
$172,897.00
|
$172,897.00
|
$1,809.00
|
$172,897.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348718493
|
CDM
|
Esophagitis, Gastroent & Misc Digest Disorders W Mcc
|
10
|
7
|
$111,372.00
|
$111,372.00
|
$1,809.00
|
$111,372.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348718697
|
CDM
|
Wnd Debrid & Skn Grft Exc Hand, For Musculo-conn Tiss Dis W Mcc
|
10
|
7
|
$127,848.00
|
$127,848.00
|
$1,809.00
|
$127,848.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348718717
|
CDM
|
Skin Grafts & Wound Debrid For Endoc, Nutrit & Metab Dis W Mcc
|
10
|
7
|
$140,790.00
|
$140,790.00
|
$1,809.00
|
$140,790.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348718859
|
CDM
|
Acute & Subacute Endocarditis W Mcc
|
10
|
7
|
$122,248.00
|
$122,248.00
|
$1,809.00
|
$122,248.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348719089
|
CDM
|
Septic Arthritis W Mcc
|
10
|
7
|
$128,579.00
|
$128,579.00
|
$1,809.00
|
$128,579.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348719408
|
CDM
|
Infectious & Parasitic Diseases W O.r. Procedure W Mcc
|
10
|
7
|
$335,592.00
|
$335,592.00
|
$1,809.00
|
$335,592.00
|
$2,171.00
|
2025-11-25
|
|
CP17660070348719473
|
CDM
|
Septic Arthritis Without Cc/mcc
|
10
|
7
|
$120,344.00
|
$120,344.00
|
$1,809.00
|
$120,344.00
|
$2,171.00
|
2025-11-25
|
|
P9060
|
HCPCS
|
Ffp Donor Retest Ea Unit
|
1
|
1
|
$158.00
|
$158.00
|
$158.00
|
$158.00
|
$158.00
|
2025-11-25
|
|
PH000088
|
CDM
|
Hydromorphone Hcl 2mg Tab
|
3
|
3
|
$1.00
|
$1.00
|
$1.00
|
$1.00
|
$1.00
|
2025-11-25
|
|
PH000106
|
CDM
|
Heparin Na 5000unit/ml,porcine
|
3
|
3
|
$7.00
|
$7.00
|
$5.00
|
$7.00
|
$5.00
|
2025-11-25
|
|
PH000129
|
CDM
|
Tramadol Hcl
|
3
|
3
|
$1.00
|
$1.00
|
$1.00
|
$1.00
|
$1.00
|
2025-11-25
|
|
PH000183
|
CDM
|
Fentanyl 25mcg Patch
|
3
|
3
|
$85.00
|
$85.00
|
$59.00
|
$85.00
|
$64.00
|
2025-11-25
|
|
PH000352
|
CDM
|
Clinimix
|
1
|
1
|
$192.00
|
$192.00
|
$192.00
|
$192.00
|
$192.00
|
2025-11-25
|
|
PH000470
|
CDM
|
Epinephrine 1mg/1ml Sdv
|
3
|
3
|
$70.00
|
$70.00
|
$49.00
|
$70.00
|
$53.00
|
2025-11-25
|
|
PH000585
|
CDM
|
Fentanyl 50mcg Patch
|
3
|
3
|
$156.00
|
$156.00
|
$109.00
|
$156.00
|
$117.00
|
2025-11-25
|
|
PH000675
|
CDM
|
Fentanyl 75mcg Patch
|
3
|
3
|
$178.00
|
$178.00
|
$125.00
|
$178.00
|
$134.00
|
2025-11-25
|
|
PH000815
|
CDM
|
Duragesic 12mcg Patch
|
3
|
3
|
$81.00
|
$81.00
|
$57.00
|
$81.00
|
$61.00
|
2025-11-25
|
|
PH000901
|
CDM
|
Oxycodone Hcl 15mg Ir
|
3
|
3
|
$2.00
|
$2.00
|
$1.00
|
$2.00
|
$2.00
|
2025-11-25
|
|
PH001052
|
CDM
|
Heparin ,porcine1000unit/ml-10
|
3
|
3
|
$14.00
|
$14.00
|
$10.00
|
$14.00
|
$11.00
|
2025-11-25
|
|
PH001054
|
CDM
|
Warfarin Sodium 2.5mg Ud
|
3
|
3
|
$3.00
|
$3.00
|
$2.00
|
$3.00
|
$2.00
|
2025-11-25
|
|
PH001122
|
CDM
|
Morphine 2mg/ml Cpj
|
3
|
3
|
$2.00
|
$2.00
|
$1.00
|
$2.00
|
$2.00
|
2025-11-25
|
|
PH001222
|
CDM
|
Heparin Sodium,porcine/pf 3ml
|
3
|
3
|
$4.00
|
$4.00
|
$3.00
|
$4.00
|
$3.00
|
2025-11-25
|
|
PH001234
|
CDM
|
Heparin Sodium,porcine 100unit
|
3
|
3
|
$7.00
|
$7.00
|
$5.00
|
$7.00
|
$5.00
|
2025-11-25
|
|
PH001428
|
CDM
|
Phenylephrine Hcl 10mg/ml-5ml
|
3
|
3
|
$7.00
|
$7.00
|
$5.00
|
$7.00
|
$5.00
|
2025-11-25
|
|
PH001475
|
CDM
|
Heparin Sodium,500unit/5ml-12
|
3
|
3
|
$4.00
|
$4.00
|
$3.00
|
$4.00
|
$3.00
|
2025-11-25
|
|
PH001505
|
CDM
|
Oxycodone Hcl Ir 10mg
|
3
|
3
|
$3.00
|
$3.00
|
$2.00
|
$3.00
|
$2.00
|
2025-11-25
|
|
PH001775
|
CDM
|
Buprenorphine 10mcg/hr
|
3
|
3
|
$375.00
|
$375.00
|
$263.00
|
$375.00
|
$281.00
|
2025-11-25
|
|
PH001987
|
CDM
|
Heparin Sodium,porc/pf 50unit/
|
3
|
3
|
$4.00
|
$4.00
|
$3.00
|
$4.00
|
$3.00
|
2025-11-25
|
|
PH001999
|
CDM
|
Epinephrine 1mg/ml 30ml
|
3
|
3
|
$177.00
|
$177.00
|
$124.00
|
$177.00
|
$133.00
|
2025-11-25
|
|
PH002054
|
CDM
|
Norepinephrine 16mg/d5w 250ml
|
1
|
1
|
$7.00
|
$7.00
|
$7.00
|
$7.00
|
$7.00
|
2025-11-25
|
|
PH002132
|
CDM
|
Buprenorphine/naloxone 8-2
|
3
|
3
|
$35.00
|
$35.00
|
$25.00
|
$35.00
|
$26.00
|
2025-11-25
|
|
PH002137
|
CDM
|
Buprenorphine/naloxone 2-0.5mg
|
3
|
3
|
$19.00
|
$19.00
|
$13.00
|
$19.00
|
$14.00
|
2025-11-25
|
|
PH002157
|
CDM
|
Heparin Sodium 10unit/ml-1ml
|
3
|
3
|
$4.00
|
$4.00
|
$3.00
|
$4.00
|
$3.00
|
2025-11-25
|
|
PH002177
|
CDM
|
Heparin Sod,porc/pf 10unit/ml-
|
3
|
3
|
$4.00
|
$4.00
|
$3.00
|
$4.00
|
$3.00
|
2025-11-25
|
|
PH002204
|
CDM
|
Vasopressin 20unit/ml 10ml
|
3
|
3
|
$26.00
|
$26.00
|
$18.00
|
$26.00
|
$20.00
|
2025-11-25
|
|
PH002223
|
CDM
|
Voriconazole 40mg/ml 75ml
|
3
|
3
|
$56.00
|
$56.00
|
$39.00
|
$56.00
|
$42.00
|
2025-11-25
|
|
PH002343
|
CDM
|
Heparin Sodium,porcine
|
3
|
3
|
$7.00
|
$7.00
|
$5.00
|
$7.00
|
$5.00
|
2025-11-25
|
|
PH002361
|
CDM
|
Morphine Sulfate 2mg/ml Vial
|
3
|
3
|
$11.00
|
$11.00
|
$8.00
|
$11.00
|
$8.00
|
2025-11-25
|
|
PH002415
|
CDM
|
Oxycodone Hcl 20mg Tab
|
3
|
3
|
$4.00
|
$4.00
|
$3.00
|
$4.00
|
$3.00
|
2025-11-25
|
|
PH002446
|
CDM
|
Heparin Sodium,porcine 5000uni
|
3
|
3
|
$7.00
|
$7.00
|
$5.00
|
$7.00
|
$5.00
|
2025-11-25
|
|
PH002565
|
CDM
|
Fentanyl Citrate/pf 50mcg/ml V
|
3
|
3
|
$9.00
|
$9.00
|
$6.00
|
$9.00
|
$7.00
|
2025-11-25
|
|
PH002674
|
CDM
|
Fentanyl Citrate/pf
|
3
|
3
|
$7.00
|
$7.00
|
$5.00
|
$7.00
|
$5.00
|
2025-11-25
|
|
PH002675
|
CDM
|
Fentanyl/ns 100ml Premix
|
3
|
3
|
$97.00
|
$97.00
|
$68.00
|
$97.00
|
$73.00
|
2025-11-25
|
|
PH002685
|
CDM
|
Norepinephrine/ns Premix
|
3
|
3
|
$7.00
|
$7.00
|
$5.00
|
$7.00
|
$5.00
|
2025-11-25
|
|
PH002714
|
CDM
|
Methotrexate Sodium/pf
|
3
|
3
|
$20.00
|
$20.00
|
$14.00
|
$20.00
|
$15.00
|
2025-11-25
|
|
PH002753
|
CDM
|
Insulin Glargine-yfgn
|
3
|
3
|
$2.00
|
$2.00
|
$1.00
|
$2.00
|
$2.00
|
2025-11-25
|
|
PH002772
|
CDM
|
Prazosin Hcl
|
3
|
3
|
$9.00
|
$9.00
|
$6.00
|
$9.00
|
$7.00
|
2025-11-25
|
|
PH002825
|
CDM
|
Norepinephrine Bit/0.9 % Nacl
|
3
|
3
|
$284.00
|
$284.00
|
$199.00
|
$284.00
|
$213.00
|
2025-11-25
|
|
PH002916
|
CDM
|
Nitroglycerin Patch Removal
|
3
|
3
|
$1.00
|
$1.00
|
$1.00
|
$1.00
|
$1.00
|
2025-11-25
|
|
PH002917
|
CDM
|
Fluphenazine 1mg Tab
|
3
|
3
|
$30.00
|
$30.00
|
$21.00
|
$30.00
|
$23.00
|
2025-11-25
|
|
PH002918
|
CDM
|
Desvenlafaxine Succinate Tab E
|
3
|
3
|
$46.00
|
$46.00
|
$32.00
|
$46.00
|
$35.00
|
2025-11-25
|
|
PH002919
|
CDM
|
Cefuroxime Axetil 500 Mg Tab
|
3
|
3
|
$32.00
|
$32.00
|
$22.00
|
$32.00
|
$24.00
|
2025-11-25
|
|
PH002920
|
CDM
|
#2 Patient Home Controlled Med
|
1
|
1
|
$1.00
|
$1.00
|
$1.00
|
$1.00
|
$1.00
|
2025-11-25
|
|
PH002921
|
CDM
|
Filgrastim
|
3
|
3
|
$797.00
|
$797.00
|
$558.00
|
$797.00
|
$598.00
|
2025-11-25
|
|
PH002922
|
CDM
|
Flu Vacc Ts2025-26(6mos Up)/pf
|
3
|
3
|
$81.00
|
$81.00
|
$57.00
|
$81.00
|
$61.00
|
2025-11-25
|
|
PH002924
|
CDM
|
Amox/clavulanate 400-57mg/5ml
|
3
|
3
|
$3.00
|
$3.00
|
$2.00
|
$3.00
|
$2.00
|
2025-11-25
|
|
PH002925
|
CDM
|
Hydrocortisone 100mg/60ml Rect
|
3
|
3
|
$103.00
|
$103.00
|
$72.00
|
$103.00
|
$77.00
|
2025-11-25
|
|
PH002927
|
CDM
|
Carbamazepine Oral Sus 100mg/5
|
3
|
3
|
$1.00
|
$1.00
|
$1.00
|
$1.00
|
$1.00
|
2025-11-25
|
|
PH002928
|
CDM
|
Rivastigmine Patch Removal
|
3
|
3
|
$1.00
|
$1.00
|
$1.00
|
$1.00
|
$1.00
|
2025-11-25
|
|
PH002929
|
CDM
|
Ephedrine Sulfate 50mg/ml
|
3
|
3
|
$62.00
|
$62.00
|
$43.00
|
$62.00
|
$47.00
|
2025-11-25
|
|
PH002930
|
CDM
|
Phenylephrine Hcl 100 Mcg/ml
|
3
|
3
|
$7.00
|
$7.00
|
$5.00
|
$7.00
|
$5.00
|
2025-11-25
|
|
PH002931
|
CDM
|
Perflutren Lipid Microspheres
|
3
|
3
|
$357.00
|
$357.00
|
$250.00
|
$357.00
|
$268.00
|
2025-11-25
|
|
PH002932
|
CDM
|
Revefenacinud 175mcg/3ml
|
3
|
3
|
$158.00
|
$158.00
|
$111.00
|
$158.00
|
$119.00
|
2025-11-25
|
|
PH002933
|
CDM
|
Dextroamphetamine/amphetamine
|
3
|
3
|
$29.00
|
$29.00
|
$20.00
|
$29.00
|
$22.00
|
2025-11-25
|