|
3
|
OTHER
|
Ecmo Or Trach W Mv 96+ Hrs Or Pdx Exc Face, Mouth & Neck W Maj O.r.
|
5
|
5
|
$499,971.41
|
$499,971.41
|
$1,803.53
|
$135,960.47
|
$96,871.84
|
2026-07-31
|
|
166
|
OTHER
|
Other Resp System O.r. Procedures W Mcc
|
3
|
3
|
$308,890.63
|
$308,890.63
|
$62,884.44
|
$88,258.86
|
$88,258.86
|
2026-07-31
|
|
981
|
OTHER
|
Extensive O.r. Procedure Unrelated To Principal Diagnosis W Mcc
|
3
|
3
|
$225,163.29
|
$225,163.29
|
$60,650.89
|
$85,124.06
|
$85,124.06
|
2026-07-31
|
|
4
|
OTHER
|
Trach W Mv 96+ Hrs Or Pdx Exc Face, Mouth & Neck Without Maj O.r.
|
5
|
5
|
$417,857.20
|
$417,857.20
|
$1,803.53
|
$104,263.27
|
$74,287.58
|
2026-07-31
|
|
987
|
OTHER
|
Non-extensive O.r. Proc Unrelated To Principal Diagnosis W Mcc
|
3
|
3
|
$212,982.11
|
$212,982.11
|
$52,858.88
|
$74,187.90
|
$74,187.90
|
2026-07-31
|
|
240
|
OTHER
|
Amputation For Circ Sys Disorders Exc Upper Limb & Toe W Cc
|
3
|
3
|
$173,269.56
|
$173,269.56
|
$47,094.45
|
$66,097.47
|
$66,097.47
|
2026-07-31
|
|
853
|
OTHER
|
Infectious & Parasitic Diseases W O.r. Procedure W Mcc
|
3
|
3
|
$122,131.86
|
$122,131.86
|
$46,080.66
|
$64,674.61
|
$64,674.61
|
2026-07-31
|
|
356
|
OTHER
|
Other Digestive System O.r. Procedures W Mcc
|
3
|
3
|
$249,191.42
|
$249,191.42
|
$43,082.09
|
$60,466.09
|
$60,466.09
|
2026-07-31
|
|
901
|
OTHER
|
Wound Debridements For Injuries W Mcc
|
3
|
3
|
$129,259.83
|
$129,259.83
|
$38,168.28
|
$53,569.51
|
$53,569.51
|
2026-07-31
|
|
167
|
OTHER
|
Other Resp System O.r. Procedures W Cc
|
3
|
3
|
$151,001.50
|
$151,001.50
|
$38,162.93
|
$53,562.01
|
$53,562.01
|
2026-07-31
|
|
673
|
OTHER
|
Other Kidney & Urinary Tract Procedures W Mcc
|
3
|
3
|
$253,728.92
|
$253,728.92
|
$38,141.53
|
$53,531.97
|
$53,531.97
|
2026-07-31
|
|
856
|
OTHER
|
Postoperative Or Post-traumatic Infections W O.r. Proc W Mcc
|
3
|
3
|
$123,753.85
|
$123,753.85
|
$38,138.86
|
$53,528.22
|
$53,528.22
|
2026-07-31
|
|
570
|
OTHER
|
Skin Debridement W Mcc
|
3
|
3
|
$110,108.56
|
$110,108.56
|
$37,903.46
|
$53,197.84
|
$53,197.84
|
2026-07-31
|
|
870
|
OTHER
|
Septicemia W Mv 96+ Hours
|
5
|
5
|
$263,505.65
|
$263,505.65
|
$1,803.53
|
$73,027.84
|
$52,032.33
|
2026-07-31
|
|
264
|
OTHER
|
Other Circulatory System O.r. Procedures
|
3
|
3
|
$259,755.44
|
$259,755.44
|
$36,159.42
|
$50,750.07
|
$50,750.07
|
2026-07-31
|
|
207
|
OTHER
|
Respiratory System Diagnosis W Ventilator Support 96+ Hours
|
5
|
5
|
$235,684.86
|
$235,684.86
|
$1,803.53
|
$70,478.69
|
$50,216.07
|
2026-07-31
|
|
500
|
OTHER
|
Soft Tissue Procedures W Mcc
|
3
|
3
|
$130,652.67
|
$130,652.67
|
$33,982.05
|
$47,694.10
|
$47,694.10
|
2026-07-31
|
|
919
|
OTHER
|
Complications Of Treatment W Mcc
|
3
|
3
|
$233,583.55
|
$233,583.55
|
$31,103.84
|
$43,654.52
|
$43,654.52
|
2026-07-31
|
|
862
|
OTHER
|
Postoperative & Post-traumatic Infections W Mcc
|
3
|
3
|
$210,880.14
|
$210,880.14
|
$29,089.64
|
$40,827.56
|
$40,827.56
|
2026-07-31
|
|
539
|
OTHER
|
Osteomyelitis W Mcc
|
3
|
3
|
$87,873.36
|
$87,873.36
|
$29,052.19
|
$40,775.00
|
$40,775.00
|
2026-07-31
|
|
542
|
OTHER
|
Pathological Fractures & Musculoskelet & Conn Tiss Malig W Mcc
|
3
|
3
|
$55,921.85
|
$55,921.85
|
$28,597.45
|
$40,136.78
|
$40,136.78
|
2026-07-31
|
|
917
|
OTHER
|
Poisoning & Toxic Effects Of Drugs W Mcc
|
3
|
3
|
$175,717.16
|
$175,717.16
|
$28,597.45
|
$40,136.78
|
$40,136.78
|
2026-07-31
|
|
94
|
OTHER
|
Bacterial & Tuberculous Infections Of Nervous System W Mcc
|
3
|
3
|
$296,127.91
|
$296,127.91
|
$28,527.91
|
$40,039.17
|
$40,039.17
|
2026-07-31
|
|
314
|
OTHER
|
Other Circulatory System Diagnoses W Mcc
|
3
|
3
|
$116,597.59
|
$116,597.59
|
$28,463.71
|
$39,949.06
|
$39,949.06
|
2026-07-31
|
|
606
|
OTHER
|
Minor Skin Disorders W Mcc
|
3
|
3
|
$121,472.58
|
$121,472.58
|
$27,300.12
|
$38,315.96
|
$38,315.96
|
2026-07-31
|
|
548
|
OTHER
|
Septic Arthritis W Mcc
|
3
|
3
|
$136,042.23
|
$136,042.23
|
$26,802.59
|
$37,617.67
|
$37,617.67
|
2026-07-31
|
|
637
|
OTHER
|
Diabetes W Mcc
|
3
|
3
|
$205,654.29
|
$205,654.29
|
$26,607.32
|
$37,343.61
|
$37,343.61
|
2026-07-31
|
|
592
|
OTHER
|
Skin Ulcers W Mcc
|
3
|
3
|
$80,929.95
|
$80,929.95
|
$25,828.92
|
$36,251.12
|
$36,251.12
|
2026-07-31
|
|
371
|
OTHER
|
Major Gastrointestinal Disorders & Peritoneal Infections W Mcc
|
3
|
3
|
$92,594.05
|
$92,594.05
|
$25,358.14
|
$35,590.37
|
$35,590.37
|
2026-07-31
|
|
189
|
OTHER
|
Pulmonary Edema & Respiratory Failure
|
3
|
3
|
$146,602.82
|
$146,602.82
|
$25,267.19
|
$35,462.73
|
$35,462.73
|
2026-07-31
|
|
871
|
OTHER
|
Septicemia Without Mv 96+ Hours W Mcc
|
3
|
3
|
$91,959.57
|
$91,959.57
|
$24,849.91
|
$34,877.06
|
$34,877.06
|
2026-07-31
|
|
640
|
OTHER
|
Nutritional & Misc Metabolic Disorders W Mcc
|
3
|
3
|
$47,983.53
|
$47,983.53
|
$24,531.59
|
$34,430.30
|
$34,430.30
|
2026-07-31
|
|
559
|
OTHER
|
Aftercare, Musculoskeletal System & Connective Tissue W Mcc
|
3
|
3
|
$42,930.19
|
$42,930.19
|
$24,344.35
|
$34,167.51
|
$34,167.51
|
2026-07-31
|
|
682
|
OTHER
|
Renal Failure W Mcc
|
3
|
3
|
$116,241.85
|
$116,241.85
|
$24,280.15
|
$34,077.40
|
$34,077.40
|
2026-07-31
|
|
698
|
OTHER
|
Other Kidney & Urinary Tract Diagnoses W Mcc
|
3
|
3
|
$71,268.74
|
$71,268.74
|
$23,635.50
|
$33,172.63
|
$33,172.63
|
2026-07-31
|
|
291
|
OTHER
|
Heart Failure & Shock W Mcc
|
3
|
3
|
$138,246.69
|
$138,246.69
|
$23,036.32
|
$32,331.67
|
$32,331.67
|
2026-07-31
|
|
391
|
OTHER
|
Esophagitis, Gastroent & Misc Digest Disorders W Mcc
|
3
|
3
|
$36,773.67
|
$36,773.67
|
$23,004.22
|
$32,286.62
|
$32,286.62
|
2026-07-31
|
|
98
|
OTHER
|
Non-bacterial Infect Of Nervous Sys Exc Viral Meningitis W Cc
|
3
|
3
|
$39,417.20
|
$39,417.20
|
$22,570.88
|
$31,678.43
|
$31,678.43
|
2026-07-31
|
|
299
|
OTHER
|
Peripheral Vascular Disorders W Mcc
|
3
|
3
|
$86,202.77
|
$86,202.77
|
$22,541.46
|
$31,637.14
|
$31,637.14
|
2026-07-31
|
|
56
|
OTHER
|
Degenerative Nervous System Disorders W Mcc
|
3
|
3
|
$106,258.36
|
$106,258.36
|
$22,501.34
|
$31,580.82
|
$31,580.82
|
2026-07-31
|
|
920
|
OTHER
|
Complications Of Treatment W Cc
|
3
|
3
|
$148,995.17
|
$148,995.17
|
$22,495.99
|
$31,573.31
|
$31,573.31
|
2026-07-31
|
|
432
|
OTHER
|
Cirrhosis & Alcoholic Hepatitis W Mcc
|
3
|
3
|
$38,749.41
|
$38,749.41
|
$22,247.22
|
$31,224.17
|
$31,224.17
|
2026-07-31
|
|
177
|
OTHER
|
Respiratory Infections & Inflammations W Mcc
|
3
|
3
|
$102,108.83
|
$102,108.83
|
$22,092.07
|
$31,006.42
|
$31,006.42
|
2026-07-31
|
|
638
|
OTHER
|
Diabetes W Cc
|
3
|
3
|
$97,339.20
|
$97,339.20
|
$21,845.98
|
$30,661.03
|
$30,661.03
|
2026-07-31
|
|
208
|
OTHER
|
Respiratory System Diagnosis W Ventilator Support <96 Hours
|
5
|
5
|
$41,760.64
|
$41,760.64
|
$1,803.53
|
$42,798.55
|
$30,493.96
|
2026-07-31
|
|
289
|
OTHER
|
Acute & Subacute Endocarditis W Cc
|
3
|
3
|
$29,246.06
|
$29,246.06
|
$20,858.94
|
$29,275.71
|
$29,275.71
|
2026-07-31
|
|
727
|
OTHER
|
Inflammation Of The Male Reproductive System W Mcc
|
3
|
3
|
$161,571.20
|
$161,571.20
|
$20,503.18
|
$28,776.39
|
$28,776.39
|
2026-07-31
|
|
602
|
OTHER
|
Cellulitis W Mcc
|
3
|
3
|
$77,497.10
|
$77,497.10
|
$20,492.48
|
$28,761.37
|
$28,761.37
|
2026-07-31
|
|
949
|
OTHER
|
Aftercare W Cc/Mcc
|
3
|
3
|
$74,163.71
|
$74,163.71
|
$20,195.56
|
$28,344.65
|
$28,344.65
|
2026-07-31
|
|
560
|
OTHER
|
Aftercare, Musculoskeletal System & Connective Tissue W Cc
|
3
|
3
|
$93,082.36
|
$93,082.36
|
$20,195.56
|
$28,344.65
|
$28,344.65
|
2026-07-31
|
|
190
|
OTHER
|
Chronic Obstructive Pulmonary Disease W Mcc
|
3
|
3
|
$71,533.80
|
$71,533.80
|
$19,534.86
|
$27,417.35
|
$27,417.35
|
2026-07-31
|
|
683
|
OTHER
|
Renal Failure W Cc
|
3
|
3
|
$82,022.96
|
$82,022.96
|
$19,478.69
|
$27,338.51
|
$27,338.51
|
2026-07-31
|
|
863
|
OTHER
|
Postoperative & Post-traumatic Infections Without Mcc
|
3
|
3
|
$54,771.08
|
$54,771.08
|
$19,478.69
|
$27,338.51
|
$27,338.51
|
2026-07-31
|
|
193
|
OTHER
|
Simple Pneumonia & Pleurisy W Mcc
|
3
|
3
|
$49,499.73
|
$49,499.73
|
$18,919.63
|
$26,553.87
|
$26,553.87
|
2026-07-31
|
|
57
|
OTHER
|
Degenerative Nervous System Disorders Without Mcc
|
3
|
3
|
$36,757.34
|
$36,757.34
|
$17,863.04
|
$25,070.94
|
$25,070.94
|
2026-07-31
|
|
641
|
OTHER
|
Nutritional & Misc Metabolic Disorders Without Mcc
|
3
|
3
|
$27,205.25
|
$27,205.25
|
$17,432.38
|
$24,466.50
|
$24,466.50
|
2026-07-31
|
|
541
|
OTHER
|
Osteomyelitis Without Cc/Mcc
|
3
|
3
|
$95,830.77
|
$95,830.77
|
$17,202.34
|
$24,143.64
|
$24,143.64
|
2026-07-31
|
|
561
|
OTHER
|
Aftercare, Musculoskeletal System & Connective Tissue Without Cc/Mcc
|
3
|
3
|
$43,422.62
|
$43,422.62
|
$17,202.34
|
$24,143.64
|
$24,143.64
|
2026-07-31
|
|
372
|
OTHER
|
Major Gastrointestinal Disorders & Peritoneal Infections W Cc
|
3
|
3
|
$81,535.99
|
$81,535.99
|
$16,434.64
|
$23,066.16
|
$23,066.16
|
2026-07-31
|
|
728
|
OTHER
|
Inflammation Of The Male Reproductive System Without Mcc
|
3
|
3
|
$85,886.98
|
$85,886.98
|
$16,228.67
|
$22,777.09
|
$22,777.09
|
2026-07-31
|
|
872
|
OTHER
|
Septicemia Without Mv 96+ Hours Without Mcc
|
3
|
3
|
$62,746.05
|
$62,746.05
|
$15,650.89
|
$21,966.17
|
$21,966.17
|
2026-07-31
|
|
699
|
OTHER
|
Other Kidney & Urinary Tract Diagnoses W Cc
|
3
|
3
|
$101,916.11
|
$101,916.11
|
$15,222.91
|
$21,365.49
|
$21,365.49
|
2026-07-31
|
|
603
|
OTHER
|
Cellulitis Without Mcc
|
3
|
3
|
$61,916.51
|
$61,916.51
|
$14,832.37
|
$20,817.36
|
$20,817.36
|
2026-07-31
|
|
812
|
OTHER
|
Red Blood Cell Disorders Without Mcc
|
3
|
3
|
$87,505.00
|
$87,505.00
|
$13,885.45
|
$19,488.36
|
$19,488.36
|
2026-07-31
|
|
866
|
OTHER
|
Viral Illness Without Mcc
|
3
|
3
|
$49,283.17
|
$49,283.17
|
$13,885.45
|
$19,488.36
|
$19,488.36
|
2026-07-31
|
|
94002
|
CPT
|
Ventilation Mgmt 1st Day
|
2
|
2
|
$3,099.00
|
$3,099.00
|
$2,169.30
|
$2,324.25
|
$2,246.78
|
2026-07-31
|
|
CP17660067616943178
|
CDM
|
Respiratory Infections & Inflammations W Mcc
|
9
|
8
|
$89,725.00
|
$89,725.00
|
$1,809.00
|
$67,294.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616954764
|
CDM
|
Other Skin, Subcut Tiss & Breast Proc W Mcc
|
9
|
8
|
$158,074.00
|
$158,074.00
|
$1,809.00
|
$118,556.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616953034
|
CDM
|
Aftercare, Musculoskeletal System & Connective Tissue W Mcc
|
9
|
8
|
$126,370.00
|
$126,370.00
|
$1,809.00
|
$94,778.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616951769
|
CDM
|
Aftercare, Musculoskeletal System & Connective Tissue Without Cc/mcc
|
9
|
8
|
$37,837.00
|
$37,837.00
|
$1,809.00
|
$28,378.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616951754
|
CDM
|
Cellulitis W Mcc
|
9
|
8
|
$89,015.00
|
$89,015.00
|
$1,809.00
|
$66,761.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616950543
|
CDM
|
Cellulitis Without Mcc
|
9
|
8
|
$89,003.00
|
$89,003.00
|
$1,809.00
|
$66,752.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616950101
|
CDM
|
Aftercare, Musculoskeletal System & Connective Tissue W Cc
|
9
|
8
|
$186,381.00
|
$186,381.00
|
$1,809.00
|
$139,786.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616950079
|
CDM
|
Other Musculoskeletal Sys & Connective Tissue Diagnoses W Cc
|
9
|
8
|
$26,177.00
|
$26,177.00
|
$1,809.00
|
$19,633.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616949890
|
CDM
|
Other Digestive System O.r. Procedures W Mcc
|
9
|
8
|
$258,158.00
|
$258,158.00
|
$1,809.00
|
$193,619.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616949661
|
CDM
|
Degenerative Nervous System Disorders Without Mcc
|
9
|
8
|
$48,682.00
|
$48,682.00
|
$1,809.00
|
$36,512.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616949209
|
CDM
|
G.i. Obstruction W Mcc
|
9
|
8
|
$200,581.00
|
$200,581.00
|
$1,809.00
|
$150,436.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616949070
|
CDM
|
Other Disorders Of Nervous System W Mcc
|
9
|
8
|
$147,481.00
|
$147,481.00
|
$1,809.00
|
$110,611.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616948970
|
CDM
|
Soft Tissue Procedures W Cc
|
9
|
8
|
$101,073.00
|
$101,073.00
|
$1,809.00
|
$75,805.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616948683
|
CDM
|
Otitis Media & Uri W Mcc
|
9
|
8
|
$41,334.00
|
$41,334.00
|
$1,809.00
|
$31,001.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616948308
|
CDM
|
Wnd Debrid & Skn Grft Exc Hand, For Musculo-conn Tiss Dis W Mcc
|
9
|
8
|
$244,606.00
|
$244,606.00
|
$1,809.00
|
$183,455.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616947629
|
CDM
|
Trach W Mv 96+ Hrs Or Pdx Exc Face, Mouth & Neck Without Maj O.r.
|
9
|
8
|
$422,230.00
|
$422,230.00
|
$1,809.00
|
$316,673.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616946723
|
CDM
|
Degenerative Nervous System Disorders W Mcc
|
9
|
8
|
$147,036.00
|
$147,036.00
|
$1,809.00
|
$110,277.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616946482
|
CDM
|
Wnd Debrid & Skn Grft Exc Hand, For Musculo-conn Tiss Dis W Cc
|
9
|
8
|
$96,125.00
|
$96,125.00
|
$1,809.00
|
$72,094.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616946009
|
CDM
|
Nonspecific Cerebrovascular Disorders W Mcc
|
9
|
8
|
$73,542.00
|
$73,542.00
|
$1,809.00
|
$55,157.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616945810
|
CDM
|
Other Digestive System Diagnoses W Mcc
|
9
|
8
|
$110,899.00
|
$110,899.00
|
$1,809.00
|
$83,174.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616945239
|
CDM
|
Other Circulatory System Diagnoses W Mcc
|
9
|
8
|
$42,532.00
|
$42,532.00
|
$1,809.00
|
$31,899.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616944678
|
CDM
|
Acute & Subacute Endocarditis W Mcc
|
9
|
8
|
$88,561.00
|
$88,561.00
|
$1,809.00
|
$66,421.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616944509
|
CDM
|
Respiratory System Diagnosis W Ventilator Support <96 Hours
|
9
|
8
|
$47,832.00
|
$47,832.00
|
$1,809.00
|
$35,874.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616944055
|
CDM
|
Peripheral Vascular Disorders Without Cc/mcc
|
9
|
8
|
$68,926.00
|
$68,926.00
|
$1,809.00
|
$51,695.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616940690
|
CDM
|
Peripheral Vascular Disorders W Mcc
|
9
|
8
|
$17,846.00
|
$17,846.00
|
$1,809.00
|
$13,385.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616940708
|
CDM
|
Osteomyelitis Without Cc/mcc
|
9
|
8
|
$112,200.00
|
$112,200.00
|
$1,809.00
|
$84,150.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616941047
|
CDM
|
Respiratory System Diagnosis W Ventilator Support 96+ Hours
|
9
|
8
|
$293,660.00
|
$293,660.00
|
$1,809.00
|
$220,245.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616941263
|
CDM
|
Amputation For Musculoskeletal Sys & Conn Tissue Dis W Mcc
|
9
|
8
|
$302,846.00
|
$302,846.00
|
$1,809.00
|
$227,135.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616941551
|
CDM
|
Other Resp System O.r. Procedures W Mcc
|
9
|
8
|
$395,424.00
|
$395,424.00
|
$1,809.00
|
$296,568.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616941557
|
CDM
|
Bacterial & Tuberculous Infections Of Nervous System W Mcc
|
9
|
8
|
$79,245.00
|
$79,245.00
|
$1,809.00
|
$59,434.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616941606
|
CDM
|
Disorders Of Pancreas Except Malignancy W Mcc
|
9
|
8
|
$102,670.00
|
$102,670.00
|
$1,809.00
|
$77,003.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616941895
|
CDM
|
Pulmonary Edema & Respiratory Failure
|
9
|
8
|
$143,874.00
|
$143,874.00
|
$1,809.00
|
$107,906.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616943643
|
CDM
|
Heart Failure & Shock W Mcc
|
9
|
8
|
$44,972.00
|
$44,972.00
|
$1,809.00
|
$33,729.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616969868
|
CDM
|
Wound Debridements For Injuries W Mcc
|
9
|
8
|
$95,497.00
|
$95,497.00
|
$1,809.00
|
$71,623.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616968972
|
CDM
|
Diabetes W Cc
|
9
|
8
|
$88,211.00
|
$88,211.00
|
$1,809.00
|
$66,158.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616968832
|
CDM
|
Nutritional & Misc Metabolic Disorders Without Mcc
|
9
|
8
|
$79,973.00
|
$79,973.00
|
$1,809.00
|
$59,980.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616967526
|
CDM
|
Nutritional & Misc Metabolic Disorders W Mcc
|
9
|
8
|
$19,726.00
|
$19,726.00
|
$1,809.00
|
$14,795.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616966136
|
CDM
|
Extensive O.r. Procedure Unrelated To Principal Diagnosis W Cc
|
9
|
8
|
$189,579.00
|
$189,579.00
|
$1,809.00
|
$142,184.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616966081
|
CDM
|
Inflammation Of The Male Reproductive System W Mcc
|
9
|
8
|
$218,063.00
|
$218,063.00
|
$1,809.00
|
$163,547.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616966050
|
CDM
|
Complications Of Treatment W Cc
|
9
|
8
|
$282,827.00
|
$282,827.00
|
$1,809.00
|
$212,120.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616965897
|
CDM
|
Renal Failure W Mcc
|
9
|
8
|
$123,835.00
|
$123,835.00
|
$1,809.00
|
$92,876.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616964914
|
CDM
|
Infectious & Parasitic Diseases W O.r. Procedure W Cc
|
9
|
8
|
$128,561.00
|
$128,561.00
|
$1,809.00
|
$96,421.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616964681
|
CDM
|
Septicemia W Mv 96+ Hours
|
9
|
8
|
$196,640.00
|
$196,640.00
|
$1,809.00
|
$147,480.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616964330
|
CDM
|
Infectious & Parasitic Diseases W O.r. Procedure W Mcc
|
9
|
8
|
$235,546.00
|
$235,546.00
|
$1,809.00
|
$176,660.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616963246
|
CDM
|
Other Endocrine, Nutrit & Metab O.r. Proc W Cc
|
9
|
8
|
$119,698.00
|
$119,698.00
|
$1,809.00
|
$89,774.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616962942
|
CDM
|
Kidney & Urinary Tract Infections Without Mcc
|
9
|
8
|
$10,454.00
|
$10,454.00
|
$1,809.00
|
$7,841.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616962821
|
CDM
|
O.r. Proc W Diagnoses Of Other Contact W Health Services W Mcc
|
9
|
8
|
$158,775.00
|
$158,775.00
|
$1,809.00
|
$119,081.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616962391
|
CDM
|
Skin Grafts & Wound Debrid For Endoc, Nutrit & Metab Dis W Mcc
|
9
|
8
|
$112,959.00
|
$112,959.00
|
$1,809.00
|
$84,719.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616962248
|
CDM
|
HIV W Major Related Condition W Cc
|
9
|
8
|
$89,316.00
|
$89,316.00
|
$1,809.00
|
$66,987.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616961727
|
CDM
|
Aftercare W Cc/mcc
|
9
|
8
|
$75,508.00
|
$75,508.00
|
$1,809.00
|
$56,631.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616961286
|
CDM
|
Kidney & Urinary Tract Infections W Mcc
|
9
|
8
|
$33,470.00
|
$33,470.00
|
$1,809.00
|
$25,103.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616960725
|
CDM
|
Septicemia Without Mv 96+ Hours W Mcc
|
9
|
8
|
$112,615.00
|
$112,615.00
|
$1,809.00
|
$84,461.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616957533
|
CDM
|
Minor Skin Disorders W Mcc
|
9
|
8
|
$124,662.00
|
$124,662.00
|
$1,809.00
|
$93,497.00
|
$1,809.00
|
2025-11-25
|
|
CP17660067616956102
|
CDM
|
Skin Debridement W Mcc
|
9
|
8
|
$210,928.00
|
$210,928.00
|
$1,809.00
|
$158,196.00
|
$1,809.00
|
2025-11-25
|
|
11047
|
CPT
|
Debr Bone Ea Addl <=20 Sq
|
2
|
2
|
$2,219.75
|
$2,219.75
|
$1,553.82
|
$1,664.81
|
$1,609.32
|
2026-07-31
|
|
94003
|
CPT
|
Ventilation Mgmt Ea Subsq Day
|
2
|
2
|
$2,193.50
|
$2,193.50
|
$1,535.45
|
$1,645.13
|
$1,590.29
|
2026-07-31
|
|
94660
|
CPT
|
CPAP/Bipap Initiation & Mgmt
|
2
|
2
|
$2,089.00
|
$2,089.00
|
$1,462.30
|
$1,566.75
|
$1,514.53
|
2026-07-31
|
|
94762
|
CPT
|
Pulse Ox Continuous/Overnight
|
2
|
2
|
$2,000.25
|
$2,000.25
|
$1,400.17
|
$1,500.19
|
$1,450.18
|
2026-07-31
|
|
36569
|
CPT
|
Picc Line Insert Without Pump
|
2
|
2
|
$1,687.00
|
$1,687.00
|
$1,180.90
|
$1,265.25
|
$1,223.08
|
2026-07-31
|
|
31622
|
CPT
|
Bronchoscopy Dx W/Wo Cell Wash
|
2
|
2
|
$1,679.00
|
$1,679.00
|
$1,175.30
|
$1,259.25
|
$1,217.28
|
2026-07-31
|
|
11044
|
CPT
|
Debr Bone 1st <= 20 Sq Cm
|
2
|
2
|
$1,651.75
|
$1,651.75
|
$1,156.22
|
$1,238.81
|
$1,197.51
|
2026-07-31
|
|
11046
|
CPT
|
Debr Musl/Fas Ea Addl <=20 Sq
|
2
|
2
|
$1,205.50
|
$1,205.50
|
$843.85
|
$904.13
|
$873.99
|
2026-07-31
|
|
90935
|
CPT
|
Hemodialysis
|
2
|
2
|
$1,048.00
|
$1,048.00
|
$733.60
|
$786.00
|
$759.80
|
2026-07-31
|
|
PH002921
|
CDM
|
Filgrastim
|
2
|
2
|
$797.00
|
$797.00
|
$558.00
|
$598.00
|
$578.00
|
2025-11-25
|
|
11045
|
CPT
|
Debr Sq Tis Ea Add <=20 Sq
|
2
|
2
|
$647.75
|
$647.75
|
$453.42
|
$485.81
|
$469.62
|
2026-07-31
|
|
11043
|
CPT
|
Debr Musl/Fas 1st <= 20 Sqcm
|
2
|
2
|
$647.75
|
$647.75
|
$453.42
|
$485.81
|
$469.62
|
2026-07-31
|
|
11042
|
CPT
|
Debr Sq Tis 1st <= 20 Sqcm
|
2
|
2
|
$647.75
|
$647.75
|
$453.42
|
$485.81
|
$469.62
|
2026-07-31
|
|
31500
|
CPT
|
Endotrachael Intubation
|
2
|
2
|
$612.00
|
$612.00
|
$428.40
|
$459.00
|
$443.70
|
2026-07-31
|
|
92950
|
CPT
|
Cpr (Code Blue)
|
2
|
2
|
$590.00
|
$590.00
|
$413.00
|
$442.50
|
$427.75
|
2026-07-31
|
|
90945
|
CPT
|
Peritoneal Dialysis
|
2
|
2
|
$429.00
|
$429.00
|
$300.30
|
$321.75
|
$311.02
|
2026-07-31
|
|
94669
|
CPT
|
Mech Chest Wall Oscill
|
2
|
2
|
$386.10
|
$386.10
|
$270.27
|
$289.58
|
$279.92
|
2026-07-31
|
|
10060
|
CPT
|
I&d Abscesssimple/Single
|
2
|
2
|
$367.50
|
$367.50
|
$257.25
|
$275.63
|
$266.44
|
2026-07-31
|
|
PH002931
|
CDM
|
Perflutren Lipid Microspheres
|
2
|
2
|
$357.00
|
$357.00
|
$250.00
|
$268.00
|
$259.00
|
2025-11-25
|
|
97167
|
CPT
|
Ot Eval High Complexity
|
2
|
2
|
$347.75
|
$347.75
|
$243.42
|
$260.81
|
$252.12
|
2026-07-31
|
|
97163
|
CPT
|
Pt Eval High Complexity
|
2
|
2
|
$347.75
|
$347.75
|
$243.42
|
$260.81
|
$252.12
|
2026-07-31
|
|
94761
|
CPT
|
Pulse Ox Multiple Det
|
2
|
2
|
$347.50
|
$347.50
|
$243.25
|
$260.63
|
$251.94
|
2026-07-31
|
|
J1610
|
HCPCS
|
Glucagen
|
2
|
2
|
$343.20
|
$343.20
|
$240.24
|
$257.40
|
$248.82
|
2026-07-31
|
|
97598
|
CPT
|
Rmvl Devital Tis Addl 20 Cm<
|
2
|
2
|
$343.00
|
$343.00
|
$240.10
|
$257.25
|
$248.68
|
2026-07-31
|
|
97597
|
CPT
|
Rmvl Devital Tis 20 Cm/<
|
2
|
2
|
$343.00
|
$343.00
|
$240.10
|
$257.25
|
$248.68
|
2026-07-31
|
|
97606
|
CPT
|
Vaccuum Therapy >50cm
|
2
|
2
|
$341.25
|
$341.25
|
$238.87
|
$255.94
|
$247.41
|
2026-07-31
|
|
29580
|
CPT
|
Appl Unna Boot Unilat
|
2
|
2
|
$303.50
|
$303.50
|
$212.45
|
$227.63
|
$220.04
|
2026-07-31
|
|
97166
|
CPT
|
Ot Eval Mod Complexity
|
2
|
2
|
$289.75
|
$289.75
|
$202.82
|
$217.31
|
$210.06
|
2026-07-31
|
|
97162
|
CPT
|
Pt Eval Mod Complexity
|
2
|
2
|
$289.75
|
$289.75
|
$202.82
|
$217.31
|
$210.06
|
2026-07-31
|
|
94770
|
CPT
|
End Tidal Co2 Detection By Ir
|
2
|
2
|
$283.00
|
$283.00
|
$198.10
|
$212.25
|
$205.18
|
2026-07-31
|
|
31502
|
CPT
|
Tracheotomy Tube Change
|
2
|
2
|
$259.50
|
$259.50
|
$181.65
|
$194.63
|
$188.14
|
2026-07-31
|
|
97605
|
CPT
|
Vaccuum Therapy <50cm
|
2
|
2
|
$255.25
|
$255.25
|
$178.67
|
$191.44
|
$185.06
|
2026-07-31
|
|
PH001775
|
CDM
|
Buprenorphine 10mcg/hr
|
2
|
2
|
$238.00
|
$238.00
|
$167.00
|
$179.00
|
$173.00
|
2025-11-25
|
|
PH002825
|
CDM
|
Norepinephrine Bit/0.9 % Nacl
|
2
|
2
|
$237.00
|
$237.00
|
$166.00
|
$178.00
|
$172.00
|
2025-11-25
|
|
97161
|
CPT
|
Pt Eval Low Complexity
|
2
|
2
|
$231.75
|
$231.75
|
$162.22
|
$173.81
|
$168.01
|
2026-07-31
|
|
97165
|
CPT
|
Ot Eval Low Complexity
|
2
|
2
|
$231.75
|
$231.75
|
$162.22
|
$173.81
|
$168.01
|
2026-07-31
|
|
94667
|
CPT
|
Manip Chest Wall (cpt) Initial
|
2
|
2
|
$219.50
|
$219.50
|
$153.65
|
$164.63
|
$159.14
|
2026-07-31
|
|
94760
|
CPT
|
Pulse Ox Single Det
|
2
|
2
|
$212.50
|
$212.50
|
$148.75
|
$159.38
|
$154.06
|
2026-07-31
|
|
94664
|
CPT
|
Demo/Eval Pt Inhal/Neb/Ippb
|
2
|
2
|
$206.75
|
$206.75
|
$144.72
|
$155.06
|
$149.89
|
2026-07-31
|
|
94668
|
CPT
|
Manip Chest Wall (cpt) Subseq
|
2
|
2
|
$198.50
|
$198.50
|
$138.95
|
$148.88
|
$143.91
|
2026-07-31
|
|
PH001999
|
CDM
|
Epinephrine 1mg/ml 30ml
|
2
|
2
|
$177.00
|
$177.00
|
$124.00
|
$133.00
|
$128.50
|
2025-11-25
|
|
PH002932
|
CDM
|
Revefenacinud 175mcg/3ml
|
2
|
2
|
$158.00
|
$158.00
|
$111.00
|
$119.00
|
$115.00
|
2025-11-25
|
|
P9060
|
HCPCS
|
Ffp Donor Retest Ea Unit
|
2
|
2
|
$150.00
|
$150.00
|
$105.00
|
$112.50
|
$108.75
|
2026-07-31
|
|
94640
|
CPT
|
Inhalation Treatment
|
2
|
2
|
$144.50
|
$144.50
|
$101.15
|
$108.38
|
$104.77
|
2026-07-31
|
|
31720
|
CPT
|
Catheter Aspiration Nasotrache
|
2
|
2
|
$121.00
|
$121.00
|
$84.70
|
$90.75
|
$87.72
|
2026-07-31
|
|
97535
|
CPT
|
Adl Training Ea 15 Min
|
2
|
2
|
$117.75
|
$117.75
|
$82.42
|
$88.31
|
$85.37
|
2026-07-31
|
|
PH002675
|
CDM
|
Fentanyl/ns 100ml Premix
|
2
|
2
|
$97.00
|
$97.00
|
$68.00
|
$73.00
|
$70.50
|
2025-11-25
|
|
PH002925
|
CDM
|
Hydrocortisone 100mg/60ml Rect
|
2
|
2
|
$86.00
|
$86.00
|
$60.00
|
$65.00
|
$62.50
|
2025-11-25
|
|
89220
|
CPT
|
Sputum Collection - Aerosol
|
2
|
2
|
$84.50
|
$84.50
|
$59.15
|
$63.38
|
$61.27
|
2026-07-31
|
|
PH002922
|
CDM
|
Flu Vacc Ts2025-26(6mos Up)/pf
|
2
|
2
|
$81.00
|
$81.00
|
$57.00
|
$61.00
|
$59.00
|
2025-11-25
|
|
36600
|
CPT
|
Arterial Puncture
|
2
|
2
|
$70.25
|
$70.25
|
$49.17
|
$52.69
|
$50.93
|
2026-07-31
|
|
PH000815
|
CDM
|
Duragesic 12mcg Patch
|
2
|
2
|
$65.00
|
$65.00
|
$46.00
|
$49.00
|
$47.50
|
2025-11-25
|
|
PH002929
|
CDM
|
Ephedrine Sulfate 50mg/ml
|
2
|
2
|
$62.00
|
$62.00
|
$43.00
|
$47.00
|
$45.00
|
2025-11-25
|
|
PH000675
|
CDM
|
Fentanyl 75mcg Patch
|
2
|
2
|
$49.00
|
$49.00
|
$34.00
|
$37.00
|
$35.50
|
2025-11-25
|
|
J1940
|
HCPCS
|
Furosemide
|
2
|
2
|
$46.72
|
$46.72
|
$32.70
|
$35.04
|
$33.87
|
2026-07-31
|
|
PH002223
|
CDM
|
Voriconazole 40mg/ml 75ml
|
2
|
2
|
$45.00
|
$45.00
|
$31.00
|
$34.00
|
$32.50
|
2025-11-25
|
|
PH000470
|
CDM
|
Epinephrine 1mg/1ml Sdv
|
2
|
2
|
$44.00
|
$44.00
|
$31.00
|
$33.00
|
$32.00
|
2025-11-25
|
|
PH000585
|
CDM
|
Fentanyl 50mcg Patch
|
2
|
2
|
$39.00
|
$39.00
|
$27.00
|
$29.00
|
$28.00
|
2025-11-25
|
|
PH002204
|
CDM
|
Vasopressin 20unit/ml 10ml
|
2
|
2
|
$26.00
|
$26.00
|
$18.00
|
$20.00
|
$19.00
|
2025-11-25
|
|
PH000183
|
CDM
|
Fentanyl 25mcg Patch
|
2
|
2
|
$18.00
|
$18.00
|
$13.00
|
$14.00
|
$13.50
|
2025-11-25
|
|
PH002714
|
CDM
|
Methotrexate Sodium/pf
|
2
|
2
|
$17.00
|
$17.00
|
$12.00
|
$13.00
|
$12.50
|
2025-11-25
|
|
PH002137
|
CDM
|
Buprenorphine/naloxone 2-0.5mg
|
2
|
2
|
$16.00
|
$16.00
|
$11.00
|
$12.00
|
$11.50
|
2025-11-25
|
|
PH001052
|
CDM
|
Heparin ,porcine1000unit/ml-10
|
2
|
2
|
$14.00
|
$14.00
|
$10.00
|
$11.00
|
$10.50
|
2025-11-25
|
|
J2930
|
HCPCS
|
Methylprednisolone Sod Succ 12
|
4
|
2
|
$12.46
|
$12.46
|
$4.90
|
$13.44
|
$8.89
|
2026-07-31
|
|
J1720
|
HCPCS
|
Solu-cortef*100/2
|
2
|
2
|
$11.58
|
$11.58
|
$8.11
|
$8.69
|
$8.40
|
2026-07-31
|
|
PH002917
|
CDM
|
Fluphenazine 1mg Tab
|
2
|
2
|
$11.00
|
$11.00
|
$8.00
|
$8.00
|
$8.00
|
2025-11-25
|
|
PH002132
|
CDM
|
Buprenorphine/naloxone 8-2
|
2
|
2
|
$11.00
|
$11.00
|
$8.00
|
$8.00
|
$8.00
|
2025-11-25
|
|
PH002361
|
CDM
|
Morphine Sulfate 2mg/ml Vial
|
2
|
2
|
$11.00
|
$11.00
|
$8.00
|
$8.00
|
$8.00
|
2025-11-25
|
|
S0164
|
HCPCS
|
Protonix IV
|
2
|
2
|
$10.00
|
$10.00
|
$7.00
|
$7.50
|
$7.25
|
2026-07-31
|
|
PH002565
|
CDM
|
Fentanyl Citrate/pf 50mcg/ml V
|
2
|
2
|
$9.00
|
$9.00
|
$6.00
|
$7.00
|
$6.50
|
2025-11-25
|
|
J0360
|
HCPCS
|
Hydralazine Hcl 20mg/ml
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
Q2009
|
HCPCS
|
Fosphenytoin Sodium
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
P9047
|
HCPCS
|
Buminate
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
P9045
|
HCPCS
|
Buminate
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J7131
|
HCPCS
|
Sodium Chloride
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J3480
|
HCPCS
|
Potassium Chloride
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J3475
|
HCPCS
|
Magnesium Sulfate
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J3430
|
HCPCS
|
Phytonadione 10mg/ml
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J3420
|
HCPCS
|
Cyanocobalamin (Vitamin B-12)
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J3411
|
HCPCS
|
Thiamine Hcl
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J3360
|
HCPCS
|
Diazepam 10mg Inj
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J3260
|
HCPCS
|
Tobramycin Sulfate 80/2
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J3243
|
HCPCS
|
Tygacil
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J3230
|
HCPCS
|
Chlorpromazine Hcl 25mg/ml
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J3105
|
HCPCS
|
Terbutaline Sulfate
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J3010
|
HCPCS
|
Fentanyl Citrate/Pf 100mcg/2ml
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J2997
|
HCPCS
|
Cathflo Activase
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J2916
|
HCPCS
|
Ferrlecit
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J2597
|
HCPCS
|
Desmopressin Acetate 4mcg/ml 1
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J2550
|
HCPCS
|
Promethazine Hcl Oc 25mg/ml
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J2543
|
HCPCS
|
Piperacillin/Tazobactam 3.375
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J2370
|
HCPCS
|
Phenylephrine Hcl
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J2310
|
HCPCS
|
Naloxone Hcl
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J2250
|
HCPCS
|
Midazolam Hcl 2mg/2ml Vial
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J2248
|
HCPCS
|
Mycamine 100mg
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J2185
|
HCPCS
|
Meropenem 500mg
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J2001
|
HCPCS
|
Lidocaine Hcl 2%-50ml
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J1956
|
HCPCS
|
Levofloxacin/D5w 500mg IV
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J1953
|
HCPCS
|
Keppra 500mg/5ml
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J1815
|
HCPCS
|
Humulin R Oc
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J1756
|
HCPCS
|
Venofer
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J1652
|
HCPCS
|
Arixtra 2.5mg
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J1650
|
HCPCS
|
Enoxaparin Sodium 40mg Syr
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J1644
|
HCPCS
|
Heparin Na 5000UNIT/ml,porcine
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J1580
|
HCPCS
|
Gentamicin Sulfate
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J1450
|
HCPCS
|
Diflucan In Saline
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J1442
|
HCPCS
|
Neupogen
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J1364
|
HCPCS
|
Erythrocin Lactobionate
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J1335
|
HCPCS
|
Invanz
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J1265
|
HCPCS
|
Dopamine Hcl 40000mcg/ml-5ml
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J1250
|
HCPCS
|
Dobutamine Hcl 12500mcg/ml-20m
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J1200
|
HCPCS
|
Diphenhydramine Hcl
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J1165
|
HCPCS
|
Phenytoin Sodium 100mg/2ml
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J1100
|
HCPCS
|
Dexamethasone Sod Phosphate
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J1080
|
HCPCS
|
Depo-testosterone
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J1040
|
HCPCS
|
Depo-medrol 80mg
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J1030
|
HCPCS
|
Methylpred Acetate 40mg
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J0885
|
HCPCS
|
Epogen
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J0878
|
HCPCS
|
Cubicin
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J0770
|
HCPCS
|
Colistin (Colistimethate Na)
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J0744
|
HCPCS
|
Cipro I.v.
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J0743
|
HCPCS
|
Primaxin
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J0713
|
HCPCS
|
Tazicef 1000mg
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J0697
|
HCPCS
|
Cefuroxime Sodium
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J0696
|
HCPCS
|
Ceftriaxone Sodium 1000mg
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J0692
|
HCPCS
|
Cefepime Hcl 1000mg
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J0690
|
HCPCS
|
Cefazolin Sodium 1000mg
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J0610
|
HCPCS
|
Calcium Gluconate
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J0461
|
HCPCS
|
Atropine Sulfate
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J0456
|
HCPCS
|
Azithromycin
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J0330
|
HCPCS
|
Anectine
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J0295
|
HCPCS
|
Ampicillin/Sulbactam 1.5gm
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J0290
|
HCPCS
|
Ampicillin Sodium 1000mg
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J0289
|
HCPCS
|
Ambisome
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J0282
|
HCPCS
|
Amiodarone Hcl
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J0278
|
HCPCS
|
Amikin
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J0171
|
HCPCS
|
Epinephrine 1mg/10ml
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J0133
|
HCPCS
|
Acyclovir Sodium
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
J0131
|
HCPCS
|
Ofirmev
|
2
|
2
|
$7.00
|
$7.00
|
$4.90
|
$5.25
|
$5.08
|
2026-07-31
|
|
PH002930
|
CDM
|
Phenylephrine Hcl 100 Mcg/ml
|
2
|
2
|
$7.00
|
$7.00
|
$5.00
|
$5.00
|
$5.00
|
2025-11-25
|
|
PH002919
|
CDM
|
Cefuroxime Axetil 500 Mg Tab
|
2
|
2
|
$7.00
|
$7.00
|
$5.00
|
$5.00
|
$5.00
|
2025-11-25
|
|
PH000106
|
CDM
|
Heparin Na 5000unit/ml,porcine
|
2
|
2
|
$7.00
|
$7.00
|
$5.00
|
$5.00
|
$5.00
|
2025-11-25
|
|
PH002446
|
CDM
|
Heparin Sodium,porcine 5000uni
|
2
|
2
|
$7.00
|
$7.00
|
$5.00
|
$5.00
|
$5.00
|
2025-11-25
|
|
PH002343
|
CDM
|
Heparin Sodium,porcine
|
2
|
2
|
$7.00
|
$7.00
|
$5.00
|
$5.00
|
$5.00
|
2025-11-25
|
|
PH002685
|
CDM
|
Norepinephrine/ns Premix
|
2
|
2
|
$7.00
|
$7.00
|
$5.00
|
$5.00
|
$5.00
|
2025-11-25
|
|
PH001428
|
CDM
|
Phenylephrine Hcl 10mg/ml-5ml
|
2
|
2
|
$7.00
|
$7.00
|
$5.00
|
$5.00
|
$5.00
|
2025-11-25
|
|
PH001234
|
CDM
|
Heparin Sodium,porcine 100unit
|
2
|
2
|
$7.00
|
$7.00
|
$5.00
|
$5.00
|
$5.00
|
2025-11-25
|
|
PH002674
|
CDM
|
Fentanyl Citrate/pf
|
2
|
2
|
$7.00
|
$7.00
|
$5.00
|
$5.00
|
$5.00
|
2025-11-25
|
|
J1630
|
HCPCS
|
Haloperidol Lactate
|
2
|
2
|
$5.90
|
$5.90
|
$4.13
|
$4.43
|
$4.28
|
2026-07-31
|
|
J1160
|
HCPCS
|
Digoxin0.5mg/2ml
|
2
|
2
|
$5.24
|
$5.24
|
$3.67
|
$3.93
|
$3.80
|
2026-07-31
|
|
J2060
|
HCPCS
|
Lorazepam 2mg/ml
|
2
|
2
|
$5.08
|
$5.08
|
$3.56
|
$3.81
|
$3.69
|
2026-07-31
|
|
J2405
|
HCPCS
|
Ondansetron HCL/Pf 4mg/2ml
|
2
|
2
|
$4.80
|
$4.80
|
$3.36
|
$3.60
|
$3.48
|
2026-07-31
|
|
J1170
|
HCPCS
|
Hydromorphone Hcl 2mg Syr
|
4
|
2
|
$4.32
|
$4.32
|
$2.91
|
$3.36
|
$3.13
|
2026-07-31
|
|
PH001222
|
CDM
|
Heparin Sodium,porcine/pf 3ml
|
2
|
2
|
$4.00
|
$4.00
|
$3.00
|
$3.00
|
$3.00
|
2025-11-25
|
|
PH001475
|
CDM
|
Heparin Sodium,500unit/5ml-12
|
2
|
2
|
$4.00
|
$4.00
|
$3.00
|
$3.00
|
$3.00
|
2025-11-25
|
|
PH001987
|
CDM
|
Heparin Sodium,porc/pf 50unit/
|
2
|
2
|
$4.00
|
$4.00
|
$3.00
|
$3.00
|
$3.00
|
2025-11-25
|
|
PH002157
|
CDM
|
Heparin Sodium 10unit/ml-1ml
|
2
|
2
|
$4.00
|
$4.00
|
$3.00
|
$3.00
|
$3.00
|
2025-11-25
|
|
PH002177
|
CDM
|
Heparin Sod,porc/pf 10unit/ml-
|
2
|
2
|
$4.00
|
$4.00
|
$3.00
|
$3.00
|
$3.00
|
2025-11-25
|
|
PH002918
|
CDM
|
Desvenlafaxine Succinate Tab E
|
2
|
2
|
$4.00
|
$4.00
|
$3.00
|
$3.00
|
$3.00
|
2025-11-25
|
|
J3370
|
HCPCS
|
Vancomycin Hcl
|
4
|
2
|
$4.00
|
$4.00
|
$0.70
|
$5.25
|
$2.83
|
2026-07-31
|
|
J1885
|
HCPCS
|
Ketorolac Tromethamine
|
4
|
2
|
$3.63
|
$3.63
|
$2.45
|
$2.82
|
$2.63
|
2026-07-31
|
|
PH001505
|
CDM
|
Oxycodone Hcl Ir 10mg
|
2
|
2
|
$3.00
|
$3.00
|
$2.00
|
$2.00
|
$2.00
|
2025-11-25
|
|
PH002772
|
CDM
|
Prazosin Hcl
|
2
|
2
|
$3.00
|
$3.00
|
$2.00
|
$2.00
|
$2.00
|
2025-11-25
|
|
PH002753
|
CDM
|
Insulin Glargine-yfgn
|
2
|
2
|
$2.00
|
$2.00
|
$1.00
|
$2.00
|
$1.50
|
2025-11-25
|
|
PH001122
|
CDM
|
Morphine 2mg/ml Cpj
|
2
|
2
|
$2.00
|
$2.00
|
$1.00
|
$2.00
|
$1.50
|
2025-11-25
|
|
PH002933
|
CDM
|
Dextroamphetamine/amphetamine
|
2
|
2
|
$2.00
|
$2.00
|
$1.00
|
$2.00
|
$1.50
|
2025-11-25
|
|
PH000901
|
CDM
|
Oxycodone Hcl 15mg Ir
|
2
|
2
|
$2.00
|
$2.00
|
$1.00
|
$2.00
|
$1.50
|
2025-11-25
|
|
PH002415
|
CDM
|
Oxycodone Hcl 20mg Tab
|
2
|
2
|
$2.00
|
$2.00
|
$1.00
|
$2.00
|
$1.50
|
2025-11-25
|
|
J2765
|
HCPCS
|
Metoclopramide Hcl Inj
|
2
|
2
|
$1.80
|
$1.80
|
$1.26
|
$1.35
|
$1.31
|
2026-07-31
|
|
PH000129
|
CDM
|
Tramadol Hcl
|
2
|
2
|
$1.00
|
$1.00
|
$1.00
|
$1.00
|
$1.00
|
2025-11-25
|
|
PH001054
|
CDM
|
Warfarin Sodium 2.5mg Ud
|
2
|
2
|
$1.00
|
$1.00
|
$1.00
|
$1.00
|
$1.00
|
2025-11-25
|
|
PH000088
|
CDM
|
Hydromorphone Hcl 2mg Tab
|
2
|
2
|
$1.00
|
$1.00
|
$1.00
|
$1.00
|
$1.00
|
2025-11-25
|
|
PH002916
|
CDM
|
Nitroglycerin Patch Removal
|
2
|
2
|
$1.00
|
$1.00
|
$1.00
|
$1.00
|
$1.00
|
2025-11-25
|
|
PH002924
|
CDM
|
Amox/clavulanate 400-57mg/5ml
|
2
|
2
|
$1.00
|
$1.00
|
$1.00
|
$1.00
|
$1.00
|
2025-11-25
|
|
PH002927
|
CDM
|
Carbamazepine Oral Sus 100mg/5
|
2
|
2
|
$1.00
|
$1.00
|
$1.00
|
$1.00
|
$1.00
|
2025-11-25
|
|
PH002928
|
CDM
|
Rivastigmine Patch Removal
|
2
|
2
|
$1.00
|
$1.00
|
$1.00
|
$1.00
|
$1.00
|
2025-11-25
|
|
J7506
|
HCPCS
|
Prednisone 20mg
|
2
|
2
|
$1.00
|
$1.00
|
$0.70
|
$0.75
|
$0.72
|
2026-07-31
|
|
Q0163
|
HCPCS
|
Diphenhydramine Hcl 25mg Cap
|
2
|
2
|
$1.00
|
$1.00
|
$0.70
|
$0.75
|
$0.72
|
2026-07-31
|
|
J7608
|
HCPCS
|
Acetylcyst20%-30ml Oc
|
2
|
2
|
$1.00
|
$1.00
|
$0.70
|
$0.75
|
$0.72
|
2026-07-31
|
|
J7507
|
HCPCS
|
Tacrolimus
|
2
|
2
|
$1.00
|
$1.00
|
$0.70
|
$0.75
|
$0.72
|
2026-07-31
|