DPCAPHRXB (Bleed, Inhib, BioA, pH, ORP via Brom Valve) CWC
Rxb Prompt Pa Form. Service code if available (hcpcs/cpt) new prior authorization. If you have more than 10 drugs or a compound drug, please use the dmr form (c) for.
DPCAPHRXB (Bleed, Inhib, BioA, pH, ORP via Brom Valve) CWC
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