Hospital

LARABIDA CHILDRENS HOSPITAL I

Chicago, IL · CCN 143301 · Rates published

1,208 distinct procedures filed

18 distinct payers

9,906 rate rows

2026-07-31 last MRF observed

Data quality

1,885 of 9,906 rate rows are consumer-grade (19.0%)

8,021 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reason	Rows
no usable negotiated amount (only an out-of-band fallback) — excluded from medians	8,021

Data source & audit trail ↓ Download audit trail (JSON)

Source MRF file	https://hospitalpricedisclosure.com/Download.aspx?pxi=fVMFe8E56VlQn4j7nOY9Gg-&f=iFd_cEPwhQHJy3lVvHy9uQ-
Found on page	https://HospitalPriceDisclosure.com/Default.aspx?ci=VH2OXYwReVTiSDRaxGv6Eg-
Discovered via	CMS hospital list
Last fetch	success · 2026-08-14
Content fingerprint	cf67d95ca5cb535d… · 3,413,782 bytes · first seen 2026-05-09

Top 50 most expensive offerings

Outliers are flagged where this hospital's filed rate is ≥2× or ≤0.5× the national median for the same code.

Code	Description	Payers	Min $	Max $	Avg median	vs national
641 MS_DRG	Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou…	1	$94,045.28	$94,045.28	$94,045.28	nat. median $8,588 outlier · 11.0×
208 MS_DRG	Respiratory System Diagnosis With Ventilator Support <=96 Hours	2	$58,561.80	$73,892.72	$66,227.26	nat. median $26,590 outlier · 2.5×
189 MS_DRG	Pulmonary Edema And Respiratory Failure	3	$20,018.28	$103,427.78	$65,162.00	nat. median $12,892 outlier · 5.1×
94 MS_DRG	Bacterial And Tuberculous Infections Of Nervous System With Mcc	1	$50,381.40	$50,381.40	$50,381.40	nat. median $34,805 1.4× median
949 MS_DRG	Aftercare With Cc/Mcc	1	$47,022.64	$47,022.64	$47,022.64	nat. median $12,344 outlier · 3.8×
556 MS_DRG	Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc	2	$33,587.60	$54,652.00	$44,119.80	nat. median $9,097 outlier · 4.8×
640 MS_DRG	Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With M…	1	$33,587.60	$33,587.60	$33,587.60	nat. median $13,243 outlier · 2.5×
205 MS_DRG	Other Respiratory System Diagnoses With Mcc	1	$23,511.32	$23,511.32	$23,511.32	nat. median $18,041 1.3× median
120 OTHER	Room And Board	6	$1,019.00	$2,506.05	$2,125.00	nat. median $473 outlier · 4.5×
5721 OTHER	Level 1 Diagnostic Tests And Related Services	3	$730.56	$1,563.68	$1,476.25	nat. median $166 outlier · 8.9×
N907 OTHER	Not Billable To Fi	2	$231.60	$1,378.51	$805.06	nat. median $177 outlier · 4.5×
5442 OTHER	Level 2 Nerve Injections	4	$683.33	$748.69	$711.11	nat. median $797 0.9× median
5693 OTHER	Level 3 Drug Administration	1	$622.79	$622.79	$622.79	nat. median $427 1.5× median
97167 CPT	Ot Evaluation‐ High Complexity	6	$355.75	$558.44	$408.61	nat. median $220 1.9× median
87507 CPT	Laboratory	6	$340.31	$408.37	$391.36	nat. median $558 0.7× median
5791 OTHER	Pulmonary Treatment	4	$252.87	$1,009.65	$390.32	nat. median $231 1.7× median
87633 CPT	Laboratory	6	$343.75	$439.94	$379.06	nat. median $539 0.7× median
99283 CPT	Acute Care Clinic	3	$160.00	$489.60	$374.40	nat. median $472 0.8× median
97163 CPT	Pt Evaluation‐ High Complexity	6	$332.76	$361.58	$351.05	nat. median $200 1.8× median
97165 CPT	Ot Evaluation‐ Low Complexity	6	$217.76	$558.44	$312.96	nat. median $188 1.7× median
97166 CPT	Ot Evaluation‐ Moderate Complexity	6	$217.76	$558.44	$311.72	nat. median $206 1.5× median
5521 OTHER	Level 1 Imaging Without Contrast	5	$214.36	$377.81	$302.08	nat. median $110 outlier · 2.7×
99285 CPT	Acute Care Clinic	2	$160.00	$435.00	$297.50	nat. median $1,204 outlier · 0.2×
99284 CPT	Acute Care Clinic	2	$160.00	$435.00	$297.50	nat. median $773 outlier · 0.4×
5023 OTHER	Level 3 Type A Ed Visits	2	$260.62	$308.37	$284.50	nat. median $394 0.7× median
99282 CPT	Acute Care Clinic	2	$160.00	$336.40	$248.20	nat. median $286 0.9× median
5724 OTHER	Level 4 Diagnostic Tests And Related Services	2	$185.63	$273.79	$229.71	nat. median $1,034 outlier · 0.2×
92523 CPT	Evaluation Speech Sounds With Receptive/expressi Ve Language	6	$163.15	$259.48	$229.25	nat. median $304 0.8× median
N801 OTHER	Therapy Services	8	$96.54	$575.27	$224.27	nat. median $292 0.8× median
5522 OTHER	Level 2 Imaging Without Contrast	8	$172.12	$697.55	$220.23	nat. median $152 1.4× median
N903 OTHER	Influenza Vaccines & Pneumococcal Pneumonia Vaccines	4	$207.95	$476.89	$218.43	nat. median $159 1.4× median
9398 OTHER	Covid-19 Vaccine Administration	5	$187.48	$704.07	$213.41	nat. median $43 outlier · 4.9×
5732 OTHER	Level 2 Minor Procedures	7	$164.04	$637.46	$211.57	nat. median $44 outlier · 4.8×
N900 OTHER	Non-covered Services	9	$46.00	$990.19	$207.98	nat. median $201 1.0× median
92610 CPT	Evaluation Of Oral & Pharyngeal Swallowing Function	6	$109.80	$259.48	$205.72	nat. median $226 0.9× median
N700 OTHER	Non-opps Clinic Services	10	$40.80	$547.12	$198.72	nat. median $139 1.4× median
92521 CPT	Evaluation Of Speech Fluency	4	$136.55	$259.48	$198.02	nat. median $228 0.9× median
N905 OTHER	Not Recognized By Opps	8	$40.80	$511.19	$197.88	nat. median $418 outlier · 0.5×
5733 OTHER	Level 3 Minor Procedures	2	$195.60	$198.58	$197.09	nat. median $76 outlier · 2.6×
5012 OTHER	Clinic Visits And Related Services	12	$50.51	$622.35	$197.00	nat. median $139 1.4× median
92507 CPT	Treatment Of Speech, Language, Voice, Communication And/orauditory Processing, I…	6	$120.12	$259.48	$194.81	nat. median $186 1.0× median
5821 OTHER	Level 1 Health And Behavior Services	9	$36.96	$518.26	$192.99	nat. median $39 outlier · 5.0×
97110 CPT	Individual Therapy Onsite	6	$142.61	$351.05	$190.17	nat. median $81 outlier · 2.4×
5823 OTHER	Level 3 Health And Behavior Services	5	$186.02	$253.02	$186.02	nat. median $185 1.0× median
99245 CPT	Outpatient Clinic	6	$171.66	$198.48	$183.94	nat. median $302 0.6× median
N800 OTHER	Clinical Diagnostic Lab Services	11	$44.17	$622.35	$179.46	nat. median $70 outlier · 2.6×
5371 OTHER	Level 1 Urology And Related Services	2	$178.43	$178.43	$178.43	nat. median $264 0.7× median
97162 CPT	Pt Evaluation‐ Moderate Complexity	6	$138.41	$351.05	$177.03	nat. median $187 0.9× median
97161 CPT	Pt Evaluation‐ Low Complexity	6	$139.15	$351.05	$171.49	nat. median $170 1.0× median
5101 OTHER	Level 1 Strapping And Cast Application	6	$101.35	$448.86	$171.35	nat. median $187 0.9× median

Other procedures at this hospital

Browse this hospital's 1,208 published procedures. Use the slice to choose what to show, then sort or filter any column.

Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code	Type	Description	Rate rows	Payers	Gross	Cash	Min $	Max $	Avg median	Last observed

5012	OTHER	Clinic Visits And Related Services	12	12	—	—	$50.51	$622.35	$197.00	2026-04-01
N800	OTHER	Clinical Diagnostic Lab Services	11	11	—	—	$44.17	$622.35	$179.46	2026-04-01
N700	OTHER	Non-opps Clinic Services	10	10	—	—	$40.80	$547.12	$198.72	2026-04-01
N900	OTHER	Non-covered Services	9	9	—	—	$46.00	$990.19	$207.98	2026-04-01
5821	OTHER	Level 1 Health And Behavior Services	9	9	—	—	$36.96	$518.26	$192.99	2026-04-01
N801	OTHER	Therapy Services	8	8	—	—	$96.54	$575.27	$224.27	2026-04-01
5522	OTHER	Level 2 Imaging Without Contrast	8	8	—	—	$172.12	$697.55	$220.23	2026-04-01
N905	OTHER	Not Recognized By Opps	8	8	—	—	$40.80	$511.19	$197.88	2026-04-01
120	OTHER	Room And Board	7	6	$2,788.00	—	$1,019.00	$2,506.05	$2,125.00	2026-07-31
5732	OTHER	Level 2 Minor Procedures	7	7	—	—	$164.04	$637.46	$211.57	2026-04-01
97167	CPT	Ot Evaluation‐ High Complexity	6	6	$610.22	—	$355.75	$558.44	$408.61	2026-07-31
87507	CPT	Laboratory	6	6	$697.68	—	$340.31	$408.37	$391.36	2026-07-31
87633	CPT	Laboratory	6	6	$1,232.27	—	$343.75	$439.94	$379.06	2026-07-31
97163	CPT	Pt Evaluation‐ High Complexity	6	6	$383.60	—	$332.76	$361.58	$351.05	2026-07-31
97165	CPT	Ot Evaluation‐ Low Complexity	6	6	$610.22	—	$217.76	$558.44	$312.96	2026-07-31
97166	CPT	Ot Evaluation‐ Moderate Complexity	6	6	$610.22	—	$217.76	$558.44	$311.72	2026-07-31
92523	CPT	Evaluation Speech Sounds With Receptive/expressi Ve Language	6	6	$291.79	—	$163.15	$259.48	$229.25	2026-07-31
92610	CPT	Evaluation Of Oral & Pharyngeal Swallowing Function	6	6	$283.54	—	$109.80	$259.48	$205.72	2026-07-31
92507	CPT	Treatment Of Speech, Language, Voice, Communication And/orauditory Processing, I…	6	6	$283.54	—	$120.12	$259.48	$194.81	2026-07-31
97110	CPT	Individual Therapy Onsite	6	6	$383.60	—	$142.61	$351.05	$190.17	2026-07-31
99245	CPT	Outpatient Clinic	6	6	$843.57	—	$171.66	$198.48	$183.94	2026-07-31
97162	CPT	Pt Evaluation‐ Moderate Complexity	6	6	$383.60	—	$138.41	$351.05	$177.03	2026-07-31
97161	CPT	Pt Evaluation‐ Low Complexity	6	6	$383.60	—	$139.15	$351.05	$171.49	2026-07-31
5101	OTHER	Level 1 Strapping And Cast Application	6	6	—	—	$101.35	$448.86	$171.35	2026-04-01
99205	CPT	Outpatient Clinic	6	6	$500.55	—	$74.10	$186.71	$170.38	2026-07-31
5692	OTHER	Level 2 Drug Administration	6	6	—	—	$46.00	$950.96	$169.20	2026-04-01
90792	CPT	Psychiatric Diagnostic Eval W/medical Services	6	6	$399.61	—	$111.55	$237.06	$164.94	2026-07-31
92597	CPT	Evaluation For Use And/or Fitting Of Voice Prosthetic Device To Supplement Oral …	6	6	$291.79	—	$91.66	$259.48	$159.48	2026-07-31
99244	CPT	Outpatient Clinic	6	6	$732.88	—	$147.24	$186.54	$153.40	2026-07-31
90791	CPT	Psychiatric Diagnostic Evaluation	6	6	$256.44	—	$108.62	$147.64	$145.68	2026-07-31
92522	CPT	Evaluation Speech Sounds	6	6	$283.54	—	$116.79	$259.48	$134.82	2026-07-31
99215	CPT	Outpatient Clinic	6	6	$510.76	—	$49.95	$193.95	$130.52	2026-07-31
99254	CPT	Professional Services	6	6	$428.00	—	$66.40	$153.60	$126.25	2026-07-31
99255	CPT	Professional Services	6	6	$587.00	—	$87.10	$182.80	$125.42	2026-07-31
87906	CPT	Laboratory	6	6	$712.54	—	$108.68	$130.42	$123.86	2026-07-31
87631	CPT	Laboratory	6	6	$346.83	—	$105.80	$123.44	$121.67	2026-07-31
88230	CPT	Laboratory	6	6	$701.52	—	$112.10	$181.60	$118.78	2026-07-31
99394	CPT	Outpatient Clinic	6	6	$392.20	—	$84.62	$188.14	$113.12	2026-07-31
99383	CPT	Outpatient Clinic	6	6	$392.20	—	$96.60	$136.95	$112.33	2026-07-31
99385	CPT	Outpatient Clinic	6	6	$442.15	—	$86.62	$137.53	$104.96	2026-07-31
99384	CPT	Outpatient Clinic	6	6	$442.15	—	$89.84	$137.53	$104.96	2026-07-31
99392	CPT	Outpatient Clinic	6	6	$346.22	—	$77.87	$139.21	$103.25	2026-07-31
90837	CPT	Psychotherapy Patient 60 Minutes	6	6	$262.45	—	$66.71	$126.99	$103.00	2026-07-31
99223	CPT	Professional Services	6	6	$473.00	—	$69.00	$193.93	$101.95	2026-07-31
88262	CPT	Laboratory	6	6	$750.47	—	$77.31	$325.50	$101.76	2026-07-31
99243	CPT	Outpatient Clinic	6	6	$555.29	—	$88.39	$121.83	$99.86	2026-07-31
99253	CPT	Professional Services	6	6	$303.00	—	$46.45	$140.61	$99.28	2026-07-31
99382	CPT	Outpatient Clinic	6	6	$392.20	—	$71.11	$126.71	$98.65	2026-07-31
77075	CPT	Radiology	6	6	$482.26	—	$92.92	$126.89	$98.10	2026-07-31
87798	CPT	Laboratory	6	6	$211.67	—	$45.83	$141.05	$94.44	2026-07-31
99381	CPT	Outpatient Clinic	6	6	$346.22	—	$67.60	$102.68	$91.90	2026-07-31
99204	CPT	Outpatient Clinic	6	6	$471.04	—	$69.65	$143.11	$91.19	2026-07-31
72082	CPT	Radiology	6	6	$362.28	—	$35.00	$96.46	$86.82	2026-07-31
90834	CPT	Psychotherapy Patient &/ Family 45 Minutes	6	6	$173.66	—	$44.20	$115.72	$85.42	2026-07-31
90847	CPT	Fam Psyctx W/pt Present	6	6	$133.21	—	$61.20	$153.94	$85.36	2026-07-31
99393	CPT	Outpatient Clinic	6	6	$346.22	—	$67.60	$138.76	$81.92	2026-07-31
87536	CPT	Laboratory	6	6	$512.51	—	$65.53	$86.90	$81.87	2026-07-31
90832	CPT	Psychotherapy Patient &/ 30 Minutes	6	6	$133.21	—	$29.48	$91.26	$81.56	2026-07-31
99214	CPT	Outpatient Clinic	6	6	$406.98	—	$72.97	$123.12	$79.98	2026-07-31
74018	CPT	Radiology	6	6	$248.89	—	$63.60	$101.76	$79.50	2026-07-31
87502	CPT	Laboratory	6	6	$211.67	—	$71.86	$101.81	$77.36	2026-07-31
99391	CPT	Outpatient Clinic	6	6	$298.25	—	$61.45	$109.54	$74.09	2026-07-31
90846	CPT	Fam Psyctx Without Pt Present	6	6	$133.21	—	$63.05	$102.35	$72.54	2026-07-31
81229	CPT	Laboratory	6	6	$2,491.84	—	$21.90	$122.40	$71.45	2026-07-31
99242	CPT	Outpatient Clinic	6	6	$389.87	—	$56.63	$86.96	$68.37	2026-07-31
71045	CPT	Radiology	6	6	$200.31	—	$46.83	$68.88	$68.10	2026-07-31
99232	CPT	Professional Services	6	6	$170.00	—	$24.90	$78.59	$67.92	2026-07-31
80307	CPT	Laboratory	6	6	$153.94	—	$47.89	$82.07	$63.03	2026-07-31
90836	CPT	Psychotherapy Pt&/family W/e&m Srvcs 45 Min	6	6	$144.49	—	$40.24	$119.07	$62.42	2026-07-31
83970	CPT	Laboratory	6	6	$248.79	—	$27.88	$74.10	$62.24	2026-07-31
87634	CPT	Laboratory	6	6	$149.27	—	$52.00	$67.60	$59.80	2026-07-31
43760	CPT	Acute Care Clinic	6	6	$165.32	—	$35.65	$70.14	$57.22	2026-07-31
99233	CPT	Professional Services	6	6	$238.00	—	$35.05	$98.07	$56.65	2026-07-31
99222	CPT	Professional Services	6	6	$360.00	—	$51.40	$132.68	$55.20	2026-07-31
99203	CPT	Outpatient Clinic	6	6	$226.30	—	$43.55	$74.61	$55.10	2026-07-31
99252	CPT	Professional Services	6	6	$253.00	—	$33.95	$67.69	$54.32	2026-07-31
74019	CPT	Radiology	6	6	$275.79	—	$38.20	$61.12	$49.66	2026-07-31
72110	CPT	Radiology	6	6	$226.88	—	$37.90	$89.02	$48.68	2026-07-31
90833	CPT	Psychotherapy Pt&/family W/e&m Srvcs 30 Min	6	6	$89.56	—	$24.62	$81.96	$48.25	2026-07-31
96150	CPT	Hlth&behavior Assmt Ea 15 Min F2f W/pt 1st Assmt	6	6	$107.36	—	$12.87	$51.95	$48.06	2026-07-31
99213	CPT	Outpatient Clinic	6	6	$288.90	—	$46.56	$84.21	$48.06	2026-07-31
80074	CPT	Laboratory	6	6	$141.43	—	$38.48	$84.83	$47.92	2026-07-31
86480	CPT	Laboratory	6	6	$373.52	—	$39.12	$51.95	$46.68	2026-07-31
72081	CPT	Radiology	6	6	$322.16	—	$22.01	$58.15	$46.68	2026-07-31
87535	CPT	Laboratory	6	6	$211.80	—	$33.77	$52.67	$45.80	2026-07-31
87491	CPT	Laboratory	6	6	$211.80	—	$27.68	$57.71	$45.80	2026-07-31
86618	CPT	Laboratory	6	6	$102.94	—	$16.39	$53.28	$44.40	2026-07-31
99202	CPT	Outpatient Clinic	6	6	$226.30	—	$21.31	$64.81	$43.96	2026-07-31
99422	CPT	Outpatient Clinic	6	6	$88.97	—	$27.14	$53.89	$43.95	2026-07-31
99251	CPT	Professional Services	6	6	$182.00	—	$32.15	$51.44	$43.72	2026-07-31
87651	CPT	Laboratory	6	6	$196.24	—	$31.48	$57.71	$43.44	2026-07-31
84445	CPT	Laboratory	6	6	$306.49	—	$26.96	$48.93	$40.81	2026-07-31
99221	CPT	Professional Services	6	6	$216.00	—	$33.90	$98.39	$40.47	2026-07-31
73565	CPT	Radiology	6	6	$262.45	—	$33.40	$48.60	$39.98	2026-07-31
99241	CPT	Outpatient Clinic	6	6	$288.90	—	$30.56	$42.40	$39.19	2026-07-31
86665	CPT	Laboratory	6	6	$109.47	—	$17.46	$49.92	$38.40	2026-07-31
77073	CPT	Radiology	6	6	$437.46	—	$28.70	$54.13	$38.02	2026-07-31
86803	CPT	Laboratory	6	6	$86.25	—	$33.70	$40.44	$36.73	2026-07-31
86355	CPT	Laboratory	6	6	$138.18	—	$31.62	$41.11	$36.30	2026-07-31
99423	CPT	Outpatient Clinic	6	6	$141.72	—	$29.00	$87.07	$36.11	2026-07-31
72040	CPT	Radiology	6	6	$333.52	—	$24.15	$43.52	$35.87	2026-07-31
73610	CPT	Radiology	6	6	$184.92	—	$28.70	$46.55	$35.43	2026-07-31
99231	CPT	Professional Services	6	6	$117.00	—	$16.40	$45.69	$34.01	2026-07-31
81243	CPT	Laboratory	6	6	$100.65	—	$28.10	$35.23	$33.72	2026-07-31
90853	CPT	Grp Psyctx	6	6	$133.21	—	$22.94	$36.71	$33.70	2026-07-31
71110	CPT	Radiology	6	6	$195.92	—	$26.15	$52.44	$33.59	2026-07-31
72100	CPT	Radiology	6	6	$433.10	—	$28.70	$49.97	$33.14	2026-07-31
73030	CPT	Radiology	6	6	$267.22	—	$22.20	$38.57	$33.08	2026-07-31
93000	CPT	EKG	6	6	$87.65	—	$22.15	$33.03	$32.77	2026-07-31
87389	CPT	Laboratory	6	6	$276.19	—	$25.41	$81.80	$32.51	2026-07-31
73080	CPT	Radiology	6	6	$137.83	—	$21.50	$45.05	$31.73	2026-07-31
70250	CPT	Radiology	6	6	$513.22	—	$21.50	$50.48	$31.07	2026-07-31
73110	CPT	Radiology	6	6	$129.28	—	$22.20	$50.52	$30.18	2026-07-31
86359	CPT	Laboratory	6	6	$152.21	—	$7.65	$36.30	$29.11	2026-07-31
73600	CPT	Radiology	6	6	$267.22	—	$21.50	$39.90	$28.40	2026-07-31
82150	CPT	Laboratory	6	6	$39.30	—	$25.52	$29.16	$28.27	2026-07-31
87591	CPT	Laboratory	6	6	$211.80	—	$27.68	$45.80	$28.18	2026-07-31
73562	CPT	Radiology	6	6	$140.63	—	$20.20	$62.55	$28.13	2026-07-31
86706	CPT	Laboratory	6	6	$90.66	—	$13.33	$33.60	$28.00	2026-07-31
73070	CPT	Radiology	6	6	$267.22	—	$19.60	$39.59	$27.98	2026-07-31
73060	CPT	Radiology	6	6	$267.22	—	$15.70	$38.57	$27.67	2026-07-31
72170	CPT	Radiology	6	6	$297.88	—	$15.70	$47.30	$27.35	2026-07-31
73590	CPT	Radiology	6	6	$269.07	—	$21.50	$38.86	$27.00	2026-07-31
82330	CPT	Laboratory	6	6	$82.66	—	$22.48	$28.88	$26.72	2026-07-31
73000	CPT	Radiology	6	6	$124.73	—	$15.00	$40.08	$26.50	2026-07-31
73630	CPT	Radiology	6	6	$171.46	—	$21.50	$42.46	$26.14	2026-07-31
86701	CPT	Laboratory	6	6	$53.91	—	$18.55	$33.70	$25.92	2026-07-31
73120	CPT	Radiology	6	6	$159.52	—	$17.00	$37.12	$25.68	2026-07-31
84681	CPT	Laboratory	6	6	$125.56	—	$12.82	$26.42	$25.68	2026-07-31
99212	CPT	Outpatient Clinic	6	6	$190.15	—	$23.78	$45.27	$25.65	2026-07-31
73100	CPT	Radiology	6	6	$286.69	—	$21.50	$42.07	$25.55	2026-07-31
77072	CPT	Radiology	6	6	$248.89	—	$21.50	$34.21	$25.49	2026-07-31
99421	CPT	Outpatient Clinic	6	6	$43.24	—	$13.19	$39.57	$25.12	2026-07-31
92508	CPT	Treatment Of Speech, Language, Voice, Communication, And/or Auditory Processing …	6	6	$260.49	—	$18.65	$25.99	$24.88	2026-07-31
73130	CPT	Radiology	6	6	$235.67	—	$18.30	$43.08	$24.88	2026-07-31
73560	CPT	Radiology	6	6	$238.12	—	$19.60	$43.46	$24.66	2026-07-31
88280	CPT	Laboratory	6	6	$179.07	—	$20.20	$32.70	$24.15	2026-07-31
99211	CPT	Outpatient Clinic	6	6	$101.30	—	$12.88	$39.22	$23.84	2026-07-31
73140	CPT	Radiology	6	6	$200.31	—	$14.35	$56.29	$23.56	2026-07-31
70360	CPT	Radiology	6	6	$229.19	—	$14.35	$39.60	$23.30	2026-07-31
88291	CPT	Laboratory	6	6	$88.66	—	$5.25	$36.80	$23.00	2026-07-31
72070	CPT	Radiology	6	6	$400.05	—	$19.60	$31.36	$22.84	2026-07-31
73090	CPT	Radiology	6	6	$248.89	—	$18.30	$36.62	$22.79	2026-07-31
82340	CPT	Laboratory	6	6	$36.75	—	$5.40	$24.89	$22.26	2026-07-31
83498	CPT	Laboratory	6	6	$163.92	—	$17.72	$26.15	$21.93	2026-07-31
81401	CPT	Laboratory	6	6	$180.92	—	$3.50	$26.28	$21.90	2026-07-31
85525	CPT	Laboratory	6	6	$89.83	—	$11.40	$29.90	$21.52	2026-07-31
84244	CPT	Laboratory	6	6	$132.86	—	$17.35	$21.52	$21.17	2026-07-31
84143	CPT	Laboratory	6	6	$172.97	—	$18.44	$21.96	$21.14	2026-07-31
84403	CPT	Laboratory	6	6	$146.75	—	$15.90	$50.56	$20.85	2026-07-31
86702	CPT	Laboratory	6	6	$81.72	—	$13.01	$24.48	$20.40	2026-07-31
84630	CPT	Laboratory	6	6	$140.42	—	$18.90	$24.19	$20.16	2026-07-31
82306	CPT	Laboratory	6	6	$178.53	—	$8.86	$23.77	$19.70	2026-07-31
80177	CPT	Laboratory	6	6	$82.77	—	$3.50	$24.03	$19.22	2026-07-31
82652	CPT	Laboratory	6	6	$232.21	—	$16.06	$37.04	$19.21	2026-07-31
86376	CPT	Laboratory	6	6	$87.81	—	$11.85	$27.65	$19.00	2026-07-31
87338	CPT	Laboratory	6	6	$86.95	—	$13.84	$24.44	$18.80	2026-07-31
84402	CPT	Laboratory	6	6	$153.83	—	$18.09	$24.50	$18.34	2026-07-31
85247	CPT	Laboratory	6	6	$51.29	—	$15.64	$27.76	$18.10	2026-07-31
86780	CPT	Laboratory	6	6	$80.11	—	$10.43	$34.58	$18.07	2026-07-31
83001	CPT	Laboratory	6	6	$112.21	—	$13.35	$20.39	$18.03	2026-07-31
84443	CPT	Laboratory	6	6	$101.43	—	$16.42	$22.12	$17.74	2026-07-31
87086	CPT	Laboratory	6	6	$48.91	—	$6.63	$31.50	$17.72	2026-07-31
84702	CPT	Laboratory	6	6	$90.89	—	$14.49	$21.26	$17.72	2026-07-31
82157	CPT	Laboratory	6	6	$176.79	—	$15.72	$26.10	$17.64	2026-07-31
80203	CPT	Laboratory	6	6	$66.67	—	$16.02	$19.84	$17.56	2026-07-31
96151	CPT	Hlth&behavior Assmt Ea 15 Min F2f W/pt Re‐assmt	6	6	$57.39	—	$12.87	$32.92	$17.43	2026-07-31
85240	CPT	Laboratory	6	6	$60.29	—	$11.23	$17.72	$17.13	2026-07-31
87390	CPT	Laboratory	6	6	$77.66	—	$14.17	$23.00	$17.08	2026-07-31
84146	CPT	Laboratory	6	6	$117.08	—	$10.40	$40.26	$16.97	2026-07-31
83021	CPT	Laboratory	6	6	$109.21	—	$14.49	$24.36	$16.93	2026-07-31
86141	CPT	Laboratory	6	6	$78.09	—	$12.46	$21.13	$16.90	2026-07-31
83516	CPT	Laboratory	6	6	$32.48	—	$8.78	$22.29	$16.81	2026-07-31
82775	CPT	Laboratory	6	6	$107.01	—	$13.42	$17.45	$16.58	2026-07-31
84153	CPT	Laboratory	6	6	$110.95	—	$13.20	$17.70	$16.50	2026-07-31
86762	CPT	Laboratory	6	6	$86.95	—	$13.85	$21.32	$16.40	2026-07-31
84270	CPT	Laboratory	6	6	$131.23	—	$15.44	$20.91	$16.38	2026-07-31
82670	CPT	Laboratory	6	6	$68.74	—	$10.91	$20.24	$16.31	2026-07-31
87040	CPT	Laboratory	6	6	$62.48	—	$9.93	$27.00	$16.23	2026-07-31
82785	CPT	Laboratory	6	6	$99.58	—	$7.16	$18.54	$15.85	2026-07-31
84520	CPT	Laboratory	6	6	$24.25	—	$12.80	$18.53	$15.44	2026-07-31
80164	CPT	Laboratory	6	6	$81.84	—	$8.87	$23.04	$15.38	2026-07-31
87340	CPT	Laboratory	6	6	$62.50	—	$13.50	$18.15	$15.23	2026-07-31
96152	CPT	Hlth&behavior Ivntj Ea 15 Min F2f Indiv	6	6	$28.87	—	$12.87	$15.96	$15.11	2026-07-31
84305	CPT	Laboratory	6	6	$128.44	—	$13.10	$20.45	$15.08	2026-07-31
96127	CPT	Brief Emotional/behavi Oral Assessment	6	6	$101.34	—	$7.20	$29.20	$14.95	2026-07-31
86160	CPT	Laboratory	6	6	$72.55	—	$11.55	$37.00	$14.78	2026-07-31
86337	CPT	Laboratory	6	6	$129.14	—	$11.80	$26.41	$14.53	2026-07-31
86431	CPT	Laboratory	6	6	$34.44	—	$5.46	$17.40	$14.50	2026-07-31
82985	CPT	Laboratory	6	6	$91.02	—	$13.42	$15.72	$14.50	2026-07-31
85246	CPT	Laboratory	6	6	$85.71	—	$13.64	$16.16	$14.40	2026-07-31
87430	CPT	Laboratory	6	6	$59.71	—	$13.57	$15.70	$14.18	2026-07-31
83003	CPT	Laboratory	6	6	$98.55	—	$8.86	$15.69	$14.10	2026-07-31
83002	CPT	Laboratory	6	6	$111.99	—	$8.86	$17.82	$14.10	2026-07-31
84132	CPT	Laboratory	6	6	$27.93	—	$9.70	$16.25	$13.98	2026-07-31
84100	CPT	Laboratory	6	6	$29.10	—	$7.79	$16.08	$13.98	2026-07-31
86644	CPT	Laboratory	6	6	$86.83	—	$13.35	$17.36	$13.85	2026-07-31
86360	CPT	Laboratory	6	6	$152.21	—	$9.70	$14.21	$13.84	2026-07-31
97150	CPT	Ot Group Supr Treat 15 Min	6	6	$44.53	—	$8.40	$15.93	$13.78	2026-07-31
82627	CPT	Laboratory	6	6	$134.01	—	$7.96	$21.39	$13.70	2026-07-31
83690	CPT	Laboratory	6	6	$41.85	—	$6.63	$15.15	$13.44	2026-07-31
86341	CPT	Laboratory	6	6	$234.87	—	$8.23	$19.04	$13.43	2026-07-31
82533	CPT	Laboratory	6	6	$98.55	—	$12.86	$16.10	$13.42	2026-07-31
86787	CPT	Laboratory	6	6	$77.91	—	$12.40	$30.00	$13.18	2026-07-31
83519	CPT	Laboratory	6	6	$120.14	—	$11.96	$13.20	$13.00	2026-07-31
83655	CPT	Laboratory	6	6	$73.18	—	$11.86	$17.66	$12.98	2026-07-31
86800	CPT	Laboratory	6	6	$88.00	—	$11.80	$15.30	$12.77	2026-07-31
86215	CPT	Laboratory	6	6	$80.23	—	$11.80	$14.75	$12.75	2026-07-31
86735	CPT	Laboratory	6	6	$78.83	—	$12.56	$15.24	$12.70	2026-07-31
83520	CPT	Laboratory	6	6	$84.98	—	$12.46	$13.82	$12.68	2026-07-31
80201	CPT	Laboratory	6	6	$72.35	—	$11.47	$22.64	$12.43	2026-07-31
86765	CPT	Laboratory	6	6	$77.86	—	$8.20	$14.66	$12.40	2026-07-31
84466	CPT	Laboratory	6	6	$77.32	—	$8.78	$14.54	$12.29	2026-07-31
82607	CPT	Laboratory	6	6	$91.12	—	$3.50	$14.50	$12.00	2026-07-31
83615	CPT	Laboratory	6	6	$36.75	—	$5.81	$12.78	$11.84	2026-07-31
80184	CPT	Laboratory	6	6	$69.32	—	$9.64	$17.72	$11.78	2026-07-31
84134	CPT	Laboratory	6	6	$88.34	—	$5.58	$14.04	$11.71	2026-07-31
82803	CPT	Laboratory	6	6	$73.05	—	$10.80	$24.77	$11.61	2026-07-31
85027	CPT	Laboratory	6	6	$31.89	—	$6.82	$21.89	$11.48	2026-07-31
82679	CPT	Laboratory	6	6	$67.64	—	$10.12	$12.65	$11.45	2026-07-31
86356	CPT	Laboratory	6	6	$81.73	—	$3.50	$13.01	$11.33	2026-07-31
82310	CPT	Laboratory	6	6	$31.42	—	$9.32	$12.12	$11.18	2026-07-31
80053	CPT	Laboratory	6	6	$64.11	$8.49 87% off	$10.36	$15.39	$11.15	2026-07-31
80069	CPT	Laboratory	6	6	$52.62	—	$8.52	$13.82	$11.02	2026-07-31
87186	CPT	Laboratory	6	6	$62.71	—	$7.03	$11.30	$10.94	2026-07-31
84481	CPT	Laboratory	6	6	$68.74	—	$10.12	$12.69	$10.91	2026-07-31
84480	CPT	Laboratory	6	6	$66.77	—	$9.56	$14.78	$10.90	2026-07-31
85025	CPT	Laboratory	6	6	$47.18	—	$8.44	$12.78	$10.72	2026-07-31
80048	CPT	Laboratory	6	6	$51.25	—	$8.46	$13.91	$10.67	2026-07-31
86255	CPT	Laboratory	6	6	$24.32	—	$7.20	$11.60	$10.66	2026-07-31
83695	CPT	Laboratory	6	6	$78.26	—	$8.14	$12.46	$10.64	2026-07-31
83721	CPT	Laboratory	6	6	$57.86	—	$9.34	$15.70	$10.50	2026-07-31
87205	CPT	Laboratory	6	6	$26.10	—	$9.11	$13.65	$10.50	2026-07-31
82728	CPT	Laboratory	6	6	$82.42	—	$7.16	$13.11	$10.30	2026-07-31
83605	CPT	Laboratory	6	6	$64.68	—	$9.02	$26.58	$10.28	2026-07-31
83036	CPT	Laboratory	6	6	$58.90	—	$6.30	$15.97	$10.25	2026-07-31
86225	CPT	Laboratory	6	6	$83.12	—	$7.05	$13.22	$10.13	2026-07-31
84075	CPT	Laboratory	6	6	$31.42	—	$4.98	$11.55	$10.04	2026-07-31
83020	CPT	Laboratory	6	6	$116.84	—	$6.34	$17.24	$9.71	2026-07-31
82784	CPT	Laboratory	6	6	$56.45	—	$5.02	$15.30	$9.55	2026-07-31
84133	CPT	Laboratory	6	6	$26.20	—	$8.40	$12.64	$9.40	2026-07-31
83935	CPT	Laboratory	6	6	$41.50	—	$6.41	$11.34	$9.32	2026-07-31
83930	CPT	Laboratory	6	6	$38.95	—	$6.17	$11.22	$9.32	2026-07-31
83525	CPT	Laboratory	6	6	$69.21	—	$8.12	$14.09	$8.86	2026-07-31
86060	CPT	Laboratory	6	6	$44.40	—	$7.02	$11.12	$8.75	2026-07-31
87088	CPT	Laboratory	6	6	$49.15	—	$7.79	$11.31	$8.54	2026-07-31
83550	CPT	Laboratory	6	6	$53.43	—	$6.12	$8.56	$8.41	2026-07-31
87070	CPT	Laboratory	6	6	$129.33	—	$7.73	$18.60	$8.29	2026-07-31
84439	CPT	Laboratory	6	6	$54.72	—	$7.11	$14.86	$8.04	2026-07-31
80076	CPT	Laboratory	6	6	$49.40	—	$6.29	$33.90	$7.98	2026-07-31
85045	CPT	Laboratory	6	6	$24.45	—	$2.62	$9.74	$7.79	2026-07-31
86038	CPT	Laboratory	6	6	$73.15	—	$5.21	$15.80	$7.67	2026-07-31
84703	CPT	Laboratory	6	6	$45.67	—	$7.16	$14.35	$7.52	2026-07-31
87101	CPT	Laboratory	6	6	$46.96	—	$6.20	$8.06	$7.42	2026-07-31
82570	CPT	Laboratory	6	6	$31.62	—	$3.50	$13.98	$7.29	2026-07-31
87015	CPT	Laboratory	6	6	$25.80	—	$6.43	$9.36	$7.20	2026-07-31
87081	CPT	Laboratory	6	6	$40.35	—	$5.80	$9.72	$7.08	2026-07-31
82565	CPT	Laboratory	6	6	$31.30	—	$5.41	$9.32	$7.00	2026-07-31
81001	CPT	Laboratory	6	6	$19.47	—	$5.72	$11.68	$6.96	2026-07-31
82550	CPT	Laboratory	6	6	$39.66	—	$6.27	$18.24	$6.87	2026-07-31
84436	CPT	Laboratory	6	6	$41.74	—	$4.50	$6.72	$6.61	2026-07-31
83735	CPT	Laboratory	6	6	$40.69	—	$6.01	$26.24	$6.45	2026-07-31
82977	CPT	Laboratory	6	6	$43.49	—	$5.40	$7.82	$6.36	2026-07-31
84550	CPT	Laboratory	6	6	$27.59	—	$4.42	$7.51	$6.35	2026-07-31
83540	CPT	Laboratory	6	6	$39.30	—	$4.90	$12.76	$6.23	2026-07-31
80061	CPT	Laboratory	6	6	$81.03	—	$3.50	$26.99	$6.22	2026-07-31
85730	CPT	Laboratory	6	6	$36.65	—	$4.82	$6.34	$5.88	2026-07-31
85046	CPT	Laboratory	6	6	$18.50	—	$5.48	$11.43	$5.88	2026-07-31
5521	OTHER	Level 1 Imaging Without Contrast	5	5	—	—	$214.36	$377.81	$302.08	2026-04-01
9398	OTHER	Covid-19 Vaccine Administration	5	5	—	—	$187.48	$704.07	$213.41	2026-04-01
5823	OTHER	Level 3 Health And Behavior Services	5	5	—	—	$186.02	$253.02	$186.02	2026-04-01
5442	OTHER	Level 2 Nerve Injections	4	4	—	—	$683.33	$748.69	$711.11	2026-04-01
5791	OTHER	Pulmonary Treatment	4	4	—	—	$252.87	$1,009.65	$390.32	2026-04-01
N903	OTHER	Influenza Vaccines & Pneumococcal Pneumonia Vaccines	4	4	—	—	$207.95	$476.89	$218.43	2026-04-01
92521	CPT	Evaluation Of Speech Fluency	4	4	$283.54	—	$136.55	$259.48	$198.02	2026-07-31
99281	CPT	Acute Care Clinic	4	4	$489.07	—	$126.56	$248.53	$143.28	2026-07-31
92526	CPT	Speech Treatment Swlng Dyfunc/orlf 15min	4	4	$283.54	—	$108.09	$154.29	$108.95	2026-07-31
97113	CPT	Pt Therapeutic Pool Use	4	4	$105.40	—	$31.93	$46.66	$40.39	2026-07-31
97803	CPT	Nutrition	4	4	$34.80	—	$18.76	$63.70	$32.81	2026-07-31
189	MS_DRG	Pulmonary Edema And Respiratory Failure	3	3	—	—	$20,018.28	$103,427.78	$65,162.00	2026-04-01
5721	OTHER	Level 1 Diagnostic Tests And Related Services	3	3	—	—	$730.56	$1,563.68	$1,476.25	2026-04-01
99283	CPT	Acute Care Clinic	3	3	$611.08	—	$160.00	$489.60	$374.40	2026-07-31
208	MS_DRG	Respiratory System Diagnosis With Ventilator Support <=96 Hours	2	2	—	—	$58,561.80	$73,892.72	$66,227.26	2026-04-01
556	MS_DRG	Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc	2	2	—	—	$33,587.60	$54,652.00	$44,119.80	2026-04-01
N907	OTHER	Not Billable To Fi	2	2	—	—	$231.60	$1,378.51	$805.06	2026-04-01
99285	CPT	Acute Care Clinic	2	2	$917.68	—	$160.00	$435.00	$297.50	2026-07-31
99284	CPT	Acute Care Clinic	2	2	$917.68	—	$160.00	$435.00	$297.50	2026-07-31
5023	OTHER	Level 3 Type A Ed Visits	2	2	—	—	$260.62	$308.37	$284.50	2026-04-01
99282	CPT	Acute Care Clinic	2	2	$489.07	—	$160.00	$336.40	$248.20	2026-07-31
5724	OTHER	Level 4 Diagnostic Tests And Related Services	2	2	—	—	$185.63	$273.79	$229.71	2026-04-01
5733	OTHER	Level 3 Minor Procedures	2	2	—	—	$195.60	$198.58	$197.09	2026-04-01
5371	OTHER	Level 1 Urology And Related Services	2	2	—	—	$178.43	$178.43	$178.43	2026-04-01
N902	OTHER	Packaged Services	2	2	—	—	$144.90	$164.04	$154.47	2026-04-01
5734	OTHER	Level 4 Minor Procedures	2	2	—	—	$7.16	$181.30	$94.23	2026-04-01
641	MS_DRG	Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou…	1	1	—	—	$94,045.28	$94,045.28	$94,045.28	2026-04-01
94	MS_DRG	Bacterial And Tuberculous Infections Of Nervous System With Mcc	1	1	—	—	$50,381.40	$50,381.40	$50,381.40	2026-04-01
949	MS_DRG	Aftercare With Cc/Mcc	1	1	—	—	$47,022.64	$47,022.64	$47,022.64	2026-04-01
640	MS_DRG	Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With M…	1	1	—	—	$33,587.60	$33,587.60	$33,587.60	2026-04-01
205	MS_DRG	Other Respiratory System Diagnoses With Mcc	1	1	—	—	$23,511.32	$23,511.32	$23,511.32	2026-04-01
5693	OTHER	Level 3 Drug Administration	1	1	—	—	$622.79	$622.79	$622.79	2026-04-01

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