Hospital

JACKSON PARISH HOSPITAL

Jonesboro, LA · CCN 191317 · Rates published

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You selected 93306 (CPT)

RT Echocardiogram CHARGE

This hospital’s price: $822 across 14 payers · range $747-$1,178

Source: https://machine-readable-files.com/jackson-parish-hospital/720549907_Jackson-Parish-Hospital_standardcharges.csv · observed 2025-09-30

This is the facility’s filed rate for this code. The comparison board’s estimate also adds the surgeon and anesthesia fees, so it is usually higher.

578 distinct procedures filed

22 distinct payers

4,201 rate rows

2025-09-30 last MRF observed · ⚠ 13 mo old

Data quality

4,169 of 4,201 rate rows are consumer-grade (99.2%)

32 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
professional (physician) fee — not the facility price	30
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians	1
exceeds 10× this hospital's gross charge — excluded from medians	1

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 13 months old. CMS requires hospitals to refresh these files at least annually, so newer rates may exist that we haven't ingested yet. The prices below are exactly as last filed.

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

Source MRF file	https://machine-readable-files.com/jackson-parish-hospital/720549907_Jackson-Parish-Hospital_standardcharges.csv
Found on page	https://ezcost.info/jackson-parish-hospital
Discovered via	Discovered by HANK
Last fetch	Latest re-check couldn't be parsed — showing last good data · 2026-10-03
Content fingerprint	49d21a1d3116b435… · 2,307,110 bytes · first seen 2026-05-06

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
J1306 HCPCS	00078-1000-60 - Leqvio 284 Mg/1.5 Ml Inj Syringe [jph]	1	$4,846.92	$4,846.92	$4,846.92	nat. median $44 outlier · 109.8×
8081565 CDM	Room/bed: Private	1	$3,943.00	$3,943.00	$3,943.00	nat. median $2,675 1.5× median
45380 CPT	45380 Colonoscopy W/biopsy Charges	3	$1,917.09	$3,775.75	$2,982.14	nat. median $1,565 1.9× median
72156 CPT	MRI Spine Cervical With + Without Contrast	1	$2,525.21	$2,525.21	$2,525.21	nat. median $1,103 outlier · 2.3×
74178 CPT	CT Abdomen And Pelvis With + Without Contrast	13	$1,020.00	$3,077.20	$2,398.33	nat. median $1,024 outlier · 2.3×
43235 CPT	43235 Gastroscopy Charges	1	$2,368.66	$2,368.66	$2,368.66	nat. median $1,313 1.8× median
72157 CPT	MRI Spine Thoracic With + Without Contrast	2	$1,940.40	$2,439.67	$2,190.03	nat. median $1,105 2.0× median
70553 CPT	MRI Brain With + Without Contrast	11	$1,561.00	$2,866.20	$2,124.36	nat. median $1,133 1.9× median
72158 CPT	MRI Spine Lumbar With + Without Contrast	4	$1,561.00	$2,458.68	$2,078.43	nat. median $1,093 1.9× median
45385 CPT	45385 Snare Polypectomy Charges	8	$1,649.31	$2,982.14	$1,917.09	nat. median $1,669 1.1× median
72142 CPT	MRI Spine Cervical With Contrast	2	$1,659.42	$2,086.39	$1,872.90	nat. median $975 1.9× median
70552 CPT	MRI Brain With Contrast	1	$1,863.07	$1,863.07	$1,863.07	nat. median $962 1.9× median
74183 CPT	MRI Abdomen With + Without Contrast	4	$1,561.00	$2,149.58	$1,750.70	nat. median $1,100 1.6× median
73723 CPT	MRI Ankle With + Without Contrast Left	1	$1,742.26	$1,742.26	$1,742.26	nat. median $1,192 1.5× median
72141 CPT	MRI Spine Cervical Without Contrast	12	$1,354.03	$2,138.92	$1,725.99	nat. median $781 outlier · 2.2×
73218 CPT	MRI Ue Non Joint Without Contrast Lt	1	$1,701.43	$1,701.43	$1,701.43	nat. median $864 2.0× median
75635 CPT	CT Angio Abdomen Aorta + Iliofemoral	4	$1,250.53	$1,989.60	$1,637.55	nat. median $722 outlier · 2.3×
70551 CPT	MRI Brain Without Contrast	11	$1,168.54	$1,704.60	$1,561.00	nat. median $784 2.0× median
74177 CPT	CT Abdomen And Pelvis With Contrast	20	$850.52	$2,409.82	$1,549.17	nat. median $974 1.6× median
70496 CPT	CT Angio Brain/Head	6	$1,450.89	$2,262.94	$1,538.29	nat. median $747 outlier · 2.1×
73721 CPT	MRI Ankle Without Contrast Left	12	$1,141.39	$1,664.99	$1,530.00	nat. median $856 1.8× median
72148 CPT	MRI Spine Lumbar Without Contrast	14	$1,365.95	$1,878.50	$1,530.00	nat. median $805 1.9× median
43239 CPT	43239 Gastroscopy W/biopsy Charges	5	$1,522.71	$2,375.66	$1,522.71	nat. median $1,375 1.1× median
43450 CPT	43450 Esophageal Dilation Charges	5	$1,522.71	$1,691.90	$1,522.71	nat. median $1,081 1.4× median
70544 CPT	MRA Brain/Head Without Contrast	1	$1,507.10	$1,507.10	$1,507.10	nat. median $826 1.8× median
72146 CPT	MRI Spine Thoracic Without Contrast	6	$1,274.31	$1,762.42	$1,489.86	nat. median $797 1.9× median
73706 CPT	CT Angio Lower Extremity Left	1	$1,460.20	$1,460.20	$1,460.20	nat. median $743 2.0× median
45378 CPT	45378 Colonoscopy Charges	4	$1,434.19	$2,220.09	$1,454.04	nat. median $1,342 1.1× median
74174 CPT	CT Angio Abdomen And Pelvis	2	$1,086.75	$1,690.50	$1,388.62	nat. median $988 1.4× median
90677 CPT	90677 Prevnar 20 Pneumococcal Vaccine	1	$1,380.51	$1,380.51	$1,380.51	nat. median $405 outlier · 3.4×
73221 CPT	MRI Shoulder Without Contrast Left	8	$1,300.27	$1,664.99	$1,324.26	nat. median $844 1.6× median
72197 CPT	MRI Pelvis With + Without Contrast	1	$1,318.15	$1,318.15	$1,318.15	nat. median $1,063 1.2× median
74176 CPT	CT Abdomen And Pelvis Without Contrast	20	$1,020.00	$1,689.80	$1,252.44	nat. median $694 1.8× median
74170 CPT	CT Abdomen With + Without Contrast	5	$1,065.37	$1,394.89	$1,232.70	nat. median $710 1.7× median
74181 CPT	MRI Abdomen Without Contrast	1	$1,208.17	$1,208.17	$1,208.17	nat. median $820 1.5× median
70488 CPT	CT Maxillofacial With + Without Contrast	1	$1,126.47	$1,126.47	$1,126.47	nat. median $637 1.8× median
70498 CPT	CT Angio Neck	10	$1,040.00	$1,367.96	$1,088.01	nat. median $739 1.5× median
71270 CPT	CT Chest With + Without Contrast	4	$798.75	$1,441.58	$1,045.95	nat. median $672 1.6× median
71275 CPT	CT Angio Chest	15	$834.05	$1,505.28	$1,040.00	nat. median $754 1.4× median
99291 CPT	99291 Facility Level Critical Care Ill/Injured Patient Init 30-74 Min	14	$895.95	$1,618.80	$1,039.50	nat. median $1,530 0.7× median
70470 CPT	CT Brain/Head With + Without Contrast	5	$820.26	$1,087.23	$1,031.31	nat. median $622 1.7× median
71271 CPT	CT Low Dose Count Screening	14	$463.37	$1,165.18	$1,030.00	nat. median $213 outlier · 4.8×
73202 CPT	CT Elbow With + Without Contrast Left	2	$983.01	$1,019.43	$1,001.22	nat. median $711 1.4× median
72193 CPT	CT Pelvis With Contrast	3	$983.79	$1,047.97	$983.79	nat. median $637 1.5× median
70460 CPT	CT Brain/Head With Contrast	2	$952.10	$967.73	$959.91	nat. median $576 1.7× median
74150 CPT	CT Abdomen Without Contrast	4	$648.34	$945.77	$945.77	nat. median $448 outlier · 2.1×
94002 CPT	Rt Ventilator Check Charge	3	$814.50	$1,188.15	$945.00	nat. median $917 1.0× median
74160 CPT	CT Abdomen With Contrast	4	$766.71	$963.99	$890.72	nat. median $652 1.4× median
70491 CPT	CT Neck Soft Tissue With Contrast	8	$694.89	$1,067.65	$873.69	nat. median $627 1.4× median
71260 CPT	CT Chest With Contrast	13	$385.88	$1,225.00	$857.50	nat. median $648 1.3× median

Other procedures at this hospital

Browse this hospital's 578 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

J1306	HCPCS	00078-1000-60 - Leqvio 284 Mg/1.5 Ml Inj Syringe [jph]	1	1	$7,800.00	$7,800.00	$4,846.92	$4,846.92	$4,846.92	2025-09-30
8081565	CDM	Room/bed: Private	1	1	$792.00	$792.00	$3,943.00	$3,943.00	$3,943.00	2025-09-30
45380	CPT	45380 Colonoscopy W/biopsy Charges	3	3	$3,347.00	$3,347.00	$1,917.09	$3,775.75	$2,982.14	2025-09-30
72156	CPT	MRI Spine Cervical With + Without Contrast	1	1	$3,507.00	$3,507.00	$2,525.21	$2,525.21	$2,525.21	2025-09-30
74178	CPT	CT Abdomen And Pelvis With + Without Contrast	13	13	$3,454.00	$3,454.00	$1,020.00	$3,077.20	$2,398.33	2025-09-30
43235	CPT	43235 Gastroscopy Charges	1	1	$2,659.00	$2,659.00	$2,368.66	$2,368.66	$2,368.66	2025-09-30
72157	CPT	MRI Spine Thoracic With + Without Contrast	2	2	$3,388.00	$3,388.00	$1,940.40	$2,439.67	$2,190.03	2025-09-30
70553	CPT	MRI Brain With + Without Contrast	11	11	$3,709.00	$3,709.00	$1,561.00	$2,866.20	$2,124.36	2025-09-30
72158	CPT	MRI Spine Lumbar With + Without Contrast	4	4	$3,414.00	$3,414.00	$1,561.00	$2,458.68	$2,078.43	2025-09-30
45385	CPT	45385 Snare Polypectomy Charges	8	8	$3,347.00	$3,347.00	$1,649.31	$2,982.14	$1,917.09	2025-09-30
72142	CPT	MRI Spine Cervical With Contrast	2	2	$2,897.00	$2,897.00	$1,659.42	$2,086.39	$1,872.90	2025-09-30
70552	CPT	MRI Brain With Contrast	1	1	$2,890.00	$2,890.00	$1,863.07	$1,863.07	$1,863.07	2025-09-30
74183	CPT	MRI Abdomen With + Without Contrast	4	4	$3,388.00	$3,388.00	$1,561.00	$2,149.58	$1,750.70	2025-09-30
73723	CPT	MRI Ankle With + Without Contrast Left	1	1	$3,237.00	$3,237.00	$1,742.26	$1,742.26	$1,742.26	2025-09-30
72141	CPT	MRI Spine Cervical Without Contrast	12	12	$2,397.00	$2,397.00	$1,354.03	$2,138.92	$1,725.99	2025-09-30
73218	CPT	MRI Ue Non Joint Without Contrast Lt	1	1	$2,363.00	$2,363.00	$1,701.43	$1,701.43	$1,701.43	2025-09-30
75635	CPT	CT Angio Abdomen Aorta + Iliofemoral	4	4	$2,533.00	$2,533.00	$1,250.53	$1,989.60	$1,637.55	2025-09-30
70551	CPT	MRI Brain Without Contrast	11	11	$2,367.00	$2,367.00	$1,168.54	$1,704.60	$1,561.00	2025-09-30
74177	CPT	CT Abdomen And Pelvis With Contrast	20	20	$2,705.00	$2,705.00	$850.52	$2,409.82	$1,549.17	2025-09-30
70496	CPT	CT Angio Brain/Head	6	6	$2,533.00	$2,533.00	$1,450.89	$2,262.94	$1,538.29	2025-09-30
73721	CPT	MRI Ankle Without Contrast Left	12	12	$2,312.00	$2,312.00	$1,141.39	$1,664.99	$1,530.00	2025-09-30
72148	CPT	MRI Spine Lumbar Without Contrast	14	14	$2,431.00	$2,431.00	$1,365.95	$1,878.50	$1,530.00	2025-09-30
43239	CPT	43239 Gastroscopy W/biopsy Charges	5	5	$2,659.00	$2,659.00	$1,522.71	$2,375.66	$1,522.71	2025-09-30
43450	CPT	43450 Esophageal Dilation Charges	5	5	$2,659.00	$2,659.00	$1,522.71	$1,691.90	$1,522.71	2025-09-30
70544	CPT	MRA Brain/Head Without Contrast	1	1	$2,368.00	$2,368.00	$1,507.10	$1,507.10	$1,507.10	2025-09-30
72146	CPT	MRI Spine Thoracic Without Contrast	6	6	$2,448.00	$2,448.00	$1,274.31	$1,762.42	$1,489.86	2025-09-30
73706	CPT	CT Angio Lower Extremity Left	1	1	$1,639.00	$1,639.00	$1,460.20	$1,460.20	$1,460.20	2025-09-30
45378	CPT	45378 Colonoscopy Charges	4	4	$2,539.00	$2,539.00	$1,434.19	$2,220.09	$1,454.04	2025-09-30
74174	CPT	CT Angio Abdomen And Pelvis	2	2	$1,898.00	$1,898.00	$1,086.75	$1,690.50	$1,388.62	2025-09-30
90677	CPT	90677 Prevnar 20 Pneumococcal Vaccine	1	1	$615.00	$615.00	$1,380.51	$1,380.51	$1,380.51	2025-09-30
73221	CPT	MRI Shoulder Without Contrast Left	8	8	$2,312.00	$2,312.00	$1,300.27	$1,664.99	$1,324.26	2025-09-30
72197	CPT	MRI Pelvis With + Without Contrast	1	1	$3,388.00	$3,388.00	$1,318.15	$1,318.15	$1,318.15	2025-09-30
74176	CPT	CT Abdomen And Pelvis Without Contrast	20	20	$2,187.00	$2,187.00	$1,020.00	$1,689.80	$1,252.44	2025-09-30
74170	CPT	CT Abdomen With + Without Contrast	5	5	$1,937.00	$1,937.00	$1,065.37	$1,394.89	$1,232.70	2025-09-30
74181	CPT	MRI Abdomen Without Contrast	1	1	$2,448.00	$2,448.00	$1,208.17	$1,208.17	$1,208.17	2025-09-30
70488	CPT	CT Maxillofacial With + Without Contrast	1	1	$1,474.00	$1,474.00	$1,126.47	$1,126.47	$1,126.47	2025-09-30
70498	CPT	CT Angio Neck	10	10	$1,900.00	$1,900.00	$1,040.00	$1,367.96	$1,088.01	2025-09-30
71270	CPT	CT Chest With + Without Contrast	4	4	$1,618.00	$1,618.00	$798.75	$1,441.58	$1,045.95	2025-09-30
71275	CPT	CT Angio Chest	15	15	$1,943.00	$1,943.00	$834.05	$1,505.28	$1,040.00	2025-09-30
99291	CPT	99291 Facility Level Critical Care Ill/Injured Patient Init 30-74 Min	14	14	$1,815.00	$1,815.00	$895.95	$1,618.80	$1,039.50	2025-09-30
70470	CPT	CT Brain/Head With + Without Contrast	5	5	$1,432.00	$1,432.00	$820.26	$1,087.23	$1,031.31	2025-09-30
71271	CPT	CT Low Dose Count Screening	14	14	$1,618.00	$1,618.00	$463.37	$1,165.18	$1,030.00	2025-09-30
73202	CPT	CT Elbow With + Without Contrast Left	2	2	$1,416.00	$1,416.00	$983.01	$1,019.43	$1,001.22	2025-09-30
72193	CPT	CT Pelvis With Contrast	3	3	$1,366.00	$1,366.00	$983.79	$1,047.97	$983.79	2025-09-30
70460	CPT	CT Brain/Head With Contrast	2	2	$1,322.00	$1,322.00	$952.10	$967.73	$959.91	2025-09-30
74150	CPT	CT Abdomen Without Contrast	4	4	$1,313.00	$1,313.00	$648.34	$945.77	$945.77	2025-09-30
94002	CPT	Rt Ventilator Check Charge	3	3	$1,650.00	$1,650.00	$814.50	$1,188.15	$945.00	2025-09-30
74160	CPT	CT Abdomen With Contrast	4	4	$1,339.00	$1,339.00	$766.71	$963.99	$890.72	2025-09-30
70491	CPT	CT Neck Soft Tissue With Contrast	8	8	$1,213.00	$1,213.00	$694.89	$1,067.65	$873.69	2025-09-30
71260	CPT	CT Chest With Contrast	13	13	$1,348.00	$1,348.00	$385.88	$1,225.00	$857.50	2025-09-30
70487	CPT	CT Maxillofacial With Contrast	3	3	$1,187.00	$1,187.00	$854.68	$854.68	$854.68	2025-09-30
70492	CPT	CT Neck Soft Tissue With + Without Contrast	1	1	$1,491.00	$1,491.00	$844.82	$844.82	$844.82	2025-09-30
93306	CPT	Rt Echocardiogram Charge	14	14	$1,322.00	$1,322.00	$746.92	$1,177.96	$822.17	2025-09-30
72131	CPT	CT Spine Lumbar Without Contrast	11	11	$1,128.00	$1,128.00	$635.42	$1,025.00	$811.90	2025-09-30
73701	CPT	CT Ankle With Contrast Left	1	1	$1,128.00	$1,128.00	$811.90	$811.90	$811.90	2025-09-30
70486	CPT	CT Maxillofacial Without Contrast	13	13	$1,128.00	$1,128.00	$636.93	$1,020.00	$811.90	2025-09-30
72128	CPT	CT Spine Thoracic Without Contrast	5	5	$1,123.00	$1,123.00	$634.45	$808.73	$808.73	2025-09-30
72192	CPT	CT Pelvis Without Contrast	6	6	$1,095.00	$1,095.00	$618.29	$975.10	$788.14	2025-09-30
84145	CPT	Procalcitonin Ref	1	1	$853.00	$853.00	$775.00	$775.00	$775.00	2025-09-30
72132	CPT	CT Spine Lumbar With Contrast	1	1	$1,364.00	$1,364.00	$770.54	$770.54	$770.54	2025-09-30
73201	CPT	CT Elbow With Contrast Left	2	2	$1,128.00	$1,128.00	$467.61	$1,025.00	$746.31	2025-09-30
81206	CPT	DNA Enzymatic Digestion	1	1	$451.00	$451.00	$740.88	$740.88	$740.88	2025-09-30
72125	CPT	CT Spine Cervical Without Contrast	14	14	$1,123.00	$1,123.00	$554.40	$1,000.58	$730.88	2025-09-30
70490	CPT	CT Neck Soft Tissue Without Contrast	5	5	$1,010.00	$1,010.00	$498.47	$899.64	$727.15	2025-09-30
70450	CPT	CT Brain/Head Without Contrast	22	22	$1,128.00	$1,128.00	$556.57	$1,025.00	$709.30	2025-09-30
73700	CPT	CT Ankle Without Contrast Left	10	10	$1,130.00	$1,130.00	$550.62	$813.49	$669.65	2025-09-30
36430	CPT	36430 Transfusion Blood/blood Components TechFee	8	8	$1,092.00	$1,092.00	$615.58	$973.14	$652.40	2025-09-30
71250	CPT	CT Chest Without Contrast	15	15	$1,128.00	$1,128.00	$635.33	$1,025.00	$645.75	2025-09-30
72195	CPT	MRI Pelvis Without Contrast	1	1	$2,448.00	$2,448.00	$630.37	$630.37	$630.37	2025-09-30
73200	CPT	CT Elbow Without Contrast Left	4	4	$961.00	$961.00	$474.58	$692.30	$615.95	2025-09-30
92950	CPT	Rt Cardiopulmonary Resuscitation Charge	3	3	$825.00	$825.00	$472.50	$735.00	$594.08	2025-09-30
70480	CPT	CT Orbits Sella Without Contrast	5	5	$1,010.00	$1,010.00	$569.09	$727.15	$578.34	2025-09-30
93922	CPT	Jph US Ankle Brachial Index	5	5	$730.00	$730.00	$414.72	$653.38	$418.32	2025-09-30
87507	CPT	Gi Profile, Stool, Pcr Ref	3	3	$479.00	$479.00	$416.78	$416.78	$416.78	2025-09-30
99285	CPT	99285 Ed Visit E M Patient, Lev 5, Req Med Approp Hstry/exam/high Mdm, Cc	19	19	$726.00	$726.00	$407.48	$660.00	$415.80	2025-09-30
76817	CPT	Jph US OB Transvaginal	1	1	$570.00	$570.00	$410.31	$410.31	$410.31	2025-09-30
76830	CPT	Jph US Transvaginal Non-OB	12	12	$570.00	$570.00	$208.00	$518.00	$410.31	2025-09-30
93880	CPT	US Carotid Duplex Bilateral	17	17	$640.00	$640.00	$360.13	$461.00	$398.09	2025-09-30
91320	CPT	91320 Comiranaty Covid Vaccine	3	3	$312.00	$312.00	$131.10	$379.70	$379.70	2025-09-30
93926	CPT	US Lower Ext Arterial Duplex Left	11	11	$600.00	$600.00	$337.28	$431.69	$372.78	2025-09-30
81338	CPT	Mpl Mutation Analysis Ref	2	2	$1,485.00	$1,485.00	$150.33	$576.41	$363.37	2025-09-30
93970	CPT	US Lower Ext Venous Duplex Bilateral	10	10	$600.00	$600.00	$295.93	$431.69	$358.06	2025-09-30
99292	CPT	Critical Care Ill/Injured Patient Addl 30 Min 99292	3	3	$605.00	$605.00	$298.65	$539.00	$346.50	2025-09-30
93925	CPT	US Lower Ext Arterial Duplex Bilateral	14	14	$600.00	$600.00	$295.93	$431.69	$343.35	2025-09-30
31500	CPT	Rt Intubation, Emergency Charge	4	4	$523.00	$523.00	$257.92	$465.50	$337.75	2025-09-30
93930	CPT	US Upper Ext Arterial Duplex Bilateral	1	1	$600.00	$600.00	$337.28	$337.28	$337.28	2025-09-30
12032	CPT	12032 Repair Intermediate S/a/t/e 2.6-7.5 Cm TechFee	1	1	$582.00	$582.00	$328.72	$328.72	$328.72	2025-09-30
12007	CPT	12007 Simple Repair Of Superficial Wounds Of Scalp, Neck, Axillae, External Geni…	1	1	$574.00	$574.00	$324.37	$324.37	$324.37	2025-09-30
11750	CPT	11750 Excision Of Nail And Nail Matrix, Partial Or Complete, For Permanent Remov…	3	3	$492.00	$492.00	$295.27	$589.04	$319.09	2025-09-30
99305	CPT	99305 Initial Nursing Facility Care, Moderate	6	6	$553.00	$553.00	$294.47	$503.00	$312.99	2025-09-30
99284	CPT	99284 Ed Visit E&m Patient, Lev 4, Req Med Approp Hstry/exam/moderate Mdm, Cc	21	21	$484.00	$484.00	$271.66	$433.60	$300.96	2025-09-30
99212	CPT	99212 Office/Outpatient Visit - Established Patient, Level 2	9	9	$152.00	$152.00	$5.00	$351.18	$300.48	2025-09-30
99202	CPT	99202 Office/Outpatient Visit - New Patient, Level 2 (15-29 Mins)	1	1	$121.00	$121.00	$295.67	$295.67	$295.67	2025-09-30
94060	CPT	Rt Pre & Post Spiro Charge	14	14	$495.00	$495.00	$240.19	$356.45	$295.65	2025-09-30
99214	CPT	99214 Office/Outpatient Visit - Established Patient, Level 4	6	6	$167.00	$167.00	$98.92	$349.49	$295.32	2025-09-30
99203	CPT	99203 Office/Outpatient Visit - New Patient, Level 3 (30-44 Min)	7	7	$193.00	$193.00	$116.65	$298.29	$294.47	2025-09-30
G0439	HCPCS	99391 Preventive Evaluation, Established Pt; < 1 Yr	8	8	$165.00	$165.00	$84.68	$396.47	$290.79	2025-09-30
G0438	HCPCS	99381 Preventive Evaluation New Pt < 1 Yr	1	1	$110.00	$110.00	$287.11	$287.11	$287.11	2025-09-30
G0402	HCPCS	G0402 Initial Preventive Physical (Welcome To Medicare)	1	1	$169.00	$169.00	$287.11	$287.11	$287.11	2025-09-30
94664	CPT	Rt Education/Instruction Charge	1	1	$317.00	$317.00	$282.24	$282.24	$282.24	2025-09-30
99397	CPT	99397 Preventive Evaluation, Established Pt; 65+ Yrs	1	1	$303.00	$303.00	$275.00	$275.00	$275.00	2025-09-30
92526	CPT	Treatment Of Swallowing Dysfunction Charge	2	2	$371.00	$371.00	$156.00	$392.00	$274.00	2025-09-30
76801	CPT	US OB < 14 Weeks Single	2	2	$380.00	$380.00	$273.27	$273.27	$273.27	2025-09-30
76857	CPT	US Bladder Scan	3	3	$380.00	$380.00	$197.48	$273.27	$273.27	2025-09-30
92612	CPT	Fees Test	2	2	$684.00	$684.00	$155.52	$384.62	$270.07	2025-09-30
J3030	HCPCS	00143-9638-05 - SUMAtriptan 6 Mg/0.5 Ml Inj Vial [jph]	1	1	$58.00	$58.00	$269.31	$269.31	$269.31	2025-09-30
94660	CPT	Rt Cpap Subsequent Charge	4	4	$369.00	$369.00	$211.05	$328.30	$265.35	2025-09-30
P9016	HCPCS	Bill Only Prbc Leukoreduced Ea Unit Fsi	11	11	$458.00	$458.00	$256.84	$407.68	$262.08	2025-09-30
83993	CPT	Calprotectin, Stool Ref	5	5	$440.00	$440.00	$19.63	$270.66	$252.00	2025-09-30
12004	CPT	12004 Simple Rpr Scalp/neck/ax/genit/trunk 7.6-12.5cm TechFee	1	1	$272.00	$272.00	$244.46	$244.46	$244.46	2025-09-30
76706	CPT	US Aaa Screening	1	1	$339.00	$339.00	$243.97	$243.97	$243.97	2025-09-30
76882	CPT	US Extremity Nonvascular Limited Left	9	9	$339.00	$339.00	$167.24	$308.00	$243.97	2025-09-30
76881	CPT	US Extremity Nonvascular Complete Left	1	1	$339.00	$339.00	$243.97	$243.97	$243.97	2025-09-30
76870	CPT	US Scrotum (Contents) With Doppler If Ind	4	4	$339.00	$339.00	$97.02	$243.97	$243.97	2025-09-30
76641	CPT	US Breast Complete Left	1	1	$339.00	$339.00	$243.97	$243.97	$243.97	2025-09-30
77080	CPT	Bd Bone Density Dexa Axial Skeleton	17	17	$422.00	$422.00	$179.00	$376.32	$241.92	2025-09-30
J1953	HCPCS	44567-0501-10 - LevETIRAcetam 500 Mg/100 Ml Premix Ivpb [jph]	6	6	$197.00	$197.00	$4.76	$408.73	$237.31	2025-09-30
94010	CPT	Rt Spirometry With Graphic Record Charge	2	2	$440.00	$440.00	$217.20	$252.00	$234.60	2025-09-30
99386	CPT	99386 Preventive Evaluation, New Pt; 40-64 Yrs	1	1	$253.00	$253.00	$230.00	$230.00	$230.00	2025-09-30
76856	CPT	US Pelvic Non OB	12	12	$339.00	$339.00	$191.96	$243.97	$229.78	2025-09-30
93971	CPT	US Lower Ext Venous Duplex Left	16	16	$380.00	$380.00	$213.80	$273.27	$226.66	2025-09-30
99283	CPT	99283 Ed Visit E&m Patient, Lev 3, Req Med Approp Hstry/exam/low Mdm, Cc	22	22	$363.00	$363.00	$203.74	$325.40	$225.72	2025-09-30
81256	CPT	Hered.Hemochromatosis, DNA Ref	2	2	$671.00	$671.00	$65.36	$384.30	$224.83	2025-09-30
82803	CPT	Blood Gas Arterial Fsi	13	13	$385.00	$385.00	$7.10	$343.00	$216.09	2025-09-30
93976	CPT	Jph US Doppler	8	8	$339.00	$339.00	$78.80	$243.97	$214.55	2025-09-30
76770	CPT	US Retroperitoneal Complete	15	15	$339.00	$339.00	$97.02	$301.84	$208.00	2025-09-30
76705	CPT	76705 US Abdomen/Lower Back Limited	18	18	$317.00	$317.00	$156.38	$244.80	$208.00	2025-09-30
72114	CPT	Xr Spine Lumbosacral With Bending 6+ Views	2	2	$321.00	$321.00	$180.28	$231.29	$205.78	2025-09-30
96374	CPT	96374- Ed Injection, Single/initial	20	20	$344.00	$344.00	$169.96	$313.00	$205.64	2025-09-30
76642	CPT	US Breast Limited Bilat	13	13	$570.00	$570.00	$163.17	$259.00	$205.15	2025-09-30
72052	CPT	Xr Spine Cervical 6+ Views	2	2	$317.00	$317.00	$204.25	$204.25	$204.25	2025-09-30
76536	CPT	US Head/Neck Soft Tissue	18	18	$339.00	$339.00	$191.39	$243.97	$204.00	2025-09-30
77063	CPT	Jph Ma Screening Tomo 3d Bilat	20	20	$283.00	$283.00	$47.27	$251.86	$203.57	2025-09-30
76700	CPT	US Abdomen Complete	16	16	$339.00	$339.00	$97.02	$243.97	$201.02	2025-09-30
99309	CPT	99309 Subsequent Nursing Facility Care, Moderate	1	1	$220.00	$220.00	$200.00	$200.00	$200.00	2025-09-30
99395	CPT	99395 Preventive Evaluation, Established Pt; 18-39 Yrs	1	1	$220.00	$220.00	$200.00	$200.00	$200.00	2025-09-30
96365	CPT	96365 In Infusion Intial Up To 1hr Charge	18	16	$344.00	$344.00	$169.96	$306.74	$197.19	2025-09-30
96360	CPT	96360 - IV Infusion Hydration Initial 31 Min-1 Hour	16	16	$344.00	$344.00	$169.96	$306.74	$197.19	2025-09-30
J2704	HCPCS	00069-0209-10 - Propofol 10mg / 1ml Inj Vial 20ml [jph]	6	5	$260.00	$260.00	$161.57	$411.10	$193.97	2025-09-30
72050	CPT	Xr Spine Cervical 4 Or 5 Views	11	11	$267.00	$267.00	$131.95	$240.64	$192.48	2025-09-30
74022	CPT	Xr Abdomen Series + Chest 1 View	8	8	$254.00	$254.00	$143.54	$226.38	$182.98	2025-09-30
10060	CPT	10060 Incision & Drainage Abscess Simple/single TechFee	2	2	$248.00	$248.00	$141.75	$220.50	$181.12	2025-09-30
72110	CPT	Xr Spine Lumbosacral 4plus Views	15	15	$254.00	$254.00	$125.43	$183.00	$179.00	2025-09-30
31720	CPT	Rt Airway Suction Charge	2	2	$317.00	$317.00	$178.96	$178.96	$178.96	2025-09-30
12013	CPT	12013 Simple Repair F/e/e/n/l/m 2.6cm-5.0 Cm TechFee	3	3	$314.00	$314.00	$172.37	$177.10	$175.96	2025-09-30
87517	CPT	Hbv, Rt Pcr, Quant Ref	2	2	$550.00	$550.00	$42.84	$308.70	$175.77	2025-09-30
93225	CPT	Holter Monitor	4	4	$275.00	$275.00	$154.98	$198.03	$174.15	2025-09-30
12001	CPT	12001 Simple Repair Scalp/neck/ax/genit/trunk 2.5cm/< TechFee	8	8	$303.00	$303.00	$166.84	$269.50	$173.25	2025-09-30
71111	CPT	Xr Ribs With Pa Chest Bilateral	4	4	$237.00	$237.00	$135.45	$212.71	$170.30	2025-09-30
12011	CPT	12011 Simple Repair F/e/e/n/l/m 2.5cm/< TechFee	3	3	$297.00	$297.00	$167.78	$264.60	$170.10	2025-09-30
94150	CPT	94150 Peak Flow Pre And Post Charge	6	6	$235.00	$235.00	$132.98	$214.00	$169.51	2025-09-30
36600	CPT	Arterial Puncture	5	5	$288.00	$288.00	$24.78	$256.76	$162.81	2025-09-30
72120	CPT	Xr Spine Lumbosacral Bending 2-3 Views	1	1	$220.00	$220.00	$158.42	$158.42	$158.42	2025-09-30
94640	CPT	94640 Non-pressurized Inhtx Charge	17	17	$317.00	$317.00	$52.82	$288.00	$156.38	2025-09-30
12002	CPT	12002 Smpl Repair Scalp/neck/ax/genit/trunk 2.6-7.5cm TechFee	5	5	$272.00	$272.00	$134.12	$247.00	$155.61	2025-09-30
99282	CPT	99282 Ed Visit E&m Patient, Lev 2, Req Med Approp Hstry/exam/mdm, Cc	19	19	$242.00	$242.00	$135.83	$220.00	$154.00	2025-09-30
12014	CPT	12014 Simple Repair F/e/e/n/l/m 5.1cm-7.5 Cm TechFee	1	1	$342.00	$342.00	$153.23	$153.23	$153.23	2025-09-30
96105	CPT	Aphasia Assessment Charge	1	1	$344.00	$344.00	$153.00	$153.00	$153.00	2025-09-30
71110	CPT	Xr Ribs 3 Views Bilateral	3	3	$212.00	$212.00	$110.47	$152.88	$152.88	2025-09-30
70200	CPT	Xr Orbits Complete	2	2	$212.00	$212.00	$152.88	$152.88	$152.88	2025-09-30
77065	CPT	Mg Mammo Digital Diagnostic Left	7	7	$209.00	$209.00	$119.70	$190.00	$150.50	2025-09-30
70260	CPT	Xr Skull Complete	4	4	$209.00	$209.00	$119.70	$150.50	$150.50	2025-09-30
77067	CPT	Mg Mammo Digital Screening Bilateral	18	18	$221.00	$221.00	$79.64	$201.00	$149.95	2025-09-30
77066	CPT	Mg Mammo Digital Diagnostic Bilat	7	7	$260.00	$260.00	$52.52	$186.94	$148.68	2025-09-30
73521	CPT	Xr Hips Min 5 Views W/ap Pelvis Bilat	11	11	$204.00	$204.00	$100.45	$181.30	$146.54	2025-09-30
99213	CPT	99213 Office/Outpatient Visit - Established Patient, Level 3	12	12	$160.00	$160.00	$5.00	$324.09	$145.00	2025-09-30
90715	CPT	90715 Tdap	14	14	$200.00	$200.00	$142.00	$230.00	$144.90	2025-09-30
88342	CPT	88342 Ap Bill Surg Ipx (First Antibody)	4	4	$251.00	$251.00	$143.64	$223.44	$143.64	2025-09-30
86920	CPT	Bb Immediate Spin	12	12	$251.00	$251.00	$51.59	$228.00	$143.57	2025-09-30
J0283	HCPCS	43066-0360-20 - Do Not Use - Amiodarone 360 Mg/200 Ml-d5% Premix IV Sol [jph]	2	2	$222.00	$222.00	$139.86	$139.86	$139.86	2025-09-30
84588	CPT	Antidiuretic Hormone Profile Ref	1	1	$156.00	$156.00	$139.16	$139.16	$139.16	2025-09-30
86618	CPT	Lyme, IgM, Early Test/Rfx Ref	2	2	$242.00	$242.00	$138.60	$138.60	$138.60	2025-09-30
84445	CPT	Tsi (Thyroid Stimulating Immunoglobulin) Ref	4	4	$438.00	$438.00	$25.05	$392.17	$138.07	2025-09-30
74019	CPT	Xr Abdomen Complete W Decub And/or Erect	8	8	$190.00	$190.00	$108.99	$137.03	$137.03	2025-09-30
70150	CPT	Xr Facial Bones 3+ Views	8	8	$190.00	$190.00	$99.03	$170.23	$137.03	2025-09-30
92523	CPT	Slp Outpatient Pediatric Development Eval	7	7	$910.00	$910.00	$66.74	$156.00	$131.19	2025-09-30
85305	CPT	Protein S Ag, Ttl Ref	2	2	$162.00	$162.00	$92.61	$168.36	$130.49	2025-09-30
70250	CPT	Xr Skull < 4 Views	6	6	$180.00	$180.00	$129.90	$129.90	$129.90	2025-09-30
72220	CPT	Xr Sacrum/Coccyx 2+ Views	7	7	$179.00	$179.00	$102.69	$159.74	$129.11	2025-09-30
84166	CPT	Protein Electro, Random U Ref	1	1	$143.00	$143.00	$127.40	$127.40	$127.40	2025-09-30
84484	CPT	Troponin I Fsi	22	22	$227.00	$227.00	$12.47	$201.88	$127.19	2025-09-30
73564	CPT	Xr Knee Complete 4+ Views Left	12	12	$186.00	$186.00	$105.02	$169.00	$126.86	2025-09-30
83880	CPT	Brain Natriuretic Peptide Bnp Fsi	20	20	$220.00	$220.00	$39.26	$200.00	$123.48	2025-09-30
71101	CPT	Xr Ribs With Pa Chest Left	13	13	$212.00	$212.00	$104.80	$189.91	$121.59	2025-09-30
73070	CPT	Xr Elbow 2 Views Left	7	7	$168.00	$168.00	$83.08	$149.94	$121.19	2025-09-30
73080	CPT	Xr Elbow Complete 3+ Views Left	10	10	$177.00	$177.00	$100.05	$127.53	$120.12	2025-09-30
93005	CPT	93005 EKG With 12+ Leads; Tracing Only	22	22	$138.00	$138.00	$108.04	$175.00	$119.70	2025-09-30
77072	CPT	Xr Bone Age Studies	4	4	$166.00	$166.00	$119.61	$119.61	$119.61	2025-09-30
99281	CPT	99281 Ed Visit For E&m Patient, Lev 1, May Not Req Presence Of Physician Or Othe…	8	8	$188.00	$188.00	$107.58	$135.45	$119.11	2025-09-30
73140	CPT	Fingers Minimum Of 2 Views	11	11	$165.00	$165.00	$94.50	$150.00	$118.82	2025-09-30
73660	CPT	Xr Toe(1st Digit) 2+ Views Left	9	9	$165.00	$165.00	$94.50	$150.00	$118.82	2025-09-30
70360	CPT	Xr Neck Soft Tissue	9	9	$165.00	$165.00	$93.21	$150.00	$118.82	2025-09-30
76886	CPT	US Hips Infant Static Limited	5	5	$162.00	$162.00	$116.44	$116.44	$116.44	2025-09-30
72100	CPT	Xr Spine Lumbosacral 2 Or 3 Views	17	17	$162.00	$162.00	$91.13	$147.00	$116.44	2025-09-30
71046	CPT	Xr Chest 2 Views	22	22	$193.00	$193.00	$108.49	$175.00	$116.38	2025-09-30
72190	CPT	Xr Pelvis Complete 3+ Views	1	1	$187.00	$187.00	$116.28	$116.28	$116.28	2025-09-30
72202	CPT	Xr Sacroiliac Joints 3+ Views	1	1	$179.00	$179.00	$115.60	$115.60	$115.60	2025-09-30
72080	CPT	Xr Spine Thoracolumbar 2+ Views	6	6	$160.00	$160.00	$91.35	$114.85	$114.85	2025-09-30
72070	CPT	Xr Spine Thoracic 2 Views	13	13	$160.00	$160.00	$89.89	$145.00	$114.85	2025-09-30
70160	CPT	Xr Nasal Bones 3+ Views	2	2	$141.00	$141.00	$101.39	$127.34	$114.37	2025-09-30
70220	CPT	Xr Sinuses Paranasal Complete	15	15	$199.00	$199.00	$112.21	$179.00	$114.03	2025-09-30
73110	CPT	Xr Wrist Complete 3+ Views Left	12	12	$165.00	$165.00	$93.21	$150.00	$112.60	2025-09-30
71120	CPT	Xr Sternum 2+ Views	2	2	$153.00	$153.00	$87.57	$136.22	$111.89	2025-09-30
82024	CPT	Acth, Plasma Ref	2	2	$181.00	$181.00	$103.40	$114.89	$109.15	2025-09-30
74018	CPT	Xr Abdomen Kub 1 View	16	16	$160.00	$160.00	$78.73	$145.00	$108.17	2025-09-30
73620	CPT	Xr Foot 2 Views Left	1	1	$150.00	$150.00	$107.73	$107.73	$107.73	2025-09-30
73630	CPT	Xr Foot Complete 3+ Views Left	17	17	$165.00	$165.00	$81.45	$150.00	$106.38	2025-09-30
86900	CPT	Bb Abo Group	12	12	$189.00	$189.00	$2.99	$168.56	$106.19	2025-09-30
96125	CPT	Standardized Cognitive Eval Charge	1	1	$409.00	$409.00	$105.02	$105.02	$105.02	2025-09-30
99195	CPT	99195��phlebotomy Therapeutic Separate Procedure	6	6	$165.00	$165.00	$60.22	$118.82	$103.80	2025-09-30
72082	CPT	Xr Spine Scoliosis 2-3 Views	5	5	$144.00	$144.00	$92.91	$131.00	$103.77	2025-09-30
73592	CPT	Xr Lower Extremity Infant (0-1yr) Left	2	2	$144.00	$144.00	$103.77	$103.77	$103.77	2025-09-30
72040	CPT	Xr Spine Cervical 2 Or 3 Views	15	15	$144.00	$144.00	$71.13	$128.38	$103.77	2025-09-30
82306	CPT	Vitamin D (25-oh), Total Fsi	20	20	$180.00	$180.00	$29.60	$160.72	$101.25	2025-09-30
73030	CPT	Xr Shoulder Complete 2+ Views Left	18	18	$165.00	$165.00	$81.45	$150.00	$99.75	2025-09-30
71100	CPT	Xr Ribs 2 Views Left	10	10	$153.00	$153.00	$86.37	$136.22	$98.83	2025-09-30
73590	CPT	Xr Tibia/Fibula Left	13	13	$153.00	$153.00	$87.18	$139.00	$98.58	2025-09-30
73562	CPT	Xr Knee 3 Views Left	15	15	$169.00	$169.00	$95.70	$121.98	$98.50	2025-09-30
J1836	HCPCS	00338-1055-48 - MetroNIDAZOLE 500 Mg/100 Ml Premix Ivpb [jph]	3	3	$138.00	$138.00	$86.94	$109.31	$97.87	2025-09-30
83519	CPT	Amyloid Beta-protein Ref	2	2	$827.00	$827.00	$6.33	$189.00	$97.66	2025-09-30
73502	CPT	Xr Hip 2-3 Views W/ap Pelvis Left	12	12	$144.00	$144.00	$81.40	$128.38	$96.69	2025-09-30
71045	CPT	Xr Chest 1 View	20	20	$162.00	$162.00	$79.82	$147.00	$96.58	2025-09-30
94761	CPT	Rt Pox, Multiple Determination Charge	13	13	$165.00	$165.00	$93.21	$150.00	$95.94	2025-09-30
J2310	HCPCS	J2310 Injection, Naloxone Hydrochloride, Per 1 Mg	3	3	$44.00	$44.00	$15.12	$107.80	$95.76	2025-09-30
73000	CPT	Xr Clavicle Left	2	2	$134.00	$134.00	$92.55	$96.64	$94.59	2025-09-30
97167	CPT	Ot High Complex Units	4	4	$417.00	$417.00	$57.26	$147.00	$94.50	2025-09-30
84305	CPT	Igf 1, Lc/Ms Ref	1	1	$149.00	$149.00	$94.50	$94.50	$94.50	2025-09-30
73501	CPT	Xr Hip 1 View Left	4	4	$165.00	$165.00	$93.21	$149.50	$94.50	2025-09-30
73120	CPT	Xr Hand 2 Views Left	4	4	$145.00	$145.00	$71.68	$131.86	$93.86	2025-09-30
80053	CPT	Comprehensive Metabolic Panel (cmp) Fsi	22	22	$165.00	$165.00	$10.56	$147.00	$92.61	2025-09-30
73552	CPT	Xr Femur 2 Views Left	10	10	$135.00	$135.00	$76.43	$120.54	$92.33	2025-09-30
70210	CPT	Xr Sinuses Paranasal < 3 Views	6	6	$128.00	$128.00	$72.08	$91.88	$91.88	2025-09-30
73600	CPT	Xr Ankle 2 Views Left	1	1	$128.00	$128.00	$91.88	$91.88	$91.88	2025-09-30
73610	CPT	Xr Ankle Complete 3+ Views Left	14	14	$150.00	$150.00	$84.51	$136.00	$91.84	2025-09-30
73130	CPT	Xr Hand Complete 3+ Views Left	15	15	$144.00	$144.00	$71.13	$128.38	$91.70	2025-09-30
83090	CPT	Homocyst(e)ine, Plasma Ref	15	15	$163.00	$163.00	$17.92	$145.04	$91.38	2025-09-30
J0737	HCPCS	00338-9549-24 - Clindamycin 600mg/NS 50mL Premix Ivpb [jph]	2	2	$134.00	$134.00	$70.50	$106.14	$88.32	2025-09-30
73090	CPT	Xr Forearm 2 Views Left	13	13	$127.00	$127.00	$62.44	$115.00	$87.84	2025-09-30
71130	CPT	Xr Sternoclavicular Joint(s)	1	1	$153.00	$153.00	$87.57	$87.57	$87.57	2025-09-30
73010	CPT	Xr Scapula Left	4	4	$135.00	$135.00	$76.43	$120.54	$87.46	2025-09-30
73020	CPT	Xr Shoulder 1 View Left	5	5	$135.00	$135.00	$76.43	$97.43	$87.23	2025-09-30
82308	CPT	Calcitonin Ref	1	1	$152.00	$152.00	$86.94	$86.94	$86.94	2025-09-30
J2270	HCPCS	00641-6125-25 - Morphine 4 mg/1mL Inj Vial [jph]	11	11	$137.00	$137.00	$84.58	$108.52	$86.31	2025-09-30
72170	CPT	Xr Pelvis 1 Or 2 Views	10	10	$132.00	$132.00	$65.16	$117.60	$85.32	2025-09-30
73560	CPT	Xr Knee 1 Or 2 Views Left	8	8	$144.00	$144.00	$80.88	$103.77	$82.53	2025-09-30
88112	CPT	Miscellaneous Lab Test	1	1	$188.00	$188.00	$81.90	$81.90	$81.90	2025-09-30
88305	CPT	88305 Ap Bill Surgical Pathology Level IV Complexity	8	8	$143.00	$143.00	$78.00	$127.40	$81.90	2025-09-30
73060	CPT	Xr Humerus Left	12	12	$128.00	$128.00	$62.52	$91.88	$80.84	2025-09-30
84681	CPT	C-peptide	2	2	$100.00	$100.00	$72.08	$89.54	$80.81	2025-09-30
97166	CPT	Ot Moderate Complex Units	7	7	$417.00	$417.00	$57.26	$127.40	$80.78	2025-09-30
97161	CPT	Pt Low Complex Units	2	2	$413.00	$413.00	$78.75	$78.75	$78.75	2025-09-30
97163	CPT	Pt High Complex Units	4	4	$413.00	$413.00	$58.94	$122.50	$78.75	2025-09-30
83970	CPT	83970 Calcium	9	9	$29.00	$29.00	$20.64	$248.00	$78.12	2025-09-30
70100	CPT	Xr Mandible Less Than 4 Views	2	2	$128.00	$128.00	$73.08	$82.27	$77.67	2025-09-30
97162	CPT	Pt Moderate Complex Units	7	7	$413.00	$413.00	$58.94	$122.50	$77.67	2025-09-30
73650	CPT	Xr Calcaneus Left	8	8	$135.00	$135.00	$66.79	$97.43	$77.49	2025-09-30
86480	CPT	QuantiFERON TB Gold (In Tube) Ref	6	6	$165.00	$165.00	$61.98	$147.00	$77.30	2025-09-30
80061	CPT	Lipid Profile Fsi	20	20	$138.00	$138.00	$13.39	$122.50	$77.17	2025-09-30
99396	CPT	99396 Preventive Evaluation, Established Pt; 40-64 Yrs	1	1	$275.00	$275.00	$76.61	$76.61	$76.61	2025-09-30
82626	CPT	Dhea Ref	2	2	$142.00	$142.00	$25.27	$126.92	$76.09	2025-09-30
73100	CPT	Xr Wrist 2 Views Left	3	3	$132.00	$132.00	$26.22	$85.10	$75.60	2025-09-30
86335	CPT	Immunofixation Urine	2	2	$125.00	$125.00	$70.38	$80.08	$75.23	2025-09-30
86787	CPT	Varicella Zoster Virus Ab (IgM) Ref	1	1	$83.00	$83.00	$75.00	$75.00	$75.00	2025-09-30
80307	CPT	Drugs Of Abuse Scr Only, 8, Wb Ref	16	16	$220.00	$220.00	$62.14	$117.60	$74.84	2025-09-30
80048	CPT	Basic Metabolic Panel (bmp) Fsi	19	19	$132.00	$132.00	$8.46	$117.60	$74.09	2025-09-30
92524	CPT	Behav/Qual Analysis Of Voice And Resonance Charge	1	1	$438.00	$438.00	$73.85	$73.85	$73.85	2025-09-30
92521	CPT	Speech Fluency Eval Charge	2	2	$531.00	$531.00	$66.74	$77.70	$72.22	2025-09-30
88341	CPT	88341 Ap Bill Surg Ipx (Add'l Antibody)	1	1	$124.00	$124.00	$69.77	$69.77	$69.77	2025-09-30
88304	CPT	88304 Ap Bill Surgical Pathology Level Iii Complexity	1	1	$121.00	$121.00	$69.30	$69.30	$69.30	2025-09-30
85302	CPT	Protein C Deficiency Profile Ref	1	1	$162.00	$162.00	$69.29	$69.29	$69.29	2025-09-30
J7120	HCPCS	00264-7750-00 - Lactated Ringers Bolus 1000 Ml [jph]	14	14	$95.00	$95.00	$51.58	$95.00	$67.55	2025-09-30
96367	CPT	96367 IV Inf Sequential Up To 1 Hr Charge	12	12	$105.00	$105.00	$51.58	$95.00	$67.55	2025-09-30
J7070	HCPCS	63323-0624-10 - Dextrose 5% In Water Sol 1000 Ml [jph]	1	1	$95.00	$95.00	$67.37	$67.37	$67.37	2025-09-30
J7030	HCPCS	00264-7800-00 - Sodium Chloride 0.9% Sol 1000 Ml [jph]	23	17	$95.00	$95.00	$12.86	$80.75	$66.50	2025-09-30
90662	CPT	90662 Influenza Virus Vaccine High Dose, Inactivated Pf Trivalent	6	6	$106.00	$106.00	$59.27	$566.77	$66.20	2025-09-30
81240	CPT	Factor Ii, DNA Analysis Ref	1	1	$169.00	$169.00	$65.69	$65.69	$65.69	2025-09-30
G0103	HCPCS	Psa, Total, Medicare Screening Fsi	6	6	$114.00	$114.00	$56.06	$101.92	$65.52	2025-09-30
97535	CPT	Adl Training Charges	4	4	$149.00	$149.00	$64.63	$101.92	$65.52	2025-09-30
J0665	HCPCS	70069-0753-01 - Marcaine 0.5% Inj Sol 50ml [jph]	2	2	$303.00	$303.00	$31.68	$98.22	$64.95	2025-09-30
J7042	HCPCS	00264-7610-00 - Dextrose 5% With 0.9% NaCl Sol 1000 Ml [jph]	4	4	$95.00	$95.00	$53.19	$75.25	$63.61	2025-09-30
92522	CPT	Speech Sound Production Eval Charge	4	4	$473.00	$473.00	$63.31	$63.31	$63.31	2025-09-30
90471	CPT	90471 Immunization Administration: First Vaccine	12	12	$70.00	$70.00	$17.78	$79.21	$63.00	2025-09-30
84481	CPT	T3, Free Ref	11	11	$112.00	$112.00	$13.43	$102.00	$62.97	2025-09-30
G0008	HCPCS	G0008 Admin Of Influenza Virus Vaccine	7	7	$70.00	$70.00	$28.99	$63.00	$61.74	2025-09-30
96372	CPT	96372 Ed Subq/IM Injection	28	20	$56.00	$56.00	$5.00	$150.24	$59.85	2025-09-30
87493	CPT	87493-c. Diff Toxigenic	11	11	$102.00	$102.00	$37.27	$93.00	$58.59	2025-09-30
82140	CPT	Ammonia Urine	2	2	$79.00	$79.00	$45.36	$70.56	$57.96	2025-09-30
J2060	HCPCS	00641-6044-25 - LORazepam 2 mg/1mL Inj Vial [jph]	9	9	$71.00	$71.00	$38.56	$56.24	$56.24	2025-09-30
83013	CPT	Helicobacter Pylori Urea Breath Test Ref	6	6	$149.00	$149.00	$39.38	$85.05	$56.07	2025-09-30
84443	CPT	Tsh Fsi	19	19	$99.00	$99.00	$16.80	$88.20	$55.57	2025-09-30
83921	CPT	Methylmalonic Acid Ref	15	15	$99.00	$99.00	$21.21	$88.20	$55.57	2025-09-30
87651	CPT	Strep A By Pcr Fsi	19	19	$99.00	$99.00	$35.09	$88.20	$55.57	2025-09-30
J0561	HCPCS	J0561 Injection, Penicillin G Benzathine, 100,000 Units	6	6	$1,772.00	$1,772.00	$54.59	$54.59	$54.59	2025-09-30
82530	CPT	Cortisol, Urinary Free Ref	1	1	$108.00	$108.00	$53.17	$53.17	$53.17	2025-09-30
J3010	HCPCS	00409-9094-22 - FentaNYL 100 Mcg/2ml Inj Vial [jph]	1	1	$67.00	$67.00	$53.07	$53.07	$53.07	2025-09-30
80164	CPT	Valproic Acid Fsi	6	6	$94.00	$94.00	$13.54	$83.30	$53.02	2025-09-30
82607	CPT	Vitamin B12 Fsi	20	20	$94.00	$94.00	$15.08	$85.00	$53.02	2025-09-30
73565	CPT	Xr Knee 1 View Standing Ap Bilateral	1	1	$165.00	$165.00	$52.83	$52.83	$52.83	2025-09-30
82105	CPT	Alpha-fetoprotein Marker	3	3	$91.00	$91.00	$16.77	$52.29	$52.29	2025-09-30
82672	CPT	Estrogen, Ttl, Serum Ref	2	2	$128.00	$128.00	$21.70	$81.20	$51.45	2025-09-30

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