Hospital

Kpc Promise Hospital Of Baton Rouge

Baton Rouge, LA · CCN 192004 · Rates published

135 distinct procedures filed

5 distinct payers

1,191 rate rows

2026-07-18 last MRF observed

Data quality

1,191 of 1,191 rate rows are consumer-grade (100.0%)

Every filed rate row passes our consumer-grade checks — none are excluded from the medians.

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

Source MRF file	https://batonrouge.kpcph.com/wp-content/uploads/sites/8/2023/12/83-4190159_KPC-Promise-Hospital-of-Baton-Rouge_standardcharges.csv
Found on page	https://batonrouge.kpcph.com/cms-price-transparency/
Discovered via	Discovered by HANK
Last fetch	not_modified · 2026-08-01
Content fingerprint	f5646702b4112cc9… · 29,043,223 bytes · first seen 2026-06-16

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
206 OTHER	Room & Board High Observation	2	$3,150.00	$3,150.00	$3,150.00	nat. median $2,808 1.1× median
200 OTHER	Room & Board Intensive Care	3	$3,150.00	$3,150.00	$3,150.00	nat. median $4,113 0.8× median
74178 CPT	CT Abd & Pelvis W/wo Contrast	1	$2,096.00	$2,096.00	$2,096.00	nat. median $539 outlier · 3.9×
72197 CPT	MRI Pelvis W/wo Contrast	1	$2,003.98	$2,003.98	$2,003.98	nat. median $606 outlier · 3.3×
110 OTHER	Room & Board Private	5	$1,812.00	$1,812.00	$1,812.00	—
111 OTHER	Room & Board Private Med/surg	4	$1,812.00	$1,812.00	$1,812.00	nat. median $9,983 outlier · 0.2×
90945 CPT	Inp Peritoneal Dialysis	1	$1,786.00	$1,786.00	$1,786.00	nat. median $553 outlier · 3.2×
120 OTHER	Room & Board Semi Private	4	$1,575.00	$1,575.00	$1,575.00	nat. median $17 outlier · 93.1×
94002 CPT	Vent Management Init Day	3	$1,300.00	$1,500.00	$1,500.00	nat. median $783 1.9× median
74177 CPT	CT Abd & Pelvis With Contrast	1	$1,364.00	$1,364.00	$1,364.00	nat. median $501 outlier · 2.7×
36569 CPT	Insertion Of Midline	3	$1,190.00	$1,250.00	$1,250.00	nat. median $1,664 0.8× median
36589 CPT	Remove Tunneled Cv Cath	1	$1,169.00	$1,169.00	$1,169.00	nat. median $803 1.5× median
90935 CPT	Hemodialysis	5	$1,152.00	$1,152.00	$1,152.00	nat. median $850 1.4× median
93970 CPT	Venous Ultrasound	3	$938.00	$938.00	$938.00	nat. median $418 outlier · 2.2×
93925 CPT	Arterial Ultrasound, Lower Ext	1	$864.00	$864.00	$864.00	nat. median $405 outlier · 2.1×
74176 CPT	CT Abd & Pelvis Without Contrast	1	$801.00	$801.00	$801.00	nat. median $333 outlier · 2.4×
93971 CPT	Venous Upper/lower Ext Unilat	2	$606.00	$606.00	$606.00	nat. median $272 outlier · 2.2×
94003 CPT	Vent Management Subsq Day	3	$601.00	$700.00	$601.00	nat. median $776 0.8× median
381 OTHER	Packed Rbc	5	$601.00	$601.00	$601.00	nat. median $4,524 outlier · 0.1×
49082 CPT	Paracentesis Abdominal Initial	1	$594.00	$594.00	$594.00	nat. median $1,031 0.6× median
71046 CPT	Xr Chest 2 Views	1	$560.35	$560.35	$560.35	nat. median $102 outlier · 5.5×
93304 CPT	Echocardiogram	1	$502.00	$502.00	$502.00	nat. median $588 0.9× median
36481 CPT	Insertion Catheter Vein,other	2	$500.00	$500.00	$500.00	nat. median $1,282 outlier · 0.4×
82803 CPT	Arterial Blood Gas With Lytes	3	$138.00	$488.48	$488.48	nat. median $43 outlier · 11.4×
74230 CPT	Modified Barium Swallow Study	1	$415.00	$415.00	$415.00	nat. median $207 outlier · 2.0×
73560 CPT	Xr Knee 2 Views	1	$399.00	$399.00	$399.00	nat. median $109 outlier · 3.7×
93922 CPT	Ankle/brachial Indices	2	$341.00	$341.00	$341.00	nat. median $198 1.7× median
74021 CPT	X-ray Abdomen 3+ Views	1	$305.00	$305.00	$305.00	nat. median $125 outlier · 2.4×
97167 CPT	Ot Eval High Complexity 60 Min	5	$300.00	$300.00	$300.00	nat. median $136 outlier · 2.2×
97163 CPT	Pt Eval High Complexity 45 Min	5	$300.00	$300.00	$300.00	nat. median $130 outlier · 2.3×
89220 CPT	Sputum Culture	2	$290.00	$290.00	$290.00	nat. median $158 1.8× median
80074 CPT	Hepatitis Acute Panel	1	$275.00	$275.00	$275.00	nat. median $67 outlier · 4.1×
94644 CPT	Aerosol Continuous 1st Hour	3	$264.00	$264.00	$264.00	nat. median $167 1.6× median
97168 CPT	Ot Re-evaluation	1	$263.00	$263.00	$263.00	nat. median $87 outlier · 3.0×
74018 CPT	Xr Abdomen 1 View (kub)	3	$250.00	$399.00	$250.00	nat. median $100 outlier · 2.5×
92522 CPT	St Eval Speech Production	5	$250.00	$250.00	$250.00	nat. median $150 1.7× median
73501 CPT	Xr Hip 1 View	1	$250.00	$250.00	$250.00	nat. median $104 outlier · 2.4×
73120 CPT	Xr Hand 1 View	1	$250.00	$250.00	$250.00	nat. median $128 2.0× median
80053 CPT	Cmp	5	$248.00	$248.00	$248.00	nat. median $18 outlier · 13.8×
94799 CPT	Respiratory Assessment Initial	5	$17.00	$323.00	$240.00	nat. median $184 1.3× median
71045 CPT	Xr Chest 1 View	4	$219.00	$399.00	$219.00	nat. median $99 outlier · 2.2×
87040 CPT	Blood Culture	4	$203.00	$203.00	$203.00	nat. median $17 outlier · 12.0×
73100 CPT	X-ray Wrist Right 2 Views	1	$200.00	$200.00	$200.00	nat. median $107 1.9× median
94660 CPT	Bipap/cpap Per Hr	2	$49.00	$330.00	$189.50	nat. median $275 0.7× median
94010 CPT	Incentive Spirometry	1	$188.00	$188.00	$188.00	nat. median $196 1.0× median
92507 CPT	St Lang/speech Treatment	3	$176.00	$176.00	$176.00	nat. median $122 1.4× median
94664 CPT	Svn Initial	3	$174.00	$174.00	$174.00	nat. median $194 0.9× median
94645 CPT	Aerosol Continuous Addl Hour	3	$174.00	$174.00	$174.00	nat. median $88 2.0× median
73564 CPT	Knee, Left (multiple Views)	1	$168.00	$168.00	$168.00	nat. median $134 1.3× median
87806 CPT	HIV-1 Antigen, With HIV 1,2 Ab	1	$163.85	$163.85	$163.85	nat. median $34 outlier · 4.8×

Other procedures at this hospital

Browse this hospital's 135 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

200	OTHER	Room & Board Intensive Care	3	3	$3,150.00	$3,150.00	$3,150.00	$3,150.00	$3,150.00	2026-07-18
206	OTHER	Room & Board High Observation	2	2	$3,150.00	$3,150.00	$3,150.00	$3,150.00	$3,150.00	2026-07-18
74178	CPT	CT Abd & Pelvis W/wo Contrast	1	1	$2,096.00	$2,096.00	$2,096.00	$2,096.00	$2,096.00	2026-07-18
72197	CPT	MRI Pelvis W/wo Contrast	1	1	$2,003.98	$2,003.98	$2,003.98	$2,003.98	$2,003.98	2026-07-18
111	OTHER	Room & Board Private Med/surg	4	4	$1,812.00	$1,812.00	$1,812.00	$1,812.00	$1,812.00	2026-07-18
110	OTHER	Room & Board Private	5	5	$1,812.00	$1,812.00	$1,812.00	$1,812.00	$1,812.00	2026-07-18
90945	CPT	Inp Peritoneal Dialysis	1	1	$1,786.00	$1,786.00	$1,786.00	$1,786.00	$1,786.00	2026-07-18
120	OTHER	Room & Board Semi Private	4	4	$1,575.00	$1,575.00	$1,575.00	$1,575.00	$1,575.00	2026-07-18
74177	CPT	CT Abd & Pelvis With Contrast	1	1	$1,364.00	$1,364.00	$1,364.00	$1,364.00	$1,364.00	2026-07-18
94002	CPT	Vent Management Init Day	4	3	$1,500.00	$1,500.00	$1,300.00	$1,500.00	$1,500.00	2026-07-18
36569	CPT	Insertion Of Midline	4	3	$1,250.00	$1,250.00	$1,190.00	$1,250.00	$1,250.00	2026-07-18
36589	CPT	Remove Tunneled Cv Cath	1	1	$1,169.00	$1,169.00	$1,169.00	$1,169.00	$1,169.00	2026-07-18
90935	CPT	Hemodialysis	5	5	$1,152.00	$1,152.00	$1,152.00	$1,152.00	$1,152.00	2026-07-18
93970	CPT	Venous Ultrasound	3	3	$938.00	$938.00	$938.00	$938.00	$938.00	2026-07-18
93925	CPT	Arterial Ultrasound, Lower Ext	1	1	$864.00	$864.00	$864.00	$864.00	$864.00	2026-07-18
74176	CPT	CT Abd & Pelvis Without Contrast	1	1	$801.00	$801.00	$801.00	$801.00	$801.00	2026-07-18
93971	CPT	Venous Upper/lower Ext Unilat	2	2	$606.00	$606.00	$606.00	$606.00	$606.00	2026-07-18
94003	CPT	Vent Management Subsq Day	5	3	$601.00	$601.00	$601.00	$700.00	$601.00	2026-07-18
381	OTHER	Packed Rbc	5	5	$601.00	$601.00	$601.00	$601.00	$601.00	2026-07-18
49082	CPT	Paracentesis Abdominal Initial	1	1	$594.00	$594.00	$594.00	$594.00	$594.00	2026-07-18
71046	CPT	Xr Chest 2 Views	1	1	$560.35	$560.35	$560.35	$560.35	$560.35	2026-07-18
93304	CPT	Echocardiogram	1	1	$502.00	$502.00	$502.00	$502.00	$502.00	2026-07-18
36481	CPT	Insertion Catheter Vein,other	2	2	$500.00	$500.00	$500.00	$500.00	$500.00	2026-07-18
74230	CPT	Modified Barium Swallow Study	1	1	$415.00	$415.00	$415.00	$415.00	$415.00	2026-07-18
73560	CPT	Xr Knee 2 Views	1	1	$399.00	$399.00	$399.00	$399.00	$399.00	2026-07-18
93922	CPT	Ankle/brachial Indices	2	2	$341.00	$341.00	$341.00	$341.00	$341.00	2026-07-18
74021	CPT	X-ray Abdomen 3+ Views	1	1	$305.00	$305.00	$305.00	$305.00	$305.00	2026-07-18
97163	CPT	Pt Eval High Complexity 45 Min	5	5	$300.00	$300.00	$300.00	$300.00	$300.00	2026-07-18
97167	CPT	Ot Eval High Complexity 60 Min	5	5	$300.00	$300.00	$300.00	$300.00	$300.00	2026-07-18
89220	CPT	Sputum Culture	2	2	$290.00	$290.00	$290.00	$290.00	$290.00	2026-07-18
80074	CPT	Hepatitis Acute Panel	1	1	$275.00	$275.00	$275.00	$275.00	$275.00	2026-07-18
94644	CPT	Aerosol Continuous 1st Hour	3	3	$264.00	$264.00	$264.00	$264.00	$264.00	2026-07-18
97168	CPT	Ot Re-evaluation	1	1	$263.00	$263.00	$263.00	$263.00	$263.00	2026-07-18
74018	CPT	Xr Abdomen 1 View (kub)	5	3	$250.00	$250.00	$250.00	$399.00	$250.00	2026-07-18
73120	CPT	Xr Hand 1 View	1	1	$250.00	$250.00	$250.00	$250.00	$250.00	2026-07-18
73501	CPT	Xr Hip 1 View	1	1	$250.00	$250.00	$250.00	$250.00	$250.00	2026-07-18
92522	CPT	St Eval Speech Production	5	5	$250.00	$250.00	$250.00	$250.00	$250.00	2026-07-18
80053	CPT	Cmp	5	5	$248.00	$248.00	$248.00	$248.00	$248.00	2026-07-18
71045	CPT	Xr Chest 1 View	7	4	$219.00	$219.00	$219.00	$399.00	$219.00	2026-07-18
87040	CPT	Blood Culture	4	4	$203.00	$203.00	$203.00	$203.00	$203.00	2026-07-18
73100	CPT	X-ray Wrist Right 2 Views	1	1	$200.00	$200.00	$200.00	$200.00	$200.00	2026-07-18
94010	CPT	Incentive Spirometry	1	1	$188.00	$188.00	$188.00	$188.00	$188.00	2026-07-18
92507	CPT	St Lang/speech Treatment	3	3	$176.00	$176.00	$176.00	$176.00	$176.00	2026-07-18
94664	CPT	Svn Initial	3	3	$174.00	$174.00	$174.00	$174.00	$174.00	2026-07-18
94645	CPT	Aerosol Continuous Addl Hour	3	3	$174.00	$174.00	$174.00	$174.00	$174.00	2026-07-18
73564	CPT	Knee, Left (multiple Views)	1	1	$168.00	$168.00	$168.00	$168.00	$168.00	2026-07-18
87806	CPT	HIV-1 Antigen, With HIV 1,2 Ab	1	1	$163.85	$163.85	$163.85	$163.85	$163.85	2026-07-18
92610	CPT	St Eval Dysphagia	5	5	$158.00	$158.00	$158.00	$158.00	$158.00	2026-07-18
97164	CPT	Pt Re-evaluation	4	4	$158.00	$158.00	$158.00	$158.00	$158.00	2026-07-18
84484	CPT	Troponin	1	1	$153.00	$153.00	$153.00	$153.00	$153.00	2026-07-18
83970	CPT	Serum Pth	1	1	$153.00	$153.00	$153.00	$153.00	$153.00	2026-07-18
301	OTHER	Cardiac Panel W Troponin	3	3	$153.00	$153.00	$153.00	$153.00	$153.00	2026-07-18
82803	CPT	Arterial Blood Gas With Lytes	5	3	$488.48	$488.48	$138.00	$488.48	$488.48	2026-07-18
84155	CPT	Serum Total Protein	2	2	$132.00	$132.00	$132.00	$132.00	$132.00	2026-07-18
82042	CPT	Albumin, Body Fluid	1	1	$131.00	$131.00	$131.00	$131.00	$131.00	2026-07-18
80200	CPT	Tobramycin Random	1	1	$126.00	$126.00	$126.00	$126.00	$126.00	2026-07-18
73020	CPT	Xr Shoulder 1 View	1	1	$122.00	$122.00	$122.00	$122.00	$122.00	2026-07-18
G0515	HCPCS	St Cognitive Skills Each 15min	1	1	$120.00	$120.00	$120.00	$120.00	$120.00	2026-07-18
82607	CPT	Vitamin B12 Level	1	1	$118.00	$118.00	$118.00	$118.00	$118.00	2026-07-18
80197	CPT	Tacrolimus Level	1	1	$116.00	$116.00	$116.00	$116.00	$116.00	2026-07-18
97150	CPT	Ot Group Therapy	1	1	$113.00	$113.00	$113.00	$113.00	$113.00	2026-07-18
92526	CPT	St Dysphagia Treatment	4	4	$105.00	$105.00	$105.00	$105.00	$105.00	2026-07-18
87400	CPT	Influenza A & B Panel	3	3	$105.00	$105.00	$105.00	$105.00	$105.00	2026-07-18
80299	CPT	Keppra Level	1	1	$102.00	$102.00	$102.00	$102.00	$102.00	2026-07-18
93005	CPT	Routine EKG 12+lds	1	1	$101.00	$101.00	$101.00	$101.00	$101.00	2026-07-18
83036	CPT	Hemoglobin A1c	2	2	$101.00	$101.00	$101.00	$101.00	$101.00	2026-07-18
87493	CPT	C-diff Test	2	2	$99.00	$99.00	$99.00	$99.00	$99.00	2026-07-18
80076	CPT	Hepatic Function Panel	1	1	$96.00	$96.00	$96.00	$96.00	$96.00	2026-07-18
89050	CPT	Body Fluid Cell Count And Diff	1	1	$95.00	$95.00	$95.00	$95.00	$95.00	2026-07-18
82570	CPT	Urine Creatinine	2	2	$84.00	$84.00	$84.00	$84.00	$84.00	2026-07-18
84443	CPT	Serum Tsh	3	3	$81.00	$81.00	$81.00	$81.00	$81.00	2026-07-18
80048	CPT	Bmp	3	3	$80.00	$80.00	$80.00	$80.00	$80.00	2026-07-18
82533	CPT	Cortisol Level	1	1	$79.00	$79.00	$79.00	$79.00	$79.00	2026-07-18
86900	CPT	Type And Crossmatch Panel	5	5	$78.75	$78.75	$78.75	$78.75	$78.75	2026-07-18
82728	CPT	Ferritin Level	1	1	$78.00	$78.00	$78.00	$78.00	$78.00	2026-07-18
80162	CPT	Serum Digoxin Level	1	1	$73.00	$73.00	$73.00	$73.00	$73.00	2026-07-18
82140	CPT	Serum Ammonia Level	1	1	$70.00	$70.00	$70.00	$70.00	$70.00	2026-07-18
97112	CPT	Pt Neuromuscular Re-ed 15 Min	3	3	$70.00	$70.00	$70.00	$70.00	$70.00	2026-07-18
92611	CPT	St Pharyngogram	1	1	$70.00	$70.00	$70.00	$70.00	$70.00	2026-07-18
80202	CPT	Vancomycin Random	5	5	$67.70	$67.70	$67.70	$67.70	$67.70	2026-07-18
98960	CPT	Pt Educa Patient Family 30min	11	5	$75.00	$75.00	$67.00	$84.00	$75.00	2026-07-18
97140	CPT	Pt Manual Therap 15 Min	2	2	$67.00	$67.00	$67.00	$67.00	$67.00	2026-07-18
87075	CPT	Blood Culture, Anaerobic	4	4	$67.00	$67.00	$67.00	$67.00	$67.00	2026-07-18
97535	CPT	Ot Adl 15 Min	8	4	$82.00	$82.00	$66.00	$120.00	$82.00	2026-07-18
82247	CPT	Ck, Total	1	1	$66.00	$66.00	$66.00	$66.00	$66.00	2026-07-18
97110	CPT	Ot Exercise Therap15 Min	10	5	$70.00	$70.00	$65.00	$75.00	$70.00	2026-07-18
87070	CPT	Culture, Body Fluid	7	5	$101.75	$101.75	$61.00	$111.00	$101.75	2026-07-18
86704	CPT	Hepatitis B Core Ag, Total	2	1	$77.12	$77.12	$60.25	$94.00	$77.12	2026-07-18
97116	CPT	Pt Gait Trn 15 Min	5	5	$58.00	$58.00	$58.00	$58.00	$58.00	2026-07-18
97124	CPT	Pt Massage 15 Min	1	1	$56.00	$56.00	$56.00	$56.00	$56.00	2026-07-18
97542	CPT	Pt Whelchr Management 15 Min	4	4	$56.00	$56.00	$56.00	$56.00	$56.00	2026-07-18
80051	CPT	Electrolyte Panel	1	1	$53.00	$53.00	$53.00	$53.00	$53.00	2026-07-18
87340	CPT	Hepatitis B Surface Ag	3	3	$51.65	$51.65	$51.65	$51.65	$51.65	2026-07-18
84132	CPT	Serum Potassium Level	3	3	$51.00	$51.00	$51.00	$51.00	$51.00	2026-07-18
94640	CPT	Hh Nebulizer Continuous	3	3	$51.00	$51.00	$51.00	$51.00	$51.00	2026-07-18
83540	CPT	Iron Level	1	1	$50.00	$50.00	$50.00	$50.00	$50.00	2026-07-18
94660	CPT	Bipap/cpap Per Hr	4	2	$189.50	$189.50	$49.00	$330.00	$189.50	2026-07-18
85610	CPT	Pt Inr	3	3	$47.00	$47.00	$47.00	$47.00	$47.00	2026-07-18
84134	CPT	Serum Prealbumin	5	5	$47.00	$47.00	$47.00	$47.00	$47.00	2026-07-18
97530	CPT	Ot Therap Activity 15 Min	5	5	$46.00	$46.00	$46.00	$46.00	$46.00	2026-07-18
85018	CPT	Hemoglobin & Hematocrit	4	4	$45.00	$45.00	$45.00	$45.00	$45.00	2026-07-18
86140	CPT	C-reactive Protein	5	5	$44.00	$44.00	$44.00	$44.00	$44.00	2026-07-18
85025	CPT	Cbc With Auto Diff	5	5	$42.75	$42.75	$42.75	$42.75	$42.75	2026-07-18
82945	CPT	Glucose, Body Fluid	1	1	$42.16	$42.16	$42.16	$42.16	$42.16	2026-07-18
84480	CPT	Free T3	1	1	$39.90	$39.90	$39.90	$39.90	$39.90	2026-07-18
80069	CPT	Renal Function Panel	5	5	$38.00	$38.00	$38.00	$38.00	$38.00	2026-07-18
85027	CPT	Cbc Without Differential	5	5	$38.00	$38.00	$38.00	$38.00	$38.00	2026-07-18
83550	CPT	Iron Saturation	1	1	$36.00	$36.00	$36.00	$36.00	$36.00	2026-07-18
86901	CPT	Blood Type Abo/rh(d) Panel	1	1	$35.00	$35.00	$35.00	$35.00	$35.00	2026-07-18
83735	CPT	Serum Magnesium	4	4	$34.00	$34.00	$34.00	$34.00	$34.00	2026-07-18
31899	CPT	Trach Button Insert	2	2	$38.50	$38.50	$32.00	$45.00	$38.50	2026-07-18
94667	CPT	Mechanical Cough Assist	1	1	$28.00	$28.00	$28.00	$28.00	$28.00	2026-07-18
84300	CPT	Urine Sodium Level	1	1	$27.83	$27.83	$27.83	$27.83	$27.83	2026-07-18
94760	CPT	Pulse Ox Daily	2	2	$25.00	$25.00	$25.00	$25.00	$25.00	2026-07-18
87086	CPT	Culture, Urine	3	3	$22.73	$22.73	$22.73	$22.73	$22.73	2026-07-18
81003	CPT	Urinalysis	4	4	$21.00	$21.00	$21.00	$21.00	$21.00	2026-07-18
82962	CPT	Accu Check	5	5	$20.00	$20.00	$20.00	$20.00	$20.00	2026-07-18
84100	CPT	Serum Phosphorus	4	4	$20.00	$20.00	$20.00	$20.00	$20.00	2026-07-18
81015	CPT	Urinalysis, Microscopic	2	2	$20.00	$20.00	$20.00	$20.00	$20.00	2026-07-18
85651	CPT	Esr	5	5	$19.00	$19.00	$19.00	$19.00	$19.00	2026-07-18
82550	CPT	Cpk	3	2	$18.35	$18.35	$18.35	$145.00	$18.35	2026-07-18
80164	CPT	Valproic Acid Level	1	1	$17.60	$17.60	$17.60	$17.60	$17.60	2026-07-18
94799	CPT	Respiratory Assessment Initial	13	5	$240.00	$240.00	$17.00	$323.00	$240.00	2026-07-18
84478	CPT	Serum Triglyceride	1	1	$16.00	$16.00	$16.00	$16.00	$16.00	2026-07-18
84466	CPT	Transferrin Level	1	1	$15.25	$15.25	$15.25	$15.25	$15.25	2026-07-18
94761	CPT	Pulse Ox Spot Check	5	5	$15.00	$15.00	$15.00	$15.00	$15.00	2026-07-18
84439	CPT	Free T4	1	1	$13.63	$13.63	$13.63	$13.63	$13.63	2026-07-18
257	OTHER	Polyethylene Glycol 3350	46	5	$10.28	$10.28	$6.00	$72.48	$10.28	2026-07-18
6	OTHER	diazePAM	1	1	$6.00	$6.00	$6.00	$6.00	$6.00	2026-07-18
258	OTHER	0.5 Normal Saline 250 Ml Bag	20	5	$14.30	$14.30	$2.00	$20.00	$14.30	2026-07-18
250	OTHER	Enoxaparin Sodium	386	5	$35.10	$35.10	$1.75	$1,603.50	$34.80	2026-07-18
270	OTHER	Blood Sugar Meter Accucheck	107	5	$27.76	$27.76	$1.00	$864.00	$27.76	2026-07-18
272	OTHER	Cath Statlock Device	191	5	$24.00	$24.00	$1.00	$681.00	$24.00	2026-07-18
271	OTHER	Cream Perineal Nutrash Rotect	72	5	$17.00	$17.00	$1.00	$146.00	$17.00	2026-07-18
636	OTHER	Heparin Sod 10k U (10mL) Vial	9	4	$16.08	$16.08	$0.80	$18.65	$16.08	2026-07-18

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