Hospital

AVERA TYLER HOSPITAL

Tyler, MN · CCN 241348 · Rates published

702 distinct procedures filed

5 distinct payers

20,456 rate rows

2026-05-21 last MRF observed

Data quality

20,404 of 20,456 rate rows are consumer-grade (99.7%)

52 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
exceeds 10× this hospital's gross charge — excluded from medians	20
percent-of-charges filed in the dollar field — excluded from medians	16
placeholder amount (≤ $0.02) — excluded from medians	16

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

Source MRF file	https://www.avera.org/app/files/public/30c119ee-35bd-417a-a15e-30ec553ee995/410853163_avera-tyler-hospital_standardcharges.csv
Discovered via	Discovered by HANK (automated)
Last fetch	not_modified · 2026-05-17
Content fingerprint	605e53919fd2c91d… · 2,727,824 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
J3101 OTHER	Tenecteplase 50 Mg/10 Ml Syrng	5	$0.41	$30,637.29	$20,119.54	nat. median $195 outlier · 103.2×
193 OTHER	Ms-DRG 193	1	$19,812.76	$19,812.76	$19,812.76	nat. median $12,881 1.5× median
J0717 OTHER	Certolizumab Pegol 400 Mg Kit	5	$3.42	$25,109.77	$16,489.61	nat. median $5 outlier · 3258.8×
871 OTHER	Ms-DRG 871	1	$14,269.00	$14,269.00	$14,269.00	nat. median $16,181 0.9× median
194 OTHER	Ms-DRG 194	1	$11,901.07	$11,901.07	$11,901.07	nat. median $8,630 1.4× median
683 OTHER	Ms-DRG 683	1	$11,901.07	$11,901.07	$11,901.07	nat. median $9,135 1.3× median
644 OTHER	Ms-DRG 644	1	$10,711.33	$10,711.33	$10,711.33	nat. median $10,379 1.0× median
964 OTHER	Ms-DRG 964	1	$10,710.13	$10,710.13	$10,710.13	nat. median $11,375 0.9× median
191 OTHER	Ms-DRG 191	1	$10,710.13	$10,710.13	$10,710.13	nat. median $8,914 1.2× median
J3262 OTHER	Tocilizumab 400 Mg/20 Ml Vial	5	$2.72	$11,665.40	$7,660.68	nat. median $7 outlier · 1075.9×
690 OTHER	Ms-DRG 690	1	$7,151.26	$7,151.26	$7,151.26	nat. median $8,286 0.9× median
95811 OTHER	Polysomnogram W CPap	5	$2,792.54	$6,574.66	$5,307.17	nat. median $996 outlier · 5.3×
J0897 OTHER	Denosumab 60 Mg/ml Syringe	5	$9.69	$7,340.77	$4,820.69	nat. median $32 outlier · 151.5×
70553 OTHER	MRI Brain Wwo Contrast	5	$729.77	$8,451.61	$4,536.29	nat. median $596 outlier · 7.6×
95810 OTHER	Polysomnogram	5	$2,378.48	$5,599.81	$4,520.26	nat. median $979 outlier · 4.6×
176 OTHER	Ms-DRG 176	1	$3,592.39	$3,592.39	$3,592.39	nat. median $8,622 outlier · 0.4×
951 OTHER	Ms-DRG 951	1	$3,592.39	$3,592.39	$3,592.39	nat. median $6,107 0.6× median
391 OTHER	Ms-DRG 391	1	$3,569.27	$3,569.27	$3,569.27	nat. median $9,924 outlier · 0.4×
81517 OTHER	Enhanced Liver Fibrosis	5	$1,800.85	$4,239.87	$3,402.82	nat. median $187 outlier · 18.2×
87154 OTHER	Culture Id By Amp Prb 6 Or 6+	5	$1,779.84	$4,190.40	$3,382.56	nat. median $227 outlier · 14.9×
74177 OTHER	CT Abd & Pelv W Contrast	5	$227.52	$3,990.58	$3,184.24	nat. median $458 outlier · 7.0×
74176 OTHER	CT Abd & Pelvis Wo Contrast	5	$95.04	$4,225.32	$3,053.56	nat. median $302 outlier · 10.1×
74178 OTHER	CT Abd & Pelv Wwo Contrast	5	$479.88	$4,546.39	$2,985.62	nat. median $495 outlier · 6.0×
J3145 OTHER	Testosterone 750 Mg/3 Ml	5	$3.84	$4,379.51	$2,876.03	nat. median $2 outlier · 1389.4×
72156 OTHER	MRI Neck Spine Wwo Dye	5	$340.05	$4,274.79	$2,807.26	nat. median $564 outlier · 5.0×
73720 OTHER	MRI Le Wwo Dye Lt	5	$233.96	$4,251.51	$2,791.97	nat. median $553 outlier · 5.0×
70549 OTHER	MRA Neck Wwo Contrast	5	$666.92	$4,240.84	$2,784.96	nat. median $592 outlier · 4.7×
72157 OTHER	MRI Chest Spine Wwo Dye	5	$535.35	$4,203.01	$2,760.12	nat. median $630 outlier · 4.4×
750 OTHER	Colonoscopy	5	$1,219.11	$5,239.94	$2,759.94	nat. median $2,494 1.1× median
74183 OTHER	MRI Abdomen Wwo Dye	5	$619.08	$4,124.44	$2,708.52	nat. median $634 outlier · 4.3×
73223 OTHER	MRI Joint Ue Wwo Dye Rt	5	$597.27	$4,016.77	$2,637.82	nat. median $618 outlier · 4.3×
70498 OTHER	CT Angiography Neck W Cont	5	$278.39	$3,211.67	$2,532.92	nat. median $328 outlier · 7.7×
70496 OTHER	CT Angiography Head W Cont	5	$246.84	$3,211.67	$2,532.92	nat. median $325 outlier · 7.8×
111 OTHER	Room Medical Unit Priv	5	$1,323.76	$3,116.61	$2,515.78	nat. median $4,074 0.6× median
C8929 OTHER	Echo M Mode 2d W Contrast	5	$1,297.39	$3,054.53	$2,500.31	nat. median $961 outlier · 2.6×
73723 OTHER	MRI Joint Le Wwo Dye Lt	5	$657.06	$3,783.00	$2,484.30	nat. median $583 outlier · 4.3×
72148 OTHER	MRI Lumbar Spine Wo Dye	5	$315.18	$3,392.09	$2,451.40	nat. median $383 outlier · 6.4×
94002 OTHER	Vent Assist & Mgmt First Day	5	$1,295.33	$3,049.68	$2,447.61	nat. median $664 outlier · 3.7×
93306 OTHER	Tte W Doppler Complete	5	$1,297.39	$3,054.53	$2,437.33	nat. median $609 outlier · 4.0×
A0427 OTHER	Amb Als Emergent Home/Hosp	5	$1,288.74	$3,034.16	$2,435.14	nat. median $820 outlier · 3.0×
73221 OTHER	MRI Joint Ue Wo Dye Lt	5	$408.12	$3,549.23	$2,330.78	nat. median $396 outlier · 5.9×
73218 OTHER	MRI Ue Wo Dye Rt	5	$79.40	$3,517.22	$2,309.76	nat. median $416 outlier · 5.6×
73718 OTHER	MRI Le Wo Dye Lt	5	$56.39	$3,517.22	$2,309.76	nat. median $401 outlier · 5.8×
70551 OTHER	MRI Brain Wo Contrast	5	$447.03	$3,496.85	$2,296.39	nat. median $394 outlier · 5.8×
72146 OTHER	MRI Chest Spine Wo Dye	5	$390.63	$3,410.52	$2,239.69	nat. median $372 outlier · 6.0×
73721 OTHER	MRI Joint Le Wo Dye Lt	5	$315.18	$3,400.82	$2,233.32	nat. median $442 outlier · 5.1×
72141 OTHER	MRI Neck Spine Wo Dye	5	$233.96	$3,371.72	$2,214.21	nat. median $372 outlier · 6.0×
71275 OTHER	CTA Chest Wwo Contrast	5	$65.60	$3,283.45	$2,156.24	nat. median $311 outlier · 6.9×
129 OTHER	Room Swing Bed Skilled	5	$1,124.76	$2,648.10	$2,137.59	nat. median $1,931 1.1× median
70544 OTHER	MRA Head Wo Contrast	5	$408.12	$3,222.34	$2,116.11	nat. median $401 outlier · 5.3×

Other procedures at this hospital

Browse this hospital's 702 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

J3101	OTHER	Tenecteplase 50 Mg/10 Ml Syrng	22	5	$31,584.00	$30,637.29	$0.41	$30,637.29	$20,119.54	2026-05-21
J0717	OTHER	Certolizumab Pegol 400 Mg Kit	22	5	$25,886.00	$25,109.77	$3.42	$25,109.77	$16,489.61	2026-05-21
J3262	OTHER	Tocilizumab 400 Mg/20 Ml Vial	22	5	$12,026.00	$11,665.40	$2.72	$11,665.40	$7,660.68	2026-05-21
J0897	OTHER	Denosumab 60 Mg/ml Syringe	22	5	$7,567.00	$7,340.77	$9.69	$7,340.77	$4,820.69	2026-05-21
95811	OTHER	Polysomnogram W CPap	18	5	$6,778.00	$6,574.66	$2,792.54	$6,574.66	$5,307.17	2026-05-21
95810	OTHER	Polysomnogram	18	5	$5,773.00	$5,599.81	$2,378.48	$5,599.81	$4,520.26	2026-05-21
70553	OTHER	MRI Brain Wwo Contrast	40	5	$5,472.00	$5,307.84	$729.77	$8,451.61	$4,536.29	2026-05-21
74178	OTHER	CT Abd & Pelv Wwo Contrast	22	5	$4,687.00	$4,546.39	$479.88	$4,546.39	$2,985.62	2026-05-21
J3145	OTHER	Testosterone 750 Mg/3 Ml	22	5	$4,514.00	$4,379.51	$3.84	$4,379.51	$2,876.03	2026-05-21
72156	OTHER	MRI Neck Spine Wwo Dye	22	5	$4,407.00	$4,274.79	$340.05	$4,274.79	$2,807.26	2026-05-21
73720	OTHER	MRI Le Wwo Dye Lt	22	5	$4,383.00	$4,251.51	$233.96	$4,251.51	$2,791.97	2026-05-21
70549	OTHER	MRA Neck Wwo Contrast	22	5	$4,372.00	$4,240.84	$666.92	$4,240.84	$2,784.96	2026-05-21
81517	OTHER	Enhanced Liver Fibrosis	16	5	$4,371.00	$4,239.87	$1,800.85	$4,239.87	$3,402.82	2026-05-21
74176	OTHER	CT Abd & Pelvis Wo Contrast	24	5	$4,356.00	$4,225.32	$95.04	$4,225.32	$3,053.56	2026-05-21
72157	OTHER	MRI Chest Spine Wwo Dye	22	5	$4,333.00	$4,203.01	$535.35	$4,203.01	$2,760.12	2026-05-21
87154	OTHER	Culture Id By Amp Prb 6 Or 6+	18	5	$4,320.00	$4,190.40	$1,779.84	$4,190.40	$3,382.56	2026-05-21
74183	OTHER	MRI Abdomen Wwo Dye	22	5	$4,252.00	$4,124.44	$619.08	$4,124.44	$2,708.52	2026-05-21
73223	OTHER	MRI Joint Ue Wwo Dye Rt	22	5	$4,141.00	$4,016.77	$597.27	$4,016.77	$2,637.82	2026-05-21
74177	OTHER	CT Abd & Pelv W Contrast	28	5	$4,114.00	$3,990.58	$227.52	$3,990.58	$3,184.24	2026-05-21
73723	OTHER	MRI Joint Le Wwo Dye Lt	44	5	$3,900.00	$3,783.00	$657.06	$3,783.00	$2,484.30	2026-05-21
73221	OTHER	MRI Joint Ue Wo Dye Lt	44	5	$3,659.00	$3,549.23	$408.12	$3,549.23	$2,330.78	2026-05-21
73718	OTHER	MRI Le Wo Dye Lt	44	5	$3,626.00	$3,517.22	$56.39	$3,517.22	$2,309.76	2026-05-21
73218	OTHER	MRI Ue Wo Dye Rt	22	5	$3,626.00	$3,517.22	$79.40	$3,517.22	$2,309.76	2026-05-21
70551	OTHER	MRI Brain Wo Contrast	22	5	$3,605.00	$3,496.85	$447.03	$3,496.85	$2,296.39	2026-05-21
72146	OTHER	MRI Chest Spine Wo Dye	22	5	$3,516.00	$3,410.52	$390.63	$3,410.52	$2,239.69	2026-05-21
73721	OTHER	MRI Joint Le Wo Dye Lt	46	5	$3,506.00	$3,400.82	$315.18	$3,400.82	$2,233.32	2026-05-21
72148	OTHER	MRI Lumbar Spine Wo Dye	24	5	$3,497.00	$3,392.09	$315.18	$3,392.09	$2,451.40	2026-05-21
72141	OTHER	MRI Neck Spine Wo Dye	22	5	$3,476.00	$3,371.72	$233.96	$3,371.72	$2,214.21	2026-05-21
750	OTHER	Colonoscopy	80	5	$3,444.00	$3,340.68	$1,219.11	$5,239.94	$2,759.94	2026-05-21
71275	OTHER	CTA Chest Wwo Contrast	22	5	$3,385.00	$3,283.45	$65.60	$3,283.45	$2,156.24	2026-05-21
70544	OTHER	MRA Head Wo Contrast	22	5	$3,322.00	$3,222.34	$408.12	$3,222.34	$2,116.11	2026-05-21
70498	OTHER	CT Angiography Neck W Cont	26	5	$3,311.00	$3,211.67	$278.39	$3,211.67	$2,532.92	2026-05-21
70496	OTHER	CT Angiography Head W Cont	26	5	$3,311.00	$3,211.67	$246.84	$3,211.67	$2,532.92	2026-05-21
59409	OTHER	Obstetrical Care	30	5	$3,308.00	$3,208.76	$1,362.90	$3,208.76	$1,701.85	2026-05-21
74181	OTHER	MRI Abdomen Wo Dye	22	5	$3,224.00	$3,127.28	$544.29	$3,127.28	$2,053.69	2026-05-21
111	OTHER	Room Medical Unit Priv	14	5	$3,213.00	$3,116.61	$1,323.76	$3,116.61	$2,515.78	2026-05-21
C8929	OTHER	Echo M Mode 2d W Contrast	20	5	$3,149.00	$3,054.53	$1,297.39	$3,054.53	$2,500.31	2026-05-21
93306	OTHER	Tte W Doppler Complete	22	5	$3,149.00	$3,054.53	$1,297.39	$3,054.53	$2,437.33	2026-05-21
94002	OTHER	Vent Assist & Mgmt First Day	16	5	$3,144.00	$3,049.68	$1,295.33	$3,049.68	$2,447.61	2026-05-21
A0427	OTHER	Amb Als Emergent Home/Hosp	16	5	$3,128.00	$3,034.16	$1,288.74	$3,034.16	$2,435.14	2026-05-21
74175	OTHER	CTA Abdom Wwo Dye	22	5	$2,880.00	$2,793.60	$82.17	$2,793.60	$1,834.56	2026-05-21
74170	OTHER	CT Abdomen Wwo Dye	22	5	$2,858.00	$2,772.26	$58.22	$2,772.26	$1,820.55	2026-05-21
J0248	OTHER	Remdesivir 100 Mg Vial	22	5	$2,797.00	$2,713.73	$12.70	$2,713.73	$1,782.11	2026-05-21
129	OTHER	Room Swing Bed Skilled	14	5	$2,730.00	$2,648.10	$1,124.76	$2,648.10	$2,137.59	2026-05-21
74160	OTHER	CT Abdomen W Dye	22	5	$2,509.00	$2,433.73	$706.77	$2,433.73	$1,598.23	2026-05-21
71260	OTHER	CT Thorax W Contrast	26	5	$2,382.00	$2,310.54	$80.31	$2,310.54	$1,822.23	2026-05-21
72125	OTHER	CT Cervical Spine Wo Contrast	24	5	$2,365.00	$2,294.05	$172.58	$2,294.05	$1,657.87	2026-05-21
72195	OTHER	MRI Pelvis Wo Dye	22	5	$2,357.00	$2,286.29	$53.64	$2,286.29	$1,501.41	2026-05-21
99291	OTHER	Critical Care 1st 30-74 Min	32	5	$2,302.00	$2,232.94	$329.00	$2,232.94	$1,207.39	2026-05-21
72128	OTHER	CT Thoracic Spine Wo Contrast	22	5	$2,299.00	$2,230.03	$107.93	$2,230.03	$1,464.46	2026-05-21
90377	OTHER	Rabies Imm Glo 300U/2Ml Kedrab	22	5	$2,190.00	$2,124.30	$21.92	$2,124.30	$1,395.03	2026-05-21
70491	OTHER	CT Soft Tissue Neck W Cont	24	5	$2,150.00	$2,085.50	$357.53	$2,085.50	$1,507.15	2026-05-21
73200	OTHER	CT Ue Wo Dye Lt	22	5	$2,150.00	$2,085.50	$70.19	$2,085.50	$1,369.55	2026-05-21
J1745	OTHER	Infliximab (Gen) 100 Mg Vial	22	5	$2,110.00	$2,047.24	$1.46	$2,047.24	$1,344.43	2026-05-21
G0390	OTHER	Trauma Team Level 4	16	5	$2,072.00	$2,009.84	$853.66	$2,009.84	$1,613.06	2026-05-21
78227	OTHER	Hida With Ef w/Pharm	16	5	$2,060.00	$1,998.20	$848.72	$1,998.20	$1,603.71	2026-05-21
684	OTHER	Trauma Team Evaluation Level 4	16	5	$1,973.00	$1,913.81	$812.88	$1,913.81	$1,535.98	2026-05-21
70480	OTHER	CT Orbit Wo Contrast	22	5	$1,865.00	$1,809.05	$192.56	$1,809.05	$1,188.01	2026-05-21
73700	OTHER	CT Le Wo Dye Lt	44	5	$1,852.00	$1,796.44	$76.65	$1,796.44	$1,179.72	2026-05-21
99285	OTHER	Emergency Room Visit Level 5	40	5	$1,792.00	$1,738.24	$267.73	$1,738.24	$1,141.50	2026-05-21
Q5104	OTHER	Infliximab-abda 100 Mg Vial	22	5	$1,752.00	$1,700.24	$52.52	$5,119.19	$1,372.46	2026-05-21
Q5101	OTHER	Filgrastim-sndz 480 Mcg/0.8ml	22	5	$1,584.00	$1,537.32	$0.72	$2,902.40	$1,240.95	2026-05-21
86366	OTHER	Musk Antibody Ref	16	5	$1,544.00	$1,497.68	$636.13	$1,497.68	$1,202.01	2026-05-21
A0429	OTHER	Amb Bls Emergent Home/Hosp	50	5	$1,528.00	$1,482.16	$629.54	$1,482.16	$1,182.67	2026-05-21
A0428	OTHER	Amb Bls Non Emerg Hosp/Hosp	64	5	$1,499.00	$1,454.03	$617.59	$1,454.03	$1,166.97	2026-05-21
72192	OTHER	CT Pelvis Wo Dye	22	5	$1,493.00	$1,448.21	$524.00	$1,448.21	$951.04	2026-05-21
74150	OTHER	CT Abdomen Wo Dye	22	5	$1,488.00	$1,443.36	$524.00	$1,443.36	$947.86	2026-05-21
92950	OTHER	Heart/Lung Resuscitation Cpr	30	5	$1,460.00	$1,416.20	$275.08	$1,416.20	$601.52	2026-05-21
93975	OTHER	Vascular Study	18	5	$1,439.00	$1,395.83	$592.87	$1,395.83	$1,126.74	2026-05-21
0003M	OTHER	Nash-fibrotest	16	5	$1,405.00	$1,362.85	$578.86	$1,362.85	$1,093.80	2026-05-21
71250	OTHER	CT Thorax Wo Contrast	24	5	$1,395.00	$1,353.15	$71.13	$1,353.15	$977.90	2026-05-21
70490	OTHER	CT Soft Tissue Neck Wo Cont	22	5	$1,395.00	$1,353.15	$277.47	$1,353.15	$888.62	2026-05-21
93925	OTHER	Arterial Duplex Le Bi	18	5	$1,353.00	$1,312.41	$557.44	$1,312.41	$1,059.40	2026-05-21
90675	OTHER	Rabies Vax Pcec/Pf 2.5Unit Vl	22	5	$1,347.00	$1,307.03	$125.24	$1,307.03	$858.33	2026-05-21
93970	OTHER	Venous Duplex	20	5	$1,340.00	$1,299.80	$552.08	$1,299.80	$1,049.22	2026-05-21
70450	OTHER	CT Head/Brain Wo Contrast	24	5	$1,328.00	$1,288.16	$24.20	$1,288.16	$930.93	2026-05-21
72131	OTHER	CT Lumbar Spine Wo Contrast	22	5	$1,328.00	$1,288.16	$234.87	$1,288.16	$845.94	2026-05-21
93880	OTHER	Extracranial Bilat Study	18	5	$1,321.00	$1,281.37	$544.25	$1,281.37	$1,034.34	2026-05-21
94660	OTHER	CPap/BiPap First Day	18	5	$1,278.00	$1,239.66	$526.54	$1,239.66	$1,000.67	2026-05-21
70486	OTHER	CT Maxillofacial Wo Contrast	22	5	$1,241.00	$1,203.77	$187.95	$1,203.77	$790.52	2026-05-21
76700	OTHER	Ultrasound Abdomen Complete	16	5	$1,215.00	$1,178.55	$500.58	$1,178.55	$945.88	2026-05-21
87529	OTHER	Hsv DNA Pcr Subtype Ref	16	5	$1,200.00	$1,164.00	$494.40	$1,164.00	$934.20	2026-05-21
710	OTHER	Recovery Phase Ii 0-2 Hours	32	5	$1,198.50	$1,162.55	$474.62	$1,207.65	$939.89	2026-05-21
C8957	OTHER	IV Infusion Prolonged	16	5	$1,196.00	$1,160.12	$492.75	$1,160.12	$931.09	2026-05-21
24650	OTHER	Fx Radial Head/Neck Wo Man Lt	16	5	$1,173.00	$1,137.81	$483.28	$1,137.81	$913.18	2026-05-21
25600	OTHER	Fx Distal Radius Lt	32	5	$1,173.00	$1,137.81	$483.28	$1,137.81	$913.18	2026-05-21
28400	OTHER	Fx Calcaneus Lt	16	5	$1,173.00	$1,137.81	$483.28	$1,137.81	$913.18	2026-05-21
27786	OTHER	Fx Distal Fibula Rt	16	5	$1,173.00	$1,137.81	$483.28	$1,137.81	$913.18	2026-05-21
23620	OTHER	Closed Tx Gr Tuberosity Fx Lt	16	5	$1,173.00	$1,137.81	$483.28	$1,137.81	$913.18	2026-05-21
Q0138	OTHER	Ferumoxy 510mg/17ml (non-esrd)	22	5	$1,145.00	$1,111.35	$0.76	$1,111.35	$729.82	2026-05-21
23600	OTHER	Fx Prox Humeral Wo Man Lt	16	5	$1,117.00	$1,083.49	$460.20	$1,083.49	$869.59	2026-05-21
27530	OTHER	Treat Knee Fracture Rt	16	5	$1,117.00	$1,083.49	$460.20	$1,083.49	$869.59	2026-05-21
26600	OTHER	Fx Metacarpal	16	5	$1,117.00	$1,083.49	$460.20	$1,083.49	$869.59	2026-05-21
26750	OTHER	Fx Distal Finger/Thumb Wo Man	16	5	$1,117.00	$1,083.49	$460.20	$1,083.49	$869.59	2026-05-21
G0379	OTHER	Observation Assess Direct Adm	16	5	$1,116.00	$1,082.52	$459.79	$1,082.52	$868.81	2026-05-21
87799	OTHER	Bk Virus Quant Pcr, Serum	36	5	$1,112.00	$1,078.64	$321.36	$1,400.68	$710.97	2026-05-21
Q9967	OTHER	Iopamidol-370 100 Ml Vial	28	5	$1,050.00	$1,018.50	$0.28	$1,018.50	$812.70	2026-05-21
99284	OTHER	Emergency Room Visit Level 4	38	5	$1,032.00	$1,001.04	$184.86	$1,001.04	$657.38	2026-05-21
76830	OTHER	Ultrasound Transvaginal	16	5	$977.00	$947.69	$402.52	$947.69	$760.60	2026-05-21
76856	OTHER	Ultrasound Pelvic Complete	18	5	$945.00	$916.65	$389.34	$916.65	$739.94	2026-05-21
76770	OTHER	Ultrasound Abdo Back Wall Comp	18	5	$933.00	$905.01	$384.40	$905.01	$730.54	2026-05-21
81206	OTHER	Bcr/abl1 Major Mutation	16	5	$920.00	$892.40	$379.04	$892.40	$716.22	2026-05-21
81207	OTHER	Bcr/abl1 Minor Mutation	16	5	$920.00	$892.40	$379.04	$892.40	$716.22	2026-05-21
0202U	OTHER	Respir Path 22 Targets Biofire	16	5	$914.00	$886.58	$376.57	$886.58	$711.55	2026-05-21
31500	OTHER	Insert Emergency Airway	30	5	$909.00	$881.73	$273.72	$881.73	$390.88	2026-05-21
J2997	OTHER	Alteplase 2 Mg Vial	22	5	$899.00	$872.41	$37.08	$872.41	$572.91	2026-05-21
99292	OTHER	Critical Care Ea Addl 30 Min	34	5	$865.00	$839.05	$164.83	$839.05	$551.00	2026-05-21
76705	OTHER	Ultrasound Abdomen Limited	22	5	$854.00	$828.38	$351.85	$828.38	$668.68	2026-05-21
88262	OTHER	Chromosome Analysis 15-20 Cell	16	5	$834.00	$808.98	$343.61	$808.98	$649.27	2026-05-21
88230	OTHER	Tissue Culture Non Neoplastic	16	5	$834.00	$808.98	$343.61	$808.98	$649.27	2026-05-21
360	OTHER	Biopsy Thyroid Percutaneous	32	5	$828.00	$803.16	$269.86	$970.97	$597.04	2026-05-21
87536	OTHER	HIV 1 Na Quan	16	5	$825.00	$800.25	$339.90	$800.25	$642.26	2026-05-21
77080	OTHER	Dexa Scan	24	5	$823.00	$798.31	$88.61	$798.31	$637.00	2026-05-21
76817	OTHER	Transvaginal US Obstetrical	18	5	$814.00	$789.58	$335.37	$789.58	$637.36	2026-05-21
93971	OTHER	Extremity Study Rt	34	5	$798.00	$774.06	$328.78	$774.06	$624.83	2026-05-21
96413	OTHER	Chemotherapy Inf Initial	20	5	$798.00	$774.06	$328.78	$774.06	$621.24	2026-05-21
76536	OTHER	Ultrasound Head And Neck	24	5	$790.00	$766.30	$325.48	$766.30	$618.57	2026-05-21
24640	OTHER	Dislocation Nursemaid Elbow Lt	60	5	$785.00	$761.45	$162.62	$761.45	$323.42	2026-05-21
Q5110	OTHER	Filgrastim-aafi 480 Mcg/0.8 Ml	22	5	$780.00	$756.91	$0.58	$927.00	$610.99	2026-05-21
J1610	OTHER	Glucagon 1 Mg/ml Vial	36	5	$779.00	$755.75	$98.91	$1,287.61	$618.62	2026-05-21
93325	OTHER	Echo Color Doppler	18	5	$779.00	$755.63	$320.95	$755.63	$609.96	2026-05-21
71111	OTHER	X-ray Ribs Bilateral 4 Views	20	5	$759.00	$736.23	$63.74	$736.23	$587.47	2026-05-21
56405	OTHER	I & D Vulva/Perineum	30	5	$749.00	$726.53	$255.90	$726.53	$330.01	2026-05-21
23650	OTHER	Dislocation Shoulder Wo AnesLT	32	5	$747.00	$724.59	$307.76	$802.00	$633.52	2026-05-21
12034	OTHER	Repair Lac Interm 7.6-12.5 Cm	30	5	$735.00	$712.95	$302.82	$712.95	$468.19	2026-05-21
12041	OTHER	Repair Lac Interm <2.5 Cm	30	5	$735.00	$712.95	$294.12	$712.95	$409.19	2026-05-21
80145	OTHER	Adalimumab	16	5	$731.00	$709.07	$301.17	$709.07	$569.08	2026-05-21
J0561	OTHER	Pen G Benzathine 600000Unit/ML	36	5	$696.00	$675.15	$53.64	$1,155.52	$552.64	2026-05-21
93321	OTHER	Doppler Echo Exam Heart	18	5	$692.00	$671.24	$285.10	$671.24	$541.84	2026-05-21
93246	OTHER	Ext ECG >7 Days Hook Up	20	5	$687.00	$666.39	$283.04	$666.39	$545.48	2026-05-21
450	OTHER	Dissolve Clot Heart Vessel	16	5	$687.00	$666.39	$283.04	$666.39	$534.83	2026-05-21
71271	OTHER	Ldct For Lung Cancer Screen	26	5	$675.00	$654.75	$101.48	$654.75	$528.53	2026-05-21
83835	OTHER	Metanephrines	20	5	$675.00	$654.75	$278.10	$654.75	$528.53	2026-05-21
76706	OTHER	Aaa Screening Medicare	16	5	$663.00	$643.11	$273.16	$643.11	$516.14	2026-05-21
76870	OTHER	Ultrasound Scrotum	18	5	$661.00	$641.17	$272.33	$641.17	$517.56	2026-05-21
80306	OTHER	Drug Screen Urine Inst Ass Obv	26	5	$654.00	$634.38	$269.45	$634.38	$512.08	2026-05-21
76775	OTHER	Ultrasound Aorta	16	5	$653.00	$633.41	$269.04	$633.41	$508.36	2026-05-21
99283	OTHER	Emergency Room Visit Level 3	38	5	$644.00	$624.68	$108.68	$624.68	$410.23	2026-05-21
Q9957	OTHER	Perflutren Lip Micro 2.2mg/2ml	22	5	$638.00	$619.21	$47.75	$619.21	$406.64	2026-05-21
76882	OTHER	US Extremity Nonvasc Limit Lt	34	5	$637.00	$617.89	$262.44	$617.89	$498.77	2026-05-21
86361	OTHER	Cd4 Absolute Count	16	5	$633.00	$614.01	$260.80	$614.01	$492.79	2026-05-21
70150	OTHER	X-ray Facial Bones 3 Views	18	5	$630.00	$611.10	$82.17	$611.10	$481.95	2026-05-21
Q9956	OTHER	Perflutren Protein-a Microdota	22	5	$630.00	$611.25	$77.76	$611.25	$401.41	2026-05-21
76604	OTHER	Ultrasound Chest	16	5	$626.00	$607.22	$257.91	$607.22	$487.34	2026-05-21
87798	OTHER	Bord Pertusis Amp Probe Ref	32	5	$623.50	$604.79	$89.82	$998.13	$317.70	2026-05-21
115	OTHER	Room Hospice Respite Care	14	5	$609.00	$590.73	$250.91	$590.73	$476.85	2026-05-21
110	OTHER	Room Custodial Care	14	5	$609.00	$590.73	$250.91	$590.73	$476.85	2026-05-21
73523	OTHER	X-ray Hips 5 Views Bi	18	5	$606.00	$587.82	$249.67	$690.20	$487.83	2026-05-21
71101	OTHER	X-ray Ribs Uni W Chest Lt	38	5	$598.00	$580.06	$246.38	$3,427.98	$481.39	2026-05-21
93356	OTHER	Myocardial Strain Image Speckl	16	5	$595.00	$577.15	$245.14	$577.15	$463.21	2026-05-21
74220	OTHER	Contrast X-ray Esophagus	18	5	$587.00	$569.39	$241.84	$569.39	$449.06	2026-05-21
81515	OTHER	Vpp	20	5	$564.00	$547.08	$232.37	$547.08	$441.61	2026-05-21
72072	OTHER	X-ray Spine Thoracic 3 Views	20	5	$563.00	$546.11	$231.96	$697.55	$453.22	2026-05-21
P9016	OTHER	Red Blood Cells Lekoreduced	18	5	$563.00	$546.11	$231.96	$546.11	$440.83	2026-05-21
92610	OTHER	Swallow Eval Non Radiol	20	5	$554.00	$537.38	$228.25	$537.38	$439.88	2026-05-21
65220	OTHER	Remove Foreign Body Eye Rt	32	5	$552.00	$535.44	$81.33	$535.44	$289.52	2026-05-21
72050	OTHER	X-ray Spine Cervical 4-5 Views	18	5	$549.00	$532.53	$226.19	$746.06	$441.95	2026-05-21
12002	OTHER	Repair Lac Simple 2.6-7.5 Cm	34	5	$539.00	$522.83	$112.84	$522.83	$343.34	2026-05-21
12011	OTHER	Repair Lac Simple <2.5 Cm	32	5	$539.00	$522.83	$107.01	$522.83	$282.70	2026-05-21
12001	OTHER	Repair Lac Simple <2.5 Cm	68	5	$539.00	$522.83	$86.23	$522.83	$282.70	2026-05-21
12013	OTHER	Repair Lac Simple 2.6-5.0 Cm	30	5	$539.00	$522.83	$109.90	$522.83	$222.07	2026-05-21
12004	OTHER	Repair Lac Simple 7.6-12.5 Cm	30	5	$539.00	$522.83	$140.14	$522.83	$222.07	2026-05-21
77067	OTHER	Mammo Screen Implant Bi	44	5	$532.00	$516.04	$219.18	$757.00	$422.41	2026-05-21
81241	OTHER	Factor V Leiden Mutation	18	5	$532.00	$516.04	$219.18	$516.04	$416.56	2026-05-21
87522	OTHER	Hep C RNA Pcr Quant	18	5	$530.00	$514.10	$218.36	$514.10	$414.99	2026-05-21
86256	OTHER	dsDNA IgG	32	5	$527.50	$511.68	$118.24	$744.96	$297.40	2026-05-21
87305	OTHER	Aspergillus Galact Antigen	16	5	$526.00	$510.22	$216.71	$510.22	$409.49	2026-05-21
73564	OTHER	X-ray Knee 4 Lt	40	5	$526.00	$510.22	$129.06	$510.22	$407.12	2026-05-21
A0998	OTHER	Ambulance No Transport	16	5	$522.00	$506.34	$215.06	$506.34	$406.38	2026-05-21
72070	OTHER	X-ray Spine Thoracic 2 Views	20	5	$521.00	$505.37	$214.65	$1,015.91	$419.41	2026-05-21
80074	OTHER	Acute Hepatitis Panel	18	5	$521.00	$505.37	$214.65	$505.37	$407.94	2026-05-21
99281	OTHER	Emergency Room Visit Level 1	32	5	$520.50	$504.88	$152.03	$651.84	$336.35	2026-05-21
12015	OTHER	Repair Lac Simple 7.6-12.5 Cm	30	5	$513.00	$497.61	$178.06	$497.61	$256.65	2026-05-21
87636	OTHER	Influ & CoV2 Pcr Ceph	18	5	$511.00	$495.67	$210.53	$495.67	$400.11	2026-05-21
72100	OTHER	X-ray Lumbosacral 2-3 Views	26	5	$511.00	$495.67	$90.44	$495.67	$400.11	2026-05-21
87637	OTHER	Influ/RSV/CoV2 Pcr Ceph	24	5	$511.00	$495.67	$210.53	$495.67	$400.11	2026-05-21
87517	OTHER	Hep B Na Quan	16	5	$510.00	$494.70	$210.12	$494.70	$397.03	2026-05-21
71046	OTHER	X-ray Chest 2v PA/Lateral	26	5	$499.00	$484.03	$205.59	$783.14	$425.65	2026-05-21
84445	OTHER	Tsi	20	5	$499.00	$484.03	$205.59	$484.03	$390.72	2026-05-21
93308	OTHER	Echo Limited	18	5	$497.00	$482.09	$204.76	$482.09	$389.15	2026-05-21
74019	OTHER	X-ray Abdomen	24	5	$496.00	$481.12	$204.35	$660.48	$399.28	2026-05-21
72220	OTHER	X-ray Sacrum Tailbone	18	5	$492.00	$477.24	$202.70	$477.24	$396.06	2026-05-21
96125	OTHER	Cognitive Performance Test St	18	5	$488.00	$473.36	$201.06	$473.36	$382.10	2026-05-21
73502	OTHER	X-ray Hip Uni 2-3 Views Rt	84	5	$481.00	$466.57	$183.34	$860.42	$376.62	2026-05-21
92523	OTHER	Speech Sound Lang Comprehen	18	5	$475.00	$460.75	$195.70	$460.75	$371.93	2026-05-21
70140	OTHER	X-ray Facial Bones < 3 Views	18	5	$472.00	$457.84	$66.51	$457.84	$361.08	2026-05-21
P9047	OTHER	Albumin Human 25% 25gr/100ml	22	5	$468.00	$454.76	$106.16	$3,118.50	$367.09	2026-05-21
10120	OTHER	I&r Foreign Body Simple	30	5	$468.00	$453.96	$192.82	$453.96	$288.79	2026-05-21
83993	OTHER	Calprotectin	16	5	$463.00	$449.11	$190.76	$449.11	$360.44	2026-05-21
36430	OTHER	Blood Administration	18	5	$451.00	$437.47	$185.81	$437.47	$353.13	2026-05-21
88184	OTHER	Flow Cytometry First Mark	18	5	$451.00	$437.47	$185.81	$437.47	$353.13	2026-05-21
82397	OTHER	Alpha Subunit Free	16	5	$445.00	$431.65	$183.34	$431.65	$346.44	2026-05-21
J0283	OTHER	Amiodarone/D5W 150mg/100ml Bag	36	5	$443.00	$429.86	$5.04	$475.86	$343.00	2026-05-21
71100	OTHER	X-ray Ribs 2 Views Rt	20	5	$438.00	$424.86	$180.46	$3,616.49	$352.59	2026-05-21
82024	OTHER	Acth Adrenocorticotropic Hor	22	5	$437.00	$423.89	$180.04	$423.89	$342.17	2026-05-21
82671	OTHER	Estrogen Fractionated	20	5	$437.00	$423.89	$180.04	$423.89	$342.17	2026-05-21
93926	OTHER	Arterial Duplex Le Lt	16	5	$437.00	$423.89	$180.04	$423.89	$340.21	2026-05-21
73562	OTHER	X-ray Knee 3 Views Rt	50	5	$434.00	$420.98	$109.76	$420.98	$339.82	2026-05-21
99282	OTHER	Emergency Room Visit Level 2	36	5	$434.00	$420.98	$64.21	$420.98	$227.63	2026-05-21
11750	OTHER	Exc Nail Matrix Part/Complete	30	5	$431.00	$418.07	$177.57	$418.07	$274.55	2026-05-21
83498	OTHER	17Oh Progesterone	18	5	$430.00	$417.10	$177.16	$417.10	$336.69	2026-05-21
94640	OTHER	Inhalation Treat Acute Initial	82	5	$428.00	$415.16	$115.77	$415.16	$239.69	2026-05-21
87497	OTHER	Cmv Quant By Pcr	20	5	$427.00	$414.19	$175.92	$414.19	$334.34	2026-05-21
96409	OTHER	Chemotherapy IV Push	18	5	$427.00	$414.19	$175.92	$414.19	$330.50	2026-05-21
93242	OTHER	Ext ECG 48 Hrs -7days Hook Up	20	5	$426.00	$413.22	$175.51	$413.22	$333.56	2026-05-21
84145	OTHER	Procalcitonin	18	5	$424.00	$411.28	$174.69	$411.28	$331.99	2026-05-21
84206	OTHER	Proinsulin	18	5	$419.00	$406.43	$172.63	$406.43	$328.08	2026-05-21
86480	OTHER	Tbint Quantiferon	22	5	$417.00	$404.49	$171.80	$404.49	$326.51	2026-05-21
73110	OTHER	X-ray Wrist 3 Views Rt	44	5	$410.00	$397.70	$58.22	$397.70	$317.34	2026-05-21
80197	OTHER	Tacrolimus	16	5	$407.00	$394.79	$167.68	$394.79	$316.85	2026-05-21
73630	OTHER	X-ray Foot 3 Views Lt	50	5	$405.00	$392.85	$65.60	$392.85	$317.12	2026-05-21
73130	OTHER	X-ray Hand Lt	48	5	$405.00	$392.85	$59.16	$392.85	$313.48	2026-05-21
J3489	OTHER	Zoledron Ac/Man/H2O 5mg/100ml	22	5	$405.00	$393.80	$11.20	$393.80	$258.61	2026-05-21
87631	OTHER	Influ And Rsv Amp Probe	18	5	$397.00	$385.09	$163.56	$385.09	$307.28	2026-05-21
A9537	OTHER	Radiophar Tc99M Mebrofenin	16	5	$394.00	$382.18	$162.33	$382.18	$306.73	2026-05-21
88305	OTHER	Surg Path L4	20	5	$394.00	$382.18	$162.33	$382.18	$303.19	2026-05-21
73080	OTHER	X-ray Elbow Rt	42	5	$394.00	$382.18	$38.91	$382.18	$301.41	2026-05-21
82523	OTHER	Cross Linked C Teleop	18	5	$393.00	$381.21	$161.92	$381.21	$307.72	2026-05-21
73522	OTHER	X-ray Hips 3-4 Views Bi	20	5	$390.00	$378.30	$160.68	$793.91	$313.95	2026-05-21
82088	OTHER	Aldosterone	18	5	$388.00	$376.36	$159.86	$376.36	$303.80	2026-05-21
80235	OTHER	Lacosamide	16	5	$387.00	$375.39	$159.44	$375.39	$301.28	2026-05-21
82803	OTHER	Blood Gas Wo Oximetry	20	5	$381.00	$369.57	$156.97	$369.57	$302.51	2026-05-21
74018	OTHER	X-ray Abdomen	24	5	$378.00	$366.66	$155.74	$523.40	$300.13	2026-05-21
72040	OTHER	X-ray Spine Cervical 2-3 Views	20	5	$377.00	$365.69	$155.32	$551.93	$303.49	2026-05-21
69210	OTHER	Remove Impacted Cerumen Bi	16	5	$375.00	$363.75	$154.50	$363.75	$291.94	2026-05-21
82652	OTHER	Vitamin D 125 Dihydroxy	16	5	$375.00	$363.75	$154.50	$363.75	$291.94	2026-05-21
70250	OTHER	X-ray Skull < 4 Views	18	5	$374.00	$362.78	$94.25	$362.78	$286.11	2026-05-21
86341	OTHER	Glutmic Acid Decarbox Aby	80	5	$372.50	$361.33	$109.18	$1,299.80	$271.31	2026-05-21
73030	OTHER	X-ray Shoulder Lt	52	5	$371.00	$359.87	$152.85	$359.87	$290.49	2026-05-21
97166	OTHER	Ot Eval Mod Complexity	20	5	$363.00	$352.11	$149.56	$352.11	$284.23	2026-05-21
J2305	OTHER	Nitroglycer/D5W 50mg/250ml Bot	22	5	$363.00	$352.77	$2.82	$352.77	$231.66	2026-05-21
88341	OTHER	Immunohisto Stain Add Per Spc	16	5	$360.00	$349.20	$148.32	$349.20	$280.26	2026-05-21
92507	OTHER	Speech Therapy Trmt	22	5	$354.00	$343.38	$145.85	$596.00	$277.18	2026-05-21
73590	OTHER	X-ray Lower Leg Lt	44	5	$352.00	$341.44	$73.88	$341.44	$272.45	2026-05-21
73610	OTHER	X-ray Ankle 3 Views Lt	44	5	$352.00	$341.44	$99.63	$341.44	$269.28	2026-05-21
97162	OTHER	Pt Eval Mod Complexity	24	5	$350.00	$339.50	$144.20	$339.50	$272.48	2026-05-21
93922	OTHER	Ankle Arm Screen	22	5	$342.00	$331.74	$140.90	$331.74	$267.79	2026-05-21
71045	OTHER	X-ray Chest 1 View	26	5	$341.00	$330.77	$140.49	$593.33	$274.51	2026-05-21
G0399	OTHER	Sleep Study Type Iii Portable	24	5	$339.00	$328.83	$139.67	$328.83	$265.44	2026-05-21
36593	OTHER	Declot/Thrombo Impl Vad	16	5	$338.00	$327.86	$139.26	$327.86	$263.13	2026-05-21
73552	OTHER	X-ray Femur 2 Views Lt	42	5	$336.00	$325.92	$130.01	$325.92	$257.04	2026-05-21
J2020	OTHER	Linezolid 600 Mg/300 Ml Bag	22	5	$333.00	$323.04	$5.96	$968.84	$260.76	2026-05-21
92526	OTHER	Dysphagia Treatment	22	5	$333.00	$323.01	$137.20	$323.01	$260.74	2026-05-21
85240	OTHER	Factor 8	16	5	$332.00	$322.04	$136.78	$322.04	$258.47	2026-05-21
73090	OTHER	X-ray Forearm 2 Views Lt	40	5	$328.00	$318.16	$135.14	$318.16	$264.04	2026-05-21
72170	OTHER	X-ray Pelvis 1-2 Views	18	5	$328.00	$318.16	$135.14	$341.88	$264.04	2026-05-21
73140	OTHER	X-ray Finger(s) Rt	42	5	$328.00	$318.16	$64.68	$318.16	$256.82	2026-05-21
73120	OTHER	X-ray Hand Lt	36	5	$328.00	$318.16	$135.14	$318.16	$250.92	2026-05-21
73100	OTHER	X-ray Wrist 2 Views Lt	18	5	$328.00	$318.16	$66.51	$318.16	$250.92	2026-05-21
73060	OTHER	X-ray Humerus Lt	38	5	$328.00	$318.16	$67.44	$318.16	$250.92	2026-05-21
73010	OTHER	X-ray Shoulder Blade Lt	18	5	$328.00	$318.16	$135.14	$318.16	$250.92	2026-05-21
73660	OTHER	X-ray Toe(s) 2 Views Lt	40	5	$328.00	$318.16	$66.51	$318.16	$250.92	2026-05-21
73620	OTHER	X-ray Foot 2 Views Lt	18	5	$328.00	$318.16	$135.14	$318.16	$250.92	2026-05-21
73560	OTHER	X-ray Knee 1-2 Views Rt	42	5	$328.00	$318.16	$84.00	$318.16	$250.92	2026-05-21
86922	OTHER	Crossmatch Ahg	18	5	$327.00	$317.19	$134.72	$317.19	$256.04	2026-05-21
85810	OTHER	Viscosity	16	5	$327.00	$317.19	$134.72	$317.19	$254.57	2026-05-21
51702	OTHER	Cath Insert Simple Indwelling	36	5	$326.00	$316.22	$133.49	$318.16	$255.34	2026-05-21
82384	OTHER	Catecholamines Fract	18	5	$326.00	$316.22	$134.31	$316.22	$255.26	2026-05-21
84305	OTHER	Somatomedin	24	5	$325.00	$315.25	$133.90	$315.25	$254.48	2026-05-21
84425	OTHER	Vitamin B1	18	5	$323.00	$313.31	$133.08	$313.31	$252.91	2026-05-21
70030	OTHER	X-ray Eye Fb Detection	14	5	$323.00	$313.31	$133.08	$313.31	$252.91	2026-05-21
51703	OTHER	Cath Insert Compl Indwelling	16	5	$321.00	$311.37	$132.25	$311.37	$249.89	2026-05-21
J0131	OTHER	Acetaminophen 1000mg/100ml Via	26	5	$320.00	$310.72	$0.10	$310.72	$245.05	2026-05-21
J3480	OTHER	Potassium Chl 10Meq/100ML Bag	38	5	$316.00	$306.80	$0.20	$307.06	$242.17	2026-05-21
87502	OTHER	Influenza A&b By Pcr	20	5	$315.00	$305.55	$129.78	$305.55	$250.12	2026-05-21
86664	OTHER	Lab-epstein Barr Nuclear Antig	20	5	$312.00	$302.64	$128.54	$302.64	$244.30	2026-05-21
73070	OTHER	X-ray Elbow Lt	20	5	$312.00	$302.64	$41.69	$302.64	$241.49	2026-05-21
73600	OTHER	X-ray Ankle 2 Views Lt	36	5	$312.00	$302.64	$86.75	$302.64	$238.68	2026-05-21
J1956	OTHER	Levofloxaci/D5W 250mg/50ml Bag	50	5	$309.00	$299.90	$2.07	$299.99	$236.59	2026-05-21
88173	OTHER	Fna Report Interpretation	18	5	$306.00	$296.82	$126.07	$296.82	$239.60	2026-05-21
84482	OTHER	Reverse T3	16	5	$306.00	$296.82	$126.07	$296.82	$238.22	2026-05-21
72202	OTHER	X-ray Si Joints 3 Views	18	5	$305.00	$295.85	$125.66	$542.46	$245.53	2026-05-21
97163	OTHER	Pt Eval High Complexity	16	5	$305.00	$295.85	$125.66	$295.85	$237.44	2026-05-21
51700	OTHER	Irrigate Bladder	32	5	$303.50	$294.39	$123.19	$298.76	$237.00	2026-05-21
97165	OTHER	Ot Eval Low Complexity	22	5	$301.00	$291.97	$124.01	$291.97	$235.68	2026-05-21
96415	OTHER	Chemotherapy Inf Ea Addl Hr	20	5	$301.00	$291.97	$124.01	$291.97	$234.32	2026-05-21
97161	OTHER	Pt Eval Low Complexity	26	5	$299.00	$290.03	$123.19	$529.00	$234.12	2026-05-21
73565	OTHER	X-ray Knees Bi	18	5	$297.00	$288.09	$122.36	$288.09	$239.09	2026-05-21
80053	OTHER	Comprehensive Metabolic Panel	26	5	$291.00	$282.27	$106.00	$282.27	$225.23	2026-05-21
83655	OTHER	Lead Blood Ref	16	5	$286.00	$277.42	$117.83	$277.42	$222.65	2026-05-21
82627	OTHER	Dheas	20	5	$285.00	$276.45	$117.42	$276.45	$226.30	2026-05-21
80185	OTHER	Phenytoin Total Ref	18	5	$285.00	$276.45	$117.42	$276.45	$223.16	2026-05-21
80162	OTHER	Digoxin	18	5	$285.00	$276.45	$117.42	$276.45	$223.16	2026-05-21
82166	OTHER	Mullerian Inhib Hormone	16	5	$284.00	$275.48	$117.01	$275.48	$221.09	2026-05-21
82306	OTHER	25 Hydvit D2 And D3	26	5	$283.00	$274.51	$116.60	$274.51	$221.59	2026-05-21
93005	OTHER	EKG Tracing	26	5	$283.00	$274.51	$116.60	$274.51	$221.59	2026-05-21
83970	OTHER	Pth	24	5	$278.00	$269.66	$114.54	$269.66	$217.67	2026-05-21
84443	OTHER	Tsh	28	5	$277.00	$268.69	$114.12	$268.69	$215.64	2026-05-21
84484	OTHER	Troponin Quant	28	5	$272.00	$263.84	$112.06	$263.84	$212.98	2026-05-21
193	OTHER	Ms-DRG 193	2	1	—	—	$19,812.76	$19,812.76	$19,812.76	2026-05-21
871	OTHER	Ms-DRG 871	2	1	—	—	$14,269.00	$14,269.00	$14,269.00	2026-05-21
683	OTHER	Ms-DRG 683	2	1	—	—	$11,901.07	$11,901.07	$11,901.07	2026-05-21
194	OTHER	Ms-DRG 194	2	1	—	—	$11,901.07	$11,901.07	$11,901.07	2026-05-21
644	OTHER	Ms-DRG 644	2	1	—	—	$10,711.33	$10,711.33	$10,711.33	2026-05-21
964	OTHER	Ms-DRG 964	2	1	—	—	$10,710.13	$10,710.13	$10,710.13	2026-05-21
191	OTHER	Ms-DRG 191	2	1	—	—	$10,710.13	$10,710.13	$10,710.13	2026-05-21
690	OTHER	Ms-DRG 690	2	1	—	—	$7,151.26	$7,151.26	$7,151.26	2026-05-21
951	OTHER	Ms-DRG 951	2	1	—	—	$3,592.39	$3,592.39	$3,592.39	2026-05-21
176	OTHER	Ms-DRG 176	2	1	—	—	$3,592.39	$3,592.39	$3,592.39	2026-05-21
391	OTHER	Ms-DRG 391	2	1	—	—	$3,569.27	$3,569.27	$3,569.27	2026-05-21

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