Hospital

SOUTHWESTERN MEDICAL CENTER

Lawton, OK · CCN 370097 · Rates published

Your selected procedure

You selected 482 (MS_DRG)

Hip And Femur Procedures Except Major Joint Without Cc/Mcc

This hospital’s price: $9,919 across 1 payer

Source: https://hospitalpricedisclosure.com/Download.aspx?pxi=t46O2wnjRVhoOnpQfKDTmA*-*&f=iFd*_*cEPwhQHJy3lVvHy9uQ*-* · observed 2025-01-01

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.

108 distinct procedures filed

12 distinct payers

12,290 rate rows

2025-01-01 last MRF observed · ⚠ 22 mo old

Data quality

456 of 12,290 rate rows are consumer-grade (3.7%)

11,834 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	11,834

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 22 months old.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://hospitalpricedisclosure.com/Download.aspx?pxi=t46O2wnjRVhoOnpQfKDTmA-&f=iFd_cEPwhQHJy3lVvHy9uQ-
Found on page	https://swmconline.com/understanding-your-healthcare-costs
Discovered via	Discovered by HANK
Last fetch	success · 2026-11-05
Content fingerprint	24a11fe5a4188b8f… · 5,156,210 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
56 MS_DRG	Degenerative Nervous System Disorders With Mcc	1	$44,473.36	$44,473.36	$44,473.36	nat. median $21,142 outlier · 2.1×
70 MS_DRG	Nonspecific Cerebrovascular Disorders With Mcc	1	$28,496.05	$28,496.05	$28,496.05	nat. median $16,310 1.7× median
177 MS_DRG	Respiratory Infections And Inflammations With Mcc	1	$25,586.16	$25,586.16	$25,586.16	nat. median $15,375 1.7× median
511 MS_DRG	Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc	1	$22,586.58	$22,586.58	$22,586.58	nat. median $19,647 1.1× median
744 MS_DRG	D&c, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc	1	$21,266.16	$21,266.16	$21,266.16	nat. median $19,058 1.1× median
67 MS_DRG	Nonspecific Cva And Precerebral Occlusion Without Infarction With Mcc	1	$19,738.01	$19,738.01	$19,738.01	nat. median $14,417 1.4× median
155 MS_DRG	Other Ear, Nose, Mouth And Throat Diagnoses With Cc	1	$18,817.46	$18,817.46	$18,817.46	nat. median $9,505 2.0× median
787 MS_DRG	Cesarean Section Without Sterilization With Cc	1	$13,316.90	$18,686.81	$18,686.81	nat. median $10,903 1.7× median
743 MS_DRG	Uterine And Adnexa Procedures For Non-malignancy Without Cc/Mcc	3	$10,778.10	$23,099.40	$18,572.73	nat. median $12,360 1.5× median
885 MS_DRG	Psychoses	6	$8,452.58	$28,694.39	$17,396.62	nat. median $12,307 1.4× median
439 MS_DRG	Disorders Of Pancreas Except Malignancy With Cc	1	$16,854.88	$16,854.88	$16,854.88	nat. median $8,925 1.9× median
291 MS_DRG	Heart Failure And Shock With Mcc	2	$8,193.88	$25,510.93	$16,852.40	nat. median $12,759 1.3× median
308 MS_DRG	Cardiac Arrhythmia And Conduction Disorders With Mcc	1	$16,763.61	$16,763.61	$16,763.61	nat. median $11,976 1.4× median
638 MS_DRG	Diabetes With Cc	1	$16,734.01	$16,734.01	$16,734.01	nat. median $9,217 1.8× median
786 MS_DRG	Cesarean Section Without Sterilization With Mcc	2	$10,859.15	$26,665.14	$15,105.77	nat. median $14,836 1.0× median
71 MS_DRG	Nonspecific Cerebrovascular Disorders With Cc	1	$14,540.19	$14,540.19	$14,540.19	nat. median $10,544 1.4× median
208 MS_DRG	Respiratory System Diagnosis With Ventilator Support <=96 Hours	1	$13,943.15	$13,943.15	$13,943.15	nat. median $25,366 0.5× median
314 MS_DRG	Other Circulatory System Diagnoses With Mcc	1	$13,236.79	$13,236.79	$13,236.79	nat. median $19,944 0.7× median
812 MS_DRG	Red Blood Cell Disorders Without Mcc	1	$13,233.08	$13,233.08	$13,233.08	nat. median $9,304 1.4× median
561 MS_DRG	Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc	1	$13,155.61	$13,155.61	$13,155.61	nat. median $8,652 1.5× median
91 MS_DRG	Other Disorders Of Nervous System With Mcc	1	$13,065.96	$13,065.96	$13,065.96	nat. median $17,042 0.8× median
559 MS_DRG	Aftercare, Musculoskeletal System And Connective Tissue With Mcc	1	$12,464.92	$12,464.92	$12,464.92	nat. median $18,112 0.7× median
522 MS_DRG	Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc	1	$12,464.49	$12,464.49	$12,464.49	nat. median $20,537 0.6× median
806 MS_DRG	Vaginal Delivery Without Sterilization Or D&c With Cc	1	$12,227.41	$12,227.41	$12,227.41	nat. median $7,621 1.6× median
862 MS_DRG	Postoperative And Post-traumatic Infections With Mcc	1	$11,194.93	$11,194.93	$11,194.93	nat. median $17,325 0.6× median
392 MS_DRG	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc	3	$4,547.31	$13,087.00	$11,001.54	nat. median $8,173 1.3× median
794 MS_DRG	Neonate With Other Significant Problems	1	$10,821.88	$10,821.88	$10,821.88	nat. median $12,610 0.9× median
68 MS_DRG	Nonspecific Cva And Precerebral Occlusion Without Infarction Without Mcc	1	$10,437.80	$10,437.80	$10,437.80	nat. median $9,198 1.1× median
482 MS_DRG	Hip And Femur Procedures Except Major Joint Without Cc/Mcc	1	$9,918.53	$9,918.53	$9,918.53	nat. median $15,979 0.6× median
793 MS_DRG	Full Term Neonate With Major Problems	1	$9,814.14	$9,814.14	$9,814.14	nat. median $33,677 outlier · 0.3×
698 MS_DRG	Other Kidney And Urinary Tract Diagnoses With Mcc	1	$9,604.57	$9,604.57	$9,604.57	nat. median $15,902 0.6× median
788 MS_DRG	Cesarean Section Without Sterilization Without Cc/Mcc	4	$6,059.49	$16,014.62	$9,568.51	nat. median $9,598 1.0× median
57 MS_DRG	Degenerative Nervous System Disorders Without Mcc	2	$7,607.98	$11,379.38	$9,493.68	nat. median $12,544 0.8× median
5374 OTHER	Level 4 Urology And Related Services	1	$9,411.70	$9,411.70	$9,411.70	nat. median $3,718 outlier · 2.5×
682 MS_DRG	Renal Failure With Mcc	3	$5,141.08	$10,366.50	$9,166.00	nat. median $14,433 0.6× median
807 MS_DRG	Vaginal Delivery Without Sterilization Or D&c Without Cc/Mcc	5	$2,086.60	$11,865.82	$8,568.17	nat. median $6,987 1.2× median
689 MS_DRG	Kidney And Urinary Tract Infections With Mcc	1	$8,510.93	$8,510.93	$8,510.93	nat. median $11,506 0.7× median
153 MS_DRG	Otitis Media And Uri Without Mcc	1	$8,266.78	$8,266.78	$8,266.78	nat. median $7,678 1.1× median
310 MS_DRG	Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc	1	$8,116.46	$8,116.46	$8,116.46	nat. median $6,284 1.3× median
377 MS_DRG	Gastrointestinal Hemorrhage With Mcc	1	$7,761.88	$7,761.88	$7,761.88	nat. median $17,281 outlier · 0.4×
387 MS_DRG	Inflammatory Bowel Disease Without Cc/Mcc	1	$7,366.37	$7,366.37	$7,366.37	nat. median $7,474 1.0× median
603 MS_DRG	Cellulitis Without Mcc	3	$3,262.40	$10,256.48	$7,208.07	nat. median $8,977 0.8× median
5731 OTHER	Level 1 Minor Procedures	1	$6,958.80	$6,958.80	$6,958.80	nat. median $32 outlier · 219.7×
189 MS_DRG	Pulmonary Edema And Respiratory Failure	1	$6,891.90	$6,891.90	$6,891.90	nat. median $12,270 0.6× median
190 MS_DRG	Chronic Obstructive Pulmonary Disease With Mcc	1	$6,619.18	$6,619.18	$6,619.18	nat. median $11,057 0.6× median
563 MS_DRG	Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Wit…	1	$6,052.08	$6,623.45	$6,337.76	nat. median $9,140 0.7× median
639 MS_DRG	Diabetes Without Cc/Mcc	1	$6,272.64	$6,272.64	$6,272.64	nat. median $6,786 0.9× median
195 MS_DRG	Simple Pneumonia And Pleurisy Without Cc/Mcc	1	$6,244.54	$6,244.54	$6,244.54	nat. median $6,812 0.9× median
194 MS_DRG	Simple Pneumonia And Pleurisy With Cc	3	$1,780.12	$6,126.50	$5,834.76	nat. median $8,511 0.7× median
699 MS_DRG	Other Kidney And Urinary Tract Diagnoses With Cc	1	$5,669.79	$5,669.79	$5,669.79	nat. median $10,303 0.6× median

Other procedures at this hospital

Browse this hospital's 108 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

56	MS_DRG	Degenerative Nervous System Disorders With Mcc	1	1	—	—	$44,473.36	$44,473.36	$44,473.36	2025-01-01
70	MS_DRG	Nonspecific Cerebrovascular Disorders With Mcc	1	1	—	—	$28,496.05	$28,496.05	$28,496.05	2025-01-01
177	MS_DRG	Respiratory Infections And Inflammations With Mcc	1	1	—	—	$25,586.16	$25,586.16	$25,586.16	2025-01-01
511	MS_DRG	Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc	1	1	—	—	$22,586.58	$22,586.58	$22,586.58	2025-01-01
744	MS_DRG	D&c, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc	1	1	—	—	$21,266.16	$21,266.16	$21,266.16	2025-01-01
67	MS_DRG	Nonspecific Cva And Precerebral Occlusion Without Infarction With Mcc	1	1	—	—	$19,738.01	$19,738.01	$19,738.01	2025-01-01
155	MS_DRG	Other Ear, Nose, Mouth And Throat Diagnoses With Cc	1	1	—	—	$18,817.46	$18,817.46	$18,817.46	2025-01-01
787	MS_DRG	Cesarean Section Without Sterilization With Cc	3	1	—	—	$13,316.90	$18,686.81	$18,686.81	2025-01-01
743	MS_DRG	Uterine And Adnexa Procedures For Non-malignancy Without Cc/Mcc	3	3	—	—	$10,778.10	$23,099.40	$18,572.73	2025-01-01
885	MS_DRG	Psychoses	9	6	—	—	$8,452.58	$28,694.39	$17,396.62	2025-01-01
439	MS_DRG	Disorders Of Pancreas Except Malignancy With Cc	1	1	—	—	$16,854.88	$16,854.88	$16,854.88	2025-01-01
291	MS_DRG	Heart Failure And Shock With Mcc	2	2	—	—	$8,193.88	$25,510.93	$16,852.40	2025-01-01
308	MS_DRG	Cardiac Arrhythmia And Conduction Disorders With Mcc	1	1	—	—	$16,763.61	$16,763.61	$16,763.61	2025-01-01
638	MS_DRG	Diabetes With Cc	1	1	—	—	$16,734.01	$16,734.01	$16,734.01	2025-01-01
786	MS_DRG	Cesarean Section Without Sterilization With Mcc	3	2	—	—	$10,859.15	$26,665.14	$15,105.77	2025-01-01
71	MS_DRG	Nonspecific Cerebrovascular Disorders With Cc	1	1	—	—	$14,540.19	$14,540.19	$14,540.19	2025-01-01
208	MS_DRG	Respiratory System Diagnosis With Ventilator Support <=96 Hours	1	1	—	—	$13,943.15	$13,943.15	$13,943.15	2025-01-01
314	MS_DRG	Other Circulatory System Diagnoses With Mcc	1	1	—	—	$13,236.79	$13,236.79	$13,236.79	2025-01-01
812	MS_DRG	Red Blood Cell Disorders Without Mcc	1	1	—	—	$13,233.08	$13,233.08	$13,233.08	2025-01-01
561	MS_DRG	Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc	1	1	—	—	$13,155.61	$13,155.61	$13,155.61	2025-01-01
91	MS_DRG	Other Disorders Of Nervous System With Mcc	1	1	—	—	$13,065.96	$13,065.96	$13,065.96	2025-01-01
559	MS_DRG	Aftercare, Musculoskeletal System And Connective Tissue With Mcc	1	1	—	—	$12,464.92	$12,464.92	$12,464.92	2025-01-01
522	MS_DRG	Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc	1	1	—	—	$12,464.49	$12,464.49	$12,464.49	2025-01-01
806	MS_DRG	Vaginal Delivery Without Sterilization Or D&c With Cc	2	1	—	—	$12,227.41	$12,227.41	$12,227.41	2025-01-01
862	MS_DRG	Postoperative And Post-traumatic Infections With Mcc	1	1	—	—	$11,194.93	$11,194.93	$11,194.93	2025-01-01
392	MS_DRG	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc	3	3	—	—	$4,547.31	$13,087.00	$11,001.54	2025-01-01
794	MS_DRG	Neonate With Other Significant Problems	1	1	—	—	$10,821.88	$10,821.88	$10,821.88	2025-01-01
68	MS_DRG	Nonspecific Cva And Precerebral Occlusion Without Infarction Without Mcc	1	1	—	—	$10,437.80	$10,437.80	$10,437.80	2025-01-01
482	MS_DRG	Hip And Femur Procedures Except Major Joint Without Cc/Mcc	1	1	—	—	$9,918.53	$9,918.53	$9,918.53	2025-01-01
793	MS_DRG	Full Term Neonate With Major Problems	1	1	—	—	$9,814.14	$9,814.14	$9,814.14	2025-01-01
698	MS_DRG	Other Kidney And Urinary Tract Diagnoses With Mcc	1	1	—	—	$9,604.57	$9,604.57	$9,604.57	2025-01-01
788	MS_DRG	Cesarean Section Without Sterilization Without Cc/Mcc	4	4	—	—	$6,059.49	$16,014.62	$9,568.51	2025-01-01
57	MS_DRG	Degenerative Nervous System Disorders Without Mcc	2	2	—	—	$7,607.98	$11,379.38	$9,493.68	2025-01-01
5374	OTHER	Level 4 Urology And Related Services	1	1	—	—	$9,411.70	$9,411.70	$9,411.70	2025-01-01
682	MS_DRG	Renal Failure With Mcc	5	3	—	—	$5,141.08	$10,366.50	$9,166.00	2025-01-01
807	MS_DRG	Vaginal Delivery Without Sterilization Or D&c Without Cc/Mcc	8	5	—	—	$2,086.60	$11,865.82	$8,568.17	2025-01-01
689	MS_DRG	Kidney And Urinary Tract Infections With Mcc	1	1	—	—	$8,510.93	$8,510.93	$8,510.93	2025-01-01
153	MS_DRG	Otitis Media And Uri Without Mcc	1	1	—	—	$8,266.78	$8,266.78	$8,266.78	2025-01-01
310	MS_DRG	Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc	1	1	—	—	$8,116.46	$8,116.46	$8,116.46	2025-01-01
377	MS_DRG	Gastrointestinal Hemorrhage With Mcc	1	1	—	—	$7,761.88	$7,761.88	$7,761.88	2025-01-01
387	MS_DRG	Inflammatory Bowel Disease Without Cc/Mcc	1	1	—	—	$7,366.37	$7,366.37	$7,366.37	2025-01-01
603	MS_DRG	Cellulitis Without Mcc	3	3	—	—	$3,262.40	$10,256.48	$7,208.07	2025-01-01
5731	OTHER	Level 1 Minor Procedures	1	1	—	—	$6,958.80	$6,958.80	$6,958.80	2025-01-01
189	MS_DRG	Pulmonary Edema And Respiratory Failure	1	1	—	—	$6,891.90	$6,891.90	$6,891.90	2025-01-01
190	MS_DRG	Chronic Obstructive Pulmonary Disease With Mcc	1	1	—	—	$6,619.18	$6,619.18	$6,619.18	2025-01-01
563	MS_DRG	Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Wit…	2	1	—	—	$6,052.08	$6,623.45	$6,337.76	2025-01-01
639	MS_DRG	Diabetes Without Cc/Mcc	1	1	—	—	$6,272.64	$6,272.64	$6,272.64	2025-01-01
195	MS_DRG	Simple Pneumonia And Pleurisy Without Cc/Mcc	1	1	—	—	$6,244.54	$6,244.54	$6,244.54	2025-01-01
194	MS_DRG	Simple Pneumonia And Pleurisy With Cc	3	3	—	—	$1,780.12	$6,126.50	$5,834.76	2025-01-01
699	MS_DRG	Other Kidney And Urinary Tract Diagnoses With Cc	1	1	—	—	$5,669.79	$5,669.79	$5,669.79	2025-01-01
832	MS_DRG	Other Antepartum Diagnoses Without O.r. Procedures With Cc	2	1	—	—	$1,483.29	$9,797.20	$5,640.24	2025-01-01
315	MS_DRG	Other Circulatory System Diagnoses With Cc	1	1	—	—	$5,580.81	$5,580.81	$5,580.81	2025-01-01
684	MS_DRG	Renal Failure Without Cc/Mcc	1	1	—	—	$5,330.12	$5,330.12	$5,330.12	2025-01-01
683	MS_DRG	Renal Failure With Cc	2	2	—	—	$3,770.91	$5,873.61	$4,822.26	2025-01-01
5061	OTHER	Hyperbaric Oxygen	1	1	—	—	$4,595.56	$4,595.56	$4,595.56	2025-01-01
641	MS_DRG	Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou…	1	1	—	—	$4,492.12	$4,492.12	$4,492.12	2025-01-01
371	MS_DRG	Major Gastrointestinal Disorders And Peritoneal Infections With Mcc	1	1	—	—	$4,454.68	$4,454.68	$4,454.68	2025-01-01
536	MS_DRG	Fractures Of Hip And Pelvis Without Mcc	1	1	—	—	$4,449.93	$4,449.93	$4,449.93	2025-01-01
N902	OTHER	Packaged Services	2	2	—	—	$875.06	$7,567.31	$4,221.18	2025-01-01
690	MS_DRG	Kidney And Urinary Tract Infections Without Mcc	3	2	—	—	$2,608.51	$11,673.59	$4,211.25	2025-01-01
309	MS_DRG	Cardiac Arrhythmia And Conduction Disorders With Cc	1	1	—	—	$4,188.48	$4,188.48	$4,188.48	2025-01-01
389	MS_DRG	Gastrointestinal Obstruction With Cc	1	1	—	—	$4,143.55	$4,143.55	$4,143.55	2025-01-01
5791	OTHER	Pulmonary Treatment	6	3	—	—	$252.49	$25,225.67	$4,070.86	2025-01-01
5302	OTHER	Level 2 Upper Gi Procedures	4	3	—	—	$1,644.25	$7,000.90	$2,913.91	2025-01-01
9042	OTHER	Glucagon Hydrochloride	1	1	—	—	$2,680.22	$2,680.22	$2,680.22	2025-01-01
795	MS_DRG	Normal Newborn	6	2	—	—	$1,769.60	$3,969.50	$2,601.76	2025-01-01
103	MS_DRG	Headaches Without Mcc	1	1	—	—	$2,585.74	$2,585.74	$2,585.74	2025-01-01
5072	OTHER	Level 2 Excision/ Biopsy/ Incision And Drainage	3	2	—	—	$1,355.15	$4,683.21	$2,544.78	2025-01-01
93	MS_DRG	Other Disorders Of Nervous System Without Cc/Mcc	1	1	—	—	$2,434.17	$2,434.17	$2,434.17	2025-01-01
5041	OTHER	Critical Care	6	6	—	—	$761.09	$2,269.72	$2,152.32	2025-01-01
5312	OTHER	Level 2 Lower Gi Procedures	11	6	—	—	$747.23	$7,053.26	$1,667.83	2025-01-01
5301	OTHER	Level 1 Upper Gi Procedures	2	1	—	—	$1,601.37	$1,601.37	$1,601.37	2025-01-01
203	MS_DRG	Bronchitis And Asthma Without Cc/Mcc	1	1	—	—	$1,570.41	$1,570.41	$1,570.41	2025-01-01
5724	OTHER	Level 4 Diagnostic Tests And Related Services	10	7	—	—	$426.28	$5,461.00	$1,486.70	2025-01-01
5025	OTHER	Level 5 Type A Ed Visits	23	12	—	—	$150.00	$4,140.85	$1,344.56	2025-01-01
5053	OTHER	Level 3 Skin Procedures	1	1	—	—	$1,306.37	$1,306.37	$1,306.37	2025-01-01
5591	OTHER	Level 1 Nuclear Medicine And Related Services	6	3	—	—	$342.20	$10,547.36	$1,126.67	2025-01-01
5593	OTHER	Level 3 Nuclear Medicine And Related Services	3	3	—	—	$12.00	$1,577.08	$1,033.59	2025-01-01
N801	OTHER	Therapy Services	19	10	—	—	$127.04	$1,920.91	$1,017.03	2025-01-01
5101	OTHER	Level 1 Strapping And Cast Application	2	2	—	—	$255.00	$1,408.84	$831.92	2025-01-01
5052	OTHER	Level 2 Skin Procedures	8	5	—	—	$206.78	$919.81	$753.06	2025-01-01
5024	OTHER	Level 4 Type A Ed Visits	20	9	—	—	$221.63	$2,855.41	$752.75	2025-01-01
5311	OTHER	Level 1 Lower Gi Procedures	1	1	—	—	$747.23	$747.23	$747.23	2025-01-01
5592	OTHER	Level 2 Nuclear Medicine And Related Services	5	4	—	—	$331.13	$1,401.73	$732.05	2025-01-01
5673	OTHER	Level 3 Pathology	2	2	—	—	$235.32	$1,063.18	$649.25	2025-01-01
5572	OTHER	Level 2 Imaging With Contrast	12	8	—	—	$196.35	$2,083.00	$642.76	2025-01-01
5023	OTHER	Level 3 Type A Ed Visits	19	10	—	—	$134.09	$1,594.60	$560.00	2025-01-01
5372	OTHER	Level 2 Urology And Related Services	1	1	—	—	$477.51	$477.51	$477.51	2025-01-01
5693	OTHER	Level 3 Drug Administration	5	2	—	—	$254.80	$4,307.85	$466.50	2025-01-01
5524	OTHER	Level 4 Imaging Without Contrast	8	7	—	—	$25.00	$1,951.45	$461.97	2025-01-01
5022	OTHER	Level 2 Type A Ed Visits	11	6	—	—	$24.09	$1,709.55	$458.03	2025-01-01
5102	OTHER	Level 2 Strapping And Cast Application	2	1	—	—	$423.50	$423.50	$423.50	2025-01-01
5523	OTHER	Level 3 Imaging Without Contrast	19	10	—	—	$178.68	$2,602.99	$332.43	2025-01-01
5571	OTHER	Level 1 Imaging With Contrast	12	7	—	—	$54.00	$3,946.20	$300.88	2025-01-01
5411	OTHER	Level 1 Gynecologic Procedures	3	2	—	—	$235.83	$369.66	$293.24	2025-01-01
5722	OTHER	Level 2 Diagnostic Tests And Related Services	8	4	—	—	$264.41	$330.83	$282.47	2025-01-01
9501	OTHER	Platelet Pheres Leukoreduced	1	1	—	—	$269.69	$269.69	$269.69	2025-01-01
5012	OTHER	Clinic Visits And Related Services	4	4	—	—	$155.01	$368.45	$252.64	2025-01-01
5051	OTHER	Level 1 Skin Procedures	9	5	—	—	$160.23	$689.90	$162.37	2025-01-01
5734	OTHER	Level 4 Minor Procedures	15	9	—	—	$74.18	$11,926.66	$145.95	2025-01-01
5692	OTHER	Level 2 Drug Administration	2	1	—	—	$78.30	$213.23	$145.76	2025-01-01
5522	OTHER	Level 2 Imaging Without Contrast	21	11	—	—	$63.69	$1,339.30	$139.59	2025-01-01
5721	OTHER	Level 1 Diagnostic Tests And Related Services	6	4	—	—	$73.50	$506.42	$88.65	2025-01-01
5733	OTHER	Level 3 Minor Procedures	10	4	—	—	$51.69	$9,079.48	$79.67	2025-01-01
5521	OTHER	Level 1 Imaging Without Contrast	19	10	—	—	$30.00	$603.58	$65.48	2025-01-01
N800	OTHER	Clinical Diagnostic Lab Services	20	12	—	—	$16.96	$1,800.75	$62.95	2025-01-01
5671	OTHER	Level 1 Pathology	1	1	—	—	$55.40	$55.40	$55.40	2025-01-01
5191	OTHER	Level 1 Endovascular Procedures	1	1	—	—	$32.35	$32.35	$32.35	2025-01-01

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