Hospital

HOSPITAL PAVIA SANTURCE

San Juan, PR · CCN 400019 · Rates published

263 distinct procedures filed

28 distinct payers

7,949 rate rows

2025-04-10 last MRF observed · ⚠ 14 mo old

Data quality

7,944 of 7,949 rate rows are consumer-grade (99.9%)

5 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	5

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 14 months old.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://hpt.inmediata.com/?handler=DF&d=0C7D0EB4-7AFE-4319-B440-FF3C21B8684D
Found on page	https://hpt.inmediata.com/index?h=0C7D0EB4-7AFE-4319-B440-FF3C21B8684D
Discovered via	CMS hospital list
Last fetch	not_modified · 2026-05-17
Content fingerprint	e832b9219a5714f5… · 1,111,184 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
93452 CPT	Exam Of Left Heart With Catheter Insertion	3	$2,100.00	$2,698.00	$2,100.00	nat. median $5,130 outlier · 0.4×
55700 CPT	Biopsy Of Prostate Using Needle	4	$400.00	$900.00	$500.00	nat. median $2,135 outlier · 0.2×
78452 CPT	Multiple Spect Scans Of Heart Muscle	18	$105.30	$1,000.00	$350.97	nat. median $1,765 outlier · 0.2×
74183 CPT	MRI Of Abdomen With And Without Contrast	25	$112.96	$1,300.00	$315.95	nat. median $1,101 outlier · 0.3×
47562 CPT	Removal Of Gallbladder Using Laparoscope	7	$168.00	$350.00	$307.87	nat. median $5,956 outlier · 0.1×
70553 CPT	MRI Of Brain With And Without Contrast	23	$101.52	$1,300.00	$306.03	nat. median $1,122 outlier · 0.3×
70543 CPT	MRI Of Face Or Neck With And Without Contrast	25	$109.71	$1,300.00	$304.50	nat. median $1,077 outlier · 0.3×
72197 CPT	MRI Of Pelvis With And Without Contrast	25	$112.96	$1,300.00	$298.74	nat. median $1,064 outlier · 0.3×
74182 CPT	MRI Of Abdomen With Contrast	25	$89.14	$800.00	$295.64	nat. median $990 outlier · 0.3×
73722 CPT	MRI Of Leg Joint With Contrast	24	$83.73	$800.00	$290.65	nat. median $1,302 outlier · 0.2×
77049 CPT	MRI Of Both Breasts With And Without Contrast	17	$117.65	$800.00	$280.56	nat. median $958 outlier · 0.3×
72157 CPT	MRI Of Middle Spinal Canal With And Without Contrast	25	$116.95	$1,300.00	$278.75	nat. median $1,093 outlier · 0.3×
72156 CPT	MRI Of Upper Spinal Canal With And Without Contrast	25	$116.74	$1,300.00	$278.38	nat. median $1,092 outlier · 0.3×
72158 CPT	MRI Of Lower Spinal Canal With And Without Contrast	25	$116.52	$1,300.00	$277.84	nat. median $1,080 outlier · 0.3×
77048 CPT	MRI Of Single Breast With And Without Contrast	16	$107.54	$800.00	$276.25	nat. median $916 outlier · 0.3×
72196 CPT	MRI Of Pelvis With Contrast	26	$89.14	$800.00	$267.52	nat. median $953 outlier · 0.3×
70552 CPT	MRI Of Brain With Contrast	23	$91.67	$800.00	$256.16	nat. median $959 outlier · 0.3×
73719 CPT	MRI Of Leg Not Including Joint With Contrast	24	$83.37	$800.00	$254.47	nat. median $973 outlier · 0.3×
72195 CPT	MRI Of Pelvis Without Contrast	25	$75.07	$800.00	$246.87	nat. median $787 outlier · 0.3×
70544 CPT	MRI Of Blood Vessels Of Head Without Contrast	22	$61.71	$800.00	$246.86	nat. median $816 outlier · 0.3×
73718 CPT	MRI Of Leg Not Including Joint Without Contrast	24	$69.29	$800.00	$245.42	nat. median $916 outlier · 0.3×
73222 CPT	MRI Of Arm With Contrast	25	$83.55	$650.00	$240.11	nat. median $1,312 outlier · 0.2×
73219 CPT	MRI Of Arm With Contrast	25	$83.55	$650.00	$240.11	nat. median $959 outlier · 0.3×
70551 CPT	MRI Of Brain Without Contrast	24	$71.02	$800.00	$239.02	nat. median $772 outlier · 0.3×
72149 CPT	MRI Of Lower Spinal Canal With Contrast	26	$92.03	$800.00	$238.52	nat. median $970 outlier · 0.2×
70545 CPT	MRI Of Blood Vessels Of Head With Contrast	22	$61.71	$800.00	$232.50	nat. median $903 outlier · 0.3×
72148 CPT	MRI Of Lower Spinal Canal Without Contrast	26	$69.05	$800.00	$227.50	nat. median $770 outlier · 0.3×
73721 CPT	MRI Of Leg Joint Without Contrast	25	$70.02	$800.00	$217.67	nat. median $899 outlier · 0.2×
74181 CPT	MRI Of Abdomen Without Contrast	26	$75.07	$800.00	$214.60	nat. median $820 outlier · 0.3×
74174 CPT	Cat Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast	20	$111.87	$450.00	$200.00	nat. median $958 outlier · 0.2×
45378 CPT	Exam Of Entire Large Intestine Using Colonoscope	7	$72.73	$200.00	$200.00	nat. median $1,330 outlier · 0.2×
G0121 HCPCS	Exam Of Entire Large Intestine Using Colonoscope	7	$72.73	$200.00	$200.00	nat. median $1,368 outlier · 0.1×
G0105 HCPCS	Exam Of Entire Large Intestine Using Colonoscope	7	$72.73	$200.00	$200.00	nat. median $1,410 outlier · 0.1×
72146 CPT	MRI Of Middle Spinal Canal Without Contrast	26	$69.12	$800.00	$199.60	nat. median $772 outlier · 0.3×
72141 CPT	MRI Of Upper Spinal Canal Without Contrast	26	$69.12	$800.00	$199.60	nat. median $765 outlier · 0.3×
73218 CPT	MRI Of Arm Without Contrast	26	$69.84	$650.00	$196.95	nat. median $896 outlier · 0.2×
73221 CPT	MRI Of Arm Without Contrast	26	$69.84	$650.00	$196.95	nat. median $879 outlier · 0.2×
74178 CPT	Cat Scan Of Abdomen And Pelvis With And Without Contrast	23	$68.75	$450.00	$194.60	nat. median $977 outlier · 0.2×
74177 CPT	Cat Scan Of Abdomen And Pelvis With Contrast	24	$68.75	$450.00	$191.25	nat. median $928 outlier · 0.2×
78227 CPT	Nuclear Medicine Study Of Liver And Bile Ducts	20	$95.00	$431.00	$190.00	nat. median $940 outlier · 0.2×
78018 CPT	Whole Body Nuclear Medicine Study To Determine Spread Of Thyroid Cancer	20	$90.00	$400.00	$187.19	nat. median $782 outlier · 0.2×
73706 CPT	Cat Scan Of Blood Vessels Of Leg With Contrast	21	$93.21	$450.00	$171.42	nat. median $760 outlier · 0.2×
74175 CPT	Cat Scan Of Blood Vessels Of Abdomen With Contrast	21	$89.58	$450.00	$165.00	nat. median $710 outlier · 0.2×
71275 CPT	Cat Scan Of Blood Vessels In Chest With Contrast	21	$80.60	$450.00	$165.00	nat. median $735 outlier · 0.2×
74170 CPT	Cat Scan Of Abdomen With And Without Contrast	23	$71.82	$650.00	$163.75	nat. median $702 outlier · 0.2×
70498 CPT	Cat Scan Of Blood Vessels In Neck With Contrast	23	$68.75	$450.00	$163.75	nat. median $722 outlier · 0.2×
74160 CPT	Cat Scan Of Abdomen With Contrast	24	$65.32	$450.00	$162.50	nat. median $645 outlier · 0.3×
72193 CPT	Cat Scan Of Pelvis With Contrast	24	$59.91	$450.00	$162.50	nat. median $629 outlier · 0.3×
71270 CPT	Cat Scan Of Chest With And Without Contrast	24	$71.10	$650.00	$158.97	nat. median $661 outlier · 0.2×
70496 CPT	Cat Scan Of Blood Vessels In Head With Contrast	23	$68.75	$450.00	$156.90	nat. median $729 outlier · 0.2×

Other procedures at this hospital

Browse this hospital's 263 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

93452	CPT	Exam Of Left Heart With Catheter Insertion	3	3	$1,125.00	$1,125.00	$2,100.00	$2,698.00	$2,100.00	2025-04-10
55700	CPT	Biopsy Of Prostate Using Needle	4	4	$797.50	$797.50	$400.00	$900.00	$500.00	2025-04-10
78452	CPT	Multiple Spect Scans Of Heart Muscle	25	18	$2,059.40	$2,059.40	$105.30	$1,000.00	$350.97	2025-04-10
74183	CPT	MRI Of Abdomen With And Without Contrast	32	25	$1,502.60	$1,502.60	$112.96	$1,300.00	$315.95	2025-04-10
47562	CPT	Removal Of Gallbladder Using Laparoscope	10	7	$350.00	$350.00	$168.00	$350.00	$307.87	2025-04-10
70553	CPT	MRI Of Brain With And Without Contrast	30	23	$1,788.09	$1,788.09	$101.52	$1,300.00	$306.03	2025-04-10
70543	CPT	MRI Of Face Or Neck With And Without Contrast	32	25	$1,502.60	$1,502.60	$109.71	$1,300.00	$304.50	2025-04-10
72197	CPT	MRI Of Pelvis With And Without Contrast	32	25	$1,502.60	$1,502.60	$112.96	$1,300.00	$298.74	2025-04-10
74182	CPT	MRI Of Abdomen With Contrast	32	25	$1,788.09	$1,788.09	$89.14	$800.00	$295.64	2025-04-10
73722	CPT	MRI Of Leg Joint With Contrast	31	24	$1,502.60	$1,502.60	$83.73	$800.00	$290.65	2025-04-10
77049	CPT	MRI Of Both Breasts With And Without Contrast	24	17	$1,762.39	$1,762.39	$117.65	$800.00	$280.56	2025-04-10
72157	CPT	MRI Of Middle Spinal Canal With And Without Contrast	32	25	$1,788.09	$1,788.09	$116.95	$1,300.00	$278.75	2025-04-10
72156	CPT	MRI Of Upper Spinal Canal With And Without Contrast	32	25	$1,788.09	$1,788.09	$116.74	$1,300.00	$278.38	2025-04-10
72158	CPT	MRI Of Lower Spinal Canal With And Without Contrast	32	25	$1,788.09	$1,788.09	$116.52	$1,300.00	$277.84	2025-04-10
77048	CPT	MRI Of Single Breast With And Without Contrast	23	16	$975.00	$975.00	$107.54	$800.00	$276.25	2025-04-10
72196	CPT	MRI Of Pelvis With Contrast	33	26	$1,456.91	$1,456.91	$89.14	$800.00	$267.52	2025-04-10
70552	CPT	MRI Of Brain With Contrast	30	23	$1,788.09	$1,788.09	$91.67	$800.00	$256.16	2025-04-10
73719	CPT	MRI Of Leg Not Including Joint With Contrast	31	24	$1,456.91	$1,456.91	$83.37	$800.00	$254.47	2025-04-10
72195	CPT	MRI Of Pelvis Without Contrast	32	25	$1,371.21	$1,371.21	$75.07	$800.00	$246.87	2025-04-10
70544	CPT	MRI Of Blood Vessels Of Head Without Contrast	29	22	$1,456.91	$1,456.91	$61.71	$800.00	$246.86	2025-04-10
73718	CPT	MRI Of Leg Not Including Joint Without Contrast	31	24	$1,456.91	$1,456.91	$69.29	$800.00	$245.42	2025-04-10
73219	CPT	MRI Of Arm With Contrast	32	25	$1,502.60	$1,502.60	$83.55	$650.00	$240.11	2025-04-10
73222	CPT	MRI Of Arm With Contrast	32	25	$1,502.60	$1,502.60	$83.55	$650.00	$240.11	2025-04-10
70551	CPT	MRI Of Brain Without Contrast	31	24	$1,456.91	$1,456.91	$71.02	$800.00	$239.02	2025-04-10
72149	CPT	MRI Of Lower Spinal Canal With Contrast	33	26	$1,788.09	$1,788.09	$92.03	$800.00	$238.52	2025-04-10
70545	CPT	MRI Of Blood Vessels Of Head With Contrast	29	22	$1,727.99	$1,727.99	$61.71	$800.00	$232.50	2025-04-10
72148	CPT	MRI Of Lower Spinal Canal Without Contrast	33	26	$1,456.91	$1,456.91	$69.05	$800.00	$227.50	2025-04-10
73721	CPT	MRI Of Leg Joint Without Contrast	32	25	$1,456.91	$1,456.91	$70.02	$800.00	$217.67	2025-04-10
74181	CPT	MRI Of Abdomen Without Contrast	33	26	$1,456.91	$1,456.91	$75.07	$800.00	$214.60	2025-04-10
G0105	HCPCS	Exam Of Entire Large Intestine Using Colonoscope	7	7	$234.43	$234.43	$72.73	$200.00	$200.00	2025-04-10
45378	CPT	Exam Of Entire Large Intestine Using Colonoscope	7	7	$234.43	$234.43	$72.73	$200.00	$200.00	2025-04-10
G0121	HCPCS	Exam Of Entire Large Intestine Using Colonoscope	7	7	$234.43	$234.43	$72.73	$200.00	$200.00	2025-04-10
74174	CPT	Cat Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast	27	20	$954.97	$954.97	$111.87	$450.00	$200.00	2025-04-10
72146	CPT	MRI Of Middle Spinal Canal Without Contrast	33	26	$1,456.91	$1,456.91	$69.12	$800.00	$199.60	2025-04-10
72141	CPT	MRI Of Upper Spinal Canal Without Contrast	33	26	$1,456.91	$1,456.91	$69.12	$800.00	$199.60	2025-04-10
73218	CPT	MRI Of Arm Without Contrast	33	26	$1,456.91	$1,456.91	$69.84	$650.00	$196.95	2025-04-10
73221	CPT	MRI Of Arm Without Contrast	33	26	$1,456.91	$1,456.91	$69.84	$650.00	$196.95	2025-04-10
74178	CPT	Cat Scan Of Abdomen And Pelvis With And Without Contrast	30	23	$954.97	$954.97	$68.75	$450.00	$194.60	2025-04-10
74177	CPT	Cat Scan Of Abdomen And Pelvis With Contrast	31	24	$954.97	$954.97	$68.75	$450.00	$191.25	2025-04-10
78227	CPT	Nuclear Medicine Study Of Liver And Bile Ducts	27	20	$795.27	$795.27	$95.00	$431.00	$190.00	2025-04-10
78018	CPT	Whole Body Nuclear Medicine Study To Determine Spread Of Thyroid Cancer	27	20	$1,004.00	$1,004.00	$90.00	$400.00	$187.19	2025-04-10
73706	CPT	Cat Scan Of Blood Vessels Of Leg With Contrast	28	21	$676.70	$676.70	$93.21	$450.00	$171.42	2025-04-10
74175	CPT	Cat Scan Of Blood Vessels Of Abdomen With Contrast	28	21	$676.70	$676.70	$89.58	$450.00	$165.00	2025-04-10
71275	CPT	Cat Scan Of Blood Vessels In Chest With Contrast	28	21	$676.70	$676.70	$80.60	$450.00	$165.00	2025-04-10
70498	CPT	Cat Scan Of Blood Vessels In Neck With Contrast	30	23	$1,448.31	$1,448.31	$68.75	$450.00	$163.75	2025-04-10
74170	CPT	Cat Scan Of Abdomen With And Without Contrast	30	23	$937.12	$937.12	$71.82	$650.00	$163.75	2025-04-10
74160	CPT	Cat Scan Of Abdomen With Contrast	31	24	$805.27	$805.27	$65.32	$450.00	$162.50	2025-04-10
72193	CPT	Cat Scan Of Pelvis With Contrast	31	24	$786.11	$786.11	$59.91	$450.00	$162.50	2025-04-10
71270	CPT	Cat Scan Of Chest With And Without Contrast	31	24	$954.97	$954.97	$71.10	$650.00	$158.97	2025-04-10
70496	CPT	Cat Scan Of Blood Vessels In Head With Contrast	30	23	$668.64	$668.64	$68.75	$450.00	$156.90	2025-04-10
70492	CPT	Cat Scan Of Soft Tissue Of The Neck With And Without Contrast	32	25	$824.55	$824.55	$68.75	$450.00	$156.08	2025-04-10
73701	CPT	Cat Scan Of Leg With Contrast	31	24	$748.98	$748.98	$59.91	$450.00	$150.00	2025-04-10
78803	CPT	Spect Scan To Locate Tumor Or Infection	26	19	$3,816.15	$3,816.15	$51.33	$350.29	$144.75	2025-04-10
70488	CPT	Cat Scan Of Facial Bones With And Without Contrast	32	25	$703.40	$703.40	$64.04	$650.00	$144.23	2025-04-10
75574	CPT	Cat Scan Of Blood Vessels Of Heart With Contrast	9	6	$805.27	$805.27	$41.25	$494.00	$142.99	2025-04-10
71260	CPT	Cat Scan Of Chest With Contrast	31	24	$805.27	$805.27	$50.39	$450.00	$141.31	2025-04-10
70470	CPT	Cat Scan Of Head Or Brain With And Without Contrast	32	25	$824.55	$824.55	$60.18	$650.00	$139.51	2025-04-10
70491	CPT	Cat Scan Of Soft Tissue Of The Neck With Contrast	33	26	$730.42	$730.42	$67.82	$450.00	$137.87	2025-04-10
78802	CPT	Nuclear Medicine Study To Locate Tumor Or Infection With Whole Body Imaging Comp…	28	21	$3,816.15	$3,816.15	$61.25	$301.23	$132.81	2025-04-10
78472	CPT	Single Nuclear Medicine Study To Evaluate Blood Ejection From The Heart During S…	26	19	$890.83	$890.83	$75.74	$250.00	$125.00	2025-04-10
78708	CPT	Complete Nuclear Medicine Study Of Kidney With Drug Administration	26	19	$560.00	$560.00	$57.83	$191.00	$124.39	2025-04-10
74261	CPT	Cat Scan Of Large Intestine Without Contrast	26	19	$300.00	$300.00	$74.43	$450.00	$123.43	2025-04-10
70460	CPT	Cat Scan Of Head Or Brain With Contrast	33	26	$730.42	$730.42	$54.80	$450.00	$122.50	2025-04-10
70487	CPT	Cat Scan Of Facial Bones With Contrast	33	26	$730.42	$730.42	$52.71	$450.00	$122.50	2025-04-10
73200	CPT	Cat Scan Of Arm Without Contrast	31	24	$703.40	$703.40	$50.64	$450.00	$122.50	2025-04-10
72125	CPT	Cat Scan Of Neck Spine Without Contrast	31	24	$711.97	$711.97	$50.25	$450.00	$120.51	2025-04-10
72128	CPT	Cat Scan Of Mid Spine Without Contrast	31	24	$805.27	$805.27	$49.68	$450.00	$119.97	2025-04-10
72131	CPT	Cat Scan Of Lower Spine Without Contrast	31	24	$711.97	$711.97	$49.56	$450.00	$119.97	2025-04-10
73700	CPT	Cat Scan Of Leg Without Contrast	31	24	$703.40	$703.40	$49.56	$450.00	$119.97	2025-04-10
70480	CPT	Cat Scan Of Eye, Ear, Or Sella Turcica Without Contrast	33	26	$703.40	$703.40	$53.55	$450.00	$119.62	2025-04-10
78306	CPT	Nuclear Medicine Study Of Bones And/or Joints In Whole Body	29	22	$656.99	$656.99	$68.28	$278.76	$119.17	2025-04-10
78315	CPT	Nuclear Medicine Study Of Bones And/or Joints With Delayed Images In 3 Phases	28	21	$833.83	$833.83	$77.68	$316.45	$117.50	2025-04-10
74176	CPT	Cat Scan Of Abdomen And Pelvis Without Contrast	31	24	$937.12	$937.12	$63.59	$450.00	$116.00	2025-04-10
72192	CPT	Cat Scan Of Pelvis Without Contrast	31	24	$703.40	$703.40	$45.97	$450.00	$114.00	2025-04-10
74150	CPT	Cat Scan Of Abdomen Without Contrast	31	24	$703.40	$703.40	$47.26	$450.00	$114.00	2025-04-10
78264	CPT	Nuclear Medicine Study Of Stomach Emptying	27	20	$695.31	$695.31	$74.50	$317.18	$110.00	2025-04-10
70486	CPT	Cat Scan Of Facial Bones Without Contrast	33	26	$703.40	$703.40	$43.73	$450.00	$109.85	2025-04-10
70490	CPT	Cat Scan Of Soft Tissue Of The Neck Without Contrast	33	26	$703.40	$703.40	$53.52	$450.00	$109.70	2025-04-10
78195	CPT	Nuclear Medicine Study Of Lymph Nodes	27	20	$435.65	$435.65	$52.50	$317.90	$109.38	2025-04-10
71250	CPT	Cat Scan Of Chest Without Contrast	33	26	$711.97	$711.97	$43.93	$450.00	$107.56	2025-04-10
70450	CPT	Cat Scan Of Head Or Brain Without Contrast	33	26	$703.40	$703.40	$36.50	$450.00	$105.00	2025-04-10
78013	CPT	Nuclear Medicine Scan Of Thyroid	23	16	$299.99	$299.99	$57.50	$185.23	$90.81	2025-04-10
78070	CPT	Nuclear Medicine Study Of Parathyroid Gland	27	20	$774.21	$774.21	$41.84	$278.76	$78.65	2025-04-10
77066	CPT	Diagnostic Mammogram Of Both Breasts	28	21	$290.00	$290.00	$24.63	$151.17	$75.86	2025-04-10
82024	CPT	Lab Test - Pituitary Hormone Level	32	25	$327.13	$327.13	$35.11	$160.00	$69.80	2025-04-10
83970	CPT	Lab Test - Parathyroid Hormone Level	31	24	$340.34	$340.34	$37.52	$130.00	$69.21	2025-04-10
82088	CPT	Lab Test - Aldosterone Hormone Level	32	25	$304.04	$304.04	$37.21	$146.00	$68.50	2025-04-10
87635	CPT	Lab Test - Identification Of Covid-19 Virus DNA Using Amplified Probe Technique	14	8	$171.33	$171.33	$51.33	$76.33	$60.66	2025-04-10
77065	CPT	Diagnostic Mammogram Of One Breast	28	21	$225.00	$225.00	$12.00	$203.80	$60.46	2025-04-10
77067	CPT	Screening Mammogram	28	21	$245.00	$245.00	$16.25	$121.82	$59.19	2025-04-10
76818	CPT	Ultrasound Evaluation Of Fetal Viability With Non-stress Test	27	20	$132.44	$132.44	$30.00	$150.00	$59.04	2025-04-10
82306	CPT	Lab Test - Vitamin D-3 Level	32	25	$357.00	$357.00	$26.91	$120.00	$57.19	2025-04-10
86360	CPT	Lab Test - Measurement Of Cd4 And Cd8 White Blood T Cells With Ratio	30	23	$267.75	$267.75	$9.52	$136.83	$56.56	2025-04-10
76872	CPT	Ultrasound Of Pelvic Cavity Via Rectum	32	25	$165.52	$165.52	$25.00	$150.00	$55.86	2025-04-10
76830	CPT	Ultrasound Of Non-pregnant Uterus	33	26	$168.98	$168.98	$25.00	$150.00	$55.00	2025-04-10
80050	CPT	Lab Test - General Health Panel	11	11	$75.00	$75.00	$10.07	$90.00	$54.00	2025-04-10
80055	CPT	Lab Test - Panel For Pregnant Patients Without HIV Testing	21	16	$75.00	$75.00	$45.00	$175.00	$54.00	2025-04-10
76801	CPT	External Ultrasound Of Pregnant Uterus In 1st Trimester	30	23	$45.00	$45.00	$25.00	$150.00	$52.29	2025-04-10
76805	CPT	External Ultrasound Of Pregnant Uterus In 2nd Or 3rd Trimester	33	26	$198.73	$198.73	$17.50	$150.00	$51.60	2025-04-10
76817	CPT	Vaginal Ultrasound Of Pregnant Uterus In 1st Trimester	30	23	$198.73	$198.73	$26.90	$150.00	$50.03	2025-04-10
76770	CPT	Complete Ultrasound Of Kidneys, Aorta, And Lymph Nodes	33	26	$317.73	$317.73	$22.75	$150.00	$50.00	2025-04-10
76700	CPT	Complete Ultrasound Of Abdomen	33	26	$264.89	$264.89	$25.00	$150.00	$50.00	2025-04-10
78012	CPT	Nuclear Medicine Study Of Thyroid By Measurement Of Iodine Uptake	23	16	$262.27	$262.27	$29.00	$85.00	$50.00	2025-04-10
84402	CPT	Lab Test - Free Testosterone Level	33	26	$214.20	$214.20	$23.16	$170.00	$45.62	2025-04-10
76881	CPT	Complete Ultrasound Of Joint	29	22	$130.00	$130.00	$19.00	$150.00	$45.45	2025-04-10
87426	CPT	Lab Test - Identification Of Covid-19 Virus Using Multiple-step Immunoassay Meth…	24	17	$75.00	$75.00	$45.23	$45.23	$45.23	2025-04-10
76705	CPT	Limited Or Follow-up Ultrasound Of Abdomen	29	22	$132.44	$132.44	$28.76	$150.00	$45.00	2025-04-10
75571	CPT	Cat Scan Of Heart Without Contrast	8	6	$711.97	$711.97	$26.12	$400.00	$44.77	2025-04-10
85303	CPT	Lab Test - Measurement Of Protein C Blood Clotting Inhibitor Activity	31	24	$518.54	$518.54	$12.58	$180.00	$42.58	2025-04-10
76536	CPT	Ultrasound Of Soft Tissue Of Head And Neck	33	26	$225.14	$225.14	$15.00	$150.00	$42.07	2025-04-10
76856	CPT	Complete Ultrasound Of Female Pelvis Unrelated To Pregnancy	33	26	$168.98	$168.98	$18.75	$150.00	$41.25	2025-04-10
76870	CPT	Ultrasound Of Scrotum	33	26	$165.52	$165.52	$20.50	$150.00	$41.00	2025-04-10
76641	CPT	Ultrasound Of Breast	30	23	$89.25	$89.25	$15.00	$150.00	$39.38	2025-04-10
76604	CPT	Ultrasound Of Chest	33	26	$176.83	$176.83	$15.00	$150.00	$38.28	2025-04-10
86361	CPT	Lab Test - Measurement Of Cd4 White Blood T Cells	30	23	$624.75	$624.75	$5.71	$108.00	$36.47	2025-04-10
84403	CPT	Lab Test - Total Testosterone Level	33	26	$48.19	$48.19	$23.47	$83.67	$35.13	2025-04-10
84481	CPT	Lab Test - Free T3 Thyroid Hormone Level	32	25	$160.65	$160.65	$15.40	$115.00	$34.80	2025-04-10
74220	CPT	X-ray Of Esophagus With Single Contrast Agent	33	26	$158.98	$158.98	$14.35	$78.56	$34.10	2025-04-10
85240	CPT	Lab Test - Measurement Of Blood Clotting Factor Viii Deficiency	32	25	$141.13	$141.13	$16.27	$125.00	$34.08	2025-04-10
82677	CPT	Lab Test - Estriol Hormone Level	31	24	$89.25	$89.25	$21.98	$72.00	$33.00	2025-04-10
77080	CPT	Measurement Of Bone Density Using Dual-energy X-rays Of Hips, Pelvis, And/or Spi…	27	20	$125.00	$125.00	$10.44	$90.00	$32.62	2025-04-10
84144	CPT	Lab Test - Progesterone Hormone Level	32	25	$163.62	$163.62	$18.96	$65.00	$32.02	2025-04-10
72082	CPT	X-ray Of Entire Back For Scoliosis Evaluation, 2-3 Views	25	18	$98.77	$98.77	$10.00	$56.27	$31.84	2025-04-10
82672	CPT	Lab Test - Estrogen Hormone Level	33	26	$249.90	$249.90	$19.72	$76.00	$31.83	2025-04-10
84153	CPT	Lab Test - Total Prostate Specific Antigen Level	33	26	$29.75	$29.75	$20.91	$120.00	$30.00	2025-04-10
84146	CPT	Lab Test - Prolactin Hormone Level	33	26	$32.13	$32.13	$17.61	$68.83	$30.00	2025-04-10
85300	CPT	Lab Test - Measurement Of Antithrombin Iii Blood Clotting Inhibitor Activity	31	24	$428.40	$428.40	$10.78	$140.00	$28.77	2025-04-10
83001	CPT	Lab Test - Fsh Hormone Level	33	26	$28.91	$28.91	$16.89	$76.00	$27.16	2025-04-10
76857	CPT	Limited Or Follow-up Ultrasound Of Female Pelvis Unrelated To Pregnancy	30	23	$88.06	$88.06	$15.48	$150.00	$25.62	2025-04-10
84154	CPT	Lab Test - Free Prostate Specific Antigen Level	31	24	$318.68	$318.68	$16.72	$145.00	$25.42	2025-04-10
84443	CPT	Lab Test - Thyroid Stimulating Hormone Level	33	26	$116.62	$116.62	$15.28	$42.75	$25.00	2025-04-10
83002	CPT	Lab Test - Lh Hormone Level	33	26	$28.91	$28.91	$16.83	$40.00	$25.00	2025-04-10
82533	CPT	Lab Test - Cortisol Hormone Level	33	26	$285.00	$285.00	$14.82	$45.00	$25.00	2025-04-10
86769	CPT	Lab Test - Identification Of Covid-19 Antibody	22	15	$45.00	$45.00	$19.00	$62.00	$25.00	2025-04-10
80061	CPT	Lab Test - Cholesterol Panel	33	26	$93.29	$93.29	$12.17	$60.00	$25.00	2025-04-10
85306	CPT	Lab Test - Measurement Of Free Protein S Blood Clotting Inhibitor Level	31	24	$253.00	$253.00	$13.93	$140.00	$24.10	2025-04-10
72110	CPT	X-ray Of Lower Back, Minimum Of 4 Views	33	26	$147.67	$147.67	$11.50	$43.77	$24.00	2025-04-10
84166	CPT	Lab Test - Protein Level In Body Fluid Other Than Blood	27	21	$270.00	$270.00	$15.53	$50.00	$24.00	2025-04-10
73522	CPT	X-ray Of Both Hips, 3-4 Views	21	16	$170.20	$170.20	$12.71	$43.66	$23.53	2025-04-10
84432	CPT	Lab Test - Thyroglobulin Hormone Level	31	24	$57.12	$57.12	$18.25	$157.50	$23.51	2025-04-10
84702	CPT	Lab Test - Pregnancy Hormone Level	33	26	$116.62	$116.62	$14.36	$58.83	$22.71	2025-04-10
84480	CPT	Lab Test - Total T3 Thyroid Hormone Level	32	25	$28.91	$28.91	$12.89	$48.00	$22.33	2025-04-10
82274	CPT	Lab Test - Identification Of Hidden Blood In Stool Using Immunoassay	28	22	$54.00	$54.00	$7.00	$48.00	$21.70	2025-04-10
71111	CPT	X-ray Of Ribs On Both Sides And Chest, 4 Or More Views	30	23	$55.00	$55.00	$12.25	$43.20	$20.89	2025-04-10
82330	CPT	Lab Test - Ionized Calcium Level	32	25	$70.00	$70.00	$9.00	$52.00	$20.64	2025-04-10
97110	CPT	Individual Physical Therapy Exercises	20	16	$20.00	$20.00	$10.73	$27.12	$20.00	2025-04-10
82607	CPT	Lab Test - Vitamin B-12 Level	33	26	$93.29	$93.29	$13.71	$49.33	$20.00	2025-04-10
72050	CPT	X-ray Of Neck, 4 Or 5 Views	33	26	$118.64	$118.64	$11.25	$40.69	$19.50	2025-04-10
74021	CPT	X-ray Of Abdomen, 3 Or More Views	27	20	$84.72	$84.72	$8.75	$33.73	$19.21	2025-04-10
73502	CPT	X-ray Of Single Hip, 2-3 Views	29	22	$88.06	$88.06	$8.00	$36.93	$18.46	2025-04-10
71110	CPT	X-ray Of Ribs On Both Sides, 3 Or More Views	33	26	$127.80	$127.80	$10.00	$33.81	$18.15	2025-04-10
82746	CPT	Lab Test - Folic Acid Level	33	26	$93.29	$93.29	$9.33	$48.75	$18.00	2025-04-10
73521	CPT	X-ray Of Both Hips, 2 Views	29	22	$170.20	$170.20	$9.00	$35.39	$17.94	2025-04-10
80185	CPT	Lab Test - Total Phenytoin Level	32	25	$93.29	$93.29	$12.05	$41.25	$17.78	2025-04-10
73564	CPT	X-ray Of Knee, 4 Or More Views	32	25	$46.00	$46.00	$8.75	$35.87	$17.74	2025-04-10
70220	CPT	X-ray Of Paranasal Sinuses, 3 Or More Views	33	26	$118.64	$118.64	$10.00	$33.70	$17.50	2025-04-10
80053	CPT	Lab Test - Comprehensive Metabolic Panel	33	26	$100.00	$100.00	$9.60	$80.00	$17.50	2025-04-10
71101	CPT	X-ray Of Ribs One On Side And Chest, 3 Or More Views	31	24	$44.00	$44.00	$12.23	$32.81	$17.49	2025-04-10
82728	CPT	Lab Test - Ferritin Level	33	26	$93.29	$93.29	$12.34	$43.53	$17.26	2025-04-10
72072	CPT	X-ray Of Mid Back, 3 Views	30	23	$45.00	$45.00	$11.19	$30.78	$17.06	2025-04-10
72190	CPT	X-ray Of Pelvis, 3 Or More Views	33	26	$66.28	$66.28	$3.20	$33.80	$17.00	2025-04-10
74019	CPT	X-ray Of Abdomen, 2 Views	28	21	$98.77	$98.77	$6.30	$31.45	$16.24	2025-04-10
72100	CPT	X-ray Of Lower Back, 2-3 Views	33	26	$98.77	$98.77	$8.50	$31.40	$16.09	2025-04-10
71046	CPT	X-ray Of Chest, 2 Views	29	22	$88.06	$88.06	$6.50	$56.72	$15.79	2025-04-10
71100	CPT	X-ray Of Ribs On One Side, 2 Views	33	26	$108.64	$108.64	$7.75	$29.55	$15.50	2025-04-10
73610	CPT	X-ray Of Ankle, 3 Or More Views	33	26	$98.77	$98.77	$7.00	$28.83	$15.50	2025-04-10
73630	CPT	X-ray Of Foot, 3 Or More Views	33	26	$88.06	$88.06	$7.00	$26.72	$15.41	2025-04-10
73080	CPT	X-ray Of Elbow, 3 Or More Views	33	26	$98.77	$98.77	$7.00	$27.76	$15.40	2025-04-10
72080	CPT	X-ray Of Mid/Lower Back Junction	33	26	$98.77	$98.77	$7.70	$29.00	$15.32	2025-04-10
84439	CPT	Lab Test - Free Thyroxine Level	32	25	$35.34	$35.34	$8.19	$41.83	$15.06	2025-04-10
73565	CPT	X-ray Of Both Knees With Standing Views	33	26	$78.89	$78.89	$6.00	$33.05	$15.00	2025-04-10
70250	CPT	X-ray Of Skull Bones, 1-3 Views	33	26	$55.00	$55.00	$7.35	$32.42	$15.00	2025-04-10
73130	CPT	X-ray Of Hand, 3 Or More Views	33	26	$78.89	$78.89	$7.00	$28.48	$15.00	2025-04-10
83036	CPT	Lab Test - Hemoglobin A1c Level	33	26	$22.49	$22.49	$8.83	$30.00	$15.00	2025-04-10
73552	CPT	X-ray Of Upper Leg, 2 Or More Views	30	23	$88.06	$88.06	$7.25	$45.36	$14.92	2025-04-10
84165	CPT	Lab Test - Protein Level In Blood	33	26	$71.40	$71.40	$11.61	$40.00	$14.65	2025-04-10
73030	CPT	X-ray Of Shoulder, 2 Or More Views	33	26	$88.06	$88.06	$7.25	$25.97	$14.00	2025-04-10
73562	CPT	X-ray Of Knee, 3 Views	33	26	$78.89	$78.89	$7.00	$32.00	$14.00	2025-04-10
72070	CPT	X-ray Of Mid Back, 2 Views	33	26	$98.77	$98.77	$7.35	$30.48	$14.00	2025-04-10
73501	CPT	X-ray Of Single Hip, 1 View	29	22	$60.92	$60.92	$5.00	$26.58	$13.76	2025-04-10
70210	CPT	X-ray Of Paranasal Sinuses, 1-2 Views	33	26	$78.89	$78.89	$7.35	$26.53	$13.70	2025-04-10
85379	CPT	Lab Test - Quantitative D-dimer Test	28	23	$135.00	$135.00	$9.71	$20.00	$13.54	2025-04-10
72040	CPT	X-ray Of Neck, 2 Or 3 Views	33	26	$88.06	$88.06	$7.35	$29.55	$13.50	2025-04-10
72200	CPT	X-ray Of Sacroiliac Joints, 1-2 Views	33	26	$108.64	$108.64	$4.20	$21.60	$13.27	2025-04-10
72220	CPT	X-ray Of Tailbone	33	26	$78.89	$78.89	$6.30	$24.99	$13.17	2025-04-10
85613	CPT	Lab Test - Measurement Of Blood Clotting Factor X Using Diluted Russell Viper Ve…	31	25	$173.85	$173.85	$5.55	$88.00	$13.15	2025-04-10
73551	CPT	X-ray Of Upper Leg, 1 View	27	20	$60.92	$60.92	$8.50	$28.80	$13.07	2025-04-10
73560	CPT	X-ray Of Knee, 1 Or 2 Views	33	26	$78.89	$78.89	$6.75	$27.40	$12.90	2025-04-10
73100	CPT	X-ray Of Wrist, 2 Views	33	26	$98.77	$98.77	$6.50	$26.37	$12.84	2025-04-10
73600	CPT	X-ray Of Ankle, 2 Views	33	26	$78.89	$78.89	$6.50	$26.48	$12.67	2025-04-10
73120	CPT	X-ray Of Hand, 2 Views	33	26	$65.56	$65.56	$6.50	$23.56	$12.67	2025-04-10
73060	CPT	X-ray Of Upper Arm	33	26	$78.89	$78.89	$7.25	$25.86	$12.67	2025-04-10
73590	CPT	X-ray Of Lower Leg	33	26	$78.89	$78.89	$6.75	$27.50	$12.67	2025-04-10
87046	CPT	Lab Test - Stool Culture For Bacteria	33	26	$81.51	$81.51	$6.45	$28.33	$12.56	2025-04-10
87045	CPT	Lab Test - Stool Culture For Bacteria	33	26	$81.51	$81.51	$6.45	$28.33	$12.56	2025-04-10
73650	CPT	X-ray Of Heel	33	26	$58.19	$58.19	$6.25	$25.00	$12.52	2025-04-10
73090	CPT	X-ray Of Lower Arm	33	26	$88.06	$88.06	$6.75	$23.10	$12.42	2025-04-10
72170	CPT	X-ray Of Pelvis, 1-2 Views	33	26	$63.66	$63.66	$5.25	$28.37	$12.40	2025-04-10
80069	CPT	Lab Test - Kidney Function Panel	33	26	$40.00	$40.00	$7.89	$53.00	$12.21	2025-04-10
73070	CPT	X-ray Of Elbow , 2 Views	33	26	$78.89	$78.89	$6.50	$24.28	$12.00	2025-04-10
84030	CPT	Lab Test - Pku Test	33	26	$126.00	$126.00	$5.00	$97.50	$12.00	2025-04-10
73620	CPT	X-ray Of Foot, 2 Views	33	26	$78.89	$78.89	$6.50	$23.10	$12.00	2025-04-10
84703	CPT	Lab Test - Pregnancy Hormone Identification	33	26	$116.62	$116.62	$6.84	$49.00	$11.88	2025-04-10
80076	CPT	Lab Test - Liver Function Panel	32	25	$70.21	$70.21	$7.43	$80.00	$11.62	2025-04-10
74018	CPT	X-ray Of Abdomen, 1 View	29	22	$69.61	$69.61	$4.90	$23.33	$11.50	2025-04-10
80048	CPT	Lab Test - Basic Metabolic Panel With Total Calcium	32	25	$76.87	$76.87	$7.69	$40.00	$11.36	2025-04-10
73140	CPT	X-ray Of Fingers	33	26	$58.19	$58.19	$4.90	$31.30	$11.29	2025-04-10
85384	CPT	Lab Test - Measurement Of Blood Clot Activity	32	25	$47.00	$47.00	$7.72	$38.49	$11.29	2025-04-10
71045	CPT	X-ray Of Chest, 1 View	29	22	$84.72	$84.72	$4.90	$24.89	$11.20	2025-04-10
73000	CPT	X-ray Of Collarbone	33	26	$69.61	$69.61	$4.20	$24.64	$11.00	2025-04-10
82575	CPT	Lab Test - Calculation Of Creatinine Clearance	33	26	$25.00	$25.00	$8.59	$23.75	$10.67	2025-04-10
82950	CPT	Lab Test - Glucose Level Following Sugar Intake	33	26	$69.61	$69.61	$6.08	$30.67	$10.40	2025-04-10
82951	CPT	Lab Test - Glucose Level Following Sugar Intake	33	26	$69.61	$69.61	$6.08	$30.67	$10.40	2025-04-10
73660	CPT	X-ray Of Toes	33	26	$69.61	$69.61	$4.90	$24.79	$10.14	2025-04-10
70360	CPT	X-ray Of Soft Tissue Of The Neck	33	26	$118.64	$118.64	$4.90	$24.99	$10.13	2025-04-10
80051	CPT	Lab Test - Electrolyte Panel	33	26	$39.74	$39.74	$6.38	$40.00	$10.00	2025-04-10
82150	CPT	Lab Test - Amylase Enzyme Level	33	26	$304.04	$304.04	$6.00	$16.00	$9.85	2025-04-10
73020	CPT	X-ray Of Shoulder, 1 View	33	26	$69.61	$69.61	$4.90	$20.59	$9.50	2025-04-10
84479	CPT	Lab Test - Thyroid Hormone Uptake Analysis	33	26	$47.00	$47.00	$5.88	$24.00	$9.41	2025-04-10
84436	CPT	Lab Test - Total Thyroxine Level	32	25	$58.19	$58.19	$6.24	$24.00	$9.35	2025-04-10
83735	CPT	Lab Test - Magnesium Level	33	26	$47.00	$47.00	$6.09	$24.00	$9.18	2025-04-10
85025	CPT	Lab Test - Complete Blood Cell Count With White Blood Cell Percentage	32	25	$35.10	$35.10	$6.64	$16.00	$9.00	2025-04-10
85730	CPT	Lab Test - Thromboplastin Time	33	26	$35.10	$35.10	$5.19	$20.00	$9.00	2025-04-10
85610	CPT	Lab Test - Measurement Of Prothrombin Time	33	26	$35.10	$35.10	$3.58	$20.00	$8.40	2025-04-10
83690	CPT	Lab Test - Lipase Enzyme Level	33	26	$47.00	$47.00	$5.76	$20.00	$8.25	2025-04-10
85027	CPT	Lab Test - Complete Blood Cell Count Without White Blood Cell Percentage	28	23	$35.10	$35.10	$4.80	$14.25	$7.38	2025-04-10
83615	CPT	Lab Test - Ldh Enzyme Level	33	26	$47.00	$47.00	$4.66	$28.00	$7.27	2025-04-10
82248	CPT	Lab Test - Direct Bilirubin Level	31	24	$35.10	$35.10	$4.56	$10.59	$7.23	2025-04-10
84460	CPT	Lab Test - Sgpt Enzyme Level	33	26	$47.00	$47.00	$5.05	$16.00	$7.22	2025-04-10
84450	CPT	Lab Test - Sgot Enzyme Level	33	26	$47.00	$47.00	$4.71	$12.00	$7.05	2025-04-10
86140	CPT	Lab Test - Measurement Of C-reactive Protein Levels	33	26	$35.10	$35.10	$3.66	$20.00	$7.05	2025-04-10
83540	CPT	Lab Test - Iron Level	33	26	$47.00	$47.00	$5.17	$16.00	$7.03	2025-04-10
84075	CPT	Lab Test - Total Alkaline Phosphatase Level	33	26	$15.00	$15.00	$4.30	$20.00	$7.00	2025-04-10
84132	CPT	Lab Test - Potassium Level	33	26	$47.00	$47.00	$4.11	$16.00	$7.00	2025-04-10
82565	CPT	Lab Test - Creatinine Level In Blood Sample	33	26	$107.10	$107.10	$4.66	$10.45	$7.00	2025-04-10
82247	CPT	Lab Test - Total Bilirubin Level	32	25	$70.21	$70.21	$4.20	$24.00	$6.83	2025-04-10
86901	CPT	Lab Test - Blood Typing For Group And Rh Status	33	26	$21.42	$21.42	$2.00	$15.00	$6.50	2025-04-10
86900	CPT	Lab Test - Blood Typing For Group And Rh Status	33	26	$21.42	$21.42	$2.00	$15.00	$6.50	2025-04-10
82310	CPT	Lab Test - Total Calcium Level In Blood	33	26	$15.00	$15.00	$4.26	$27.40	$6.37	2025-04-10
82540	CPT	Lab Test - Creatine Level	33	26	$58.19	$58.19	$4.92	$45.00	$6.32	2025-04-10
84550	CPT	Lab Test - Uric Acid Level	33	26	$35.10	$35.10	$4.11	$12.00	$6.16	2025-04-10
82465	CPT	Lab Test - Total Cholesterol Level	33	26	$35.10	$35.10	$3.95	$10.00	$6.12	2025-04-10
82570	CPT	Lab Test - Creatinine Level In Sample Other Than Blood	33	26	$46.88	$46.88	$4.51	$12.73	$6.00	2025-04-10
84520	CPT	Lab Test - Urea Nitrogen Level In Blood	33	26	$35.10	$35.10	$3.59	$16.00	$6.00	2025-04-10
84300	CPT	Lab Test - Sodium Level In Urine Sample	33	26	$47.00	$47.00	$3.06	$8.00	$6.00	2025-04-10
84100	CPT	Lab Test - Phosphate Level	33	26	$35.10	$35.10	$4.13	$16.00	$6.00	2025-04-10
82947	CPT	Lab Test - Glucose Level In Blood	33	26	$23.20	$23.20	$4.47	$16.00	$5.94	2025-04-10
85660	CPT	Lab Test - Screening For Sickle Cell Anemia	33	26	$35.10	$35.10	$3.00	$16.00	$5.75	2025-04-10
84157	CPT	Lab Test - Total Protein Level In Body Fluid Other Than Blood Or Urine	29	22	$18.00	$18.00	$3.34	$52.00	$5.60	2025-04-10
84540	CPT	Lab Test - Urea Nitrogen Level In Urine	33	26	$47.00	$47.00	$3.73	$12.73	$5.56	2025-04-10
84156	CPT	Lab Test - Total Protein Level In Urine	29	22	$15.00	$15.00	$3.34	$30.00	$5.50	2025-04-10
81000	CPT	Lab Test - Manual Analysis Of Urine By Dipstick With Microscope Evaluation	30	23	$12.00	$12.00	$2.92	$16.00	$5.47	2025-04-10
85045	CPT	Lab Test - Immature Red Blood Cell Count	27	22	$12.00	$12.00	$3.63	$10.00	$5.44	2025-04-10
82945	CPT	Lab Test - Glucose Level In Body Fluid Other Than Blood	31	24	$23.20	$23.20	$3.66	$44.00	$5.21	2025-04-10
82948	CPT	Lab Test - Glucose Level In Blood Using Strip	29	24	$12.61	$12.61	$1.77	$8.00	$5.00	2025-04-10
85049	CPT	Lab Test - Platelet Count	30	23	$35.10	$35.10	$3.00	$8.00	$5.00	2025-04-10
81001	CPT	Lab Test - Machine Analysis Of Urine By Dipstick With Microscope Evaluation	33	26	$23.20	$23.20	$2.88	$8.00	$5.00	2025-04-10
85651	CPT	Lab Test - Sedimentation Rate	33	26	$23.20	$23.20	$3.23	$8.55	$4.83	2025-04-10
85008	CPT	Lab Test - Examination Of White Blood Cells Using Microscope	33	26	$12.00	$12.00	$2.51	$17.00	$4.68	2025-04-10
82270	CPT	Lab Test - Identification Of Hidden Blood In Stool Sample Using Chemical Reagent…	32	25	$23.20	$23.20	$2.69	$20.80	$4.38	2025-04-10
85014	CPT	Lab Test - Red Blood Cell Volume	33	26	$12.61	$12.61	$2.07	$7.00	$3.00	2025-04-10
85018	CPT	Lab Test - Hemoglobin Blood Count	33	26	$12.61	$12.61	$1.78	$6.65	$3.00	2025-04-10
81003	CPT	Lab Test - Machine Analysis Of Urine By Dipstick	18	17	$12.61	$12.61	$2.04	$8.00	$2.77	2025-04-10

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