Hospital

AVERA MISSOURI RIVER HEALTH CENTER

Gettysburg, SD · CCN 431302 · Rates published

724 distinct procedures filed

5 distinct payers

9,803 rate rows

2026-05-09 last MRF observed

Data quality

9,785 of 9,803 rate rows are consumer-grade (99.8%)

18 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	12
no usable negotiated amount (only an out-of-band fallback) — excluded from medians	4
placeholder amount (≤ $0.02) — excluded from medians	2

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

Source MRF file	https://www.avera.org/app/files/public/5380b4cd-f869-4c7e-87f7-01531b5e668d/460234354_avera-missouri-river-center_standardcharges.csv
Discovered via	Discovered by HANK (automated)
Last fetch	not_modified · 2026-05-17
Content fingerprint	1907b8ad41357e10… · 2,779,893 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
J3245 OTHER	Tildrakizumab-asmn 100Mg/Ml Sy	5	$5.04	$56,787.72	$46,140.03	nat. median $139 outlier · 331.3×
J2327 OTHER	Risankizumab-rzaa 600 Mg/10 Ml	5	$68.09	$45,688.70	$37,122.07	nat. median $16 outlier · 2345.0×
J3380 OTHER	Vedolizumab 300 Mg Vial	5	$72.63	$41,229.60	$33,499.05	nat. median $24 outlier · 1419.5×
4652 OTHER	Apr-DRG 4652	1	$21,284.59	$21,284.59	$21,284.59	nat. median $5,262 outlier · 4.0×
177 OTHER	Ms-DRG 177	1	$15,919.96	$15,919.96	$15,919.96	nat. median $16,359 1.0× median
391 OTHER	Ms-DRG 391	1	$15,306.82	$15,306.82	$15,306.82	nat. median $9,924 1.5× median
64 OTHER	Ms-DRG 64	1	$13,776.36	$13,776.36	$13,776.36	nat. median $19,110 0.7× median
191 OTHER	Ms-DRG 191	1	$13,655.90	$13,655.90	$13,655.90	nat. median $8,914 1.5× median
872 OTHER	Ms-DRG 872	1	$13,022.54	$13,022.54	$13,022.54	nat. median $8,903 1.5× median
81352 OTHER	Tp53 Somatic Mutation, Prog	5	$7,183.15	$11,051.00	$9,426.50	nat. median $346 outlier · 27.2×
392 OTHER	Ms-DRG 392	1	$9,198.70	$9,198.70	$9,198.70	nat. median $8,098 1.1× median
536 OTHER	Ms-DRG 536	1	$9,197.50	$9,197.50	$9,197.50	nat. median $8,350 1.1× median
194 OTHER	Ms-DRG 194	2	$9,197.50	$19,638.50	$9,197.50	nat. median $8,630 1.1× median
195 OTHER	Ms-DRG 195	1	$9,197.50	$9,197.50	$9,197.50	nat. median $6,715 1.4× median
603 OTHER	Ms-DRG 603	1	$9,197.50	$9,197.50	$9,197.50	nat. median $9,288 1.0× median
193 OTHER	Ms-DRG 193	1	$9,197.50	$9,197.50	$9,197.50	nat. median $12,881 0.7× median
1391 OTHER	Apr-DRG 1391	1	$8,240.73	$8,240.73	$8,240.73	nat. median $3,886 outlier · 2.1×
74178 OTHER	CT Abd & Pelv Wwo Contrast	5	$479.88	$8,718.00	$7,859.27	nat. median $495 outlier · 15.9×
Q5111 OTHER	Pegfilgrastim-cbqv 6 Mg/0.6 Ml	5	$1,112.40	$8,925.00	$7,251.57	nat. median $164 outlier · 44.3×
74177 OTHER	CT Abd & Pelv W Contrast	5	$227.52	$7,832.00	$7,060.55	nat. median $458 outlier · 15.4×
74174 OTHER	CTA Abd&Pelv Wwo Dye	5	$71.13	$8,409.00	$6,832.32	nat. median $502 outlier · 13.6×
74176 OTHER	CT Abd & Pelvis Wo Contrast	5	$95.04	$7,297.00	$6,578.24	nat. median $302 outlier · 21.8×
153 OTHER	Ms-DRG 153	1	$6,142.84	$6,142.84	$6,142.84	nat. median $7,429 0.8× median
73720 OTHER	MRI Le Wwo Dye Lt	5	$233.96	$7,130.00	$5,793.12	nat. median $553 outlier · 10.5×
J0129 OTHER	Abatacept 250 Mg Vial	5	$588.00	$6,454.87	$5,244.58	nat. median $49 outlier · 106.5×
70496 OTHER	CT Angiography Head W Cont	5	$246.84	$5,193.00	$4,933.35	nat. median $325 outlier · 15.2×
74183 OTHER	MRI Abdomen Wwo Dye	5	$619.08	$5,805.00	$4,716.57	nat. median $634 outlier · 7.4×
J0585 OTHER	Botulinum Tx Type A 200 Un Vl	5	$59.81	$5,559.00	$4,525.02	nat. median $7 outlier · 637.3×
74175 OTHER	CTA Abdom Wwo Dye	5	$82.17	$5,313.00	$4,316.82	nat. median $336 outlier · 12.9×
70553 OTHER	MRI Brain Wwo Contrast	5	$729.77	$4,515.00	$4,289.25	nat. median $596 outlier · 7.2×
73222 OTHER	MRI Joint Ue W Dye Lt	5	$530.75	$5,053.00	$4,105.57	nat. median $884 outlier · 4.6×
73721 OTHER	MRI Joint Le Wo Dye Lt	5	$315.18	$4,300.00	$4,085.00	nat. median $442 outlier · 9.2×
71275 OTHER	CTA Chest Wwo Contrast	5	$65.60	$4,620.00	$3,940.86	nat. median $311 outlier · 12.7×
72157 OTHER	MRI Chest Spine Wwo Dye	5	$535.35	$4,515.00	$3,876.45	nat. median $630 outlier · 6.2×
73718 OTHER	MRI Le Wo Dye Lt	5	$56.39	$4,515.00	$3,876.45	nat. median $401 outlier · 9.7×
72156 OTHER	MRI Neck Spine Wwo Dye	5	$340.05	$4,515.00	$3,876.45	nat. median $564 outlier · 6.9×
72158 OTHER	MRI Lumbar Spine Wwo Dye	5	$340.97	$4,300.00	$3,876.45	nat. median $576 outlier · 6.7×
J1439 OTHER	Ferric Carboxymalt 750mg/15ml	5	$11.91	$4,487.80	$3,828.09	nat. median $1 outlier · 3112.3×
J9202 OTHER	Goserelin 3.6 Mg Implant	5	$77.09	$4,663.34	$3,788.97	nat. median $780 outlier · 4.9×
72141 OTHER	MRI Neck Spine Wo Dye	5	$233.96	$4,300.00	$3,706.90	nat. median $372 outlier · 10.0×
72148 OTHER	MRI Lumbar Spine Wo Dye	5	$315.18	$4,300.00	$3,706.90	nat. median $383 outlier · 9.7×
70492 OTHER	CT Soft Tissue Neck Wwo Cont	5	$422.85	$4,318.00	$3,683.25	nat. median $255 outlier · 14.4×
70498 OTHER	CT Angiography Neck W Cont	5	$278.39	$4,945.00	$3,672.70	nat. median $328 outlier · 11.2×
73221 OTHER	MRI Joint Ue Wo Dye Rt	5	$408.12	$4,515.00	$3,667.90	nat. median $396 outlier · 9.3×
72131 OTHER	CT Lumbar Spine Wo Contrast	5	$234.87	$3,969.00	$3,578.06	nat. median $164 outlier · 21.8×
72132 OTHER	CT Lumbar Spine W Contrast	5	$313.35	$4,338.00	$3,524.62	nat. median $437 outlier · 8.1×
72146 OTHER	MRI Chest Spine Wo Dye	5	$390.63	$4,300.00	$3,517.65	nat. median $372 outlier · 9.5×
70543 OTHER	MRI Orbit Face Neck Wwo Cont	5	$335.45	$4,300.00	$3,493.75	nat. median $604 outlier · 5.8×
73218 OTHER	MRI Ue Wo Dye Lt	5	$79.40	$4,300.00	$3,493.75	nat. median $416 outlier · 8.4×
71260 OTHER	CT Thorax W Contrast	5	$80.31	$4,217.00	$3,436.15	nat. median $260 outlier · 13.2×

Other procedures at this hospital

Browse this hospital's 724 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

J3245	OTHER	Tildrakizumab-asmn 100Mg/Ml Sy	8	5	$56,787.00	$55,084.09	$5.04	$56,787.72	$46,140.03	2026-05-09
J2327	OTHER	Risankizumab-rzaa 600 Mg/10 Ml	8	5	$45,688.00	$44,318.04	$68.09	$45,688.70	$37,122.07	2026-05-09
J3380	OTHER	Vedolizumab 300 Mg Vial	8	5	$41,229.00	$39,992.71	$72.63	$41,229.60	$33,499.05	2026-05-09
4652	OTHER	Apr-DRG 4652	2	1	—	—	$21,284.59	$21,284.59	$21,284.59	2026-05-09
177	OTHER	Ms-DRG 177	2	1	—	—	$15,919.96	$15,919.96	$15,919.96	2026-05-09
391	OTHER	Ms-DRG 391	2	1	—	—	$15,306.82	$15,306.82	$15,306.82	2026-05-09
64	OTHER	Ms-DRG 64	1	1	—	—	$13,776.36	$13,776.36	$13,776.36	2026-05-09
191	OTHER	Ms-DRG 191	2	1	—	—	$13,655.90	$13,655.90	$13,655.90	2026-05-09
872	OTHER	Ms-DRG 872	1	1	—	—	$13,022.54	$13,022.54	$13,022.54	2026-05-09
81352	OTHER	Tp53 Somatic Mutation, Prog	7	5	$11,051.00	$10,719.47	$7,183.15	$11,051.00	$9,426.50	2026-05-09
392	OTHER	Ms-DRG 392	2	1	—	—	$9,198.70	$9,198.70	$9,198.70	2026-05-09
195	OTHER	Ms-DRG 195	2	1	—	—	$9,197.50	$9,197.50	$9,197.50	2026-05-09
536	OTHER	Ms-DRG 536	2	1	—	—	$9,197.50	$9,197.50	$9,197.50	2026-05-09
194	OTHER	Ms-DRG 194	3	2	—	—	$9,197.50	$19,638.50	$9,197.50	2026-05-09
193	OTHER	Ms-DRG 193	2	1	—	—	$9,197.50	$9,197.50	$9,197.50	2026-05-09
603	OTHER	Ms-DRG 603	2	1	—	—	$9,197.50	$9,197.50	$9,197.50	2026-05-09
1391	OTHER	Apr-DRG 1391	2	1	—	—	$8,240.73	$8,240.73	$8,240.73	2026-05-09
74178	OTHER	CT Abd & Pelv Wwo Contrast	10	5	$8,718.00	$8,456.46	$479.88	$8,718.00	$7,859.27	2026-05-09
Q5111	OTHER	Pegfilgrastim-cbqv 6 Mg/0.6 Ml	8	5	$8,925.00	$8,657.25	$1,112.40	$8,925.00	$7,251.57	2026-05-09
74177	OTHER	CT Abd & Pelv W Contrast	12	5	$7,832.00	$7,597.04	$227.52	$7,832.00	$7,060.55	2026-05-09
74174	OTHER	CTA Abd&Pelv Wwo Dye	8	5	$8,409.00	$8,156.73	$71.13	$8,409.00	$6,832.32	2026-05-09
74176	OTHER	CT Abd & Pelvis Wo Contrast	12	5	$7,297.00	$7,078.09	$95.04	$7,297.00	$6,578.24	2026-05-09
153	OTHER	Ms-DRG 153	2	1	—	—	$6,142.84	$6,142.84	$6,142.84	2026-05-09
73720	OTHER	MRI Le Wwo Dye Lt	8	5	$7,130.00	$6,916.10	$233.96	$7,130.00	$5,793.12	2026-05-09
J0129	OTHER	Abatacept 250 Mg Vial	8	5	$6,454.00	$6,261.22	$588.00	$6,454.87	$5,244.58	2026-05-09
70496	OTHER	CT Angiography Head W Cont	11	5	$5,193.00	$5,037.21	$246.84	$5,193.00	$4,933.35	2026-05-09
74183	OTHER	MRI Abdomen Wwo Dye	10	5	$5,805.00	$5,630.85	$619.08	$5,805.00	$4,716.57	2026-05-09
J0585	OTHER	Botulinum Tx Type A 200 Un Vl	10	5	$5,559.00	$5,392.23	$59.81	$5,559.00	$4,525.02	2026-05-09
74175	OTHER	CTA Abdom Wwo Dye	8	5	$5,313.00	$5,153.61	$82.17	$5,313.00	$4,316.82	2026-05-09
70553	OTHER	MRI Brain Wwo Contrast	11	5	$4,515.00	$4,379.55	$729.77	$4,515.00	$4,289.25	2026-05-09
73222	OTHER	MRI Joint Ue W Dye Lt	8	5	$5,053.00	$4,901.41	$530.75	$5,053.00	$4,105.57	2026-05-09
73721	OTHER	MRI Joint Le Wo Dye Lt	21	5	$4,300.00	$4,171.00	$315.18	$4,300.00	$4,085.00	2026-05-09
71275	OTHER	CTA Chest Wwo Contrast	11	5	$4,620.00	$4,481.40	$65.60	$4,620.00	$3,940.86	2026-05-09
73718	OTHER	MRI Le Wo Dye Lt	20	5	$4,300.00	$4,171.00	$56.39	$4,515.00	$3,876.45	2026-05-09
72156	OTHER	MRI Neck Spine Wwo Dye	10	5	$4,300.00	$4,171.00	$340.05	$4,515.00	$3,876.45	2026-05-09
72157	OTHER	MRI Chest Spine Wwo Dye	10	5	$4,300.00	$4,171.00	$535.35	$4,515.00	$3,876.45	2026-05-09
72158	OTHER	MRI Lumbar Spine Wwo Dye	10	5	$4,300.00	$4,171.00	$340.97	$4,300.00	$3,876.45	2026-05-09
J1439	OTHER	Ferric Carboxymalt 750mg/15ml	9	5	$4,487.00	$4,353.17	$11.91	$4,487.80	$3,828.09	2026-05-09
J9202	OTHER	Goserelin 3.6 Mg Implant	8	5	$4,663.00	$4,523.44	$77.09	$4,663.34	$3,788.97	2026-05-09
72141	OTHER	MRI Neck Spine Wo Dye	11	5	$3,902.00	$3,784.94	$233.96	$4,300.00	$3,706.90	2026-05-09
72148	OTHER	MRI Lumbar Spine Wo Dye	11	5	$3,902.00	$3,784.94	$315.18	$4,300.00	$3,706.90	2026-05-09
70492	OTHER	CT Soft Tissue Neck Wwo Cont	9	5	$4,318.00	$4,188.46	$422.85	$4,318.00	$3,683.25	2026-05-09
70498	OTHER	CT Angiography Neck W Cont	11	5	$3,866.00	$3,750.02	$278.39	$4,945.00	$3,672.70	2026-05-09
73221	OTHER	MRI Joint Ue Wo Dye Rt	21	5	$4,300.00	$4,171.00	$408.12	$4,515.00	$3,667.90	2026-05-09
72131	OTHER	CT Lumbar Spine Wo Contrast	10	5	$3,969.00	$3,849.93	$234.87	$3,969.00	$3,578.06	2026-05-09
72132	OTHER	CT Lumbar Spine W Contrast	8	5	$4,338.00	$4,207.86	$313.35	$4,338.00	$3,524.62	2026-05-09
72146	OTHER	MRI Chest Spine Wo Dye	10	5	$3,902.00	$3,784.94	$390.63	$4,300.00	$3,517.65	2026-05-09
70543	OTHER	MRI Orbit Face Neck Wwo Cont	8	5	$4,300.00	$4,171.00	$335.45	$4,300.00	$3,493.75	2026-05-09
73218	OTHER	MRI Ue Wo Dye Lt	8	5	$4,300.00	$4,171.00	$79.40	$4,300.00	$3,493.75	2026-05-09
71260	OTHER	CT Thorax W Contrast	11	5	$3,617.00	$3,508.49	$80.31	$4,217.00	$3,436.15	2026-05-09
74170	OTHER	CT Abdomen Wwo Dye	8	5	$4,113.00	$3,989.61	$58.22	$4,113.00	$3,341.81	2026-05-09
70491	OTHER	CT Soft Tissue Neck W Cont	10	5	$3,673.00	$3,562.81	$357.53	$4,112.00	$3,311.21	2026-05-09
70551	OTHER	MRI Brain Wo Contrast	11	5	$3,832.00	$3,717.04	$447.03	$4,300.00	$3,268.70	2026-05-09
70544	OTHER	MRA Head Wo Contrast	8	5	$3,890.00	$3,773.30	$408.12	$3,890.00	$3,160.62	2026-05-09
190	OTHER	Ms-DRG 190	2	1	—	—	$3,088.18	$3,088.18	$3,088.18	2026-05-09
446	OTHER	Ms-DRG 446	2	1	—	—	$3,088.18	$3,088.18	$3,088.18	2026-05-09
690	OTHER	Ms-DRG 690	2	1	—	—	$3,088.18	$3,088.18	$3,088.18	2026-05-09
72125	OTHER	CT Cervical Spine Wo Contrast	12	5	$3,391.00	$3,289.27	$172.58	$3,391.00	$3,056.98	2026-05-09
72128	OTHER	CT Thoracic Spine Wo Contrast	11	5	$3,105.00	$3,011.85	$107.93	$3,105.00	$2,949.75	2026-05-09
70487	OTHER	CT Maxillofacial W Contrast	8	5	$3,597.00	$3,489.09	$268.29	$3,597.00	$2,922.56	2026-05-09
111	OTHER	Room Medical Unit Priv	6	5	$3,164.00	$3,069.08	$2,056.60	$3,164.00	$2,852.35	2026-05-09
70482	OTHER	CT Orbit Wwo Contrast	10	5	$3,351.00	$3,250.47	$261.57	$3,351.00	$2,825.20	2026-05-09
73701	OTHER	CT Le W Dye Lt	16	5	$3,433.00	$3,330.01	$268.01	$3,433.00	$2,789.32	2026-05-09
70486	OTHER	CT Maxillofacial Wo Contrast	10	5	$3,086.00	$2,993.42	$187.95	$3,086.00	$2,782.03	2026-05-09
70470	OTHER	CT Head/Brain Wwo Contrast	8	5	$3,417.00	$3,314.49	$241.32	$3,417.00	$2,776.31	2026-05-09
70490	OTHER	CT Soft Tissue Neck Wo Cont	10	5	$3,028.00	$2,937.16	$277.47	$3,028.00	$2,729.74	2026-05-09
72193	OTHER	CT Pelvis W Dye	8	5	$3,105.00	$3,011.85	$593.33	$3,105.00	$2,522.82	2026-05-09
72192	OTHER	CT Pelvis Wo Dye	10	5	$2,741.00	$2,658.77	$597.02	$3,681.00	$2,471.01	2026-05-09
70450	OTHER	CT Head/Brain Wo Contrast	13	5	$2,591.00	$2,513.27	$24.20	$3,254.00	$2,461.45	2026-05-09
71250	OTHER	CT Thorax Wo Contrast	11	5	$2,805.00	$2,720.85	$71.13	$2,805.00	$2,392.67	2026-05-09
P9037	OTHER	Platelet Pheresis Leuk Red Irr	7	5	$2,746.00	$2,663.62	$1,784.90	$2,746.00	$2,342.34	2026-05-09
74160	OTHER	CT Abdomen W Dye	8	5	$2,879.00	$2,792.63	$706.77	$2,879.00	$2,339.19	2026-05-09
J0248	OTHER	Remdesivir 100 Mg Vial	8	5	$2,847.00	$2,762.23	$70.71	$2,847.66	$2,313.72	2026-05-09
70480	OTHER	CT Orbit Wo Contrast	9	5	$2,695.00	$2,614.15	$192.56	$2,695.00	$2,298.84	2026-05-09
120	OTHER	Room Medical Unit Semi Private	6	5	$2,461.00	$2,387.17	$1,599.65	$2,461.00	$2,218.59	2026-05-09
73700	OTHER	CT Le Wo Dye Lt	20	5	$2,571.00	$2,493.87	$76.65	$4,296.00	$2,193.06	2026-05-09
Q5121	OTHER	Infliximab-axxq 100 Mg Vial	8	5	$2,179.00	$2,114.48	$1,416.92	$4,302.83	$2,070.89	2026-05-09
99291	OTHER	Critical Care 1st 30-74 Min	15	5	$3,113.00	$3,019.61	$228.45	$3,113.00	$2,023.45	2026-05-09
73201	OTHER	CT Ue W Dye Lt	8	5	$2,450.00	$2,376.50	$90.44	$2,450.00	$1,990.62	2026-05-09
73200	OTHER	CT Ue Wo Dye Lt	18	5	$2,226.00	$2,159.22	$70.19	$2,750.00	$1,898.78	2026-05-09
86341	OTHER	Islet Cell Antibody Ica 512	25	5	$1,994.00	$1,934.18	$122.85	$2,414.00	$1,700.88	2026-05-09
Q5104	OTHER	Infliximab-abda 100 Mg Vial	8	5	$1,763.00	$1,710.20	$1,146.01	$5,119.19	$1,674.94	2026-05-09
99285	OTHER	Emergency Room Visit Level 5	17	5	$2,087.00	$2,024.39	$184.62	$2,087.00	$1,611.16	2026-05-09
G0480	OTHER	Clonidine, Serum	23	5	$2,019.00	$1,958.43	$189.80	$2,357.00	$1,595.01	2026-05-09
80230	OTHER	Infliximab Qn w/Reflex To Ab,S	7	5	$1,773.00	$1,719.81	$1,152.45	$1,773.00	$1,512.37	2026-05-09
87471	OTHER	Bartonella DNA Amp Probe	8	5	$1,649.00	$1,599.53	$1,071.85	$1,649.00	$1,486.57	2026-05-09
88377	OTHER	Morph Ana Ea Man Multpx Hema	7	5	$1,652.00	$1,602.44	$1,073.80	$1,652.00	$1,409.16	2026-05-09
76942	OTHER	US Guide For Needle Placement	10	5	$1,445.00	$1,401.65	$939.25	$1,445.00	$1,372.75	2026-05-09
689	OTHER	Trauma Team Evaluation Level 5	9	5	$1,409.00	$1,366.73	$915.85	$14,044.45	$1,338.55	2026-05-09
25605	OTHER	Fx Distal Radius W Man Lt	15	5	$1,643.00	$1,593.71	$396.00	$1,643.00	$1,268.40	2026-05-09
87118	OTHER	Mycobacterial Id, Each	7	5	$1,479.00	$1,434.63	$961.35	$1,479.00	$1,261.59	2026-05-09
129	OTHER	Room Swing Bed Skilled	6	5	$1,332.00	$1,292.04	$865.80	$1,332.00	$1,200.80	2026-05-09
73523	OTHER	X-ray Hips 5 Views Bi	10	5	$1,301.00	$1,261.97	$690.20	$1,301.00	$1,172.85	2026-05-09
G0390	OTHER	Trauma Team Level 5	7	5	$1,362.00	$1,321.14	$885.30	$1,362.00	$1,161.79	2026-05-09
82397	OTHER	Infliximab Ab, S	7	5	$1,360.00	$1,319.20	$884.00	$1,360.00	$1,160.08	2026-05-09
87529	OTHER	Hsv DNA Amp Probe	7	5	$1,290.00	$1,251.30	$838.50	$1,290.00	$1,100.37	2026-05-09
92950	OTHER	Heart/Lung Resuscitation Cpr	9	5	$1,158.00	$1,123.26	$752.70	$1,216.00	$1,100.10	2026-05-09
20670	OTHER	Remove Implant Superficial	13	5	$1,688.00	$1,637.36	$174.84	$1,688.00	$1,097.20	2026-05-09
77002	OTHER	Needle Localization By X-ray	11	5	$1,116.00	$1,082.52	$83.48	$1,116.00	$1,060.20	2026-05-09
761	OTHER	Pain Clinic Level 1	21	5	$1,107.00	$1,073.79	$712.40	$1,610.00	$1,046.50	2026-05-09
87507	OTHER	Gi Pathogens Panel Ref	7	5	$1,195.00	$1,159.15	$776.75	$1,195.00	$1,019.34	2026-05-09
90678	OTHER	Rsv Vaccine Bivalent	8	5	$1,249.00	$1,212.31	$41.69	$1,249.80	$1,015.46	2026-05-09
99284	OTHER	Emergency Room Visit Level 4	18	5	$1,284.00	$1,245.48	$127.14	$1,284.00	$1,002.81	2026-05-09
Q0138	OTHER	Ferumoxy 510mg/17ml (non-esrd)	9	5	$1,145.00	$1,111.35	$7.28	$1,145.72	$977.30	2026-05-09
Q0139	OTHER	Ferumoxytol 510 Mg/17 Ml Vial	8	5	$1,145.00	$1,111.35	$7.28	$1,145.72	$930.90	2026-05-09
72120	OTHER	X-ray Ls Spine Bending 2-3 V	9	5	$1,070.00	$1,037.90	$152.07	$1,070.00	$912.71	2026-05-09
72072	OTHER	X-ray Spine Thoracic 3 Views	11	5	$955.00	$926.35	$620.75	$955.00	$907.25	2026-05-09
P9040	OTHER	Rbc Packed Leuko-reduc Irrad	7	5	$1,056.00	$1,024.32	$686.40	$1,056.00	$900.77	2026-05-09
94660	OTHER	CPap/BiPap First Day	7	5	$1,045.00	$1,013.65	$679.25	$1,045.00	$891.39	2026-05-09
96413	OTHER	Chemotherapy Inf Initial	9	5	$914.00	$886.58	$594.10	$914.00	$868.30	2026-05-09
73522	OTHER	X-ray Hips 3-4 Views Bi	8	5	$940.00	$911.80	$611.00	$940.00	$797.87	2026-05-09
77067	OTHER	Mammo Screen Implant Bi	17	5	$824.00	$799.28	$535.60	$826.00	$782.80	2026-05-09
0202U	OTHER	Respir Path 22 Targets Biofire	7	5	$870.00	$843.90	$565.50	$870.00	$742.11	2026-05-09
Q5110	OTHER	Filgrastim-aafi 480 Mcg/0.8 Ml	8	5	$780.00	$756.91	$507.21	$927.00	$741.30	2026-05-09
73502	OTHER	X-ray Hip Uni 2-3 Views Rt	36	5	$345.00	$334.65	$224.25	$1,131.00	$735.15	2026-05-09
71101	OTHER	X-ray Ribs Uni W Chest Lt	20	5	$756.00	$733.32	$491.40	$3,427.98	$718.60	2026-05-09
J2997	OTHER	Alteplase 2 Mg Vial	8	5	$879.00	$852.77	$37.08	$879.14	$714.31	2026-05-09
72220	CPT	Sacrum Or Coccyx Min 2 View	6	5	$774.00	$750.78	$503.10	$774.00	$697.76	2026-05-09
87556	OTHER	Mtb DNA Probe (arup)	7	5	$805.00	$780.85	$523.25	$805.00	$686.67	2026-05-09
72220	OTHER	X-ray Sacrum Tailbone	14	5	$774.00	$750.78	$447.69	$774.00	$660.22	2026-05-09
J1611	OTHER	Glucagon (Fresenius Kabi) Vial	8	5	$794.00	$770.88	$81.80	$794.72	$645.71	2026-05-09
J1610	OTHER	Glucagon 1 Mg/ml Vial	8	5	$794.00	$770.88	$98.91	$794.72	$645.71	2026-05-09
12041	OTHER	Repair Lac Interm <2.5 Cm	15	5	$826.00	$801.22	$173.83	$826.00	$637.67	2026-05-09
P9016	OTHER	Red Blood Cells Lekoreduced	9	5	$662.00	$642.14	$430.30	$1,324.00	$628.90	2026-05-09
73552	OTHER	X-ray Femur 2 Views Lt	16	5	$758.00	$735.26	$130.01	$758.00	$615.88	2026-05-09
99283	OTHER	Emergency Room Visit Level 3	18	5	$787.00	$763.39	$74.82	$787.00	$614.64	2026-05-09
72040	OTHER	X-ray Spine Cervical 2-3 Views	12	5	$666.00	$646.02	$432.90	$666.00	$600.40	2026-05-09
A9585	OTHER	Gadobutrol Inj 10 Mm/10 Ml Vl	19	5	$800.00	$776.00	$2.69	$800.00	$600.00	2026-05-09
23600	OTHER	Fx Prox Humeral Wo Man Lt	14	5	$698.00	$677.06	$453.70	$698.00	$595.39	2026-05-09
J0695	OTHER	Ceftolozane/Tazobac 1.5gr Vial	8	5	$730.00	$708.99	$7.71	$730.92	$593.87	2026-05-09
12044	OTHER	Repair Lac Interm 7.6-12.5 Cm	13	5	$826.00	$801.22	$253.91	$826.00	$593.10	2026-05-09
80299	OTHER	Dexamethasone	14	5	$867.50	$841.48	$100.10	$1,581.00	$590.83	2026-05-09
P9047	OTHER	Albumin Human 25% 25gr/100ml	8	5	$618.00	$600.27	$402.24	$3,118.50	$587.89	2026-05-09
77080	OTHER	Dexa Scan	11	5	$609.00	$590.73	$88.61	$609.00	$578.55	2026-05-09
12014	OTHER	Repair Lac Simple 5.1-7.5 Cm	7	5	$666.00	$646.02	$432.90	$666.00	$568.10	2026-05-09
12052	OTHER	Repair Lac Interm 2.6-5.0 Cm	13	5	$826.00	$801.22	$238.97	$826.00	$559.61	2026-05-09
11402	OTHER	Exc Ben Lesion 1.1-2.0 Trunk	15	5	$724.00	$702.28	$138.88	$724.00	$558.93	2026-05-09
74019	OTHER	X-ray Abdomen	12	5	$582.00	$564.54	$378.30	$660.48	$552.90	2026-05-09
12042	OTHER	Repair Lac Interm 2.6-7.5 Cm	13	5	$826.00	$801.22	$235.09	$826.00	$550.12	2026-05-09
84445	OTHER	Tsi	9	5	$569.00	$551.93	$369.85	$662.00	$540.55	2026-05-09
12011	OTHER	Repair Lac Simple <2.5 Cm	15	5	$700.00	$679.00	$64.07	$700.00	$540.40	2026-05-09
73080	OTHER	X-ray Elbow Lt	20	5	$598.00	$580.06	$38.91	$598.00	$539.10	2026-05-09
83993	OTHER	Calprotectin	9	5	$566.00	$549.02	$367.90	$566.00	$537.70	2026-05-09
87637	OTHER	Influ/RSV/CoV2 Pcr Ceph	10	5	$582.00	$564.54	$378.30	$582.00	$524.67	2026-05-09
G0379	OTHER	Observation Assess Direct Adm	9	5	$609.00	$590.73	$174.00	$609.00	$519.48	2026-05-09
70260	OTHER	X-ray Skull 4 Views	10	5	$571.00	$553.87	$72.96	$571.00	$514.75	2026-05-09
73090	OTHER	X-ray Forearm 2 Views Lt	16	5	$626.00	$607.22	$282.72	$626.00	$508.62	2026-05-09
85220	OTHER	Factor 5 Activity	7	5	$594.00	$576.18	$386.10	$594.00	$506.68	2026-05-09
73130	OTHER	X-ray Hand Lt	22	5	$532.00	$516.04	$59.16	$532.00	$505.40	2026-05-09
72070	OTHER	X-ray Spine Thoracic 2 Views	12	5	$525.00	$509.25	$341.25	$1,015.91	$498.75	2026-05-09
11106	OTHER	Incisional Biopsy 1st Lesion	15	5	$756.00	$733.32	$69.02	$756.00	$491.40	2026-05-09
72100	OTHER	X-ray Lumbosacral 2-3 Views	12	5	$544.00	$527.68	$90.44	$544.00	$490.41	2026-05-09
99195	OTHER	Phlebotomy Therapeutic	9	5	$516.00	$500.52	$335.40	$516.00	$490.20	2026-05-09
73060	OTHER	X-ray Humerus Rt	18	5	$573.00	$555.81	$67.44	$573.00	$488.77	2026-05-09
87636	OTHER	Influ & CoV2 Pcr Ceph	9	5	$511.00	$495.67	$332.15	$511.00	$485.45	2026-05-09
12004	OTHER	Repair Lac Simple 7.6-12.5 Cm	14	5	$666.00	$646.02	$84.56	$666.00	$473.52	2026-05-09
81515	OTHER	Vpp	9	5	$497.00	$482.09	$323.05	$497.00	$472.15	2026-05-09
11441	OTHER	Exc Ben Lesion 0.6-1.0 Face	13	5	$724.00	$702.28	$158.62	$724.00	$470.60	2026-05-09
12018	OTHER	Repair Lac Simple >30.0 Cm	13	5	$700.00	$679.00	$197.72	$700.00	$466.70	2026-05-09
93246	OTHER	Ext ECG >7 Days Hook Up	9	5	$491.00	$476.27	$319.15	$491.00	$466.45	2026-05-09
12013	OTHER	Repair Lac Simple 2.6-5.0 Cm	13	5	$700.00	$679.00	$66.94	$700.00	$455.00	2026-05-09
86256	OTHER	dsDNA IgG	14	5	$633.50	$614.50	$160.55	$1,020.00	$455.00	2026-05-09
12002	OTHER	Repair Lac Simple 2.6-7.5 Cm	15	5	$700.00	$679.00	$67.93	$700.00	$455.00	2026-05-09
12015	OTHER	Repair Lac Simple 7.6-12.5 Cm	13	5	$700.00	$679.00	$108.66	$700.00	$455.00	2026-05-09
85379	OTHER	D-dimer Quant	11	5	$478.00	$463.66	$310.70	$478.00	$454.10	2026-05-09
71100	OTHER	X-ray Ribs 2 Views Lt	18	5	$476.00	$461.72	$74.00	$3,616.49	$452.20	2026-05-09
86860	OTHER	Antibody Elution Rbc Ea	7	5	$523.00	$507.31	$339.95	$523.00	$446.12	2026-05-09
73030	OTHER	X-ray Shoulder Lt	22	5	$469.00	$454.93	$237.65	$469.00	$445.55	2026-05-09
82653	OTHER	Pancreatic Elastase	7	5	$521.00	$505.37	$338.65	$521.00	$444.41	2026-05-09
88305	OTHER	Surg Path L4	9	5	$516.00	$500.52	$103.20	$516.00	$440.15	2026-05-09
87631	OTHER	Influ And Rsv Amp Probe	9	5	$461.00	$447.17	$299.65	$486.00	$437.95	2026-05-09
80053	OTHER	Comprehensive Metabolic Panel	12	5	$456.00	$442.32	$296.40	$456.00	$433.20	2026-05-09
71046	OTHER	X-ray Chest 2v PA/Lateral	13	5	$452.00	$438.44	$293.80	$783.14	$429.40	2026-05-09
36430	OTHER	Blood Administration	9	5	$451.00	$437.47	$293.15	$748.00	$428.45	2026-05-09
73564	OTHER	X-ray Knee 4 Rt	8	5	$525.00	$509.25	$129.06	$525.00	$426.56	2026-05-09
74018	OTHER	X-ray Abdomen	10	5	$448.00	$434.56	$291.20	$523.40	$425.80	2026-05-09
26720	OTHER	Fx Finger/Thumb Wo Man	7	5	$491.00	$476.27	$319.15	$491.00	$418.82	2026-05-09
73590	OTHER	X-ray Lower Leg Rt	19	5	$487.00	$472.39	$73.88	$596.00	$415.41	2026-05-09
96365	OTHER	Inf Therapy Med Initial	21	5	$500.00	$485.00	$279.50	$500.00	$408.50	2026-05-09
80069	OTHER	Renal Function Panel	10	5	$427.00	$414.19	$277.55	$427.00	$405.65	2026-05-09
82951	OTHER	Glucose Tol 1st 3 Specimens	9	5	$426.00	$413.22	$276.90	$426.00	$404.70	2026-05-09
97162	OTHER	Pt Eval Mod Complexity	11	5	$426.00	$413.22	$276.90	$426.00	$404.70	2026-05-09
97161	OTHER	Pt Eval Low Complexity	11	5	$426.00	$413.22	$276.90	$426.00	$404.70	2026-05-09
10120	OTHER	I&r Foreign Body Simple	15	5	$517.00	$501.49	$126.55	$517.00	$399.12	2026-05-09
86255	OTHER	Pla2R Elisa	7	5	$467.00	$452.99	$303.55	$467.00	$398.35	2026-05-09
73610	OTHER	X-ray Ankle 3 Views Lt	24	5	$467.00	$452.99	$99.63	$467.00	$398.35	2026-05-09
10061	OTHER	I&d Abscess Comp/Multiple	15	5	$457.00	$443.29	$173.85	$506.04	$395.79	2026-05-09
73565	OTHER	X-ray Knees Bi	8	5	$486.00	$471.42	$267.09	$486.00	$394.88	2026-05-09
72050	OTHER	X-ray Spine Cervical 4-5 Views	10	5	$405.00	$392.85	$263.25	$746.06	$394.88	2026-05-09
99282	OTHER	Emergency Room Visit Level 2	15	5	$511.00	$495.67	$44.27	$511.00	$394.49	2026-05-09
70030	OTHER	X-ray Eye Fb Detection	6	5	$429.00	$416.13	$278.85	$429.00	$386.75	2026-05-09
80076	OTHER	Hepatic Function Panel	10	5	$404.00	$391.88	$262.60	$404.00	$383.80	2026-05-09
80179	OTHER	Salicylate	10	5	$403.00	$390.91	$261.95	$403.00	$382.85	2026-05-09
80143	OTHER	Acetaminophen	10	5	$403.00	$390.91	$261.95	$403.00	$382.85	2026-05-09
71045	OTHER	X-ray Chest 1 View	13	5	$403.00	$390.91	$261.95	$593.33	$382.85	2026-05-09
90677	OTHER	Pneumo Conjugate Vaccine 20 Va	10	5	$405.00	$393.04	$263.38	$405.20	$382.64	2026-05-09
82610	OTHER	Cystatin C	7	5	$446.00	$432.62	$289.90	$446.00	$380.44	2026-05-09
73110	OTHER	X-ray Wrist 3 Views Lt	20	5	$410.00	$397.70	$58.22	$410.00	$369.62	2026-05-09
36593	OTHER	Declot/Thrombo Impl Vad	7	5	$432.00	$419.04	$280.80	$432.00	$368.50	2026-05-09
73562	OTHER	X-ray Knee 3 Views Lt	21	5	$385.00	$373.45	$109.76	$385.00	$365.75	2026-05-09
97165	OTHER	Ot Eval Low Complexity	8	5	$426.00	$413.22	$276.90	$426.00	$363.38	2026-05-09
97166	OTHER	Ot Eval Mod Complexity	7	5	$426.00	$413.22	$276.90	$426.00	$363.38	2026-05-09
80306	OTHER	Drug Screen Urine Inst Ass Obv	9	5	$382.00	$370.54	$248.30	$382.00	$362.90	2026-05-09
73630	OTHER	X-ray Foot 3 Views Rt	23	5	$421.00	$408.37	$65.60	$421.00	$359.11	2026-05-09
84482	OTHER	Reverse T3	9	5	$378.00	$366.66	$245.70	$378.00	$359.10	2026-05-09
96360	OTHER	Inf Therapy Hyd Initial	23	5	$482.00	$467.54	$232.05	$482.00	$357.00	2026-05-09
27808	OTHER	Fx Bimalleolar Ankle Lt	8	5	$396.00	$384.12	$257.40	$396.00	$357.00	2026-05-09
24600	OTHER	Dislocation Elbow Wo Anes Rt	13	5	$356.00	$345.32	$231.40	$926.91	$356.00	2026-05-09
72170	OTHER	X-ray Pelvis 1-2 Views	10	5	$389.00	$377.33	$252.85	$389.00	$355.72	2026-05-09
28490	OTHER	Fx Great Toe	7	5	$416.00	$403.52	$270.40	$416.00	$354.85	2026-05-09
28400	OTHER	Fx Calcaneus Lt	7	5	$416.00	$403.52	$270.40	$416.00	$354.85	2026-05-09
28470	OTHER	Fx Metatarsal	7	5	$416.00	$403.52	$270.40	$416.00	$354.85	2026-05-09
27824	OTHER	Fx Distal Tibia Lt	7	5	$416.00	$403.52	$270.40	$416.00	$354.85	2026-05-09
27530	OTHER	Treat Knee Fracture Rt	7	5	$416.00	$403.52	$270.40	$416.00	$354.85	2026-05-09
80048	OTHER	Basic Metabolic Panel	12	5	$369.00	$357.93	$239.85	$369.00	$350.55	2026-05-09
96415	OTHER	Chemotherapy Inf Ea Addl Hr	9	5	$368.00	$356.96	$239.20	$640.00	$349.60	2026-05-09
88184	OTHER	Flow Cytometry First Mark	10	5	$367.00	$355.99	$238.55	$367.00	$348.65	2026-05-09
110	OTHER	Room Custodial Care	6	5	$386.00	$374.42	$250.90	$386.00	$347.98	2026-05-09
12001	OTHER	Repair Lac Simple <2.5 Cm	30	5	$700.00	$679.00	$51.59	$700.00	$346.00	2026-05-09
115	CPT	Room Hospice Respite Care	6	5	$383.00	$371.51	$248.95	$383.00	$345.27	2026-05-09
80202	OTHER	Vancomycin	9	5	$362.00	$351.14	$235.30	$362.00	$343.90	2026-05-09
84153	OTHER	Psa Total	9	5	$362.00	$351.14	$235.30	$362.00	$343.90	2026-05-09
80074	OTHER	Acute Hepatitis Panel	9	5	$362.00	$351.14	$235.30	$362.00	$343.90	2026-05-09
G0103	OTHER	Psa Screen	10	5	$362.00	$351.14	$235.30	$362.00	$343.90	2026-05-09
83970	OTHER	Pth	10	5	$362.00	$351.14	$235.30	$362.00	$343.90	2026-05-09
82378	OTHER	Cea	9	5	$362.00	$351.14	$235.30	$362.00	$343.90	2026-05-09
12031	OTHER	Repair Lac Intermed <2.5 Cm	13	5	$430.00	$417.10	$181.84	$430.00	$339.70	2026-05-09
97167	OTHER	Ot Eval High Complexity	9	5	$356.00	$345.32	$231.40	$405.00	$338.20	2026-05-09
27780	OTHER	Treatment Fibula Fracture Lt	7	5	$396.00	$384.12	$257.40	$396.00	$337.79	2026-05-09
27786	OTHER	Fx Distal Fibula Lt	7	5	$396.00	$384.12	$257.40	$396.00	$337.79	2026-05-09
26750	OTHER	Fx Distal Finger/Thumb Wo Man	7	5	$396.00	$384.12	$257.40	$396.00	$337.79	2026-05-09
26600	OTHER	Fx Metacarpal	7	5	$396.00	$384.12	$257.40	$396.00	$337.79	2026-05-09
25622	OTHER	Fx Carpal Scaphoid Wo Man Rt	7	5	$396.00	$384.12	$257.40	$396.00	$337.79	2026-05-09
25600	OTHER	Fx Distal Radius Rt	7	5	$396.00	$384.12	$257.40	$396.00	$337.79	2026-05-09
99223	OTHER	IP/Obs Initial High Comp	6	5	$322.00	$312.34	$209.42	$389.40	$334.66	2026-05-09
88368	OTHER	Morphometric Ana Ea Hematologi	7	5	$389.00	$377.33	$252.85	$389.00	$331.82	2026-05-09
86043	OTHER	Acetylcholine Mod Aby	7	5	$388.00	$376.36	$252.20	$388.00	$330.96	2026-05-09
72200	OTHER	X-ray Si Joints	10	5	$339.00	$328.83	$220.35	$483.57	$330.52	2026-05-09
86480	OTHER	Tbint Quantiferon	9	5	$385.00	$373.45	$250.25	$385.00	$328.41	2026-05-09
11765	OTHER	Wedge Exc Nail Fold	15	5	$504.00	$488.88	$96.00	$504.00	$327.60	2026-05-09
83880	OTHER	B Type Natriuretic Peptide	11	5	$344.00	$333.68	$223.60	$344.00	$326.80	2026-05-09
10160	OTHER	Punc Asp Abscess Hematoma Cyst	15	5	$420.00	$407.40	$114.68	$420.00	$324.24	2026-05-09
J0613	OTHER	Calcium Gluc/NS (Wgcc) 1,000Mg	7	5	$340.00	$330.60	$221.53	$340.82	$323.78	2026-05-09
84702	OTHER	Hcg Beta Quan Serum	9	5	$339.00	$328.83	$220.35	$339.00	$322.05	2026-05-09
99205	OTHER	New Patient Level 5 High Comp	6	5	$215.00	$208.55	$193.98	$382.02	$320.46	2026-05-09
70250	OTHER	X-ray Skull < 4 Views	10	5	$353.00	$342.41	$94.25	$353.00	$318.23	2026-05-09
87798	OTHER	Bord Parapertussis Amp Arup	48	5	$409.00	$396.73	$127.40	$914.00	$317.48	2026-05-09
86922	OTHER	Crossmatch Ahg	9	5	$333.00	$323.01	$216.45	$333.00	$316.35	2026-05-09
73551	OTHER	X-ray Femur 1 View Rt	8	5	$389.00	$377.33	$101.48	$389.00	$316.06	2026-05-09
71271	OTHER	Ldct For Lung Cancer Screen	11	5	$330.00	$320.10	$101.48	$330.00	$313.50	2026-05-09
86870	OTHER	Rbc Antibody Identif Panel	7	5	$367.00	$355.99	$238.55	$367.00	$313.05	2026-05-09
82104	OTHER	Alpha 1 Antitrypsin Pheno	9	5	$329.00	$319.13	$213.85	$364.00	$312.55	2026-05-09
71120	OTHER	X-ray Sternum 2 Views	10	5	$346.00	$335.62	$79.40	$346.00	$311.92	2026-05-09
82530	OTHER	Cortisol Free Urine	7	5	$364.00	$353.08	$236.60	$364.00	$310.49	2026-05-09
87493	OTHER	C Diff By Pcr	11	5	$321.00	$311.37	$208.65	$321.00	$304.95	2026-05-09
82627	OTHER	Dheas	9	5	$320.00	$310.40	$208.00	$320.00	$304.00	2026-05-09
24650	OTHER	Fx Radial Head/Neck Wo Man Lt	7	5	$356.00	$345.32	$231.40	$356.00	$303.67	2026-05-09
93242	OTHER	Ext ECG 48 Hrs -7days Hook Up	9	5	$319.00	$309.43	$207.35	$467.00	$303.05	2026-05-09
73020	OTHER	X-ray Shoulder Lt	20	5	$336.00	$325.92	$187.95	$336.00	$302.90	2026-05-09
73560	OTHER	X-ray Knee 1-2 Views Lt	22	5	$318.00	$308.46	$84.00	$318.00	$302.05	2026-05-09
70160	OTHER	X-ray Facial Bones 3 Views	8	5	$371.00	$359.87	$86.75	$371.00	$301.44	2026-05-09
87497	OTHER	Cmv Quant By Pcr	8	5	$333.00	$323.01	$216.45	$333.00	$300.20	2026-05-09
93005	OTHER	EKG Tracing	11	5	$312.00	$302.64	$202.80	$312.00	$296.40	2026-05-09
82166	OTHER	Mullerian Inhib Hormone	7	5	$346.00	$335.62	$224.90	$346.00	$295.14	2026-05-09
82553	OTHER	Cpk Mb Fraction	9	5	$310.00	$300.70	$201.50	$327.00	$294.50	2026-05-09
11750	OTHER	Exc Nail Matrix Part/Complete	15	5	$453.00	$439.41	$96.71	$453.00	$294.45	2026-05-09
11401	OTHER	Exc Ben Lesion 0.6-1.0 Trunk	13	5	$419.00	$406.43	$126.70	$419.00	$289.52	2026-05-09
82803	OTHER	Blood Gas Wo Oximetry	10	5	$320.00	$310.40	$208.00	$320.00	$288.48	2026-05-09
G0438	OTHER	Annual Wellness Visit Initial	6	5	$231.00	$224.07	$92.40	$358.02	$286.56	2026-05-09
J3480	OTHER	D5/Ns Kcl 20 Meq 1000 Ml Bag	26	5	$316.00	$306.80	$9.57	$948.87	$283.88	2026-05-09
J1956	OTHER	Levofloxac/D5W 750mg/150ml Bag	10	5	$309.00	$299.90	$2.07	$309.18	$278.73	2026-05-09
P9017	OTHER	Plasma Fresh Frozen	9	5	$292.00	$283.24	$189.80	$584.00	$277.40	2026-05-09
96402	OTHER	Injection Chemo Sq/IM Hormonal	7	5	$320.00	$310.40	$208.00	$320.00	$272.96	2026-05-09
J0131	OTHER	Acetaminophen 1000mg/100ml Via	11	5	$318.00	$309.32	$145.73	$318.89	$272.01	2026-05-09
73140	OTHER	X-ray Finger(s) Lt	20	5	$301.00	$291.97	$64.68	$301.00	$271.35	2026-05-09
82077	OTHER	Alcohol/Ethanol Auto Analyzer	10	5	$285.00	$276.45	$185.25	$285.00	$270.75	2026-05-09
80185	OTHER	Phenytoin Total	9	5	$285.00	$276.45	$185.25	$285.00	$270.75	2026-05-09
87075	OTHER	Culture Anaerobe Exept Bld	9	5	$285.00	$276.45	$185.25	$285.00	$270.75	2026-05-09
11102	OTHER	Tangential Biopsy 1st Lesion	13	5	$416.00	$403.52	$45.38	$416.00	$270.40	2026-05-09
11042	OTHER	Debride Skin Subq 20 Cm	15	5	$416.00	$403.52	$59.40	$416.00	$270.40	2026-05-09
11000	OTHER	Debride Infect Skin Up To 10%	13	5	$416.00	$403.52	$33.36	$416.00	$270.40	2026-05-09
11104	OTHER	Punch Biopsy 1st Lesion	13	5	$416.00	$403.52	$56.71	$416.00	$270.40	2026-05-09
87040	OTHER	Culture Blood	11	5	$283.00	$274.51	$183.95	$283.00	$268.85	2026-05-09
96374	OTHER	IV Push Injection Initial	21	5	$361.00	$350.17	$173.55	$361.00	$267.00	2026-05-09
80061	OTHER	Lipid Panel	11	5	$279.00	$270.63	$181.35	$279.00	$265.00	2026-05-09
86301	OTHER	Ca 19-9	9	5	$278.00	$269.66	$180.70	$278.00	$264.10	2026-05-09
87385	OTHER	Histoplasma Antigen	7	5	$308.00	$298.76	$200.20	$308.00	$262.72	2026-05-09
73120	OTHER	X-ray Hand Rt	8	5	$317.00	$307.49	$198.99	$317.00	$257.56	2026-05-09
70140	OTHER	X-ray Facial Bones < 3 Views	10	5	$282.00	$273.54	$66.51	$282.00	$254.22	2026-05-09
Q9967	OTHER	Iopamidol-370 100 Ml Vial	21	5	$600.00	$582.00	$58.50	$600.00	$253.80	2026-05-09
73620	OTHER	X-ray Foot 2 Views Rt	8	5	$312.00	$302.64	$202.80	$312.00	$253.50	2026-05-09
J0744	OTHER	Ciprofloxac/D5 400mg/200ml Bag	8	5	$311.00	$302.57	$5.85	$311.93	$253.44	2026-05-09
84484	OTHER	Troponin Quant	11	5	$264.00	$256.08	$171.60	$264.00	$250.80	2026-05-09
80203	OTHER	Zonisamide	9	5	$264.00	$256.08	$171.60	$292.00	$250.80	2026-05-09
97163	OTHER	Pt Eval High Complexity	9	5	$294.00	$285.18	$81.00	$294.00	$250.78	2026-05-09
64615	OTHER	Chemodenerv Muscle Migraine	6	5	$159.00	$154.23	$138.83	$321.69	$248.63	2026-05-09
82668	OTHER	Erythropoietin	7	5	$291.00	$282.27	$189.15	$291.00	$248.22	2026-05-09
J1836	OTHER	Metronidazole/Ns 500mg/100ml	8	5	$304.00	$295.15	$0.32	$304.28	$247.23	2026-05-09
99222	OTHER	Inpatient Initial/Obs Mod Comp	6	5	$162.00	$157.14	$141.80	$274.01	$246.06	2026-05-09
64483	OTHER	Inj Foramen Epidural L/s Bi	12	5	$1,266.50	$1,228.51	$134.72	$312.87	$244.09	2026-05-09

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