Hospital

BOWDLE HOSPITAL - CAH

Bowdle, SD · CCN 431318 · Rates published

597 distinct procedures filed

6 distinct payers

7,879 rate rows

2026-05-14 last MRF observed

Data quality

7,867 of 7,879 rate rows are consumer-grade (99.8%)

12 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	10
placeholder amount (≤ $0.02) — excluded from medians	2

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

Source MRF file	https://bowdlehc.com/wp-content/uploads/bowdle-healthcare-center_standardcharges.csv
Found on page	https://bowdlehc.com/
Discovered via	Discovered by HANK (automated)
Last fetch	not_modified · 2026-05-18
Content fingerprint	7df62f64abb0c926… · 2,191,699 bytes · first seen 2026-05-14

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
J2327 OTHER	Risankizumab-rzaa 600 Mg/10 Ml	5	$68.09	$20,284.42	$16,481.09	nat. median $16 outlier · 1041.1×
J3380 OTHER	Vedolizumab 300 Mg Vial	5	$72.63	$17,955.94	$14,589.20	nat. median $24 outlier · 618.2×
177 OTHER	Ms-DRG 177	1	$14,264.32	$14,264.32	$14,264.32	nat. median $16,359 0.9× median
J3101 OTHER	Tenecteplase 50 Mg/10 Ml Syrng	5	$0.41	$14,016.04	$11,388.03	nat. median $195 outlier · 58.4×
544 OTHER	Ms-DRG 544	1	$10,705.72	$10,705.72	$10,705.72	nat. median $8,214 1.3× median
J0717 OTHER	Certolizumab Pegol 400 Mg Kit	5	$3.42	$11,483.38	$9,330.24	nat. median $5 outlier · 1843.9×
74177 OTHER	CT Abd & Pelv W Contrast	5	$227.52	$6,997.54	$6,308.28	nat. median $458 outlier · 13.8×
74176 OTHER	CT Abd & Pelvis Wo Contrast	5	$95.04	$5,832.37	$5,257.88	nat. median $302 outlier · 17.4×
74178 OTHER	CT Abd & Pelv Wwo Contrast	5	$479.88	$6,413.32	$5,210.82	nat. median $495 outlier · 10.5×
74174 OTHER	CTA Abd&Pelv Wwo Dye	5	$71.13	$6,244.06	$5,073.30	nat. median $502 outlier · 10.1×
70553 OTHER	MRI Brain Wwo Contrast	5	$729.77	$5,243.78	$4,260.57	nat. median $596 outlier · 7.1×
J3111 OTHER	Romosozumab-aqqg 210 Mg/2.34Ml	5	$1.56	$5,092.30	$4,137.49	nat. median $13 outlier · 316.3×
Q5122 OTHER	Pegfilgrastim 6 Mg/0.6 Ml Syr	5	$2,528.99	$3,939.75	$3,696.21	nat. median $146 outlier · 25.3×
72141 OTHER	MRI Neck Spine Wo Dye	5	$233.96	$4,512.14	$3,666.11	nat. median $372 outlier · 9.9×
70498 OTHER	CT Angiography Neck W Cont	5	$278.39	$4,232.59	$3,610.40	nat. median $328 outlier · 11.0×
812 OTHER	Ms-DRG 812	1	$3,592.12	$3,592.12	$3,592.12	nat. median $7,461 outlier · 0.5×
J1569 OTHER	Immune Glob Gamagar 20gr/200ml	5	$21.77	$4,315.56	$3,506.39	nat. median $52 outlier · 67.3×
71275 OTHER	CTA Chest Wwo Contrast	5	$65.60	$4,062.24	$3,465.09	nat. median $311 outlier · 11.1×
70551 OTHER	MRI Brain Wo Contrast	5	$447.03	$4,217.30	$3,426.56	nat. median $394 outlier · 8.7×
72148 OTHER	MRI Lumbar Spine Wo Dye	5	$315.18	$4,090.63	$3,323.64	nat. median $383 outlier · 8.7×
J0897 OTHER	Denosumab 60 Mg/ml Syringe	5	$9.69	$6,039.29	$3,253.57	nat. median $32 outlier · 102.3×
71260 OTHER	CT Thorax W Contrast	5	$80.31	$3,586.13	$3,232.89	nat. median $260 outlier · 12.4×
120 OTHER	Room Medical Unit Semi Private	5	$2,317.25	$3,565.00	$3,213.85	nat. median $1,852 1.7× median
G0390 OTHER	Trauma Team Level 5	5	$2,541.79	$3,910.45	$3,212.44	nat. median $1,527 outlier · 2.1×
689 OTHER	Trauma Team Evaluation Level 5	5	$2,541.79	$3,910.45	$3,212.44	nat. median $11,307 outlier · 0.3×
Q5111 OTHER	Pegfilgrastim-cbqv 6 Mg/0.6 Ml	5	$1,112.40	$3,945.00	$3,205.32	nat. median $164 outlier · 19.6×
70491 OTHER	CT Soft Tissue Neck W Cont	5	$357.53	$3,518.42	$3,171.86	nat. median $282 outlier · 11.3×
70496 OTHER	CT Angiography Head W Cont	5	$246.84	$3,666.94	$3,127.90	nat. median $325 outlier · 9.6×
73721 OTHER	MRI Joint Le Wo Dye Lt	5	$315.18	$3,666.94	$2,979.39	nat. median $442 outlier · 6.7×
70492 OTHER	CT Soft Tissue Neck Wwo Cont	5	$422.85	$3,666.94	$2,979.39	nat. median $255 outlier · 11.7×
73700 OTHER	CT Le Wo Dye Lt	5	$76.65	$3,597.05	$2,922.60	nat. median $180 outlier · 16.3×
73221 OTHER	MRI Joint Ue Wo Dye Lt	5	$408.12	$3,385.20	$2,750.47	nat. median $396 outlier · 6.9×
73200 OTHER	CT Ue Wo Dye Rt	5	$70.19	$3,385.20	$2,750.47	nat. median $185 outlier · 14.9×
J0881 OTHER	Darbepoetin Alfa 500mcg/ml Syr	5	$2,069.93	$3,184.50	$2,692.92	nat. median $4 outlier · 645.0×
71270 OTHER	CT Thorax Wwo Contrast	5	$82.17	$3,175.54	$2,580.13	nat. median $304 outlier · 8.5×
95811 OTHER	Polysomnogram W CPap	5	$2,022.22	$3,111.11	$2,555.78	nat. median $996 outlier · 2.6×
70490 OTHER	CT Soft Tissue Neck Wo Cont	5	$277.47	$3,098.00	$2,517.12	nat. median $172 outlier · 14.6×
72125 OTHER	CT Cervical Spine Wo Contrast	5	$172.58	$2,610.97	$2,353.79	nat. median $173 outlier · 13.6×
70486 OTHER	CT Maxillofacial Wo Contrast	5	$187.95	$2,610.97	$2,353.79	nat. median $178 outlier · 13.2×
71250 OTHER	CT Thorax Wo Contrast	5	$71.13	$2,541.08	$2,290.78	nat. median $163 outlier · 14.0×
74170 OTHER	CT Abdomen Wwo Dye	5	$58.22	$2,450.45	$2,209.08	nat. median $308 outlier · 7.2×
95810 OTHER	Polysomnogram	5	$1,719.85	$2,645.92	$2,173.62	nat. median $979 outlier · 2.2×
72131 OTHER	CT Lumbar Spine Wo Contrast	5	$234.87	$2,610.97	$2,121.41	nat. median $164 outlier · 12.9×
70450 OTHER	CT Head/Brain Wo Contrast	5	$24.20	$2,317.22	$1,976.59	nat. median $146 outlier · 13.6×
J1459 OTHER	Immune Glob Privige 10gr/100ml	5	$0.29	$2,114.80	$1,718.28	nat. median $54 outlier · 31.6×
28490 OTHER	Fx Great Toe	5	$1,254.66	$1,930.24	$1,585.69	nat. median $251 outlier · 6.3×
93306 OTHER	Tte W Doppler Complete	5	$1,100.90	$1,693.69	$1,526.87	nat. median $609 outlier · 2.5×
76700 OTHER	Ultrasound Abdomen Complete	5	$1,088.83	$1,675.13	$1,376.12	nat. median $144 outlier · 9.5×
93975 OTHER	Vascular Study	5	$964.62	$1,484.03	$1,219.13	nat. median $296 outlier · 4.1×
Q9967 OTHER	Iopamidol-370 100 Ml Vial	5	$253.80	$1,500.00	$1,218.75	nat. median $6 outlier · 196.9×

Other procedures at this hospital

Browse this hospital's 597 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

82306	OTHER	25 Hydvit D2 And D3	19	5	$293.00	$293.75	$180.29	$293.75	$250.57	2026-05-14
82024	OTHER	Acth Adrenocorticotropic Hor	8	5	$452.00	$452.09	$293.86	$452.09	$371.39	2026-05-14
80074	OTHER	Acute Hepatitis Panel	8	5	$405.00	$405.13	$263.33	$405.13	$332.81	2026-05-14
99236	OTHER	Admit/Discharge Same Day High	6	5	$549.00	$549.28	$322.41	$436.48	$391.90	2026-05-14
P9047	OTHER	Albumin Human 25% 25gr/100ml	6	5	$191.00	$191.70	$124.61	$191.70	$172.82	2026-05-14
82085	OTHER	Aldolase	8	5	$226.00	$226.04	$146.93	$226.04	$185.69	2026-05-14
82088	OTHER	Aldosterone	8	5	$404.00	$404.04	$262.63	$404.04	$331.92	2026-05-14
A0429	OTHER	Amb Bls Emergent Home/Hosp	32	5	$874.00	$874.69	$568.55	$910.73	$732.80	2026-05-14
80151	OTHER	Amiodarone	8	5	$293.00	$293.75	$190.94	$293.75	$241.31	2026-05-14
82150	OTHER	Amylase Serum	10	5	$203.00	$203.11	$132.02	$203.11	$183.10	2026-05-14
93922	OTHER	Ankle Arm Screen	8	5	$785.00	$785.15	$510.35	$785.15	$645.00	2026-05-14
29581	OTHER	Appl Multi Layer Ven Wnd Compr	10	5	$263.00	$263.17	$52.63	$263.17	$216.19	2026-05-14
761	OTHER	Application/Rem Cast Or Splint	24	5	$193.00	$193.44	$66.01	$295.93	$158.91	2026-05-14
29065	OTHER	Apply Long Arm Cast Lt	12	5	$207.00	$207.48	$137.65	$186.84	$149.55	2026-05-14
93925	OTHER	Arterial Duplex Le Bi	8	5	$1,039.00	$1,039.58	$675.73	$1,039.58	$854.01	2026-05-14
93926	OTHER	Arterial Duplex Le Lt	8	5	$967.00	$967.51	$628.88	$967.51	$794.81	2026-05-14
83880	OTHER	B Type Natriuretic Peptide	10	5	$307.00	$307.94	$200.16	$307.94	$277.61	2026-05-14
82607	OTHER	B12	10	5	$215.00	$215.12	$139.83	$215.12	$193.93	2026-05-14
80048	OTHER	Basic Metabolic Panel	13	6	$245.00	$245.70	$159.71	$245.70	$233.42	2026-05-14
82232	OTHER	Beta 2 Microglobulin	8	5	$270.00	$270.82	$176.03	$270.82	$222.48	2026-05-14
86146	OTHER	Beta-2-glycoprotein IgG	8	5	$250.00	$250.07	$162.55	$250.07	$205.44	2026-05-14
51798	OTHER	Bladder Scan	10	5	$230.00	$230.41	$149.77	$230.41	$207.71	2026-05-14
36430	OTHER	Blood Administration	10	5	$733.00	$733.82	$146.76	$733.82	$602.84	2026-05-14
82803	OTHER	Blood Gas Wo Oximetry	8	5	$303.00	$303.68	$197.39	$303.68	$249.48	2026-05-14
87493	OTHER	C Diff By Pcr	10	5	$388.00	$388.75	$252.69	$388.75	$350.46	2026-05-14
86140	OTHER	C-reactive Protein	10	5	$232.00	$232.60	$151.19	$232.60	$209.69	2026-05-14
86301	OTHER	Ca 19-9	8	5	$197.00	$197.65	$128.47	$197.65	$162.37	2026-05-14
86300	OTHER	Ca 27-29	8	5	$252.00	$252.25	$163.96	$252.25	$207.22	2026-05-14
83993	OTHER	Calprotectin	8	5	$184.00	$184.55	$119.96	$184.55	$151.60	2026-05-14
93798	OTHER	Cardiac Rehab Ii Monitored	10	5	$346.00	$346.16	$225.00	$346.16	$312.06	2026-05-14
86147	OTHER	Cardiolipin Antibody	8	5	$204.00	$204.20	$132.73	$204.20	$167.75	2026-05-14
99211	OTHER	Care/Removal Urinary Catheter	48	5	$208.00	$208.57	$102.21	$228.80	$159.25	2026-05-14
82379	OTHER	Carnitine Total And Free	8	5	$446.00	$446.63	$290.31	$446.63	$366.91	2026-05-14
82384	OTHER	Catecholamines Fract	8	5	$262.00	$262.08	$170.35	$262.08	$215.30	2026-05-14
P9612	OTHER	Cath For Collecting Specimen	8	5	$330.00	$330.72	$214.97	$330.72	$271.69	2026-05-14
51703	OTHER	Cath Insert Compl Indwelling	8	5	$257.00	$257.71	$167.51	$257.71	$211.71	2026-05-14
51702	OTHER	Cath Insert Simple Indwelling	10	5	$200.00	$200.93	$130.60	$200.93	$181.13	2026-05-14
85025	OTHER	Cbc W Auto Diff	12	6	$165.00	$165.98	$107.89	$165.98	$149.63	2026-05-14
J0717	OTHER	Certolizumab Pegol 400 Mg Kit	8	5	$11,483.00	$11,483.38	$3.42	$11,483.38	$9,330.24	2026-05-14
82390	OTHER	Cerulaplasmin	8	5	$198.00	$198.74	$129.18	$198.74	$163.26	2026-05-14
82507	OTHER	Citric Acid Urine	8	5	$187.00	$187.82	$122.08	$187.82	$154.30	2026-05-14
86200	OTHER	Citrulline Antibody	8	5	$215.00	$215.12	$139.83	$215.12	$176.72	2026-05-14
G0480	OTHER	Clobazam	8	5	$335.00	$335.24	$217.91	$335.24	$275.40	2026-05-14
87497	OTHER	Cmv Quant By Pcr	10	5	$1,263.00	$1,263.44	$821.24	$1,263.44	$1,138.99	2026-05-14
97129	OTHER	Cognitive Skills Development	8	5	$215.00	$215.12	$139.83	$215.12	$176.72	2026-05-14
80053	OTHER	Comprehensive Metabolic Panel	11	5	$233.00	$233.69	$151.90	$233.69	$199.34	2026-05-14
82550	OTHER	Cpk Total	10	5	$197.00	$197.65	$128.47	$197.65	$178.19	2026-05-14
99291	OTHER	Critical Care 1st 30-74 Min	14	5	$1,765.00	$1,765.76	$329.00	$1,765.76	$1,160.99	2026-05-14
99292	OTHER	Critical Care Ea Addl 30 Min	14	5	$440.00	$440.08	$164.83	$440.08	$289.35	2026-05-14
86920	OTHER	Crossmatch Immed Spin	10	5	$226.00	$226.04	$45.21	$226.04	$185.69	2026-05-14
74177	OTHER	CT Abd & Pelv W Contrast	10	5	$6,997.00	$6,997.54	$227.52	$6,997.54	$6,308.28	2026-05-14
74178	OTHER	CT Abd & Pelv Wwo Contrast	8	5	$6,413.00	$6,413.32	$479.88	$6,413.32	$5,210.82	2026-05-14
74176	OTHER	CT Abd & Pelvis Wo Contrast	10	5	$5,832.00	$5,832.37	$95.04	$5,832.37	$5,257.88	2026-05-14
74170	OTHER	CT Abdomen Wwo Dye	10	5	$2,450.00	$2,450.45	$58.22	$2,450.45	$2,209.08	2026-05-14
70496	OTHER	CT Angiography Head W Cont	9	5	$3,666.00	$3,666.94	$246.84	$3,666.94	$3,127.90	2026-05-14
70498	OTHER	CT Angiography Neck W Cont	9	5	$4,232.00	$4,232.59	$278.39	$4,232.59	$3,610.40	2026-05-14
72125	OTHER	CT Cervical Spine Wo Contrast	10	5	$2,610.00	$2,610.97	$172.58	$2,610.97	$2,353.79	2026-05-14
70450	OTHER	CT Head/Brain Wo Contrast	11	5	$2,317.00	$2,317.22	$24.20	$2,317.22	$1,976.59	2026-05-14
73700	OTHER	CT Le Wo Dye Lt	8	5	$3,597.00	$3,597.05	$76.65	$3,597.05	$2,922.60	2026-05-14
72131	OTHER	CT Lumbar Spine Wo Contrast	8	5	$2,610.00	$2,610.97	$234.87	$2,610.97	$2,121.41	2026-05-14
70486	OTHER	CT Maxillofacial Wo Contrast	10	5	$2,610.00	$2,610.97	$187.95	$2,610.97	$2,353.79	2026-05-14
70491	OTHER	CT Soft Tissue Neck W Cont	10	5	$3,518.00	$3,518.42	$357.53	$3,518.42	$3,171.86	2026-05-14
70490	OTHER	CT Soft Tissue Neck Wo Cont	8	5	$3,098.00	$3,098.00	$277.47	$3,098.00	$2,517.12	2026-05-14
70492	OTHER	CT Soft Tissue Neck Wwo Cont	8	5	$3,666.00	$3,666.94	$422.85	$3,666.94	$2,979.39	2026-05-14
71260	OTHER	CT Thorax W Contrast	10	5	$3,586.00	$3,586.13	$80.31	$3,586.13	$3,232.89	2026-05-14
71250	OTHER	CT Thorax Wo Contrast	10	5	$2,541.00	$2,541.08	$71.13	$2,541.08	$2,290.78	2026-05-14
71270	OTHER	CT Thorax Wwo Contrast	8	5	$3,175.00	$3,175.54	$82.17	$3,175.54	$2,580.13	2026-05-14
73200	OTHER	CT Ue Wo Dye Rt	8	5	$3,385.00	$3,385.20	$70.19	$3,385.20	$2,750.47	2026-05-14
74174	OTHER	CTA Abd&Pelv Wwo Dye	8	5	$6,244.00	$6,244.06	$71.13	$6,244.06	$5,073.30	2026-05-14
71275	OTHER	CTA Chest Wwo Contrast	11	5	$4,062.00	$4,062.24	$65.60	$4,062.24	$3,465.09	2026-05-14
87070	OTHER	Culture Bacteria Oth	10	5	$210.00	$210.76	$136.99	$210.76	$190.00	2026-05-14
87040	OTHER	Culture Blood	10	5	$239.00	$239.15	$155.45	$239.15	$215.59	2026-05-14
85379	OTHER	D-dimer Quant	11	5	$456.00	$456.46	$296.70	$456.46	$389.36	2026-05-14
J0881	OTHER	Darbepoetin Alfa 500mcg/ml Syr	8	5	$3,184.00	$3,184.50	$2,069.93	$3,184.50	$2,692.92	2026-05-14
J0897	OTHER	Denosumab 60 Mg/ml Syringe	14	5	$3,337.00	$3,337.00	$9.69	$6,039.29	$3,253.57	2026-05-14
77080	OTHER	Dexa Scan	10	5	$622.00	$622.44	$88.61	$622.44	$561.13	2026-05-14
82627	OTHER	Dheas	10	5	$319.00	$319.96	$207.97	$319.96	$288.44	2026-05-14
80162	OTHER	Digoxin	8	5	$197.00	$197.65	$128.47	$197.65	$162.37	2026-05-14
85613	OTHER	Drvvt	8	5	$373.00	$373.46	$242.75	$373.46	$306.79	2026-05-14
87799	OTHER	Ebv By Pcr Quant	10	5	$1,093.00	$1,093.09	$710.51	$1,093.09	$985.42	2026-05-14
93308	OTHER	Echo Limited	8	5	$1,162.00	$1,162.98	$755.94	$1,162.98	$955.38	2026-05-14
93005	OTHER	EKG Tracing	13	6	$305.00	$305.76	$198.74	$305.76	$290.47	2026-05-14
99282	OTHER	Emergency Room Visit Level 2	10	5	$482.00	$482.66	$313.73	$482.66	$435.12	2026-05-14
99283	OTHER	Emergency Room Visit Level 3	17	6	$690.00	$690.14	$108.68	$690.14	$532.79	2026-05-14
99284	OTHER	Emergency Room Visit Level 4	17	5	$936.00	$936.94	$110.65	$936.94	$623.07	2026-05-14
99285	OTHER	Emergency Room Visit Level 5	16	5	$1,351.00	$1,351.90	$267.73	$1,351.90	$971.34	2026-05-14
86663	OTHER	Epstein Barr Early Antigen	8	5	$215.00	$215.12	$139.83	$215.12	$176.72	2026-05-14
99212	OTHER	Est Patient Level 2 Wound Care	8	5	$289.00	$289.12	$187.93	$289.12	$237.51	2026-05-14
99213	OTHER	Est Patient Level 3 Wound Care	14	5	$317.00	$317.20	$98.49	$317.20	$208.56	2026-05-14
92522	OTHER	Eval St Speech Production	8	5	$318.00	$318.86	$207.26	$318.86	$261.94	2026-05-14
11441	OTHER	Exc Ben Lesion 0.6-1.0 Face	6	5	$405.00	$405.13	$272.97	$364.78	$291.58	2026-05-14
11421	OTHER	Exc Ben Lesion 0.6-1.0 Neck	6	5	$476.00	$476.11	$223.11	$304.78	$238.34	2026-05-14
11401	OTHER	Exc Ben Lesion 0.6-1.0 Trunk	6	5	$376.00	$376.74	$216.16	$289.52	$231.18	2026-05-14
11402	OTHER	Exc Ben Lesion 1.1-2.0 Trunk	6	5	$324.00	$324.32	$236.15	$318.30	$252.56	2026-05-14
11423	OTHER	Exc Ben Lesion 2.1-3.0 Neck	6	5	$303.00	$303.68	$322.18	$431.79	$345.16	2026-05-14
11440	OTHER	Exc Ben Lesion <0.5 Face Ears	6	5	$297.00	$297.02	$221.35	$290.05	$236.12	2026-05-14
11420	OTHER	Exc Ben Lesion <0.5 Neck Ext	6	5	$375.00	$375.65	$169.24	$229.43	$180.87	2026-05-14
11641	OTHER	Exc Mal Lesion 0.6-1.0 Face	16	5	$163.00	$163.80	$106.47	$432.43	$163.80	2026-05-14
11642	OTHER	Exc Mal Lesion 1.1-2.0 Face	14	5	$163.00	$163.80	$106.47	$507.05	$159.71	2026-05-14
11602	OTHER	Exc Mal Lesion 1.1-2.0 Trunk	14	5	$163.00	$163.80	$106.47	$451.89	$159.71	2026-05-14
24075	OTHER	Excise Tumor Arm <3cm Lt	6	5	$345.00	$345.00	$667.44	$901.40	$724.31	2026-05-14
26160	OTHER	Excision Cyst Hand/Finger	6	5	$502.00	$502.32	$655.34	$873.26	$713.68	2026-05-14
93880	OTHER	Extracranial Bilat Study	10	5	$1,214.00	$1,214.30	$242.86	$1,214.30	$997.55	2026-05-14
93971	OTHER	Extremity Study Lt	16	5	$1,039.00	$1,039.58	$675.73	$1,039.58	$854.01	2026-05-14
82728	OTHER	Ferritin	10	5	$176.00	$176.90	$114.98	$176.90	$159.48	2026-05-14
Q5110	OTHER	Filgrastim-aafi 300 Mcg/0.5 Ml	8	5	$177.00	$177.94	$115.66	$927.00	$169.04	2026-05-14
88184	OTHER	Flow Cytometry First Mark	8	5	$480.00	$480.48	$312.31	$480.48	$394.72	2026-05-14
83001	OTHER	Fsh	10	5	$200.00	$200.93	$130.60	$200.93	$181.13	2026-05-14
23500	OTHER	Fx Clavicle Rt	8	5	$237.00	$237.12	$154.13	$237.12	$194.79	2026-05-14
27786	OTHER	Fx Distal Fibula Rt	8	5	$205.00	$205.30	$133.44	$205.30	$168.66	2026-05-14
26750	OTHER	Fx Distal Finger/Thumb Wo Man	8	5	$205.00	$205.30	$133.44	$205.30	$168.66	2026-05-14
25600	OTHER	Fx Distal Radius Lt	8	5	$205.00	$205.30	$133.44	$205.30	$168.66	2026-05-14
26720	OTHER	Fx Finger/Thumb Wo Man	8	5	$205.00	$205.30	$133.44	$205.30	$168.66	2026-05-14
28490	OTHER	Fx Great Toe	8	5	$1,930.00	$1,930.24	$1,254.66	$1,930.24	$1,585.69	2026-05-14
28470	OTHER	Fx Metatarsal	8	5	$647.00	$647.92	$421.15	$647.92	$532.27	2026-05-14
82941	OTHER	Gastrin	8	5	$217.00	$217.31	$141.25	$217.31	$178.52	2026-05-14
J1610	OTHER	Glucagon 1 Mg/ml Vial	8	5	$317.00	$317.68	$98.91	$317.68	$258.12	2026-05-14
82951	OTHER	Glucose Tol 1st 3 Specimens	8	5	$496.00	$496.86	$322.96	$496.86	$408.17	2026-05-14
82952	OTHER	Glucose Tol Addl Spec #1	8	5	$297.00	$297.02	$193.06	$297.02	$244.00	2026-05-14
84703	OTHER	Hcg Beta Qual	10	5	$205.00	$205.30	$133.44	$205.30	$185.08	2026-05-14
81025	OTHER	Hcg Beta Qual Urine	8	5	$205.00	$205.30	$133.44	$205.30	$168.66	2026-05-14
86803	OTHER	Hcv Antibody	8	5	$198.00	$198.74	$129.18	$198.74	$163.26	2026-05-14
G0472	OTHER	Hcv Antibody Screen	8	5	$204.00	$204.20	$132.73	$204.20	$167.75	2026-05-14
86682	OTHER	Helminth Antibody Nos	8	5	$501.00	$501.28	$325.83	$501.28	$411.80	2026-05-14
81256	OTHER	Hemochromat Mutation	8	5	$744.00	$744.74	$484.08	$744.74	$611.80	2026-05-14
83051	OTHER	Hemoglobin Plasma	8	5	$198.00	$198.74	$129.18	$198.74	$163.26	2026-05-14
87536	OTHER	HIV 1 Na Quan	8	5	$500.00	$500.14	$325.09	$500.14	$410.87	2026-05-14
86812	OTHER	Hla B27	8	5	$340.00	$340.70	$221.46	$340.70	$279.88	2026-05-14
J7323	OTHER	Hyaluronate (Euflexxa)20MG/2ML	8	5	$645.00	$645.64	$419.67	$1,787.24	$613.36	2026-05-14
J7325	OTHER	Hylan Polymer A&b 48mg/6ml Syr	8	5	$945.00	$945.00	$614.25	$1,735.19	$897.75	2026-05-14
J1569	OTHER	Immune Glob Gamagar 20gr/200ml	8	5	$4,315.00	$4,315.56	$21.77	$4,315.56	$3,506.39	2026-05-14
J1459	OTHER	Immune Glob Privige 10gr/100ml	8	5	$2,114.00	$2,114.80	$0.29	$2,114.80	$1,718.28	2026-05-14
86334	OTHER	Immunofix Electroph Serum	19	5	$241.00	$241.33	$149.06	$241.33	$205.85	2026-05-14
88341	OTHER	Immunohisto Stain Add Per Spc	8	5	$231.00	$231.92	$150.75	$231.92	$190.53	2026-05-14
88342	OTHER	Immunohisto Stain Init Pr Spec	8	5	$220.00	$220.48	$143.31	$220.48	$181.12	2026-05-14
96360	OTHER	Inf Therapy Hyd Initial	10	5	$283.00	$283.92	$184.55	$283.92	$255.95	2026-05-14
96366	OTHER	Inf Therapy Med Ea Addl Hr	12	5	$181.00	$181.27	$117.83	$181.27	$163.42	2026-05-14
96365	OTHER	Inf Therapy Med Initial	21	5	$283.00	$283.92	$184.55	$397.49	$283.92	2026-05-14
Q5104	OTHER	Infliximab-abda 100 Mg Vial	8	5	$782.00	$782.17	$508.41	$5,119.19	$743.06	2026-05-14
87636	OTHER	Influ & CoV2 Pcr Ceph	8	5	$472.00	$472.84	$307.35	$472.84	$388.44	2026-05-14
87804	OTHER	Influenza A Antigen	19	5	$198.00	$198.74	$123.51	$198.74	$169.53	2026-05-14
87502	OTHER	Influenza A&b By Pcr	8	5	$255.00	$255.53	$166.09	$255.53	$209.92	2026-05-14
99222	OTHER	Inpatient Initial/Obs Mod Comp	6	5	$331.00	$331.97	$202.33	$274.01	$246.06	2026-05-14
99221	OTHER	Inpatient/Obs Initial Low Comp	6	5	$252.00	$252.25	$127.26	$194.22	$157.56	2026-05-14
99233	OTHER	Inpatient/Obs Subsequent High	6	5	$277.00	$277.37	$184.54	$250.08	$204.29	2026-05-14
32551	OTHER	Insertion Chest Tube Rt	14	5	$580.00	$580.32	$297.55	$580.32	$406.43	2026-05-14
J1815	OTHER	Insulin Glar 100Unit/ML 10ml	28	5	$278.50	$279.13	$168.26	$391.85	$258.88	2026-05-14
82330	OTHER	Ionized Calcium	8	5	$349.00	$349.44	$227.14	$349.44	$287.06	2026-05-14
Q9967	OTHER	Iopamidol-370 100 Ml Vial	10	5	$1,500.00	$1,500.00	$253.80	$1,500.00	$1,218.75	2026-05-14
99239	OTHER	IP/Obs Discharge >30 Min	6	5	$269.00	$269.72	$179.47	$243.58	$204.89	2026-05-14
99223	OTHER	IP/Obs Initial High Comp	6	5	$488.00	$488.12	$270.04	$389.40	$334.66	2026-05-14
51700	OTHER	Irrigation Bladder Simple	8	5	$404.00	$404.04	$262.63	$404.04	$331.92	2026-05-14
96375	OTHER	IV Injection Subsequent	11	5	$163.00	$163.80	$106.47	$163.80	$155.61	2026-05-14
96374	OTHER	IV Push Injection Initial	11	5	$283.00	$283.92	$184.55	$283.92	$242.18	2026-05-14
86664	OTHER	Lab-epstein Barr Nuclear Antig	8	5	$215.00	$215.12	$139.83	$215.12	$176.72	2026-05-14
87899	OTHER	Legionella Antigen Urine	37	5	$236.00	$236.96	$48.67	$440.08	$210.51	2026-05-14
83002	OTHER	Lh	10	5	$186.00	$186.73	$121.37	$186.73	$168.33	2026-05-14
86618	OTHER	Lyme Disease Antibody	8	5	$241.00	$241.33	$156.86	$241.33	$198.25	2026-05-14
77067	OTHER	Mammo Screen Implant Bi	30	6	$654.00	$654.11	$388.97	$763.31	$578.89	2026-05-14
83835	OTHER	Metanephrines Urine	8	5	$278.00	$278.46	$181.00	$278.46	$228.75	2026-05-14
83921	OTHER	Methylmalonic Acid	8	5	$494.00	$494.68	$321.54	$494.68	$406.38	2026-05-14
86381	OTHER	Mitochondrial Antibody	8	5	$191.00	$191.10	$124.22	$191.10	$156.99	2026-05-14
70551	OTHER	MRI Brain Wo Contrast	8	5	$4,217.00	$4,217.30	$447.03	$4,217.30	$3,426.56	2026-05-14
70553	OTHER	MRI Brain Wwo Contrast	8	5	$5,243.00	$5,243.78	$729.77	$5,243.78	$4,260.57	2026-05-14
73721	OTHER	MRI Joint Le Wo Dye Lt	16	5	$3,666.00	$3,666.94	$315.18	$3,666.94	$2,979.39	2026-05-14
73221	OTHER	MRI Joint Ue Wo Dye Lt	8	5	$3,385.00	$3,385.20	$408.12	$3,385.20	$2,750.47	2026-05-14
72148	OTHER	MRI Lumbar Spine Wo Dye	8	5	$4,090.00	$4,090.63	$315.18	$4,090.63	$3,323.64	2026-05-14
72141	OTHER	MRI Neck Spine Wo Dye	8	5	$4,512.00	$4,512.14	$233.96	$4,512.14	$3,666.11	2026-05-14
87641	OTHER	Mrsa By Pcr	10	5	$182.00	$182.36	$118.53	$182.36	$164.40	2026-05-14
177	OTHER	Ms-DRG 177	2	1	—	—	$14,264.32	$14,264.32	$14,264.32	2026-05-14
544	OTHER	Ms-DRG 544	2	1	—	—	$10,705.72	$10,705.72	$10,705.72	2026-05-14
812	OTHER	Ms-DRG 812	2	1	—	—	$3,592.12	$3,592.12	$3,592.12	2026-05-14
97605	OTHER	Neg Pressure Wound Dme <50 Cm	10	5	$323.00	$323.23	$210.10	$323.23	$291.39	2026-05-14
97606	OTHER	Neg Pressure Wound Dme >50 Cm	8	5	$436.00	$436.80	$283.92	$436.80	$358.83	2026-05-14
83935	OTHER	Osmolality Urine	10	5	$215.00	$215.12	$139.83	$215.12	$193.93	2026-05-14
97167	OTHER	Ot Eval High Complexity	8	5	$388.00	$388.75	$252.69	$388.75	$319.36	2026-05-14
97165	OTHER	Ot Eval Low Complexity	10	5	$277.00	$277.37	$180.29	$277.37	$250.05	2026-05-14
97166	OTHER	Ot Eval Mod Complexity	8	5	$326.00	$326.51	$212.23	$326.51	$268.23	2026-05-14
87798	OTHER	Parvovirus Pcr	8	5	$188.00	$188.92	$122.80	$188.92	$155.20	2026-05-14
Q5122	OTHER	Pegfilgrastim 6 Mg/0.6 Ml Syr	8	5	$3,890.00	$3,890.75	$2,528.99	$3,939.75	$3,696.21	2026-05-14
Q5111	OTHER	Pegfilgrastim-cbqv 6 Mg/0.6 Ml	8	5	$3,945.00	$3,945.00	$1,112.40	$3,945.00	$3,205.32	2026-05-14
J0561	OTHER	Pen G Benzathine 1200000Un/2ML	8	5	$507.00	$507.78	$260.76	$507.78	$412.57	2026-05-14
81418	OTHER	Pharmacogenomic Geno	8	5	$305.00	$305.76	$198.74	$305.76	$251.18	2026-05-14
90677	OTHER	Pneumo 20 Valent Vacc 0.5 Ml	11	6	$444.00	$444.60	$288.99	$444.60	$422.37	2026-05-14
90732	OTHER	Pneumococcal 23 Vax 0.5 Ml Syr	8	5	$213.00	$213.30	$67.16	$213.30	$173.31	2026-05-14
95810	OTHER	Polysomnogram	8	5	$2,645.00	$2,645.92	$1,719.85	$2,645.92	$2,173.62	2026-05-14
95811	OTHER	Polysomnogram W CPap	8	5	$3,111.00	$3,111.11	$2,022.22	$3,111.11	$2,555.78	2026-05-14
84144	OTHER	Progesterone	10	5	$180.00	$180.18	$117.12	$180.18	$162.43	2026-05-14
84146	OTHER	Prolactin	8	5	$194.00	$194.38	$126.35	$194.38	$159.69	2026-05-14
G0103	OTHER	Psa Screen	10	5	$167.00	$167.08	$108.60	$167.08	$150.62	2026-05-14
84153	OTHER	Psa Total	10	5	$211.00	$211.85	$137.70	$211.85	$190.99	2026-05-14
97161	OTHER	Pt Eval Low Complexity	12	6	$277.00	$277.37	$180.29	$277.37	$263.50	2026-05-14
97162	OTHER	Pt Eval Mod Complexity	10	5	$326.00	$326.51	$65.30	$326.51	$268.23	2026-05-14
83970	OTHER	Pth	10	5	$290.00	$290.47	$188.81	$290.47	$261.86	2026-05-14
82542	OTHER	Pth Like Protein	8	5	$386.00	$386.57	$251.27	$386.57	$317.56	2026-05-14
86638	OTHER	Q Fever Antibody	8	5	$269.00	$269.72	$175.32	$269.72	$221.57	2026-05-14
90377	OTHER	Rabies Imm Glo 300U/2Ml Kedrab	8	5	$1,295.00	$1,295.00	$21.92	$1,295.00	$1,052.19	2026-05-14
90675	OTHER	Rabies Vax Pcec/Pf 2.5Unit Vl	8	5	$614.00	$614.42	$125.24	$614.42	$499.22	2026-05-14
86870	OTHER	Rbc Antibody Identif Panel	8	5	$268.00	$268.63	$174.61	$268.63	$220.68	2026-05-14
97168	OTHER	Re Evaluation Ot	8	5	$218.00	$218.40	$141.96	$218.40	$179.42	2026-05-14
P9016	OTHER	Red Blood Cells Lekoreduced	10	5	$587.00	$587.50	$235.00	$587.50	$482.63	2026-05-14
J0248	OTHER	Remdesivir 100 Mg Vial	8	5	$1,247.00	$1,247.98	$70.71	$1,247.98	$1,013.99	2026-05-14
80069	OTHER	Renal Function Panel	10	5	$321.00	$321.05	$208.68	$321.05	$289.43	2026-05-14
84244	OTHER	Renin	8	5	$245.00	$245.70	$159.71	$245.70	$201.84	2026-05-14
12055	OTHER	Repair Lac Interm 12.6-20.0 Cm	14	5	$182.00	$182.00	$118.30	$824.66	$177.45	2026-05-14
12052	OTHER	Repair Lac Interm 2.6-5.0 Cm	14	5	$172.00	$172.54	$112.15	$559.61	$168.22	2026-05-14
12041	OTHER	Repair Lac Interm <2.5 Cm	14	5	$172.00	$172.54	$112.15	$409.19	$168.22	2026-05-14
12031	OTHER	Repair Lac Intermed <2.5 Cm	6	5	$644.00	$644.28	$307.22	$423.98	$328.60	2026-05-14
0202U	OTHER	Respir Path 22 Targets Biofire	8	5	$1,243.00	$1,243.79	$808.46	$1,243.79	$1,021.77	2026-05-14
J2327	OTHER	Risankizumab-rzaa 600 Mg/10 Ml	8	5	$20,284.00	$20,284.42	$68.09	$20,284.42	$16,481.09	2026-05-14
J3111	OTHER	Romosozumab-aqqg 210 Mg/2.34Ml	8	5	$5,092.00	$5,092.30	$1.56	$5,092.30	$4,137.49	2026-05-14
120	OTHER	Room Medical Unit Semi Private	6	5	$3,565.00	$3,565.00	$2,317.25	$3,565.00	$3,213.85	2026-05-14
129	OTHER	Room Swing Bed Skilled	6	5	$1,013.00	$1,013.00	$658.45	$1,013.00	$913.22	2026-05-14
90679	OTHER	RSVPreF3 Antigen Comp 120 Mcg	8	5	$493.00	$493.00	$125.24	$493.00	$400.56	2026-05-14
86762	OTHER	Rubella IgG	8	5	$235.00	$235.87	$153.32	$235.87	$193.77	2026-05-14
86765	OTHER	Rubeola IgG Antibody	8	5	$187.00	$187.85	$122.10	$187.85	$154.32	2026-05-14
72220	CPT	Sacrum Or Coccyx Min 2 View	6	5	$515.00	$515.42	$335.02	$515.42	$464.65	2026-05-14
87635	OTHER	Sars-cov-2 Amp Probe	10	5	$369.00	$369.10	$239.91	$369.10	$332.75	2026-05-14
87812	OTHER	SarsCoV & Influ Ab Ag By Ia	10	5	$167.00	$167.08	$108.60	$167.08	$150.62	2026-05-14
84270	OTHER	Sex Hormone Binding Globulin	10	5	$271.00	$271.91	$176.74	$271.91	$245.12	2026-05-14
11303	OTHER	Shave Lesion >2.0 Trunk Limb	6	5	$425.00	$425.88	$142.25	$201.52	$152.57	2026-05-14
86015	OTHER	Smooth Muscle Antibody	8	5	$191.00	$191.10	$124.22	$191.10	$156.99	2026-05-14
92523	OTHER	Speech Sound Lang Comprehen	8	5	$692.00	$692.33	$450.01	$692.33	$568.75	2026-05-14
92507	OTHER	Speech Therapy Trmt	8	5	$307.00	$307.94	$200.16	$307.94	$252.97	2026-05-14
88305	OTHER	Surg Path L4	10	5	$412.00	$412.78	$268.31	$412.78	$372.12	2026-05-14
92610	OTHER	Swallow Eval Non Radiol	8	5	$333.00	$333.06	$216.49	$333.06	$273.61	2026-05-14
84481	OTHER	T3 Free	10	5	$245.00	$245.70	$159.71	$245.70	$221.50	2026-05-14
84480	OTHER	T3 Total	10	5	$188.00	$188.92	$122.80	$188.92	$170.31	2026-05-14
80197	OTHER	Tacrolimus	10	5	$412.00	$412.78	$268.31	$412.78	$372.12	2026-05-14
86480	OTHER	Tbint Quantiferon	10	5	$573.00	$573.30	$372.64	$573.30	$516.83	2026-05-14
J3101	OTHER	Tenecteplase 50 Mg/10 Ml Syrng	8	5	$14,016.00	$14,016.04	$0.41	$14,016.04	$11,388.03	2026-05-14
84402	OTHER	Testosterone Fre Female/Child	10	5	$262.00	$262.08	$170.35	$262.08	$236.26	2026-05-14
84403	OTHER	Testosterone Total Ref	28	5	$250.00	$250.07	$151.19	$334.15	$227.41	2026-05-14
83520	OTHER	Thyrotropin Recept Aby	37	5	$386.00	$386.57	$135.57	$516.52	$251.27	2026-05-14
86777	OTHER	Toxoplasma IgG	8	5	$238.00	$238.06	$154.74	$238.06	$195.57	2026-05-14
86778	OTHER	Toxoplasma IgM	8	5	$307.00	$307.94	$200.16	$307.94	$252.97	2026-05-14
689	OTHER	Trauma Team Evaluation Level 5	8	5	$3,910.00	$3,910.45	$2,541.79	$3,910.45	$3,212.44	2026-05-14
G0390	OTHER	Trauma Team Level 5	8	5	$3,910.00	$3,910.45	$2,541.79	$3,910.45	$3,212.44	2026-05-14
84484	OTHER	Troponin Quant	12	5	$239.00	$239.15	$155.45	$239.15	$215.59	2026-05-14
84443	OTHER	Tsh	10	5	$179.00	$179.09	$116.41	$179.09	$161.45	2026-05-14
93306	OTHER	Tte W Doppler Complete	10	5	$1,693.00	$1,693.69	$1,100.90	$1,693.69	$1,526.87	2026-05-14
76770	OTHER	Ultrasound Abdo Back Wall Comp	11	6	$1,202.00	$1,202.29	$781.49	$1,202.29	$1,142.18	2026-05-14
76700	OTHER	Ultrasound Abdomen Complete	8	5	$1,675.00	$1,675.13	$1,088.83	$1,675.13	$1,376.12	2026-05-14
76705	OTHER	Ultrasound Abdomen Limited	19	5	$1,133.00	$1,133.50	$736.77	$1,303.12	$1,076.83	2026-05-14
76775	OTHER	Ultrasound Aorta	8	5	$976.00	$976.25	$634.56	$976.25	$801.99	2026-05-14
76882	OTHER	Ultrasound Axilla Rt	24	5	$536.00	$536.17	$348.51	$1,536.44	$509.36	2026-05-14
76536	OTHER	Ultrasound Head And Neck	10	5	$957.00	$957.68	$191.54	$957.68	$786.74	2026-05-14
76856	OTHER	Ultrasound Pelvic Complete	8	5	$1,247.00	$1,247.06	$810.59	$1,247.06	$1,024.46	2026-05-14
76870	OTHER	Ultrasound Scrotum	8	5	$790.00	$790.61	$513.90	$790.61	$649.49	2026-05-14
76830	OTHER	Ultrasound Transvaginal	8	5	$1,306.00	$1,306.03	$848.92	$1,306.03	$1,072.90	2026-05-14
80202	OTHER	Vancomycin	8	5	$194.00	$194.38	$126.35	$194.38	$159.69	2026-05-14
90750	OTHER	Varicella Zoster Adjuvant Vax	10	5	$319.00	$319.02	$207.36	$319.02	$287.60	2026-05-14
93975	OTHER	Vascular Study	8	5	$1,484.00	$1,484.03	$964.62	$1,484.03	$1,219.13	2026-05-14
93976	OTHER	Vascular Study	8	5	$1,054.00	$1,054.87	$685.67	$1,054.87	$866.58	2026-05-14
J3380	OTHER	Vedolizumab 300 Mg Vial	8	5	$17,955.00	$17,955.94	$72.63	$17,955.94	$14,589.20	2026-05-14
93970	OTHER	Venous Duplex	11	6	$1,262.00	$1,262.35	$820.53	$1,262.35	$1,199.23	2026-05-14
84590	OTHER	Vitamin A	8	5	$245.00	$245.70	$159.71	$245.70	$201.84	2026-05-14
84425	OTHER	Vitamin B1	10	5	$190.00	$190.01	$123.51	$190.01	$171.30	2026-05-14
84207	OTHER	Vitamin B6	10	5	$470.00	$470.65	$305.92	$470.65	$424.29	2026-05-14
74019	OTHER	X-ray Abdomen	11	5	$505.00	$505.60	$328.64	$660.48	$480.32	2026-05-14
74018	OTHER	X-ray Abdomen	11	5	$388.00	$388.75	$252.69	$523.40	$369.31	2026-05-14
73600	OTHER	X-ray Ankle 2 Views Rt	18	5	$336.00	$336.34	$86.75	$336.34	$286.90	2026-05-14
73610	OTHER	X-ray Ankle 3 Views Lt	20	5	$458.00	$458.64	$99.63	$458.64	$413.47	2026-05-14
71045	OTHER	X-ray Chest 1 View	12	5	$393.00	$393.12	$255.53	$593.33	$373.46	2026-05-14
71046	OTHER	X-ray Chest 2v PA/Lateral	11	5	$470.00	$470.65	$305.92	$783.14	$447.12	2026-05-14
73000	OTHER	X-ray Collar Bone Lt	16	5	$440.00	$440.08	$187.04	$440.08	$357.56	2026-05-14
73070	OTHER	X-ray Elbow Lt	16	5	$424.00	$424.79	$41.69	$424.79	$345.14	2026-05-14
73080	OTHER	X-ray Elbow Rt	18	5	$549.00	$549.28	$38.91	$549.28	$468.54	2026-05-14
70030	OTHER	X-ray Eye Fb Detection	8	5	$433.00	$433.52	$281.79	$433.52	$411.84	2026-05-14
70140	OTHER	X-ray Facial Bones < 3 Views	10	5	$574.00	$574.39	$66.51	$574.39	$517.81	2026-05-14
73552	OTHER	X-ray Femur 2 Views Lt	16	5	$479.00	$479.39	$130.01	$479.39	$389.50	2026-05-14
73140	OTHER	X-ray Finger(s) Lt	20	5	$293.00	$293.75	$58.75	$293.75	$250.57	2026-05-14
73620	OTHER	X-ray Foot 2 Views Lt	16	5	$354.00	$354.90	$212.82	$354.90	$288.36	2026-05-14
73630	OTHER	X-ray Foot 3 Views Lt	18	5	$424.00	$424.79	$65.60	$424.79	$362.35	2026-05-14
73090	OTHER	X-ray Forearm 2 Views Lt	16	5	$536.00	$536.17	$282.72	$536.17	$435.63	2026-05-14
73130	OTHER	X-ray Hand Lt	20	5	$446.00	$446.63	$59.16	$446.63	$402.64	2026-05-14
73120	OTHER	X-ray Hand Lt	16	5	$238.00	$238.06	$154.74	$238.06	$201.03	2026-05-14
73502	OTHER	X-ray Hip Uni 2-3 Views Rt	21	5	$331.00	$331.97	$215.78	$860.42	$315.37	2026-05-14
73523	OTHER	X-ray Hips 5 Views Bi	8	5	$349.00	$349.44	$227.14	$690.20	$331.97	2026-05-14
73060	OTHER	X-ray Humerus Lt	16	5	$525.00	$525.25	$67.44	$525.25	$426.76	2026-05-14
73560	OTHER	X-ray Knee 1-2 Views Lt	20	5	$354.00	$354.90	$84.00	$354.90	$319.95	2026-05-14
73562	OTHER	X-ray Knee 3 Views Rt	18	5	$282.00	$282.83	$56.57	$282.83	$229.80	2026-05-14
73590	OTHER	X-ray Lower Leg Lt	16	5	$552.00	$552.55	$73.88	$573.30	$448.11	2026-05-14
72100	OTHER	X-ray Lumbosacral 2-3 Views	10	5	$704.00	$704.34	$90.44	$704.34	$572.27	2026-05-14
72170	OTHER	X-ray Pelvis 1-2 Views	10	5	$393.00	$393.12	$255.53	$393.12	$357.67	2026-05-14
71100	OTHER	X-ray Ribs 2 Views Rt	18	5	$440.00	$440.08	$88.02	$3,616.49	$418.08	2026-05-14
71111	OTHER	X-ray Ribs Bilateral 4 Views	8	5	$626.00	$626.81	$63.74	$626.81	$509.28	2026-05-14
71101	OTHER	X-ray Ribs Uni W Chest Rt	18	5	$488.00	$488.12	$317.28	$3,427.98	$463.71	2026-05-14
72220	OTHER	X-ray Sacrum Tailbone	14	5	$744.00	$744.74	$439.65	$744.74	$489.65	2026-05-14
73010	OTHER	X-ray Shoulder Blade Rt	8	5	$446.00	$446.63	$174.17	$446.63	$362.89	2026-05-14
73030	OTHER	X-ray Shoulder Lt	20	5	$446.00	$446.63	$89.33	$446.63	$380.98	2026-05-14
72040	OTHER	X-ray Spine Cervical 2-3 Views	10	5	$891.00	$891.07	$551.93	$891.07	$803.30	2026-05-14
72052	OTHER	X-ray Spine Cervical 6 Views	8	5	$1,416.00	$1,416.48	$818.73	$1,416.48	$1,150.89	2026-05-14
72081	OTHER	X-ray Spine Scoliosis 1 View	8	5	$511.00	$511.06	$112.53	$511.06	$415.24	2026-05-14
72020	OTHER	X-ray Spine Single View	8	5	$666.00	$666.12	$244.37	$666.12	$541.22	2026-05-14
72070	OTHER	X-ray Spine Thoracic 2 Views	8	5	$722.00	$722.90	$469.88	$1,015.91	$686.76	2026-05-14
72072	OTHER	X-ray Spine Thoracic 3 Views	8	5	$751.00	$751.30	$488.35	$751.30	$697.55	2026-05-14
73660	OTHER	X-ray Toe(s) 2 Views Rt	8	5	$293.00	$293.75	$66.51	$293.75	$238.68	2026-05-14
73100	OTHER	X-ray Wrist 2 Views Lt	16	5	$393.00	$393.12	$66.51	$393.12	$319.41	2026-05-14
73110	OTHER	X-ray Wrist 3 Views Lt	20	5	$446.00	$446.63	$58.22	$446.63	$402.64	2026-05-14

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