Hospital

AVERA DE SMET MEMORIAL HOSPITAL - CAH

De Smet, SD · CCN 431332 · Rates published

731 distinct procedures filed

5 distinct payers

19,724 rate rows

2026-05-21 last MRF observed

Data quality

19,692 of 19,724 rate rows are consumer-grade (99.8%)

32 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
percent-of-charges filed in the dollar field — excluded from medians	16
exceeds 10× this hospital's gross charge — excluded from medians	12
placeholder amount (≤ $0.02) — excluded from medians	4

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

Source MRF file	https://www.avera.org/app/files/public/2e34ab5e-829e-46eb-9b0e-c49857a0ce65/460224604_avera-desmet-hospital_standardcharges.csv
Discovered via	Discovered by HANK (automated)
Last fetch	not_modified · 2026-05-17
Content fingerprint	865cf5d9c6972436… · 2,632,241 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
J3380 OTHER	Vedolizumab 300 Mg Vial	5	$72.63	$37,975.12	$29,401.36	nat. median $24 outlier · 1245.8×
J3101 OTHER	Tenecteplase 50 Mg/10 Ml Syrng	5	$0.41	$30,637.29	$23,056.93	nat. median $195 outlier · 118.2×
641 OTHER	Ms-DRG 641	1	$20,604.70	$20,604.70	$20,604.70	nat. median $8,198 outlier · 2.5×
J0717 OTHER	Certolizumab Pegol 400 Mg Kit	5	$3.42	$25,109.77	$19,440.65	nat. median $5 outlier · 3842.0×
J2506 OTHER	Pegfilgrastim 6 Mg/0.6 Ml Syr	5	$64.98	$19,871.51	$15,385.06	nat. median $124 outlier · 124.0×
536 OTHER	Ms-DRG 536	1	$13,747.64	$13,747.64	$13,747.64	nat. median $8,350 1.6× median
J3111 OTHER	Romosozumab-aqqg 210 Mg/2.34Ml	5	$1.56	$11,171.48	$8,649.26	nat. median $13 outlier · 661.3×
J1569 OTHER	Immune Glob Gamagar 20gr/200ml	5	$21.77	$9,509.65	$7,362.62	nat. median $52 outlier · 141.3×
194 OTHER	Ms-DRG 194	1	$6,890.58	$6,890.58	$6,890.58	nat. median $8,630 0.8× median
192 OTHER	Ms-DRG 192	1	$6,890.58	$6,890.58	$6,890.58	nat. median $6,927 1.0× median
310 OTHER	Ms-DRG 310	1	$6,383.92	$6,383.92	$6,383.92	nat. median $452 outlier · 14.1×
J3032 OTHER	Eptinezumab-jjmr 100Mg/Ml Vial	5	$90.03	$7,920.30	$6,132.11	nat. median $21 outlier · 287.5×
J0897 OTHER	Denosumab 60 Mg/ml Syringe	5	$9.69	$7,349.92	$5,690.51	nat. median $32 outlier · 178.9×
74178 OTHER	CT Abd & Pelv Wwo Contrast	5	$479.88	$7,075.18	$5,324.62	nat. median $495 outlier · 10.8×
74174 OTHER	CTA Abd&Pelv Wwo Dye	5	$71.13	$6,603.76	$5,112.81	nat. median $502 outlier · 10.2×
78452 OTHER	Myocard Perf Spect Rest Stress	5	$1,200.00	$5,850.07	$4,710.21	nat. median $1,353 outlier · 3.5×
74177 OTHER	CT Abd & Pelv W Contrast	5	$227.52	$6,002.36	$4,686.84	nat. median $458 outlier · 10.2×
74176 OTHER	CT Abd & Pelvis Wo Contrast	5	$95.04	$6,002.36	$4,596.54	nat. median $302 outlier · 15.2×
72132 OTHER	CT Lumbar Spine W Contrast	5	$313.35	$4,176.82	$3,233.81	nat. median $437 outlier · 7.4×
74170 OTHER	CT Abdomen Wwo Dye	5	$58.22	$4,252.00	$3,193.25	nat. median $308 outlier · 10.4×
J1439 OTHER	Ferric Carboxymalt 750mg/15ml	5	$11.91	$4,223.00	$3,178.14	nat. median $1 outlier · 2583.9×
689 OTHER	Trauma Team Evaluation Level 5	5	$2,614.30	$3,901.34	$3,141.18	nat. median $11,307 outlier · 0.3×
70498 OTHER	CT Angiography Neck W Cont	5	$278.39	$3,996.40	$3,094.12	nat. median $328 outlier · 9.4×
71275 OTHER	CTA Chest Wwo Contrast	5	$65.60	$4,090.49	$3,078.41	nat. median $311 outlier · 9.9×
70496 OTHER	CT Angiography Head W Cont	5	$246.84	$3,940.14	$3,050.56	nat. median $325 outlier · 9.4×
111 OTHER	Room Medical Unit Priv	5	$2,397.20	$3,577.36	$2,996.50	nat. median $4,074 0.7× median
G0390 OTHER	Trauma Team Level 5	5	$2,490.15	$3,716.07	$2,992.01	nat. median $1,527 2.0× median
71270 OTHER	CT Thorax Wwo Contrast	5	$82.17	$3,827.62	$2,963.44	nat. median $304 outlier · 9.7×
72131 OTHER	CT Lumbar Spine Wo Contrast	5	$234.87	$3,870.30	$2,912.70	nat. median $164 outlier · 17.7×
74160 OTHER	CT Abdomen W Dye	5	$706.77	$3,717.04	$2,877.83	nat. median $297 outlier · 9.7×
93351 OTHER	Stress Tte Complete	5	$2,371.85	$3,539.53	$2,849.87	nat. median $551 outlier · 5.2×
C8929 OTHER	Echo M Mode 2d W Contrast	5	$2,363.40	$3,636.00	$2,839.72	nat. median $961 outlier · 3.0×
70470 OTHER	CT Head/Brain Wwo Contrast	5	$241.32	$3,638.47	$2,817.00	nat. median $276 outlier · 10.2×
93306 OTHER	Tte W Doppler Complete	5	$2,363.40	$3,526.92	$2,806.99	nat. median $609 outlier · 4.6×
74175 OTHER	CTA Abdom Wwo Dye	5	$82.17	$3,588.03	$2,777.95	nat. median $336 outlier · 8.3×
72126 OTHER	CT Cervical Spine W Contrast	5	$214.92	$3,573.48	$2,766.69	nat. median $444 outlier · 6.2×
72129 OTHER	CT Thoracic Spine W Contrast	5	$128.15	$3,549.23	$2,747.91	nat. median $263 outlier · 10.5×
99291 OTHER	Critical Care 1st 30-74 Min	5	$329.00	$3,992.52	$2,706.27	nat. median $887 outlier · 3.1×
71260 OTHER	CT Thorax W Contrast	5	$80.31	$3,521.10	$2,649.90	nat. median $260 outlier · 10.2×
72128 OTHER	CT Thoracic Spine Wo Contrast	5	$107.93	$3,411.49	$2,641.26	nat. median $172 outlier · 15.3×
72125 OTHER	CT Cervical Spine Wo Contrast	5	$172.58	$3,411.49	$2,567.41	nat. median $173 outlier · 14.9×
74150 OTHER	CT Abdomen Wo Dye	5	$791.13	$3,243.68	$2,511.35	nat. median $163 outlier · 15.4×
71250 OTHER	CT Thorax Wo Contrast	5	$71.13	$3,232.04	$2,502.33	nat. median $163 outlier · 15.3×
70450 OTHER	CT Head/Brain Wo Contrast	5	$24.20	$3,029.31	$2,319.72	nat. median $146 outlier · 15.9×
70491 OTHER	CT Soft Tissue Neck W Cont	5	$357.53	$2,989.54	$2,249.86	nat. median $282 outlier · 8.0×
72193 OTHER	CT Pelvis W Dye	5	$593.33	$2,708.24	$2,155.42	nat. median $278 outlier · 7.8×
J0248 OTHER	Remdesivir 100 Mg Vial	5	$70.71	$2,762.23	$2,138.59	nat. median $7 outlier · 295.2×
72192 OTHER	CT Pelvis Wo Dye	5	$597.02	$2,601.54	$2,014.18	nat. median $157 outlier · 12.8×
70490 OTHER	CT Soft Tissue Neck Wo Cont	5	$277.47	$2,673.32	$2,011.88	nat. median $172 outlier · 11.7×
Q5121 OTHER	Infliximab-axxq 100 Mg Vial	5	$1,412.42	$8,501.52	$1,958.91	nat. median $33 outlier · 58.5×

Other procedures at this hospital

Browse this hospital's 731 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

J3380	OTHER	Vedolizumab 300 Mg Vial	16	5	$39,149.00	$37,975.12	$72.63	$37,975.12	$29,401.36	2026-05-21
J3101	OTHER	Tenecteplase 50 Mg/10 Ml Syrng	20	5	$31,584.00	$30,637.29	$0.41	$30,637.29	$23,056.93	2026-05-21
641	OTHER	Ms-DRG 641	4	1	—	—	$20,604.70	$20,604.70	$20,604.70	2026-05-21
J0717	OTHER	Certolizumab Pegol 400 Mg Kit	16	5	$25,886.00	$25,109.77	$3.42	$25,109.77	$19,440.65	2026-05-21
J2506	OTHER	Pegfilgrastim 6 Mg/0.6 Ml Syr	16	5	$20,486.00	$19,871.51	$64.98	$19,871.51	$15,385.06	2026-05-21
536	OTHER	Ms-DRG 536	4	1	—	—	$13,747.64	$13,747.64	$13,747.64	2026-05-21
J3111	OTHER	Romosozumab-aqqg 210 Mg/2.34Ml	16	5	$11,516.00	$11,171.48	$1.56	$11,171.48	$8,649.26	2026-05-21
J1569	OTHER	Immune Glob Gamagar 20gr/200ml	16	5	$9,803.00	$9,509.65	$21.77	$9,509.65	$7,362.62	2026-05-21
194	OTHER	Ms-DRG 194	4	1	—	—	$6,890.58	$6,890.58	$6,890.58	2026-05-21
192	OTHER	Ms-DRG 192	4	1	—	—	$6,890.58	$6,890.58	$6,890.58	2026-05-21
310	OTHER	Ms-DRG 310	4	1	—	—	$6,383.92	$6,383.92	$6,383.92	2026-05-21
J3032	OTHER	Eptinezumab-jjmr 100Mg/Ml Vial	16	5	$8,165.00	$7,920.30	$90.03	$7,920.30	$6,132.11	2026-05-21
J0897	OTHER	Denosumab 60 Mg/ml Syringe	16	5	$7,577.00	$7,349.92	$9.69	$7,349.92	$5,690.51	2026-05-21
74178	OTHER	CT Abd & Pelv Wwo Contrast	20	5	$7,294.00	$7,075.18	$479.88	$7,075.18	$5,324.62	2026-05-21
74174	OTHER	CTA Abd&Pelv Wwo Dye	16	5	$6,808.00	$6,603.76	$71.13	$6,603.76	$5,112.81	2026-05-21
78452	OTHER	Myocard Perf Spect Rest Stress	24	5	$6,031.00	$5,850.07	$1,200.00	$5,850.07	$4,710.21	2026-05-21
74177	OTHER	CT Abd & Pelv W Contrast	24	5	$6,188.00	$6,002.36	$227.52	$6,002.36	$4,686.84	2026-05-21
74176	OTHER	CT Abd & Pelvis Wo Contrast	22	5	$6,188.00	$6,002.36	$95.04	$6,002.36	$4,596.54	2026-05-21
72132	OTHER	CT Lumbar Spine W Contrast	16	5	$4,306.00	$4,176.82	$313.35	$4,176.82	$3,233.81	2026-05-21
74170	OTHER	CT Abdomen Wwo Dye	20	5	$4,252.00	$4,124.44	$58.22	$4,252.00	$3,193.25	2026-05-21
J1439	OTHER	Ferric Carboxymalt 750mg/15ml	20	5	$4,353.00	$4,223.00	$11.91	$4,223.00	$3,178.14	2026-05-21
689	OTHER	Trauma Team Evaluation Level 5	16	5	$4,022.00	$3,901.34	$2,614.30	$3,901.34	$3,141.18	2026-05-21
70498	OTHER	CT Angiography Neck W Cont	20	5	$4,120.00	$3,996.40	$278.39	$3,996.40	$3,094.12	2026-05-21
71275	OTHER	CTA Chest Wwo Contrast	22	5	$4,217.00	$4,090.49	$65.60	$4,090.49	$3,078.41	2026-05-21
70496	OTHER	CT Angiography Head W Cont	20	5	$4,062.00	$3,940.14	$246.84	$3,940.14	$3,050.56	2026-05-21
111	OTHER	Room Medical Unit Priv	12	5	$3,688.00	$3,577.36	$2,397.20	$3,577.36	$2,996.50	2026-05-21
G0390	OTHER	Trauma Team Level 5	16	5	$3,831.00	$3,716.07	$2,490.15	$3,716.07	$2,992.01	2026-05-21
71270	OTHER	CT Thorax Wwo Contrast	16	5	$3,946.00	$3,827.62	$82.17	$3,827.62	$2,963.44	2026-05-21
72131	OTHER	CT Lumbar Spine Wo Contrast	20	5	$3,990.00	$3,870.30	$234.87	$3,870.30	$2,912.70	2026-05-21
74160	OTHER	CT Abdomen W Dye	16	5	$3,832.00	$3,717.04	$706.77	$3,717.04	$2,877.83	2026-05-21
93351	OTHER	Stress Tte Complete	20	5	$3,649.00	$3,539.53	$2,371.85	$3,539.53	$2,849.87	2026-05-21
C8929	OTHER	Echo M Mode 2d W Contrast	20	5	$3,636.00	$3,526.92	$2,363.40	$3,636.00	$2,839.72	2026-05-21
70470	OTHER	CT Head/Brain Wwo Contrast	16	5	$3,751.00	$3,638.47	$241.32	$3,638.47	$2,817.00	2026-05-21
93306	OTHER	Tte W Doppler Complete	22	5	$3,636.00	$3,526.92	$2,363.40	$3,526.92	$2,806.99	2026-05-21
74175	OTHER	CTA Abdom Wwo Dye	16	5	$3,699.00	$3,588.03	$82.17	$3,588.03	$2,777.95	2026-05-21
72126	OTHER	CT Cervical Spine W Contrast	16	5	$3,684.00	$3,573.48	$214.92	$3,573.48	$2,766.69	2026-05-21
72129	OTHER	CT Thoracic Spine W Contrast	16	5	$3,659.00	$3,549.23	$128.15	$3,549.23	$2,747.91	2026-05-21
99291	OTHER	Critical Care 1st 30-74 Min	28	5	$4,116.00	$3,992.52	$329.00	$3,992.52	$2,706.27	2026-05-21
71260	OTHER	CT Thorax W Contrast	22	5	$3,630.00	$3,521.10	$80.31	$3,521.10	$2,649.90	2026-05-21
72128	OTHER	CT Thoracic Spine Wo Contrast	16	5	$3,517.00	$3,411.49	$107.93	$3,411.49	$2,641.26	2026-05-21
72125	OTHER	CT Cervical Spine Wo Contrast	22	5	$3,517.00	$3,411.49	$172.58	$3,411.49	$2,567.41	2026-05-21
74150	OTHER	CT Abdomen Wo Dye	16	5	$3,344.00	$3,243.68	$791.13	$3,243.68	$2,511.35	2026-05-21
71250	OTHER	CT Thorax Wo Contrast	20	5	$3,332.00	$3,232.04	$71.13	$3,232.04	$2,502.33	2026-05-21
70450	OTHER	CT Head/Brain Wo Contrast	22	5	$3,123.00	$3,029.31	$24.20	$3,029.31	$2,319.72	2026-05-21
70491	OTHER	CT Soft Tissue Neck W Cont	20	5	$3,082.00	$2,989.54	$357.53	$2,989.54	$2,249.86	2026-05-21
72193	OTHER	CT Pelvis W Dye	18	5	$2,792.00	$2,708.24	$593.33	$2,708.24	$2,155.42	2026-05-21
J0248	OTHER	Remdesivir 100 Mg Vial	16	5	$2,847.00	$2,762.23	$70.71	$2,762.23	$2,138.59	2026-05-21
72192	OTHER	CT Pelvis Wo Dye	16	5	$2,682.00	$2,601.54	$597.02	$2,601.54	$2,014.18	2026-05-21
70490	OTHER	CT Soft Tissue Neck Wo Cont	20	5	$2,756.00	$2,673.32	$277.47	$2,673.32	$2,011.88	2026-05-21
Q5121	OTHER	Infliximab-axxq 100 Mg Vial	20	5	$2,172.00	$2,107.76	$1,412.42	$8,501.52	$1,958.91	2026-05-21
93925	OTHER	Arterial Duplex Le Bi	20	5	$2,472.00	$2,397.84	$1,606.80	$2,397.84	$1,930.63	2026-05-21
73700	OTHER	CT Le Wo Dye Lt	32	5	$2,512.00	$2,436.64	$76.65	$2,436.64	$1,886.51	2026-05-21
73200	OTHER	CT Ue Wo Dye Lt	32	5	$2,506.00	$2,430.82	$70.19	$2,430.82	$1,882.01	2026-05-21
76700	OTHER	Ultrasound Abdomen Complete	20	5	$2,413.00	$2,340.61	$1,568.45	$2,340.61	$1,812.16	2026-05-21
99285	OTHER	Emergency Room Visit Level 5	34	5	$2,679.00	$2,598.63	$267.73	$2,598.63	$1,781.54	2026-05-21
76770	OTHER	Ultrasound Abdo Back Wall Comp	20	5	$2,306.00	$2,236.82	$1,498.90	$2,236.82	$1,731.81	2026-05-21
93975	OTHER	Vascular Study	20	5	$2,281.00	$2,212.57	$1,482.65	$2,212.57	$1,713.03	2026-05-21
93880	OTHER	Extracranial Bilat Study	22	5	$2,115.00	$2,051.55	$1,374.75	$2,051.55	$1,670.85	2026-05-21
11043	OTHER	Debride Muscle/Fascia 20 Cm	28	5	$2,529.00	$2,453.13	$302.96	$2,453.13	$1,662.82	2026-05-21
93017	OTHER	Cardiovascular Stress Test	24	5	$2,091.00	$2,028.27	$1,359.15	$2,028.27	$1,633.07	2026-05-21
93970	OTHER	Venous Duplex	20	5	$2,160.00	$2,095.20	$1,404.00	$2,095.20	$1,622.16	2026-05-21
Q5104	OTHER	Infliximab-abda 100 Mg Vial	16	5	$1,758.00	$1,705.35	$1,142.76	$5,119.19	$1,584.92	2026-05-21
129	OTHER	Room Swing Bed Skilled	12	5	$1,846.00	$1,790.62	$1,199.90	$1,790.62	$1,499.88	2026-05-21
P9035	OTHER	Platelet Pheresis Leuko Reduc	16	5	$1,913.00	$1,855.61	$1,243.45	$1,855.61	$1,494.05	2026-05-21
93226	OTHER	ECG Monit/Report Up To 48 Hour	16	5	$1,859.00	$1,803.23	$1,208.35	$1,803.23	$1,451.88	2026-05-21
76856	OTHER	Ultrasound Pelvic Complete	16	5	$1,775.00	$1,721.75	$1,153.75	$1,721.75	$1,386.28	2026-05-21
70486	OTHER	CT Maxillofacial Wo Contrast	20	5	$1,894.00	$1,837.18	$187.95	$1,837.18	$1,382.62	2026-05-21
80230	OTHER	Infliximab Qn w/Reflex To Ab,S	20	5	$1,773.00	$1,719.81	$1,152.45	$1,719.81	$1,375.85	2026-05-21
99284	OTHER	Emergency Room Visit Level 4	38	5	$1,877.00	$1,820.69	$184.86	$1,820.69	$1,370.21	2026-05-21
76775	OTHER	Ultrasound Aorta	16	5	$1,729.00	$1,677.13	$1,123.85	$1,677.13	$1,350.35	2026-05-21
93930	OTHER	Duplex Arterial Ue Complete	16	5	$1,603.00	$1,554.91	$1,041.95	$1,554.91	$1,251.94	2026-05-21
81381	OTHER	Hla B*57:01	16	5	$1,590.00	$1,542.30	$1,033.50	$1,542.30	$1,241.79	2026-05-21
94660	OTHER	CPap/BiPap First Day	32	5	$1,582.00	$1,534.54	$753.35	$1,944.85	$1,213.74	2026-05-21
93971	OTHER	Extremity Study Rt	36	5	$1,537.00	$1,490.89	$999.05	$1,537.00	$1,200.39	2026-05-21
11404	OTHER	Exc Ben Lesion 3.1-4.0 Trunk	28	5	$1,788.00	$1,734.36	$334.03	$1,734.36	$1,175.61	2026-05-21
71101	OTHER	X-ray Ribs Uni W Chest Lt	36	5	$1,326.00	$1,286.22	$861.90	$3,427.98	$1,131.08	2026-05-21
90675	OTHER	Rabies Vacc Hmn Post-ex Nonim	16	5	$1,475.00	$1,431.29	$125.24	$1,431.29	$1,108.14	2026-05-21
93926	OTHER	Arterial Duplex Le Rt	20	5	$1,452.00	$1,408.44	$276.40	$1,408.44	$1,090.45	2026-05-21
11042	OTHER	Debride Skin Subq 20 Cm	34	5	$1,614.00	$1,565.58	$120.87	$1,565.58	$1,073.31	2026-05-21
J0881	OTHER	Darbepoet Alfa 40mcg/0.4ml Syr	52	5	$997.00	$967.74	$416.07	$4,588.63	$1,057.62	2026-05-21
82397	OTHER	Infliximab Ab, S	20	5	$1,360.00	$1,319.20	$884.00	$1,319.20	$1,055.36	2026-05-21
72110	OTHER	X-ray Lumbosacral 4 Views	16	5	$1,405.00	$1,362.85	$67.44	$1,362.85	$1,055.16	2026-05-21
76705	OTHER	Ultrasound Abdomen Limited	22	5	$1,344.00	$1,303.68	$844.74	$1,303.68	$1,037.57	2026-05-21
96413	OTHER	Chemotherapy Inf Initial	20	5	$1,337.00	$1,296.89	$869.05	$1,296.89	$1,012.55	2026-05-21
0202U	OTHER	Respir Path 22 Targets Biofire	16	5	$1,296.00	$1,257.12	$842.40	$1,257.12	$1,012.17	2026-05-21
93976	OTHER	Vascular Study	16	5	$1,286.00	$1,247.42	$835.90	$1,247.42	$1,004.37	2026-05-21
93246	OTHER	Ext ECG >7 Days Hook Up	22	5	$1,286.00	$1,247.42	$835.90	$1,247.42	$1,003.08	2026-05-21
93242	OTHER	Ext ECG 48 Hrs -7days Hook Up	20	5	$1,266.00	$1,228.02	$822.90	$1,228.02	$981.79	2026-05-21
11106	OTHER	Incisional Biopsy 1st Lesion	28	5	$1,409.00	$1,366.73	$111.84	$1,366.73	$926.42	2026-05-21
72050	OTHER	X-ray Spine Cervical 4-5 Views	16	5	$1,193.00	$1,157.21	$746.06	$1,157.21	$895.94	2026-05-21
Q0138	OTHER	Ferumoxy 510mg/17ml (non-esrd)	16	5	$1,145.00	$1,111.35	$7.28	$1,111.35	$860.44	2026-05-21
73523	OTHER	X-ray Hips 5 Views Bi	16	5	$1,136.00	$1,101.92	$690.20	$1,101.92	$853.13	2026-05-21
90651	OTHER	9vHPV 3 Dose	16	5	$1,114.00	$1,080.58	$189.30	$1,080.58	$836.62	2026-05-21
84445	OTHER	Tsi	16	5	$1,061.00	$1,029.17	$689.65	$1,029.17	$828.64	2026-05-21
71110	OTHER	X-ray Ribs Bilateral 3 Views	20	5	$1,088.00	$1,055.36	$47.21	$1,055.36	$814.32	2026-05-21
80197	OTHER	Tacrolimus	16	5	$1,042.00	$1,010.74	$677.30	$1,010.74	$813.80	2026-05-21
71100	OTHER	X-ray Ribs 2 Views Lt	36	5	$891.00	$864.27	$579.15	$3,616.49	$803.24	2026-05-21
90684	OTHER	Pneumo Conjugate Vaccine 21 Va	20	5	$1,050.00	$1,018.79	$474.00	$1,050.30	$788.78	2026-05-21
73522	OTHER	X-ray Hips 3-4 Views Bi	16	5	$910.00	$882.70	$591.50	$882.70	$785.07	2026-05-21
90677	OTHER	Pneumo 20 Valent Vacc 0.5 Ml	34	5	$965.00	$936.39	$380.34	$1,050.20	$767.23	2026-05-21
76536	OTHER	Ultrasound Head And Neck	24	5	$971.00	$941.87	$631.15	$941.87	$758.35	2026-05-21
72100	OTHER	X-ray Lumbosacral 2-3 Views	20	5	$1,032.00	$1,001.04	$90.44	$1,001.04	$753.36	2026-05-21
64450	OTHER	Inject Anes Agent Oth Nerve Lt	28	5	$1,124.00	$1,090.28	$83.15	$1,090.28	$739.03	2026-05-21
J1610	OTHER	Glucagon 1 Mg/ml Vial	28	5	$763.00	$740.62	$98.91	$1,287.61	$732.99	2026-05-21
80074	OTHER	Acute Hepatitis Panel	20	5	$930.00	$902.10	$604.50	$1,044.63	$726.33	2026-05-21
99283	OTHER	Emergency Room Visit Level 3	36	5	$1,039.00	$1,007.83	$108.68	$1,007.83	$724.70	2026-05-21
Q9967	OTHER	Iopamidol-370 100 Ml Vial	24	5	$964.00	$935.08	$253.80	$935.08	$723.97	2026-05-21
110	OTHER	Room Custodial Care	12	5	$879.00	$852.63	$571.35	$852.63	$714.19	2026-05-21
80050	OTHER	General Health Panel	24	5	$869.00	$842.93	$564.85	$842.93	$713.88	2026-05-21
92950	OTHER	Heart/Lung Resuscitation Cpr	28	5	$1,042.00	$1,010.74	$275.08	$1,010.74	$685.12	2026-05-21
73564	OTHER	X-ray Knee 4 Lt	34	5	$870.00	$843.90	$129.06	$843.90	$671.64	2026-05-21
72072	OTHER	X-ray Spine Thoracic 3 Views	20	5	$816.00	$791.52	$530.40	$791.52	$663.00	2026-05-21
76870	OTHER	Ultrasound Scrotum	16	5	$846.00	$820.62	$549.90	$820.62	$660.73	2026-05-21
76604	OTHER	Ultrasound Chest	16	5	$841.00	$815.77	$546.65	$815.77	$656.82	2026-05-21
80306	OTHER	Drug Screen Urine Inst Ass Obv	16	5	$825.00	$800.25	$536.25	$800.25	$644.33	2026-05-21
31500	OTHER	Insert Emergency Airway	28	5	$971.00	$941.87	$273.72	$941.87	$638.43	2026-05-21
76830	OTHER	Ultrasound Transvaginal	16	5	$807.00	$782.79	$524.55	$782.79	$630.26	2026-05-21
71046	OTHER	X-ray Chest 2v PA/Lateral	26	5	$738.00	$715.86	$479.70	$783.14	$629.51	2026-05-21
76882	OTHER	US Extremity Nonvasc Limit Rt	36	5	$806.00	$781.82	$523.90	$806.00	$629.49	2026-05-21
P9040	OTHER	Rbc Packed Leuko-reduc Irrad	16	5	$803.00	$778.91	$521.95	$778.91	$627.14	2026-05-21
93325	OTHER	Echo Color Doppler	16	5	$802.00	$777.94	$521.30	$777.94	$626.36	2026-05-21
72040	OTHER	X-ray Spine Cervical 2-3 Views	24	5	$811.00	$786.67	$154.40	$786.67	$592.03	2026-05-21
97606	OTHER	Neg Pressure Wound Dme >50 Cm	16	5	$758.00	$735.26	$492.70	$735.26	$592.00	2026-05-21
88305	OTHER	Surg Path L4	20	5	$749.00	$726.53	$486.85	$749.00	$584.97	2026-05-21
72082	OTHER	X-ray Spine 2-3 View	16	5	$769.00	$745.93	$130.92	$745.93	$577.52	2026-05-21
Q9957	OTHER	Perflutren Lip Micro 2.2mg/2ml	16	5	$764.00	$741.32	$47.75	$741.32	$573.95	2026-05-21
90620	OTHER	MenB 2 Dose IM	16	5	$759.00	$736.23	$254.82	$736.23	$570.01	2026-05-21
96360	OTHER	Inf Therapy Hyd Initial	24	5	$724.00	$702.28	$470.60	$702.28	$565.44	2026-05-21
96365	OTHER	Inf Therapy Med Initial	24	5	$724.00	$702.28	$470.60	$702.28	$565.44	2026-05-21
72070	OTHER	X-ray Spine Thoracic 2 Views	20	5	$695.00	$674.15	$251.70	$1,015.91	$564.69	2026-05-21
73502	OTHER	X-ray Hip Uni 2-3 Views Rt	66	5	$422.00	$409.34	$274.30	$860.42	$561.60	2026-05-21
93922	OTHER	Ankle Arm Screen	20	5	$714.00	$692.58	$464.10	$692.58	$557.63	2026-05-21
74019	OTHER	X-ray Abdomen	20	5	$672.00	$651.84	$436.80	$660.48	$546.00	2026-05-21
99204	OTHER	New Patient Level 4 Wound Care	28	5	$814.00	$789.58	$207.60	$789.58	$535.20	2026-05-21
11402	OTHER	Exc Ben Lesion 1.1-2.0 Trunk	28	5	$814.00	$789.58	$236.15	$789.58	$535.20	2026-05-21
Q9956	OTHER	Perflutren Protein-a Microdota	20	5	$731.00	$709.31	$77.76	$709.31	$533.81	2026-05-21
40650	OTHER	Repr Lip Fll Thckns Vermiln On	28	5	$552.00	$535.44	$358.80	$844.82	$529.92	2026-05-21
93225	OTHER	Holter Monitor Hook Up <48 Hrs	16	5	$678.00	$657.66	$440.70	$657.66	$529.52	2026-05-21
29581	OTHER	Appl Multi Layer Ven Wnd Compr	22	5	$670.00	$649.90	$435.50	$704.00	$529.30	2026-05-21
99282	OTHER	Emergency Room Visit Level 2	24	5	$677.00	$656.69	$440.05	$656.69	$528.74	2026-05-21
73552	OTHER	X-ray Femur 2 Views Lt	40	5	$705.00	$683.85	$130.01	$683.85	$514.65	2026-05-21
73080	OTHER	X-ray Elbow Rt	34	5	$665.00	$645.05	$38.91	$645.05	$513.38	2026-05-21
92524	OTHER	Behavral Qualit Analys Voice	16	5	$655.00	$635.35	$425.75	$635.35	$511.56	2026-05-21
86870	OTHER	Rbc Antibody Identif Panel	16	5	$649.00	$629.53	$421.85	$629.53	$506.87	2026-05-21
70250	OTHER	X-ray Skull < 4 Views	20	5	$686.00	$665.42	$94.25	$665.42	$500.78	2026-05-21
11760	OTHER	Repair Nailbed	28	5	$756.00	$733.32	$221.56	$733.32	$497.07	2026-05-21
83880	OTHER	Pro-b Type Natriuretic Peptide	42	5	$472.00	$457.84	$306.80	$739.14	$495.30	2026-05-21
73130	OTHER	X-ray Hand Lt	40	5	$672.00	$651.84	$59.16	$651.84	$490.56	2026-05-21
70030	OTHER	X-ray Eye Fb Detection	16	5	$542.00	$525.74	$352.30	$5,074.70	$488.62	2026-05-21
87799	OTHER	Ebv By Pcr Quant	16	5	$620.00	$601.40	$403.00	$601.40	$484.22	2026-05-21
87906	OTHER	HIV 1 Sequence Integras Resist	16	5	$601.00	$582.97	$390.65	$582.97	$469.38	2026-05-21
85335	OTHER	Factor 8 Inhibitor	16	5	$599.00	$581.03	$389.35	$581.03	$467.82	2026-05-21
73630	OTHER	X-ray Foot 3 Views Lt	40	5	$634.00	$614.98	$65.60	$614.98	$466.58	2026-05-21
P9016	OTHER	Red Blood Cells Lekoreduced	20	5	$617.00	$598.49	$401.05	$598.49	$463.37	2026-05-21
82610	OTHER	Cystatin C	16	5	$590.00	$572.30	$383.50	$572.30	$460.79	2026-05-21
12053	OTHER	Repair Lac Interm 5.1-7.5 Cm	28	5	$576.00	$558.72	$374.40	$600.32	$459.31	2026-05-21
73110	OTHER	X-ray Wrist 3 Views Lt	40	5	$629.00	$610.13	$58.22	$610.13	$459.17	2026-05-21
73060	OTHER	X-ray Humerus Rt	16	5	$605.00	$586.85	$67.44	$586.85	$454.36	2026-05-21
73030	OTHER	X-ray Shoulder Lt	40	5	$617.00	$598.49	$237.65	$598.49	$450.41	2026-05-21
81206	OTHER	Bcr/abl1 Major Mutation	16	5	$576.00	$558.72	$374.40	$558.72	$449.86	2026-05-21
87637	OTHER	Influ/RSV/CoV2 Pcr Ceph	20	5	$598.00	$580.06	$373.03	$580.06	$449.10	2026-05-21
73562	OTHER	X-ray Knee 3 Views Lt	40	5	$608.00	$589.76	$109.76	$589.76	$447.73	2026-05-21
72220	OTHER	X-ray Sacrum Tailbone	20	5	$605.00	$586.85	$393.25	$586.85	$447.69	2026-05-21
77067	OTHER	Mammography Screening Digital	24	5	$569.00	$551.93	$369.85	$551.93	$444.39	2026-05-21
28400	OTHER	Fx Calcaneus Lt	16	5	$566.00	$549.02	$367.90	$549.02	$442.04	2026-05-21
11045	OTHER	Debride Skin Subq Addl 20 Cm	34	5	$664.00	$644.08	$48.41	$644.08	$441.56	2026-05-21
73560	OTHER	X-ray Knee 1-2 Views Lt	38	5	$571.00	$553.87	$84.00	$553.87	$440.81	2026-05-21
86341	OTHER	Glutmic Acid Decarbox Aby	16	5	$564.00	$547.08	$366.60	$547.08	$440.49	2026-05-21
12034	OTHER	Repair Lac Interm 7.6-12.5 Cm	28	5	$548.00	$531.56	$356.20	$571.03	$437.23	2026-05-21
97598	OTHER	Debride Wound Addl 20 Cm	28	5	$664.00	$644.08	$22.81	$644.08	$436.58	2026-05-21
80175	OTHER	Lamotrigine	16	5	$556.00	$539.32	$361.40	$539.32	$434.24	2026-05-21
93321	OTHER	Doppler Echo Exam Heart	16	5	$556.00	$539.32	$361.40	$539.32	$434.24	2026-05-21
92523	OTHER	Speech Sound Lang Comprehen	20	5	$556.00	$539.32	$361.40	$623.00	$434.24	2026-05-21
71045	OTHER	X-ray Chest 1 View	26	5	$508.00	$492.76	$330.20	$593.33	$433.32	2026-05-21
88184	OTHER	Flow Cytometry First Mark	16	5	$554.00	$537.38	$360.10	$537.38	$432.68	2026-05-21
93308	OTHER	Echo Limited	16	5	$551.00	$534.47	$358.15	$534.47	$430.33	2026-05-21
12052	OTHER	Repair Lac Interm 2.6-5.0 Cm	28	5	$548.00	$531.56	$356.20	$559.61	$429.86	2026-05-21
85303	OTHER	Protein C Activity	16	5	$548.00	$531.56	$356.20	$531.56	$427.99	2026-05-21
73610	OTHER	X-ray Ankle 3 Views Lt	40	5	$580.00	$562.60	$99.63	$562.60	$423.40	2026-05-21
12032	OTHER	Repair Lac Interm 2.6-7.5 Cm	32	5	$548.00	$531.56	$356.20	$534.49	$418.79	2026-05-21
26720	OTHER	Fx Finger/Thumb Wo Man	28	5	$463.00	$449.11	$300.95	$517.16	$418.20	2026-05-21
80299	OTHER	Dexamethasone	20	5	$555.00	$538.35	$108.40	$538.35	$416.80	2026-05-21
73590	OTHER	X-ray Lower Leg Lt	40	5	$564.00	$547.08	$73.88	$547.08	$411.72	2026-05-21
99281	OTHER	Emergency Room Visit Level 1	38	5	$423.00	$410.31	$84.60	$651.84	$410.31	2026-05-21
85379	OTHER	D-dimer Quant	24	5	$499.00	$484.03	$324.35	$484.03	$409.93	2026-05-21
81207	OTHER	Bcr/abl1 Minor Mutation	16	5	$522.00	$506.34	$339.30	$506.34	$407.68	2026-05-21
A9500	OTHER	Radiophar Tc99M Sestamibi Dose	24	5	$521.00	$505.37	$219.20	$505.37	$406.90	2026-05-21
12031	OTHER	Repair Lac Intermed <2.5 Cm	32	5	$548.00	$531.56	$307.22	$531.56	$400.04	2026-05-21
87636	OTHER	Influ & CoV2 Pcr Ceph	16	5	$511.00	$495.67	$332.15	$495.67	$399.09	2026-05-21
10120	OTHER	I&r Foreign Body Simple	32	5	$606.00	$587.82	$215.90	$587.82	$398.44	2026-05-21
80179	OTHER	Salicylate	16	5	$507.00	$491.79	$329.55	$491.79	$395.96	2026-05-21
81241	OTHER	Factor V Leiden Mutation	16	5	$504.00	$488.88	$327.60	$488.88	$393.62	2026-05-21
99236	OTHER	Admit/Discharge Same Day High	12	5	$677.00	$656.69	$322.41	$436.48	$391.90	2026-05-21
12051	OTHER	Repair Lac Interm <2.5 Cm	28	5	$548.00	$531.56	$341.90	$531.56	$391.68	2026-05-21
88342	OTHER	Immunohisto Stain Init Pr Spec	16	5	$501.00	$485.97	$325.65	$485.97	$391.28	2026-05-21
73000	OTHER	X-ray Collar Bone Lt	32	5	$519.00	$503.43	$187.04	$503.43	$389.77	2026-05-21
80053	OTHER	Comprehensive Metabolic Panel	26	5	$455.00	$441.35	$295.75	$441.35	$388.12	2026-05-21
80061	OTHER	Lipid Panel	24	5	$445.00	$431.65	$289.25	$431.65	$379.59	2026-05-21
82653	OTHER	Pancreatic Elastase	16	5	$486.00	$471.42	$315.90	$471.42	$379.56	2026-05-21
73070	OTHER	X-ray Elbow Lt	36	5	$519.00	$503.43	$41.69	$503.43	$378.87	2026-05-21
96125	OTHER	Cognitive Performance Test St	16	5	$484.00	$469.48	$314.60	$469.48	$378.00	2026-05-21
72170	OTHER	X-ray Pelvis 1-2 Views	20	5	$517.00	$501.49	$336.05	$501.49	$377.41	2026-05-21
86361	OTHER	Cd4 Absolute Count	18	5	$477.00	$462.69	$310.05	$462.69	$376.83	2026-05-21
87338	OTHER	H Pylori Antigen Stool	16	5	$480.00	$465.60	$312.00	$465.60	$374.88	2026-05-21
90734	OTHER	Mcv4 Or MenACWY IM	16	5	$499.00	$484.03	$57.95	$484.03	$374.75	2026-05-21
83519	OTHER	Igf Binding Protein 1	16	5	$476.00	$461.72	$309.40	$461.72	$371.75	2026-05-21
92507	OTHER	Speech Therapy Trmt	16	5	$471.00	$456.87	$306.15	$456.87	$367.85	2026-05-21
92522	OTHER	Eval St Speech Production	16	5	$463.00	$449.11	$300.95	$449.11	$361.61	2026-05-21
74018	OTHER	X-ray Abdomen	22	5	$422.00	$409.34	$274.30	$523.40	$359.97	2026-05-21
80143	OTHER	Acetaminophen	16	5	$460.00	$446.20	$299.00	$446.20	$359.26	2026-05-21
92610	OTHER	Swallow Eval Non Radiol	16	5	$459.00	$445.23	$298.35	$445.23	$358.48	2026-05-21
73090	OTHER	X-ray Forearm 2 Views Lt	40	5	$480.00	$465.60	$282.72	$465.60	$350.40	2026-05-21
70100	OTHER	X-ray Mandible < 4 Views	16	5	$457.00	$443.29	$102.20	$443.29	$343.21	2026-05-21
85305	OTHER	Protein S Total	16	5	$437.00	$423.89	$284.05	$423.89	$341.30	2026-05-21
93798	OTHER	Cardiac Rehab Ii Monitored	20	5	$448.00	$434.56	$291.20	$434.56	$339.07	2026-05-21
36430	OTHER	Blood Administration	20	5	$451.00	$437.47	$293.15	$437.47	$338.70	2026-05-21
73120	OTHER	X-ray Hand Rt	16	5	$451.00	$437.47	$198.99	$437.47	$338.70	2026-05-21
85302	OTHER	Protein C Antigen	16	5	$433.00	$420.01	$281.45	$420.01	$338.17	2026-05-21
51700	OTHER	Irrigation Bladder Simple	38	5	$345.00	$334.65	$224.25	$519.00	$337.35	2026-05-21
84402	OTHER	Testosterone Fre Female/Child	20	5	$448.00	$434.56	$64.30	$434.56	$336.45	2026-05-21
86382	OTHER	Rabies Ab Screen	16	5	$430.00	$417.10	$279.50	$417.10	$335.83	2026-05-21
99223	OTHER	IP/Obs Initial High Comp	12	5	$620.00	$601.40	$270.04	$389.40	$334.66	2026-05-21
71271	OTHER	Ldct For Lung Cancer Screen	24	5	$444.00	$430.68	$101.48	$430.68	$333.44	2026-05-21
86644	OTHER	Cmv Antibody IgG	64	5	$423.50	$410.80	$181.35	$575.21	$330.62	2026-05-21
30903	OTHER	Control Anterior Hemorrhage Lt	28	5	$496.00	$481.12	$149.60	$481.12	$326.12	2026-05-21
12041	OTHER	Repair Lac Interm <2.5 Cm	28	5	$441.00	$427.77	$286.65	$427.77	$325.36	2026-05-21
80048	OTHER	Basic Metabolic Panel	22	5	$381.00	$369.57	$247.65	$369.57	$324.99	2026-05-21
51705	OTHER	Suprapubic Cath Change	16	5	$414.00	$401.58	$269.10	$401.58	$323.34	2026-05-21
99306	OTHER	Nf Initial Visit High	12	5	$475.00	$460.75	$264.20	$387.63	$322.74	2026-05-21
85240	OTHER	Factor 8	16	5	$412.00	$399.64	$267.80	$399.64	$321.77	2026-05-21
99205	OTHER	New Patient Level 5 High Comp	12	5	$271.00	$262.87	$282.08	$382.02	$320.46	2026-05-21
86140	OTHER	C-reactive Protein	24	5	$375.00	$363.75	$243.75	$363.75	$319.88	2026-05-21
88312	OTHER	Special Stain Afb	32	5	$409.50	$397.22	$261.95	$403.52	$319.76	2026-05-21
82077	OTHER	Alcohol/Ethanol Auto Analyzer	22	5	$414.00	$401.58	$269.10	$401.58	$319.61	2026-05-21
80069	OTHER	Renal Function Panel	20	5	$425.00	$412.25	$276.25	$412.25	$319.18	2026-05-21
73100	OTHER	X-ray Wrist 2 Views Lt	32	5	$425.00	$412.25	$66.51	$412.25	$319.18	2026-05-21
73020	OTHER	X-ray Shoulder Lt	32	5	$425.00	$412.25	$187.95	$412.25	$319.18	2026-05-21
71120	OTHER	X-ray Sternum 2 Views	16	5	$424.00	$411.28	$79.40	$411.28	$318.42	2026-05-21
87536	OTHER	HIV 1 Na Quan	18	5	$403.00	$390.91	$261.95	$390.91	$318.37	2026-05-21
87517	OTHER	Hep B Na Quan	16	5	$407.00	$394.79	$264.55	$394.79	$317.87	2026-05-21
99292	OTHER	Critical Care Ea Addl 30 Min	28	5	$479.00	$464.63	$164.83	$464.63	$314.95	2026-05-21
J3489	OTHER	Zoledron Ac/Man/H2O 5mg/100ml	16	5	$414.00	$402.39	$17.25	$402.39	$311.54	2026-05-21
87329	OTHER	Giardia Antigen	22	5	$394.00	$382.18	$256.10	$382.18	$311.26	2026-05-21
73620	OTHER	X-ray Foot 2 Views Lt	40	5	$425.00	$412.25	$85.00	$412.25	$310.25	2026-05-21
73600	OTHER	X-ray Ankle 2 Views Rt	36	5	$425.00	$412.25	$86.75	$412.25	$310.25	2026-05-21
83993	OTHER	Calprotectin	20	5	$413.00	$400.61	$268.45	$400.61	$310.16	2026-05-21
73501	OTHER	X-ray Hip Uni 1 View Rt	16	5	$344.00	$333.68	$223.60	$711.09	$310.12	2026-05-21
27530	OTHER	Treat Knee Fracture Rt	16	5	$396.00	$384.12	$257.40	$384.12	$309.27	2026-05-21
27520	OTHER	Treat Kneecap Fracture Lt	16	5	$396.00	$384.12	$257.40	$384.12	$309.27	2026-05-21
26750	OTHER	Fx Distal Finger/Thumb Wo Man	16	5	$396.00	$384.12	$257.40	$384.12	$309.27	2026-05-21
24670	OTHER	Fx Ulna Proximal Wo Man Lt	16	5	$396.00	$384.12	$257.40	$384.12	$309.27	2026-05-21
23500	OTHER	Fx Clavicle Lt	16	5	$396.00	$384.12	$257.40	$384.12	$309.27	2026-05-21
27786	OTHER	Fx Distal Fibula Lt	16	5	$396.00	$384.12	$257.40	$384.12	$309.27	2026-05-21
25600	OTHER	Fx Distal Radius Lt	36	5	$396.00	$384.12	$257.40	$384.12	$305.71	2026-05-21
G0480	OTHER	Nicotine Cotinine	16	5	$391.00	$379.27	$254.15	$379.27	$305.37	2026-05-21
99235	OTHER	Admit/Discharge Same Day Mod	12	5	$519.00	$503.43	$247.05	$334.65	$302.36	2026-05-21
G0438	OTHER	Annual Wellness Visit Initial	12	5	$230.00	$223.10	$184.13	$358.02	$297.00	2026-05-21
26600	OTHER	Fx Metacarpal	16	5	$377.00	$365.69	$245.05	$365.69	$294.44	2026-05-21
25660	OTHER	Dislocate Radiocarpal W Man Lt	16	5	$377.00	$365.69	$245.05	$365.69	$294.44	2026-05-21
25650	OTHER	Fx Ulnar Styloid Lt	16	5	$377.00	$365.69	$245.05	$365.69	$294.44	2026-05-21
25530	OTHER	Fx Ulnar Shaft Wo Man Rt	16	5	$377.00	$365.69	$245.05	$365.69	$294.44	2026-05-21
24650	OTHER	Fx Radial Head/Neck Wo Man Lt	32	5	$377.00	$365.69	$245.05	$365.69	$294.44	2026-05-21
24576	OTHER	Fx Humeral Condylar Wo Man Rt	16	5	$377.00	$365.69	$245.05	$365.69	$294.44	2026-05-21
87529	OTHER	Hsv DNA Amp Probe	16	5	$377.00	$365.69	$245.05	$365.69	$294.44	2026-05-21
82803	OTHER	Blood Gas Wo Oximetry	20	5	$377.00	$365.69	$245.05	$377.00	$294.44	2026-05-21
86318	OTHER	Infectious Mono Test	20	5	$392.00	$380.24	$254.80	$380.24	$294.39	2026-05-21
73660	OTHER	X-ray Toe(s) 2 Views Lt	36	5	$403.00	$390.91	$66.51	$390.91	$294.19	2026-05-21
82670	OTHER	Estradiol Total	22	5	$375.00	$363.75	$69.07	$363.75	$289.50	2026-05-21
97166	OTHER	Ot Eval Mod Complexity	20	5	$385.00	$373.45	$250.25	$373.45	$289.13	2026-05-21
84481	OTHER	T3 Free	20	5	$385.00	$373.45	$85.73	$373.45	$289.13	2026-05-21
87425	OTHER	Rotavirus	18	5	$364.00	$353.08	$236.60	$353.08	$287.56	2026-05-21
97602	OTHER	Debride Wound Non-selective	22	5	$364.00	$353.08	$236.60	$353.08	$287.56	2026-05-21
87493	OTHER	C Diff By Pcr	20	5	$366.00	$355.02	$237.90	$355.02	$285.85	2026-05-21
11300	OTHER	Shave Lesion <0.5 Trunk Limbs	28	5	$431.00	$418.07	$67.60	$418.07	$283.38	2026-05-21
84702	OTHER	Hcg Beta Quan Serum	20	5	$377.00	$365.69	$51.31	$365.69	$283.12	2026-05-21
90632	OTHER	Hepatitis A Vaccine Adult IM	20	5	$314.00	$304.58	$204.10	$345.69	$283.07	2026-05-21
84403	OTHER	Testosterone Total Ref	22	5	$365.00	$354.05	$64.30	$354.05	$281.78	2026-05-21
97162	OTHER	Pt Eval Mod Complexity	22	5	$358.00	$347.26	$208.05	$347.26	$276.38	2026-05-21
87476	OTHER	Lyme Disease DNA Amp Probe	20	5	$368.00	$356.96	$127.80	$356.96	$276.37	2026-05-21
82378	OTHER	Cea	16	5	$353.00	$342.41	$229.45	$342.41	$275.69	2026-05-21
51702	OTHER	Cath Insert Simple Indwelling	42	5	$392.00	$380.24	$188.50	$380.24	$275.50	2026-05-21
82384	OTHER	Catecholamines Fract	20	5	$365.00	$354.05	$63.50	$354.05	$274.12	2026-05-21
12013	OTHER	Repair Lac Simple 2.6-5.0 Cm	44	5	$375.00	$363.75	$109.90	$363.75	$273.75	2026-05-21
12011	OTHER	Repair Lac Simple <2.5 Cm	34	5	$375.00	$363.75	$107.01	$363.75	$273.75	2026-05-21
11104	OTHER	Punch Biopsy 1st Lesion	28	5	$416.00	$403.52	$92.98	$403.52	$273.52	2026-05-21
11102	OTHER	Tangential Biopsy 1st Lesion	32	5	$416.00	$403.52	$45.00	$403.52	$273.52	2026-05-21
85306	OTHER	Protein S Functional	16	5	$347.00	$336.59	$225.55	$336.59	$271.00	2026-05-21
82166	OTHER	Mullerian Inhib Hormone	20	5	$359.00	$348.23	$130.19	$348.23	$269.61	2026-05-21
96367	OTHER	Inf Therapy Med Sequential	42	5	$329.00	$319.13	$98.04	$355.02	$267.18	2026-05-21
87807	OTHER	Rsv	16	5	$342.00	$331.74	$222.30	$331.74	$267.10	2026-05-21
99310	OTHER	Nf Visit High	12	5	$390.00	$378.30	$223.80	$327.84	$266.75	2026-05-21
82746	OTHER	Folic Acid Blood	20	5	$355.00	$344.35	$43.86	$344.35	$266.61	2026-05-21
73140	OTHER	X-ray Finger(s) Lt	40	5	$365.00	$354.05	$64.68	$354.05	$266.45	2026-05-21
86334	OTHER	Immunofix Electroph Serum	20	5	$341.00	$330.77	$221.65	$330.77	$266.32	2026-05-21
86592	OTHER	Rpr	16	5	$341.00	$330.77	$221.65	$330.77	$266.32	2026-05-21
87177	OTHER	Ova And Parasites Smears	20	5	$338.00	$327.86	$219.70	$327.86	$263.98	2026-05-21
J1956	OTHER	Levofloxac/D5W 500mg/100ml Bag	34	5	$368.00	$357.83	$2.07	$357.83	$263.73	2026-05-21
86922	OTHER	Crossmatch Ahg	22	5	$333.00	$323.01	$216.45	$323.01	$263.07	2026-05-21
J2305	OTHER	Nitroglycer/D5W 50mg/250ml Bot	16	5	$349.00	$339.28	$3.20	$339.28	$262.68	2026-05-21
12002	OTHER	Repair Lac Simple 2.6-7.5 Cm	32	5	$375.00	$363.75	$112.84	$363.75	$261.56	2026-05-21

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