Hospital

AVERA DE SMET MEMORIAL HOSPITAL - CAH

De Smet, SD · CCN 431332 · Rates published

730 distinct procedures filed

5 distinct payers

9,866 rate rows

2026-07-15 last MRF observed

Data quality

9,844 of 9,866 rate rows are consumer-grade (99.8%)

22 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	8
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians	6
exceeds 10× this hospital's gross charge — excluded from medians	6
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/2e34ab5e-829e-46eb-9b0e-c49857a0ce65/460224604_avera-desmet-hospital_standardcharges.csv
Discovered via	Discovered by HANK (automated)
Last fetch	not_modified · 2026-11-07
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 HCPCS	Vedolizumab 300 Mg Vial	5	$72.63	$37,975.12	$29,401.36	nat. median $204 outlier · 144.3×
J3101 HCPCS	Tenecteplase 50 Mg/10 Ml Syrng	5	$0.41	$30,637.29	$23,056.93	nat. median $4,042 outlier · 5.7×
641 MS_DRG	Ms-DRG 641	1	$20,604.70	$20,604.70	$20,604.70	nat. median $8,082 outlier · 2.5×
J0717 HCPCS	Certolizumab Pegol 400 Mg Kit	5	$3.42	$25,109.77	$19,440.65	nat. median $1,753 outlier · 11.1×
J2506 HCPCS	Pegfilgrastim 6 Mg/0.6 Ml Syr	5	$64.98	$19,871.51	$15,385.06	nat. median $1,662 outlier · 9.3×
536 MS_DRG	Ms-DRG 536	1	$13,747.64	$13,747.64	$13,747.64	nat. median $8,421 1.6× median
J3111 HCPCS	Romosozumab-aqqg 210 Mg/2.34Ml	5	$1.56	$11,171.48	$8,649.26	nat. median $734 outlier · 11.8×
J1569 HCPCS	Immune Glob Gamagar 20gr/200ml	5	$21.77	$9,509.65	$7,362.62	nat. median $1,075 outlier · 6.9×
194 MS_DRG	Ms-DRG 194	1	$6,890.58	$6,890.58	$6,890.58	nat. median $8,489 0.8× median
192 MS_DRG	Ms-DRG 192	1	$6,890.58	$6,890.58	$6,890.58	nat. median $7,101 1.0× median
310 MS_DRG	Ms-DRG 310	1	$6,383.92	$6,383.92	$6,383.92	nat. median $6,281 1.0× median
J3032 HCPCS	Eptinezumab-jjmr 100Mg/Ml Vial	5	$90.03	$7,920.30	$6,132.11	nat. median $84 outlier · 73.4×
J0897 HCPCS	Denosumab 60 Mg/ml Syringe	5	$9.69	$7,349.92	$5,690.51	nat. median $1,990 outlier · 2.9×
74174 CPT	CTA Abd&Pelv Wwo Dye	5	$4,425.20	$6,603.76	$5,531.50	nat. median $980 outlier · 5.6×
74178 CPT	CT Abd & Pelv Wwo Contrast	5	$479.88	$7,075.18	$5,324.62	nat. median $1,023 outlier · 5.2×
78452 CPT	Myocard Perf Spect Rest Stress	5	$1,200.00	$5,850.07	$4,710.21	nat. median $1,797 outlier · 2.6×
74177 CPT	CT Abd & Pelv W Contrast	5	$227.52	$6,002.36	$4,686.84	nat. median $970 outlier · 4.8×
74176 CPT	CT Abd & Pelvis Wo Contrast	5	$95.04	$6,002.36	$4,596.54	nat. median $691 outlier · 6.6×
71275 CPT	CTA Chest Wwo Contrast	5	$2,741.05	$4,090.49	$3,255.52	nat. median $753 outlier · 4.3×
72132 CPT	CT Lumbar Spine W Contrast	5	$313.35	$4,176.82	$3,233.81	nat. median $764 outlier · 4.2×
74170 CPT	CT Abdomen Wwo Dye	5	$58.22	$4,252.00	$3,193.25	nat. median $710 outlier · 4.5×
J1439 HCPCS	Ferric Carboxymalt 750mg/15ml	5	$11.91	$4,223.00	$3,178.14	nat. median $19 outlier · 163.1×
689 CDM	Trauma Team Evaluation Level 5	5	$2,614.30	$3,901.34	$3,141.18	nat. median $1,169 outlier · 2.7×
70498 CPT	CT Angiography Neck W Cont	5	$278.39	$3,996.40	$3,094.12	nat. median $735 outlier · 4.2×
70496 CPT	CT Angiography Head W Cont	5	$246.84	$3,940.14	$3,050.56	nat. median $741 outlier · 4.1×
111 CDM	Room Medical Unit Priv	5	$2,397.20	$3,577.36	$2,996.50	nat. median $434 outlier · 6.9×
G0390 HCPCS	Trauma Team Level 5	5	$2,490.15	$3,716.07	$2,992.01	nat. median $3,222 0.9× median
71270 CPT	CT Thorax Wwo Contrast	5	$82.17	$3,827.62	$2,963.44	nat. median $678 outlier · 4.4×
72131 CPT	CT Lumbar Spine Wo Contrast	5	$234.87	$3,870.30	$2,912.70	nat. median $457 outlier · 6.4×
74160 CPT	CT Abdomen W Dye	5	$706.77	$3,717.04	$2,877.83	nat. median $650 outlier · 4.4×
93351 CPT	Stress Tte Complete	5	$2,371.85	$3,539.53	$2,849.87	nat. median $814 outlier · 3.5×
C8929 HCPCS	Echo M Mode 2d W Contrast	5	$2,363.40	$3,636.00	$2,839.72	nat. median $1,358 outlier · 2.1×
70470 CPT	CT Head/Brain Wwo Contrast	5	$241.32	$3,638.47	$2,817.00	nat. median $618 outlier · 4.6×
93306 CPT	Tte W Doppler Complete	5	$2,363.40	$3,526.92	$2,806.99	nat. median $988 outlier · 2.8×
74175 CPT	CTA Abdom Wwo Dye	5	$82.17	$3,588.03	$2,777.95	nat. median $714 outlier · 3.9×
72126 CPT	CT Cervical Spine W Contrast	5	$214.92	$3,573.48	$2,766.69	nat. median $756 outlier · 3.7×
72129 CPT	CT Thoracic Spine W Contrast	5	$128.15	$3,549.23	$2,747.91	nat. median $576 outlier · 4.8×
99291 CPT	Critical Care 1st 30-74 Min	5	$329.00	$3,992.52	$2,706.27	nat. median $1,519 1.8× median
71260 CPT	CT Thorax W Contrast	5	$80.31	$3,521.10	$2,649.90	nat. median $647 outlier · 4.1×
72128 CPT	CT Thoracic Spine Wo Contrast	5	$107.93	$3,411.49	$2,641.26	nat. median $458 outlier · 5.8×
72125 CPT	CT Cervical Spine Wo Contrast	5	$172.58	$3,411.49	$2,567.41	nat. median $471 outlier · 5.5×
74150 CPT	CT Abdomen Wo Dye	5	$791.13	$3,243.68	$2,511.35	nat. median $448 outlier · 5.6×
71250 CPT	CT Thorax Wo Contrast	5	$71.13	$3,232.04	$2,502.33	nat. median $463 outlier · 5.4×
70450 CPT	CT Head/Brain Wo Contrast	5	$2,029.95	$3,029.31	$2,410.96	nat. median $446 outlier · 5.4×
70491 CPT	CT Soft Tissue Neck W Cont	5	$357.53	$2,989.54	$2,249.86	nat. median $626 outlier · 3.6×
72193 CPT	CT Pelvis W Dye	5	$593.33	$2,708.24	$2,155.42	nat. median $636 outlier · 3.4×
J0248 HCPCS	Remdesivir 100 Mg Vial	5	$70.71	$2,762.23	$2,138.59	nat. median $516 outlier · 4.1×
72192 CPT	CT Pelvis Wo Dye	5	$597.02	$2,601.54	$2,014.18	nat. median $455 outlier · 4.4×
70490 CPT	CT Soft Tissue Neck Wo Cont	5	$277.47	$2,673.32	$2,011.88	nat. median $448 outlier · 4.5×
Q5121 HCPCS	Infliximab-axxq 100 Mg Vial	5	$1,412.42	$8,501.52	$1,958.91	nat. median $209 outlier · 9.4×

Other procedures at this hospital

Browse this hospital's 730 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

90651	CPT	9vHPV 3 Dose	8	5	$1,114.00	$1,080.58	$189.30	$1,080.58	$836.62	2026-07-15
80143	CPT	Acetaminophen	8	5	$460.00	$446.20	$299.00	$446.20	$359.26	2026-07-15
80074	CPT	Acute Hepatitis Panel	10	5	$930.00	$902.10	$604.50	$1,044.63	$726.33	2026-07-15
99236	CPT	Admit/Discharge Same Day High	6	5	$677.00	$656.69	$322.41	$436.48	$391.90	2026-07-15
99235	CPT	Admit/Discharge Same Day Mod	6	5	$519.00	$503.43	$247.05	$334.65	$302.36	2026-07-15
82077	CPT	Alcohol/Ethanol Auto Analyzer	11	5	$414.00	$401.58	$269.10	$401.58	$319.61	2026-07-15
93922	CPT	Ankle Arm Screen	10	5	$714.00	$692.58	$464.10	$692.58	$557.63	2026-07-15
G0438	HCPCS	Annual Wellness Visit Initial	6	5	$230.00	$223.10	$184.13	$358.02	$297.00	2026-07-15
29581	CPT	Appl Multi Layer Ven Wnd Compr	11	5	$670.00	$649.90	$435.50	$704.00	$529.30	2026-07-15
93925	CPT	Arterial Duplex Le Bi	10	5	$2,472.00	$2,397.84	$1,606.80	$2,397.84	$1,930.63	2026-07-15
93926	CPT	Arterial Duplex Le Rt	10	5	$1,452.00	$1,408.44	$276.40	$1,408.44	$1,090.45	2026-07-15
80048	CPT	Basic Metabolic Panel	11	5	$381.00	$369.57	$247.65	$369.57	$324.99	2026-07-15
81206	CPT	Bcr/abl1 Major Mutation	8	5	$576.00	$558.72	$374.40	$558.72	$449.86	2026-07-15
81207	CPT	Bcr/abl1 Minor Mutation	8	5	$522.00	$506.34	$339.30	$506.34	$407.68	2026-07-15
92524	CPT	Behavral Qualit Analys Voice	8	5	$655.00	$635.35	$425.75	$635.35	$511.56	2026-07-15
36430	CPT	Blood Administration	10	5	$451.00	$437.47	$293.15	$437.47	$338.70	2026-07-15
82803	CPT	Blood Gas Wo Oximetry	10	5	$377.00	$365.69	$245.05	$377.00	$294.44	2026-07-15
87493	CPT	C Diff By Pcr	10	5	$366.00	$355.02	$237.90	$355.02	$285.85	2026-07-15
86140	CPT	C-reactive Protein	12	5	$375.00	$363.75	$243.75	$363.75	$319.88	2026-07-15
83993	CPT	Calprotectin	10	5	$413.00	$400.61	$268.45	$400.61	$310.16	2026-07-15
93798	CPT	Cardiac Rehab Ii Monitored	10	5	$448.00	$434.56	$291.20	$434.56	$339.07	2026-07-15
93017	CPT	Cardiovascular Stress Test	12	5	$2,091.00	$2,028.27	$1,359.15	$2,028.27	$1,633.07	2026-07-15
82384	CPT	Catecholamines Fract	10	5	$365.00	$354.05	$63.50	$354.05	$274.12	2026-07-15
51702	CPT	Cath Insert Simple Indwelling	21	5	$392.00	$380.24	$188.50	$380.24	$275.50	2026-07-15
86361	CPT	Cd4 Absolute Count	9	5	$477.00	$462.69	$310.05	$462.69	$376.83	2026-07-15
82378	CPT	Cea	8	5	$353.00	$342.41	$229.45	$342.41	$275.69	2026-07-15
J0717	HCPCS	Certolizumab Pegol 400 Mg Kit	8	5	$25,886.00	$25,109.77	$3.42	$25,109.77	$19,440.65	2026-07-15
96413	CPT	Chemotherapy Inf Initial	10	5	$1,337.00	$1,296.89	$869.05	$1,296.89	$1,012.55	2026-07-15
86644	CPT	Cmv Antibody IgG	32	5	$423.50	$410.80	$181.35	$575.21	$330.62	2026-07-15
96125	CPT	Cognitive Performance Test St	8	5	$484.00	$469.48	$314.60	$469.48	$378.00	2026-07-15
80053	CPT	Comprehensive Metabolic Panel	13	5	$455.00	$441.35	$295.75	$441.35	$388.12	2026-07-15
30903	CPT	Control Anterior Hemorrhage Lt	14	5	$496.00	$481.12	$149.60	$481.12	$326.12	2026-07-15
94660	CPT	CPap/BiPap First Day	16	5	$1,582.00	$1,534.54	$753.35	$1,944.85	$1,213.74	2026-07-15
99291	CPT	Critical Care 1st 30-74 Min	14	5	$4,116.00	$3,992.52	$329.00	$3,992.52	$2,706.27	2026-07-15
99292	CPT	Critical Care Ea Addl 30 Min	14	5	$479.00	$464.63	$164.83	$464.63	$314.95	2026-07-15
86922	CPT	Crossmatch Ahg	11	5	$333.00	$323.01	$216.45	$323.01	$263.07	2026-07-15
74177	CPT	CT Abd & Pelv W Contrast	12	5	$6,188.00	$6,002.36	$227.52	$6,002.36	$4,686.84	2026-07-15
74178	CPT	CT Abd & Pelv Wwo Contrast	10	5	$7,294.00	$7,075.18	$479.88	$7,075.18	$5,324.62	2026-07-15
74176	CPT	CT Abd & Pelvis Wo Contrast	11	5	$6,188.00	$6,002.36	$95.04	$6,002.36	$4,596.54	2026-07-15
74160	CPT	CT Abdomen W Dye	8	5	$3,832.00	$3,717.04	$706.77	$3,717.04	$2,877.83	2026-07-15
74150	CPT	CT Abdomen Wo Dye	8	5	$3,344.00	$3,243.68	$791.13	$3,243.68	$2,511.35	2026-07-15
74170	CPT	CT Abdomen Wwo Dye	10	5	$4,252.00	$4,124.44	$58.22	$4,252.00	$3,193.25	2026-07-15
70496	CPT	CT Angiography Head W Cont	10	5	$4,062.00	$3,940.14	$246.84	$3,940.14	$3,050.56	2026-07-15
70498	CPT	CT Angiography Neck W Cont	10	5	$4,120.00	$3,996.40	$278.39	$3,996.40	$3,094.12	2026-07-15
72126	CPT	CT Cervical Spine W Contrast	8	5	$3,684.00	$3,573.48	$214.92	$3,573.48	$2,766.69	2026-07-15
72125	CPT	CT Cervical Spine Wo Contrast	11	5	$3,517.00	$3,411.49	$172.58	$3,411.49	$2,567.41	2026-07-15
70450	CPT	CT Head/Brain Wo Contrast	9	5	$3,123.00	$3,029.31	$2,029.95	$3,029.31	$2,410.96	2026-07-15
70470	CPT	CT Head/Brain Wwo Contrast	8	5	$3,751.00	$3,638.47	$241.32	$3,638.47	$2,817.00	2026-07-15
73700	CPT	CT Le Wo Dye Lt	16	5	$2,512.00	$2,436.64	$76.65	$2,436.64	$1,886.51	2026-07-15
72132	CPT	CT Lumbar Spine W Contrast	8	5	$4,306.00	$4,176.82	$313.35	$4,176.82	$3,233.81	2026-07-15
72131	CPT	CT Lumbar Spine Wo Contrast	10	5	$3,990.00	$3,870.30	$234.87	$3,870.30	$2,912.70	2026-07-15
70486	CPT	CT Maxillofacial Wo Contrast	10	5	$1,894.00	$1,837.18	$187.95	$1,837.18	$1,382.62	2026-07-15
72193	CPT	CT Pelvis W Dye	9	5	$2,792.00	$2,708.24	$593.33	$2,708.24	$2,155.42	2026-07-15
72192	CPT	CT Pelvis Wo Dye	8	5	$2,682.00	$2,601.54	$597.02	$2,601.54	$2,014.18	2026-07-15
70491	CPT	CT Soft Tissue Neck W Cont	10	5	$3,082.00	$2,989.54	$357.53	$2,989.54	$2,249.86	2026-07-15
70490	CPT	CT Soft Tissue Neck Wo Cont	10	5	$2,756.00	$2,673.32	$277.47	$2,673.32	$2,011.88	2026-07-15
72129	CPT	CT Thoracic Spine W Contrast	8	5	$3,659.00	$3,549.23	$128.15	$3,549.23	$2,747.91	2026-07-15
72128	CPT	CT Thoracic Spine Wo Contrast	8	5	$3,517.00	$3,411.49	$107.93	$3,411.49	$2,641.26	2026-07-15
71260	CPT	CT Thorax W Contrast	11	5	$3,630.00	$3,521.10	$80.31	$3,521.10	$2,649.90	2026-07-15
71250	CPT	CT Thorax Wo Contrast	10	5	$3,332.00	$3,232.04	$71.13	$3,232.04	$2,502.33	2026-07-15
71270	CPT	CT Thorax Wwo Contrast	8	5	$3,946.00	$3,827.62	$82.17	$3,827.62	$2,963.44	2026-07-15
73200	CPT	CT Ue Wo Dye Lt	16	5	$2,506.00	$2,430.82	$70.19	$2,430.82	$1,882.01	2026-07-15
74174	CPT	CTA Abd&Pelv Wwo Dye	6	5	$6,808.00	$6,603.76	$4,425.20	$6,603.76	$5,531.50	2026-07-15
74175	CPT	CTA Abdom Wwo Dye	8	5	$3,699.00	$3,588.03	$82.17	$3,588.03	$2,777.95	2026-07-15
71275	CPT	CTA Chest Wwo Contrast	9	5	$4,217.00	$4,090.49	$2,741.05	$4,090.49	$3,255.52	2026-07-15
82610	CPT	Cystatin C	8	5	$590.00	$572.30	$383.50	$572.30	$460.79	2026-07-15
85379	CPT	D-dimer Quant	12	5	$499.00	$484.03	$324.35	$484.03	$409.93	2026-07-15
J0881	HCPCS	Darbepoet Alfa 40mcg/0.4ml Syr	26	5	$997.00	$967.74	$416.07	$4,588.63	$1,057.62	2026-07-15
11043	CPT	Debride Muscle/Fascia 20 Cm	14	5	$2,529.00	$2,453.13	$302.96	$2,453.13	$1,662.82	2026-07-15
11042	CPT	Debride Skin Subq 20 Cm	17	5	$1,614.00	$1,565.58	$120.87	$1,565.58	$1,073.31	2026-07-15
11045	CPT	Debride Skin Subq Addl 20 Cm	17	5	$664.00	$644.08	$48.41	$644.08	$441.56	2026-07-15
97598	CPT	Debride Wound Addl 20 Cm	14	5	$664.00	$644.08	$22.81	$644.08	$436.58	2026-07-15
97602	CPT	Debride Wound Non-selective	11	5	$364.00	$353.08	$236.60	$353.08	$287.56	2026-07-15
J0897	HCPCS	Denosumab 60 Mg/ml Syringe	8	5	$7,577.00	$7,349.92	$9.69	$7,349.92	$5,690.51	2026-07-15
80299	CPT	Dexamethasone	10	5	$555.00	$538.35	$108.40	$538.35	$416.80	2026-07-15
25660	CPT	Dislocate Radiocarpal W Man Lt	8	5	$377.00	$365.69	$245.05	$365.69	$294.44	2026-07-15
93321	CPT	Doppler Echo Exam Heart	8	5	$556.00	$539.32	$361.40	$539.32	$434.24	2026-07-15
80306	CPT	Drug Screen Urine Inst Ass Obv	8	5	$825.00	$800.25	$536.25	$800.25	$644.33	2026-07-15
93930	CPT	Duplex Arterial Ue Complete	8	5	$1,603.00	$1,554.91	$1,041.95	$1,554.91	$1,251.94	2026-07-15
87799	CPT	Ebv By Pcr Quant	8	5	$620.00	$601.40	$403.00	$601.40	$484.22	2026-07-15
93226	CPT	ECG Monit/Report Up To 48 Hour	8	5	$1,859.00	$1,803.23	$1,208.35	$1,803.23	$1,451.88	2026-07-15
93325	CPT	Echo Color Doppler	8	5	$802.00	$777.94	$521.30	$777.94	$626.36	2026-07-15
93308	CPT	Echo Limited	8	5	$551.00	$534.47	$358.15	$534.47	$430.33	2026-07-15
C8929	HCPCS	Echo M Mode 2d W Contrast	10	5	$3,636.00	$3,526.92	$2,363.40	$3,636.00	$2,839.72	2026-07-15
99281	CPT	Emergency Room Visit Level 1	19	5	$423.00	$410.31	$84.60	$651.84	$410.31	2026-07-15
99282	CPT	Emergency Room Visit Level 2	12	5	$677.00	$656.69	$440.05	$656.69	$528.74	2026-07-15
99283	CPT	Emergency Room Visit Level 3	18	5	$1,039.00	$1,007.83	$108.68	$1,007.83	$724.70	2026-07-15
99284	CPT	Emergency Room Visit Level 4	19	5	$1,877.00	$1,820.69	$184.86	$1,820.69	$1,370.21	2026-07-15
99285	CPT	Emergency Room Visit Level 5	17	5	$2,679.00	$2,598.63	$267.73	$2,598.63	$1,781.54	2026-07-15
J3032	HCPCS	Eptinezumab-jjmr 100Mg/Ml Vial	8	5	$8,165.00	$7,920.30	$90.03	$7,920.30	$6,132.11	2026-07-15
82670	CPT	Estradiol Total	11	5	$375.00	$363.75	$69.07	$363.75	$289.50	2026-07-15
92522	CPT	Eval St Speech Production	8	5	$463.00	$449.11	$300.95	$449.11	$361.61	2026-07-15
11402	CPT	Exc Ben Lesion 1.1-2.0 Trunk	14	5	$814.00	$789.58	$236.15	$789.58	$535.20	2026-07-15
11404	CPT	Exc Ben Lesion 3.1-4.0 Trunk	14	5	$1,788.00	$1,734.36	$334.03	$1,734.36	$1,175.61	2026-07-15
93242	CPT	Ext ECG 48 Hrs -7days Hook Up	10	5	$1,266.00	$1,228.02	$822.90	$1,228.02	$981.79	2026-07-15
93246	CPT	Ext ECG >7 Days Hook Up	11	5	$1,286.00	$1,247.42	$835.90	$1,247.42	$1,003.08	2026-07-15
93880	CPT	Extracranial Bilat Study	11	5	$2,115.00	$2,051.55	$1,374.75	$2,051.55	$1,670.85	2026-07-15
93971	CPT	Extremity Study Rt	18	5	$1,537.00	$1,490.89	$999.05	$1,537.00	$1,200.39	2026-07-15
85240	CPT	Factor 8	8	5	$412.00	$399.64	$267.80	$399.64	$321.77	2026-07-15
85335	CPT	Factor 8 Inhibitor	8	5	$599.00	$581.03	$389.35	$581.03	$467.82	2026-07-15
81241	CPT	Factor V Leiden Mutation	8	5	$504.00	$488.88	$327.60	$488.88	$393.62	2026-07-15
J1439	HCPCS	Ferric Carboxymalt 750mg/15ml	10	5	$4,353.00	$4,223.00	$11.91	$4,223.00	$3,178.14	2026-07-15
Q0138	HCPCS	Ferumoxy 510mg/17ml (non-esrd)	8	5	$1,145.00	$1,111.35	$7.28	$1,111.35	$860.44	2026-07-15
88184	CPT	Flow Cytometry First Mark	8	5	$554.00	$537.38	$360.10	$537.38	$432.68	2026-07-15
82746	CPT	Folic Acid Blood	10	5	$355.00	$344.35	$43.86	$344.35	$266.61	2026-07-15
28400	CPT	Fx Calcaneus Lt	8	5	$566.00	$549.02	$367.90	$549.02	$442.04	2026-07-15
23500	CPT	Fx Clavicle Lt	8	5	$396.00	$384.12	$257.40	$384.12	$309.27	2026-07-15
27786	CPT	Fx Distal Fibula Lt	8	5	$396.00	$384.12	$257.40	$384.12	$309.27	2026-07-15
26750	CPT	Fx Distal Finger/Thumb Wo Man	8	5	$396.00	$384.12	$257.40	$384.12	$309.27	2026-07-15
25600	CPT	Fx Distal Radius Lt	18	5	$396.00	$384.12	$257.40	$384.12	$305.71	2026-07-15
26720	CPT	Fx Finger/Thumb Wo Man	14	5	$463.00	$449.11	$300.95	$517.16	$418.20	2026-07-15
24576	CPT	Fx Humeral Condylar Wo Man Rt	8	5	$377.00	$365.69	$245.05	$365.69	$294.44	2026-07-15
26600	CPT	Fx Metacarpal	8	5	$377.00	$365.69	$245.05	$365.69	$294.44	2026-07-15
24650	CPT	Fx Radial Head/Neck Wo Man Lt	16	5	$377.00	$365.69	$245.05	$365.69	$294.44	2026-07-15
24670	CPT	Fx Ulna Proximal Wo Man Lt	8	5	$396.00	$384.12	$257.40	$384.12	$309.27	2026-07-15
25530	CPT	Fx Ulnar Shaft Wo Man Rt	8	5	$377.00	$365.69	$245.05	$365.69	$294.44	2026-07-15
25650	CPT	Fx Ulnar Styloid Lt	8	5	$377.00	$365.69	$245.05	$365.69	$294.44	2026-07-15
80050	CPT	General Health Panel	12	5	$869.00	$842.93	$564.85	$842.93	$713.88	2026-07-15
87329	CPT	Giardia Antigen	11	5	$394.00	$382.18	$256.10	$382.18	$311.26	2026-07-15
J1610	HCPCS	Glucagon 1 Mg/ml Vial	14	5	$763.00	$740.62	$98.91	$1,287.61	$732.99	2026-07-15
86341	CPT	Glutmic Acid Decarbox Aby	8	5	$564.00	$547.08	$366.60	$547.08	$440.49	2026-07-15
87338	CPT	H Pylori Antigen Stool	8	5	$480.00	$465.60	$312.00	$465.60	$374.88	2026-07-15
84702	CPT	Hcg Beta Quan Serum	10	5	$377.00	$365.69	$51.31	$365.69	$283.12	2026-07-15
92950	CPT	Heart/Lung Resuscitation Cpr	14	5	$1,042.00	$1,010.74	$275.08	$1,010.74	$685.12	2026-07-15
87517	CPT	Hep B Na Quan	8	5	$407.00	$394.79	$264.55	$394.79	$317.87	2026-07-15
90632	CPT	Hepatitis A Vaccine Adult IM	10	5	$314.00	$304.58	$204.10	$345.69	$283.07	2026-07-15
87536	CPT	HIV 1 Na Quan	9	5	$403.00	$390.91	$261.95	$390.91	$318.37	2026-07-15
87906	CPT	HIV 1 Sequence Integras Resist	8	5	$601.00	$582.97	$390.65	$582.97	$469.38	2026-07-15
81381	CPT	Hla B*57:01	8	5	$1,590.00	$1,542.30	$1,033.50	$1,542.30	$1,241.79	2026-07-15
93225	CPT	Holter Monitor Hook Up <48 Hrs	8	5	$678.00	$657.66	$440.70	$657.66	$529.52	2026-07-15
87529	CPT	Hsv DNA Amp Probe	8	5	$377.00	$365.69	$245.05	$365.69	$294.44	2026-07-15
10120	CPT	I&r Foreign Body Simple	16	5	$606.00	$587.82	$215.90	$587.82	$398.44	2026-07-15
83519	CPT	Igf Binding Protein 1	8	5	$476.00	$461.72	$309.40	$461.72	$371.75	2026-07-15
J1569	HCPCS	Immune Glob Gamagar 20gr/200ml	8	5	$9,803.00	$9,509.65	$21.77	$9,509.65	$7,362.62	2026-07-15
86334	CPT	Immunofix Electroph Serum	10	5	$341.00	$330.77	$221.65	$330.77	$266.32	2026-07-15
88342	CPT	Immunohisto Stain Init Pr Spec	8	5	$501.00	$485.97	$325.65	$485.97	$391.28	2026-07-15
11106	CPT	Incisional Biopsy 1st Lesion	14	5	$1,409.00	$1,366.73	$111.84	$1,366.73	$926.42	2026-07-15
96360	CPT	Inf Therapy Hyd Initial	12	5	$724.00	$702.28	$470.60	$702.28	$565.44	2026-07-15
96365	CPT	Inf Therapy Med Initial	12	5	$724.00	$702.28	$470.60	$702.28	$565.44	2026-07-15
96367	CPT	Inf Therapy Med Sequential	21	5	$329.00	$319.13	$98.04	$355.02	$267.18	2026-07-15
86318	CPT	Infectious Mono Test	10	5	$392.00	$380.24	$254.80	$380.24	$294.39	2026-07-15
82397	CPT	Infliximab Ab, S	10	5	$1,360.00	$1,319.20	$884.00	$1,319.20	$1,055.36	2026-07-15
80230	CPT	Infliximab Qn w/Reflex To Ab,S	10	5	$1,773.00	$1,719.81	$1,152.45	$1,719.81	$1,375.85	2026-07-15
Q5104	HCPCS	Infliximab-abda 100 Mg Vial	8	5	$1,758.00	$1,705.35	$1,142.76	$5,119.19	$1,584.92	2026-07-15
Q5121	HCPCS	Infliximab-axxq 100 Mg Vial	10	5	$2,172.00	$2,107.76	$1,412.42	$8,501.52	$1,958.91	2026-07-15
87636	CPT	Influ & CoV2 Pcr Ceph	8	5	$511.00	$495.67	$332.15	$495.67	$399.09	2026-07-15
87637	CPT	Influ/RSV/CoV2 Pcr Ceph	10	5	$598.00	$580.06	$373.03	$580.06	$449.10	2026-07-15
64450	CPT	Inject Anes Agent Oth Nerve Lt	14	5	$1,124.00	$1,090.28	$83.15	$1,090.28	$739.03	2026-07-15
31500	CPT	Insert Emergency Airway	14	5	$971.00	$941.87	$273.72	$941.87	$638.43	2026-07-15
Q9967	HCPCS	Iopamidol-370 100 Ml Vial	12	5	$964.00	$935.08	$253.80	$935.08	$723.97	2026-07-15
99223	CPT	IP/Obs Initial High Comp	6	5	$620.00	$601.40	$270.04	$389.40	$334.66	2026-07-15
51700	CPT	Irrigation Bladder Simple	19	5	$345.00	$334.65	$224.25	$519.00	$337.35	2026-07-15
80175	CPT	Lamotrigine	8	5	$556.00	$539.32	$361.40	$539.32	$434.24	2026-07-15
71271	CPT	Ldct For Lung Cancer Screen	12	5	$444.00	$430.68	$101.48	$430.68	$333.44	2026-07-15
J1956	HCPCS	Levofloxac/D5W 500mg/100ml Bag	17	5	$368.00	$357.83	$2.07	$357.83	$263.73	2026-07-15
80061	CPT	Lipid Panel	12	5	$445.00	$431.65	$289.25	$431.65	$379.59	2026-07-15
87476	CPT	Lyme Disease DNA Amp Probe	10	5	$368.00	$356.96	$127.80	$356.96	$276.37	2026-07-15
77067	CPT	Mammography Screening Digital	12	5	$569.00	$551.93	$369.85	$551.93	$444.39	2026-07-15
90734	CPT	Mcv4 Or MenACWY IM	8	5	$499.00	$484.03	$57.95	$484.03	$374.75	2026-07-15
90620	CPT	MenB 2 Dose IM	8	5	$759.00	$736.23	$254.82	$736.23	$570.01	2026-07-15
192	MS_DRG	Ms-DRG 192	2	1	—	—	$6,890.58	$6,890.58	$6,890.58	2026-07-15
194	MS_DRG	Ms-DRG 194	2	1	—	—	$6,890.58	$6,890.58	$6,890.58	2026-07-15
310	MS_DRG	Ms-DRG 310	2	1	—	—	$6,383.92	$6,383.92	$6,383.92	2026-07-15
536	MS_DRG	Ms-DRG 536	2	1	—	—	$13,747.64	$13,747.64	$13,747.64	2026-07-15
641	MS_DRG	Ms-DRG 641	2	1	—	—	$20,604.70	$20,604.70	$20,604.70	2026-07-15
82166	CPT	Mullerian Inhib Hormone	10	5	$359.00	$348.23	$130.19	$348.23	$269.61	2026-07-15
78452	CPT	Myocard Perf Spect Rest Stress	12	5	$6,031.00	$5,850.07	$1,200.00	$5,850.07	$4,710.21	2026-07-15
97606	CPT	Neg Pressure Wound Dme >50 Cm	8	5	$758.00	$735.26	$492.70	$735.26	$592.00	2026-07-15
99204	CPT	New Patient Level 4 Wound Care	14	5	$814.00	$789.58	$207.60	$789.58	$535.20	2026-07-15
99205	CPT	New Patient Level 5 High Comp	6	5	$271.00	$262.87	$282.08	$382.02	$320.46	2026-07-15
99306	CPT	Nf Initial Visit High	6	5	$475.00	$460.75	$264.20	$387.63	$322.74	2026-07-15
99310	CPT	Nf Visit High	6	5	$390.00	$378.30	$223.80	$327.84	$266.75	2026-07-15
G0480	HCPCS	Nicotine Cotinine	8	5	$391.00	$379.27	$254.15	$379.27	$305.37	2026-07-15
J2305	HCPCS	Nitroglycer/D5W 50mg/250ml Bot	8	5	$349.00	$339.28	$3.20	$339.28	$262.68	2026-07-15
97166	CPT	Ot Eval Mod Complexity	10	5	$385.00	$373.45	$250.25	$373.45	$289.13	2026-07-15
87177	CPT	Ova And Parasites Smears	10	5	$338.00	$327.86	$219.70	$327.86	$263.98	2026-07-15
82653	CPT	Pancreatic Elastase	8	5	$486.00	$471.42	$315.90	$471.42	$379.56	2026-07-15
J2506	HCPCS	Pegfilgrastim 6 Mg/0.6 Ml Syr	8	5	$20,486.00	$19,871.51	$64.98	$19,871.51	$15,385.06	2026-07-15
Q9957	HCPCS	Perflutren Lip Micro 2.2mg/2ml	8	5	$764.00	$741.32	$47.75	$741.32	$573.95	2026-07-15
Q9956	HCPCS	Perflutren Protein-a Microdota	10	5	$731.00	$709.31	$77.76	$709.31	$533.81	2026-07-15
P9035	HCPCS	Platelet Pheresis Leuko Reduc	8	5	$1,913.00	$1,855.61	$1,243.45	$1,855.61	$1,494.05	2026-07-15
90677	CPT	Pneumo 20 Valent Vacc 0.5 Ml	17	5	$965.00	$936.39	$380.34	$1,050.20	$767.23	2026-07-15
90684	CPT	Pneumo Conjugate Vaccine 21 Va	10	5	$1,050.00	$1,018.79	$474.00	$1,050.30	$788.78	2026-07-15
83880	CPT	Pro-b Type Natriuretic Peptide	21	5	$472.00	$457.84	$306.80	$739.14	$495.30	2026-07-15
85303	CPT	Protein C Activity	8	5	$548.00	$531.56	$356.20	$531.56	$427.99	2026-07-15
85302	CPT	Protein C Antigen	8	5	$433.00	$420.01	$281.45	$420.01	$338.17	2026-07-15
85306	CPT	Protein S Functional	8	5	$347.00	$336.59	$225.55	$336.59	$271.00	2026-07-15
85305	CPT	Protein S Total	8	5	$437.00	$423.89	$284.05	$423.89	$341.30	2026-07-15
97162	CPT	Pt Eval Mod Complexity	11	5	$358.00	$347.26	$208.05	$347.26	$276.38	2026-07-15
11104	CPT	Punch Biopsy 1st Lesion	14	5	$416.00	$403.52	$92.98	$403.52	$273.52	2026-07-15
86382	CPT	Rabies Ab Screen	8	5	$430.00	$417.10	$279.50	$417.10	$335.83	2026-07-15
90675	CPT	Rabies Vacc Hmn Post-ex Nonim	8	5	$1,475.00	$1,431.29	$125.24	$1,431.29	$1,108.14	2026-07-15
A9500	HCPCS	Radiophar Tc99M Sestamibi Dose	12	5	$521.00	$505.37	$219.20	$505.37	$406.90	2026-07-15
86870	CPT	Rbc Antibody Identif Panel	8	5	$649.00	$629.53	$421.85	$629.53	$506.87	2026-07-15
P9040	HCPCS	Rbc Packed Leuko-reduc Irrad	8	5	$803.00	$778.91	$521.95	$778.91	$627.14	2026-07-15
P9016	HCPCS	Red Blood Cells Lekoreduced	10	5	$617.00	$598.49	$401.05	$598.49	$463.37	2026-07-15
J0248	HCPCS	Remdesivir 100 Mg Vial	8	5	$2,847.00	$2,762.23	$70.71	$2,762.23	$2,138.59	2026-07-15
80069	CPT	Renal Function Panel	10	5	$425.00	$412.25	$276.25	$412.25	$319.18	2026-07-15
12052	CPT	Repair Lac Interm 2.6-5.0 Cm	14	5	$548.00	$531.56	$356.20	$559.61	$429.86	2026-07-15
12032	CPT	Repair Lac Interm 2.6-7.5 Cm	16	5	$548.00	$531.56	$356.20	$534.49	$418.79	2026-07-15
12053	CPT	Repair Lac Interm 5.1-7.5 Cm	14	5	$576.00	$558.72	$374.40	$600.32	$459.31	2026-07-15
12034	CPT	Repair Lac Interm 7.6-12.5 Cm	14	5	$548.00	$531.56	$356.20	$571.03	$437.23	2026-07-15
12051	CPT	Repair Lac Interm <2.5 Cm	14	5	$548.00	$531.56	$341.90	$531.56	$391.68	2026-07-15
12041	CPT	Repair Lac Interm <2.5 Cm	14	5	$441.00	$427.77	$286.65	$427.77	$325.36	2026-07-15
12031	CPT	Repair Lac Intermed <2.5 Cm	16	5	$548.00	$531.56	$307.22	$531.56	$400.04	2026-07-15
12013	CPT	Repair Lac Simple 2.6-5.0 Cm	22	5	$375.00	$363.75	$109.90	$363.75	$273.75	2026-07-15
12002	CPT	Repair Lac Simple 2.6-7.5 Cm	16	5	$375.00	$363.75	$112.84	$363.75	$261.56	2026-07-15
12011	CPT	Repair Lac Simple <2.5 Cm	17	5	$375.00	$363.75	$107.01	$363.75	$273.75	2026-07-15
11760	CPT	Repair Nailbed	14	5	$756.00	$733.32	$221.56	$733.32	$497.07	2026-07-15
40650	CPT	Repr Lip Fll Thckns Vermiln On	14	5	$552.00	$535.44	$358.80	$844.82	$529.92	2026-07-15
0202U	CPT	Respir Path 22 Targets Biofire	8	5	$1,296.00	$1,257.12	$842.40	$1,257.12	$1,012.17	2026-07-15
J3111	HCPCS	Romosozumab-aqqg 210 Mg/2.34Ml	8	5	$11,516.00	$11,171.48	$1.56	$11,171.48	$8,649.26	2026-07-15
110	CDM	Room Custodial Care	6	5	$879.00	$852.63	$571.35	$852.63	$714.19	2026-07-15
111	CDM	Room Medical Unit Priv	6	5	$3,688.00	$3,577.36	$2,397.20	$3,577.36	$2,996.50	2026-07-15
129	CDM	Room Swing Bed Skilled	6	5	$1,846.00	$1,790.62	$1,199.90	$1,790.62	$1,499.88	2026-07-15
87425	CPT	Rotavirus	9	5	$364.00	$353.08	$236.60	$353.08	$287.56	2026-07-15
86592	CPT	Rpr	8	5	$341.00	$330.77	$221.65	$330.77	$266.32	2026-07-15
87807	CPT	Rsv	8	5	$342.00	$331.74	$222.30	$331.74	$267.10	2026-07-15
80179	CPT	Salicylate	8	5	$507.00	$491.79	$329.55	$491.79	$395.96	2026-07-15
11300	CPT	Shave Lesion <0.5 Trunk Limbs	14	5	$431.00	$418.07	$67.60	$418.07	$283.38	2026-07-15
88312	CPT	Special Stain Afb	16	5	$409.50	$397.22	$261.95	$403.52	$319.76	2026-07-15
92523	CPT	Speech Sound Lang Comprehen	10	5	$556.00	$539.32	$361.40	$623.00	$434.24	2026-07-15
92507	CPT	Speech Therapy Trmt	8	5	$471.00	$456.87	$306.15	$456.87	$367.85	2026-07-15
93351	CPT	Stress Tte Complete	10	5	$3,649.00	$3,539.53	$2,371.85	$3,539.53	$2,849.87	2026-07-15
51705	CPT	Suprapubic Cath Change	8	5	$414.00	$401.58	$269.10	$401.58	$323.34	2026-07-15
88305	CPT	Surg Path L4	10	5	$749.00	$726.53	$486.85	$749.00	$584.97	2026-07-15
92610	CPT	Swallow Eval Non Radiol	8	5	$459.00	$445.23	$298.35	$445.23	$358.48	2026-07-15
84481	CPT	T3 Free	10	5	$385.00	$373.45	$85.73	$373.45	$289.13	2026-07-15
80197	CPT	Tacrolimus	8	5	$1,042.00	$1,010.74	$677.30	$1,010.74	$813.80	2026-07-15
11102	CPT	Tangential Biopsy 1st Lesion	16	5	$416.00	$403.52	$45.00	$403.52	$273.52	2026-07-15
J3101	HCPCS	Tenecteplase 50 Mg/10 Ml Syrng	10	5	$31,584.00	$30,637.29	$0.41	$30,637.29	$23,056.93	2026-07-15
84402	CPT	Testosterone Fre Female/Child	10	5	$448.00	$434.56	$64.30	$434.56	$336.45	2026-07-15
84403	CPT	Testosterone Total Ref	11	5	$365.00	$354.05	$64.30	$354.05	$281.78	2026-07-15
689	CDM	Trauma Team Evaluation Level 5	8	5	$4,022.00	$3,901.34	$2,614.30	$3,901.34	$3,141.18	2026-07-15
G0390	HCPCS	Trauma Team Level 5	8	5	$3,831.00	$3,716.07	$2,490.15	$3,716.07	$2,992.01	2026-07-15
27530	CPT	Treat Knee Fracture Rt	8	5	$396.00	$384.12	$257.40	$384.12	$309.27	2026-07-15
27520	CPT	Treat Kneecap Fracture Lt	8	5	$396.00	$384.12	$257.40	$384.12	$309.27	2026-07-15
84445	CPT	Tsi	8	5	$1,061.00	$1,029.17	$689.65	$1,029.17	$828.64	2026-07-15
93306	CPT	Tte W Doppler Complete	11	5	$3,636.00	$3,526.92	$2,363.40	$3,526.92	$2,806.99	2026-07-15
76770	CPT	Ultrasound Abdo Back Wall Comp	10	5	$2,306.00	$2,236.82	$1,498.90	$2,236.82	$1,731.81	2026-07-15
76700	CPT	Ultrasound Abdomen Complete	10	5	$2,413.00	$2,340.61	$1,568.45	$2,340.61	$1,812.16	2026-07-15
76705	CPT	Ultrasound Abdomen Limited	11	5	$1,344.00	$1,303.68	$844.74	$1,303.68	$1,037.57	2026-07-15
76775	CPT	Ultrasound Aorta	8	5	$1,729.00	$1,677.13	$1,123.85	$1,677.13	$1,350.35	2026-07-15
76604	CPT	Ultrasound Chest	8	5	$841.00	$815.77	$546.65	$815.77	$656.82	2026-07-15
76536	CPT	Ultrasound Head And Neck	12	5	$971.00	$941.87	$631.15	$941.87	$758.35	2026-07-15
76856	CPT	Ultrasound Pelvic Complete	8	5	$1,775.00	$1,721.75	$1,153.75	$1,721.75	$1,386.28	2026-07-15
76870	CPT	Ultrasound Scrotum	8	5	$846.00	$820.62	$549.90	$820.62	$660.73	2026-07-15
76830	CPT	Ultrasound Transvaginal	8	5	$807.00	$782.79	$524.55	$782.79	$630.26	2026-07-15
76882	CPT	US Extremity Nonvasc Limit Rt	18	5	$806.00	$781.82	$523.90	$806.00	$629.49	2026-07-15
93975	CPT	Vascular Study	10	5	$2,281.00	$2,212.57	$1,482.65	$2,212.57	$1,713.03	2026-07-15
93976	CPT	Vascular Study	8	5	$1,286.00	$1,247.42	$835.90	$1,247.42	$1,004.37	2026-07-15
J3380	HCPCS	Vedolizumab 300 Mg Vial	8	5	$39,149.00	$37,975.12	$72.63	$37,975.12	$29,401.36	2026-07-15
93970	CPT	Venous Duplex	10	5	$2,160.00	$2,095.20	$1,404.00	$2,095.20	$1,622.16	2026-07-15
74019	CPT	X-ray Abdomen	10	5	$672.00	$651.84	$436.80	$660.48	$546.00	2026-07-15
74018	CPT	X-ray Abdomen	11	5	$422.00	$409.34	$274.30	$523.40	$359.97	2026-07-15
73600	CPT	X-ray Ankle 2 Views Rt	18	5	$425.00	$412.25	$86.75	$412.25	$310.25	2026-07-15
73610	CPT	X-ray Ankle 3 Views Lt	20	5	$580.00	$562.60	$99.63	$562.60	$423.40	2026-07-15
71045	CPT	X-ray Chest 1 View	13	5	$508.00	$492.76	$330.20	$593.33	$433.32	2026-07-15
71046	CPT	X-ray Chest 2v PA/Lateral	13	5	$738.00	$715.86	$479.70	$783.14	$629.51	2026-07-15
73000	CPT	X-ray Collar Bone Lt	16	5	$519.00	$503.43	$187.04	$503.43	$389.77	2026-07-15
73070	CPT	X-ray Elbow Lt	18	5	$519.00	$503.43	$41.69	$503.43	$378.87	2026-07-15
73080	CPT	X-ray Elbow Rt	17	5	$665.00	$645.05	$38.91	$645.05	$513.38	2026-07-15
70030	CPT	X-ray Eye Fb Detection	8	5	$542.00	$525.74	$352.30	$5,074.70	$488.62	2026-07-15
73552	CPT	X-ray Femur 2 Views Lt	20	5	$705.00	$683.85	$130.01	$683.85	$514.65	2026-07-15
73140	CPT	X-ray Finger(s) Lt	20	5	$365.00	$354.05	$64.68	$354.05	$266.45	2026-07-15
73620	CPT	X-ray Foot 2 Views Lt	20	5	$425.00	$412.25	$85.00	$412.25	$310.25	2026-07-15
73630	CPT	X-ray Foot 3 Views Lt	20	5	$634.00	$614.98	$65.60	$614.98	$466.58	2026-07-15
73090	CPT	X-ray Forearm 2 Views Lt	20	5	$480.00	$465.60	$282.72	$465.60	$350.40	2026-07-15
73130	CPT	X-ray Hand Lt	20	5	$672.00	$651.84	$59.16	$651.84	$490.56	2026-07-15
73120	CPT	X-ray Hand Rt	8	5	$451.00	$437.47	$198.99	$437.47	$338.70	2026-07-15
73501	CPT	X-ray Hip Uni 1 View Rt	8	5	$344.00	$333.68	$223.60	$711.09	$310.12	2026-07-15
73502	CPT	X-ray Hip Uni 2-3 Views Rt	33	5	$422.00	$409.34	$274.30	$860.42	$561.60	2026-07-15
73522	CPT	X-ray Hips 3-4 Views Bi	8	5	$910.00	$882.70	$591.50	$882.70	$785.07	2026-07-15
73523	CPT	X-ray Hips 5 Views Bi	8	5	$1,136.00	$1,101.92	$690.20	$1,101.92	$853.13	2026-07-15
73060	CPT	X-ray Humerus Rt	8	5	$605.00	$586.85	$67.44	$586.85	$454.36	2026-07-15
73560	CPT	X-ray Knee 1-2 Views Lt	19	5	$571.00	$553.87	$84.00	$553.87	$440.81	2026-07-15
73562	CPT	X-ray Knee 3 Views Lt	20	5	$608.00	$589.76	$109.76	$589.76	$447.73	2026-07-15
73564	CPT	X-ray Knee 4 Lt	17	5	$870.00	$843.90	$129.06	$843.90	$671.64	2026-07-15
73590	CPT	X-ray Lower Leg Lt	20	5	$564.00	$547.08	$73.88	$547.08	$411.72	2026-07-15
72100	CPT	X-ray Lumbosacral 2-3 Views	10	5	$1,032.00	$1,001.04	$90.44	$1,001.04	$753.36	2026-07-15
72110	CPT	X-ray Lumbosacral 4 Views	8	5	$1,405.00	$1,362.85	$67.44	$1,362.85	$1,055.16	2026-07-15
70100	CPT	X-ray Mandible < 4 Views	8	5	$457.00	$443.29	$102.20	$443.29	$343.21	2026-07-15
72170	CPT	X-ray Pelvis 1-2 Views	10	5	$517.00	$501.49	$336.05	$501.49	$377.41	2026-07-15
71100	CPT	X-ray Ribs 2 Views Lt	18	5	$891.00	$864.27	$579.15	$3,616.49	$803.24	2026-07-15
71110	CPT	X-ray Ribs Bilateral 3 Views	10	5	$1,088.00	$1,055.36	$47.21	$1,055.36	$814.32	2026-07-15
71101	CPT	X-ray Ribs Uni W Chest Lt	18	5	$1,326.00	$1,286.22	$861.90	$3,427.98	$1,131.08	2026-07-15
72220	CPT	X-ray Sacrum Tailbone	10	5	$605.00	$586.85	$393.25	$586.85	$447.69	2026-07-15
73030	CPT	X-ray Shoulder Lt	20	5	$617.00	$598.49	$237.65	$598.49	$450.41	2026-07-15
73020	CPT	X-ray Shoulder Lt	16	5	$425.00	$412.25	$187.95	$412.25	$319.18	2026-07-15
70250	CPT	X-ray Skull < 4 Views	10	5	$686.00	$665.42	$94.25	$665.42	$500.78	2026-07-15
72082	CPT	X-ray Spine 2-3 View	8	5	$769.00	$745.93	$130.92	$745.93	$577.52	2026-07-15
72040	CPT	X-ray Spine Cervical 2-3 Views	12	5	$811.00	$786.67	$154.40	$786.67	$592.03	2026-07-15
72050	CPT	X-ray Spine Cervical 4-5 Views	8	5	$1,193.00	$1,157.21	$746.06	$1,157.21	$895.94	2026-07-15
72070	CPT	X-ray Spine Thoracic 2 Views	10	5	$695.00	$674.15	$251.70	$1,015.91	$564.69	2026-07-15
72072	CPT	X-ray Spine Thoracic 3 Views	10	5	$816.00	$791.52	$530.40	$791.52	$663.00	2026-07-15
71120	CPT	X-ray Sternum 2 Views	8	5	$424.00	$411.28	$79.40	$411.28	$318.42	2026-07-15
73660	CPT	X-ray Toe(s) 2 Views Lt	18	5	$403.00	$390.91	$66.51	$390.91	$294.19	2026-07-15
73100	CPT	X-ray Wrist 2 Views Lt	16	5	$425.00	$412.25	$66.51	$412.25	$319.18	2026-07-15
73110	CPT	X-ray Wrist 3 Views Lt	20	5	$629.00	$610.13	$58.22	$610.13	$459.17	2026-07-15
J3489	HCPCS	Zoledron Ac/Man/H2O 5mg/100ml	8	5	$414.00	$402.39	$17.25	$402.39	$311.54	2026-07-15

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