Hospital

Crosbyton Clinic Hospital

Crosbyton, TX · CCN 451345 · Rates published

1,137 distinct procedures filed

4 distinct payers

5,361 rate rows

2025-10-01 last MRF observed

Data quality

4,993 of 5,361 rate rows are consumer-grade (93.1%)

368 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
template filing: same amount across many unrelated codes — excluded	368

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

Source MRF file	https://secure.claraprice.net/price-transparency/UBNQ-1659976856091/machine-readable/750711276_crosbyton-clinic-hospital_standardcharges.json
Found on page	https://secure.claraprice.net/price-transparency/crosbyton-clinic
Discovered via	Discovered by HANK
Last fetch	Latest re-check couldn't be parsed — showing last good data · 2026-05-19
Content fingerprint	8ccbf14ae665ec20… · 43,814 bytes · first seen 2026-05-18

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
46074 CPT	Conj Estrogen 25mg Im/i	4	$300.00	$1,266.00	$1,092.00	nat. median $457 outlier · 2.4×
12017 CPT	Sim Repr Fa/ea/no/20.1-	4	$221.00	$933.00	$805.00	nat. median $520 1.5× median
13132 CPT	Rpr Cplx Fhead/chn 2.6-	4	$218.00	$921.00	$794.00	nat. median $877 0.9× median
31530 CPT	Larynscp Dir W/fb Remov	4	$201.00	$846.00	$729.50	nat. median $2,041 outlier · 0.4×
92977 CPT	Throm Coro IV Infusion	4	$190.00	$799.00	$689.00	nat. median $499 1.4× median
32020 CPT	Tube Throacost W/wo Wa	4	$184.00	$776.00	$669.50	nat. median $3,704 outlier · 0.2×
27250 CPT	Clo Tx Hip Dis Trauma W	4	$165.00	$698.00	$601.50	nat. median $467 1.3× median
93971 CPT	Duplex Scan Unilat Extr	4	$95.00	$1,116.00	$593.00	nat. median $361 1.6× median
13121 CPT	Repr Cplx Scalp/2.6-7.5	4	$148.00	$623.00	$537.50	nat. median $814 0.7× median
12054 CPT	Lay Clo Fa/ea/lip 7.6-1	4	$144.00	$606.00	$523.50	nat. median $625 0.8× median
20525 CPT	Remov Fb Mus/t She Deep	4	$140.00	$589.00	$508.00	nat. median $2,953 outlier · 0.2×
76830 CPT	Ultrasound Pelvis Through Vagina	4	$133.00	$560.00	$483.00	nat. median $249 1.9× median
76817 CPT	U/s Transvag Pregnant	4	$133.00	$560.00	$483.00	nat. median $218 outlier · 2.2×
99285 CPT	Emergency Department Vi	4	$128.00	$542.00	$467.50	nat. median $1,228 outlier · 0.4×
92950 CPT	Cariopul Resuscitation	4	$123.00	$518.00	$446.50	nat. median $604 0.7× median
63323 CPT	Glucagon Recomb 1mg	4	$120.00	$504.00	$435.00	nat. median $118 outlier · 3.7×
93970 CPT	Venous Doppler Extrem B	4	$114.00	$480.00	$414.00	nat. median $581 0.7× median
12045 CPT	Lay Clo Nek/ha/ft12.6-2	4	$114.00	$479.00	$413.00	nat. median $833 outlier · 0.5×
13131 CPT	Repr Cplx Fhead/chn1.1-	4	$113.00	$475.00	$410.00	nat. median $638 0.6× median
12016 CPT	Simp Repr Face/er/12.6-	4	$111.00	$468.00	$404.00	nat. median $555 0.7× median
32002 CPT	Thoracente W/insrt Tube	4	$111.00	$467.00	$403.00	nat. median $5,305 outlier · 0.1×
12053 CPT	Lay Clo Fa/ea/lip 5.1-7	4	$110.00	$466.00	$402.00	nat. median $593 0.7× median
27550 CPT	Clo Tx Knee Disloc Wo A	4	$109.00	$461.00	$397.50	nat. median $531 0.7× median
13101 CPT	Repr Complx Trunk 2.6-7	4	$109.00	$461.00	$397.50	nat. median $855 outlier · 0.5×
11760 CPT	Repair Nail Bed	4	$108.00	$457.00	$394.00	nat. median $719 0.5× median
93886 CPT	Tcd Complete	4	$106.00	$448.00	$386.50	nat. median $444 0.9× median
23675 CPT	Clo Dislo Shoulder Fx W	4	$104.00	$440.00	$380.00	nat. median $1,668 outlier · 0.2×
24600 CPT	Tx Clo Elbow Disloc Wo	4	$104.00	$439.00	$379.00	nat. median $498 0.8× median
92960 CPT	Card Ele Conver Arrhy E	4	$102.00	$431.00	$372.00	nat. median $1,011 outlier · 0.4×
23650 CPT	Clo Tx Shoul Disloc W/m	4	$102.00	$430.00	$371.50	nat. median $501 0.7× median
12035 CPT	Lay Clo Sclp/ax/12.6-20	4	$102.00	$430.00	$370.50	nat. median $661 0.6× median
30905 CPT	Contl Nasal Hem Post With	4	$102.00	$428.00	$369.00	nat. median $290 1.3× median
93975 CPT	Duplex Scan Complete	4	$63.00	$1,918.00	$359.50	nat. median $570 0.6× median
13120 CPT	Repr Cplx Scp/1.-2.5	4	$97.00	$407.00	$351.50	nat. median $726 outlier · 0.5×
30906 CPT	Nas Hem Post W/pack Sub	4	$95.00	$401.00	$346.00	nat. median $354 1.0× median
80050 CPT	General Health Panel	4	$95.00	$400.00	$345.00	nat. median $179 1.9× median
76805 CPT	Abdomial Ultrasound Of Pregnant Uterus	4	$92.00	$386.00	$333.00	nat. median $257 1.3× median
12015 CPT	Simp Repr Face/ea 7.6-1	4	$90.00	$379.00	$327.50	nat. median $362 0.9× median
27840 CPT	Clo Tx Ank Disloc Wo An	4	$90.00	$378.00	$325.50	nat. median $536 0.6× median
99291 CPT	Critical Care Cont Care	4	$79.00	$1,010.00	$321.50	nat. median $1,611 outlier · 0.2×
76856 CPT	U/s Pelvic	4	$87.00	$366.00	$316.50	nat. median $273 1.2× median
12044 CPT	Lay Clo Nck/ha/ft 7.6-1	4	$87.00	$366.00	$316.50	nat. median $775 outlier · 0.4×
10121 CPT	Incs & Remov Fb Subq Co	4	$87.00	$366.00	$315.50	nat. median $1,689 outlier · 0.2×
33010 CPT	Pericardiocentesis Init	4	$86.00	$363.00	$313.50	nat. median $969 outlier · 0.3×
27560 CPT	Clo Tx Patel Dislo Wo A	4	$86.00	$362.00	$312.00	nat. median $497 0.6× median
305173 CDM	Pediatric Screen	4	$85.00	$359.00	$310.00	nat. median $310 1.0× median
74400 CPT	Xr Pyelogram Ivp	4	$85.00	$358.00	$308.50	nat. median $306 1.0× median
28190 CPT	Remov Fb Foot Subq	4	$85.00	$357.00	$308.00	nat. median $891 outlier · 0.3×
86003 CPT	Regional Screen	4	$84.00	$354.00	$305.50	nat. median $21 outlier · 14.3×
87799 CPT	Bk Virus Rt-DNA Pcr	4	$84.00	$354.00	$305.00	nat. median $177 1.7× median

Other procedures at this hospital

Browse this hospital's 1,137 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

46074	CPT	Conj Estrogen 25mg Im/i	4	4	$1,583.00	$1,583.00	$300.00	$1,266.00	$1,092.00	2025-10-01
12017	CPT	Sim Repr Fa/ea/no/20.1-	4	4	$1,166.00	$1,166.00	$221.00	$933.00	$805.00	2025-10-01
13132	CPT	Rpr Cplx Fhead/chn 2.6-	4	4	$1,151.00	$1,151.00	$218.00	$921.00	$794.00	2025-10-01
31530	CPT	Larynscp Dir W/fb Remov	4	4	$1,057.00	$1,057.00	$201.00	$846.00	$729.50	2025-10-01
92977	CPT	Throm Coro IV Infusion	4	4	$999.00	$999.00	$190.00	$799.00	$689.00	2025-10-01
32020	CPT	Tube Throacost W/wo Wa	4	4	$970.00	$970.00	$184.00	$776.00	$669.50	2025-10-01
27250	CPT	Clo Tx Hip Dis Trauma W	4	4	$872.00	$872.00	$165.00	$698.00	$601.50	2025-10-01
93971	CPT	Duplex Scan Unilat Extr	12	4	$1,248.00	$1,248.00	$95.00	$1,116.00	$593.00	2025-10-01
13121	CPT	Repr Cplx Scalp/2.6-7.5	4	4	$779.00	$779.00	$148.00	$623.00	$537.50	2025-10-01
12054	CPT	Lay Clo Fa/ea/lip 7.6-1	4	4	$758.00	$758.00	$144.00	$606.00	$523.50	2025-10-01
20525	CPT	Remov Fb Mus/t She Deep	4	4	$736.00	$736.00	$140.00	$589.00	$508.00	2025-10-01
76817	CPT	U/s Transvag Pregnant	4	4	$700.00	$700.00	$133.00	$560.00	$483.00	2025-10-01
76830	CPT	Ultrasound Pelvis Through Vagina	4	4	$700.00	$700.00	$133.00	$560.00	$483.00	2025-10-01
99285	CPT	Emergency Department Vi	4	4	$677.00	$677.00	$128.00	$542.00	$467.50	2025-10-01
92950	CPT	Cariopul Resuscitation	4	4	$647.00	$647.00	$123.00	$518.00	$446.50	2025-10-01
63323	CPT	Glucagon Recomb 1mg	4	4	$630.00	$630.00	$120.00	$504.00	$435.00	2025-10-01
93970	CPT	Venous Doppler Extrem B	4	4	$600.00	$600.00	$114.00	$480.00	$414.00	2025-10-01
12045	CPT	Lay Clo Nek/ha/ft12.6-2	4	4	$599.00	$599.00	$114.00	$479.00	$413.00	2025-10-01
13131	CPT	Repr Cplx Fhead/chn1.1-	4	4	$594.00	$594.00	$113.00	$475.00	$410.00	2025-10-01
12016	CPT	Simp Repr Face/er/12.6-	4	4	$585.00	$585.00	$111.00	$468.00	$404.00	2025-10-01
32002	CPT	Thoracente W/insrt Tube	4	4	$584.00	$584.00	$111.00	$467.00	$403.00	2025-10-01
12053	CPT	Lay Clo Fa/ea/lip 5.1-7	4	4	$582.00	$582.00	$110.00	$466.00	$402.00	2025-10-01
13101	CPT	Repr Complx Trunk 2.6-7	4	4	$576.00	$576.00	$109.00	$461.00	$397.50	2025-10-01
27550	CPT	Clo Tx Knee Disloc Wo A	4	4	$576.00	$576.00	$109.00	$461.00	$397.50	2025-10-01
11760	CPT	Repair Nail Bed	4	4	$571.00	$571.00	$108.00	$457.00	$394.00	2025-10-01
93886	CPT	Tcd Complete	4	4	$560.00	$560.00	$106.00	$448.00	$386.50	2025-10-01
23675	CPT	Clo Dislo Shoulder Fx W	4	4	$550.00	$550.00	$104.00	$440.00	$380.00	2025-10-01
24600	CPT	Tx Clo Elbow Disloc Wo	4	4	$549.00	$549.00	$104.00	$439.00	$379.00	2025-10-01
92960	CPT	Card Ele Conver Arrhy E	4	4	$539.00	$539.00	$102.00	$431.00	$372.00	2025-10-01
23650	CPT	Clo Tx Shoul Disloc W/m	4	4	$538.00	$538.00	$102.00	$430.00	$371.50	2025-10-01
12035	CPT	Lay Clo Sclp/ax/12.6-20	4	4	$537.00	$537.00	$102.00	$430.00	$370.50	2025-10-01
30905	CPT	Contl Nasal Hem Post With	4	4	$535.00	$535.00	$102.00	$428.00	$369.00	2025-10-01
93975	CPT	Duplex Scan Complete	8	4	$1,364.00	$1,364.00	$63.00	$1,918.00	$359.50	2025-10-01
13120	CPT	Repr Cplx Scp/1.-2.5	4	4	$509.00	$509.00	$97.00	$407.00	$351.50	2025-10-01
30906	CPT	Nas Hem Post W/pack Sub	4	4	$501.00	$501.00	$95.00	$401.00	$346.00	2025-10-01
80050	CPT	General Health Panel	4	4	$500.00	$500.00	$95.00	$400.00	$345.00	2025-10-01
76805	CPT	Abdomial Ultrasound Of Pregnant Uterus	4	4	$483.00	$483.00	$92.00	$386.00	$333.00	2025-10-01
12015	CPT	Simp Repr Face/ea 7.6-1	4	4	$474.00	$474.00	$90.00	$379.00	$327.50	2025-10-01
27840	CPT	Clo Tx Ank Disloc Wo An	4	4	$472.00	$472.00	$90.00	$378.00	$325.50	2025-10-01
99291	CPT	Critical Care Cont Care	8	4	$839.00	$839.00	$79.00	$1,010.00	$321.50	2025-10-01
12044	CPT	Lay Clo Nck/ha/ft 7.6-1	4	4	$458.00	$458.00	$87.00	$366.00	$316.50	2025-10-01
76856	CPT	U/s Pelvic	4	4	$458.00	$458.00	$87.00	$366.00	$316.50	2025-10-01
10121	CPT	Incs & Remov Fb Subq Co	4	4	$457.00	$457.00	$87.00	$366.00	$315.50	2025-10-01
33010	CPT	Pericardiocentesis Init	4	4	$454.00	$454.00	$86.00	$363.00	$313.50	2025-10-01
27560	CPT	Clo Tx Patel Dislo Wo A	4	4	$452.00	$452.00	$86.00	$362.00	$312.00	2025-10-01
305173	CDM	Pediatric Screen	4	4	$449.00	$449.00	$85.00	$359.00	$310.00	2025-10-01
74400	CPT	Xr Pyelogram Ivp	4	4	$447.00	$447.00	$85.00	$358.00	$308.50	2025-10-01
28190	CPT	Remov Fb Foot Subq	4	4	$446.00	$446.00	$85.00	$357.00	$308.00	2025-10-01
86003	CPT	Regional Screen	4	4	$443.00	$443.00	$84.00	$354.00	$305.50	2025-10-01
87799	CPT	Bk Virus Rt-DNA Pcr	4	4	$442.00	$442.00	$84.00	$354.00	$305.00	2025-10-01
12052	CPT	Lay Clo Fa/ea/lip 2.6-5	4	4	$441.00	$441.00	$84.00	$353.00	$304.50	2025-10-01
93880	CPT	Carotid Doppler	8	4	$471.00	$471.00	$72.00	$448.00	$296.50	2025-10-01
99284	CPT	Emergency Department Vi	4	4	$426.00	$426.00	$81.00	$341.00	$294.00	2025-10-01
93306	CPT	Echocomplete W Color Fl	8	4	$827.00	$827.00	$71.00	$1,024.00	$290.00	2025-10-01
36481	CPT	Placmt Cen Ven Cath>age	4	4	$414.00	$414.00	$79.00	$331.00	$286.00	2025-10-01
A0010	HCPCS	Ambul Ser Als 2	12	4	$450.00	$450.00	$66.00	$560.00	$282.00	2025-10-01
23500	CPT	Clo Tx Clav Fx Wo Manip	4	4	$404.00	$404.00	$77.00	$323.00	$279.00	2025-10-01
54700	CPT	Inc Drain Epidid, Testi	4	4	$400.00	$400.00	$76.00	$320.00	$276.00	2025-10-01
A0427	HCPCS	Ambul Ser Als1 Emergenc	4	4	$400.00	$400.00	$76.00	$320.00	$276.00	2025-10-01
87497	CPT	Cytomegvirus,quanti,p	4	4	$397.00	$397.00	$75.00	$318.00	$274.00	2025-10-01
12034	CPT	Lay Clo Sclp/ax/tr7.6-1	4	4	$396.00	$396.00	$75.00	$317.00	$273.00	2025-10-01
76700	CPT	Ultrasound Of Abdomen	8	4	$468.00	$468.00	$66.00	$469.00	$271.50	2025-10-01
27760	CPT	Clo Tx Med Malleolus Fx	4	4	$386.00	$386.00	$73.00	$309.00	$266.50	2025-10-01
76705	CPT	U/s Abdomen Ruq	4	4	$382.00	$382.00	$72.00	$306.00	$264.00	2025-10-01
76604	CPT	U/s Chest	4	4	$382.00	$382.00	$72.00	$306.00	$264.00	2025-10-01
76770	CPT	U/s Retroperitoneal	4	4	$382.00	$382.00	$72.00	$306.00	$264.00	2025-10-01
80074	CPT	Acute Hepatitis Panel	4	4	$380.00	$380.00	$72.00	$304.00	$262.00	2025-10-01
275156	CDM	Tube, Blakemore	4	4	$379.00	$379.00	$72.00	$303.00	$261.50	2025-10-01
26600	CPT	Clo Tx Metacarp Sing Wo	4	4	$378.00	$378.00	$72.00	$302.00	$261.00	2025-10-01
26700	CPT	Clo Tx Mcp Disl Sng W/m	4	4	$378.00	$378.00	$72.00	$302.00	$261.00	2025-10-01
25605	CPT	Clo Tx Fx D/radius W/ma	4	4	$377.00	$377.00	$72.00	$302.00	$260.50	2025-10-01
88180	CPT	B And T Lymphocytes *	4	4	$374.00	$374.00	$71.00	$299.00	$258.50	2025-10-01
42809	CPT	Remov Fb From Pharynx	4	4	$371.00	$371.00	$70.00	$297.00	$256.00	2025-10-01
93930	CPT	Arterial Doppler Up Ext	4	4	$367.00	$367.00	$70.00	$294.00	$253.00	2025-10-01
93922	CPT	Ankle/arm Index	4	4	$367.00	$367.00	$70.00	$294.00	$253.00	2025-10-01
87320	CPT	Chlamydia Serology *3	4	4	$367.00	$367.00	$70.00	$294.00	$253.00	2025-10-01
93923	CPT	Segmental Pressure	4	4	$367.00	$367.00	$70.00	$294.00	$253.00	2025-10-01
76936	CPT	Art Dop Pseudoaneurysm	4	4	$367.00	$367.00	$70.00	$294.00	$253.00	2025-10-01
87490	CPT	Chlamydiazyme	4	4	$367.00	$367.00	$70.00	$294.00	$253.00	2025-10-01
93888	CPT	Tdc Limited	4	4	$367.00	$367.00	$70.00	$294.00	$253.00	2025-10-01
93931	CPT	Arterial Doppler Up Ext	4	4	$367.00	$367.00	$70.00	$294.00	$253.00	2025-10-01
31500	CPT	Intuba Endotrac Emer Pr	4	4	$365.00	$365.00	$69.00	$292.00	$252.00	2025-10-01
12014	CPT	Simp Repr Face/ea 5.1-7	4	4	$363.00	$363.00	$69.00	$290.00	$250.50	2025-10-01
71111	CPT	Xr Ribs W/ap Chest 4 Vi	4	4	$362.00	$362.00	$69.00	$290.00	$250.00	2025-10-01
275887	CDM	Cath 4.0 Picc Without Tray	4	4	$360.00	$360.00	$68.00	$288.00	$248.50	2025-10-01
21480	CPT	Clo Tx Tempomandi Dis S	4	4	$358.00	$358.00	$68.00	$286.00	$247.50	2025-10-01
93925	CPT	Arterial Dopp Bil Low E	8	4	$358.50	$358.50	$66.00	$294.00	$247.00	2025-10-01
12051	CPT	Lay Clo Fa/er/noos 2.5	4	4	$354.00	$354.00	$67.00	$283.00	$244.50	2025-10-01
12042	CPT	Lay Clo Neck/ha/ft 2.6-	4	4	$354.00	$354.00	$67.00	$283.00	$244.50	2025-10-01
12005	CPT	Sim Repr Sclp/ax/12.6-2	4	4	$354.00	$354.00	$67.00	$283.00	$244.50	2025-10-01
82088	CPT	Aldosterone	8	4	$344.50	$344.50	$62.00	$290.00	$237.00	2025-10-01
275558	CDM	Ivt:filter For Platelet	2	2	$302.00	$302.00	$227.00	$242.00	$234.50	2025-10-01
76536	CPT	U/s Head Neck Soft Tiss	4	4	$337.00	$337.00	$64.00	$270.00	$232.50	2025-10-01
86611	CPT	Cat Scratch Antibody	4	4	$332.00	$332.00	$63.00	$266.00	$229.00	2025-10-01
72052	CPT	Xr Spine Cervical 6>	8	4	$332.00	$332.00	$60.00	$280.00	$228.50	2025-10-01
71048	CPT	Xr Chest Complete 4 Vie	4	4	$327.00	$327.00	$62.00	$262.00	$225.50	2025-10-01
86335	CPT	Ife Other Than Serum	4	4	$325.00	$325.00	$62.00	$260.00	$224.50	2025-10-01
23600	CPT	Clo Tx Prox Humeral Fx	4	4	$324.00	$324.00	$61.00	$259.00	$223.50	2025-10-01
49080	CPT	Peritoncentes Abd Parac	4	4	$324.00	$324.00	$61.00	$259.00	$223.50	2025-10-01
13100	CPT	Repr Complx Tr 1.1-2.5	4	4	$324.00	$324.00	$61.00	$259.00	$223.50	2025-10-01
275333	CDM	Cath, 7fr Lumen 16c	4	4	$324.00	$324.00	$61.00	$259.00	$223.50	2025-10-01
10061	CPT	I&d Abscess Complic/mx	4	4	$324.00	$324.00	$61.00	$259.00	$223.50	2025-10-01
275885	CDM	Midline 3fr	4	4	$322.00	$322.00	$61.00	$258.00	$222.50	2025-10-01
275886	CDM	Midline 4fr.	4	4	$322.00	$322.00	$61.00	$258.00	$222.50	2025-10-01
275622	CDM	Tray Subclavian	4	4	$317.00	$317.00	$60.00	$254.00	$219.00	2025-10-01
76062	CPT	Xr Bone Survey Axial	4	4	$311.00	$311.00	$59.00	$249.00	$214.50	2025-10-01
41240	CPT	Repr Lac 2.5/ant 2/3 To	4	4	$310.00	$310.00	$59.00	$248.00	$214.00	2025-10-01
12032	CPT	Lay Clo Sclp/ax/tr 2.6-	4	4	$308.00	$308.00	$58.00	$246.00	$212.50	2025-10-01
83582	CPT	Fractionated 17ketost	4	4	$303.00	$303.00	$57.00	$242.00	$209.00	2025-10-01
97597	CPT	Rmvl Devital Tis 20 Cm/	4	4	$300.00	$300.00	$57.00	$240.00	$207.00	2025-10-01
11750	CPT	Removal Nail Bed	4	4	$300.00	$300.00	$57.00	$240.00	$207.00	2025-10-01
73521	CPT	Xray Hips Bil W Pelvis	4	4	$298.00	$298.00	$57.00	$238.00	$206.00	2025-10-01
91105	CPT	Gastric Intub Asp Lav T	4	4	$297.00	$297.00	$56.00	$238.00	$205.00	2025-10-01
70260	CPT	Xr Skull Complete 4 Vie	4	4	$297.00	$297.00	$56.00	$238.00	$205.00	2025-10-01
76061	CPT	Xr Bone Survey	4	4	$297.00	$297.00	$56.00	$238.00	$205.00	2025-10-01
72114	CPT	Xr Spine Ls W Bend 6 Vi	4	4	$297.00	$297.00	$56.00	$238.00	$205.00	2025-10-01
46050	CPT	I&d Perianal Abscess Su	4	4	$295.00	$295.00	$56.00	$236.00	$203.50	2025-10-01
46040	CPT	I&d Ischio/perirect Abs	4	4	$295.00	$295.00	$56.00	$236.00	$203.50	2025-10-01
28630	CPT	Clo Tx Metphal Jt Dis W	4	4	$295.00	$295.00	$56.00	$236.00	$203.50	2025-10-01
83013	CPT	H Pylori Breath Test	4	4	$295.00	$295.00	$56.00	$236.00	$203.50	2025-10-01
80301	CPT	Drug Screen Blood	4	4	$290.00	$290.00	$55.00	$232.00	$200.50	2025-10-01
80053	CPT	Blood Test, Comprehensive Group Of Blood Chemicals	8	4	$300.50	$300.50	$49.00	$274.00	$200.50	2025-10-01
16030	CPT	Debrid Subq Wo Large	4	4	$289.00	$289.00	$55.00	$231.00	$199.50	2025-10-01
83088	CPT	Histamine	4	4	$287.00	$287.00	$54.00	$230.00	$198.00	2025-10-01
26720	CPT	Clo Tx Phal Shaft Fx Pr	4	4	$284.00	$284.00	$54.00	$227.00	$196.00	2025-10-01
12041	CPT	Lay Clo Neck/hands 2.5	4	4	$283.00	$283.00	$54.00	$226.00	$195.00	2025-10-01
80157	CPT	Carbamazepine S/p Fre	4	4	$282.00	$282.00	$54.00	$226.00	$195.00	2025-10-01
87428	CPT	Sarscov2 +Flu A&b	4	4	$279.00	$279.00	$53.00	$223.00	$192.50	2025-10-01
82384	CPT	Plasma Catechol Fract	4	4	$279.00	$279.00	$53.00	$223.00	$192.50	2025-10-01
30903	CPT	Contrl Nasal Hem Ant Co	4	4	$278.00	$278.00	$53.00	$222.00	$192.00	2025-10-01
275879	CDM	Hinged Knee Brace	4	4	$277.00	$277.00	$53.00	$222.00	$191.50	2025-10-01
81256	CPT	Hfe Hemochromatosis	4	4	$275.00	$275.00	$52.00	$220.00	$189.50	2025-10-01
74210	CPT	Xr Pharynx Cervical Eso	4	4	$273.00	$273.00	$52.00	$218.00	$188.50	2025-10-01
L4396	HCPCS	Rt Static Afo Positioni	4	4	$272.00	$272.00	$52.00	$218.00	$187.50	2025-10-01
26605	CPT	Clo Tx Fx Metacarp W Ma	4	4	$271.00	$271.00	$51.00	$217.00	$187.00	2025-10-01
12013	CPT	Sim Repr Face/ea/2.6-5.	4	4	$270.00	$270.00	$51.00	$216.00	$186.50	2025-10-01
74022	CPT	Xr Abd Series 2> W Ches	4	4	$269.00	$269.00	$51.00	$215.00	$185.50	2025-10-01
73522	CPT	Xray Hip Bil W Pelvis 3	4	4	$269.00	$269.00	$51.00	$215.00	$185.50	2025-10-01
72074	CPT	Xr Thoracic 4 Views	4	4	$269.00	$269.00	$51.00	$215.00	$185.50	2025-10-01
72110	CPT	X-ray Of Lower Back	4	4	$269.00	$269.00	$51.00	$215.00	$185.50	2025-10-01
72082	CPT	Xr Spine 2-3 Views	4	4	$269.00	$269.00	$51.00	$215.00	$185.50	2025-10-01
305174	CDM	Food Screen	4	4	$267.00	$267.00	$51.00	$214.00	$184.00	2025-10-01
26770	CPT	Clo Tx Ip Jtt Dis Sng W	4	4	$265.00	$265.00	$50.00	$212.00	$183.00	2025-10-01
31505	CPT	Laryngscp Indir Sep Pro	4	4	$265.00	$265.00	$50.00	$212.00	$183.00	2025-10-01
76775	CPT	U/s Abd Aorta Limited	12	4	$337.00	$337.00	$36.00	$306.00	$181.00	2025-10-01
76815	CPT	U/s Fetal Age	12	4	$337.00	$337.00	$35.00	$306.00	$180.50	2025-10-01
83050	CPT	Methemoglobin *	4	4	$261.00	$261.00	$50.00	$209.00	$180.00	2025-10-01
82360	CPT	Quantitative Analysis	4	4	$260.00	$260.00	$49.00	$208.00	$179.50	2025-10-01
83519	CPT	Achr Block Antibodies	4	4	$260.00	$260.00	$49.00	$208.00	$179.50	2025-10-01
86644	CPT	C M V Antibodies Igg	4	4	$257.00	$257.00	$49.00	$206.00	$177.50	2025-10-01
275522	CDM	Straight Teleform Tip 6	4	4	$257.00	$257.00	$49.00	$206.00	$177.50	2025-10-01
73520	CPT	Xr Hip Bil 2v Inc A/p P	4	4	$254.00	$254.00	$48.00	$203.00	$175.50	2025-10-01
A0150	HCPCS	Amb Ser Als1 Non Emerge	8	4	$260.50	$260.50	$43.00	$237.00	$174.50	2025-10-01
36334	CPT	Ife Serum	4	4	$253.00	$253.00	$48.00	$202.00	$174.50	2025-10-01
20520	CPT	Remov Fb Mus/ten She Si	4	4	$251.00	$251.00	$48.00	$201.00	$173.00	2025-10-01
12004	CPT	Rpr S/n/ax/gen/tk7.6-12	4	4	$250.00	$250.00	$47.00	$200.00	$173.00	2025-10-01
82656	CPT	Elastase,pancreatic F	4	4	$250.00	$250.00	$47.00	$200.00	$173.00	2025-10-01
93924	CPT	U/s Lower Extrem Rest/t	4	4	$250.00	$250.00	$47.00	$200.00	$173.00	2025-10-01
28490	CPT	Clo Tx Fx G Toe Phal Wo	4	4	$248.00	$248.00	$47.00	$198.00	$171.00	2025-10-01
28470	CPT	Clo Tx Metatarsal Fx Wo	4	4	$247.00	$247.00	$47.00	$198.00	$170.50	2025-10-01
70330	CPT	Xr Tmj O/c Bilateral	4	4	$244.00	$244.00	$46.00	$195.00	$168.50	2025-10-01
70130	CPT	Xr Mastoid 3 Views A Si	4	4	$244.00	$244.00	$46.00	$195.00	$168.50	2025-10-01
73565	CPT	Xr Knees Bilat Ap/stand	4	4	$244.00	$244.00	$46.00	$195.00	$168.50	2025-10-01
99283	CPT	Emergency Department Vi	4	4	$243.00	$243.00	$46.00	$194.00	$167.50	2025-10-01
28660	CPT	Clo Tx Interphag Jt Dis	8	4	$243.50	$243.50	$45.00	$198.00	$167.50	2025-10-01
275585	CDM	Tube, Gastrostomy	4	4	$242.00	$242.00	$46.00	$194.00	$167.00	2025-10-01
275466	CDM	Ent:gastrostomy Tube 20	4	4	$242.00	$242.00	$46.00	$194.00	$167.00	2025-10-01
275465	CDM	Ent:gastrostomy Tube 18	4	4	$242.00	$242.00	$46.00	$194.00	$167.00	2025-10-01
26725	CPT	Clo Tx Phalangeal Fx With	4	4	$239.00	$239.00	$45.00	$191.00	$165.00	2025-10-01
43760	CPT	Change Gastrostom Tube	4	4	$239.00	$239.00	$45.00	$191.00	$165.00	2025-10-01
77072	CPT	Xr Bone Age Study	8	4	$276.00	$276.00	$40.00	$272.00	$164.50	2025-10-01
70150	CPT	Xr Facial Bones Min 3 V	4	4	$236.00	$236.00	$45.00	$189.00	$163.00	2025-10-01
86689	CPT	HIV Confirm	4	4	$235.00	$235.00	$45.00	$188.00	$162.00	2025-10-01
86694	CPT	Herpes Type I&ii Sero	4	4	$231.00	$231.00	$44.00	$185.00	$159.50	2025-10-01
12031	CPT	Layer Clo Sclp/ax/2.5 O	4	4	$230.00	$230.00	$44.00	$184.00	$159.00	2025-10-01
72202	CPT	Xr Cacroiliac Jt >3 Vie	7	4	$212.00	$212.00	$40.00	$170.00	$158.00	2025-10-01
80048	CPT	Basic Metabolic Panel	4	4	$228.00	$228.00	$43.00	$182.00	$157.50	2025-10-01
10140	CPT	I&d Hematoma/seroma/flu	4	4	$228.00	$228.00	$43.00	$182.00	$157.50	2025-10-01
26750	CPT	Clo Tx Dis Phalan Fx Fi	8	4	$226.50	$226.50	$39.00	$198.00	$155.50	2025-10-01
76870	CPT	U/s Scrotum	8	4	$234.00	$234.00	$38.00	$214.00	$155.00	2025-10-01
86665	CPT	Ebv Panel	4	4	$222.00	$222.00	$42.00	$178.00	$153.50	2025-10-01
80173	CPT	Haloperidol	4	4	$221.00	$221.00	$42.00	$177.00	$152.50	2025-10-01
L1830	HCPCS	Knee Immobilizer 16"	4	4	$221.00	$221.00	$42.00	$177.00	$152.50	2025-10-01
86316	CPT	Immu Tumor Anti/oth Q	4	4	$220.00	$220.00	$42.00	$176.00	$152.00	2025-10-01
275597	CDM	Brace Gel Cast Ankle	4	4	$219.00	$219.00	$42.00	$175.00	$151.00	2025-10-01
305185	CDM	Trh Stimulate	4	4	$219.00	$219.00	$42.00	$175.00	$151.00	2025-10-01
83695	CPT	Apolipoprotein Each	4	4	$219.00	$219.00	$42.00	$175.00	$151.00	2025-10-01
46083	CPT	Incs Thrombos Hem Ext	4	4	$214.00	$214.00	$41.00	$171.00	$148.00	2025-10-01
87521	CPT	Hepatitis C Amplif Pr	4	4	$215.00	$215.00	$41.00	$172.00	$148.00	2025-10-01
24670	CPT	Clo Tx Prox Ulnar Fx With	4	4	$214.00	$214.00	$41.00	$171.00	$148.00	2025-10-01
24640	CPT	Clo Tx Radial Head Sub	4	4	$214.00	$214.00	$41.00	$171.00	$148.00	2025-10-01
25650	CPT	Closed Tx Ulnar Styloid	4	4	$213.00	$213.00	$40.00	$170.00	$147.00	2025-10-01
72072	CPT	Xr Spine Thoracic 3 Vie	4	4	$212.00	$212.00	$40.00	$170.00	$146.50	2025-10-01
72050	CPT	Xr Spine Cervical 4 Vie	4	4	$212.00	$212.00	$40.00	$170.00	$146.50	2025-10-01
71130	CPT	Xr Sternoclavicular Jt	4	4	$212.00	$212.00	$40.00	$170.00	$146.50	2025-10-01
71120	CPT	Xr Sternum 2 Views	4	4	$212.00	$212.00	$40.00	$170.00	$146.50	2025-10-01
71101	CPT	Xr Ribs A/p Chest 3 Vie	4	4	$212.00	$212.00	$40.00	$170.00	$146.50	2025-10-01
71047	CPT	Chest 3 Views	4	4	$212.00	$212.00	$40.00	$170.00	$146.50	2025-10-01
70380	CPT	Xr Salivary Gland/calcu	4	4	$212.00	$212.00	$40.00	$170.00	$146.50	2025-10-01
70220	CPT	Xr Sinuses Complete 3 V	4	4	$212.00	$212.00	$40.00	$170.00	$146.50	2025-10-01
70200	CPT	Xr Orbits Complete 4 Vi	4	4	$212.00	$212.00	$40.00	$170.00	$146.50	2025-10-01
70110	CPT	Xr Mandible Cmplt 4 Vie	4	4	$212.00	$212.00	$40.00	$170.00	$146.50	2025-10-01
73564	CPT	Xr Knee 4 Views	4	4	$212.00	$212.00	$40.00	$170.00	$146.50	2025-10-01
73050	CPT	Xr Acromclav Jt W/wo We	4	4	$212.00	$212.00	$40.00	$170.00	$146.50	2025-10-01
72190	CPT	Xr Pelvis 3 Views	4	4	$212.00	$212.00	$40.00	$170.00	$146.50	2025-10-01
72120	CPT	Xr Spine L/s Bend Only	4	4	$212.00	$212.00	$40.00	$170.00	$146.50	2025-10-01
72100	CPT	Xr Spine Lumsac 2-3 Vie	4	4	$212.00	$212.00	$40.00	$170.00	$146.50	2025-10-01
78131	CPT	Olanzapine 10mg	4	4	$211.00	$211.00	$40.00	$169.00	$145.50	2025-10-01
84591	CPT	Vitamin Nos	4	4	$210.00	$210.00	$40.00	$168.00	$145.00	2025-10-01
275613	CDM	Boot Cast	4	4	$209.00	$209.00	$40.00	$167.00	$144.50	2025-10-01
28515	CPT	Clo Tx Fx Phalange Not	4	4	$209.00	$209.00	$40.00	$167.00	$144.50	2025-10-01
99292	CPT	Critical Care Addl 30 M	4	4	$209.00	$209.00	$40.00	$167.00	$144.50	2025-10-01
26740	CPT	Clo Tx Artic Fx Phalan	4	4	$206.00	$206.00	$39.00	$165.00	$142.50	2025-10-01
28510	CPT	Clo Tx Fx Phal Not G To	4	4	$204.00	$204.00	$39.00	$163.00	$141.00	2025-10-01
69200	CPT	Remov Fb Ext Aud Can Wo	4	4	$200.00	$200.00	$38.00	$160.00	$138.00	2025-10-01
56420	CPT	I&d Bartholin's Gland C	4	4	$200.00	$200.00	$38.00	$160.00	$138.00	2025-10-01
470009	CDM	Transport Only	4	4	$200.00	$200.00	$38.00	$160.00	$138.00	2025-10-01
83883	CPT	Nephelometry Ea Analy	8	4	$201.50	$201.50	$35.00	$176.00	$138.00	2025-10-01
82671	CPT	Estrogens, Total, Uri	4	4	$199.00	$199.00	$38.00	$159.00	$137.00	2025-10-01
86618	CPT	Lyme Antibodies	4	4	$199.00	$199.00	$38.00	$159.00	$137.00	2025-10-01
275980	CDM	Cast, Leg, Adlt,l/w/hl,	4	4	$199.00	$199.00	$38.00	$159.00	$137.00	2025-10-01
21800	CPT	Clo Tx Rib Fx Uncomp Ea	4	4	$197.00	$197.00	$37.00	$158.00	$136.00	2025-10-01
86160	CPT	Complement Total (Ch	4	4	$197.00	$197.00	$37.00	$158.00	$136.00	2025-10-01
82677	CPT	Estriol, Placental, S	4	4	$194.00	$194.00	$37.00	$155.00	$134.00	2025-10-01
71110	CPT	Xr Ribs Bilateral 3 Vie	4	4	$194.00	$194.00	$37.00	$155.00	$134.00	2025-10-01
27786	CPT	Clo Tx Fx Fibula Without Ma	4	4	$193.00	$193.00	$37.00	$154.00	$133.50	2025-10-01
25600	CPT	Clo Tx Dist Radial Fx W	4	4	$193.00	$193.00	$37.00	$154.00	$133.50	2025-10-01
82952	CPT	Glucose Tolerance2	12	4	$216.00	$216.00	$31.00	$183.00	$133.00	2025-10-01
12002	CPT	Repr Sclp Ext 2.6-7.5	8	4	$193.00	$193.00	$35.00	$160.00	$133.00	2025-10-01
11730	CPT	Avuls Nail Pt Par/comp	4	4	$191.00	$191.00	$36.00	$153.00	$131.50	2025-10-01
83872	CPT	Synovial Fluid Analys	4	4	$191.00	$191.00	$36.00	$153.00	$131.50	2025-10-01
86812	CPT	Hla-b27	4	4	$189.00	$189.00	$36.00	$151.00	$130.50	2025-10-01
93325	CPT	Doppler Color Flow	4	4	$188.00	$188.00	$36.00	$150.00	$129.50	2025-10-01
93307	CPT	Echo Comp Without Color Flo	4	4	$188.00	$188.00	$36.00	$150.00	$129.50	2025-10-01
12001	CPT	Rpr S/n/ax/gen/trk2.5cm	8	4	$188.50	$188.50	$34.00	$160.00	$129.50	2025-10-01
84402	CPT	Testosterone Free	4	4	$188.00	$188.00	$36.00	$150.00	$129.50	2025-10-01
90909	CPT	Hydrocortisone 250mg	4	4	$187.00	$187.00	$35.00	$150.00	$129.00	2025-10-01
70210	CPT	Xr Sinus Paranasal <3 V	4	4	$187.00	$187.00	$35.00	$150.00	$129.00	2025-10-01
96360	CPT	IV Inf Hydrat Ini 31min	4	4	$187.00	$187.00	$35.00	$150.00	$129.00	2025-10-01
93308	CPT	Limited Echo	4	4	$186.00	$186.00	$35.00	$149.00	$128.50	2025-10-01
E0193	CDM	Powered Air Flotation	4	4	$186.00	$186.00	$35.00	$149.00	$128.50	2025-10-01
12011	CPT	Rpr F/e/e/n/l/m/2.5cm/<	4	4	$186.00	$186.00	$35.00	$149.00	$128.50	2025-10-01
E0373	HCPCS	Pressure Reduce Mattres	4	4	$186.00	$186.00	$35.00	$149.00	$128.50	2025-10-01
86777	CPT	Toxoplasmosis*	4	4	$186.00	$186.00	$35.00	$149.00	$128.50	2025-10-01
93320	CPT	Cardiac Doppler	4	4	$186.00	$186.00	$35.00	$149.00	$128.50	2025-10-01
84244	CPT	Plasma Renin	4	4	$185.00	$185.00	$35.00	$148.00	$128.00	2025-10-01
84597	CPT	Vitamin K	4	4	$185.00	$185.00	$35.00	$148.00	$128.00	2025-10-01
83880	CPT	Natriuretic Peptide	4	4	$185.00	$185.00	$35.00	$148.00	$128.00	2025-10-01
93926	CPT	Art Dop Unilateral Low	4	4	$185.00	$185.00	$35.00	$148.00	$128.00	2025-10-01
73030	CPT	Xr Shoulder Complete	4	4	$185.00	$185.00	$35.00	$148.00	$128.00	2025-10-01
86325	CPT	Immunoelect Protein C	12	4	$246.00	$246.00	$24.00	$201.00	$127.50	2025-10-01
87338	CPT	Helicobacter Pylori S	4	4	$184.00	$184.00	$35.00	$147.00	$127.00	2025-10-01
72200	CPT	Xr Sacroiliac Jt <3view	4	4	$184.00	$184.00	$35.00	$147.00	$127.00	2025-10-01
76977	CPT	Bone Density	4	4	$183.00	$183.00	$35.00	$146.00	$126.00	2025-10-01
275516	CDM	Splint Short Leg	2	2	$161.00	$161.00	$121.00	$129.00	$125.00	2025-10-01
72070	CPT	Xr Spine Thoracic 2 Vie	4	4	$181.00	$181.00	$34.00	$145.00	$125.00	2025-10-01
71100	CPT	Xr Ribs Unilateral 2 Vi	4	4	$181.00	$181.00	$34.00	$145.00	$125.00	2025-10-01
71046	CPT	Xr Chest 2 Views	4	4	$181.00	$181.00	$34.00	$145.00	$125.00	2025-10-01
70100	CPT	Xr Mandible <4 Views	4	4	$181.00	$181.00	$34.00	$145.00	$125.00	2025-10-01
82232	CPT	Beta 2 Microglobulin	4	4	$181.00	$181.00	$34.00	$145.00	$125.00	2025-10-01
74019	CPT	Xr Abdomen 2 Views	4	4	$181.00	$181.00	$34.00	$145.00	$125.00	2025-10-01
73592	CPT	Xr Low Extrem Infant 2v	4	4	$181.00	$181.00	$34.00	$145.00	$125.00	2025-10-01
82951	CPT	Glucose Tolerance 3hr	4	4	$181.00	$181.00	$34.00	$145.00	$125.00	2025-10-01
73562	CPT	Xr Knee 3 Views	4	4	$181.00	$181.00	$34.00	$145.00	$125.00	2025-10-01
73502	CPT	Xr Hip 2-3 Views	4	4	$181.00	$181.00	$34.00	$145.00	$125.00	2025-10-01
73110	CPT	Xr Wrist Min 3 Views Co	4	4	$181.00	$181.00	$34.00	$145.00	$125.00	2025-10-01
73092	CPT	Xr Upper Extremity Infa	4	4	$181.00	$181.00	$34.00	$145.00	$125.00	2025-10-01
73010	CPT	Xr Scapula Complete	4	4	$181.00	$181.00	$34.00	$145.00	$125.00	2025-10-01
92953	CPT	Tempor Transut Pacing	4	4	$180.00	$180.00	$34.00	$144.00	$124.00	2025-10-01
40991	CPT	Phytonadione 10mg/1ml	4	4	$180.00	$180.00	$34.00	$144.00	$124.00	2025-10-01
29505	CPT	Applic Long Leg Splint	4	4	$178.00	$178.00	$34.00	$142.00	$123.00	2025-10-01
83921	CPT	Methylmalonic Acid	4	4	$177.00	$177.00	$34.00	$142.00	$122.50	2025-10-01
82554	CPT	Cpk Isoforms	4	4	$176.00	$176.00	$33.00	$141.00	$121.50	2025-10-01
258158	CDM	Td Adult & Adolescent U	4	4	$176.00	$176.00	$33.00	$141.00	$121.50	2025-10-01
30901	CPT	Cont Nasal Hemorr Ant S	4	4	$174.00	$174.00	$33.00	$139.00	$120.50	2025-10-01
76641	CPT	U/s Breast Complete Uni	4	4	$175.00	$175.00	$33.00	$140.00	$120.50	2025-10-01
28400	CPT	Clo Tx Calcaneal Fx Without	4	4	$174.00	$174.00	$33.00	$139.00	$120.50	2025-10-01
82710	CPT	Fattotal (Quant) *	4	4	$175.00	$175.00	$33.00	$140.00	$120.50	2025-10-01
24565	CPT	Clo Tx Fx Humeral W Man	4	4	$175.00	$175.00	$33.00	$140.00	$120.50	2025-10-01
24530	CPT	Clo Tx Sup/tran Hum Without	4	4	$175.00	$175.00	$33.00	$140.00	$120.50	2025-10-01
E0194	HCPCS	Air Fluidized Bed	4	4	$172.00	$172.00	$33.00	$138.00	$118.50	2025-10-01
83874	CPT	Myoglobin *	4	4	$171.00	$171.00	$32.00	$137.00	$118.00	2025-10-01
85379	CPT	D Dimer	8	4	$170.00	$170.00	$31.00	$140.00	$117.00	2025-10-01
275984	CDM	Cast, Leg, Adlt,s/w/hl,	4	4	$166.00	$166.00	$31.00	$133.00	$115.00	2025-10-01
80069	CPT	Kidney Function Panel Test	4	4	$165.00	$165.00	$31.00	$132.00	$114.00	2025-10-01
10080	CPT	I&d Pilonidal Cyst Simp	4	4	$164.00	$164.00	$31.00	$131.00	$113.00	2025-10-01
51719	CPT	Dicyclomine 20 Mg/2ml	4	4	$164.00	$164.00	$31.00	$131.00	$113.00	2025-10-01
87324	CPT	Clostridium Dificile	4	4	$160.00	$160.00	$30.00	$128.00	$110.50	2025-10-01
16025	CPT	Debrid Wubq Wo Anes Med	4	4	$160.00	$160.00	$30.00	$128.00	$110.50	2025-10-01
72040	CPT	Xr Spine Cervical 2-3 V	4	4	$159.00	$159.00	$30.00	$127.00	$109.50	2025-10-01
70370	CPT	Xr Pharynx/larynx	4	4	$159.00	$159.00	$30.00	$127.00	$109.50	2025-10-01
70360	CPT	Xr Neck Soft Tissue	4	4	$159.00	$159.00	$30.00	$127.00	$109.50	2025-10-01
70328	CPT	Xr Tmj O/c Unilateral	4	4	$159.00	$159.00	$30.00	$127.00	$109.50	2025-10-01
70250	CPT	Xr Skull <4 Views	4	4	$159.00	$159.00	$30.00	$127.00	$109.50	2025-10-01
84442	CPT	Tbg	4	4	$158.00	$158.00	$30.00	$126.00	$109.50	2025-10-01
70160	CPT	Xr Nasal Bones Min 3 Vi	4	4	$159.00	$159.00	$30.00	$127.00	$109.50	2025-10-01
70140	CPT	Xr Facial Bones <3 View	4	4	$159.00	$159.00	$30.00	$127.00	$109.50	2025-10-01
70120	CPT	Xr Mastoid <3 View A Si	4	4	$159.00	$159.00	$30.00	$127.00	$109.50	2025-10-01
80195	CPT	Rapamune (Sirolimus)	4	4	$158.00	$158.00	$30.00	$126.00	$109.50	2025-10-01
87536	CPT	HIV-1 Quantification	4	4	$159.00	$159.00	$30.00	$127.00	$109.50	2025-10-01

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